New World Health Semen Analysis Parameters

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In 2010 the World Health Organization (WHO) updated its reference values for the Semen Analysis.[1] This update was long overdue as the last version was published in 1999.

There is a significant difference on how the old and new reference ranges were derived. In the past, semen data from random populations of men were analyzed and the results were plotted on a statistical distribution curve. The 5th percentile was considered to be the lower limit of normal (or reference), in another word, 95% of men tested would have sperm parameters higher than the reference ranges.

In WHO 2010, the new normal values are based on data from men with proven fertility, men who were known to help their partners conceive in the previous 12 months. Following a large analysis of semen parameters from over 4000 men in 14 countries, a new set of 5th percentile parameters was recommended. Below are the comparisons of the old and new reference values:

Parameter WHO 1999  WHO 2010
Volume  2 ml 1.5 ml
Concentration 20 million/ml   15 million/ml
Progressive motility 50% 32%
Normal forms 14%   4%

Based on our experience, concentration and progressive motility are the most important sperm parameters in predicting the likelihood of pregnancy via coitus or intrauterine insemination. For example, when sperm concentration is < 10 million/ml and/or progressive motility < 20%, the chance of pregnancy using the conventional methods is very low. In vitro fertilization would provide the best chance of pregnancy.

Somewhat more difficult to interpret is sperm morphology, or the proportion of sperm that appear perfect under light microscopy. Morphology is the most subjective parameter in a semen analysis with different centers using different criteria to evaluate morphology. Moreover, technicians within the same laboratory can give different values using the same grading scheme.

As can be seen above, there is a large difference between the WHO morphology references for 2010 and 1999, reflecting the subjective nature of this parameter. At IVFMD we usually do not use morphology when recommending initial treatment. In our experience, as long as sperm  Concentration and motility are within normal ranges, poor morphology scores do not necessarily preclude pregnancy. Over the years we have seen many men with isolated low morphology scores (0-3%) who became biological fathers without the need for IVF or ICSI.

The new WHO criteria are unique because for the first time, a semen sample under evaluation can be compared to those of fertile men. We have found the new standards to be quite helpful in assessing the male fertility potential. If you have any questions about the new parameters, do feel free to contact

Reference: Cooper, TG et al. WHO reference values for human semen characteristics. Hum. Reprod. Update. 2010. 16(5):559

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About

Dr. Le is the founder of IVFMD and has aspired from day one to make leading edge fertility treatment as affordable as possible. He has special interest in all aspects of Assisted Reproductive Technologies, especially IVF protocols for women with low ovarian reserve.
http://www.ivfmd.net

4 Responses to “New World Health Semen Analysis Parameters”

  1. ope says:

    My hubby semen analysis gies thus: 106 per ml,60% morphology,40%motility bt has staphylocus and

    • Sy Le, M.D. says:

      It’s possible that the semen sample was contaminated with skin bacteria during collection. Infection of the male genital tract is another possibility if there are white blood cells in the semen. A repeat collection with can confirm whether there is an infection.

  2. estabrq says:

    what abnormal colors of semen samples (semen analysis)?

    • Sy Le, M.D. says:

      The normal color of semen is cloudy white. Red color of the semen suggests presence of blood in the semen seen in cases of infection or injury of the bladder and the male genital tract. A yellow color can occur when there is pus in the semen in cases of infection. A very clear color can occur when there is no sperm in the semen. A semen analysis can help clarify the diagnoses.

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