Diagnosis Of Male Factor Infertility Research Articles

Metabolomics analysis of seminal plasma in patients with idiopathic Oligoasthenoteratozoospermia using high-resolution NMR spectroscopy.

Male infertility is a global health issue caused by a combination of different factors. Specialists generally rely on semen analysis to diagnose male infertility. However, it is known that diagnostic semen analysis fails to identify about 50% of male infertility disorders. Recently, metabolomics has been proven to be a powerful technique for the diagnosis of different diseases. To determine whether metabolites could be used as potential biomarkers for the diagnosis of male factor infertility through comparing seminal plasma samples from infertile men with oligoasthenoteratozospermia (OAT) and samples from normozoospermic controls. This study utilized high-resolution 1 H NMR spectroscopy to reveal whether the metabolomic changes of seminal plasma obtained from 31 patients with oligoasthenoteratozospermia (OAT) are different from the ones obtained from 28 normozoospermic controls. Multivariate statistical analysis of NMR data concluded that the metabolomic profile of samples from patients with OAT exhibits statistically significant differences when compared to the controls. The differences were based on the metabolites lactate, citrate, lysine, arginine, valine, glutamine, creatinine, α-ketoglutaric acid, spermine, putrescine, and tyrosine. Except the tyrosine, levels of the above metabolites were significantly decreased in patients with OAT compared to the controls. The levels of citrate, choline, spermine, putrescine, α-ketoglutaric acid, valine, and tyrosine were significantly different (p<5×10-4 ) between two groups. On the other hand, levels of lactate, creatinine, lysine, arginine, and glutamine were also statistically significant (0.001<p<0.05). However, considering the p-values, the physiological relevance of these metabolites may be lower when compared to the others. A PLS-DA model built on the NMR data achieved 89.29% sensitivity and 93.55% specificity results in a leave-one-out cross-validation process. 1 H NMR spectroscopy-based metabolomic analysis could be used as a diagnostic tool for the diagnosis of oligoasthenoteratozospermia.

The effect of endometriosis on the antimüllerian hormone level in the infertile population.

To determine whether the presence of endometriosis in infertile women without prior ovarian surgery influences markers of ovarian reserve, AMH and FSH. A retrospective cohort study included three groups of women who presented for IVF treatment at our tertiary care center from 04/27/2015 to 05/31/2017: women with endometriosis and prior ovarian surgery (EnSx), women with endometriosis without prior ovarian surgery (En), and women with a primary diagnosis of male factor infertility (MF; reference group). There were 671 patients that met inclusion criteria (78 EnSx, 60 En, and 533 MF). Compared to the MF group (3.6 ± 3.0), a lower mean AMH level (ng/mL) was observed in the EnSx group (2.5 ± 2.5; aβ - 1.21; 95% CI [- 1.79, -0.62]) and in the En group (2.5 ± 2.2; aβ - 1.11; 95% CI [- 1.68, - 0.54]). Both endometriosis groups had a statistically significantly higher proportion of patients with an AMH < 1 (EnSx, 24.4%; OR, 2.39 [95% CI, 1.31, 4.36]; En, 28.3%; OR, 2.67 [95% CI, 1.41, 5.08]) compared to the MF group (13.9%). The mean baseline FSH level (lU/L) was statistically significantly higher in both endometriosis groups (EnSx, 8.6 ± 4.3; β, 1.37 [95% CI, 0.39, 2.34]; En, 8.4 ± 3.7; β, 0.96 [95% CI, 0.04, 1.87]) compared to the MF group (7.3 ± 2.2). Among infertility patients with endometriosis, with and without a history of ovarian surgery, ovarian reserve markers were worse (lower AMH and higher FSH) and a higher proportion had decreased ovarian reserve as measured by AMH compared to women with MF.

Male infertility problems of patients with strict sperm morphology between 5–14% may be missed with the current WHO guidelines

Objective: In 2010 W.H.O. changed the lower reference limit for strict sperm morphology from 15 to 4%. The change was based on 5th percentile cut points from a meta-analysis on a published series of fertile men. This study investigates if patients referred for evaluation with sperm morphologies between 5–14% have identifiable etiologies of male infertility.Materials and methods: I.R.B. approval was obtained to review records for patients referred to the University of Michigan Center of Reproductive Medicine between May 2012–May 2014 whom had a sperm morphology of 5–14%. Semen analysis, hormone levels, and information related to an infertility diagnosis, were recorded into a de-identified database. Patients were placed into the categories ‘Varicocele’, ‘Hypogonadism’, ‘Intercourse problems’, ‘Anti-sperm antibodies (A.S.A.)’, ‘Other’ or ‘No diagnosis’.Results: A total of 253 patients were included in the study. Of these, 96/253 (38%) had a clinical varicocele; 44/253 (17%) hypogonadism; 4/253 (2%) intercourse problems; 11/253 (4%) evidence of sperm antibodies; and 15/253 (6%) had various other problems deemed potentially contributing causes of infertility. In all, nearly 67% of the subjects were identified to have a potential contributing etiology of male infertility. Similar results were found for the men with isolated low morphology (n = 194).Conclusions: This study demonstrates that 67% of men in infertile couples, who have strict sperm morphology between 5 and 14%, are found to have a potential contributing male factor infertility diagnosis. This raises the possibility that the new lower reference value for sperm morphology may result in missed opportunities for proper infertility assessment.

The impact of the localisation of endometriosis lesions on ovarian reserve and assisted reproduction techniques outcomes

This case-control study was designed to evaluate the impact of endometriosis and the presence of endometrioma (OMA) per se on the serum anti-Müllerian hormone (AMH) level and also to compare the in vitro fertilisation/intracytoplasmic sperm injection (IVF/ICSI) outcomes after therapeutic surgery in endometriosis patients, according to the localisation of endometriosis lesions. One hundred and fifty two infertile women ≤40 years with suspicious symptoms were surgically evaluated to detect the aetiology of infertility at the Royan Institute during this study and, in parallel, 131 patients with a male factor infertility diagnosis were considered as the control group. The serum AMH level and IVF/ICSI outcomes were compared according to the nature and extension degree of endometriosis lesions. The results demonstrated that the existence of a deep infiltrating endometriosis (DIE) with and without OMA was associated with a significant decrease in AMH level, antral follicle count and ovarian sensitivity index (OSI) (p < .001 and p = .007, respectively). The multivariable logistic regression analysis adjusted for confounding factors indicated that the OSI and the existence of DIE with and without OMA were a significant predictive variable for clinical pregnancy and for live birth. On the basis of our results, the severity of endometriosis and the location of its lesions could affect an ovarian reserve and the ovarian stimulation outcomes.Impact StatementWhat is already known on this subject? Previous studies have evaluated the impact of endometrioma (OMA) on ovarian reserve and the assisted reproduction technology (ART) outcomes and controversial results have been reported; therefore, it seems that this topic still needs further research.What the results of this study add? In the present study, the effect of endometriosis lesions’ localisation on ovarian reserve and the success rate of the in vitro fertilisation/intracytoplasmic sperm injection (IVF/ICSI) cycle after therapeutic surgery were compared with that of the control group. It was found that the existence of a deep infiltrating endometriosis (DIE) with and without OMA was associated with a significant decrease in the anti-Müllerian hormone (AMH) level, antral follicle count, ovarian sensitivity index (OSI), clinical pregnancy and live birth rates.What the implications are of these findings for clinical practice and/or further research? The results of this study has a practical value in the decision making process for the ovarian stimulation protocol in patients with the different severity of endometriosis and the counselling regarding the success rate of IVF or ICSI/embryo transfer cycles.

Role of Genetic Testing in Male Infertility

Male-factor infertility is responsible for 30-55% of all infertility cases. The causes of male infertility include varicocele, endocrine disorders, genital tract infections, genetic disorders and idiopathic. It is estimated that genetic abnormalities contribute to 50% of male infertility. In daily practice, the diagnosis of male infertility has been based on history taking, relevant physical examination, hormone tests and basic semen analysis with a strong emphasis on the assessment of sperm concentration, motility, and morphology. Although recent development in assisted-reproductive technologies such as in vitro fertilization and intrauterine insemination increases the chance of clinical pregnancy and live birth, genetic counseling and testing should always be performed whenever genetic risks are related to the cause of infertility for the identification of possible genetic abnormalities and to assess the risk of transmitting the genetic defects to future generations. Genetic defects affect male infertility by disrupting hormonal homeostasis, spermatogenesis, and sperm quality. These genetic defects include chromosomal abnormalities (e.g. Klinefelter Syndrome), Y chromosome deletions, and cystic fibrosis transmembrane conductance regulator gene mutations. The utilization of genetic counseling and testing is also important to predict the success of sperm retrieval in men with certain genetic abnormalities. To name a few, genetic analysis at the chromosomal level (karyotyping), androgen receptor gene mutations test, cystic fibrosis test, and Y chromosome microdeletions analysis should be considered in the diagnosis of male factor infertility where genetic risks are present.

PD01-01 SURGICALLY ACQUIRED SPERM USE FOR ASSISTED REPRODUCTIVE TECHNOLOGY: TRENDS AND PERINATAL OUTCOMES, UNITED STATES, 2004-2015

You have accessJournal of UrologyInfertility: Therapy I1 Apr 2018PD01-01 SURGICALLY ACQUIRED SPERM USE FOR ASSISTED REPRODUCTIVE TECHNOLOGY: TRENDS AND PERINATAL OUTCOMES, UNITED STATES, 2004-2015 Jennifer Kawwass, Jeani Chang, Sheree Boulet, Ajay Nangia, Akanksha Mehta, and Dmitry Kissin Jennifer KawwassJennifer Kawwass More articles by this author , Jeani ChangJeani Chang More articles by this author , Sheree BouletSheree Boulet More articles by this author , Ajay NangiaAjay Nangia More articles by this author , Akanksha MehtaAkanksha Mehta More articles by this author , and Dmitry KissinDmitry Kissin More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.214AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The impact of mode of semen acquisition on reproductive outcomes among couples undergoing treatment with assisted reproductive technology (ART) has not been well characterized. We investigated national trends, and compared pregnancy and perinatal outcomes between surgically acquired and ejaculated sperm use among fresh, non-donor in vitro fertilization cycles in which the male partner has infertility. METHODS This retrospective cohort study used data from U.S. fertility clinics reporting to the National ART Surveillance System (NASS) between 2004 and 2015 (n=369,426 fresh non-donor cycles with male factor infertility). We assessed trends in use of surgically acquired (testicular and epididymal) and ejaculated sperm using the Cochran-Armitage test. To the subset of these ART cycles that used intracytoplasmic sperm injection (ICSI) (n=347,078 cycles), we applied multivariable log binomial regression to compare pregnancy and perinatal outcomes for cycles that used surgically acquired versus ejaculated sperm. Outcomes examined included biochemical pregnancy, intrauterine pregnancy, and live birth (>20 weeks) per embryo transfer cycle; miscarriage (<20 weeks) and singleton live birth per pregnancy; and normal birthweight (>2500g) and full term delivery (>37 weeks) per singleton pregnancy. We performed subgroup analyses for cycles with a sole diagnosis of male factor infertility (no female factors) and for the subset of such cycles in which the female partner was under 35 years old. RESULTS Percentage of cycles in which the male partner had male factor infertility that used surgically acquired sperm increased over the study period (9.8% in 2004 to 11.6% in 2015, p<0.05). The proportion of cycles using testicular sperm also increased significantly over the study period (4.9% in 2004 to 6.5% in 2015, p<0.05); no change was detected for epididymal sperm use. Among fresh, non-donor ICSI cycles for patients with male factor infertility, outcomes were similar between cycles involving epididymal sperm and cycles involving testicular sperm versus those using ejaculated sperm. Results were similar for both subgroup analyses. CONCLUSIONS Surgically acquired sperm use increased over the study period. Mode of semen acquisition does not appear to significantly impact pregnancy and perinatal outcomes among couples undergoing IVF ICSI for treatment of male factor infertility. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e60 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Jennifer Kawwass More articles by this author Jeani Chang More articles by this author Sheree Boulet More articles by this author Ajay Nangia More articles by this author Akanksha Mehta More articles by this author Dmitry Kissin More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Intracytoplasmic sperm injection use in states with and without insurance coverage mandates for infertility treatment, United States, 2000–2015

To compare indications and trends in intracytoplasmic sperm injection (ICSI) use for invitro fertilization (IVF) cycles among residents of states with and without insurance mandates for IVF coverage. Cross-sectional analysis of the National Assisted Reproductive Technology Surveillance System from 2011 to 2015 for the main outcome and from 2000 to 2015 for trends. IVF cycles performed in U.S. fertility clinics. Fresh IVF cycles. Residency in a state with an insurance mandate for IVF (n = 8 states) versus no mandate (n = 43 states, including DC). ICSI use by insurance coverage mandate status stratified by male-factor infertility diagnosis. During 2000-2015, there were 1,356,377 fresh IVF cycles, of which 25.8% (n = 350,344) were performed for residents of states with an insurance coverage mandate for IVF. ICSI use increased significantly during 2000-2015 in states both with and without a mandate; however, for non-male-factor infertility cycles, the percentage increase in ICSI use was greater among nonmandate states (34.6% in 2000 to 73.9% in 2015) versus mandate states (39.5% in 2000 to 63.5% in 2015). For male-factor infertility cycles, this percentage increase was ∼7.3% regardless of residency in a state with an insurance mandate for IVF. From 2011 to 2015, ICSI use was lower in mandate versus nonmandate states, both for cycles with (91.5% vs. 94.5%), and without (60.3% vs. 70.9%) male-factor infertility. Mandates for IVF coverage were associated with lower ICSI use for non-male-factor infertility cycles.

Accuracy of human sperm DNA oxidation quantification and threshold determination using an 8-OHdG immuno-detection assay.

Can a discriminant threshold be determined for human sperm DNA oxidation? A discriminant threshold was found with 65.8% of 8-hydroxy-2'-deoxyguanosine (8-OHdG)-positive sperm cells and a mean intensity of fluorescence (MIF) of 552 arbitrary units. Oxidative stress is known to interfere with sperm quality and fertilizing capacity. However, current practice does not include the routine determination of oxidative DNA damage in spermatozoa; optimized consensus protocols are lacking and no thresholds of normality have been established. Intra- and inter-method comparisons between four protocols (I-IV) were conducted to determine the most relevant and efficient means of assessing human sperm 8-OHdG content. Tests of assay repeatability, specificity, sensitivity and stability were performed to validate an optimized methodology for routine diagnostic use. This prospective study compared three immuno-detection methods including immunocytochemistry, fluorescence microscopy and flow cytometry. Sperm DNA oxidation for 80 patients was determined relative to semen parameters and clinical conditions, using the selected immuno-detection protocol in comparison with a commercial kit. These patients (age 35 ± 1 years: mean ± SEM) presented with normozoospermic (n = 40) or altered parameters (necro- or/and astheno- or/and teratozoospermia or/and leukocytospermia). Significant positive Pearson and Spearman correlations were determined for 8-OHdG values and sperm parameters using protocol III. A notable high and positive correlation was revealed for MIF with BMI and leukocyte concentration. Protocol III was the most discriminating method regarding assay repeatability, specificity, sensitivity, stability and reliability for sperm parameter alterations, in particular leukocytospermia according to parametric or non-parametric tests, effect-size determinations and factorial analysis such as principal component analysis and factor discriminant analysis. Of interest is that 39% of the subjects with 'pathological' sperm DNA oxidation values were normozoospermic. The oligozoospermic population was not evaluated in this study because insufficient material was available to carry out the comparisons. However, spermatozoa concentration was taken into account in the statistical analysis. Our study is the first validation of a protocol to determine a discriminant threshold for human sperm DNA oxidation. The protocol's detection accuracy for 8-OHdG human sperm DNA residues, stability over time, and relationship to human sperm quality were demonstrated. The assay should find application in the diagnosis of male factor infertility associated with oxidative stress. This work was funded by institutional grants from the CNRS, INSERM and Université Clermont Auvergne (to J.R.D.) and by Clermont-Ferrand Hospital-CECOS research funds (to L.J. and F.B.). P.G., A.M., R.J.A. and J.D. are, respectively, CEO, scientific director and scientific advisors of a US-based biotech company (Celloxess, Princeton, NJ, USA) involved in preventative medicine with a focus on the generation of antioxidant oral supplements.

Detrimental effects of endometriosis on oocyte morphology in intracytoplasmic sperm injection cycles: a retrospective cohort study

While an association can be addressed among endometriosis and subfertility, the causal relationship has not been elucidated yet. Impaired oocyte quality in endometriosis patients has been accused for the unsuccessful outcomes of assisted reproductive techniques. There are limited studies in literature evaluated association between endometriosis and oocyte morphology. We conducted this retrospective study to evaluate whether morphological abnormalities of oocytes are more common in women with endometriosis than women with diagnosis of male factor infertility as a source of healthy oocytes. Totally 1568 oocytes, 775 (49.4%) in endometriosis groups and 793 (50.6%) in control group were evaluated for morphological parameters before ICSI cycles. Abnormal oocyte morphology was detected in 352 (22.4%) of 1568 oocytes. Of the abnormal oocytes, 208 (59.1%) were in endometriosis group and 144 (40.9%) in control group (p < .001). The following dysmorphisms were significantly higher in oocytes retrieved from endometriosis group: dark cytoplasm; dark, large or thin zona pellucida; and flat or fragmented polar body (p < .05 for all). When morphological parameters for oocytes of endometriosis patients evaluated, the oocyte defects has increased significantly in endometriosis patients. These findings are thought to be useful to clarify the subfertility in endometriosis patient, which needs to be confirmed with further studies.

What does a single semen sample tell you? implications for the diagnosis of male factor infertility

What does a single semen sample tell you? implications for the diagnosis of male factor infertility

Trends in Use of and Reproductive Outcomes Associated With Intracytoplasmic Sperm Injection

Since its introduction in 1992, intracytoplasmic sperm injection (ICSI) has been increasingly used in patients without severe male factor infertility despite the lack of clear evidence of a benefit over conventional in vitro fertilization (IVF). Compared with pregnancies resulting from conventional IVF, pregnancies resulting from the use of ICSI are associated with 1.5 to 4 times increased risk of chromosomal abnormalities, birth defects, intellectual disabilities, imprinting disorders, and autism. Intracytoplasmic sperm injection is considerably more expensive than conventional IVF. The aim of this retrospective observational study was to assess national trends and reproductive outcomes of fresh IVF cycles associated with the use of ICSI compared with conventional IVF with respect to clinical indications for ICSI use. Although only fresh embryos were transferred, it is unlikely that outcomes for frozen-thawed embryos would differ. Data were obtained from the US National Assisted Reproductive Technology Surveillance System for all fresh and ICSI cycles performed during 1996 to 2012. The primary study outcomes were (1) trends in use of ICSI during 1996 to 2012 with respect to male factor infertility, unexplained infertility, maternal age 38 years or older, low oocyte yield (<5 oocytes retrieved), and 2 or more prior assisted reproductive technology cycles and no prior live birth, and (2) reproductive outcomes during 2008 to 2012 for conventional IVF and ICSI cycles, stratified by the presence or absence of male factor infertility. A total of 1,395,634 fresh IVF cycles were identified between1996 and 2012; 908,767 (65.1%) used ICSI, and 486,867 cycles (34.9%) used conventional IVF. Male factor infertility was identified in 499,135 (35.8%) of fresh cycles. During 2006 to 2012, ICSI use among cycles with male factor infertility increased from 76.3% (10,876/14,259) to 93.3% (32,191/34,506) (P < 0.001), whereas its use for those without male factor infertility increased from 15.4% (4,197/27,191) to 66.9% (42,321/63,250) (P < 0.001). During 2008 to 2012, 494,907 fresh IVF cycles were identified, 74.6% of which used ICSI. Male factor infertility was reported in 35.7% (176,911/494,907) of fresh cycles. The risk for multiple births among these cycles was significantly lower in those undergoing ICSI compared with conventional IVF (30.9% vs 34.2%); the adjusted relative risk (RR) was 0.87, with a 95% confidence interval (CI) of 0.83 to 0.91. Compared with conventional IVF, ICSI use among cycles without male factor infertility (n = 317,996) was associated with lower rates of implantation (23.0% vs 25.2%; adjusted RR, 0.93; 95% CI, 0.91–0.95), live birth (36.5% vs 39.2%; adjusted RR, 0.95; 95% CI, 0.93–0.97), and multiple live births (30.1% vs 31.0%; adjusted RR, 0.93; 95% CI, 0.91–0.95). These findings show that ICSI use among fresh IVF cycles in the United States increased from 36.4% to 76.2% between 1996 and 2012. The largest relative increase occurred in cycles without male factor infertility. The data show no improvement in postfertilization reproductive outcomes with use of ICSI over conventional IVF in the absence of male factor infertility, irrespective of male factor infertility diagnosis.

Semen Parameters as Predictors of Fertilization Success in Conventional Insemination Cases: Is Hyaluronan Binding Assay (HBA) More Sensitive in Normospermic Samples?

Semen analysis (SA) may provide initial diagnosis of male factor infertility. The reliability of repeated SA producing valuable prognostic information for in vitro fertilization (IVF) success is inconsistent. The risk of failed fertilization is low (∼5%) and the financial and emotional costs of an unsuccessful IVF cycle are significant1. HBA is a sperm function test that provides qualitative assessment of sperm quality, maturity, and fertilization potential by measuring the proportion of sperm bound to hyaluronan.

Transplantation of zona-free cleavage stage embryo into an empty zona with successful blastulation, a case series

Transplantation of zona-free cleavage stage embryo into an empty zona with successful blastulation, a case series

Temporal and geospatial trends in male factor infertility with assisted reproductive technology in the United States from 1999–2010

To estimate the prevalence of male factor infertility diagnosis within the context of assisted reproductive technology (ART) clinics and its geographic and temporal distribution from 1999-2010. Population study based on patients presenting for care at ART centers. Clinics providing ART services. All male patients seeking infertility care at ART clinics. Data were obtained from the Centers for Disease Control and Prevention, analyzed, geocoded, and mapped. Prevalence of male factor infertility diagnosis in a couple seeking infertility care. Between 1999 and 2010, 1,057,402 cycles of ART using nonfrozen, nondonor eggs were performed, increasing from 62,809 cycles in 1999 to 99,289 cycles in 2010. Nationwide in ART clinics, the period prevalence of isolated male factor infertility was 17.1% and the prevalence of overall male factor infertility diagnoses was 34.6%. The highest prevalence was reported in New Mexico (56.4%) and lowest in Mississippi (24.2%). The prevalence of male factor infertility diagnosis varies significantly by time and space within the United States, whereas its overall prevalence has remained remarkably stable. This study provides the spatial analytic framework for future research to explore factors associated with male factor infertility.

Treatment of male infertility.

Major difficulties exist in the accurate and meaningful diagnosis of male reproductive dysfunction, and our understanding of the epidemiology and etiology of male infertility has proven quite complex.The numerous spermatozoa produced in mammals and other species provides some degree of protection against adverse environmental conditions represented by physical and chemical factors that can reduce reproductive function and increase gonadal damage even resulting in testicular cancer or congenital malformations. The wide fluctuations of sperm production in men, both geographical and temporal, may reflect disparate environmental exposures, occurring on differing genetic backgrounds, in varying psychosocial conditions, and leading to the diversified observed outcomes.Sperm analysis is still the cornerstone in diagnosis of male factor infertility, indeed, individually compromised semen paramaters while adequately address therapeutic practices is progressively flanked by additional tests. Administration of drugs, IUI, correction of varicocele, and, to a certain extent, IVF although they may not be capable of restoring fertility itself often result in childbearing.

Double intrauterine insemination versus single intrauterine insemination for male factor infertility

Intrauterine insemination (IUI) is a first-line approach for the treatment of infertility. Traditionally, IUI is performed 36 hours after a documented lutenizing hormone surge in order to time insemination with ovulation. In an attempt to optimize pregnancy rates after IUI, “double”(one IUI on 2 consecutive days) IUI has been employed. Double IUI increases the amount of available sperm for fertilization by increasing the frequency of insemination. The optimal time for double insemination has been described as performing the first IUI 12-18 hours after injection of human chorionic gonadotropin (hCG), followed by a second IUI 34-60 hours later. There is evidence that double IUI is superior to single IUI in subfertile couples, however its benefit is unclear for male factor infertility. We hypothesized that clinical pregnancy rates(CPR) would be improved with double IUI in patients with male factor infertility. Retrospective chart review. Data from 146 couples who underwent 451 IUI cycles from January 1, 2009 to December 31, 2011 were reviewed after IRB approval. Natural, Clomid, Tamoxifen and gonadotropin cycles were included. There were 82 double IUI and 369 single IUI's performed. Male factor infertility was defined as the presence of either teratozoospermia (Kruger score ≤5%), asthenozoospermia or oligozoospermia. Chi-square analysis was used to determine differences between the two groups (Graphpad Instat). Statistical significance=P<0.05. The CPR was 12% for all single IUI cycles and 14% for all double IUI cycles (P=0.7). For IUI cycles where diagnosis of male factor infertility was present (n=207 cycles), the CPR for double IUI was 19% (n=47), as compared to single IUI (n=160), with a CPR of 9.4% (P=0.05). Post-hoc power analysis was 33%. Overall, there is no difference in the CPR between single and double IUI cycles. However, patients with a diagnosis of male factor infertility may benefit from double IUI. Further studies with larger numbers are necessary.

Sequential analysis of sperm functional aspects involved in fertilisation: a pilot study

The development of diagnostic techniques in andrology as a second level of approach to the diagnosis of male factor infertility has enthused the focus of researchers on the development of a sequential diagnostic programme for these men. Semen samples of 78 men form couples undergoing in vitro fertilisation therapy were used in the study. The semen samples were used to test sperm functional aspects known to interfere with fertilisation. These tests included semen profile, DNA integrity, apoptosis, chromatin packaging, acridin orange staining, zona binding capacity, zona-induced acrosome reaction (AR). Results were correlated with fertilisation outcome. Statistical analyses of the recorded data were carried out using a logistic regression analysis model on all sperm functional tests. A negative and significant association with the fertilisation rates was recorded for DNA damage (r = -0.56; P ≤ 0.0005). A positive significant correlation was recorded between fertilisation rates and sperm with normal DNA (r = -0.57, P ≤ 0.0004), and zona-induced AR (r = 0.33, P ≤ 0.002). Diagnostic andrology can be regarded as a mandatory part of the male factor patient's work-up schedule to assist clinicians with the most suitable therapeutic modality to follow.

Sperm DNA damage measured by the alkaline Comet assay as an independent predictor of male infertility and in vitro fertilization success

To evaluate sperm DNA fragmentation and semen parameters to diagnose male factor infertility and predict pregnancy after IVF. Prospective study. Academic research laboratory. Seventy-five couples undergoing IVF and 28 fertile donors. Sperm DNA fragmentation was measured by the alkaline Comet assay in semen and sperm after density gradient centrifugation (DGC). Binary logistic regression was used to analyze odds ratios (OR) and relative risks (RR) for IVF outcomes. Semen parameters and sperm DNA fragmentation in semen and DGC sperm compared with fertilization rates, embryo quality, and pregnancy. Men with sperm DNA fragmentation at more than a diagnostic threshold of 25% had a high risk of infertility (OR: 117.33, 95% confidence interval [CI]: 12.72-2,731.84, RR: 8.75). Fertilization rates and embryo quality decreased as sperm DNA fragmentation increased in semen and DGC sperm. The risk of failure to achieve a pregnancy increased when sperm DNA fragmentation exceeded a prognostic threshold value of 52% for semen (OR: 76.00, CI: 8.69-1,714.44, RR: 4.75) and 42% for DGC sperm (OR: 24.18, CI: 2.89-522.34, RR: 2.16). Sperm DNA testing by the alkaline Comet assay is useful for both diagnosis of male factor infertility and prediction of IVF outcome.

Men's experiences of infertility and infertility treatment 5 years after diagnosis of male factor infertility: a retrospective cohort study

The aim of this study was to describe the perceptions of infertile men regarding the impact of infertility on their intimate relationships, their experience of treatment and their sources of information and support. A cross-sectional survey of a consecutive cohort of men diagnosed 5 years earlier as infertile at Melbourne IVF and the Royal Women's Hospital Reproductive Services, Melbourne was conducted. Study-specific questions assessed the impact of male factor infertility on the intimate relationships, their perceived quality of infertility-related health care and their preferred sources of infertility-related information and personal support and the effectiveness of these. The response rate was 41% (112/276). Male factor infertility was reported to have had a negative impact on the intimate partner relationship by 25% of men, and 32% reported a negative effect on their sexual satisfaction. Satisfaction with medical care and clinic information was high and not influenced by the outcome of the treatment. Clinic-provided information and discussion with clinic staff were the most strongly preferred sources of information, and the partner and clinic staff were the most valued sources of personal support. Very few men found support groups useful and less than half confided in friends. The findings suggest that for a significant subgroup of men, male factor infertility affects their intimate relationship negatively. Wider sources of social support are not used by infertile men as they rely predominantly on clinic-provided information and support. This indicates that psychologically informed supportive clinical care is particularly important for men diagnosed as infertile.

The gender gap in the time costs of infertility treatment: examination of a prospective U.S. cohort

OBJECTIVE: In addition to the financial burden placed on couples seeking reproductive assistance, there is also a time cost. While it is generally assumed that both members of an infertile couple share the costs of treatment, less is understood about how the time commitments of infertility services are divided. DESIGN: Prospective U.S. cohort of infertile couples. MATERIALS AND METHODS: Infertile couples were recruited from 8 reproductive endocrinology practices for a longitudinal study of the impact of infertility. From questionnaires; demographic, socioeconomic, and reproductive factors were assessed. Follow up interviews were conducted at 4, 10, and 18 months during which time participants recorded diaries in which they annotated time spent on infertility treatment including clinic visits, travel, telephone, and other tasks. RESULTS: 371 couples completed cost diaries. Mean female age was 35.6 ± 4.8 years, while mean male age was 36.8 ± 5.6 years. Over an 18 month time period, women reported spending significantly more time on infertility related activities (median: 51.5 hours, range: 0 to 537) compared to men (median: 18.5 hours, range: 0 to 265; p<0.01). These differences in time expenditures between genders persisted regardless of infertility diagnosis (p<0.01). When examining women, those from couples with a male factor infertility etiology, reported significantly higher time expenditures (p<0.05). A similar trend toward larger time expenditures was also noted in men from couples with a male factor (p=0.06). In contrast, there was no difference in time expenditures whether a female factor was present among female (p=0.74) or male respondents (p=0.95). CONCLUSION: Women from infertile couples spend significantly more time on on infertility related activities than do their male partners. A diagnosis of male factor infertility significantly increases the time costs for both members of an infertile couple, while female factor infertility has no significant effect on a couple's time expenditures.