title: Analysis of semen parameters in male referrals: impact of reference limits, stratification by fertility categories, predictors of change, and comparison of normal semen parameters in subfertile couples.
abstract: OBJECTIVE
  To [1] determine the impact of semen reference limits on referrals for male fertility evaluations, [2] analyze the stratification of subjects based on published "normal" thresholds, [3] analyze the odds of changing fertility categories during serial tests and thereby the potential impact of inherent variability of semen parameters on referrals, and [4] determine variable(s) predictive of change.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  Academic referral center for male fertility.
  
  
  METHODS
  New encounters in a male fertility clinic over a 5-year period that straddles the publication of World Health Organization (WHO) 2010 reference values.
  
  
  METHODS
  None.
  
  
  METHODS
  Demographic and clinical variables, semen values, and fertility categories as follows: BE (below WHO 2010 criteria), BTWN (above WHO 2010 but below WHO 1999 criteria), and N (above WHO 1999 criteria).
  
  
  RESULTS
  A total of 82.3% of initial semen tests were categorized as BE, and the predominance of this category was unchanged by publication of the WHO 2010 criteria. Men with initial semen analysis categorized as BTWN or N represented 16.2% and 1.5% of the referral population, respectively. Subjects initially categorized as BTWN were more likely to change fertility categories, and overwhelmingly this migration was downward. Analysis of normal individual semen parameters revealed statistically worse mean concentration and motility when at least one other parameter fell below the WHO 2010 criteria.
  
  
  CONCLUSIONS
  Men with semen results above reference criteria are underrepresented, indicating that reference limits influence referral patterns for male fertility evaluations. Normal mean concentration and motility were lower in men with at least one other individual semen parameter below the 2010 criteria, suggesting global dysfunction in spermatogenesis.
authors.affiliation: Center for Male Fertility, Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, Ohio. Electronic address: karen.c.baker.mil@mail.mil.
authors.forename: Karen
authors.initials: K
authors.lastname: Baker
authors.affiliation: Department of Quantitative Health Science, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Jianbo
authors.initials: J
authors.lastname: Li
authors.affiliation: Center for Male Fertility, Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Edmund
authors.initials: E
authors.lastname: Sabanegh
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D000368:Aged; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data; D015276:Health Care Rationing / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D007248:Infertility, Male / Q000453:epidemiology* / Q000473:pathology*; D038622:Internationality; D008297:Male; D008875:Middle Aged; D009820:Ohio / Q000453:epidemiology; D018579:Patient Selection; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D015995:Prevalence; D012016:Reference Values; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D018456:Reproductive Medicine / Q000592:standards / Q000706:statistics & numerical data*; D055101:Semen Analysis / Q000592:standards* / Q000706:statistics & numerical data*; D012680:Sensitivity and Specificity; D014600:Utilization Review; D014944:World Health Organization; D055815:Young Adult
keywords: Semen analysis; infertility male; referral and consultation