The effect of the new 2010 World Health Organization criteria for semen analyses on male infertility

Objective: To quantify the effect of the new 2010 World Health Organization (WHO) semen analysis reference values on reclassifying previous semen analysis parameters and definition of patients with male factor infertility. Design: A multi-institutional retrospective chart review. Setting: University and private male infertility clinics. Patient(s): Men referred for infertility evaluation. Intervention(s): Comparison of semen analysis values based on 2010 versus 1999 reference criteria. Main Outcome Measure(s): Quantification of the change based on individual sperm parameters and as a whole. Result(s): A total of 184 men had at least two semen analyses; 13 (7%), 17 (9.2%), 34 (18.4%), and 29 (15.7%) patients changed classification to being at or above the reference values by the 2010 criteria for semen volume, sperm concentration, motility, and morphology, respectively. A total of 501 men had one semen analysis on file; 40 (7.9%), 31 (6.2%), 50 (9.9%), and 74 (19.3%) would change classification for volume, concentration, motility, and morphology, respectively. Overall, 103 patients (15.1%) who had one or more parameter below the reference value on the original analysis were converted to having all parameters at or above the 2010 reference values. Conclusion(s): The 2010 reference values result in some infertile men being reclassified as fertile if status is based on semen analysis alone. This may lead to fewer men being referred for proper infertility evaluation or treatment.