A Complement for the WHO Laboratory Manual for the Examination and Processing of Human Semen (First Edition, 2010).

The WHO “Laboratory manual for the Examination and processing of human semen” is a reference guide, firstly published in 1980, to standardize the procedures for the examination of human semen. It has been updated three times; the last version was published in 2010(1) It provided guidance about many aspect of semen examination like: semen collection, macroscopic and microscopic examinations, immunological properties, microbiological properties and biochemical properties of seminal plasma. Semen examination is the first laboratory test to study the physio-patological testicular function in adults and it may also be useful for investigating male fertility status as well as monitoring spermatogenesis during and following male fertility regulation.

The aim of this work is trying to standardize the way of describing in clinical laboratory reports the properties related to semen examination.

The systematic syntax described here is the one recommended jointly by the International Union of Pure and Applied Chemistry (IUPAC) and the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC), and endorsed by many other scientific and health care organisations, for all types of properties measured or examined in the clinical laboratory (2,3). This syntax is intended as a mean to improve the communication worldwide on semen determinations, both measurements and examinations.

The IUPAC-IFCC systematic syntax of any property requires the description of: (i) the biological system under study [e.g.: semen], (ii) the system component taken into account [e.g.: Spermatozoa], and (iii) the kind-of-property [e.g.: number (of Spermatozoa) fraction]. When necessary, a specification may be added in parenthesis to any of these elements.

Fixing the order of these three elements — system, component and kind-of-property — according to the internationally recommended syntax, the outcome is a phrase that, in short, describes a generic property as follows:

System (specification)—Component(specification); kind-of-property(specification)

The specific rules to describe the elements of a generic property and the examination result are given in the following points.

Full name with initial upper-case letter or the corresponding symbol. Two series of symbols have been recommended for biological systems; one series is for English and other Anglo-Saxon languages, and the other one is for Romance, Latin-derived, languages.

Specification in parenthesis following the name or symbol of the system without a space, when necessary. For the type of properties included in this text, usually the specification is the supersystem to which the biological systems under consideration belongs [e.g.: Cells(Sem)].

A long dash (—), rather than two hyphens (--), following the system name or symbol, or eventually its parenthetic specification, and without a space, separating system from component.

No space before the component separating it from system or its specification.

Unabbreviated systematic or trivial recommended name with initial upper-case letter. Names used for components are the official names recommended by the international scientific organisations. Abbreviations are to be avoided, also when the system is given by code.

Names of two separate entities entering into numerator and denominator respectively of a ratio between two quantities of the same system and having the same kind-of-property, both names with initial upper-case letter and separated by a slash with no space before or after.

Specification in parenthesis following the name without space. Elements of specification separated by semicolon and space.

A semicolon following component name or specification parenthesis, and without a space, separating component and its specification from kind-of-property.

A space before the kind-of-property separating it from the semicolon that follows component.

Full name with initial lower-case letter or an abbreviation. There is a list of recommended names and abbreviations in many languages.

Specification in parenthesis following the name or abbreviation without a space. Elements of specification in full, in abbreviated or coded form, separated by semicolon and space. Names of kinds-of-property may be supplemented with specifications necessary to avoid misunderstandings. The specifications are related to the measurement procedure, including previous events, time-related information, calibration, and notes on the analytical procedure.

One or more spaces before the relational operator separating it from the kind-of-property.

When the relational operator is the symbol of ‘equal to’ (=) and there are many spaces separating it from the kind-of-property, this relational operator may be omitted.

One space before the result separating it from the relational operator.

The examination result.

RULES TO DESCRIBE THE RESULT:

In Table 1 the description of properties related to human semen examination according to the WHO “Laboratory manual for the Examination and processing of human semen” (1) are shown.

Table 1

Description of the properties related to human semen examination

Properties related with collection of semen
NPU03411	Pt—Sexual abstinence; time =
NPU03410	Sem—Duration after ejaculation; time =
*	Sem—Sample delivering; time =
	Pt—Semen collection; location({home; clinical laboratory) =
Properties related with the initial macroscopic examination
NPU03409	Sem—Liquefaction; time(37 oC; WHO 2010; {≤ 60 min; > 60 min}) =
	Pt—Semen(ejaculate); wholeness(WHO 2010;{0; 1} =
NPU03992	Pt—Semen; colour (WHO 2010; {grey-opalescent; red-brown; yellow}) =
NPU03407	Pt—Semen; clarity(proc.; {transparent; opaque}) =
NPU03408	Pt—Semen; arb.viscosity(WHO 2010) =
NPU03412	Pt—Semen; vol.(WHO 2010) =
NPU02414	Pt—Seminal plasma; pH(WHO 2010) =
Properties related with the initial (phase-contrast) microscopic examination
NPU03457	Sperm—Spermatozoa(agglutinated); num.fr. (WHO 2010) =
	Sperm—Spermatozoa(head-to-head aggl.); arb.num.(proc.;{l, 2, 3, 4}) =
	Sperm—Spermatozoa(tail-to-tail aggl.); arb.num.(proc.;{l, 2, 3, 4}) =
	Sperm—Spermatozoa(tail-tip-to-tail-tip aggl.); arb.num.(proc.;{l, 2, 3, 4}) =
	Sperm—Spermatozoa(mixed aggl.); arb.num.(proc.;{l, 2, 3, 4}) =
	Sperm—Spermatozoa(tangle aggl.); arb.num.(proc.;{l, 2, 3, 4}) =
NPU03462	Sperm—Spermatozoa motility; num.fr.(list; proc.)
	Sperm—Spermatozoa(progressive motility); num.fr. (WHO 2010) =
NPU08728	Sperm—Spermatozoa(non-progressive motility); num.fr. (WHO 2010) =
NPU08729	Sperm—Spermatozoa(immotile); num.fr. (WHO 2010) =
NPU08748	Sperm—Spermatozoa(motile with IgA); num.fr.(IBT; proc.) =
NPU03460	Sperm—Spermatozoa(motile with IgA); num.fr.(MAR; proc.) =
NPU08749	Sperm—Spermatozoa(motile with IgG); num.fr.(IBT; proc.) =
NPU03461	Sperm—Spermatozoa(motile with IgG); num.fr.(MAR; proc.) =
NPU08750	Sperm—Spermatozoa(motile with IgM); num.fr.(IBT; proc.) =
NPU08725	Sperm—Spermatozoa(motile with IgM); num.fr.(MAR; proc.) =
NPU18195	Sem—Spermatozoa; motility(3 h; proc.) =
NPU18194	Sem—Spermatozoa; motility(proc.) =
NPU03997	Sem—Spermatozoa; vel.(curvilinear) =
NPU03453	Sem—Spermatozoa rotation; frequency =
Properties related with the spermatozoa vitality
NPU03459	Sperm—Spermatozoa(live); num.fr.(WHO 2010) =
Properties related with the spermatozoa concentration in semen
NPU03455	Sem—Spermatozoa; num.c. =
NPU14374	Sem—Spermatozoa; arb.c.(proc.) =
NPU18891	Sem—Spermatozoa; arb.num.(proc.) =
NPU18199	Sem—Spermatozoa; arb.num.c.(proc.) =
NPU18843	Sem—Spermatozoa; life span(after ejaculation) =
NPU03454	Sem—Spermatozoa; num.(proc.) =
Properties related with the microscopic examination of stained smears
NPU03456	Sperm—Spermatozoa; morphology(list; proc.)
NPU18887	Sperm—Spermatozoa; morphology(proc.) =
NPU08574	Sperm—Spermatozoa(normal); num.fr. =
NPU08722	Sperm—Head(amorph); num.fr. =
NPU08579	Sperm—Head(duplicate); num.fr. =
NPU08575	Sperm—Head(large oval); num.fr. =
NPU08581	Sperm—Head(pin); num.fr. =
NPU08578	Sperm—Head(pyriform); num.fr. =
NPU08580	Sperm—Head(round); num.fr. =
NPU08576	Sperm—Head(small oval); num.fr. =
NPU08577	Sperm—Head(tapering); num.fr. =
NPU08723	Sperm—Head(vacuolated); num.fr. =
NPU08583	Sperm—Midpiece(abnormal); num.fr. =
NPU08587	Sperm—Tail(coiled); num.fr. =
NPU08588	Sperm—Tail(duplicate); num.fr. =
NPU08963	Sperm—Tail(norm.); num.fr. =
NPU08724	Sperm—Tail(swollen); num.fr. =
NPU08584	Sperm—Cytoplasmic droplet; num.fr. =
	Sperm—Excess residual cytoplasm; num.fr. =
Properties related with the microscopic examination of cells other than mature spermatozoa in semen
NPU01520	Sem—Cells other than spermatozoa; num.c.(list; proc.)
	Sem—CD45+ cells; num.c.(WHO 2010)
	Sperm—CD45+ cells;num.fr.(WHO 2010)
	Cells(Sem)—Peroxidase;arb.cont.(WHO 2010)
	Sperm—CD45+ cells;num.fr.(WHO 2010)
NPU20193	Sem—Epithelial cells + immature germ cells+leukocytes; num.c.(WHO 2010) =
	Spem—Epithelial cells + immature germ cells+leukocytes); num.fr.(WHO 2010) =
NPU08718	Sem—Germ cells+leukocytes; num.c.(WHO 2010) =
	Sperm—Germ cells+leukocytes; num.fr.(WHO 2010) =
	Sem—Isolate heads; num.c. =
	Sem—Isolate tails; num.c. =
NPU03448	Sem—Spermatic cell type; num.c.(list; proc.)
NPU03443	Sem—Spermatids(sab); num.c. =
NPU03444	Sem—Spermatids(scb); num.c. =
NPU03449	Sem—Spermatocytes(primary); num.c. =
NPU03450	Sem—Spermatocytes(secondary); num.c. =
NPU03451	Sem—Spermatogonia; num.c. =
Immunological properties related with spermatozoa
NPU03447	SemP—Spermatozoal antibody; arb.c.(IBT; proc.) =
NPU08962	SemP—Spermatozoal antibody; arb.c.(MAR; proc.) =
NPU03445	CerMu—Spermatozoal antibody; arb.c.(proc.) =
NPU03446	P(B)—Spermatozoal antibody; arb.c.(proc.) =
NPU26759	P(B)—Spermatozoal antibody; arb.subst.c.(proc.) =
Biochemical properties related with seminal plasma
NPU02097	SemP—Fructose; subst.c. =
NPU02215	SemP—Glucan 1,3-α-glucosidase; cat.c.(37 °C; WHO 2010) =
NPU16940	SemP—Zinc(II); subst.c. =
NPU01067	SemP—Acid phosphatase, prostatic type; cat.c.(37 °C; WHO 2010) =
NPU01484	SemP—L-Carnitine; subst.c. =
NPU01593	SemP—Citrate; subst.c. =
NPU08720	SemP—Glycerophosphocholine; subst.c. =
Indices of multiple sperm defects
NPU08574	Sperm—Spermatozoa(normal); num.fr. = a
NPU08574	Sperm—Spermatozoa(abnormal); num.fr. = b
NPU08721	Sperm—Head(abnormal); num.fr. = c
NPU08583	Sperm—Tail(midpiece abnormal); num.fr. = d
	Sperm—Tail(principal piece abnormal); num.fr. = e
	Sperm—Excess residual cytoplasm; num.fr. = f
Multiple anomalies index (MAI) = (c + d + e)/b
Teratozoospermia index (TZI) = (c + d + e +f)/b
Sperm deformity index (SDI) = (c + d + e +fj/(a + b)
Properties related with the interaction between spermatozoa and cervical mucus
NPU08752	Sem(Pt ID)+CerMu(Pt ID)—Spermatozoal penetration; k-o-p(Kremer; proc.) =
NPU03458	Sem(Pt ID)+CerMu(Pt ID)—Spermatozoal penetration; k-o-p(post-coital; proc.) =
NPU08751	Sem(Pt ID)+CerMu(Pt ID)—Spermatozoal penetration; k-o-p(SCMC; proc.) =
Microbiological properties related with semen
NPU06124	Sem—Bacterium(ag); taxon(proc.) =
NPU06724	Sem—Bacterium(ag; spec.); arb.c.(proc.) =
NPU06174	Sem—Bacterium(DNA); taxon(proc.) =
NPU06774	Sem—Bacterium(DNA; spec.); arb.c.(proc.) =
NPU06574	Sem—Bacterium(RNA); taxon(proc.) =
NPU07174	Sem—Bacterium(RNA; spec.); arb.c.(proc.) =
NPU17947	Sem—Bacterium(spec.); suscept.(list; MBC; proc.) =
NPU17913	Sem—Bacterium(spec.); suscept.(list; MIC; proc.) =
NPU13748	Sem—Bacterium(spec.); suscept.(list; ord.sc.; proc.) =
NPU07277	Sem—Bacterium(spec.); suscept.(list; rat.sc.; proc.) =
NPU06677	Sem—Bacterium; arb.c.(proc.) =
NPU06077	Sem—Bacterium; taxon(proc.) =
NPU18710	Sem—Bacterium+fungus; taxon =
NPU06274	Sem—Fungus(ag); taxon(proc.) = ?
NPU06874	Sem—Fungus(ag; spec.); arb.c.(proc.) =
NPU06324	Sem—Fungus(DNA); taxon(proc.) =
NPU06924	Sem—Fungus(DNA; spec.); arb.c.(proc.) =
NPU06624	Sem—Fungus(RNA); taxon(proc.) =
NPU07224	Sem—Fungus(RNA; spec.); arb.c.(proc.) =
NPU06824	Sem—Fungus(spec.); arb.c.(proc.) =
NPU07324	Sem—Fungus(spec.); suscept.(list; ord.sc.; proc.) =
NPU13830	Sem—Fungus(spec.); suscept.(list; rat.sc.; proc.) =
NPU06224	Sem—Fungus; taxon.(proc.) =
NPU06424	Sem—Virus(ag); taxon.(proc.) =
NPU07024	Sem—Virus(ag; spec.); arb.c.(proc.) =

Most of the properties have already been defined by IUPAC-IFCC (4), so they have NPU code; but some others have been systematically described for first time in this article. In the table these properties are the ones without NPU code.

When the symbol * appears means that the description is an alternative description proposed in this article for the property just above described.