Routine Semen Analysis Research Articles

Difference in the seminal plasma protein expression in unexplained infertile men with successful and unsuccessful in vitro fertilisation outcome.

Unexplained male infertility (UMI) is a condition in which routine semen analysis fails to detect subcellular sperm dysfunctions. In the present research, a comparative proteomics study of seminal plasma (SP) was conducted in men with unexplained infertility whose female partners had undergone in vitro fertilisation (IVF) treatment to find differences in the SP protein profile. Five UMI men with successful and eight with unsuccessful IVF outcome enrolled in this study. Two-dimensional polyacrylamide gel electrophoresis (2D-PAGE) technique was used for protein separation. The differentially expressed proteins were identified using mass spectrometry. Results indicated that at least two different protein spots, including clusterin and epididymal secretory protein E1, were over-expressed (1.5- and 2-fold change, respectively, p<0.05) while prostate-specific antigen was downregulated (0.3-fold change, p<0.05) in the successful group as compared with the unsuccessful group. Considering the role of all three identified proteins in the sperm quality, the results of the present study introduced these proteins as new candidate biomarkers for success of IVF in UMI couples.

Changes of Quality of Semen after Swim up Method during Intrauterine Insemination: A Single Centered Experience in Dhaka City

Background: Quality of semen is very important during intrauterine insemination.Objectives: The purpose of the present study was to observe the changes of quality of semen after swim up method during intrauterine insemination.Methodology: This analytical type of cross-sectional study was carried out at a private infertility centre (Central Hospital Limited, Dhaka) in Dhaka city of Bangladesh from January 2012 to December 2017 for a period of 6 years. Infertile couples who already had undergone natural cycles of super-ovulation for six months or whose duration of infertility was more than one year were included. Semen samples were collected by the process of masturbation in semen production room after three days of abstinence in sterile, labelled container. After production all samples were placed in an incubator at 37 degrees Celsius for 30 minutes for liquefaction. Routine semen analysis was performed using World Health Organizations’ (WHO) semen analysis criteria. Then the samples were randomly assigned to be processed either with swim-up or density-gradient procedure.Result: A total number of 789 male respondents were recruited for this study. The mean age with SD of the study population was 28.96±5.382 with the range of 19 to 46 years. The mean changes of sperm concentration before and after swim up method was 52.70±42.88 with the 95% confidence of 49.58 to 55.82 (p=0.000). The mean changes of sperm motility before and after swim up method was 29.03±14.849 with the 95% confidence of 30.11 to 27.95 (p=0.000). The mean changes of sperm morphology before and after swim up method was 23.96±11.328 (p=0.000).Conclusion: There is a significant changes of quality of semen after swim up method during intrauterine inseminationJournal of National Institute of Neurosciences Bangladesh, 2018;4(1): 54-57

Prognostic value of post thaw semen quality parameters, mitochondrial integrity and cholesterol content of sperm membrane vis-à-vis conception rate in Frieswal bulls

The present study aimed to analyze the quantitative relationship of membrane cholesterol content (Chol content), mitochondrial integrity (Δψm), and quality parameters of spermatozoa (SQP) at post-thaw stage with conception rate (CR) and estimated relative conception rate (ERCR) in Frieswal bulls. For the experiment, frozen semen straws (32) were collected from the SF laboratory and CR (Total insemination 3482) was obtained from Field Progeny Testing units. Based on the CR, bulls were grouped into low, medium or high groups (G I, G II and G III, respectively). SQP, viz. viability (Eosin Nigrosin), post thaw motility, biochemical integrity of the membrane (HOS res), acrosome integrity (Giemsa, and fluorochromes fluorescein isothiocyanate Pisum sativum agglutinin and propidium iodide, respectively), chol-content, and Δψm using fluorescent probe JC-1 (5,5’,6,6’-tetrachloro- 1,1’,3,3’-tetraethylbenzimi-dazolylcarbocyanine iodide) were determined. The values thus obtained were subjected to the stepwise regression analysis using the least squares principles for each group, and the CR and ERCR were regressed on the various SQP. Pearson’s correlation coefficients were estimated between the CR and ERCR values and the various SQPs. The coefficient of determination (R2) moderately higher for all the models and ranged from 63.70–93.40% (high and medium group, respectively). High R2 value of the prediction equation for the herd and bulls with medium CR (75.9 and 93.4%, respectively) reveal their suitability to predict the CR and ERCR potential of the cryopreserved semen. Study results point to inclusion of cholesterol content and Δψm estimation in routine semen analysis before long-term storage or usage for insemination purposes.

Laparoscopic Testicular Artery Saving Varicocelectomy for Varicocele in Adolescents

AbstractBackground: Varicocele is generally considered to be the most common correctable cause of male infertility.Testicular disproportion is considered to be the most important sign of testicular damage in absence of the possibility to do routine semen analysis in adolescent.Aim of the Study: The aim of our work is to evaluate the feasibility, recurrence rate and postoperative complications of laparoscopic varicocelectomy with preservation of the testicular artery in adolescents.Patients and Methods: Our prospective clinical study was done between May 2016 and May 2017 at pediatric surgery unit, General Surgery Department, Tanta University Hospital. The study included twenty patients presented with symptomatic varicocele. Then, laparoscopic varicocelectomy with preser-vation of the testicular artery were done for these cases. The operation time, the success rate, the incidence of complications, the length of the hospital stay and conversion to open varic-ocelectomy and data of follow-up were recorded.Results: Total Operation time ranged between 10 and 40 minutes which was statistically significant in correlation with bilateral cases. There were testicular catch up growth in 5 cases and we had no testicular atrophy in the other cases Recurrence occurred in 2 cases in the period of follow-up (6 months).Conclusions: Laparoscopic approach had advantages of minimal surgical trauma, lower morbidity and time sparing, faster recovery and better microscopic dissection with pres-ervation of the spermatic artery.

Days of abstinence does not affect post-vasectomy semen analysis results

The American Urologic Association (AUA) Vasectomy Guidelines recommend that a post-vasectomy semen analysis (PVSA) be done 8-16 weeks after vasectomy with either azoospermia or <100,000 non-motile sperm/mL serving as the criteria for vasectomy success.1 The impact of the period of abstinence (POA) on the results of a PVSA is unknown. A short POA prior to PVSA may serve as a marker of higher sexual activity (i.e. more ejaculations) in the post-vasectomy interval and thus lead to an increased chance of an acceptable PVSA. However, while studies have shown alterations in sperm concentration and motility with variable POAs for a routine semen analysis, it is unclear if POA has an impact on the chance of finding <100,000 non-motile sperm/mL on PVSA. Retrospective review of patients who had a vasectomy by a single urologist. With institutional board approval, the PVSAs of men who had a vasectomy by a single urologist between January 2000 and July 2017 were retrospectively analyzed. Information was collected on the time since vasectomy, days of abstinence prior to collection, sperm count, and motility. Student t-tests were performed to examine the impact of POA on PVSA. In total, 875 men who underwent a vasectomy returned for a PVSA. Of these, 794 men (90.7%) had a PVSA demonstrating azoospermia and 48 (5.5%) had >100,000 sperm/mL or motile sperm. In the azoospermic men, the mean time since vasectomy was 151 days (range 10-1989) compared to 100 days (range 24-189) in those with >100,000 sperm or motile sperm (p = 0.15), and no difference in the POA was observed (4.4 vs 5.3 days respectively, p = 0.27). When examining men whose PVSA was done within the recommended 8-16 weeks after vasectomy, no difference in the POA between men with azoospermia and those with >100,000 sperm/mL or motile sperm was observed (3.4 vs 3.3 days, p = 0.84). Even when azoospermic men were compared to those with the presence of any sperm on PVSA, there was no difference in the POA (3.4 vs 3.5 days, p = 0.84). Of those men tested < 8 weeks after vasectomy, 23/25 were azoospermic with intervals since vasectomy as short as 10 days and 2/25 demonstrated >100,000 sperm/mL or motile sperm. The POA does not appear to affect the results of a PVSA. As such, the length of the POA does not need to be considered with regards to when men should provide a PVSA.

Impact of age, clinical conditions, and lifestyle on routine semen parameters and sperm kinematics

To assess the impact of aging on routine semen and computer-assisted sperm analysis (CASA) motility parameters according to the current World Health Organization guidelines; and to evaluate the effect of obesity and lifestyle (alcohol consumption, cigarette smoking) in older men's semen. Blind cross-sectional study. Research laboratory and andrology and reproduction laboratory. A population of 11,706 men. None. Semen analysis: routine (semen volume, sperm concentration and count, motility, vitality, morphology, hypo-osmotic swelling test, round and peroxidase-positive cell concentration) and CASA (straight-line velocity, curvilinear velocity, average path velocity, linearity, straightness, beat cross frequency, wobble, amplitude of lateral head displacement, and mean angular displacement) parameters; and body mass index. A negative correlation was found between age and routine semen parameters: volume, sperm count, motility, vitality, total motile spermatozoa and normal-motile spermatozoa, round cell concentration, and hypo-osmotic swelling test values. Several CASA variables (straight-line velocity, curvilinear velocity, average path velocity, beat cross frequency, amplitude of lateral head displacement, and mean angular displacement) were also negatively affected. Using 40years as a cut-off value, significant differences in most parameters correlated to age. In a selected subpopulation of men unexposed to known fertility-compromising factors, the same evaluations were performed, finding some parameters still decreased. Although obesity exerted a significant deleterious effect on older patients' semen quality, alcohol consumption and cigarette smoking mildly affected it. Male aging, with the contribution of unhealthy conditions, are paramount effectors of sperm quality deterioration.

Sistemas de análisis computadorizado de semen en la reproducción animal

Computer-assisted semen analysis (CASA) is used in animal reproduction with the objective of evaluating spermquality, quickly and reliably. Currently, artificial insemination centers must have reliable and objective systems thatensure the reliability of reproductive data. The aim of this paper was to review computer-assisted semen analysisin livestock species. The use of CASA systems replace routine quality analyzes that introduce biases and leads to different inaccuracy degrees. In addition, if intrinsic limitations of microscopy or sperm with different motilitypatterns are considered, it is most likely that considerable variability will be introduced which will have an impact on the objectivity of the estimation. At first, this type of technology was inaccessible, but they are currently used routinelyin most research laboratories for the evaluation of sperm samples of different species of zootechnical interest..Computerized techniques are able to issue reports with a high number of characteristics, to minimize the subjectivefactor of routine semen analysis, and to ensure a better correlation with the fertilizing capacity of spermatozoa by the relationship between sperm motility and functional competence. The use of CASA systems together with multivariatestatistical analysis have demonstrated the existence of kinetic and morphometric subpopulations in ejaculates ofdifferent species, eliminating the idea that ejaculates are homogeneous, formed by a single sperm population with normal distribution.

Sperm DNA fragmentation (SDF) index on day of transvaginal oocyte retrieval (TVOR) does not correlate with the incidence of segmental aneuploidy in blastocysts analyzed with targeted next generation sequencing (NGS)

Sperm DNA fragmentation (SDF) is more common in infertile men and has been found to be associated with recurrent miscarriage in some studies1. SDF testing evaluates the extent of DNA strand breaks in a given specimen and has been proposed as an adjunct to routine semen analysis. Given that high levels of SDF indicate a greater number of DNA strand breaks in sperm, some have proposed that the association between high SDF and poor reproductive performance may reflect segmental aneuploidy that has not traditionally been detectable with preimplantation genetic screening (PGS)2. However, the increased resolution of NGS allows for improved identification of segmental imbalances and may be useful in addressing this question3. To evaluate the association between segmental aneuploidy (duplications and deletions) and sperm DNA fragmentation levels among trophectoderm biopsy samples evaluated with targeted NGS. This was a subgroup analysis of a prospective cohort study of females 35-40 years of age undergoing IVF with ICSI and PGS between December 2014 and May 2017. Routine clinical care was performed through TVOR, at which time a 0.5mL semen aliquot was isolated from the fresh specimen. SDF was evaluated with the Sperm Chromatin Structure Assay (SCSA®). Beginning in July 2016, PGS samples were evaluated using NGS and segmental aneuploid calls were included in clinical reports (in addition to whole chromosome aneuploidy). Reports indicated the % of fragmented sperm DNA (DFI). Patients were divided into 2 groups: (<15% and >15%) and incidence of segmental aneuploidy was compared between the groups in 2 ways: 1) any segmental aneuploidy (among all embryos, including those with an additional whole chromosome aneuploidy) and 2) segmental aneuploidy only (no other whole chromosome aneuploidy). A total of 169 cases were included in the analysis. DFI <15% was found in 123 specimens, while DFI >15% was found in 45 specimens. The median DFI for the entire study population was 11 (interquartile range: 8 to 15). Men in the 15% DFI group were older (40.6 vs. 38.0, p<0.01), but there was no difference in the age of the female partner (37.9 vs. 37.4, p = 0.71). There was no difference in the rate of conversion to blastocyst. The incidence of any segmental aneuploidy and only segmental aneuploidy was no different between the groups. The incidence of whole chromosome aneuploidy was also no different (Table 1). Specimens with elevated DNA Fragmentation used for ICSI do not result in an increased incidence of segmental aneuploidy in trophectoderm biopsy samples evaluated by NGS. These results suggest three possible rationales: 1) DNA damage in the male may be at least partially repaired by oocyte-derived mechanisms, 2) small deletions and duplications may be below the diagnostic threshold of current NGS technologies, or 3) SDF testing, which relies on average levels among pooled sperm, may be limited in its ability to prognosticate embryonic segmental aneuploidy.Tabled 1Table 1DFI ≤15% (N=126)DFI >15% (N=43)P ValueDFI %9 (7-12)20 (16-27)<0.001Female Age (years)37.4 ± 1.637.9 ± 1.90.71Male Age (Years)38 ± 5.940.6 ± 5.9<0.01Oocytes Retrieved13.2 ± 8.111.5 ± 9.00.18Blastulation Rate48.2% (525/1089)50.8% (159/313)0.45Whole Chromosome Aneuploidy (per embryo)34.7% (182/585)35.8% (57/159)0.86Any segmental aneuploidy (including in embryos with whole chromosome aneuploidy also)10.7% (56/525)11.9% (19/159)0.75Only segmental aneuploidy present (no other whole chromosome aneuploidy)5.3% (28/525)5% (8/159)0.99 Open table in a new tab

Significance of differentiation of round cell count in semen in infertile men: A cost-effective study

Background: The significance of the presence of immature germ cells (IGCs) and leukocytes in semen have not very frequently been highlighted in the diagnostic criteria of male infertility. Round cell count differentiation aids in better clinical correlation. Aim and Objectives: To differentiate the round cells into IGCs and leukocytes in the semen and to find their correlation with the total sperm count and sperm motility. Materials and Methods: Semen samples from patients at Bharati hospital, Sangli for evaluation of infertility from July 2014 to January 2015 were analyzed as per the WHO criteria. After the consent and collection of the semen sample, routine semen analysis was done. Smears of semen were prepared and stained by Leishman stain. The round cells were counted and differentiated into IGCs and leukocytes. Results: We studied 103 cases. Semen parameters such as total sperm count, motility were noted. The smears were studied for differential counts of round cell count into IGC count and leukocyte. The cases were divided into four groups based on total sperm count. Maximum number of cases was found in group III. Our study shows that round cell count is 5%–10% of the total sperm count. Negative correlation was noted between the total sperm count and IGCs. The correlation of total sperm count and leukocytes was negative and significant. Conclusion: The present study shows that differentiation of round cells in the semen can be effectively differentiated into spermatogenic and nonspermatogenic cells with the use of simple and cost-effective stain like Leishman stain. The correlation of sperm count with the IGCs and leukocytes and sperm motility is of immense use to find out the possible cause of infertility.

WITHDRAWN: Cytogenetics alteration in adult men involved in the recycling of electronic wastes

Abstract In this data article, 146 villagers (exposed group) were randomly selected from the workers who involved in the e-wastes recycling directly as a daily job in Tianjin. Control group, including 121 villagers, came from another town without e-waste disposal sites. Chromosomal aberrations (CA) and cytokinesis blocking micronucleus (CBMN) were performed to detect the cytogenetic effect for each subject. DNA damage was detected using comet assay; the DNA percentage in the comet tail (TDNA%), tail moment (TM), and Olive tail moment (OTM) were recorded to describe DNA damage to lymphocytes and spermatozoa. Routine semen analysis, spermatozoa motility and morphology were analyzed. The RT 2 Profiler PCR array was used to measure levels of expression of 84 genes related to quality of DNA. It showed significant relationships between CA, CBMN, DNA damage and exposure time in exposure subjects. The alteration of sperm motility rate, abnormality rate and total sperm counts had association with exposure time and age.

The effect of in-vitro myoinositol supplementation of human sperm on the outcome of cryopreservation

Objective: To investigate the effects of in vitro Myo- inositol supplementation of cryopreserved human semen on the post-thaw sperm quality. Design: A randomized controlled clinical trial (RCT). Materials and Methods: The study included 41 fresh semen samples obtained from 41 infertile men. Following routine semen analysis and estimation of sperm motion kinetics by CASA, each sample was divided into 2 identical aliquots. One aliquot (Myo- aliquot) was cryopreserved after Myo-inositol supplementation, while the other aliquot was cryopreserved as it is. Semen analysis and sperm motion kinetics were re – estimated and sperm cryosurvival rate was calculated for both aliquots after thawing. Results: Among patients with abnormal semen samples, Myo aliquot showed a highly significant increase in the following parameters in comparison with control aliquot: Percentage of progressive motility (P< 0.00001), percentage of total motility (P=0.00001), cryosurvival rate (P< 0.00001) and PR recovery rate (P< 0.0001). All sperm motion kinetics were also higher in Myo aliquot than control aliquot among this group, but failed to reach a statistical significant difference. Conclusion: in vitro myoinositol supplementation of human sperm prior to cryopreservation resulted in a highly significant increase in cryosurvival rate among abnormal semen samples, and an increase in cryosurvival rate among normozoopermic samples that failed to reach a statistical significant difference. These findings may pave the way to include myoinositol in the manufacture of human sperm cryopreservation media.

A few more fragments: putting sperm DNA integrity testing into clinical practice.

While routine semen analysis has been the cornerstone of the male fertility evaluation, we know that it is far from a perfect predictor of fertility, and there will be some couples who struggle to obtain a live birth despite the male having a normal semen analysis. Indeed, the World Health Organization semen analysis normal reference ranges were based on samples from fertile men (1). The LIFE study, a prospective observational cohort study of 501 couples, which looked at the relationship between routine semen parameters and time to pregnancy, found that on multivariate analysis, none of the routine semen parameters (volume, concentration, motility or morphology) were associated with time to pregnancy. Only male age and female body mass index (BMI) were associated with the time to pregnancy (2). From both this data and others, we know that the standard semen analysis is not a perfect predictor for male infertility (3). These limitations have led to the investigation of sperm DNA fragmentation as an adjunctive test to guide the management of the sub-fertile couple.

Guidelines on sperm DNA fragmentation testing.

Male factor subfertility is present in more than 50% of the couples treated with assisted reproductive techniques. Routine semen analysis provides information on semen volume as well as sperm concentration, motility, and morphology. Standardized methods have been published by the World Health Organization (WHO) (1). Nevertheless the investigation of male factor involvement should always include a complete medical history and physical examination. Endocrine evaluation, ultrasonography, specialized tests on semen and sperm, and genetic screening are additional tests to be used if required.

Commentary: the value of testing sperm DNA fragmentation in infertile men.

Over the past 20 years, the necessity and usefulness of clinically testing for DNA fragmentation in spermatozoa has been increasingly researched and debated. Studies have shown that sperm with impaired DNA integrity are related to prolonged time to pregnancy, significantly lower conception rates both naturally and after intrauterine insemination (IUI), as well as increased pregnancy loss. High levels of sperm DNA damage have also been linked to poor integrity of the embryonic genome and impaired embryo development. However, both scientists and clinicians remain divided as to whether the potential information that the measurement of immature chromatin or fragmented DNA in spermatozoa may offer, in addition to that provided by routine semen analysis, is actually relevant in a clinical setting. In a recent paper, a select team of authorities in the field of male infertility recommended a practice guideline pertaining to the clinical value of sperm DNA fragmentation assessment (1). The group employed an evidence-based approach to describe clinical scenarios that most warranted sperm DNA testing as well as the management of patients with high sperm DNA fragmentation.

Smartphone-based optical system for sperm viability testing

Sperm viability, an assessment of the membrane integrity, is a parameter measured as part of a routine semen analysis. It is especially important for samples with less than 30% motility [1]. Currently, sperm viability testing is performed manually by a technician using a benchtop compound microscope. We developed a low-cost, simple smartphone-based system for sperm viability testing. Such a test can be augmented with our earlier work on automated point-of-care smartphone-based sperm concentration and motility measurements.

Development of treatment strategies in men with vulnerable sperm

Dr. Samplaski, in her commentary, elegantly discussed different issues surrounding sperm DNA fragmentation (SDF) (1) and the author largely endorsed the practice recommendations by Agarwal et al. (2). Firstly, she stated the drawbacks of routine semen analysis in the evaluation of male infertility supported by data from the LIFE study (3). This was followed by discussion of the testing methodologies. The author then further elaborated on interventions for mitigating high SDF and stressed on the use of antioxidant and testicular sperm as possible treatment strategies. Additional information on deleterious effects of cryopreservation on SDF was highlighted. Finally, the author summarized towards the end in last paragraph that “plan for an intracytoplasmic sperm injection (ICSI) cycle with a fresh testicular sperm extraction (TESE)/testicular sperm aspiration (TESA)” if SDF is persistently high even after correction of all reversible factors.

Adapted methods for scanning electron microscopy (SEM) in assessment of human sperm morphology.

Infertility is a widespread problem, and in some cases, the routine basic semen analysis is not sufficient to detect the cause of male infertility. The use of the scanning electron microscope (SEM) could provide a detailed insight into spermatozoa morphology, but it requires specific sample preparation techniques. The purpose of this study was to select, adjust, and optimize a method for the preparation of spermatozoa samples prior to SEM analysis, and to establish the protocol required for its use in clinical practice. We examined sperm samples of 50 men. The samples were fixed with modified iso-osmolar aldehyde solution followed by osmium post-fixation. In the first method, dehydration of the cells and subsequent critical point drying (CPD) were performed on a coverslip. In the second method, the samples were dehydrated in centrifuge tubes; hexamethyldisilazane (HMDS) was used as a drying agent instead of CPD, and the samples were air-dried. The third procedure was based on a membrane filter. The samples were dehydrated and dried with HMDS in a Gooch crucible, continuously, without centrifugation or redispersion of the sample. Our results showed that the fixation with modified iso-osmolar aldehyde solution followed by osmium post-fixation, and combined with dehydration and CPD on a coverslip, is the most convenient procedure for SEM sample preparation. In the case of small-size samples or low sperm concentration, dehydration and drying with HMDS on the membrane filter enabled the best reliability, repeatability, and comparability of the results. The presented procedures are suitable for routine use, and they can be applied to confirm as well as to correct a diagnosis.

Patterns of Semen Analysis: Experiences of a Laboratory Catering to Semi Urban Population of Delhi

Background:Infertilityis defined as failure of a couple to conceive after one year of regular sexual intercourse. It remains both prevalent and problematic among couples worldwide. The analysis of semen remains the preliminary investigation for males in the workup of infertility in couples.It is a key element in the fertility evaluation of men and permits male reproductive potential to be evaluated in association with possible risk factors.Aim: To assess and analyse the semen characteristics of all the males who presented to our hospital, irrespective of primary or secondary infertility.Material and Methods: This is an observational study conducted in the Department of Pathology, Hamdard Institute of Medical Sciences, Delhi; from Jan 2012 to Oct 2013. Semen of 139 subjects were evaluated and results analyzed.Results: The present study included 139 subjects whose age ranged from 22 years to 48 years with a mean age of 29.42 years. Patients were divided into oligospermia[17%], normospermia[16%] and azoospermia[9%]. 42.5% of the cases had sperm counts in the range of 51-80million/ml. Asthenospermia was seen in 22.1% of the cases.An age specific comparative analysis of the mean sperm counts, total motility and normal morphology revealed a decline in the aaverage values of these parameters with age.Conclusions: Routine semen analysis remains the backbone of the evaluation of the male factor infertility, but it is important to acknowledge the limitation of semen analysis with respect to collection, processing, evaluation, biological variation of the parameters and lack of information on sperm function. A normal semen analysis does not guarantee the fertilization potential of sperm.Bangladesh Journal of Medical Science Vol.16(2) 2017 p.314-319

Sperm aneuploidy after testicular cancer treatment: data from a prospective multicenter study performed within the French Centre d’Étude et de Conservation des Oeufs et du Sperme network

To study sperm aneuploidy in a population of testicular cancer (TC) patients treated with the use of either bleomycin-etoposide-cisplatin (BEP) chemotherapy or radiotherapy. Multicenter prospective longitudinal study of TC patients analyzed before treatment and after 3, 6, 12, and 24months (T3-T24). Fifty-four TC patients and a control group of 10 fertile sperm donors. University hospital laboratories. Routine semen analyses; sperm aneuploidy and diploidy. Comparison of sperm characteristics and sperm chromosome abnormalities during TC patient follow-up. Semen characteristics recovered pretreatment values 12months after radiotherapy and 24months after more than two BEP cycles. A significant increase in sperm disomy YY and XX was observed in the TC group before treatment compared with the control group. After more than two BEP cycles, the mean sperm aneuploidy rate increased significantly at T12 and reached the pretreatment value at T24. After radiotherapy, the mean sperm aneuploidy returned to the pretreatment value at T12. At T24, nearly 40% of TC patients did not recover their pretreatment sperm aneuploidy rate. Genetic counseling of TC patients should include information on the potential elevated risk of aneuploid conceptus from sperm recovered after treatment and the necessity to postpone conception up to ≥12months after radiotherapy and ≥24months after more than two BEP chemotherapy cycles. However, few men receiving one or two BEP cycles and some dropouts are the main limitations of this study.

Effectiveness of transurethral seminal vesiculoscopy in the treatment of persistent hematospermia, and oligoasthenozoospermia and azoospermia from ejaculatory duct obstruction

Objective: To analyze the effectiveness of transurethral seminal vesiculoscopy in the treatment of persistent hematospermia, and oligoasthenozoospermia and azoospermia from ejaculatory duct obstruction. Methods: The clinical date of 56 cases of persistent hematospermia, or azoospermia/oligoasthenozoospermia from ejaculatory duct obstruction treated with transurethral seminal vesiculoscopy between November 2013 and January 2016 in the First Affiliated Hospital of Fujian Medical University were reviewed. A total of 30 cases were persistent hematospermia for 6 months to 3 years, with no response to routine antibiotic therapy for >4 weeks; 24 cases were obstructive azoospermia; and the other 2 cases were extreme oligoasthenozoospermia. Transrectal ultrasound of the prostate and seminal vesicles, and pelvic magnetic resonance imaging (MRI) were performed before the surgery, finding seminal vesicle dilation in 28 cases, ejaculatory duct dilation in 18 cases, seminal vesicle and ejaculatory duct dilation in 7 cases, seminal vesicle dilation with ejaculatory duct cyst in 2 cases, and bilateral ejaculatory duct dilation with prostatic utricle cyst in 1 case. After the transurethral seminal vesiculoscopy, follow-up examinations were performed to assess the effectiveness of the surgery for ≥3 months. Results: The surgery was successful in all the patients, with the duration of surgery ranging from 30 to 148 minutes. Among the 30 patients with hematospermia, calculi in ejaculatory duct or seminal vesicle was found in 20 cases, while inflammation or dark red jelly-like substances in seminal vesicle was seen in all cases. In the follow-up of 9.7 months (3.0-13.0 months), hematospermia in 26 (26/30, 86.7%)patients was relieved or cured after 1-6 times of ejaculation; the other 4 (4/30, 13.3%)cases still had hematospermia. In postoperative semen analysis for the 24 cases of azoospermia from ejaculatory duct obstruction, sperms were detected in 16(16/24, 66.7%)cases, but sperms were not found after 6 months following the surgery in 1 of the 16 case, thus re-obstruction was suspected; in the other 8 (8/24, 33.3%)cases, sperms could not be found in multiple semen analyses in >12 months after the surgery. The 2 cases of extreme oligoasthenozoospermia had obvious improvement in routine semen analysis in 1 and 3 months after the surgery. Except for 1 case of scrotum swelling after surgery, no postoperative complications (retrograde ejaculation, urinary incontinence, or rectal injury) were observed. Conclusions: Transurethral seminal vesiculoscopy was an effective therapy for persistent hematospermia. More strict operation indication and careful performance are necessary for azoospermia oligoasthenozoospermia from ejaculatory duct obstruction.