Male infertility: WHO Manual – the importance of semen analysis and a complete work-up
The much awaited WHO (World Health Organization) new manual on Semen Analysis has been released 10 years after the previous one. This sixth edition includes relevant updates with some new reference standards based on research conducted on many males not just in one geographical area but from across the world. A methodical and efficient semen analysis is the foundation of the male fertility evaluation and the results affect the patient’s diagnosis, medical recommendation and treatment.
However, a routine semen analysis is not sufficient to provide a man with the best options for overcoming infertility, since it does not cover in depth the ability to detect epigenetic deficiencies and sperm DNA which may affect the development of the embryo, implant and wellbeing of the offspring.
An ideal andrological assessment is required, which will include the person’s medical history, a physical examination, semen analysis, endocrine (glands which secrete hormones or other products into the blood) assessment and other tests such as SDF (sperm DNA fragmentation). With a complete work-up, underlying medical and infertility conditions will come to light, clarifying the diagnosis and ensuring that the right treatment is meted out. In this way, the general health of the person, fertility prospects and health of the offspring can be protected.
Generally, the references in the WHO manual are used worldwide. The reference values in the 2010 manual relied on data of semen analysis of about 2000 men with a time to pregnancy of less than 12 months. These differed slightly from previous manuals which were based on sperm parameters in fertile men with no specific time to pregnancy. In this 6th edition, there is a combination of the previous 2010 data with additional data of fertile men collected between 2010 and 2020, with the same time to pregnancy of less than 12 months. These included men from Southern Europe, Asia and Africa which were not represented or semi-represented earlier. However, the 6th edition mentions that the 5th centile values (earlier reference values) are one way to obtain the results but they alone are insufficient to diagnose male infertility.
The advanced examinations included in the Manual detail the importance of using different tests to investigate the ability of the sperm to fertilize an egg and develop a healthy embryo. These tests include SDF tests such as the SCSA (Sperm Chromatin Structure Assay), TUNEL and Comet assay. Other tests such as SAT (Sperm Aneuploidy Test to study genetic factors), ROS (reactive oxygen species) and SOS (Sperm Oxidative Stress) are also relevant. The results of these extended examinations provide clinical information which help many people and couples make decisions, when they are faced with inexplicable infertility or miscarriages, male patients with clinical varicocele, those with risk factors due to lifestyle and toxic exposure, failed artificial insemination, IVF (In Vitro fertilisation) or ICSI (Intracytoplasmic sperm injection).
Correctable disorders such as genital tract infections, varicocele, endocrine, obstructions in the reproductive tract and exposure to environmental and occupational toxicants can be identified with an overall work up. They can also identify those irreversible conditions which are suitable for ART (assisted reproductive technology) using the patient’s own sperm. Also identifiable are those situations where adoption or donor insemination are the solutions.
Male infertility has now been recognised as a public health concern. The management and prevention, where possible, has become an important part of the reproductive health agenda. A complete andrology work up can also help to identify coexisting diseases or health-threatening conditions which require medical care. Hence, the importance of these tests cannot be denied.
Semen analysis and advanced examinations are complex procedures and need to be performed in a well equipped and qualified andrology laboratory. We, at Andrology Center, are pleased to state that we are the only centre in India licensed to conduct the SCSA (Sperm Chromatin Structure Assay) test referred to in the WHO Manual, which accurately identifies DNA fragmentation of the sperm.
We are the only centre in India licensed to conduct the SCSA (Sperm Chromatin Structure Assay) test, which is the gold standard of Sperm DNA Fragmentation testing. It quickly and accurately identifies sperm with DNA fragmentation. The accuracy of the results is guaranteed. Based on such results, you could consult a Fertility expert for further guidance and/or treatment.