Diagnosis Of Male Infertility Research Articles

The effect of neutral alpha glucosidase on semen parameters.

To investigate the relationship between the activity of neutral α-glucosidase in seminal plasma and semen quality. To explore the effect of secretory capability of the epididymis on male fertility. A retrospective analysis of 542 men treated in the Center for Reproductive Medicine and Infertility from February to December 2022, the semen parameters and neutral α-glucosidase were tested and compared among different groups. These 542 men included normozoospermia, oligospermia, asthenospermia and teratozoospermia. There was statistical difference in neutral alpha glucosidase (NAG) level among different groups with different sperm concentration, motility and morphology (P＜0.001). The NAG activity in seminal plasma was positively correlated with ejaculate volume and sperm concentration, meanwhile a very weak positive correlation was found between NAG level and sperm motility, sperm morphology, respectively. Our results indicated that the secretion of NAG affected the volume, concentration, motility and morphology of sperm to a certain extent. Given that NAG is a specific and marker enzyme in epididymis, where is the site of sperm maturation, we can conclude that there is a close relationship between NAG and sperm quality. Therefore, seminal plasma NAG has a definite clinical value in helping diagnosis of male infertility.

Seminal plasma S100A8/A9 as a potential biomarker of genital tract inflammation

Abstract Infections and inflammatory reactions in the male genital tract are the leading causes of male infertility with a prevalence of 6%–10%, primarily affecting testicular and epididymal function and ultimately compromising sperm quality. However, most infertile patients with genital infection/inflammation are asymptomatic and easily overlooked. Traditional indicators, including white blood cells, elastase, and other components in semen, can reflect inflammation of the genital tract, but there is still a lack of a uniform standard method of detection. Therefore, it is necessary to explore reliable markers in semen that reflect the inflammatory status of the genital tract. Using the experimental autoimmune orchitis (EAO) model to simulate noninfectious chronic orchitis, we successfully collected ejaculated seminal fluid from EAO rats using optimized electrical stimulation devices. Proteomic analysis was performed using isobaric tags for relative and absolute quantification (iTRAQ). Compared to the control group, 55 upregulated and 105 downregulated proteins were identified in seminal plasma samples from the EAO group. In a preliminary screening, the inflammation-related protein S100A8/A9 was upregulated. We further verified that S100A8/A9 was increased in seminal plasma and highly expressed in testicular macrophages of the EAO model. In patients with oligoasthenospermia and genital tract infections, we also found that S100A8/A9 levels were remarkably increased in seminal plasma and testicular macrophages. S100A8/A9 in semen may be a potential biomarker for chronic genital inflammation. Our study provides a new potential biomarker for early diagnosis and further understanding of male infertility caused by genital inflammation.

Comparative evaluation of visual-palpatory findings with scrotal doppler ultrasound data for varicocele diagnosis

Introduction. Current evidence suggests that management of any grade of varicocele can improve male fertility. However, diagnosis of grade 1 varicocele in infertile men without the use of scrotal Doppler ultrasound may cause overtreatment.Objective. To study the comparability and accuracy of the visual palpatory examination method with the scrotal Doppler ultrasound data for the diagnosis of varicocele.Material & methods. Between November 2005 to January 2022, 2871 patients diagnosed with varicocele and infertility who underwent microsurgical varicocelectomy by inguinal access were examined at RSSPMCU. The average age of the patients was 30.16 ± 0.09 (18 – 60) years. Of the 2871 patients, 2592 (90.3%) were diagnosed by physical examination, and 279 (9.7%) patients underwent additional scrotal Dopper ultrasound.Results. After Doppler scrotal imaging was introduced into practice, the proportion of patients with bilateral varicocele increased from 32.2% to 61.6% (p < 0.01). The proportion of patients with right-sided varicocele also increased significantly. Experienced physicians during physical examination of infertility patients did not diagnose grade 1 varicocele in 4.3%.Conclusions. The implementation of scrotal Doppler ultrasound for the diagnosis of male infertility improved the detection of grade 1 varicocele and bilateral varicocele. In turn, this contributed to earlier elimination of the male factor of infertility in this contingent of patients.

A Review Diagnosing Male Infertility: Beyond Conventional Semen Analysis

Infertility, defined as the inability of couples to conceive after one year of consistent, unprotected sexual contact, is a widespread concern affecting a significant portion of the population. Notably, between 14 to 17% of couples may encounter infertility at some point during their reproductive journey. This review delves into the realm of diagnosing male infertility beyond conventional semen analysis. Conventional semen analysis, which is a globally accepted tool for male infertility, primarily focuses on assessing sperm count, motility, viability, and morphology, leaving certain aspects of sperm functionality unexplored. These limitations necessitate the integration of advanced semen analysis techniques to provide a more comprehensive evaluation. Advanced semen analysis encompasses a range of sophisticated tests that probe deeper into the intricacies of male fertility. These tests include assessing sperm penetration capabilities, acrosomal discharge, and spermatozoa Reactive Oxygen Species (ROS) levels. Moreover, advanced semen analysis encompasses tests like sperm chromatin structure assay, DNA damage assessment, sperm proteomics, sperm metabolomics, and high sperm magnification microscopy, all of which shed light on various facets of sperm function and quality. While advanced semen analysis techniques offer a more comprehensive understanding of male infertility, their uptake and utilization in clinical practice have been limited. This review aims to elucidate the roles, merits, and drawbacks of both conventional and advanced semen analysis in diagnosing male infertility. This review sheds light on the strengths and weaknesses of each approach, it promotes a more nuanced approach to male infertility diagnosis, enhancing the prospects of successful conception for infertility challenged couples.

Sperm Chromatin Dispersion Test Detects Sperm DNA Fragmentation Mainly Associated with Unviable Spermatozoa and Underestimates the Values with Respect to TUNEL Assay.

Several clinical laboratories assess sperm DNA fragmentation (sDF) in addition to semen analysis in male infertility diagnosis. Among tests evaluating sDF, TUNEL (Terminal deoxynucleotidyl transferase dUTP nick end labeling) and SCD (Sperm Chromatin Dispersion) are widely used. Our lab developed a modified version of TUNEL (TUNEL/PI) able to distinguish two sperm populations (PI Brighter and PI Dimmer) differently associated with sperm viability and reproductive outcomes. The aim of this study was to compare sDF levels detected by SCD and TUNEL/PI in the semen samples from 71 male subjects attending our Andrology Laboratory. Our results demonstrate that SCD is less sensitive in determining sDF compared to TUNEL/PI. The statistically significant positive correlation found between sDF evaluated by SCD and PI Dimmer (consisting of all dead spermatozoa) suggests that SCD mainly detects sDF in unviable spermatozoa. We confirmed that most spermatozoa detected by SCD are unviable by performing SCD after incubation in hypo-osmotic medium to discriminate viable and unviable cells in 52 samples. Such results might explain the lower ability of this test in discriminating couples having successful ART outcomes demonstrated in published metanalyses. Overall, our results indicate that SCD is less sensitive in evaluating sDF for diagnostic purposes.

Premature Chromatid Separation Trait Found During the Diagnosis of Male Infertility: A Case Report

Premature Chromatid Separation Trait Found During the Diagnosis of Male Infertility: A Case Report

Proteomic biomarkers in seminal plasma as predictors of reproductive potential in azoospermic men.

Azoospermia, characterized by an absence of sperm in the ejaculate, represents the most severe form of male infertility. While surgical sperm retrieval in obstructive azoospermia (OA) is successful in the majority of cases, patients with non-obstructive azoospermia (NOA) show retrieval rates of only about 50% and thus frequently have unnecessary surgery. Surgical intervention could be avoided if patients without preserved spermatogenesis are identified preoperatively. This prospective study aimed to discover biomarkers in seminal plasma that could be employed for a non-invasive differential diagnosis of OA/NOA in order to rationalize surgery recommendations and improve success rates. All patients signed written informed consent, underwent comprehensive andrological evaluation, received human genetics to exclude relevant pathologies, and patients with azoospermia underwent surgical sperm retrieval. Using label-free LC-MS/MS, we compared the proteomes of seminal plasma samples from fertile men (healthy controls (HC), n=8) and infertile men diagnosed with 1) OA (n=7), 2) NOA with successful sperm retrieval (mixed testicular atrophy (MTA), n=8), and 3) NOA without sperm retrieval (Sertoli cell-only phenotype (SCO), n=7). Relative abundance changes of two candidate markers of sperm retrieval, HSPA2 and LDHC, were confirmed by Western Blot. We found the protein expression levels of 42 proteins to be significantly down-regulated (p ≤ 0.05) in seminal plasma from SCO NOA patients relative to HC whereas only one protein was down-regulated in seminal plasma from MTA patients. Analysis of tissue and cell expression suggested that the testis-specific proteins LDHC, PGK2, DPEP3, and germ-cell enriched heat-shock proteins HSPA2 and HSPA4L are promising biomarkers of spermatogenic function. Western blotting revealed a significantly lower abundance of LDHC and HSPA2 in the seminal plasma of men with NOA (SCO and MTA) compared to controls. The results indicate that certain testis-specific proteins when measured in seminal plasma, could serve as indicators of the presence of sperm in the testis and predict the success of sperm retrieval. Used in conjunction with conventional clinical assessments, these proteomic biomarkers may assist in the non-invasive diagnosis of idiopathic male infertility.

The Role of Artificial Intelligence in Male Infertility: Evaluation and Treatment: A Narrative Review

Male infertility has affected an increasingly large population over the past few decades, affecting over 186 million people globally. The advent of assisted reproductive technologies (ARTs) and artificial intelligence (AI) has changed the landscape of diagnosis and treatment of male infertility. Through an extensive literature review encompassing the PubMed, Google Scholar, and Scopus databases, various AI techniques such as machine learning (ML), artificial neural networks (ANNs), deep learning (DL), and natural language processing (NLP) were examined in the context of evaluating seminal quality, predicting fertility potential, and improving semen analysis. Research indicates that AI models can accurately estimate the quality of semen, diagnose problems with sperm, and provide guidance on reproductive health decisions. In addition, developments in smartphone-based semen analyzers and computer-assisted semen analysis (CASA) are indicative of initiatives to improve the price, portability, and accuracy of results. Future directions point to possible uses for AI in ultrasonography assessment, microsurgical testicular sperm extraction (microTESE), and home-based semen analysis. Overall, AI holds significant promise in revolutionizing the diagnosis and treatment of male infertility, offering standardized, objective, and efficient approaches to addressing this global health challenge.

MicroRNAs in Male Fertility.

Around 50% of all occurrences of infertility are attributable to the male factor, which is a significant global public health concern. There are numerous circumstances that might interfere with spermatogenesis and cause the body to produce abnormal sperm. While evaluating sperm, the count, the speed at which they migrate, and their appearance are the three primary characteristics that are analyzed. MicroRNAs, also known as miRNAs, are present in all physiological fluids and tissues. They participate in both physiological and pathological processes. Researches have demonstrated that the expression of microRNA genes differs in infertile men. These genes regulate spermatogenesis at various stages and in several male reproductive cells. Hence, microRNAs have the potential to act as useful indicators in the diagnosis and treatment of male infertility and other diseases affecting male reproduction. Despite this, additional research is necessary to determine the precise miRNA regulation mechanisms.

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.

Phenomenological Study of the Experience of Infertility in Romanian Patients: The Female Perspective

The subjective experience of infertility, the emotions, thoughts and problems stated in the patients' narratives show that thepsycho-social impact of infertility is real, and patients need permanent support, the recent qualitative studies suggest. Thepresent paper explores the patients' experiences with a diagnosis of female or male infertility from the perspective ofpatients undergoing IVF to become pregnant. The sample included 17 participants, patients of a private reproductivehealth and fertility clinic in Iasi, Romania. Patients were interviewed based on a semi-structured interview guide to obtaininformation about the infertility experience, from diagnosis to IVF procedures, regardless of the therapeutic approach.The data was enriched through observation notes. The data obtained were analyzed from a qualitative perspective, with aphenomenological approach, to describe and interpret the experience of infertility from the patient's perspective tounderstand and deepen the diagnosis's effect on personal, social and couple life. Six theme clusters emerged from thecollected data related to the perceived definition of maternity, the personal infertility story, the array of identifiedemotions, couple dynamics, perceived social support and coping strategies. The body of literature gives increased interestto the biomedical aspect of infertility. However, its completion with information related to the patient's life context and themeanings attributed to it provides relevant data for therapeutic success.

(302) Intertest Reliability of Seminal Round Cells and Leukocytes Without Treatment in Men Presenting for Infertility

Abstract Introduction Pyospermia may be due to infection or inflammation along the male reproductive tract. Semen round cells and leukocytes can have a major impact on the management of infertility yet we have a poor understanding of the natural history of patients with seminal round cells or pyospermia. Objective We aimed to assess the intertest reliability of seminal leukocytes and round cells within serial semen analyses in patients without treatment. Methods We conducted a retrospective review of men presenting to a high-volume fertility center for evaluation who had multiple semen analyses assessed for leukocytes between 2/1/2022 and 1/1/2023. Men with azoospermia or who received treatment for pyospermia including antibiotics or surgery in the interval between the tests were excluded. We recorded round cells, the presence of leukocytes, and days between tests. The presence of leukocytes was detected using QwikCheck™ Test Strips which report a positive result if the concentration of leukocytes was greater or equal to 1 million/ml. A Bland-Altman assessment of agreement was conducted to assess the agreement of the number of round cells between the first and second semen analysis. The limits of agreement (LoA) represent the 95% confidence intervals between which we expect most of the differences between measurements. The number of round cells was log-transformed prior to analysis as they were positively skewed. A Cohen Kappa test was used to assess the agreement between the presence of leukocytes in the first sample and the second sample. Results One hundred patients were included in the analysis. The mean time between tests was 75 days (SD: 68.3 days) ranging from 1 to 285 days. There was a median of 2.95 million round cells in the initial semen analysis and 2.45 million round cells in the follow-up semen analysis. Nineteen patients had positive leukocytes on the initial sample and fifteen on the second sample. Eight patients had persistently positive leukocytes. The assessment of agreement for the round cells in the initial and follow-up semen analysis shows a lower LoA of 22% and an upper LoA of 582% meaning that most measurements of round cells in the follow-up tests are estimated to be between 22% and 582% of the initial measurement. The wide range of LoAs suggests poor agreement between tests. The kappa for the presence of leukocytes in the first and second sample was 0.36 (CI 0.13-0.60) which would be considered a fair agreement. Conclusions Round cells and semen leukocytes are poorly understood but are used to aid in the diagnosis and management of male infertility. The number of round cells and the presence of pyospermia between samples varies greatly in patients even without treatment. Providers should consider these discrepancies prior to initiating treatment of pyospermia in men presenting for infertility. Further study is needed to gain a better understanding of how round cells and semen leukocytes should influence management of men with infertility. Providers should be cautious when using the presence of round cells or pyospermia to influence treatment as there is poor consistency between tests even without pyospermia treatment. Disclosure No.

FEATURES OF IMMUNOLOGICAL CHANGES IN INFERTILITY DIAGNOSIS

The aim. To study and summarize modern immunological methods of laboratory diagnosis of the causes of infertility.
 Materials and methods. An analytical review and analysis of the scientific literature in recent years, covering the study of immunological causes of infertility and, accordingly, the use of immunological methods of diagnosis and treatment of infertility.
 Results and discussion. Infertility treatment is an urgent medical problem because, according to the WHO, every sixth person faces this problem during their lifetime. Immunological aspects play an important role in infertility and account for 5% of infertility among men and women. In cases where the cause of infertility cannot be explained by the presence of specific organic signs in a couple, the identification of immunological mechanisms of infertility becomes more crucial. The immunological causes of infertility are still underestimated, as the mother’s immune system plays a major role in the successful implantation of the embryo and the carrying of a pregnancy. The relevant areas of immunological research are HLA typing to determine the immunological «compatibility» of couples, the study of the role of antisperm antibodies (ASA) in the development of infertility, and the use of exosomes as biomarkers of reproductive system diseases that may be the cause of infertility. In accordance with the material reviewed, we have identified the main areas of research into the causes, diagnosis, and treatment of infertility, which require further detailed study for the successful overcoming of infertility in the future.
 Conclusion. We have reviewed the articles that included materials on the study of immunological methods of infertility research and identified three currently relevant methods for identifying the causes and diagnosis of this disease, which continue to require thorough study to solve the problems of infertility. Carriage of the HLA-DQA1*5 allele can be used as a marker of the degree of HLA-DQA1 compatibility of a couple, as well as the use of some exosome markers, such as endometriosis-specific exosome characteristics such as miR-214-3p, EVLGMNP1, AFAP1-AS1. There is also no doubt that there is a high correlation between elevated levels of ASA and female infertility, so special attention should be paid to ASA in the diagnosis of male infertility.

Sperm induction of somatic cell-cell fusion as a novel functional test.

The fusion of mammalian gametes requires the interaction between IZUMO1 on the sperm and JUNO on the oocyte. We have recently shown that ectopic expression of mouse IZUMO1 induces cell-cell fusion and that sperm can fuse to fibroblasts expressing JUNO. Here, we found that the incubation of mouse sperm with hamster fibroblasts or human epithelial cells in culture induces the fusion between these somatic cells and the formation of syncytia, a pattern previously observed with some animal viruses. This sperm-induced cell-cell fusion requires a species-matching JUNO on both fusing cells, can be blocked by an antibody against IZUMO1, and does not rely on the synthesis of new proteins. The fusion is dependent on the sperm's fusogenic capacity, making this a reliable, fast, and simple method for predicting sperm function during the diagnosis of male infertility.

Novel variations in TENT5D lead to teratozoospermia in infertile patients.

Teratozoospermia is the main pathogenic factor of male infertility. However, the genetic etiology of teratozoospermia is largely unknown. This study aims to clarify the relationship between novel variations in TENT5D and teratozoospermia in infertile patients. Two infertile patients were enrolled. Routine semen analysis of patients and normal controls was conducted with the WHO guidelines. Whole-exome sequencing (WES) was conducted to identify pathogenic variants in the two patients. Morphology and ultrastructure analysis of spermatozoa in the two patients was determined by Papanicolaou staining, scanning electron microscopy (SEM), and transmission electron microscopy (TEM). The functional effect of the identified variants was analyzed by immunofluorescence staining and western blotting. The expression of TENT5D in different germ cells was detected by immunofluorescence staining. Two new hemizygous variations, c.101C>T (p.P34L) and c.125A>T (p.D42V), in TENT5D were detected in two patients with male infertility. Morphology analysis showed abnormalities in spermatozoa morphology in the two patients, including multiple heads, headless, multiple tails, coiled, and/or bent flagella. Ultrastructure analysis showed that most of the spermatozoa exhibited missing or irregularly arranged '9+2' structures. Further functional experiments confirmed the abrogated TENT5D protein expression in patients. In addition, both p.P34L and p.D42V substitutions resulted in a conformational change of the TENT5D protein. We precisely analyzed the subcellular localization of TENT5D in germ cells in humans and mice. And we found that TENT5D was predominantly detected in the head and flagellum of elongating spermatids and epididymal spermatozoa. Our results showed further evidence of a relationship between TENT5D mutation and human male infertility, providing new genetic insight for use in the diagnosis and treatment of male infertility.

Splicing Mutation in DNALI1 Causes Male Infertility with Severe Oligoasthenoteratozoospermia in Humans.

Oligo-astheno-teratozoospermia (OAT), which is a common cause of male infertility, can be caused by genetic factors. This study reports on a case of a male patient suffering from infertility concomitant with OAT. Whole-exome sequencing (WES) confirmed the presence of a homozygous variant (NM_003462: c.464-1G > A) in the DNALI1 gene via Sanger sequencing. Immunofluorescence staining demonstrated that the DNALI1 signal was nearly undetectable in the patient's sperm. Bioinformatics analysis revealed that this mutation could reverse the splicing of the exon 4 acceptor splice site. A minigene experiment was performed to verify the mutation and the results confirmed that the mutation disrupted the splicing. Our findings show that this rare mutation in DNALI1 contributes to male infertility and OAT in humans, thereby expanding our understanding of the causes and pathogenesis of male infertility. This knowledge facilitates genetic counseling, clinical diagnosis, and therapeutic development of male infertility.

Clinical use of redox biomarkers for diagnosis of male infertility

Clinical use of redox biomarkers for diagnosis of male infertility

Male Infertility: New Developments, Current Challenges, and Future Directions.

There have been many significant scientific advances in the diagnostics and treatment modalities in the field of male infertility in recent decades. Examples of these include assisted reproductive technologies, sperm selection techniques for intracytoplasmic sperm injection, surgical procedures for sperm retrieval, and novel tests of sperm function. However, there is certainly a need for new developments in this field. In this review, we discuss advances in the management of male infertility, such as seminal oxidative stress testing, sperm DNA fragmentation testing, genetic and epigenetic tests, genetic manipulations, artificial intelligence, personalized medicine, and telemedicine. The role of the reproductive urologist will continue to expand in future years to address different topzics related to diverse questions and controversies of pathophysiology, diagnosis, and therapy of male infertility, training researchers and physicians in medical and scientific research in reproductive urology/andrology, and further development of andrology as an independent specialty.

Genetic Diagnosis in Male Infertility

The male factor is responsible for more than half of infertile couples. It is caused by diverse factors. Amongst them, genetic and epigenetic abnormalities are important disorders. Appropriate genetic diagnosis is the key to understanding male factor infertility. It is interesting to note that genetic abnormalities of any disease vary from one region to another due to ethnic, geographic, and other differences. Our experience with the Pakistani population is similar. We have found novel genetic mutations in familial Idiopathic hypogonadotropic hypogonadism (IHH) specific to our patients. Familial IHH of Pakistan were studied through whole genome sequencing and we found novel mutations in GnRHR, KISS1R, and ANOS1 genes. We have found IHH families with X linked mode of inheritance and novel deletions in the ANOS1 gene that could be prevented by avoiding cousin marriages that are common in Pakistan. Similar results were found for our patients suffering from congenital absent vas deferens. This is why every region needs indigenous research to understand the genetic and epigenetic abnormalities of its population. The current presentation will highlight and discuss further research updates in this area. Today we have high hopes for the future of genetic medicine, but any developments in treatment strategies would require an understanding of the genetic patterns of different populations. It is an uphill task, especially for developing countries, so broadly-based collaborative studies are required with the facilitation of global organisations like “ASPIRE”.

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.