Poor reproducibility of percentage of normally shaped sperm using the World Health Organization Fifth Edition strict grading criteria

Karen C Baker¹, Anne Z Steiner², Karl R Hansen³, Kurt T Barnhart⁴, Marcelle I Cedars⁵, Richard S Legro⁶, Michael P Diamond⁷, Stephen A Krawetz⁸, Rebecca Usadi⁹, Valerie L Baker¹⁰, R Matthew Coward¹¹, Fangbai Sun¹², Robert Wild¹³, Puneet Masson¹⁴, James F Smith¹⁵, Nanette Santoro¹⁶, Heping Zhang¹⁷

Affiliations

¹ Division of Urology, Duke University, Durham, North Carolina.
² Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina.
³ Department of Obstetrics and Gynecology, Health Sciences Center, University of Oklahoma, Oklahoma City, Oklahoma.
⁴ Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania.
⁵ Department of Obstetrics and Gynecology, University of California-San Francisco, San Francisco, California.
⁶ Department of Obstetrics and Gynecology, Pennsylvania State University, Hershey, Pennsylvania.
⁷ Department of Obstetrics and Gynecology, Medical College of Georgia, Augusta University, Augusta, Georgia.
⁸ Department of Obstetrics and Gynecology & Center for Molecular Medicine and Genetics, Wayne State University, Detroit, Michigan.
⁹ Department of Reproductive Endocrinology and Infertility, Atrium Health, Charlotte, North Carolina.
¹⁰ Department of Gynecology and Obstetrics, Johns Hopkins University, Lutherville, Maryland.
¹¹ Department of Urology, University of North Carolina, Chapel Hill, North Carolina.
¹² Department of Biostatistics, Yale School of Public Health, New Haven Connecticut.
¹³ Department of Obstetrics and Gynecology, Biostatistics and Epidemiology University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
¹⁴ Department of Urology, University of Pennsylvania, Philadelphia, Pennsylvania.
¹⁵ Department of Urology, University of California-San Francisco, San Francisco, California.
¹⁶ Department of Obstetrics and Gynecology, University of Colorado, Aurora, Colorado.
¹⁷ Collaborative Center for Statistics in Science, Yale School of Public Health, New Haven, Connecticut.

PMID: 35789726
PMCID: PMC9250115
DOI: 10.1016/j.xfre.2022.03.003

Poor reproducibility of percentage of normally shaped sperm using the World Health Organization Fifth Edition strict grading criteria

Karen C Baker et al. F S Rep. 2022.

. 2022 Mar 17;3(2):110-115.

doi: 10.1016/j.xfre.2022.03.003. eCollection 2022 Jun.

Authors

Affiliations

¹ Division of Urology, Duke University, Durham, North Carolina.
² Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina.
³ Department of Obstetrics and Gynecology, Health Sciences Center, University of Oklahoma, Oklahoma City, Oklahoma.
⁴ Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania.
⁵ Department of Obstetrics and Gynecology, University of California-San Francisco, San Francisco, California.
⁶ Department of Obstetrics and Gynecology, Pennsylvania State University, Hershey, Pennsylvania.
⁷ Department of Obstetrics and Gynecology, Medical College of Georgia, Augusta University, Augusta, Georgia.
⁸ Department of Obstetrics and Gynecology & Center for Molecular Medicine and Genetics, Wayne State University, Detroit, Michigan.
⁹ Department of Reproductive Endocrinology and Infertility, Atrium Health, Charlotte, North Carolina.
¹⁰ Department of Gynecology and Obstetrics, Johns Hopkins University, Lutherville, Maryland.
¹¹ Department of Urology, University of North Carolina, Chapel Hill, North Carolina.
¹² Department of Biostatistics, Yale School of Public Health, New Haven Connecticut.
¹³ Department of Obstetrics and Gynecology, Biostatistics and Epidemiology University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
¹⁴ Department of Urology, University of Pennsylvania, Philadelphia, Pennsylvania.
¹⁵ Department of Urology, University of California-San Francisco, San Francisco, California.
¹⁶ Department of Obstetrics and Gynecology, University of Colorado, Aurora, Colorado.
¹⁷ Collaborative Center for Statistics in Science, Yale School of Public Health, New Haven, Connecticut.

PMID: 35789726
PMCID: PMC9250115
DOI: 10.1016/j.xfre.2022.03.003

Abstract

Objective: To determine the reproducibility of the World Health Organization Fifth Edition (WHO5) strict grading methodology by comparing the percentage of morphologically normal sperm (PNS) recorded by the core laboratory with results obtained at the fertility centers participating in a multisite clinical trial.

Design: Secondary cohort analysis of data from the Males, Antioxidants, and Infertility trial.

Setting: Fertility centers.

Patients: Semen values of 171 men participating in a multicenter, double-blind, randomized, placebo-controlled trial evaluating the effect of antioxidants on male fertility.

Interventions: Not applicable.

Main outcome measures: Strict morphology expressed as PNS as determined at each fertility center and the core central laboratory for the same semen sample.

Results: No correlation was found in the PNS values for the same semen sample between the core laboratory and fertility center laboratories either as a group or by individual site. Interobserver agreement was similarly low (κ = 0.05 and 0.15) between the core and fertility laboratories as a group for strict morphology, categorized by the WHO5 lower reference limits of 4% and 0, respectively. Moderate agreement was found between the core and 2 individual fertility laboratories for the cutoff value of 0 (κ = 0.42 and 0.57). The remainder of the comparisons demonstrated poor to fair agreement.

Conclusions: Strict morphology grading using the WHO5 methodology demonstrated overall poor reproducibility among a cohort of experienced fertility laboratories. This lack of correlation and agreement in the PNS values calls into question the reproducibility, and thereby the potential applicability, of sperm strict morphology testing.

Keywords: Semen analysis; male factor infertility; quality control; spermatozoa; teratozoospermia.

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References

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Poor reproducibility of percentage of normally shaped sperm using the World Health Organization Fifth Edition strict grading criteria

Affiliations

Poor reproducibility of percentage of normally shaped sperm using the World Health Organization Fifth Edition strict grading criteria

Authors

Affiliations

Abstract

References

Grants and funding

LinkOut - more resources

Full Text Sources