Are WHO Recommendations to Perform 2 Consecutive Semen Analyses for Reliable Diagnosis of Male Infertility Still Valid?

PURPOSE: We evaluated whether a second semen analysis as suggested by the WHO Laboratory Manual for the Examination of Human Semen and Sperm-Cervical Mucus Interaction would improve diagnostic reliability in the evaluation of male infertility. MATERIALS AND METHODS: We analyzed a total of 5,132 semen samples from 2,566 men who underwent at least 2 consecutive semen analyses at a university fertility center. Reproducibility and correlation between the first and second analyses were evaluated for sperm concentration, motility and morphology according to the WHO criteria as well as the total motile sperm count. RESULTS: = 0.57). The discriminating capacity of each semen parameter to distinguish between men with a normal vs a pathological second semen analysis was rather limited (ROC AUC 0.72 to 0.79). CONCLUSIONS: In accordance with WHO recommendations 2 consecutive semen analysis should be performed.