WHO manual...Who should care?*

The long-awaited and much anticipated fourth edition of the World Health Organization (WHO) Laboratory Manual for the Examination of Human Semen and Sperm–Cervical Mucus Interaction has been published very recently (WHO, 1999). The primary objective(s) of the manual are to provide a framework for, and encourage the use of, standard policies and procedures for semen and sperm analysis, and to establish reference values for semen parameters. The goal is that global use of the manual and compliance with its policies and procedures will facilitate and enable the comparison and amalgamation of results between laboratories. One significant positive outcome is the seamless and (boundary-less) care of patients. The above-mentioned goals and objectives are laudable, and they are consistent with the WHO's previous aims. However, numerous studies consistently demonstrate poor standardization of techniques in semen analysis (e.g. Ombelet et al., 1997). Consequently, there is little or no possibility of being able to compare test results between laboratories. Indeed, if current conditions persist, we simply will not have the ability to interpret test results that emanate from laboratories other than our own. Thus, the primary question is: will the fourth edition of the manual realize its primary objective?