Significance of sperm characteristics in the evaluation of male infertility

Center for Advanced Research in Human Reproduction, Infertility and Sexual Function, Glickman Urological Institute, Department of Obstetrics-Gynecology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Fertility and sterility (Impact Factor: 4.59). 04/2006; 85(3):629-34. DOI: 10.1016/j.fertnstert.2005.08.024
Source: PubMed


To compare sperm characteristics among: patients undergoing infertility evaluation, patients with male factor infertility (MFI), healthy sperm donors, and men with proven fertility; to examine the overlap of sperm characteristics in all four of these groups; and to identify good discriminators of fertility versus infertility among sperm characteristics.
Retrospective study.
Male infertility clinic at a tertiary care hospital.
Proven fertile men (n = 56), normal donors (n = 91), men presenting for infertility evaluation (n = 406), and MFI patients (n = 166).
Routine semen analysis.
Using current World Health Organization (WHO) reference values, a large group of MFI patients presented with higher sperm concentration (27.5 x 10(6) to 99.2 x 10(6)), resulting in broader overlap with fertile men and poor sensitivity (0.48). Similarly, percentage normal morphology (%) using Tygerberg's strict criteria was low in most of the MFI patients (sensitivity 0.83), almost half of the fertile men also presented with abnormal morphology (specificity 0.51). Of all the variables examined, sperm motility (%) was superior, having minimum overlap range (lower and upper cut-off values 46% and 75%) and high sensitivity (0.74) and specificity (0.90). Areas under curve were higher for motility (0.90) and concentration (0.84) compared with morphology (WHO 0.65 and Tygerberg's strict criteria 0.74).
Sperm motility and concentration provide more accurate information than morphology (WHO and Tygerberg's criteria) during infertility evaluation. Redefining the reference values for concentration and morphology may significantly increase the importance of routine semen analysis.

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    • "Morphology of the spermatozoa is the end result of a highly complex process of cellular modifications occurring during the process of spermiogenesis (Rowe et al., 1993; WHO, 1999). Spermatozoal morphology is considered as the best predictor of fertility by some clinicians (Menkveld et al., 2001; Nallella et al., 2006). It has always been an important part of semen analysis to evaluate the percentage of morphologically normal spermatozoa as well as the determination of various morphological defects (Rowe et al., 1993; WHO, 1999). "
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    • "Infertility is the inability to contribute conception after 12 months of unprotected intercourse; this may be due to male, female or some unexplained factors. Males alone contribute 35% to 40 % of infertile cases [1] [2] . "
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    • "Increasing incidence of infertility has been a global health as well as a social problem, where 35-40% of male partners are solely responsible.[1] Apart from the well-known conventional causes, i.e., disturbance in the endocrine system, anatomy, genetic makeup, varicocele or torsion, occurrence of diabetes and subtle unknown infections, chronic exposure to toxic chemicals and differential unhygienic lifestyle patterns too contribute to male infertility.[2] Tobacco consumption is one of the lifestyle factors that is often detrimental to human health as a whole.[3] "
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