Critical Appraisal of World Health Organization's New Reference Values for Human Semen Characteristics and Effect on Diagnosis and Treatment of Subfertile Men
Abstract
In 2010, the World Health Organization established new reference values for human semen characteristics that are markedly lower than those previously reported. Despite using controlled studies involving couples with a known time to pregnancy to establish the new limits, the reference studies are limited with regard to the population analyzed and the methods used for semen evaluation. The present review discusses concerns related to the new reference values for semen characteristics, including the effect on patient referral, diagnosis, and treatment of recognized conditions, such as varicocele, and on the indications for assisted reproductive technologies.
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The relevance of the WHO classification for the prognosis of an infertile couple and the choice of treatment is questionable or poor.
“Although this classification suggests accuracy, the relevance for the prognosis of an infertile couple and the choice of treatment is questionable.”
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 Esteves et al., 2012
Cites
Slama, R. (2002) · Human Reproduction · doi:10.1093/humrep/17.2.503 · Cited by 308 · see citing works
Role of antioxidants in the treatment of male infertility
Kefer, J. C., Agarwal, A., & Sabanegh, E. (2009) · International Journal of Urology · doi:10.1111/j.1442-2042.2009.02280.x · Cited by 273 · see citing works
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Eisenberg, M. L., Esteves, S. C., Lamb, D. J., Hotaling, J. M., Giwercman, A., Hwang, K., & Cheng, Y.-S. (2023) · Nature Reviews Disease Primers · doi:10.1038/s41572-023-00459-w · Cited by 536 · see citing works
Self-citationThe Sixth Edition of the WHO Manual for Human Semen Analysis: A Critical Review and SWOT Analysis
Boitrelle, F., Shah, R., Saleh, R., Henkel, R., Kandil, H., Chung, E., Vogiatzi, P., Zini, A., Arafa, M., & Agarwal, A. (2021) · Life · doi:10.3390/life11121368 · Cited by 271 · see citing works
“However, after its publication, the 5th Edition was criticized for suggesting reference ranges of semen parameters as the mainstay in the evaluation of the male fertility potential [11,16].”
BackgroundSelf-citationHamilton, J. A. M., Cissen, M., Brandes, M., Smeenk, J. M. J., de Bruin, J. P., Kremer, J. A. M., Nelen, W. L. D. M., & Hamilton, C. J. C. M. (2015) · Human Reproduction · doi:10.1093/humrep/dev058 · Cited by 236 · see citing works
- Authors
- Esteves, S. C., Zini, A., Aziz, N., Alvarez, J. G., Sabanegh, E. S., & Agarwal, A.
- Affiliations
- Androfert (BR)
- McGill University (CA)
- Liverpool Women's Hospital (GB)
- Cleveland Clinic (US)
- Corresponding author
- Agarwal, Ashok
- Venue
- Urology
- Publisher
- Elsevier BV
- Published
- 2012-01
- Volume
- 79
- Issue
- 1
- Pages
- 16-22
- ISSN
- 0090-4295 (ISSN-L)
- OpenAlex
- W2131505982
- Cited by
- 214
- References
- 2
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 9 · 2023: 14 · 2022: 9 · 2021: 18 · 2020: 21 · 2019: 17 · 2018: 15 · 2017: 26 · 2016: 16 · 2015: 24 · 2014: 14 · 2013: 14 · 2012: 11
- FWCI
- 1.98
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Urology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Sperm and Testicular Function
- Health Sciences › Health Professions › General Health Professions › Male Reproductive Health Studies
- Health Sciences › Medicine › Reproductive Medicine › Reproductive Health and Technologies
- Keywords
- semen parameters, male infertility, subfertility, semen analysis, varicocele, assisted reproduction, infertility diagnosis, referral
- MeSH terms
- Adult, Age Factors, Brazil, Female, Humans, Infertility, Male, Male, Middle Aged, Pregnancy, Reference Values, Semen, Sperm Count, Varicocele, World Health Organization, Incidence, Risk Assessment, Semen Analysis, Young Adult
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