The New 2010 WHO Manual and the Need to Address some Related Dilemmas

Regarding the variations in the quality of semen analysis, several papers have critically reviewed the diverse semen analysis results from a large number of studies carried out in different races and geographical areas over a long period of time. Most of these studies indicate decreased semen quality, especially sperm concentration (counts to less than 50%) and morphology between the years 1940 – 1990 (1). Nevertheless, the major problem of these meta-analyses is the use of collected data from different regions done in different time intervals with a wide range of methods and different levels of standardization. Most of these studies have problems in their case inclusion criteria, number of cases, size of the study and the employed techniques for semen analysis, which could negatively affect the results severely. As an example, many companies that provide external quality control for andrology laboratories, such as UK-NEQAS, have shown that in spite of the current WHO guidelines for semen analysis, the evaluated laboratories, inside and outside UK, are using different procedures and criteria for semen analysis. For example, WHO has recommended the use of improved Neubauer or Makler chamber to determine sperm counts, however, the reported chambers used by laboratories include: 1- Burker-turk, 2- Fast Read, 3- Fuchs Rosenthar, 4- Horwell, 5- Improved Neubauer, 6- Ieja, 7-Makler, 8- Microcell, 9- SQA-A, 10- CASA, 12- Weber or other local chambers and even without any chamber that may severely influence the accuracy of the results and also the criteria for the evaluation of sperm morphology and motility