Presentation Authors: Gal Wald*, Russell Hayden, Miriam Feliciano, Marc Goldstein, New York, NY
Introduction: The semen analysis (SA) is the principle lab test for the evaluation of the infertile male. However, barring situations of absolute azoospermia or complete asthenospermia, the predictive value of the SA is low. In similar fashion, the specific case of morphology has also been challenged, as reflected in the recent AUA-ASRM guidelines in which isolated teratospermia no longer serves as an indication for varicocele repair. From the reproductive urologist's perspective, we sought to assess if the additional costs required for Kruger strict morphology (WHO5) (normal â‰¥ 4%) added value beyond the criteria of the WHO 4th edition (WHO4) (normal â‰¥ 14%).
Methods: A retrospective chart review was conducted to collect all semen analysis results between Jan 2010 and Apr 2018. All samples were examined by a single andrologist at our center. Men with azoospermia and/or incomplete data were excluded from the analysis. To assess the correlation between Kruger (WHO5) and WHO4 morphology results, we calculated the Kendall rank correlation coefficient using R (v 3.4).
Results: A total of 3,804 SAs were identified within the study period. A total of 596 SAs included both Kruger (WHO5) and WHO4 morphologies from a cohort of 519 subjects. The mean age was 39.6 years (std 7.5). Mean seminal volume, sperm concentration, and motility were 2.6 mL (1.4), 54.0 M/mL (36.5), and 54.7% (17.3%), respectively. The Kendall rank correlation coefficient of Kruger (WHO5) and WHO4 was 0.84 (p < 0.001). 332 SAs (56%) had abnormal Kruger (WHO5) morphology, of which 331/332 (99%) were also abnormal by WHO4. Overall, by the WHO4 morphologic criteria, 549 SAs were read as abnormal (92%).
Conclusions: Based on a series conducted by a single andrologist, Kruger (WHO5) and WHO4 morphologic criteria correlate closely. Only one out of 332 men with abnormal Kruger (WHO5) morphology had a normal WHO4 morphology. Given the limited predictive value of sperm morphology, the additional cost and effort of Kruger (WHO5) criteria are not warranted in lieu of, or in addition to, the WHO4 classification.