Prediction of male infertility by the World Health Organization laboratory manual for assessment of semen analysis: A systematic review

Peer review under responsibility of Arab Association of Urology.

Abstract

Objective To discuss the role, reliability and limitations of the semen analysis in the evaluation of fertility with reference to the World Health Organization (WHO) fifth edition guidelines, with semen analysis reference values published in 2010. We also discuss the limitations of using a single threshold value to distinguish ‘abnormal’ and ‘normal’ parameters.

Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to search the MEDLINE, EMBASE, and the Cochrane electronic database for articles discussing the effectiveness of semen analysis.

Results Limitations affecting the reliability of semen analysis as a predictor of fertility were found. These include: the lack of consideration of the female factor, the vaguely defined threshold values, and the intra-individual variation in semen parameters.

Conclusions Impaired semen parameters alone cannot be used to predict fertility as these men still have a chance of being fertile, except when a man has azoospermia, necrospermia or globozoospermia.

Abbreviations:

• ASA
• anti-sperm antibodies
• PRISMA
• Preferred Reporting Items for Systematic Reviews and Meta-Analyse

Keywords:

• Semen analysis
• WHO
• Fifth edition guidelines
• Laboratory manual
• Male infertility
• Prediction

Notes

Peer review under responsibility of Arab Association of Urology.