Lancet Diabetes Endocrinol. If material is not included in the chapter's Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. Essentially, the new manual comprises three parts: semen examination; sperm preparation and cryopreservation; and quality control and assurance. Fertil Steril. The use of computer aid does not exclude additional evaluation by the human eye [70, 71]. >> The current limits are still arbitrary and future studies with clinical outcomes in the various groups will help refine these limits. Principal parameters evaluated during semen analysis. 6 0 obj /Type /Catalog endobj On the contrary, if one or more semen parameters are altered, repetition is necessary in order to rule out potential pre-analytical and analytical factors, together with biological variability. /A 27 0 R /H /I Sperm number, motility, and morphology should not be considered individually but in combination. /Resources 19 0 R Bethesda, MD 20894, Web Policies PubMed The editors of the 6th edition acknowledge that the reference ranges described in the 5th edition should be abandoned as they are of limited value in differentiating fertile from infertile men. Subsequent studies provided further analysis and information for the importance of the new method evaluating sperm morphology for obtaining better results in patients with male factor infertility. Filimberti E, DeglInnocenti S, Borsotti M, Quercioli M, Piomboni P, Natali I, et al. The following table [69] represents changes for cut off values for semen parameters according consecutive WHO manuals: Sperm sample evaluation in a modern andrology lab might be measured by the means of CASA. << /Parent 2 0 R In case of normozoospermia, a second analysis is not mandatory. London, SW7 2QJ, In conditions such as azoospermia, globozoospermia or necrozoospermia, exceptions are made and male infertility could be stated [32]. Different techniques for sperm retrieval: percutaneous epididymal sperm aspiration (PESA), microsurgical epididymal sperm aspiration (MESA), testicular sperm aspiration (TESA) or testicular sperm extraction (TESE) could be applied in order to obtain reproductive cells for further use in in vitro fertilization (IVF) or ICSI treatment [38]. MSOME selection is made under inverted light emitting microscope with Differential interference contrast or Nomarski differential interference contrast optics and digital camera at high magnification ranging from 6600 to 13,000. WHO standards of Semen Analysis | ACIMC << The roles of sperm DNA fragmentation, seminal oxidative stress, and reactive oxygen species have been highlighted and the diverse forms of sperm chromosomal abnormalities and gene mutations are also emphasized. When according to laboratory test a patient is diagnosed with azoospermia, further hormonal and genetic tests along with andrology, urology, genetic consultation and ultrasound scan are needed [35]. As stated above, when no spermatozoa is present in the ejaculate, it is important to evaluate the sediment after centrifugation, as their presence is indicative of cryptozoospermia (scenario A). However, fertility is a couple-concept and even severe alterations of semen parameters (much below the fifth percentile) can be compatible with the induction of pregnancy, provided that the female partners fertility status is optimal. !o![]cpCV|B!W|?_q#MB_j K Tej:H _jUIu|tTxG{{ KWtZ:-qpdH_I+4RW17UFKt1acIT+=\VFW:KIA)#fT(}EuPo|=z RW`4B*JX3X,&PUnAhPJoMPncDC9 Y.PW|~\JZdvsl-o_)}G6.Qmu9HEX/:g)Jq\wc{-[_BJ\_L78{mwi 6yS1hshA6w,9Fp%c,Mb/l>%\uWJ+j7ylb \aM Cr;s6 F>3$e6%EB#%,j&KO8f1G[]U0'b5P51b/ 1990;54:30814. An official website of the United States government. >> 2022;45:1085113. The reduction in sperm motility, called asthenozoospermia (total motility <42% and progressive motility <30%) can be due to congenital or acquired factors. << Oligozoospermia: sperm concentration or TSC lower than the fifth percentile value (Table 13.1). A return to the earlier classification of the 4th edition of WHO manual for sperm motility [10] is a welcome improvement as it allows a better characterization of motility and may provide additional prognostic information. Establishment of certain values for semen in order to predict chances of conception generates the need of references for male fertility. Azoospermia, affecting about 1% of the general male population, is incompatible with natural pregnancy. The long-awaited 6th edition will be read and followed with great interest by everyone involved in the care of male reproductive health. /Type /Pages 2020;34:101473. This controversy stems in part from the modest predictive value of SDF tests in reproduction and the multitude of available tests with variable thresholds and inter-lab variability. Over the years many reproductive specialists have been constantly debating, suggesting and remodeling the frame values of the semen in reference to male fertility. Esteves SC, Zini A, Aziz N, Alvarez JG, Sabanegh ES, Jr, Agarwal A. These are classified as normal, borderline, and pathological. Among them, the evaluation of sperm DNA fragmentation is already introduced in many laboratories all over the world; however, its clinical utility remains still controversial [1, 9]. Selecting a proper technique must be strongly individual according the couples infertility history and ART treatment plan along with semen quality. 3 0 obj The site is secure. The lower 5th percentile was used to define the reference values for normal semen parameters. Obstructive azoospermia (OA): could be due to obstruction in the epididymis, vas deferens or the ejaculatory duct [36]; it could also be the consequence of infections, inflammation, scrotal trauma, rare genetic conditions (cystic fibrosis), vasectomy or injury of vas deferens or previous surgery [37]. The tests assessing sperm DNA fragmentation and seminal oxidative stress are well-described. endobj endobj Get notified of new articles with our ESHRE newsletter. Indeed, sperm agglutination can be caused by other factors rather than autoimmunity, as well as antibodies can be present without sperm agglutination. Centrifugation of the whole ejaculated volume is necessary in order to detect specific conditions [33]. The Sperm: Parameters and Evaluation | IntechOpen Apart from spermatozoa, epithelial and round cells can be observed in the ejaculate. /C [0 1 1] /MediaBox [0.0 0.0 595.28 841.89] The spectrum of semen phenotypes associated with centriole defects ranges from azoo/oligozoospermia to astheno/teratozoospermia. Google Scholar. Resurrecting the spermatogenesis process could be achieved depending on the factors inducing azoospermia. In fact, there is a substantial overlap of semen examination results between fertile and infertile men [3]. Reduced semen volume with normal pH, instead, can be seen in case of severe hypoandrogenism (scenario C). (1) This latest sixth edition, published in July, is said to be among the most widely used references in reproductive medicine but, over the past few years, one of the most questioned. The procedures for semen examination include basic (routine) examinations, extended examinations (which may be used by laboratories or clinicians in certain situations), and advanced tests (which are not currently recommended for routine use and are primarily for research purposes). /Dests 15 0 R 2012;62:32432. To overcome male infertility in ART different protocols for sperm processing have been developed. Prevalence of anti-sperm antibodies and relationship of degree of sperm auto-immunization to semen parameters and post-coital test outcome: a retrospective analysis of over 10 000 men. Andrology. Spermatozoa obtained by either DGC or SU have longer telomeres compared sperm cells in the raw semen [139]. A criticism of the 5th edition was the decision to eliminate the reporting of rapidly progressive motility, and the editors of the 6th edition have now reverted back to a four-category classification as follows: Rapidly progressive: 25 m/s, or at least half tail length per second. Decision limits were introduced by Guzick et al [9], who proposed a two-level reference range narrative by defining an intermediate group of values. We are a community of more than 103,000 authors and editors from 3,291 institutions spanning 160 countries, including Nobel Prize winners and some of the worlds most-cited researchers. A second ejaculate within a short-term period of approximately 60 min has been shown to improve seminal quality as compared with the first ejaculate in patients with epididymal necrozoospermia [29]. The https:// ensures that you are connecting to the Both prostate and seminal vesicles contribute to the semen pH with their secretions: prostate produces an acidic fluid, while seminal vesicles produce an alkaline fluid leading to the typical neutral pH, around 7.27.4. . Department of Experimental and Clinical Biomedical Sciences Mario Serio, Centre of Excellence DeNothe, University of Florence, Florence, Italy, You can also search for this author in The sixth edition of the - ScienceDirect Sperm-cervical mucus interaction: collection of mucus, in vitro test, postcoital test: 2nd: 1987: 67: Semen: Standard testsincludes all in the 1st edition + sperm antibody tests Optional testssemen culture, seminal fluid biochemistry, zona-free hamster oocyte penetration test, sperm migration test Criteria of normality of semen samples . The New WHO Manual on Semen Analysis: A Review, Comments and Clinical Interpretation of Semen Analysis | SpringerLink Semen sample parameters could be influenced by various factors such as sexual abstinence periods [8, 9], gonadal activity [10], abnormal hormonal levels [11], testicle size [12], body mass index (BMI) [13, 14, 15], urogenital infections and antibiotics or anabolic substances intake [16, 17, 18], individual diet regiment [19, 20, 21], working environment and lifestyle [22, 23, 24]. 10 0 obj /Parent 2 0 R Semen analysis is a fundamental step in the evaluation of the male fertility potential. Before The 6th edition recognizes the increasing clinical relevance of seminal oxidative stress by dedicating a section to the methods assigned for ROS testing. In men with severe oligozoospermia, concentration of less than 5 106 sperm/ml, possibility of residual spermatogenic function decline has been reported [50]. The sperm centrioles. The Sperm: Parameters and Evaluation - Academia.edu /Type /Annot Human spermatozoa contain two centrioles: the proximal one (PC), located near the head base, and the distal one (DC), located at the base of the axoneme. /Resources 17 0 R /CropBox [0.0 0.0 595.28 841.89] The main macroscopic alterations are summarized in Table 13.2. Mazaheri Moghaddam M, Mazaheri Moghaddam M, Hamzeiy H, Baghbanzadeh A, Pashazadeh F, Sakhinia E. Genetic basis of acephalic spermatozoa syndrome, and intracytoplasmic sperm injection outcomes in infertile men: a systematic scoping review. dy,O#yhx/#iB5T}-N1T =*@p*g |DWQAe~ sperm parameters are not fully predictive for natural pregnancy. /Author Google Scholar. Sperm morphology assessment is aimed at the evaluation of the shape of spermatozoon, which consists of a head and tail, connected through the midpiece, a thicker part of the tail containing mitochondria. A normal concentration is 20106/mL, borderline lies between 10 to 20106/mL, and pathological is <10106/mL. /Rect [261.063 62.174 309.702 63.171] << 11 0 obj endobj Distribution of semen examination results 2020A follow up of data collated for the WHO semen analysis manual 2010. Bonomo Teaching Hospital Andria, Andria, Italy. Krausz, C., Farnetani, G. (2023). Improved semen quality after a short-interval second ejaculation. The clinical awareness of nutritional balance in disease occurrence, progression and outcome is still limited, but the need of balanced diet nutrients and antioxidants is urged and necessary [132, 133]. endobj Sperm DNA fragmentation index significantly decreased compared to baseline (p < 0.001) and the 3month therapy (p = 0.014) in treated men. /Rotate 0 /TrimBox [0 0 595.276 779.528] Sperm centrioles have many different functions, which are essential not only for flagellum movement but also for normal morphology, cell division, and zygote development [19]. Hum Genet. >> A novel structuretail axoneme intra-lumenal spiral (TAILS)was reviled and described [60]. For instance, abnormal positioning of centrioles can lead to dysplasia of the fibrous sheath [19]. Shterev for most helpful discussions while summarizing this chapter. Sixth edition; T.K . Macrozoospermia is typically associated with a high rate of aneuploidy and polyploidy caused by the nondisjunction of chromosomes or defective cytokinesis during meiosis [16]. Therefore, sperm centriole defects may cause failure of embryo development. The sixth edition of the WHO Laboratory Manual for the - PubMed Slow progressive: 5 to <25 m/s, or at least one head length to less than half tail length/sec. Some external factors such as exposure to toxins (toluene, methoxyethanol, sulfur dioxide), metals (cadmium) chemotherapy and ionizing radiation (cancer treatment) may also influence ROS levels and form OS. WHO introduces its sixth updated manual on semen analysis Essentially, the new manual comprises three parts: semen examination; sperm preparation and cryopreservation; and quality control and assurance. /H /I 4i?Y
For motility normal is defined as 50% progressively motile sperm, borderline is 35% to 49% progressively motile, while a pathological sample is defined as <35% progressively motile sperm. In case of complete globozoospermia, ICSI should be followed by artificial oocyte activation [11]. /CropBox [0.0 0.0 595.276 779.528] To date our community has made over 100 million downloads. Andrology. The Sixth Edition of the WHO Manual for Human Semen Analysis: A Oxidative stress and nutritional status are of importance to every person as antioxidant deficiency and malnutrition may alter the health in general. The editors of the 6th edition have acknowledged these limitations (Appendix 8.1 of the manual) and stipulated that semen examination cannot strictly differentiate between pathological and normal samples. endobj /Rect [192.022 660.868 193.019 661.864] 2021;38:57386. Critical appraisal of World Health Organization's new reference values for human semen characteristics and effect on diagnosis and treatment of subfertile men. When a female partner is involved, counseling should consider the fact that female age is a leading factor in conception and postponing the ART or natural conception, could seriously decrease the chances of having a baby [115, 116, 117, 118, 119]. /Type /Annot Calogero AE, Duca Y, Condorelli RA, la Vignera S. Male accessory gland inflammation, infertility, and sexual dysfunctions: a practical approach to diagnosis and therapy. The Sixth Edition of the WHO Manual for Human Semen Analysis: A It provides information on whether infertility can be related to the male partner and is able to identify alterations which can guide clinicians towards tailored diagnostic exams. The Sixth Edition of the WHO Manual for Human Semen Analysis: A Post-radiotherapy treatments also show in altered number of structural and numerical chromosome aneuploidies (from 6 to 67% respectively [65]. 12Department of Surgery, McGill University, Montreal, QC, Canada. The WHO manual is freely accessible at the following link: https://www.who.int/publications/i/item/9789240030787. Briefly, this new edition covers semen analysis, spermatozoa preparation and cryopreservation and quality control. This coagulum is typically liquefied within 15-30 min, mainly by the activity of the prostate-Figure 1. Azoospermia can be divided into obstructive (OA) and non-obstructive (NOA) forms. /Title The New England journal of medicine. Limitations of semen analysis as a test of male fertility and anticipated needs from newer tests. >> endobj << Recently, the intact human flagellum has been studied using cryo-electron microscopy and tomography [59]. Semen volume not only expresses the secretory activity of these glands, but also their responses to autonomous nerve stimulation elicited by sexual arousal, which will lead to smooth muscle contractions that empties each gland. Methods How? Semen analysis is divided into macroscopic and microscopic evaluation, and it provides information on the efficiency of spermatogenesis and the integrity of post-testicular structures. /OpenAction [3 0 R /Fit] Semen analysis, as a standard laboratory test, gives basic information on spermatogenesis, secretory activity of the gonads and patency of the male genital tract [2]. Overview The fifth edition includes information on sperm preparation for clinical use or specialized assays and on cyropreservation, an expanded section on quality control in the semen analysis laboratory and evidence-based reference ranges and reference limits for various semen characteristics. The most important change proposed in the 6th edition is the adoption of decision limits to differentiate normal from abnormal ejaculates. As CBAVD has been associated with mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene [108, 109] investigating the condition and genetic testing and consultation prior the procedures should be provided as there is a risk for the couple to have a child with cystic fibrosis [110]. In the large majority of patients affected by teratozoospermia (normal forms <4%), head, midpiece, tail, and cytoplasmic residue defects are combined, and different spermatozoa may present different types of abnormalities. Non progressive: <5 m/s, or less than one head length. CAS DNA integrity and sperm hereditary information are essential to the offspring as male gametes has major contribution to the fertilization processes, embryo quality and embryo development even in early gestational stages [74, 75, 76]. In fact, because infertility involves male and female factors, it will not be possible to predict fertility using parameters from either partner alone, unless there is azoospermia in the man or premature ovarian failure in the woman [30]. Cryptozoospermia: absence of spermatozoa in the ejaculate but present in the pellet after centrifugation. Therefore, the diagnosis of azoospermia must be confirmed in at least two semen analysis (possibly after the whole spermatogenic cycle) because it could be a temporary disorder, or it could alternate with cryptozoospermia. These mixed morphological defects are usually related to defective spermatogenesis or epididymal inflammation. Csilla Krausz . There are some limitations related to each method used and that is now an open field to research and establish new noninvasive protocols for sperm selection in the routine practice. However, what seems to benefit its practice is the better understanding of sperm morphology and function [95]. Comparison between infertile men and donors showed that excess ROS values had a sensitivity of 68.8% and specificity of 93.8% in correlation with poor semen parameters and could result in infertility [129, 130]. Taking care of lifestyle factors as body mass index (BMI), diets, alcohol intake, smoking, using some additional nutrition and vitamin supplements might affect sperm parameters and contribute to the chances of a couple to conceive. ASA can interfere with physiological reproduction at many levels, affecting sperm number and motility, the ability to transit through cervical mucus, acrosome reaction, and zona pellucida binding [9, 10]. << In March 2021, the WHO released a preliminary draft of the 6th edition of its manual for public review and suggestions (https://www.who.int/publications/i/item/9789241547789). /CropBox [0.0 0.0 595.276 779.528] Since the introduction of ICSI as routine procedure, the significance of standard semen analysis was neglected, as sperm concentration and motility have no longer such importance, since a single sperm cell has to be injected. Studies demonstrate association between elevated ROS levels and abnormal sperm concentration, motility, morphology, higher DNA damage and apoptosis. Three quantitative alterations can be distinguished as follows: Azoospermia: absence of spermatozoa in the ejaculate and in the pellet after centrifugation. Innovations In Assisted Reproduction Technology, Submitted: November 22nd, 2018 Reviewed: November 27th, 2019 Published: January 23rd, 2020, Edited by Nidhi Sharma, Sudakshina Chakrabarti, Yona Barak and Adrian Ellenbogen, Total Chapter Downloads on intechopen.com. Sperm abnormalities are a major factor of human infertility. Machine learning-based clustering to identify the combined effect of Morphology has been categorized as normal when typical forms are 14%, borderline is between 4% and 13% and pathological morphology is below 4%. Congenital bilateral absence of vas deferens (CBAVD) and the lack of sperm cells in the ejaculate are superable using microsurgical TESE or PESA followed by ICSI [107]. /Subject