The sixth edition of the WHO manual for human semen analysis: A critical review and SWOT analysis
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Date
2021
Authors
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Journal ISSN
Volume Title
Publisher
MDPI
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.
Description
Keywords
World Health Organization (WHO), Human semen, Sperm, Sperm DNA, Oxidative stress, Semen analysis, Seminal oxidative stress, DNA fragmentation
Citation
Boitrelle, F., et al. A. 2021. The Sixth Edition of the WHO Manual for Human Semen Analysis: A Critical Review and SWOT Analysis. Life 2021, 11, 1368. https://doi.org/10.3390/life11121368