Citation Information :
Ferro B, Sousa F, Carvalho A, Ferreira AF, Sousa L, Sousa AP, Parada B, Cortesão P, Santos TA. Altered Sperm Analysis, Where Are We Now? The Reality of the Reproductive Medicine Unit of a Tertiary University Center. Int J Infertil Fetal Med 2023; 14 (2):85-93.
Background: In the last decades, a substantial decline in sperm counts has been described. We aim to evaluate clinical outcomes of treatment strategies in patients referred to andrology due to abnormal sperm parameters.
Materials and methods: Observational descriptive study performed at one country's largest public reproductive unit during 5 years (2015–2019). Patients were selected according to the World Health Organization (WHO) criteria for sperm analysis.
Results: A total of 670 patients were included, with a median age of 35 (18–54) years old. During the infertility investigation, 15 patients were diagnosed with Klinefelter syndrome and two with a disorder of sexual development (46, XX). Three malignant testicular tumors were identified. Among treatments applied—varicocele correction was the most frequent (31.49%, n = 210), followed by antioxidant therapy (11.04%, n = 74). Posttreatment sperm analysis was obtained in 255 cases, demonstrating an improvement in 58.04% (n = 148), including normalization in 6.67% (n = 17) of men. An assisted reproductive technique (ART) was performed in 45.97% (n = 308), with a clinical pregnancy rate per initiated cycle of 26.92% (n = 91). Among azoospermic patients (19.55%, n = 131), there was a higher exposure to heat (p = 0.02) and a higher prevalence of previous testicular surgery (p = 0.002), and orchitis (p = 0.022). Varicocele was more frequent in non-azoospermic patients (p = 0.007), while Y chromosome microdeletions and chromosomal alterations were mostly found in azoospermic patients (p = 0.004 and p < 0.001, respectively).
Conclusion: Even in patients with a poor prognosis a priori, improvements in sperm parameters or sperm retrieval might be achieved after treatment, namely low-grade varicocele correction.
Clinical significance: An adequate investigation of male infertility can improve reproductive outcomes and contribute to an early diagnosis/secondary prevention of tumors.
Fainberg J, Kashanian JA. Recent advances in understanding and managing male infertility. F1000Res 2019;8:F1000 Faculty Rev-670. DOI: 10.12688/f1000research.17076.1
Leaver RB. Male infertility: an overview of causes and treatment options. Br J Nurs 2016;25(18):S35–S40. DOI: 10.12968/bjon.2016.25.18.S35
Agarwal A, Baskaran S, Parekh N, et al. Male infertility. Lancet 2021;397(10271):319–333. DOI: 10.1016/S0140-6736(20)32667-2
Choy JT, Eisenberg ML. Male infertility as a window to health. Fertilit Steril 2018;110(5):810–814. DOI: 10.1016/j.fertnstert.2018.08.015
Katz DJ, Teloken P, Shoshany O, et al. Male infertility-the other side of the equation. Aust Fam Physician 2017;46(9):641–646. DOI: 10.3316/informit.074841403579652
Jensen CFS, Østergren P, Dupree JM, et al. Varicocele and male infertility. Nat Rev Urol 2017;14(9):523–533. DOI: 10.1038/nrurol.2017.98
Sharma A, Minhas S, Dhillo WS, et al. Male infertility due to testicular disorders. J Clin Endocrinol Metab 2021;106(2):e442–e459. DOI: 10.1210/clinem/dgaa781
Organization WH: Department of reproductive health and research. WHO laboratory manual for the examination and processing of human semen. 2010, 5:21–22.
Halvaei I, Litzky J, Esfandiari N. Advanced paternal age: effects on sperm parameters, assisted reproduction outcomes and offspring health. Reprod Biol Endocrinol 2020;18(1):110. DOI: 10.1186/s12958-020-00668-y
Candela L, Boeri L, Capogrosso P, et al. Correlation among isolated teratozoospermia, sperm DNA fragmentation and markers of systemic inflammation in primary infertile men. PLos One 2021;16(6):e0251608. DOI: 10.1371/journal.pone.0251608
Cocuzza M, Alvarenga C, Pagani R. The epidemiology and etiology of azoospermia. Clinics (Sao Paulo) 2013;68(1):15–26. DOI: 10.6061/clinics/2013(sup01)03
Sansone A, Di Dato C, de Angelis C, et al. Smoke, alcohol and drug addiction and male fertility. Reprod Biol Endocrinol 2018;16(1):3. DOI: 10.1186/s12958-018-0320-7
Practice Committee of the American Society for Reproductive Medicine, Practice Committee of the American Society for Reproductive Medicine. Smoking and infertility: a committee opinion. Fertil Steril 2018;110(4):611–618. DOI: 10.1016/j.fertnstert.2018.06.016
Bundhun PK, Janoo G, Bhurtu A, et al. Tobacco smoking and semen quality in infertile males: a systematic review and meta-analysis. BMC Public Health 2019;19(1):36. DOI: 10.1186/s12889-018-6319-3
Katib A. Mechanisms linking obesity to male infertility. Cent Eur J Urol 2015;68(1):79–85. DOI: 10.5173/ceju.2015.01.435
Liu XG, Hu HY, Guo Y, et al. Correlation between Y chromosome microdeletion and male infertility. Genet Mol Res 2016;15(2): DOI: 10.4238/gmr.15028426
Stouffs K, Vloeberghs V, Gheldof A, et al. Are AZF b deletions always incompatible with sperm production? Andrology 2017;5(4):691–694. DOI: 10.1111/andr.12350
Zhang Y, Li LL, Xue LT, et al. Complete AZFb deletion of Y chromosome in an infertile male with severe oligoasthenozoospermia: case report and literature review. Urology 2017;102:111–115. DOI: 10.1016/j.urology.2016.07.022
Harton GL, Tempest HG. Chromosomal disorders and male infertility. Asian J Androl 2012;14(1):32–39. DOI: 10.1038/aja.2011.66
Stormont GD, Deibert CM. Genetic causes and management of male infertility. Transl Androl Urol 2021;10(3):1365–1372. DOI: 10.21037/tau.2020.03.34
Jarow J, Kolettis PN, Lipshultz LR. The optimal evaluation of the infertile male: AUA best practice statement. 2010.
Majzoub A, Arafa M, Starks C, et al. 46 XX karyotype during male fertility evaluation; case series and literature review. Asian J Androl 2017;19(2):168–172. DOI: 10.4103/1008-682X.181224
de la Chapelle A. The etiology of maleness in XX men. Hum Genet 1981,58(1):105–116. DOI: 10.1007/BF00284157
Kim IW, Khadilkar AC, Ko EY, et al. 47, XYY syndrome and male infertility. Rev Urol 2013;15(4):188–196. DOI: 10.3909/riu0580
Bonomi M, Rochira V, Pasquali D, et al. Klinefelter syndrome (KS): genetics, clinical phenotype and hypogonadism. J Endocrinol Invest 2017;40(2):123–134. DOI: 10.1007/s40618-016-0541-6
Ohlander SJ, Lindgren MC, Lipshultz LI. Testosterone and male infertility. Urol Clin North Am 2016;43(2):195–202. DOI: 10.1016/j.ucl.2016.01.006
Lotti F, Maggi M. Ultrasound of the male genital tract in relation to male reproductive health. Human Reprod Update 2015;21(1):56–83. DOI: 10.1093/humupd/dmu042
Vernaeve V, Bonduelle M, Tournaye H, et al. Pregnancy outcome and neonatal data of children born after ICSI using testicular sperm in obstructive and non-obstructive azoospermia. Hum Reprod 2003;18(10):2093–2097. DOI: 10.1093/humrep/deg403
Donoso P, Tournaye H, Devroey P. Which is the best sperm retrieval technique for non-obstructive azoospermia? a systematic review. Hum Reprod Update 2007;13(6):539–549. DOI: 10.1093/humupd/dmm029
Hanson BM, Eisenberg ML, Hotaling JM. Male infertility: a biomarker of individual and familial cancer risk. Fertil Steril 2018;109(1):6–19. DOI: 10.1016/j.fertnstert.2017.11.005
Armstrong JM, Keihani S, Hotaling JM. Use of ultrasound in male infertility: appropriate selection of men for scrotal ultrasound. Curr Urol Rep 2018;19(8):58. DOI: 10.1007/s11934-018-0810-3
Carmignani L, Gadda F, Mancini M, et al. Detection of testicular ultrasonographic lesions in severe male infertility. J Urol 2004;172(3):1045–1047. DOI: 10.1097/01.ju.0000134892.10525.39
Onur MR, Firdolas F, Onur R, et al. Scrotal ultrasonography: should it be used in routine evaluation of infertile men? Andrologia 2008;40(1):58–61. DOI: 10.1111/j.1439-0272.2008.00812.x
Liu Y, Zhang N, He Y, et al. Spontaneous conception outcome in infertile women after four-dimensional hysterosalpingo-contrast-sonography. BMC Pregnancy Childbirth 2020;20(1):638. DOI: 10.1186/s12884-020-03315-x
Kroese AC, de Lange NM, Collins J, et al. Surgery or embolization for varicoceles in subfertile men. Cochrane Database Syst Rev 2012;10:CD000479. DOI: 10.1002/14651858.CD000479.pub5
Barati E, Nikzad H, Karimian M. Oxidative stress and male infertility: current knowledge of pathophysiology and role of antioxidant therapy in disease management. Cell Mol Life Sci 2020;77(1):93–113. DOI: 10.1007/s00018-019-03253-8
Thaker H, Ko EY, Sabanegh ES, et al. Empirical medical therapy for idiopathic male infertility. F S Rep 2020;1(1):15–20. DOI: 10.1016/j.xfre.2020.04.003
Leslie SW, Siref LE, Khan MA: Male infertility. 2020.
Teixeira DM, Hadyme Miyague A, Barbosa MA, et al. Regular (ICSI) versus ultra-high magnification (IMSI) sperm selection for assisted reproduction. Cochrane Database Syst Rev 2020;2(2):CD010167. DOI: 10.1002/14651858.CD010167.pub3
Zarinara A, Zeraati H, Kamali K, et al. The success rate and factors affecting the outcome of assisted reproductive treatment in subfertile men. Iran J Public Health 2020;49(2):332–340. DOI: 10.18502/ijph.v49i2.3100