A couple is investigated for infertility. The male partner's semen analysis shows: volume 2.5 mL, pH 7.5, concentration 8 × 10^6/mL, total motility 42%, progressive motility 25%, normal morphology 2% (strict Kruger criteria), WBC 0.4 × 10^6/mL. Which WHO 2021 criteria define this sample as abnormal, and what is the MOST important parameter for outcome?

• A Oligozoospermia (< 16 million/mL) is the key abnormality; concentration is the most predictive parameter
• B Teratozoospermia (normal morphology < 4%) is the defining abnormality; morphology best predicts fertilization
• C This is a normal semen analysis by WHO 2021 lower reference limits
• D Asthenozoospermia (progressive motility < 32%) is the defining abnormality; motility is the best predictor of IUI success ✓

Explanation

WHO 2021 lower reference limits (5th percentile, 95% CI): concentration ≥ 16 million/mL; total motility ≥ 42%; progressive motility ≥ 30%; normal morphology ≥ 4%; total sperm number ≥ 39 million. This sample has progressive motility of 25% (< 30%) = asthenozoospermia, and morphology 2% (< 4%) = teratozoospermia. Concentration is 8 million/mL which is < 16 million/mL = oligozoospermia. So it is oligo-astheno-teratozoospermia (OAT). Progressive motility is the most clinically relevant parameter for predicting IUI success and natural conception. For IVF versus ICSI decisions, total motile sperm count (TMSC) and morphology guide the choice.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.