Semen Analysis Parameters Research Articles

P-029 Sperm DNA fragmentation measured by novel sperm chromatin dispersion-based assay is associated with semen parameter and embryo quality after IVF

Abstract Study question To evaluate the association between sperm DNA fragmentation measured by two new SCD-based assay and sperm parameters as well as ART outcomes. Summary answer Sperm DNA fragmentation assessed by novel sperm DNA fragmentation assay is significantly negative correlated with semen parameters and embryo quality. What is known already Sperm DNA fragmentation (SDF) is one of the major defects in sperm chromatin. This may lead to male infertility, abnormal embryological development, and pregnancy loss. To date, SDF testing has emerged as a means of diagnosis in some medical institutions as an additional assessment for predicting fecundity and guiding treatment regimen. Assisted reproductive technology (ART) such as IVF and ICSI have played a pivotal role in the treatment of infertility over two decades. However, a parts of patients with high level of SDF underwent ART may still have poor clinical outcome. Study design, size, duration A total of 200 participants was included in this prospective cohort study. Data was collected from the reproductive medicine center from June 2020 through December 2021. Participants/materials, setting, methods This study included 200 infertile couples attending for assisted reproductive treatment. Semen sample collected on the day of fertilization was analyzed for SDF by using LensHooke® R10 (R10) and LensHooke® R11 (R11) kits. Semen analysis parameters, embryologic outcome, and clinical outcome after ART treatment were compared between groups with low-level SDF and high-level SDF. Main results and the role of chance The SDF assessed by R10 was negatively correlated with sperm total motility (Spearman's ρ=-0.24,P=0.0007). The SDF assessed by R11 was negatively correlated with sperm concentration (Spearman's ρ=-0.26, P = 0.0002), total motility (Spearman's ρ=-0.45, P < 0.0001), progressive motility (Spearman's ρ=-0.29, P < 0.0001), and normal morphology (Spearman's ρ=-0.43, P < 0.0001). Moreover, SDF obtained by the R10 in asthenozoospermic (26.9% ± 19.5%, p < 0.05) was significantly higher than that in normozoospermic samples (14.8% ± 8.9%). SDF obtained by the R11 in oligozoospermic (21.1% ± 17.9%,p<0.01), asthenozoospermic (25.3% ± 19.4%, p < 0.001), teratozoospermic (17% ± 13.2%, p < 0.01), and oligoasthenoteratozoospermic samples (35.6% ± 24.5%, p < 0.0001) were significantly higher than that in normozoospermic samples (7.9% ± 4.2%). In addition, there was significant difference in good embryo rate post IVF between the groups of low SDF (< 14%) and high SDF (≥ 14%), as measured by R11. Limitations, reasons for caution To focus on male factor-related infertility, the female partner with an age above 38 years old was not enrolled, however, other female factors were not precluded from this study. Wider implications of the findings Sperm DNA fragmentation has proven to be a valuable biomarker in male fertility evaluation, while its significance as a predictor of clinical outcomes following ART requires further investigation. Trial registration number CS2-20012

P-607 Basal serum luteinizing hormone and total testosterone levels do not impact the outcomes of in-vitro fertilization in women with polycystic ovarian syndrome (PCOS)

Abstract Study question Do basal serum luteinizing hormone (LH) and total testosterone (TT) levels affect the outcomes of patients with PCOS undergoing in vitro fertilization? Summary answer LH and TT does not impact number of mature oocytes, fertilization rates, and high-quality blastocysts frozen, in PCOS with GnRH-antagonist protocol IVF with hyper-responses. What is known already The impact of basal serum LH and TT levels on IVF outcomes is debatable. Worldwide, there are many clinics that will postpone ovarian stimulation until a lower basal LH or TT is obtained in women with PCOS based on the assumption that outcomes will subsequently be more successful. However, hormones are released in a pulsatile fashion and single levels are unlikely to reflect patient status. There is a paucity of research addressing this concern. Study design, size, duration We completed a single university-centre retrospective cohort study comparing the outcomes of PCOS patients undergoing freeze-all GnRH antagonist IVF cycles divided into 50% groupings for basal serum LH and TT levels between the dates of January, 2013 and December, 2019. There were 76 women identified and confirmed on chart review to have a diagnosis of PCOS per the 2003 Rotterdam criteria. Participants/materials, setting, methods Patients were divided into the 50% with the lowest LH levels(1.0-7.0 IU/L) and highest LH(7.1-29.0 IU/L). The same was done for TT(0.30-1.50 vs. 1.6-5.6 nmol/L). These two groups were compared using chi-square test and t-test as indicated. Demographics included: serum estradiol, follicle stimulating hormone, thyroid stimulating hormone, prolactin, TT, free testosterone, gravida, parity, female age, male age, semen analysis parameters, antral follicle count, and duration of infertility. IRB approval was obtained(2020-5971). Data is X±SD. Main results and the role of chance When assessing based on LH, there were no differences in demographics(P > 0.05 in all cases) except for TT(1.4±1.0 vs. 1.9±0.9 nmol/L-p=0.02) and free-testosterone(0.6±0.5 vs. 0.9±0.5 nmol/L-p=0.03). The number of oocytes collected(26.8±7.4 vs. 27.3±9.6-p=0.82), mature oocytes(19.9± 6.8 vs. 20.2±7.8-p=0.88), and frozen high-quality blastocysts(7.0±4.4 vs. 8.2±5.1-p=0.25) were similar. The percent of MII that fertilized(75%±16 vs. 74%±19-p=0.78), the percent of 2PN that grew to blastocysts(47%±23 vs. 55%±27-p=0.18) and the percent of MII that grew to blastocyst(35%±18 vs. 40%±19-p=0.25) were similar. Among subjects who underwent embryo transfer, clinical pregnancy rates(33% vs. 45%-p=0.36) and live birth rates(22% vs 32%-p=0.39) were similar when comparing lowest vs. highest percentile, respectively. When comparing demographics by TT grouping, differences were previous pregnancies(0.9±1.2 vs. 0.3±0.7-p=0.02), serum TSH(1.66±0.96 vs. 2.43±1.90 nmol/L-p=0.04), and duration of infertility(2.3±2.0 vs 3.7±2.7years-p=0.04). The number of oocytes collected(27.5±7.5 vs. 28.3±9.7-p=0.73), MII oocytes(20.5±6.9 vs. 20.4±8.3-p=0.98), and frozen high-quality blastocysts(6.9±4.0 vs. 8.1±5.7-p=0.32) were similar. The percent of MII that fertilized(73%±19 vs. 74%±17-p=0.96), the percent of 2PN that grew into blastocysts(48%±23 vs. 53%±28-p=0.50) and the percent of MII that grew to blastocyst(34%±17 vs. 38%±19-p=0.36) were similar. Among subjects undergoing embryo transfer, clinical pregnancy rates(46% vs. 44%-p=0.90) and live birth rates(38% vs 26%-p=0.33) were similar when comparing lowest vs. highest percentile respectively. Limitations, reasons for caution Our study was limited to GnRH-antagonist cycles with freeze all embryos. Thus, findings may not be applicable to IVF cycles with fresh embryo transfer. It is a retrospective study and therefore is at risk for inherent biases. Wider implications of the findings Our findings provide reassurance that elevated basal serum LH and TT levels do not impact IVF outcomes in hyper-responding patients and therefore should not result in cycle cancellation or delay in those with PCOS undergoing GnRH-antagonist cycles with anticipated hyper-responses. Trial registration number N/A

P714: EFFECT OF TYROSINE KINASE INHIBITORS ON MALE FERTILITY IN PATIENTS WITH CHRONIC PHASE CHRONIC MYELOID LEUKAEMIA

Background: With the current availability of 3+ generations of tyrosine kinase inhibitors (TKIs) and the resultant survival benefit, chronic phase chronic myeloid leukaemia (CP-CML) is considered a chronic disease for most patients. Consequently, haematologists are faced more with questions regarding the effects of treatment on fertility and pregnancy outcomes. Whilst the teratogenic effect of TKIs is well established, data on their effect on fertility, and especially male fertility, are scarce. Semen analysis parameters (sperm number, motility and morphology) remain the cornerstone in assessing male fertility, despite its limitations in comprehensively assessing sperm functions. Aims: To compare semen analysis parameters before and after TKI therapy in CP-CML patients treated in the haematology department of Imperial College Healthcare NHS Trust (ICHNT). Methods: In collaboration with the Andrology Department, newly diagnosed men with CP-CML are offered sperm banking before starting cytoreductive or TKI therapy, and sperm analyses are routinely undertaken. Patients treated with TKIs who had sperm banking at diagnosis were invited for repeat semen analysis. Treatment history and semen analysis parameters were collected from patients’ paper/electronic medical records. Median and range were used to summarize continuous non-parametric data. Paired sample t-test was used to compare continuous semen analysis parameters before and after TKI therapy. Double-sided p value of < 0.05 was considered as statistically significant. SPSS version 25 software was used for statistical analysis. Results: Twenty-five patients were identified to have a semen analysis performed around the time of starting TKI therapy and were approached for repeat testing. Of those, 13 refused to participate, 1 was an international patient no longer residing in the UK and 1 stopped TKI therapy for treatment free remission trial. Therefore, 10 patients were finally included. Median age at diagnosis was 35.6 years (range: 22.9-45.4) and patients were diagnosed between 2001 to 2014. Six and 2 patients received hydroxyurea and interferon α, respectively, before TKI therapy. Six patients received 1 TKI (imatinib (IM), n = 4; nilotinib (NIL), n = 1; bosutinib (BOS), n = 1), 2 received 2 TKIs (IM followed by NIL), and 2 received 3 TKIs (IM, DAS, NIL and IM, NIL, DAS). Switches were for failure and/or intolerance. Median duration of TKI therapy at the time of repeat semen analysis was 5.9 years (range: 3.3-16.5). Patients 6 and 10 had the initial semen analysis after 736 and 475 days, respectively, from commencing TKI therapy and all remaining patients had it before starting. All patients had a deep molecular response at the time of the repeat semen analysis. The differences between sperm concentration, % progressive motility and % total motility were all non-statistically significant (p = 0.457, 0.535, and 0.574, respectively). In 2 patients the semen parameters were below the reference ranges in both occasions. Morphology (% normal forms) was less than the reference 4% in the repeat samples of 5 patients (Table 1). Image:Summary/Conclusion: In our cohort, no significant differences were found in sperm concentration or motility before and after treatment with different TKIs for a prolonged period. The relevance of the finding of a low % of normal forms, in the presence of normal sperm concentration and motility, in some of the patients in the semen sample after TKI therapy is not clear. Studies with larger sample size would be needed to confirm or refute our findings.

Relationship between paternal factors and embryonic aneuploidy of paternal origin

To determine if there is a relationship between paternal factors and embryonic aneuploidy of paternal origin using preimplantation genetic testing for aneuploidy (PGT-A). Retrospective cohort. Academic. Couples undergoing invitro fertilization with PGT-A. None. To determine if there is an association between paternal age, body mass index (BMI), or semen analysis parameters and paternal aneuploidy. From January 2015-2020, 453 invitro fertilization cycles (1,720 embryos) underwent PGT-A using single nucleotide polymorphism microarrays with parental support bioinformatics. The mean (±SD) was 36.5 (±3.5) years for maternal age, 39.5 (±5.5) years for paternal age, 24.7 (±5.0) kg/m2 for maternal BMI, and 27.6 (±4.3) kg/m2 for paternal BMI. Embryonic aneuploidy of paternal origin was found in 8.4% (144/1,720) embryos. There were 1,533 embryos with a recorded paternal BMI. Rates of embryonic aneuploidy of paternal origin were similar between men across BMI groups: BMI 18-24.9 kg/m2 was 7.2% (referent); BMI 25-29.9 kg/m2 was 8.4% (odds ratio [OR], 1.12; 95% confidence interval [CI], 0.79-1.82); and BMI ≥30 kg/m2 was 9.1% (OR, 1.31; 95% CI, 0.83-2.08). There were 854 embryos from men with a normal and 866 from men with an abnormal semen analysis. No differences were found in the rate of embryonic aneuploidy of paternal origin between men with normal and abnormal sperm concentration, total count, motility, progressive motility, or morphology. No significant difference was seen in rates of aneuploidy between men aged <50 years and those aged ≥50 years (OR, 1.69; 95% CI, 0.96-2.98). No association was found between paternal age, BMI, or semen analysis parameters and paternal aneuploidy.

Elastographic evaluation of the effect of sickle cell anemia on testicles: a prospective study.

To quantitatively determine testicular tissue stiffness values using shear wave elastography (SWE) in males that have sickle cell anemia (SCA) and to evaluate the relationship between elastography results and semen analysis parameters and hormone levels. Fifty patients diagnosed with SCA and followed up in the hematology outpatient clinic were evaluated in the urology outpatient clinic as the study group. In addition, there were 88 patients without any SCA-related complaints in the control group. We compared these groups with respect to their values, spermiogram parameters, testicular volume, and SWE values. Among patients in the SCA group, 28% had impaired sperm parameters. When testicular elastography was assessed, the testicular volumes were materially lower in the SCA group in comparison to the control group [right testicular volume: 14.76 (12.77-18.12) and 19.68 (15.12-24.18), respectively, p< 0.001; left testicular volume: 14.11 (11.06-17.32) and 16.59 (13.38-20.13), respectively, p= 0.015]. Additionally, the left testis central stiffness and the left testis inferior stiffness were significantly higher in the SCA group (p< 0.001 and p= 0.014, respectively). The age and hydroxyurea use had a worse effect on sperm parameters in patients with SCA (odds ratio: -0.161 and -1.914, standard deviation: 0.071 and 0.921, and p= 0.024 and p= 0.038, respectively). We consider that the technique utilized in this study for SWE values is fast and can be adopted as a reliable diagnostic tool and follow-up practice in routine clinical practice to evaluate the acuteness of damage to the testicles in patients having SCA.

Developing a novel prediction model for the impact of varicocelectomy on postoperative fertility.

The objective of this study was to evaluate inflammatory markers as predictors of fertility after varicocelectomy and to develop a prediction model. This prospective cohort was conducted on patients with varicoceles who were presented to the clinic of Imam Reza hospital of Tehran during 2019-2020. Semen analysis, complete blood count (CBC), and scrotal ultrasonography was requested. Patients with abnormalities of semen analysis were chosen as candidates for varicocelectomy. 6 months after the operation, semen analysis was repeated. Hematologic and semen analysis parameters were recorded at baseline and follow-up visits. Treatment success was defined as 50% increase in total motile sperm count (TMSC) in cases with preoperative TMSC> 5 million/cc or 100% increase in TMSC in cases with preoperative TMSC< 5 million/cc. Patients were then categorized into two groups based on treatment success and statistical analysis was performed on these two groups. 124 infertile patients with varicocele were evaluated in our study. 52 patients (41.93%) showed improvements in semen analysis after varicocelectomy. After univariate and multivariate analysis three parameters were used in our predictive model as body mass index (BMI)>23.70 kg/m2 (4 scores), neutrophil-lymphocyte ratio (NLR) >1.80 (3 scores), and TMSC<14.69 million (2 scores). A cut-off value of 5 was associated with an 87.5% sensitivity and an 84.6% specificity for the prediction of failure of varicocelectomy. Varicocelectomy can improve semen analysis parameters in almost all infertile men with varicocele. Using BMI, NLR, and baseline TMSC as the suggested scoring system can predict the success of varicocelectomy for improving fertility and determine the appropriate infertile candidates for surgery.

PD09-01 LOW BIRTH WEIGHT IS ASSOCIATED WITH SPERM DNA FRAGMENTATION AND ASSISTED REPRODUCTIVE TECHNOLOGY OUTCOMES IN PRIMARY INFERTILE MEN—RESULTS OF A CROSS-SECTIONAL STUDY

PD09-01 LOW BIRTH WEIGHT IS ASSOCIATED WITH SPERM DNA FRAGMENTATION AND ASSISTED REPRODUCTIVE TECHNOLOGY OUTCOMES IN PRIMARY INFERTILE MEN—RESULTS OF A CROSS-SECTIONAL STUDY

PD09-11 VEIN DIAMETER ON ULTRASOUND AS PREDICTOR OF SEMEN PARAMETER IMPROVEMENT AFTER VARICOCELECTOMY

You have accessJournal of UrologyCME1 May 2022PD09-11 VEIN DIAMETER ON ULTRASOUND AS PREDICTOR OF SEMEN PARAMETER IMPROVEMENT AFTER VARICOCELECTOMY Leon Telis, Alan Paniagua Cruz, Kirolos Meilika, Hira Chaudhry, Michael Huaman, and Boback M. Berookhim Leon TelisLeon Telis More articles by this author , Alan Paniagua CruzAlan Paniagua Cruz More articles by this author , Kirolos MeilikaKirolos Meilika More articles by this author , Hira ChaudhryHira Chaudhry More articles by this author , Michael HuamanMichael Huaman More articles by this author , and Boback M. BerookhimBoback M. Berookhim More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002535.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Clinical presence and grade of varicocele has been associated with the degree of spermatogenic response to varicocelectomy. There have been no objective pre-operative factors that have been found to correlate with spermatogenic improvement post-varicocelectomy. We aim to determine whether preoperative venous diameter on ultrasound may predict semen parameter improvement post-varicocelectomy. METHODS: We performed a retrospective chart review of a single-surgeon cohort of patients undergoing microsurgical varicocelectomy to assess the impact of pre-operative ultrasound varicocele diameter on changes in semen analysis. Sonography was performed at local centers with experience in scrotal Doppler sonography. Maximal internal spermatic vein diameters were reported. Paired t-test and Wilcoxon signed-rank test were used to analyze changes in pre- and post-operative semen parameters. Paired t-test was used to further analyze changes in pre- and post-operative semen parameters among unilateral vs bilateral varicocelectomy. Statistical significance was defined as p <0.05. Kendall rank coefficient was performed to assess correlation of varicocele clinical grade and vein diameter on ultrasound. RESULTS: The last 180 consecutive patients who underwent subinguinal microsurgical varicocelectomy were evaluated. Median age of patients was 32 years (range 19-57). 56 patients with available post-operative semen analyses underwent bilateral repair and 49 patients underwent unilateral repair. Mean time from surgery to post-operative semen analysis was 5.4 months. Men who underwent varicocelectomy with vein diameter >3.5 mm had a significant improvement in sperm concentration. Improvement in sperm motility and morphology was also noted in this cohort and approached statistical significance. Those with varicoceles <3.5 mm did not demonstrate an improvement in semen parameters. Significant improvement in semen concentration and morphology was noted among patients undergoing bilateral repair. There was a statistically significant association between clinical and radiographic varicocele size (tau = 0.391, p <0.001). CONCLUSIONS: We identified an improvement in semen analysis parameters after varicocele repair in men with clinical varicoceles with venous diameter >3.5 mm on ultrasound. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e181 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Leon Telis More articles by this author Alan Paniagua Cruz More articles by this author Kirolos Meilika More articles by this author Hira Chaudhry More articles by this author Michael Huaman More articles by this author Boback M. Berookhim More articles by this author Expand All Advertisement PDF DownloadLoading ...

The efficacy of amoxapine for ejaculatory dysfunction

ABSTRACT Introduction Amoxapine, as a tricyclic antidepressant, inhibits noradrenalin reuptake and is often used in the treatment for retrograde ejaculation in Japan. Objective To evaluate the efficacy of amoxapine for ejaculatory disorder in our hospital, retrospectively. Methods Seventeen men (age 38.4 ± 5.2 y) complaining with infertility or decrease of ejaculated semen volume who received amoxapine (25-75 mg/day) for retrograde ejaculation or emission less were included. The changes of semen analysis parameters before and after amoxapine therapy were examined. When the semen volume increased after therapy, it was considered to be effective. Wilcoxson signed-ranks test was used for statistical analysis. P &amp;lt; 0.05 was considered to be significant. This study was approved by the ethical committee of Toyama university hospital. Results It was diagnosed retrograde ejaculation in 15 patients (complete type 3, partial type 12 cases), and emission less in two patients. The causes of ejaculatory disorders were diabetes mellitus in 4 patients, urethral trauma in 1 patient, antidepressants in 1 patient, anti-androgenetic alopecia drugs in 1 patient, sigmoidectomy for dolichocolon and proctopexy for rectal prolapse in 1 patient, and unknown cause in 9 patients. The average value of BMI in patients was 25.0 ± 4.18. Each patient had normal level of the total testosterone in blood. The average score of International Index of Erectile Function score and Erection hardness score before treatment showed 49.8 ± 17.9, 3.13 ± 0.62, respectively. The efficacy rate of amoxapine was 78.6%. Before and after amoxapine therapy, semen volume increased significantly from 0.29 ± 0.31 ml to 1.23 ± 1.56 ml, sperm concentration did from 19.5 ± 34.7 × 106/ml to 99.3 ± 172.7 × 106/ml, and total sperm count did from 7.83 ± 14.0 × 106 to 94.8 ± 149.7 × 106, respectively. By the amoxapine therapy, the antegrade ejaculated sperm count ratio* significantly increased from 28.1 ± 37.6 to 65.7 ± 40.1%. The average duration of amoxapine therapy was 13.0 ± 20.6 months and the maximum duration was 80 months. No side effects were observed. Of all patients, 15 patients would hope to have baby. There were 3 spontaneous pregnancies and 2 pregnancies due to assisted reproductive technology. All 5 pregnancies resulted in delivery. Conclusions It was suggested that amoxapine is an effective drug for ejaculatory disorder and might not only increase ejaculation volume but also improve sperm concentration and total sperm count. *(total sperm counts in ejaculated semen / (total sperm counts in ejaculated semen + total sperm counts in urine after orgasm)) × 100% Disclosure Work supported by industry: no.

Microplastics May Be a Significant Cause of Male Infertility.

Due to the problematic degradation properties of plastics, the decomposition of plastic results in the formation of numerous microplastics (MPs), less than 5 mm in diameter. These MPs enter the soil and the ocean, eventually passing through the air, water, or food chain back to the human body and harming human health. In the last 80 years, male semen analysis parameters have shown a significant decline for unknown reasons, speculated to be caused by pollutants. No studies examined the relationship between human MP exposure and male infertility. In this article, we reviewed the relevant animal experimental research literature in recent years and calculated that the minimum human equivalent dose of MPs leading to abnormal male semen quality is 0.016 mg/kg/d. The literature comparison found that MP exposure in Japan and South Korea was close to this value. These results suggest that MPs can affect male semen quality and that MPs may significantly impact male fertility.

Impact of heavy alcohol consumption and cigarette smoking on sperm DNAintegrity.

The purposes of the presents study were to investigate the impact of alcohol consumption and cigarette smoking on semen parameters and sperm DNA quality, as well as to determine whether tobacco smoking, or alcohol consumption causes more deterioration of sperm quality. Two hundred and eleven semen samples of men were included in this study. Four groups were studied: heavy smokers (N=48), heavy drinkers (N=52), non-smokers (n=70), and non-drinkers (n=41). Semen parameters were determined according to WHO guidelines, protamine deficiency assessed by chromomycin (CMA3) staining, and sperm DNA fragmentation (sDF) evaluated by TUNEL assay. Sperm parameters were significantly higher in non-smokers versus smokers and in non-drinkers versus drinkers (p < 0.005). However, protamine deficiency and sDF were significantly lower in non-smokers versus smokers and in non-drinkers versus drinkers (p < 0.0001). No significant difference in the semen analysis parameters was observed between heavy smokers and heavy drinkers (semen volume: 3.20 ± 1.43 vs. 2.81 ± 1.56 ml, semen count: 65.75 ± 31.32 vs. 53.51 ± 32.67 mill/ml, total motility: 24.27 ± 8.18 vs. 23.75 ± 1.75%, sperm vitality: 36.15 ± 18.57 vs. 34.62 ± 16.65%, functional integrity: 41.56 ± 18.57 vs. 45.96 ± 17.98% and the morphologically normal spermatozoa: 28.77 ± 11.82 vs. 27.06 ± 13.13%, respectively). However, protamine deficiency was significantly higher among drinkers than smokers (37.03 ± 9.75 vs. 33.27 ± 8.56%, p=0.020). The sDF was also significantly higher among drinkers than smokers (22.37 ± 7.60 vs. 15.55 ± 3.33%, p < 0.0001). Thus, cigarette smoking, and heavy alcohol intake can deteriorate sperm quality. However, alcohol consumption deteriorates sperm maturity and damages DNA integrity at significantly higher rates than cigarette smoking.

Fertility after Curative Therapy for Sickle Cell Disease: A Comprehensive Review to Guide Care.

Curative therapy for sickle cell disease (SCD) currently requires gonadotoxic conditioning that can impair future fertility. Fertility outcomes after curative therapy are likely affected by pre-transplant ovarian reserve or semen analysis parameters that may already be abnormal from SCD-related damage or hydroxyurea treatment. Outcomes are also likely affected by the conditioning regimen. Conditioning with myeloablative busulfan and cyclophosphamide causes serious gonadotoxicity particularly among post-pubertal females. Reduced-intensity and non-myeloablative conditioning may be acutely less gonadotoxic, but more short and long-term fertility outcome data after these approaches is needed. Fertility preservation including oocyte/embryo, ovarian tissue, sperm, and experimental testicular tissue cryopreservation should be offered to patients with SCD pursing curative therapy. Regardless of HSCT outcome, longitudinal post-HSCT fertility care is required.

Varicocele Repair Improves Static Oxidation Reduction Potential as a Measure of Seminal Oxidative Stress Levels in Infertile Men: A Prospective Clinical Trial Using the MiOXSYS System

ObjectiveTo assess whether varicocele repair improves oxidative stress (OS) measured by the MiOXSYS system. MethodsA prospective clinical trial was performed on male patients ages 18 and older who had not fathered a child within the previous 12 months, with a clinically palpable varicocele, who completed all aspects of the study who were enrolled through a couple's fertility center with on-site andrology laboratory testing. Men that met inclusion criteria were offered enrollment in the clinical trial and signed informed consents to participate, after having a history and physical examination. Semen analysis with OS measurement was obtained preoperatively and repeat semen analysis with OS measurement obtained 3 months following varicocele repair. Changes in postoperative semen analysis parameters, static oxidation reduction potential (sORP), and sperm DNA fragmentation (SDF) indices when available were compared to these values preoperatively. ResultsOf the 177 subjects, 49 subjects met inclusion criteria. The data of OS suggests negative correlations with major semen parameters. Semen parameters and OS revealed statistically significant improvements following varicocele repair from baseline. Of the 49 subjects included, 22 completed all aspects of testing postoperatively. Subgroup analysis shows statistically significant negative correlations between OS and semen parameters. Forward progressive motility, SDF, and sORP demonstrated statistically significant improvements 3 months following varicocele repair in comparison to preoperatively. ConclusionVaricocele repair in infertile men improved sORP as measured by the clinically useful MiOXSYS system.

The effect of semen collection at home on intrauterine insemination outcomes

The WHO 2010 guidelines recognize at-home semen collection as an acceptable alternative to standard collection at the clinic in "exceptional circumstances." There is lack of sufficient data to determine the need for revisiting these recommendations for treatment purposes. To determine whether at-home semen collection has any effect on intrauterine insemination (IUI) cycle outcomes. This is a retrospective cohort study of 729 IUI treatment cycles (382 patients) performed at an academic fertility center from September 19, 2019 to December 31, 2020. Semen collected at the "clinic" was used for 343 cycles before the Coronavirus Disease 2019 (COVID-19) pandemic (September 19, 2019 to March 21, 2020), and "at-home" collected specimens were used for 386 cycles following revised protocols with COVID-19-driven changes (May 30, 2020 to December 31, 2020). Logistic regression models were performed to evaluate the effect of "at-home" semen collection on achieving a positive pregnancy test (PPT) and a clinical pregnancy (CP). Male and female partners' age, ovarian reserve biomarkers, and stimulation regimens used were similar in the "clinic" and "at-home" groups. In unadjusted models, "at-home" collection had no significant effect on the odds for a PPT [OR (95%CI): 0.733 (0.503-1.069)] or CP [0.816 (0.543-1.226)]. These results persisted even when adjusting for maternal age and anti-Müllerian hormone: PPT [0.739 (0.505-1.081)] and CP [0.826 (0.547-1.248)]. Of the semen analysis parameters under evaluation, only motility appeared to significantly impact the odds of achieving a PPT [1.014 (1.004-1.025)] and a CP [1.017 (1.006-1.029)]. This effect was slightly attenuated for samples collected "at-home" [1.012 (0.997-1.027) and 1.015 (0.999-1.031), respectively, for PPT and CP]. This study adds important information to the limited literature regarding the effect of at-home semen collection on IUI outcomes. Under adequate protocols, at-home semen collection should be considered a safe alternative. Additional research is needed to optimize such protocols. Our data suggest that at-home semen collection does not negatively impact IUI pregnancy outcomes.

Quantitative karyological analysis of immature germ cells from ejaculate with normal sperm count

Introduction. The number of immature germ cells (IGCs) in ejaculate and the ratio of these cells at different stages of their differentiation can reflect meiotic progression and the state of spermatogenesis. Quantitative karyological analysis of immature germ cells from the ejaculate (QKA IGCs) makes it possible to distinguish and analyze all the stages of cell differentiation during spermatogenesis.Purpose. To analyze the spermatogenesis in men with impaired fertility and possible correlation between semen analysis and QKA IGCs parameters. Materials and methods. We analyzed 52 semen samples with normal sperm concentration, normal ejaculate volume and pH. Sperm examination according to WHO criteria and QKA IGCs from the ejaculate were performed (patent of L.F. Kurilo No. 2328736, 2007). According to the number of leukocytes, we divided two groups: a group with normal concentration of leukocytes in the ejaculate (group 1, n = 34) and a group with leukospermia (group 2, n = 18).Results. Increased IGCs index was found in 56 % of the samples in group 1 and 61 % of the samples in group 2. A positive statistically significant correlation was found between the number of spermatocytes I and sperm concentration (group 1), as well as the number of spermatocytes I and morphologically normal spermatozoa (group 2). The average number of non-divided spermatids in group 2 was statistically higher than in group 1. A negative statistically significant correlation was found between the number of non-divided spermatids and the number of morphologically normal spermatozoa, as well as the concentration of germ cells (group 2). Increased IGCs index was found in both pathozoospermia and normozoospermia.Conclusions. The QKA IGCs is an independent method for spermatogenesis evaluation and can be recommended as part of the protocol for examining men with reproductive disorders along with standard semen analysis.

322 Feasibility of Loupe Assisted Subinguinal Varicocelectomy in Treatment of Male Infertility

Abstract Aim To study the impact of loupe-assisted subinguinal varicocelectomy on semen quality, serum testosterone level, and spontaneous pregnancy rate. Method The data were prospectively collected for 102 infertile men with clinical varicocele. The preoperative values of semen analysis parameters and serum testosterone level were compared with postoperative values at 6 months. Spontaneous pregnancy was assessed at 6 months. Results The mean age of patients was 31.56 ± 4.31 years. Primary infertility was reported in 86 patients, while 16 had secondary infertility. Bilateral varicocele was seen in 79 patients while 23 had a unilateral varicocele. The total sperm concentration (x106/ml) before and after varicocelectomy was 12.82 ±3.91 and 20.06 ±2.13 respectively (p&amp;lt;0.0001). The total sperm motility (%) before and after varicocelectomy was 37.67 ±7.23 and 55.46 ±4.51 respectively (p&amp;lt;0.0001). The sperm morphology (Kruger/Strict morphology criteria, %) before and after varicocelectomy was 3.11 ±0.80 and 3.70 ±0.78 respectively (p&amp;lt;0.0001). The serum testosterone level (ng/dl) before and after varicocelectomy was 323.90 ±67.81 and 396.74 ±40.88 respectively (p&amp;lt;0.0001). The Spontaneous pregnancy rate in couples with primary and secondary infertility was 18.60% and 31.25% respectively. The difference in their rates was not significant (p = 0.251). The overall spontaneous pregnancy rate was 20.5 %. Conclusions Loupe-assisted sub-inguinal varicocelectomy is a safe and effective modality for treating infertile men, particularly when provision for microscopic surgery is unavailable. However, only large-size comparative studies or multi-centric trials can confirm this.

Relationship between serum vitamin D levels semen parameters and sperm DNA damage in men with unexplained infertility.

The aim of the study was to investigate the relationship between serum level of vitamin D, semen analysis parameters and sperm DNA damage in men with unexplained subfertility. Fifty-eight men diagnosed with unexplained infertility and 50 age and BMI matched fertile men were included in the study. A participant whose semen parameter is normal but pregnancy is not achieved was accepted as unexplained male infertility. Blood samples were taken from all participants following three-day abstinence for measurement of vitamin D. Sperm DNA damage was assessed by Aniline Blue staining of the collected samples. Compared with the fertile men, male patients with unexplained infertility had significantly lower vit D levels (27.00 ng/mL (12.63-39.30) vs. 23.66 ng/mL (7.50-55.00), p<0.004). While the number of patients with vitamin D levels lower than 20 ng/mL was 26 (44.8%) in the infertile group, it was recorded as 5 (10.0%) in the fertile group (p<0.001). DNA damage was found in 31.50% (9.0-71.0) of the infertile men and 26.00% (11.0-54.0) of the fertile men. DNA damage was found to be significantly higher in the unexplained infertile group (p<0.002). In men with unexplained male infertility, serum vit D levels were positively correlated with total sperm count (r = 0.527, p<0.001), total motility (r = 0.527, p<0.001) and sperm morphology (r = 0.416, p = 0.001). There was a negative and significant correlation between vit D levels and sperm DNA damage (r = -0.605, p<0.001). In the logistic regression analysis, serum vit D > 20 ng/mL led to an improvement in fertility outcome. Men with unexplained infertility exhibit decreased serum vit D levels and increased sperm DNA damage.

Sperm quality and morphometry characterization of cryopreserved canine sperm in ACP-106c or TRIS.

Morphological sperm evaluation supported by the morphometry can be used in the determination of the seminal quality and in the investigation of potential extenders. Although there are studies comparing TRIS and ACP extenders, there are no comparative studies between them for the computerized assisted semen analysis (CASA), sperm viability, membrane functionality and sperm morphometry parameters of cryopreserved canine semen. Hence, we aimed to evaluate the effects of ACP-106c and TRIS on post-freezing canine sperm quality. Five dogs were submitted to semen collection twice with one-week interval. The semen was evaluated within the parameters: total motility, vigor, concentration, viability, plasma membrane functionality, morphology and morphometry. In the morphometric evaluation, the morphologically normal sperm was measured as: length, width, area and perimeter of the head and the midpiece, tail length and total length. The parameters of ellipticity, elongation, regularity and roughness were determined. Then, the semen was divided into two aliquots that were diluted in TRIS or ACP-106c, with the addition of egg yolk and glycerol. The diluted semen was refrigerated and frozen. The thawed samples were evaluated. Total motility, viability, sperm membrane functionality and normal morphology reduced after thawing in both extenders (morphology reduced from 89.60 ± 1.3% to 84.40 ± 1.8 and 84.60 ± 1.1% in TRIS and ACP-106c, respectively). However, it did not differ between TRIS and ACP-106c. In the ACP-106c the sperm head defects in cryopreserved semen were higher compared to fresh semen (P < 0.05). For all the morphometric parameters evaluated, there were no differences between fresh and cryopreserved samples (3.70 ± 0.4% vs. 2.30 ± 0.5%). In kinetics, with an interval of one week statistical differences between the extenders were found only in the parameters ALH and LIN (P < 0.05). Regardless of the extender, there were no changes in the morphometric parameters of sperm after thawing.

Pattern of semen analysis in male partners of infertile couples in Western Ethiopia: Retrospective cross-sectional study.

Objectives:This study assesses the pattern of semen analysis results in male partners of infertile couples at Gimbie Adventist Hospital, Western Ethiopia, 2021.Methods:A retrospective cross-sectional study on 131 semen samples of male partners of infertile couples was conducted at Gimbie Adventist Hospital from 5 September 2021 to 5 October 2021. All semen samples were processed and analyzed according to methods and standards outlined by the World Health Organization laboratory manual for the examination and processing of human semen 2010. The data were coded and entered into EpiData version 3.1, and then cleaned and exported to Statistical Package for Social Sciences (SPSS for Windows version 25) for analysis. The results were presented in tables, figures, and charts.Results:The age of study participants ranges from 20 to 65 years with a mean age of 30.2 ± 8.1 years. Sperm cell count, morphology, total motility, and vitality below the World Health Organization reference level were found in 48.9%, 27.5%, 43.5%, and 67.2% of the analyzed samples, respectively. Low power of hydrogen and high viscosity were observed in 31.3% and 16.8% of the semen samples, respectively. The majority, 84%, had one or more abnormal semen analysis parameters. Asthenozoospermia (43.5%), necrozoospermia (25.2%), oligozoospermia (24%), azoospermia (24%), and oligoasthenoteratozoospermia (25.2%) were the severe forms of abnormal semen analysis findings detected in this study. The decline in sperm cell morphology and motility were noticed after the age of 31–34 years.Conclusion:In this study, both sperm quantity and quality were more affected when compared to similar studies. Only 16% of analyzed samples had normal semen parameters. Given this finding, identifying risk factors and introducing advanced diagnostic modalities for the workup of male infertility in the study area are highly recommended.

Semen analysis: a workflow for an appropriate assessment of the male fertility status.

Infertility is a worldwide problem that affects 9-15% of couples in reproductive age. In about half of the cases, it recognizes, alone or in combination, a male cause. In addition to a reproductive problem, male infertility can result from a systemic disease. Consequently, semen analysis, a fundamental test in the diagnosis of male infertility, represents a useful indicator not only of a man's reproductive capacity but also of his health and lifestyle. Given the key role of semen analysis, only accredited laboratories should perform it and experienced clinicians should be called into play in its interpretation. In this article, we have extensively examined how the macroscopic and microscopic parameters of semen analysis, alone or associated with each other, allow clinicians to orient towards specific diagnoses that can be confirmed by further ad-hoc tests. On this basis, we also proposed a diagnostic flowchart focused on the results of the semen analysis.