Altered Semen Parameters Research Articles

P-019 Impact of severely altered sperm parameters on ICSI outcomes: A retrospective analysis of embryo morphokinetics and cumulative clinical outcomes of 10,622 embryos

Abstract Study question How do severely altered parameters in both ejaculated and surgically retrieved testicular sperm affect preimplantation embryo morphokinetics, blastocyst quality and cumulative clinical outcomes? Summary answer Severely altered semen parameters impaired fertilization, embryo morphokinetics, and blastocyst quality, but only the use of testicular sperm reduced cumulative outcomes, including live birth rates. What is known already Semen quality is a significant determinant of reproductive success. Sperm play a crucial role in embryonic genome activation and facilitate embryo progression to the blastocyst stage. Yet, comprehensive analyses of embryo developmental outcomes in cases of male factor infertility remain scarce. Limited by small study cohorts, inconsistent findings and a lack of cumulative outcomes, existing studies have failed to provide a clear understanding of the differential impacts of altered semen parameters on embryo development. Uncertainty about outcomes following the use of poor-quality or testicular sperm complicates clinical management, ultimately leaving patients without comprehensive information to make informed treatment decisions. Study design, size, duration This retrospective study evaluated 10,622 embryos derived from 1,680 patients, across 1,837 ICSI cycles. We included both autologous (n = 429) and donor oocyte (n = 1,407) cycles, performed at a single IVF center between January 2019 and August 2023. To assess differences in critical aspects of reproductive success, we compared various embryo developmental and clinical outcomes across cycles using sperm with severely altered parameters (either ejaculated or obtained through testicular sperm extraction, TESE) to those using normospermic samples. Participants/materials, setting, methods Embryos were distributed into four groups according to sperm quality and origin, as per WHO guidelines: normospermia (n = 8,798), severe oligospermia (<5 million/ml; n = 567), severe oligoastenospermia (<5 million/ml and progressive motility <32%; n = 716) and TESE (n = 541). We assessed differences in embryo morphokinetics using adjusted Cox survival curves. We used multivariate analyses to evaluate associations between sperm groups and clinical outcomes, adjusting for relevant confounders pertaining to patient demographics and treatment characteristics. P-values <0.05 were considered significant. Main results and the role of chance Compared to normospermia, altered semen parameters resulted in lower mean fertilization rates (74.5% normospermia versus 69.7% severe oligospermia, 69.1% severe oligoastenospermia and 60.6% TESE). While oligospermia and oligoastenospermia showed a negative correlation with fertilization rates (R2=-0.05, p = 0.02 and R2=-0.07, p < 0.0001, respectively), this trend was more pronounced for TESE (R2= -0.12, p < 0.0001). Embryo morphokinetics were comparable for normospermia, oligospermia and oligoastenospermia. However, TESE resulted in faster early morphokinetic patterns (tPNf, t2, t3, t4 and t5; p < 0.05), and similar t8, tsB, tB, with comparable cell cycle durations (s2, s3, cc2 and cc3; p > 0.05). Compared to normospermia, severe oligospermia had no effect on inner cell mass (ICM) (OR = 0.93, 95%CI: 0.72-1.21) nor trophectoderm (TE) quality (OR = 0.79, 95%CI: 0.58-1.06), while oligoastenospermia reduced the odds of having a good quality ICM (OR = 0.75, 95%CI: 0.58-0.97) but showed no effect on TE (OR = 0.94, 95%CI: 0.71-1.23). Notably, TESE had the most profound effect on blastocyst quality (ICM, OR = 0.68, 95%CI: 0.49-0.92; TE, OR = 0.68, 95%CI: 0.46-0.98). Following the first embryo transfer, ongoing pregnancy rates were similar across all groups, apart from TESE (R2=-0.217, p = 0.0160). Unlike the other groups (p > 0.05), TESE also led to decreased cumulative implantation, ongoing pregnancy, and live birth rates compared to normospermia (R2=-0.19, p = 0.03; R2=-0.23, p = 0.009; R2=-0.22, p = 0.019, respectively). Limitations, reasons for caution The primary limitation of this study is its retrospective design, which may not account for all confounders. Moreover, lifestyle factors, such as smoking or alcohol consumption were not considered. The reliance on data from a single IVF center may also restrict the generalizability of the results to a broader population. Wider implications of the findings Our findings underscore the imperative need for careful consideration of sperm quality for ICSI, highlighting the distinct challenges presented by TESE sperm for achieving reproductive success. While altered semen parameters compromised fertilization rates and embryo quality, TESE cycles were markedly less efficient, ultimately leading to reduced cumulative live birth rates. Trial registration number not applicable

Determination of Electrolytes and Trace Elements in Biological Samples from Patients with Altered Semen Parameters: a Correlational Analysis.

The effects of important nutrients such as calcium (Ca), copper (Cu), iron (Fe), magnesium (Mg), selenium (Se), and zinc (Zn) have been investigated in relation to male fertility due to their roles in proper spermatogenesis, sperm maturation, motility, and optimal sperm function. An imbalance between these elements has been associated with several pathologic conditions and male reproductive issues. The purpose of this study was to determine the essential trace and electrolytes elements, such as Ca, Cu, Fe, Mg, Se, and Zn, in human biological samples (blood, serum, and semen) from patients with male infertility. This study used correlational analysis to determine the potential associations between these elements and male fertility. Imbalances in these elements have been linked to various pathological conditions and male reproductive issues. One hundred eighty referent male adults and two hundred twenty-nine patients diagnosed with subtypes of infertility were included in the study, divided into two age groups. Acid digestion was controlled using a microwave oven, and the essential trace elements and electrolytes in the oxidized biological samples were determined using atomic absorption spectrometry. Certified reference materials of blood and serum were used to validate the accuracy of the methodology. The results showed that the concentrations of Ca, Cu, Fe, Mg, Se, and Zn in the blood, serum, and seminal plasma of male adults in all age groups were higher than those in patients with different infertility phenotypes. Essential element deficiency in all biological fluid samples may significantly negatively affect human reproductive health and lead to male infertility. Through a multidimensional approach, our study sought to unravel the intricate biochemical signatures associated with OAT, providing insights that may shape the landscape of diagnostic and therapeutic strategies for male reproductive health.

Serum and Seminal Plasma Levels of Lead and Arsenic in Cigarette Smokers and Their Relation to the Semen Parameters

Male infertility along with altered semen parameters have been related to smoking. Smoking-related elevations in serum and seminal lead (Pb) and arsenic (As) may play a role in mediating the toxic effects of smoking on seminogram. This research aims to determine whether smoking has any significant impact on Pb and As levels in the seminal plasma and serum, as well as on the various semen parameters, when compared to nonsmokers. In total, 80 adult males were included: 60 smokers and 20 age-matched nonsmokers. Based on the number of cigarettes smoked/day (CPD), the smokers were categorized into mild (1–10), moderate (11–20), and severe (> 20). The analysis of semen was conducted in accordance with the 2010 WHO laboratory manual. Using an atomic absorption spectrophotometer, Pb and As concentrations in the serum and seminal plasma of all groups were determined. Compared to nonsmokers, smokers had a significantly reduced sperm count, motility, and viability, as well as a larger percentage of aberrant forms (P = 0.001, 0.025, 0.034, 0.002 respectively). Smokers had higher Pb concentrations in their serum and seminal fluid than nonsmokers (P = 0.002, 0.001 respectively). Seminal Pb had a significant negative correlation with sperm count (P = 0.004, r = -0.320). Serum Pb levels were found to positively correlate with seminal Pb levels (P 0.001, r = 0.648), and cigarette smokers had substantially greater seminal As levels than nonsmokers (P = 0.024). Sperm viability was strongly inversely related to seminal As (P = 0.042, r = -0.264). Seminal As levels and aberrant sperm shapes were found to be significantly correlated (P = 0.001, r = 0.414). In smokers, a significant positive relationship between seminal As and seminal Pb was observed. Therefore, semen parameters could be adversely affected by smoking through high levels of Pb and As (P = 0.012, r = 0.298).

The Effect of Month-Long Daily Fasting on Semen Parameters: A Retrospective Cohort Study

Objective: The aim of the study was to determine whether Ramadan month-long daily fasting affects semen analysis parameters. Methods: This retrospective cohort study was conducted in tertiary academic medical center. Medical records of 97 Muslim patients who were admitted to the IVF unit from May 2011 to May 2021 were reviewed. Only men who provided at least one semen sample during Ramadan period (Ramadan month +70 days after) and one sample not during Ramadan were included. Semen characteristics of each patient were independently compared to themselves. Results: The post-gradient semen analysis indicated significantly lower progressive sperm motility (mean 30.01 ± 20.46 vs. 38.12 ± 25.13) (p < 0.001). The decrease in the progressive motility remained significant among patients with non-male factor indications (p < 0.001). In the non-male factor indication group, the difference in the progressive motility of the post-gradient semen analysis between the 2 samples was not statistically significant (p = 0.4). There were no significant differences between semen parameters before centrifuging. The incidence of asthenospermia (progressive sperm motility <32%) as an absolute parameter was higher after centrifuging the semen sample during the Ramadan period (p = 0.04). Conclusions: Semen samples collected during Ramadan period were associated with lower progressive motility and reduced semen volume compared to semen samples from the same men outside of the Ramadan period. A possible effect of these altered semen parameters on fertility should be investigated further.

O-046 Nutritional habits might improve your fertility

Abstract Many lifestyle factors have been identified as risk factors for male infertility. For example, an unbalanced diet leading to overweight, obesity, metabolic disorders, and micronutrient deficiencies can have consequences for male reproductive functions. Obese men present more often altered semen parameters and a reduced chance of pregnancy naturally or after medically assisted procreation. In some cases, weight loss can reverse the adverse effects of obesity. However, few interventional studies have demonstrated the effectiveness of a preconceptional intervention in men. In contrast, more and more studies are highlighting the importance of a balanced diet and physical activity to improve fertility. A qualitatively adequate and balanced diet and appropriate daily intake of micronutrients are fundamental for male reproductive functions. Some teams have highlighted the benefits of the Mediterranean diet on sperm production, whereas the Western diet, including reconstituted meats, fried foods, and sweet foods and drinks, was associated with altered semen parameters. However, few interventional studies have confirmed the impact of men's diets on the chances of natural or medically assisted pregnancy and live birth, and their results are controversial. Therefore, robust randomised controlled studies are needed. Practical advice and education can be recommended to men who wish to conceive to help them maintain or achieve the public health recommendations that encourage a balanced diet, such as the Mediterranean diet.

Sperm epigenetics landscape: correlation with embryo quality, reproductive outcomes and offspring's health.

Epigenetics refers to how gene expression and function are modulated without modifying the DNA sequence but through subtle molecular changes or interactions with it. As spermatogenesis progresses, male germ cells suffer plenty of epigenetic modifications, resulting in the definitive epigenome of spermatozoa conditioning its functionality, and this process can be altered by several internal and external factors. The paternal epigenome is crucial for sperm function, fertilization, embryo development, and offspring's health, and altered epigenetic states are associated with male infertility with or without altered semen parameters, embryo quality impairment, and worse ART outcomes together with the future offspring's health risks mainly through intergenerational transmission of epigenetic marks. Identifying epigenetic biomarkers may improve male factor diagnosis and the development of targeted therapies, not only to improve fertility but also to allow an early detection of risk and disease prevention in the progeny. While still there is much research to be done, hopefully in the near future, improvements in high-throughput technologies applied to epigenomes will permit our understanding of the underlying epigenetic mechanisms and the development of diagnostics and therapies leading to improved reproductive outcomes. In this review, we discuss the mechanisms of epigenetics in sperm and how epigenetics behave during spermatogenesis. Additionally, we elaborate on the relationship of sperm epigenetics with sperm parameters and male infertility, and highlight the impact of sperm epigenetic alterations on sperm parameters, embryo quality, ART outcomes, miscarriage rates and offspring's health. Furthermore, we provide insights into the future research of epigenetic alterations in male infertility.

Prolactin and spermatogenesis: new lights on the interplay between prolactin and sperm parameters.

To clarify the relationship between one the most gender-specific hormone, i.e. prolactin (PRL), and semen parameters in men. A retrospective, observational, cohort, real-world study was carried out, enrolling all men performing a semen analysis and PRL examination from 2010 to 2022. For each patient, the first semen analys was extracted, associated to PRL, total testosterone (TT), follicle stimulating hormone (FSH) and luteinizing hormone (LH). Hyperprolactinaemia (>35 ng/mL) was excluded. 1211 subjects were included. PRL serum levels were lower in normozoospermia compared to azoospermia (p = 0.002) and altered semen parameters (p = 0.048) groups. TT serum levels were not different among groups (p = 0.122). Excluding azoospermic men, PRL serum levels were lower in normozoospermic patients, when compared to other groups of semen alterations. An inverse correlation was detected between PRL and sperm concentration. Considering normozospermic subjects, PRL was directly related to both non-progressive sperm motility (p = 0.014) and normal sperm morphology (p = 0.040). Subdiving the cohort in quartiles according to PRL distribution, the highest motilities were observed in the second PRL quartile (8.30-11.10 ng/mL) and asthenozoospermia was significantly predicted by FSH (p < 0.001) and second PRL quartile (p = 0.045). The PRL-spermatogenesis connection seems to be mild, although low-normal PRL levels are associated with the best spermatogenetic profile. PRL serum levels could mirror the immunoregulatory status within the testis, suggesting that there is a sort of 'PRL optimal window' reflecting an efficent spermatogenesis. Alternatively, men with good semen parameters might have a higher central dopaminergic tone resulting in low PRL levels.

Telomere Length, a New Biomarker of Male (in)Fertility? A Systematic Review of the Literature.

Male factors are suspected in around half cases of infertility, of which up to 40% are diagnosed as idiopathic. In the context of a continuously increased resort to ART and increased decline of semen parameters, it is of greatest interest to evaluate an additional potential biomarker of sperm quality. According to PRISMA guidelines, this systematic review of the literature selected studies evaluating telomere length in sperm and/or in leukocytes as a potential male fertility biomarker. Twenty-two publications (3168 participants) were included in this review of experimental evidence. For each study, authors determined if there was a correlation between telomere length and semen parameters or fertility outcomes. Of the 13 studies concerning sperm telomere length (STL) and semen parameters, ten found an association between short STL and altered parameters. Concerning the impact of STL on ART results, the data are conflicting. However, eight of the 13 included studies about fertility found significantly longer sperm telomeres in fertile men than in infertile men. In leukocytes, the seven studies reported conflicting findings. Shorter sperm telomeres appear to be associated with altered semen parameters or male infertility. Telomere length may be considered as a new molecular marker of spermatogenesis and sperm quality, and thus is related to male fertility potential. However, additional studies are needed to define the place of the STL in the assessment of individual fertility.

Statins and Male Fertility: Is There a Cause for Concern?

The well-known 3-hydroxyl 3-methyl glutaryl-Coenzyme A reductase inhibitors, called statins, have been the main medication used in the treatment of hypercholesterolemia and some cases of cardiovascular diseases. The effectiveness of this drug in controlling cholesterol production is impeccable, however, patients often complain of a variety of side effects, such as myalgia, muscle atrophy, and in some cases, rhabdomyolysis. Not only has the use of statins caused the aforementioned side effects, but they are also shown to cause testicular discomfort, erectile dysfunction, altered semen parameters, and modified steroid hormone production. These reported adverse effects on male fertility are not generally agreed upon, as some have shown the use to be beneficial. Hence, this makes the aftermath effect of statin use on male fertility debatable and controversial. The negative effects have been associated with imbalanced or reduced steroid hormones, which are necessary for proper spermatogenesis and other sexual functions. Meanwhile, the beneficial effects are related to statin’s anti-inflammatory and cardioprotective properties. These contradictory findings are in part due to the different age of users, concentrations of statins, the type and duration of treatment, and the underlying disease and/or comorbidities. Therefore, the current study aims to analyze the literature and gather evidence as to the effects of statin on male sexual health and reproductive parameters, and subsequently give recommendations for the direction of future studies.

Association of Vitamin D and Reproductive Hormones With Semen Parameters in Infertile Men.

BackgroundHypovitaminosis D has been linked with poor semen parameters and endocrinological factors in male infertility. This study aimed to analyze the association of serum vitamin D levels and reproductive hormones such as follicle-stimulating hormone (FSH), luteinizing hormone (LH), and total testosterone (TT) with the semen parameters in a cohort of infertile men.MethodologyIn this study, 224 infertile men (aged 18-45 years) were recruited after applying inclusion and exclusion criteria. Semen analysis was performed as per the 2010 World Health Organization (WHO) criteria. The patients were divided into two groups on the basis of semen parameters: normozoospermic men and men with one or more altered semen parameters as per the WHO 2010 guidelines for all the analysis. Vitamin D and hormone levels were evaluated by quantitative competitive immunoassay by chemiluminescent microparticle immunoassay technology with flexible assay protocols (Architect, Abbott Diagnostics, Lake Forest, IL, USA). The patients were further divided into three groups on the basis of vitamin D levels: Sufficient (>20 ng/mL), insufficient (12-20 ng/mL), and deficient (<12 ng/mL). These groups were compared for different semen and hormonal parameters.ResultsOut of the 224 infertile men included, 124 were normozoospermic while 100 patients had one or more altered semen parameters. The median age of the participants was 30 years (minimum = 18 years, maximum = 45 years). The serum vitamin D and TT levels were significantly lower (p < 0.0001) and FSH (p = 0.001) and LH levels (p < 0.0001) were significantly higher in those with one or more altered semen parameters compared to the normozoospermic men. The sperm concentration, total motility, linear progressive motility, percentage normal morphology, and serum TT levels were significantly lower in the patients with serum vitamin D levels of <12 ng/mL in both the normozoospermic men and those with one or more altered semen parameters compared to patients with higher vitamin D levels. Semen parameters such as sperm concentration, total motility, linear progressive motility, and morphology were positively correlated with the levels of serum vitamin D and TT.ConclusionsVitamin D deficiency was examined in a large proportion of infertile men. Serum vitamin D and TT levels were positively associated with semen parameters evident from lower levels of vitamin D and TT in men with altered semen parameters compared to normozoospermic men. However, further comprehensive studies with larger sample sizes should be conducted to further validate the role of vitamin D in male infertility by checking the effect of vitamin D supplementation on semen parameters.

Twenty-First Century Viral Pandemics: A Literature Review of Sexual Transmission and Fertility Implications in Men.

IntroductionThe 21st century has seen a series of viral pandemics that have collectively infected millions of individuals. To understand factors that may contribute to viral spread and address long-term health sequelae for survivors, it is important to review evidence regarding viral presence in semen, sexual transmission potential, and possible effects on fertility.AimTo review the current literature regarding the sexual transmissibility of recent viral pandemics and their effects on semen parameters and fertility. We review evidence for the following viruses: Ebola, Zika, West Nile, pandemic influenza, severe acute respiratory syndrome (SARS), and SARS-corona virus-2 (SARS-CoV-2).MethodsA literature search was conducted to identify relevant studies. Titles and abstracts were reviewed for relevance. References from identified articles were searched and included, if appropriate.Main Outcome MeasuresThe main outcome measure of this study was reviewing of peer-reviewed literature.ResultsBoth the Ebola virus and Zika virus are present in semen, but only the Zika virus shows consistent evidence of sexual transmission. Current evidence does not support the presence of the West Nile virus, pandemic influenza, SARS, and SARS-CoV-2 in semen. The Zika virus appears to alter semen parameters in a way that diminishes fertility, but the effect is likely time limited. The West Nile virus and SARS have been associated with orchitis in a small number of case reports. Viruses that cause febrile illness, such as pandemic influenza, SARS, and SARS-CoV-2, are associated with decreased sperm count and motility and abnormal morphology. SARS and SARS-CoV-2 may interact with angiotensin-converting enzyme 2 receptors present in the testes, which could impact spermatogenesis.ConclusionsWe have reported the presence in semen, sexual transmission potential, and fertility side effects of recent viral pandemics. Overall, semen studies and fertility effects are highly understudied in viral pandemics, and rigorous study on these topics should be undertaken as novel pandemics emerge.Payne K, Kenny P, Scovell JM, et al. Twenty-First Century Viral Pandemics: A Literature Review of Sexual Transmission and Fertility Implications for Men. Sex Med Rev 2020;8:518–530.

Multilevel approach to male fertility by machine learning highlights a hidden link between haematological and spermatogenetic cells.

Male infertility represents a complex clinical condition requiring an accurate multilevel assessment, in which machine learning technology, combining large data series in non-linear and highly interactive ways, could be innovatively applied. A longitudinal, observational, retrospective, big data study was carried out, applying for the first time the ML in the context of male infertility. A large database including all semen samples collected between 2010 and 2016 was generated, together with blood biochemical examinations, environmental temperature and air pollutants exposure. First, the database was analysed with principal component analysis and multivariable linear regression analyses. Second, classification analyses were performed, in which patients were a priori classified according to semen parameters. Third, machine learning algorithms were applied in a training phase (80% of the entire database) and in a tuning phase (20% of the data set). Finally, conventional statistical analyses were applied considering semen parameters and those other variables extracted during machine learning. The final database included 4239 patients, aggregating semen analyses, blood and environmental parameters. Classification analyses were able to recognize oligozoospermic, teratozoospermic, asthenozoospermic and patients with altered semen parameters (0.58 accuracy, 0.58 sensitivity and 0.57 specificity). Machine learning algorithms detected three haematological variables, that is lymphocytes number, erythrocyte distribution and mean globular volume, significantly related to semen parameters (0.69 accuracy, 0.78 sensitivity and 0.41 specificity). This is the first machine learning application to male fertility, detecting potential mathematical algorithms able to describe patients' semen characteristics changes. In this setting, a possible hidden link between testicular and haematopoietic tissues was suggested, according to their similar proliferative properties.

Sperm cryostorage in a dry tank: An accurate alternative

This prospective study aimed to determine the effects of dry nitrogen cryostorage on human sperm characteristics in comparison with liquid nitrogen cryostorage. For this purpose, 42 men undergoing routine semen analysis (21 normozoospermia and 21 with altered semen parameters) were analyzed. After slow freezing, half of the straws of each sample were randomly stored in liquid and dry tanks, at the top and bottom levels of the latter. After 6 months storage, thawed samples were treated by density gradient centrifugation and sperm characteristics were compared. There was no difference in sperm progressive motility (15.1% ± 14.2% vs. 15.1% ± 12.7%; p = 0.76), sperm vitality (25.5% ± 17.7% vs. 26.2% ± 19%; p = 0.71), percentages of acrosome-reacted spermatozoa (38% ± 8.5% vs. 38.5% ± 7.4%; p = 0.53) and DNA fragmentation spermatozoa (27.3% ± 12.4% vs. 28.5% ± 12.9%, p = 0.47) after cryostorage in the dry or the liquid nitrogen tank. Moreover, we did not observe differences between either cryostorage system for normal and altered sperm samples. This lack of difference was also observed whatever the floor level of cryostorage in the dry tank. The temperature measurement of the dry tank showed a stable temperature at −194 °C throughout storage whatever the storage floor level, guaranteeing the stability of the low temperatures suitable for human sperm storage. Because of its greater safety, dry storage without contact with the liquid phase should be preferred and can be a useful alternative for the cryostorage of human sperm samples.

Gender characteristics of autoimmune hypogonadism

Autoimmune gonadal lesions represent a highly heterogenous conditions affecting men and women of reproductive age and resulting in loss of endocrine function and, eventually, infertility. Well-known and well-documented risk factors exist, and the presence or suspicion of autoimmune disorder should be regarded as an important one. For the purpose of the present study, ELISA kits according to the proprietary technology for detection of antitesticular and antiovarian antibodies were developed. Among men with autoimmune orchitis an increased level of antibodies to steroid-producing testicular cells, decreased serum total and free testosterone and altered semen parameters were found. Combined autoimmune diseases were present (autoimmune thyroiditis, vitiligo, type 1 diabetes) in 13.5 % of cases. In women with autoimmune oophoritis the main finding was anovulation with preserved serum FSH and LH levels (91.6 %) and luteal insufficiency (8.4 %). In total, 19.4 % of patients had other autoimmune diseases (autoimmune thyroiditis, vitiligo, chronic autoimmune hepatitis, rheumatoid arthritis, systemic lupus erythematosus).

The Role of Anogenital Distance Measurement in the Prediction of The Efficacy of Varicocelectomy in Primary Male Infertility

Abstract Background: Anogenital distance is a marker of genital development and adult testicular function. It is currently difficult to assess which patients are most likely to benefit from varicocelectomy. The present study showed that men with a longer AGD had a higher likelihood of improvement after varicocelectomy. Aim of Study: Is to evaluate the role of Anogenital Distance (AGD) measurement in the prediction of the efficacy of varicocelectomy on the improvement of semen parameters in primary male infertility. Material and Methods: •A prospective study included sixty male patients presented with primary infertility and clinical evident primary varic-ocele with altered semen parameters. •All patients underwent measuring the distance from the posterior aspect of the scrotum to the anal verge in millimeters using a digital caliper. •All patients underwent varicocelectomy (subinguinal ap-proach) by the same experienced surgeon using intraoperative Doppler and magnification loupe. •All patients were followed-up with semen analysis after 6 months of varicocele repair. Results: •Overall, 76.7% of our patients (46 patients) revealed improvement in their semen parameters after 6 months of varicocelectomy, men with longer AGD had better improve-ment in their semen parameters after surgery than men with shorter AGD, 30 patients (88.2%) with AGD >!30mm vs. 16 patients (61.5%) with AGD 30mm. The sperm concentration increased from 13.5 to 18.8 million sperm per ml (p-value <0.001), the progressive motility (A + B) increased from 27.9% to 39.5% (p-value <0.001), the mean abnormal forms decreased from 57.2% to 36.2% (p-value <0.001). While in the other group with AGD <30mm there was no statistical differences in different semen parameters post-operatively. Conclusions: AGD may provide a novel metric to assess intrinsic testicular function and predict efficacy of varicocele repair.

Sildenafil's impact on male infertility: what has changed in 20 years?

Sildenafil has had a dramatic influence on the field of sexual medicine over the past 20 years. Not only have phosphodiesterase-5 (PDE5) inhibitors improved the treatment of erectile dysfunction (ED), they have indirectly contributed to the treatment of male factor infertility. A review of the literature between 1998 - 2018 was performed using PubMed with regards to sildenafil and male infertility. Numerous studies have demonstrated sildenafil's safety and efficacy for treating ED. Sildenafil does not alter semen parameters, and, in fact, may positively affect semen parameters. Sildenafil is helpful for treating ED caused by the psychological stress of infertility treatments. Sildenafil has improved the treatment of ED and may have a benefit on semen parameters. This has aided in the management of male factor infertility, and has contributed to hundreds of thousands of pregnancies that would have been more difficult, as it was before its advent.

Zika virus infects human testicular tissue and germ cells.

Zika virus (ZIKV) is a teratogenic mosquito-borne flavivirus that can be sexually transmitted from man to woman. The finding of high viral loads and prolonged viral shedding in semen suggests that ZIKV replicates within the human male genital tract, but its target organs are unknown. Using ex vivo infection of organotypic cultures, we demonstrated here that ZIKV replicates in human testicular tissue and infects a broad range of cell types, including germ cells, which we also identified as infected in semen from ZIKV-infected donors. ZIKV had no major deleterious effect on the morphology and hormonal production of the human testis explants. Infection induced a broad antiviral response but no IFN upregulation and minimal proinflammatory response in testis explants, with no cytopathic effect. Finally, we studied ZIKV infection in mouse testis and compared it to human infection. This study provides key insights into how ZIKV may persist in semen and alter semen parameters, as well as a valuable tool for testing antiviral agents.

Anogenital distance is associated with genital measures and seminal parameters but not anthropometrics in a large cohort of young adult men

Is the anogenital distance (AGD) correlated to anthropometric, genital and sperm parameters in young adult men? We observed that reduced AGD is strongly associated with altered semen parameters and reduced testicular volume. Abnormalities in the foetal development of the testis have been suggested as causative of common male reproductive disorders, such as cryptorchidism, hypospadias, reduced semen quality and testicular germ cell tumour, collectively defined as 'testicular dysgenesis syndrome'. In human epidemiological studies, alterations in AGD have been frequently associated with clinically relevant outcomes of reproductive health, suggesting AGD as a marker of foetal testicular development. This study was performed within the annual screening protocol to evaluate male reproductive health in the high schools of Padua and surroundings (Veneto Region, the North-East of Italy). Here we report the findings of 794 subjects who completed the study protocol between October 2016 and May 2017. We evaluated 794 students aged 18-19 years recording the following parameters: height, weight, BMI, waist circumference, arm span, pubis-to-floor and crown-to-pubis length, penile length and circumference, testicular volumes, semen parameters and AGD (measured from the posterior base of the scrotum to the centre of the anus). Of the subjects, 49% had an abnormal arm span-height difference (>3 cm) and 63.4% had an altered ratio of crown-to-pubis/pubis-to-floor length (≤0.92). The rate of subjects with reduced testicular volume was 23%. Median sperm concentration was 51.0× 106/ml and total sperm count was 122.5 × 106. AGD showed a direct positive relation with testicular volume and penile length and circumference (R = 0.265, 0.176 and 0.095, respectively, all P < 0.05). No significant relation was observed between AGD and anthropometric parameters. Sperm concentration, total sperm count, progressive motility and normal morphology showed a significant and positive correlation with AGD (R = 0.205, 0.210, 0.216 and 0.117, respectively, all P < 0.05). Our cohort of young adults is not representative of the general population. Hormonal evaluation was missing. Our findings show that AGD is associated with testicular volumes, penile measures and seminal parameters in young adult men. Because AGD is hormonally determined during foetal life, the reported high incidence of reduced semen quality and reduced testicular volume could be related to a reduced androgenic exposure in utero. AGD could represent a simple and useful method to evaluate testicular and penile development in adult men. The authors have no potential conflict of interest to declare. No external funding was obtained for this study. N/A.

Variables affecting semen quality and its relation to fertility in the dog: A retrospective study

Although semen analysis is routinely used to evaluate the male reproductive potential in the canine species, only a few authors have attempted to relate semen characteristics to donor traits, such as age or weight, and fertility. This study evaluated the effects of dogs' age (young: 0–24 months, adult: 25–84 months, old: >84 months), size (small: <15 kg, medium: 16–40 kg, large: >40 kg) and reason for semen collection (evaluation, artificial insemination, cryopreservation or research purposes) on the seminal characteristics and related the main seminal characteristics with fresh AI results. Overall, 251 semen examinations were performed from 140 dogs presented between 2000 and 2015 at the University of Pisa Veterinary Teaching Hospital. Conventional semen parameters (semen volume, sperm concentration and total number, subjective motility and sperm morphology) were evaluated. Overall, 227 (90.4%) samples contained spermatozoa. Azoospermic samples resulted from complete (n = 13, 9 dogs), or incomplete ejaculations (n = 11, 8 dogs), based on seminal alkaline phosphatase concentration and/or ancillary examinations. Reason for semen collection had a significant effect on semen volume, sperm total number and sperm concentration. The proportion of normal spermatozoa was lower in dogs presented for semen evaluation (P < 0.05). Dog size affected ejaculate volume and total sperm number, which was lower in small dogs compared to medium (P < 0.01 and P < 0.05, respectively) and large-sized dogs (P < 0.01). Age had no influence on volume, sperm number or motility. The proportion of normal spermatozoa was higher in young animals than in old ones (P < 0.05). There was a significantly higher proportion of midpiece defects in old dogs compared to young ones (P < 0.01). Total sperm number, motility and proportion of morphologically normal spermatozoa in the semen used in AIs resulting in a pregnancy were 627.6 × 106, 83.9% and 64.9%, respectively, all significantly higher than in the unsuccessful AIs, where they were 389.4 × 106, 66.5% and 42% (P < 0.05). In conclusion, age, size and reason for semen collection may affect main sperm parameters and must be taken into consideration during the interpretation of a routine semen evaluation. In turn, altered semen parameters may affect fertility after artificial insemination.

Prolonged exposure of dietary phytoestrogens on semen characteristics and reproductive performance of rabbit bucks

The effects of inclusion of different sources of dietary phytoestrogens on antioxidant capacity, hormonal balance, libido, semen quality, and fertility of rabbit bucks were studied. Twenty-one, adult, fertile, V-line bucks were randomly allocated into 3 homogenous groups (n = 7/treatment) and received control diet (phytoestrogens-free diet, CON) or soybean meal isoflavones–containing diet (SMI) or linseed meal lignans–containing diet (LML) for 12 wk. The diets were formulated to be isocaloric and isonitrogenous. The concentrations of isoflavones in the SMI diet were 24.04 mg/100 g dry matter (DM) daidzein and 13.10 mg/100 g DM genistein. The major phytoestrogen detected in the LML diet was secoisolariciresinol (36.80 mg/100 g DM). Treatment had no effects on body weight, feed intake and rectal temperature of bucks. Compared with control, bucks fed the SMI and LML diets had higher (P < 0.001) blood plasma total antioxidant capacity (0.98 ± 0.12, 1.50 ± 0.13, and 2.29 ± 0.17 mM/L for CON, SMI, and LML, respectively), and lower (P < 0.01) blood plasma malondialdehyde (2.76 ± 0.23, 1.76 ± 0.16, and 1.70 ± 0.18 nmol/mL for CON, SMI, and LML, respectively), whereas activities of reduced glutathione and superoxide dismutase (SOD) enzymes were not affected. Bucks fed the SMI and LML diets had greater (P < 0.001) concentrations of blood plasma triiodothyronine. Feeding the SMI and LML diets decreased (P < 0.01) libido (8.26 ± 0.71, 12.18 ± 0.97, and 14.12 ± 1.12 s for CON, SMI, and LML, respectively), sperm concentration (327.7 ± 21.6, 265.8 ± 36.8, and 226.5 ± 20.1 × 106/mL for CON, SMI, and LML, respectively), testosterone (5.16 ± 0.95, 3.91 ± 0.63, and 3.04 ± 0.92 ng/mL for CON, SMI, and LML, respectively), and seminal plasma fructose compared with the CON diet. The percentage of progressive motile sperm was improved (P < 0.001) by both phytoestrogen-containing diets. Feeding the SMI diet increased (P = 0.02) the percentage of live sperm compared with CON, whereas LML resulted in an intermediate value. Dietary treatment of bucks did not affect kindling rates or litter sizes of does, and did not affect birth weights or viabilities of kits. In conclusion, prolonged consumption of dietary isoflavones or lignans did not impair semen fertilizability. This may be due to the benefits of antioxidant activity or due to the benefits of other components in the diet. Dietary phytoestrogens did evoke obvious decreases in libido and steroidogenesis with altered semen parameters.