A. Bollendorf

The hypoosmotic swelling test as a useful adjunct to the semen analysis to predict fertility potential

The sperm HOS test was highly predictive of eventual achievement of pregnancy in women in whom other infertility factors had been corrected. No woman conceived whose partners HOS was less than 50%. The results of spermiograms did not correlate with conception rate.

Evaluation of sperm morphology using Kruger's strict criteria.

Prospective and retrospective studies were conducted to evaluate sperm morphology using strict criteria for predicting fertilization capacity in males. Severely impaired male fertility potential was measured by a result of less than or equal to 4% (denotes percentage sperm having normal morphology) and scores of greater than 14% indicated normal fertilization potential. There were no statistically significant differences found in pregnancy rates in partners of men with normal morphology of less than or equal to 4% vs. those with 14% or greater (chi 2 analysis): the prospective study showed a 41% pregnancy rate in less than or equal to 4% group vs. 29% rate in greater than 14% group (p = 0.44 NS); the retrospective analysis showed a 50% pregnancy rate in the group with less than or equal to 4% morphology scores vs. 67% in greater than 14% group (p = 0.45 NS). When only the men with normal motile density (greater than 10 x 10(6)/ml) were evaluated, a statistical difference was found in the retrospective study between the group with morphology results greater than 14% (93%) vs. the group less than or equal to 4% (40%). However, the 56% success rate in the men with less than 10 x 10(6)/ml sperm and normal morphology less than or equal to 4% reduces the significance of the diagnosis of sperm morphology using the new strict criteria.

Correlation of semen analysis and hypoosmotic swelling test with subsequent pregnancies

The hypoosmotic swelling (HOS) test was evaluated in 40 men whose wives had no apparent fertility factors. Only one of 29 men with normal semen parameters had a surbnormal HOS test, and that couple failed to conceive compared to 27 of 28 with normal HOS test who did conceive. All five couples with husbands with subnormal semen parameters but with normal HOS tests achieved a pregnancy, but none of the three with abnormal HOS tests achieved a pregnancy. The results suggest that the HOS test might be of value in predicting which couples should be more patient despite low semen parameters.

Correlation of Computerized Semen Analysis with Successful Fertilization of Oocytes in an in Vitro Fertilization Program

Sixty-nine couples enrolled in 123 in vitro fertilization-embryo transfer cycles were categorized by percentage fertilization; the results of categorization were compared with those of computerized semen analysis carried out with the CellSoft semen analyzer. Four groups were established: group 1 had 75% fertilization or greater; group 2 had 34% to 74% fertilization; group 3 had 1% to 33% fertilization; and group 4 had 0% fertilization. Statistical differences in certain semen parameters (motility, linearity, and straight-line velocity) were found comparing groups 1 and 3 using the initial ejaculate. A significant number of patients in group 1 had all normal semen parameters, but no statistical difference could be found in group 3 or 4 because of variations in specific abnormal parameters in the groups. When the straight-line velocity-motile density (SLVMD) calculation was used, a significant difference was seen between group 1 and group 3 and between group 1 and group 4 (p less than 0.01); 65% of group 3 and 76% of group 4 had an abnormal SLVMD. SLVMD is a useful calculation to predict fertilization rates in vitro from the initial ejaculate.

Semen Characteristics and Infertility in Aging

A study was initiated to compare the spermiograms according to age in 570 consecutive men with a history of infertility. The semen was evaluated by computer-assisted semen analysis (CSA) and by the hyposmotic swelling test (HOS). A statistical difference was seen between men over 50 years of age compared with younger men, but only for the HOS scores and velocity. No statistical differences were found on any of the other parameters. Since most semen parameters were similar even in the men over age 50, a definite decline in fertility potential with increasing age could not be determined by this study.

Male Sex Preselection: Swim-Up Technique and Insemination of Women After Ovulation Induction

Insemination of women with sperm treated by the swim-up technique resulted in 81% male offspring. This was achieved even in women taking ovulation-inducing drugs, in whom the albumin gradient separation technique not only is not effective in male preselection but in which the female sex is favored. Confirmation of these initial data is needed as well as an investigation of the swim-ups efficacy of producing male offspring in women not taking ovulation-inducing drugs.

Correlation of Motile Sperm Density and Subsequent Pregnancy Rates in Infertile Couples

By carefully evaluating a group of infertile couples in whom each female factor was identified and corrected, the motile density of the male ejaculate did not appear to contribute significantly to the infertility problem unless it was below 2.5 × 106/mL, as evidenced by similar 6-month pregnancy rates in all other couples.

INTERPRETATION AND MISINTERPRETATION OF SEMEN PARAMETERS

Semen analysis, which is traditionally used to evaluate male fertility, may be misleading if sample is lost or inadequately mixed. A short or excessive abstinence period may cause a low count or a high count with low motility. Damage from low temperature or delay in evaluation may decrease the reported motility. Computer-assisted semen analysis has eliminated some of the variability and has allowed the evaluation of other sperm motion variables such as sperm velocity, linearity, maximum and mean amplitude lateral head displacement, and beat-cross frequency. These measurements may also occasionally be misleading. Other tests may give a better indication of the function of sperm. The hamster egg penetration test has been used but is technically difficult, and perhaps that is why there is controversy as to the clinical value of the test in predicting subfertile sperm despite normal conventional semen analysis. Some recent data suggest that the hypo-osmotic swelling test, which determines the functional integrity of the sperm membrane, may be the appropriate prognosticator. There is a need for further studies to define the best method to determine whether a male factor is responsible for a couples infertility.

Adverse effect of clomiphene citrate on sperm morphology.

The beneficial effect of clomiphene citrate (CC) in treating male infertility is controversial. To evaluate the effects of CC on sperm morphology using strict criteria, the semen analyses of 74 men were evaluated at intervals ranging from 1 to 18 months of treatment. Seventy patients receiving no medication were used as control. The patients in each category were divided into three subgroups: A (1-3 months), B (4-6 months), and C (greater than 6 months). In the control group, there were no significant differences in percentages or total normal forms between baseline and repeat semen analysis at any interval. Treatment with CC for 1-3 months did not adversely affect percentages of normal forms. Treatment for greater than 3 months caused a highly significant decrease in percentage of normal forms. Three months of CC caused no change in the absolute number of morphologically normal sperm, but longer periods (greater than 6 months) were associated with a significant decrease. There was significant deterioration of sperm function as measured by percentage of normal forms in patients treated with CC for 4-18 months. The physiological clinical significance remains to be investigated.

Noninvasive techniques for improving fertility potential of retrograde ejaculates.

Several noninvasive techniques have been employed for insemination of sperm recovered from the bladder following retrograde ejaculation, and at least 33 pregnancies have been reported [3, 4, 5, 9, 17, 18]. The main objective of the various procedures is to quickly separate the spermatozoa from the toxic urine and/or to mitigate the adverse bladder environment [12]