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Meunier L, Sorci G, Abi Hussein H, Hingrat Y, Rehspringer N, Saint-Jalme M, Lesobre L, Torres Carreira J. Pre-but not post-meiotic senescence affects sperm quality and reproductive success in the North African houbara bustard. Front Ecol Evol 2022. [DOI: 10.3389/fevo.2022.977184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Age-dependent reduction in reproductive success can arise due to multiple factors including a deterioration of reproductive physiology. Senescing males have been shown to produce ejaculates with poor sperm quality, which impinges on male reproductive success. In addition to individual age, gamete age can also affect male reproductive success. Accordingly, variance in male reproductive success can be due to pre-meiotic (referring to individual age) and post-meiotic senescence (sperm age). Here, we tested whether male senescence and sperm cell aging have additive or interactive effects on male reproductive success in a bird with a promiscuous mating system, the North African houbara bustard. To assess the effect of pre-meiotic aging, we compared male reproductive success between two age classes (3-6- and 12–16-year-old). To infer the effect of post-meiotic aging, male ejaculates were collected at three-time intervals following a common initial collection (day 1, 5, and 10). Therefore, day 1 ejaculates are supposed to contain younger sperm than day 5 and 10 ejaculates. Following controlled artificial inseminations, reproductive success was assessed using three fitness-linked traits (hatching success, chick growth rate and survival). In addition to reproductive output, we also assessed whether pre- and post-meiotic aging affected a wide range of sperm and ejaculate traits. In agreement with previous reports, we found that males in the older age class produced less sperm with poorer motility compared to young individuals. However, contrary to the prediction, we found that ejaculates collected at day 5 and 10 tended to have better sperm traits such as motility and velocity. The results on sperm traits were generally mirrored in the effect on reproductive success since young males produced offspring that grew faster and had better survival during the first month of life, and eggs fertilized by sperm collected at day 5 had the highest hatching success. In any of the models, there was evidence for interactive effects of male and sperm age. Overall, these results confirm the role of pre-meiotic aging on male reproductive success. The lack of evidence for sperm aging could come from the experimental design but might also reflect the pattern of mating frequency in a species with a lek-based mating system.
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Palacin-Martinez C, Alvarez M, Montes-Garrido R, Neila-Montero M, Anel-Lopez L, de Paz P, Anel L, Riesco MF. Frequency of Semen Collection Affects Ram Sperm Cryoresistance. Animals (Basel) 2022; 12:ani12121492. [PMID: 35739829 PMCID: PMC9219472 DOI: 10.3390/ani12121492] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/02/2022] [Accepted: 06/06/2022] [Indexed: 12/13/2022] Open
Abstract
The improvement of frozen-thawed sperm quality has been mostly approached from the view of cryopreservation protocol optimization in terms of cryoprotectant solutions, freezing-thawing rates and antioxidant supplementation, while the impact of sperm collection frequency remains unknown in rams. In this work, a multiparametric study was carried out in cooled and frozen-thawed semen to evaluate sperm quality after different semen collection frequencies during a month: zero sperm collection (0 CW), four sperm collections per week (4 CW), and ten sperm collections per week (10 CW). Traditional analyses have been applied, in combination with novel technologies related to redox balance. Frozen-thawed semen quality showed a significant decrease (p < 0.05) in 0 CW and 10 CW in comparison to 4 CW, concerning motility and kinetics parameters. However, apoptosis showed a significant increase (p < 0.05) in 10 CW in comparison to 0 CW and 4 CW. The employment methods related to redox balance provided us with the definitive probe to ensure the influence of collection frequency on balance redox after thawing. Specifically, glutathione peroxidase (GPX) and superoxide dismutase (SOD) activity showed a significant decrease (p < 0.05) in 10 CW compared to 0 CW and 4 CW. The characterization of alternative strategies to sperm cryopreservation based on consideration of male sexual regimes, could improve the quality of frozen-thawed sperm.
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Affiliation(s)
- Cristina Palacin-Martinez
- Assisted Reproduction Techniques Research Group (Itra-ULE), INDEGSAL, University of León, 24071 León, Spain
- Animal Reproduction and Obstetrics, Department of Veterinary Medicine, Surgery and Anatomy, University of León, 24071 León, Spain
| | - Mercedes Alvarez
- Assisted Reproduction Techniques Research Group (Itra-ULE), INDEGSAL, University of León, 24071 León, Spain
- Animal Reproduction and Obstetrics, Department of Veterinary Medicine, Surgery and Anatomy, University of León, 24071 León, Spain
| | - Rafael Montes-Garrido
- Assisted Reproduction Techniques Research Group (Itra-ULE), INDEGSAL, University of León, 24071 León, Spain
- Animal Reproduction and Obstetrics, Department of Veterinary Medicine, Surgery and Anatomy, University of León, 24071 León, Spain
| | - Marta Neila-Montero
- Assisted Reproduction Techniques Research Group (Itra-ULE), INDEGSAL, University of León, 24071 León, Spain
- Animal Reproduction and Obstetrics, Department of Veterinary Medicine, Surgery and Anatomy, University of León, 24071 León, Spain
| | - Luis Anel-Lopez
- Assisted Reproduction Techniques Research Group (Itra-ULE), INDEGSAL, University of León, 24071 León, Spain
- Anatomy, Department of Veterinary Medicine, Surgery and Anatomy, University of León, 24071 León, Spain
| | - Paulino de Paz
- Assisted Reproduction Techniques Research Group (Itra-ULE), INDEGSAL, University of León, 24071 León, Spain
- Cellular Biology, Department of Molecular Biology, University of León, 24071 León, Spain
| | - Luis Anel
- Assisted Reproduction Techniques Research Group (Itra-ULE), INDEGSAL, University of León, 24071 León, Spain
- Animal Reproduction and Obstetrics, Department of Veterinary Medicine, Surgery and Anatomy, University of León, 24071 León, Spain
| | - Marta F Riesco
- Assisted Reproduction Techniques Research Group (Itra-ULE), INDEGSAL, University of León, 24071 León, Spain
- Cellular Biology, Department of Molecular Biology, University of León, 24071 León, Spain
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Ayad B, Omolaoye TS, Louw N, Ramsunder Y, Skosana BT, Oyeipo PI, Du Plessis SS. Oxidative Stress and Male Infertility: Evidence From a Research Perspective. FRONTIERS IN REPRODUCTIVE HEALTH 2022; 4:822257. [PMID: 36303652 PMCID: PMC9580735 DOI: 10.3389/frph.2022.822257] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 01/17/2022] [Indexed: 11/30/2022] Open
Abstract
Male fertility potential can be influenced by a variety of conditions that frequently coincide. Spermatozoa are particularly susceptible to oxidative damage due to their limited antioxidant capacity and cell membrane rich in polyunsaturated fatty acids (PUFAs). The role of oxidative stress (OS) in the etiology of male infertility has been the primary focus of our Stellenbosch University Reproductive Research Group (SURRG) over the last 10 years. This review aims to provide a novel insight into the impact of OS on spermatozoa and male reproductive function by reviewing the OS-related findings from a wide variety of studies conducted in our laboratory, along with those emerging from other investigators. We will provide a concise overview of the production of reactive oxygen species (ROS) and the development of OS in the male reproductive tract along with the physiological and pathological effects thereof on male reproductive functions. Recent advances in methods and techniques used for the assessment of OS will also be highlighted. We will furthermore consider the current evidence regarding the association between OS and ejaculatory abstinence period, as well as the potential mechanisms involved in the pathophysiology of various systemic diseases such as obesity, insulin resistance, hypertension, and certain mental health disorders which have been shown to cause OS induced male infertility. Finally, special emphasis will be placed on the potential for transferring and incorporating research findings emanating from different experimental studies into clinical practice.
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Affiliation(s)
- Bashir Ayad
- Department of Physiology, Faculty of Medicine, Misurata University, Misrata, Libya
- Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Temidayo S. Omolaoye
- Department of Basic Medical Sciences, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Nicola Louw
- Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Yashthi Ramsunder
- Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Bongekile T. Skosana
- Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Peter I. Oyeipo
- Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
- Department of Physiology, College of Health Sciences, Osun State University, Osogbo, Nigeria
| | - Stefan S. Du Plessis
- Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
- Department of Basic Medical Sciences, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
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Mascherek A, Reidick MC, Gallinat J, Kühn S. Is Ejaculation Frequency in Men Related to General and Mental Health? Looking Back and Looking Forward. Front Psychol 2021; 12:693121. [PMID: 34434144 PMCID: PMC8382266 DOI: 10.3389/fpsyg.2021.693121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 07/19/2021] [Indexed: 11/13/2022] Open
Abstract
Despite its relevance for human sexuality, literature on potential effects of ejaculation frequency and masturbation on general and mental health outcomes is sparse. Reasons for this knowledge gap include a general lack of interest, but also methodological challenges and still existing superstition. This paper reconciles literature from various fields to extract relevant information on how ejaculation frequency effects general and mental health outcomes. Culture-bound syndromes have been reported in countries still strictly tabooing or condemning masturbation. Masturbatory guilt describes a phenomenon in individuals experiencing a discrepancy between moral standards and own behavior with respect to masturbation. Abstinence is one aspect under study in the area of fertility treatment. Specific time frames and their respective implications on quality of sperm remain inconclusive. Limited temporal resolution capacities hamper the precise study of brain structures directly activated during ejaculation. The relation between ejaculation frequency and hormonal influences remains poorly understood. Future research that specifically addresses ejaculation frequency and potential mental and general health outcomes is needed. In contrast to extracting knowledge as a byproduct from other studies with a different focus, this enables sound study designs and could provide evidence-based results which could then be further discussed and interpreted.
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Affiliation(s)
- Anna Mascherek
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mirjam Christina Reidick
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jürgen Gallinat
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Simone Kühn
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Li J, Shi Q, Li X, Guo J, Zhang L, Quan Y, Ma M, Yang Y. The Effect of Male Sexual Abstinence Periods on the Clinical Outcomes of Fresh Embryo Transfer Cycles Following Assisted Reproductive Technology: A Meta-Analysis. Am J Mens Health 2021; 14:1557988320933758. [PMID: 32804026 PMCID: PMC7436826 DOI: 10.1177/1557988320933758] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
A sexual abstinence period (SAP) lasting for 2–7 days is recommended before undertaking semen analyses. However, there is no consensus regarding the length of the SAP for couples using assisted reproductive technology (ART). Therefore, a meta-analysis was performed to compare the effect of short SAPs (less than 4 days) and long SAPs (4–7 days) on the clinical outcomes of fresh embryo transfer cycles after ART. A total of four studies were included in the meta-analysis. Although the fertilization rate in short SAP couples was higher than that in long SAP couples, a pooled analysis demonstrated that it was not statistically significant (p = .09). The implantation rate was, however, significantly higher in short SAP couples (p = .0001). The pooled analysis revealed that the pregnancy rate was significantly higher in short SAP couples than that in long SAP couples. The overall odds ratio (OR) for the pregnancy rate was 1.44 (p = .0006). No significant difference in miscarriage rates between the short and long SAP couples was found (p = .88). The meta-analysis indicates that a shorter abstinence period could result in higher implantation and pregnancy rates for patients undertaking ART treatments.
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Affiliation(s)
- Jinhong Li
- Center of Reproductive Medicine, West China Second University Hospital, Sichuan University, Chengdu, Sichuan Province, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan Province, China
| | - Qingquan Shi
- Center of Reproductive Medicine, West China Second University Hospital, Sichuan University, Chengdu, Sichuan Province, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan Province, China
| | - Xiaohong Li
- Center of Reproductive Medicine, West China Second University Hospital, Sichuan University, Chengdu, Sichuan Province, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan Province, China
| | - Junliang Guo
- Center of Reproductive Medicine, West China Second University Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Long Zhang
- Center of Reproductive Medicine, West China Second University Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Yi Quan
- Center of Reproductive Medicine, West China Second University Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Ming Ma
- Andrology Laboratory, West China Hospital, Chengdu, Sichuan Province, China
| | - Yihong Yang
- Center of Reproductive Medicine, West China Second University Hospital, Sichuan University, Chengdu, Sichuan Province, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan Province, China
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Sokol P, Drakopoulos P, Polyzos NP. The Effect of Ejaculatory Abstinence Interval on Sperm Parameters and Clinical Outcome of ART. A Systematic Review of the Literature. J Clin Med 2021; 10:3213. [PMID: 34361997 PMCID: PMC8347289 DOI: 10.3390/jcm10153213] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/06/2021] [Accepted: 07/14/2021] [Indexed: 12/18/2022] Open
Abstract
Since the publication of the first edition of the WHO (World Health Organization) Laboratory Manual for the examination of Human Semen in 1980, the reference values of sperm parameters have been updated on four occasions. Currently and globally, most of the laboratories analyzing semen samples use the latest, 5th edition of the manual that recommends ejaculatory abstinence from two to seven days before producing the sample for examination. While this standardized interval of time facilitates the interpretation of the results and research, no solid evidence exists to support the WHO-recommended abstinence time for a semen analysis in order to optimize clinical outcomes after assisted reproduction. Most of the studies refer to different clinical outcomes, different groups of patients and different editions of the WHO Laboratory Manual, including heterogeneous intervals of abstinence or sperm parameters. The aim of the current systematic review was to evaluate available evidence correlating ejaculatory abstinence time with clinical outcomes and sperm parameters analyzed according to the last edition of the World Health Organization Laboratory Manual reference values in different male populations. The results from the included studies indicate that WHO abstinence recommendations may need revision, given that a shorter ejaculatory abstinence interval appears to be associated with improved sperm parameters, such as sperm DNA fragmentation, progressive motility or morphology, while evidence suggests a potential increase in embryo euploidy rates and pregnancy outcomes.
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Affiliation(s)
- Piotr Sokol
- Department of Reproductive Medicine, Dexeus University Hospital, 08028 Barcelona, Spain;
| | - Panagiotis Drakopoulos
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, 1090 Brussels, Belgium;
- Centre for Reproductive Medicine, Vrije Universiteit Brussel, 1050 Brussels, Belgium
| | - Nikolaos P. Polyzos
- Department of Reproductive Medicine, Dexeus University Hospital, 08028 Barcelona, Spain;
- Faculty of Medicine and Health Sciences, University of Ghent (UZ Gent), 9000 Gent, Belgium
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Okada FK, Andretta RR, Spaine DM. One day is better than four days of ejaculatory abstinence for sperm function. REPRODUCTION AND FERTILITY 2020; 1:1-10. [PMID: 35128419 PMCID: PMC8812405 DOI: 10.1530/raf-20-0018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 09/11/2020] [Indexed: 11/24/2022] Open
Abstract
According to the World Health Organization guidelines, ejaculatory abstinence (EA) of 2–7 days is recommended for semen analysis. This study aimed to determine how seminal quality may be affected by two EA periods from the same man. Seminal samples from 65 men were evaluated by conventional semen analysis and qualitative characteristics after 1 and 4 days of EA (two samples/man). The semen was qualitatively analyzed by examining oxidative activity (intracellular and seminal plasma), sperm function (acrosome integrity, mitochondrial activity, and nuclear DNA integrity), and epididymal function. As expected, samples collected after 1 day of EA showed a decrease in volume and sperm total number compared to samples collected after 4 days of EA. The sperm motility of the samples collected after 1 day of EA was better compared to samples collected after 4 days of EA. Oxidative activity measured was lower after 1 day of EA compared with those measured after 4 days of EA. With regards to sperm function, samples collected after 1 day of EA showed an increase in acrosome integrity, mitochondrial activity, and nuclear DNA integrity compared with samples collected after 4 days of EA. Epididymal function showed no difference between the two-time points. Although samples collected after 4 days of EA showed better results for sperm quantity, samples collected after 1 day of EA showed better qualitative results, including motility, oxidative activity, and sperm function. Thus, it can be concluded that sperm storage at the epididymal tail may make spermatozoa more susceptible to oxidative damage.
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Affiliation(s)
- Fatima Kazue Okada
- Human Reproduction Section, Division of Urology, Department of Surgery, Federal University of São Paulo, R. Borges Lagoa, São Paulo, São Paulo, Brazil
| | - Rhayza Roberta Andretta
- Human Reproduction Section, Division of Urology, Department of Surgery, Federal University of São Paulo, R. Borges Lagoa, São Paulo, São Paulo, Brazil
| | - Deborah Montagnini Spaine
- Human Reproduction Section, Division of Urology, Department of Surgery, Federal University of São Paulo, R. Borges Lagoa, São Paulo, São Paulo, Brazil
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Zimmer F, Imhoff R. Abstinence from Masturbation and Hypersexuality. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:1333-1343. [PMID: 32130561 PMCID: PMC7145784 DOI: 10.1007/s10508-019-01623-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 11/19/2019] [Accepted: 12/28/2019] [Indexed: 05/04/2023]
Abstract
Despite the lack of evidence for negative health effects of masturbation, abstinence from masturbation is frequently recommended as a strategy to improve one's sexual self-regulation. We adopted a framework of perceived problems with pornography to collect first hints about whether abstinence from masturbation stems from a psychological and behavioral "addiction" or conflicting attitudes. In an online questionnaire survey recruited via a non-thematic Reddit thread (n = 1063), most participants reported that they had tried to be abstinent from masturbation. As visible from zero-order correlations and multiple linear regression, motivation for abstinence was mostly associated with attitudinal correlates, specifically the perception of masturbation as unhealthy. While there were associations with hypersexuality, no significant correlation with behavioral markers such as maximum number of orgasms was found. Higher abstinence motivation was related to a higher perceived impact of masturbation, conservatism, and religiosity and to lower trust in science. We argue that research on abstinence from masturbation can enrich the understanding of whether and how average frequencies of healthy behavior are pathologized.
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Affiliation(s)
- Felix Zimmer
- Social and Legal Psychology, Department of Psychology, Johannes Gutenberg University Mainz, Binger Str. 14-16, 55122, Mainz, Germany.
| | - Roland Imhoff
- Social and Legal Psychology, Department of Psychology, Johannes Gutenberg University Mainz, Binger Str. 14-16, 55122, Mainz, Germany
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Marsh C, McCracken M, Gray M, Nangia A, Gay J, Roby KF. Low total motile sperm in transgender women seeking hormone therapy. J Assist Reprod Genet 2019; 36:1639-1648. [PMID: 31250175 DOI: 10.1007/s10815-019-01504-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 06/11/2019] [Indexed: 12/31/2022] Open
Abstract
PURPOSE This study was undertaken to compare semen quality, hormonal status, and social factors in transgender women seeking fertility preservation with those of fertile cisgender men. Long-range goals are to establish standard practice measures ensuring optimum semen quality for cryopreservation and fertility preservation in transgender women. METHODS This is a case-control study carried out at an academic medical center. Cases are transgender women seeking fertility preservation prior to initiation of hormone therapy. Controls are cisgender men recently fathering a child. All participants completed the Depression Anxiety Stress Scales 21 survey and additional survey questions related to personal behaviors. Complete semen analysis was carried out in a clinical andrology laboratory according to WHO guidelines, 5th edition. Serum follicle stimulating hormone, estradiol, and testosterone were measured at the time of semen analysis. RESULTS Sperm concentration, total sperm per ejaculate, total motile sperm, volume, and normal sperm morphology were significantly lower in transgender females compared with fertile cisgender men. Other measures of semen parameters and hormone concentrations were not different between groups. Survey results indicated transgender women were more likely to have symptoms of depression, anxiety, and stress and utilize tucking and tight undergarments, compared with controls; however, both groups reported similar numbers of ejaculations per week. CONCLUSIONS Although semen parameters were low, cryopreservation of sperm prior to hormone therapy is a viable fertility preservation option for most transgender women. The etiology of the differences in semen parameters is not known. Enhanced education related to personal behaviors or treatment to reduce effects of stressors prior to cryopreservation may improve future fertility potential.
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Affiliation(s)
- Courtney Marsh
- Department of Obstetrics & Gynecology, University of Kansas Medical Center, Kansas City, KS, 66160, USA.
- Center for Advanced Reproductive Medicine, University of Kansas Medical Center, Overland Park, KS, 66211, USA.
- Institute for Reproduction and Perinatal Health, University of Kansas Medical Center, Kansas City, KS, 66160, USA.
| | - Megan McCracken
- Department of Obstetrics & Gynecology, University of Kansas Medical Center, Kansas City, KS, 66160, USA
- Center for Advanced Reproductive Medicine, University of Kansas Medical Center, Overland Park, KS, 66211, USA
| | - Meredith Gray
- Department of Obstetrics & Gynecology, University of Kansas Medical Center, Kansas City, KS, 66160, USA
| | - Ajay Nangia
- Institute for Reproduction and Perinatal Health, University of Kansas Medical Center, Kansas City, KS, 66160, USA
- Department of Urology, University of Kansas Medical Center, Kansas City, KS, 66160, USA
| | - Judy Gay
- Department of Obstetrics & Gynecology, University of Kansas Medical Center, Kansas City, KS, 66160, USA
- Center for Advanced Reproductive Medicine, University of Kansas Medical Center, Overland Park, KS, 66211, USA
| | - Katherine F Roby
- Department of Obstetrics & Gynecology, University of Kansas Medical Center, Kansas City, KS, 66160, USA.
- Center for Advanced Reproductive Medicine, University of Kansas Medical Center, Overland Park, KS, 66211, USA.
- Institute for Reproduction and Perinatal Health, University of Kansas Medical Center, Kansas City, KS, 66160, USA.
- Department of Anatomy & Cell Biology, University of Kansas Medical Center, Kansas City, KS, 66160, USA.
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