Diagnosis Of Male Factor Infertility Research Articles

P-038 Sperm head morphometric reference values of 1856 sperms in fertile Asian males

Abstract Study question To explore comprehensive normal sperm morphometric reference values by measuring 1856 sperms in fertile males using artificial intelligence (AI) technique. Summary answer Four novel describing parameters of sperm head (size, shape, area, and uniformity) and 14 other features for normal sperm head were extracted and characterized. What is known already Sperm head morphology is crucial for male factor infertility diagnosis and assessment of male reproductive potential. The human spermatozoon is one of the most diverse cell types known. However, most assessment criteria have only 3 morphometric parameters (Length, width, and length/width ratio) for sperm head morphometric measurement. We detailed the features of sperm head by defining and characterizing 14 parameters based on AI. Study design, size, duration This is a prospective observational study. The study included 1856 normal sperm images from 23152 stained sperm acquired by an Automated Sperm Morphology Analysis (ASMA) system. The measured sperm morphometry data were acquired from May 2020 to December 2021. Participants/materials, setting, methods All participants (54 fertile males) had fathered a child naturally during the past year. The measured sperm morphometry data were acquired from candidate donors of the Sichuan Province Human Sperm Bank (SPHSB, Chengdu, China). Images of 23,152 stained sperm captured by ASMA. All sperm images were assessed by three experienced technicians. Finally, we concluded 14 morphometric data from normal sperm by measuring sizes in pixels. Main results and the role of chance (1) Characteristics of sperm head size and shape: We present eight sperm head size and shape parameters for the 1856 visually normal spermatozoa. The median head size parameters included head length of 4.02 (95% CI: 4.01–4.05) μm, head width of 2.52 (95% CI: 2.52–2.54) μm, length to width ratio of 1.59 (95% CI: 1.59–1.62), and head girth of 11.18 (95% CI: 11.17–11.25) μm. The median head symmetry parameters included short axis symmetry (SAS) of 92.1% (95% CI: 88.3%–89.2%) and the long axis symmetry (LAS) of 94.3% (95% CI: 91.6%–92.3%). The median head shape parameters included median of ellipse intersection over union (EIoU) of 88.9% (95% CI: 85.4%–86.3%) and girth intersection over union (GIoU) of 102.4% (95% CI: 102.4%–102.5%). (2) Characteristics of sperm head area and acrosome uniformity: Descriptive analysis of the sperm head area characteristics included a median sperm head area of 7.72 (95% CI: 7.74–7.85) μm2, acrosome area of 3.67 (95% CI: 3.77–3.88) μm2, acrosome area ratio of 48.2% (95% CI: 47.8%–48.6%), post-acrosomal area of 3.95 (95% CI: 3.95–4.00) μm2, acrosome uniformity of 88.6% (95% CI: 88.6%–89.1%), and nuclear uniformity of 100.0% (95% CI: 99.8%–99.9%). Limitations, reasons for caution This study had several limitations that should be noted. The use of samples from a single center, covering relatively young participants from only seven provinces in China, could limit the usage of our findings. The use of only three technicians to assess the samples may have introduced a subjective bias. Wider implications of the findings The measurement technique was accurate, objective, and highly informative by AI. The data provide extremely detailed information for reference studies and comparison of sperm head parameters among different male groups. These new parameters can be applied in routine semen analysis when assessing sperm morphology and male fertility potential. Trial registration number not applicable

The psychosocial impact of male infertility on men undergoing ICSI treatment: a qualitative study.

Male infertility is in 20-70% of cases the cause of a couple's infertility. Severe forms of male infertility are best treated with Intracytoplasmic Sperm Injection (ICSI). The psychosocial impact of infertility and ICSI on men is unclear because the focus is socially, clinically, and scientifically on women. However, there is evidence that it can affect the psychological well-being of men, but these studies are mainly quantitative. Qualitative research needed to explore the experiences of infertile men in-depth is limited. Therefore, the objective of this study was to clarify the psychosocial consequences of male infertility on men undergoing ICSI to understand their experiences with reproduction problems more comprehensively. In this generic qualitative study, men who were undergoing or had undergone ICSI after a male factor infertility diagnosis were included. A purposive sample with maximum variation was sought in a fertility clinic of one university medical centre in the Netherlands. Data were collected through individual face-to-face semi-structured interviews. Thematic analysis was used to identify themes from the data. Nineteen Dutch men were interviewed. The mean duration of the interviews was 90min. An everyday contributing backpack was identified as the main theme, as men indicated that they always carried the psychosocial consequences of infertility and ICSI with them. Different world perspective, Turbulence of emotions, Changing relation, and Selective sharing were the psychosocial consequences that men were most affected by. Moreover, men indicated that they were Searching for contribution during ICSI because the focus was entirely on the woman. Men with male infertility experience psychosocial problems due to infertility and ICSI treatment. Healthcare professionals need to recognize the impact of infertility on men and create room for a role for them during ICSI.

Normal sperm head morphometric reference values in fertile Asian males.

Sperm head morphology is crucial for male factor infertility diagnosis and assessment of male reproductive potential. Several criteria are available to analyze sperm head morphology, but they are limited by poor methodology comparability and population applicability. This study aimed to explore comprehensive and new normal morphometric reference values for spermatozoa heads in fertile Asian males. An automated sperm morphology analysis system captured 23 152 stained spermatozoa from confirmed fertile males. Of these samples, 1856 sperm head images were annotated by three experienced laboratory technicians as "normal". We employed 14 novel morphometric features to describe sperm head size (head length, head width, length/width ratio, and girth), shape (ellipse intersection over union, girth intersection over union, short-axis symmetry, and long-axis symmetry), area (head, acrosome, postacrosomal areas, and acrosome area ratio), and degrees of acrosome and nuclear uniformity. This straight-forward method for the morphometric analysis of sperm by accurate visual measurements is clinically applicable. The measured parameters present valuable information to establish morphometric reference intervals for normal sperm heads in fertile Asian males. The presented detailed measurement data will be valuable for interlaboratory comparisons and technician training. In vitro fertilization and andrology laboratory technicians can use these parameters to perform objective morphology evaluation when assessing male fertilization potential.

#355 : “No One Asked Me If I’m Alright”: A Mixed Methods Study Exploring Information/Support Needs and Challenges Engaging Men Diagnosed with Male-Factor Infertility

Background and Aims: Men desire to be actively involved in preconception care. However, health systems do not consistently or proactively engage men and there is little acknowledgement of their needs during this time. The lack of gender-specific service provision in infertility treatment likely contributes to men’s poorer mental wellbeing following infertility diagnosis and infertility treatment. This research sought to understand males’ psychosocial and support needs when diagnosed with male-factor infertility. Method: Mixed methods design, assessing men who had undergone diagnosis and/or treatment for male-factor infertility in past five years within Australia. Study comprised: 1) online survey (assessing psychological functioning, fertility knowledge, information sources, social support and perception of resources) and 2) semi-structured interviews to further explore participants’ lived experiences of male-factor infertility. Participants were recruited through Andrology clinics, social media, infertility support pages and ANZICA counsellors. Results: During their infertility journeys, participants mostly received information fertility doctors/nurses and the internet. However, their preferred method of informational knowledge would be through a verified male infertility website. Qualitative data were analysed by reflexive thematic analysis, which resulted in three key themes, each with two sub-themes, summarising pertinent aspects of men’s lived experiences when diagnosed with male-factor infertility (Figure 1). The majority of participants were in later stages of their fertility journey, indicating they felt more prepared to discuss their experiences given most (or all) of the initial-stage emotional and physical intensity of their diagnosis and active treatment had passed. Conclusion: There is a clear need for in/fertility services to implement proactive support approaches that engage directly with male patients and acknowledge the complexity of lived experiences when receiving a diagnosis of male-factor infertility.

"No One Asked Me If I'm Alright": A Mixed-Methods Study Exploring Information/Support Needs and Challenges Engaging Men Diagnosed With Male-Factor Infertility.

There is limited research exploring men's experiences of infertility, and fewer previous studies have examined what information and support men desire after being diagnosed specifically with male-factor infertility. We conducted a mixed-methods study utilizing a combined sequential, concurrent design (online survey/semi-structured interviews). Survey outcomes (N =12) were analyzed using quantitative data analysis, while qualitative survey data (N = 5) was analyzed by reflexive thematic analysis. Heterosexual men (>18 years), fluent in English, diagnosed solely with male-factor infertility/sub-fertility, who required assisted reproductive treatment within Australia in the past 5 years were recruited online and through fertility clinics Australia-wide. Most men reported that their information and support needs were only somewhat, slightly or not at all met. Preferred information sources on male infertility were a dedicated online resource, app, or fertility doctor/specialist, while support was preferred from fertility specialists and partners. Three themes were identified from the qualitative analysis about men's experiences and support needs when diagnosed with male infertility (a) Ultimate threat to masculinity; (b) Holistic care, and (c) the power of words. The information-rich data collected provided valuable insights into men's experiences of male-factor infertility and important considerations to improve recruitment for future research. A diagnosis of male-factor infertility has the potential to be deeply impactful and difficult to navigate for men. Adequate and holistic information, recognition of emotional impacts, proactive offers of support and sensitive language are needed to improve men's experiences when undergoing assisted reproductive technology.

Frozen embryo transfer outcomes decline with increasing female body mass index in female but not male factor infertility: analysis of 56,564 euploid blastocyst transfers

ObjectiveTo evaluate the association of body mass index (BMI) with cycle outcomes after euploid frozen blastocyst transfer. DesignRetrospective cohort study. SettingNot applicable. Patient(s)A total of 56,564 first single autologous euploid frozen embryo transfers (FET) from the 2016-2019 Society for Assisted Reproductive Technology database were analyzed by BMI and by World Health Organization BMI cohorts. Sub-analyses were performed on cycles among patients with a sole diagnosis of polycystic ovary syndrome (PCOS) (n = 4,626) and among patients with only male factor (n = 10,854). Intervention(s)None. Main outcome measure(s)Clinical pregnancy, pregnancy loss, and live birth. Results(s): Success rates and adjusted odds ratios (aORs) with 95% confidence intervals (CIs) for all outcomes were most favorable among those with normal BMI and progressively worsened with increasing BMI. These trends persisted among patients with PCOS for clinical pregnancy (aOR 0.99, 95% CI 0.98-0.997, p 0.003), pregnancy loss (aOR 1.02, 95% CI 1.01-1.04, p 0.01), and live birth (aOR 0.98, 95% CI 0.97-0.99, p <0.001), but not among patients with male factor only for clinical pregnancy (aOR 1.00, 95% CI 0.99-1.01, p 0.425), pregnancy loss (aOR 1.01, 95% CI 0.99-1.03, p 0.07), or live birth (aOR 0.99, 95% CI 0.98-1.00, p 0.08). Conclusion(s): In the largest cohort to date, increasing BMI was associated with decreased pregnancy and live birth and increased pregnancy loss following euploid FET among the entire cohort and among patients with a sole diagnosis of PCOS; however, these results were attenuated among patients with a sole diagnosis of male factor infertility, suggesting that associated female infertility diagnoses and not BMI alone may underly this trend.

PD18-04 PROSPECTIVE VALIDATION OF AN EPIGENETIC SPERM QUALITY TEST FOR MEN SEEKING FERTILITY CARE

You have accessJournal of UrologyCME1 Apr 2023PD18-04 PROSPECTIVE VALIDATION OF AN EPIGENETIC SPERM QUALITY TEST FOR MEN SEEKING FERTILITY CARE Kristin Brogaard, Ryan Miller, Jordan Kassab, Jabez Gondokusumo, Sabine Itani, Mohamad Jabin, and Larry Lipshultz Kristin BrogaardKristin Brogaard More articles by this author , Ryan MillerRyan Miller More articles by this author , Jordan KassabJordan Kassab More articles by this author , Jabez GondokusumoJabez Gondokusumo More articles by this author , Sabine ItaniSabine Itani More articles by this author , Mohamad JabinMohamad Jabin More articles by this author , and Larry LipshultzLarry Lipshultz More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003273.04AboutPDF 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 that has changed very little over the last several decades and has been shown to have limited predictive value. Here we present results on the analysis of men seeking fertility care using a newly available epigenetic sperm quality test (SpermQT). METHODS: SpermQT is a newly developed assessment of sperm quality that identifies male factor infertility missed by the standard semen analysis. SpermQT results are highly predictive of pregnancy in individuals undergoing IUI. Specifically, SpermQT looks at DNA methylation profiles of 1233 promoters and calculates deviations in these profiles away from a healthy state. The accumulation of gene promoters that differ from the defined healthy state is associated with poorer fertility outcomes. SpermQT was run on 157 semen samples from consented patients at a single academic center. Semen parameters, hormones, medications, health history, fertility treatments, and outcomes were compared to the SpermQT result for each sample, with pregnancy and live birth data continually being collected. RESULTS: In the 157 samples analyzed, 17% had a Poor SpermQT results (N=26). Of the 17% with a Poor result, 92% had normal semen. Additionally, there was no significant relation between SpermQT, age (r2=0.0008), DFI (r2=0.00005), and BMI (r2=0.002). Men on antioxidant treatment tended to have fewer unstable promoters (p=0.06) compared to those not on antioxidant treatment, while men with a history of THT (N=20) have more unstable promoters (p=0.02) than those without (N=1-6). Only 12 men in the study had pregnancy outcomes associated with IUI. Within these 12, individuals with a pregnancy from IUI had an average of 5.6 unstable promoters (std 3.5) while individuals unable to achieve pregnancy had an average of 19.8 unstable promoters (std 19.8). No statistical differences was identified in the number of unstable promoters between men with or without a pregnancy who underwent IVF-ICSI (p=0.4). CONCLUSIONS: Here we support earlier findings that SpermQT identifies men who would be missed by standard laboratory techniques as the number of unstable promoters in SpermQT is not correlated with semen parameters, age, and BMI. Early data indicates that men unable to conceive with IUI have a dominance of unstable promoters; however, more outcomes data is needed to verify these early results. Using these data, SpermQT can direct clinicians the most effective treatment. Source of Funding: NSF - SBIR © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e503 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kristin Brogaard More articles by this author Ryan Miller More articles by this author Jordan Kassab More articles by this author Jabez Gondokusumo More articles by this author Sabine Itani More articles by this author Mohamad Jabin More articles by this author Larry Lipshultz More articles by this author Expand All Advertisement PDF downloadLoading ...

Possible Gender Differences in the Level of Perceived Social Support in Couples Who Are Experiencing Issues With Infertility.

ObjectiveThe purpose of this study is to examine whether there are gender differences in the level of perceived social support in couples experiencing issues with fertility.MethodsA total of 938 participants aged 18-47 years, with self-reported issues of infertility, were evaluated using the Multidimensional Scale of Perceived Social Support (MSPSS) which comprises three subscales which correspond with distinct sources of social support: significant other (SO), family, and friends. Differences between sexes for total score and for all subscale scores were subsequently analyzed using SPSS Statistics (IBM Corp, Armonk, USA).ResultsMean total scores and scores on all subscales (SO, family, friend) were higher in women (5.13 ± 1.10, 5.90 ± 1.20, 4.53 ± 1.53, 4.97 ± 1.40, respectively) compared with men (4.43 ± 1.58, 5.04 ± 1.90, 4.06 ± 1.76, 4.20 ± 1.81, respectively), a statistically significant difference of 0.70 (95% CI, -1.11 to -0.28), t(63.018) = -3.360, p = .001), 0.86 (95% CI, -1.35 to -0.36), t(62.277) = -3.452, p = .001, 0.47 (95% CI, -0.94 to -0.01), t(65.219) = -2.039, p = 0.046, 0.76 (95% CI, -1.24 to -0.29), t(63.018) = -3.360, p = 0.002), respectively. Males with male-factor infertility had a statistically significantly lower mean total score than males with female-factor infertility, -2.22 (95% CI, -3.71 to -0.74), p= 0.005. For males and females with male-factor infertility, mean “total” score was 2.73 (95% CI, 1.43 to 4.03) points lower for males than females, F(1,22) = 18.89, p < 0.001, partial η2 = 0.462.ConclusionPerceived social support among individuals experiencing issues with fertility was higher in females than in males across all subscales (SO, family, friends) with the biggest difference seen in SO score. Total scores differed with respect to infertility diagnosis in males but not in females, and amongst males and females with a male-factor infertility diagnosis, total scores were statistically significantly lower in males compared with females. Given the implications of high levels of perceived social support on improved overall well-being, our findings underscore the importance of implementing interventions that are focused on improving perceptions of social support in males experiencing issues with infertility, with specific consideration given to the unique experiences/ challenges and factors that may impact their experience.

Donor sperm recipients: fertility treatments, trends, and pregnancy outcomes.

PurposeTo report fertility treatment use and outcomes among patients who use donor sperm for intrauterine insemination (IUI), in vitro fertilization (IVF), and reciprocal IVF (co-IVF).MethodsThis is a retrospective review of patients who used donor sperm at an urban, southeastern academic reproductive center between 2014 and 2020.ResultsAmong the 374 patients presenting for care, 88 (23.5%) were single, 188 (50.3%) were in a same-sex female partnership, and 98 (26.2%) had a male partner with a diagnosis of male factor infertility. Most patients did not have infertility (73.2%). A total of 1106 cycles were completed, of which there were 931 IUI cycles, 146 traditional IVF cycles, and 31 co-IVF cycles. Live birth rates per cycle were 11% in IUI, 42% in IVF, and 61% in co-IVF. Of all resulting pregnancies, hypertensive disorders were most commonly experienced (18.0%), followed by preterm delivery (15.3%), neonatal complications (9.5%), gestational diabetes (4.8%), and fetal growth restriction (4.8%). Of the 198 infants born, fifteen (8.3%) required admission to the neonatal intensive care unit and three (1.7%) demised. Pregnancy and neonatal complications were more likely to occur in older patients and patients with elevated body mass index.ConclusionThe use of donor sperm for fertility treatment is increasing. These data show reassuring live birth rates; however, they also highlight the risks of subsequent pregnancy complications. With the expansion of fertility treatment options for patients, these data assist provider counseling of patients regarding anticipated cycle success rates and possible pregnancy complications.

Embryologic outcomes among patients using a microfluidics chip compared to density gradient centrifugation to process sperm: a paired analysis.

To evaluate embryologic outcomes among paired IVF cycles in which a microfluidics chip was utilized compared to density gradient centrifugation for sperm processing. This was a retrospective cohort study of 88 paired IVF cycles from patients aged 18-44years at a university-affiliated IVF center. Fresh cycles from patients undergoing ICSI with sperm processed by a microfluidics chamber (microfluidics cycles) were compared to the same patients' previous ICSI cycles in which sperm was processed via density gradient centrifugation (control cycles). The primary outcome was the high-quality blastulation rate. High-quality blastulation rate per oocyte retrieved was significantly higher in the microfluidics group compared to the control group (21.1% versus 14.5%, p < 0.01) as was the blastulation rate per 2PN (42.7% versus 30.8%, p < 0.01). Fertilization rates were significantly higher in the microfluidics group. The euploidy rate per oocyte retrieved was significantly higher in the microfluidics group compared with the control group (8.5% versus 4.3%, p = 0.04), while the euploidy rate per embryo biopsied was comparable (32.6% versus 21.8%, p = 0.09). In patients with male factor infertility, the high-quality blastulation rate was similar between the control and microfluidics cycles. There was a significantly higher blastulation rate among microfluidics cycles in patients without a diagnosis of male factor infertility (p < 0.01). In this study, several embryologic outcomes, including fertilization rate, high-quality blastulation rate, and euploidy rate, were significantly higher in the microfluidics group compared to the control group. Microfluidics sperm processing may be a way to improve embryologic outcomes.

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 ...

Assisted reproductive technology cycles involving male factor infertility in the United States, 2017–2018: data from the National Assisted Reproductive Technology Surveillance System

ObjectiveTo describe the prevalence and treatment characteristics of assisted reproductive technology (ART) cycles involving specific male factor infertility diagnoses in the United States.DesignCross-sectional analysis of ART cycles in the National ART Surveillance System (NASS).SettingClinics that reported patient ART cycles performed in 2017 and 2018.Patient(s)Patients who visited an ART clinic and the cycles were reported in the NASS. The ART cycles included all autologous and donor cycles that used fresh or frozen embryos.Intervention(s)Not applicable.Main Outcome MeasuresAnalyses used new, detailed reporting of male factor infertility subcategories, treatment characteristics, and male partner demographics available in the NASS.Result(s)Among 399,573 cycles started with intent to transfer an embryo, 30.4% (n = 121,287) included a male factor infertility diagnosis as a reason for using ART. Of these, male factor only was reported in 16.5% of cycles, and both male and female factors were reported in 13.9% of cycles; 21.8% of male factor cycles had >1 male factor. Abnormal sperm parameters were the most commonly reported diagnoses (79.7%), followed by medical condition (5.3%) and genetic or chromosomal abnormalities (1.0%).Males aged ≤40 years comprised 59.6% of cycles with male factor infertility. Intracytoplasmic sperm injection was the primary method of fertilization (81.7%). Preimplantation genetic testing was used in 26.8%, and single embryo transfer was used in 66.8% of cycles with male factor infertility diagnosis.Conclusion(s)Male factor infertility is a substantial contributor to infertility treatments in the United States. Continued assessment of the prevalence and characteristics of ART cycles with male factor infertility may inform treatment options and improve ART outcomes. Future studies are necessary to further evaluate male factor infertility.

A dietary score representing the overall relation of men’s diet with semen quality in relation to outcomes of infertility treatment with assisted reproduction

ObjectiveTo examine the impact of men’s diet on outcomes of infertility treatment with assisted reproductive technology (ART) using an empirical score representing the relation of diet with semen quality.DesignProspective cohort study.SettingFertility center at an academic medical center.Patient(s)We included 296 men (688 semen samples) to identify an empirical dietary pattern and 231 couples (406 ART cycles) to investigate the association of this diet pattern with ART outcomes.Intervention(s)Men’s diet was assessed at baseline using a validated questionnaire. An empirical dietary pattern reflecting the overall relation of diet with semen quality was identified using reduced rank regression.Main Outcome Measure(s)The primary outcome was live birth per treatment cycle. The secondary outcomes were fertilization, implantation, and clinical pregnancy.Result(s)Men had a median baseline age and body mass index of 36.8 years and 26.9 kg/m2, respectively. Although the empirical diet pattern was significantly associated with all semen parameters, the empirical diet score was not related to any clinical outcome of infertility treatment after ART. The adjusted probabilities of relevant clinical outcomes in the lowest and highest quartiles of the empirical score were 0.62 (0.50–0.73) and 0.55 (0.45–0.66) for implantation, 0.57 (0.46–0.69) and 0.50 (0.40–0.61) for clinical pregnancy, and 0.49 (0.37–0.62) and 0.36 (0.25–0.48) for live birth. Analyses excluding couples with a diagnosis of male factor infertility and, separately, excluding intracytoplasmic sperm injection cycles yielded similar results.Conclusion(s)A dietary score representing the overall association of diet with semen quality parameters was not associated with ART outcomes.

P–106 The evaluation of dietary score representing the overall effect of men’s diet to semen quality on couple’s fertility

Abstract Study question Is men’s diet associated with assisted reproductive technology (ART) outcomes? Summary answer An empirical dietary score representing the overall effect of men’s diet on semen quality was unrelated to ART outcomes. What is known already Multiple studies have related various aspects of men’s diet to semen quality. Generally, healthier foods, such as fish, vegetables, and fruits, have been related to better semen quality, whereas unhealthy foods, like processed and red meats, have had the opposite relationship. Nevertheless, while bulk semen parameters are important biomarkers of male fertility and a diagnostic cornerstone for male factor infertility, they are imperfect predictors of a couple’s fertility. Study design, size, duration Couples presenting to the Massachusetts General Hospital Fertility Center between April 2007 and April 2018 were invited to participate in the Environment and Reproductive Health (EARTH) study, a prospective cohort study. Men’s diet was assessed with a previously validated food frequency questionnaire. A dietary score reflecting the overall relation of men’s food intake with semen quality parameters was empirically derived using reduced rank regression (RRR). The resulting dietary score was related to ART outcomes. Participants/materials, setting, methods We used information from 349 men (908 semen samples) to derive the empirical diet pattern and data from 231 couples (407 ART cycles). The primary outcome was the probability of live birth per treatment cycle; secondary outcomes were semen quality, and fertilization, implantation, and clinical pregnancy rates. We evaluated the association between the dietary score and these outcomes using logistic generalized linear mixed models to account for repeated cycles while adjusting for confounders. Main results and the role of chance Men had a median baseline age and BMI of 36.8 years and 26.9 kg/m2, respectively. The empirical diet pattern was significantly associated with all semen parameters. One standard deviation increase in the empirical diet pattern was associated with lower volume (–0.10 standard units [95% CI: –0.17 to –0.04]) and to higher sperm total sperm count (0.13 standard units [0.06 to 0.20]), concentration (0.17 standard units [0.10 to 0.24]), total motility (0.14 standard units [0.07 to 0.20]), progressive motility (0.08 standard units [0.01 to 0.15]), and normal morphology (0.18 standard units [0.11 to 0.25]). Couples with men in the lowest quartile of the empirical score were more likely to have a diagnosis of male infertility than couples with men in the highest quartile (49% vs 24%). Despite the association with semen parameters, the empirical diet score was not related to any clinical outcome of infertility treatment with ART. The adjusted probabilities of implantation, clinical pregnancy and live birth in the lowest and highest quartile of the empirical score were 0.62 (0.50–0.73) and 0.55 (0.45–0.66), 0.57 (0.46–0.69) and 0.50 (0.40–0.61), and 0.49 (0.37–0.62) and 0.36 (0.25–0.48), respectively. Analyses excluding couples with a diagnosis of male factor infertility yielded similar results. Limitations, reasons for caution We evaluated the relationship only among couples presenting to a fertility center and therefore it is unclear whether findings can be generalized to couples trying to conceive without ART. Wider implications of the findings: Given ART is a robust intervention including stringent sperm selection procedures, any effect that empirical diet may have on a couple’s chances of conceiving through assisted reproduction is unlikely to reflect the effect of these factors on bulk semen quality parameters. Trial registration number The project was funded by ES009718, ES022955, ES026648, and ES000002 from the National Institute of Environmental Health Sciences, and P30DK46200 from the National Institute of Diabetes and Digestive and Kidney Diseases

Characterizing the Epidemiology and Provider Landscape of Male Infertility Care in the United States

ObjectiveTo characterize the epidemiology of male factor infertility and identify which types of providers are treating infertile men in the United States. Materials and methodsThe National Ambulatory Medical Care Survey was queried between 2006 and 2016 for all ambulatory care visits. Men with a diagnosis of infertility were identified by international classification of disease coding. Comorbidities, demographic and visit information were abstracted from the patients’ medical record by a combination of trained surveyors and physicians. The survey data was weighted to create nationally representative estimates, and a combination of Chi-squared and Student's t-tests were utilized to determine significance. Result(s)Among the 8.7 billion patient visits between 2006 and 2016, there were 3,422,000 male encounters with a diagnosis of male factor infertility. The most common provider type for male factor infertility encounters was urology (42.12%) followed by primary care (39.79%), gynecology (7.05%) and all other provider types (11.01%). A significant number of men seen for infertility had comorbidities such as cancer (115,000 men, 3.36%) diabetes (267,000 men, 7.81%), depression (301,000 men, 8.8%), and active tobacco use (857,000 men, 30.3%). ConclusionIn a nationally representative sample, more than 50% of ambulatory care visits for male factor infertility were not seen by urologists. These men also had a significant number of comorbidities for a relatively young cohort, emphasizing the importance of multidisciplinary care for men with a diagnosis of infertility.

Simplified sperm testing devices: a possible tool to overcome lack of accessibility and inconsistency in male factor infertility diagnosis. An opportunity for low- and middle- income countries.

Manual semen assessment (MSA) is a key component in a male's fertility assessment. Clinicians rely on it to make diagnostic and treatment decisions. When performed manually, this routine laboratory test is prone to variability due to human intervention which can lead to misdiagnosis and consequently over- or under- treatment. For standardisation, continuous training, quality control (QC) programs and pricy Computer-Assisted Sperm Analysis (CASA) systems have been proposed, yet, without resolving intra- and inter-laboratory variability. In response, promising simplified sperm testing devices, able to provide cost-effective point-of-care male infertility diagnosis are prospected as a plausible solution to resolve variability and increase access to sperm testing. A throughout literature research for semen testing, sperm analysis, smart-phone assisted semen analysis, 'at-home' semen testing, male infertility, infertility in developing countries, infertility in low- and middle-income countries (LMIC) and quantitative sperm analysis was performed. A total of 14 articles, specific to 'at-home' simplified sperm assessment, were included to treat the core subject. Continuous training and consistent QC, are sine qua none conditions to achieve accurate and comparable MSA. Compliance does not rule-out variability, nevertheless. Emerging simplified sperm assessment devices are an actual alternative to resolve the lack of standardisation and accessibility to sperm analysis. YO ® , SEEM ® , and ExSeed ® are commercially available, user-friendly smartphone-based devices which can accurately measure volume, sperm concentration (millions/ml) and total motile sperm count. More broadly, by cost-effectiveness, availability, accuracy and convenient application, these devices could effectively select patients for first-line artificial reproduction treatments such as intrauterine insemination. Accuracy and cost-effectiveness make smart-phone based sperm testing devices a practical and realistic solution to overcome variability in MSA. Importantly, these tools represent an actual opportunity to standardise and improve male subfertility diagnosis and treatment, especially in LMIC. However, before clinical application is possible, guidelines, further testing with special attention on accuracy in washed sperm, availability, cost-benefit and reliability are required.

DOES INTRACYTOPLASMIC SPERM INJECTION (ICSI) PROVIDE ANY BENEFIT OVER IN VITRO FERTILIZATION (IVF) ON PREGNANCY OUTCOMES IN NON-MALE FACTOR INFERTILITY CYCLES UNDERGOING PRE-IMPLANTATION GENETIC TESTING FOR ANEUPLOIDY (PGT-A)?

ICSI is currently the recommended fertilization method for cycles undergoing PGT-A 1. To our knowledge there are no studies evaluating pregnancy outcomes of PGT-A transferred embryos inseminated by IVF versus ICSI. Our objective is to evaluate whether significant differences exist in pregnancy outcomes from PGT-A transferred embryos fertilized by IVF compared to ICSI. Retrospective cohort study at a single academic institution. All frozen embryo transfers (FET) performed from 1/2016 to 2/2020 that underwent PGT-A from trophectoderm biopsy and tested by next generation sequencing were evaluated. Exclusion criteria included diagnosis of male factor infertility, embryos tested for pre-implantation genetic testing for monogenic disorders, structural rearrangements, or HLA-typing, cryopreserved oocytes, blastomere or polar body biopsy, in vitro maturation, rescue ICSI, and split IVF/ICSI cycles. Patient demographics, infertility diagnoses, cycle characteristics, and pregnancy outcomes including not pregnant, biochemical pregnancy, miscarriage, ongoing pregnancy (OP), and live birth (LB) were collected. Primary outcome was OP/LB rates. Secondary outcomes included miscarriage and biochemical rates. Chi-square or Fisher’s exact test, as appropriate, and Mann-Whiney test were used for categorical and continuous variables, respectively. Outcomes between both groups were compared using a repeated-measures mixed-effects logistic regression model, in which the rates were adjusted for confounding variables attained during the univariate screen. Results were considered statistically significant with a p-value <0.05. A total of 317 FET’s met criteria (IVF-150 [47.3%]; ICSI-167 [52.7%]). Significant difference between the IVF and ICSI cohort existed in age (35.8 y/o vs. 36.8 y/o, respectively, p=0.03), BMI (23.6 vs 25.1, respectively, p=0.005), and ethnicities. LB/OP rates and miscarriage/biochemical rates demonstrated no significant differences in IVF vs. ICSI inseminated groups (Table 1). There were no significant differences in pregnancy outcomes in FET’s between IVF and ICSI inseminated embryos that underwent PGT-A. The use of ICSI in non-male factor infertility cycles undergoing PGT-A does not provide an advantage for LB/OP rates over IVF.Table 1IVF (150)ICSI (167)p-valueNot pregnant35.7%37.3%0.79Biochemical12.1%14.8%0.62Miscarriage11.4%7.8%0.43Live birth37.3%35.0%0.69Biochemical/Miscarriage23.6%22.5%0.85Live birth/Ongoing39.8%38.3%0.74 Open table in a new tab

ALWAYS ICSI? A SWOT analysis.

Intracytroplasmatic sperm injection (ICSI) is a common procedure used to improve reproductive results, even among couples without male factor infertility. However, the evidence available is still uncertain on the possible advantages and deficiencies that this procedure may have in patients with no formal indication for ICSI. A SWOT (strengths, weaknesses, opportunities, threats) analysis examines the possible advantages and deficiencies of performing ICSI in these patients with no formal indication. The evidence suggests that ICSI is not justified for non-male factor infertile couples requiring in vitro conception. One of the major strengths associated to the procedure is the virtual elimination of cases further complicated by total fertilization failure and a combination between IVF and ICSI on sibling oocytes has been advised in the literature. Greater technical difficulties, higher costs and performing an unnecessary invasive technique in some cases represent some of the weaknesses of the procedure, and questions regarding safety issues should not be ruled out. Despite the widespread use of ICSI in patients without a formal diagnosis of male factor infertility, evidence demonstrating its effectiveness in this population is still lacking. Additional large and well-designed randomized controlled trials are needed to clarify definitive indications for ICSI in non-male factor infertility.

Evaluation, Treatment, and Insurance Coverage for Couples With Male Factor Infertility in the US: A Cross-Sectional Analysis of Survey Data

To characterize the evaluation, treatment, and insurance coverage among couples with male factor infertility in the United States. A cohort of 969 couples undergoing fertility treatment with a diagnosis of male factor infertility were identified from an online survey. The proportion of men that were seen/not seen by a male were compared. Insurance coverage related to male factor was also assessed. Overall, 98.0% of the men reported at least one abnormal semen parameter. Of these, 72.0% were referred to a male fertility specialist with the majority being referred by the gynecologist of their female partner. As part of the male evaluation, 72.2% had blood hormone testing. Of the 248 men who were not recommended to see a male fertility specialist, 96.0% had an abnormal semen analysis including 7.6% who had azoospermia. Referral to a male fertility specialist was largely driven by severity of male factor infertility rather than socioeconomic status. Insurance coverage related to male factor infertility was poor with low coverage for sperm extractions (72.9% reported 0-25% coverage) and sperm freezing (83.7% reported 0-25% coverage). Although this cohort includes couples with abnormal semen parameters, 28% of the men were not evaluated by a male fertility specialist. In addition, insurance coverage for services related to male factor was low. These findings may be of concern as insufficient evaluation and coverage of the infertile man could lead to missed opportunities for identifying reversible causes of infertility/medical comorbidities and places an unfair burden on the female partner.

The social construction of male infertility: a qualitative questionnaire study of men with a male factor infertility diagnosis.

Although recent research has highlighted the distressing impact of infertility for men, fertility issues are still routinely seen as a 'women's issue' - even when male factor infertility is highlighted. This article reports findings from a qualitative questionnaire study focusing on a sample of men with a male factor infertility diagnosis; an under-researched and marginalised group in the context of reproductive medicine. Our analysis suggests that male factor infertility is viewed by men as a failure of masculinity, as stigmatising and silencing, and as an isolating and traumatic experience. It is also clear that these themes are shaped by wider societal discourses which present men as (unproblematically) fertile, uninvested in parenthood and stoic in their approach to emotional distress. Such norms also ensure that reproduction continues to be presented as a 'women's issue' which burdens women and marginalises men. In understanding male factor infertility experiences, the damaging nature of the social construction of male fertility is then more clearly illuminated.