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Lamb DJ, Marinaro JA. Can semen parameters predict pregnancy outcomes? Fertil Steril 2023; 120:709-714. [PMID: 37414207 DOI: 10.1016/j.fertnstert.2023.06.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 06/28/2023] [Accepted: 06/28/2023] [Indexed: 07/08/2023]
Abstract
Semen analysis is an integral component of the evaluation and management of men with infertility. Although it is important for patient counseling and clinical decision making, a conventional semen analysis cannot reliably predict the chance of pregnancy or differentiate fertile vs. infertile men (except in the most extreme cases). Advanced, nonstandard sperm functional tests may provide additional discriminatory and prognostic power; however, further research is needed to determine how to best incorporate these tests into modern clinical practice. Therefore, the primary applications of a conventional semen analysis should be to judge the severity of infertility, estimate the effects of future therapy, and measure the response to current therapy.
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Affiliation(s)
- Dolores J Lamb
- Department of Urology, Weill Cornell Medicine, New York, New York
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2
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Eisenberg ML, Esteves SC, Lamb DJ, Hotaling JM, Giwercman A, Hwang K, Cheng YS. Male infertility. Nat Rev Dis Primers 2023; 9:49. [PMID: 37709866 DOI: 10.1038/s41572-023-00459-w] [Citation(s) in RCA: 56] [Impact Index Per Article: 56.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/09/2023] [Indexed: 09/16/2023]
Abstract
Clinical infertility is the inability of a couple to conceive after 12 months of trying. Male factors are estimated to contribute to 30-50% of cases of infertility. Infertility or reduced fertility can result from testicular dysfunction, endocrinopathies, lifestyle factors (such as tobacco and obesity), congenital anatomical factors, gonadotoxic exposures and ageing, among others. The evaluation of male infertility includes detailed history taking, focused physical examination and selective laboratory testing, including semen analysis. Treatments include lifestyle optimization, empirical or targeted medical therapy as well as surgical therapies that lead to measurable improvement in fertility. Although male infertility is recognized as a disease with effects on quality of life for both members of the infertile couple, fewer data exist on specific quantification and impact compared with other health-related conditions.
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Affiliation(s)
- Michael L Eisenberg
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA.
- Department of Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, CA, USA.
| | - Sandro C Esteves
- ANDROFERT Andrology and Human Reproduction Clinic, Campinas, Brazil
- Division of Urology, Department of Surgery, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Dolores J Lamb
- Center for Reproductive Genomics, Weill Cornell Medical College, New York, NY, USA
- Englander Institute for Precision Medicine, Weill Cornell Medical College, New York, NY, USA
- Department of Urology, Weill Cornell Medical College, New York, NY, USA
| | - James M Hotaling
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | | | - Kathleen Hwang
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Yu-Sheng Cheng
- Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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3
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Silber SJ. The Y chromosome in the era of intracytoplasmic sperm injection: a personal review. Fertil Steril 2011; 95:2439-48.e1-5. [PMID: 21704208 DOI: 10.1016/j.fertnstert.2011.05.070] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Revised: 05/24/2011] [Accepted: 05/24/2011] [Indexed: 11/30/2022]
Abstract
The Y chromosome contains 60 multicopy genes composed of nine different gene families concentrated in regions of multiple repeat sequences called amplicons arranged in mirror images called palindromes. This pattern is susceptible to deletions caused by homologous recombination with itself, and can explain the presence of small numbers of sperm in otherwise azoospermic men.
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Affiliation(s)
- Sherman J Silber
- Infertility Center of St. Louis, St. Luke's Hospital, St. Louis, Missouri 63017, USA.
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van der Steeg JW, Steures P, Eijkemans MJ, F. Habbema JD, Hompes PG, Kremer JA, van der Leeuw-Harmsen L, Bossuyt PM, Repping S, Silber SJ, Mol BW, van der Veen F. Role of semen analysis in subfertile couples. Fertil Steril 2011; 95:1013-9. [DOI: 10.1016/j.fertnstert.2010.02.024] [Citation(s) in RCA: 109] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Revised: 02/04/2010] [Accepted: 02/09/2010] [Indexed: 11/28/2022]
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Abstract
Ultrasound has become essential in the diagnosis and management of the infertile male. Scrotal ultrasonography provides a detailed examination of the testes and assesses the presence or absence of varicoceles and can identify other abnormalities of the scrotal contents and the spermatic cord. Transrectal ultrasonography can "visualize" the excurrent ejaculatory ductal system, including the ejaculatory ducts, seminal vesicles, and vas deferens. The expansion of these ultrasonographic techniques has provided the urologist with non- or minimally invasive techniques with which to evaluate the infertile male. These advancements consequently have led to innovative surgical and radiologic treatments.
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Affiliation(s)
- M Zahalsky
- Department of Urology, Beth Israel Medical Center, 10 Union Square East, New York, NY 10003, USA.
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Affiliation(s)
- S J Silber
- Infertility Center of St. Louis, St. Luke's Hospital, MO 63017, USA.
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Gil-Salom M, Minguez Y, Rubio C, Ruiz A, Remohi J, Pellicer A. Intracytoplasmic sperm injection: a treatment for extreme oligospermia. J Urol 1996; 156:1001-4. [PMID: 8709295 DOI: 10.1016/s0022-5347(01)65685-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE We evaluated the efficacy of intracytoplasmic sperm injection in patients with extreme oligospermia. MATERIALS AND METHODS A total of 67 intracytoplasmic sperm injection cycles was attempted in 58 infertile couples in which the husbands had extreme oligospermia (less than 100,000 spermatozoa per ml. ejaculate). RESULTS Fertilization was achieved in 65 of 67 cycles. Mean fertilization rate per cycle was 66.4%. A total of 18 clinical pregnancies was obtained, for a pregnancy rate of 26.8% per started cycle. There were 4 miscarriages and 8 live births from 5 deliveries. Nine pregnancies are ongoing. CONCLUSIONS Intracytoplasmic sperm injection in patients with extreme oligospermia is associated with high fertilization rates and offers the chance of pregnancy to these otherwise intractably infertile couples.
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Affiliation(s)
- M Gil-Salom
- Instituto Valenciano de Infertilidad, University of Valencia Medical School, Spain
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8
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Intracytoplasmic Sperm Injection. J Urol 1996. [DOI: 10.1097/00005392-199609000-00044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Liu DY, Johnston R, Baker HW. Ability of spermatozoa to bind to the zona pellucida during oligozoospermia induced with testosterone during a male contraceptive trial. INTERNATIONAL JOURNAL OF ANDROLOGY 1995; 18 Suppl 1:39-44. [PMID: 7558387 DOI: 10.1111/j.1365-2605.1995.tb00637.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
To determine the ability of spermatozoa to bind to the zona pellucida (ZP) in testosterone-induced oligozoospermia, previously fertile men participating in the World Heath Organization (WHO) male contraceptive trial in Melbourne were studied while oligozoospermic to various degrees. Semen analysis were performed according to WHO methods. One or two ejaculates from each subject were cryopreserved before commencing weekly intramuscular injections of 200 mg testosterone enanthate. The frozen spermatozoa were used as controls for ZP-binding tests of spermatozoa obtained during testosterone-induced oligozoospermia (< 10 x 10(6)/ml) in either the suppression or efficacy (n = 6) and recovery (n = 3) phases. Two other subjects in the recovery phase with normozoospermia were also tested. Human oocytes that failed to fertilized in vitro from infertile patients were used for the sperm-ZP binding test. Control (frozen) spermatozoa were labelled with fluorescein isothiocyanate and test (oligozoospermic semen) spermatozoa were labelled with tetramethylrhodamine B isothiocyanate. A mixture of equal numbers of labelled motile control and test spermatozoa were incubated with 4-6 ZP. There was a significantly (p < 0.01) lower number of spermatozoa bound per ZP in oligozoospermic samples (65 +/- 7, mean +/- SEM) than in controls (80 +/- 7). However, there were still large numbers of spermatozoa bound to the ZP for all the oligozoospermic samples. Five subjects had similar numbers of spermatozoa bound to the ZP for both control and oligozoospermic samples. Overall, the ZP-binding ratio of test and control spermatozoa averaged 0.82 (range 0.51-1.13).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- D Y Liu
- Department of Obstetrics and Gynaecology, University of Melbourne, Australia
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11
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Abstract
As a first step towards a new form of male contraception--sperm cryopreservation, vasectomy and eventual artificial insemination--the military services should begin a large-scale sperm cryopreservation programme.
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Affiliation(s)
- C Djerassi
- Department of Chemistry, Stanford University, California 94305-5080
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Lenzi A, Lombardo F, Gandini L, Alfano P, Dondero F. Computer assisted sperm motility analysis at the moment of induced pregnancy during gonadotropin treatment for hypogonadotropic hypogonadism. J Endocrinol Invest 1993; 16:683-6. [PMID: 8282963 DOI: 10.1007/bf03348911] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Two azoospermic patients with isolated hypogonadotropic hypogonadism (IHH) no. 1,24-year-old, and no. 2,31-year-old), never treated before, were given gonadotropin therapy (GT), (FSH, 225 IU/week, and HCG, 4000 IU/week) and followed up monthly for sperm characteristics. After 6 (no. 1) and 9 (no. 2) months of treatment, immotile spermatozoa appeared in the semen. Two months later motile spermatozoa also appeared. A motile sperm concentration sufficiently high for computer motion analysis (CASA) was achieved 1 month later 9th and 12th month, respectively. At the 13th (no. 1) and 17th (no. 2) month of GT, CASA showed a small population of spermatozoa with a very good motility pattern. In the next ovulatory cycle the patients' partners became pregnant.
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Affiliation(s)
- A Lenzi
- Laboratorio di Immunologia della Riproduzione e Seminologia, Università di Roma La Sapienza, Italy
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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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Bendvold E, Gottlieb C, Bygdeman M, Eneroth P. Depressed semen quality in Swedish men from barren couples: a study over three decades. ARCHIVES OF ANDROLOGY 1991; 26:189-94. [PMID: 1872651 DOI: 10.3109/01485019108987642] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The semen quality of men who participated in an infertility investigation in 1956 was compared with that from men from similar populations in the years 1966, 1976, and 1986. The sperm parameters studied included total sperm count and sperm morphology. A significant reduction over this 30-year period was observed for both parameters. The total sperm count decreased from 467 million in 1956 to 305 million in 1986 (mean, p less than 0.0001) and the percentage of sperm with normal morphology diminished from 53% to 37% (mean, p less than 0.0001) during the same period. This Swedish study, like studies in other industrialized countries, indicates a decline in semen quality over the past few decades.
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Affiliation(s)
- E Bendvold
- Department of Obstetrics and Gynecology, Karolinska Hospital, Stockholm, Sweden
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Vantman D, Koukoulis G, Burris AS, Banks SM, Dennison L, Sherins RJ. Sperm motion characteristics in men with isolated hypogonadotropic hypogonadism treated with gonadotropin. Fertil Steril 1989; 51:162-6. [PMID: 2642809 DOI: 10.1016/s0015-0282(16)60447-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The authors compared curvilinear velocity (Vc) and linearity (L) of sperm from fertile oligospermic men with isolated hypogonadotropic hypogonadism (IHH) to Vc and L of sperm from fertile normal men in order to determine if sperm motion analysis is better than sperm density as an indicator of fertility potential. Nine fertile men with IHH treated with exogenous gonadotropins and 20 fertile normal men were studied. Sperm density was significantly lower in the men with IHH compared with normal men (15.5 +/- 4.8 x 10(6)/ml versus 92.4 +/- 9.7 x 10(6)/ml; mean +/- standard error of the mean [SEM]; P less than 0.01) as was percent motility (51.4 +/- 4.7 versus 73.4 +/- 3.1; P less than 0.01). While a small but significant difference in Vc was noted between the groups at the 40 micron/second cumulative distribution point (P less than 0.01), no difference in L was found between the two groups. When the men with IHH were subgrouped according to sperm density (greater than 20 x 10(6)/ml versus less than or equal to 20 x 10(6)/ml, no differences in Vc were found between the subsets, but for L sperm were somewhat less directional for the subgroup with a density less than or equal to 20 x 10(6)/ml (P = 0.05). Coanalysis using both Vc and L parameters indicated that sperm from IHH patients were distributed similarly to sperm from normal men. However, sperm motion characteristics in men with unexplained infertility were different from values measured in normal men and IHH patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- D Vantman
- Developmental Endocrinology Branch, National Institute of Child Health and Human Development, Bethesda, Maryland
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Burris AS, Clark RV, Vantman DJ, Sherins RJ. A low sperm concentration does not preclude fertility in men with isolated hypogonadotropic hypogonadism after gonadotropin therapy. Fertil Steril 1988; 50:343-7. [PMID: 3135208 DOI: 10.1016/s0015-0282(16)60084-5] [Citation(s) in RCA: 85] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
In order to define the minimal number of sperm needed for conception, we studied semen characteristics of men with isolated hypogonadotropic hypogonadism (IHH) who became sperm-positive during gonadotropin therapy. Twenty-two of 24 men (92%) proved fertile, initiating a total of 40 pregnancies. The mean (+/- standard error of the mean) sperm concentration at the time of conception was 16.7 +/- 4.0 X 10(6)/ml. However, 71% of pregnancies were conceived when the mean sperm concentration was less than 20 X 10(6)/ml; in 16%, the mean sperm concentration was less than 1 X 10(6)/ml. Mean total sperm count correlated highly with sperm concentration (r = 0.67, P less than 0.001). We conclude that men with IHH can initiate conception even when their sperm concentration is well below the conventional lower limit of 20 X 10(6)/ml.
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Affiliation(s)
- A S Burris
- Development Endocrinology Branch, National Institutes of Child Health and Human Development, Bethesda, Maryland 20892
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