Human Reproduction, Vol. 16, No. 6, 1165-1171,
June 2001
© 2001 European Society of Human Reproduction and Embryology
Semen parameters, including WHO and strict criteria morphology, in a fertile and subfertile population: an effort towards standardization of in-vivo thresholds
1 Reproductive Biology Unit, Department of Obstetrics and Gynaecology, Tygerberg Hospital and University of Stellenbosch, Tygerberg, 7505 South Africa, Departments of 2 Obstetrics and Gynaecology and 3 Epidemiology, University Medical Centre St Radboud, 6500 HB Nijmegen, The Netherlands, 4 Biostatistics Division, Centre for Epidemiological Research in South Africa, Medical Research Council, South Africa and 5 Department of Chemical Endocrinology, University Medical Centre St Radboud, 6500 HB Nijmegen, The Netherlands
In this study, the semen analysis results of a fertile population were compared with those from a subfertile population, in order to establish normal cut-off values for the standard semen parameters with the aid of receiver operating characteristic (ROC) curve analysis. The fertile group comprised healthy males (n = 107) without any history of fertility problems, the partners of whom had had a spontaneous pregnancy within one year of unprotected intercourse and were pregnant at the time of the male's inclusion into the study. A total of 103 males from couples attending the infertility clinic, and with an initial sperm count of <20x106/ml were recruited to form the subfertile population. The best discriminating parameter between the two populations was sperm morphology evaluated according to WHO criteria at a cut-off point of 31% normal spermatozoa. The other cut-off values were at 8% for the acrosome index, 45% for motility, and 4% normal spermatozoa for strict criteria. Recalculating the ROC curve cut-off values based on an assumed 50% prevalence of subfertility in an assisted reproductive setting, the cut-off points were reduced to 21% and 3% normal spermatozoa for WHO and strict criteria respectively. For motility, the new cut-off value was at 20% motile spermatozoa, for motility quality at 3.5 (on a scale of 1–6), the acrosome index at 3% normal acrosomes, and the teratozoospermia index at 2.09.
Key words: fertile and subfertile population/semen analysis/sperm morphology/strict criteria/WHO criteria
6 To whom correspondence should be addressed at: Department of Obstetrics and Gynaecology/Epidemiology, University Medical Centre Nijmegen, PO Box 9101, 6500 HB Nijmegen, The Netherlands. E-mail: R.steegers{at}mie.kul.nl
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