The Sixth Edition of the WHO Manual for Human Semen Analysis: A Critical Review and SWOT Analysis

Florence Boitrelle, Rupin Shah, Ramadan Saleh, Ralf Henkel, Hussein Kandil, Eric Chung, Paraskevi Vogiatzi, Armand Zini, Mohamed Arafa, Ashok Agarwal, Florence Boitrelle, Rupin Shah, Ramadan Saleh, Ralf Henkel, Hussein Kandil, Eric Chung, Paraskevi Vogiatzi, Armand Zini, Mohamed Arafa, Ashok Agarwal

Abstract

Semen analysis is the cornerstone of male fertility evaluation with WHO guidelines providing the basis for procedural standardization and reference values worldwide. The first WHO manual was published in 1980, and five editions have been subsequently released over the last four decades. The 6th Edition was published in July 2021. In this review, we identify the key changes of this 6th Edition. Additionally, we evaluate the utility of this 6th Edition in clinical practice using SWOT (strengths, weaknesses, opportunities, and threats) analysis. This new Edition has made the analysis of basic semen parameters more robust, taking into account the criticisms and grey areas of the previous editions. The tests assessing sperm DNA fragmentation and seminal oxidative stress are well-described. The main novelty is that this latest edition abandons the notion of reference thresholds, suggesting instead to replace them with "decision limits". While this seems attractive, no decision limits are proposed for either basic semen parameters, or for extended or advanced parameters. This critical review of the 6th Edition of the WHO laboratory manual combined with a SWOT analysis summarizes the changes and novelties present in this new Edition and provides an in-depth analysis that could help its global use in the coming years.

Keywords: SWOT; WHO laboratory manual 6th Edition; oxidative stress; semen; sperm; sperm DNA fragmentation.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
SWOT (“strengths” (S), “weaknesses” (W), “opportunities” (O) and “threats” (T)) analysis of the 6th Edition of the WHO manual for human semen analysis. SA: semen analysis. SDF: sperm DNA fragmentation. FISH: fluorescent in situ hybridization. OS: oxidative stress.

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Source: PubMed

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