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Detection of sperm cells by single-stage and two-stage deep object detectors. Biomed Signal Process Control 2023. [DOI: 10.1016/j.bspc.2023.104630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Dupesh S, Pandiyan N, Pandiyan R, Kartheeswaran J, Prakash B. Ejaculatory abstinence in semen analysis: does it make any sense? Ther Adv Reprod Health 2020; 14:2633494120906882. [PMID: 32596668 PMCID: PMC7297125 DOI: 10.1177/2633494120906882] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 01/22/2020] [Indexed: 12/15/2022] Open
Abstract
Background The precise effect of ejaculatory abstinence on semen parameters is highly debatable, especially among subfertile men. Previous studies on effect of abstinence time on different semen parameters have reported controversial results. The aim of this study was to retrospectively assess the variance of semen parameters with different periods of ejaculatory abstinence among both a population of normozoospermic (n = 1621) and oligozoospermic (n = 416) Tamil men, presenting to a fertility clinic for an infertility evaluation (N = 2037). Materials and Methods A retrospective analysis of 2037 semen analysis reports involved grouping patients based on their ejaculatory abstinence, that is, <24 h, 1 to 2 days, 3 to 7 days, 8 to 15 days, 16 to 30 days, and >30 days. All semen parameters were assessed as per the World Health Organization (WHO, 2010) recommended guidelines. The unpaired two-tailed t-test and Welch's analysis of variance (ANOVA) combined with Games-Howell post hoc test were used for statistical analysis. A p value <0.05 was considered to be statistically significant. Result A retrospective analysis of data (N = 2037) identified no statistically significant differences in semen parameters of sperm concentration, percentage of progressively motile sperm, and normal sperm morphology in both normozoospermic and oligozoospermic individuals across different groups of abstinence. Semen volume was the only parameter that showed a statistically significant difference in both groups (p < 0.0001). In both normozoospermic and oligozoospermic men, the group with <24 h abstinence had the highest mean percentage of progressively motile sperm and normal sperm morphology. Conclusion The findings of this study suggest that ejaculatory abstinence may be highly arbitrary, and the recommendation of a strict 2- to 7-day abstinence per the WHO may be liberalized. In both normozoospermic and oligozoospermic men, semen parameters associated with an abstinence of <24 h were found to be noninferior as compared to longer ejaculatory abstinence intervals. These findings support in eliminating conservative recommendations as far as abstinence is concerned and suggest that patients may be asked to collect a semen sample on the day they present for an infertility evaluation, regardless of abstinence.
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Affiliation(s)
- Shah Dupesh
- VRR Institute of Biomedical Sciences, University of Madras, 1/7, MRB Avenue, Bhajanai Koil Street, Kattupakkam, Chennai 600056, India
| | - Natarajan Pandiyan
- Department of Reproductive Medicine, Chettinad Hospital & Research Institute, Chennai, India
| | - Radha Pandiyan
- Department of Reproductive Medicine, Chettinad Hospital & Research Institute, Chennai, India
| | | | - Bhaskar Prakash
- Department of Urology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
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Kaadaaga HF, Ajeani J, Ononge S, Alele PE, Nakasujja N, Manabe YC, Kakaire O. Prevalence and factors associated with use of herbal medicine among women attending an infertility clinic in Uganda. Altern Ther Health Med 2014; 14:27. [PMID: 24433549 PMCID: PMC3898407 DOI: 10.1186/1472-6882-14-27] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 01/10/2014] [Indexed: 11/12/2022]
Abstract
Background Infertility is a public health problem associated with devastating psychosocial consequences. In countries where infertility care is difficult to access, women turn to herbal medicines to achieve parenthood. The aim of this study was to determine the prevalence and factors associated with herbal medicine use by women attending the infertility clinic. Methods This was a cross-sectional study of 260 women attending the infertility clinic at Mulago hospital. The interviewer administered questionnaire comprised socio-demographic characteristics, infertility-related aspects and information on herbal medicine use. The main outcome measure was herbal medicines use for infertility treatment. Determinants of herbal medicine use were assessed using multivariable logistic regression. Results The majority (76.2%) of respondents had used herbal medicines for infertility treatment. The mean age of the participants was 28.3 years ± 5.5. Over 80% were married, 59.6% had secondary infertility and 2/3 of the married participants were in monogamous unions. In a multivariable model, the variables that were independently associated with increased use of herbal medicine among infertile patients were being married (OR 2.55, CI 1.24-5.24), never conceived (OR 4.08 CI 1.86-8.96) and infertility for less than 3 years (OR 3.52 CI 1.51-8.821). Factors that were associated with less use of herbal medicine among infertile women were being aged 30 years or less (OR 0.18 CI 0.07-0.46), primary and no education (OR 0.12 CI 0.05-0.46) and living with partner for less than three years (OR 0.39 CI 0.16-0.93). Conclusions The prevalence of herbal medicine use among women attending the infertility clinic was 76.2%. Herbal medicine use was associated with the participants’ age, level of education, marital status, infertility duration, nulliparity, and duration of marriage. Medical care was often delayed and the majority of the participants did not disclose use of herbal medicines to the attending physician. Health professionals should enquire about use of herbal medicines. This may help in educating the patients about the health risks of using herbal medicine and may reduce delays in seeking appropriate care. Collaboration of health professionals with herbal medicine practitioners would help identify the common herbal medicines used for infertility treatment, their potential benefits and harm.
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Jeon YE, Jung JA, Kim HY, Seo SK, Cho S, Choi YS, Lee BS. Predictive factors for pregnancy during the first four intrauterine insemination cycles using gonadotropin. Gynecol Endocrinol 2013; 29:834-8. [PMID: 23862582 DOI: 10.3109/09513590.2013.808324] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Although a variety of factors have been reported as affecting pregnancy rates after intrauterine insemination (IUI), there have been conflicting results on prognostic factors. This study aimed to determine predictive factors for pregnancy in patients undergoing the first four IUI cycles. METHODS A total of 348 IUI cycles using clomiphene citrate or letrozole combined with gonadotropin, or gonadotropin only were analyzed. Baseline clinical characteristics, variables related to ovulation induction and sperm parameters were compared between pregnant (n = 54) and non-pregnant groups (n = 294). Logistic regression analysis was performed to identify factors that could predict a pregnancy. RESULTS The overall clinical pregnancy rate was 15.5% (54/348) per cycle and 30.0% (54/180) per couple. During the first four IUI cycles, logistic regression analysis revealed that woman who were 39 years or older (OR: 0.263, 95% CI: 0.076-0.906, p = 0.034), longer duration of infertility (OR: 0.967, 95% CI: 0.942-0.993, p = 0.012), endometriosis (versus unexplained infertility; OR: 0.177, 95% CI: 0.040-0.775, p = 0.022) and endometrial thickness below 7 mm (OR: 0.114, 95% CI: 0.015-0.862, p = 0.035) were unfavorable factors to predict clinical pregnancy. CONCLUSIONS Women with old age, longer duration of infertility, the presence of endometriosis or thin endometrium in the preovulatory phase may have unfavorable outcomes during the first four IUI cycles.
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Affiliation(s)
- Young Eun Jeon
- Department of Obstetrics and Gynecology, Gangnam Severance Hospital, Yonsei University College of Medicine, Gangnam-gu Seoul, Republic of Korea
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Additional value of computer assisted semen analysis (CASA) compared to conventional motility assessments in pig artificial insemination. Theriogenology 2011; 76:1473-86.e1. [DOI: 10.1016/j.theriogenology.2011.05.040] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Revised: 05/03/2011] [Accepted: 05/04/2011] [Indexed: 11/21/2022]
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Tomlinson MJ, Pooley K, Simpson T, Newton T, Hopkisson J, Jayaprakasan K, Jayaprakasan R, Naeem A, Pridmore T. Validation of a novel computer-assisted sperm analysis (CASA) system using multitarget-tracking algorithms. Fertil Steril 2010; 93:1911-20. [DOI: 10.1016/j.fertnstert.2008.12.064] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2008] [Revised: 12/16/2008] [Accepted: 12/17/2008] [Indexed: 10/21/2022]
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Bassas Arnau L. [Exploration of testicular function]. ACTA ACUST UNITED AC 2009; 56:18-31. [PMID: 19627705 DOI: 10.1016/s1575-0922(09)70190-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2008] [Accepted: 09/22/2008] [Indexed: 10/21/2022]
Abstract
The main endocrine function of the testis after puberty is testosterone production. In most cases, hypogonadism in adult men can be diagnosed by determining total testosterone concentration. Due to the circadian rhythm of testosterone secretion, blood samples should be extracted early in the morning. The results of commercially available methods for analysis show considerable variability. Furthermore, the threshold for the symptoms of hypogonadism may differ in each individual. For these reasons, moderately low testosterone levels should be interpreted with caution before a diagnosis of hypogonadism can be established. In these cases, determination of either free or bioavailable testosterone can be useful. Direct methods can be used or the respective concentrations can be calculated on the basis of total testosterone and sex hormone-binding globulin (SHBG). This latter method is easy to perform but the results are less reliable. Endocrinological evaluation of the testes should also include analysis of the gonadotropins (follitropin [FSH] and lutropin [LH]), which are described in another article in this series. Inhibin B is a biological marker of the amount and the physiological status of Sertoli cells in the postpubertal testis. Inhibin B may improve the information given by FSH for the determination of spermatogenic reserve in non-obstructive azoospermia, but determination of this glycoprotein is not currently used for routine assessment. The most important laboratory test to study reproductive function in men is semen analysis. However, the predictive power of this test is limited by the analytical imprecision of current methods, all of which are manual, and by the biological variability of most of their components. Special attention should be paid to pre-analytical procedures, because they require the understanding and participation of the patient. Some organizations and societies have proposed standardized methods to help improve the quality of semen analysis and reliable exchange of the results of seminogram. Biochemical markers of the prostate, seminal vesicles and epididymis in seminal plasma can indicate the level of damage in hypospermia or azoospermia. The fertility potential of sperm cells can be investigated with a variety of tests and assays, but none of them can yet be recommended for routine practice. Congenital hypogonadism is frequently caused by chromosome abnormalities, particularly sex chromosomal aneuploidies. Other causes of infertility include structural aberrations of autosomes. The main cytogenetic technique performed to determine chromosome constitution is karyotyping. To detect submicroscopic defects, this test can be performed in conjunction with fluorescent in situ hybridization (FISH).
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Affiliation(s)
- Lluís Bassas Arnau
- Laboratorio de Andrología, Fundación Puigvert, Cartagena 340, 08025 Barcelona, España.
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Gandini R, Konda D, Reale CA, Pampana E, Maresca L, Spinelli A, Stefanini M, Simonetti G. Male varicocele: transcatheter foam sclerotherapy with sodium tetradecyl sulfate--outcome in 244 patients. Radiology 2008; 246:612-8. [PMID: 18227549 DOI: 10.1148/radiol.2462061295] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To retrospectively evaluate the recurrence rate, resolution of pain, improvement of semen parameters, and achievement of pregnancy after transcatheter foam sclerotherapy (TCFS) in varicocele by using sodium tetradecyl sulfate (STS) foam. MATERIALS AND METHODS The institutional review board approved the study; informed consent was waived. A retrospective study was conducted in 244 consecutive male patients (mean age, 28.2 years; range, 17-42 years) with 280 varicoceles treated with TCFS between January 2000 and January 2004. The gonadal vein was selectively catheterized by using left antecubital transbrachial venous access; a foam of 3% STS and air was injected. Follow-up was performed with physical and Doppler ultrasonographic examinations and by using a questionnaire-based assessment of pain and pregnancy. Semen analysis was performed according to World Health Organization guidelines. Significant differences in semen parameters before and after treatment were determined by using the Wilcoxon signed rank test. RESULTS Technical success rate was 97.1% (272 varicoceles). Complete follow-up results (mean, 40.3 months +/- 19.46 [standard deviation]) in 225 varicoceles (80.4%) revealed eight (3.6%) grade II-III recurrent varicoceles and resolution of pain in 164 (96.5%) of 170 cases. Statistically significant improvement of all semen parameters was achieved in infertile patients after treatment (P < .001). Of 59 patients with pretreatment sperm alterations who desired pregnancy, 23 (39.0%) achieved pregnancy (mean follow-up, 28.6 months +/- 7.77). CONCLUSION TCFS in male varicocele with 3% STS foam was associated with a low recurrence rate, a high rate of pain resolution, and a significant improvement of pretreatment sperm parameter alterations; a substantial increase in pregnancy achievement was obtained for patients with pretreatment sperm alterations who desired pregnancy.
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Affiliation(s)
- Roberto Gandini
- Department of Diagnostic Imaging, University Polyclinic of Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
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van Zyl JA, Menkveld R. Oligozoospermia: recent prognosis and the outcome of 73 pregnancies in oligozoospermic couples. Andrologia 2006; 38:87-91. [PMID: 16669917 DOI: 10.1111/j.1439-0272.2006.00720.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The minimum value for each of the five main semen parameters, below which conception rarely occurred or did not occur at all, was calculated in a group of 1884 couples complaining of primary and secondary infertility: 304 conceptions including first as well as consecutive conceptions, occurred. The parameters evaluated were (minimum value calculated in this study between brackets) volume (1.0 ml), sperm count ml(-1) (2.0 million), total sperm count (4.0 million), motility (10%), forward progression (2.0 MacLeod units: scale 1-4) and normal sperm morphology (3%). The pregnancy rate in the group of 308 oligozoospermic men and the minimum value of semen parameters were the cornerstones in determining the prognosis for oligozoospermic patients. A sperm count of >2.0 million ml(-1) was considered relatively adequate for eventual conception judged by the 68 of 308 (22.1%) pregnancies that occurred among oligozoospermic men in this study, provided that the other five semen parameters showed values above the minimum value. In cases where the average sperm count was <2 million ml(-1), the chances for conception became rare, viz five of 308 (1.6%). The total number of pregnancies in the group classified as oligozoospermic was 73 (23.7%). With these pregnancies there was no increase in the rate of foetal wastage and congenital abnormalities. Abortion occurred in 15.09% and ectopic pregnancy in 0.9% among first and consecutive pregnancies. One infant among the 56% boys and 44% girls was born with congenital abnormalities. Most of these infants had a normal birth mass of >2500 g.
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Affiliation(s)
- J A van Zyl
- Department of Andrology and Department of Obstetrics and Gynecology, University of Stellenbosch and Tygerberg Hospital, Tygerberg, South Africa.
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van der Merwe FH, Kruger TF, Oehninger SC, Lombard CJ. The Use of Semen Parameters to Identify the Subfertile Male in the General Population. Gynecol Obstet Invest 2005; 59:86-91. [PMID: 15572878 DOI: 10.1159/000082368] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2004] [Accepted: 09/27/2004] [Indexed: 11/19/2022]
Abstract
AIMS To present a structured review of the literature published on semen parameters and in vivo fertility potential and to establish fertility/subfertility thresholds for sperm morphology using Tygerberg strict criteria, sperm concentration, and sperm motility. METHOD The published literature comparing fertile and subfertile populations between 1983 and 2002 was reviewed. RESULTS A total of 265 articles were identified by the sourcing methodology, but only four articles provided data that could be tabulated and analyzed. Using receiver-operating characteristics curves, morphology proved to be the best predictor of subfertility in 2 of the 4 articles, with concentration and motility also showing good predictive power. The thresholds calculated ranged between 4 and 10% for morphology, between 13.5 x 10(6)/ml and 34 x 10(6)/ml for concentration, and between 32 and 52% for motility. A second set of much lower thresholds was calculated in three of the articles using either a 15 or 50% prevalence of subfertility in the population or the tenth percentile of the fertile population. The adjusted thresholds were between 3 and 5% for morphology, between 9 x 10(6)/ml and 20 x 10(6)/ml for concentration, and between 20 and 30% for motility. CONCLUSIONS Because these lower thresholds have a much higher positive predictive value, we suggest that thresholds of <5% normal sperm morphology, a concentration <15 x 10(6)/ml, and a motility <30% should be used to identify the subfertile male. The lower threshold for morphology also fits in vitro fertilization and intrauterine insemination data calculated previously. Using the parameters in combination increases the clinical value of semen analysis.
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Affiliation(s)
- F H van der Merwe
- Reproductive Biology Unit, Department of Obstetrics and Gynecology, University of Stellenbosch and Tygerberg Hospital, Tygerberg, South Africa.
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Jensen TK, Andersson AM, Jørgensen N, Andersen AG, Carlsen E, Petersen JH, Skakkebaek NE. Body mass index in relation to semen quality and reproductive hormones among 1,558 Danish men. Fertil Steril 2004; 82:863-70. [PMID: 15482761 DOI: 10.1016/j.fertnstert.2004.03.056] [Citation(s) in RCA: 447] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2003] [Revised: 03/15/2004] [Accepted: 03/15/2004] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To examine the relationship between body mass index (BMI) and semen quality among young men from the general population. DESIGN Cross-sectional study. SETTING Danish young men were approached when they attended a compulsory physical examination to determine their fitness for military service. PATIENT(S) From 1996-1998, 1,558 (19%) young men (mean age 19 years) volunteered. MAIN OUTCOME MEASURE(S) Semen volume (in milliliters), sperm concentration (in million per milliliter), percentage of motile spermatozoa, percentage of spermatozoa with normal morphology, total sperm count (in million), and testis size (in milliliters). In addition, serum reproductive hormones were measured. RESULT(S) Serum T, sex hormone-binding globulin (SHBG), and inhibin B all decreased with increasing BMI, whereas free androgen index and E(2) increased with increasing BMI. Serum FSH was higher among slim men. After control for confounders, men with a BMI <20 kg/m(2) had a reduction in sperm concentration and total sperm count of 28.1% (95% confidence interval [CI] 8.3%-47.9%) and 36.4% (95% CI 14.6%-58.3%), respectively, and men with a BMI >25 kg/m(2) had a reduction in sperm concentration and total sperm count of 21.6% (95% CI 4.0%-39.4%) and 23.9% (95% CI 4.7%-43.2%), respectively, compared to men with BMI between 20-25 kg/m(2). Percentages of normal spermatozoa were reduced, although not significantly, among men with high or low BMI. Semen volume and percentage of motile spermatozoa were not affected by BMI. CONCLUSION(S) High or low BMI was associated with reduced semen quality. It remains to be seen whether the increasing occurrence of obesity in the Western world may contribute to an epidemic of poor semen quality registered in some of the same countries. If so, some cases of subfertility may be preventable.
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Affiliation(s)
- Tina Kold Jensen
- University Department of Growth and Reproduction, Rigshospitalet, Copenhagen, Denmark.
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Hirano Y, Shibahara H, Shimada K, Yamanaka S, Suzuki T, Takamizawa S, Motoyama M, Suzuki M. Accuracy of sperm velocity assessment using the Sperm Quality Analyzer V. Reprod Med Biol 2004; 2:151-157. [PMID: 29699178 DOI: 10.1111/j.1447-0578.2003.00039.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Aim: The correct diagnosis of the functional capacity of human sperm is limited. The Sperm Quality Analyzer (SQA) with the visualization system (SQA V, Medical Electronic System, Hatavorzo, Israel), an upgraded version of SQA, was recently developed to provide a rapid and low-cost quantitative evaluation of sperm quality as well as sperm velocity assessment. The aim of the present study was to evaluate whether the SQA V's new parameters correlate with computer-aided sperm analysis (CASA) estimates. Methods: Semen quality analysis of 66 fresh samples was determined using SQA V and CASA. Results: There were significant correlations of total sperm concentration (P < 0.001), sperm motility (P = 0.145), and percentage of progressive motile sperm (P = 0.001), between the SQA V variables and the CASA estimates. The sperm velocity assessed by SQA V was significantly correlated with some of the CASA estimates, including sperm motility (P = 0.001), the percentage of progressively motile sperm (P < 0.001), straight-line velocity (P < 0.001), curvilinear velocity (P < 0.001) and average path velocity (P < 0.001). However, it did not correlate with amplitude of lateral head displacement, beat cross frequency, straightness, or linearity, assessed by CASA. Conclusion: Assessment of sperm motility has been shown as one of the important factors to predict the functional capacity of human sperm. On the basis of the present study, SQA V is considered useful for screening sperm quality in the management of male infertility. (Reprod Med Biol 2003; 2: 151-157).
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Affiliation(s)
- Yuki Hirano
- Department of Obstetrics and Gynecology, Jichi Medical School and
| | | | - Kazuhiko Shimada
- Department of Obstetrics and Gynecology, Jichi Medical School and
| | - Seiji Yamanaka
- Department of Obstetrics and Gynecology, Jichi Medical School and
| | - Tatsuya Suzuki
- Department of Obstetrics and Gynecology, Jichi Medical School and
| | | | | | - Mitsuaki Suzuki
- Department of Obstetrics and Gynecology, Jichi Medical School and
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Kratz E, Poland DCW, van Dijk W, Katnik-Prastowska I. Alterations of branching and differential expression of sialic acid on alpha-1-acid glycoprotein in human seminal plasma. Clin Chim Acta 2003; 331:87-95. [PMID: 12691868 DOI: 10.1016/s0009-8981(03)00084-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND The degree of branching and types of fucosylation of glycans on alpha(1)-acid glycoprotein (AGP) have been found to be associated with alpha(1)-acid glycoprotein concentrations in human seminal plasma. The glycosylation pattern of alpha(1)-acid glycoprotein in seminal plasma obtained from men living in infertile couples can undergo alterations in relation to sperm analysis and/or alpha(1)-acid glycoprotein concentrations. METHODS The glycosylation of alpha(1)-acid glycoprotein was studied upon the reactivity with specific lectins by crossed affinity immunoelectrophoresis (concanavalin A), and by glycoprotein lectin immunosorbent assay (Maackia amurensis and Sambucus nigra lectins), as well as high pH anion-exchange chromatography with pulsed amperometric detection. RESULTS Nonsignificant differences in alpha(1)-acid glycoprotein glycan branching and degree of its sialylation were observed among the AGP derived from seminal plasmas in relation to spermiogram and sperm morphology. However, significant concentration-dependent differences were found in extent of branching and type of sialylation. CONCLUSIONS The presence in seminal plasma of high concentrations of aberrantly glycosylated AGP molecules might be indicative for a chronic inflammatory condition in the reproductive tract, and can be used as additional tool to subdivide the seminal plasmas of men living in infertile couples.
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Affiliation(s)
- Ewa Kratz
- Department of Chemistry and Immunochemistry, Wrocław Medical University, Bujwida 44a., 50-345, Wrocław, Poland
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Tournaye H, Verheyen G, Albano C, Camus M, Van Landuyt L, Devroey P, Van Steirteghem A. Intracytoplasmic sperm injection versus in vitro fertilization: a randomized controlled trial and a meta-analysis of the literature. Fertil Steril 2002; 78:1030-7. [PMID: 12413989 DOI: 10.1016/s0015-0282(02)03377-0] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To compare ICSI with IVF using two insemination concentrations in moderate male infertility and to compare these data with other randomized controlled trials (RCTs). DESIGN Prospective, randomized, controlled trial and meta-analysis. SETTING University-based tertiary referral center. PATIENT(S) Seventy-three couples undergoing ART. INTERVENTION(S) In one IVF group a standard insemination concentration of 0.2 x 10(6)/mL was used, whereas in the other group a high insemination concentration (HIC) of 0.8 x 10(6)/mL was used. Each protocol was compared with ICSI on sibling oocytes. MAIN OUTCOME MEASURE(S) Fertilization, fertilization failure, and embryonic development. RESULT(S) The overall fertilization rate was significantly lower after standard IVF than after ICSI: 37.4% vs. 64.3%. Where HIC IVF was used, the overall fertilization rate was not significantly different from that after ICSI: 59.6% vs. 67.6%. Eight randomized controlled trials were selected and reviewed together with the present randomized controlled trial by meta-analysis. The risk ratio for an oocyte to become fertilized was 1.9 (95% confidence interval of 1.4 to 2.5) in favor of ICSI, and 3.1 ICSI cycles may be needed to avoid one complete fertilization failure after conventional IVF (95% CI of 1.7 to 12.4). CONCLUSION(S) The data from this study and the meta-analysis show that ICSI is a more efficient technique in terms of fertilization, but not in comparison with HIC IVF.
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Affiliation(s)
- Herman Tournaye
- Center for Reproductive Medicine, Dutch-Speaking Brussels Free University, Brussels, Belgium.
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Burrows PJ, Schrepferman CG, Lipshultz LI. Comprehensive office evaluation in the new millennium. Urol Clin North Am 2002; 29:873-94. [PMID: 12516759 DOI: 10.1016/s0094-0143(02)00091-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The success of a comprehensive office-based evaluation of male-factor infertility depends on the physician's thorough understanding of risk assessment in the history, identification of pertinent physical examination findings, and correct assessment of laboratory data. Office-based ultrasonographic techniques have already increased the urologist's ability to visualize suspected anatomic abnormalities, and the use of functional tests of sperm has given greater depth to the limited, but essential, prognostic capabilities of the routine semen analysis.
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Affiliation(s)
- Peter J Burrows
- Division of Male Reproductive Medicine and Surgery, Scott Department of Urology, Baylor College of Medicine, 6560 Fannin, Houston, Texas 77030, USA
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Suzuki T, Shibahara H, Tsunoda H, Hirano Y, Taneichi A, Obara H, Takamizawa S, Sato I. Comparison of the Sperm Quality Analyzer IIC variables with the computer-aided sperm analysis estimates. INTERNATIONAL JOURNAL OF ANDROLOGY 2002; 25:49-54. [PMID: 11869377 DOI: 10.1046/j.1365-2605.2002.00324.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Sperm Quality Analyzer (SQA) IIC, an upgrade version, is an inexpensive device and provides a quantitative estimation of sperm motility, whereas the use of computer-aided sperm analysis (CASA) provides high precision and provision of quantitative data on sperm kinetics. The aim of the present study was to evaluate if the SQA IIC variables correlated with the CASA estimates. Semen quality analysis of 71 fresh semen samples was performed using SQA IIC and CASA. Total sperm concentration, percentage of progressively motile sperm, percentage of normal morphology, motile sperm concentration, sperm motility index (SMI) and functional sperm count (FSC) determinations were performed using SQA IIC. Sperm concentration, sperm motility, and sperm motion variables including amplitude of lateral head displacement (ALH), beat cross frequency (BCF), curvilinear velocity (VCL), straight line velocity (VSL), average path velocity (VAP), linearity (LIN=VSL/VCL), and straightness (STR=VSL/VAP) were evaluated simultaneously on the same semen samples using CASA. The sperm characteristics were compared between SQA IIC and CASA. There were significant correlations of sperm concentration (r=0.634, p < 0.0001), sperm motility (r=0.697, p < 0.0001), and motile sperm concentration (r=0.757, p < 0.0001) between the two devices. Both SMI and FSC significantly correlated with eight CASA estimates, including sperm concentration, sperm motility, motile sperm concentration, ALH, VCL, VSL, VAP, and Rapid. SQA IIC is simple and easy to use. Moreover, the SQA IIC variables well correlated with the CASA estimates. As a screening test for semen quality, SQA IIC is considered as useful in the management of male infertility.
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Affiliation(s)
- Tatsuya Suzuki
- Department of Obstetrics and Gynecology, Jichi Medical School, Kawachi-gun, Tochigi, Japan
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Guzick DS, Overstreet JW, Factor-Litvak P, Brazil CK, Nakajima ST, Coutifaris C, Carson SA, Cisneros P, Steinkampf MP, Hill JA, Xu D, Vogel DL. Sperm morphology, motility, and concentration in fertile and infertile men. N Engl J Med 2001; 345:1388-93. [PMID: 11794171 DOI: 10.1056/nejmoa003005] [Citation(s) in RCA: 797] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although semen analysis is routinely used to evaluate the male partner in infertile couples, sperm measurements that discriminate between fertile and infertile men are not well defined. METHODS We evaluated two semen specimens from each of the male partners in 765 infertile couples and 696 fertile couples at nine sites. The female partners in the infertile couples had normal results on fertility evaluation. The sperm concentration and motility were determined at the sites; semen smears were stained at the sites and shipped to a central laboratory for an assessment of morphologic features of sperm with the use of strict criteria. We used classification-and-regression-tree analysis to estimate threshold values for subfertility and fertility with respect to the sperm concentration, motility, and morphology. We also used an analysis of receiver-operating-characteristic curves to assess the relative value of these sperm measurements in discriminating between fertile and infertile men. RESULTS The subfertile ranges were a sperm concentration of less than 13.5 x 10(6) per milliliter, less than 32 percent of sperm with motility, and less than 9 percent with normal morphologic features. The fertile ranges were a concentration of more than 48.0 x 10(6) per milliliter, greater than 63 percent motility, and greater than 12 percent normal morphologic features. Values between these ranges indicated indeterminate fertility. There was extensive overlap between the fertile and the infertile men within both the subfertile and the fertile ranges for all three measurements. Although each of the sperm measurements helped to distinguish between fertile and infertile men, none was a powerful discriminator. The percentage of sperm with normal morphologic features had the greatest discriminatory power. CONCLUSIONS Threshold values for sperm concentration, motility, and morphology can be used to classify men as subfertile, of indeterminate fertility, or fertile. None of the measures, however, are diagnostic of infertility.
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Affiliation(s)
- D S Guzick
- Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, NY 14642, USA.
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Vazquez-Levin MH, Chue J, Goldberg S, Medley NE, Nagler HM. The relationship between critical evaluation of sperm morphology and the TYB-optimized zona free hamster oocyte sperm penetration assay. INTERNATIONAL JOURNAL OF ANDROLOGY 1999; 22:329-35. [PMID: 10509234 DOI: 10.1046/j.1365-2605.1999.00188.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The objective of this study was to analyse the relationship between the percentage of spermatozoa in semen with normal morphology, assessed using the Tygerberg criteria, and sperm fertilizing ability assessed using the TYB-optimized zona free hamster oocyte sperm penetration assay (TYB-optimized SPA), to evaluate the predictive value of strict morphology on outcome of the SPA. In a retrospective study, 56 samples were analysed. In addition to routine semen parameters, the percentage of spermatozoa with normal morphology (A forms) and the average number of penetrations per oocyte (Sperm Capacitation Index) was evaluated in all cases. Using a multiple linear regression analysis with all semen parameters, sperm morphology was the best predictor (p = 0.001) of the SPA score. The agreement between the percentage of A forms and the Sperm Capacitation Index beyond chance (kappa coefficient) was 0.5842. Twenty-two specimens had abnormal SPA scores, with 21 exhibiting abnormal sperm morphology (Sensitivity = 96%). The remaining 34 samples had normal Sperm Capacitation Index values; of these, 23 had normal sperm morphology in semen (Specificity = 68%). The positive predictive value was 96%, and the negative predictive value was 66%. All semen samples from control donors had normal semen parameters and Sperm Capacitation Index values. In conclusion, the percentage of spermatozoa with normal morphology assessed using Tygerberg criteria (> 14% A forms) are predictive of the results in the TYB-optimized SPA. However, sperm morphology appears to be a better predictor when it is normal than when it is abnormal.
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Affiliation(s)
- M H Vazquez-Levin
- Instituto de Biología y Medicina Experimental, Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
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20
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Abstract
The inability to conceive a child is most often viewed as a private matter, but public health perspectives and skills can contribute greatly to our knowledge about infertility, and the development of effective and rational public policy for prevention, access to health care, and regulation of new technologies. We offer a primer of public health aspects of infertility in an effort to encourage the broad spectrum of public health professionals to become more knowledgeable about these topics and join in the national debate about preventive strategies, cost-benefit assessment, resource allocation, and ethics.
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MESH Headings
- Costs and Cost Analysis
- Female
- Humans
- Infertility, Female/economics
- Infertility, Female/etiology
- Infertility, Female/prevention & control
- Infertility, Female/psychology
- Infertility, Female/therapy
- Infertility, Male/economics
- Infertility, Male/etiology
- Infertility, Male/prevention & control
- Infertility, Male/psychology
- Infertility, Male/therapy
- Male
- Public Health/economics
- Reproductive Techniques/economics
- Social Problems/economics
- Social Problems/prevention & control
- Social Problems/psychology
- United States
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Affiliation(s)
- A T Fidler
- Public Health Practice Program Office, Centers for Disease Control and Prevention, Atlanta, USA.
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Bonde JP, Ernst E, Jensen TK, Hjollund NH, Kolstad H, Henriksen TB, Scheike T, Giwercman A, Olsen J, Skakkebaek NE. Relation between semen quality and fertility: a population-based study of 430 first-pregnancy planners. Lancet 1998; 352:1172-7. [PMID: 9777833 DOI: 10.1016/s0140-6736(97)10514-1] [Citation(s) in RCA: 471] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Semen analysis is part of the routine assessment of infertile couples. WHO defines a sperm concentration above 20x10(6) per mL seminal fluid as normal. We studied the association between semen quality and the probability of conception in a single menstrual cycle in Danish couples with no previous reproductive experience. METHODS In 1992-94, we invited 52,255 trades-union members aged 20-35 years, who lived with a partner and had no children to take part in the study; 430 couples agreed. The couples discontinued use of contraception, and were followed up for six menstrual cycles or until a pregnancy was verified within this period. Each man was asked to provide a semen sample at enrolment (which was analysed without freezing). Women kept a daily record of vaginal bleeding and sexual activity. The association between semen quality and likelihood of pregnancy was assessed by logistic regression, adjusted for sexual activity and female factors associated with low fertility. RESULTS There were 256 (59.5%) pregnancies among the 430 couples: 165 (65.0%) among those with a sperm concentration of 40x10(6)/mL or more and 84 (51.2%) among those with lower sperm concentrations. The probability of conception increased with increasing sperm concentration up to 40x10(6)/mL, but any higher sperm density was not associated with additional likelihood of pregnancy. The proportion of sperm with normal morphology was strongly related to likelihood of pregnancy independently of sperm concentration. Semen volume and motility were of limited value in pregnancy prediction. INTERPRETATION Our study suggests that the current WHO guidelines for normal semen quality should be used with caution. Some men with sperm counts above the lower limit of the normal range defined by WHO may in fact be subfertile.
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Affiliation(s)
- J P Bonde
- Department of Occupational Medicine, University Hospital or Aarhus, Denmark
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22
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Abstract
Within 40 s the Sperm Quality Analyzer (United Medical Systems, Santa Ana, CA, USA) provides a numerical value called the sperm motility index. This index reflects both the concentration of motile sperm cells and the intensity of their motility and cannot be determined by conventional semen analysis. To assess the diagnostic value and reliability of the sperm motility index, 155 ejaculates were investigated by the sperm quality analyzer and routine manual methods. The sperm motility index shows a good correlation with sperm density, motility, morphology, which are crucial parameters for male fertility.
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23
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Matson PL. Clinical value of tests for assessing male infertility. BAILLIERE'S CLINICAL OBSTETRICS AND GYNAECOLOGY 1997; 11:641-54. [PMID: 9692008 DOI: 10.1016/s0950-3552(97)80004-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The laboratory assessment of the male partner of an infertile couple is an important aspect of the overall investigation of that couple. The laboratory tests are designed essentially to determine whether (a) the semen samples contain adequate numbers of normal motile sperm, and the sperm are able (b) to migrate to the site of fertilization and (c) to fertilize oocytes. Within this framework, tests can be viewed as being either descriptive, in terms of describing the ejaculate and sperm, or assessing functional qualities of the sperm. Irrespective of the nature of the test, it must satisfy simple criteria, namely being reproducible and able to discriminate between the fertile and infertile populations reliably. External quality assurance programmes now exist for semen analysis and allied techniques to help laboratories to standardize their reporting and to identify the source of possible errors.
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Affiliation(s)
- P L Matson
- Concept Fertility Centre, King Edward Memorial Hospital, Subiaco, Western Australia, Australia
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24
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Shlansky-Goldberg RD, VanArsdalen KN, Rutter CM, Soulen MC, Haskal ZJ, Baum RA, Redd DC, Cope C, Pentecost MJ. Percutaneous varicocele embolization versus surgical ligation for the treatment of infertility: changes in seminal parameters and pregnancy outcomes. J Vasc Interv Radiol 1997; 8:759-67. [PMID: 9314365 DOI: 10.1016/s1051-0443(97)70657-2] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To compare the success of percutaneous varicocele embolization to surgical ligation with regard to changes in semen characteristics and pregnancy outcome. MATERIALS AND METHODS Infertility records from 346 men who underwent correction of their varicocele for infertility (surgical ligation 149; embolization 197) were reviewed retrospectively. Preprocedural and postprocedural semen analyses and pregnancy outcomes were obtained with use of chart and telephone follow-up. RESULTS In men who successfully impregnated their partners, there were significant improvements in sperm density, percent total improvement, motility, and progression. Postprocedural (embolization vs surgery) percentage increases in seminal parameters were density, 156.8% versus 138.5%; total, 168.8% versus 157.91%; and motility, 2.7% versus 3.2%. The percent of individuals who had a change in sperm progression was 31% versus 41%. There was no statistical difference between the techniques based on t tests. The pregnancy rates were similar for the two groups, 39% and 34% for embolization and surgery, respectively. CONCLUSION There is no significant statistical difference in seminal values or pregnancy outcome between the two techniques.
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Affiliation(s)
- R D Shlansky-Goldberg
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia 19104, USA
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25
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Abdul-Aziz M, MacLusky NJ, Bhavnani BR, Casper RF. Hyaluronidase activity in human semen: correlation with fertilization in vitro*†*Supported by Medical Research Council of Canada, Ottawa, Ontario, Canada.†Presented in part at the Canadian Fertility and Andrology Society, St. Andrew’s by the Sea, New Brunswick, Canada, September 7 to 9, 1994. Fertil Steril 1995. [DOI: 10.1016/s0015-0282(16)57976-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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26
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Paston MJ, Sarkar S, Oates RP, Badawy SZ. Computer-aided semen analysis variables as predictors of male fertility potential. ARCHIVES OF ANDROLOGY 1994; 33:93-9. [PMID: 7818377 DOI: 10.3109/01485019408987809] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A computer-aided semen analysis (CASA) was used to allow digitizing the motion of the spermatozoon. This procedure allows an objective means of judging semen quality, especially the translational movements of spermatozoa. Forty-three couples were included in the study. The average age of the male was 35.5 +/- 4.7 years and that of the female was 32.7 +/- 4.7 years. The average duration of infertility was 3.8 +/- 2.3 years. Using multiple linear regression analysis of 26 prognostic variables, a cluster of 8 variables significantly predicted pregnancy maximally. The 8 variables and the resultant multiple correlation coefficients were used to generate a multiple regression equation which allowed the correct separation of the population into fertile and infertile couples. The mean pregnancy predictor values of the fertile and infertile populations were significantly different using the analysis of variance.
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Affiliation(s)
- M J Paston
- Department of Ob/Gyn, SUNY Health Science Center, Syracuse 13210
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27
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Bahamondes L, Alma FA, Faúndes A, Vera S. Score prognosis for the infertile couple based on historical factors and sperm analysis. Int J Gynaecol Obstet 1994; 46:311-5. [PMID: 7806001 DOI: 10.1016/0020-7292(94)90411-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To identify variables, obtained from historical factors and sperm analysis, associated with greater chances of pregnancy in infertile couples. METHODS The study was carried out in Córdoba, Argentina. The characteristics of 247 couples consulting for infertility who achieved pregnancy within 3 years of their first visit were compared with those of 312 couples who did not become pregnant. We evaluated the relationship between the age of the woman and her partner, the type and duration of infertility, length of the last three menstrual cycles, history of pelvic surgery in the woman, and testicular volume, sperm density, motility and morphology in her partner, and the achievement of pregnancy. For the analysis, logistic regression was used. RESULTS Six variables had a predictive value: sperm morphology, the woman's age, type and duration of infertility, her history of pelvic surgery, and duration of menstrual cycles. CONCLUSIONS The best prognosis for future fertility in infertile couples is correlated with a higher percentage of normal sperm morphology, younger woman's age, secondary infertility, fewer years of infertility, negative history of pelvic surgery, and abnormal menstrual cycles.
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Affiliation(s)
- L Bahamondes
- Centro de Controle e Pesquisas das Doenças Materno-Infantis (CEMICAMP), Campinas, SP, Brazil
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28
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Eimers JM, te Velde ER, Gerritse R, Vogelzang ET, Looman CW, Habbema JD. The prediction of the chance to conceive in subfertile couples. Fertil Steril 1994; 61:44-52. [PMID: 8293843 DOI: 10.1016/s0015-0282(16)56451-6] [Citation(s) in RCA: 118] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To develop a model that can predict the chance to conceive spontaneously in subfertile couples. DESIGN In a cohort study, a consecutive series of patients consulting infertility was followed up. We related information from previous history, physical examination, postcoital tests (PCT), semen analyses, and sperm penetration meter tests with the occurrence of a spontaneous pregnancy. SETTING Fertility center in a university hospital. PATIENTS Nine hundred ninety-six couples consulting for infertility due to cervical hostility, male subfertility, or unexplained infertility. INTERVENTIONS None. MAIN OUTCOME MEASURE(S) Time between intake and occurrence of the first spontaneous pregnancy. RESULTS Information from the previous history (duration of infertility, primary or secondary female infertility, age of the woman, fertility problems in male's family), the percentage motile sperm in the first semen analysis, and the result of the first PCT are sufficient to predict the chance to conceive. A pocket chart is presented for easy use of the model. CONCLUSIONS With a limited amount of diagnostic information, the chance to conceive spontaneously can be predicted.
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Affiliation(s)
- J M Eimers
- Department of Public Health, Erasmus University Rotterdam, The Netherlands
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29
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Abstract
OBJECTIVE To develop a fertility prognosis model for infertile couples. DESIGN Prospective follow-up study. PARTICIPANTS In the period November 30, 1977 to June 1, 1985, 321 consecutive couples were investigated for infertility at Hvidovre University Hospital. Investigation of the female included detection of ovarian, cervical, and anatomic disorders, whereas in the male semen analysis and sperm penetration test (P-test) were performed. Altogether, 108 couples (34%) conceived, whereas 213 (66%) were observed for an average of 2.3 years without having achieved pregnancy. MAIN OUTCOME MEASURE The Cox regression model was used to predict the time required to conceive based on informations provided by fertility investigations. RESULTS Three of 16 prognostic variables (the period of infertility, the female infertility factor, and the P-test) possess significant prognostic information. The period of infertility and the P-test are best scored as continuous variables, whereas the female infertility factor are best categorized in four classes, i.e., normal, ovulation or cervical disorder, anatomic disorder, or a combination of disorders. CONCLUSIONS The three prognostic variables are combined to form a prognostic index that predicts the fecundability of the individual infertile couple.
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Affiliation(s)
- E Bostofte
- Department of Obstetrics and Gynecology, Hvidovre University Hospital, Copenhagen, Denmark
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30
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Holland-Moritz H, Krause W. Semen analysis and fertility prognosis in andrological patients. INTERNATIONAL JOURNAL OF ANDROLOGY 1992; 15:473-84. [PMID: 1483737 DOI: 10.1111/j.1365-2605.1992.tb01141.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Semen analyses of 529 men who consulted our department due to infertility problems, were related to the time period prior to conception, with factors adversely affecting the fertility of the female partner taken into consideration. The statistical method used was Cox's proportional-hazard model of regression. Untransformed, logarithmically transformed and dichotomized semen analysis variables were included in the calculations. The relationship between the following parameters and the probability of conception was examined: sperm count, sperm motility, progressive sperm motility, morphology and sperm motility remaining 24 h after ejaculation. All variables co-varied with the probability of conception; however, the exact type of relationship could not be determined by regression analyses. Cox's model assumes an exponential relationship. Our data suggest that this assumption is not suitable for fertility investigations. Using conventionally defined limiting values for normal and pathological semen quality, statistical analysis yielded significant differences in fertility between both categories for all of the variables considered; in the stepwise regression analysis, however, it could be shown that progressive motility and morphology alone were sufficient to discriminate between normal and pathological semen quality. The results are interpreted as indicating that, as a result of semen analysis, it is possible to predict the individual probability of conception if the exact shape of the relationship can be determined, which, up to now, has not been accomplished.
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Affiliation(s)
- H Holland-Moritz
- Department of Andrology, Medical Centre of Dermatology, Philipps-Universität, Marburg, Germany
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31
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Abstract
OBJECTIVE To review recent studies on the development of new tests of human sperm function and evaluation of which sperm characteristics are most important for fertilization in vitro by logistic regression analysis. STUDY SELECTION Recent studies on the relationship between putative and new tests of human sperm function and fertility in vitro or in vivo are discussed in this review. Some physiological and technical aspects are included. MAIN OUTCOME MEASURES Fertilization rates in vitro and sperm tests including standard semen analysis, improved morphology assessment, objective assessment of sperm motility and movement characteristics, nuclear maturity, hypo-osmotic swelling, the acrosome and the acrosome reaction, acrosin activity, human sperm-hamster oocyte penetration assay, and sperm-zona pellucida (ZP) and sperm-oolemma binding. RESULTS The percentages of sperm with normal morphology and a normal intact acrosome, mean linearity, and the number of sperm binding to the ZP were highly significant related to fertilization rates in vitro. Other sperm tests evaluated usually provided no additional information about fertilization rates. The human ZP is highly selective for binding of morphologically normal sperm. Acrosome-reacted human sperm have little or no ability to bind to the ZP. CONCLUSION Results of in vitro fertilization can be used to evaluate tests of human sperm function. Logistic regression analysis is a powerful method for determining which groups of sperm characteristics are independently related to fertilization rates. Normal morphology, linearity, acrosome status, and sperm-ZP binding are the most important characteristics for fertilization in vitro.
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Affiliation(s)
- D Y Liu
- Department of Obstetrics and Gynaecology, University of Melbourne, Royal Women's Hospital, Victoria, Australia
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Tournaye H, Devroey P, Camus M, Valkenburg M, Bollen N, Van Steirteghem AC. Zygote intrafallopian transfer or in vitro fertilization and embryo transfer for the treatment of male-factor infertility: a prospective randomized trial. Fertil Steril 1992; 58:344-50. [PMID: 1633900 DOI: 10.1016/s0015-0282(16)55195-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To compare zygote intrafallopian transfer (ZIFT) and in vitro fertilization and embryo transfer (IVF-ET) as treatments of male-factor infertility. DESIGN Patients were prospectively randomized to ZIFT or IVF-ET. SETTING In vitro fertilization program of the Centre for Reproductive Medicine of the Dutch-speaking Brussels Free University, Belgium, which is a tertiary referral institution. PATIENTS One hundred fifty-seven couples were enrolled in the study. Inclusion criteria allowed only first trials of couples with long-standing infertility caused by a male factor. Female factors were excluded. INTERVENTIONS In ZIFT, up to three fertilized oocytes were transferred into one single patient fallopian tube by means of laparoscopy 18 hours after insemination. In IVF-ET, cleaving embryos were replaced into the uterine cavity about 48 hours after insemination. MAIN OUTCOME MEASURES Fertilization and transfer rates, implantation and pregnancy rates, pregnancy outcome, and cost per procedure were evaluated. RESULTS Implantation rates of 12.3% and 10% per replaced conceptus were achieved for ZIFT and IVF-ET, respectively. CONCLUSIONS This study demonstrates no therapeutic advantage of ZIFT over IVF-ET in male-factor infertility in terms of reproductive outcome or economic benefit.
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Affiliation(s)
- H Tournaye
- Centre for Reproductive Medicine, University Hospital, Dutch-speaking Brussels Free University (Vrije Universiteit Brussel), Belgium
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Ratcliffe JM, Gladen BC, Wilcox AJ, Herbst AL. Does early exposure to maternal smoking affect future fertility in adult males? Reprod Toxicol 1992; 6:297-307. [PMID: 1521002 DOI: 10.1016/0890-6238(92)90192-v] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Animal data suggest that prenatal exposure to certain tobacco smoke components such as nicotine may affect the development of the male gonadal axis, which may in turn affect future adult fertility. There are no previous epidemiologic studies on the potential effects of early (prenatal and childhood) exposure to maternal smoking on the reproductive system in adult male offspring. To investigate this question, we used data from a follow-up study of reproductive function and fertility among young adult sons of mothers who had participated in a randomized clinical trial of diethylstilbestrol use during pregnancy. We observed no significant effects of early exposure to maternal smoking on conventional semen characteristics, hormone levels (follicle stimulating hormone [FSH], luteinizing hormone [LH] and testosterone), urogenital abnormalities and diseases, or perceived infertility problems. Current active smoking by the men was, however, associated with a significant decrease in the percentage of sperm with normal morphology.
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Affiliation(s)
- J M Ratcliffe
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina 27709
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Marshburn PB, McIntire D, Carr BR, Byrd W. Spermatozoal characteristics from fresh and frozen donor semen and their correlation with fertility outcome after intrauterine insemination. Fertil Steril 1992; 58:179-86. [PMID: 1624002 DOI: 10.1016/s0015-0282(16)55157-7] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To determine if conventional sperm parameters, specific characteristics of sperm motion determined by computer-aided semen analysis (CASA), sperm penetration assay (SPA), and/or spontaneous acrosome reaction assay could best predict fertility outcome after intrauterine insemination (IUI) from frozen donor sperm. DESIGN A retrospective analysis of 2,245 cycles of therapeutic donor IUIs were initially studied; 1,147 cycles that met selection criteria were used in this report. SETTING A university-based assisted reproductive technology center. PATIENTS, PARTICIPANTS All IUIs were performed on women with documented patency of at least one fallopian tube, ovulatory cycles, and who did not receive human menopausal gonadotropins. Sperm donors had to be used for at least four different recipients (mean of 15) and at least 14 different cycles of insemination (mean of 41). INTERVENTIONS None. MAIN OUTCOME MEASURE Pregnancy. RESULTS Statistical comparisons were made between donors of different relative fertility by using the Mann-Whitney test, Spearman's rank correlation, and multiple regression analysis. These analyses demonstrated that the most significant predictors of the fertility of frozen-thawed donor sperm were curvilinear velocity, straight line velocity, and the total number of motile sperm inseminated. The number of sperm with spontaneous acrosome reactions negatively correlated with fertility outcome, and SPA provided no predictive value. CONCLUSIONS Our study supports the hypothesis that the study of sperm motion characteristics using CASA after thawing and washing of cryopreserved sperm is a better predictor of fertile outcome after IUI than analysis of fresh semen.
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Affiliation(s)
- P B Marshburn
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas 75235-9032
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Bostofte E, Bagger P, Michael A, Stakemann G. The sperm penetration test (P-test) can predict fecundability in the male partner from infertile couples. Andrologia 1992; 24:125-9. [PMID: 1503248 DOI: 10.1111/j.1439-0272.1992.tb02624.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Three hundred and twenty-one consecutive couples were investigated for infertility at Hvidovre University Hospital in the period from November 1977 to June 1985. The male partners were evaluated in two ways: the classical semen analysis, and the ability of sperm to penetrate fresh hen egg white, the P-test. A Cox regression analysis was used to describe the relation between these variables and fecundability, i.e. the time required to conceive. Four of thirteen variables--the number of morphologically normal spermatozoa, the number of motile spermatozoa, the P-test, and the man's age--each have significant relation to the fecundability. However, when covariation is considered, only the P-test and the man's age possess significant prognostic information, whereas the variables of the classical semen analysis do not. This indicates that the P-test may replace the classical semen analysis when trying to predict individual pregnancy probabilities. Finally, the P-test and the man's age are combined to form a prognostic index which predicts the fecundability of the male partner in the individual infertile couple.
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Affiliation(s)
- E Bostofte
- Department of Obstetrics and Gynecology, Hvidovre University Hospital, Copenhagen, Denmark
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Affiliation(s)
- S B Jaffe
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons of Columbia University, New York, New York
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Dunphy BC, Barratt CL, von Tongelen BP, Cooke ID. Male cigarette smoking and fecundity in couples attending an infertility clinic. Andrologia 1991; 23:223-5. [PMID: 1741486 DOI: 10.1111/j.1439-0272.1991.tb02542.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The relationship between male cigarette smoking and fertility was studied for 330 couples attending an infertility clinic. 59% did not smoke, 10% smoked between 1 and 5 per day, 8% smoked between 6 and 10 per day, 16% smoked 11-20 per day and 7% smoked more than 20 per day. There was no significant association between smoking and any semen parameter. 138 men had a female partner who was apparently normal. There was no significant difference in smoking habits between the 'normal' and 'abnormal' female groups. Couples were followed-up for up to 32 months. Nineteen women had a treatment independent conception within the 'normal' female group. There was no significant association between the number of cigarettes smoked and the fertility outcome.
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Affiliation(s)
- B C Dunphy
- Harris Birthright Centre for Reproductive Medicine, Jessop Hospital for Women, Sheffield, United Kingdom
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Dunphy BC, Barratt CL, Cooke ID. Male alcohol consumption and fecundity in couples attending an infertility clinic. Andrologia 1991; 23:219-21. [PMID: 1741485 DOI: 10.1111/j.1439-0272.1991.tb02541.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The relationship between male alcohol intake and fertility was studied for 258 couples attending an infertility clinic. 21% consumed less than 1 unit per week on average, 10% consumed between 1 and 5 units per week, 23% consumed between 6 and 10 units per week, 27% consumed 11 to 20 units per week and 19% consumed more than 20 units per week. There was no significant association between alcohol consumption and any semen parameter. 110 men had a female partner who was apparently normal. There was no significant difference in the alcohol intake between the 'normal' and 'abnormal' female groups. Couples were followed-up for up to 32 months. Sixteen women had a treatment independent conception within the 'normal' female group. There was no significant association between the amount of alcohol consumed per week and the fertility outcome.
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Affiliation(s)
- B C Dunphy
- Harris Birthright Centre for Reproductive Medicine, Jessop Hospital for Women, Sheffield, United Kingdom
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Dunphy BC, Barratt CL, Kay R, Thomas EJ, Neal LM, Cooke ID. The importance of employing stringent methods to recruit fertile male controls. Andrologia 1991; 23:35-9. [PMID: 1897753 DOI: 10.1111/j.1439-0272.1991.tb02490.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Two methods of recruiting fertile male controls were evaluated and compared. The first group was recruited from the partners of women attending an antenatal clinic without obtaining details of their reproductive history. The second group was recruited after obtaining a detailed reproductive history from the couple and employing stringent entry criteria. Entry criteria for the second group included a length of exposure to the risk of pregnancy of not more than 12 months and no previous episode of involuntary infertility for either partner. There were significant differences between the distributions of semen parameters obtained from the two groups, indicating that the selection criteria for "fertile" men significantly influence results obtained and therefore that it is important to employ stringent criteria for the recruitment of fertile male controls. The group which was recruited by stringent criteria (mean length of exposure to the risk of pregnancy of 3 months) was characterised by a significantly higher median concentration of spermatozoa which exhibited slow linear or nonlinear motility. This confirms the findings of a previous study which suggested that slow linear or nonlinear motility are superior forms of spermatozoal motion.
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Affiliation(s)
- B C Dunphy
- Harris Birthright Centre for Reproductive Medicine, Jessop Hospital for Women, Sheffield, United Kingdom
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Dunphy BC, Kay R, Robinson JN, Cooke ID. The placebo response of subfertile couples to attending a tertiary referral centre. Fertil Steril 1990; 54:1072-5. [PMID: 2245831 DOI: 10.1016/s0015-0282(16)54007-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The objective of this study was to determine whether there was a placebo response to clinic attendance in couples with prolonged (greater than 4 years) subfertility. From 4 to 18 years of subfertility we observed a treatment independent cumulative conception rate of 22%, which was independent of the length of subfertility. Twenty-seven women conceived after 1 to 4 years' subfertility, and 30 conceived after greater than 4 years' subfertility. The fecundity of the latter group was significantly greater than that of women with 1 to 4 years' subfertility, being similar to "normal" subjects who had stopped contraception. This study demonstrates that a subgroup of apparently normal women with greater than 4 years' subfertility responded positively to clinic attendance independent of any investigation(s) or therapy.
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Affiliation(s)
- B C Dunphy
- Harris Birthright Research Centre for Reproductive Medicine, Jessop Hospital for Women, Headington, Oxford, United Kingdom
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Dunphy BC, Li TC, Macleod IC, Barratt CL, Lenton EA, Cooke ID. The interaction of parameters of male and female fertility in couples with previously unexplained infertility**Supported by a Harris Birthright grant, Royal College of Obstetricians and Gynaecologists, London, United Kingdom.††Presented at XIII World Congress of Fertility and Sterility, Marrakesh, Morocco, October 1989. Fertil Steril 1990. [DOI: 10.1016/s0015-0282(16)53940-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ramsewak SS, Cooke ID, Li TC, Kumar A, Monks NJ, Lenton EA. Are factors that influence oocyte fertilization also predictive? An assessment of 148 cycles of in vitro fertilization without gonadotropin stimulation. Fertil Steril 1990; 54:470-4. [PMID: 2397790 DOI: 10.1016/s0015-0282(16)53764-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Fertilization characteristics of 152 consecutively obtained oocytes in an in vitro fertilization (IVF) program employing only natural and clomiphene citrate-induced cycles were retrospectively analyzed. Fertilization occurred significantly more often (1) in women with tubal infertility, (2) in spontaneous cycles, and (3) in cases of secondary infertility. Grade I sperm motility from the original semen sample and the duration of infertility were also significant influencing factors. A similar sperm correlate was not identified on samples after sperm migration. Preovulatory follicular fluid steroids, progesterone (P), estradiol (E2), E2:P ratio, and luteinizing hormone (LH), as well as baseline plasma LH and the magnitude of the LH surge did not correlate with fertilization. However, when the identified factors were used to predict fertilization (discriminant analysis), only 58.3% of oocytes were correctly classified. This data supports the concept of performing IVF as a test in its own right.
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Affiliation(s)
- S S Ramsewak
- Department of Obstetrics and Gynaecology, University of Sheffield, Jessop Hospital for Women, United Kingdom
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Dunphy BC, Barratt CL, Kay R, Jones DE, Cooke ID. Postcoital test: which form of spermatozoal motility is associated with a good fertility outcome? Andrologia 1990; 22:269-73. [PMID: 2240622 DOI: 10.1111/j.1439-0272.1990.tb01977.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The objectives of this study were to examine the predictive value of the PCT in relation to treatment-independent conception rates, to determine which cutoff point best predicted fertility outcome, and which form of spermatozoal motility on PCT is most significantly related to fertility outcome. A prospective study was undertaken of couples referred for the investigation of "unexplained" infertility. One hundred and twenty six couples were recruited between July 1984 and April 1986. On further investigation female infertility factors were identified in 32 (25%) of couples, who were therefore excluded from the study. All conceptions were treatment independent. The relationship between the result of the postcoital test and the chance of conception was studied using a modification of Cox's regression model of life table analysis. The mean length of involuntary infertility prior to referral was 75 months (range = 18-192, SD = 39.2). The mean length of follow-up was 18 months (range = 1-34, SD = 8.4). A 98% follow-up rate was achieved. Eighteen women conceived, giving a 32-month treatment-independent conception rate of 22%. A cutoff point of one spermatozoon exhibiting sluggish motility per HPF was the most effective method of classifying the results of the postcoital test (X2(1) = 4.28, P = 0.037, RR = 4.7. This would suggest that the most efficient form of spermatozoal motion in cervical mucus is slow or sluggish motility.
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Affiliation(s)
- B C Dunphy
- Harris Birthright Centre for Reproductive Medicine, Jessop Hospital for Women, Sheffield, United Kingdom
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Dunphy BC, Kay R, Barratt CL, Cooke ID. Quality control during the conventional analysis of semen, an essential exercise. JOURNAL OF ANDROLOGY 1989; 10:378-85. [PMID: 2592267 DOI: 10.1002/j.1939-4640.1989.tb00124.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Intra- and inter-technician variability in assessing sperm motility by the methods recently advocated by the World Health Organization (WHO) were studied. The intra- and inter-technician variability in estimating sperm concentration and the intra-technician variability in assessing sperm morphology were also examined. Intra-technician variability in assessing sperm motility appeared to be related to the natural ability and/or training of the observer. Although in general the intra-technician variability was low, there were marked and clinically significant differences between observers when assessing the same semen sample. There was no significant difference between observers in the assessment of sperm concentration, and intra-technician variability was low. When assessing sperm morphology, the intra-technician variability was potentially large (above a level of 20% morphologically ideal spermatozoa). Technicians should be recruited who have natural ability as observers. Quality control appears to be an essential exercise for any center that plans to relate semen parameters to fertility outcome.
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Affiliation(s)
- B C Dunphy
- Harris Birthright Centre for Reproductive Medicine, Jessop Hospital for Women, Sheffield, United Kingdom
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Dunphy BC, Kay R, Barratt CL, Cooke ID. Is routine examination of the male partner of any prognostic value in the routine assessment of couples who complain of involuntary infertility? Fertil Steril 1989; 52:454-6. [PMID: 2776899 DOI: 10.1016/s0015-0282(16)60918-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The purpose of this study was to determine whether routine examination of the male partner is of value in assessing couples complaining of involuntary infertility. The relationship between male age, a previous paternity, male physical characteristics, and fertility outcome was examined. Life table analysis was performed after accounting for known female factors. Five hundred forty-four couples were recruited to the study. All conceptions were independent of treatment to either partner in which the female partner was found to be "normal" on investigation. Although male age and several physical characteristics were related to fertility outcome when all couples were examined, this was, by virtue of these variables, being related to female age and the length of involuntary infertility before investigation. When only those couples were examined in which the female partner was normal on investigation (n = 250), past paternity (x1(2) = 4.21, P = 0.040, RR = 1.81) was the only variable that retained a significant relationship to fertility outcome. It was concluded that routine examination of the male partner is of no prognostic value for couples complaining of involuntary infertility.
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Affiliation(s)
- B C Dunphy
- Harris Birthright Research Centre for Reproductive Medicine, Jessop Hospital for Women, Sheffield, United Kingdom
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