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A unique view on male infertility around the globe
Abstract and Figures
Infertility affects an estimated 15% of couples globally, amounting to 48.5 million couples. Males are found to be solely responsible for 20-30% of infertility cases and contribute to 50% of cases overall. However, this number does not accurately represent all regions of the world. Indeed, on a global level, there is a lack of accurate statistics on rates of male infertility. Our report examines major regions of the world and reports rates of male infertility based on data on female infertility.
Our search consisted of systematic reviews, meta-analyses, and population-based studies by searching the terms "epidemiology, male infertility, and prevalence." We identified 16 articles for detailed study. We typically used the assumption that 50% of all cases of infertility are due to female factors alone, 20-30% are due to male factors alone, and the remaining 20-30% are due to a combination of male and female factors. Therefore, in regions of the world where male factor or rates of male infertility were not reported, we used this assumption to calculate general rates of male factor infertility.
Our calculated data showed that the distribution of infertility due to male factor ranged from 20% to 70% and that the percentage of infertile men ranged from 2·5% to 12%. Infertility rates were highest in Africa and Central/Eastern Europe. Additionally, according to a variety of sources, rates of male infertility in North America, Australia, and Central and Eastern Europe varied from 4 5-6%, 9%, and 8-12%, respectively.
This study demonstrates a novel and unique way to calculate the distribution of male infertility around the world. According to our results, at least 30 million men worldwide are infertile with the highest rates in Africa and Eastern Europe. Results indicate further research is needed regarding etiology and treatment, reduce stigma & cultural barriers, and establish a more precise calculation.
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... The estimated male infertility rate in the general European population is 7·5% [8,9], with 30% of cases considered idiopathic infertility. Among the recognized etiologies, testicular dysfunction is the most frequent cause of disturbed spermatogenesis (cryptorchidism, varicoceles, cytotoxic drugs). ...
... The semen collection method analysis highlighted a significant difference for the SMA3 patients, who were more likely to have self-collected samples due to less motor impairment. The sperm concentration was abnormal in 95% of the SMA2 patients, while 61% of SMA3 patients had abnormal sperm concentration [estimated at 7.5% in European populations [8,9]. Azoospermia was significantly more frequent in the SMA2 patients rather than in SMA3 patients (45% vs. 7.7%). ...
... To our knowledge, this is the first study to demonstrate fertility disorders in relation to spermogram abnormalities in male SMA patients. Fertility disorders affect ~ 40% of our SMA population, a significantly higher rate than compared to the prevalence in the general population (estimated at 7.5% in European populations [8,9]). In the present cohort, the SMA2 patients had a higher frequency of fertility disorders, which was also correlated with lower SMN2 copy numbers, lower weight, shorter height, and lower MFM or RULM scores. ...
Background
Spinal muscular atrophy (SMA) patients benefit from pre-mRNA splicing modifiers targeting the SMN2 gene, which aims to increase functional SMN production. The animal toxicity affecting spermatogenesis associated with one such treatment raised questions about male SMA patients’ spermatogenesis.
Methods
This descriptive, cross-sectional study was conducted from June 2022 to July 2023. The study involved adult male patients with genetically confirmed SMA type 2 (SMA2) or SMA3 from 13 French neuromuscular centers. The patients’ general data, motor severity, urological history, exposure to certain factors, parenthood, and spermogram results were obtained. All patients were enrolled prior to exposure to risdiplam.
Findings
Sixty-eight patients were enrolled ( 36 SMA2 and 32 SMA3 patients). Forty-one patients had fertility data (parenthood history and spermogram analyses) and underwent 33 spermograms. Fertility disorders were identified in 27 of the 41 patients (65·9%, 95%CI 51·3–80·4%) in particular SMA2 patients: 19 cases (90 . 5%, CI 77·9–100%) (SMA3: 8 cases (40%, CI 18·5–61·5%). Among the patients with available spermograms, 81% (27/33) had abnormal sperm concentration; 30% presented azoospermia. These abnormalities were significantly associated with SMA type (more prevalent in SMA2 patients, p < 0·001), disease motor severity, which included age at the loss of walking ability and wheelchair use duration ( p < 0·001). The Motor Function Measure (MFM) determined that the sperm counts were also correlated with disease severity ( p < 0·01).
Interpretation
The fertility disorders were correlated with SMA severity and were particularly evident in SMA2 patients. In the latter, sperm concentration positively correlated with MFM. This study is the first one to link fertility disorders with spermogram abnormalities in SMA males. Understanding spermatogenesis in SMA is crucial, especially with new therapies such as risdiplam. Consequently, conducting systematic spermogram studies prior to SMA treatment is recommended.
... Factors such as unhealthy diet, obesity, and environmental pollution have been related to reduced fertility in men and women. In addition, demographic, geographical, and cultural factors help to infertility outbreaks [3][4][5]. Assisted reproductive technology (ART) has been increasingly utilized in recent decades, with more than 2.5 million cycles performed each year [4]. Although the number of cycles of ART increases each year, the success rate of ART remains around 33% per cycle [6]. ...
... Despite this, the aspiration of parent's gametes can still be realized through IVF, the most prevalent form of ART, designed to address male, female, or combined fertility obstacles [35]. Globally, around 50 million couples face fertility-related issues, with~30% of cases primarily attributed to male factor infertility [1,3]. Factors like environmental pollution [36], inappropriate dietary [37,38], and obesity [39] have been linked to diminished sperm and oocyte quality. ...
Objective: Infertility is indeed a significant global health concern. The quality of gametes plays a pivotal role in determining the success rates of assisted reproductive technology (ART) cycles. In contemporary fertility and reproductive medicine, the utilization of machine learning (ML) has emerged as a powerful tool for processing large datasets, offering the potential to enhance existing ART practices. The objective of this review study was to assess sperm and oocyte characteristics in humans using ML techniques. This approach can contribute to a more precise evaluation of the gamete, leading to improved decision-making and potentially higher success rates in ART procedures. Using of ML abilities, researchers can obtain valuable insights into the quality of gametes, thereby optimizing fertility treatments for individuals and couples experiencing infertility issues.
Materials and Methods: We conducted a comprehensive search on PubMed, Google Scholar, and Scopus using the keywords “Machine Learning AND Quantification AND IVF.” Eligible articles were initially screened based on their titles. After the title screening, a second screening was performed based on the abstracts of the selected articles. Finally, the full articles of the remaining studies were reviewed to ensure they met our inclusion criteria. From each eligible study, we extracted the following information: author(s) of the study, publication year, and the method employed to evaluate human oocyte quality.
Conclusion: The development of a properly trained ML system will require careful attention to data quality, measurement, sample size, and ethics issues agreement.
... Estimates indicate that 15% of couples worldwide experience infertility [1], with more than 70 million couples around the world affected by subfertility or infertility [2]. Research suggests that male factors contribute to approximately 30% to 50% of all infertility cases [3,4]. A grow-ing body of research is aimed at identifying modifiable characteristics to improve the management of infertility [5][6][7]. ...
... Male infertility can be caused by genetic abnormalities and medical conditions, but modifiable environmental and lifestyle factors also play a substantial role [3]. Since diet has been implicated as one such modifiable risk factor [4], recent studies have increasingly focused on the potential impacts of dietary patterns and nutrients on semen quality and reproductive health [8,9]. Evidence suggests that changes in one's diet-a key component of lifestyle-may effectively reduce inflammation and, consequently, the risk of infertility [10]. ...
... Male infertility constitutes a global problem and is believed to be responsible for 40-60% of all infertility cases [1,2], affecting around 2.5-12% of men [1]. As far as its etiology is concerned, male infertility has been classified into pre-testicular, testicular, post-testicular, mixed, and idiopathic [3]. ...
... Male infertility constitutes a global problem and is believed to be responsible for 40-60% of all infertility cases [1,2], affecting around 2.5-12% of men [1]. As far as its etiology is concerned, male infertility has been classified into pre-testicular, testicular, post-testicular, mixed, and idiopathic [3]. ...
Background/Objectives: Male infertility is a significant global health issue, comprising approx. 50% of all infertility cases. Semen cryopreservation, a critical component of assisted reproductive technologies (ARTs), is a method commonly used in a wide range of situations, including gonadotoxic treatments such as radiation or chemotherapy, hazardous occupational exposures, and various medical conditions. Although historically viewed as potentially damaging to sperm, recent findings suggest that cryopreservation, when performed with appropriate techniques, may in fact enhance semen quality by improving the proportion of healthy spermatozoa, particularly in terms of their morphological parameters. The aim of this study was to evaluate the impact of cryopreservation on sperm morphology and viability, utilizing advanced morphological assessments pre- and post-freezing. Methods: Semen samples were collected from 97 patients undergoing infertility treatment at the KRIOBANK clinic (Białystok, Poland). The semen was liquefied and prepared in the form of slides. Sperm morphology was then assessed using an OLYMPUS BX40 microscope at 60× magnification. Results: The findings of the study revealed significant improvements in sperm morphology, with increased percentages of normal sperm and reductions in deformation indices post-thaw. Conclusions: The findings indicate that optimized cryopreservation protocols may support the selection of higher-quality sperm, offering valuable benefits for ART applications. These results challenge certain past assumptions regarding the impact of cryopreservation and underscore the need for refined freezing techniques to maintain and potentially enhance semen quality for reproductive use.
... Various factors in both men and women can cause infertility. These etiologies are diverse, including endocrine disorders, infectious diseases, obstructions of the genital tract, gametogenesis defects in both females and males, implantation defects, erection or ejaculation problems, as well as genetic causes [2] . However, in many cases, the identification of the exact cause is challenged. ...
Genetic etiologies of infertility are little mentioned in Africa, mainly due to the lack of technical genetics platforms in many African countries. Identifying these genetic factors involves the use of cytogenetic and molecular genetic techniques. In this retrospective study spanning 13 years, we assessed the role of chromosomal anomalies in the etiology of couple infertility in Benin. This study included patients admitted to the cytogenetics laboratory of the Faculty of Health Sciences of Cotonou for a cytogenetic examination as part of a couple infertility exploration from January 2010 to December 2022. Out of 1996 karyotype requests, 205 karyotypes were carried out to explore the couple's infertility (10.27%). We found 5.34% numerical anomalies and 7.28% structural anomalies. These findings highlight the significance of cytogenetic analyses in the etiological investigation of couple infertility in Benin and enable the establishment of adequate genetic counseling for infertile couples.
... As a result, the etiology of couples' infertility can be attributed to one member of the couple or both [2][3][4]. The World Health Organization (WHO) estimates that the male factor is involved in 30-50% of infertility cases [5,6]. According to clinical recommendations, every infertile couple should be evaluated before the trials start. ...
Approximately half of infertility cases are attributed to male gender. Low sperm counts can be interpreted to be a potential for male infertility. In addition, sufficient sperm count is a considerably important factor for some assisted reproductive technologies, such as in vitro fertilization (IVF). Therefore, the detection of sperms in semen samples, especially at low counts, is of great significance for the diagnosis of infertility and the onset of its treatment. Surface-enhanced Raman scattering (SERS) has been an interesting approach for researchers and medical sectors in recent years due to its potential to provide high-sensitive biosensors. In the present work, glass slide substrates coated with silver nanoparticles (AgNPs) were employed as SERS-based biosensors for the detection of mice sperms swam and trapped to AgNPs. Moreover, 100%, 80%, 40%, 20%, and 10% concentrations of semen samples were prepared by dilution using PBS solution, and each sample was deposited on developed biosensors. The novelty of the present research was the development of a sensitive and cost-effective biosensor for the detection of sperms in low concentrations of semen samples. The enhancement of intensity of Raman laser outcomes using the fabricated substrates was demonstrated through the finite-difference time-domain (FDTD) simulation. This concept allowed us to identify sperms, even at their low counts and low concentrations of semen samples.
... In recent years, this prevalence has been on the rise, posing significant psychological, physical, and economic challenges to affected individuals and impacting societal stability [3]. Female factors contribute to 50 % of all infertility cases, while male factors account for 20-30 % [4]. Direct or indirect causes of female infertility encompass advanced age, endocrine issues, reproductive organ damage, ovarian insufficiency, endometriosis, polycystic ovary syndrome, or sexually transmitted diseases [5]. ...
... Epidemiological studies conducted in Russia confirmed that the proportion of infertile marriages among the population of reproductive age (for women 15 to 49 years of age) ranges from 8 to 17% [1], which corresponds to the critical level sensu World Health Organization. On average, one in eighth couples faces this problem when planning their first child, and one in six couples face the challenge when planning their second child [2]. ...
Background — This article is dedicated to the study of the effect of medical and social factors on the health of children born as a result of assisted reproductive technology (ART) in late reproductive age (LRA) women. Every year, there is a deterioration in the reproductive health of married couples, an increase in the frequency of infertile marriages, as well as an increase in the number of women over 35 years of age who gave birth to children as a result of ART. Material and Methods — The study included 648 children (4-6 years old) born as a result of ART by women aged 35-45 years (the main group: MG). All children resided in the city of Samara. The control group (CG) included 648 children (4-6 years old) who were born from spontaneous conception and met the following criteria: their mother’s age at birth exceeding 35 years, their age from 4 to 6 years, born from a singleton full-term (≥37 weeks of gestation) pregnancy. The main distinguishing feature between the MG and CG was birth after using ART. The children’s health was assessed comprehensively, based on the results of physical and medical examinations, and a study of the child’s development history. The course of pregnancy and childbirth, along with maternal morbidity, based on outpatient medical records, as well as their social and hygienic characteristics based on questionnaire data, were investigated. The following research methods were employed: sociological (questionnaire), direct observation, analytical, and statistical. Results — We assessed children’s health as follows: the subgroup with good health included 18.0% of children in the MG vs. 21.9% in the CG (p=0.055). The proportion of the subgroup of children with poor health was 56.2% in the MG vs. 36.1% in the CG (p=0.048). Conclusion — We identified 18 significant risk factors that negatively affected the health of children born as a result of ART in LRA women.
... The latest data indicate that the prevalence of infertility in married couples of reproductive age is 17-26 %, of which 56 % require treatment (Carson and Kallen, 2021;Legese et al., 2023). Further estimates indicate that 10-15 % of reproductive couples in the world face this problem, while in our environment the percentage of reproductive couples who are infertile and in need of treatment is as high as 18 %, with an increasing trend in recent years (Agarwal et al., 2015;Inhorn and Patrizio, 2015;Dourou et al., 2023). ...
... Global reports indicate a decline in male fertility (Sengupta, 2017) associated with multiple interfered factors related to genetic, environmental and nutritional ones. According to estimates of the World Health Organization (WHO), between 45 and 80 million couples worldwide are infertile (Rutstein &Shah, 2004 andAgarwal et al., 2015). The ability to achieve a clinical pregnancy is known as fertility (Zegers, 2017). ...
... normal/intact spermatogenesis from OA patients (normal spermatogenesis; NSP, n = 3; clinical score 10), biopsies with a phenotype of spermatid arrest from NOA patients (SDA, n = 4, four biopsies from 3 patients were used; contain somatic cells and germ cells up to round spermatids, clinical score [4][5], and biopsies with a phenotype of Sertoli cell only (SCO, n = 3; complete absence of germ cells, clinical score 0). Total RNA was extracted using the PeqGOLD total RNA kit following the manufacturer's protocol (PeqGOLD total RNA kit, VWR Life Sciences). ...
Purpose
Sperm morphology and motility are major contributors to male‐factor infertility, with many genes predicted to be involved. This study aimed to elucidate differentially expressed transcripts in human testis tissues of normal and abnormal spermatogenesis that could reveal new genes that may regulate sperm morphology and function.
Methods
Human testis biopsies were collected from men with well‐characterized phenotypes of normal spermatogenesis, spermatid arrest, and Sertoli cell‐only phenotype, and transcriptional differences were quantified by RNA‐sequencing (RNA‐Seq). Differentially expressed genes (DEGs) were filtered based on predominant expression in spermatids and gene functional annotations relevant to sperm morphology and motility. Selected 10 DEGs were validated by qRT‐PCR and the localization of two proteins was determined in testis biopsies.
Results
The analysis revealed 6 genes (SPATA31E1, TEKT3, SLC9C1, PDE4A, CFAP47, and TNC) that are excellent candidates for novel genes enriched in developing human sperm. The immunohistochemical localization of two proteins, ORAI1 and SPATA31E1, in testis biopsies, verified that both are expressed in developing human germ cells, with SPATA31E1 enriched in late spermatocytes and spermatids.
Conclusion
This study identified human germ cell‐enriched genes that could play functional roles in spermiogenesis and could thus be important in the development of morphologically normal, motile sperm.
... Infertility is a global issue that affects approximately 15% of couples worldwide. Importantly, male factors contribute to nearly half of all infertility cases, highlighting the importance of addressing male infertility alongside female infertility [1,2]. One common cause of male infertility is teratozoospermia, which refers to morphological defects in spermatozoa. ...
Background
Acephalic spermatozoa syndrome is a rare but severe type of teratozoospermia. The familial trait of acephalic spermatozoa syndrome suggests that genetic factors play an important role. However, known mutations account for only some acephalic spermatozoa syndrome patients, and more studies are needed to elucidate its pathogenesis. The current study aimed to elucidate the pathogenesis of acephalic spermatozoa syndrome caused by PMFBP1 mutation.
Results
We identified a homozygous splice site mutation (NM_031293.2, c.2089-1G > T) in PMFBP1 through Sanger sequencing. Western blotting and immunofluorescence analyses revealed that this splice site mutation resulted in the absence of PMFBP1 protein expression in the patient's sperm cells. We generated an in vitro model carrying the splice site mutation in PMFBP1 and confirmed, through RT‒PCR and Sanger sequencing, that it led to a deletion of 4 base pairs from exon 15.
Conclusion
A homozygous splice site mutation results in a deletion of 4 bp from exon 15 of PMFBP1 , thereby affecting the expression of the PMFBP1 protein. The absence of PMFBP1 protein expression can lead to acephalic spermatozoa syndrome. This finding elucidates the underlying cause of acephalic spermatozoa syndrome associated with this specific mutation (NM_031293.2, c.2089-1G > T) in PMFBP1 .
... Some studies suggest that antioxidants, particularly zinc and selenium, may support the production of seminal fluid, potentially increasing semen volume [21][22][23][24][25]. ...
The effect of antioxidants on sperm quality parameters and pregnancy rates in idiopathic male infertility has been a subject of interest in recent reproductive medicine research. Idiopathic male infertility refers to cases where the cause of infertility is unknown despite standard investigations. Oxidative stress has been identified as a potential contributing factor to male infertility. It happens when the body's levels of antioxidants and reactive oxygen species (ROS) are out of equilibrium. Elevated ROS levels can damage sperm by affecting their DNA, membranes, and motility, ultimately compromising fertility. Since antioxidants neutralize ROS, they have been proposed as a treatment to improve sperm function in cases of idiopathic infertility.
... Infertility is a complex and emotionally challenging medical condition affecting approximately 10% to 15% of couples globally [1]. Male factor infertility, which is solely responsible for 20% to 30% of cases and contributes to 50% of all infertility cases [2,3], may result from problems with semen quantity, semen quality, or the structure of the male genital tract [4]. ...
Objective:
The choice between utilizing testicular or ejaculatory sperm for intracytoplasmic sperm injection (ICSI) in men with severe oligozoospermia or cryptozoospermia is a crucial aspect of managing male infertility. This study aimed to identify a predictive factor that could guide this decision-making process.
Methods:
Seventy-five infertile men with severe oligozoospermia or cryptozoospermia were included in the analysis. On the day of ovum pick-up, these participants were divided into three groups (n=25 each) based on their sperm concentrations: cryptozoospermia, 0.1-1 million/mL and 1-5 million/mL. Patients in each group underwent ICSI, which involved the insemination of sibling oocytes using either ejaculated spermatozoa or testicular spermatozoa obtained via fine-needle aspiration. We evaluated the rates of fertilization, cleavage, high-quality embryo production, and blastocyst formation.
Results:
In patients with sperm concentrations below 1 million/mL, testicular sperm demonstrated higher rates of fertilization (p<0.001), cleavage (p=0.01), high-quality embryo formation (p=0.003), and blastocyst development (p=0.04) compared to ejaculated sperm. In cases of cryptozoospermia, testicular sperm was associated with a higher fertilization rate (p<0.001) and a marginally higher rate of high-quality embryos (p=0.06). Conversely, in patients with sperm concentrations exceeding 1 million/mL, ejaculated sperm yielded superior outcomes.
Conclusion:
This study underscores the significance of considering sperm concentration when advising on sperm retrieval techniques to improve ICSI outcomes in men diagnosed with severe oligozoospermia or cryptozoospermia. Further research is necessary to confirm predictive factors that assist in decision-making regarding the source of sperm, whether from ejaculate, testicular aspiration, or biopsies.
... Infertility is a multifaceted condition, affecting approximately one in seven couples in Western countries, with the male factors contributing to nearly 50% of cases, figures projected to increase (1)(2)(3). Studies in patients suffering infertility have shown that common conditions detected after bilateral biopsy of the testes are Sertoli cell-only syndrome (around 25-37%), hypospermatogenesis (approximately 19%), and germ cell maturation arrest (approximately 7-12.5%) (4,5). ...
... In nearly 50% of couples experiencing infertility, the cause is due to a defect in the male partner which includes mainly azoospermia and oligozoospermia [1,2]. Among the many causes, Y chromosome microdeletions (YCMD) are observed in 7-10% of men with non-obstructive azoospermia and oligozoospermia [3,4]. ...
Purpose
Y chromosome microdeletions (YCMD) are a common cause of azoospermia and oligozoospermia in men. Herein, we developed a machine learning-based web tool to predict sperm retrieval rates and success rates of assisted reproduction (ART) in men with YCMD.
Methods
Data on ART outcomes of men with YCMD who underwent ART were extracted from published studies by performing a systematic review. This data was used to develop a web-based predictive algorithm using machine learning.
Results
FertilitY Predictor classifies the type of YCMD into AZFa, AZFb, AZFc, their combinations, and gr/gr deletions based on the genetic markers as input. Further, it predicts the probability of sperm retrieval, fertilization rate, clinical pregnancy rate, and live birth rate based on the type of YCMD. Validation studies demonstrated its high accuracy and predictability for sperm retrieval, clinical pregnancy rates, and live birth rates. The tool predicts that men with deletions have a chance of sperm retrieval that varies with type of deletions, the clinical pregnancy rates and live birth rates are lower in men with AZF deletions. A trial version of the tool is available at http://fertilitypredictor.sbdaresearch.in.
Conclusions
FertilitY Predictor allows users to classify AZFa, AZFb, AZFc, and gr/gr deletions and also predict the outcomes of ART based on the type of deletions.
Trial registration
PROSPERO (CRD42022311738).
... Infertility is a widespread health concern, affecting about 15% of couples globally, with male-related factors responsible for 30-40% of cases. Abnormal sperm head morphology is one of the main factors contributing to this problem [1]. A typical sperm head is oval and consists primarily of the acrosome and nucleus. ...
Male infertility remains a significant global health concern, with abnormal sperm head morphology recognized as a key factor impacting fertility. Traditional analysis of sperm morphology through manual microscopy is labor-intensive and susceptible to variability among observers. In this study, we introduce a deep learning framework designed to automate sperm head classification, integrating EdgeSAM for precise segmentation with a Sperm Head Pose Correction Network to standardize orientation and position. The classification network employs flip feature fusion and deformable convolutions to capture symmetrical characteristics, which enhances classification accuracy across morphological variations. Our model achieves a test accuracy of 97.5% on the HuSHem and Chenwy datasets, outperforming existing methods and demonstrating greater robustness to rotational and translational transformations. This approach offers a streamlined, automated solution for sperm morphology analysis, providing a reliable tool to support clinical fertility diagnostics and research applications.
... Approximately half of infertility cases are related to male reproduction, and it is estimated that at least 30 million men struggle with infertility all over the world (Agarwal et al., 2015;Jungwirth et al., 2019). However, most of the time, although the difficulty in reproduction may stem from either of the spouses, women are exposed to medical procedures more, spend more effort to adapt to the treatment process, and face more psychosocial difficulties of the infertility process (Cousineau & Domar, 2007;Öskan-Fırat & Hotun-Şahin, 2022). ...
The study aimed to investigate the types of social support provided by forum members in response to questions posed by women with infertile spouses on the Women’s Club forum, specifically within discussions centered on divorce due to infertility. Topics and comments on the subject of “divorce due to male-related infertility” in the Women’s Club forum between 2008 and 2023 were analyzed. Five topics and 487 comments were analyzed through inductive thematic analysis, and 458 different codes emerged. The codes were grouped into four themes: informational support, emotional support, intellectual and critical support, and relationship improvement support. Consequently, women considering divorce due to male-related infertility are provided informational, emotional, and relationship-focused, and querying social support through the forum. These types of social support indicate factors that may affect marital adjustment during the infertility process. Therefore, it is recommended that experts who provide professional support to these couples should pay attention to these factors and that the scope of psychosocial services currently provided in Turkey should be person-specific to cover the social support needs of these couples.
... The diagnosis of infertility also requires the need for medical intervention, including, but not limited to, the use of donor gametes or donor embryos in order to achieve a successful pregnancy either as an individual or with a partner. 1 According to a published study, between 10% and 15% of couples worldwide have been diagnosed, with Southeast Asia and Sub-Saharan Africa having the highest rates. 2,3 Infertility can be due to male reproductive issues, female reproductive issues, or both. For the females, the reproductive issues can range from ovarian disorders, ovulation disorders, fallopian tube disorders, uterine disorders, cervical disorders, and so on and so forth. ...
Background: Oocyte donation is a third-party treatment employed in assisted reproductive technology where good-quality oocytes obtained from young females are used by females with advanced age, poor ovarian reserve, and poor oocyte quality for in-vitro fertilization. A major challenge facing this treatment option is the availability of donors, and this study was done to ascertain the demographics of donors and their prior knowledge and experience of the process. The aim is to provide information that can be used to improve awareness and execution of the process. Methods: This is a multi-center cross-sectional study that enrolled 154 participants who donated their oocytes between May 1st, 2023, and June 30th, 2024, in five major fertility clinics located in Abuja, Nigeria. Questionnaires were used to obtain data from the donors; the information obtained was analyzed using IBM SPSS Statistics 29.0.1.1. and presented as simple descriptive statistics. Results: Average age was 23.7 years, and 71% of the participants had secondary education as their highest level of education. A total of 45% admitted to having anxieties prior to the procedure, of which 7.3% graded their anxiety as severe. During the procedure, 29.9% experienced symptoms, but only 27.1% stated that they would be willing to undergo the procedure again. Conclusions: Opportunistic health education and adequate pre-procedure counseling are recommended to increase awareness of oocyte donation and improve the experience of the participants.
... Infertility is commonly defined as the inability of a couple to conceive after 12 months of regular, unprotected intercourse (3). According to the World Health Organization, approximately 15% of couples worldwide experience fertility issues, with male factors contributing to 50% of these cases (4). The etiology of male infertility is diverse, encompassing testicular dysfunction, endocrine disorders, lifestyle factors, congenital anatomical abnormalities, exposure to gonadotoxic agents, and aging (5). ...
... Fertility represents the capacity of a healthy couple to reproduce through normal sexual activity (1). Today, on a world scale, infertility affects approximately 15% of couples that are of reproductive age (2) and in approximately 20-50% of cases, the medical reasons are of a masculine nature (3). There are a number of tests that try to establish the reference values for semen function evaluation. ...
Aims and objectives: To identify the possible associations between semen parameters and different demographic or lifestyle factors with known roles in fertility. Material and methods: The present retrospective study has taken place over a period of 12 months and has included 876 male patients who have presented themselves for fertility medical testing in a Fertility Center. They provided semen samples which were analysed through the use of semen analysis, according to the World Health Organisation (WHO) standards, providing basic information about spermatogenesis. Results: Some significant statistical correlations were observed between different sperm parameters and demographic and lifestyle factors. Conclusions: The present study shows that age, the number of abstinence days, obesity, smoking, some medical condition like varicocele or genetic factors,, as well as correct patient sample collection and analysing methods can greatly influence the different diagnostics decisions, on the basis of the sperm analysis, with different significations regarding the masculine fertility prognostic.
... Infertility a ects approximately 15% of couples worldwide, with male factor infertility contributing to about 50% of these cases [1]. Intracytoplasmic sperm injection (ICSI) is a specialized form of in vitro fertilization (IVF) that involves the direct injection of a single spermatozoon into the cytoplasm of a mature oocyte. ...
Infertility can harm a patient in physical, psychological, spiritual, and medical ways. This illness is unusual because it affects the patient's companion and the patient individually. Infertility is a multifactorial disease, and various etiological factors like infection are known to develop this disorder. Recently published studies reported that different bacteria, such as Chlamydia trachomatis, Mycoplasma spp., Ureaplasma urealyticum, Escherichia coli, Staphylococcus aureus, and Pseudomonas aeruginosa, can lead to infertility by immunopathological effects, oxidative stress, and adverse effects on sperm concentration, motility, morphology, and DNA condensation. Among viruses, Human papillomavirus and Herpes simplex virus reduce sperm progressive motility and sperm concentration. The viruses can lead to the atrophy of the germinal epithelium and degenerative changes in the testes. Candida albicans also harm sperm quality, motility, and chromatin integrity and induce apoptosis in sperm cells. Finally, Trichomonas vaginalis leads to distorted heads, broken necks, and acrosomes exocytosis in sperms. This parasite decreases sperm viability and functional integrity. Noteworthy, oxidative stress could have a role in many pathological changes in the reproductive system. Recent findings show that microorganisms can increase reactive oxygen species concentration inside the host cells, leading to oxidative stress and sperm distress and dysfunction. Therefore, this article explores the potential significance of critical bacteria linked to infertility and their pathogenic mechanisms that can affect sperm function and the female reproductive system.
STUDY QUESTION
What is the prevalence and trend of infertility among individuals of childbearing age at global, regional, and national levels by sex and socio-demographic index (SDI) across 21 regions and 204 countries and territories?
SUMMARY ANSWER
Our findings reveal a growing prevalence of infertility among individuals aged 15–49 years worldwide from 1990 to 2021, with an expected continued increase through 2040.
WHAT IS KNOWN ALREADY
Infertility is a persistent global reproductive health issue, leading to significant societal and health consequences. No study has specifically described the current prevalence of infertility, its secular trend, or the variations between regions or countries with different SDI levels.
STUDY DESIGN, SIZE, DURATION
A sex- and SDI-stratified systematic analysis of the prevalence of infertility across 21 regions and 204 countries and territories from 1990 to 2021 has been performed.
PARTICIPANTS/MATERIALS, SETTING, METHODS
We retrieved data from the Global Burden of Disease Study (GBD) 2021 on the count and crude rate of infertility prevalence for individuals aged 15–49 years across 204 countries and territories from 1990 to 2021. In the GBD 2021 framework, infertility is defined as the absence of a live birth in a couple who have been in a union for at least 5 years and are actively trying to conceive, or in a couple who have been in a union for at least 5 years since their last live birth, with no use of contraceptives during this period. Estimated annual percent change was calculated to quantify the temporal trend in age-standardized prevalence rates (ASPRs) for infertility by sex, age, and SDI. The Bayesian age-period-cohort model was used to project the ASPRs from 2022 to 2040.
MAIN RESULTS AND ROLE OF CHANCE
In 2021, an estimated 55 000 818 men and 110 089 459 women were living with infertility worldwide, corresponding to approximately 1820.6 cases per 100 000 population (1.8%) for males and 3713.2 cases per 100 000 population (3.7%) for females. Regionally, the highest infertility prevalence was observed in middle SDI regions, such as East and South Asia and Eastern Europe. Infertility primarily affected the age group of 35–39 years and females in most regions, with some notable exceptions. Between 1990 and 2021, the global ASPRs of infertility increased by an average of 0.49% (95% CI 0.34–0.63) for males and 0.68% (0.51–0.86) for females. Additionally, the fastest increase in female infertility occurred in high SDI regions, while the most significant rise in male infertility was seen in low-middle SDI areas. Furthermore, the global ASPR of male infertility is projected to rise more rapidly than that of female infertility from 2022 to 2040.
LIMITATIONS, REASONS FOR CAUTION
The primary data sources for the infertility burden in the GBD 2021 are population-based surveys; however, less-developed regions often lack complete population-based statistics, leading to potential reporting bias of the infertility burden in these areas due to data sparsity and incompleteness. Additionally, this study could not separately assess the prevalence and trends of primary and secondary infertility. Furthermore, the GBD 2021 does not provide the attributable proportion of each cause of infertility; hence, we cannot compare the contribution of these causes to infertility by sex, age, and location.
WIDER IMPLICATIONS OF THE FINDINGS
Sexual and reproductive health are crucial for individuals’ health, economic development, and overall human wellbeing. It is essential for governments and the public to recognize the severity of infertility and prioritize the implementation of targeted interventions to enhance reproductive health.
STUDY FUNDING/COMPETING INTEREST(S)
This study was supported by the grants from the Science and Technology Project of Jiangmen (2020030103110009027). The authors have declared no conflict of interest.
TRIAL REGISTRATION NUMBER
N/A.
Introduction: The past two decades have been marked by an increasing awareness and acceptance of the problems faced by couples struggling with infertility. The process of oogenesis is vital for human reproduction. With the increasing application of in vitro fertilization (IVF) as a treatment for infertility, more possibilities for identification of morphological defects in oocytes have been available. Furthermore, the rapid rise in genetic diagnostics allows for an even deeper analysis of the genetic defects at the basis of female infertility.
Materials and methods: We present a clinical case of a 35-year-old woman with fertility issues referred for genetic testing due to the production of immature oocytes as a result of IVF. For this purpose, whole-genome sequencing (WGS) was performed with subsequent targeted analysis of 332 genes associated with female infertility.
Results: One novel likely pathogenic heterozygous splice donor variant in the ZP2 gene was identified (NM_003460.1:c.151+1G>A). The variant was associated with oocyte maturation defect type 6 and could potentially explain the patient's infertility.
Conclusion: The current study broadens the mutational spectrum associated with human infertility. The novel variant in the ZP2 gene expands the variety of ZP-gene family mutations, proposes autosomal dominant mode of inheritance and provides possible diagnostic markers for patients with oocyte maturation defects, empty follicle syndrome, diminished oocyte fertilization, implantation failure, zona
pellucida anomalies. In addition, clarification of the proband's underlying genetic cause of infertility allows precise genetic counseling for the couple and enables assisted reproduction specialists to take appropriate measures for future IVF procedures.
Introduction: This cross-sectional study investigated the relationship between hormonal imbalances and semen quality parameters in 48 male patients seeking fertility treatment in Puntland, Somalia. Semen analysis and hormonal assays were conducted to examine correlations between reproductive hormones ( FSH, LH, Prolactin, and Testosterone ) and a composite Semen Quality Index ( SQi ). Results Statistical analysis revealed a significant positive correlation between testosterone and SQi (r = 0.28, p = 0.042) and a negative correlation between FSH and SQi (r = -0.31, p = 0.024). Multiple regression analysis demonstrated that hormonal factors accounted for 32.4% of the variance in semen quality (R² = 0.324, p < 0.001). FSH showed a significant negative association (β = -0.286, p = 0.003) while testosterone demonstrated a significant positive relationship (β = 0.245, p = 0.012) with semen quality. Conclusion These findings suggest that hormonal imbalances, particularly in FSH and testosterone levels, significantly influence male fertility parameters. The study provides valuable insights for understanding male infertility in the Somali context, though larger longitudinal studies are needed to establish causality and explore additional contributing factors.
A BSTRACT
Infertility presents multifaceted challenges that encompass both physical and emotional burdens. Yoga, as a comprehensive system of mind–body medicine, serves as an effective intervention for managing male factor infertility, a complex lifestyle disorder with significant psychosomatic elements. This review explores the transformative role of yoga in addressing both the emotional and physical dimensions of infertility. By incorporating physical postures, breath control and meditation, yoga promotes emotional well-being and enhances reproductive health by improving the integrity of nuclear and mitochondrial genomes as well as the epigenome. In addition, yoga contributes to maintaining sperm telomere length through the regulation of seminal free radical levels and increased telomerase activity, which are crucial for optimal embryo cleavage and the development of high-quality blastocysts. Integrating yoga as an adjunctive therapeutic approach fosters a supportive intrauterine environment and facilitates physiological homoeostasis, thereby increasing the likelihood of successful fertilisation and implantation. Gentle asanas and flowing sequences promote relaxation, alleviate tension and cultivate emotional stability, while meditation aids in emotional healing and resilience during the infertility journey. Specific asanas, such as Baddha Konasana (bound angle pose), Bhujangasana (cobra pose) and Sarvangasana (shoulder stand), stimulate reproductive organs, enhance blood circulation and regulate hormone production. Pranayama techniques further support endocrine balance and overall vitality. Moreover, yoga provides a non-invasive strategy for managing fertility-related conditions leading to improved reproductive health and overall well-being. This review aims to elucidate the comprehensive role of yoga in improving male infertility, focusing on its impact on sperm nuclear and mitochondrial genomes, the epigenome and telomere health. In addition, it underscores the importance of self-care, open communication and shared experiences with partners. Practicing yoga regularly supports psychosocial well-being, promotes holistic healing, enhances physical and mental health and probably helps in improving reproductive health, thereby fostering resilience and self-efficacy throughout the journey of fertility and reproduction.
A BSTRACT
Background
Male infertility emerges as an important cause during the evaluation of infertile couples. Varicocele is a well-known cause of male infertility. The role of seminal lactoferrin, an iron-binding glycoprotein, in male fertility is unclear and needs further investigation. Recently, it has been linked to some sperm abnormalities and subfertility.
Aim
This study aims to detect seminal lactoferrin levels in infertile men with varicocele and their relation to semen parameters and fertility status. We investigated a possible link between seminal lactoferrin and iron.
Settings and Design
A cross-sectional study was conducted through the outpatient clinic.
Materials and Methods
Seventy-five individuals were included in 3 groups (33 infertile men with varicocele, 25 infertile men without varicocele and 17 fertile participants without varicocele). Conventional semen analysis was conducted, and seminal plasma was obtained in all groups to detect lactoferrin and iron levels.
Statistical Analysis Used
Statistical analysis was performed by SPSS version 24.
Results
In infertile men with varicocele, seminal lactoferrin (155.92 ± 8.4 ng/ml, P = 0.296) and iron levels (260.71 ± 38.3 μg/dl, P = 0.409) were not significantly different from other groups. There was a positive correlation between seminal lactoferrin, iron levels and sperm concentrations and counts. Seminal iron and lactoferrin were significant independent predictors of sperm concentration. A negative correlation was reported between seminal lactoferrin levels and age. Lactoferrin in seminal plasma was not correlated with seminal iron.
Conclusion
Infertile men with varicocele have seminal lactoferrin levels comparable to other infertile men and possibly fertile individuals. Iron concentrations are not linked to lactoferrin levels in seminal plasma.
Introduction
One in six people of reproductive age experience infertility in their lifetime throughout the world, often with devastating consequences. Men are often invisible in infertility research and services, yet masculinity and reproductive agency intersect within social, cultural and religious contexts to shape their experiences of infertility and masculine expression. This study aims to provide insights into the lived experience of male infertility, the availability and access of infertility services for men within the biomedical sector in Bangladesh and the potential willingness of men to use home-based semen testing.
Methods and analysis
This qualitative study will be conducted in Dhaka and Khulna districts in Bangladesh over 18 months (late 2023–2025). A total of 35 biomedically diagnosed infertile men will be selected for interview using convenience sampling. Additionally, 25 key informants, including healthcare providers from public and private fertility clinics and health policymakers, will be interviewed. Service availability will be documented by creating a list of fertility clinics and cataloguing services offered in a selection of these clinics. Both inductive and deductive thematic analysis will be used.
Ethics and dissemination
The study has been reviewed and approved by the Brighton and Sussex Medical School’s Research and Governance Ethics Committee (RGEC: ER/BSMS9E3G/1), Institutional Review Board of icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh) and the WHO Ethics Review Committee (WHO ERC, AID: A66040). A comprehensive participant information sheet containing the study aims, objectives and data collection procedures will be provided to eligible participants and informed consent obtained. Two dissemination workshops will be held, one with the community at the field level and another with the key stakeholders, that is policymakers, health service and clinical stakeholders to disseminate the results of the study and its implications for fertility care for men with infertility in Bangladesh and other low- and middle-income countries. Scientific manuscripts will be published in open-access journals to inform the global community.
The morphological quality and fertilizing potential of the ovum is of key importance for the outcome of in-vitro procedures – a very small
percentage of them result in the birth of a live baby. At the same time, with the continuous increase in the reproductive age of women, the
number and quality of obtained eggs for the purposes of in-vitro procedures is constantly decreasing. Knowing the factors of the external
environment for the eggs and the impact these factors on quality of oocytes and their potential, makes it possible to try to maintain them in
optimal parameters and minimize their negative influence.
Key words: oocyte quality, external factors
Морфологичното качество и оплодителният потенциал на яйцеклетката е от ключово значение за изхода от ин-витро
процедурите – много малък процент от тях водят до раждането на живо бебе. В същото време с непрекъснатото увеличаване
на репродуктивната възраст на жените, броят и качеството на получаваните яйцеклетки за целите на ин-витро
процедурите непрекъснато намалява. Познаването на факторите на външната за яйцеклетките среда и тяхното
въздействие върху качеството и потенциала им, дава възможност да се опитваме да ги поддържаме в оптимални параметри
и да минимизираме негативното им влияние.
Ключови думи: качество на яйцеклетката, външни фактори
Male genitourinary dysfunction causes serious physical or mental distress, such as infertility and psychological harm, which leads to impaired quality of life. Current conventional treatments involving drug therapy, surgical repair, and tissue grafting have a limited effect on recovering the function and fertility of the genitourinary organs. To address these limitations, various biomaterials have been explored, with collagen-based materials increasingly gaining attention for reconstructing the male genitourinary system due to their superior biocompatibility, biodegradability, low antigenicity, biomimetic 3D matrix characteristics, hemostatic efficacy, and tissue regeneration capabilities. This review covers the recent biomedical applications of collagen-based materials including treatment of erectile dysfunction, premature ejaculation, penile girth enlargement, prostate cancer, Peyronie's disease, chronic kidney disease, etc. Although there are relatively few clinical trials, the promising results of the existing studies on animal models reveal a bright future for collagen-based materials in the treatment of male genitourinary diseases.
Graphic Abstract
STUDY QUESTION
Can semen parameters predict long-term health outcomes in men?
SUMMARY ANSWER
There is a lack of evidence to suggest a higher risk of comorbidities in men with poor semen concentration.
WHAT IS KNOWN ALREADY
Male infertility has been long associated with a higher mortality risk and possibly higher chance of developing comorbidities but there has been less focus on semen analysis as a potential predictive factor.
STUDY DESIGN, SIZE, DURATION
We searched PubMed/MEDLINE, EMBASE, and EBM databases from inception to December 2023. MESH term strategy: heading 1 (‘OR’, semen analysis, sperm count, sperm parameter*, male infertility, azoospermia, aspermia, oligospermia, teratozoospermia, asthenozoospermia) ‘AND’ heading 2 (‘OR’, morbidity, mortality, diabetes, cancer, cardiovascular, death, hypertension, stroke, long-term health). We included all studies that analyzed the risk of mortality and/or future development of comorbidities in men with at least one semen analysis. Case series and reviews were excluded.
PARTICIPANTS/MATERIALS, SETTING, METHODS
A narrative synthesis was done for all studies and meta-analysis where possible. Odds ratio (ORs) (95% CI, P-value) were calculated for all men with one suboptimal semen parameter and associated with the risk of a particular outcome. The risk of bias was assessed with QUADAS-2.
MAIN RESULTS AND THE ROLE OF CHANCE
Twenty-one studies were finally included. There was either a high or unclear risk of bias in all studies. The results only allowed for meta-analysis on categories of sperm concentration. We found a 2-fold increase in mortality risk in azoospermic men compared to oligospermic (OR 1.96, 95% CI: 1.29–2.96) and normozoospermic (OR 2.00, 95% CI: 1.23–3.25) groups, but not in oligospermic compared to normozoospermic (OR 1.04, 95% CI: 0.52–2.09). There was no difference in risk of cardiovascular disease in any of the sperm concentration groups (azoospermic-oligospermic OR 0.94, 95% CI: 0.74–1.20, azoospermic-normozoospermic OR 1.11, 95% CI: 0.71–1.75, and oligospermic-normozoospermic OR 1.12, 95% CI: 0.80–1.55). OR for diabetes in azoospermic men was higher only compared to oligospermic (OR 2.16, 95% CI: 1.55–3.01). The risk of all-site cancer was higher in azoospermic men compared to oligospermic (OR 2.16, 95% CI: 1.55–3.01) and normozoospermic (OR 2.18, 95% CI: 1.20–3.96). Only azoospermic men might be at higher risk of testicular cancer when compared to men with normal sperm concentration (OR 1.80, 95% CI: 1.12–2.89).
LIMITATIONS, REASONS FOR CAUTION
Although our pooled analysis shows an increased risk of mortality and all-site cancer risk in azoospermic men, the results show a lack of evidence to suggest a higher risk of comorbidities in men with poor semen concentration. Given the limited available data, the nature of the studies, and the high risk of bias, the results should be interpreted with caution.
WIDER IMPLICATIONS OF THE FINDINGS
There is not enough data to confirm the usability of semen analysis as a predictor of poor long-term health in men, especially within the general population.
STUDY FUNDING/COMPETING INTEREST(S)
No funding was obtained for this study. A.M. has received funding from Merck Serono, Ferring, Gedeon Richter, Pharmasure, and Cook Medical to attend medical conferences; has been a participant in an advisory board for Ferring; and has given an invited lecture for a Merck Serono advisory board. S.N. has received funding for medical conference attendance from Ferring and Cook Medical.
REGISTRATION NUMBER
PROSPERO No. CRD42024507563.
Male infertility is among one of the most challenging health concerns in the world. Traditional therapeutic interventions such as semen and testicular tissue cryopreservation aim to restore or preserve male fertility. However, these methods are subject to limitations that impact their efficacy and are infeasible in cases such as patients who cannot produce mature sperm due to genetic or pathological disorders. Moreover, with the number of cases of prepubertal boys who must undergo gonadotoxic treatments rising, alternatives have been sought for fertility preservation to enhance reproductive rates in vitro and in vivo. Tissue engineering is a promising area that can address aspects that current therapies may not fully encompass through the creation of bioartificial testicular structures or 3D culture systems that allow the establishment of the essential conditions for sperm production. This study aims to first give a brief overview of stem cell therapy in treating male infertility and then go more in-depth regarding the novel methods and procedures based on tissue engineering that have the potential to offer new treatments for infertility caused by testicular disorders and defects.
Ever since its implementation in 1992, the intra-cytoplasmic sperm injection (ICSI) technique has been hailed as a game-changer for enhancing the outcomes of in vitro fertilization (IVF) treatment in cases of infertility due to male factors. However, ICSI was later widely applied to cases of infertility not due to male factors without evidence proving its effectiveness. According to the 2022 report of the European IVF Monitoring Council (EIM), the rate of fertilization cases using ICSI method accounts for 70% of IVF cases in European countries, meanwhile the conventional IVF method accounts for only 30% and this rate has remained stable from 2006 until recently. The question is whether cases of infertility not due to male factors that are indicated for pre-implantation genetic testing (PGT) should be fertilized and create embryos using ICSI or conventional IVF to minimize invasiveness and reduce costs while still ensuring the accuracy of the test results.
Objective
To examine the association between semen parameters, assessed according to World Health Organization (WHO)‐2021 criteria, and paternal body mass index (BMI) and age, with embryological and clinical outcomes in ICSI cycles involving preimplantation genetic testing for aneuploidy (PGT‐A).
Design
Retrospective study at a private in vitro fertilization (IVF) clinic.
Subjects
3101 couples undergoing 4013 intracytoplasmic sperm injection (ICSI) + PGT‐A cycles with own‐oocytes (years 2013–2021).
Intervention
We performed trophectoderm biopsy, and comprehensive chromosome testing to report uniform aneuploidies and vitrified‐warmed euploid single‐blastocyst‐transfers. Regression analyses adjusted for relevant confounders were conducted to outline putative associations of semen analysis and characteristics and paternal BMI and age with all embryological/clinical outcomes.
Results
Maternal age was the only significant confounding variable affecting euploidy blastocyst rate (EBR) (primary embryological outcome). When categorized, motility < 5 th ‐percentile (‐2.5%, 95%CI ‐4.9 to ‐0.2%, p = 0.03), concentration plus morphology < 5 th ‐percentile (‐2.7%,95%CI ‐4.8 to ‐0.6%, p = 0.01), concentration plus morphology plus motility < 5 th ‐percentile (‐4.0%,95%CI ‐5.5 to ‐2.6%, p < 0.01), obstructive‐azoospermia [OA] (‐5.5%,95%CI ‐9 to ‐2%, p = 0.02) and non‐obstructive azoospermia (NOA) (‐5.8%,95%CI ‐10.9 to ‐0.6%, p = 0.03) showed significantly lower results compared to all parameters > 5 th ‐percentile. Furthermore, after adjusting for maternal age and the number of metaphase‐II‐oocytes inseminated, the only significant confounding variable affecting the chance of obtaining ≥ 1 live birth among completed cycles (primary clinical outcome) was basal and post sperm processing motility. When categorized, concentration plus morphology plus motility < 5 th ‐percentile (multivariable‐OR: 0.73, 95%CI 0.58–0.93, p = 0.01) and OA (multivariable‐OR: 0.47, 95%CI 0.24–0.92, p = 0.03) showed significantly lower chances compared to all parameters > 5 th ‐percentile. Advanced paternal age (defined as > 44 years) was associated only with lower day 5‐blastocyst and Gardner's AA‐grade (i.e., top quality) blastocyst rates.
Conclusions
This comprehensive analysis provides IVF professionals with useful figures to counsel infertile couples about their chances of success, taking into account the impact of semen characteristics and paternal BMI and age. These estimates are valuable for personalized decision‐making about the most effective reproductive strategies to adopt, especially not underestimating male factor, by improving sperm concentration and motility whenever possible before assisted reproductive technologies.
The purpose of this review is to integrate understanding of epidemiology and infertility. A primer on epidemiologic science and an example disease for which the design of epidemiologic investigations is readily apparent are provided. Key features of infertility that limit epidemiologic investigation are described and a survey of available data on the epidemiology of infertility provided. Finally, the work that must be completed to move this area of research forward is proposed, and, with this new perspective of "infertility as a disease," improvements envisioned in public health that may be gained through improved understanding of the epidemiology of male infertility.
Global, regional, and national estimates of prevalence of and tends in infertility are needed to target prevention and treatment efforts. By applying a consistent algorithm to demographic and reproductive surveys available from developed and developing countries, we estimate infertility prevalence and trends, 1990 to 2010, by country and region.
We accessed and analyzed household survey data from 277 demographic and reproductive health surveys using a consistent algorithm to calculate infertility. We used a demographic infertility measure with live birth as the outcome and a 5-y exposure period based on union status, contraceptive use, and desire for a child. We corrected for biases arising from the use of incomplete information on past union status and contraceptive use. We used a Bayesian hierarchical model to estimate prevalence of and trends in infertility in 190 countries and territories. In 2010, among women 20-44 y of age who were exposed to the risk of pregnancy, 1.9% (95% uncertainty interval 1.7%, 2.2%) were unable to attain a live birth (primary infertility). Out of women who had had at least one live birth and were exposed to the risk of pregnancy, 10.5% (9.5%, 11.7%) were unable to have another child (secondary infertility). Infertility prevalence was highest in South Asia, Sub-Saharan Africa, North Africa/Middle East, and Central/Eastern Europe and Central Asia. Levels of infertility in 2010 were similar to those in 1990 in most world regions, apart from declines in primary and secondary infertility in Sub-Saharan Africa and primary infertility in South Asia (posterior probability [pp] ≥0.99). Although there were no statistically significant changes in the prevalence of infertility in most regions amongst women who were exposed to the risk of pregnancy, reduced child-seeking behavior resulted in a reduction of primary infertility among all women from 1.6% to 1.5% (pp = 0.90) and a reduction of secondary infertility among all women from 3.9% to 3.0% (pp>0.99) from 1990 to 2010. Due to population growth, however, the absolute number of couples affected by infertility increased from 42.0 million (39.6 million, 44.8 million) in 1990 to 48.5 million (45.0 million, 52.6 million) in 2010. Limitations of the study include gaps in survey data for some countries and the use of proxies to determine exposure to pregnancy.
We analyzed demographic and reproductive household survey data to reveal global patterns and trends in infertility. Independent from population growth and worldwide declines in the preferred number of children, we found little evidence of changes in infertility over two decades, apart from in the regions of Sub-Saharan Africa and South Asia. Further research is needed to identify the etiological causes of these patterns and trends. Please see later in the article for the Editors' Summary.
Infertility seems to be a great worldwide problem. Many publications present the epidemiology of infertility, but the percentage distribution of factors responsible for infertility varies significantly. The objective was to define infertility profiles in Poland assessed according to the information provided by 4 large infertility centers: Bialystok, Poznan, Szczecin and Warsaw.
Multicenter study was performed. Couples with primary infertility, attending one of the four centers in Poland, were asked to fulfill a questionnaire. Overall 1517 questionaires were analysed: Bialystok - 468, Poznan - 325, Szczecin - 341, Warsaw - 383. Only semen analyses fulfilling WHO Manual 1999 criteria were used in the study and were afterwards compared with 2010 WHO standards.
Results from 4 Polish centers showed that the average age of infertile women was 31.41 years and of infertile men 33.2 years. The mean duration of infertility equaled 3.31 years. Among 1517 surveyed women, no pathological findings concerning reproductive abilities were observed in 1088 cases (71.72%). In the remaining patients the following were diagnosed: uterine factor in 26 (6.02%) women, ovulation disorders in 134 (31.33%), including 70 (16.27%) of PCOS patients, tubal factor in 165 (38.55%) and endometriosis in 145 (33.73%). The average of 18.9% of couples had a mixed cause of infertility, while idiopathic factor was assigned to 15.99%. In the study male factor accounted for 55.73% of cases. Change of reference values for semen analysis implemented in 2010 caused an increase in the number of normal results and asthenozoospermia.
According to the data provided by Polish infertility centers the rate of male factor as a reason of infertility has reached 55.73%. However, the implementation of new reference values for semen analysis in 2010 led to the decrease in male factor frequency and the increase in the rate of idiophatic infertility. Anovulatory cycles and endometriosis are the main reasons affecting the female reproductive potential.
In 2010, the World Health Organization established new reference values for human semen characteristics that are markedly lower than those previously reported. Despite using controlled studies involving couples with a known time to pregnancy to establish the new limits, the reference studies are limited with regard to the population analyzed and the methods used for semen evaluation. The present review discusses concerns related to the new reference values for semen characteristics, including the effect on patient referral, diagnosis, and treatment of recognized conditions, such as varicocele, and on the indications for assisted reproductive technologies.
Semen quality is taken as a surrogate measure of male fecundity in clinical andrology, male fertility, reproductive toxicology, epidemiology and pregnancy risk assessments. Reference intervals for values of semen parameters from a fertile population could provide data from which prognosis of fertility or diagnosis of infertility can be extrapolated.
Semen samples from over 4500 men in 14 countries on four continents were obtained from retrospective and prospective analyses on fertile men, men of unknown fertility status and men selected as normozoospermic. Men whose partners had a time-to-pregnancy (TTP) of < or =12 months were chosen as individuals to provide reference distributions for semen parameters. Distributions were also generated for a population assumed to represent the general population.
The following one-sided lower reference limits, the fifth centiles (with 95th percent confidence intervals), were generated from men whose partners had TTP < or = 12 months: semen volume, 1.5 ml (1.4-1.7); total sperm number, 39 million per ejaculate (33-46); sperm concentration, 15 million per ml (12-16); vitality, 58% live (55-63); progressive motility, 32% (31-34); total (progressive + non-progressive) motility, 40% (38-42); morphologically normal forms, 4.0% (3.0-4.0). Semen quality of the reference population was superior to that of the men from the general population and normozoospermic men.
The data represent sound reference distributions of semen characteristics of fertile men in a number of countries. They provide an appropriate tool in conjunction with clinical data to evaluate a patient's semen quality and prospects for fertility.
Background: Infertility is defined as one year unprotected intercourse without pregnancy. It greatly affects couples' quality of life, and has great impact on their careers, everyday activities, sexual and non-sexual relationships. Objective: To study the prevalence of both primary and secondary infertility and demographic characteristics of it in Yazd province.Materials and Methods: We studied 5200 married defined couples in 260 randomized clusters. These couples were interviewed based on using a structured questionnaire. Then, for etiological evaluation, infertile couples were referred to the Research and Clinical Center for Infertility.Results: Among these couples, 277 cases of infertility were encountered and the overall prevalence of infertility was 5.52% (95% CI from 4.9% to 6.1%). In total 170 couples (3.48%) had primary and 107 (2.04%) had secondary infertility. The prevalence of infertility in rural and urban areas was 5.3% and 6.8% respectively. Female factors were more common (57.5%) in etiologic assessment of infertility.Conclusion: Our data showed a lower total prevalence of infertility in our people compared to the other countries. Furthermore, there was significant difference in infertility prevalence between geographic parts of the province. Female factors and among them ovarian disorders were the main cause of infertility in central part of Iran.
Primary infertility is a key issue in the developed world, while the developing world has high rates of secondary infertility. The impact of HIV/AIDS on fertility is insufficiently explored. One of the most important barriers to access to infertility treatment is cost; at the same time the role of social and cultural factors in restricting access should not be underestimated. IVF has become the standard therapy for female infertility, and ICSI for infertility of the male partner. However, the use of these therapies should not be initiated without a thorough investigation and, whenever possible, individual diagnosis of the underlying causes of infertility. Multiple gestation remains one of the most challenging and controversial issues in the treatment of infertility. Current IVF practices are often blamed for this; in this respect, attention should also be focused on the role of ovarian stimulation in ovulation induction. National guidelines and national registries for assisted reproductive technology (ART) are becoming more widespread and are expected to play an important role in promoting best practice in ART in the future.
Worldwide, male infertility contributes to more than half of all cases of childlessness; yet, it is a reproductive health problem that is poorly studied and understood. This article examines the problem of male infertility in two Middle Eastern locales, Cairo, Egypt, and Beirut, Lebanon, where men may be at increased risk of male infertility because of environmental and behavioral factors. It is argued that male infertility may be particularly problematic for Middle Eastern men in their pronatalist societies; there, both virility and fertility are typically tied to manhood. Thus, male infertility is a potentially emasculating condition, surrounded by secrecy and stigma. Furthermore, the new reproductive technology called intracytoplasmic sperm injection (ICSI), designed specifically to overcome male infertility, may paradoxically create additional layers of stigma and secrecy, due to the complex moral and marital dilemmas associated with Islamic restrictions on third-party donation of gametes.
This report presents national estimates of the fertility of men and women aged 15-44 years in the United States in 2006-2010 based on the National Survey of Family Growth (NSFG). Data are compared with similar measures for 2002.
Descriptive tables of numbers, percentages, and means are presented and discussed. Data were collected through in-person interviews of a nationally representative sample of the household population aged 15-44 years in the United States between July 2006 and June 2010. The 2006-2010 NSFG sample is comprised of 22,682 respondents including 10,403 men and 12,279 women. The overall response rate for the 2006-2010 NSFG was 77%, 75% for men and 78% for women.
Many of the fertility measures among men and women aged 15-44 based on the 2006-2010 NSFG were generally similar to those reported based on the 2002 NSFG. The mean age at first child's birth for women was 23 and the mean age at first child's birth for men was 25. One-half of first births to women were in their 20s and two-thirds of first births were fathered by men who were in their 20s. On average, women aged 15-44 have 1.3 children as of the time of the interview. By age 40, 85% of women had had a birth, and 76% of men had fathered a child. In 2006-2010, 22% of first births to women occurred within cohabiting unions, up from 12% in 2002. These measures differed by Hispanic origin and race and other demographic characteristics.
Context:
New data regarding the diagnosis and treatment of male infertility have emerged and led to an update of the European Association of Urology (EAU) guidelines for Male Infertility.
Objective:
To review the new EAU guidelines for Male Infertility.
Evidence acquisition:
A comprehensive work-up of the literature obtained from Medline, the Cochrane Central Register of Systematic Reviews, and reference lists in publications and review articles was developed and screened by a group of urologists and andrologists appointed by the EAU Guidelines Committee. Previous recommendations based on the older literature on this subject were taken into account. Levels of evidence and grade of guideline recommendations were added, modified from the Oxford Centre for Evidence-based Medicine Levels of Evidence.
Evidence summary:
These EAU guidelines are a short comprehensive overview of the updated guidelines of male infertility as recently published by the EAU (http://www.uroweb.org/guidelines/online-guidelines/), and they are also available in the National Guideline Clearinghouse (http://www.guideline.gov/).
An understanding of the medical causes of infertility is crucial in order to reduce incidences of Infertility and for improving the clinical management of infertility. Although there were much data on infertility in other African countries, no data exist on infertility in Sudan. Seven hundred and ten Sudanese couples were investigated for the infertility in Khartoum Fertility Center, Sudan: 443 (62.4%) had primary infertility and 267 (37.6%) had secondary infertility. The mean (standard deviation) duration of the infertility was 5.2 (4.3) years. A positive male factor alone was found in 257 (36.2%) couples and a female factor in 350 (49.3%) couples: eleven (1.5%) couples had a combination of male and female factors: and the cause of infertility was unexplained in 92 (13.0%) couples. Oligozoospermia and asthenozoospermia were factors responsible for 16.8% and 17.5% of male infertility, respectively. Failure of ovulation (60.3%) was the most common cause of female infertility. The study revealed a high proportion of secondary infertility and a greater contribution of the female factors to infertility.
To estimate the prevalence and main causes of infertility, a multicentre survey was conducted over 1 year (July 1988-June 1989) in three regions of France. All the 1686 couples in these regions, who consulted a practitioner for primary or secondary infertility during this period, were included in the investigation. The prevalence rate of infertility was found to be 14.1%, indicating that one woman out of seven in France will consult a doctor for an infertility problem during her reproductive life. The main causes of female infertility were ovulation disorders (32%) and tubal damage (26%), and of male infertility oligo-terato-asthenozoospermia (21%), asthenozoospermia (17%), teratozoospermia (10%) and azoospermia (9%). Infertility was also found to be caused by disorders in both the male and female partners together; thus in 39% of cases both the man and woman presented with disorders. The woman alone was responsible for infertility in one-third of cases and the man alone in one-fifth. Unexplained infertility was found in 8% of the couples surveyed.
The World Health Organisation sponsored a multicentre, collaborative investigation of a standard approach to evaluating infertile couples. The study was conducted between 1979 and 1984 in thirty-three medical centres in twenty-five countries throughout the developed and developing world. Over 5800 couples completed the investigation. African centres had a pattern of infertility different from those in other developing regions or the developed countries. African couples were more likely than those from elsewhere to have secondary infertility or longer duration, a history of sexually transmitted diseases or pregnancy complications, and infertility diagnoses (such as bilateral tubal occlusion or pelvic adhesions) suggestive of previous genital infections.
Determinants of infertility were studied in 340 women in Eastern Gabon, an area situated in the "infertility belt" of Central Africa. Fallopian tube occlusion was diagnosed in 82.8% of cases, showing the importance of infection-related causes. Women with tubal occlusion did not differ significantly from women with normal tubes in obstetrical history or prevalence of Neisseria gonorrhoeae or Chlamydia trachomatis on endocervical culture. Antecedents of pelvic inflammatory disease or a pelvic mass were significantly more common in the group with tubal occlusion. This group also had a significantly higher prevalence of serum chlamydial antibodies at a titer of 1/64 or higher. Hormonal factors were found in 31.7% of women, a cervical factor in 29.0% and mechanical factors in 5.6%. No diagnosis could be made in 12.2% of cases. During the investigation, 4.4% of women became pregnant. The predominance of infectious related causes of infertility makes it imperative to focus resources on prevention programs of upper genital tract infections in women.
Infertility in the developing world has been relatively neglected as an international health problem and a topic of social scientific and epidemiological inquiry. In this study, we examine factors placing poor urban Egyptian men and women at risk of infertility, and we explore the sociocultural and political-economic contexts in which these health-demoting factors are perpetuated. Our approach to the problem of Egyptian infertility attempts an explicit merging of ethnographic and epidemiological research designs, methods of data collection and analysis, and interpretive insights to provide improved understanding of the factors underlying infertility in the urban Egyptian setting.
To study care-seeking behavior for infertility treatment in different European countries.
Multicenter surveys of randomly selected women in the child bearing age.
Five countries participated in the study: Denmark, Germany, Italy, Poland, and Spain. Data were collected from 1991 to 1993 as part of a concerted action.
Population-based samples of women 25 to 44 years of age. The sample sizes ranged from 442 women in Poland to 2,729 in Italy. Participation rates ranged from 54% in Germany to 87% in Denmark. Data were collected by means of a highly structured questionnaire used at a face-to-face interview.
Waiting time to pregnancy, time, and type of treatment for infertility.
Less than half of the infertile couples seek medical help in most European countries. The lowest proportion seeking help was found in Poland and the highest in Denmark.
The increasing demand for infertility treatment is expected to continue, because the potential unmet need is outspoken in most European countries.
The study examined the epidemiology and causes of infertility in Tomsk, Western Siberia, using methodological approaches recommended by WHO and was based on the findings for a randomly selected sample of 2000 married women aged 18-45 years. Among the respondents, 333 couples were considered infertile since they had not conceived after 12 months or more of unprotected intercourse. This group of infertile couples was offered comprehensive clinical investigations but only 186 couples completed them. The infertility rate in Tomsk was 16.7%, being caused by diseases of the female reproduction system in 52.7% of the couples and by male reproductive diseases in 6.4%. In 38.7% of couples, both spouses suffered from infertility, while in 2.2% of cases the cause of infertility was not determined. Among the causes of female infertility, secondary infertility dominated (12.9% of all the women questioned), while primary infertility affected 3.8% of the women. The most frequent causes of female infertility were disturbances to tubal patency (36.5%) and pelvic adhesions (23.6%). Endocrine pathology was found in 32.8% of cases. The most frequent cause of male infertility was inflammatory disease of male accessory glands (12.9%). In 8.6% of cases infection resulted in obstructive azoospermia. Varicocele was registered in 11.3% of cases, and idiopathic pathospermia in 20.9%. Inflammatory complications among females were 4.2 times more frequent than among males.
The Practice Guidelines Committee of the American Urological Association, Inc. (AUA) commissioned a Male Infertility Best Practice Policy Committee (MIBPPC) in 1998 to bridge the gap in male infertility between leading edge science and clinical practice, and provide urologists, gynecologists, reproductive endocrinologists, primary care practitioners, reproductive researchers and other health care providers with guidance for excellence of care in this rapidly changing field. The MIBPPC chose not to create a comprehensive treatise on male infertility, but rather to focus on areas that are new, poorly understood, poorly standardized, controversial and/or rapidly changing. The MIBPPC divided its efforts into 4 interrelated sections: 1) optimal evaluation of the infertile male, 2) evaluation of the azoospermic male, 3) management of obstructive azoospermia, and 4) varicocele and infertility. A separate report was created for each topic. The reports were submitted to peer review by 125 physicians and researchers from the disciplines of urology, gynecology, reproductive endocrinology, primary care and family medicine, andrology and reproductive laboratory medicine. The reports were then reviewed and approved by the Practice Guidelines Committee of the AUA the Practice Committee of the American Society for Reproductive Medicine (ASRM) and the boards of the 2 organizations. The reports were printed and distributed jointly by the AUA and ASRM in 2001. We reviewed each report of the MIBPPC.
Poland has been considered a representative country for the population of Central and Eastern Europe as it has genetically homogenous population and reveals profound similarities in economical and historical processes common for all countries of the region. According to our observations there is approximately 20% of infertile couples in Poland (lack of concentration after at least 12 month of unprotected intercourse) and 40-60% of them are infertile because of the male factor. However, studies of infertility in Poland that have been conducted so far need to be verified. The changes connected with the style of life and new tendencies observed during the tedious political changes had considerable influence on childbearing rate in Poland. Additional factors diminishing the fertility rate are: the change of the status of women in a society, raising amount of everyday stress, the high rate (17%) of unemployment and the low average income. Furthermore, in Poland, the diagnostics and treatment (assisted reproductive technology) are entirely financed from the private funds of a patient. Summing up, the problem of childlessness in Central and Eastern Europe is a complex one and very alarming therefore it is necessary to work out and to implement research, preventative and therapeutic programmes strengthened through the international cooperation of specialized centers of excellence.
Infertility is of public health importance in Nigeria and many other developing nations because of its high prevalence and especially due to its serious social implications. A review of the epidemiology of infertility in Nigeria and other parts of Sub-Saharan Africa is presented and socio-cultural issues including the social impact on couples are discussed. The major cause of infertility in Africa is infection--STDs, post-abortal and puerperal sepsis. Beliefs about causes, and failure of orthodox methods of treatment have led many couples to seek solution from traditional doctors and faith healers without success. Infertility causes marital disharmony, which often leads to divorce. Women are often blamed for the infertility and men engage in polygyny in an attempt to have children. The couple can also suffer stress from the management of the infertility. Adoption is not popular and assisted reproduction has medico-legal implications. Preventive measures are suggested, including counselling at every stage of the management.
Three hundred and fourteen Nigerian couples were evaluated thoroughly for the cause of their infertility in our clinics located at Nnewi and Awka in Southeastern Nigeria. Two hundred and four (65.0%) of them had primary infertility and 110 (35%) had secondary infertility. The median duration of the infertility was 5 years and majority of the female patients (67.2%) were aged between 25 and 34 years. A positive male factor alone was found in 133 (42.4%) couples and female factor alone in 81 (25.8%) couples (P<0.01). Sixty-five (20.7%) couples had a combination of male and female factors, while the cause of infertility was unexplained in 35 (11.1%) couples. Oligozoospermia (35.9%) and asthenozoospermia (32.3%) were the most common aetiological factors responsible for male infertility. Tubal occlusion (49.0%) was the most common cause of female infertility. Genital tract infection resulting from sexual promiscuity and poorly treated sexual transmitted diseases were responsible for these abnormalities. In this part of the world, the wife is commonly blamed whenever there is infertility. However, this study has revealed the greater contribution of male factors to infertility. More attention should be paid to male partners whenever a couple presents for infertility. Men should also be a major target of any intervention aim at prevention.
To determine the clinical patterns and major causes of infertility in Mongolia, based on the clinical and laboratory findings of both partners, and to compare the findings with data from the published World Health Organization (WHO) multicenter study.
Four hundred and thirty infertile couples who attended the Infertility Clinic of the State Research Center on Maternal Child Health in 1998-2002 were included in the study. The couples had not had a viable birth after at least 1 year of unprotected intercourse and agreed to be fully investigated according to the WHO protocol 'Standardized Investigation of the Infertile Couple'.
The mean duration of infertility of couples was 4.9 +/- 0.2 years. 43.7% of women had secondary infertility. In the females, the prevalence of past history of sexually transmitted infection (STI) and pelvic inflammatory disease were 33.5% and 25.1%, respectively. In the male partner, 44.2% reported a history of STI and 27.7% had previous testicular damage. 32.8% of women had a tubal factor. The most common causes of male infertility were obstructive azoospermia (8.4%), male accessory gland infection (6.7%) and acquired testicular damage (5.4%). In 45.8% of couples, infertility was due to a female factor and in 25.6% of cases, infertility was due to a male factor. 9.8% of couples had no demonstrable cause in either partner and 18.8% of couples had an infertility diagnosis in both partners.
Patterns of female infertility did not differ significantly from those in the WHO study. Male infertility had a unique pattern, as there was a high prevalence of obstructive azoospermia and previous testicular damage.
Fertility and pregnancy: an epidemiologic perspective
- A J Wilcox
- AJ Wilcox
Wilcox AJ. Fertility and pregnancy: an epidemiologic perspective. 1st ed.
New York: Oxford University Press; 2010.
Infecundity, infertility, and childlessness in developing countries
- S O Rutstein
- I H Shah
- SO Rutstein
Rutstein SO, Shah IH. Infecundity, infertility, and childlessness in developing
countries. DHS Comparative Reports No. 9. Geneva: World Health
Organization; 2004.
The health of Australia’s males. Health. Canberra: Australian Institute of Health and Welfare
- H P Collins
- D Kalisch
- HP Collins
Collins HP, Kalisch D. The health of Australia's males. Health. Canberra:
Australian Institute of Health and Welfare; 2011.
- Sn Matetakufa
Matetakufa SN. Infertility: Our Own Gift. New Internationalist. 1998. http://
newint.org/features/1998/07/05/infertility/ Accessed 17 December 2014.
Infertility: Our Own Gift
- S N Matetakufa
Matetakufa SN. Infertility: Our Own Gift. New Internationalist. 1998. http://
newint.org/features/1998/07/05/infertility/ Accessed 17 December 2014.
Mother or nothing: the agony of infertility
- R Sembuya
Sembuya R. Mother or nothing: the agony of infertility. Bull World Health
Organ. 2010;88:881-2.
World Health Organization reference values for human semen characteristics
- T G Cooper
- E Noonan
- S Eckardstein
- J Auger
- Hwg Baker
- H M Behre
- TG Cooper