Incidence Of Infertility Research Articles

Infertility: Understanding investigation and treatment options

The World Health Organisation has defined infertility as the inability to become pregnant after 12 months of regular unprotected vaginal sexual intercourse. Primary infertility refers to couples that have never conceived, whereas secondary infertility refers to couples that have failed to conceive despite previous pregnancy. In the general population, 80% of couples are expected to be able to conceive within a year and 90% by the end of 2 years. With the rising trend for increasing maternal age at time of first pregnancy and the obesity epidemic, the incidence of infertility is likely to increase. Couples unable to conceive will seek help and advice from their GP. Infertility is highly emotive, and patients and their partners subject to investigation and management for infertility are likely to experience anxiety. Although primarily managed in secondary care, a robust understanding of investigation and treatment options for infertility can enable GPs to educate and support patients, as well as manage expectations.

A case of acardiac acephalus: Variant of trap sequence

The incidences of twin gestation and higher order multi-fetal pregnancies are on increasing trend. There are increased use of ovulation induction drugs and assisted reproductive technology in this era owing to higher incidences of infertility and better diagnostics and treatment modalities. And with increased use of these methods, comes increased incidence of complications. Incidences of complications are more in monozygotic pregnancies than in dizygotic twin. Acardiac twin is a rare, severe congenital malformation seen in monozygotic twin gestation, which is incompatible with life. Acardiac twin, also known as TRAP (Twin Reversed Arterial Perfusion Sequence); results from abnormal placental vasculature.Early diagnosis of acardiac twin by ultrasonography and colordoppler is essential for timely management and preventing complications like preterm delivery, cardiac failure and intrauterine fetal death of ‘ pump’co-twin. Here we are reporting a case of an antenatally diagnosed mono-chorionic twin pregnancy with acardiac twin, which was managed conservatively. Proper monitoring and timely decision for terminationresulted in preterm delivery of a live, normal twin along with an acardiac co-twin.

Comparison of ovulation induction with letrozole plus dexamethasone and letrozole alone in infertile women with polycystic ovarian disease: An RCT.

BackgroundInfertility is characterized by the inability to obtain a successful pregnancy after 6 months or more with unprotected and regular intercourse. In developing countries, the incidence of infertility is 2%. The causes of infertility could be male factor or female factor, or mixed factor.ObjectiveThis study was conducted with the aim of comparison the ovarian response to letrozole alone and letrozole plus dexamethasone in infertile women with poly cystic ovarian disease (PCOS).Materials and MethodsThis randomized clinical trial was conducted on 120 infertile women with PCOS referred to Ali-Ebne-Abitaleb hospital, Zahedan, Iran from February to August 2017 into two groups: group I received letrozole alone and group II recived letrozole plus dexamethasone. The endometrial thickness, follicle diameter, and ovulation were evaluated and compared by ultrasound on days 12 to 14.ResultsThe mean thickness of endometrium was not different between two groups. Pregnancy rate was 8% in letrozole group and 23% in Letrozole plus Dexamethasone (p = 0.024). Also, the mean diameter of follicles in two groups were not statistically significant.ConclusionOverall, this study showed that dexamethasone may increase pregnancy rate.

The Impact of Endometriosis on the Quality of Life and the Incidence of Depression-A Cohort Study.

The objective was to evaluate the quality of life and the incidence of depression among women suffering from endometriosis. Afterwards, the dependency between pelvic pain, its severity and stages of endometriosis were analyzed. The study protocol included women of reproductive ages with confirmed endometriosis. The stage of disease was conferred according to the ASRM (American Society of Reproductive Medicine) classification. Women fulfilled two questionnaires: “WERF EPHect Clinical Questionnaire” and self-prepared survey about fertility disorders. The study group comprised of 246 respondents. A total of 77.2% of women were symptomatic. The most common complaints were chronic pelvic pain (CPP, 71.1%), dysmenorrhea (69.0%) and dyspareunia (45.2%). Intensity of pain was independent from the stage of endometriosis. The incidence of infertility and the time to conceive increased with the stage of disease (stage 1—52.8%, 3.4 years; stage 2—66.7%, 4.1 years; stage 3—61.3%, 3.7 years; stage 4—96%, 6.1years; p = 0.02 and 0.03, respectively). The prevalence of depression was positively correlated with the beginning of dyspareunia (14.5 vs. 19.6 years old., p = 0.002). CPP (OR(odds ratio) = 3.8, 95% CI 1.2–12.8, p = 0.04) and painful defecation (OR = 7.7, 95% CI 1.4–42.3, p = 0.01) increased the risk of depression. Symptoms related to endometriosis and severity of pain correlate with the prevalence of depression. Stage of endometriosis is significantly related to the prevalence of infertility.

Effect and mechanism of PI3K/AKT/mTOR signaling pathway in the apoptosis of GC-1 cells induced by nickel nanoparticles

Nickel nanoparticles (Ni NPs) have a wide range of application prospects, but there is still a lack of their safety evaluation for the reproductive system. Nowadays, male reproductive health has been widely concerned because of the increasing incidence of male infertility. Studies have shown that Ni NPs can cause male reproductive toxicity. The purpose of this study was to investigate the toxicity of Ni NPs on GC-1 cells, a mouse spermatogonia cell line, and to explore the possible mechanism underlying the induction of apoptosis via PI3K/AKT/mTOR signaling pathway. The cell ultrastructure was firstly observed under a transmission electron microscope. Then, cell proliferation, cycle and apoptosis were detected by CCK-8 and flow cytometry, respectively. Furthermore, the expression levels of related proteins and genes were determined by Western blot and Reverse transcription-polymerase chain reaction, respectively. The results showed that Ni NPs could not only cause changes in cell ultrastructure, decreased survival rate and arrested G1 phase cell cycle, but also activated apoptosis pathway by inhibiting the PI3K/AKT/mTOR signaling pathway. The results of this study provide novel insights to explore the mechanisms of reproductive toxicity of Ni NPs and are of great significance to develop safety evaluation criteria for Ni NPs.

Association between male body mass index and semen parameters

Objective: Obesity is a modern-day epidemic. Body mass index (BMI) is an easily computed surrogate marker of obesity. The incidence of obesity has paralleled the incidence of male infertility. The evidence of the association between BMI and semen parameters stays rather inconclusive. The aim of this study was to understand the association between BMI and semen parameters of male subjects evaluated at the infertility clinic. Materials and Methods: A prospective study was conducted on 410 male subjects (>18 years of age) who were referred to clinical pathology from the infertility clinic. Semen analysis for macroscopic parameters – total sperm concentration, motility, morphology, and viability, was done as per the guidelines laid by the WHO (WHO-5th edition 2010). Results: All the semen parameters showed higher aberrations in the obese group than the normal BMI group. However, on Pearson Chi-square analysis, none of these differences were found to be statistically significant (P > 0.05). On Pearson correlation analysis, none of the parameters showed a statistically significant correlation with BMI. Conclusion: The present study did not find any statistically significant differences for the commonly measured semen parameters, among the three BMI groups. We thus conclude that increased BMI or obesity has no significant impact on the semen parameters.

Increased risk of severe maternal morbidity among infertile women: analysis of US claims data

Severe maternal morbidity continues to be an issue of national and global concern and is increasing in incidence. The incidence of infertility is also on the rise, and infertile women experience a higher risk of incident chronic medical disease and cancer, suggesting that fertility may serve as a window to a woman's overall health. To investigate the risk of severe maternal morbidity by maternal fertility status. This was a retrospective cohort analysis using Optum's de-identifed Clinformatics Data Mart Database between 2003 and 2015. Infertile women stratified by infertility diagnosis, testing, or treatment were compared to fertile women seeking routine gynecologic care. In both groups, only women who underwent pregnancy and delivery of a singleton during the follow-up period were included. Main outcomes were severe maternal morbidity indicators, defined by the Centers for Disease Control and Prevention and identified by International Classification of Diseases 10th Revision and Common Procedural Technology codes within 6 weeks of each delivery. Results were adjusted for maternal age, race, education, nulliparity, smoking, obesity, delivery mode, preterm birth, number of prenatal visits, and year of delivery. A total of 19,658 women comprised the infertile group and 525,695 women comprised the fertile group. The overall incidence of any severe maternal morbidity indicator was 7.0% among women receiving fertility treatment, 6.4% among women receiving a fertility diagnosis, 5.5% among women receiving fertility testing, and 4.3% among fertile women. Overall, infertile women had a significantly higher risk of developing any severe maternal morbidity indicator (adjusted odds ratio, 1.22; confidence interval, 1.14-1.31, P < .01) as well as a significantly higher risk of disseminated intravascular coagulation (adjusted odds ratio, 1.48; confidence interval, 1.26-1.73, P < .01), eclampsia (adjusted odds ratio, 1.37; confidence interval, 1.05-1.79, P < .01), heart failure during procedure orsurgery (adjusted odds ratio, 1.54; confidence interval, 1.21-1.97, P<.01), internal injuries of the thorax, abdomen, or pelvis (adjusted odds ratio, 1.59; confidence interval, 1.12-2.26, P < .01), intracranial injuries (adjusted odds ratio, 1.77; confidence interval, 1.20-2.61, P < .01), pulmonary edema (adjusted odds ratio, 2.18; confidence interval, 1.54-3.10, P < .01), thrombotic embolism (adjusted odds ratio, 1.58; confidence interval, 1.14-2.17, P < .01), and blood transfusion (adjusted odds ratio, 1.50; confidence interval, 1.30-1.72, P < .01) compared to fertile women. Fertile women did not face a significantly higher risk of any maternal morbidity indicator compared to infertile women. In subgroup analysis by maternal race/ethnicity, the likelihood of severe morbidity was significantly higher among fertile black women compared to fertile white women. There was no difference between infertile black women and infertile white women after multivariable adjustment. Using an insurance claims database, we report that women diagnosed with infertility and women receiving fertility treatment experience a significantly higher risk of multiple indicators of severe maternal morbidity compared to fertile women. The increased risk of severe maternal morbidity noted among fertile black women compared to fertile white women is attenuated among infertile black women, who face risks similar to those of infertile white women.

The impact of thyroid autoantibodies on the cycle outcome and embryo quality in women undergoing intracytoplasmic sperm injection

BackgroundThe influence of thyroid autoimmunity in in–vitro fertilization/intracytoplasmic sperm injection (ICSI) cycles is still a controversial issue. Although some women are euthyroid, some studies found thyroid dysfunction and thyroid autoimmunity increased the incidence of infertility. We aimed to evaluate the impact of anti-thyroid antibodies on the cycle parameters, embryo quality, and pregnancy outcomes in women who underwent ICSI cycles.ResultsFertilization rate was significantly higher in anti-thyroid antibody-negative patients than in anti-thyroid antibody-positive patients (97.1 ± 10.5 vs. 91.5 ± 19.8, respectively, p = 0.003). Clinical pregnancy, miscarriage, and ongoing pregnancy rates were not different among study groups. The presence of top-quality embryo was lower in anti-thyroid antibody-positive patients but it did not reach any statistical significance (56.5% vs. 67.8%, p = 0.09). In the subgroup analysis, there were no significant differences except for the miscarriage rate according to the TSH threshold.ConclusionThe clinical pregnancy and ongoing pregnancy were not affected by the positivity of anti-thyroid antibodies. We showed that thyroid autoimmunity may have an impact on fertilization rate and embryo quality in patients undergoing ICSI cycles. Miscarriage rate also increases with thyroid autoimmunity and TSH levels above 2.5 μIU/L.

Progress in Research on Sperm DNA Fragmentation.

With the increasing incidence of male infertility, routine detection of semen is insufficient to accurately assess male fertility. Infertile men, who have lower odds of conceiving naturally, exhibit high levels of sperm DNA fragmentation (SDF). The mechanisms driving SDF include abnormal spermatogenesis, oxidative stress damage, and abnormal sperm apoptosis. As these factors can induce SDF and subsequent radical changes leading to male infertility, detection of the extent of SDF has become an efficient routine method for semen analysis. Although it is still debated, SDF detection has become a research hotspot in the field of reproductive medicine as a more accurate indicator for assessing sperm quality and male fertility. SDF may be involved in male infertility, reproductive assisted outcomes, and growth and development of offspring. The effective detection methods of SDF are sperm chromatin structure analysis (SCSA), terminal transferase-mediated dUTP end labeling (TUNEL) assay, single-cell gel electrophoresis (SCGE) assay, and sperm chromatin dispersion (SCD) test, and all of these methods are valuable for assisted reproductive techniques. Currently, the preferred method for detecting sperm DNA integrity is SCSA. However, the regulation network of SDF is very complex because the sperm DNA differs from the somatic cell DNA with its unique structure. A multitude of molecular factors, including coding genes, non-coding genes, or methylated DNA, participate in the complex physiological regulation activities associated with SDF. Studying SDF occurrence and the underlying mechanisms may effectively improve its clinical treatments. This review aimed to outline the research status of SDF mechanism and detection technology-related issues, as well as the effect of increased SDF rate, aiming to provide a basis for clinical male infertility diagnosis and treatment.

Implications of Assisted Reproductive Technologies for Pregnancy Outcomes in Mammals.

Development of assisted reproductive technologies has been driven by the goals of reducing the incidence of infertility, increasing the number of offspring from genetically elite animals, facilitating genetic manipulation, aiding preservation and long-distance movement of germplasm, and generating research material. Superovulation is associated with reduced fertilization rate and alterations in endometrial function. In vitro production of embryos can have a variety of consequences. Most embryos produced in vitro are capable of establishing pregnancy and developing into healthy neonatal animals. However, in vitro production is associated with reduced ability to develop to the blastocyst stage, increased incidence of failure to establish pregnancy, placental dysfunction, and altered fetal development. Changes in the developmental program mean that some consequences of being produced in vitro can extend into adult life. Reduced competence of the embryo produced in vitro to develop to the blastocyst stage is caused largely by disruption of events during oocyte maturation and fertilization. Conditions during embryo culture can affect embryo freezability and competence to establish pregnancy after transfer. Culture conditions, including actions of embryokines, can also affect the postnatal phenotype of the resultant progeny.

Nicotine attenuates global genomic DNA methylation by influencing DNMTs gene expression in human endometrial stromal cells

BackgroundThere is increasing evidence indicating an incidence of infertility and also the risk of endometrial cancers among smokers. However, the mechanism underlying nicotine adverse effect on female reproduction remains unclear. Growing evidence has suggested that environmental exposures such as nicotine could modulate the epigenome. No study has yet been published to evaluate the direct effect of nicotine on the epigenome profiling of human endometrial stromal cells (HESC). Herein, we decided to examine the direct effects of nicotine on global genomic DNA methylation status and DNA methyl- transferases (DNMTs) gene expression in HESC. HESC were treated with different doses of nicotine (0 or control, 10− 11, 10− 8 and 10− 6) M for 24 h and their genomic global DNA methylation and gene expression of DNMTs (DNMT1, DNMT3A, and DNMT3B) were investigated using ELISA and real-time PCR, respectively.ResultsNicotine treatments reduced the average level of DNMTs gene expression by 90, 79, and 73.4% in 10− 11, 10− 8 and 10− 6 M of nicotine treated cells as compared to control cells, respectively (p < 0.05). Also, 10− 8 and 10− 6 M of nicotine concentrations effectively reduced the amounts of 5-methylated cytosine (5-mC) by 1.09 and 1.87% compared to control cells, respectively (p < 0.05). The 5-mC percentages were positively correlated with the relative cellular DNMTs expression in HESC as verified by the Pearson correlation test.ConclusionAn interesting possibility raised by the current study is that the reduced genomic global DNA methylation level in HESC may be partly due to the suppression of DNMTs gene expression caused by nicotine in these cells.Graphical abstract

Socio-economic Status, rearing practices and reproductive performance of buffaloes under field conditions of Haryana

Present study was carried out to examine the reproductive status and incidence of infertility in buffaloes in Haryana. The study was carried out in 40 villages of 10 districts and 1000 respondents constituted the study sample. Data on socioeconomic profile of respondents, buffalo rearing practices, reproductive status and incidence of infertility were collected. The analysis revealed that respondents were pre-dominantly having medium land holding size and their education qualification ranged from matric to secondary level and dairy was the main purpose for buffalo rearing. Major proportion of respondents (67.3%) did not maintain any record and 62.2 per cent of respondents were breeding their buffaloes through artificial insemination (AI). The age at first conception, service period and calving interval was found to be 31.98 months, 42.03 months, 110.81 days and 420.80 days, respectively indicating better reproductive status of buffaloes. Low incidence of calving related disorders such as retained placenta (2.41%), genital prolapsed (1.93%), dystocia (1.59%), abortion (0.69), premature birth (0.21) and still birth (0.21) were observed. The incidence of anestrus and repeat breeding was 9.47 per cent and 6.34 per cent in buffaloes, respectively whereas delayed pubertal and repeat breeder were reported in 9.69 and 6.79 per cent heifers, respectively.

Previous ovarian surgery increases the risk of tubal factor infertility

Aim: Previous ovarian surgery for endometriosis results in decreased ovarian reserve and poor response to treatment in women with infertility. However, the impact of previous overall ovarian surgery on the incidence of infertility is unclear. Therefore the authors investigated impact of previous ovarian surgery on infertility incidence. Materials and Methods: This is a case-control study using retrospectively collected data in women who received infertility treatment (cases) or delivered babies (controls) at a tertiary center between 2003 and 2012. Results: The frequency of previous ovarian surgery was similar in both groups (p &gt; 0.05) but it was higher in women with tubal infertility than their matched controls (p &lt; 0.05). Also, the frequency of previous reproductive organ surgery was higher in the case group and in women with tubal or unexplained infertility (p &lt; 0.05). Conclusion: Previous ovarian surgery is not associated with entire infertility, but may increase tubal factor infertility through adhesion formation and damage to adjacent tubes.

Incidence of Infertility in Female Buffaloes due to some Reproductive Disorders

Incidence of Infertility in Female Buffaloes due to some Reproductive Disorders

Sperm Abnormalities: In the Male Partners of Infertile Couples from Kanyakumari District

ABSTRACTBackgroundInfertility has been identified as a health issue worldwide and it is of great concern among married couples in our society. Scientifically, it has been established that both males and females can contribute to infertility. However, in most cases, women are held responsible for the same without proper diagnosis. Statistically, female factors contribute to about 40–60% of infertility cases, whereas 20–40% of infertility cases are due to factors contributed by males, of which, deficiency in semen quality is the major cause which accounts for 40–50% of infertility cases. A decrease in semen quality has been reported which can be due to lifestyle changes, occupational exposures to chemicals, heat, and stress.AimsTo study the prevalence of infertility, distribution of sperm abnormalities, and the impact of occupation on men visiting a tertiary clinic.Settings and designMale partners of infertile couples who visited the fertility center were considered for the study.Materials and methodsSeminal fluid was analyzed for volume, sperm concentration, motility (progressive motility), and morphology.ResultsIn this study conducted in our center, we found that 55.8% of the patients had sperm abnormalities, among which teratozoospermia was the commonly observed anomaly.ConclusionMale factors equally contribute to infertility as female factors. Semen analysis is the crucial diagnostic test for infertility assessment of the male partner.Key messagesThe incidence of male infertility has been increasing recently and the evaluation and prognosis of male subfertility are challenging. Although semen analysis is the primary test for the assessment of infertility in males, it does not recognize the abnormality in idiopathic infertility. Thus, new techniques and methods need to be developed to improve accuracy and reduce variation.How to cite this articleViswambharan N, Manavalan M. Sperm Abnormalities: In the Male Partners of Infertile Couples from Kanyakumari District. Int J Infertil Fetal Med 2020;11(1):16–19.

Clinical Update on Home Testing for Male Fertility.

Male factor infertility accounts for about 50% of the incidence of infertility in couples. In current practice, the men must attend a clinic or hospital facility to provide a semen analysis, which is key to the diagnosis of the male reproductive potential. However, many men are often embarrassed with the process and conventional semen analysis requires complex, labor intensive inspection with a microscope. To mitigate these problems, one of the solutions can be at-home semen analysis. In this review we examine the literature of currently available at home semen analysis test kits, describe their limitations, and compare them to the conventional lab-based methods.

Pengetahuan dan Sikap mengenai Infertilitas pada Mahasiswa Fakultas Kedokteran dan Fakultas Non Kedokteran Universitas YARSI

Infertility is a disease characterized by the failure to establish a pregnancy after 12 months of regular unprotected sexual intercourse. As the incidence of infertility increases, knowledge and attitude about infertility on students may decrease the incidence of infertility in the future. The aim of this study is to determine and compare the knowledge and attitude regarding infertility among YARSI University students based on their faculty and gender. This was an analytic study with cross-sectional design, which conducted on September until November 2016. The samples were using bachelor’s degree students from 2013 classes of YARSI University in total 86 respondents. Data were obtained by using questionnaire that has been validated. This study used univariate and bivariate analysis method.The results of this study showed that majority of students have moderate level of knowledge regarding infertility (46,5%) and good attitude towards infertility (97%). Significant difference was found in knowledge about infertility between faculties (p value 0,000; less than 0,05). While there was no significant difference in knowledge about infertility between genders with (p value 0,471; more than 0,05). Significant differences were also not found in attitudes regarding infertility between faculties with (p value 0,399; more than 0.05) and genders with (p value 0,083; more than 0.05). Based on the research results medical students have a better knowledge about infertility than non-medical student. Faculty affect the knowledge about infertility, but do not affect the attitude towards infertility. Meanwhile, genders do not affect both knowledge and attitude towards infertility. Thus, it is important to improve student’s knowledge and attitude regarding infertility

Knowledge, attitude and practice regarding menstrual hygiene among adolescent girls in a rural private school

Background: Being a developing country, India is faced with many health problems which can be averted by education and implementation of basic guidelines. Menstrual hygiene is one such topics which is rarely brought to attention but forms an integral part of a women’s life. This topic has been neglected not only in rural areas but in the poor socioeconomic corners of metropolitan cities. This ignorance has taken a great toll on the quality of life of women. Poor hygiene predisposes them to reproductive tract infections which may lead to increased incidence of infertility and mortality. Misconceptions regarding this have also prevented women to seek out professional help. Keeping this in mind the study was undertaken to spread awareness and eliminate the taboo this topic is regarded with.Methods: A cross sectional study was conducted amongst adolescent girls in a private school located in Angaon village, Bhiwandi Taluka, Mumbai. A self-administered questionnaire was given to the adolescent girls to assess their knowledge, attitude and practices regarding menstrual cycle. Percentages were used for statistical analysis.Results: 83 girls (96.51%) were aware of menstrual cycle. 49 (56.98%) girls perceived that menstrual blood is dirty. 72 (83.72%) knew that it is a physiological process. 85 (98.84%) were also aware about menstrual hygiene. 85 (98.4%) felt that girls should be addressed regarding menstrual cycle, hygiene before achieving menarche. 50 (58.14%) girls followed restrictions during menstruation.Conclusions: The findings of the present study emphasize the need to address physiology about menstrual cycle as well as the myths and misconceptions associated with it.

A Systematic Review of Organic Versus Conventional Food Consumption: Is There a Measurable Benefit on Human Health?

The current review aims to systematically assess the evidence related to human health outcomes when an organic diet is consumed in comparison to its conventional counterpart. Relevant databases were searched for articles published to January 2019. Clinical trials and observational research studies were included where they provided comparative results on direct or indirect health outcomes. Thirty-five papers met the criteria for inclusion in the review. Few clinical trials assessed direct improvements in health outcomes associated with organic food consumption; most assessed either differences in pesticide exposure or other indirect measures. Significant positive outcomes were seen in longitudinal studies where increased organic intake was associated with reduced incidence of infertility, birth defects, allergic sensitisation, otitis media, pre-eclampsia, metabolic syndrome, high BMI, and non-Hodgkin lymphoma. The current evidence base does not allow a definitive statement on the health benefits of organic dietary intake. However, a growing number of important findings are being reported from observational research linking demonstrable health benefits with organic food consumption. Future clinical research should focus on using long-term whole-diet substitution with certified organic interventions as this approach is more likely to determine whether or not true measurable health benefits exist.

Association of sperm DNA fragmentation (SDF) with different parameters that may be related to fertility and reproduction

Aim of study to see the association of the presence of DNA fragmentation in males with smoking, low sperm motility, infertility, and recurrent pregnancy loss. Sperm DNA integrity is an important factor in normal fertilization and embryo development. Test for SDF seems to be a good option for the husband of females with unexplained history of recurrent miscarriages or infertility. DNA damage can be induced by environmental mechanisms like smoking.40 males referred to our genetic laboratory for DNA fragmentation test for different causes, we calculate the incidence of SDF among them and evaluate their conditions regarding association with infertility, recurrent abortions, and also we study their age, smoking and sperm count and motility. 27 patients had positive results, so the incidence of DNA fragmentation was 67.5 %. 8 of 27 their age were more than 35years (29.6%).12 of 27 were smokers (44.4%).15 of 27 had sperm count less than 15 million (55.5%).20 patients of these 27 had a history of infertility (74%).7 patients of 27; their wife had a history of recurrent pregnancy loss (25%).DNA fragmentation associated with low sperm count and motility, smoking, and high incidence of infertility and recurrent miscarriages.