Is the WHO spermogram up to date?

January 9, 2011

Is the spermogram still up to date according to the WHO standard?

The spermogram, i.e., the evaluation of the concentration, motility, and % proportion of normally shaped sperm, serves reproductive medicine doctors to decide on an adequate treatment for the infertile couple. Taking into account the female fertility factors, it also serves to decide whether, for example, inseminations IVF or other IVF ICSI therapy seem advisable.

At least 20% of the couples suffer from so-called idiopathic infertility, i.e., there are no identifiable causes for the unwanted childlessness.

In recent years, there have been a growing number of studies that strongly question whether the factors of the „traditional“ spermogram are really sufficient for assessing sperm functional ability and thus for assessing fertility.

Various environmental factors (pollution, chemicals in food, nicotine, drugs, medications, radiation) but also some diseases (diabetes, cancer, infections) cause molecular breaks in the DNA strands, i.e., directly in the genetic information, through „oxidative stress“.

So %-called sperm fragmentation tests can determine the percentage of sperm with breaks within their DNA strands. A growing number of studies show that there is a close relationship between the so-called „sperm fragmentation index“ (SFI) and the pregnancy rate (SRR IVF), the fertilization rate, but also such factors as embryo quality and the incidence of miscarriages.

Currently, an FSH level of up to 15% is considered normal; with an FSH level between 15 and 30%, serious consideration should already be ICSI given to measures such as these IVF or even to undergoing donor sperm treatment. Values above 30% already warrant considering sperm donor treatment.

If circumstances allow, it can be attempted to improve sperm fragmentation by reducing „oxidative stress“. A healthier lifestyle and the cessation of nicotine can already improve the SFI after a few months. Additionally, dietary supplements can be beneficial. Since a normal WHO spermogram is obviously not a guarantee of a healthy sperm count. no If it automatically proves the presence of normal male fertility, all couples should be advised to undergo a sperm fragmentation test to avoid having to wait unnecessarily long for adequate, i.e., successful, treatment.

However, it is currently still largely unclear why an improvement in the fertilization and pregnancy rate occurs during ICSI therapy. One possible explanation is that the sperm that are already selected by light microscopy—that is, those without fragmentation—are more likely to be selected and injected into the egg cell.

Sources:

Clinical Implications of sperm DNA damage - Sheena E. M. Lewis & Luke Simon
(Center for Public Health, Queens University of Belfast, Northern Ireland UK)

Medical Treatment of male infertility- Vivian Rittenberg & Tarek El-Toukhy
(Assisted Conception Unit, Guy's and St. Thomas' Hospital, London UK)

The role of antioxidant therapy in the treatment of male infertility
(Center for Reproductive Medicine, Glickman Urological & Kidney Institute, Cleveland, Ohio, USA etc.)

From “Human Fertility” Vol. 13, Number 4, December 2010