A new computerized method of reading sperm morphology (strict criteria) is as efficient as technician reading

Semen quality changes during infection and recovery phases of mild-to-moderate COVID-19 in reproductive-aged patients: a prospective case series

BACKGROUND

Despite the documented effects of the coronavirus disease 2019 (COVID-19) on spermatogenesis, the reversibility of these effects is uncertain. We aimed to assess the changes of sperm quality between the infection and recovery phases of COVID-19 in reproductive-aged men. The semen quality of men with mild-to-moderated COVID-19 (defined by the degrees of symptoms and chest involvement on computed tomography) was studied during October, 2020-May, 2021 at our hospital. Two semen samples were analyzed at timings estimated to represent spermatogenic cycles during the infection and recovery phases of COVID-19.

RESULTS

A total of 100 patients were included with mean ± SD (range) age of 24.6 ± 3.3 (21-35) years. During infection, 33% of patients had abnormal semen quality. However, a significant reduction was found in this abnormality from 33 to 11% (P < 0.001) after recovery from infection. In a comparison of the two semen analyses, there were significant improvements in the mean values of sperm progressive motility (P =0.043) and normal morphology (P < 0.001). However, the mean sperm concentration showed a statistically insignificant increase (P = 0.844).

CONCLUSIONS

In reproductive-aged patients with mild-to-moderate COVID-19, the effects on seminal quality were recoverable, represented by significant improvements in the means of progressive sperm motility and normal morphology between the infection and recovery phases of COVID-19.

TRIAL REGISTRATION

ClinicalTrials, NCT04595240 .

Decline of Sperm Quality over the Last Two Decades in the South of Europe: A Retrospective Study in Infertile Patients

Semen quality has a direct relation to male fertility. Whether sperm variables in humans have decreased over the last years is still uncertain, with some studies showing a decline and others reporting no changes. In this regard, previous research has suggested that lifestyle and environmental conditions may contribute to this variability, calling for regional studies. The present work is a retrospective, unicentric study that includes semen samples analyzed between 1997 and 2017 at the Parc Taulí Hospital (Barcelona metropolitan area). First, a multivariate analysis including the age as a confounding factor showed a statistically significant decrease in semen volume, pH, progressive motility, morphology and total motile sperm over time. Contrarily, no significant variation in sperm count or concentration was observed. Mean reductions per year were -0.02 mL for volume, -0.57% for progressively motile sperm and -0.72% for sperm with normal morphology. Interestingly, the average annual temperature registered by the Spanish Meteorology Agency negatively correlated to sperm morphology and sperm count (Rs = -0.642; p = 0.002 and Rs = -0.435; p = 0.049, respectively). In conclusion, the present study based on infertile patients from the Barcelona area found a decline in sperm motility and morphology, without effects on sperm count. Changes in temperature appeared to be associated to this decline, but further studies are needed to address the mechanisms linked to the observed variations.

Machine learning for sperm selection

Infertility rates and the number of couples seeking fertility care have increased worldwide over the past few decades. Over 2.5 million cycles of assisted reproductive technologies are being performed globally every year, but the success rate has remained at ~33%. Machine learning, an automated method of data analysis based on patterns and inference, is increasingly being deployed within the health-care sector to improve diagnostics and therapeutics. This technique is already aiding embryo selection in some fertility clinics, and has also been applied in research laboratories to improve sperm analysis and selection. Tremendous opportunities exist for machine learning to advance male fertility treatments. The fundamental challenge of sperm selection - selecting the most promising candidate from 10⁸ gametes - presents a challenge that is uniquely well-suited to the high-throughput capabilities of machine learning algorithms paired with modern data processing capabilities.

Predictive Capacity of Boar Sperm Morphometry and Morphometric Sub-Populations on Reproductive Success after Artificial Insemination

Simple Summary

The efficiency of swine production measured as litter size influences the profitability of the pig industry. Furthermore, sow fertility potential depends in part on the boar semen quality and reproductive efficiency. The objective of this study is to compare boar sperm head size and morphometric features of shape to evaluate their relationships with reproductive success after artificial insemination (AI). A morphometric analysis of boar ejaculate reveals morphometrically separate sub-populations. The differences between sub-populations are displayed for sperm head size. In addition, sperm clustering into sub-populations did not have a predictive capacity on litter size variables. Nevertheless, the morphometric variables of the sperm may have a predictive, albeit reduced, capacity regarding litter size variables. The results of this study therefore open up possibilities for future assessments of fertility.

Abstract

The aim of the study was to compare the morphometric features of sperm head size and shape from the Pietrain line and the Duroc × Pietrain boar crossbred terminal lines, and to evaluate their relationship with reproductive success after artificial insemination of sows produced from crossbreeding the York, Landrace and Pietrain breeds. Semen samples were collected from 11 sexually mature boars. Only ejaculates with greater than 70% motility rate and <15% of abnormal sperm were used for artificial inseminations (AI) and included in the study. Samples were analyzed using an ISAS^®v1 computer-assisted sperm analysis system for eight morphometric parameters of head shape and size (CASA-Morph). Sub-populations of morphometric ejaculates were characterized using multivariate procedures, such as principal component (PC) analysis and clustering methods (k-means model). Four different ejaculate sub-populations were identified from two PCs that involved the head shape and size of the spermatozoa. The discriminant ability of the different morphometric sperm variables to predict sow litter size was analyzed using a receiver operating characteristics (ROC) curve analysis. Sperm head length, ellipticity, elongation, and regularity showed significant predictive capacity on litter size (0.59, 0.59, 0.60, and 0.56 area under curve (AUC), respectively). The morphometric sperm sub-populations were not related to sow litter size.

The effects of sacubitril/valsartan and ramipril on the male fertility in hypertensive rats

OBJECTIVE:

Renin angiotensinogen system (RAS) inhibitors, ramipril and sacubitril/valsartan are frequently used in the treatment of cardiovascular diseases. Although they are known as contraindicated during pregnancy in hypertensive women, there is not any outcome of their safety in male fertility after exposure to ramipril or sacubitril/valsartan. In this study, we aimed to evaluate the effects of ramipril and sacubitril/valsartan to highlight their safety in the male fertility in normotensive and hypertensive rats.

METHODS:

Adult male normotensive and dexamethasone-induced hypertensive rats were treated with sacubitril/valsartan, ramipril and saline for 18 days. Arterial blood pressures were verified using carotid artery cannulation. Male fertility parameters, including the testis weights, histopathologic scoring of the testis, sperm count, sperm motility, morphology, and serum testosterone levels, were analyzed in treated and nontreated normotensive/hypertensive rats.

RESULTS:

Sacubitril/valsartan or ramipril treatments did not reveal a significant difference in sperm production, testicular morphology, and radioimmunoassay of serum testosterone levels compared to the control group. However, sperm motility was significantly reduced in rats under RAS inhibition.

CONCLUSION:

This finding was likely mediated by the identification of Ang receptors in the tails of rat sperm given that Ang receptors may play a role in the modulation of sperm motility. Identification of RAS-related proteins involved in sperm motility may help to explain their roles in motility. Our data provide general safety evidence for the male fertilization ability after paternal sacubitril/valsartan and ramipril exposure.

Novel compound heterozygous DNAAF2 mutations cause primary ciliary dyskinesia in a Han Chinese family

PURPOSE

Primary ciliary dyskinesia (PCD), which commonly causes male infertility, is an inherited autosomal recessive disorder. This study aimed to investigate the clinical manifestations and screen mutations associated with the dynein axonemal assembly factor 2 (DNAAF2) gene in a Han Chinese family with PCD.

METHODS

A three-generation family with PCD was recruited in this study. Eight family members underwent comprehensive medical examinations. Genomic DNA was extracted from the participants' peripheral blood, and targeted next-generation sequencing technology was used to perform the mutation screening. The DNAAF2 expression was analyzed by immunostaining and Western blot.

RESULTS

The proband exhibited the typical clinical features of PCD. Spermatozoa from the proband showed complete immotility but relatively high viability. Two novel compound heterozygous mutations in the DNAAF2 gene, c.C156A [p.Y52X] and c.C26A [p.S9X], were identified. Both nonsense mutations were detected in the proband, whereas the other unaffected family members carried either none or only one of the two mutations. The two nonsense heterozygous mutations were not detected in the 600 ethnically matched normal controls or in the Genome Aggregation Database. The defect of the DNAAF2 and the outer dynein arms and inner dynein arms were notably observed in the spermatozoa from the proband by immunostaining.

CONCLUSION

This study identified two novel compound heterozygous mutations of DNAAF2 leading to male infertility as a result of PCD in a Han Chinese family. The findings may enhance the understanding of the pathogenesis of PCD and improve reproductive genetic counseling in China.

Ultra-structural analysis of human spermatozoa by aperture scanning near-field optical microscopy

Scanning near-field optical microscopy (SNOM) represents a potential candidate for investigation of ultrastructure in human spermatozoa. It is a noninvasive optical technique that offers two main advantages: minimal sample preparation and simultaneous topographical and optical images acquisition with a spatial resolution beyond the diffraction limit. This enables the combination of surface characterization and information from the inner cellular organization in a single acquisition providing an immediate and comprehensive analysis of the cellular portions. In this work spermatozoa are immobilized on poly-L-lysine coated coverslips, fixed according to a standard protocol and imaged by aperture-SNOM in air. In the SNOM images, all peculiar sperm portions show well-resolved optical features, which exhibit good similarities with the structures revealed in transmission electron microscopy images, as compared with literature data. The optical features of anomalous spermatozoa are clearly different as respect with those observed for healthy ones. This analysis reveals the potentialities of SNOM and opens to its application to high-resolution analysis of sperm morphological alterations, which might be relevant in reproductive medicine.

The use of aniline blue chromatin condensation test on prediction of pregnancy in mild male factor and unexplained male infertility

The aim of this study was to investigate the possibility of using sperm function tests (hypoosmotic swelling test [HOS], aniline blue [AB] staining test, and sperm chromatin dispersion [SCD]) to predict intrauterine insemination [IUI] success rate. A total of 243 couples with mild male factor or unexplained male infertility who underwent IUI were evaluated prospectively. The results of basic sperm analysis and sperm function tests were compared between pregnant or nonpregnant groups. The HOS (11.9 ± 9.6% vs. 10.1 ± 8.5%, p = 0.35) and SCD tests (32.9 ± 21.0% vs. 29.9 ± 19.0%, p = 0.48) were not significantly different between pregnant (n = 22) and nonpregnant (n = 221) groups. However, the AB staining negativity rate was significantly higher in the pregnant group compared to the nonpregnant group (35.2 ± 20.8% and 24.4 ± 18.0%, p = 0.008). On ROC analysis, a cut-off value of 24% for AB negativity showed a sensitivity and a specificity value of 82.35% and 51.38% (AUC) = 0.653; 95% confidence interval: 0.571-0.72 P (Area = 0.5) = 0.0267, respectively, for prediction of pregnancy. Our study showed that the sperm chromatin maturity, assessed by AB stain, may predict the pregnancy in couples with unexplained female infertility plus mild male factor or unexplained male infertility. The HOS and SCD failed to predict the pregnancy in this group of couples.

Seminal SIRT1 expression in infertile oligoasthenoteratozoospermic men with varicocoele

In a case-controlled study, we assessed the expressed seminal NAD-dependent protein deacetylase (SIRT1) expression in infertile oligoasthenoteratozoospermic (OAT) men associated with varicocoele. Our study involved 81 men, recruited from the University hospitals, after ethical approval and informed consent. They were allocated into fertile normozoospermic men (n = 23), infertile OAT men without varicocoele (n = 23) and infertile OAT men with varicocoele (n = 35). Inclusion criteria consisted of confirmation of abnormal semen parameters and normal female partners whereas exclusion criteria were leukocytospermia, tobacco smoking, hormonal therapy, immunological disorders, dyslipidemia, hypogonadism, cardiovascular disorders, morbid obesity, and hepatic or renal failures. All participants had an interview to assess clinical history, clinical examination, semen analysis, and estimation of seminal SIRT1 expression. Seminal SIRT1 expression was significantly lower in infertile OAT men than fertile men. Among infertile OAT men, seminal SIRT1 expression was significantly lower in those with varicocoele than in those without. Additionally, seminal SIRT1 expression was significantly lower in varicocoele grade III cases compared with other grades. Seminal SIRT1 expression was positively correlated with sperm concentration (r = 0.327, p = 0.001), total sperm motility (r = 0.532, p = 0.001), and sperm normal forms (r = 0.469, p = 0.001). Our results suggest that seminal SIRT1 expression has a role of male infertility being significantly decreased in infertile OAT men in general and in infertile OAT men associated with varicocoele in particular.

Improving sperm banking efficiency in endangered species through the use of a sperm selection method in brown bear (Ursus arctos) thawed sperm

Background

Sperm selection methods such as Single Layer Centrifugation (SLC) have been demonstrated to be a useful tool to improve the quality of sperm samples and therefore to increase the efficiency of other artificial reproductive techniques in several species. This procedure could help to improve the quality of genetic resource banks, which is essential for endangered species. In contrast, these sperm selection methods are optimized and focused on farm animals, where the recovery task is not as important as in endangered species because of their higher sperm availability. The aim of this study was to evaluate two centrifugation methods (300 x g/20 min and 600 x g/10 min) and three concentrations of SLC media (Androcoll-Bear −80, 65 and 50%) to optimise the procedure in order to recover as many sperm with the highest quality as possible. Sperm morphology could be important in the hydrodynamic relationship between the cell and centrifugation medium and thus the effect of sperm head morphometry on sperm yield and its hydrodynamic relationship were studied.

Results

The samples selected with Androcoll-Bear 65% showed a very good yield (53.1 ± 2.9) although the yield from Androcoll-Bear 80% was lower (19.3 ± 3.3). The latter showed higher values of motility than the control immediately after post-thawing selection. However, both concentrations of colloid (65 and 80%) showed higher values of viable sperm and viable sperm with intact acrosome than the control. After an incubation of 2 h at 37 °C, the samples from Androcoll-Bear 80% had higher kinematics and proportion of viable sperm with intact acrosome. In the morphometric analysis, the sperm selected by the Androcoll-Bear 80% showed a head with a bigger area which was more elongated than the sperm from other treatments.

Conclusions

We conclude that sperm selection with Androcoll-Bear at either 65% or 80% is a suitable technique that allows a sperm population with better quality than the initial sample to be obtained. We recommend the use of Androcoll-Bear 65% since the yield is better than Androcoll-Bear 80%. Our findings pave the way for further research on application of sperm selection techniques to sperm banking in the brown bear.

Electronic supplementary material

The online version of this article (doi:10.1186/s12917-017-1124-2) contains supplementary material, which is available to authorized users.

Automatic classification of human sperm head morphology

BACKGROUND AND OBJECTIVE

Infertility is a problem that affects up to 15% of couples worldwide with emotional and physiological implications and semen analysis is the first step in the evaluation of an infertile couple. Indeed the morphology of human sperm cells is considered to be a clinical tool dedicated to the fertility prognosis and serves, mainly, for making decisions regarding the options of assisted reproduction technologies. Therefore, a complete analysis of not only normal sperm but also abnormal sperm turns out to be critical in this context. This paper sets out to develop, implement and calibrate a novel methodology to characterize and classify sperm heads towards morphological sperm analysis. Our work is aimed at focusing on a depth analysis of abnormal sperm heads for fertility diagnosis, prognosis, reproductive toxicology, basic research or public health studies.

METHODS

We introduce a morphological characterization for human sperm heads based on shape measures. We also present a pipeline for sperm head classification, according to the last Laboratory Manual for the Examination and Processing of Human Semen of the World Health Organization (WHO). In this sense, we propose a two-stage classification scheme that permits to classify sperm heads among five different classes (one class for normal sperm heads and four classes for abnormal sperm heads) combining an ensemble strategy for feature selection and a cascade approach with several support vector machines dedicated to the verification of each class. We use Fisher's exact test to demonstrate that there is no statistically significant differences between our results and those achieved by domain experts.

RESULTS

Experimental evaluation shows that our two-stage classification scheme outperforms some state-of-the-art monolithic classifiers, exhibiting 58% of average accuracy. More interestingly, on the subset of data for which there is a total agreement between experts for the label of the samples, our system is able to provide 73% of average classification accuracy.

CONCLUSIONS

We show that our system behaves like a human expert; therefore it can be used as a supplementary source for labeling new unknown data. However, as sperm head classification is still a challenging issue due to the uncertainty on the class label of each sperm head, with the consequent high degree of variability among domain experts, we conclude that there are still opportunities for further improvement in designing a more accurate system by investigating other feature extraction methods and classification schemes.

Foreword to Sperm morphometrics today and tomorrow special issue in Asian Journal of Andrology

Early in his investigations, Leeuwenhoek (1670s)1 deduced that spermatozoa were alive and an integral part of semen, rather than artifacts or parasites. He eventually observed spermatozoa in the semen of men, dogs, horses, birds, fishes, amphibians, molluscs, and many insects, and concluded that they must be a universal feature of male reproduction. The huge differences in sperm form among species have been discussed in relation to evolutionary changes dictated by the egg and its investments.2 Spallanzani (1800s)1 was the first scientist to develop successful methods for artificial insemination, first with amphibians and later with dogs. With these experiments, he showed that physical contact between intact spermatozoa and ova was necessary to achieve the fertilization. Some years later (1820s), Prévost and Dumas1 performed the defining experiment to identify correctly the function of spermatozoa in reproduction.

Assisted reproductive technologies for male subfertility

BACKGROUND

Intra-uterine insemination (IUI), in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI) are frequently used fertility treatments for couples with male subfertility. The use of these treatments has been subject of discussion. Knowledge on the effectiveness of fertility treatments for male subfertility with different grades of severity is limited. Possibly, couples are exposed to unnecessary or ineffective treatments on a large scale.

OBJECTIVES

To evaluate the effectiveness and safety of different fertility treatments (expectant management, timed intercourse (TI), IUI, IVF and ICSI) for couples whose subfertility appears to be due to abnormal sperm parameters.

SEARCH METHODS

We searched for all publications that described randomised controlled trials (RCTs) of the treatment for male subfertility. We searched the Cochrane Menstrual Disorders and Subfertility Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, PsycINFO and the National Research Register from inception to 14 April 2015, and web-based trial registers from January 1985 to April 2015. We applied no language restrictions. We checked all references in the identified trials and background papers and contacted authors to identify relevant published and unpublished data.

SELECTION CRITERIA

We included RCTs comparing different treatment options for male subfertility. These were expectant management, TI (with or without ovarian hyperstimulation (OH)), IUI (with or without OH), IVF and ICSI. We included only couples with abnormal sperm parameters.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected the studies, extracted data and assessed risk of bias. They resolved disagreements by discussion with the rest of the review authors. We performed statistical analyses in accordance with the guidelines for statistical analysis developed by The Cochrane Collaboration. The quality of the evidence was rated using the GRADE methods. Primary outcomes were live birth and ovarian hyperstimulation syndrome (OHSS) per couple randomised.

MAIN RESULTS

The review included 10 RCTs (757 couples). The quality of the evidence was low or very low for all comparisons. The main limitations in the evidence were failure to describe study methods, serious imprecision and inconsistency. IUI versus TI (five RCTs)Two RCTs compared IUI with TI in natural cycles. There were no data on live birth or OHSS. We found no evidence of a difference in pregnancy rates (2 RCTs, 62 couples: odds ratio (OR) 4.57, 95% confidence interval (CI) 0.21 to 102, very low quality evidence; there were no events in one of the studies).Three RCTs compared IUI with TI both in cycles with OH. We found no evidence of a difference in live birth rates (1 RCT, 81 couples: OR 0.89, 95% CI 0.30 to 2.59; low quality evidence) or pregnancy rates (3 RCTs, 202 couples: OR 1.51, 95% CI 0.74 to 3.07; I(2) = 11%, very low quality evidence). One RCT reported data on OHSS. None of the 62 women had OHSS.One RCT compared IUI in cycles with OH with TI in natural cycles. We found no evidence of a difference in live birth rates (1 RCT, 44 couples: OR 3.14, 95% CI 0.12 to 81.35; very low quality evidence). Data on OHSS were not available. IUI in cycles with OH versus IUI in natural cycles (five RCTs)We found no evidence of a difference in live birth rates (3 RCTs, 346 couples: OR 1.34, 95% CI 0.77 to 2.33; I(2) = 0%, very low quality evidence) and pregnancy rates (4 RCTs, 399 couples: OR 1.68, 95% CI 1.00 to 2.82; I(2) = 0%, very low quality evidence). There were no data on OHSS. IVF versus IUI in natural cycles or cycles with OH (two RCTs)We found no evidence of a difference in live birth rates between IVF versus IUI in natural cycles (1 RCT, 53 couples: OR 0.77, 95% CI 0.25 to 2.35; low quality evidence) or IVF versus IUI in cycles with OH (2 RCTs, 86 couples: OR 1.03, 95% CI 0.43 to 2.45; I(2) = 0%, very low quality evidence). One RCT reported data on OHSS. None of the women had OHSS.Overall, we found no evidence of a difference between any of the groups in rates of live birth, pregnancy or adverse events (multiple pregnancy, miscarriage). However, most of the evidence was very low quality.There were no studies on IUI in natural cycles versus TI in stimulated cycles, IVF versus TI, ICSI versus TI, ICSI versus IUI (with OH) or ICSI versus IVF.

AUTHORS' CONCLUSIONS

We found insufficient evidence to determine whether there was any difference in safety and effectiveness between different treatments for male subfertility. More research is needed.

Head morphology of ram spermatozoa is associated with their ability to migrate in vitro and correlates with fertility

Fertility is a highly complex biological function that depends on several properties of spermatozoa that are necessary for them to overcome various barriers in the female reproductive tract to reach the fertilisation site. This ability has been evaluated in vitro using cervical mucus migration tests. Head morphology has been widely studied, and various studies have reported correlations between head morphology and motility, fertility and DNA fragmentation. In the present study, we first evaluated the relationship between the ability of ram spermatozoa to overcome the mucus surrogate barrier in an in vitro migration test and sperm head morphology. Sperm motility (determined by computer-aided sperm analysis) and the acrosomal status, viability and mitochondrial status (determined by flow cytometry) of control and migrating spermatozoa were assessed. Principal component analysis and clustering analysis of the values for the morphometric parameters assessed defined three cell subpopulations. One of these subpopulations, namely spermatozoa with a short and wide head, was absent from samples collected after conclusion of the migration test. Second, we evaluated relationships among head morphology characteristics, the ability to penetrate the artificial mucus and fertility. We did not find any correlation between fertility and the number of spermatozoa that migrated, whereas there was a negative correlation between the proportion of spermatozoa with a short and wide head in the fresh sperm sample and fertility. In conclusion, the head morphology of spermatozoa was associated with their ability to overcome a mucus barrier in a migration test, and the relative size of the non-migrating subpopulation was negatively related to male fertility.

The application of scanning near field optical imaging to the study of human sperm morphology

Background

The morphology of spermatozoa is a fundamental aspect to consider in fertilization, sperm pathology, assisted reproduction and contraception. Head, neck, midpiece, principal and terminal part of flagellum are the main sperm components to investigate for identifying morphological features and related anomalies. Recently, scanning near-field optical microscopy (SNOM), which belongs to the wide family of nanoscopic techniques, has opened up new routes for the investigation of biological systems. SNOM is the only technique able to provide simultaneously highly resolved topography and optical images with a resolution beyond the diffraction limit, typical of conventional optical microscopy. This offers the advantage to obtain complementary information about cell surface and cytoplasmatic structures.

Results

In this work human spermatozoa both healthy and with morphological anomalies are analyzed by SNOM, to demonstrate the potentiality of such approach in the visualization of sperm morphological details. The combination of SNOM topography with optical (reflection and transmission) images enables to examine typical topographic features of spermatozoa together with underlying cytoplasmic structures. Indeed the head shape and inner components as acrosome and nucleus, and the organization of mitochondria in the midpiece region are observed. Analogously for principal tract of the tail, the ridges and the columns are detected in the SNOM topography, while their internal arrangement can be observed in the corresponding SNOM optical transmission images, without requiring specific staining procedures or invasive protocols.

Conclusions

Such findings demonstrate that SNOM represents a versatile and powerful tool to describe topographical and inner structural details of spermatozoa simultaneously. This analysis could be helpful for better characterizing several morphological anomalies, often related to sperm infertility, which cannot be examined by conventional techniques all together.

Electronic supplementary material

The online version of this article (doi:10.1186/s12951-014-0061-5) contains supplementary material, which is available to authorized users.

Synchronised approach for intrauterine insemination in subfertile couples

BACKGROUND

In many countries intrauterine insemination (IUI) is the treatment of first choice for a subfertile couple when the infertility work up reveals an ovulatory cycle, at least one open Fallopian tube and sufficient spermatozoa. The final goal of this treatment is to achieve a pregnancy and deliver a healthy (singleton) live birth. The probability of conceiving with IUI depends on various factors including age of the couple, type of subfertility, ovarian stimulation and the timing of insemination. IUI should logically be performed around the moment of ovulation. Since spermatozoa and oocytes have only limited survival time correct timing of the insemination is essential. As it is not known which technique of timing for IUI results in the best treatment outcome, we compared different techniques for timing IUI and different time intervals.

OBJECTIVES

To evaluate the effectiveness of different synchronisation methods in natural and stimulated cycles for IUI in subfertile couples.

SEARCH METHODS

We searched for all publications which described randomised controlled trials of the timing of IUI. We searched the Cochrane Menstrual Disorders and Subfertility Group Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL) (1966 to October 2014), EMBASE (1974 to October 2014), MEDLINE (1966 to October 2014) and PsycINFO (inception to October 2014) electronic databases and prospective trial registers. Furthermore, we checked the reference lists of all obtained studies and performed a handsearch of conference abstracts.

SELECTION CRITERIA

Randomised controlled trials (RCTs) comparing different timing methods for IUI were included. The following interventions were evaluated: detection of luteinising hormone (LH) in urine or blood, single test; human chorionic gonadotropin (hCG) administration; combination of LH detection and hCG administration; basal body temperature chart; ultrasound detection of ovulation; gonadotropin-releasing hormone (GnRH) agonist administration; or other timing methods.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected the trials, extracted the data and assessed study risk of bias. We performed statistical analyses in accordance with the guidelines for statistical analysis developed by The Cochrane Collaboration. The overall quality of the evidence was assessed using GRADE methods.

MAIN RESULTS

Eighteen RCTs were included in the review, of which 14 were included in the meta-analyses (in total 2279 couples). The evidence was current to October 2013. The quality of the evidence was low or very low for most comparisons . The main limitations in the evidence were failure to describe study methods, serious imprecision and attrition bias.Ten RCTs compared different methods of timing for IUI. We found no evidence of a difference in live birth rates between hCG injection versus LH surge (odds ratio (OR) 1.0, 95% confidence interval (CI) 0.06 to 18, 1 RCT, 24 women, very low quality evidence), urinary hCG versus recombinant hCG (OR 1.17, 95% CI 0.68 to 2.03, 1 RCT, 284 women, low quality evidence) or hCG versus GnRH agonist (OR 1.04, 95% CI 0.42 to 2.6, 3 RCTS, 104 women, I(2) = 0%, low quality evidence).Two RCTs compared the optimum time interval from hCG injection to IUI, comparing different time frames that ranged from 24 hours to 48 hours. Only one of these studies reported live birth rates, and found no difference between the groups (OR 0.52, 95% CI 0.27 to 1.00, 1 RCT, 204 couples). One study compared early versus late hCG administration and one study compared different dosages of hCG, but neither reported the primary outcome of live birth.We found no evidence of a difference between any of the groups in rates of pregnancy or adverse events (multiple pregnancy, miscarriage, ovarian hyperstimulation syndrome (OHSS)). However, most of these data were very low quality.

AUTHORS' CONCLUSIONS

There is insufficient evidence to determine whether there is any difference in safety and effectiveness between different methods of synchronization of ovulation and insemination. More research is needed.

Gold-standard and improved framework for sperm head segmentation

Semen analysis is the first step in the evaluation of an infertile couple. Within this process, an accurate and objective morphological analysis becomes more critical as it is based on the correct detection and segmentation of human sperm components. In this paper, we present an improved two-stage framework for detection and segmentation of human sperm head characteristics (including acrosome and nucleus) that uses three different color spaces. The first stage detects regions of interest that define sperm heads, using k-means, then candidate heads are refined using mathematical morphology. In the second stage, we work on each region of interest to segment accurately the sperm head as well as nucleus and acrosome, using clustering and histogram statistical analysis techniques. Our proposal is also characterized by being fully automatic, where a user intervention is not required. Our experimental evaluation shows that our proposed method outperforms the state-of-the-art. This is supported by the results of different evaluation metrics. In addition, we propose a gold-standard built with the cooperation of a referent expert in the field, aiming to compare methods for detecting and segmenting sperm cells. Our results achieve notable improvement getting above 98% in the sperm head detection process at the expense of having significantly fewer false positives obtained by the state-of-the-art method. Our results also show an accurate head, acrosome and nucleus segmentation achieving over 80% overlapping against hand-segmented gold-standard. Our method achieves higher Dice coefficient, lower Hausdorff distance and less dispersion with respect to the results achieved by the state-of-the-art method.

Digital holography as a method for 3D imaging and estimating the biovolume of motile cells

Sperm morphology is regarded as a significant prognostic factor for fertilization, as abnormal sperm structure is one of the most common factors in male infertility. Furthermore, obtaining accurate morphological information is an important issue with strong implications in zoo-technical industries, for example to perform sorting of species X from species Y. A challenging step forward would be the availability of a fast, high-throughput and label-free system for the measurement of physical parameters and visualization of the 3D shape of such biological specimens. Here we show a quantitative imaging approach to estimate simply and quickly the biovolume of sperm cells, combining the optical tweezers technique with digital holography, in a single and integrated set-up for a biotechnology assay process on the lab-on-a-chip scale. This approach can open the way for fast and high-throughput analysis in label-free microfluidic based "cytofluorimeters" and prognostic examination based on sperm morphology, thus allowing advancements in reproductive science.

CASA derived human sperm abnormalities: correlation with chromatin packing and DNA fragmentation

PURPOSE

The present study was undertaken to evaluate the effects of morphokinetic abnormalities of human spermatozoa on chromatin packing and DNA integrity and possible beneficial effects of sperm selection in ICSI.

METHODS

Semen samples from 1002 patients were analysed for morphology and motility using CASA. Protamine status and DNA fragmentation were analysed by chromomycin A3 staining and sperm chromatin dispersion assay respectively.

RESULTS

Sperms with elongated, thin, round, pyri, amorphous, micro and macro forms were significantly higher in teratozoospermic and oligoasthenoteratozoospermic groups. Significant difference in chromatin packing and DNA fragmentation index was observed in these abnormal groups compared with normal. Similarly significant correlation was also seen between abnormal motility parameters and DNA fragmentation index in asthenozoospermic group compared with normal.

CONCLUSIONS

Specific abnormal morphological forms have higher incidence of chromatin packing abnormalities and DNA fragmentation. Using these sperms in ICSI might have an impact on fertilization, embryo development and abortion rates. These can be selectively avoided during ICSI procedure to improve ART outcome.

Identification of bovine sperm head for morphometry analysis in quantitative phase-contrast holographic microscopy

An investigation is reported of the identification and measurement of region of interest (ROI) in quantitative phase-contrast maps of biological cells by digital holographic microscopy. In particular, two different methods have been developed for in vitro bull sperm head morphometry analysis. We show that semen analysis can be accomplished by means of the proposed techniques . Extraction and measurement of various parameters are performed. It is demonstrated that both proposed methods are efficient to skim the data set in a preselective analysis for discarding anomalous data.

Zaditen (Ketotifen), as mast cell blocker, improves sperm quality, chromatin integrity and pregnancy rate after varicocelectomy

Surgery is considered the most common choice for the treatment of male infertility with clinical varicocele. Increased numbers of mast cells (MCs) have been associated with different types of infertility, including varicocele. Despite there being different reports on improved fertility following administration of MC blockers, there is no report on the effect of a MC blocker on varicocele or after varicocelectomy. Therefore, the aim of this study was to evaluate the effect of Zaditen on semen quality, protamine content, DNA damage and fertility post-surgery. The study included 103 infertile men who were referred to Isfahan Fertility and Infertility Center for varicocelectomy. Varicocele individuals were randomly divided into control (52) and treatment groups (51). Semen parameters, WBC/mL, protamine content (chromomycin A3 staining) and DNA integrity (sperm chromatin dispersion test) were assessed before and 3 months after surgery. Comparison of the aforesaid parameters between the two groups revealed significant improvement in the treatment group compared with the control group, with the exception of DNA integrity. In addition, the cumulative pregnancy significantly improved by 9 months post-surgery in the treatment group (41.17%) compared with the control group (21.15%). The results of this study, for the first time, reveal that MC blockers such as Zaditen improve semen parameters, chromatin integrity and pregnancy rates when administered as adjunct therapy post-varicocelectomy.

Sperm morphology assessment using David's classification: time to switch to strict criteria? Prospective comparative analysis in a selected IVF population

The aim of this study was to compare assessment of sperm morphology by using David's classification (DC), a method of manual analysis most common in France, with a computer-assisted method (Integrated Visual Optical System) based on the strict criteria (CASA SC) for their ability to predict fertilization in a selected in vitro fertilization (IVF) population. A total of 120 couples engaged in IVF protocols were prospectively included in the study. To focus mainly on sperm morphology, couples were excluded in cases of abnormalities of sperm concentration and/or motility and immunological factors and when a low number of oocytes were collected. Sperm morphology analysis was performed on the day of oocyte retrieval by the same trained biologist. Our results showed a moderate correlation between the two techniques (r = 0.49). The DC sperm morphology analysis was less indicative of fertilization than CASA SC (r = 0.07, p = 0.47 vs. r = 0.22, p = 0.014). Using receiver-operating characteristics analysis, we showed that DC was not discriminating in the prediction of fertilization (AUC = 0.572). DC seemed less appropriate for the prediction of fertilization success or failure. In contrast, with CASA SC, the previously determined cut-off value of around 14% was confirmed (AUC = 0.735, cut-off = 6%). Our results argue in favour of the replacement of DC by SC to tend towards worldwide standardization.

Seminal plasma reactive oxygen species-antioxidants relationship with varicocele grade

This work aimed to assess seminal plasma reactive oxygen species (ROS)-antioxidants relationship with varicocele grade in infertile men with oligoasthenoteratozoospermia (OAT). The study included 89 infertile OAT men with varicocele divided into grade I (n = 22) and grade II (n = 43), grade III (n = 24) and compared with 20 healthy fertile controls. In their seminal plasma, two ROS parameters (malondialdehyde [MDA], hydrogen peroxide [H(2) O(2) ]) and four antioxidants (superoxide dismutase [SOD], catalase [Cat], glutathione peroxidase [GPx], vit.C) were estimated. There was significant increase in seminal MDA, H(2) O(2) and significant decrease in seminal SOD, Cat, GPx, vit.C in varicocele-associated OAT cases when compared with the controls. Compared with grade I cases, varicocele cases with grades II, III demonstrated significant increase in estimated seminal MDA, H(2) O(2) and significant decrease in seminal SOD, Cat, GPx, vit.C. It is concluded that seminal oxidative stress (OS) is related to increased varicocele grade in infertile OAT men associated with varicocele.

Synchronised approach for intrauterine insemination in subfertile couples

BACKGROUND

Intrauterine insemination (IUI) should logically be performed around the moment of ovulation. Since spermatozoa and oocytes have only limited survival times correct timing is essential. As it is not known which technique of timing for IUI results in the best treatment outcome, we compared different techniques for timing IUI and different time intervals.

OBJECTIVES

To evaluate the effectiveness of different synchronisation methods in natural and stimulated cycles for IUI in subfertile couples.

SEARCH STRATEGY

We searched for all publications which described randomised controlled trials of the timing of IUI. We searched the Cochrane Menstrual Disorders and Subfertility Group Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), (1966 to March 2009), EMBASE (1974 to March 2009) and Science Direct (1966 to March 2009) electronic databases. Furthermore, we checked the reference lists of all obtained studies and performed a handsearch of conference abstracts.

SELECTION CRITERIA

Only truly randomised controlled trials comparing different timing methods for IUI were included. The following interventions were evaluated: detection of luteinising hormone (LH) in urine or blood, single test; human chorionic gonadotropin (hCG) administration; combination of LH detection and hCG administration; basal body temperature chart; ultrasound detection of ovulation; gonadotropin-releasing hormone (GnRH) agonist administration; or other timing methods.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected the trials to be included according to the above mentioned criteria. We performed statistical analyses in accordance with the guidelines for statistical analysis developed by The Cochrane Collaboration.

MAIN RESULTS

Ten studies were included comparing urinary LH surge versus hCG injection; recombinant hCG versus urinary hCG; and hCG versus a GnRH agonist. One study compared the optimum time interval from hCG injection to IUI. The results of these studies showed no significant differences between different timing methods for IUI expressed as live birth rates: hCG versus LH surge (odds ratio (OR) 1.0, 95% CI 0.06 to 18); urinary hCG versus recombinant hCG (OR 1.2, 95% CI 0.68 to 2.0); and hCG versus GnRH agonist (OR 1.1, 95% CI 0.42 to 3.1). All the secondary outcomes analysed showed no significant differences between treatment groups.

AUTHORS' CONCLUSIONS

There is no evidence to advise one particular treatment option over another. The choice should be based on hospital facilities, convenience for the patient, medical staff, costs and drop-out levels. Since different time intervals between hCG and IUI did not result in different pregnancy rates, a more flexible approach might be allowed.

Early effects of extracorporeal shock‐wave lithotripsy exposure on testicular sperm morphology

OBJECTIVE

To investigate the effects of extracorporeal shock-wave lithotripsy (ESWL) applied to the pelvic region on testicular histology and spermatogenesis.

MATERIAL AND METHODS

ESWL (2000 shock waves over a 20-min period at 18 kV) was applied to 12 adult New Zealand male rabbits. The rabbits were divided into three equal groups: those in Group 1 were sacrificed 1 h after the intervention, those in Group 2 were sacrificed on the 3rd day and those in Group 3 were sacrificed on the 7th day. Both testicles were removed for histopathological examination to investigate the effects of ESWL. Transmission electron microscopy (TEM) was used to detect ultrastructural changes. Epididymal and testicular touch-print preparations were stained with SperMac stain in order to evaluate the morphology of the spermatozoa.

RESULTS

There were no significant differences between the groups in terms of sperm morphology (p = 0.386). TEM revealed only huge vacuolation of Sertoli cells and diffuse edema in the mitochondria of Sertoli cells.

CONCLUSION

No detrimental effect of ESWL on sperm morphology was detected in this study. We conclude that shock waves do not cause severe permanent effects but only transient disorders in testes.

Intra-uterine insemination versus fallopian tube sperm perfusion for non-tubal infertility

BACKGROUND

Controlled ovarian hyperstimulation (COH) combined with intrauterine insemination (IUI) is commonly offered to couples with subfertility that does not involve the fallopian tubes. Another method is fallopian tube sperm perfusion (FSP). This technique ensures the presence of higher sperm densities in the fallopian tubes at the time of ovulation than does standard IUI. The aim of this review was to determine whether FSP and IUI differ in improving the probability of conception.

OBJECTIVES

To investigate whether pregnancy and live birth outcomes differ between fallopian tube sperm perfusion and intrauterine insemination in the treatment of non-tubal subfertility.

SEARCH STRATEGY

We searched the Menstrual Disorders and Subfertility Group Trials Register (October 2008), MEDLINE (January 1966 to October 2008), and EMBASE (January 1988 to October 2008). Abstracts of the American Society for Reproductive Medicine (1987 to 2008) and European Society for Human Reproduction and Embryology (1987 to 2008) meetings were searched using the same key or text words.

SELECTION CRITERIA

Only truly randomised controlled studies comparing FSP with IUI were included in this review. Couples with non-tubal subfertility who have been trying to conceive for at least one year were included.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected the trials for inclusion based on the quality of the studies.

MAIN RESULTS

Eight studies involving 595 couples were included in the meta-analysis. Only one study reported the live birth rate and there was no evidence of a difference between FSP and IUI (OR 1.2, 95% CI 0.39 to 3.5). There was no evidence of a difference between FSP and IUI for clinical pregnancy per couple (OR 1.2, 95% CI 0.79 to 1.7). A subgroup analysis which included couples with unexplained subfertility only (n = 239) did not report any difference between FSP and IUI (OR 1.6, 95% CI 0.89 to 2.8).

AUTHORS' CONCLUSIONS

For non-tubal subfertility, the results indicate no clear benefit for FSP over IUI. Therefore the advice offered to subfertile couples regarding the comparative use of FSP versus IUI in the treatment of non-tubal subfertility should reflect this.

Standardization of sample preparation, staining and sampling methods for automated sperm head morphometry analysis of boar spermatozoa

The accuracy of computer-assisted sperm morphometry analysis (CASMA) depends on the careful preparation, fixation and staining of spermatozoa. The efficiency of CASMA may be enhanced by developing optimized protocols. The aim of the present study was to evaluate the influence of sperm washing and the use of three staining techniques [rapid Panoptic, Hemacolor and Harris's Haematoxylin (HH)] on image-processing accuracy and boar sperm head morphometry. Sperm washing had a significant effect on samples stained with rapid Panoptic, increasing the percentage of correctly binarized sperm heads and the contrast between cells and background. However, rapid Panoptic yielded the lowest percentage of properly digitized sperm heads. HH provided the highest cell/background contrast, and also greater sperm head staining intensity, but discrimination of sperm midpieces was considered insufficient. Hemacolor occupied an intermediate position, providing acceptable colour intensity and satisfactory cell/background contrast. Use of different staining procedures prompted dimensional differences in sperm head morphometry. Significant differences between animals were observed for all morphometric parameters. Low within-animal variation coefficients reflected a homogeneous sperm head population. Between-animal variation coefficients were relatively high for Hemacolor and HH, and significantly high for the rapid Panoptic stain. Using Panoptic and HH, stable morphometric measurements required at least 100 properly digitized sperm heads rather than 200, while Hemacolor required only 50 spermatozoa. These results indicate that both washing of semen and staining procedures significantly affect the accuracy of image processing and sperm head dimensions. Hemacolor and HH proved to be the best staining techniques for evaluating sperm head dimensions in boar.

Testicular nitric oxide and thiobarbituric acid reactive substances levels in obstructive azoospermia: a possible role in pathophysiology of infertility

Objective. The aim of the study is to evaluate the levels of nitrite/nitrate and thiobarbituric acid reactive substances (TBARS) and their relationship with seminal parameters in experimental obstructive azoospermic rats to explain the possible mechanism of impaired sperm quality in obstructive azoospermia. Methods. A total of 10 male Spraque-Dawley rats underwent bilateral vas resection and ligation (Group-1 = vasectomy group). The findings were compared with control group (Group-2 = sham group, n = 10). Animals were sacrificed 8 weeks after surgery. Testes were removed and used for the evaluation of nitrate/nitrite and TBARS levels and for histology. Epididymal-aspirated seminal plasma was used for semen count and morphological analysis according to the Kruger criteria. Results. Testicular tissue nitrate/nitrite and TBARS levels were 35.7 ± 3.1 μmol/g protein and 3.7 ± 0.1 nmol/g protein in Group-1, and 19.3 ± 0.7 μmol/g protein and 3.1 ± 0.1 nmol/g protein in Group-2, respectively. Both parameters showed statistical differences between the two groups. Testicular tissue nitrate/nitrite and TBARS levels showed negative and statistically significant correlations with sperm motility and morphology. Conclusions. The present study showed that testicular nitrate/nitrite and TBARS levels were increased in obstructive azoospermia. For that reason, we concluded that antioxidant treatment can be recommended to patients before sperm extraction for artificial reproduction due to obstructive infertility after vasectomy reversal.

Influence of staining and sampling procedures on goat sperm morphometry using the Sperm Class Analyzer

Computer-assisted sperm morphometry analysis (ASMA) has improved the assessment of sperm morphology, but the results depend on the use of adequate sampling and staining procedures of spermatozoa from individual species. In this study, the Sperm Class Analyzer ASMA system was used for the morphometric analysis of goat sperm heads. Semen samples, obtained from four bucks, were used to evaluate the influence of three staining procedures (Diff-Quik, Hemacolor and Harris' Haematoxylin) on the accuracy of image processing and sperm morphometry, the effect of the number of cells analysed and the repeatability of the method. These experiments were performed to obtain objective, accurate and reliable sperm morphometric measurements of goat spermatozoa. Diff-Quik and Harris' Haematoxylin were significantly (p<0.05) more accurate than Hemacolor. However, Diff-Quik obtained the highest proportion of correctly analysed sperm heads (86.06%) and the lowest coefficients of variation on the image processing and morphometric measurements. The staining methods affected significantly the sperm dimensions (p<0.001) with increased values from Diff-Quik than Hemacolor and Harris' Haematoxylin, respectively (Diff-Quik>Hemacolor>Harris' Haematoxylin). No differences in morphometric parameters were found when 100, 150, 175 or 200 spermatozoa were analysed. The repeatability of results obtained was very high since no differences were found when measuring the same sperm on multiple attempts. In conclusion, to obtain objective, accurate and repeatable sperm morphometric measurements by the Sperm Class Analyzer system in goats, the analysis of 100 spermatozoa from slides which have been previously stained with Diff-Quik is recommended.

The effects of cryopreservation on the morphometric dimensions of Iberian red deer (Cervus elaphus hispanicus) epididymal sperm heads

Computer-automated sperm-head morphometry was used in this study to determine the effects of cryopreservation on red deer sperm-head morphometry. Epididymal sperm samples were collected from 40 mature stags and were divided. One portion was diluted at room temperature in a Tris-citrate egg yolk medium, containing 6% glycerol. A microscope slide was prepared from single extended sperm samples prior to freezing. The remainder of each sample was frozen in nitrogen vapours. After thawing, sperm smears were prepared as described above. All slides were air dried and stained with Hemacolor. The sperm-head dimensions for length, width, area, perimeter and shape factor (length/width), for a minimum of 135 spermatozoa were determined for each slide by means of the Sperm-Class Analyser (SCA). Firstly, our results show that cryopreservation substantially reduced (p < 0.001) sperm motility and plasma membrane and acrosome integrities. In addition, sperm heads were significantly smaller in cryopreserved spermatozoa than in the companion extended samples for area (32.05 microm2 vs 32.56 microm2; p < 0.05), length (8.46 microm vs 8.53 microm; p < 0.0001) and shape factor (1.833 vs 1.849; p < 0.0001) for all stags. These differences were found within 29 of 40 stags (75%) for at least three of the morphometric parameters. The individual variability (CV) of sperm head measurements from extended samples was negatively correlated (p < 0.005) with the per cent of change in sperm head measurements after cryopreservation for area (r = -0.465), width (r = -0.483) and perimeter (r = -0.375). Thus, the lower the sperm head variability in the extended samples, the greater the sperm change as a consequence of the cryopreservation. These results suggest that the variability (heterogeneity) in sperm head dimensions of individual stags may be a good indicator of sperm freezability.

Morphometric changes in goat sperm heads induced by cryopreservation

Two experiments were designed to evaluate the effect of cryopreservation on morphometric characteristics of the goat sperm head. To address this question, we evaluated the size of the sperm head in fresh control cells, post-cooling cells after equilibration with the glycerol preservation solution, and post-thawing cells. Assessment was by automated morphometric sperm head analysis (ASMA) using phase-contrast microscopy without staining. In the first experiment, ASMA was performed on heterospermic pooled samples (fresh, post-cooling after equilibration with the glycerol preservation solution and post-thawing): length, width, area and perimeter were measured. In the second experiment, sperm viability was assessed by Hoechst staining and head morphometry was carried out as before, simultaneously during the cryopreservation process, and the head size was identified for both live and dead spermatozoa. The data were analysed by principal component analysis (PCA). The purpose of PCA is to derive a small number of linear combinations (principal components) from a set of variables (length, width, area and perimeter), that retain as much of the information in the original variables as possible. The main findings that have emerged from this study are that (i) a simple procedure has been developed for measuring spermatozoa heads without staining, which minimises the possibility that sperm head dimensions were influenced by procedural artefacts; (ii) the dimensions of goat sperm heads after cryopreservation in skimmed milk-glucose medium were smaller than in fresh sperm, but this was due to the equilibration phase with the cryoprotectant and not to the cryopreservation process itself; and (iii) dead spermatozoa showed smaller heads than live sperm, consequent upon the loss of membrane function. No differences were observed between post-cooling cells after equilibration with the glycerol preservation solution and post-thawing spermatozoa and only minor osmotic differences between them and fresh sperm were observed.

Sperm DNA fragmentation negatively correlates with velocity and fertilization rates but might not affect pregnancy rates

OBJECTIVE

To evaluate sperm DNA fragmentation in correlation with sperm parameters and IVF/intracytoplasmic sperm injection (ICSI) outcomes.

DESIGN

Retrospective review.

SETTING

A tertiary infertility referral clinic.

PATIENT(S)

We collected 303 semen samples from patients undergoing IVF with or without ICSI.

INTERVENTION(S)

Terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate-biotin nick end labeling (TUNEL) assay, measurement of fertilization rates, good embryo rates, and pregnancy rates for the IVF/ICSI program.

MAIN OUTCOME MEASURE(S)

The percentage of sperm with DNA fragmentation, correlated with semen analysis parameters and IVF/ICSI outcomes.

RESULT(S)

Sperm DNA fragmentation rates were significantly higher in patients with abnormal sperm parameters than in those with normal sperm parameters. When sperm DNA fragmentation was >10%, fertilization rates were affected. Sperm DNA fragmentation rates were negatively correlated with sperm velocity parameters but did not affect pregnancy outcomes.

CONCLUSION(S)

The results indicated that sperm DNA fragmentation affects fertilization rates and sperm motility but might not affect pregnancy rates.

A multicenter study evaluating the flowcytometric-based kit for semen analysis

OBJECTIVE

To evaluate the precision and accuracy of a flowcytometric-based semen analysis kit and its application in four fertility centers, as compared with routine microscopic evaluation.

DESIGN

A prospective comparative study.

SETTING

Four fertility centers, located in Israel and the United States.

PATIENT(S)

Patients referred to fertility clinic for sperm evaluation.

INTERVENTION(S)

The precision of semen analysis by both methods was evaluated by inter- and intra-technician studies. The accuracy of the sperm counts obtained was assessed by counting a diluted sample and comparing the obtained results with the expected results according to the dilution factor.

MAIN OUTCOME MEASURE(S)

Sperm count, morphology, motility, viability, white cell count, antisperm antibodies.

RESULT(S)

The flowcytometric-based kit for semen analysis is more precise and accurate than the manual routine method. Smaller coefficient of variance (CV%) with results were obtained by the flowcytometric-based kit for all semen parameters as compared with the routine manual methods. Sperm density values determined by the flowcytometric-based kit correlated better with the dilution factor. The agreement rates between the flowcytometric and manual methods are sperm count 90%, motility 82%, vitality 70%, round cell counts 78%, and sperm bound antibodies 100%.

CONCLUSION(S)

Semen analysis by flowcytometric-based kit is advantageous because of improved precision and accuracy compared with the routine method. It provides similar clinical information to that obtained by routine method for sperm count, motility, and antisperm antibodies, and more accurate results for round cell counts (labeled all subclasses) and vitality.

Automated sperm morphometry and morphology analysis of canine semen by the Hamilton-Thorne analyser

Computer-assisted sperm morphometry has the potential to eliminate several drawbacks inherent to the current methods of sperm morphology evaluation, and allows for the identification of subtle sperm characteristics which cannot be detected by visual evaluation. In the present study, the Metrix Oval Head Morphology software implemented in the Hamilton-Thorne CEROS (version 12.1; HTR 12.1 Metrix) computer-aided semen analyser was evaluated for canine sperm morphometry and morphology analysis. Comparison of sperm morphometric measurements of 200 spermatozoa from pooled semen samples (n = 4) at 40x and 60x demonstrated a more accurate identification of the sperm head boundaries at a magnification level 60x. Dilution of pooled semen samples (n = 4) to a sperm concentration of 50 x 10(6) ml(-1) allowed for a correct evaluation of the sperm cell dimensions whereas 100 x 10(6) and 200 x 10(6) ml(-1) resulted in a higher percentage of rejected spermatozoa due to overlapping. No differences in morphometric dimensions were found when 100 or 200 spermatozoa were evaluated for each of 15 dogs. The mean morphometric parameters of canine spermatozoa, based on the fresh ejaculates of 23 dogs, were: major 6.65 +/- 0.20 microm; minor 3.88 +/- 0.14 microm; area 20.66 +/- 1.04 microm2; elongation 58.64 +/- 2.58 %; perimeter 17.57 +/- 0.43 microm and tail length 48.93 +/- 10.16 microm. Large variations in morphometric dimensions were detected among individual dogs. After cryopreservation, significantly lower morphometric dimensions were obtained for all the evaluated sperm samples (n = 12). Finally, a correlation of 0.82 (P < 0.05) was established for the percentage of normal spermatozoa assessed by subjective evaluation and by the HTR 12.1 Metrix (n = 39 semen samples). In conclusion, dilution of the semen samples to approximately 50 x 10(6) spermatozoa/ml and an objective lens magnification of 60x, analysing at least 100 spermatozoa, are the technical settings proposed to obtain reliable and objective sperm morphometric measurements by the HTR 12.1 Metrix in canine.

Canine fresh and cryopreserved semen evaluation

There is little doubt that objective assessment of multiple parameters related to the functional and morphological characteristics of spermatozoa, increase the predictability of the fertilizing potential of a semen sample. Conventional microscopic methods for sperm evaluation in combination with the more objective computer-assisted sperm motility and morphology analyzers and flow cytometry, have allowed investigators to obtain precise information about the morphofunctional status of spermatozoa, which already has resulted in a better understanding of sperm biology and of some of the mechanisms involved in sperm cryoinjury. In addition, assays based on in vitro fertilization provide valuable information about the functional ability of spermatozoa when interacting with the oocyte. Although objective methods for dog sperm evaluation are available for many researchers, considerable effort has still to be invested in order to standardize physiological sperm parameters for the results to be interpretable under unified criteria. In the present paper some of the classical and new methods currently used for dog sperm evaluation are reviewed, though not exhaustively, covering some aspects of the sperm cell that are useful in estimating its functional ability.

Use of the Sperm-Class Analyser for objective assessment of human sperm morphology

The Sperm-Class Analyser was validated for assessing morphometric parameters of the head and midpiece of unwashed and washed human ejaculated spermatozoa from volunteers providing a wide range of semen quality. A higher proportion of sperm could be assessed (86% fresh semen and 75% washed sperm) if Hemacolor staining was used rather than DiffQuik (80 and 73%) or Papanicolaou (78 and 68%). Different stains employed different fixatives and the area, length, width and perimeter of the sperm head was significantly larger for washed sperm stained by Hemacolor and DiffQuik. Acrosomal area ranged from 48 to 51% of the sperm head area and this percentage was larger for washed sperm stained with DiffQuik. Sperm at the end of the slide, distant from the initial semen droplet, were larger in area and perimeter than those at that site or in the middle. The high precision and reproducibility of the equipment required assessing only 50 sperm on the slide. Far greater variation was found in head width, relative acrosomal area and midpiece width between different slides prepared from the same ejaculate, highlighting the inherent variability within the ejaculate and smear preparation, and requiring more than one slide to be assessed.