Effect of age on sperm fertility potential: oocyte donation as a model

Male age negatively impacts embryo development and reproductive outcome in donor oocyte assisted reproductive technology cycles

OBJECTIVE

To determine whether male age influences embryo development and reproductive potential in assisted reproductive technology cycles.

DESIGN

Retrospective cohort analysis.

SETTING

Private IVF center.

PATIENT(S)

One thousand twenty-three male partners participating in anonymous oocyte donation cycles.

INTERVENTION(S)

Infertile couples undergoing 1,023 anonymous oocyte donation cycles.

MAIN OUTCOME MEASURE(S)

Live birth rate.

RESULT(S)

A significant increase in pregnancy loss, decrease in live birth rate, and decrease in blastocyst formation rate were noted in men >50 years of age. There was no significant difference in implantation rate, pregnancy rate, or early embryo development through the cleavage stage (demonstrated by fertilization rate, embryo cleavage rate, percentage of nonfertilized or polyspermic embryos, rate of embryo arrest, or seven or more cell embryo development on day 3). Men < or =45 years of age had significantly more semen volume and more motile sperm than men >45 years of age. There was no significant change in sperm morphology or concentration.

CONCLUSION(S)

After controlling for female age with use of the donor oocyte model, male age >50 years significantly affected pregnancy outcomes and blastocyst formation rates. Semen volume and total motility decreased with increasing male age. Initial embryo morphology through the cleavage stage was not affected.

Paternal effects on early embryogenesis

Historically, less attention has been paid to paternal effects on early embryogenesis than maternal effects. However, it is now apparent that certain male factor infertility phenotypes are associated with increased DNA fragmentation and/or chromosome aneuploidies that may compromise early embryonic development. In addition, there is a growing body of evidence that the fertilizing sperm has more function than just carrying an intact, haploid genome. The paternally inherited centrosome is essential for normal fertilization, and the success of higher order chromatin packaging may impact embryogenesis. Epigenetic modifications of sperm chromatin may contribute to the reprogramming of the genome, and sperm delivered mRNA has also been hythesized to be necessary for embryogenesis. There is less information about the epigenetic factors affecting embryogenesis than genetic factors, but the epigenetics of gamete and early embryogenesis is a rapidly advancing field.

The male biological clock is ticking: a review of the literature

The term biological clock is usually used by physicians and psychologists to refer to the declining fertility, increasing risk of fetal birth defects and alterations to hormone levels experienced by women as they age. Female fecundity declines slowly after the age of 30 years and more rapidly after 40 and is considered the main limiting factor in treating infertility. However, there are several scientific reports, chapters in books and review articles suggesting that men may also have a biological clock. The aim of our study was to conduct a review of the literature, based on the Medical Literature Analysis and Retrieval System Online (Medline), to evaluate the male biological clock. After adjustments for other factors, the data demonstrate that the likelihood that a fertile couple will take more than 12 months to conceive nearly doubles from 8% when the man is < 25 years old to 15% when he is > 35 years old. Thus, paternal age is a further factor to be taken into account when deciding on the prognosis for infertile couples. Also, increasing male age is associated with a significant decline in fertility (five times longer to achieve pregnancy at the age of 45 years). Patients and their physicians therefore need to understand the effects of the male biological clock on sexual and reproductive health, in that it leads to erectile dysfunction and male infertility, as well as its potential implications for important medical conditions such as diabetes and cardiovascular diseases.

Prise en charge en Assistance médicale à la procréation des femmes de 38 ans et plus: résultats d'une enquête à propos de 84 couples

OBJECTIVE

More and more young women are delaying childbearing until the fourth decade of life: thus, Assisted Reproductive Techniques centres receive more and more requests from ageing women. The aim of the study is to analyse the purpose of these requests, the biological and clinical features of these patients and the results in our infertility centre.

PATIENTS AND METHODS

A retrospective study was carried out at the CHU of Saint-Etienne from 01.01.01 to 31.12.04. We analysed the social, clinical and biological features of 84 couples when the woman's age was equal or superior to 38 years, representing 218 cycles. A questionnaire was used to collect social data.

RESULTS

Several factors can explain the increasing number of ageing women consulting for infertility: extend university time and professional career, professional stability, contraception and late meeting of the partner, false reassuring information concerning progress in ART, second child desire after a late first pregnancy, but also second marital unions and child desire in the redefined couple. In our study, above 40 years old, the pregnancy (19.4 versus 10.5%) and delivery rates (16.7 versus 5.8%) clearly decreased in IUI. Thus, most of the clinicians propose, in first choice, an IVF cycle to a 40 year-old woman. The ultrasound measurement of antral follicle count can accurately evaluate the prognosis in terms of pregnancy (P<0.01) and delivery rate (P=0.03). For patients with unfavourable prognosis, oocyte donation, embryo donation, or adoption can be considered.

DISCUSSION AND CONCLUSION

ART cannot compensate for the natural decrease in pregnancy rates and the increase in early miscarriages in ageing women. Therefore, it is essential to inform young women of the negative effects of age on their potential fertility.

Association between age and epididymal and accessory sex gland function and their relation to sperm motility

Increased male age has been associated with significant reduction in pregnancy rates. This study investigated the association between age, the function of epididymal and accessory sex glands, and their relation to sperm motility. Ejaculates from 498 men assessed for infertility were analysed according to WHO [1999] guidelines. Seminal markers of epididymal (neutral alpha-glucosidase (NAG)), prostatic (prostate-specific antigen (PSA) and zinc), and seminal vesicle function (fructose) were measured. Four groups according to age were defined: G(21-30) (21-30 years), G(31-40) (31-40 years), G(41-50) (41-50 years), and G(>50) (51-66 years). Percentage progressive motility was significantly lower in G(>50) compared with G(21-30). NAG, PSA, zinc, and fructose were significantly lower in G(>50) compared with G(21-30). In a multiple regression analysis model, NAG and PSA showed positive significant association with percentage progressive motility. The opposite trend was found regarding zinc. No association between fructose and percentage progressive motility was shown. In this cross-sectional study, declined sperm motility observed in men over 50 years of age might be due to age-dependent changes in epididymal and accessory sex gland function.

Paternal age and outcome of intracytoplasmic sperm injection

In a retrospective study, the outcome of intracytoplasmic sperm injection (ICSI) in two age groups of men was studied. Couples with male partners aged 50 years and over (group A) (n = 227) with mean age of 53 +/- 5 years were compared with couples with younger age-group male partners (group B) (n = 227) with a mean age of 38.4 +/- 5.8 years. The control group of younger men was selected so that the women's age matched between the two groups. There was no significant difference in pregnancy rate between the two groups (37.9 versus 36.6%; OR = 1.06, 95% CI = 0.72-1.55). There was also no significant difference in the pregnancy rate between men aged 60 years and over as compared with men aged 50 to 59 years (OR = 1.00, 95% CI 0.74-1.37). However, the long-term outcome of these pregnancies needs further investigation. Semen analysis showed significantly lower motility in group A (37.4 +/- 20.4) versus group B (46.4 +/- 15.5; P < 0.0001). There was a significantly higher fertilization rate in younger men (P < 0.0001; OR = 1.36, 95% CI = 1.19-1.55), but this did not affect the pregnancy rate. In conclusion, it appears that paternal age has no effect on the pregnancy rate after ICSI.

Quantitative effects of male age on sperm motion

BACKGROUND

Semen quality is associated with fertility status, but there is little quantitative information on risk factors that affect semen quality, especially in non-clinical populations. Advancing male age has been associated with a decline in semen quality, with the largest effect being on sperm motility. However, there is little quantitative data on the specific components of sperm motion that are affected by male age.

METHODS

We performed linear regression analyses of 14 aspects of semen quality measured by computer-assisted semen analysis (CASA) in a non-clinical cohort of 90 non-smoking men, aged 22-80 years, who had no history of infertility or reproductive problems.

RESULTS

We found age-associated declines in CASA-determined motility (% motile, 0.8% per year; % progressively motile, 0.9% per year; % rapidly motile, 0.4% per year, P <or= 0.001) and three quantitative aspects of sperm motion [linearity (LIN), 0.2% per year; straight line velocity (VSL), 0.2% per year, and average path velocity (VAP), 0.3% per year, P < 0.05], with no evidence for age thresholds and no significant association with abstinence duration. Age was not significantly associated with amplitude of lateral head (ALH) displacement, beat cross frequency (BCF) and nuclear elongation or size.

CONCLUSIONS

Quantitative analysis of sperm motion indicates that as men age, they produce fewer motile sperm, which are able to travel less along a linear path, thus covering less forward distance per unit time. These findings may have fertility implications for men who choose to delay fatherhood.

Age-related decline in sperm deoxyribonucleic acid integrity in patients evaluated for male infertility

The purpose of this study was to analyze the relationship of male age and DNA integrity in men presenting for investigation of infertility. We found that men 45 years and older had significantly greater DNA fragmentation than younger men.

Seminal characteristics and sexual behavior in men of different age groups: is there an aging effect?

AIM

To assess the seminal characteristics as well as the sexual behavior of men of various age groups to establish the presence of an aging effect on those characteristics.

METHODS

Semen samples were collected from men (n = 792) undergoing in vitro fertilization or intrauterine insemination in cases of female factor infertility only. Samples were collected using a seminal collection device at intercourse and evaluated manually according to World Health Organization (WHO) standards. Men were divided into four groups according to their ages: (i) 20-30, (ii) 31-40, (iii) 41-50 and (iv) 51-60 years, and their seminal characteristics and responses to a sexual behavior questionnaire were compared.

RESULTS

The data showed statistically significant differences in the seminal characteristics tested, most notably in the sperm concentration, motility, grade of motility, hypo-osmotic swelling and normal sperm morphology. Furthermore, the decline in normal sperm morphology with age was more pronounced when using strict criteria rather than WHO standards. There were also differences in total sperm count, total motile sperm and total functional sperm fraction (assessed by both WHO and strict criteria). Significant differences were also observed in the sexual behavior patterns in older men in terms of the number of years they have been trying to conceive, sexual frequency and sexual satisfaction.

CONCLUSION

The data clearly illustrate an aging effect on semen characteristics and sexual behavior in men as they age. It is suggested that the aging effect be taken into consideration when proposing normal standard values for semen characteristics in routine semen analysis as outlined by WHO standards.

Oocyte and embryo donation 2006: reviewing two decades of innovation and controversy

For over 21 years, oocyte and embryo donation have been used to treat infertility caused by a variety of conditions affecting the ovary. Many disorders, including premature ovarian failure, advanced reproductive age, unexplained recurrent implantation failure and inherited conditions, are amenable to gamete donation, with high pregnancy rates and good obstetrical outcomes observed in recipients. Protocols for the medical screening of recipients and donors, as well as infectious disease and genetic testing, have become relatively uniform and well accepted. Established guidelines allow synchronization of the menstrual cycles of both women to ensure that embryos are transferred to a receptive endometrium. The high demand for donor services has led to escalating costs and long waiting lists. American programmes bid against each other to secure the participation of young women often motivated as much by financial reward as altruism. In the United States, where the majority of oocyte donation is practised, more than 100,000 treatment cycles have occurred. However, to date no meaningful longitudinal studies detailing the long term effects of treatment on donors, recipients, children born, or families created have been published. Throughout its history, oocyte and embryo donation has proven to be both efficacious and clinically innovative, yet remains highly controversial.

Recruitment of sperm donors: the Newcastle-upon-Tyne experience 1994–2003

BACKGROUND

The demand for sperm donors has continued despite the introduction of ICSI. This study was undertaken in the light of impending changes in donor anonymity laws to evaluate the recruitment process of sperm donors.

METHODS

Retrospective analysis of 1101 potential sperm donors in a tertiary referral centre between January 1994 and August 2003. The main outcome measures were to determine the demographic details, recruitment rate and reasons for rejection of donors.

RESULTS

The majority of the applicants were aged <36 years (88.07%), students (54.88%), without a partner (53.47%), unmarried (85.38%) and without proven fecundity (78.67%). Only 3.63% of the applicants were released as donors, 30.79% defaulted, whilst 64.48% were rejected. The most common reason for rejection was suboptimal semen quality (85.07%). Over the years, the numbers of the applicants and released donors have declined significantly. The overall clinical pregnancy rate from donor sperm during this period was 23.52%.

CONCLUSIONS

In this successful anonymous sperm donor programme only a small proportion of the applicants are released as donors. The significant decline in released sperm donors coupled with the potential effects of loss of donor anonymity means that new strategies for sperm donor recruitment are urgently required.

Effects of vasectomy on spermatogenesis and fertility outcome after testicular sperm extraction combined with ICSI

BACKGROUND

Each year 40,000 men have a vasectomy in the UK whilst another 2400 request a reversal to begin a second family. Sperm can now be obtained by testicular biopsy and subsequently used in assisted conception with ICSI. The study aims were to compare sperm yields of men post-vasectomy or with obstructive azoospermia (OA) of unknown aetiology with yields of fertile men and to assess any alteration in the clinical pregnancy rates after ICSI.

METHODS

Testicular tissue was obtained by Trucut needle from men who had undergone a vasectomy >5 years previously or had OA from other causes and from fertile men during vasectomy. Seminiferous tubules were milked to measure sperm yields. Numbers of Sertoli cells and spermatids and thickness of the seminiferous tubule walls were assessed using quantitative computerized analysis.

RESULTS AND CONCLUSIONS

Sperm yields/g testis were significantly decreased in men post-vasectomy and in men with OA, relative to fertile men. Significant reductions were also observed in early (40%) and mature (29%) spermatid numbers and an increase of 31% was seen in the seminiferous tubule wall (basal membrane and collagen thickness) of vasectomized men compared with fertile men. Clinical pregnancy rates in couples who had had a vasectomy were also significantly reduced.

What factors affect intracytoplasmic sperm injection outcomes?

Within the last decade, intracytoplasmic sperm injection (ICSI), a new assisted reproductive technique that allows for the direct injection of spermatozoa into the oocyte, has become available to infertile couples. While most studies indicate that ICSI has success rates similar to those of traditional in vitro fertilization, there are many concerns about the safety of the procedure, including increased risks of chromosomal and developmental abnormalities in children conceived by ICSI. Factors that contribute to these increased risks have not been well elucidated. The purpose of this paper is to review the latest literature concerning 1) the adverse outcomes associated with ICSI; and 2) factors that affect the success rates of ICSI (with emphasis on paternal factors).

TARGET AUDIENCE

Obstetricians & Gynecologists, Family Physicians.

LEARNING OBJECTIVES

After completion of this article, the reader should be able to explain the procedure, intracytoplasmic sperm injection (ICSI), to outline the data surrounding chromosomal and developmental outcomes after ICSI, and to list and explain the potential factors that influence ICSI.

The effect of advancing paternal age on pregnancy and live birth rates in couples undergoing in vitro fertilization or gamete intrafallopian transfer

OBJECTIVE

This study was undertaken to determine effects of male aging on sperm parameters, fertilization, pregnancy, and live birth rates among in vitro fertilization (IVF) or gamete intrafallopian transfer (GIFT) couples. The impact of female age was also investigated.

STUDY DESIGN

Prospective study was made up of 221 IVF and GIFT couples.

RESULTS

Pregnancy rates declined as the male subjects aged. Each additional year of paternal age was associated with 11% increased odds (P=.007) of not achieving a pregnancy, and 12% odds (P=.01) of not having a successful live birth. For first-time IVF/GIFT recipients, each additional year of paternal age was associated with a 5% increased odds of not achieving a pregnancy, whereas for repeaters it was 40% (P=.01). Advancing maternal age was associated with decreased numbers of oocytes retrieved or fertilized. Women 40 years or older compared with younger than 35 years had greater than 4-fold risk of not becoming pregnant, and greater than 20-fold risk of not achieving a live birth.

CONCLUSION

Advancing paternal (and maternal) age had a deleterious effect on IVF and GIFT outcomes.

Effect of male age on fertility: evidence for the decline in male fertility with increasing age

OBJECTIVE

To evaluate the effect of men's age on time to pregnancy (TTP) using age at the onset of pregnancy attempts, adjusting for the confounding effects of women's age, coital frequency, and life-style characteristics.

DESIGN

Observational study.

SETTINGS

Teaching hospital in Hull, United Kingdom.

PATIENT(S)

Two thousand one hundred twelve consecutive pregnant women.

INTERVENTION(S)

A questionnaire inquiring about TTP, contraceptive use, pregnancy planning, previous subfertility, previous pregnancies, age, and individual life-style characteristics of both partners.

MAIN OUTCOME MEASURE(S)

Time to pregnancy, conception rates, and relative risk of subfecundity for men and women's age groups.

RESULTS

As with women's age, increasing men's age was associated with significantly rising TTP and declining conception rates. A fivefold increase in TTP occurred with men's age >45 years. Relative to men <25 years old, those >45 years were 4.6-fold and 12.5-fold more likely to have had TTP of >1 or >2 years. Restricting the analysis to partners of young women revealed similar effects of increasing men's age. Women >35 years were 2.2-fold more likely to be subfertile than women <25 years. The results were comparable, whether age at conception or at the onset of pregnancy attempts was analyzed, and they remained unchanged after adjustment for the confounding factors.

CONCLUSION(S)

Evidence for and quantification of the decline in men's fertility with increasing age is provided.

Male age is not an independent factor to affect the outcome of assisted reproductive techniques

Controversy exists whether advanced male age is associated with poor sperm quality and subsequent failure in the assisted reproductive techniques (ART). The purpose of this study was to evaluate the effect of male age on sperm quality and the outcome of ART as well as the association of male age with other relevant factors, particularly with the female age. A retrospective study was performed in order to evaluate the effect of male age on the sperm parameters in 880 routine seminal analyses. Additionally, sperm parameters were also compared among different age groups in 919 cases with male factor infertility who had been included in an ART programme. The laboratory and clinical results of ART (fertilization rate, number and quality of embryos transferred, as well as pregnancy rates) were compared according to different age groups. The results were also evaluated by one-way correlation and also step-wise logistic regression analysis to identify the interactions and correlations between different parameters. There were no statistically significant differences between male age groups in terms of sperm concentration, motility and morphology either in routine seminal analyses or in ART groups. In the ART group, a statistically significant linear correlation was present between male and female ages. Male age was increasing in parallel to female age. Female age was also correlated significantly with ART results. In one-way correlation analysis, male age was found to be correlated with the pregnancy rate, but not with fertilization rate and the quality of the transferred embryos. However, regression analysis revealed that correlation between male age and pregnancy results was simply dependent on the effect of the female age. Seminal parameters did not reveal a significant change with the increasing male age. The effect of male age on ART results in cases with male factor infertility is not a direct effect but a reflection of the negative impact of the parallel increase in the female age.

[What medical intervention in the late desire for a child?]

Therapeutical decisions in case of unsuccessful late child wish in a woman aged more than 35, must take into account several issues. In a context where time cannot be considered as "therapeutical" in the sense that the probability of onset of a pregnancy per cycle can not increase with time, the moment of check-up for infertility can be fixed at 6 months of sexual intercourse, assumed to be possibly fecundant. The assessment of ovarian age allows to formulate a double prognosis, that of therapeutical efficacy for obtaining onset of pregnancy and that of the quality of possible conceptus. The choice of treatment from the etiological check-up will not go from the simplest to the more sophisticated as is done for younger women. This is an important issue since the remaining time of possible fertility is short.

Comparison of semen quality in older and younger men attending an andrology clinic

The effects of age on semen quality were analysed in patients referred to an andrology outpatient clinic in a retrospective study covering a period of 3 years. Semen analyses of older men (n = 66; > or = 50 years; median: 53) were compared with those of young patients (n = 134; 21-25 years; median 24). The duration of sexual abstinence was longer among older patients (median: 5.5 vs. 5.0 days; + 10%, P < 0.05). Even after adjustment for duration of sexual abstinence, progressive motility (- 27%, P < 0.01), percentage of morphologically normal spermatozoa (- 44%, P < 0.01) and semen volume (- 29%, P < 0.0005) were significantly lower in older than in younger men. Impaired sperm morphology was mainly attributed to abnormal staining of flagella (+ 50%, P < 0.05) and an increased portion of coiled or bent tails (+ 44%, P = 0.001) indicating epididymal dysfunction. Total sperm count and sperm concentration were unaffected by age. Age-dependent changes in accessory gland function, as indicated by fructose concentration (- 27%, P < 0.05), was correlated with lower semen volume. Moreover, serum testosterone levels were significantly reduced in the group of older men (median: 3.0 vs. 3.6 ng ml-1; -17%, P < 0.005).

The lack of influence of age on male fertility

OBJECTIVE

This study was undertaken to determine the effect of male aging on sperm quality as determined by semen analysis, the fertilization rate of human oocytes in vitro, and live birth rates.

STUDY DESIGN

Retrospective analysis correlating outcome measures with male age was performed for 558 oocyte donation cycles in 441 couples. The oocyte donation model was chosen because it controls for oocyte quality and endometrial receptivity, which allows variations in sperm quality as a function of male age to be the only dependent variable. Outcome measures analyzed were semen analysis, fertilization rates in vitro, pregnancy rates, live birth rates, and cumulative live birth rates by life-table analysis.

RESULTS

There was a negative correlation between male age and total sperm count, but there was no correlation between male age and any of the other parameters in the semen analysis. There was no association between male age and the fertilization rate of donated oocytes in vitro, pregnancy rates, or live birth rates. Recipient couples were grouped by quartiles of male age, and cumulative live birth rates were the same in the 4 groups.

CONCLUSION

Whereas male aging is associated with a significant decline in total sperm count, this change is not reflected in a decreased fertilization rate or a decreased live birth rate in the oocyte donation model.

Effects of male age on semen quality and fertility: a review of the literature

OBJECTIVE

To review the literature on the association between male age and semen quality (semen volume, concentration, motility, and morphology) and fertility status (pregnancy rate and time to pregnancy/subfecundity).

METHOD(S)

Review of English language-published research over the last 20 years from January 1, 1980, through December 31, 1999, using MEDLINE and Biosis databases. Studies with insufficient numbers of subjects, case reports, case series, or anecdotal data were excluded.

RESULT(S)

Among the methodologically stronger studies, decreases in semen volume of 3%-22%, decreases in sperm motility of 3%-37%, and decreases in percent normal sperm of 4%-18% were likely when comparing 30-year-old men to 50-year-old men. Most studies examining fertility status suggest a relationship between male age and fertility, but the results are most likely confounded by female partner age. Among studies that did control for female age, comparisons between men under 30 and men over 50 found relative decreases in pregnancy rates between 23% and 38%. A comparison of the various age categories showed that the increased risks for subfecundity ranged from 11% to 250%.

CONCLUSION(S)

The weight of the evidence suggests that increased male age is associated with a decline in semen volume, sperm motility, and sperm morphology but not with sperm concentration.

Antioxidant activity in the semen of fertile and infertile men

OBJECTIVES

To evaluate catalase- and superoxide dismutase (SOD)-like activities in the seminal plasma of fertile and infertile men.

METHODS

Semen samples were obtained from consecutive men presenting for vasectomy (n = 12) and infertility evaluation (n = 105) at our institution. Catalase-like activity was measured by the decrease in hydrogen peroxide after incubation with seminal plasma. SOD-like activity was measured as the inhibition of nitroblue tetrazolium reduction due to superoxide anion generation by xanthine plus xanthine oxidase.

RESULTS

Mean seminal catalase-like activity (+/-SEM) in fertile men was not significantly different from that of infertile men (369 +/- 49 versus 326 +/- 17 U/mL, respectively). Mean SOD-like activity in the semen of infertile men was significantly greater than in the semen of fertile controls (46.7 +/- 1.5 versus 37.0 +/- 2.8 U/mL, respectively, P <0.05).

CONCLUSIONS

Our data show that infertile men do not have deficient seminal plasma SOD- and/or catalase-like activity (two key antioxidants). These findings suggest that the high semen ROS levels in some infertile men are likely due to excessive generation of ROS rather than deficient ROS scavenging activity in semen.

Donor age is paramount to success in oocyte donation

Several reports suggest increasing age in oocyte donors decreases the chances of in-vitro fertilization (IVF) success, while others describe no effect. The published data concerning gravidity and parity are similarly conflicting. To further address these questions, we retrospectively studied 445 consecutive donor IVF cycles at two large university-based IVF practices. Donor cycles were analysed for the number of oocytes retrieved, gravidity, parity, and age of the donor, and pregnancy outcome in recipients. The previous gravidity and parity of the donor were not associated with successful pregnancy in recipients. The number of oocytes retrieved was positively correlated with pregnancy. However, after adjusting for donor age, neither prior fertility nor the number of oocytes retrieved were significant predictors. In contrast, the donor's age was highly associated with recipient success. We conclude that the age of the oocyte donor is a significant predictor of pregnancy success and should be a major factor in selecting prospective candidates. The gravidity and parity of the donor are insignificant predictors, as are the total number of oocytes retrieved at the time of oocyte harvest.

Seasonal variations and age-related changes in human sperm count, motility, motion parameters, morphology, and white blood cell concentration

OBJECTIVE

To determine the presence of any seasonal variations and age-related changes in sperm parameters in andrology patients and fertile donors.

DESIGN

Retrospective analysis.

SETTING

University medical center andrology laboratory.

PATIENT(S)

The database of 2,065 semen analyses was retrospectively reviewed for the period of March 1, 1996, to October 31, 1998.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURES(S)

The sperm count, motility, motile count, progressive straightline velocity, and percentage of rapid sperm were determined with the Hamilton-Thorne IVOS analyzer with standard setup parameters.

RESULT(S)

There were no significant seasonal differences in the patient's volume, sperm count, motility, motile count, whereas the percentage of rapid sperm and progressive straightline velocity were significantly lower in the spring. Correlation analysis of patient semen parameters versus age implied that as age increases there is a tendency for these semen parameters to decrease, whereas percent tail defects showed a significant positive correlation with age.

CONCLUSION(S)

Age-adjusted analyses of seasonal variations in andrology patient semen parameters showed significant seasonal variation in the percentage rapid motile sperm and straightline velocity, as well as the percent tail defects, percent immature sperm, and the percent tapered sperm. Such seasonal variations might prove to be clinically relevant and important when designing experimental protocols.

The influence of advanced age on the outcome of assisted reproduction

PURPOSE

Our purpose was to determine the influence of age on the outcome of assisted reproduction, with particular interest in women aged 40 years or older.

METHODS

A retrospective review of the 779 patients enrolled in the Royal Hospital for Women Fertility Group fertility program between 1987 and 1994 was performed. The results for women aged 40 years or older were compared with those for women between 36 and 39 years and those younger than 36 years. The main outcome measures were pregnancy rate, pregnancy outcome, fertilization rate, and ovarian response.

RESULTS

Compared with those in younger women, pregnancy rate, pregnancy outcome, fertilization rate, and ovarian response to controlled ovarian stimulation were significantly worse in women aged 40 years or older.

CONCLUSIONS

The outcome of assisted reproduction in women of 40 years of age or older was extremely poor. Compared with those in younger women, pregnancy outcome and ovarian response to controlled ovarian stimulation were significantly worse in women of 40 years or more.

Pregnancy and birth rates after oocyte donation

OBJECTIVE

To determine accumulated conception and live birth rates in ovum donation.

DESIGN

Retrospective study from a computer database. Pregnancies with one gestational sac observed by ultrasound have been included as conceptional cycles and pregnancies that resulted in one live child were recorded for the analysis of the live birth rates. Life table analysis was applied.

SETTING

Oocyte donation program at the Instituto Valenciano de Infertilidad.

PATIENT(S)

Three hundred ninety-seven recipients undergoing a total of 627 ETs were analyzed.

INTERVENTION(S)

Ovarian stimulation and ovum pick-up in donors. Uterine ET in recipients after appropriate exogenous steroid replacement.

MAIN OUTCOME MEASUREMENT(S)

Accumulated and estimated (95% confidence intervals [CI]) conception and live birth rates in the oocyte donation program as well as considering age and cause of infertility of the recipients.

RESULT(S)

Pregnancy rate after one cycle was 53.4% (CI 50.9% to 55.9%), with a delivery rate of 42.6% (CI 40.1% to 45.1%). Accumulated pregnancy rate increased up to 94.8% (CI 90.6% to 99.0%) after four transfers. Similarly, live birth rates reached 88.7% (CI 88.1% to 89.3%) after four attempts of ET by ovum donation. Cycle fecundity rates were maintained at approximately 50% after each attempt. Implantation rate was 18.3% (430/2,340 replaced embryos). Age and cause of entering the program did not influence the overall results of ovum donation.

CONCLUSION(S)

Oocyte donation is a successful treatment modality for infertile couples that offers even higher success rates than natural conception. No difference in cumulative pregnancy rate was observed regardless of recipient age, indication for oocyte donation, or number of cycles attempted.