Semen analysis with regard to sperm number, sperm morphology and functional aspects
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The new World Health Organization (WHO) Manual for Semen Analysis contains several improvements. One is that the 20 million spermatozoa per mL paradigm has been ousted in favour of proper calculations of lower reference limits for semen from men, whose partners had a time-to-pregnancy of 12 months or less. The recommendation to grade the progressive motility as described in the third and fourth editions of the WHO manual was not evidence-based, and WHO was therefore motivated to abandon it. However, the new recommendation is not evidence-based either, and it is difficult to understand the rational for the new assessment. It may have been a compromise to avoid returning to the rather robust system recommended in the first edition (1980). The unconditional recommendation of the 'Tygerberg strict criteria' is not evidence-based, and seems to be the result of an unfortunate bias in the composition of the Committee in favour of individuals known to support the 'strict criteria' method. This recommendation will have negative effects on the development of andrology as a scientific field. Given the importance of the WHO manual, it is unfortunate that the recommendations for such important variables, as motility and morphology, lack evidence-based support.
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Spermatozoa in cervical mucus cannot be proven to be functionally better than those with the same appearance and form in seminal plasma.
“As a manner of illustration, consider that spermatozoa in the cervical mucus cannot be proven to be functionally better than those with the same appearance and form in the seminal plasma.23”
From Men with a complete absence of normal sperm morphology exhibit high rates of success without assisted reproduction (2017) · cites this paper as [23]
The Introduction discusses sperm function, and section 5 discusses morphology, but neither compares spermatozoa in cervical mucus with similarly shaped spermatozoa in seminal plasma. Searches for “cervical mucus” and for the claimed functional comparison found no passage addressing it in our copy. (LLM, conf=0.72)
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Cited by
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The 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
Smith, R., Kovac, J., Cajipe, M., Lamb, D., & Lipshultz, L. (2017) · Asian Journal of Andrology · doi:10.4103/1008-682x.189211 · Cited by 66 · see citing works
- Authors
- Eliasson, R.
- Corresponding author
- Eliasson, Rune
- Venue
- Asian Journal of Andrology
- Publisher
- Medknow
- Published
- 2010-01
- Volume
- 12
- Issue
- 1
- Pages
- 26-32
- ISSN
- 1008-682X (ISSN-L)
- 1745-7262
- PMC
- PMC3739674
- OpenAlex
- W2080133261
- Cited by
- 94
- References
- 0
- Citations by year
- 2026: 4 · 2025: 1 · 2024: 10 · 2023: 12 · 2022: 4 · 2021: 6 · 2020: 4 · 2019: 5 · 2018: 2 · 2017: 4 · 2016: 6 · 2015: 7 · 2014: 7 · 2013: 5 · 2012: 2
- FWCI
- 8.38
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc-sa
- Locations
- Asian Journal of Andrology (publishedVersion, cc-by-nc-sa)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (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 analysis, sperm count, sperm morphology, sperm motility, evidence-based recommendations, male infertility
- MeSH terms
- Humans, Male, Manuals as Topic, Sperm Count, Sperm Motility, Spermatozoa, World Health Organization, Semen Analysis
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