Mean Sperm Density Research Articles

MP30-15 THE QUESTIONABLE CLINICAL UTILITY OF SPERM MORPHOLOGY: RATE OF ISOLATED TERATOSPERMIA IN A POPULATION OF FERTILE MEN

You have accessJournal of UrologyCME1 Apr 2023MP30-15 THE QUESTIONABLE CLINICAL UTILITY OF SPERM MORPHOLOGY: RATE OF ISOLATED TERATOSPERMIA IN A POPULATION OF FERTILE MEN David Miller, Lucille Cheng, Anna Wecht, and Kathleen Hwang David MillerDavid Miller More articles by this author , Lucille ChengLucille Cheng More articles by this author , Anna WechtAnna Wecht More articles by this author , and Kathleen HwangKathleen Hwang More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003258.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The assessment of sperm morphology remains a standard component of the semen analysis however its clinical utility is not well-defined. The WHO guidelines have progressively decreased the percentage of normal morphology over the years and the current provided reference range is 4% or greater. Despite these increasingly strict criteria for the assessment of morphology the clinical relevance remains questionable. Furthermore, accurate repeatability of sperm morphology assessment has been shown to be low due to differences in proficiency between labs and technicians themselves. To better understand the impact of sperm morphology on fertility we assessed sperm morphology in a population of known fertile men. METHODS: Healthy men over 18 years of age were recruited to provide one semen sample prior to vasectomy from 3/2020 to 8/2022. To be included in the study participants were required to have biological children under the age of 5 years old, with no history of difficulty achieving pregnancy, and had undergone no prior fertility procedures. Sperm morphology was analyzed using Papanicolaou stain with Kruger strict criteria by two technicians in an Andrology specialty laboratory per the WHO 5th edition manual. RESULTS: There were 65 men who participated in the study, of which there was a morphology assessment available for 65 patients. The average age of participants was 36 and the mean BMI was 27.9 (20-43.7). Of those with smoking history available, 61% of men were non-smokers, 20% were former smokers, and 13% were current smokers. Patients had an average of 2.7 children with a mean age of the youngest child of 15 months old. The mean sperm density was 57.3 mil/ml, the mean motility was 61%, and mean progressive motility was 76%. The median morphology was 3%. There were 33 patients (51%) with 3% or lower sperm morphology including one patient who had 0% normal morphology (Figure 1). The most common morphologic abnormalities were head shape defects (n=58), followed by coiled tails (n=15) with some patients having both abnormalities. CONCLUSIONS: Over half of fertile male patients had lower than normal sperm morphology in our study. The results of our study further question the clinical relevance of sperm morphology on fertility outcomes and if the current approach in assessing morphology is too strict. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e396 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information David Miller More articles by this author Lucille Cheng More articles by this author Anna Wecht More articles by this author Kathleen Hwang More articles by this author Expand All Advertisement PDF downloadLoading ...

Air pollution and semen parameters in men seeking fertility treatment for the first time.

The purpose of this paper was to analyze the relationship between the selected chemical air pollutants found in the Lublin Province and the semen parameters of men seeking fertility treatment for the first time. The study involved an analysis of semen sample test results obtained from male patients first reporting for fertility treatment in reproductive health centers in the Lublin Province, Poland. The data set comprises semen parameters of 13 148 men, and the number of samples in the reference period was 255-769 annually. Data on air pollution were obtained from the website of the Polish General Environmental Inspectorate and included selected chemical air pollutant levels, i.e., NO2, SO2, O3, and PM10. The mean PM10 levels in the air increased, on average, by 0.65 μg/m3 annually in 2000-2015 (p = 0.029); the mean levels of O3, NO2, SO2 did not change significantly in the analyzed period. There were increasing trends in the mean sperm density and total sperm count of the subjects in 1992-2015 (p < 0.001). The mean percentage of sperm with normal morphology significantly decreased in the subsequent analysis periods: 1992-1998 (p = 0.001); 1999-2009 (p < 0.001); 2010-2015 (p = 0.001). A significant negative correlation was found between the ozone levels in the air in the Lublin Province and the percentage of sperm with normal morphology (r = -0.8311, p = 0.040). Exposure to ozone in the air contributes to decreased percentages of sperm with normal sperm morphology. Over the years, there was an increasing trend in sperm density in the men first reporting for fertility treatment, and a decreasing trend in the percentage of sperm with normal morphology. Int J Occup Med Environ Health. 2019;32(3):387-99.

Sperm cryopreservation for fertility preservation in male patients with cancer at a single-center in Japan

Advanced treatment modalities for cancer have led to improved prognosis in patients with cancer. However, these treatments may adversely affect the fertility of these patients. Therefore, peritreatment preservation of fertility in adolescent and young adult populations is very important. For male patients, sperm cryopreservation before the initiation of treatment for cancer is currently the most effective method for the preservation of fertility. We performed a retrospective cohort analysis of a sperm cryopreservation protocol at the Yokohama City University Medical Center between 2012 and 2017. A total of 235 men were referred and attempted sperm cryopreservation during this period. The most prevalent diseases were hematological malignancies (38.7%; leukemia, malignant lymphoma, and multiple myeloma), testicular cancer (32.3%, including extragonadal germ cell tumor), bone and soft tissue sarcoma (8.5%), lung cancer (4.7%), prostate cancer (4.3%), and brain tumor (2.6%) in descending order. The median age of patients was 31 (range: 13–65) years, mean sperm density and motility were 28.54±30.25 106/mL, and 20.38±20.62%, respectively. Sperm cryopreservation was successfully performed in 195 patients (83.0%). In those with cryopreservation failure (36 patients; 15.3%), the primary causes were azoospermia or poor semen quality. In the remaining 4 patients (1.7%), testicular spermatozoa were successfully cryopreserved through surgical extraction. In the cryopreservation failure group (n=36), 23 patients (63.9%) were referred after initiation of treatment. Of those, 17 patients were referred from the departments of hematology and oncology. Moreover, sperm density was significantly lower in patients who under gone treatment than in those of the pretreatment group (P=0.003). Cryopreserved sperm from 18 patients was used in 23 in vitro fertilization cycles, resulting in a clinical pregnancy rate of 56.5% per cycle. It is important to inform other departments regarding the option for sperm cryopreservation before initiating treatment in patients with cancer.

Microscopic varicocelectomy as a treatment option for patients with severe oligospermia.

PurposeMany studies have shown improved semen parameters after varicocele surgery; however, the benefit in terms of improved pregnancy rates and live births is still disputed in cases of severe oligoasthenozoospermia (OAS). The present study evaluated the outcome of microscopic subinguinal varicocelectomy in terms of the spontaneous pregnancy rate in patients with severe OAS.Materials and MethodsThis was a retrospective, observational, analytic study of 56 men with OAS who underwent microscopic varicocelectomy at our center between 2008 and 2015. The subjects were followed for a mean period of 12.4 months. Outcome was compared among groups of men with mild (sperm concentration, 10.2–19 million/mL), moderate (5.7–9.5 million/mL), and severe (<5 million/mL) OAS who were operated on during the same period.ResultsA total of 13 of 35 men (37.1%) with severe OAS achieved spontaneous pregnancy. Mean sperm density increased from 2.29 million/mL preoperatively to 14.09 million/mL postoperatively. The mean time to pregnancy from the date of surgery was 8.5 months. The spontaneous pregnancy rate in men with mild and moderate OAS was 62.5% and 46.2%, respectively.ConclusionsAlthough pregnancy rates after varicocele surgery are lower preoperatively in men with severe OAS than in men with mild or moderate OAS, the spontaneous pregnancy rate of 37.1% still compares very favorably with outcomes after a single attempt at in vitro fertilization.

Semen quality and sperm ultrastructure of Himalayan snowtrout Schizothorax plagiostomus Heckel, 1838

The aim of this study was to characterise physical and biochemical aspects of semen as well as to investigate the fine structure of spermatozoa of the Himalayan snowtrout Schizothorax plagiostomus Heckel, 1838 using scanning and transmission electron microscopy. The species breed twice in a year and semen was collected during both seasons, i.e. from 24 males in February and March, 2015 and from 30 males in September and October, 2015. Size of the fish ranged from 13.5 to 36 cm in February-March and 12.3 to 38 cm in September-October. The mean milt volume (ml), sperm density (×1010 ml-1) and spermatocrit (%) values were 2.25±1.26, 2.22±0.53 and 78.87± 8.25 in February-March and 2.12±1.25, 2.12±0.52 and 75.54±8.23 in September-October respectively. Biochemical parameters of seminal plasma viz., total protein (g dl-1), carbohydrates (mg dl-1) and total lipids were 0.312±0.05, 1.348±0.07 and 26.4±2.23 in February-March and 0.340±0.05, 1.34±0.1 and 26.4±3.19 in September-October respectively. Scanning and transmission electron microscopy studies of sperm revealed that the sperm was composed of an ovoid shaped head without acrosome, ellipsoidal midpiece with mitochondria and tail or flagellum. Flagellum had a typical 9+2 axoneme arrangement. The mean length (μm) of head, midpiece, flagella and total length of sperm were 1.82±0.24, 0.35±0.07, 20.18±0.79 and 22.3±3 respectively. For both the breeding seasons, sperm motility decreased significantly with time post-activation.

Standardization of fertilization protocols for the European eel, Anguilla anguilla

Standardization of artificial fertilization protocols for the European eel, Anguilla anguilla, is a prerequisite for optimizing the use of available gametes in hatchery facilities and for conserving sperm from high quality males, which is either cryopreserved or in living gene banks. The objectives of this research were to provide a rapid, accurate and precise method to quantify sperm density by examining the relationship between sperm density and absorbance by use of a spectrophotometer, determine the optimal number of sperm required to fertilize eggs in a controlled setting, and explore how long eggs are receptive to fertilization post-stripping. Mean sperm density and absorbance at 350 nm were 1.54e + 10 ± 4.95e + 9 sperm/mL and 1.91 ± 0.22 nm, respectively. Regression analysis demonstrated a highly significant positive relationship between sperm density and absorbance using a spectrophotometer at 350 nm (R2 = 0.94, p < 0.001, y = 2.273e + 10x − 2.805e + 10); significant but slightly weaker relationships were also detected at 400, 500, and 600 nm (R2 ≥ 0.93, p < 0.001). Fertilization success using sperm to egg ratios ranging from 1.3e + 3 to 1.0e + 6 sperm per egg increased from 37.5 to 68.1%, respectively. Sperm to egg ratio had a significant effect on fertilization success (p < 0.0001), where fertilization success increased from 1.3e + 3 to 2.5e + 4 sperm per egg; adding greater than 2.5e + 4 sperm per egg had no significant effect. Furthermore, the duration of time post-stripping had a significant effect on egg fertilization success (p < 0.0001), such that between 0 and 10 min post-stripping 57.4 to 78.2% of the eggs were fertilized while at 15 min post-stripping a significant decrease in fertilization success was detected (47.5%). For all statistical models, the female variance component was significant for fertilization success (p < 0.0001) and explained ≥ 84% of the models variance. In conclusion, European eel eggs should be fertilized within 10 min post-stripping using 2.5e + 4 sperm per egg. Together, these findings will contribute to the development of European eel breeding technology and further our understanding on sperm biology and reproductive biology in fishes.

Decline of semen quality during IVF is not associated with subjective male stress

The aim of the present study was to assess if semen quality declines during in vitro fertilization (IVF) and whether or not this phenomenon is triggered by chronic male stress. In order to test this hypothesis, we first investigated a retrospective cohort of 155 male IVF patients (testing cohort). Subsequently, we started a prospective cohort study in men undergoing their first IVF and assessed semen quality and subjective male chronic stress using a validated tool, i.e. the Fertility Problem Inventory (FPI) questionnaire. The association between stress and sperm quality decline measured 4–6 weeks before the start of IVF (T1) and at the day of oocyte retrieval (T2) was the primary outcome. Live birth rate, first trimester abortion and rate of poor responders were secondary outcomes. In the testing cohort, mean progressive motility, but not mean sperm density significantly declined. There were 78/154 (51%) men who showed a decline in semen density and 50/154 (32%) men who showed a decline in progressive motility. In the validation cohort, progressive motility declined, whereas, sperm density increased from T1 to T2. Of 78 men, 27 men had increased stress (FPI-score > 146). Sperm density and progressive motility were not significantly different in men with and without stress. However, in the presence of male stress, couples had a higher rate of poor responders, miscarriages and a lower rate of live births. Subjective stress is not associated with a decline in semen quality observed during IVF but may be associated with adverse pregnancy outcome.

Tunel assay on swim up samples AIDS in predicting IVF outcomes

To evaluate the results of TUNEL testing on unprocessed and processed sperm samples used for fertilization during an IVF cycle and outcome. Prospective study. TUNEL assay was performed on the unprocessed semen sample (A), the swim-up or density gradient sample used to fertilize the oocytes (B), and on the fraction of sperm usually discarded after processing (C) in a series of unselected patients undergoing ART at our center. Semen parameters, male and female age, female FSH and AMH, number of eggs retrieved, fertilization rate, and use of ICSI were recorded and analyzed. Interactive clustering analysis was used to determine TUNEL thresholds for each sample group. Pregnancy was used as the primary outcome measure. Data on 47 couples were analyzed. Mean age (95%CI) of males was 35.3 (34.3-36.3), and females was 34.2 (33.3 to 35.1). Mean sperm density was 76 mil/ml (63-89), motility 49% (45-52), Kruger morphology 7.9% (1.5-14.3). Processing the sperm statistically decreased the percentage of TUNEL positive sperm from 9.48 (95% CI)to 2.12 (95% CI) P<0.0001. TUNEL results of (A) correlated with (C) (r=0.52, P=0.0003). TUNEL results of (C) was the best predictor of positive pregnancy but especially in 19 nulligravid women The relative risk of failure to achieve a pregnancy was 1.8 (1.0-3.2) for TUNEL >10% (P=0.02), and 2.5 (0.9-6.7) for TUNEL>15% (P=0.05). No pregnancies were observed in 4 patients if TUNEL was >25% (P=0.002). For couples with TUNEL <5 %, 80% of couples achieved pregnancy in the evaluated treatment cycle vs 53% with TUNEL > 5%. TUNEL testing may aid in predicting outcomes of IVF. Since the threshold of DNA fragmentation in sperm needs to be fairly high before the sperm will be TUNEL positive, the results of the unused sample after processing may provide the most insight into IVF outcomes.

The effect of magnified bilateral varicocele ligation on semen quality and the natural paternity rate in subfertile men, based on the sum of varicocele grading

ObjectiveTo evaluate the effect of magnified bilateral varicocele ligation on the semen quality and natural paternity rate in subfertile men, based on the sum of varicocele grading. Patients and methodsIn a prospective longitudinal study, 78 patients (mean age 36.5years, range 21–56) with a total of 156 varicoceles underwent bilateral varicocele ligation. Patients included had bilateral, primary and clinically palpable varicoceles, with a normal hormonal profile and abnormal semen; patients excluded had unilateral varicocele, or were recurrent cases, had infraclinical varicocele or had a genetic abnormality. Patients were classified into five groups (A–E), based on the findings of a physical examination; A included 13 patients with grade sum II (I+I), B included 21 with grade sum III (II+I), C included 25 with grade sum IV (II+II) or (III+I), D included 11 with grade sum V (III+II) and E included eight with grade sum VI (III+III). The follow-up was scheduled at 3, 6 and 12months to assess semen variables and the natural paternity rate; 16 patients continued to a 36-month follow-up. Data were analysed statistically using a paired t-test to compare the mean sperm variables before and after surgery, with P<0.05 considered to indicate significant differences. ResultsOf the 78 patients, 74 completed the follow-up at 3months and only seven missed the 6-month follow-up. Overall, the mean sperm density, total sperm motility and sperm morphology increased from 13.44 to 26.48×106/mL, 27.4% to 53% and 41.4% to 65.0%, respectively; the differences were statistically significant for all variables (P<0.001). For each group separately there were significant improvements for both sperm density and motility, but for sperm morphology there were significant improvements in all groups except E, where the improvement was not correlated with those in the other groups. The paternity rate (by natural pregnancy) at 2years was 26.9%, and this increased to 41% within 3years. ConclusionMagnified bilateral varicocele ligation based on the sum of varicocele grading significantly improved semen quality and the natural paternity rate in subfertile men.

Robotic vasovasostomy: description of technique and review of initial results.

Vasovasostomy (VV) for iatrogenic infertility is commonly employed for patients with obstructive intervals of less than 15years, with the microsurgical technique gaining favor over use of loupe magnification due to precision suture placement. We present our technique of a robot-assisted VV and compare surgical times of staff to resident. Twenty patients with iatrogenic infertility and obstructed intervals of less than 10years underwent robot-assisted VV, 17 utilizing a single-layer reapproximation and 3 using a double-layer reapproximation. Average patient age was 32.9years. Following vasal exposure, the staff performed the robot-assisted anastomosis on one side followed by the resident on the opposite side. Reanastomosis times and semen analyses were recorded. Twenty patients underwent successful single- or double-layer robot-assisted vasovasostomy. Mean console time for staff to complete the vasal reconstruction was 37.6min compared to the resident time of 54min. Mean total operative time for all procedures was 187min (single-layer procedure averaged 182min compared to double-layer repair which averaged 238min). Thirteen patients returned for follow-up semen analysis, with twelve patients demonstrating sperm within the ejaculate. Additionally, two patients reported pregnancies for a patency rate of 93%. Mean sperm density was 14 million/ml with motility of 26.4%. Robot-assisted vasovasostomy is a technically feasible procedure demonstrating adequate results on follow-up semen analysis, and can be included in training residents in robotic surgery. Additional data are needed to determine its role in the management of iatrogenic infertility.

Effects of Maternal Lead Acetate Exposure during Lactation on Postnatal Development of Testis in Offspring Wistar Rats

Objective(s) During recent years, there has been an increasing interest in contribution of environmental pollutants as heavy metals to human male infertility. Present study was aimed to investigate the effects of maternal lead acetate exposure during lactation on postnatal development of testis in offspring rats. Materials and Methods A total of 60 female rats randomly divided into four equal groups; control and three treatment groups received 20, 100 and 300 mg/kg/day lead acetate via drinking water from day 2 to day 21 of lactation. At 7, 14, 21, 28, 60, 90 and 120 days after birth, the testis weight and volume of offspring were measured and their epididymal semen analyzed. Following tissue processing, 5 µm sections were stained with haematoxylineosin and evaluated with quantitative techniques. Testicular parameters in different groups were compared by one-way ANOVA. Results Testis weight and volume of offspring decreased significantly in a dose-related manner in moderate (P< 0.05) and high (P< 0.01) doses groups. Dose-dependent significant reductions were seen in seminiferous tubules diameter and germinal epithelium height during neonatal, prepubertal and postpubertal periods in moderate (P< 0.05) and high (P< 0.01) doses groups until 90 and 120 days after birth, respectively. Significant decreases were observed in mean sperm density of offspring at puberty in moderate and high doses groups until 90 and 120 days after birth, respectively. Testosterone levels decreased significantly in a dose-related manner at puberty in moderate and high doses groups. Conclusion

A prospective double‐blind randomized placebo‐controlled study of the effect of saffron (Crocus sativusLinn.) on semen parameters and seminal plasma antioxidant capacity in infertile men with idiopathic oligoasthenoteratozoospermia

Male factor infertility is a multifactorial disorder that affects a significant percentage of infertile couples; however, many of them remained untreated. In recent years, considerable numbers of infertile men have sought 'herbal remedies' as an effective treatment. Among 'herbal remedies', saffron is recommended for male infertility in our community. The effect of saffron was evaluated compared with placebo for the treatment of idiopathic male factor infertility. The study included 260 infertile men with idiopathic oligoasthenoteratozoospermia (OAT) who were randomized to saffron 60 mg/day (130, group 1) or a similar regimen of placebo (130, group 2) for 26 weeks. The two groups were compared for changes in semen parameters and total seminal plasma antioxidant capacity. Saffron administration did not result in beneficial effects. At the end of the study no statistically significant improvements were observed in either group in any of the studied semen parameters (sperm density, morphology and motility) (all p = 0.1). At the end of the trial, patients in group 1 had a mean motility of 25.7 ± 2.4%, which was not statistically different from the mean of 24.9 ± 2.8% in the placebo group (p = 0.1). Normal sperm morphology was 18.7 ± 4.7% and 18.4 ± 4.3%, in groups 1 and 2, respectively (p = 0.1). Patients treated with saffron and placebo had a mean sperm density of 20.5 ± 4.6% and 21.4 ± 4.6% per mL, respectively (p = 0.1). Saffron administration did not improve total seminal plasma antioxidant capacity, compared with baseline (p = 0.1) and placebo subjects (p = 0.1). Based on Pearson correlations, each semen parameter did not correlate significantly with treatment duration, including sperm density (r = 0.146, p = 0.13), percent of motile sperm (r = 0.145, p = 0.15) and percent of sperm with normal morphology (r = 0.125, p = 0.30). Saffron does not statistically significantly improve semen parameters in infertile men with idiopathic OAT. If medical professionals want to prescribe herbal remedies for male infertility, previous rigorous scientific investigations, documenting their safety and efficacy are required.

Low dose human chorionic gonadotropin prevents azoospermia and maintains fertility in hypogonadal men on testosterone replacement therapy

OBJECTIVE: Exogenous testosterone administration decreases serum gonadotropins, impairs normal spermatogenesis and suppresses intratesticular testosterone levels. Azoospermia occurs in 65% of patients on testosterone replacement therapy(TRT). Recent studies have demonstrated that intratesticular testosterone levels can be maintained during exogenous TRT with co-administration of low dose human chorionic gonadotropin(HCG). It is hypothesized that HCG is protective and supports continued spermatogenesis in patients on TRT. DESIGN: This is a retrospective review of patients on TRT that were given low-dose HCG to preserve their fertility from 2008-2009. MATERIALS AND METHODS: TRT was administered as a daily topical gel or a weekly injection. Men desiring to preserve fertility were also prescribed HCG 500 units every other day. Serum testosterone, semen analysis and pregnancy outcomes were obtained before and after initiation of therapy. Statistical analysis was performed using SPSS. RESULTS: A total of 17 men were treated, with mean follow-up of 8.6 months. 71% of patients were on injectable testosterone and 29% were on topical gel. Mean serum testosterone was 290 prior to treatment and 960 during treatment. Mean sperm density was 34 M/ml prior to TRT and 26 M/ml during treatment(p=0.5). Mean sperm motility was 47% prior to therapy and 51% during therapy(p=0.8). Compared to baseline, 6/17 of patients had a lower sperm density and 2/17 had a decrease in motility during TRT. However, no patient became azoospermic. Pregnancy was achieved in 9/12 of patients attempting to conceive during treatment. CONCLUSION: Low dose HCG may be beneficial for men in their reproductive years that require TRT. HCG is protective and supportive of continued spermatogenesis when given in conjunction with injectable or topical TRT. Concurrent HCG use can preserve fertility in hypogonadal males desiring pregnancy while on TRT. Longer follow-up is needed to determine whether this benefit is sustained.

Pre-operative Serum Level of Inhibin B as a Predictor of Spermatogenesis Improvement After Varicocelectomy

Due to various reasons, spermatogenesis might not improve after varicocelectomy. Inhibin B, a sertoli cell glycoprotein, has proved itself as a marker of spermatogenesis. In this study, we measured serum level of inhibin B in patients with varicocele and through comparing pre and post operative semen analysis data, we tried to use serum level of inhibin B as a predictor of spermatogenetic improvement. This prospective clinical trial was carried out between September 2007 and September 2008 on 36 infertile men with high grade unilateral or bilateral varicocele. Scrotal ultrasonography and measurement of seminal parameters and serum level of inhibin B were performed for the patients and after confirmation of impaired spermatogenesis, they underwent a subinguinal nonmicroscopic varicocelectomy by a single surgeon. Physical examination, scrotal ultrasonography, and semen analysis were repeated at postoperative months of 3 and 6. Statistical data analysis was done by independent and paired sample t test and Spearman's Rho test. Mean size of the testis remained the same (P = .5), but mean sperm density, normal morphology, and motility all increased statistically significant after the operation (P < .05, P = .042, P = .023). A significant relationship was found between serum levels of inhibin B and the testis sperm count and morphology (P < .05), but not sperm motility (P > 0.05). It seems that serum level of inhibin B can be used as a reliable pre-operative marker of testicular potential activity and can also predict chance of spermatogenesis after varicocelectomy and save patients from useless surgical procedures.

Decreasing sperm quality: a global problem?

BackgroundCarlsen and coworkers (1992) reviewed 61 heterogeneous observational studies on semen quality published between 1938 and 1990. This review indicates that mean sperm density decreased significantly between 1940 and 1990. An extended meta-analysis with 101 studies confirmed a decline in sperm density for the period from 1934 to 1996 (2000). The key message of the meta-analyses is that sperm counts have decreased globally by about 50% over the past decades. This assessment has been questioned.DiscussionA major methodological problem of the meta-analysis is the use of data collected in different countries, at different times, on different populations and with different methods of semen analysis. Furthermore, the results of studies concerning semen analysis are frequently biased e.g. by selection criteria of volunteers. In most studies on human semen characteristics the populations under study are insufficiently defined and the study participants are not a representative population sample. The incidence of testicular cancer has increased in Caucasian men worldwide. The investigation of common risk factors for male reproductive disorders requires well designed epidemiological studies and the collection of individual data.SummaryFormer meta-analyses of sperm count data show a global downward trend. This conclusion should be interpreted with caution. The included studies are of great heterogeneity due to geographical and/or ethnical variation, different study designs and different methodological standards. Population-based prospective studies are needed to investigate secular trends in male reproductive disorders.

Zur Bedeutung der linearen Cervixmucuspenetration (CMP) für die Bewertung der Spermatozoenqualität

Linear mucus penetration of spermatozoa from 75 arbitrary selected men was evaluated using a non-commercial bovine cervix mucus preparation in the same way as Penetrak, but using round glass capillary tubes instead of flat plastic tubes. The mean penetration value was 28.7 +/- 7.10 mm in 90 min and the mean sperm density 36.0 +/- 22.79 x 10(6) ml. Mucus penetration was more correlated to sperm density (r = 0.6) than to any other semen parameter. Consequently it seems to be necessary to evaluate a sliding discrimination index for adequate penetration rate depending on sperm density (regression line and confidence interval). Numerical methods for comparison of penetration rates are suggested.

Effect of lower versus higher doses of tamoxifen on pituitary-gonadal function and sperm indices in oligozoospermic men.

Administration of the antiestrogen tamoxifen for one month to 12 patients with idiopathic oligozoospermia significantly increased the mean basal testosterone (T) level and the responses of luteinizing hormone (LH) and follicle stimulating hormone (FSH) to constant luteinizing hormone releasing hormone (LHRH) infusion but did not significantly influence the mean oestradiol (E2) levels or the E2 over testosterone ratio. Mean sperm concentration and total sperm output increased by about 70% after a mean treatment period of 5.5 +/- 0.4 months. No statistically significant difference was found between the two subgroups of patients treated with either the lower (5 or 10 mg once daily) or higher dose of tamoxifen (10 mg twice daily) with respect to basal or LHRH stimulated gonadotropin and testosterone response or the E2/T ratio and the effect on sperm density and total sperm output. In both subgroups the sperm motility and morphology remained unchanged. In conclusion higher doses of tamoxifen in this study prove not to be superior to lower doses in improving mean sperm density and total sperm output. The relative small percentage of patients achieving normalisation of only these sperm parameters pleads for further search for more effective selection of patients and other more effective treatment modalities in patients with idiopathic oligozoospermia.

Effect of chronic aromatase inhibition by delta 1-testolactone on pituitary-gonadal function in oligozoospermic men.

Aromatase inhibition by delta 1-testolactone (Teslac, 500 mg twice daily) for 6 months in 9 patients with idiopathic oligozoospermia lowered the levels of serum estradiol (E2) and thereby sex hormone binding globulin (SHBG) (rS = +0.40, p less than 0.025) to values -35 and -25%, respectively, below the pretreatment values (P less than 0.001 and less than 0.005). The E2 decrease was accompanied by a temporary increase (+50%) in the levels of follicle stimulating hormone (FSH), not of luteinizing hormone (LH), and of 17 alpha-hydroxyprogesterone (17 alpha-OHP), but less of testosterone (T) (+30%), which led to a transient rise in the 17 alpha-OHP/T ratio. The T/E2 ratio and "free T" index (T/SHBG) almost doubled until the end of the treatment period. During delta 1-testolactone treatment the mean sperm density gradually rose from 8.1 +/- 1.3 (SEM) before to 21.3 +/- 6.7 X 10(6)/ml after 6 months (P less than 0.01), whereas the total sperm count almost threefold increased (P less than 0.05). Sperm concentrations exceeding 20 X 10(6)/ml were achieved in 4 of the 9 patients. Two of these patients' wives became pregnant. Although the data point to a pivotal role of estrogens in the pathogenesis of the spermatogenic lesion in some patients with idiopathic oligozoospermia, the lack of a beneficial effect of estrogen lowering in others points to a multicausal nature of the disease entity.

Pretreatment Semen Parameters in Men With Cancer

Whether the presence or specific type of cancer significantly affects semen quality is controversial. We evaluated the semen parameters and associated malignancies of men with cancer who cryopreserved sperm at our institution before undergoing therapy. We reviewed the database from our cryopreservation laboratory during a 5-year period. Office charts of 409 of 1,409 patients were available for review. Age at banking, semen volume, sperm density, percent motile sperm and type of cancer were recorded. Semen parameters were compared to values for fertile and subfertile men established by the National Cooperative Reproductive Medicine Network as well as from a large local pre-vasectomy cohort to consider geographic variations. A total of 717 semen samples from 409 men included 45% with testicular cancer, 10% with Hodgkin's lymphoma, 7% with nonHodgkin's lymphoma, 6% with sarcoma, 6% with prostate cancer, 5% with leukemia, 3% with gastrointestinal cancer and 2% with central nervous system tumors. Of these men 16% had unspecified or other rare malignancies. Mean patient age was 29.9 years (range 11.9 to 87.7), mean semen volume was 2.8 ml (range 0.1 to 15.0), mean sperm density was 47.4 x 10(6)/ml (range 0.1 to 320) and mean sperm motility was 50.0% (range 1% to 90%). For men with testicular cancer sperm density and motility were in the intermediate range. Parameters for men with all other malignancies were in the fertile range for density and intermediate range for motility. Men with most types of cancer have pretreatment semen parameters in the fertile range for density and in the intermediate range for motility. However, men with testicular cancer statistically have lower semen quality compared to those with other malignancies. These findings further highlight the importance of pretreatment fertility preservation in this patient population before undergoing gonadotoxic treatments.

Gene expression alterations in cryptorchid males using spermatozoal microarray analysis

To identify differential spermatozoal gene expression patterns using microarray between controls and patients with cryptorchidism. Prospective laboratory analysis. Pediatric urology clinic and laboratory of an academic hospital in the United States. Ten control patients and 12 cryptorchid males (8 unilateral, 4 bilateral). Ejaculates were collected and motile sperm were isolated by Percoll centrifugation, total RNA was extracted and verified using sperm-specific reverse transcriptase-polymerase chain reaction (RT-PCR). Biotin-labeled amplified RNA was hybridized to Affymetrix Human Genome Focus arrays. Differentially expressed genes were identified using permutation t-test. Semen analyses and differential spermatozoal gene expression patterns measured by microarray. Mean semen volume was not different between control and patients with cryptorchidism. Mean sperm density was significantly decreased between control, unilateral, and bilateral cryptorchid samples (110 vs. 87 vs. 16 million/mL). From the microarray expression data, we identified 43 genes differentially expressed between the two groups. Thirty-eight genes were significantly underexpressed in the cryptorchid samples including many transcriptional factors (cul3, prm1, hspcd35) and a testis-specific cell-adhesion gene (tpx-1) involved in germ cell maturation and sperm tail formation. An antiapoptotic gene (TNFAIP3) was highly overexpressed in the cryptorchid samples. Gene expression profiles offer insight into the diverse alterations that occur in cryptorchidism. The observed changes in spermatozoal expression of transcriptional and antiapoptotic genes may result in poor seminal parameters in formerly cryptorchid males.