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Male infertility problems of patients with strict sperm morphology between 5-14% may be missed with the current WHO guidelines

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OBJECTIVE: In 2010 W.H.O. changed the lower reference limit for strict sperm morphology from 15 to 4%. The change was based on 5th percentile cut points from a meta-analysis on a published series of fertile men. This study investigates if patients referred for evaluation with sperm morphologies between 5-14% have identifiable etiologies of male infertility.

MATERIALS AND METHODS: I.R.B. approval was obtained to review records for patients referred to the University of Michigan Center of Reproductive Medicine between May 2012-May 2014 whom had a sperm morphology of 5-14%. Semen analysis, hormone levels, and information related to an infertility diagnosis, were recorded into a de-identified database. Patients were placed into the categories 'Varicocele', 'Hypogonadism', 'Intercourse problems', 'Anti-sperm antibodies (A.S.A.)', 'Other' or 'No diagnosis'.

RESULTS: A total of 253 patients were included in the study. Of these, 96/253 (38%) had a clinical varicocele; 44/253 (17%) hypogonadism; 4/253 (2%) intercourse problems; 11/253 (4%) evidence of sperm antibodies; and 15/253 (6%) had various other problems deemed potentially contributing causes of infertility. In all, nearly 67% of the subjects were identified to have a potential contributing etiology of male infertility. Similar results were found for the men with isolated low morphology (n = 194).

CONCLUSIONS: This study demonstrates that 67% of men in infertile couples, who have strict sperm morphology between 5 and 14%, are found to have a potential contributing male factor infertility diagnosis. This raises the possibility that the new lower reference value for sperm morphology may result in missed opportunities for proper infertility assessment.

Original languageEnglish
JournalScandinavian Journal of Urology
Volume52
Issue number5-6
Pages (from-to)427-431
Number of pages5
ISSN2168-1805
DOIs
Publication statusPublished - 4 Jan 2019

    Research areas

  • Male infertility, reference values, semen analysis, Teratozoospermia/diagnosis, World Health Organization, Humans, Semen Analysis, Infertility, Male/diagnosis, Male, Reference Values, Hypogonadism/diagnosis, Spermatozoa/pathology, Adult, Varicocele/diagnosis, Practice Guidelines as Topic

ID: 56162039