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Bae JW, Hwang JM, Lee WJ, Kim DH, Yi JK, Ha JJ, Oh DY, Kwon WS. Application of sperm motion kinematics and motility-related proteins for prediction of male fertility. Theriogenology 2024; 218:223-230. [PMID: 38359560 DOI: 10.1016/j.theriogenology.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 01/31/2024] [Accepted: 02/05/2024] [Indexed: 02/17/2024]
Abstract
The selection of superior sires is paramount for enhancing the efficiency of animal production in the livestock industry. However, semen quality assessment still relies on conventional semen analysis techniques in both animals and humans. Despite extensive efforts to develop various biomarkers for more accurate and precise predictions of male fertility potential, more effective physiological indicators and advance potential biomarkers are needed. Herein, we aimed to develop new potential biomarkers related to sperm motion kinematics for male fertility prediction. We first evaluated sperm motion kinematic parameters and expression levels of sperm motility-related proteins of 30 Duroc boars. We then explored the correlation between litter size, sperm motion kinematics parameters, and sperm motility-related proteins. Progressive sperm motility (%), rapid sperm motility (%), slow sperm motility (%), straight-line velocity (μm/s), linearity (%), beat cross frequency (Hz), mean angular displacement (degree), wobble (%) were correlated with litter size. Furthermore, the expression of axonemal dynein light intermediate polypeptide 1 (DNALI1) and radial spoke head protein 9 homolog (RSPH9) correlated with litter size. The overall accuracy exceeded 60% for predicting litter size using these sperm motion parameters and proteins. Notably, our study observed an increase in litter size after predicting litter size using these parameters and proteins. Thus, sperm motion kinematic parameters and protein expression, particularly of DNALI1 and RSPH9, could serve as new biomarkers for male fertility. These results may contribute to improved understanding of the mechanisms underlying sperm motility.
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Affiliation(s)
- Jeong-Won Bae
- Department of Animal Science and Biotechnology, Kyungpook National University, Sangju, Gyeongsangbuk-do, 37224, Republic of Korea
| | - Ju-Mi Hwang
- Department of Animal Science and Biotechnology, Kyungpook National University, Sangju, Gyeongsangbuk-do, 37224, Republic of Korea
| | - Woo-Jin Lee
- Department of Animal Science and Biotechnology, Kyungpook National University, Sangju, Gyeongsangbuk-do, 37224, Republic of Korea
| | - Dae-Hyun Kim
- Department of Animal Science, Chonnam National University, Gwangju, 61186, Republic of Korea
| | - Jun Koo Yi
- School of Animal Life Convergence Science, Hankyong National University, Anseong, 17579, Republic of Korea
| | - Jae Jung Ha
- Gyeongbuk Livestock Research Institute, Yeongju, Gyeongsangbuk-do, 36052, Republic of Korea
| | - Dong Yep Oh
- Gyeongbuk Livestock Research Institute, Yeongju, Gyeongsangbuk-do, 36052, Republic of Korea.
| | - Woo-Sung Kwon
- Department of Animal Science and Biotechnology, Kyungpook National University, Sangju, Gyeongsangbuk-do, 37224, Republic of Korea; Research Center for Horse Industry, Kyungpook National University, Sangju, Gyeongsangbuk-do, 37224, Republic of Korea.
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Siddharth K, Kumar T, Zabihullah M. Interobserver Variability in Semen Analysis: Findings From a Quality Control Initiative. Cureus 2023; 15:e46388. [PMID: 37927724 PMCID: PMC10620459 DOI: 10.7759/cureus.46388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2023] [Indexed: 11/07/2023] Open
Abstract
Introduction For laboratory tests, precision and accuracy are indispensable to ensure reliable results for both clinical diagnosis and research endeavors. The accuracy and reliability of results are important because they have an impact on both patient management and research. In this study, we evaluated the inter-observer variability between a trained technician and two academic residents, which acted both as a quality control measure as well as an assessment of training outcomes. Material and methods Freshly obtained semen samples from 28 subjects coming to the andrology laboratory were used. Semen analysis was performed by a regular technician permanently posted in the laboratory and two residents on completion of their posting in the andrology laboratory. All three examined the same sample after liquefaction for assessment of sperm motility, sperm concentration, sperm vitality, and sperm morphology. Semen analysis was done as per the recommendations of the WHO. Results The results of the study are presented as a coefficient of variation (CV), S charts, and Bland-Altman plot where we evaluated the interobserver variability in parameters on semen analysis of the same sample by three different assessors. The mean CV for sperm concentration across the samples was 6.24%. For sperm vitality, sperm morphology, and sperm motility the mean CV was 10.14%, 2.66%, and 8.11%, respectively. The S chart and Bland-Altman plot found a few random errors in measurements. Conclusion Regular quality control assessments are essential and should be implemented in andrology laboratories to ensure accurate and reliable results. Proper training of laboratory personnel is also vital for consistent outcomes. Other measures such as equipment calibration, use of high-quality reagents, and standard reporting are also crucial for the best results from a laboratory.
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Affiliation(s)
- Kumar Siddharth
- Physiology, All India Institute of Medical Sciences (AIIMS) Patna, Patna, IND
| | - Tribhuwan Kumar
- Physiology, All India Institute of Medical Sciences (AIIMS) Patna, Patna, IND
| | - Md Zabihullah
- Physiology, All India Institute of Medical Sciences (AIIMS) Patna, Patna, IND
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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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Aghazarian A, Huf W, Pflüger H, Klatte T. The 1999 and 2010 WHO reference values for human semen analysis to predict sperm DNA damage: A comparative study. Reprod Biol 2020; 20:379-383. [PMID: 32527621 DOI: 10.1016/j.repbio.2020.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 04/19/2020] [Accepted: 04/24/2020] [Indexed: 12/24/2022]
Abstract
Standard semen parameters are often used to predict male fertility, but whether the 2010 World Health Organization (WHO 2010) thresholds are better predictors than the 1999 thresholds has not been investigated. In this study, we addressed this issue using sperm DNA fragmentation (SDF) as a marker of male fertility in 134 subfertile male individuals. To compare the predictive value of the 1999 thresholds with the 2010 cutoffs, the Youden indices (YIs) of all possible thresholds were calculated using receiver operating characteristic (ROC) curves and compared to each other and to the respective YIs of optimal thresholds. We found that the area under the ROC curves of progressive motility and vitality was the highest among standard semen parameters, and that the YI of both parameters from the 2010 manual was comparable to the respective optimal YIs. In contrast, the threshold of sperm concentration and total sperm number from both WHO recommendations demonstrated low YIs, with substantial differences to the respective optimal YIs. The YIs of normal morphology cutoffs from both WHO manuals were slightly different from each other and from the respective optimal YIs. In conclusion, the 2010 thresholds for progressive motility and vitality are superior to the 1999 thresholds in predicting SDF, whereas the cutoff value of sperm concentration, total sperm number and normal morphology may need further revisions to increase their accuracy.
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Affiliation(s)
- Artin Aghazarian
- Department of Urology, Krankenhaus Hietzing mit Neurologischem Zentrum Rosenhügel, Vienna, Austria; Department of Laboratory Medicine, Krankenhaus Hietzing mit Neurologischem Zentrum Rosenhügel, Vienna, Austria.
| | - Wolfgang Huf
- Department of Laboratory Medicine, Krankenhaus Hietzing mit Neurologischem Zentrum Rosenhügel, Vienna, Austria; Karl Landsteiner Institute for Clinical Risk Management, Vienna, Austria
| | - Heinz Pflüger
- Department of Urology, Krankenhaus Hietzing mit Neurologischem Zentrum Rosenhügel, Vienna, Austria
| | - Tobias Klatte
- Department of Urology, Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Bournemouth, United Kingdom; Department of Surgery, University of Cambridge, Cambridge, United Kingdom
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Portela JMD, Tavares RS, Mota PC, Ramalho-Santos J, Amaral S. High glucose concentrations per se do not adversely affect human sperm function in vitro. Reproduction 2015; 150:77-84. [DOI: 10.1530/rep-15-0100] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 04/29/2015] [Indexed: 11/08/2022]
Abstract
Diabetes mellitus (DM) represents one of the greatest concerns to global health and it is associated with diverse clinical complications, including reproductive dysfunction. Given the multifactorial nature of DM, the mechanisms that underlie reproductive dysfunction remain unclear. Considering that hyperglycemia has been described as a major effector of the disease pathophysiology, we used anin vitroapproach to address the isolated effect of high glucose conditions on human sperm function, thus avoiding otherin vivoconfounding players. We performed a complete and integrated analysis by measuring a variety of important indicators of spermatozoa functionality (such as motility, viability, capacitation status, acrosomal integrity, mitochondrial superoxide production and membrane potential) in human sperm samples after incubation withd- andl-glucose (5, 25, or 50 mM) for 24 and 48 h. No direct effects promoted by 25 or 50 mMd-glucose were found for any of the parameters assessed (P>0.05), except for the acrosome reaction, which was potentiated after 48 h of exposure to 50 mMd-glucose (P<0.05). Interestingly, non-metabolizablel-glucose drastically increased superoxide production (P<0.05) and suppressed sperm motility (P<0.05) and capacitation (P<0.05) after 24 h of treatment, whereas mitochondrial membrane potential (P<0.05), acrosomal integrity (P<0.01) and viability (P<0.05) were later decreased. The overall results suggest that high glucose levelsper sedo not influence human sperm functionin vitro, which stresses the importance of other factors involved in DM pathology. Nevertheless, the absence of metabolizable glucose contributes to a severe impairment of sperm function and thus compromises male fertility.Free Portuguese abstract: A Portuguese translation of this abstract is freely available athttp://www.reproduction-online.org/content/150/1/77/suppl/DC1.
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Ghasemi H, Karimi J, Goodarzi MT, Khodadadi I, Tavilani H, Moridi H, Kheiripour N. Seminal plasma zinc and magnesium levels and their relation to spermatozoa parameters in semen of diabetic men. Int J Diabetes Dev Ctries 2015. [DOI: 10.1007/s13410-015-0408-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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Esteves SC. Clinical relevance of routine semen analysis and controversies surrounding the 2010 World Health Organization criteria for semen examination. Int Braz J Urol 2014; 40:443-53. [DOI: 10.1590/s1677-5538.ibju.2014.04.02] [Citation(s) in RCA: 107] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Accepted: 02/19/2014] [Indexed: 01/25/2023] Open
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Esteves SC, Sharma RK, Gosálvez J, Agarwal A. A translational medicine appraisal of specialized andrology testing in unexplained male infertility. Int Urol Nephrol 2014; 46:1037-52. [PMID: 24771472 DOI: 10.1007/s11255-014-0715-0] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 04/05/2014] [Indexed: 02/06/2023]
Abstract
The diagnostic and prognostic validity of sperm function biomarkers is particularly relevant for males with unexplained infertility in which routine semen analysis fails to detect subcellular sperm dysfunctions. In this general review, we examine the role and significance of specialized andrology laboratory tests from past to present and provide a glance toward the future. We concluded that the assessment of sperm DNA damage and oxidative stress provide a relatively independent measure of fertility that yields diagnostic and prognostic information complementary to, but distinct and more significant than, standard sperm parameters. Since none of the available methods for such testing have been fully translated, further research is necessary to evaluate their cost-effectiveness when applied in large scale to daily medical practice. Application of translational medicine concepts would also be useful to accelerate the clinical application of recent discoveries in the fields of genomics, proteomics and metabolomics.
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Affiliation(s)
- Sandro C Esteves
- Androfert, Andrology and Human Reproduction Clinic, Av. Dr. Heitor Penteado, 1464, Campinas, São Paulo, 13075-460, Brazil,
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Paradowska-Dogan A, Fernandez A, Bergmann M, Kretzer K, Mallidis C, Vieweg M, Waliszewski P, Zitzmann M, Weidner W, Steger K, Kliesch S. Protamine mRNA ratio in stallion spermatozoa correlates with mare fecundity. Andrology 2014; 2:521-30. [DOI: 10.1111/j.2047-2927.2014.00211.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 02/26/2014] [Accepted: 02/27/2014] [Indexed: 01/12/2023]
Affiliation(s)
- A. Paradowska-Dogan
- Department of Urology, Pediatric Urology and Andrology; Justus Liebig University of Giessen; Giessen Germany
| | - A. Fernandez
- Centre of Reproductive Medicine and Andrology; University Clinic Muenster; Muenster Germany
| | - M. Bergmann
- Institute for Veterinary Anatomy, Histology and Embryology; Justus Liebig University of Giessen; Giessen Germany
| | - K. Kretzer
- Institute for Veterinary Anatomy, Histology and Embryology; Justus Liebig University of Giessen; Giessen Germany
| | - C. Mallidis
- Centre of Reproductive Medicine and Andrology; University Clinic Muenster; Muenster Germany
| | - M. Vieweg
- Department of Urology, Pediatric Urology and Andrology; Justus Liebig University of Giessen; Giessen Germany
| | - P. Waliszewski
- Department of Urology, Pediatric Urology and Andrology; Justus Liebig University of Giessen; Giessen Germany
| | - M. Zitzmann
- Centre of Reproductive Medicine and Andrology; University Clinic Muenster; Muenster Germany
| | - W. Weidner
- Department of Urology, Pediatric Urology and Andrology; Justus Liebig University of Giessen; Giessen Germany
| | - K. Steger
- Department of Urology, Pediatric Urology and Andrology; Justus Liebig University of Giessen; Giessen Germany
| | - S. Kliesch
- Centre of Reproductive Medicine and Andrology; University Clinic Muenster; Muenster Germany
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Khaksar Z, Jelodar G, Hematian H, Poorahmadi M. Alterations in gonadal and testicular cells of male fetuses and neonates of diabetic rats. COMPARATIVE CLINICAL PATHOLOGY 2013. [DOI: 10.1007/s00580-012-1537-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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11
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Fen CTC, Lee SN, Lim MN, Yu SL. Relationship between Sperm Hyaluronan-Binding Assay (HBA) Scores on Embryo Development, Fertilisation, and Pregnancy Rate in Patients Undergoing Intra-Cytoplasmic Sperm Injection (ICSI). PROCEEDINGS OF SINGAPORE HEALTHCARE 2013. [DOI: 10.1177/201010581302200207] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction: The novel development of the sperm hyaluronan-binding assay (HBA) has now been routinely used in some laboratories worldwide to predict sperm maturity and functionality. Hence, the purpose of this study is to evaluate if embryo development, quality, fertilisation and pregnancy rates are affected by low HBA values. Methods: A total of192 female patients who underwent intra-cytoplasmic sperm injection (ICSI) were compared retrospectively in terms of embryo development, fertilisation, and pregnancy rates with their husbands' HBA score. Patients' husbands were required to undergo a HBA test before the start of their stimulation cycle to determine if their semen was suitable to undergo ICSI or in-vitro fertilisation (IVF). P-value < 0.05 was considered significant. Results: Patients were divided into four groups, group A (HBA ≤ 15%), group B (HBA > 15% < 35%), group C (HBA ≥ 35% < 60%), and group D (HBA ≥ 60%). The fertilisation rate for groups A, B, C, and D were 67.9%, 73.1%, 72.5%, and 77.1% respectively. Group D had a fertilisation rate significantly higher than the rest of the groups ( p = 0.016). The pregnancy rate for group D was also significantly higher amongst the four groups ( p = 0.041), whereas the pregnancy rate for groups B and C was similar (42.4% versus 41.1% respectively). Day three cleavage rate (the ability to reach six cells and beyond) was highest for group D compared to the other groups ( p = 0.002). Conclusion: The higher the HBA score, the better the fertilisation, pregnancy, and cleavage rates. This shows that HBA does have the ability to select mature sperms with normal chromosome development and oocyte-binding capability.
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Affiliation(s)
- Carine To Chiou Fen
- Centre for Assisted Reproduction, Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore
| | - Shaw Ni Lee
- Centre for Assisted Reproduction, Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore
| | - Mui Nee Lim
- Centre for Assisted Reproduction, Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore
| | - Su Ling Yu
- Centre for Assisted Reproduction, Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore
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Pacey AA. Are sperm counts declining? Or did we just change our spectacles? Asian J Androl 2013; 15:187-90. [PMID: 23353722 PMCID: PMC3739163 DOI: 10.1038/aja.2012.165] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Revised: 12/18/2012] [Accepted: 12/18/2012] [Indexed: 11/09/2022] Open
Affiliation(s)
- Allan A Pacey
- Department of Human Metabolism, University of Sheffield, Sheffield S10 2SF, UK.
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13
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Falling sperm counts and global estrogenic pollution: what have we learned over 20 years? Asian J Androl 2013; 15:159-61. [PMID: 23416895 DOI: 10.1038/aja.2013.8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Alves MG, Martins AD, Rato L, Moreira PI, Socorro S, Oliveira PF. Molecular mechanisms beyond glucose transport in diabetes-related male infertility. Biochim Biophys Acta Mol Basis Dis 2013; 1832:626-35. [PMID: 23348098 DOI: 10.1016/j.bbadis.2013.01.011] [Citation(s) in RCA: 150] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 01/15/2013] [Indexed: 02/06/2023]
Abstract
Diabetes mellitus (DM) is one of the greatest public health threats in modern societies. Although during a few years it was suggested that DM had no significant effect in male reproductive function, this view has been challenged in recent years. The increasing incidence of DM worldwide will inevitably result in a higher prevalence of this pathology in men of reproductive age and subfertility or infertility associated with DM is expected to dramatically rise in upcoming years. From a clinical perspective, the evaluation of semen parameters, as well as spermatozoa deoxyribonucleic acid (DNA) integrity, are often studied due to their direct implications in natural and assisted conception. Nevertheless, recent studies based on the molecular mechanisms beyond glucose transport in testicular cells provide new insights in DM-induced alterations in male reproductive health. Testicular cells have their own glucose sensing machinery that react to hormonal fluctuations and have several mechanisms to counteract hyper- and hypoglycemic events. Moreover, the metabolic cooperation between testicular cells is crucial for normal spermatogenesis. Sertoli cells (SCs), which are the main components of blood-testis barrier, are not only responsible for the physical support of germ cells but also for lactate production that is then metabolized by the developing germ cells. Any alteration in this tied metabolic cooperation may have a dramatic consequence in male fertility potential. Therefore, we present an overview of the clinical significance of DM in the male reproductive health with emphasis on the molecular mechanisms beyond glucose fluctuation and transport in testicular cells.
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Affiliation(s)
- M G Alves
- University of Beira Interior, Covilhã, Portugal.
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Mallidis C, Cooper TG, Hellenkemper B, Lablans M, Uckert F, Nieschlag E. Ten years' experience with an external quality control program for semen analysis. Fertil Steril 2012; 98:611-616.e4. [PMID: 22633256 DOI: 10.1016/j.fertnstert.2012.05.006] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Revised: 04/26/2012] [Accepted: 05/03/2012] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To gauge the performance of laboratories and impact of the German semen analysis external quality control program (QuaDeGA) over its first 10 years. DESIGN Retrospective analysis of QuaDeGA's twice yearly distribution of fixed semen samples and electronic material documenting sperm motility. Ranking of each participant's responses was determined according to their relation to a "target window." SETTING Multicenter. PAITENT(S): Healthy donors. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Laboratory performance, World Health Organization (WHO) adherence. RESULT(S) Over 19 runs, there was a steady increase of participants (280 laboratories), the largest group being private urologic practices. Although use of WHO-recommended Neubauer chamber (from 33% to 55%) and diluent (from 11% to 32%) increased, the opposite occurred with morphology staining protocols (from 41% to 19%). Overall, <8% of laboratories truly followed WHO guidelines. Median-based comparisons, replacing reference laboratories, resulted in a merging of performance rankings regardless of the protocols used. CONCLUSION(S) Adherence to WHO recommendations is low, with the majority of laboratories using methods expressly opposed by the guidelines. Participation in QuaDeGA was found to improve the performance of the laboratories involved in the program. However, the use of median-based ranking, while decreasing the extent of variance between laboratories, brings into question the significance of the rankings.
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Affiliation(s)
- Con Mallidis
- Center of Reproductive Medicine and Andrology, University of Münster, Münster, Germany.
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Kampf A. Tales of healthy men: male reproductive bodies in biomedicine from 'Lebensborn' to sperm banks. Health (London) 2012; 17:20-36. [PMID: 22674746 DOI: 10.1177/1363459312447251] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Using the example of 'sperm tales', borne out of the biomedical technologies that went hand in hand with the establishment of the 'science of man' (andrology), the article engages with the epistemic evolution of interrelated biomedical theories and concepts of what constitutes a 'healthy' reproductive male body. The article asks: how has the normative ideal male body been either perpetuated or interrogated through these tales of male reproduction at the interface between scientific and medical technologies? And how were changes to the normalization of male bodies central to clinical practices and cultural understandings of health and illness? With many aspects of the medical history of male reproduction in the 20th century still unexplored, this article will focus on the growing intervention of biomedicine to 'treat' male infertility by way of the classification, standardization and normalization of male corporeality, focusing in particular on the representation and construction of men and the male body, as reflected in medical science and practice from the second half of the 20th century onwards in Germany. The article analyses the rise in importance of sperm in biomedical investigation, including a consideration of the construction of infertility as the defining force behind concepts of 'healthy men', and examines the related conceptualization of male reproductive bodies at the crossroad between 'healthy' and 'normal'. It is argued that the ideal of male reproduction as being inherently healthy has lost ground. By the late 20th century, male bodies have become vulnerable, at least as represented in medical science and technology.
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Affiliation(s)
- Antje Kampf
- School of Medicine, Johannes Gutenberg-University Mainz, Am Pulverturm 13, Mainz, 55131, Germany.
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17
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Franken DR, Oehninger S. Semen analysis and sperm function testing. Asian J Androl 2011; 14:6-13. [PMID: 22179512 DOI: 10.1038/aja.2011.58] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Despite controversy regarding the clinical value of semen analysis, male fertility investigation still relies on a standardized analysis of the semen parameters. This is especially true for infertility clinics in both developing and developed countries. Other optional tests or sophisticated technologies have not been widely applied. The current review addresses important changes in the analysis of semen as described in the new World Health Organization (WHO) manual for semen analysis. The most important change in the manual is the use of evidence-based publications as references to determine cutoff values for normality. Apart from the above mentioned changes, the initial evaluation and handling methods remain, in most instances, the same as in previous editions. Furthermore, the review evaluates the importance of quality control in andrology with emphasis on the evaluation of sperm morphology. WHO sperm morphology training programmes for Sub-Saharan countries were initiated at Tygerberg Hospital in 1995. The external quality control programme has ensured that the majority of participants have maintained their morphological reading skills acquired during initial training. This review reports on current sperm functional tests, such as the induced acrosome reaction, and sperm-zona pellucida binding assays, as well as the impact of sperm quality in terms of DNA integrity, and the relationship of sperm function tests to sperm morphology.
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Affiliation(s)
- Daniel R Franken
- Department of Obstetrics and Gynaecology, Tygerberg Hospita, Cape Town, South Africa.
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Palacios ER, Clavero A, Gonzalvo MC, Rosales A, Mozas J, Martinez L, Ramirez JP, Bjorndahl L, Morancho-Zaragoza J, Fernandez-Pardo E, Castilla JA. Acceptable variability in external quality assessment programmes for basic semen analysis. Hum Reprod 2011; 27:314-22. [DOI: 10.1093/humrep/der413] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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19
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Amiri I, Karimi J, Piri H, Goodarzi MT, Tavilani H, Khodadadi I, Ghorbani M. Association between nitric oxide and 8-hydroxydeoxyguanosine levels in semen of diabetic men. Syst Biol Reprod Med 2011; 57:292-5. [DOI: 10.3109/19396368.2011.621508] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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20
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Zuvela E, Junk S, Moska N, Matson P. The use of latex beads in external quality assurance and internal quality control for routine semen analysis. Reprod Biol 2011; 11:264-75. [DOI: 10.1016/s1642-431x(12)60071-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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21
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Karimi J, Goodarzi MT, Tavilani H, Khodadadi I, Amiri I. Increased receptor for advanced glycation end products in spermatozoa of diabetic men and its association with sperm nuclear DNA fragmentation. Andrologia 2011; 44 Suppl 1:280-6. [PMID: 21919942 DOI: 10.1111/j.1439-0272.2011.01178.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Although the majority of patients with diabetes have disorders in sexual function, associations between diabetes mellitus and sperm function at the molecular level are largely unknown. As receptor for advanced glycation end products plays a key role in many diabetic complications, we hypothesised that it may be involved in sperm nuclear DNA fragmentation. RAGE levels were determined using ELISA and western blot analysis in sperm samples from 32 diabetic and 35 nondiabetic men. Sperm DNA fragmentation was assessed using TUNEL assay. Diabetic men had significantly higher mean levels of RAGE protein (P < 0.001) and DNA fragmentation (P < 0.001) in spermatozoa. Sperm RAGE was directly correlated to sperm DNA fragmentation in diabetic men (r = 0.81, P < 0.001). The high positive correlation between RAGE levels and nuclear DNA fragmentation in spermatozoa of diabetic men suggests a central role of RAGE in disturbances in sexual function of diabetic men.
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Affiliation(s)
- J Karimi
- Department of Biochemistry, Medical School, Hamadan University of Medical Sciences, Hamadan, Iran
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22
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O’Neill J, Czerwiec A, Agbaje I, Glenn J, Stitt A, McClure N, Mallidis C. Differences in mouse models of diabetes mellitus in studies of male reproduction. ACTA ACUST UNITED AC 2010; 33:709-16. [DOI: 10.1111/j.1365-2605.2009.01013.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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23
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Semen analysis: a new manual and its application to the understanding of semen and its pathology. Asian J Androl 2010; 12:11-3. [PMID: 20111075 DOI: 10.1038/aja.2009.12] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
This article reviews the latest edition of the World Health Organization's manual on semen analysis, a comprehensive instructional guide. The methodology used in the assessment of the usual variables in semen analysis is described, as are many of the less common, but very valuable, sperm function tests. Seminal fluid preparation techniques for procedures such as in vitro fertilization and intrauterine insemination are also outlined in the manual. In addition, it details many useful techniques for the assessment of seminal fluid. It will be a very useful manual for any laboratory that carries out analyses of seminal fluid.
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Abstract
Accurate semen analysis is critical for decisions about patient care, as well as for studies addressing overall changes in semen quality, contraceptive efficacy and effects of toxicant exposure. The standardization of semen analysis is very difficult for many reasons, including the use of subjective techniques with no standards for comparison, poor technician training, problems with proficiency testing and a reluctance to change techniques. The World Health Organization (WHO) Semen handbook (2010) offers a vastly improved set of standardized procedures, all at a level of detail that will preclude most misinterpretations. However, there is a limit to what can be learned from words and pictures alone. A WHO-produced DVD that offers complete demonstrations of each technique along with quality assurance standards for motility, morphology and concentration assessments would enhance the effectiveness of the manual. However, neither the manual nor a DVD will help unless there is general acknowledgement of the critical need to standardize techniques and rigorously pursue quality control to ensure that laboratories actually perform techniques 'according to WHO' instead of merely reporting that they have done so. Unless improvements are made, patient results will continue to be compromised and comparison between studies and laboratories will have limited merit.
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25
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Status of semen analysis-comment on "A survey on the status of semen analysis in 118 laboratories in China" by Jin-Chun Lu et al. in Asian Journal of Andrology. Asian J Androl 2010; 12:115-7. [PMID: 20111091 DOI: 10.1038/aja.2009.7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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26
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Boone WR, Higdon HL, Johnson JE. Quality Management Issues in the Assisted Reproduction Laboratory. ACTA ACUST UNITED AC 2010. [DOI: 10.1177/205891581000100103] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In the United States, the Clinical Laboratory Improvement Act (CLIA) of 1988 describes requirements and guidelines for implementing a quality control/quality assurance (QC/QA) program for moderate and high complexity laboratories. These requirements and guidelines apply to Assisted Reproductive Technology (ART) laboratories as well. The general topic of QC and QA as it pertains to in vitro fertilization (IVF) and embryo transfer (ET) is extensively reviewed. This review summarizes many of the QC and QA events that contribute to the advancement of knowledge in this biotechnological field. These events include control of the culture environment inside and outside of the incubator, as well as factors that affect culture media. This review also discusses, in considerable detail, the QC and the QA that pertain to equipment used within the laboratory and how to control for potential contaminants, which reside within the laboratory. This review provides evidence to indicate the need for laboratory personnel to monitor quality improvement issues on a continuous basis. Personnel must be willing to change as improvements in technology occur in order to meet the ever-evolving demands of a more difficult patient population. Suggestions for meeting these demands are offered.
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Affiliation(s)
- William R. Boone
- Greenville Hospital System University Medical Center, Greenville, South Carolina Department of Obstetrics and Gynecology
| | - H. Lee Higdon
- Greenville Hospital System University Medical Center, Greenville, South Carolina Department of Obstetrics and Gynecology
| | - Jane E. Johnson
- Greenville Hospital System University Medical Center, Greenville, South Carolina Department of Obstetrics and Gynecology
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27
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Pacey AA. Quality assurance and quality control in the laboratory andrology. Asian J Androl 2010; 12:21-5. [PMID: 20111077 PMCID: PMC3739672 DOI: 10.1038/aja.2009.16] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2009] [Revised: 01/08/2009] [Accepted: 02/06/2009] [Indexed: 11/09/2022] Open
Abstract
Quality assurance (QA) and quality control (QC) are fundamental aspects of any laboratory measurement. However, in comparison with other medical disciplines, the need for QA and QC in laboratory andrology has been recognized only recently. Furthermore, there is evidence that the effort required to undertake QA and QC has not been wholly welcomed by some clinicians. Nevertheless, accrediting bodies and regulatory authorities increasingly require evidence that laboratories have effective QA and QC measures in place because both are central to the quality management processes. Following the publication of the 5th edition of the World Health Organization Laboratory Manual, existing QA and QC systems will need to be updated to take into account some of the methodological changes recommended by the manual. Three of these are discussed in this commentary; they relate to: (i) the move to infer semen volume from its weight; (ii) the re-classification of sperm motility grades from four to three; and (iii) the publication of a lower reference limit for morphology of 4% (with a corresponding 95% confidence interval of 3%-4%). The importance of QA and QC in all laboratory tests, including up and coming new tests to assess sperm DNA integrity, is discussed. The need for adequate initial training and continuing professional development programmes to support laboratory scientists performing andrology is also described.
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28
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Handelsman DJ, Cooper TG. Foreword to Semen Analysis in 21st Century Medicine special issue in Asian Journal of Andrology. Asian J Androl 2010; 12:7-10. [PMID: 20111074 PMCID: PMC3739668 DOI: 10.1038/aja.2009.49] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- David J. Handelsman
- Reproductive Endocrinology & Andrology, ANZAC Research Institute, Sydney, Australia
| | - Trevor G. Cooper
- Andrology Laboratory, Institute of Reproductive Medicine of the University, Munster, Germany
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29
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30
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Aguilar J, Alvarez C, Morancho-Zaragoza J, Prats-Gimenez R, Ramírez JP, Fernández-Pardo E, Martínez L, Calafell R, Duran I, Castilla JA. Quality specifications for seminal parameters based on clinicians' opinions. Scandinavian Journal of Clinical and Laboratory Investigation 2009; 68:68-76. [PMID: 17852803 DOI: 10.1080/00365510701496470] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND The aim of this study was to identify analytical quality specifications for seminal parameters based on clinicians' opinions, and to compare with those based on biological variability and state of the art. MATERIAL AND METHODS Two questionnaires with case histories were sent to laboratories participating in the Spanish programme of external quality on semen analysis for distribution to as many specialist clinicians as possible. Our intention was to determine the critical difference (CD), defined as the difference needed between two consecutive results obtained from semen analysis to be 95 % confident that the two results actually are different. Subsequently, we calculated the specifications of analytical quality in accordance with the clinicians' opinions. RESULTS The CDs obtained from the median value of the differences between the initial value and that given in the clinicians' replies were similar in clinical situations of improvement or worsening in the infertile normozoospermic male, and also in worsening situations for male patients presenting a significant alteration in seminal parameters. For improvement in this latter case, the CD cited as necessary in the clinicians' opinion was much higher than that for the other clinical situations. At a desirable level of quality, for concentration and total motility the coefficients of variation in the clinicians' opinion were below those based on biological variability and the state of the art. However, for type "a+b" motility, type "a" motility, morphology and vitality the coefficients of variation based on the clinicians' opinions were higher than those based on biological variability and lower than those based on the state of the art. CONCLUSIONS Quality specifications for seminal parameters based on clinicians' opinions depend to a large extent on the clinical situation and on the seminal parameter being analysed.
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Affiliation(s)
- J Aguilar
- Banco de Semen CEIFER, Granada, Spain
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31
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Impact of a second semen analysis on a treatment decision making in the infertile man with varicocele. Fertil Steril 2009; 91:1809-11. [DOI: 10.1016/j.fertnstert.2008.01.100] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2007] [Revised: 01/29/2008] [Accepted: 01/29/2008] [Indexed: 11/18/2022]
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32
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Chen X, Zhang W, Luo Y, Long X, Sun X. Predictive value of semen parameters inin vitrofertilisation pregnancy outcome. Andrologia 2009; 41:111-7. [DOI: 10.1111/j.1439-0272.2008.00898.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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33
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Jequier AM, Phillips N. Cystic dilatation of the rete testis: a hidden diagnosis among infertile men. Reprod Biomed Online 2009; 18:190-4. [PMID: 19192338 DOI: 10.1016/s1472-6483(10)60255-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Cystic dilatation of the rete testis, often also known as cystic ectasia of the rete testis, is a poorly understood condition that may be a cause of male infertility. This study examined the frequency of this condition in 749 men attending an infertility clinic with their partners. Of these 749 men, semen analysis was abnormal in 275 (37%) but apparently normal in 474 (63%). All the men attending the infertility clinic underwent a testicular ultrasound. Of these 749 men, the lesion was present in nine (1.2%); it was present bilaterally in three and unilaterally in six. In two men, one of whom had a bilateral lesion, the sperm count was normal. It is unclear whether this lesion is a cause of infertility but it is important that this condition is diagnosed so that its prevalence and its relationship to infertility can be ascertained.
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Affiliation(s)
- Anne M Jequier
- PIVET Medical Centre, 166 Cambridge Street, Leederville, Western Australia 6007, Australia.
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34
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Waberski D, Petrunkina A, Töpfer-Petersen E. Can external quality control improve pig AI efficiency? Theriogenology 2008; 70:1346-51. [DOI: 10.1016/j.theriogenology.2008.06.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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35
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Abstract
Traditionally, the diagnosis of male infertility has relied upon microscopic assessment and biochemical assays to determine human semen quality. The conventional parameters given most importance have been the concentration, motility, and morphology of sperm in the ejaculate. Most laboratories also include ‘sperm suitability’ tests where the subpopulations of sperm more likely to finish the marathon journey to the oocyte are separated by density centrifugation. These tests are essential to provide the fundamental information on which clinicians base their initial diagnosis. However, none of these parameters addresses sperm function and their clinical value in predicting fertility is questionable. The advent of intracytoplasmic sperm injection (ICSI) has further reduced the significance and perceived need for sperm quality tests since ICSI requires only one sperm, not subject to classic, or indeed any, tests for the procedure to be successful. Over the past decade, a number of laboratory tests have been developed to determine properties of sperm function. These include quantitative sperm motion parameters, capacitation, basal and induced acrosome reactions, sperm–zona pellucida interactions and nuclear and mitochondrial sperm DNA but few have been adopted into routine clinical use. International collaborations should be initiated to develop clinically relevant molecular and functional tests with agreed protocols and clinical thresholds as a matter of urgency.
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Affiliation(s)
- Sheena E M Lewis
- School of Medicine, Obstetrics and Gynaecology, Queen's University Belfast, Institute of Clinical Science, Grosvenor Road, Belfast BT12 6BA, UK.
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36
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Phillips N, Jequier AM. Early testicular cancer: a problem in an infertility clinic. Reprod Biomed Online 2007; 15:520-5. [DOI: 10.1016/s1472-6483(10)60383-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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37
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Ye H, Huang GN, Gao Y, Liu DY. Relationship between human sperm-hyaluronan binding assay and fertilization rate in conventional in vitro fertilization. Hum Reprod 2006; 21:1545-50. [PMID: 16595551 DOI: 10.1093/humrep/del008] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Sperm-hyaluronan-binding assay (HBA) is one of the commercial kits being marketed for routine testing of sperm maturity and fertility. However, there is no report of whether the HBA can provide additional information over standard semen analysis for sperm-fertilizing ability. The objective of this study was to investigate the relationship between HBA and fertilization rate in conventional IVF. METHODS A total of 175 IVF patients with > or = 3 mature oocytes inseminated were included in the study. Both the standard semen analysis and the HBA were performed on the same ejaculated sperm samples used for IVF treatments. Relationships between the semen analysis and the HBA results and fertilization rate were analysed by both the Spearman test and the multivariate logistic regression analysis. RESULTS Both total and progressive sperm motility and normal morphology were highly correlated with HBA scores. While both normal sperm morphology and HBA scores were statistically significantly related to fertilization rates, the HBA was less significant than normal sperm morphology. The HBA does not provide additional information for identifying patients with a poor fertilization rate. CONCLUSION HBA is highly significantly correlated with sperm motility and morphology but is less significant than sperm morphology in relation to the fertilization rate in IVF. Thus, the clinical predictive value of HBA for sperm-fertilizing ability in vitro is limited.
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Affiliation(s)
- Hong Ye
- Reproductive and Genetics Institute, Chongqing Obstetrics and Gynecology Hospital, Chongqing, China
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38
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Pacey AA. Is quality assurance in semen analysis still really necessary? A view from the andrology laboratory. Hum Reprod 2006; 21:1105-9. [PMID: 16396933 DOI: 10.1093/humrep/dei460] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Quality assurance (QA) is a fundamental part of laboratory medicine, of which internal and external QA (proficiency testing) is an important part. In a recent debate article published in Human Reproduction, it was argued that it was no longer necessary for semen analysis to be subject to QA, primarily because it is now being performed robustly and there is little evidence that it has any real clinical value. In response to this argument, it is suggested here that although there may have been some improvements in the training of laboratory scientists, recent studies have shown that the techniques of semen analysis are still poorly implemented at many locations. Moreover, as the impact of the introduction of QA into the andrology laboratory begins to take effect, there are a growing number of studies showing that the results of semen analysis do correlate well with natural conception and some assisted reproductive technologies. However, since the processes of QA are central to the principles of total quality management, which in turn underpins the process of laboratory accreditation, QA needs to remain in the andrology (and embryology) laboratory so that they can achieve the same accredited status as medical laboratories in other disciplines.
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Affiliation(s)
- A A Pacey
- Academic Unit of Reproductive and Developmental Medicine, The University of Sheffield, Royal Hallamshire Hospital, Sheffield, UK.
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39
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Castilla JA, Alvarez C, Aguilar J, González-Varea C, Gonzalvo MC, Martínez L. Influence of analytical and biological variation on the clinical interpretation of seminal parameters. Hum Reprod 2005; 21:847-51. [PMID: 16361288 DOI: 10.1093/humrep/dei423] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Quality assurance in semen analysis has been questioned recently in this journal. Based on the limited capacity of seminal parameter in the determination of fertility, the authors advocated abandoning methods of quality assurance in semen analysis for clinical situations. In this article, we explore arguments as to why quality assurance in semen analysis for clinical use is not 'a waste of time'. Imprecision and within-subject biological variations are the two major components involved in the dispersion of seminal parameter results obtained by analysis of a semen sample from an individual. As within-subject biological variation is constant across geography, time and population, imprecision is a very important factor in the quality of laboratory test results. We analyse this influence on various seminal parameters and observe that there is an amount of error that can be tolerated without invalidating the medical usefulness of seminal parameter determination. However, there is a maximum allowable analytical error above which the medical usefulness of seminal parameter results is invalidated. The level of performance required to facilitate clinical decision-making is termed quality specification. We comment on different strategies to define the maximum allowable analytical error.
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Affiliation(s)
- J A Castilla
- Unidad de Reproducción, Hospital Virgen de las Nieves, Granada, Departamento de Ciencias de la Salud, Universidad de Jaén, Jaén, Unidad de Reproducción, Clínica Avicena, Jaén and Laboratorio CEIFER, Granada, Spain.
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40
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Holt WV. Is quality assurance in semen analysis still really necessary? A spermatologist's viewpoint. Hum Reprod 2005; 20:2983-6. [PMID: 16006459 DOI: 10.1093/humrep/dei189] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In a provocative article to this Journal, Anne Jecquier, an eminent andrologist who, more than 20 years ago, was a prime mover in suggesting the need for quality assurance (QA) in andrology laboratories, has now proposed that the QA schemes may no longer be needed. Here I reply to that proposition, largely by agreeing that, since the QA schemes have brought about higher technical standards in laboratories, Anne Jecquier's assertion is possibly true. However, vigilance is still needed in discriminating between unproductive investment of time and energy in the refinement of tests that may offer little information about fertility, and maintaining technical standards such that where necessary they provide the requisite information. Thus, although it may not matter in practice whether a sperm concentration is estimated as 100 or 200 x 10(6)/ml, distinguishing between 25 and 100 x 10(6)/ml would probably influence a clinician's treatment decisions. Anne Jecquier also suggested that sperm function tests have limited predictive value in terms of fertility assessment. While I agree that this is largely true at present, I also argue that these tests are probably not developed to their full potential. I am optimistic that tests to distinguish and quantify the population of fertilization-competent sperm within an ejaculate will eventually become available.
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Affiliation(s)
- W V Holt
- Institute of Zoology, Zoological Society of London, Regent's Park, London NW1 4RY, UK.
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