Does methylphenidate use affect sperm parameters in patients undergoing infertility investigation? A retrospective analysis of 9769 semen samples.

Total Normal Motile Sperm Count Plays no Role in Clinical pregnancy Rate After Intrauterine Insemination

Introduction: A varicocele is a vascular lesion characterised by dilatation and tortuosity of the veins of the pampiniform plexus and is found in approximately one-fifth of the adult male population. It is the most common cause of treatable infertility. Physical examination may or may not show a varicocele which is mostly diagnosed only when patients present with infertility or adolescents during a physical examination, like testicular hypotrophy, impairment in spermatogenesis mainly in the form of low or absent count, decreased sperm motility, and abnormal sperm morphology. Treatment for varicocele includes medical therapies, radiological embolization, and surgical techniques. Medical therapy, including antioxidants and anti-inflammatory agents, has been utilized with variable success. Radiological embolization of varicocele is a new technique in the treatment of varicocele, but it is associated with high recurrences and high cost. Varicoceles are surgically treated either by open or laparoscopic approaches the principal aim being occlusion of the dilated veins of the pampiniform plexus. A definitive conclusion of indication of medical treatment cannot be drawn at present because most published studies have inadequate design and lack controls. Various studies in the past have concluded significant changes in sperm parameters (total count, motility, morphology) post-varicocele repair. However, few other studies suggest no improvement in sperm parameters following surgical varicocele repair and studies that conclude recommendations against repair of varicocele. Thus, conflicting opinions have opened the scope to establish this fact by this study. Aim: To evaluate changes in sperm morphology, sperm count, and sperm motility in a patient with varicocele after varicocele surgery. Materials and methods: The study was conducted in the Department of Surgery, North Delhi Municipal Corporation Medical College & Hindu Rao Hospital, Delhi, India from August 2019 to February 2021. The sample size was calculated to be 50 using Slovin’s formula with a confidence level of 95% with a margin error taken as 5% (p - value 0.05). Sperm morphology, sperm count, and sperm motility were the parameters studied before and after 3 months of surgery. Results: The majority of patients belonged to the age group of 18 to 25 years (42%) followed by 26 to 35 years (40%) (27.78 ± 6.547 years). Left-sided varicocele was more common (54%), followed by bilateral varicocele (42%). Varicocele grade II was most common (58%) followed by grade I (30%) and lastly grade III (12%). Total sperm count improved by 8.88 million per ml after varicocelectomy. Total sperm motility improved by 6.08% after the surgery. Total normal sperm forms improved by 6.44% after varicocele repair. Conclusion: Based on the findings it was concluded that Varicocelectomy results in significant improvement in total sperm count, total sperm motility, and total normal sperm morphology. The best improvement was seen in sperm count followed by total normal sperm forms and lastly total sperm motility.

To determine the influence of sperm parameters inseminated on the outcome of intrauterine insemination (IUI) in patients undergoing ovarian stimulation with clomiphen citrat (CC) or human menopausal gonadotropin (HMG) therapy, a retrospective review was performed for 2 years on data from the IUI program. 190 couples underwent a total of 268 IUI cycles in which CC or HMG was used for ovulation induction. The initial sperm concentration (mil/ml), motility (percent), preprocessing total motile sperm (TMS) count (million), fast motile sperm (percent) and postprocessing sperm concentration (mil/ml), motility (percent), TMS count, fast motile sperm (percent), sperm morphology, hypoosmotic swelling (HOS) scores, semen leuocytes, and bacteria were analyzed. 268 inseminations were followed by a pregnancy rate of 12% and couple pregnancy rate of 17%. On multivariable logistic regression analysis, total motile sperm (TMS) count, percent motility, and percent of fast motile sperm were independent prognostic factors of fertility. The impact of the preprocessing and postprocessing sperm parameters on pregnancy outcome after IUI was evaluated. There was a trend toward an increasing percent of conception with increasing TMS count, motility, and percent of fast motile sperm. The TMS count, motility and percent of fast motile sperm independently predict success with IUI. Patients with original sperm motility > or = 30% had a higher cumulative pregnancy rate (74%) than patient with motility < 30% (p < 0.005). Pregnancy rate increased 4 times with motility of > or = 30%.

The aim of this experimental study was to evaluate whether infertile patients may benefit from the evaluation of bio-functional sperm parameters in addition to the conventional semen analysis. To accomplish this, we evaluated the correlation between conventional and bio-functional sperm parameters based on their percentile distribution in search of a potential threshold of these latter that associates with conventional sperm parameter abnormalities. The study was conducted on 577 unselected patients with infertility lasting at least 12 months. We identified cut-off values according to the median of the population for mitochondrial membrane potential (MMP), number of alive spermatozoa, and chromatin abnormality. High MMP (HMMP) (≥46.25%) was associated with sperm concentration, sperm count, progressive motility, and normal form. Low MMP (LMMP) (≥36.5%) was found to be associated with semen volume, sperm concentration, total sperm count, progressive motility, total motility, and normal form. The number of alive spermatozoa (≥71.7%) was associated with sperm concentration and progressive motility whereas abnormal chromatin compactness (≥21.10%) was associated with sperm concentration, total sperm count, and progressive motility. The data would suggest that, for every increase in the percentile category of sperm concentration, the risk of finding an HMMP≤46.25 is reduced by 0.4 and by 0.66 for a total sperm count. This risk is also reduced by 0.60 for every increase in the percentile category of sperm progressive motility and by 0.71 for total sperm motility. Each increment of percentile category of the following sperm parameter was followed by a decrease in the risk of finding an LMMP≤36.5: sperm concentration 1.66, total sperm count 1.28, sperm progressive motility 1.27, total sperm motility 1.76, and normal form 1.73. Lastly, the data showed that, for every increase in the percentile category of total sperm count, the risk of finding an abnormal chromatin compactness ≤21.10 is reduced by 1.25 (1.04–1.51, p < 0.05) and an increase of total sperm motility is associated with a reduced risk by 1.44 (1.12–1.85, p < 0.05). Results suggest a correlation between bio-functional and conventional sperm parameters that impact the sperm fertilizing potential. Therefore, the evaluation of bio-functional sperm parameters by flow cytometry may be useful to explain some cases of idiopathic male infertility.

The application of fertility preservation, initially intended for oncological patients prior to gonadotoxic treatment, has extended in recent years to transgender and gender-non-conforming individuals undergoing therapy for gender compatibility. To examine semen quality and survival in transgender women pursuing semen cryopreservation in the presence or absence of gender-affirming hormonal medication. In this retrospective cohort study, we reviewed data of 74 consecutive transgender women presenting for semen cryopreservation at a single center between 2000 and 2019. Semen parameters before and after cryopreservation were compared to a control group composed of 100 consecutive sperm bank donor candidates. A subgroup analysis of subjects who had used gender-affirming hormonal treatment was also performed. Compared to the control group, transgender women had lower total sperm count (144.0 vs. 54.5 million, respectively, p<0.001), lower sperm motility percentage (65.0% vs. 51.0%, respectively, p<0.001), and lower total motile sperm count (94.0 vs. 27.0 million, respectively, p<0.001). Values were further decreased in transgender women who had received hormonal treatment before sperm cryopreservation. Post-thawing motility rate remained lower in the transgender group compared to the control group (20.0% vs. 45.0%, respectively, p<0.001), and the total motile count remained lower as well (2.7 vs. 9.0 million, respectively, p<0.001). Following sperm cryopreservation, the post-thaw decreases in total motile sperm count were higher in the transgender group compared with the control group (91.5% vs. 90.0%). Further subdivision in the transgender group showed that the decrease in total motile sperm count was lower for transgender women who did not use gender-affirming hormonal treatment compared to those who did (-89.7% vs. -92.6%, respectively, p<0.01). Sperm parameters in transgender women are poor compared to candidates for sperm donation representing the general population. Specimens collected after discontinuation of gender-affirming hormone treatments were further impaired. Moreover, post-thawing sperm total motile count, motility, and overall sperm survival were reduced in transgender women.

Sperm motility in baseline spermogram is predictive of total motile sperm after preparation for insemination

The purpose of this study was to determine the impact of post-wash total progressive motile sperm count (TPMSC) and semen volume on pregnancy outcomes in intrauterine insemination (IUI) cycles. The retrospective study included a total of 156 cycles (141 couples) and was performed in our center over a 24-month period. The semen parameters were recorded for each man and each insemination. The semen samples were re-evaluated after the preparation process. Post-wash TPMSC values were divided into four groups; Group 1: <1×10(6); Group 2: 1-4.9×10(6); Group 3: 5-9.9×10(6); Group 4: 10×10(6) and >10×10(6). Post-wash inseminated semen volume was divided into three groups; Group 1: 0.3 mL; Group 2: 0.4 mL; Group 3: 0.5 mL. The effect of post-wash total progressive motile sperm and semen volume on pregnancy outcomes was evaluated. The pregnancy rates per cycle and per couple were 27.56% and 30.49%, respectively. There was not a significant relationship between the inseminated semen volume and pregnancy rate (p>0.05). However, a significant linear-by-linear association was documented between the TPMSC and pregnancy rate (p=0.042). Our findings suggest that the post-wash inseminated semen volume should be between 0.3-0.5 mL. An average post-wash total motile sperm count of 10×10(6) may be a useful threshold value for IUI success, but more studies are needed to determine a cut-off value for TPMSC.

Seminal oxidative stress has been shown to be a key factor in the development of male infertility. However, the benefits of infertility treatments with antioxidants such as coenzyme Q10 (CoQ10) remains controversial. The aim of the present study was to assess the effects of CoQ10 supplementation on semen quality, i.e., semen volume, total sperm number, sperm concentration, total sperm motility, percentage of progressive sperm motility and sperm morphology. In addition, the effects of CoQ10 supplementation on circulating testosterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH), and inhibin B levels were evaluated. A systematic review and a meta-analysis of randomized controlled trials (RCTs) were performed to assess the effects of CoQ10 supplementation on semen quality and serum levels of male reproductive hormones. We conducted a strategic literature search in the Cochrane, EMBASE, PubMed/MEDLINE, Scopus, and Web of Science databases and collected only RCTs. The data in the collected RCTs were then meta-analyzed according to PRISMA guidelines. Out of 2,144 collected studies, only eight were classified eligible. The studies included a total of 877 male subjects; 462 CoQ10-treated and 415 untreated/placebo-treated. We found significantly higher total sperm counts (SMD -13.38 [95% CI: -16.33, -10.43] P< 0.0001), total (SMD -7.26 [95% CI: -10.15, -4.36] P< 0.00001) and progressive motility (SMD -6.386 [95% CI: -10.04, -2.73] P= 0.0006), and normally formed sperm (SMD -1.96 [95% CI: -3.29, -0.62] P= 0.004) in CoQ10-treated male subjects compared with untreated/placebo-treated male subjects. Nonetheless, there was a significant inter-study heterogeneity in these studies. Moreover, significantly higher serum testosterone (SMD -0.59 [95% CI: -0.79, -0.40] P< 0.00001) and inhibin B levels (SMD -0.92 [95% CI: -1.47, -0.37] P= 0.001) were recorded in CoQ10-treated subjects compared to untreated/placebo-treated subjects. In addition, CoQ10 supplementation significantly lowered serum LH (SMD 1.77 [95% CI: 1.26, 2.28] P< 0.00001) and FSH concentrations (SMD 1.60 [95% CI: 1.38, 1.81] P< 0.00001). Interestingly, there was no significant inter-study heterogeneity in the hormonal studies. However, CoQ10 supplementation had no significant effect on semen volume (SMD 0.12 [95% CI: -0.13, 0.37] P= 0.34) and sperm concentration (SMD -6.69 [95% CI: -16.28, 2.90] P= 0.17). Our study shows that CoQ10 supplementation increases total sperm count, total and progressive sperm motility, and the proportion of normally formed sperm in association with higher serum testosterone and inhibin B levels. Our study therefore supports the view in the literature of a beneficial use of CoQ10 in male infertility treatment. However, further well-designed RCTs with sufficiently large numbers of subjects are required to reach a final conclusion.

Study question Is there an association between advancing male age and worsening seminal parameters (If so, is it possible to define an age-threshold for semen quality decline)? Summary answer Only sperm morphology and motility-related parameters exhibited a significant negative association with age, particularly from the age of 40 years. What is known already While the importance of advanced maternal age on reduced fertility and higher reproductive risks is well documented, scarce and controversial are the information regarding the role of aging on male fertility potential. Indeed, growing concerns arise from the trend in the advancing average parenthood age in Western countries. Study design, size, duration A retrospective study was conducted in 11,307 consecutive semen samples obtained from men who attended the Andrology Unit of the University Hospital of L’Aquila, during the period from January 1992 to January 2022 for evaluation of their fertility potential. Participants/materials, setting, methods Semen samples were collected by masturbation into sterile containers after a sexual abstinence of 2-7 days. Total sperm count (TSC) was calculated by multiplying sperm concentration and the volume of the ejaculate, motile sperm concentration (MSC) was calculated by multiplying sperm concentration and progressive motility (%), and the total motile sperm count (TMSC) was calculated by multiplying MSC and volume. Leukocytospermia was defined as &amp;gt; 1x106 peroxidase-positive cells/mL. Main results and the role of chance Three hundred and forty-nine patients with azoospermia or severe oligozoospermia (&amp;lt;5x106 spz/ml) were excluded. Moreover, 8,450 were excluded because they were only subjected to semen analysis without concomitant clinical evaluation. Therefore, 2,508 subjects have been included in the final analysis. Significant inverse correlations were observed between male age and semen volume (p=0.04), total (p&amp;lt;0.0001) and progressive sperm motility (p&amp;lt;0.0001), TMSC (p=0.01), total progressive motile count (p=0.008), and percentage of spermatozoa with normal morphology (p=0.001), but not with sperm concentration (p=0.8) and TSC (p=0.2). After adjustment for abstinence time, smoking, history of genital tract infections, genital trauma, varicocele, cryptorchidism, orchiectomy, and the year the semen analysis, a significant negative association was found for total (p&amp;lt;0.0001) and progressive motility (p=0.0003), TSC (p=0.001), total progressive motile count (p=0.001), and normal morphology (p=0.035). The comparison of seminal parameters among age quartiles revealed that the age group above 40 years was associated with a significant reduction in total and progressive motility, total motile, and total progressive motile count, while the decline in the percentage of normal forms appeared to be earlier. Limitations, reasons for caution The present study did not analyze couple reproductive outcomes. Moreover, since sperm DNA fragmentation was available only for a limited number of subjects, it was not possible to assess its possible association with male aging. Wider implications of the findings In the light of the possible role of oxidative stress in affecting semen parameters in men aged over 40, the optimization of paternal lifestyle combined with targeted antioxidants treatments could be valuable preventive tools in the couple infertility work-up. Trial registration number not applicable

Are Sperm Strict Morphology and Motility Only for the Selection of Assisted Reproductive Technologies or for the Prediction of Sperm Functional Capacity?

The role of hormones on semen parameters in patients with idiopathic or varicocele-related oligoasthenoteratozoospermia (OAT) syndrome

Association between ambient temperature and semen quality: A longitudinal study of 10 802 men in China

As wildfires become more prevalent, their impact on fertility warrants evaluation. We aimed to examine the impact of smoke exposure on semen analysis parameters of intrauterine insemination patients in the greater Seattle, WA area. We hypothesized that wildfire smoke exposure was associated with a decline in total motile sperm count. Retrospective cohort study. Patients undergoing fertility treatments at the University of Washington in 2018-2022. Subjects were exposed to seasonal wildfire events in the fall of 2018, 2020, and 2022. Pre-exposure semen was a diagnostic fresh sample prior to each respective wildfire event while post-exposure semen was taken at time of intrauterine insemination (IUI) during the wildfire smoke exposure windows. All subjects acted as their own controls in a paired pre-post analysis. Primary outcome measure was total motile sperm count; secondary outcomes measures are semen volume, sperm concentration, total sperm count, total progressively motile sperm count, percent motile sperm, percent progressively motile sperm. We identified 84 subjects who underwent IUI across the 2018 (n = 27), 2020 (n = 30), and 2022 (n = 27) wildfire smoke events. Median time between initial semen analysis and semen analysis for IUI was 4 months. We observed a decline in sperm concentration, total sperm count, total motile sperm count, and total progressively motile sperm count. We also observed an increase in percent progressively motile sperm. These trends did not differ across event year. Our results are consistent with a prior small study demonstrating that wildfire smoke exposure is associated with declines in sperm quality. These findings highlight the need for further research on the effects of wildfire smoke exposure on human sperm and fertility treatments, especially as smoke exposures are expected to increase with climate change.

Wildfire smoke exposure is associated with decreased sperm concentration and total motile sperm count.

Peripubertal blood lead levels and semen quality in a prospective cohort study of Russian men