Semen Analysis Parameters Research Articles

Semen static oxidation-reduction potential is not helpful in evaluating male fertility.

Infertility affects a significant percentage of couples worldwide, with male infertility contributing substantially in a considerable number of cases. Research indicates that oxidative stress is a critical factor impacting male fertility. To explore the relationship between semen static oxidation-reduction potential (sORP), sperm parameters, and validated biomarkers of oxidative stress in infertile men. This cross-sectional study involved 202 men diagnosed with idiopathic male factor infertility and male partners from couples with unexplained infertility. Multivariable linear regression to query the associations between sORP, sperm parameters, and oxidative aggression biomarkers (lipid peroxidation, mitochondrial membrane potential, annexin V, and sperm DNA fragmentation). SORP has no linear association with any semen analysis parameter. Furthermore, its relationship with validated biomarkers of oxidative stress was inconsistent. sORP was inversely related to lipid peroxidation (multivariable linear regression coefficient: -0.64), positively associated with sperm DNA fragmentation (multivariable linear regression coefficient: 3.20), and unrelated to mitochondrial membrane potential or annexin V. There is no clear or consistent relationship between sORP and validated oxidative aggression biomarkers or sperm parameters. Our findings suggest that sORP is unlikely to be helpful in the evaluation of a male with idiopathic infertility.

Role of varicocelectomy in infertile patients with clinical varicocele and isolated sperm defects

ObjectiveThis study investigated the outcomes of microsurgical subinguinal varicocelectomy (MV) on semen and hormonal parameters in cases with isolated sperm defects (oligo-, astheno-, or terato-zoospermia). MethodsRetrospective review of charts of patients who underwent MV for clinically palpable varicocele between 2011 and 2019 at our institution was undertaken. All patients diagnosed with isolated oligo-, astheno-, or terato-zoospermia in the preoperative semen analysis were included. Men with azoospermia, history of genitourinary infection, or utilizing peri-operative fertility medications were excluded. Collected data included patient demographics, and results of routine semen analysis, DNA fragmentation, and hormone parameters (follicle stimulating hormone, luteinizing hormone, testosterone, and estradiol) before MV and up to 6 months postoperatively. ResultsA total of 331 patients with isolated sperm defects were included. Postoperatively, 83.3 % of isolated oligozoospermic patients showed a significant improvement in sperm concentration. Among isolated asthenozoospermic men, 76.7 % and 66.0 % showed postoperative significant improvement of total and progressive motility, respectively. For the teratozoospermic group, 70 % of patients showed a significant improvement in normal morphology. No changes were observed in other semen or hormone parameters that were examined. ConclusionMV is a valid and effective treatment modality for patients with isolated sperm defects that significantly corrects their respective semen abnormality and improves their chances of natural conception.

Investigating the Anogenital Distance as a Predictive Factor for Improvement in Semen Analysis Parameters After Varicocele Surgery

Background: A varicocele is an unusual enlargement and twisting of veins within the pampiniform plexus, contributing to male infertility. Varicoceles are prevalent in approximately 11 to 15 percent of adult males and can impact testicular function. Varicocelectomy is recommended for non-azoospermic infertile men with abnormal seminal parameters, although uncertainties exist regarding the specific parameters indicating the need for surgery. This study investigates the potential relationship between anogenital distance (AGD) and semen analysis factors before and after varicocelectomy. Methods: The study enrolled 35 males with primary varicocele, excluding those with certain conditions. AGD measurements were taken before surgery, and patients subsequently underwent varicocelectomy. Comprehensive assessments and laboratory examinations were conducted preoperatively, and follow-up semen analyses were performed six months postoperatively. Results: Preoperative and postoperative semen analyses revealed no significant differences in sperm parameters. Statistical analyses indicated no significant correlation between AGD and sperm concentration before or after surgery. Despite these findings, the study contributes valuable information to the ongoing debate on the impact of varicocelectomy on male fertility. Conclusions: This study, while highlighting the limitations and uncertainties, suggests that AGD may not be a significant predictive factor for improvements in semen analysis after varicocelectomy. The nuanced nature of varicocele-associated male infertility underscores the ongoing need for comprehensive research to clarify the true effects of varicocelectomy. Individual patient factors and careful evaluation of available evidence remain crucial in managing varicocele-associated male infertility.

Influence of male body mass index on semen analysis parameters and in vitro fertilization outcomes.

Concurrent global increase of prevalence of obesity and male fertility implies link between overweight and obesity with male subfertility. This hypothesis is supported by numerous population-based epidemiological studies. Increase in body mass index (BMI) is associated with poor sperm quality in fertile, and more noticeable in infertile men. Nevertheless, some studies disprove damaging effect of BMI on semen quality. To examine the influence of men's BMI in infertile couples undergoing in vitro fertilization (IVF) on semen analysis parameters and IVF outcomes. Study encompassed all couples who underwent IVF at Gynecology and Obstetrics Clinic Narodni Front in Belgrade during 2018 and 2019. Exclusion criteria were azoospermia, conditions and diseases that could affect the semen analysis parameters (diabetes, malignant diseases treated with radiation and/or chemotherapy, trauma or surgery of the genital organs, mumps or undescended testicles in childhood). Evaluated semen analysis parameters included semen ejaculate volume, sperm pH, sperm count, sperm motility, and sperm morphology. IVF outcomes comprised total number of embryos, number and percentage of obtained good-quality embryos and clinical pregnancy rates. Based on BMI value, participants were divided into a group of underweight (Group 1), normally weight (Group 2), overweight (Group 3), and obese men (Group 4). After applying inclusion and exclusion criteria, 411 men (couples) were included in the analysis. The largest number of men were overweight, while the smallest belonged to the group of underweight participants. There are no significant differences in the semen analysis parameters between study groups. Correlation analysis shown weak and insignificant correlation between BMI and semen analysis parameters. The number and proportion of good quality embryos is significantly lower in overweight and obese study groups compared to normal weight and underweight groups (2.89, 2.91, 2.42, and 2.36, respectively, P = .041). The differences in other IVF outcomes: total number of embryos (3.61, 3.74, 3.21, and 3.37, respectively) and clinical pregnancy rates (41.26%, 43.09%, 42.78%, and 39.95%, respectively) between study groups were not significant (P > .05). BMI does not significantly affect semen analysis parameters, but a higher BMI is associated with a lower number and proportion of good quality embryos in IVF outcomes.

Dynamics of ejaculate parameters from 2017 to 2023: a retrospective single-center analysis

Introduction: One of the most important tests to evaluate male fertility is a semen analysis. Assessment of ejaculate parameters allows to assume possible causes of male infertility and helps to determine further treatment. According to modern literature there is a slight but constant deterioration of ejaculate parameters with time.Purpose of the study: to evaluate semen analysis parameters in patients examined in one medical center.Materials and Methods: retrospective evaluation of semen analyses performed in the same laboratory from January 1, 2017 to October 31, 2023 was performed with a total of 47902 patients included. The ejaculate volume, concentration and number of spermatozoa, the proportion of spermatozoa of different categories of motility, sand the proportion of morphologically normal spermatozoa were evaluated. Statistical processing of data was performed using MS Office and SPSS v26 software packages.Results: the mean semen volume from 2017 to 2023 was 3.5 ± 1.5 mL, sperm concentration was 51.9 ± 39.3 million/mL, progressively motile spermatozoa was 48.2 ± 16.5%, number of progressively motile spermatozoa in the sample was 93.7 ± 94.3 million, motile spermatozoa 55.6 ± 17.4%, total motile spermatozoa was 107.5 ± 105.6 million, mean number of morphologically normal forms was 2.8 ± 1.4% in 2017, 2.2 ± 0.9% in 2023, and 3.5 ± 1.5% during the observation period. Mean pH of ejaculate was 7.6 ± 0.3 with noted tendency to increase (7.38 ± 0.33 in 2017, 7.6 ± 0.38 in 2023). The proportion of samples with azoospermia increased from 2.8% in 2017 to 4.5% in 2023. Mean number of patients with cryptozoospermia was 1.5%.Conclusion: there is a trend of decreasing proportion of morphologically normal spermatozoa, increasing ejaculate pH and increasing frequency of azoospermia from 2017 to 2023.

Post-Preparation Total Motile Sperm Count in Infertile Men and The Success Rate of Intrauterine Insemination at Rumah Sakit Kasih Ibu Denpasar in 2022

Background: Every married couple hopes to have children, but not all can fulfil that desire. A married couple finds themselves unable to achieve pregnancy after 12 months of regular unprotected sexual intercourse, which can be called infertility. Infertility can also occur in men. In dealing with infertility, intrauterine insemination (IUI) is a cost-effective and non-invasive Assisted Reproductive Technology (ART) procedure. The condition of male infertility can be detected through semen analysis. One of the parameters in semen analysis is the total motile sperm count (TMSC). Objective: This research seeks to establish the relationship between post-preparation TMSC and the success rate of the IUI procedure. Methods: This research adopts a descriptive-analytical design employing a cross-sectional methodology. Non-probability sampling was utilized as the sampling technique, and the data analyzed were secondary data from the medical records of male patients aged 25 to 45 years old diagnosed with infertility. The subjects had undergone IUI at Rumah Sakit Kasih Ibu Denpasar from January 1 to December 31, 2022. Results: From the 35 obtained samples, 12 individuals (34.3%) had a post-preparation TMSC of ≥10 × 106, while 23 individuals (65.7%) had a post-preparation TMSC of <10 × 106. The success rate of the Intrauterine Insemination (IUI) procedure was 17.1%, with 4 couples (33.3%) having a post-preparation TMSC of ≥10 × 106 and 2 couples (8.7%) with a post-preparation TMSC of <10 × 106. The Fisher's Exact test carried out has obtained a result (p=0.151), while the value of the odds ratio (OR) obtained (OR=5.250) Conclusion: Based on statistical analysis, it can be concluded that there is no significant association between post-preparation TMSC in infertile men and the success rate of IUI procedures (p > 0.05). The odds ratio (OR) obtained is 5.250 (95% CI 0.799-34.496).

Transgenerational effects of paternal exposures: the role of germline de novo mutations.

Germline de novo mutations (DNMs) refer to spontaneous mutations arising during gametogenesis, resulting in genetic changes within germ cells that are subsequently transmitted to the next generation. While the impact of maternal exposures on germline DNMs has been extensively studied, more recent studies have begun to highlight the increasing importance of the effects of paternal factors. In this review, we have summarized the existing literature on how various exposures experienced by fathers affect the germline DNM burden in their spermatozoa, as well as their consequences for semen analysis parameters, pregnancy outcomes, and offspring health. A growing body of literature supports the conclusion that advanced paternal age (APA) correlates with a higher germline DNM rate in offspring. Furthermore, lifestyle choices, environmental toxins, assisted reproductive techniques (ART), and chemotherapy are associated with the accumulation of paternal DNMs in spermatozoa, with deleterious consequences for pregnancy outcomes and offspring health. Ultimately, our review highlights the clear importance of the germline DNM mode of inheritance, and the current understanding of how this is affected by various paternal factors. In addition, we explore conflicting reports or gaps of knowledge that should be addressed in future research.

Urine microbes and predictive metagenomic profiles associate with abnormalities in sperm parameters: implications for male subfertility

To explore the taxonomic and predicted functional relationship between the urine microbiome and alterations of semen analysis (SA) parameters. Cross-sectional study. Academic medical center. Men presenting for fertility evaluation or men presenting for vasectomy consultation with proven biological paternity were recruited and stratified on the basis of alterations, or lack thereof, in SA parameters. Changes in the functional and taxonomic urine microbiome profiles of participants with or without alterations in SA parameters. Seventy-three participants were included in our study. Men with abnormal sperm motility (N = 27) showed a nearly 50-fold higher abundance of Dialister micraerophilus compared with those with normal sperm motility (N = 46). This relationship persisted on canonical correlational analysis (r = 0.439). Men with abnormal sperm concentration (N = 20) showed a lower abundance of Enterococcus faecalis and Staphylococcus aureus, compared with those with normal sperm concentration (N = 53). The urine of participants with impaired sperm motility demonstrated dramatic differences in predictive functional profiles in pathways involved in oxidation-reduction balance and cell longevity. Our findings underscore differences in the urinary microbiome and abnormalities in semen parameters, especially sperm motility. By incorporating predictive functional profiling, we also highlight possible mechanisms that may drive the observed differences in sperm parameters.

(092) Racial/ethnic Differences in Semen Parameters and Male Reproductive Hormones in the United States: A Systematic Review and Meta-Analysis

Abstract Introduction Semen quality and reproductive hormones are key indicators of male fertility potential, but studies have reported inconsistent results on racial/ethnic differences in these factors in the United States. Objective To perform a meta-analysis evaluating pooled differences in semen analysis parameters and male reproductive hormones across racial/ethnic groups in the United States through a systematic literature search. Methods PubMed, Scopus, and Web of Science were systematically searched up to December 17, 2022, with no language limitation. All studies on racial/ethnic variations in semen parameters and male reproductive hormones among the general population of the United States were included in this meta-analysis. Standardized mean difference (SMD) and its 95% confidence interval (95%CI) between races/ethnicities were pooled using the random-effects model. Newcastle–Ottawa Quality Assessment Scale (NOS) was used for risk of bias assessment. Heterogeneity was assessed by the I2 index. Results Our search yielded 731 articles. After screening, 9 studies were included. These studies had a low risk of bias (NOS ≥ 7) and involved a total of 7,641 participants. The pooled analysis showed no significant differences between White and Black men in the percent of total motility (p-value=0.513; I2=99.76%), total testosterone (p-value=0.272; I2=99.79%), free testosterone (p-value=0.220; I2=99.78%), and estradiol (p-value=0.876; I2=96.90%). However, higher sperm concentration (SMD=3.64; 95%CI: 0.18, 7.09; p-value=0.039; I2=99.53%) and total sperm count (SMD=6.04; 95%CI: 0.09, 11.99; p-value=0.046, I2=99.68%) were estimated for White men compared to Black men. Additionally, higher sperm concentration (SMD=1.39; 95%CI: 0.56, 2.23; p-value=0.001, I2=92.06%) and total motility (SMD=3.06; 95%CI: 0.09, 6.02; p-value=0.043, I2=99.14%) were estimated for Hispanic men compared to non-Hispanic men, with no differences in total sperm count (p-value=0.579, I2=97.79%) or total testosterone (p-value=0.078, I2=95.95%) (Figure 1). Conclusions This meta-analysis demonstrated reductions in semen analysis parameters, especially sperm concentration, for Black and non-Hispanic men relative to White and Hispanic men in the United States. Disclosure No.

(260) Functional and Taxonomic Urine Microbiome Differences in Men with Abnormal Semen Analysis Parameters

Abstract Introduction Male factors contribute to nearly half of all cases of infertility. Next-generation sequencing technologies have allowed for a more nuanced understanding of the widespread influence of the microbiome on health and human disease. Recent evidence has emerged revealing a potential role for the urinary microbiome in impacting male fertility and subfertility, though studies on this topic are sparse. Objective Here, we explore the complex relationship between the urine microbiome and alterations of SA parameters. Methods Men presenting for fertility evaluation or men presenting for vasectomy consultation with proven biological paternity were recruited. Clinical data and urine samples were collected from the patients and SA was performed. Patients were then stratified according to alterations in SA parameters. Urine samples underwent DNA extraction, PCR amplification and 16S rRNA sequencing. Taxonomic microbiome community profiling was performed. Predictive metagenomics was performed using Tax4Fun2 with reference to the KEGG database. Results N = 73 participants were included in the study and were stratified based on alterations, or lack thereof, in SA parameters. Men with abnormal sperm motility (N = 27) showed a higher abundance of urine Dialister micraerophilus (p = 0.0322) compared to those with normal sperm motility (N = 46). This relationship persisted on canonical correlational analysis (r = 0.439, p = 0.0114). Furthermore, when stratifying by sperm motility, nine differentially abundant pathways emerged from predictive metagenomic analysis including pathways critical for basic microbial cell functioning (intermediary metabolism pathways, FoxO signaling, longevity regulating pathways) in addition to pathways synthesizing and breaking down potentially bioactive metabolites (notably long- and short-chain fatty acid metabolism). Men with abnormal sperm concentration (N = 20) showed a lower abundance of urine Enterococcus faecalis (p = 0.0121) and urine Staphylococcus aureus (p = 0.0375), compared to those with normal sperm concentration (N = 53). These findings are outlined in the differential abundance box plots generated from the Analysis of composition of Microbiota with Bias Correction (ANCOM-BC) in Figure 1 and the differential abundance box plots from the predictive functional analysis in Figure 2. Conclusions Our exploratory analysis suggests a role for not just an altered microbial taxonomic profile but also an altered functional profile in men with abnormal SA parameters. These changes in SA parameters may come about through differences in urine microbial metabolite production including short-chain fatty acids or byproducts of intermediary metabolic processes such as those that may contribute to a pro-inflammatory microenvironment. These findings appear to be aligned with the very limited number of studies exploring similar lines of inquiry. These pathways and microbial communities may represent potential therapeutic targets. Further, more mechanistic, investigations are necessary. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: MicrogenDx, Metuchen Pharmaceuticals, Antares Pharma, Boston Scientific, and Endo Pharmaceuticals.

Semen microbiota are dramatically altered in men with abnormal sperm parameters

There has recently been an explosion of studies implicating the human microbiome in playing a critical role in many disease and wellness states. The etiology of abnormal semen analysis (SA) parameters is not identified in 30% of cases; investigations involving the semen microbiome may bridge this gap. Here, we explore the relationship between the semen microbiome and alterations of sperm parameters. We recruited men presenting for fertility evaluation or vasectomy consultation with proven biological paternity. SA and next generation sequencing was performed. Differential abundance testing using Analysis of composition of Microbiota with Bias Correction (ANCOM-BC) was performed along with canonical correlational analysis for microbial community profiling. Men with abnormal (N = 27) sperm motility showed a higher abundance of Lactobacillus iners compared to those with normal (N = 46) sperm motility (mean proportion 9.4% versus 2.6%, p = 0.046). This relationship persisted on canonical correlational analysis (r = 0.392, p = 0.011). Men with abnormal sperm concentration (N = 20) showed a higher abundance of Pseudomonas stutzeri (2.1% versus 1.0%, p = 0.024) and Pseudomonas fluorescens (0.9% versus 0.7%, p = 0.010), but a lower abundance of Pseudomonas putida (0.5% versus 0.8%, p = 0.020), compared to those with normal sperm concentration (N = 53). Major limitations are related to study design (cross-sectional, observational). Our results suggest that a small group of microorganisms may play a critical role in observed perturbations of SA parameters. Some of these microbes, most notably Lactobacillus iners, have been described extensively within other, fertility-related, contexts, whereas for others, this is the first report where they have potentially been implicated. Advances in our understanding of the semen microbiome may contribute to potentially new therapeutic avenues for correcting impairments in sperm parameters and improving male fertility.

Weight Loss as Therapeutic Option to Restore Fertility in Obese Men: A Meta-Analytic Study.

Weight loss has been shown to significantly elevate testosterone serum levels, though the impact on semen analysis parameters and fertility remains incompletely understood. The objective of this study was to examine the influence of body weight loss on semen parameters in obese men. A meta-analysis was performed that included clinical trials in which a semen analysis before and after weight loss was evaluated. All strategies potentially available for weight loss were considered eligible. The primary outcome was the comparison of conventional semen analysis parameters before and after weight loss. Twelve studies were considered including 345 subjects (mean age 37.6±7.9 years; mean baseline body mass index 45.4±6.0 kg/m²). Weight loss resulted in a significant increase of sperm concentration (effect size 0.495, standard error 0.251 [0.003, 0.986], p=0.049) and progressive motility (effect size 0.567, standard error 0.372 [0.370, 0.764], p<0.001). Moreover, a significant decrease of sperm DNA fragmentation index after weight loss (effect size -0.689, standard error 0.278 [-1.123, -0.255], p=0.002) was observed. This meta-analytic analysis confirmed that body weight loss may improve qualitative and quantitative sperm characteristics providing evidence for suggesting weight loss to male partners with obesity and semen analysis alteration in couples attempting conception.

Effect of Carob and Ginseng Supplements on Semen Analysis Parameters, Sexual Function, and Sex Hormones in Infertile Men: Double-Blind, Randomized Controlled Trial Study

Abstract Background: Infertility is one of the most common problems in the world; there is a growing demand for herbal medicines to treat infertility-related problems. Materials and Methods: A randomized controlled trial with three groups was conducted, each with 30 participants. The first group was administered 1.5 grams of Carob daily, the second group was administered 1.5 grams of Ginseng daily, and the third group received a placebo. The treatment was administered for 12 weeks, and before and after the intervention, semen parameters, testosterone, prolactin, luteinizing hormone, follicle-stimulating hormone, thyroid hormones, and sexual function were evaluated. Sexual function was assessed using the International Index of Erectile Function Questionnaire. Results: The mean (SD) age of participants was 34.83 (6.22), 34.60 (5.78), and 33.67 (5.82) years in Carob, Ginseng, and Placebo groups, respectively. The results showed that in the Carob group, the normal volume of semen (Z 133 = 3.05, p = 0.02) and the normal shape of sperm (Z 134 = 2.97, p = 0.01) increased significantly compared to the control group. In the Ginseng group, the normal volume (Z 133 = 3.90, p = 0.001) and the normal viscosity of semen (Z 133 = 2.36, p = 0.01) increased significantly compared to the control group.The Carob group showed a significant increase in normal sperm counts and testosterone hormone levels (Z 131 = 2.81, p = 0.05). The Ginseng group demonstrated a significant improvement in orgasm function (H2 = 6.14, p = 0.04) and the total score of the International Index of Erectile Function (IIEF) (H2 = 5.8, p = 0.05). Conclusions: Carob supplements are suggested to enhance some semen parameters and male sex hormones. For infertile men, Ginseng can be beneficial in improving sexual function.

Динамика показателей эякулята за период с 2017 по 2023 год: ретроспективный одноцентровой анализ

Introduction: One of the most important tests to evaluate male fertility is a semen analysis. Assessment of ejaculate parameters allows to assume possible causes of male infertility and helps to determine further treatment. According to modern literature there is a slight but constant deterioration of ejaculate parameters with time. Purpose of the study: to evaluate semen analysis parameters in patients examined in one medical center. Materials and Methods: retrospective evaluation of semen analyses performed in the same laboratory from January 1, 2017 to October 31, 2023 was performed with a total of 47902 patients included. The ejaculate volume, concentration and number of spermatozoa, the proportion of spermatozoa of different categories of motility, sand the proportion of morphologically normal spermatozoa were evaluated. Statistical processing of data was performed using MS Office and SPSS v26 software packages. Results: the mean semen volume from 2017 to 2023 was 3.5 В± 1.5 mL, sperm concentration was 51.9 В± 39.3 million/mL, progressively motile spermatozoa was 48.2 В± 16.5%, number of progressively motile spermatozoa in the sample was 93.7 В± 94.3 million, motile spermatozoa 55.6 В± 17.4%, total motile spermatozoa was 107.5 В± 105.6 million, mean number of morphologically normal forms was 2.8 В± 1.4% in 2017, 2.2 В± 0.9% in 2023, and 3.5 В± 1.5% during the observation period. Mean pH of ejaculate was 7.6 В± 0.3 with noted tendency to increase (7.38 В± 0.33 in 2017, 7.6 В± 0.38 in 2023). The proportion of samples with azoospermia increased from 2.8% in 2017 to 4.5% in 2023. Mean number of patients with cryptozoospermia was 1.5%. Conclusion: there is a trend of decreasing proportion of morphologically normal spermatozoa, increasing ejaculate pH and increasing frequency of azoospermia from 2017 to 2023.

Testicular appendix (hydatid of Morgagni) torsion in adult urological management: evaluation of treatment outcomes

Introduction. Testicular appendix (hydatid of Morgagni) torsion (TAT) is relatively rare in patients over 18 years of age. To date, there are no systematised data on the long-term results of TAT treatment depending on the diagnostic and therapeutic tactics undertaken. Accordingly, there are no clear algorithms for the management of such patients.Objective. To evaluate and compare long-term results of various treatment options for patients with testicular appendix torsion over the age of 18 years.Materials &amp; methods. The age of patients is from 18 to 46 years. We analysed the treatment results of TAT-patients in three comparison groups: those who received conservative treatment for uncomplicated course of the disease (group 1, n = 17), early surgical treatment for complicated course (group 2, n = 16), and patients who were operated on for complicated course if conservative therapy was ineffective (group 3, n = 17). The exclusion criteria were concomitant scrotal pathology (hydrocele, funicular hydrocele, varicocele, epididymitis); severe somatic pathology (diabetes mellitus, hypertension, heart attack, stroke). Evaluation of long-term results was carried out 9 – 12 months after the acute episode. Scrotal ultrasound (US) and Doppler US of testicular vessels were compared, endocrine status (levels of total testosterone, luteinising hormone, follicle-stimulating hormone) and reproductive function were studied based on the results of semen analysis and MAR-test.Results. Analyses of long-term clinical data revealed recurrent orchalgia in 29.4% of patients in group 3. Also, in group 3, US revealed testicular asymmetry in 47.1% of patients accompanied by hypotrophy of the affected testis up to 20.8% of the volume compared to the contralateral testis. There were no significant changes and differences in groups 1 and 2. Evaluation of endocrine function showed no significant difference of the studied groups from the control normative indicators. Semen analysis parameters were not significantly changed in groups 1 and 2. In group 3, asthenozoospermia was found in 23.5% of cases, and teratozoospermia was detected in 29.4% of patients.Conclusion. Conservative treatment for TAT without inflammatory changes does not lead to impaired spermatogenesis and structural changes of both the testis and its appendix in the long-term follow-up period and is the most accepted in practice. Early surgical intervention for inflammatory changes shows similar long-term results. Prolonged conservative treatment for TAT in secondary orchoepidididymitis with delayed surgery significantly worsens long-term results. This fact also demonstrates the need for early surgery in complicated TAT.

Assessment of Expression Levels and Localization Patterns of Phospholipase C zeta in Different Grades of HOST in Human Sperm.

Phospholipase C zeta (PLC-ζ) deficiency in sperm can underlie oocyte activation failure after intracytoplasmic sperm injection (ICSI). The aim of this study was to determine PLC-ζ expression and location in individual spermatozoa in each host score so that a hypo-osmotic swelling test (HOST) may be used to help routine sperm selection for ICSI. In this experimental study, fresh semen samples were randomly obtained from 30 men who were referred to the Andrology Unit of the Infertility Center. Samples were processed by density gradient centrifugation (DGC) and exposed to hypotonic conditions. Seven different tail patterns, classified from 'a' to 'g' can be detected according to World Health Organization (WHO) criteria. Then, the PLC-ζ protein localization pattern was assessed by quantitative Immunofluorescence in individual sperm Host grades. Moreover, the sperm content of PLC-ζ protein was evaluated by flow cytometry correlated with semen analysis parameters. In the present study, quantitive immunofluorescence analysis indicated that sperm from different host grades exhibited seven localization patterns of PLC-ζ of acrosomal (A); equatorial (EQ), and postacrosomal (PA) patterns. A+EQ=acrosomal and equatorial, A+PA=acrosomal and post-acrosomal, EQ+PA=equatorial and post-crosomal, and A+EQ+PA. The sperm from HOST grade 'd' exhibited significantly higher PLC-ζ (A+PA) and (A+EQ+PA) staining compared to sperm from other grades (P=0.006). The sperm from grade 'd' exhibited higher PLC-ζ (EQ+PA) compared with other grades (P=0.001). However, grade 'd' was not significantly different from 'c' (P=0.087). Analysis of the combined results confirmed that there was a clear reduction in PLC-ζ immunofluorescence in Host grades 'a', 'f' and 'g' sperms. Our data suggest that HOST may represent a useful diagnostic tool for the selection of sperms exhibiting a higher level of PLC-ζ expression.

The Effect of Month-Long Daily Fasting on Semen Parameters: A Retrospective Cohort Study

Objective: The aim of the study was to determine whether Ramadan month-long daily fasting affects semen analysis parameters. Methods: This retrospective cohort study was conducted in tertiary academic medical center. Medical records of 97 Muslim patients who were admitted to the IVF unit from May 2011 to May 2021 were reviewed. Only men who provided at least one semen sample during Ramadan period (Ramadan month +70 days after) and one sample not during Ramadan were included. Semen characteristics of each patient were independently compared to themselves. Results: The post-gradient semen analysis indicated significantly lower progressive sperm motility (mean 30.01 ± 20.46 vs. 38.12 ± 25.13) (p < 0.001). The decrease in the progressive motility remained significant among patients with non-male factor indications (p < 0.001). In the non-male factor indication group, the difference in the progressive motility of the post-gradient semen analysis between the 2 samples was not statistically significant (p = 0.4). There were no significant differences between semen parameters before centrifuging. The incidence of asthenospermia (progressive sperm motility <32%) as an absolute parameter was higher after centrifuging the semen sample during the Ramadan period (p = 0.04). Conclusions: Semen samples collected during Ramadan period were associated with lower progressive motility and reduced semen volume compared to semen samples from the same men outside of the Ramadan period. A possible effect of these altered semen parameters on fertility should be investigated further.

Sperm dna bridges versus genetic variability: an editorial

Sperm DNA fragmentation is recognized to compromise male fertility. The data entail that sperm DNA damage can be competently treated with oral antioxidant administration during a comparatively short time period. It is an understanding that the 2 types of DNA appear to be different and autonomously packaged molecules; though, research has demonstrated the interdependent nature of these conformations in contributing to male infertility. Data must endure to be congregated to establish strong associations between traditional semen analysis parameters and sperm DNA integrity; this information remnants controversial and useless in clinical practice until novel techniques for the diagnosis and treatment of sperm DNA can be established. More modern technology must be employed to correlate such information into valuable clinical awareness. This editorial is the collation of reports relating to research on sperm DNA biochemistry and molecular biology to establish an opinion revealing sperm DNA integrity likely to be both tremendously fragile and remarkably significant for male fertility.

P-065 A systematic review of the accuracy of laboratory semen analysis as a test of fertility

Abstract Study question Which semen parameters are predictive of treatment-dependent and treatment-independent reproductive outcomes? Summary answer Progressive motility predicted treatment-independent pregnancy, total motile sperm count (TMSC) predicted failed fertilisation with IVF and pregnancy following IUI, and morphology predicted pregnancy after IUI. What is known already Semen analysis, an essential component of any fertility work-up, is useful in identifying azoospermia and oligozoospermia, but its discriminatory capacity to identify fertile and infertile men has been questioned, including by the World Health Organisation (WHO). It has also been suggested that a combination of semen parameters has better predictive value than a single parameter. We conducted a systematic review of the literature to determine the association between different semen parameters and spontaneous (treatment-independent) pregnancy outcomes, as well as pregnancy outcomes following various fertility treatments (treatment-dependent outcomes). Study design, size, duration A protocol was registered prospectively with PROSPERO (CRD42021251988). A systematic search of MEDLINE, EMBASE, Web of Science, and the Cochrane Central Register of Controlled Trials was undertaken to include papers published from 1st January 2000 to 25th May 2021. Studies were not limited by language. Two reviewers independently screened the search results and undertook data extraction. Risk of bias assessment was undertaken with the QUADAS-2 or QUIPS tool, depending on study design. Participants/materials, setting, methods Studies were eligible if they included men undergoing semen analysis for any indication and reported the accuracy of one or more semen analysis parameters in predicting treatment-dependent or treatment-independent reproductive outcomes – these included fertilisation rate, clinical pregnancy, live birth, and time to pregnancy. Studies were excluded if semen analysis was not the primary test being assessed or no reproductive outcomes were reported. Main results and the role of chance Of 5236 publications and 139 full-text articles, 62 studies were included. 52 studies reported treatment-dependent outcomes and 10 reported treatment-independent outcomes. Most treatment-dependent studies lacked key information and were rated as unclear risk of bias in at least one domain (79.3% overall). Half of the treatment-independent studies were high risk of bias in at least one domain. Of all semen parameters, progressive motility and sperm concentration predicted treatment-independent pregnancy outcomes. Three studies concluded progressive motility predicted pregnancy rates at a range of thresholds (threshold 24%: area under the curve (AUC) 0.909; &amp;lt;32% vs ≥ 32%: adjusted odds ratio (aOR) 4.2 (95% CI 1.1-15) and &amp;lt;50% vs ≥ 50%: aOR 2.8 (95% CI 1.3-6.1); per 10% reduction in progressive motility, pregnancy chances reduced by 11%: hazard ratio (HR) 0.89 (95% CI 0.85-0.93)). Sperm concentration predicted pregnancy within 6 months (≥20 vs &amp;lt; 20 million/ml, adjusted rate ratio 0.68 (95% CI 0.52-0.91)) and 12 months (adjusted HR 1.35 (95% CI 1.09-1.66)). In those undergoing IUI, pre-/post-wash TMSC and morphology predicted pregnancy, but with no clear threshold values. TMSC predicted “total fertilisation failure” in an IVF population (AUC 0.631-0.75). In an ICSI population, no semen parameter predicted fertilisation rate, pregnancy, or live birth rate. Limitations, reasons for caution Meta-analysis was not possible due to a wide range of cut-off values used for each semen parameter. Due to the low quality of the evidence included, poorly detailed female populations, and WHO manual methods often not being used for reporting, the findings of this review should be viewed with caution. Wider implications of the findings Whilst this review has identified certain semen parameters in isolation are predictive of pregnancy in treatment-dependent and treatment-independent scenarios, clear threshold values have not been identified. This questions the reporting of morphology as it is labour intensive to assess and is only predictive of pregnancy in a population having IUI. Trial registration number Not applicable

O-023 ‘The PiNC Trial’: Progesterone in Natural Cycles for the treatment of unexplained infertility

Abstract Study question Does exogenous progesterone for luteal phase support in natural cycles affect the biochemical, clinical pregnancy, livebirth or miscarriage rates in women with unexplained infertility (UI)? Summary answer Progesterone luteal support lead to an increase in livebirth rate from 7% to 15.3% and a decrease in miscarriage rates from 40% to 20%. What is known already Unexplained infertility is a diagnosis likely to encompass a population with varying underlying subtle pathologies. The only treatments currently recommended for treating UI are intrauterine insemination (IUI) and IVF/ICSI which are both expensive and invasive. The evidence for IUI with and without controlled ovarian hyperstimulation (COH) is inconclusive. A recent systematic review and meta-analysis reported a progesterone-mediated reduction in endometrial receptivity as a possible mechanism in the pathogenesis of UI. No trial has been published investigating the effectiveness of exogenous progesterone for luteal support in otherwise natural, unmedicated cycles to improve reproductive outcomes in couples with UI. Study design, size, duration We conducted an open-label, parallel arm, single centre, randomised controlled trial of an investigational medicinal product (cTIMP) from February 2020 to November 2022. We randomised 143 couples with UI to either luteal phase progesterone support or no luteal phase support and analysed the results on an intention-to-treat basis. Each couple participated for 3 menstrual cycles and they were followed up until either the end of a 3rd non-conceptual cycle or any resulting pregnancy. Participants/materials, setting, methods Couples with normal semen analysis (WHO 2020), regular ovulation, bilateral patent tubes, female partner aged ≤42yrs and BMI ≤30 were recruited and randomised following screening and informed consent. Participants timed their luteinising hormone (LH) surge using digital ovulation kits and had timed intercourse for 3 cycles. The treatment group took progesterone suppositories 400mg bd for 14 days after the LH surge. All pregnancies were scanned at 6-7/40 and ongoing pregnancies followed up to delivery. Main results and the role of chance 143 couples were recruited and randomised. Livebirth rates were 11/72 (15.3%) in the treatment group vs. 5/71 (7.0%) in the control group (Odds Ratio (OR) 2.38, 95%CI 0.78-7.24). Biochemical pregnancy rates (defined by a positive urinary pregnancy test) were 15/72 (20.8%) (treatment) vs 10/71 (14.1%) (control) (OR 1.61, 95%CI 0.67-3.86). Clinical pregnancy rates (defined by a gestation sac seen on ultrasound at a minimum of 6/40 gestation) were 14/72 (19.4%) (treatment) vs 9/71 (12.7%) (control) (OR 1.66, 95% CI 0.67-4.13). The miscarriage rate including biochemical losses was 3/15 (20%) of all pregnancies (treatment) vs. 4/10 (40%) (control). One pregnancy in the control group was terminated due to fetal anomalies. There was one ectopic pregnancy in the treatment group. Logistic regression demonstrated that none of the pregnancy outcomes were affected by participant age, BMI, ovarian reserve markers, previous parity or semen analysis parameters. The two participants in the treatment group who experienced miscarriages were both off-protocol. Although the results did not reach statistical significance, the 15.3% livebirth rate and OR of 2.37 for livebirths are clinically significant (equivalent to the success rates of stimulated intrauterine insemination treatment) as is the miscarriage rate of 0/11 clinical intra-uterine pregnancies for women taking progesterone as per protocol.Limitations, reasons for caution Despite the lack of statistical significance, differences in livebirth and miscarriage rates are clinically significant compared with alternative treatments. The trial was unblinded but the objective outcomes are unlikely to be affected by this. A larger trial using the effect size from this study to guide sample size is planned. Wider implications of the findings The treatment investigated here represents a simple, non-invasive and inexpensive option that is acceptable to couples with UI and may increase their chance of pregnancy and livebirth. If this treatment offers similar success rates to stimulated IUI it is likely to become a first-line option for many couple worldwide. Trial registration number 2019-003468-27