Advanced Reproductive Care Center of Irving has helped thousands of patients realizing their dream of becoming parents while earning a reputation for excellent and thoughtful medical care.
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Saturday, November 26th, 2011
By Julian Escobar, M.D.
In 2010 the World Health Organization (WHO) updated its reference values for the Semen Analysis.[1] This update was long overdue as the last version was published in 1999.
There is a significant difference on how the old and new reference ranges were derived. In the past, semen data from random populations of men were analyzed and the results were plotted on a statistical distribution curve. The 5th percentile was considered to be the lower limit of normal (or reference), in another word, 95% of men tested would have sperm parameters higher than the reference ranges.
In WHO 2010, the new normal values are based on data from men with proven fertility, men who were known to help their partners conceive in the previous 12 months. Following a large analysis of semen parameters from over 4000 men in 14 countries, a new set of 5th percentile parameters was recommended. Below are the comparisons of the old and new reference values:
| WHO 1999 | WHO 2010 | |
| Volume | 2 ml | 1.5 ml |
| Concentration | 20 million/ml | 15 million/ml |
| Progressive motility | 50% | 32% |
| Normal forms | 14% | 4% |
Based on our experience, concentration and progressive motility are the most important sperm parameters in predicting the likelihood of pregnancy via coitus or intrauterine insemination. For example, when sperm concentration is < 10 million/ml and/or progressive motility < 20%, the chance of pregnancy using the conventional methods is very low. In vitro fertilization would provide the best chance of pregnancy.
As can be seen above, there is a large difference between the WHO morphology references for 2010 and 1999, reflecting the subjective nature of this parameter. Thus we usually do not use morphology when recommending initial treatment. In our experience, as long as sperm concentration and motility are within normal ranges, poor morphology scores do not necessarily preclude pregnancy. Over the years we have seen many men with isolated low morphology scores (0-3%) who became biological fathers without the need for IVF or ICSI.
The new WHO criteria are unique because for the first time, a semen sample under evaluation can be compared to those of fertile men. We have found the new standards to be quite helpful in assessing the male fertility potential. If you have any questions about the new parameters, do feel free to contact us.
[1] Cooper, TG et al. WHO reference values for human semen characteristics. Hum. Reprod. Update. 2010. 16(5):559
Thursday, September 15th, 2011
By Julian C. Escobar, M.D.
LH (Luteinizing Hormone) is the pituitary hormone that induces ovulation in the midcycle. This hormone is released from the brain into the circulation causing release of the egg 34-36 hours later. The hormone can also be identified in the urine and ovulation usually follows 12-24 hours later, with most patients ovulating by 48 hours after LH is first detected in the urine. Consequently, the most fertile days are the day of the surge and the next 2 days. For those patients undergoing intrauterine insemination (IUI), the optimal day for the procedure is the day after the surge is first detected.
Ovulation kits do not necessarily increase the chance of pregnancy in couples having regular intercourse, but they can be helpful in ovulatory women who have infrequent intercourse or who are having an IUI.
The LH surge starts in the morning for most women, and thus LH is detectable in the urine in the late afternoon. False positives and false negatives are commonly seen. False LH positives can be seen when high constant levels of LH occurs in the circulation (as seen in patients with polycystic ovaries) or a few days after taking ovulation induction drugs (Clomid, Femara). False negatives can occur with high fluid intake (dilution effect) or when the LH surge is too transient and occurs between testing times (twice-a-day testing can help minimize this, but is unnecessary for most patients).
Menses usually occur 14 days after the LH surge, therefore, LH testing should be started approximately 17 days before a menstrual period is expected, and can be stopped once a positive surge is detected.
Most LH kits today are very accurate, but the highest accuracy is found in those that are easy to use and interpret, and those with a high level of LH sensitivity. For a conclusive positive or negative result, digital kits appear to be the easiest to interpret.
According to a study from Johns Hopkins University published in Fertility and Sterility in May of this year, the highest performing products are: ClearPlan Easy Ovulation Test Pack, First Response, and Clear Blue Easy (they also have the One Month Ovulation Test).
References: Brezina et al. F&S May 2011; Speroff et al. Clinical Gynecologic Endocrinology and Infertility, 8th Ed.
