A prognostic score for subfertile men based on anamnestic data and semen variables

The advantages of standardized evaluation of male infertility

Healthcare can be improved by standardization and by evaluation of diagnostic methods and treatments. In the field of andrology, in which large patient numbers are required for the evaluation of diagnostic procedures and treatments, structured data collection and multicentre studies are especially warranted. Concomitant with routine clinical practice, a large amount of clinical data are collected that may be used to evaluate andrological care. Structuring and electronic storage of data holds promise in terms of clarity and accessibility of the data and its use for validation studies. The aim of the present work was to study the merits of routine collection of a common dataset in a computer-based patient record (CPR) for standardization, quality of data and clinical research. It was studied whether the data were of sufficient quality and accessibility for much needed studies on aetiology, interventions and diagnostics in andrology. Data collection in a structured CPR promoted complete and comprehensive data. We describe the advantages, pitfalls and solutions with this approach. Data on the uniform examination of 1549 infertile men became readily accessible. Population characteristics, basal associations and original studies were enabled and provided insight into the efficiency of clinical practice. In 66% of men, a cause for their infertility was identified, which provides a better rationale for treatment than semen parameters alone. For more than 30% of the patients, a rational andrological treatment was available, which could be deployed before assisted reproductive technologies were resorted to. However, most treatments have not been properly validated. The thorough diagnostic evaluation identifies subgroups that require an evidence base for treatment and further study on aetiology and diagnosis. Structured collection of uniform patient data through a CPR was feasible and facilitated the evaluation of diagnostic and therapeutic modalities. The reported advantages, pitfalls and solutions with this approach may help other centres to decide on how to implement a CPR. Conscientious collection of a standard data set in infertility centres facilitates pooling of data and evidence-based multicentre research.

The effect of smelter work on fecundity

Time to pregnancy (TTP) has been proposed as a screening instrument for the detection of environmental and occupational hazards to reproduction. Our aim was to determine whether reduced fecundity could be found among smelter workers and couples living near the smelter. The number of Months required to achieve a pregnancy was determined via a questionnaire, and TTP was analyzed using a logistic regression model with a cutoff at 12 months. No significant findings were found for a risk of having to wait for more than 12 months to achieve pregnancy because of occupational or environmental exposure. It could be that the exposure variables tested were not sensitive enough in detecting hazards to reproduction or that they were of minor importance. A tendency toward a prolonged TTP was found for couple living near the smelter.

Score prognosis for the infertile couple based on historical factors and sperm analysis

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.

Association of elevated estradiol with remote testicular trauma in young infertile men

OBJECTIVE

To determine the incidence of remote testicular trauma and of possible related permanent hormonal and seminal changes in infertile men.

DESIGN

Retrospective clinical study of hormonal and seminal parameters in a subpopulation of infertile men.

SETTING

Andrology Clinic in an academic research environment.

PARTICIPANTS

Infertile men, with and without history of remote testicular trauma, and fertile volunteers.

MAIN OUTCOME MEASURES

Percentage of infertile men with history of blunt testicular trauma, concentrations of reproductive hormones, and semen parameters.

RESULTS

Significant remote blunt testicular trauma was reported by 16.8% of infertile men. This had occurred 2 to 17 years (mean, 16.4 years) before evaluation, mostly with contact sports at adolescent age. Estradiol concentrations after testicular trauma were 19% and 25% higher than in infertile men without history of testicular injury and in fertile controls. Elevated E2 levels did not correlate with T. Infertile men with and without history of testicular trauma showed changes in seminal parameters.

CONCLUSION

The incidence of remote blunt testicular trauma in infertile men is unexpectedly high. After injury, FSH-stimulated aromatization of T may increase testicular E2 production, interfere with spermatogenesis, and cause infertility. Consistent use of protective devices in contact sports is recommended.

The prediction of the chance to conceive in subfertile couples

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.

Semen analysis and fertility prognosis in andrological patients

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.

Aniline blue staining as a marker of sperm chromatin defects associated with different semen characteristics discriminates between proven fertile and suspected infertile men

A retrospective study of 49 men with proven fertility and 396 suspected infertile men was conducted with the primary objective of investigating the relationship between the nuclear maturity of sperm and male fertility. Acidic aniline blue staining was used to detect chromatin defects of sperm nuclei related to their nucleoprotein content as associated with DNA. The discriminant value of the percentage of unstained nuclei (= percentage of mature heads, MH) and of other semen characteristics, was analysed by a stepwise (forward) linear regression model. Semen characteristics that discriminated significantly between the two groups of subjects were, in descending order: (1) the percentage of normal sperm, (2) the percentage of amorphous heads, (3) the percentage of tapered heads, (4) semen volume, and (5) the percentage of MH. The discriminant value of each of the significant characteristics was studied by means of ROC-curves. MH had the best ROC-curve profile; its cut-off value was found to be equal to 70% (74.5 +/- 2.6% for the donor group versus 53.0 +/- 1.1% for the patient group). A simple infertility score (SIS) including MH, was built according to the cut-off values inferred from the ROC-curves. SIS allowed an overall satisfactory separation of the two groups (less than or equal to 4 = fertile, 5-6 = uncertainty zone, greater than 6 = infertile). Our results indicate that the addition of the evaluation of sperm head maturity to routine semen analysis improves the assessment of fertility in men.