Intra- and inter-individual variability in human sperm concentration, motility and vitality assessment during a workshop involving ten laboratories

The influence of lifestyle and biological factors on semen variability

PURPOSE

Semen parameters are subjected to within-individual variability over time. The driving factors for this variability are likely multi-factorial, with healthier lifestyle associated with better semen quality. The extent in which variations in individual's lifestyle contributes to within-individual semen variability is unknown.

METHODS

A total of 116 repeat semen samples from 29 men aged 19-37 over 6 months were collected. Basic semen analysis as per 5th WHO manual and extended semen parameters (sperm DNA fragmentation, redox potential and lipid peroxidation, sperm binding to hyaluronan and hyperactive motility) were assessed. An additional 39 lifestyle/biological factors (weight, blood pressure, etc.) were collected at each sample including validated health questionnaires SF36 Health Status, Australian Recommend Food Score, and International Physical Activity Questionnaire.

RESULTS

Only 10 out of the 39 lifestyle factors varied within men across samples including age (P = 0.0024), systolic blood pressure (P = 0.0080), social functioning (P = 0.0340), energy (P = 0.0069), non-alcoholic caffeinated beverages (P = 0.0010), and nutrition (P < 0.0001). The only semen parameter that varied between collections was sperm morphology (coefficient of variation 23.8 (6.1-72.0), P < 0.05). We only observed weak (r < 0.3) to moderate (r > 0.3- < 0.6) correlations between lifestyle factors, including body mass index, waist circumference, nutrition, exercise, blood pressure and semen parameters including sperm count, progressive motility, and sperm DNA fragmentation (P < 0.05).

CONCLUSION

In healthy men from the general population, semen quality and associated lifestyle factors do not significantly vary over 6 months, indicating that one semen sample is likely sufficient for determining male fertility in this population.

Metabolic characterization of human sperm cells using the Seahorse metabolic flux analyzer

BACKGROUND

The concerning trend on male infertility global prevalence, together with the unexplainable causes in half of those cases, highlights that there are still aspects of this disease to be understood and solved. To address this issue, one should not only be aware of the limitations of the implemented diagnostic tools, but also understand the sperm cell in depth, structurally, biochemically, molecularly in order to develop reliable and ready-to-be new/improved diagnostic tools. In this sense, the sperm cells metabolism, highly related to its functionality, seems to be a promising aspect to explore. Though there is much information on the human sperm metabolism, there is still a lack of a quick integrated and comprehensive analysis that may be introduced with the potential to reveal innovative clinically relevant information.

OBJECTIVES

Find metabolic details on human sperm that can be accessed easily, in real time and using few cells, relying on the bivalent potential of the Seahorse flux analyzer (SFA).

RESULTS

We have obtained standard records on human sperm cells' oxygen consumption rate (OCR) and extracellular acidification rate (ECAR), that together with the metabolic metrics provided information on sperm cells' oxidative and glycolytic metabolism. Furthermore, a metabolic interindividual variation was observed.

DISCUSSION AND CONCLUSION

Although the comparison with other species or cell types is not linear and warrant further studies, the metabolic profile of human sperm cells seems to be similar to that of other species. Altogether our results corroborate the value of SFA for metabolic human sperm cell analysis, warranting new studies, and anticipating several applications in the male infertility field.

Rapid, automated quantification of Haemonchus contortus ova in sheep faecal samples

Haemonchus contortus is one of the most pathogenic nematodes affecting small ruminants globally and is responsible for large economic losses in the sheep and goat industry. Anthelmintic resistance is rampant in this parasite and thus parasite control programs must account for drug efficacy on individual farms and, sometimes, whether H. contortus is the most prevalent trichostrongylid. Historically, coproculture has been the main way to determine the prevalence of H. contortus in faecal samples due to the inability to morphologically differentiate between trichostrongylid egg types, but this process requires a skilled technician and takes multiple days to complete. Fluoresceinated peanut agglutinin (PNA) has been shown to specifically bind H. contortus and thus differentiate eggs based on whether they fluoresce, but this method has not been widely adopted. The ParasightTM System (PS) fluorescently stains helminth eggs in order to identify and quantify them, and the H. contortus PNA staining method was therefore adapted to this platform using methodology requiring only 20 min to obtain results. In this study, 74 fecal samples were collected from sheep and analyzed for PNA-stained H. contortus, using both PS and manual fluorescence microscopy. The percentage of H. contortus was determined based on standard total strongylid counts with PS or brightfield microscopy. Additionally, 15 samples were processed for coproculture with larval identification, and analyzed with both manual and automated PNA methods. All methods were compared using the coefficient of determination (R2) and the Lin's concordance correlation coefficient (ρc). ParasightTM and manual PNA percent H. contortus results were highly correlated with R2 = 0.8436 and ρc = 0.9100 for all 74 fecal samples. Coproculture versus PS percent H. contortus were also highly correlated with R2 = 0.8245 and ρc = 0.8605. Overall, this system provides a rapid and convenient method for determining the percentage of H. contortus in sheep and goat fecal samples without requiring specialized training.

Normal sperm head morphometric reference values in fertile Asian males

ABSTRACT

Sperm head morphology is crucial for male factor infertility diagnosis and assessment of male reproductive potential. Several criteria are available to analyze sperm head morphology, but they are limited by poor methodology comparability and population applicability. This study aimed to explore comprehensive and new normal morphometric reference values for spermatozoa heads in fertile Asian males. An automated sperm morphology analysis system captured 23 152 stained spermatozoa from confirmed fertile males. Of these samples, 1856 sperm head images were annotated by three experienced laboratory technicians as "normal". We employed 14 novel morphometric features to describe sperm head size (head length, head width, length/width ratio, and girth), shape (ellipse intersection over union, girth intersection over union, short-axis symmetry, and long-axis symmetry), area (head, acrosome, postacrosomal areas, and acrosome area ratio), and degrees of acrosome and nuclear uniformity. This straight-forward method for the morphometric analysis of sperm by accurate visual measurements is clinically applicable. The measured parameters present valuable information to establish morphometric reference intervals for normal sperm heads in fertile Asian males. The presented detailed measurement data will be valuable for interlaboratory comparisons and technician training. In vitro fertilization and andrology laboratory technicians can use these parameters to perform objective morphology evaluation when assessing male fertilization potential.

Association between dietary total antioxidant capacity and semen quality among men attending an infertility clinic: a cross-sectional study

STUDY QUESTION

Is dietary non-enzymatic antioxidant capacity related to semen quality?

SUMMARY ANSWER

The only statistically significant association of semen quality parameters with dietary total antioxidant capacity (DTAC) detected was an inverse association between DTAC and ejaculate volume.

WHAT IS KNOWN ALREADY

Growing interest exists regarding the role of diet in influencing semen quality. While DTAC is linked to favorable health outcomes, its association with semen quality, especially among men attending infertility clinics, remains understudied.

STUDY DESIGN SIZE DURATION

This cross-sectional study was carried out between June and December of 2020. In total, 1715 participants were included in the final analysis.

PARTICIPANTS/MATERIALS SETTING METHODS

Men who attended an infertility clinic in China were enrolled. Experienced clinical technicians performed the semen analysis. The DTAC indices included the ferric-reducing ability of plasma, oxygen radical absorbance capacity, total reactive antioxidant potential, and Trolox equivalent antioxidant capacity. The quantile regression model was used for multivariate analysis.

MAIN RESULTS AND THE ROLE OF CHANCE

After adjustment for a variety of confounding variables, a significant inverse association was identified between DTAC and ejaculate volume (βcontinuous FRAP = -0.015, 95% CI = -0.023, -0.006, βT3 vs T1 = -0.193, 95% CI = -0.379, -0.006, Ptrend = 0.007; βcontinuous TRAP = -0.019, 95% CI = -0.041, 0.002, βT3 vs T1 = -0.291, 95% CI = -0.469, -0.112, Ptrend = 0.002). The majority of DTAC indices have no statistically significant association with semen quality parameters.

LIMITATIONS REASONS FOR CAUTION

We cannot infer causality because of the nature of the cross-sectional study design. The robustness of the conclusion may be compromised by the exactness of non-enzymatic antioxidant capacity estimation.

WIDER IMPLICATIONS OF THE FINDINGS

Our findings demonstrated no association between DTAC indices and semen quality parameters among men attending an infertility clinic, except for ejaculate volume. Even though our findings are mostly non-significant, they contribute novel knowledge to the field of study while also laying the groundwork for future well-designed studies.

STUDY FUNDING/COMPETING INTERESTS

This work was supported by the JieBangGuaShuai Project of Liaoning Province [grant number 2021JH1/10400050], the Clinical Research Cultivation Project of Shengjing Hospital [grant number M1590], and the Outstanding Scientific Fund of Shengjing Hospital [grant number M1150]. The sponsors had no role in study design, or in the collection, analysis, and interpretation of data, or in the writing of the report, or in the decision to submit the article for publication. There are no conflicts of interest to declare.

TRIAL REGISTRATION NUMBER

N/A.

QTLs and Candidate Genes Associated with Semen Traits in Merino Sheep

Ram semen traits play a significant role in conception outcomes, which in turn may influence reproductive efficiency and the overall productivity and profitability of sheep enterprises. Since hundreds of ewes may be inseminated from a single ejaculate, it is important to evaluate semen quality prior to use in sheep breeding programs. Given that semen traits have been found to be heritable, genetic variation likely contributes to the variability observed in these traits. Identifying such genetic variants could provide novel insights into the molecular mechanisms underlying variability in semen traits. Therefore, this study aimed to identify quantitative trait loci (QTLs) associated with semen traits in Merino sheep. A genome-wide association study (GWAS) was undertaken using 4506 semen collection records from 246 Merino rams collected between January 2002 and May 2021. The R package RepeatABEL was used to perform a GWAS for semen volume, gross motility, concentration, and percent post-thaw motility. A total of 35 QTLs, located on 16 Ovis aries autosomes (OARs), were significantly associated with either of the four semen traits in this study. A total of 89, 95, 33, and 73 candidate genes were identified, via modified Bonferroni, within the QTLs significantly associated with volume, gross motility, concentration, and percent post-thaw motility, respectively. Among the candidate genes identified, SORD, SH2B1, and NT5E have been previously described to significantly influence spermatogenesis, spermatozoal motility, and high percent post-thaw motility, respectively. Several candidate genes identified could potentially influence ram semen traits based on existing evidence in the literature. As such, validation of these putative candidates may offer the potential to develop future strategies to improve sheep reproductive efficiency. Furthermore, Merino ram semen traits are lowly heritable (0.071-0.139), and thus may be improved by selective breeding.

Maternal fever during pregnancy and male offspring reproductive health: A longitudinal cohort study in young Danish males

BACKGROUND

Maternal fever during pregnancy has been associated with an increased risk of genital malformations, but the implication for long-term reproductive health in the offspring is unknown.

OBJECTIVES

To investigate associations between timing, duration, and temperature of fetal exposure to maternal fever and sons' semen quality, testicular volume, and levels of reproductive hormones in early adulthood. Further, to examine whether concurrent use of antipyretics and/or antibiotics modified the effect.

MATERIALS AND METHODS

We used the Fetal Programming of Semen Quality cohort consisting of men born to women enrolled in the Danish National Birth Cohort. Self-reported information on maternal fever was collected twice during pregnancy (median 16 and 31 pregnancy weeks) and categorized as any fever during pregnancy, fever during early pregnancy (weeks 1-15), and fever exclusively during late pregnancy (weeks 16-42). Semen quality and concentrations of reproductive hormones were measured at a clinical examination at the age of 18.9 years. We used negative binomial regression to examine the associations, adjusting for maternal age at birth, maternal smoking, family occupational status, and precision variables related to semen quality and hormonal levels, for example, abstinence time.

RESULTS

986 men were included in the study, of which 23% had mothers reporting at least one episode of fever. We found no strong indications of associations between maternal fever during pregnancy and male reproductive health in young men. Concurrent use of antipyretics and antibiotics did not modify the association.

DISCUSSION

Strengths include the large sample size, prospectively collected data, and the adjustment for maternal factors during pregnancy and important precision variables. A limitation is the crude self-reported information on maternal fever.

CONCLUSION

We found no evidence to support that timing, duration, or temperature of maternal fever during pregnancy has a long-term impact on semen characteristics, testicular volume, or level of reproductive hormones in male offspring.

Study on Sperm-Cell Detection Using YOLOv5 Architecture with Labaled Dataset

Infertility has recently emerged as a severe medical problem. The essential elements in male infertility are sperm morphology, sperm motility, and sperm density. In order to analyze sperm motility, density, and morphology, laboratory experts do a semen analysis. However, it is simple to err when using a subjective interpretation based on laboratory observation. In this work, a computer-aided sperm count estimation approach is suggested to lessen the impact of experts in semen analysis. Object detection techniques concentrating on sperm motility estimate the number of active sperm in the semen. This study provides an overview of other techniques that we can compare. The Visem dataset from the Association for Computing Machinery was used to test the proposed strategy. We created a labelled dataset to prove that our network can detect sperms in images. The best not-super tuned result is mAP 72.15.

Sperm mitochondrial DNA copy number mediates the association between seminal plasma selenium concentrations and semen quality among healthy men

Selenium (Se) is essential for successful male reproduction. However, the association of Se status with human semen quality remains controversial and the underlying mechanisms are poorly understood. We measured seminal plasma Se concentrations, sperm mitochondrial DNA copy number (mtDNAcn), and sperm quality parameters among healthy Chinese men screened as potential sperm donors. Linear mixed-effects models were used to investigate the associations of within-subject pooled seminal plasma Se concentrations (n = 1159) with repeated sperm quality parameters (n = 5617); mediation analyses were applied to evaluate the mediating role of sperm mtDNAcn (n = 989). Seminal plasma Se concentrations were positively associated with sperm concentration and total count (both P for trend < 0.001). In adjusted models, men in the top vs. bottom quartiles of seminal plasma Se concentrations had 70.1 % (95 % CI: 53.3 %, 88.9 %) and 59.1 % (95 % CI: 40.5 %, 80.2 %) higher sperm concentration and total count, respectively. Meanwhile, we observed inverse associations between seminal plasma Se concentrations and sperm mtDNAcn, and between sperm mtDNAcn and sperm motility, concentration, and total count (all P for trend < 0.05). Mediation analyses suggested that sperm mtDNAcn mediated 19.7 % (95 % CI: 15.9 %, 25.3 %) and 23.1 % (95 % CI: 17.4 %, 33.4 %) of the associations between seminal plasma Se concentrations and sperm concentration and total count, respectively. Our findings suggest that Se is essential for male spermatogenesis, potentially by affecting sperm mtDNAcn.

Antigen Unmasking Is Required to Clinically Assess Levels and Localisation Patterns of Phospholipase C Zeta in Human Sperm

Mammalian oocyte activation is initiated by intracellular calcium (Ca2+) oscillations, driven by the testis-specific phospholipase C zeta (PLCζ). Sperm PLCζ analysis represents a diagnostic measure of sperm fertilisation capacity. The application of antigen unmasking/retrieval (AUM) generally enhanced the visualisation efficacy of PLCζ in mammalian sperm, but differentially affected the PLCζ profiles in sperm from different human males. It is unclear whether AUM affects the diagnosis of PLCζ in human sperm. Herein, we examined whether the application of AUM affected the correlation of PLCζ profiles with sperm parameters and fertilisation capacity. PLCζ fluorescence levels and localisation patterns were examined within the sperm of males undergoing fertility treatment (55 patients aged 29-53) using immunofluorescence in the absence/presence of AUM. The changes in PLCζ profiles following AUM were examined in relation to sperm health and fertilisation outcome. AUM enhanced the observable levels and specific localisation patterns of PLCζ in relation to both optimal sperm parameters and fertilisation outcome, without which significant differences were not observed. The extent of the change in levels and localisation ratios of PLCζ was also affected to a larger degree in terms of the optimal parameters of sperm fertility and fertilisation capacity by AUM. Collectively, AUM was essential to accurately assesses PLCζ in human sperm in both scientific and clinical contexts.

Modern surgical treatment of azoospermia

PURPOSE OF REVIEW

To review noteworthy research from the last 2 years on surgical management of azoospermia.

RECENT FINDINGS

The recommended treatments for nonobstructive and obstructive azoospermia have not appreciably changed. However, recent level-1 evidence has reinforced superiority of micro-dissection testicular sperm extraction over sperm aspiration in men with nonobstructive azoospermia, and several studies have identified genetic and other clinical factors that may aid in selecting candidates for testicular sperm extraction. Machine learning technology has shown promise as a decision support system for patient selection prior to sperm retrieval as well a tool to aid in sperm identification from testis tissue.

SUMMARY

Most men with obstructive azoospermia who desire fertility can be offered either surgical reconstruction or sperm retrieval. For men with nonobstructive azoospermia, sperm retrieval with microdissection testicular sperm extraction remains the gold standard treatment. Uncovering more genetic causes of nonobstructive azoospermia may aid in properly counseling and selecting patients for microdissection testicular sperm extraction. Neural networks and deep learning may have a future role in patient selection for surgical sperm retrieval and postprocedural sperm identification.

Sperm as a Carrier of Genome Instability in Relation to Paternal Lifestyle and Nutritional Conditions

Endogenous and exogenous factors can severely affect the integrity of genetic information by inducing DNA damage and impairing genome stability. The extent to which men with and without subfertility are exposed to several adverse lifestyle factors and the impact on sperm DNA fragmentation (SDF), sperm chromatin maturity (condensation and decondensation), stability (hypo- and hypercondensation) and sperm aneuploidy are assessed in this study. Standardized assays employing flow cytometry were used to detect genome instability in 556 samples. Semen parameters deteriorated with age, BMI, increased physical activity and smoking. Age and BMI were associated with increased SDF. Increased BMI was associated with increased hypocondensed chromatin and decreased decondensed chromatin. Increase in age also caused an increase in sex chromosome aneuploidy in sperms. Surprisingly, alcohol abuse reduced chromatin hypercondensation and drug abuse reduced SDF. Although genome instability was more pronounced in the subfertile population as compared to the fertile group, the proportion of men with at least one lifestyle risk factor was the same in both the fertile and subfertile groups. While one in three benefited from nutritional supplementation, one in five showed an increase in SDF after supplementation. Whilst the message of ‘no smoking, no alcohol, no drugs, but a healthy diet’ should be offered as good health advice, we are a long way from concluding that nutritional supplementation would be beneficial for male fertility.

Evaluating an external quality assurance program for semen analysis in China during 2009-2020

INTRODUCTION

Semen analysis (SA) plays a key role in guiding treatments of male reproductive diseases and infertility due to male factors; however, it remains challenging to conduct an accurate SA due to lack of standardization, highly subjective assessments, and problems with automated procedures. Therefore, quality assurance (QA) and teaching courses are essential for making the laboratory results more consistent.

MATERIALS AND METHODS

The external quality assurance (EQA) scheme was organized by national human sperm bank technology training bases in Guangdong province in China between 2009 and 2020. Until 2020, 124 laboratories from China participated in the EQA program. The EQA scheme per year has been organized involving two semen aliquots for sperm concentration, two video recordings for motility, and two smears for sperm morphology. All samples used in the EQA scheme were obtained from different healthy donors or patients.

RESULTS

We estimated that the median coefficient of variation (CV) of sperm concentration, ignoring the method used, was 26.6%. Using a 100 µm deep counting chamber led to a decreasing CV of 13.6%. For sperm motility, the median CV of nonprogressive motility was high (50.8%), but the CV of progressive motility (13.2%), immotile sperm (14.3%), and total motility (11.8%) were acceptable. The morphology assessment revealed large variability (44.4%) irrespective of the classification criteria.

DISCUSSION

The reduction of interlaboratory variability is still a challenge during SA in China. Therefore, it is critical to increase awareness of joining EQA schemes and establish standardized training centers to follow WHO-recommended procedures toward Chinese standards.

Reproductive function in men conceived with in vitro fertilization and intracytoplasmic sperm injection

OBJECTIVE

To determine the semen quality and reproductive hormones of men conceived by in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) compared with men conceived without assisted reproductive technology (ART).

DESIGN

Cohort study.

SETTING

IVF centers in Victoria and the Western Australian Raine Study.

PATIENT(S)

Men conceived with IVF/ICSI and men conceived without ART aged 18-25 years.

INTERVENTION(S)

Clinical review.

MAIN OUTCOME MEASURE(S)

The primary outcome was the prevalence of severe oligozoospermia (sperm concentration, <5 million/mL). The secondary outcomes were total sperm count, total and progressive motility, total motile count, normal morphology, and serum testosterone, luteinizing hormone (LH) and follicle-stimulating hormone (FSH).

RESULTS

There was no difference in the prevalence of severe oligozoospermia between 120 men conceived with IVF/ICSI and 356 men conceived without ART (9% vs. 5.3%). Men conceived with IVF/ICSI had similar sperm concentration, total sperm count, and total motile count but lower mean total (55.3% vs. 60.6%) and progressive (44.7% vs. 53.9%) sperm motility with higher mean normal morphology (8.5% vs. 5.4%). Differences in progressive motility (ß, -9.9; 95% confidence interval [CI], -16.7 - -3.0), normal morphology (ß, 4.3; 95% CI, 3.0-5.7), and proportion with abnormal morphology (adjusted odds ratios, 0.1; 95% CI, 0.04-0.5) remained significant after adjusting for confounders. Men conceived with IVF/ICSI had lower mean FSH (3.3 IU/L) and LH (3.9 IU/L) levels and higher mean testosterone levels (19.1 nmol/L) than controls (4.2 IU/L, 11.0 IU/L, and 16.8 nmol/L).

CONCLUSION

This study of men conceived with IVF/ICSI found similar sperm output to men conceived without ART. Overall, the results are reassuring.

Artificial Intelligence Based Machine Learning Models Predict Sperm parameter Upgrading after Varicocele Repair: A Multi-Institutional Analysis

PURPOSE

Varicocele repair is recommended in the presence of a clinical varicocele together with at least one abnormal semen parameter, and male infertility. Unfortunately, up to 50% of men who meet criteria for repair will not see meaningful benefit in outcomes despite successful treatment. We developed an artificial intelligence (AI) model to predict which men with varicocele will benefit from treatment.

MATERIALS AND METHODS

We identified men with infertility, clinical varicocele, and at least one abnormal semen parameter from two large urology centers in North America (Miami and Toronto) between 2006 and 2020. We collected pre and post-operative clinical and hormonal data following treatment. Clinical upgrading was defined as an increase in sperm concentration that would allow a couple to access previously unavailable reproductive options. The tiers used for upgrading were: 1-5 million/mL (ICSI/IVF), 5-15 million/mL (IUI) and >15 million/mL (natural conception). Thus moving from ICSI/IVF to IUI, or from IUI to natural conception, would be considered an upgrade. AI models were trained and tested using R to predict which patients were likely to upgrade after surgery. The model sorted men into categories that defined how likely they were to upgrade after surgery (likely, equivocal, and unlikely).

RESULTS

Data from 240 men were included from both centers. A total of 45.6% of men experienced an upgrade in sperm concentration following surgery, 48.1% did not change, and 6.3% downgraded. The data from Miami were used to create a random forest model for predicting upgrade in sperm concentration. On external validation using Toronto data, the model accurately predicted upgrade in 87% of men deemed likely to improve, and in 49% and 36% of men who were equivocal and unlikely to improve, respectively. Overall, the personalized prediction for patients in the validation cohort was accurate (AUC 0.72).

CONCLUSIONS

A machine learning model performed well in predicting clinically meaningful post-varicocelectomy sperm parameters using pre-operative hormonal, clinical, and semen analysis data. To our knowledge, this is the first prediction model to show the utility of hormonal data, as well as the first to use machine learning models to predict clinically meaningful upgrading. This model will be published online as a clinical calculator that can be used in the preoperative counseling of patients.

Prenatal exposure to phenols and benzophenones in relation to markers of male reproductive function in adulthood

INTRODUCTION

Environmental exposure during fetal life may disrupt testicular development. In humans, a limited number of studies have investigated whether these adverse effects persist into adulthood. Using data from a prospective, population-based birth cohort study, The Copenhagen Mother-Child cohort, the objective was to assess if there is an association between fetal exposure to selected phenols and benzophenones and markers of testicular function in adult men.

METHODS

Pregnant women were recruited in 1997-2001. Their sons were examined clinically at 18-20 years of age, with focus on adult markers of reproductive function (anogenital distance (AGD), semen quality and reproductive hormones). In total, 101 18-20-year-old men were included, whose mothers during pregnancy had a serum sample drawn and analyzed for bisphenol A (BPA) and seven other simple phenols, as well as six benzophenones. To investigate the association between chemical levels (in tertiles, T1-T3) in relation to markers of reproductive function, univariate and multiple linear regression analyses were performed.

RESULTS

In fully adjusted analyses, increased levels of luteinizing hormone (LH) were observed with higher fetal exposure to BPA (percentage difference (95%CI)) (T2: 12% (-8%,36%) and T3: 33% (10%,62%), compared to T1) and benzophenone-3 (BP-3) (T2: 21% (-2%,49%), T3: 18% (-4%,45%)), while no clear association was seen to total testosterone (TT). Higher levels of BPA and BP-3 were associated with a lower TT/LH ratio, although only significant for BPA (p-trend=0.01). No associations were seen to AGD or markers of semen quality.

CONCLUSION

In conclusion, high exposure to BPA and BP-3 was associated with a compensated reduced Leydig cell function but no other changes in markers of reproductive health. As maternal levels of BPA and BP-3 were not correlated, separate effects may be at play. Larger studies on long-term reproductive consequences of prenatal exposures are warranted to validate our findings.

Relevant Biological Effects of Varicocele Embolization with N-Butyl Cyanoacrylate Glue on Semen Parameters in Infertile Men

Surgical treatment or varicocele embolization (VE) with sclerosing or mechanical embolic agents have been shown to improve the semen parameters of infertile men. The aim of this study was to evaluate the impact of VE using N-butyl cyanoacrylate (NBCA) glue on semen parameters in infertile men. From January 2014 to June 2018, infertile adult patients with stage 3 varicocele and an initial semen analysis showing at least one abnormal semen parameter, and who were successfully embolized with NBCA Glubran^®2 glue, were retrospectively recruited. The availability of a second semen analysis after VE was mandatory for patient inclusion. The primary endpoint was the change in total sperm number (TSN) after VE. The other parameters of interest were progressive and total sperm motilities (Smot) at 1 h (H1), sperm vitality (SV) and morphology (SMor). One hundred and two patients were included. Eight patients presented null TSN before and after VE. Among the remaining 94 patients, a significant improvement in the median TSN after VE was shown (31.79 × 10⁶/ejaculate [IQR: 11.10-127.40 × 10⁶/ejaculate] versus 62.24 × 10⁶/ejaculate [IQR: 17.90-201.60 × 10⁶/ejaculate], p = 0.0295). Significant improvement in TSN was found for the 60 oligo- or azoospermic patients (p = 0.0007), whereas no significant change was found for the 42 patients with normal initial TSN (p = 0.49). Other parameters, such as progressive and total SMot, SV and SMor, also significantly improved after VE (p = 0.0003, 0.0013, 0.0356 and 0.007, respectively). The use of NBCA glue as an embolic agent for VE in infertile men with stage 3 varicocele significantly improves the semen parameters.

Simplified sperm testing devices: a possible tool to overcome lack of accessibility and inconsistency in male factor infertility diagnosis. An opportunity for low- and middle- income countries

Background

Manual semen assessment (MSA) is a key component in a male’s fertility assessment. Clinicians rely on it to make diagnostic and treatment decisions. When performed manually, this routine laboratory test is prone to variability due to human intervention which can lead to misdiagnosis and consequently over- or under- treatment. For standardisation, continuous training, quality control (QC) programs and pricy Computer-Assisted Sperm Analysis (CASA) systems have been proposed, yet, without resolving intra- and inter-laboratory variability. In response, promising simplified sperm testing devices, able to provide cost-effective point-of-care male infertility diagnosis are prospected as a plausible solution to resolve variability and increase access to sperm testing.

Materials and methods

A throughout literature research for semen testing, sperm analysis, smart-phone assisted semen analysis, ‘at-home’ semen testing, male infertility, infertility in developing countries, infertility in low- and middle-income countries (LMIC) and quantitative sperm analysis was performed. A total of 14 articles, specific to ‘at-home’ simplified sperm assessment, were included to treat the core subject.

Results

Continuous training and consistent QC, are sine qua none conditions to achieve accurate and comparable MSA. Compliance does not rule-out variability, nevertheless. Emerging simplified sperm assessment devices are an actual alternative to resolve the lack of standardisation and accessibility to sperm analysis. YO ® , SEEM ® , and ExSeed ® are commercially available, user-friendly smartphone-based devices which can accurately measure volume, sperm concentration (millions/ml) and total motile sperm count. More broadly, by cost-effectiveness, availability, accuracy and convenient application, these devices could effectively select patients for first-line artificial reproduction treatments such as intrauterine insemination.

Conclusions

Accuracy and cost-effectiveness make smart-phone based sperm testing devices a practical and realistic solution to overcome variability in MSA. Importantly, these tools represent an actual opportunity to standardise and improve male subfertility diagnosis and treatment, especially in LMIC. However, before clinical application is possible, guidelines, further testing with special attention on accuracy in washed sperm, availability, cost-benefit and reliability are required.

The effect of analyst training on fecal egg counting variability

Fecal egg counts (FECs) are essential for veterinary parasite control programs. Recent advances led to the creation of an automated FEC system that performs with increased precision and reduces the need for training of analysts. However, the variability contributed by analysts has not been quantified for FEC methods, nor has the impact of training on analyst performance been quantified. In this study, three untrained analysts performed FECs on the same slides using the modified McMaster (MM), modified Wisconsin (MW), and the automated system with two different algorithms: particle shape analysis (PSA) and machine learning (ML). Samples were screened and separated into negative (no strongylid eggs seen), 1-200 eggs per gram of feces (EPG), 201-500 EPG, 501-1000 EPG, and 1001+ EPG levels, and ten repeated counts were performed for each level and method. Analysts were then formally trained and repeated the study protocol. Between analyst variability (BV), analyst precision (AP), and the proportion of variance contributed by analysts were calculated. Total BV was significantly lower for MM post-training (p = 0.0105). Additionally, AP variability and analyst variance both tended to decrease for the manual MM and MW methods. Overall, MM had the lowest BV both pre- and post-training, although PSA and ML were minimally affected by analyst training. This research illustrates not only how the automated methods could be useful when formal training is unavailable but also how impactful formal training is for traditional manual FEC methods.

Comparison of two automated sperm analyzers using 2 different detection methods versus manual semen assessment

PURPOSE

The exploration of male infertility is mainly based on semen analysis, but its evaluation might be affected by the operator's competence and subjectivity. This led to the development of automated semen analyzing systems. Despite continuous improvement, the precision and correlation of these automated systems with manual sperm assessment performed strictly according to WHO guidelines remains variable in the literature, and their role in daily practice is debated.

METHODS

In this double blind prospective study, we compared the results provided by 2 automated systems based on different concepts (CASA and electro-optical signal) with manual sperm assessment. Sperm concentration, motility and morphology were performed simultaneously and independently by different operators, blinded to each other.

RESULTS

A total of 102 unselected men attending the andrology department for routine sperm analysis were included in the study. We found no significant difference between each automated method and manual assessment for all sperm parameters, except for sperm morphology assessment where the electro-optical system gave higher results and performed slightly poorer than CASA. Correlation was moderate to high between manual assessment and each automated methods for all sperm parameters, with randomly distributed differences.

CONCLUSIONS

Overall, these results show that both types of automated systems can be implemented in andrology laboratory for routine sperm analysis.

A study of pregnancy rates in "cleared" male factor couples

Background

Among couples with male factor infertility, the natural pregnancy rates associated with classic male factor treatments are well described. In couples with unexplained infertility, the proportion due to occult male factor is unclear. We hypothesized that many men diagnosed with unexplained infertility are actually fertile. We describe the 1-year natural pregnancy rates among couples in whom the male partner has been “cleared” of infertility on urologic evaluation.

Methods

Consecutive infertile couples were recruited from a single practice (PJT) over a 3-year period. A thorough male factor evaluation was performed, including a history, physical examination and 2 semen analyses. Based on this assessment, male partners in whom bulk semen parameters were normal were “cleared” from further evaluation. Lifestyle modifications were allowed, but no medical or surgical treatments were offered. The presence or absence of a female factor evaluation was not required for study inclusion. Subjects were followed for 12 months or until a pregnancy was achieved. Subjects were contacted via telesurvery 1-year later and pregnancy status ascertained. Simple descriptive statistics were used to evaluate the significance of observations.

Results

Fifty-four men were enrolled in the study. The mean duration of infertility was 1.5 years (range, 0.4 to 4.0 years) and the mean male and female partner ages were 38.6 and 35.1 years, respectively. On evaluation, 40% of men were noted to have significant fertility risks that included a clinical varicocele, exposures, and androgen altering medications. Among n=31 couples with known pregnancy outcomes, 20/31 (65%) conceived naturally at a mean of 9 months after evaluation (range, 3–30 mos). Another 1/31 (3%) couples conceived with intrauterine insemination (IUI) and 4/31 (13%) conceived with IVF-ICSI.

Conclusions

A significant proportion of men diagnosed with unexplained infertility have lifestyle risk factors on urologic evaluation. Care in the form of counseling at-risk patients regarding lifestyle issues, in the absence of formal treatment, may have value in improving the fertility potential in this population. Indeed, natural conception rates among men identified with unexplained infertility are substantial and suggest that many of these men are truly fertile.

Lack of trusted diagnostic tools for undetermined male infertility

Semen analysis is the cornerstone of evaluating male infertility, but it is imperfect and insufficient to diagnose male infertility. As a result, about 20% of infertile males have undetermined infertility, a term encompassing male infertility with an unknown underlying cause. Undetermined male infertility includes two categories: (i) idiopathic male infertility-infertile males with abnormal semen analyses with an unknown cause for that abnormality and (ii) unexplained male infertility-males with "normal" semen analyses who are unable to impregnate due to unknown causes. The treatment of males with undetermined infertility is limited due to a lack of understanding the frequency of general sperm defects (e.g., number, motility, shape, viability). Furthermore, there is a lack of trusted, quantitative, and predictive diagnostic tests that look inside the sperm to quantify defects such as DNA damage, RNA abnormalities, centriole dysfunction, or reactive oxygen species to discover the underlying cause. To better treat undetermined male infertility, further research is needed on the frequency of sperm defects and reliable diagnostic tools that assess intracellular sperm components must be developed. The purpose of this review is to uniquely create a paradigm of thought regarding categories of male infertility based on intracellular and extracellular features of semen and sperm, explore the prevalence of the various categories of male factor infertility, call attention to the lack of standardization and universal application of advanced sperm testing techniques beyond semen analysis, and clarify the limitations of standard semen analysis. We also call attention to the variability in definitions and consider the benefits towards undetermined male infertility if these gaps in research are filled.

A preliminary study of sperm identification in microdissection testicular sperm extraction samples with deep convolutional neural networks

Sperm identification and selection is an essential task when processing human testicular samples for in vitro fertilization. Locating and identifying sperm cell(s) in human testicular biopsy samples is labor intensive and time consuming. We developed a new computer-aided sperm analysis (CASA) system, which utilizes deep learning for near human-level performance on testicular sperm extraction (TESE), trained on a custom dataset. The system automates the identification of sperm in testicular biopsy samples. A dataset of 702 de-identified images from testicular biopsy samples of 30 patients was collected. Each image was normalized and passed through glare filters and diffraction correction. The data were split 80%, 10%, and 10% into training, validation, and test sets, respectively. Then, a deep object detection network, composed of a feature extraction network and object detection network, was trained on this dataset. The model was benchmarked against embryologists' performance on the detection task. Our deep learning CASA system achieved a mean average precision (mAP) of 0.741, with an average recall (AR) of 0.376 on our dataset. Our proposed method can work in real time; its speed is effectively limited only by the imaging speed of the microscope. Our results indicate that deep learning-based technologies can improve the efficiency of finding sperm in testicular biopsy samples.

Reproductive context of extremely short sperm in the parasitic wasp Cotesia congregata (Hymenoptera: Braconidae)

Among adaptive traits under sexual selection, the length of spermatozoa shows high interspecific variation. In insects, extremes exist for both short and long sperm. The spermatozoa of the endoparasitic wasp Cotesia congregata (Say) are the shortest flagellated sperm described in animals, 6.6 µm in length. By comparison, the sperm of Drosophila bifurca are almost 6000 times longer. Thus, C. congregata has the potential to shed light on the selection pressures that drive variation in sperm length in relation to their production and use. The reproductive organs, sperm counts, controlled oviposition and sex ratios were investigated. The testes showed stratified differentiation stages of spermatogenesis, and sperm counts revealed continuous spermatogenesis in the late pupal stage. The small female spermatheca stored ~1000 sperm, resulting in an extremely high sperm concentration. The number of progeny per brood decreased over time until depletion of eggs. Females produced up to 370 daughters, corresponding to the effective use of 34% of the average sperm stock. Haploid males made up a greater proportion of broods in later parasitisms. Sperm miniaturization may be an adaptation to transfer increased quantities for the entire reproductive life of females in the absence of sperm competition but in the reduced space offered by the spermatheca.

Sperm nuclear maturity and chromatin stability in subfertile patients: Density gradient centrifugation is fair but non-discriminative in selecting the right population

Multiple technologies exploring chromatin structure anomalies have been applied during the last decade to evaluate fertility disorders and to increase the predictive value of sperm analysis for procreation in vivo and in vitro. Our aim was to implement sperm nuclear maturity and nuclear chromatin stability as a functional test for male infertility diagnosis and to compare it with a fertile group. As semen processing is an integral part of assisted reproductive technologies the impact of density gradient centrifugation in selecting sperm based on nuclear maturity and stability was also analyzed. Flow cytometry combined with fluorescent dyes exhibiting affinity for DNA was implemented. Both nuclear parameters correlated significantly with semen parameters. The control fertile group had significantly higher mean condensed population and a significantly lower hypocondensed and hypercondensed fractions as compared to the subfertile study group. Density gradient centrifugation succeeded in selecting the condensed population in both the control and study groups, while reducing the hypocondensed percentage. The hypercondensed population which was ten-fold higher in the study group remained unchanged after selection, in both the control and the study groups. Sperm nuclear maturity and chromatin stability appears to be homogenous in the fertile sperm donors and heterogeneous in subfertile patients. Sperm preparation for assisted reproduction should aim to minimize the risk of abnormal spermatozoa being used for fertilization.

The Prevalence of Y-chromosome Microdeletions in Oligozoospermic Men: A Systematic Review and Meta-analysis of European and North American Studies

CONTEXT

European and North American guidelines recommend Y-chromosome microdeletion (YCM) screening in azoospermic and oligozoospermic men with sperm concentrations of <5 million sperm/ml; however, numerous studies have suggested that YCMs are rare when sperm concentrations are >1 million sperm/ml.

OBJECTIVE

We systematically reviewed and meta-analyzed European and North American studies to determine the prevalence of a complete YCM in oligozoospermic men with sperm concentrations of >0-1, >1-5, and >5-20 million sperm/ml, and to determine whether 1 or 5 million sperm/ml is the most appropriate sperm concentration threshold for YCM screening.

EVIDENCE ACQUISITION

A systematic review of MEDLINE, EMBASE, Cochrane Library, and ClinicalTrials.gov was performed for studies assessing the prevalence of a complete YCM in oligozoospermic men in European and North American studies.

EVIDENCE SYNTHESIS

Thirty-seven studies were identified during a systematic review (n = 12 492 oligozoospermic men). All complete YCMs in oligozoospermic men were AZFc microdeletions. Eighteen studies contained data conducive to meta-analysis (n = 10 866 men). Comparing the pooled estimated prevalence by sperm concentration, complete YCMs were significantly more common in men with sperm concentrations of >0-1 million sperm/ml (5.0% [95% confidence interval {CI}: 3.6-6.8%]) versus >1-5 million sperm/ml (0.8% [95% CI: 0.5-1.3%], p < 0.001). YCMs were similar in men with sperm concentrations of >1-5 and >5-20 million sperm/ml (0.8% [95% CI: 0.5-1.3%] vs 0.5% [95% CI: 0.2-0.9%], p = 0.14).

CONCLUSIONS

In Europe and North America, the majority of YCMs occur in men with sperm concentrations of ≤1 million sperm/ml, with <1% identified in men with >1 million sperm/ml. Male infertility guidelines for North America and Europe should reconsider the sperm concentration screening thresholds to recommend testing for YCMs only for men with sperm concentrations of <1 million sperm/ml.

PATIENT SUMMARY

Complete Y-chromosome microdeletions (YCMs) are rare in men with >1 million sperm/ml. Routine screening for YCMs should occur only if sperm concentration is ≤1 million sperm/ml.

The Effect of Supplementation with Some Essential Oils on the Mobility and the Vitality of Human Sperm

The objective of this work is to study the improvement effect of some essential oils of sage (Salvia officinalis), oregano (Origanum vulgare), and eucalyptus (eucalyptus globulus) on the physiological parameters characterizing the quality of human sperm (mobility and vitality). We find natural biomolecules to improve sperm quality to increase the chances of success of very low in vitro fertilization (IVF) that stagnate around 20%. Sperm samples were mixed with different concentrations of essential oils. The effect of these essential oils on the motility and vitality of spermatozoa has been analyzed. The mobility was determined using a Computer Assisted Sperm Analysis (CASA). In the other side, the evaluation of sperm vitality was performed by staining eosin 2% and the microscopic examination is carried out via optical microscope. A drop of sperm will be mixed with a drop of eosin solution 2%, spread between the slip and coverslip, then allowed to air dry, and examined under a microscope. A significant improvement in the mobility and vitality of human spermatozoa has been noted with oregano. Eucalyptus after 10 min of exposure also significantly improves the mobility and vitality of the spermatozoa. Sage does not improve mobility for these incubation times but significantly improves vitality.

Axonemal doublet microtubules can split into two complete singlets in human sperm flagellum tips

Motile flagella are crucial for human fertility and embryonic development. The distal tip of the flagellum is where growth and intra-flagellar transport are coordinated. In most model organisms, but not all, the distal tip includes a 'singlet region', where axonemal doublet microtubules (dMT) terminate and only complete A-tubules extend as singlet microtubules (sMT) to the tip. How a human flagellar tip is structured is unknown. Here, the flagellar tip structure of human spermatozoa was investigated by cryo-electron tomography, revealing the formation of a complete sMT from both the A-tubule and B-tubule of dMTs. This different tip arrangement in human spermatozoa shows the need to investigate human flagella directly in order to understand their role in health and disease.

Dynamic assessment of human sperm DNA damage II: the effect of sperm concentration adjustment during processing

PURPOSE

To evaluate the effect of sperm concentration adjustment in human ejaculates on the sperm DNA quality and longevity.

METHODS

Semen samples were obtained from 30 donors with a normal spermiogram. Following centrifugation, the sperm pellet was resuspended in PBS, and the sperm concentration adjusted to 200, 100, 50, 25, 12, and 6 × 10⁶/mL. Each set of samples was incubated at 37 °C for 24 h, and the sperm DNA damage was assessed using the chromatin-dispersion test following 0 h, 2 h, 6 h, and 24 h of incubation.

RESULTS

Sperm DNA fragmentation (SDF) did not differ between the selected experimental conditions at T0; however, Kaplan-Meier estimates for survival showed significant differences with respect to the dilution and time (all P values were smaller than .001). DNA fragmentation in semen samples adjusted to 200 × 10⁶/mL was approximately 3.3 times higher when compared to samples containing 25 × 10⁶/mL and 3.9 higher in comparison with samples adjusted to 12 × 10⁶/mL following 2 h of in vitro incubation. Although there was evidence of individual variation in SDF during the incubation period, the general finding was that lower sperm concentrations resulted in a slower rate of DNA fragmentation.

CONCLUSIONS

Incubation of spermatozoa for ART purposes should be done following a concentration adjustment below 25 × 10⁶/mL in order to avoid a higher susceptibility of the sperm DNA molecule towards fragmentation.

Superhydrophobic Soot Coated Quartz Crystal Microbalances: A Novel Platform for Human Spermatozoa Quality Assessment

The functionality of human spermatozoa is a key factor for the success rate of natural human reproduction, but unfortunately the infertility progressively increases due to multifarious environmental factors. Such disquieting statistics requires the employment of sophisticated computer-assisted methods for semen quality analysis, whose precision, however, is unreliable in cases of patients with low sperm concentrations. In this study, we report a novel quartz crystal microbalance (QCM) based biosensor for in-situ quality assessment of male gametes, comprising a superhydrophobic soot coating as an interface sensing material. The soot deposition on the surface of a 5 MHz QCM eliminates the noise that normally arises upon immersion of the uncoated sensor in the test liquid environment, allowing the detection of human spermatozoa down to 1000–100,000 units/mL (1–100 ppb). Furthermore, the soot coated QCM delimitates in a highly repeatable way the immotile and motile sperm cells by inducing fundamentally distinct responses in respect to sensor sensitivity and signal trends. The obtained results reveal the strong potential of the superhydrophobic QCM for future inclusion in diverse laboratory analyses closely related to the in vitro fertilization procedures, with a final aim of gaining practical approaches for diagnoses and selection of male gametes.

JG. The effects of male age on sperm DNA damage: an evaluation of 2,178 semen samples

OBJECTIVE

This study aimed to evaluate the effects of male age on sperm DNA damage.

METHODS

This cross-sectional study included semen samples collected from 2,178 men seen at an infertility clinic. For DNA integrity analysis, the proportions of spermatozoa showing DNA fragmentation (TUNEL assay), abnormal chromatin packaging/underprotamination (chromomycin A3), abnormal mitochondrial membrane potential (MMP/MitoTracker Green), and apoptosis (annexin V) were recorded. For group comparisons, enrolled subjects were divided into three groups based on their ages: ≤35 years; 36-44 years; and ≥45 years. The associations between age and sperm parameters were assessed using Spearman's rank correlation coefficient.

RESULTS

Although aging did not affect sperm apoptosis (p>.05), sperm DNA fragmentation and MMP deteriorated significantly with age (p<.05). Chromatin packaging/protamination improved significantly with age (p<.05).

CONCLUSION

Sperm DNA fragmentation worsened with age and was apparently associated with mitochondrial damage. The age-related increase in sperm DNA damage suggests that delaying childbearing, not only in women but also in men, might jeopardize a couple's reproductive capacity. The increase seen in chromatin packaging might represent a protective feature for DNA. However, additional studies must be performed to confirm the results concerning chromatin packaging/protamination.

Dynamic assessment of human sperm DNA damage I: the effect of seminal plasma-sperm co-incubation after ejaculation

AIM

The purpose of the study was to evaluate the impact of seminal plasma in human ejaculates on the sperm DNA quality and DNA longevity.

METHODS

Semen samples for this study were obtained from 20 donors with a normal spermiogram. Following centrifugation, the sperm pellet was resuspended either in the seminal plasma proceeding from its respective donor, or in an equal amount of PBS, adjusting the concentration to 50 × 10⁶/ml. Each set of samples was incubated at 37 °C for 24 h and the sperm DNA damage was assessed using the chromatin-dispersion test following 0, 2, 6, and 24 h of incubation.

RESULTS

Sperm DNA fragmentation (SDF) did not differ between the two experimental conditions at T0; however, Kaplan-Meier estimates to test for survival showed an statistical significant increase of SDF in the seminal plasma group when compared to the PBS group following all timeframes (p 0.000). With respect to sperm DNA longevity, the most dramatic loss of sperm DNA quality occurred during the first 2 h of incubation, with the rate of SDF (rSDF) in the seminal plasma being 2.1 more intense than in PBS. Interestingly, the rSDF was found to vary significantly between individuals, which was confirmed with significant correlations in all rSDF timeframes (rSDF T0-2, p 0.049; rSDF T2-6, p 0.000; rSDF T6-24: p 0.000).

CONCLUSIONS

Co-incubation of semen samples in seminal plasma after ejaculation increases iatrogenic sperm damage. This effect is statistically significant after 2 h of co-incubation. Subsequently, for ART purposes seminal plasma must be quickly removed after ejaculation-liquefaction, to avoid a higher susceptibility of sperm DNA towards fragmentation.

Comparison of semen quality between university-based and private assisted reproductive technology laboratories

OBJECTIVE

Obtaining a semen analysis (SA) is an essential step in evaluating infertile men. Despite using standardized procedures for analysis semen quality in the same individual often varies on repeated tests. The objective of this study was to investigate inter-laboratory variation in semen quality between private- and university-based assisted reproductive technology (ART) laboratories.

MATERIALS AND METHODS

IRB approval was obtained to retrospectively evaluate men with a SA at both the private- and university-based ART laboratories. When more than one SA was available from either laboratory, the first at each laboratory was selected for analysis. Comparison of major semen parameters was performed using descriptive statistics and Bland-Altman plots, with differences tested using Wilcoxon-signed rank test.

RESULTS

Twenty-eight men aged 33 ± 5 (mean ± SD) years were included in the study. Motility was higher at the private laboratories compared to the university-based laboratory (Median difference -12.5%, 95% confidence interval -20.3%; -5.5%). Percent normal morphology was higher at the university-based laboratory compared to private laboratories (5.0%, 3.6%; 6.9%). No significant differences were found in volume, concentration and total motile sperm count although the Bland-Altman plot bias for concentration was clinically significant (15.9 × 10⁶/ml).

CONCLUSIONS

In this small series, motility was significantly higher at private laboratories compared to a university-based laboratory but was above WHO reference limits at both places. Normal sperm morphology was significantly lower in semen analyses performed at private laboratories compared to a university-based laboratory and was below WHO reference limits.

JG. Influence of the abstinence period on human sperm quality: analysis of 2,458 semen samples

OBJECTIVE

The aim of this study was to evaluate the influence of different periods of abstinence on conventional semen parameters as well as functional parameters in human semen, including mitochondrial function, chromatin packing and sperm DNA fragmentation.

METHODS

We recruited a cohort of 2,458 men undergoing infertility investigation. Semen analyses were performed according to WHO guidelines/morphology-motile sperm organelle morphology examination/MSOME. For DNA integrity analysis, the percentages of DNA fragmentation (TUNEL), abnormal chromatin packaging/underprotamination (chromomycin A3/CMA3), abnormal mitochondrial membrane potential (MMP/MitoTracker Green), and apoptosis (annexin-V) were recorded. Associations between the sexual abstinence period and sperm parameters were assessed using Spearman correlation. For group comparisons, the subjects were categorized according to the sexual abstinence period (SAP) into three groups: SAP <2 days, SAP 2-5 days, and SAP >5 days.

RESULTS

The duration of abstinence had a statistically significant positive influence on sperm concentration and volume, the number of leukocytes and a statistically significant negative influence on sperm motility and vitality. The percentages of DNA fragmentation and MMP (mitochondrial damage) worsened with the increased duration of abstinence. The percentage of sperm protamination was statistically significantly increased with abstinence.

CONCLUSION

Increase in the sexual abstinence period influences sperm quality. This study reinforces the importance of the duration of ejaculatory abstinence on semen parameter variation. It highlights the deleterious effect of increased abstinence on DNA damage, which is most likely associated with ROS (mitochondrial damage/number of leukocytes). The increase in chromatin packaging can represent a protective feature for DNA.

JG. Semen parameters in men with varicocele: DNA fragmentation, chromatin packaging, mitochondrial membrane potential, and apoptosis

OBJECTIVE

To evaluate varicocele effects on conventional semen parameters: sperm DNA fragmentation, chromatin packaging, mitochondrial membrane potential (MMP) and sperm apoptosis.

METHODS

A cross-sectional study was carried out with semen samples from 2,399 men of couples who attended an infertility clinic. A total of 16.3% (391/2399) of the men were diagnosed with varicocele by a urologist.

RESULTS

A regression analysis revealed that the percentages of sperm with DNA fragmentation, abnormal chromatin packaging, and abnormal MMP were significantly increased in individuals with varicocele, when compared to men without varicocele. Apoptosis was not influenced by varicocele. Conventional semen parameters were significantly worse in individuals with the disease. On the other hand, in men with varicocele, Spearman's correlation demonstrated that early apoptosis and abnormal MMP showed a positive and significant correlation with sperm DNA fragmentation.

CONCLUSION

Men with varicocele had worse semen parameters, including increased levels of sperm DNA fragmentation, inactive mitochondria, and abnormal chromatin packaging. These changes are possible causes of infertility in individuals with varicocele.

Validation of a laboratory-developed test of human sperm capacitation

Sperm must undergo capacitation to become fertilization competent. Here we validated that monosialotetrahexosylganglioside (GM1 ) localization patterns, which were assessed in the Cap-Score™ Sperm Function Test, reflect a capacitated state in human sperm. First, we defined patterns representing sperm that do or do not respond to stimuli for capacitation. Sperm with "capacitated" patterns had exposed acrosomal carbohydrates and underwent acrosome exocytosis in response to calcium ionophore (A23187). Precision was evaluated by percent change of the Cap-Score measured for 50, 100, 150, and 200 sperm. Changes of 11%, 6%, and 5% were observed (n ≥ 23); therefore, we counted ≥150 sperm per condition. Variance within and between readers was evaluated using 20 stitched image files generated from unique ejaculates. Two trained readers randomly resampled each image 20 times, reporting an average standard deviation of 3 Cap-Score units and coefficient of variation of 13% when rescoring samples, with no difference between readers. Semen liquefaction times ≤2 hr and mechanical liquefaction with Pasteur or wide-orifice transfer pipettes did not alter Cap-Score values. However, liquefaction with chymotrypsin (p = 0.002) and bromelain (p = 0.049) reduced response to capacitating stimuli and induced membrane damage, while counterintuitively improving sperm motility. Together, these data validate the Cap-Score assay for the intended purpose of providing information on sperm capacitation and male fertility. In addition to its clinical utility as a diagnostic tool, this test of sperm function can reveal the impact of common practices of semen handling on the ability of sperm to respond to capacitation stimuli.

Automatic classification of human sperm head morphology

BACKGROUND AND OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

[Inter-and intra-operator variability in the analysis of semen parameters: results from a quality control program]

Introduction

L’analyse du sperme est d’une importance majeure dans l’exploration de l'infertilité masculine. Afin de s’assurer de la fiabilité des résultats rendus, l’implantation du management de qualité en spermiologie est devenue une nécessité.Le but de ce travail a été d’évaluer la variabilité intra- et inter-opérateurau cours de l’analyse des paramètres spermatiques au sein de notre laboratoire de spermiologie, à travers la mise en place d’un programme de contrôle de qualité.

Méthodes

Quatre opérateurs ayant des niveaux d’expérience différents ont participé à l’étude. La variabilité inter-individuelle des résultats des lectures de la mobilité, la concentration et la morphologie spermatique a été évaluée sur plusieurs échantillons de sperme de qualités différentes. Pour chaque paramètre spermatique, la variabilité intra-individuelle a été évaluée en analysant les résultats des lectures de plusieurs aliquotes issus de chacun des échantillons utilisés.

Résultats

Les coefficients de variation moyens inter-opérateurs ont été de12.8%, 19.8% et 48.9% pour la mobilité, la concentration et la morphologie spermatique, respectivement. Les coefficients de variation moyens intra-opérateurs ont été de6.9%, 12.3%et 42.7% pour la mobilité, la concentration, et la morphologie spermatique, respectivement. Mis à part quelques écarts (erreurs aléatoires), la plupart des mesures réalisées ont été dans les limites d’acceptabilité pour l’ensemble des opérateurs.La variabilité de l’évaluation morphologique des spermatozoïdes a été particulièrement influencée par le niveau d’expérience de l’opérateur.

Conclusion

Les résultats de cette étude mettent l’accent sur la nécessité d’une formation adéquate du personnel de laboratoire, et de la participation régulière aux contrôles de qualité internes afin de minimiser les divergences et d’améliorer la fiabilité des résultats.

A multilaboratory study on the variability of bovine semen analysis

To evaluate the variability of semen analysis, five replicates of 10 different bovine frozen semen batches were coded with different identification numbers and submitted to various laboratories for evaluation. Three studies were conducted: study I included eight laboratories in semen processing centers in the United States; study II included one laboratory in one semen processing center and five veterinary university laboratories in the United States; and study III included five veterinary university laboratories in Brazil. Evaluation methodology, sample classification criteria, and reporting format varied considerably among laboratories. There were laboratory effects (P < 0.05) on sperm concentration, motility, and morphology results in all studies. When Bland-Altman plots were evaluated, differences in sperm concentration were approximately between -5 and +5 × 10(6) sperm/mL in study I, when the same method of evaluation was used by all laboratories but ranged between -30 and +30 × 10(6) sperm/mL in studies II and III. Differences in the proportions of motile sperm were approximately -30% to +30%, and differences in the proportion of normal sperm were -15% to +15% in studies I and II; these differences were -15% to +15% and -10% to +10%, respectively, in study III. Mean absolute (one tail) proportional differences in estimates across all laboratories ranged from 9% to 31%, 16% to 37%, and 9% to 14% for sperm concentration, motile sperm, and normal sperm across studies; much larger (48%-86%) differences were observed for sperm abnormality categories. Intralaboratory and interlaboratory precision varied considerably across laboratories and seemed to be at least in part related to methods used for evaluation; precision was better when the NucleoCounter was used for evaluation of sperm concentration, whereas the use of computer-assisted sperm analysis for evaluation of sperm motility resulted in greater precision in some but not all laboratories. None of the laboratories that classified samples as satisfactory or unsatisfactory achieved complete consistency for all replicates within all batches. In addition, consistent classification among laboratories was observed for just three batches in studies II and III. These observations put the reliability of semen analysis in check and make it very difficult, if not impossible, to meaningfully interpret evaluation results.

Current updates on laboratory techniques for the diagnosis of male reproductive failure

The incidence of male reproductive failure leading to infertility, whether due to delayed parenthood, environmental issues, genetic factors, drugs, etc., is increasing throughout the world. The diagnosis and prognosis of male subfertility have become a challenge. While the basic semen assessment has been performed for many years, a number of studies question the value of the traditional semen characteristics. This is partly due to inadequate methods and standardization, limited knowledge of technical requirements for quality assurance, and an incomplete understanding of what clinical information a semen assessment can provide. Laboratories currently performing semen and endocrine assessment show great variability. The World Health Organization (WHO) manual for the evaluation of semen has been the core of andrology and fertility evaluation that has helped in further development of this field over many years. These include the physical appearance of the ejaculate, assessments of sperm count, motility, vitality, morphology, and functional aspects of the sperm and semen sample. These tests also include male endocrine profile, biochemical evaluation of the semen, detection of antisperm antibodies in serum, the use of computer-aided sperm analysis (CASA), sperm DNA integrity, and its damage due to oxidative stress. Assisted reproductive techniques (e.g., IVF, ICSI) have shown great success but are too expensive. Further development in this field with newer techniques and extensive training/instructions can improve accuracy and reduce variability, thus maintaining the quality and standards of such an evaluation. There is an urgent need to have standardized training centers and increased awareness in this area of men's health for reproductive success.