World Health Organization reference values for human semen characteristics*‡
Abstract
BACKGROUND: Semen quality is taken as a surrogate measure of male fecundity in clinical andrology, male fertility, reproductive toxicology, epidemiology and pregnancy risk assessments. Reference intervals for values of semen parameters from a fertile population could provide data from which prognosis of fertility or diagnosis of infertility can be extrapolated. METHODS: Semen samples from over 4500 men in 14 countries on four continents were obtained from retrospective and prospective analyses on fertile men, men of unknown fertility status and men selected as normozoospermic. Men whose partners had a time-to-pregnancy (TTP) of < or =12 months were chosen as individuals to provide reference distributions for semen parameters. Distributions were also generated for a population assumed to represent the general population. RESULTS: The following one-sided lower reference limits, the fifth centiles (with 95th percent confidence intervals), were generated from men whose partners had TTP < or = 12 months: semen volume, 1.5 ml (1.4-1.7); total sperm number, 39 million per ejaculate (33-46); sperm concentration, 15 million per ml (12-16); vitality, 58% live (55-63); progressive motility, 32% (31-34); total (progressive + non-progressive) motility, 40% (38-42); morphologically normal forms, 4.0% (3.0-4.0). Semen quality of the reference population was superior to that of the men from the general population and normozoospermic men. CONCLUSIONS: The data represent sound reference distributions of semen characteristics of fertile men in a number of countries. They provide an appropriate tool in conjunction with clinical data to evaluate a patient's semen quality and prospects for fertility.
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The WHO classification is based on the fifth percentile cut-off values of a cohort of 1953 men with proven fertility.
“This classification is based on the fifth percentile cut-off values of a cohort of 1953 men with proven fertility.”
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 Cooper et al., 2010
The WHO modified its criteria in 2010.
“Forced by the increasing doubt about the composition of the reference populations used in earlier WHO manuals, the WHO modified its criteria in 2010 (Cooper et al., 2010).”
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 Cooper et al., 2010
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- Authors
- Cooper, T. G., Noonan, E., von Eckardstein, S., Auger, J., Baker, H. W. G., Behre, H. M., Haugen, T. B., Kruger, T., Wang, C., Mbizvo, M. T., & Vogelsong, K. M.
- Affiliations
- University of Münster (DE)
- Fred Hutch Cancer Center (US)
- Hôpital Cochin (FR)
- Royal Women's Hospital (AU)
- University Hospital in Halle (DE)
- Stellenbosch University (ZA)
- The Lundquist Institute (US)
- World Health Organization (CH)
- Corresponding author
- Cooper, Trevor G.
- Venue
- Human Reproduction Update
- Publisher
- Oxford University Press (OUP)
- Published
- 2009-11-24
- Volume
- 16
- Issue
- 3
- Pages
- 231-245
- ISSN
- 1355-4786 (ISSN-L)
- 1460-2369
- OpenAlex
- W2159902645
- Semantic Scholar
- c163afd75335f71d4ca34bbda06eead46e0ca4e0
- Cited by
- 2,827
- References
- 133
- Citations by year
- 2026: 83 · 2025: 112 · 2024: 170 · 2023: 204 · 2022: 261 · 2021: 286 · 2020: 258 · 2019: 246 · 2018: 210 · 2017: 186 · 2016: 151 · 2015: 162 · 2014: 156 · 2013: 136 · 2012: 92
- FWCI
- 69.14
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Human Reproduction Update (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 quality, male fertility, time to pregnancy, sperm concentration, sperm motility, sperm viability, sperm morphology, normozoospermic men, fertility assessment, WHO reference values
- MeSH terms
- Adolescent, Adult, Aged, Fathers, Humans, Infertility, Male, Male, Middle Aged, Reference Values, Semen, World Health Organization, Semen Analysis, Young Adult
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