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In Reply As noted in our article, the lack of information on the details of the male factor evaluation, including results of semen analyses, is a limitation of the study. Even though it is possible that some male factor infertility diagnoses were misclassified due to inaccurate reporting or temporal changes in the criteria for defining an abnormal semen analysis, we note that the discrepancy rate (the proportion of assisted reproductive technology cycles with incorrectly reported diagnosis) for male factor infertility in the CDC’s National Assisted Reproductive Technology Surveillance System (NASS) has remained consistently low (around 4%) with most of the difference due to underreporting.1
Boulet SL, Mehta A, Kissin DM. Intracytoplasmic Sperm Injection and Reproductive Outcomes—Reply. JAMA. 2015;313(16):1672-1673. doi:10.1001/jama.2015.3118