Boitrelle Florence, Shah Rupin, Saleh Ramadan, Henkel Ralf, Kandil Hussein, Chung Eric, Vogiatzi Paraskevi, Zini Armand, Arafa Mohamed, Agarwal Ashok
Department of Reproductive Biology, Fertility Preservation, Andrology and CECOS, Poissy Hospital, 78300 Poissy, France.
Department BREED, UVSQ, INRAE, Paris Saclay University, 78000 Jouy-en-Josas, France.
Life (Basel). 2021 Dec 9;11(12):1368. doi: 10.3390/life11121368.
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.
精液分析是男性生育力评估的基石，世界卫生组织（WHO）的指南为全球范围内的检测程序标准化和参考值提供了依据。WHO的第一版手册于1980年出版，在过去的四十年中随后又发布了五个版本。第6版于2021年7月出版。在本综述中，我们确定了第6版的关键变化。此外，我们使用SWOT（优势、劣势、机会和威胁）分析评估了第6版在临床实践中的实用性。考虑到前几版的批评意见和灰色地带，这个新版本使基本精液参数的分析更加稳健。对评估精子DNA碎片和精液氧化应激的检测方法也有详细描述。主要的新颖之处在于，这个最新版本摒弃了参考阈值的概念，而是建议用“决策限度”取而代之。虽然这看起来很有吸引力，但无论是基本精液参数，还是扩展或高级参数，都没有提出决策限度。对WHO实验室手册第6版的这一批判性综述结合SWOT分析，总结了这个新版本中的变化和新颖之处，并提供了深入分析，这有助于其在未来几年在全球范围内的应用。
