Are WHO Recommendations to Perform 2 Consecutive Semen Analyses for Reliable Diagnosis of Male Infertility Still Valid?

PURPOSE We evaluated whether a second semen analysis as suggested by the WHO Laboratory Manual for the Examination of Human Semen and Sperm-Cervical Mucus Interaction would improve diagnostic reliability in the evaluation of male infertility. MATERIALS AND METHODS We analyzed a total of 5,132 semen samples from 2,566 men who underwent at least 2 consecutive semen analyses at a university fertility center. Reproducibility and correlation between the first and second analyses were evaluated for sperm concentration, motility and morphology according to the WHO criteria as well as the total motile sperm count. RESULTS Altogether 51.2% of the second analyses confirmed the initial findings according to WHO criteria and 60% confirmed them when applying total motile sperm count criteria. After finding normozoospermia on the initial analysis 27% of the second semen analyses were pathological. Following a first pathological semen analysis 23% of the second analyses were normal and 77% were pathological. The coefficient of variation ranged from 0.23 to 0.60. The Spearman correlation coefficient was high for sperm concentration (rs = 0.84) and normal morphology (rs = 0.80) but lower for progressive motility (rs = 0.57). The discriminating capacity of each semen parameter to distinguish between men with a normal vs a pathological second semen analysis was rather limited (ROC AUC 0.72 to 0.79). CONCLUSIONS In accordance with WHO recommendations 2 consecutive semen analysis should be performed