Idiopathic Oligoasthenospermia Research Articles

Effect of coenzyme Q10 supplementation on spermogram parameters, sperm DNA integrity, reproductive hormones and partner pregnancy rate in infertile men with idiopathic oligoasthenospermia

Effect of coenzyme Q10 supplementation on spermogram parameters, sperm DNA integrity, reproductive hormones and partner pregnancy rate in infertile men with idiopathic oligoasthenospermia

The role of oral antioxidants in the improvement of sperm parameters in infertile men.

A variety of pathologic conditions may increase oxidative stress in semen resulting in structural modifications to spermozoa's plasma membrane that interfere with sperm motility, morphology, and count. Antioxidants are currently being marketed to treat male infertility. In semen, antioxidants may decrease oxidative stress and potentially improve sperm parameters. In this narrative, mini-review we evaluated the effectiveness of antioxidants in infertility. This mini-review of the current literature has been carried out through searching of the PubMed and Google scholar databases. The literature review suggests that there is evidence that oral antioxidants such as selenium, carnitine, zinc, coenzymeQ10, vitamins E and C, etc. alone or in combinations, improve sperm count, motility, morphology as well as pregnancy rates in infertile men with idiopathic oligoasthenospermia. Unfortunately, most of these studies are poorly designed, limited by sample size, varying in dosage, differing inprimary end points, and most notably lacking live birth data. Importantly, large randomized, well-designed, placebo-controlled trials are needed.

Coenzyme Q10 improves sperm motility and antioxidant status in infertile men with idiopathic oligoasthenospermia.

Oxidative stress is a key player in the development of idiopathic male infertility (IMI), and various antioxidants have been used for the treatment of IMI with inconsistent results. Coenzyme Q10 (CoQ10) is a cofactor and an antioxidant that may improve semen parameters and reduce oxidative stress in patients with idiopathic oligoasthenospermia (OA). Therefore, this study aimed to explore the effect of CoQ10 on semen parameters and antioxidant markers in patients with idiopathic OA. Fifty patients with idiopathic OA and 35 fertile controls were enrolled in this prospective controlled study. All participants underwent a comprehensive fertility assessment. All patients received CoQ10 (300 mg/day) orally once daily for 3 months. Semen parameters, seminal CoQ10 levels, reactive oxygen species (ROS) levels, total antioxidant capacity (TAC), superoxide dismutase (SOD), and glutathione peroxidase (GPx) were measured in patients and controls at the start of the study and after 3 months. Treatment with CoQ10 resulted in increased sperm progressive motility (p<0.05), total motility (p<0.01), seminal TAC (p<0.01), SOD (p<0.05), GPx (p<0.001), and seminal CoQ10 (p<0.001) levels and reduced ROS (p<0.01) in patients as compared to baseline. Sperm concentration and motility were also significantly correlated with antioxidant measures and seminal CoQ10 levels (r=0.38-0.57). CoQ10 therapy (300 mg/day for 3 months) improved sperm motility and seminal antioxidant markers in patients with idiopathic OA. Therefore, CoQ10 could be a promising treatment for patients with idiopathic infertility and may improve their fertility potential.

Medical Treatment in Men with Infertility Can Be Misinterpreted as Doping Practice: A Case of Unintentional World Anti-doping Agency (WADA) Code Violation

Introduction: Clomiphene, a selective estrogen receptor modulator (SERM), is a drug which is primarily used for the treatment of anovulatory infertility in female patients. Although as an off-label use, some authorities and physicians use this drug for the treatment of idiopathic oligoasthenospermia in male patients. Clomiphene has two isomers and multiple metabolites, and its cis isomer (Zuclomiphene) can be detected in urine for as long as eight months in some cases. Case Presentation: A 30-year-old male futsal player used clomiphene for infertility for two months. After 17 weeks from the last dose, his urine sample result came out as an adverse analytical finding for clomiphene. Despite the initial ruling on a four-year ban by the national anti-doping agency, the appeals committee reduced the athlete's ban to two years after receiving explanations from the athlete, his appropriate doping record, and the fact that no trace of other substances, such as anabolic androgenic steroids (AAS) was found in the player's sample. Conclusions: In this article, the authors try to show the importance of athletes' familiarity with the anti-doping code and try to emphasize the importance of the fact that athletes should receive therapeutic use exemption (TUE) if they take any drugs with doping potential.

Glutathione S-transferase genetic polymorphisms and fluoride-induced reproductive toxicity in men with idiopathic infertility.

Male infertility caused by idiopathic oligoasthenospermia (OAT) is known as idiopathic male infertility. Glutathione S-transferase (GST) and fluoride may play important roles in idiopathic male infertility, but their effects are still unknown. Our study examined the relationship between GST polymorphisms and fluoride-induced toxicity in idiopathic male infertility and determined the underlying mechanism. Sperm, blood, and urine samples were collected from 560 males. Fluoride levels were measured by a highly selective electrode method, and GST genotypes were identified using polymerase chain reaction (PCR) and PCR-restriction fragment length polymorphism (PCR-RFLP). Semen parameters, DNA fragmentation index (DFI), mitochondrial membrane potential (MMP), and oxidative stress (OS) biomarkers were statistically assessed at the P < 0.05 level. Compared with healthy fertile group, semen parameters, fluoride levels, OS biomarkers, sex hormone levels, and MMP and DFI levels were lower in the idiopathic male infertility group. For glutathione S-transferase M1 (GSTM1[-]) and glutathione S-transferase T1 (GSTT1[-]) or glutathione S-transferase P1 (GSTP1) mutant genotypes, levels of semen fluoride, OS, MMP, and DFI were considerably higher, and the mean levels of sperm parameters and testosterone were statistically significant in GSTM1(+), GSTT1(+), and GSTP1 wild-type genotypes. Both semen and blood fluoride levels were associated with oxidative stress in idiopathic male infertility patients. Elevated fluoride in semen with the genotypes listed above was linked to reproductive quality in idiopathic male infertility patients. In conclusion, GST polymorphisms and fluorine may have an indicative relationship between reproductive quality and sex hormone levels, and OS participates in the development of idiopathic male infertility.

Comparison of the effects of coenzyme Q10 and Centrum multivitamins on semen parameters, oxidative stress markers, and sperm DNA fragmentation in infertile men with idiopathic oligoasthenospermia.

ObjectiveOxidative stress and sperm DNA fragmentation (SDF) have been linked to idiopathic male infertility (IMI). Various antioxidants have been tried to improve semen parameters and fertility potential in IMI patients, but with inconsistent results. The study aimed to compare the effects of coenzyme Q10 (CoQ10) and Centrum multivitamins on semen parameters, seminal antioxidant capacity, and SDF in infertile men with idiopathic oligoasthenospermia (OA).MethodsThis prospective controlled clinical study involved 130 patients with idiopathic OA and 58 fertile controls. The patients were divided randomly into two groups: the first group received CoQ10 (200 mg/day orally) and the second group received Centrum multivitamins (1 tablet/day) for 3 months. Semen parameters, CoQ10 levels, reactive oxygen species (ROS), total antioxidant capacity (TAC), catalase, SDF, and serum hormone levels (follicle-stimulating hormone, luteinizing hormone, testosterone, and prolactin) were compared at baseline and after 3 months. ResultsBoth CoQ10 and Centrum improved sperm concentration and motility, but the improvement was greater with Centrum therapy (p<0.05). Similarly, both therapies improved antioxidant capacity, but TAC and catalase improvement was greater (p<0.01 and p<0.001 respectively) with CoQ10, whereas ROS (p<0.01) and SDF (p<0.001) improvements were greater with Centrum administration. Centrum therapy was associated with reduced serum testosterone (p<0.05).ConclusionIn conclusion, both CoQ10 and Centrum were effective in improving semen parameters, antioxidant capacity, and SDF, but the improvement was greater with Centrum than with CoQ10. Therefore, Centrum—as a source of combined antioxidants—may provide more effective results than individual antioxidants such as CoQ10 in the treatment of infertile men with idiopathic OA.

Predictors of pregnancy and time to pregnancy in infertile men with idiopathic oligoasthenospermia pre- and post-coenzyme Q10 therapy.

Different antioxidants including coenzyme Q10 (CoQ10) have been tried to treat idiopathic male infertility (IMI) with variable results. Therefore, this study aimed to determine the clinical and biochemical predictors of pregnancy outcome and time to pregnancy (TTP) in infertile men with idiopathic oligoasthenospermia (OA) pre‐ and post‐CoQ10 therapy. This prospective controlled clinical study included 178 male patients with idiopathic OA and 84 fertile men (controls). Patients received 200 mg of oral CoQ10 once daily for 6 months. Demographics, semen parameters, seminal CoQ10 levels, reactive oxygen species (ROS) levels, total antioxidant capacity (TAC), catalase (CAT), glutathione peroxidase (GPx), sperm DNA fragmentation (SDF) and body mass index were measured and compared at baseline and after 6 months. All participants were followed up for another 18 months for pregnancy outcome and TTP. CoQ10 therapy for 6 months significantly improved semen parameters, antioxidant measures and reduced SDF. The pregnancy rate was 24.2% and TTP was 20.52 ± 6.72 months in patients as compared to 95.2% and 5.73 ± 6.65 months in fertile controls. After CoQ10 therapy, CoQ10 level, sperm concentration, motility and ROS were independent predictors of pregnancy outcome and CoQ10 level, male age, sperm concentration, motility, ROS and GPx were independent predictors of TTP in patients. In conclusion, CoQ10 therapy of 6 months is a potential treatment for men with idiopathic OA. CoQ10 level, male age, semen parameters, ROS and GPx could potentially be used as diagnostic biomarkers for male fertility and predictors for pregnancy outcome and TTP in these patients.

Effect of glutathione S-transferase gene polymorphisms on semen quality in patients with idiopathic male infertility.

ObjectiveTo investigate the relationship between glutathione S-transferase enzyme (GSTM1, T1, and P1) genetic variants and semen quality in men with idiopathic infertility.MethodsSperm characteristics were measured using computer-assisted sperm analysis. The malondialdehyde (MDA), nitric oxide (NO), and total antioxidant capacity (TAC) activities were detected by spectroscopic analysis, and 8-hydroxy-2′-deoxyguanosine (8-OHdG) was detected by enzyme-linked immunosorbent assay.ResultsThis study included 246 idiopathic infertile men and 117 controls. The GSTM1(−), T1(−), and M1/T1(−/−) genotype frequencies significantly differed between the groups. The GSTM1(−) and T1(−) genotypes in idiopathic infertile men negatively correlated with sperm concentration, motility, mitochondrial membrane potential, and other parameters. However, these genotypes positively correlated with the amplitude of the lateral head displacement and NO and 8-OHdG levels. The GSTT1(−) genotype positively correlated with mean angular displacement and MDA activity. GSTM1(−) and T1(−) had a synergistic effect on semen quality. Sperm motility, normal morphology, straightness, and TAC were lower and amplitude of lateral head displacement and MDA were higher in the GSTP1(A/G + G/G) group than in the GSTP1(A/A) group among men with idiopathic infertility.ConclusionsGSTM1, T1, and P1 genetic variants may be risk factors for infertility by affecting the semen quality men with idiopathic oligoasthenospermia.

Mitochondrial DNA sequencing and large-scale genotyping identifies MT-ND4 gene mutation m.11696G>A associated with idiopathic oligoasthenospermia.

Genetic variants of mitochondrial DNA (mtDNA) were implicated to be associated with male infertility. Our previous whole mitochondrial genome sequencing and association study has identified two susceptibility mtDNA variants for oligoasthenospermia in Han Chinese men. In this study, we tested promising associations in an extended validation using 670 idiopathic oligoasthenospermia cases and 793 healthy controls to identify additional risk variants. We found that the genetic variant of m.11696G>A showed significantly higher frequency in the case group than that in the control group (odds ratio (OR) 2.21, 95% CI 1.21-4.04) (P=7.90×10−3). To elucidate the exact role of the genetic variants in spermatogenesis, two main sperm parameters (sperm count and motility) were taken into account. We found that m.11696G>A was associated with low sperm motility, with the OR of 2.38 (95 % CI 1.27-4.46) (P =5.22×10−3). These results advance our understanding of the genetic susceptibility to oligoasthenospermia and more functional studies are needed to provide insights into its pathogenic mechanism.

A genome-wide association study of mitochondrial DNA in Chinese men identifies two risk single nucleotide substitutions for idiopathic oligoasthenospermia

Mitochondrial DNA (mtDNA) is believed to be both the source and target of reactive oxygen species (ROS), and mtDNA genetic alterations have been reported to be associated with molecular defects in the oxidative phosphorylation (OXPHOS) system. In order to investigate the potentially susceptible mtDNA genetic variants to oligoasthenospermia, we conducted a two-stage study in 921 idiopathic infertile men with oligoasthenospermia and 766 healthy controls using comprehensive molecular analysis. In the screen stage, we used next generation sequencing (NGS) in 233 cases and 233 controls to screen oligoasthenospermia susceptible mitochondrial genetic variants. In total, seven variants (C5601T, T12338C, A12361G, G13928C, A15235G, C16179T and G16291A) were screened to be potentially associated with idiopathic oligoasthenospermia. In the validation stage, we replicated these variants in 688 cases and 533 healthy controls using SNPscan. Our results demonstrated that the genetic alteration of C16179T was associated with idiopathic male infertility (odds ratio (OR) 3.10, 95% CI 1.41–6.79) (p=3.10×10−3). To elucidate the exact role of the genetic variants in spermatogenesis, two main sperm parameters (sperm count and motility) were taken into account. We found that C16179T was associated with both low sperm count and motility, with ORs of 4.18 (95% CI 1.86–9.40) (p=1.90×10−4) and 3.17 (95% CI 1.40–7.16) (p=3.50×10−3), respectively. Additionally, A12361G was found to be associated with low sperm count, with an OR of 3.30 (95% CI 1.36–8.04) (p=5.50×10−3). These results indicated that C16179T influenced both the process of spermatogenesis and sperm motility, while A12361G may just only participate in the process of spermatogenesis. Further investigation in larger populations and functional characterizations are needed to validate our findings.

Tamoxifen is a potent antioxidant modulator for sperm quality in patients with idiopathic oligoasthenospermia.

To explore the new mechanisms of tamoxifen (TAM) in the treatment for patients with idiopathic oligoasthenospermia-antioxidation. In a prospective, randomized, controlled clinical trial, 120 cases of idiopathic oligoasthenospermia were enrolled and randomly assigned to the indomethacin group (n = 60) treated with indomethacin (25 mg, bid) and TAM group (n = 60) treated with TAM (10 mg, bid) for 3 months. Before and after treatment, we evaluated semen parameters, serum malondialdehyde (MDA) and total antioxidant capacity (TAC), seminal plasma MDA and TAC, spermatozoa intracellular reactive oxygen species (ROS), sperm succinate dehydrogenase (SDH) activity, sperm mitochondrial membrane potential (MMP), and sperm adenosine triphosphate (ATP) content. The independent t test and one-way repeated measures analysis of variance were used to compare the variables between and within two groups. In the indomethacin group, the percentage of progressive motile sperms, total motility, sperm MMP, and ATP content were increased significantly after 3-month treatment (P < 0.05). In the TAM group, total sperm count, sperm concentration, the percentage of progressive motile sperms, total motility, serum and seminal plasma TAC, sperm MMP, and ATP content were significantly improved or increased (P < 0.05), while spermatozoa intracellular ROS was significantly decreased (P < 0.05). Compared to the indomethacin group, TAM treatment showed better improvement in total sperm count, sperm concentration, serum TAC, seminal plasma TAC, spermatozoa intracellular ROS, and sperm SDH activity. TAM treatment can significantly improve sperm quality, which is achieved through alleviating oxidative stress, improving sperm mitochondrial functionality, and subsequently increasing sperm motility.

S038: Conservative medicamentous treatment of patients suffering from idiopathic oligoasthenospermia

S038: Conservative medicamentous treatment of patients suffering from idiopathic oligoasthenospermia

Recombinant follitropin alfa/lutropin alfa in fertility treatment

Recombinant human follicle stimulating hormone (rFSH) and luteinizing hormone (LH), also known as follitropin alpha and lutropin alpha, are manufactured by genetic engineering techniques which ensure high quality and batch to batch consistency. Follitropin alpha can be used for controlled ovarian hyperstimulation in assisted reproduction, ovulation induction for WHO group I and II anovulatory infertility and in men with hypogonadotrophic hypogonadism (HH) or idiopathic oligo-asthenospermia. Current evidence suggests superiority of urinary human menopausal gonadotropin (HMG) over follitropin alpha in controlled ovarian hyperstimulation for IVF in terms of live birth rate per couple. Addition of lutropin to follitropin alpha in an unselected IVF population does not appear to confer any benefit; however, it may have a role in ovulation induction in women with hypothalamic hypogonadism. Urinary HMG preparations (especially currently available highly purified preparations) are more cost effective than rFSH in terms of cost per ongoing pregnancy. However, women using rFSH injection pen devices have higher levels of satisfaction as compared to those using urinary HMG by means of conventional syringes.

The Efficacy of Recombinant Human Follicle‐Stimulating Hormone in the Treatment of Various Types of Male‐Factor Infertility at a Single University Hospital

The aim of the study was to prospectively investigate the efficacy of recombinant human follicle-stimulating hormone (rhFSH) in the treatment of various types of male-factor infertility at a single university hospital. The study included 61 infertile men receiving rhFSH because of various type of male infertility. Treatment included 100-150 IU of rhFSH 2-3 times/wk. All men were divided into 4 groups: hypogonadotropic hypogonadism (n = 21), isolated follicle-stimulating hormone (FSH) deficiency (n = 13), idiopathic oligoasthenospermia (n = 16) and maturation arrest on testicular biopsy (n = 11). Total motile sperm count (TMSC), serum FSH level, and testicular volume were compared before and after treatment in all groups. In the hypogonadotropic hypogonadism group, spermatozoa appeared in the ejaculate, with a mean TMSC of 6.67 +/- 1.57 million, in 15 of 21 patients (71.4%) who were totally azoospermic before the treatment. In the isolated FSH deficiency group, TMSC significantly increased from 6.64 +/- 3.27 to 32.4 +/- 9.09 million after the treatment (P = .003). TMSC did not significantly increase in the idiopathic oligoasthenospermia group. Two of the men with maturation arrest (18.1%) had spermatozoa in the ejaculate after the treatment. rhFSH therapy may be effectively used to improve sperm parameters in infertile men with hypogonadotropic hypogonadism and isolated FSH deficiency. In addition, rhFSH may effect some improvement by either providing sperm in ejaculate or increasing intracytoplasmic sperm injection success in infertile men with maturation arrest.

The Role of Carnitine in the Male Reproductive System

Carnitine is highly concentrated in the epididymis and spermatozoa, where it may serve as an intramitochondrial vehicle for the acyl group, which in the form of acyl CoA acts as a substrate for the oxidation process producing energy for sperm respiration and motility. To date, studies in rodents and humans suggest that sperm count, motility, and maturation are related to epididymal free carnitine concentrations. Moreover, supplementation with carnitine improves sperm quality and/or quantity in testes of mice exposed to physical insults, such as heat and X-irradiation, and in men with idiopathic oligoasthenospermia. These benefits may be due to increased mitochondrial fatty acid oxidation resulting in improvement in motility of epididymal sperm. The antiapoptotic effect(s) of carnitine in the testes may also contribute, but this remains speculative and requires further investigation. Research to uncover the many characteristics and mechanisms of action of carnitine in somatic and germ cells may provide insights into the pathophysiology of germ cell apoptosis, the prevention of germ cell death, and possibly specific therapy of some forms of infertility. Further well-controlled, carefully designed, larger-scale studies are necessary and desirable before widespread clinical use as an infertility therapy can be contemplated.

Anti-oestrogen therapy for idiopathic oligoasthenospermia − A meta-analysis of randomized trial

Anti-oestrogen therapy (clomiphene citrate or tamoxifen) has been suggested as a method for the treatment of idiopathic oligoasthenospermia. However, the true value of the therapy is still controversial. The aim of this work was to conduct a meta-analysis of randomized controlled trials in order to clarify the situation. We have calculated that in order to improve the clinical pregnancy rate from 20 to 30%, the least number needed to study was 317 patients in each arm of the study, accepting a probability of 80% of detecting a true difference and taking 5% as the level of significance.

Management of idiopathic oligoasthenospermia with lycopene

Management of idiopathic oligoasthenospermia with lycopene

Deconvolution analysis of bioassayable LH secretion and half-life in men with idiopathic oligoasthenospermia.

To further investigate the nature of neuroendocrine disturbances of the hypothalamopituitary-gonadal axis in idiopathic male infertility, we studied 12 infertile men with oligoasthenozoospermia and 13 euspermic controls, matched for age and body mass index, by blood withdrawal at 10-min intervals for 8 h to analyse pulsatile release of bioactive LH (b-LH). The rat interstitial cell testosterone (RICT) bioassay was used in conjunction with a recently validated multiparameter deconvolution algorithm, to estimate the endogenous half-life of b-LH, its secretory burst frequency, amplitude, duration and mass. Oligoasthenospermic men exhibited significant (p < 0.05) alterations within the LH axis; namely: (1) a prolonged half-life of b-LH (92 min in euspermic men, 127 min in oligoasthenospermic men); (2) a reduced b-LH secretory burst amplitude (2.2 +/- 1.2 IU/l/min in euspermic men, 1.7 +/- 0.8 IU/l/min in oligoasthenospermic men); (3) a lower bioactive/immunoactive (b/i) ratio for LH secretory burst amplitude (14 in euspermic men, 4 in oligoasthenospermic men); (4) a reduced b/i ratio in the mass of LH secreted per burst (5.4 in euspermic men, 4.1 in oligoasthenospermic men) and (5) decreased coordinate release of b-LH and testosterone in infertile men, as assessed by cross-correlation analysis. These disturbances differ from the neuroendocrine dysregulation described in other states of male hypogonadotrophism.

Clomiphene or tamoxifen for idiopathic oligo/asthenospermia.

Oligo-astheno-teratospermia (sperm of low concentration, reduced motility and increased abnormal morphology) of unknown cause is common and the need for treatment is felt by patients and doctors alike. As a result, a variety of empirical, non-specific treatments have been used in an attempt to improve semen characteristics and fertility. The administration of anti-oestrogens is a common treatment because anti oestrogens interfere with the normal negative feedback of sex steroids at hypothalamic and pituitary levels in order to increase endogenous gonadotropin-releasing hormone secretion from the hypothalamus and FSH and LH secretion directly from the pituitary. In turn, FSH and LH stimulate Leydig cells in the testes, and this has been claimed to lead to increased local testosterone production, thereby boosting spermatogenesis with a possible improvement in fertility. There may also be a direct effect of anti-oestrogens on testicular spermatogenesis or steroidogenesis. This review considers the available evidence of the effect of both Clomiphene citrate and tamoxifen, both of which have a predominant anti-oestrogenic effect, for idiopathic oligo and/or asthenospermia. The objective was to assess the effects of treating subfertile men with anti-oestrogens (clomiphene or tamoxifen) on pregnancy rates among couples where subfertility has been attributed to idiopathic oligo- and/or asthenospermia. The Cochrane Subfertility Review Group specialised register of controlled trials was searched". Randomised trials of anti-oestrogen therapy for 3 months or more compared to placebo or no placebo for subfertile males among couples where subfertility is attributed to male factor. Data were extracted independently by two reviewers. Any differences were resolved with a third reviewer. Ten studies involving 738 men were included. Five of the trials did not specify method of randomisation. Anti-oestrogens had a positive effect on endocrinal outcomes, such as serum testosterone levels. In trials with secure randomisation there was no difference in the pregnancy rate between the anti-oestrogen groups and the control groups (odds ratio 1.26, 95% confidence interval 0.99 to 1.56). The overall pregnancy rate for these five trials was 15.4% compared to the spontaneous rate of 12.5% in the control groups. These odds increased to 1.56 (95% confidence interval 0.99 to 2.19) when all 10 trials were included, but this result is likely to be artificially inflated. Anti-oestrogens appear to have a beneficial effect on endocrinal outcomes, but there is not enough evidence to evaluate the use of anti-oestrogens for increasing the fertility of males with idiopathic oligo-asthenospermia.

Cryopreservation of the occasionally improved semen samples for intrauterine insemination: a new approach in the treatment of idiopathic male infertility

To assess the value of treating idiopathic male infertility by intrauterine insemination (IUI) of the occasionally improved cryopreserved semen. Two groups of idiopathic oligospermic patients were chosen at random and treated by IUI using processed fresh semen in group A and the best available cryopreserved semen samples pooled with fresh samples in group B. Egyptian IVF-ET Centre, Maadi, CAiro, Egypt. One hundred fifty infertile couples because of idiopathic oligoasthenospermia. Intrauterine insemination. The pregnancy rate was evaluated after an average of three treatment cycles. The pregnancy rate (PR) was significantly higher in group B when compared with group A. The improvement in the PR was highly significant in the subgroup of patients for whom reasonable semen samples could be collected and cryopreserved. Our study indicates that IUI with fresh semen pooled with cryopreserved occasionally improved semen samples for the treatment of oligoasthenospermia results in an improved PR.