1. Interpreting Semen Analysis Results
SandroC. Esteves, MD, PhD
ANDROFERT, Campinas, Brazil
Reproductive Andrology Surgery Workshop II
Reproductive Medicine Unit -JahraHospital -Kuwait 2014
2. Contents
Semen analysis overview
WHO reference values
Implications to clinical management
Proposal of a new report template
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3. Semen analysis is the most used biomarker to predict fertility potential
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4. Routine Semen Analysis
ïŹPhysical characteristics of ejaculate
ïŹSperm count
ïŹSperm motility
ïŹSperm morphology
ïŹSperm vitality
ïŹLeukocyte count
ïŹAdditional tests (fructose, etc)
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6. ïŹPre-analytical
Instructions for collection
Rejection criteria
Abstinence period
ïŹAnalytical
Standard operating procedures
ïŹPost-analytical
Report
Is the lab good enough?
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7. ANDROFERT
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WHO Manual: it is free!
9. Urology 2012; 79(1):16-22
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10. How the references were obtained
ï§1953 specimens
ï§Recent fathers (Time-to-Pregnancy; TTP) †12 mo.
ï§Data extracted from 5 studies
ï§Laboratories with QC
ï§Morphology by Krugerâs method
Cooper TG, Noonan E, von EckardsteinS, Auger J, Baker H, BehreH, Haugen T, Kruger T, Wang C, MibzvoMT, VogelsongK
World Health Organization reference values for human semen characteristics.
Hum ReprodUpdate 16: 231-245, 2010.
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11. Percentile
5%
50%*
95%
Volume (mL)
1.5
3.7
6.8
Count (x106/mL)
15.0
73.0
213.0
Totalcount(x106)
39.0
255.0
802.0
% Motile
40
61
78
% Progressivemotility
32
55
72
% Normal(Kruger)
4
15
44
% Alive
58
79
91
Cooper et al: World Health Organization reference values for human semen characteristics.
Hum ReprodUpdate 16: 231-245, 2010
Esteves, 12
How the references were obtained
12. Critical Appraisal of the WHO New Reference Values for Human Semen and Impact on Diagnosis and Treatment of SubfertileMenEsteves, Zini, Aziz et al, Urology, in press
Columbia
USA
Melbourne
Australia
Turku
Finland
Oslo
Norway
Edimburgh
UK
Paris
France
Copenhagen
Denmark
Esteves, 13
13. WHO 2010: What changed?
âąPercentile â5â to determine lower cutoff limits
âąStrict (Kruger) morphology
âąSingle specimen per individual
Method
âąRecent fathers (known TTP)
âąSelection bias
Studied population
Esteveset al. Critical Appraisal of the WHO New Reference Values for Human Semen and Impact on Diagnosis and Treatment of SubfertileMen. Urology2012; 79(1):16-22.
Esteves, 14
14. How do the new references impact clinical management?
Referral
Treatment
ART
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15. ParametersPatient
Volume (mL)
2,3
Count (106/mL)16,5
Progressivemotility(%)40
Vitality(%)65
Morphology(%)9
Referral Deferment
References
1999
2010
â„ 2
â„ 1.5
â„ 20
â„ 15
â„ 50
â„ 32
â„ 75
â„ 58
(14)
â„ 4
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16. 987 couples with infertility duration > 12 months
Esteves, IntBrazJ Urol2014
53% reclassification
due to morphology
Semen Analysis Report
Esteves, 17
Abnormal results as per WHO 1999
38.7%
Redefined as âNormalâ as per WHO 2010
17. Cause of infertility in up to 35% men
Guidelinesâ recommendation:
Palpable (clinical)
Abnormal semen analysis results
Male Infertility Best Practice Policy Committee -AUA, 2004;
European Association of Urology. Guidelines on Male Infertility, 2010.
Varicocele Treatment
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18. 87.8
49.9
37.4
62.9
56
55.6
8.4
7.3
6.1
No varicocele
Grade 2 Varicocele
Grade 3 Varicocele
Adolescents with and without Varicocele
Count (million/mL)
Progressive motility (% a+b)
Morphology (%)
Mori et al. Does varicocele grade determine extent of alteration to spermatogenesis in adolescents? FertilSteril90: 1769-1773, 2008.
P=0.003
P<0.001
Varicocele
Esteves, 19
19. ICSI
IVF & IUI
ART
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20. Semen analysis alone should not be used to counseling or treatment indication
ïŹSemen characteristics that discriminate fertile from infertile men not well defined
ïŹBiological variability
ïŹNot account for sperm dysfunctions
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21. History taking, physical examination, endocrine profile and laboratory sperm function testing are minimum standards
Esteves, et al 2011; 2012; 2014
Male infertility evaluation goes far beyond a simple semen analysis
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23. Thank You
ŰŽÙ۱ۧ
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