{"id":18,"date":"2010-06-09T15:51:12","date_gmt":"2010-06-09T15:51:12","guid":{"rendered":"http:\/\/www.maledoc.com\/blog\/?p=18"},"modified":"2019-08-16T07:42:21","modified_gmt":"2019-08-16T13:42:21","slug":"the-new-who","status":"publish","type":"post","link":"https:\/\/www.maledoc.com\/blog\/2010\/06\/09\/the-new-who\/","title":{"rendered":"The New WHO"},"content":{"rendered":"

A first test of male fertility is the semen analysis. \u00a0You do your thing, and a technician counts the sperm, sees how they’re moving, what they look like and whether they’re alive. \u00a0For decades, the World Health Organization has published criteria for these numbers to alert a man that he might have a problem when it comes to impregnating a woman. \u00a0Until recently, the numbers were a consensus of expert opinion, but in the latest edition<\/a>, the WHO criteria changed substantially.<\/p>\n

What the WHO is currently doing is to dispense with expert opinion, and just lay the numbers out for all to see. \u00a0Table II from the paper<\/a> shows the numbers for men from couples who conceived within a year. \u00a0Take sperm concentration, for example. \u00a0For centile 5, the sperm concentration is 15 million per ml. \u00a0That means that only 5% of couples where the man had 15 million\/ml sperm or less conceived within a year. \u00a0For centile 50, the concentration was 73 million\/ml, meaning that 50% of couples conceived within a year when the sperm concentration was up to that number. \u00a0You get the idea.<\/p>\n

The problem is that people like cutoffs, and in the latest edition, the WHO chose centile 5 as the line in the sand. \u00a0It’s a good number for thinking that below it, couple infertility likely involves the male. \u00a0But keep in mind that at centile 10, only 10% of couples conceived within a year. \u00a0In other words, having sperm numbers above the centile 5 cutoff doesn’t guarantee that the sperm are trouble free.<\/p>\n

Frankly, I think the WHO numbers are most useful to get a ballpark idea of how fertility may be related to what’s inside the semen. \u00a0I prefer the approach David Guzick and colleagues took<\/a>, where they applied a statistical method called Classification and Regression Tree (CART) analysis to sperm, which gives two cutoffs in a “green light, yellow light, red light” fashion. \u00a0For example, CART analysis came up with 13.5 million\/ml and 48 million\/ml for sperm concentration. \u00a0At 13.5 million\/ml sperm or less, the “red light,” couple infertility likely involves the male. \u00a0At 48 million\/ml or more, your sperm probably are “green light” good to go. \u00a0Between 13.5 million\/ml and 48 million\/ml, the “yellow light,” sperm may or may not be the problem. \u00a0You can find the Guzick CART cutoffs here<\/a>.<\/p>\n

A lot of people, including doctors and fertility specialists, are confused about the new WHO cutoffs. \u00a0Expect a little consternation about them for a bit.<\/p>\n

WHO\u00a0Table\u00a0II <\/a>Distribution of values, lower reference limits and their 95% CI for semen parameters from fertile men whose partners had a time-to-pregnancy of 12 months or less<\/p>\n\n\n\n
\n\n\n\n\n\n\n\n\n\n\n\n\n
<\/td>\nN<\/em><\/td>\nCentiles <\/p>\n
\n<\/td>\n		<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
<\/td>\n<\/td>\n2.5<\/td>\n(95% CI)<\/td>\n5<\/td>\n(95% CI)<\/td>\n10<\/td>\n25<\/td>\n50<\/td>\n75<\/td>\n90<\/td>\n95<\/td>\n97.5<\/td>\n<\/tr>\n
\n
\n<\/td>\n<\/tr>\n
Semen volume (ml)<\/td>\n1941<\/td>\n1.2<\/td>\n(1.0\u20131.3)<\/td>\n1.5<\/td>\n(1.4\u20131.7)<\/td>\n2<\/td>\n2.7<\/td>\n3.7<\/td>\n4.8<\/td>\n6<\/td>\n6.8<\/td>\n7.6<\/td>\n<\/tr>\n
Sperm concentration (106<\/sup>\/ml)<\/td>\n1859<\/td>\n9<\/td>\n(8\u201311)<\/td>\n15<\/td>\n(12\u201316)<\/td>\n22<\/td>\n41<\/td>\n73<\/td>\n116<\/td>\n169<\/td>\n213<\/td>\n259<\/td>\n<\/tr>\n
Total number (106<\/sup>\/Ejaculate)<\/td>\n1859<\/td>\n23<\/td>\n(18\u201329)<\/td>\n39<\/td>\n(33\u201346)<\/td>\n69<\/td>\n142<\/td>\n255<\/td>\n422<\/td>\n647<\/td>\n802<\/td>\n928<\/td>\n<\/tr>\n
Total motility (PR + NP, %)*<\/td>\n1781<\/td>\n34<\/td>\n(33\u201337)<\/td>\n40<\/td>\n(38\u201342)<\/td>\n45<\/td>\n53<\/td>\n61<\/td>\n69<\/td>\n75<\/td>\n78<\/td>\n81<\/td>\n<\/tr>\n
Progressive motility (PR, %)*<\/td>\n1780<\/td>\n28<\/td>\n(25\u201329)<\/td>\n32<\/td>\n(31\u201334)<\/td>\n39<\/td>\n47<\/td>\n55<\/td>\n62<\/td>\n69<\/td>\n72<\/td>\n75<\/td>\n<\/tr>\n
Normal forms (%)<\/td>\n1851<\/td>\n3<\/td>\n(2.0\u20133.0)<\/td>\n4<\/td>\n(3.0\u20134.0)<\/td>\n5.5<\/td>\n9<\/td>\n15<\/td>\n24.5<\/td>\n36<\/td>\n44<\/td>\n48<\/td>\n<\/tr>\n
Vitality (%)<\/td>\n428<\/td>\n53<\/td>\n(48\u201356)<\/td>\n58<\/td>\n(55\u201363)<\/td>\n64<\/td>\n72<\/td>\n79<\/td>\n84<\/td>\n88<\/td>\n91<\/td>\n92<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

*PR, progressive motility (WHO, 1999 grades a + b); NP, non-progressive motility (WHO, 1999 grade c).<\/p>\n","protected":false},"excerpt":{"rendered":"

A first test of male fertility is the semen analysis. \u00a0You do your thing, and a technician counts the sperm, sees how they’re moving, what they look like and whether they’re alive. \u00a0For decades, the World Health Organization has published criteria for these numbers to alert a man that he might have a problem when […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4],"tags":[5,40,41,39],"class_list":["post-18","post","type-post","status-publish","format-standard","hentry","category-fertility","tag-semen-analysis","tag-sperm-count","tag-sperm-motility","tag-who-criteria"],"_links":{"self":[{"href":"https:\/\/www.maledoc.com\/blog\/wp-json\/wp\/v2\/posts\/18","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.maledoc.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.maledoc.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.maledoc.com\/blog\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.maledoc.com\/blog\/wp-json\/wp\/v2\/comments?post=18"}],"version-history":[{"count":0,"href":"https:\/\/www.maledoc.com\/blog\/wp-json\/wp\/v2\/posts\/18\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.maledoc.com\/blog\/wp-json\/wp\/v2\/media?parent=18"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.maledoc.com\/blog\/wp-json\/wp\/v2\/categories?post=18"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.maledoc.com\/blog\/wp-json\/wp\/v2\/tags?post=18"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}