The 1999 and 2010 WHO reference values for human semen analysis to predict sperm DNA damage: A comparative study

Standard semen parameters are often used to predict male fertility, but whether the 2010 World Health Organization (WHO 2010) thresholds are better predictors than the 1999 thresholds has not been investigated. In this study, we addressed this issue using sperm DNA fragmentation (SDF) as a marker of male fertility in 134 subfertile male individuals. To compare the predictive value of the 1999 thresholds with the 2010 cutoffs, the Youden indices (YIs) of all possible thresholds were calculated using receiver operating characteristic (ROC) curves and compared to each other and to the respective YIs of optimal thresholds. We found that the area under the ROC curves of progressive motility and vitality was the highest among standard semen parameters, and that the YI of both parameters from the 2010 manual was comparable to the respective optimal YIs. In contrast, the threshold of sperm concentration and total sperm number from both WHO recommendations demonstrated low YIs, with substantial differences to the respective optimal YIs. The YIs of normal morphology cutoffs from both WHO manuals were slightly different from each other and from the respective optimal YIs. In conclusion, the 2010 thresholds for progressive motility and vitality are superior to the 1999 thresholds in predicting SDF, whereas the cutoff value of sperm concentration, total sperm number and normal morphology may need further revisions to increase their accuracy.