The Promise of Home-based Early Screening for Male Infertility.

Over the past two decades, one of the most common reproductive problems has been infertility. Infertility is a disease of the reproductive system characterized by the inability to conceive after 12 months or more of regular unprotected sexual intercourse. According to the World Health Organization (WHO), the reproductive rate has declined drastically, with male infertility now accounting for 36% of cases, often due to abnormalities in sperm production. Currently, infertility screening is still done manually, evaluating sperm samples using a microscope, which often produces inconsistent results. However, advances in computer technology have resulted in significant research aimed at improving the analysis of male sperm infertility. This study utilized deep learning technology to identify sperm using the YOLOv5 method. This study involved several stages with data collection using 1330 photos with 2 classes, namely sperm and non-sperm in video format. The second stage involved preprocessing the dataset, which included data extraction, cropping, resizing, and labeling the data for training. The final stage involved testing the trained model to detect and classify sperm based on morphology. The experimental results show that the proposed method is effective in accurately classifying sperm images and analyzing motion videos from recorded video data with a mAP result of 73.1%.Therefore, in the context of this study, the YOLOv5 model is considered efficient in detecting and classifying objects, both sperm and non-sperm

To analyze the infection of chlamydia (CT) and gonorrhea (NG) in female infertility and male infertility population, and to explore the correlation between CT and NG infection and infertility. A case-control study was conducted to retrospectively analyze the specimens submitted by patients from the Third Xiangya Hospital of Central South University from January 2021 to December 2022. The results showed that a total of 32 184 specimens were collected, and the positive rates of CT were 4.41% (1 419/32 184), and positive rats of NG were 1.42% (457/32 184). In the infertility group (n=3 366), 2 987 were females and 379 were males. In the control group (n=3 366), 2 509 were females and 857 were males. The CT positive rate of the infertility group was 13.61% (458/3 366), which was significantly higher than that of the control group 3.30% (111/3 366), and the difference was statistically significant (χ2=4.245, P<0.05), and the NG positive rate of the infertility group was 6.36% (214/3 366), which was significantly higher than that of the control group 0.89% (30/3 366), and the difference was statistically significant (χ2=4.011, P<0.05). A total of 23 992 female genital tract swab specimens were collected, including 2 987 in the infertility group and 2 509 in the control group, and the positive rate of CT in the female infertility subgroup was 10.41% (311/2 987), which was significantly higher than that in the control group 3.75% (94/2 509), the difference was statistically significant (χ2=4.132, P<0.05), and the NG positive rate of 8.73% (261/2 987) in the female infertility subgroup was significantly higher than that in the control group 0.40% (10/2 509), and the difference was statistically significant (χ2=4.242, P<0.05). A total of 8 192 male urine samples were collected, including 379 in the infertility group and 857 in the control group, and the CT positive rate of the male infertility subgroup was 13.72% (52/379), which was significantly higher than that of the control group 3.38% (29/857), and the difference was statistically significant (χ2=5.267, P<0.05), and the positive rate of NG in the male infertility subgroup was 12.66% (48/379), which was significantly higher than that of the control group 0.93% (8/857), and the difference was statistically significant (χ2=4.166, P<0.05). Among the 2 987 female specimens in the infertility group, 1 034 were in the primary infertility subgroup and 1 953 were in the secondary infertility subgroup, and the positive rates of CT were 7.93% (82/1 034) and 15.72% (307/1 953), respectively, and the positive rates of NG were 3.87% (40/1 034) and 8.65% (169/1 953) respectively, and the difference was not statistically significant (χ2=0.185, P>0.05) and (χ2=0.002, P>0.05). In conclusion, the infection rate of genital tract CT and NG is high in the infertility population, CT and NG are recommended as routine examination indicators for eugenics and infertility screening.

Multiplex polymerase chain reaction (PCR) has been widely used to detect Y-chromosome microdeletions, which is one of the major causes of male infertility. Both the European Academy of Andrology (EAA) and the European Molecular Genetics Quality Network (EMQN) have recommended the use of sY84 and sY86 markers for the detection of azoospermia factor a (AZFa) microdeletion during DNA testing for male infertility. In this study, a large-scale analysis of AZF microdeletion in a total of 630 Chinese males, including healthy semen donors (n=200), infertile males with normal sperm count (n=226) and patients with either nonobstructive azoospermia or severe oligozoospermia (n=204), was performed. A series of nine sequence-tagged site (STS) markers from the AZF region of the Y chromosome was used to detect microdeletions. All primers were designed based on the recommendations of the National Center for Biotechnology Information. An unusually high incidence (73/630, 11.6%) of sY84-absent but sY86-present genotypes was observed in the AZFa microdeletion screening. Sequencing the sY84-flanking region revealed a total of 73 patients with sY84-absent but sY86-present genotypes have a T-to-G transversion at the fifth base from the 5' end of the reverse sY84 primer. These prevalent false positives, which were not only observed in infertile men, but also observed in donors, resulted from a single-nucleotide polymorphism (SNP) named rs72609647 in the targeting sequence of the reverse sY84 primer. Our study suggests that a pre-screening of existence of rs72609647 polymorphism can prevent the frequent false positive results of AZFa microdeletions detection in the infertile Chinese males. Given the SNP rs72609647 was recently found in a deep sequencing of a Chinese individual, the current EAA and EMQN standards may need to be scrutinized among different populations to avoid the potential genetic variations in the primer binding sequences.

Portable semen analyzer for automated, rapid measurement of sperm motility and concentration

Introduction Infertility is a major health problem, worldwide, which affects 10-15% of couples. About half percent of infertility cases are related to male-related factors. Male infertility is a complex disease that is the result of various insults as lifestyle issues, genetics, and epigenetic factors. Idiopathic infertility is responsible for 30% of total cases. The genetic factors responsible for male infertility include chromosomal abnormalities, deletions of chromosome Y, and mutations and genetic variations of key genes. Areas covered In this review article, we aimed to narrate performed studies on polymorphisms of essential genes involved in male infertility including folate metabolizing genes, oxidative stress-related genes, inflammation, and cellular pathways related to spermatogenesis. Moreover, possible pathophysiologic mechanisms responsible for genetic polymorphisms are discussed. Expert opinion Analysis and assessment of these genetic variations could help in screening, diagnosis, and treatment of idiopathic male infertility.

BackgroundApproximately half of preterm births are attributable to maternal infections, which are commonly undetected and untreated in low-income settings. Our primary aim is to determine the impact of early pregnancy screening and treatment of maternal genitourinary tract infections on the incidence of preterm live birth in Sylhet, Bangladesh. We will also assess the effect on other adverse pregnancy outcomes, including preterm birth (stillbirth and live birth), late miscarriage, maternal morbidity, and early onset neonatal sepsis.Methods/DesignWe are conducting a cluster randomized controlled trial that will enroll 10,000 pregnant women in Sylhet district in rural northeastern Bangladesh. Twenty-four clusters, each with ~4000 population (120 pregnant women/year) and served by a community health worker (CHW), are randomized to: 1) the control arm, which provides routine antenatal and postnatal home-based care, or 2) the intervention arm, which includes routine antenatal and postnatal home-based care plus screening and treatment of pregnant women between 13 and 19 weeks of gestation for abnormal vaginal flora (AVF) and urinary tract infection (UTI). CHWs conduct monthly pregnancy surveillance, make 2 antenatal and 4 postnatal home visits for all enrolled pregnant women and newborns, and refer mothers or newborns with symptoms of serious illness to the government sub-district hospital. In the intervention clusters, CHWs perform home-based screening of AVF and UTI. Self-collected vaginal swabs are plated on slides, which are Gram stained and Nugent scored. Women with AVF (Nugent score ≥4) are treated with oral clindamycin, rescreened and retreated, if needed, after 3 weeks. Urine culture is performed and UTI treated with nitrofurantoin. Repeat urine culture is performed after 1 week for test of cure. Gestational age is determined by maternal report of last menstrual period at study enrollment using prospectively completed study calendars, and in a subset by early (<20 week) ultrasound. CHWs prospectively collect data on all pregnancy outcomes, maternal and neonatal morbidity and mortality.Implications/DiscussionFindings will enhance our understanding of the burden of AVF and UTI in rural Bangladesh, the impact of a maternal screening-treatment program for genitourinary tract infections on perinatal health, and help formulate public health recommendations for infection screening in pregnancy in low-resource settings.Trial registrationThe study was registered on ClinicalTrials.gov:NCT01572532 on December 15, 2011. The study was funded by NICHD: R01HD066156.

Where are we going with gene screening for male infertility?

For many years, genetic screening for male infertility was limited to a few analyses: karyotyping, screening for Y microdeletions, and tests for the most frequent cystic fibrosis transmembrane conductance regulator (CFTR) gene variants. The development of new technologies, such as chromosome microarray or new genome sequencing, has broadened access to whole-genome analyses. Over the last decade, many genetic defects have been described, and new strategies seem to emerge. Hence, by focusing on peripheral (rather than central) failures of spermatogenesis, the objectives of the present study were to review the latest data on clinical practice (rather than the physiopathology of these genetic abnormalities) and suggest new guidelines for the genetic screening of male infertility.

Infertility is a serious public health issue affecting around 15% of couples globally. Of the 60-80 million people of reproductive age affected by infertility, 40-50% are due to male factor while 30-40% of cases are still idiopathic. The recent global deterioration in sperm quality raises apprehensions regarding the toxic effects of environmental pollutants on reproductive health of males. Environmental toxicants have shown strong evidences for inducing oxidative stress affecting spermatogenesis severely, thereby leading to reduced sperm motility, count, and DNA damage. Reactive oxygen species (ROS) influences the spermatozoa development and transit process both internally and externally. Low level of ROS is indispensable for critical physiological sperm processes like sperm capacitation, motility, acrosome reaction, hyper-activation, sperm-oocyte interaction, etc., while excessive ROS disrupt antioxidant molecules which is detrimental to normal functioning of the sperm. Hence, identification of potential environmental toxicant may have clinical relevance for early screening and diagnosis of male infertility.

Current approaches to diagnosing male infertility inadequately assess the complexity of the male gamete. Beyond the paternal haploid genome, spermatozoa also deliver coding and non-coding RNAs to the oocyte. While sperm-borne RNAs have demonstrated potential involvement in embryo development, the underlying mechanisms remain unclear. In this study, 47 sperm samples from normozoospermic males undergoing fertility treatment using donor oocytes were sequenced and analyzed to evaluate associations between sperm RNA elements (exon-sized sequences) and blastocyst progression. A total of 366 RNA elements (REs) were significantly associated with blastocyst rate (padj < 0.05), some of which were linked to genes related to critical developmental processes, including mitotic spindle formation and both ectoderm and mesoderm specification. Of note, 27 RE-associated RNAs are predicted targets of our previously reported list of developmentally significant miRNAs. Inverse RE-miRNA expression patterns were consistent with miRNA-mediated down-regulation. This study provides a comprehensive set of REs which differ by the patient’s ability to produce blastocysts. This knowledge can be leveraged to improve clinical screening of male infertility and ultimately reduce time to pregnancy.

Current and future genetic screening for male infertility

Genetic causes of male infertility are abnormalities in chromosome numbers and/or structures, Y-chromosome deletions and gene mutations. Genetic screening of male infertility is rarely done in our country. The purpose of the study was to investigate the frequencies and types of Y chromosome microdeletions in infertile men, based on studies done in the Human Genetics Laboratory of the Pasteur Institute in Morocco. A total of 543 infertile men were screened for Y chromosome microdeletions. The prevalence of AZF Y-chromosome microdeletions among infertile men range from 3% to 10% depending on patients selected. The most frequent microdeletions were detected in the AZFc region, followed by AZFbc, AZFb, AZFa, AZFab. These results indicate the need for Y chromosome microdeletion screening for better management of infertile patients.We hope to encourage use of genetic diagnosis and also research in this field to initiate collaboration for clinical management and appropriate genetic diagnosis and counselling for male infertility.

An increasing number of studies show declining sperm counts; however, semen analyses are uncommon until the evaluation for infertility. Semen analysis is a safe, reliable and relatively inexpensive screening test, assessing male fertility and directing further work-up. In young men, the use of semen analysis may identify disease prior to attempted conception and result in improved fertility potential when combined with lifestyle changes, medical or surgical therapy. Furthermore, if sperm counts are significantly low, evaluation and management for genetic causes can be initiated. Our commentary outlines why screening for male infertility in young adult men may be beneficial. We discuss options for early intervention, including sperm cryopreservation, if defects in sperm parameters are identified.

BackgroundInfertility is a significant public health issue in global women’s health. As the trend of delayed childbearing among women increases, the associated risks have garnered growing attention. Previous studies have indicated a potential association between reproductive factors and infertility, although the precise nature of this relationship remains unclear. Therefore, investigating the relationship between reproductive factors and infertility is of considerable academic and practical significance.MethodsThis study is based on data from the US National Health and Nutrition Examination Survey (NHANES) collected between 2017 and 2020, and includes 1,891 women. Multiple regression analyses and restricted cubic spline (RCS) curves were employed to evaluate the relationships of age at first birth (AFB), age at last birth (ALB), and number of live births (NLB) with infertility. Potential confounders such as age and race were controlled for in the analysis.ResultsThe results indicated that increases in AFB and ALB were significantly associated with a heightened risk of infertility, whereas an increase in NLB was significantly linked to a reduced risk. Specifically, a J-shaped relationship was observed between AFB and infertility, a U-shaped association between ALB and infertility, and a linear negative correlation between NLB and infertility. Subgroup analysis revealed that living alone was significantly associated with infertility risk, with certain subgroups exhibiting a lower risk.ConclusionThis study elucidates the critical relationship between reproductive factors and the risk of infertility. Delays in AFB and ALB were found to significantly increase the risk of infertility, whereas an increase in NLB markedly reduced the risk. These findings provide a basis for the early screening and intervention of infertility, and offer scientific support for the evaluation of women’s reproductive health and policy-making. Future research should further explore the underlying mechanisms of these factors across different populations and conduct in-depth analyses using longitudinal data.

This study was to survey the relationship between semen values and demographics, comorbidities, and recreational substance use in a large cohort of adult men at the University of Chicago Medical Center Department of Urology (Chicago, IL, USA). We performed an analysis from January 2013 to December 2023 of semen samples obtained from adult patients at our institution and collected their demographics, comorbid medical conditions, and recreational substance use information. Patients were divided into categories of normozoospermia, oligozoospermia, and azoospermia on the basis of the 5th version of the World Health Organization (WHO) guidelines. Data were analyzed by univariate linear and logistic regression models, after which statistically significant variables were placed into multivariable models. Azoospermia and oligozoospermia were both associated with Caucasian or Black, Indigenous, and People of Color (BIPOC) race (both P < 0.001), increasing age (P = 0.005 and P < 0.001, respectively), anemia (P < 0.001 and P = 0.02, respectively), lifetime tobacco use (both P < 0.001), lifetime alcohol use (P = 0.02 and P < 0.001, respectively), and lifetime use of at least two recreational substances (P < 0.001 and P = 0.003, respectively) in multivariable models. Oligospermia was additionally associated with benign prostatic hyperplasia (BPH; P = 0.003) in multivariable models. This study suggests that at-risk populations may benefit from additional early screening and workup for infertility.