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

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

ABSTRACTThe majority of facilities in Japan that offer artificial insemination as part of assisted reproduction programs currently perform semen collection in the early morning. The total motile sperm count of the semen used in intrauterine insemination is an important factor in achieving successful fertilization and subsequent childbirth. The present study was initiated to determine whether semen parameters varied with the time of day at which the semen sample was collected. The study subjects were 20 fertile males and 20 infertile males with abnormal seminograms who attended our Reproduction Center. Semen was collected early in the morning (morning collection group) and in the evening (evening collection group) from the same subjects, and total motile sperm count was assessed as the primary outcome measure. As secondary outcome measures, semen volume, sperm concentration, sperm motility and total sperm count were assessed. A sexual abstinence period of 3 days was set for all participants. The semen samples were analyzed using CASA CEROS, a sperm motility analysis system, and the data from the morning and evening collection groups were compared using a Wilcoxon signed rank test. We found that the fertile males had a significantly higher total motile sperm count and total sperm count in the evening collection group than in the morning collection group. In contrast, the male infertility patients showed no significant difference in total sperm count between the two collection times; however, the total motile sperm count was significantly higher in the evening collection group than the morning collection group. Our analyses indicate that total motile sperm count in ejaculated semen is significantly higher after evening collection than after morning collection. From a male side perspective, we suggest that successful intrauterine insemination might be easier to achieve using semen collected in the evening than in the early morning.Abbreviations: IUI: intrauterine insemination; OAT: oligoasthenoteratozoospermia; TSC: total sperm count; TMSC: total motile sperm count

In vitro fertilization (IVF) and GIFT have been proposed as therapeutic approaches in infertile couples where a significant male factor is present. To date, few published data are available relating the success rate of GIFT to the severity of the male factor. In this report the results of the first 172 GIFT cases were analyzed. The overall pregnancy rate was 18.0%. The relationship between the occurrence of pregnancy and sperm count (millions/ml), total sperm count (millions/ejaculate), % motility, motile sperm count (millions/ml) and total motile sperm count (millions/ejaculate) were examined. Significant direct correlations were observed between the clinical pregnancy rate and sperm count, total sperm count, motile sperm count and total motile sperm count. Motile sperm count and total motile sperm count had the best correlations with clinical pregnancy rates, which were over 24.0% in groups with motile sperm counts exceeding 40 X 10(6) cells/ml or total motile sperm counts greater than 100 X 10(6)/ejaculate. The clinical pregnancy rates were 12.5% and 7.7%, respectively, for groups with motile sperm counts under 10 X 10(6)/ml and total motile sperm counts below 25 X 10(6)/ejaculate. No correlation was found between percent motile cells and pregnancy rate. Results of the sperm penetration assay using zona-free hamster eggs were available in a subpopulation of 27 patients. No significant correlation between this sperm penetration assay and pregnancy rate could be demonstrated. The incidence of chemical pregnancy showed a significant negative correlation with the total motile sperm count, indicating a higher incidence of early pregnancy wastage in cases of oligozoospermia.(ABSTRACT TRUNCATED AT 250 WORDS)

Are peripubertal blood lead levels (BLLs) associated with semen parameters and serum reproductive hormones among young Russian men? We observed a suggestion of lower ejaculate volume with higher peripubertal BLL but no associations of BLLs with reproductive hormones measured throughout adolescence or with other sperm parameters measured at adulthood. Lead is a known reproductive toxicant and endocrine disruptor. Previous literature has shown associations between high lead exposure and poorer semen quality both in occupationally and environmentally exposed men. However, to our knowledge, no longitudinal studies have explored the association of childhood lead exposure with semen parameters and reproductive hormones in young men. The Russian Children's Study is a prospective cohort study that enrolled 516 boys at age 8-9 years in 2003-2005 and followed them annually for 10 years. BLLs were measured at entry and lifestyle and health questionnaires were completed. Reproductive hormones were measured in blood samples collected every 2 years. Among the 516 boys enrolled, 481 had BLLs measured at entry. Of these, 453 had at least one measurement of serum testosterone, follicle stimulating hormone (FSH) or luteinizing hormone (LH) (median = 5 samples per boy) and 223 had semen samples collected ∼10 years after enrolment. Semen assessment included ejaculated volume, sperm concentration, progressive motility and total sperm count, and parameters were categorized using published andrology standards for low semen quality based on sperm count and motility. Linear mixed models were used to examine the associations of log-transformed BLLs (and BLL categories) with reproductive hormones and semen parameters, adjusting for potential confounders. Among the 223 young men with peripubertal BLLs and at least one semen sample (total samples = 438), the median (interquartile range) BLL was 3 (2, 5) µg/dl and 27% had BLL ≥5 µg/dl. Overall, 49% of the semen samples fell below reference levels for sperm count and/or motility. Men with peripubertal BLL ≥5 µg/dl had significantly lower ejaculated volume than those with BLL <5 µg/dl (mean = 2.42 vs 2.89 ml, P = 0.02), but this difference was attenuated in adjusted models (mean = 2.60 vs 2.83 ml, P = 0.25). No associations were observed between BLL measured at age 8-9 years and reproductive hormone levels or sperm parameters, including sperm concentration, total count, progressive motility and total progressive motile sperm count, or with the probability of having low semen quality based on sperm count/motility. Only a subset of the original cohort participated in the semen quality portion of the study, although inverse probability weighting was used to account for possible selection bias. BLLs were only measured at a single time in peripuberty, and other exposure time periods, including later or longer-term childhood exposure, may be more predictive of semen quality. The young men were also exposed to other chemical contaminants before and during pubertal development. While semen volume often receives less attention than other sperm parameters, it is an important component of male fertility. Additional prospective studies covering different exposure windows and including other seminal plasma biomarkers are warranted to explore our finding of potentially lower ejaculated volume with higher BLLs and to confirm the lack of associations for other semen parameters among youth exposed to environmental BLLs. Funding was provided through grants R01ES0014370 and P30ES000002 from the National Institute of Environmental Health Sciences, grant R82943701 from the U.S. Environmental Protection Agency, and grant 18-15-00202 from the Russian Science Foundation (O.S and Y.D.). All authors report no competing interests. N/A.

EFFICACY OF CLOMIPHENE CITRATE IN SUBFERTILE MEN STRATIFIED BY PRE-TREATMENT SEX HORMONE LEVELS AND SPERM CONCENTRATION

To what extent are self-reported sleep health measures associated with semen quality? Poor sleep health-including short and long sleep durations, increased frequency of sleep trouble, and poor sleep quality-was associated with reduced sperm concentration, total sperm count, and total motile sperm count, and, in the case of short sleep duration and increased frequency of sleep trouble, reduced semen volume. Semen quality has declined over the past several decades. Sleep health may affect semen quality through multiple pathways, including endocrine dysfunction, and population-based prospective studies of the association are scarce. We analyzed cross-sectional data from 690 male participants (1247 semen samples) aged ≥21 years at enrollment (2015-2023) in Pregnancy Study Online, a North American preconception cohort study. At baseline, participants provided self-reported data on sleep duration in the past month and frequency of sleep trouble in the previous 2weeks. A subset of participants completed the Pittsburgh Sleep Quality Index. We used generalized estimating equations (GEE) models to estimate mean percentage differences (%D) and 95% CIs for the associations of sleep health with semen parameters (semen volume, sperm concentration, percent motility), ascertained using a validated at-home semen testing kit. We also used GEE models to estimate prevalence ratios for poor semen quality (low vs normal) based on World Health Organization (WHO) standards. Comparing sleep durations of <6 vs 7-8.9 h/day, %Ds (95% CIs) were -11.3% (-23.6%, 1.1%), -16.4% (-45.0%, 26.9%), -27.1% (-53.1%, 13.2%), and -20.0% (-50.3%, 28.8%) for semen volume, sperm concentration, total sperm count, and total motile sperm count, respectively. We observed similar associations for ≥9 vs 7-8.9 h/day and sperm concentration (-14.4% [-44.9%, 33.0%]), total sperm count (-13.9% [-44.1%, 32.7%]), and total motile sperm count (-6.8% [-42.1%, 49.9%]). Comparing sleep trouble >50% of the time vs never, %Ds (95% CIs) were -3.3% (-12.0%, 5.4%), -11.9% (-29.9%, 10.8%), -16.2% (-34.3%, 7.0%), and -16.9% (-37.3%, 9.9%) for semen volume, sperm concentration, total sperm count, and total motile sperm count, respectively. Comparing global Pittsburgh Sleep Quality Index scores of >5 (poor sleep quality) vs ≤5 (good sleep quality), %Ds (95% CIs) were -18.1% (-33.5%, 0.9%), -19.2% (-34.6%, -0.1%), and -16.3% (-33.5%, 5.4%) for sperm concentration, total sperm count, and total motile sperm count, respectively. Analyses based on WHO semen quality standards showed consistent results. Non-differential misclassification of sleep health was possible due to our reliance on self-reported data collected at a single point in time. Non-differential misclassification of semen quality was also possible, as participants used an at-home semen testing kit to measure semen parameters. We cannot rule out bias due to residual or unmeasured confounding. Given that the study population was restricted to pregnancy planners who enrolled via the Internet, our findings may not be generalizable to other populations. Our findings are generally consistent with previous research, supporting a relationship between poor sleep health and worse semen quality. We analyzed data from a population-based sample of pregnancy planners, which overcomes limitations from most prior studies that relied on convenience samples of infertile couples or sperm donors. These findings may inform sleep interventions to improve reproductive health outcomes. This work was supported by the following grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, USA: R01HD086742, R01HD105863, R21HD094322. J.J.Y. is an employee of Optum and owns stock in UnitedHealth Group. G.J.S. is an employee of and holds stock in Labcorp, which manufactures the male fertility testing kits used in this study. He is also a co-inventor on multiple patents related to the male fertility testing kits reported in this manuscript: US #10376877, US #11471881, and US #11714034. M.L.E. is an advisor for Doveras, Hannah, Next, Illumicell, Legacy, and HisTurn, which includes a small equity grant of options. S.M.B. has received consulting fees from Idorsia Pharmaceuticals and Apnimed in the past 12 months, participated in a Data Safety Monitoring Board or Advisory Board for PCORI and AHRQ, and served in a leadership role for the Sleep Research Society and American Academy of Sleep Medicine. All other authors have no disclosures to report. N/A.

The aim of this study was to retrospectively evaluate the effects of male age and ejaculatory abstinence on semen parameters and reproductive hormones among men residing in Africa and the Middle East. A total of 70,142 semen analysis results were analysed and grouped according to the age intervals (16 - 20, 21 - 30, 31 - 40, 41 - 50, 51 - 60, >60) and ejaculatory abstinence ( - 5 days and >5 days). Semen parameters i.e. volume, concentration, progressive motility, total progressively motile count, morphology, total normal sperm count, DNA fragmentation, viability, sORP, normed sORP were specifically evaluated. Additionally, for each age interval, reproductive hormones i.e. estradiol, luteinizing hormone, follicle stimulating hormone, testosterone and prolactin were evaluated. Semen volume, total progressively motile count, sperm morphology and total normal sperm count constantly decrease significantly after the age of 30 years. Sperm concentration started declining significantly after the age of 50 years. There was a constant age- related increase in number of spermatozoa with damaged DNA. sORP constantly increased up to 60 years. Furthermore, constantage-related decreases in FSH, serum testosterone and prolact in were observed from patients aged between 16 years and 60 years. Semen volume, sperm concentration, progressive motility and normal morphology were significantly higher in patients having > 5 days of abstinence. Patients having > 5 days of abstinence had the lowest normed sORP. Male age significantly affects sperm parameters and reproductive hormones in fertile and infertile men residing in Africa and the Middle East. Prolonged abstinence days provides better semen quality.

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

The objective of this study was to compare (i) the intracytoplasmic sperm injection outcomes among groups with different total motile sperm count ranges, (ii) the intracytoplasmic sperm injection outcomes between groups with normal and abnormal total motile sperm count, and (iii) the predictive values of WHO 2010 cut-off values and pre-wash total motile sperm count for the intracytoplasmic sperm injection outcomes, in couples with male infertility. This study included data from 518 patients undergoing their first intracytoplasmic sperm injection cycle as a result of male infertility. Couples were divided into five groups according to their total motile sperm count: Group I, total motile sperm count <1×10(6) ; group II, total motile sperm count 1-5×10(6) ; group III, total motile sperm count 5-10×10(6) ; group IV, total motile sperm count 10-20×10(6) ; and group V, total motile sperm count >20×10(6) (which was considered a normal total motile sperm count value). Then, couples were grouped into an abnormal and normal total motile sperm count group. The groups were compared regarding intracytoplasmic sperm injection outcomes. The predictive values of WHO 2010 cut-off values and total motile sperm count for the intracytoplasmic sperm injection outcomes were also investigated. The fertilization rate was lower in total motile sperm count group I compared to total motile sperm count group V (72.5±17.6 vs. 84.9±14.4, p=0.011). The normal total motile sperm count group had a higher fertilization rate (84.9±14.4 vs. 81.1±15.8, p=0.016) and lower miscarriage rate (17.9% vs. 29.5%, p=0.041) compared to the abnormal total motile sperm count group. The total motile sperm count was the only parameter that demonstrated a predictive value for the formation of high-quality embryos on D2 (OR: 1.18, p=0.013), formation of high-quality embryos on D3 (OR: 1.12, p=0.037), formation of blastocysts on D5 (OR: 1.16, p=0.011), blastocyst expansion grade on D5 (OR: 1.27, p=0.042), and the odds of miscarriage (OR: 0.52, p<0.045). The total motile sperm count has a greater predictive value than the WHO 2010 cut-off values for laboratory results and pregnancy outcomes in couples undergoing intracytoplasmic sperm injection as a result of male infertility.

Objectives In the investigations of infertile couples, the contribution of male partners has recently caught the attention of researchers, and more and more investigations like DNA fragmentation tests, microfluidics, physiological intracytoplasmic sperm injection, and intracytoplasmic morphological sperm injection are being resorted to for better Assisted Reproductive Technology (ART) results. Male fertility is intrinsically linked to overall health, with a growing body of evidence indicating that medical comorbidities and conditions detrimental to men’s health are consistently associated with compromised reproductive function. Considering the fact that 15% of the male human genome is dedicated to reproductive functions, it is plausible that other health disorders may also be associated with impairments in fertility. This study was planned to look into factors which are causing such a rise in male infertility and its association with various semen parameters. Material and Methods A cross-sectional study was undertaken over an 18-month period at the infertility clinic of a tertiary care centre, enrolling 151 infertile males exhibiting abnormal semen parameters in accordance with the WHO 2010 guidelines. A comprehensive evaluation of their biochemical and endocrinological profiles was performed, and the correlation between these parameters and semen abnormalities was systematically examined. Results A significant negative correlation was observed between various semen parameters and diastolic blood pressure (DBP), prolactin, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), follicle-stimulating hormone (FSH), and oestrogen. DBP (mmHg) correlated negatively with sperm concentration (million/ml) (R = −0.161). CRP (mg/l) correlated with sperm concentration and total sperm count (×10 6 /ejaculate) (R = −0.180 and −0.208, respectively). ESR (mm/hour) correlated with sperm concentration and total sperm count (R = −0.214 and −0.198, respectively). FSH (IU/l) correlated with sperm concentration and total sperm count (R = −0.216 and −0.206, respectively). Prolactin (μg/l) correlated with sperm concentration, total sperm count, and total motile sperm count (TMSC) (R = −0.210, −0.264, and −0.191, respectively). Oestrogen (pg/ml) showed the strongest negative correlation with sperm concentration, total sperm count, and TMSC (R = −0.387, −0.357, and −0.171, respectively). Conversely, significant positive correlations were observed between semen parameters and both uric acid and lipid profile. Serum uric acid (mg/dl) correlated positively with sperm morphology (%) (R = 0.203). Low-density lipoprotein (mg/dl) correlated with sperm concentration and total sperm count (R = 0.231 and 0.259, respectively), while triglycerides (mg/dl) correlated with sperm concentration and total sperm count (R = 0.197 and 0.204, respectively). However, triglycerides also showed a significant negative correlation with total motility (%) and progressive motility (%) (R = −0.186 and −0.180, respectively). Conclusion Our findings demonstrated that DBP, prolactin, ESR, CRP, FSH, and oestrogen exhibited significant negative correlations with various semen parameters, whereas uric acid and lipid profile parameters showed significant positive correlations. These results suggest that systemic health factors exert a considerable influence on male reproductive potential, highlighting the importance of evaluating overall health status in the assessment and management of male infertility.

Introduction Infertility is the inability to achieve pregnancy after one year of unprotected intercourse. However, over 50% of couples undergoing infertility evaluations will conceive within 2 to 3 years, either naturally or with the help of interventions such as intrauterine insemination or in vitro fertilization, leading to a successful pregnancy. The study aimed to assess the impact of total progressive motile sperm count on the live birth rate in intrauterine insemination (IUI) procedures. Material and Methods This prospective cohort study was conducted during 2022–2023 at Yas Hospital Complex of Tehran University of Medical Sciences, Iran on infertile couples who were referred to this center for IUI. Participants were mothers under 43 years old with a sperm count of at least 1 million. Ovarian stimulation was conducted using various protocols, and sperm was prepared using the swim-up method. The luteal phase was supported with progesterone, and pregnancies were confirmed through ultrasound and β-hCG measurement. Results In this study, 374 cases underwent 581 IUI cycles. The clinical pregnancy rate was 23.5%, and the live birth rate was 14.4%. In cases of clinical pregnancy, sperm count, TPMS, and TMSC were significantly higher, and abnormal morphology and SDFA were significantly lower compared to cases with no clinical pregnancy. There was no statistically significant difference in sperm indices between groups in cases of abortion and live birth. Factors such as shorter duration of marriage, primary infertility, infertility origin (male or female), absence of varicocele, clomiphene consumption, and decreased SDFA are all associated with an increased likelihood of achieving clinical pregnancy. The data we obtained indicates that TPMS and TMSC can predict clinical pregnancy. The area under the curve for clinical pregnancy was 0.628 for TPMC and 0.598 for TMSC. When the cutoff value for TPMC was set at 50%, the specificity for clinical pregnancy was 46%, and the sensitivity was 67%. Similarly, for TMSC, at a cutoff value of 51.50% for a clinical pregnancy, the specificity and sensitivity were 70% and 58%, respectively. The data shows that the number and percentage of live births and clinical pregnancies increase as the quantity within the respective groups increases. Conclusion The study found that both the total motile sperm count (TMSC) and total progressive motile sperm count (TPMC) was significant factors in predicting the success of Intrauterine Insemination (IUI). TPMC was identified as a significant predictor of clinical pregnancy and live birth rates in IUI procedures

In this study, we aimed to evaluate the effect of oral antioxidant treatment on semen parameters and pregnancy rates in infertile men who underwent varicocelectomy. The study was conducted between January 2016 and January 2018. Subinguinal microscopic varicocelectomy was performed in 90 patients who were referred for infertility and diagnosed with clinical varicocele. The patients were divided into two groups. The first group received antioxidant treatment for 6 months after the operation (n = 62); the second group did not receive treatment after the operation (n = 28). The semen analysis was performed at the time of diagnosis and at 6 months postoperatively. The postoperative treatment semen parameters and pregnancy rates between the two groups were compared. The improvement in total sperm count ( + 45.9% vs + 26.8%), total motile sperm count ( + 50.6% vs + 29.7%), sperm concentration ( + 71.4% vs + 54.5%), sperm count in normal morphology ( + 75.7% vs + 39.9%), and total ( + 28.6% vs + 18.3%) and progressive motile sperm count ( + 60.4% vs + 38.9%) were significantly higher in the treated group than in the untreated group (p = 0.011, p < 0.001, p = 0.008, p < 0.001, p = 0.024 and p < 0.001, respectively). The clinical pregnancy rate in the first group was significantly higher than that in the second group (29% vs 17.9%) (p = 0.029). We concluded that the antioxidant treatment provides an important contribution to varicocelectomy outcomes and improves pregnancy rates.

Semen from 10 932 male partners of infertile couples was analysed and sperm parameter trends were evaluated at the Reproduction Biology Laboratory of the University Hospital of Marseille (France) between 1988 and 2007. After 3-6 days of abstinence, semen samples were collected. Measurements of seminal fluid volume, pH, sperm concentration, total sperm count, motility and detailed morphology of spermatozoa were performed. Sperm parameters were analysed on the entire population and in men with normal total numeration (≥40 million per ejaculate). The whole population demonstrated declining trends in sperm concentration (1.5% per year), total sperm count (1.6% per year), total motility (0.4% per year), rapid motility (5.5% per year) and normal morphology (2.2% per year). In the group of selected samples with total normal sperm count, the same trends of sperm quality deterioration with time were observed. Our results clearly indicate that the quality of semen decreased in this population over the study period.

Total Motile Sperm Count in Adolescent Boys with Varicocele is Associated with Hormone Levels and Total Testicular Volume.

The aim of the present study was to determine whether there were significant monthly variations in the semen parameters (i.e. volume, sperm count, total sperm count, motile and normal sperm count) of men living in a Mediterranean climate area. A total of 10 877 semen analysis results were included. Semen samples were obtained as a part of an initial screening of male partners from couples with infertility problems who were attending our laboratory from 1970 to 2000. Log transformation and cubic root transformation were used to test the sample distribution. Statistical significance was adjusted by year of examination, patient's age and sexual abstinence period by performing covariance analyses. Differences between months were assessed with the Bonferroni post-hoc test. There was an increase in March and a decrease in September in the adjusted mean sperm count (p < 0.0005), total sperm count (p < 0.0005), motile sperm count (p=0.01) and normal sperm count (p=0.002). There were no variations in semen volume in the study period. Monthly changes in semen quality are confirmed in this population.