title: Total motile sperm count: a better indicator for the severity of male factor infertility than the WHO sperm classification system.
abstract: OBJECTIVE
  Does the prewash total motile sperm count (TMSC) have a better predictive value for spontaneous ongoing pregnancy (SOP) than the World Health Organization (WHO) classification system?
  
  
  CONCLUSIONS
  The prewash TMSC shows a better correlation with the spontaneous ongoing pregnancy rate (SOPR) than the WHO 2010 classification system.
  
  
  BACKGROUND
  According to the WHO classification system, an abnormal semen analysis can be diagnosed as oligozoospermia, astenozoospermia, teratozoospermia or combinations of these and azoospermia. This classification is based on the fifth percentile cut-off values of a cohort of 1953 men with proven fertility. Although this classification suggests accuracy, the relevance for the prognosis of an infertile couple and the choice of treatment is questionable. The TMSC is obtained by multiplying the sample volume by the density and the percentage of A and B motility spermatozoa.
  
  
  METHODS
  We analyzed data from a longitudinal cohort study among unselected infertile couples who were referred to three Dutch hospitals between January 2002 and December 2006. Of the total cohort of 2476 infertile couples, only the couples with either male infertility as a single diagnosis or unexplained infertility were included (n = 1177) with a follow-up period of 3 years.
  
  
  METHODS
  In all couples a semen analysis was performed. Based on the best semen analysis if more tests were performed, couples were grouped according to the WHO classification system and the TMSC range, as described in the Dutch national guidelines for male infertility. The primary outcome measure was the SOPR, which occurred before, during or after treatments, including expectant management, intrauterine insemination, in vitro fertilization or intracytoplasmic sperm injection. After adjustment for the confounding factors (female and male age, duration and type of infertility and result of the postcoital test) the odd ratios (ORs) for risk of SOP for each WHO and TMSC group were calculated. The couples with unexplained infertility were used as reference.
  
  
  RESULTS
  A total of 514 couples did and 663 couples did not achieve a SOP. All WHO groups have a lower SOPR compared with the unexplained group (ORs varying from 0.136 to 0.397). Comparing the couples within the abnormal WHO groups, there are no significant differences in SOPR, except when oligoasthenoteratozoospermia is compared with asthenozoospermia [OR 0.501 (95% CI 0.311-0.809)] and teratozoospermia [OR 0.499 (95% CI: 0.252-0.988)], and oligoasthenozoospermia is compared with asthenozoospermia [OR 0.572 (95% CI: 0.373-0.877)]. All TMSC groups have a significantly lower SOPR compared with the unexplained group (ORs varying from 0.171 to 0.461). Couples with a TMSC of <1 × 10(6) and 1-5 × 10(6) have significantly lower SOPR compared with couples with a TMSC of 5-10 × 10(6) [respectively, OR 0.371 (95% CI: 0.215-0.64) and OR 0.505 (95% CI: 0.307-0.832)].
  
  
  CONCLUSIONS
  To include all SOPs during the follow-up period of 3 years, couples were not censured at the start of treatment.
  
  
  CONCLUSIONS
  Roughly, three prognostic groups can be discerned: couples with a TMSC <5, couples with a TMSC between 5 and 20 and couples with a TMSC of more than 20 × 10(6) spermatozoa. We suggest using TMSC as the method of choice to express severity of male infertility.
  
  
  BACKGROUND
  None.
authors: Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands jozefienhamilton@gmail.com.
authors: J A M
authors: JA
authors: Hamilton
authors: Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands.
authors: M
authors: M
authors: Cissen
authors: Radboud University Medical Center, Nijmegen, The Netherlands.
authors: M
authors: M
authors: Brandes
authors: St. Elisabeth Hospital, Tilburg, The Netherlands.
authors: J M J
authors: JM
authors: Smeenk
authors: Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands.
authors: J P
authors: JP
authors: de Bruin
authors: Radboud University Medical Center, Nijmegen, The Netherlands.
authors: J A M
authors: JA
authors: Kremer
authors: Radboud University Medical Center, Nijmegen, The Netherlands.
authors: W L D M
authors: WL
authors: Nelen
authors: Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands.
authors: C J C M
authors: CJ
authors: Hamilton
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007248:Infertility, Male / Q000145:classification* / Q000175:diagnosis*; D008137:Longitudinal Studies; D008297:Male; D011379:Prognosis; D015203:Reproducibility of Results; D055101:Semen Analysis; D012720:Severity of Illness Index; D013076:Sperm Count; D013081:Sperm Motility; D013094:Spermatozoa; D014944:World Health Organization
keywords: World health organization criteria; male subfertility; semen analysis; spontaneous ongoing pregnancy rate; total motile sperm count