Assessment Of Male Infertility Research Articles

(303) The Predictive Role of Baseline Hormone Profile Evaluation for the Likelihood of Having a Child in Infertile Men

Abstract Introduction Sex hormone profile evaluation is commonly used in male infertility assessment to identify potential hormonal imbalances and underlying issues that can impact sperm production, sperm quality, or reproductive organ function. Objective To evaluate the likelihood of having a child in subfertile and infertile men within five years based on their serum hormone levels on their initial encounter for infertility evaluation/treatment. Methods We identified a retrospective cohort from the Subfertility, Health, and Assisted Reproduction (SHARE) study (compiled 1996-2017) linked with familial information from the Utah Population Database (UPDB) including all men with a measured value of albumin, follicle-stimulating hormone (FSH), luteinizing hormone (LH), Free testosterone (T), total, and bioavailable T, sex hormone binding globulin (SHBG), and estradiol (E). We included men who had a semen analysis (SA) within 1 year of their hormone measurement. The primary outcome of the study was any evidence of childbirth, and the secondary outcome was the time from baseline hormone evaluation to childbirth. All men were followed for 60 months after their recorded hormone value for evidence of childbirth. Using Cox proportional hazards models, we modeled the likelihood of having a child and the time to childbirth (using linear regression) against the quintile of hormone distribution. Results A total number of 1298 men who underwent hormone profile evaluation and SA were included in this study. The mean age for the total cohort was 33 (29-37) years old. Men who had a child at the end of the study period (31 (28-36)) were significantly younger than men without a child at the end of the study with a mean age of (35.5 (32-40.25)) (p < 0.001). The mean sperm concentration for the total cohort was 7.6 (1-27.4) (M/ml) and the mean total progressive motile count was 9 (0.9-47) (M). Overall, semen parameters showed no significant differences between men who had a child at the end of the study follow-up versus men who did not. Our models showed that prolactin serum levels in quantile 7 have the highest ratio (2.236 (0.919-5.44) p=0.076) for the likelihood of having a child. Total testosterone in quantiles 3 and 5 showed an increased likelihood of having a child (2.119 (1.176-3.821) (p=0.012), (2.518 (1.412-4.491)) (p=0.002), respectively. Albumin in quantiles 5-9 followed a similar pattern with the highest ratio in quantile 8 (3.551 (1.486-8.487)) (p=0.004). Our results did not show meaningful patterns between semen parameters, serum hormone levels, and time to having a child. Conclusions The outcomes of this study indicate that prolactin, total testosterone, and albumin serum levels on the first visit in men with infertility concerns are associated with an increased likelihood of having a child. Abnormal semen analysis outcomes are not well associated with hypoandrogenism in infertile men. Our study shows that baseline serum prolactin, total testosterone, and albumin levels can be used to estimate the likelihood of having a child in subfertile and infertile men. These findings can provide the basis for further studies to determine an optimal screening method for male-factor infertility related to abnormal hormone levels. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Equity/salary/officer in company: Paterna bio, firmtech; Consulting: Turtle health, maximus, carrot; inherent bio.

Sperm DNA Fragmentation: Causes, Effects and Relevance in IVF Outcomes

Sperm DNA fragmentation, characterized by damaged or broken DNA strands within sperm cells, has been recognized as an important factor in male infertility and poor ART outcome. This lecture aims to provide an overview of the causes, effects, and relevance of sperm DNA fragmentation in in vitro fertilization (IVF) outcomes and look into the latest evidences from the literatures. Causes: Sperm DNA fragmentation can result from various factors, including oxidative stress, advanced paternal age, lifestyle factors such as smoking and excessive alcohol consumption, environmental exposures, genotoxic agents, and underlying genetic abnormalities. These factors can induce DNA damage during sperm development, during the transit of sperm through the male reproductive tract or during the storage of the sperm in epididymis. Relevance in IVF Outcomes: The assessment of sperm DNA fragmentation has emerged as a valuable tool in evaluating male infertility and predicting IVF success. Several methods, including the sperm chromatin structure assay (SCSA), terminal deoxynucleotidyl transferase dUTP nick-end labelling (TUNEL), comet assay, and other commercial detection kits, are available to measure sperm DNA fragmentation. Previous small cohort studies have demonstrated that higher levels of sperm DNA fragmentation are associated with lower pregnancy rates, decreased embryo quality, and an increased risk of pregnancy loss in IVF cycles. Therefore, incorporating sperm DNA fragmentation analysis into the routine assessment of male infertility can aid in optimizing treatment strategies and improving IVF outcomes. Recent evidences: Latest large clinical studies showed a limited association to IVF outcome. The DFI remains controversial as a predictive tool. Nonetheless, sperm DNA fragmentation is still believed to be a significant factor affecting male fertility and IVF outcomes. Further research is warranted to explore the mechanisms underlying DNA fragmentation, develop standardized assessment methods, and explore potential interventions to mitigate the adverse effects of sperm DNA damage on IVF success.

A Comparative Investigation Applying Testicular Fine Needle Aspiration Cytology and Open Testicular Biopsy Histology for the Diagnosis of Azoospermia and Severe Oligospermia.

Open testicular biopsy histology and fine needle aspiration cytology (FNAC) are the most popular tests used to diagnose male infertility. This study aimed to assess the cytological characteristics of 186 infertile males aged 24-63 with testicular FNAC. Furthermore, the existing relationship between males with severe oligospermia (sperm count: 5 million/ml) and azoospermia was investigated via both cytological and histological diagnosis methods. With a 1.5-inch and 25-gauge needle, the testis was aspirated from three locations (the upper, middle, and lower poles). Papanicolaou stain or Giemsa stain was used to make smears on albumenized slides, which were then dried in the air and stained. A biopsy of the testicles was performed there, preserved in Bouins solution, processed as usual, and stained with hematoxylin and eosin stain. According to our findings, 66.7% of patients had secondary maturation arrest, whereas 18.3% and 15.1% of them had hypospermatogenesis and Sertoli cell only (SCO). Results of the comparison showed that both procedures were very similar. According to biopsy histological examinations, only 3 (1.6%) of the 28 normal FNAC instances had hypospermatogenesis with lymphocyte infiltration. The majority of SCO patients were over 50 years old. These findings revealed that FNAC is more effective than testicular histology for the assessment of male infertility.

A study of sperm quality assessment: Morphological defect in patients with normal sperm count

Background: Sperm morphology is the major benchmark in assessment of male infertility. There are limited studies available on frequency of qualitative defects of sperm in patients with normal sperm count. Hence, the present study was done to assess the morphological defects in patients with normal sperm counts who came for infertility work up. Aims and Objectives: The aim of the study was to evaluate the correlation of qualitative defects of sperm in patients having normal sperm counts. Materials and Methods: We have collected 70 samples with normal sperm count (≥15 million/mL). After routine sperm count and motility, Smears were fixed in ethanol and stained with Papanicolaou stain. Minimum of 200 spermatozoa were analyzed per sample. We have recorded normal sperm morphology and abnormal morphology and we have further categorized the data. Morphology was categorized as defect in head, middle piece and tail. Results: Most common morphological abnormalities detected in head region were double head (60%) followed by tapering head (42%). Most common defect observed in middle piece region was thick middle piece (57%) followed by bent neck (48%). Most frequent defect in tail region was coiled tail (14%). We have recorded 40 cases (57%) out of 70 showed multiple morphological defects. Conclusion: Qualitative defects in sperm play a key role in infertility workup. We must have to acknowledge the importance of morphological assessment of semen.

The Future Is Coming: Artificial Intelligence in the Treatment of Infertility Could Improve Assisted Reproduction Outcomes-The Value of Regulatory Frameworks.

Infertility is a global health issue affecting women and men of reproductive age with increasing incidence worldwide, in part due to greater awareness and better diagnosis. Assisted reproduction technologies (ART) are considered the ultimate step in the treatment of infertility. Recently, artificial intelligence (AI) has been progressively used in the many fields of medicine, integrating knowledge and computer science through machine learning algorithms. AI has the potential to improve infertility diagnosis and ART outcomes estimated as pregnancy and/or live birth rate, especially with recurrent ART failure. A broad-ranging review has been conducted, focusing on clinical AI applications up until September 2022, which could be estimated in terms of possible applications, such as ultrasound monitoring of folliculogenesis, endometrial receptivity, embryo selection based on quality and viability, and prediction of post implantation embryo development, in order to eliminate potential contributing risk factors. Oocyte morphology assessment is highly relevant in terms of successful fertilization rate, as well as during oocyte freezing for fertility preservation, and substantially valuable in oocyte donation cycles. AI has great implications in the assessment of male infertility, with computerised semen analysis systems already in use and a broad spectrum of possible AI-based applications in environmental and lifestyle evaluation to predict semen quality. In addition, considerable progress has been made in terms of harnessing AI in cases of idiopathic infertility, to improve the stratification of infertile/fertile couples based on their biological and clinical signatures. With AI as a very powerful tool of the future, our review is meant to summarise current AI applications and investigations in contemporary reproduction medicine, mainly focusing on the nonsurgical aspects of it; in addition, the authors have briefly explored the frames of reference and guiding principles for the definition and implementation of legal, regulatory, and ethical standards for AI in healthcare.

P-115 The ageing sperm: molecular mechanisms underlying the age-associated decline in human sperm quality

Abstract Study question Are there ageing-related alterations in human sperm protein and small RNA content that can be responsible for the age-associated decline in male fertility? Summary answer Our results revealed a set of proteins and small RNAs, particularly miRNAs, that are altered in older men. What is known already Male infertility is a common health problem strongly influenced by lifestyle and environment. Advanced paternal age, in particular, has been largely associated with alterations in testicular structure and function, impaired semen parameters and DNA integrity, lower pregnancy rates and decline in offspring fitness. The decline in sperm quality with age was also associated with an increase in oxidative stress. However, only a few studies reported the deregulation of specific sperm proteins or RNAs associated with this risk factor for male infertility. Study design, size, duration A hundred and twenty Portuguese men from the Aveiro region were recruited between January 2019 and December 2020 at Hospital Infante D. Pedro E.P.E. (Aveiro, Portugal). All donors provided semen samples for in vitro studies with human spermatozoa. Samples were divided into four groups according to men’s age: (G1) less than 30 years; (G2) between 30 and 35 years; (G3) between 35 and 40 years and (G4) more than 40 years. Participants/materials, setting, methods One hundred twenty human sperm samples from volunteer donors were included in this study. Basic semen analyses were performed according to WHO’s guidelines. To avoid the possible contamination by somatic cells, density gradient sperm selection was performed. Nineteen normozoospermic human sperm samples were divided into four groups according to their age and their proteome was evaluated by quantitative proteomic analysis. The small RNA content of sixteen human sperm samples was investigated using small RNA sequencing. Main results and the role of chance In this study 120 men aged between 19- and 56-years old (mean age 35.2 ± 6.32 years) were recruited. Our data showed no correlation between paternal age and any seminal parameter investigated, contrary to what was previously described in other study populations. Proteomic analyses revealed 46 differentially expressed proteins (DEPs) between the four study groups (p-value< 0.05;|log2FC|=1.5). In particular, lysosomal protein LAMP1 was significantly upregulated in sperm from men younger than 30 years old compared with men with more than 35 years old. In men younger than 35 years old, cytochrome c oxidase subunit 3 (MT-CO3) and DnaJ homolog subfamily A member 1 (DNAJA1) were consistently downregulated in relation to sperm from men aged between 35 and 40 years old. Gene ontology analysis of all the deregulated sperm proteins shown that response to unfolded protein, positive regulation of mitochondrion organization, negative regulation of phosphoprotein phosphatase activity, positive regulation of apoptotic process, and spermatogenesis are common biological processes affected. Transcriptomic analysis identified 5 differentially expressed miRNAs (DEMs) between the four groups studied (p-value< 0.05), among which has-miR-374c-3p and miR-103a-3p were significantly upregulated in men younger than 35 years old compared to sperm from men aged between 35 and 40 years old. Limitations, reasons for caution The major limitations of this study are the relatively small sample size and the limited number of participants younger than 20 years and older than 45 years. Additionally, we cannot exclude the influence of unmeasured confounders, including lifestyle factors such as alcohol consumption, diet, exercise, and stress, in our findings. Wider implications of the findings Despite reproductive history and basic semen analysis being the primary steps in the assessment of male infertility, this routine examination is insufficient to explain almost 30% of the cases. The DEPs and DEMs identified could help to elucidate and/or became potential diagnostic markers for age-associated decline in human sperm quality. Trial registration number not applicable

PD09-02 USE OF A NEW EPIGENETIC SPERM QUALITY TEST (SPERMQT) FOR MEN SEEKING FERTILITY CARE

You have accessJournal of UrologyCME1 May 2022PD09-02 USE OF A NEW EPIGENETIC SPERM QUALITY TEST (SPERMQT) FOR MEN SEEKING FERTILITY CARE Chad Pollard, Ryan Miller, Kristin Brogaard, and Larry Lipshultz Chad PollardChad Pollard More articles by this author , Ryan MillerRyan Miller More articles by this author , Kristin BrogaardKristin Brogaard More articles by this author , and Larry LipshultzLarry Lipshultz More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002535.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: New technology and diagnostics are needed for better assessment of male infertility. The mainstay of male factor infertility diagnosis is the standard semen analysis (sperm concentration, motility, and morphology) has changed very little over the last several decades and has been shown to have limited value. Here we complete a prospective analysis of men seeking fertility care using a newly available epigenetic sperm quality test (SpermQT). METHODS: SpermQT was run on 50 sperm samples from consented patients at a single academic center. The SpermQT was developed and validated by a university associated bioscience company and is now available commercially. SpermQT looks specifically at DNA methylation sperm patterns at 10,000 promoters and has shown an 84% PPV for identifying men at high risk for no live birth from IUI or natural conception, and needing IVF with ICSI. Semen parameters, hormones, medications, health history, fertility treatments, and outcomes were analyzed for each sample, with 30 of the 50 samples having pregnancy data to date. Associations between the SpermQT results and the provided data were examined using standard statistical methods. RESULTS: Analysis was completed on all samples that passed the quality control measures of the SpermQT. In the 50 samples analyzed, 22% had the SpermQT high-risk result (N=11). Of the 22% with a high-risk result, 73% of the men had normal semen parameters (concentration and motility). There was no statistically significant difference between the high-risk and low-risk between chronological ages, epigenetic sperm ages, % motility, smoking status, alcohol consumption, and BMI. However, for concentration the high-risk group had a statistically significant higher sperm concentration compared to the low-risk group (p=0.007) attesting to the unique quality of the epigenetic testing. Pregnancy outcomes were known for 30 out of the 50 patients, with 7% (N=2) achieving pregnancy to date. 100% of the pregnancies were from men with a low-risk result, and no man with a high-risk result has yet established a pregnancy. CONCLUSIONS: Epigenetics is a growing field of scientific interest that is only starting to have an impact on the field of male infertility. Here we show the epigenetic sperm quality high-risk result is irrespective of semen quality. With continued collection of data for pregnancy outcomes we can further assess its utility in clinical care. The uniqueness of epigenetics is that it can be modified with lifestyle, which is a feature that can be leveraged in future research and has potential for the treatment of patients. Source of Funding: Burnett Research Fund © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e177 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Chad Pollard More articles by this author Ryan Miller More articles by this author Kristin Brogaard More articles by this author Larry Lipshultz More articles by this author Expand All Advertisement PDF DownloadLoading ...

Evaluation and assessment of male infertility in Primary care; A review

Infertility is a common condition seen in primary care practices. The World Health Organization estimates that 9% of couples worldwide struggle with fertility issues and that the male factor contributes to 20-30% of all infertility cases. The diagnosis of infertility in men is primarily based on semen analysis. The main parameters of semen include concentration, appearance, and motility of sperm. Recently, the demand for infertility services has increased, and infertile couples are seen frequently by primary care physicians. A flexible, patient-centred approach is indicated. This article outlines the Family Physician`s evaluation of male infertility and indications for referral to a male infertility specialist. Key words: Male infertility, primary care, spermatogenesis, azoospermia.

Application of real-time shear wave elastography in the assessment of male infertility.

Shear wave elastography (SWE) is recognized as a suitable imaging modality for identifying and characterizing testicular diseases. Recent exploration of SWE has focused on its feasibility in evaluating histopathological changes in the testicular parenchyma, with researchers increasingly focusing on the relationship between testicular stiffness and male fertility. In this study, we aimed to investigate the diagnostic value of SWE for distinguishing the relationship between spermatogenic defects and testicular stiffness in males of reproductive age. This was a single center, cross-sectional study conducted from July 2017 to December 2019. A total of 1,116 consecutive patients who were voluntarily participating in in-vitro fertilization (IVF)-assisted conception at our hospital were recruited to the study. The cohort included 497 normozoospermia patients (Group I), 335 with normozoospermia and decreased motility and agglutination (Group II), 138 with oligozoospermia (Group III), 105 with non-obstructive azoospermia (Group-NOA), and 41 with obstructive azoospermia (Group-OA). We conducted SWE of each participant's testes and the testicular elastic modulus was calculated. The differences of testicular elastic modulus were compared among groups. Linear regression analysis was conducted to determine the correlation between sperm concentration and either testicular volume or testicular elastic modulus. Receiver operating characteristic (ROC) curves were drawn to evaluate the diagnostic efficiency of the maximum elastic modulus (Emax), mean elastic modulus (Emean), and maximum minus the minimum elastic modulus {E[max-min]}. The Emax, Emean, and E[max-min] increased gradually in groups I, II, III, and Group-NOA, with statistical differences between groups (P<0.01). Testicular volume was shown to be positively correlated with sperm concentration (r=0.476; P<0.01), while the Emax, Emean, and E[max-min] were negatively correlated with sperm concentration (r=-0.511, -0.357, and -0.524, respectively; P<0.01). The ROC curves were established based on the Emax, Emean, and E[max-min] and were used to distinguish Group-OA from Group-NOA. The areas under the ROC curve (AUCs) were 0.910, 0.863, and 0.900, respectively. We also used ROC curves to distinguish the severe oligozoospermia subgroup and Group-NOA from other groups, for which the AUCs were 0.877, 0.791, and 0.878, respectively. The SWE is an effective supplement to routine ultrasound examination and can be used to diagnose and differentiate spermatogenetic dysfunction.

Sperm DNA Fragmentation in Reproductive Medicine: A Review.

Approximately 15% of the world's couples suffer from infertility during their reproductive period of which the male factor is responsible for 50% of cases. Male factor infertility is multifactorial in origin, and sperm DNA fragmentation (SDF) has also been linked to male infertility including idiopathic male infertility. Some degree of controlled DNA nicking is essential for adequate DNA compaction, but excessive SDF is usually associated with reduced male fertility potential, reduced fertilisation, poor embryo quality, recurrent pregnancy loss and poor assisted reproductive techniques (ARTs) outcomes. Although semen analysis remains the gold standard for diagnosis of male factor infertility worldwide, its limitations motivated the search and the development of complementary tests of sperm function and integrity. SDF assay is an emerging diagnostic tool in infertile men, and several indications for SDF testing in infertile couples have also been proposed. The use of SDF in routine male infertility assessment is, however, still controversial. Furthermore, both direct and indirect SDF tests are now available. Hence, the present review was conducted to summarise the recent evidence of SDF, underlying mechanisms, clinical indications, diagnostic tests, as well as the role of SDF in male factor infertility, pregnancy and ART outcomes.

The Gender Gap in the Diagnostic-Therapeutic Journey of the Infertile Couple.

Medical procreation impairs both the biological and psychological lives of couples. However, male and female attitudes to infertility are different and require a different approach during the IVF journey. Thus, the gender impact assessment (GIA) method was used to analyse original studies present in the literature. We found some gender-related differences and, subsequently, possible outcomes of intervention to improve healthy reproduction management and prevent infertility. In particular, it became apparent that there was the need for an in-depth male infertility assessment and a gender-specific follow-up.

European Association of Urology Guidelines Panel on Male Sexual and Reproductive Health: A Clinical Consultation Guide on the Indications for Performing Sperm DNA Fragmentation Testing in Men with Infertility and Testicular Sperm Extraction in Nonazoospermic Men

Accumulating evidence has highlighted the contribution of oxidative stress and sperm DNA fragmentation (SDF) in the pathophysiology of male infertility. SDF has emerged as a novel biomarker of risk stratification for patients undergoing assisted reproductive technologies. Studies have also supported the use of testicular over ejaculated sperm at the time of intracytoplasmic sperm injection, as testicular sperm may have lower SDF than ejaculated samples. The European Association of Urology Working Panel on Male Sexual and Reproductive Health provides an evidence-based consultation guide on the indications for SDF testing in male infertility and also for testicular sperm extraction (TESE) in nonazoospermic men. We present the limitations and advantages of SDF testing and a framework to ensure that it is appropriately utilised in clinical practice. Furthermore, we critically appraise the current literature advocating the use of TESE in nonazoospermic men. Patient summaryThis article reviews the evidence supporting the use of sperm DNA fragmentation testing in the assessment of male infertility and testicular sperm extraction in nonazoospermic men.

LABORATORY DIAGNOSTICS OF MALE INFERTILITY. BIOMARKERS AND METHODS. Part II

The new paradigm have been arise concerning to samples, markers and methods for assessment of male infertility. Nowadays, a sample “semen” and “sperm sediment” take a key role in examination and management of the subfertile couple. The advantages of sample “semen” such as non-invasive painless procedure as well as the wider range of diagnostic findings by number of methods (cytology, molecular and cultural) highlight the increasly importance of this diagnostic approach in comparison with conventional ones – prostate secretion and urethral scraping which obtained by invasive procedures – by massage and damaging a mucus membrane, respectively. According to the Russian register this review also presents the current situation with the work list of kits and devices for assessment of male infertility and inflammatory of male accessory glands.

Should Scrotal Color Doppler Ultrasound Be Routinely Indicated in Fertility Evaluation of Non-Azoospermic Men?

Objective: Scrotal ultrasound is not a routine investigation in the clinical approach to male infertility analysis. This study aims to identify the role of testicular Doppler ultrasound in male infertility assessment and its relation to semen parameters in non-azoospermic men. Methods: Cross-sectional descriptive analysis of 558 men from infertile couples were examined at the Hue Center for Reproductive Endocrinology and Infertility, Hue University Hospital from June 2016 to May 2018. Some cohort characteristics, semen analysis and testicular Doppler ultrasound were analyzed. Men with acute systemic diseases, acute urinary tract infection, hepatic dysfunction, malignant diseases, retrograde ejaculation, cryptorchidism or azoospermia were excluded. Results: The mean volumes of the right and left testicles were 8.87 and 8.77 ml, respectively. The total volume of the 2 sides was 17.63 ± 4.34 ml (95% confidence interval 17.27-18.00 ml). The mean right resistive index (RI) was 0.61 ± 0.23, and the mean left RI was 0.59 ± 0.01. The rate of normal semen quality was 23.2% in group with varicocele and 30.6% in group with non-varicocele. The ultrasound results from the normal semen group were much different from those of the abnormal semen group regarding testicular volume: mean right testis volume: 9.67 ± 1.88 vs. 8.75 ± 2.34 ml, p = 0.0096; mean left testis volume: 9.54 ± 1.78 vs. 8.51 ± 2.44 ml, p = 0.0047; mean total volume of 2 sides: 19.21 ± 3.60 vs. 17.26 ± 4.59 ml, p = 0.005 (varicocele group); mean right testis volume: 9.21 ± 2.21 vs. 8.63 ± 2.21 ml, p = 0.029 (non-varicocele group). The other indexes of color Doppler ultrasound (peak systolic velocity, end diastolic velocity, RI) were not found to correlate with semen quality. Conclusions: Testicular volume which has a close relation to the semen parameters could be used as a clinical prediction factor for the quality of semen.

Deep Learning-Based Morphological Classification of Human Sperm Heads.

Human infertility is considered as a serious disease of the reproductive system that affects more than 10% of couples across the globe and over 30% of the reported cases are related to men. The crucial step in the assessment of male infertility and subfertility is semen analysis that strongly depends on the sperm head morphology, i.e., the shape and size of the head of a spermatozoon. However, in medical diagnosis, the morphology of the sperm head is determined manually, and heavily depends on the expertise of the clinician. Moreover, this assessment as well as the morphological classification of human sperm heads are laborious and non-repeatable, and there is also a high degree of inter and intra-laboratory variability in the results. In order to overcome these problems, we propose a specialized convolutional neural network (CNN) architecture to accurately classify human sperm heads based on sperm images. It is carefully designed with several layers, and multiple filter sizes, but fewer filters and parameters to improve efficiency and effectiveness. It is demonstrated that our proposed architecture outperforms state-of-the-art methods, exhibiting 88% recall on the SCIAN dataset in the total agreement setting and 95% recall on the HuSHeM dataset for the classification of human sperm heads. Our proposed method shows the potential of deep learning to surpass embryologists in terms of reliability, throughput, and accuracy.

Correlation between Semen Analysis and Testicular Shear-Wave Elastography in Patients with Testicular Varicocele

Background: Varicocele is an abnormal dilation and tortuosity of the internal spermatic veins within the pampiniform plexus Varicocele is common among adolescents and may contribute significantly to the risk of subfertility in adulthood. They are found in about 15% of adult males and 20–40% of all infertile men. Objective: To find correlation between shear wave elastography result and semen analysis in cases of varicocele. Methods: This prospective study was carried out on 66 patients with primary infertility and clinically detectable varicocele who admitted to the Urology Department Andrology Unit, Zagazig University hospitals during the period from 15/3/2018 to 15/9/2018. Testicular SWE was done for all patients, computer-assisted semen analysis and duppler scrotal ultrasound. Results: Showed that the most varicose character was bilateral grade III of testicular varicocele with primary complain. The highest SWE was 4.27and the lowest SWE was 1.84. SWE was significantly negative correlated with motility and count. On the other hand, there was a non significant negative correlation between SWE stiffness index and progress motility. Conclusion: Our study showed that Testicular SWE is a good test easily applicable and repeatable imaging method, has the potential to be used in the assessment of male infertility with clinically detectable varicocele.

Fine-Needle Aspiration Cytology of the Testes for the Classification of Azoospermia and Its Value in the Assessment of Male Infertility

Background: Infertility is an ever-increasing problem in today’s world. It can be due to male or female causes. Azoospermia seen in 5–10% of infertile men is due to obstructive or non-obstructive causes. Traditionally, testicular biopsy is the gold standard for evaluation. Fine-needle aspiration (FNA), however, is minimally invasive, provides qualitative and quantitative information about spermatogenesis, and can aid in assisted reproductive techniques making it a novel technique for the evaluation of male infertility. Objective: We aimed to classify different causes of azoospermia into different patterns based upon FNA, and assess the utility of cell indices in classifying cases into different patterns. Method: We conducted a prospective and a retrospective study of 42 azoospermic males, confirmed on semen analysis, over a period of 5 years. Patients were subjected to FNA of the testes. Smears were prepared, air-dried, wet-fixed, and then stained with May-Grünwald Giemsa and Papanicolaou stains, respectively. Cells were identified using predetermined morphologic criteria, and various indices were calculated followed by statistical analysis of the observations. Results: The mean age of 40 patients who satisfied the adequacy criteria was 32.75 years (range 22–48 years). Thirty-four patients had primary infertility and 6 had secondary infertility. Of these, 12 had normal spermatogenesis, 8 had hypo-spermatogenesis, 3 had early and 7 had late maturation arrest, 6 had Sertoli cell-only syndrome (SCOS), and there were different results in each testicle in 4 cases. The Sperm Index (SI) was significantly higher in all cases of normal spermatogenesis than in any of the hypo-spermatogenesis cases (p = 0.009). The Sertoli Index (SEI) in cases of hypo-spermatogenesis and maturation arrest was significantly higher than in cases of normal spermatogenesis (p < 0.001). The Sperm-Sertoli Index (SSI) also showed significant differences between cases of hypo-spermatogenesis and normal spermatogenesis (p < 0.001). These indices were useful in categorising patients with azoospermia. Conclusion: FNA helps to easily and accurately identify all types of testicular cells without biopsy. SI, SEI, and SSI are powerful cell indices for assessing the extent of spermatogenesis and classifying various causes of azoospermia. Bilateral sampling and multiple aspirations give a better mapping of spermatogenesis within the testes. Testicular FNA can thus play a very important role in the evaluation of male infertility.

Obesity and metabolic syndrome associated with systemic inflammation and the impact on the male reproductive system.

Obesity and metabolic syndrome (MetS) are global epidemics, driven by an obesogenic environment. This is mediated by complex underlying pathophysiology, in which chronic inflammation is an important aetiological and mechanistic phenomenon. A shift towards a subclinical TH 1-lymphocyte mediated innate and chronic inflammatory response is well defined in obesity and MetS, demonstrated in multiple systems including visceral adiposity, brain (hypothalamus), muscles, vasculature, liver, pancreas, testes, epididymis, prostate and seminal fluid. Inflammatory cytokines disrupt the hypothalamic-pituitary-testes axis and steroidogenesis cascades (hypogonadotropic hypogonadism), spermatogenesis (poor semen parameters, including DNA fragmentation and detrimental epigenetic modification) and results in subclinical prostatitis and prostate hyperplasia. This review aims to highlight the role of chronic inflammation in obesity and MetS, cytokines in male reproductive physiology and pathophysiology, the impact on steroidogenesis and spermatogenesis, prostate pathology and erectile dysfunction. Currently, it is recommended that clinical assessment of male infertility and reproductive dysfunction in obese and MetS patients includes inflammation assessment (highly sensitive C-reactive protein), and appropriate advice and therapeutic options are incorporated in the management options. However, the mechanisms and therapeutic options remain poorly understood and require significant interdisciplinary research to identify potential novel therapeutic strategies.

Assessment of Male Infertility

As a result of modern life, postponement of gestational age, obesity, electromagnetic waves, hormone and genetically modified foods, stress, smoking and alcohol use and sexually transmitted diseases directly cause negative effects on human health. The reproductive system, which is sensitive to environmental changes, is the most affected. In recent years, the usage of assisted reproductive techniques led to an increase in the number of men as well women who consults health institutions for assistance in conception. Because factors pertaining to males comprise half of all fertility problems. In this context, all these factors should be considered when assessing infertile men. Nowadays, many new methods such as endocrine tests, sperm analysis, radiological evaluation, testis biopsy, immunological tests and sperm function tests have been developed to diagnose and assess male infertility. Thanks to these methods, fertility success rates have increased. Therefore, when assessing infertile males, nurses should determine the condition causing fertility, provide accurate information about the prognosis, provide counseling during the research, provide support and training, and offer treatment options according to the evaluation results.&#x0D; Keywords: Infertility assessment, male infertility, fertility, nursing.

Use of Ultrasound in Male Infertility: Appropriate Selection of Men for Scrotal Ultrasound.

Male factor infertility is a complex and multifaceted problem facing the modern urologist and is identified in 30-40% of infertile couples. This review focuses on the use of ultrasound, as an adjunct screening tool, in the initial evaluation of male infertility. Access to male reproductive urologist for assessment of male infertility is limited and about a quarter of infertile couples do not complete the male component in their infertility assessment. Ultrasound evaluation of the infertile male is low-cost and non-invasive and helps uncover underlying pathologies that may be missed during the initial assessment. The addition of ultrasound allows the physician to accurately assess testicular anatomy and dimensions, as well as vascular environments, which may help guide treatment decisions. Scrotal ultrasound evaluation, in conjunction with a semen analysis and as an adjunct to physical exam, can be offered in the initial assessment of men who present for infertility consultation given its low cost, non-invasive nature, and ability to detect and discriminate between various etiologies of male infertility. Further, when directed by physical exam and semen analysis findings, it provides a valuable tool to select men for referral to a reproductive urologist, especially for infertile couples who are only screened by reproductive endocrinologists and female infertility specialists.