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Cited by 150Sperm and Testicular FunctionReproductive Health and TechnologiesMale Reproductive Health Studies

Role of semen analysis in subfertile couples

Open access
van der Steeg, Jan W., Steures, Pieternel, Eijkemans, Marinus J.C., F. Habbema, J. Dik, Hompes, Peter G.A., Kremer, Jan A.M., van der Leeuw-Harmsen, Loes, Bossuyt, Patrick M.M. +4 more·2011·Fertility and Sterility
DOI 10.1016/j.fertnstert.2010.02.024
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Abstract

Objective To evaluate the associations between the results of the male partner's semen analysis (classified according to the World Health Organization [WHO] criteria) and fathering a child without any treatment. Design Prospective multicenter cohort study. Setting Twenty subfertility centers in The Netherlands. Patient(s) A total of 3,345 consecutive couples presenting for subfertility. Intervention(s) None. Main outcome measure(s) Associations between the results of the male partner's semen analysis, classified according to the WHO criteria, and fathering a child without any treatment within a time horizon of 1 year. Subsequently, we redefined semen quality criteria and reevaluated the associations. Result(s) Follow-up data of 3,129 couples (94%) were available, of which 517 (17%) had a healthy pregnancy without treatment. The 1-year pregnancy rate in men with WHO normozoospermia did not differ significantly from that in men with WHO impaired semen (24% vs. 23%). In contrast, we observed lower chances of fathering a child for sperm concentrations <40 × 10(6)/mL, total sperm count <200 × 10(6), and sperm morphology <20% normal forms. With a multivariable regression model based on the redefined male semen subfertility criteria we were able to make a finer differentiation between subfertile men, with probabilities of fathering a child ranging from 7% to 41%. Conclusion(s) The current WHO criteria for semen quality do not discriminate between fertile and subfertile men. Our redefined and graded semen criteria have strong predictive value. If interpreted correctly, the fast and inexpensive semen analysis remains the gold standard for defining a man's role in subfertility.

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  • The semen analysis is a poor predictor of pregnancy in the low TMSC range.

    “Once again it is shown that the semen analysis is a poor predictor of pregnancy in this low range (Van der Steeg et al., 2011).”

    From Total motile sperm count: a better indicator for the severity of male factor infertility than the WHO sperm classification system (2015) · cites this paper as Van der Steeg et al., 2011

    The paper’s conclusion (FIGURE 2; page not supplied) says reinterpreted semen parameters correlate strongly with natural conception and explicitly rejects dismissing semen analysis as a predictor. The Reinterpretation of the Semen Parameters section also reports associations at lower sperm counts. It does find that WHO normal-versus-abnormal categories discriminate poorly, but it does not establish poor prediction specifically in a low total motile sperm count (TMSC) range. (LLM, conf=0.84)

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  • Van der Steeg et al. (2011) concluded that the predictive value of the WHO classification of semen analysis was poor.

    “Van der Steeg et al. (2011) tried to validate the 1999-WHO criteria (WHO, 1999) for spontaneous pregnancy chance in a large longitudinal cohort of infertile couples and concluded that the predictive value of the WHO classification of semen analysis was poor.”

    From Total motile sperm count: a better indicator for the severity of male factor infertility than the WHO sperm classification system (2015) · cites this paper as Van der Steeg et al. (2011)

  • Van der Steeg et al. (2011) concluded that the WHO cut-off values are not good predictors, as their spline curves show that actual values are more informative than purely dichotomizing the parameters.

    “They concluded that the cut-off values as defined by the WHO are not good predictors, as the spline curves of the different sperm parameters they produced clearly show that the actual values are more informative than purely dichotomizing the parameters, as the WHO does.”

    From Total motile sperm count: a better indicator for the severity of male factor infertility than the WHO sperm classification system (2015) · cites this paper as van der Steeg et al. (2011)

  • In Van der Steeg et al. (2011), the different WHO categories did not show a clear pattern of success rate.

    “In their study the different WHO categories did not show a clear pattern of success rate.”

    From Total motile sperm count: a better indicator for the severity of male factor infertility than the WHO sperm classification system (2015) · cites this paper as Van der Steeg et al. (2011)

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References 35 · Cited by 150

Research works printed but not linked: 29

  1. Hull MG, Glazener CM, Kelly NJ, Conway DI, Foster PA, Hinton RA, et al. Population study of causes, treatment, and outcome ofinfertility. Br Med J (Clin Res Ed) 1985;291:1693-1697.
  2. Wang X, Chen C, Wang L, Chen D, Guang W, French J. Conception, early pregnancy loss, and time to clinical pregnancy: a population-based pro- spective study. Fertil Steril 2003;79:577-84.
  3. Gnoth C, Godehardt D, Godehardt E, Frank- Herrmann P, Freundl G. Time to pregnancy: results of the German prospective study and impact on the management of infertility. Hum Reprod 2003;18: 1959-66.
  4. De Kretser DM. Male infertility. Lancet 1997;349: 787-90.
  5. Evers JL. Female subfertility. Lancet 2002;360: 151-9.
  6. Nallella KP, Sharma RK, Aziz N, Agarwal A. Signif- icance of sperm characteristics in the evaluation of male infertility. Fertil Steril 2006;85:629-34.
  7. MacLeod J, Gold RZ. The male factor in fertility and infertility. II. Sperm counts in 1000 men of known fertility and in 1000 cases of infertile marriage. J Urol 1951;66:436.
  8. MacLeod J, Gold RZ. The male factor in fertility and infertility. VI. Semen quality and other factors in relation to ease of conception. Fertil Steril 1953;4:10.
  9. Zukerman Z, Rodriguez-Rigau LJ, Smith KD, Steinberger E. Frequency distribution of sperm counts in fertile and infertile males. Fertil Steril 1977;28:1310-3.
  10. David G, Jouannet P, Martin-Boyce A, Spira A, Schwartz D. Sperm counts in fertile and infertile men. Fertil Steril 1979;31:453-5.
  11. Kovacs AT, Lecton JF, Matthews CD, Steigrad SJ, Saunders DM, Jones WR, et al. The outcome of arti- ficial donor insemination compared to the husband's fertility status. Clin Reprod Fertil 1982;1:295.
  12. Emperaire JC, Gauzere-Soumireu E, Audebert AJ. Female fertility and donor insemination. Fertil Steril 1982;37:90-3.
  13. Hargreave TB, Elton RA. Is conventional sperm anal- ysis of any use? Br J Urol 1983;55:774-9.
  14. Schoyswan R, Gerris. Twelve year followup: study of pregnancy rates in 1921 couples with idiopathically impaired male fertility. Acta Eur Fertil 1983;14:51-5.
  15. Baker HWG, Burger HG, de Kretser D. Male infertil- ity. In: Steinberger E, Frajese C, Steinberger A, eds. Reproductive medicine. New York: Raven Press, 1986:187-97.
  16. Sokol RZ, Sparkes R. Demonstrated paternity in spite of severe idiopathic oligospermia. Fertil Steril 1987;47:356-8.
  17. Sherins R. A low sperm concentration does not pre- clude fertility in men with isolated hypogonadotropic hypogonadism after gonadotropin therapy. Fertil Steril 1988;50:343-7.
  18. Silber SJ. Evaluation and treatment of male infertility. Clin Obstet Gynecol 2000;43:854-88.
  19. World Health Organization. WHO laboratory manual for the examination of human semen and semen-cervi- cal mucus interaction. Singapore: Press Concern, 1980.
  20. Ombelet W, Bosmans E, Janssen M, Cox A, Vlasselaer J, Gyselaers W, et al. Semen parameters in a fertile versus subfertile population: a need for change in the interpretation of semen testing. Hum Reprod 1997;12:987-93.
  21. Bonde JP, Ernst E, Jensen TK, Hjollund NH, Kolstad H, Henriksen TB, et al. Relation between se- men quality and fertility: a population-based study of 430 first-pregnancy planners. Lancet 1998;352: 1172-7.
  22. Zinaman MJ, Brown CC, Selevan SG, Clegg ED. Se- men quality and human fertility: a prospective study with healthy couples. J Androl 2000;21:145-53.
  23. Guzick DS, Overstreet JW, Factor-Litvak P, Brazil CK, Nakajima ST, Coutifaris C, et al. Sperm morphology, motility, and concentration in fertile and infertile men. N Engl J Med 2001;345:1388-93.
  24. Menkveld R, Wong WY, Lombard CJ, Wetzels AM, Thomas CM, Merkus HM, et al. Semen parameters, including WHO and strict criteria morphology, in a fertile and subfertile population: an effort toward standardization of in-vivo thresholds. Hum Reprod 2001;16:1165-71.
  25. Jouannet P, Ducot B, Feneux D, Spira A. Male factors and the likelihood of pregnancy in infertile couples. I. Study of sperm characteristics. Int J Androl 1988;11: 379-94.
  26. World Health Organization. WHO laboratory manual for the examination of human semen and semen-cer- vical mucus interaction. 4th ed. Cambridge, U.K.: Cambridge University Press, 1999.
  27. Hunault CC, Habbema JDF, Eijkemans MJC, Collins JA, Evers JL, te Velde ER. Two new prediction rules for spontaneous pregnancy leading to live birth among subfertile couples, based on the synthesis of three previous models. Hum Reprod 2004;19:2019-26.
  28. Van der Steeg JW, Steures P, Eijkemans MJ, Habbema JD, Hompes PG, Broekmans FJ, et al. Preg- nancy is predictable: a large-scale prospective exter- nal validation of the prediction of spontaneous pregnancy in subfertile couples. Hum Reprod 2007;22:536-42.
  29. Harrell FE Jr, Lee KL, Pollock BG. Regression models in clinical studies: determining relationships between predictors and response. J Natl Cancer Inst 1988;80:1198-202.

Authors
van der Steeg, J. W., Steures, P., Eijkemans, M. J. C., F. Habbema, J. D., Hompes, P. G. A., Kremer, J. A. M., van der Leeuw-Harmsen, L., Bossuyt, P. M. M., Repping, S., Silber, S. J., Mol, B. W. J., & van der Veen, F.
Affiliations
  • Erasmus MC (NL)
  • Amsterdam UMC Location Vrije Universiteit Amsterdam (NL)
  • Radboud University Medical Center (NL)
  • Amsterdam UMC Location University of Amsterdam (NL)
  • St. Luke's Hospital (US)
ORCID
Venue
Fertility and Sterility
Publisher
Elsevier BV
Published
2011-03
Volume
95
Issue
3
Pages
1013-1019
ISSN
0015-0282 (ISSN-L)
DOI
10.1016/j.fertnstert.2010.02.024
OpenAlex
W2127048828
Cited by
150
References
35
Citations by year
2026: 2 · 2025: 3 · 2024: 11 · 2023: 4 · 2022: 12 · 2021: 11 · 2020: 14 · 2019: 12 · 2018: 9 · 2017: 12 · 2016: 12 · 2015: 16 · 2014: 6 · 2013: 13 · 2012: 3
FWCI
9.38
Type
journal article
Language
en
Open access
Licence
Locations
  • Fertility and Sterility (publishedVersion)
  • PubMed (publishedVersion)
  • Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
  • EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
  • Digital Academic REpository of VU University Amsterdam (Vrije Universiteit Amsterdam) (submittedVersion)
  • Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
  • Pure Amsterdam UMC (submittedVersion)
  • Radboud Repository (Radboud University) (submittedVersion)
Funders
ZonMw
Topics
  • Health Sciences › Medicine › Reproductive Medicine › Sperm and Testicular Function
  • Health Sciences › Medicine › Reproductive Medicine › Reproductive Health and Technologies
  • Health Sciences › Health Professions › General Health Professions › Male Reproductive Health Studies
Keywords
semen analysis, male subfertility, subfertile couples, spontaneous conception, sperm concentration, total sperm count, sperm morphology, pregnancy rate, male infertility
MeSH terms
Adult, Female, Fertility, Follow-Up Studies, Humans, Infertility, Male, Male, Middle Aged, Predictive Value of Tests, Pregnancy, Prospective Studies, Registries, Regression Analysis, Semen, World Health Organization, Multivariate Analysis, Pregnancy Rate

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