الفهرس 
Introduction & Aim of the workOnly 14 pages are availabe for public view
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Abstract
Semen is an organic fluid, which may contain spermatozoa. It is secreted by the gonads (sexual glands) and other sexual organs of male and can fertilize female ova via process known as ejaculation. Seminal fluid contains several components besides spermatozoa: proteolytic and other enzymes (acid phosphatase and fibrinolysin) as well as fructose, amino acids, citrate, flavins, phosphorylcholine, prostaglandins, proteins, vitamin C. are elements of seminal fluid which promote the survival of spermatozoa and provide a medium through which they can move or ”swim”. Semen is produced and originates mainly from the seminal vesicle, lesser extent from prostate & bulbo-uretheral glands. Sperms are matured and produced through process known as spermatogenesis.
The World Health Organization (WHO) periodically releases manuals for the laboratory examination of human semen. The first was published in 1980, with subsequent updates in 1987, 1992, and 1999. These manuals are used as a source of standard methods for laboratories performing semen analyses worldwide. The WHO published its updated 5th edition laboratory manual in late 2010, and, for the first time, multi-country semen analysis results from recent fathers with a known time-to-pregnancy (TTP), defined as the number of months (or cycles) from stopping contraception to achieving pregnancy, were incorporated. The reference values were obtained from data involving 4500 fertile men from 14 countries.
This prospective study was conducted at out-patient clinic of Urology Department- Minia University hospital & included 706 randomly selected cases from August 2010 to October 2011. Adult men were included in this study whether single or married with exclusion of cases with known female partner fertility problems; (tubal obstruction, ovarian cyst …..etc) & cases who couldn’t give semen in the lab due to psychological or physical cause.
Each case underwent complete history taking (occupational, medical, surgical, sexual, female and family history), careful physical examination (general, genital and D/R) and laboratory investigation (semen analysis).
Semen analysis was examined macroscopically (volume, color, liquefaction and viscosity) & microscopically (count/ml, count/ejaculate, motility, morphology, aggregation, agglutination).
Out of the 706 cases 458 were single & 248 cases were married. Married cases were further subdivided into fertile men (187 cases), infertile men (61 cases) which further divided into primary infertility (24 cases) and secondary infertility (37 cases).
We found that 5th percentile of progressive motility of fertile cases (25.7%) is below WHO 5th edition parameter (32 %) while volume, sperm concentration and morphologically normal sperms are above WHO parameters.
But in infertile cases, we found that 5th percentile of morphological normal a sperm (23.9 %) is above WHO 5th edition parameter (4 %) however volume, sperm concentration and progressive motility (%) are within WHO parameters (below lower reference values).
Finally, we found that –in fertile men- sperm concentration below lower reference value of WHO 5th edition is 0.5 % while sperm concentration –in infertile men- above lower reference value of WHO is 30.1 %. To progressive motility -in fertile men- cases below lower reference value of WHO 5th edition is 4.8 % while no cases in infertile men -above lower reference value of WHO 5th edition. Morphology of fertile cases below lower reference value is 0%; however infertile cases with parameters above lower reference value of WHO 5th edition is 76%.
We conclude that WHO manual 5th edition is not accurate in distinguishing between fertile & infertile men. We calculated fertility threshold based on clinical data and not using statistical analysis (5th percentile) as used in WHO 5th edition & found that fertility threshold for sperm concentration 17.5 (106), progressive motility 30 % and morphology 23%.