Semen reference values, sperm in the OR scrutinized

Key Points

Cutting-edge research in the field is changing the way urologists who specialize in male infertility ply their craft. A case in point is the area of sperm morphology, in which recently released and much-talked-about World Health Organization data described lower reference limits for morphologically normal sperm.

"Now, with the adoption of more strict morphology, the numbers of normal-looking sperm that classify a man as 'normal' are much lower," said Craig S. Niederberger, MD, professor and head of urology at the University of Illinois at Chicago. "In a certain sense, that's a practical nod to the fact that we no longer have technicians who are trained only in the old WHO morphology anymore."

"The clinical result of that," Dr. Niederberger said, "is that we have patients coming into our offices saying, 'My wife's IUI isn't working because my sperm looked funny.' And our response is that the majority of sperm in all men is funny looking."

Technicians must examine sperm closely

A separate report, expected to be released soon, will show that in up to 7% of men undergoing testicular sperm extraction, sperm was found in testicular tissue sent to a laboratory that was not found in the operating room.

The effect of that finding, Dr. Niederberger suggested, is that technicians should put in extra time and effort looking for sperm in such samples.

"Just a quick look won't do it all the time," he said. "Sometimes you really need to go looking for it.

"When we first start training technicians to get sperm out of testicular tissue, in many cases they'll call a half-hour later to say they found nothing, whereas the more mature technician will spend hours looking for sperm."