Kruger Strict Morphology Research Articles

Evaluation of the aquaporin molecules characterization in the sperm cells of men from different aged.

Male infertility rises for many reasons, along with age; therefore, we aimed to research the characterization of aquaporin-3, 7, and 8 in human sperm belonging to different age groups. This study was conducted on sperm samples of men aged over 18 years. A total of 60 men were included in the study and divided into three age groups: group 1, age 18-25 years (n = 20); group 2, age 26-35 years (n = 20); and group 3, age ≥35 years (n = 20). Sperm ejaculates obtained from each participant were used for spermiogram tests, Kruger strict morphology analysis, and immunohistochemistry. We observed no statistically significant differences in terms of macroscopic and microscopic sperm testing. The immunostaining score of aquaporin-3 was the lowest in group 1 and increased in group 3 and group 2, respectively (p < 0.05). Aquaporin-8 immunostaining only increased in group 2 (p < 0.05). Aquaporin-7 immunostaining scores were not different between the groups (p > 0.05). When the immunostaining scores of aquaporin molecules were compared with each other, aquaporin-7 was significantly increased compared with the others (p < 0.05). According to the results, it can be stated that aquaporin-3 and aquaporin-8 molecules were more expressed at age 26 to 35 years, and aquaporin-7 was densely expressed from age 18 to 25 years. If the characterization of these molecules is adversely affected, male infertility may eventually emerge. We recommend further advanced-level studies on this subject.

Outcome reporting across randomized controlled trials evaluating potential treatments for male infertility: a systematic review.

STUDY QUESTIONWhat are the primary outcomes and outcome measures used in randomized controlled trials (RCTs) evaluating potential treatments for male infertility in the last 10 years?SUMMARY ANSWEROutcome reporting across male infertility trials is heterogeneous with numerous definitions and measures used to define similar outcomes.WHAT IS KNOWN ALREADYNo core outcome set for male infertility trials has been developed. Male infertility trials are unique in that they have potentially three participants, a man, a female partner and their offspring and this will likely lead to significant variation in outcome reporting in randomized trials.STUDY DESIGN, SIZE, DURATIONA systematic review of RCTs mapping outcomes and outcome measures evaluating potential treatments for men with infertility registered in the Cochrane Register of Controlled Trials (CENTRAL) between January 2010 and July 2021.PARTICIPANTS/MATERIALS, SETTING, METHODS screening and study selection was undertaken in duplicate using a review protocol that was developed prior to commencing the review. No risk of bias assessment was undertaken as this review aims to report on outcome reporting only.MAIN RESULTS AND THE ROLE OF CHANCEOne hundred and seventy-five RCTs were identified, and given the large number of studies we limited our review to the 100 largest trials. Seventy-nine different treatments were reported across the 100 largest RCTs including vitamin and dietary supplements (18 trials), surgical treatments (18 trials) and sperm selection techniques (22 trials). When considering the largest 100 trials (range: 80–2772 participants), 36 primary and 89 secondary outcomes were reported. Forty-seven trials reported a primary outcome and 36 trials clearly defined their primary outcome. Pregnancy outcomes were inconsistently reported and included pregnancy rate (51 trials), pregnancy loss including miscarriage, ectopic pregnancy, stillbirth (9 trials) and live birth (13 trials). Trials consistently reporting the same outcome frequently used different definitions. For example, semen quality was reported by 75 trials and was defined in 7 different ways, including; the World Health Organization (WHO) 2010 criteria (32 trials), WHO 1999 criteria (18 trials), WHO 1992 criteria (3 trials), WHO 1999 and 1992 criteria (1 trial) and the Kruger strict morphology criteria (1 trial).LIMITATIONS, REASONS FOR CAUTIONWe only evaluated the 100 largest trials published in the last 10 years and did not report outcomes on the remaining 75. An outcome was included as a primary outcome only if clearly stated in the manuscript and we did not contact authors to clarify this. As our review mapped outcomes and outcome measures, we did not undertake an integrity assessment of the trials included in our review.WIDER IMPLICATIONS OF THE FINDINGSMost randomized trials evaluating treatments for male infertility report different outcomes. Only half of the RCTs reported pregnancy rate and even fewer reported live birth; furthermore, the definitions of these outcomes varies across trials. Developing, disseminating and implementing a minimum data set, known as a core outcome set, for male infertility research could help to improve outcome selection, collection and reporting.STUDY FUNDING/COMPETING INTEREST(S)A.P.—chairman of external scientific advisory committee of Cryos International Denmark ApS, member of the scientific advisory board for Cytoswim LDT and ExSeed Health. Guest lecture at the ‘Insights for Fertility Conference’, funded by MERK SERONO Limited. M.v.W.—holds a ZON-MW research grant. No external funding was obtained for this study.

Assessing the clinical value of the Kruger strict morphology criteria over the World Health Organization fourth edition criteria

ObjectiveTo assess if the newer Kruger strict morphology (WHO5; normal ≥4%) adds any clinical value beyond the criteria of the World Health Organization fourth edition (WHO4; normal ≥14%).DesignRetrospective study.SettingTertiary hospital.Patient(s)Men without known azoospermia who had semen analysis (SA) collected over a 10-year period of time.Intervention(s)Morphology classification under Kruger WHO5 strict criteria and WHO4 criteria.Main Outcome Measure(s)Correlation between the WHO5 and WHO4 morphological classifications.Result(s)A total of 4,510 SAs were identified during the study period. Of these, both Kruger WHO5 and WHO4 morphologies were included in 932 SAs (20.7%) from a total of 691 men. The median age of the men was 37 years (interquartile range, 32.0–43.8 years). The mean (±SD) semen volume, sperm concentration, and motility were 2.6 ± 1.4 mL, 50.0 ± 35.6 × 106/mL, and 53.1% ± 18.6%, respectively. The correlation between the WHO4 and WHO5 morphology assessments was high (Spearman correlation coefficient = 0.94). Only 545 (58.5%) of 932 SAs had abnormal Kruger WHO5 morphology, of which 543 (99.6%) of 545 also had abnormal morphology by the WHO4 criteria.Conclusion(s)The Kruger WHO5 and WHO4 morphologic criteria correlate closely. Only two men (0.4%) with an abnormal Kruger morphology had normal WHO4 morphology. Given the limited predictive value of sperm morphology, the additional cost and effort of Kruger criteria may not be warranted in lieu of, or in addition to, the WHO4 classification.

Influence of Sperm Morphology on the Outcome of Assisted Reproductive Technique—Intracytoplasmic Sperm Injection Cycles: A Retrospective Analysis

ABSTRACTAimThe aim of this study was to evaluate the influence of spermatozoa morphology on ICSI cycle outcome parameters in couples with male factor infertility.DesignRetrospective study.SettingUniversity-level tertiary care center.Patients and methodsOne hundred and forty-eight couples with male factor infertility who had undergone intracytoplasmic sperm injection (ICSI) cycle from 2010 to December 2012 were included in this analysis. The semen samples of the male partners were classified according to the three predictive categories of the Tygerberg strict criteria: excellent prognosis (&gt; 14% morphologically normal spermatozoa), good prognosis (5–14%) and poor prognosis (&lt; 5%).Main outcome measuresThe primary outcome was the embryo quality rate.ResultsPatients in the poor prognosis subgroups exhibited deficits in spermatozoa concentration, motility and total motile fraction. The variations in the outcome parameters of fertilization rate, embryo development rate and embryo quality did not correlate with sperm morphology.ConclusionOur study suggests that Kruger's strict morphology criteria of the fresh semen sample is not a good predictor for the ICSI cycle outcome.How to cite this articlePreetha RP, Kamath MS, Aleyamma TK, Muthukumar K. Influence of Sperm Morphology on the Outcome of Assisted Reproductive Technique-Intracytoplasmic Sperm Injection Cycles: A Retrospective Analysis. Int J Infertil Fetal Med 2015;6(3):122-127.

Quest for An Ideal, Simple and Cost-Effective Stain for Morphological Assessment of Sperms.

Recent alarming trends of a substantial rise in the number of cases of infertility with as many as 30-40% being attributed to male-factor associated causes have created a need for further studies and advancements in semen analysis. Despite the focus on semen analysis over the years, assessment of sperm morphology has not been given due importance although it is a simple, standard and baseline diagnostic modality. It can be used to predict the need and outcome of Artificial Reproductive Techniques such as Invitro Fertilization, Gamete Intra Fallopian Tube Transfer and Intra Cytoplasmic Sperm Injection. To find the ideal, simple and cost-effective basic stain for assessment of sperm morphology in a rural tertiary care set- up where advanced equipment for assessment of sperm morphometry are inaccessible. An updated way of determining sperm shape is called the Kruger's strict morphology method. Keeping this as the standard criterion, we studied semen samples of 62 healthy male subjects using four basic staining techniques and the consensus of four independent observers was tabulated. We found that Haematoxylin and Eosin stain was the best stain for assessment of sperm head morphology. Rapid Papanicolau stain was the most ideal, simple and cost-effective stain for overall assessment of sperm morphology. Sperm morphology assessment remains the baseline necessity for the diagnosis and management of male factor associated infertility when advanced techniques are unavailable, inaccessible or unaffordable.

Bacterial communities in semen from men of infertile couples: metagenomic sequencing reveals relationships of seminal microbiota to semen quality.

Some previous studies have identified bacteria in semen as being a potential factor in male infertility. However, only few types of bacteria were taken into consideration while using PCR-based or culturing methods. Here we present an analysis approach using next-generation sequencing technology and bioinformatics analysis to investigate the associations between bacterial communities and semen quality. Ninety-six semen samples collected were examined for bacterial communities, measuring seven clinical criteria for semen quality (semen volume, sperm concentration, motility, Kruger's strict morphology, antisperm antibody (IgA), Atypical, and leukocytes). Computer-assisted semen analysis (CASA) was also performed. Results showed that the most abundant genera among all samples were Lactobacillus (19.9%), Pseudomonas (9.85%), Prevotella (8.51%) and Gardnerella (4.21%). The proportion of Lactobacillus and Gardnerella was significantly higher in the normal samples, while that of Prevotella was significantly higher in the low quality samples. Unsupervised clustering analysis demonstrated that the seminal bacterial communities were clustered into three main groups: Lactobacillus, Pseudomonas, and Prevotella predominant group. Remarkably, most normal samples (80.6%) were clustered in Lactobacillus predominant group. The analysis results showed seminal bacteria community types were highly associated with semen health. Lactobacillus might not only be a potential probiotic for semen quality maintenance, but also might be helpful in countering the negative influence of Prevotella and Pseudomonas. In this study, we investigated whole seminal bacterial communities and provided the most comprehensive analysis of the association between bacterial community and semen quality. The study significantly contributes to the current understanding of the etiology of male fertility.

Polymorphisms in folate-metabolizing genes and risk of idiopathic male infertility: a study on a Russian population and a meta-analysis

To investigate the association of polymorphisms in the folate-metabolizing genes with idiopathic male infertility in a Russian population and to perform a meta-analysis. A case-control study. Research laboratory. 275 men with idiopathic male infertility and a population sample of 349 men. Determining the genotypes of polymorphisms MTHFR C677T, MTHFR A1298C, MTR A2756G, MTRR A66G, SHMT1 C1420T, MTHFD1 G1958A, and CBS 844ins68. Semen analyses performed according to the World Health Organization guidelines (WHO, 1999) and Kruger strict morphology test. None of the polymorphisms were significantly associated with idiopathic male infertility after the implementation of Bonferroni correction for multiple testing, although the MTHFD1 G1958A and MTR A2756G polymorphisms showed an association before the Bonferroni correction. Meta-analysis revealed an association by use of fixed-effects model of MTHFR C677T with the risk of azoospermia. These findings suggest that polymorphisms in folate-metabolizing genes could be involved in the etiology of male infertility. Additional studies performed on larger groups are necessary to investigate the possible associations.

Kruger strict morphology and post-thaw progressive motility in cryopreserved human spermatozoa

The purpose of this prospective study was to evaluate Kruger strict morphology and conventional semen analysis in predicting cryosurvival and the progressive motility recovery rate of frozen spermatozoa. Our study included 56 semen samples with >10 million spermatozoa per ejaculate. The main outcome measures were conventional semen analysis, strict morphology analysis by the Kruger method, cryosurvival rate and post-thaw sperm motility. A significant reduction in sperm motility after cryopreservation was demonstrated. The freeze-thawing process caused a 66% reduction in rapid progressive motile spermatozoa, a 45% reduction in slow progressive motile spermatozoa and a 2% reduction in nonprogressive motile spermatozoa. The cryosurvival and progressive motility recovery rates were not correlated with parameters of conventional semen analysis, such as sperm concentration, motility, WHO morphology and total motile count, but the progressive motility recovery rate was significantly correlated with the percentage of spermatozoa exhibiting Kruger normal morphology (P = 0.028). The recovery rate of rapidly progressive motility was profoundly decreased compared with slow progressive motility following the frozen-thaw procedure of semen. Kruger strict morphology assessment was a better predictor of the progressive motility recovery rate following the freezing-thaw procedure than parameters of conventional semen analysis.

1797: Comparison of Kruger Strict Morphology among Fertile and Infetile Males

1797: Comparison of Kruger Strict Morphology among Fertile and Infetile Males

O-147: Use of the sperm DNA decondensation (SDD) assay to predict failed pregnancies for donor egg patients following intra-cytoplasmic sperm injection (ICSI)

1. To establish whether the SDD assay predicts failed pregnancies for egg donor patients. 2. To identify other semen or sperm parameters during In-Vitro Fertilization (IVF) which positively correlate with SDD values. Sperm DNA function plays an important role in establishing ongoing pregnancies. The SDD assay provides insight into sperm function during fertilization compared to semen analysis parameters. The SDD assay measures the rate of sperm decondensation in a controlled in-vitro environment of Xenopus laevis frog egg extract. This critical step of fertilization is time-dependent. It is theorized that untimely sperm decondensation effects normal gene activation sequences during fertilization. Breakdowns in gene activation may produce normal phenotypic embryos that are incapable of going to full-term delivery. This study aims to utilize the sperm SDD assay to predict outcomes of IVF procedures using donor eggs. Six couples underwent an IVF cycle using donor eggs with ICSI. No couple had the same anonymous egg donor. On the morning of egg retrieval the male partner collected a semen sample by masturbation. A portion of the semen was prepared for overnight shipment to Repromedix, Inc; the remainder was used for the ICSI procedure. The data collected included; age of donor, age of recipient, age of male partner, Kruger strict morphology on neat semen, Kruger strict morphology on post-density gradient (DG) sperm, sperm deformity index (SDI) on neat semen, SDI on post-DG sperm, SDD, round cells (identified), fertilization rate, density, motility, total motile sperm post-DG, number of embryos at 6-cell or greater on day 3, number of embryos transferred (ET) on day 3, cleavage rate and ongoing pregnancy rate on fresh and frozen embryos (FE). Of the six couples tested thus far, 3 have established an ongoing pregnancy (one of the 3 couples failed on fresh ET but has an ongoing pregnancy following subsequent FET). All 3 ongoing pregnancies had normal SDD values. Two subjects had normal SDD values with negative pregnancy outcomes. Interestingly, subject 4 had the only abnormal SDD value thus far and the recipient had a miscarriage late in the first trimester of pregnancy. This couple also failed a subsequent FET. Other parameters which seem to indicate fecundity potential were number of 6-cell embryos or greater on day 3, fertilization rate, Kruger strict morphology and the SDI (See table).Tabled 1 The SDD assay may diagnose unexplained failed pregnancies in Men with normal semen parameters. Results show thus far that normal semen parameters alone are not reliable criteria for predicting the establishment of a full-term pregnancy. However, our data shows that Kruger strict morphology and the SDI may provide valuable information into failed pregnancies following IVF when their SDD values are in normal range. The SDD assay may be a useful tool in predicting negative pregnancies or miscarriages following IVF.

P-628: Sperm bound to hyaluronic acid or to human zona pellucida exhibit similar levels of improvement in tygerberg strict morphology scores

During spermiogenesis, a plasma membrane remodeling step facilitates formation of zona pellucida and hyaluronic acid(HA) binding sites in sperm. Thus, diminished maturity sperm, which contain surplus cytoplasm and show consequential abnormal morphology, are unable to bind to HA. We have tested the hypothesis that there will be an improvement in the proportion of sperm with normal Kruger strict morphology in HA-bound sperm fractions of semen samples, similar to the 4.2x increase reported by the Tygerberg, South Africa (TSA) group for zona pellucida bound sperm fractions of teratozoospermic specimens (Mol. Repr. Dev., 1991). Strict sperm morphology was determined in semen and in their respective HA-bound fractions in 30 men (Sperm conc. range: 7.4-115x106/mL, motility: 45.6±3.1%) by three independent investigators. Two readers were from the USA (US1 and US2) and the third, TSA, who was blinded to the A and B surface of slides, was from South Africa. METHODS: For sperm evaluation, a two-chamber version of the HBA slide (MidAtlantic Diagnostics) was used. An aliquot of semen was smeared on the uncoated A side. In another aliquot, the sperm were allowed to bind to the HA-coated surface of B side, to determine HA-binding score. After Diff-Quik staining, 200 sperm were evaluated for strict morphology by each investigator on the A and B sides. The sperm maturity markers, CK-activity (cytoplasmic retention) and HspA2 chaperone were assessed, as published previously. Statistical analysis by paired T-test, Wilcoxon ranked sum test, and Spearman correlations were by Sigma Stat (Jandel). All values are mean±SEM. Comparing the three readers, US1 and US2 used stricter criteria than TSA. The % normal scores by the three investigators for A semen and the respective B HA-bound sides were: US1: 6.6±0.7% (range:14.7) and 13.5±1.4% (range: 33.2): US2: 8.9±0.9 (range:20.7) and 14.5±1.4 (range:29.8); TSA: 11.0±1.1 (range: 23) and 26.5±2.1 (range: 50), A vs. B p<0.003 in all readers. There were similar variations in Kruger strict morphology score improvements from the A to B sides: US1: 2.2x, US2:1.8x and TSA: 3.1x. However, despite the differences in “strictness,” the evaluations were internally consistent among USA1, USA2, and TSA between r=0.38 and 0.66 (p=0.039 - <0.001). The rationale for the morphology improvements is supported by the relationships between HA-binding scores and sperm maturity markers: HA-binding vs. CK activity: r= -0.56, p=0.004; HA-binding vs. HspA2 levels: r=0.55, p=0.005. Most revealing are the % increase in sperm with normal morphology bound to HA from the 19 teratozoospermic (<14% normal) samples: 226% and 194% for the stricter US1 and US2. However, TSA found a 376% improvement, a value nearly identical to the 420% improvement found in zona pellucida-bound sperm by the TSA group in 1991. CONCLUSIONS: Consistent with our hypothesis, there was a significant improvement in normal strict morphology scores in the HA-bound vs. semen sperm fractions. The improvement was comparable to those reported earlier for zona pellucida-bound sperm. The relationships between sperm maturity, HA-binding and normal morphology are further supported by the HA-binding scores and sperm maturity markers. This selection/separation method holds promise for semen evaluation and ICSI programs, as mature normal forms are highly selected.

The effects of subinguinal varicocelectomy on Kruger morphology and semen parameters.

We studied the effect of varicocele ligation on Kruger strict morphology criteria and semen parameters in patients with infertility. A total of 90 patients diagnosed with varicoceles and a normal morphological sperm ratio of less than 14% were evaluated before and 6 months after varicocelectomy. Preoperatively and postoperatively sperm density, motility and morphology using Kruger strict criteria were analyzed. The Wilcoxon test was used to measure levels of statistical significance in all analyses. Significant improvement in sperm concentration and motility was evident after varicocele ligation (p <0.0002 and <0.0001, respectively). Using the Kruger classification sperm morphology evaluation revealed a significant increase in the percent of normal forms, and of forms with head and acrosome defects (p <0.0001, <0.0014 and <0.0028, respectively). There were no concomitant changes in strict morphology in forms with mid piece and tail defects or immature forms (p >0.05). Of the 90 patients 18 (20%) achieved a successful full-term pregnancy, including 14 via natural cycle intercourse and 4 by intrauterine insemination. Surgical correction of varicocele was associated with significant improvement in density, motility and sperm morphology evaluated using the Kruger classification.

Semen characteristics after overnight shipping: preservation of sperm concentrations, HspA2 ratios, CK activity, cytoplasmic retention, chromatin maturity, DNA integrity, and sperm shape.

We tested several approaches that can be used to preserve sperm attributes and the objective biochemical markers of sperm maturity and function for assessment in a remote centralized laboratory after overnight shipping of semen samples. Addition of phenyl-methyl-sulfonyl-fluoride (PMSF) to a final concentration of 20 microg/mL semen at 4 degrees C has preserved sperm concentrations and HspA2 isoform ratios, even at room temperature, simulating a shipping delay in moderate ambient temperatures. Regarding the attributes of individual spermatozoa, the patterns of CK-immunocytochemistry (demonstrates cytoplasmic retention in diminished-maturity spermatozoa); aniline blue staining pattern (tests chromatin maturity); sperm shape assessed by both Kruger strict morphology and computer assisted morphometry; and sperm DNA integrity, as tested by DNA nick translation, all remained unchanged. Thus, the PMSF-4 degrees C conditions preserved sperm concentrations and the cytoplasmic and nuclear biomarkers of sperm cellular maturity and function for next-day analysis. This shipping method will facilitate the early detection of subtle changes in semen quality that can affect sperm function, even when there has been no decline in sperm concentrations to signal possible toxic effects. Furthermore, sample preservation will enable investigators to evaluate semen for toxicology studies and for diagnosis of male infertility from remote locations. Home collection of semen should enhance study participation, and semen assessment in centralized laboratories will address concerns regarding interlaboratory variations and quality control.

Sperm selection for ICSI: shape properties do not predict the absence or presence of numerical chromosomal aberrations.

We hypothesize that the potential relationship between abnormal sperm morphology and increased frequency of numerical chromosomal aberrations is based on two attributes of diminished sperm maturity: (i) cytoplasmic retention and consequential sperm shape abnormalities; and (ii) meiotic errors caused by low levels of the HspA2 chaperone, a component of the synaptonemal complex. Because sperm morphology and aneuploidies were assessed in semen, but not in the same spermatozoa, previous studies addressing this relationship were inconclusive. We recently demonstrated that sperm shape is preserved following fluorescence in situ hybridization (FISH). Thus, we examined the shape and chromosomal aberrations in the same sperm. We performed phase contrast microscopy and FISH, using centromeric probes for chromosomes X, Y, 10, 11 and 17 in 15 men. The fluorescence and respective phase contrast images were digitized using the Metamorph program. We studied 1286 sperm (256 disomic, 130 diploid and 900 haploid sperm) by three criteria: head and tail dimensions, head shape and Kruger strict morphology. Furthermore, in each analysis, we considered whether disomic or diploid sperm may be distinguished from haploid sperm. There was an overall, but not discriminative, relationship between abnormal sperm dimensions or shape and increased frequencies of numerical chromosomal aberrations. However, approximately 68 of the 256 disomic, and four of 130 diploid sperm showed head and tail dimensions comparable with the most normal, lowest tertile of the 900 haploid spermatozoa. Considering all 1286 sperm, among those with the most regular, symmetrical shape (n = 367), there were 63 and five with disomic and diploid nuclei, respectively. In line with these findings, among the 256 disomic sperm, 10% were Kruger normal. Sperm dimensions or shape are not reliable attributes in selection of haploid sperm for ICSI.

Post-processed semen specimens with deficits in strict morphology may not require intracytoplasmic sperm injection (ICSI) to achieve good reproductive outcomes

Post-processed semen specimens with deficits in strict morphology may not require intracytoplasmic sperm injection (ICSI) to achieve good reproductive outcomes

Biochemical markers of sperm function: male fertility and sperm selection for ICSI

The expression of a 70 kDa chaperone protein, HspA2 (formerly called CK-M), has been identified in mature human spermatozoa. The central role of HspA2 has been established, as the expression level of this protein is related to sperm cellular maturity, DNA integrity, chromatin maturity, chromosomal aneuploidy frequency and sperm function, including fertilizing potential. The spermiogenetic events of cytoplasmic extrusion and remodelling of the plasma membrane, which facilitate the formation of zona pellucida binding site(s) in human spermatozoa, are related. Finally, the presence of the hyaluronic acid (HA) receptor on the plasma membrane of mature sperm coupled with the HA-coated slide sperm-binding assay, facilitates the testing of infertile men and the selection of single mature spermatozoa for ICSI. Because mature spermatozoa have no residual cytoplasm, the HA-bound sperm fraction is also enriched in spermatozoa that are normal by the Kruger strict morphology method.

The Effects of Subinguinal Varicocelectomy on Kruger Morphology and Semen Parameters

We studied the effect of varicocele ligation on Kruger strict morphology criteria and semen parameters in patients with infertility. A total of 90 patients diagnosed with varicoceles and a normal morphological sperm ratio of less than 14% were evaluated before and 6 months after varicocelectomy. Preoperatively and postoperatively sperm density, motility and morphology using Kruger strict criteria were analyzed. The Wilcoxon test was used to measure levels of statistical significance in all analyses. Significant improvement in sperm concentration and motility was evident after varicocele ligation (p <0.0002 and <0.0001, respectively). Using the Kruger classification sperm morphology evaluation revealed a significant increase in the percent of normal forms, and of forms with head and acrosome defects (p <0.0001, <0.0014 and <0.0028, respectively). There were no concomitant changes in strict morphology in forms with mid piece and tail defects or immature forms (p >0.05). Of the 90 patients 18 (20%) achieved a successful full-term pregnancy, including 14 via natural cycle intercourse and 4 by intrauterine insemination. Surgical correction of varicocele was associated with significant improvement in density, motility and sperm morphology evaluated using the Kruger classification.

Multivariate analysis of parameters that predict response to microsurgical varicocele repair.

Multivariate analysis of parameters that predict response to microsurgical varicocele repair.

Is it worth repairing bilateral subclinical varicocele?

Objective: Although the significance of subclinical varicocele is unclear, there is some literature to suggest that significant improvements in semen quality and pregnancy rates can be achieved after surgery. We asked the question whether it might be reasonable to repair men with bilateral subclinical varicocele, and review our findings from these here.Design: Retrospective study of a consecutive series of infertile patients with subclinical varicocele.Materials/Methods: The study included 33 infertile patients with abnormal semen parameters and bilateral subclinical varicoceles diagnosed by scrotal color Doppler ultrasonography. The ultrasound criteria included the presence of retrograde blood reflux into the internal spermatic vein with the diameter of vein >2.5 mm at rest in the supine position without a Valsalva maneuver. Preoperative clinical findings, hormones, pre- and postoperative semen parameters including Kruger strict morphology were obtained in all patients. All patients underwent bilateral microsurgical either inguinal or subinguinal varicocele repair. A positive response to varicocele repair was defined as a 50% increase in total motile sperm counts (TMC) in the ejaculate from preoperatively to postoperatively. Spontaneous pregnancies were also assessed in all patients. Paired t test was used to compare pre- and post-operative semen parameters.Results: The mean age of the patients was 30 ± 1.1 years (18–43). The mean duration of infertility was 3.6 ± 0.65 years (1–18). The mean diameter of the internal spermatic vein was 3.2 ± 0.17 mm on the left side, and 2.9 ± 0.14 mm on the right side. The response to varicocele repair was observed in 18 out of 33 patients (54.5%), and 9 out of 27 couples (33.3%) achieved spontaneous pregnancy with the mean time of 7.2 ± 1.5 months after the surgery. The mean TMC increased from 22.8 ± 7.2 million to 35.8 ± 8.3 million (p = 0.026), and the mean Kruger strict morphology (%) increased from 4.8 ± 1.7 to 6.3 ± 1.5 (p = 0.037), postoperatively. In addition, when the seminal response to surgery was compared between the responders and non-responders, there were no differences in the mean patients age, testicular volumes, infertility duration, preoperative serum FSH and free testosterone levels, the diameters of internal spermatic veins, preoperative sperm count/ml, WHO and Kruger strict morphologies.Conclusions: This data strongly suggest that semen quality significantly improves in a half of patients with bilateral subclinical varicocele after surgery. The degree of improvement in postoperative TMC and pregnancy rate approximates the results of palpable varicocele repair. Objective: Although the significance of subclinical varicocele is unclear, there is some literature to suggest that significant improvements in semen quality and pregnancy rates can be achieved after surgery. We asked the question whether it might be reasonable to repair men with bilateral subclinical varicocele, and review our findings from these here. Design: Retrospective study of a consecutive series of infertile patients with subclinical varicocele. Materials/Methods: The study included 33 infertile patients with abnormal semen parameters and bilateral subclinical varicoceles diagnosed by scrotal color Doppler ultrasonography. The ultrasound criteria included the presence of retrograde blood reflux into the internal spermatic vein with the diameter of vein >2.5 mm at rest in the supine position without a Valsalva maneuver. Preoperative clinical findings, hormones, pre- and postoperative semen parameters including Kruger strict morphology were obtained in all patients. All patients underwent bilateral microsurgical either inguinal or subinguinal varicocele repair. A positive response to varicocele repair was defined as a 50% increase in total motile sperm counts (TMC) in the ejaculate from preoperatively to postoperatively. Spontaneous pregnancies were also assessed in all patients. Paired t test was used to compare pre- and post-operative semen parameters. Results: The mean age of the patients was 30 ± 1.1 years (18–43). The mean duration of infertility was 3.6 ± 0.65 years (1–18). The mean diameter of the internal spermatic vein was 3.2 ± 0.17 mm on the left side, and 2.9 ± 0.14 mm on the right side. The response to varicocele repair was observed in 18 out of 33 patients (54.5%), and 9 out of 27 couples (33.3%) achieved spontaneous pregnancy with the mean time of 7.2 ± 1.5 months after the surgery. The mean TMC increased from 22.8 ± 7.2 million to 35.8 ± 8.3 million (p = 0.026), and the mean Kruger strict morphology (%) increased from 4.8 ± 1.7 to 6.3 ± 1.5 (p = 0.037), postoperatively. In addition, when the seminal response to surgery was compared between the responders and non-responders, there were no differences in the mean patients age, testicular volumes, infertility duration, preoperative serum FSH and free testosterone levels, the diameters of internal spermatic veins, preoperative sperm count/ml, WHO and Kruger strict morphologies. Conclusions: This data strongly suggest that semen quality significantly improves in a half of patients with bilateral subclinical varicocele after surgery. The degree of improvement in postoperative TMC and pregnancy rate approximates the results of palpable varicocele repair.

VARICOCELECTOMY IMPROVES SPERM STRICT MORPHOLOGY AND MOTILITY

Purpose We prospectively examined the effect of varicocelectomy on standard semen parameters and Kruger strict morphology, including site of specific sperm defect. Materials and Methods Kruger strict morphology and routine semen analysis were performed in a blinded fashion before and a minimum of 4 months after varicocelectomy in 61 subfertile men with a primary diagnosis of varicocele. Results Sperm motility, total number of motile sperm, and percentage and total number of sperm with normal strict morphology were significantly increased after varicocele repair. Average density was also increased, while volume and forward progression were unchanged. The percentage of normal head strict morphology was significantly improved, whereas tail and neck morphology did not reflect similar changes. Conclusions Varicocele repair in subfertile men improves Kruger strict morphology. In addition, motility and total motile sperm are significantly improved after repair. Since the stoichiometry of the sperm head is crucial to egg and sperm interaction, this decrease in head defects may be partially responsible for the increase in pregnancy rates after varicocele repair.