Marc Anthony Fischer

Prevalence of abnormal sperm DNA denaturation in fertile and infertile men

OBJECTIVES To examine the prevalence of abnormal sperm DNA denaturation (DD), a marker of sperm DNA integrity, in a group of fertile and infertile men. METHODS Eighty-eight nonazoospermic, infertile men and 13 fertile men underwent standard semen analysis and acridine orange sperm DNA integrity studies. Standard semen parameters (sperm concentration, motility, and morphology) and sperm DNA integrity (expressed as the percentage of spermatozoa with DD) were measured. RESULTS Of the 88 infertile men, 13 had completely normal semen parameters and the remaining 75 had at least one abnormal semen parameter. The mean (+/-SE) sperm DD level was significantly lower in the population of infertile men with normal semen parameters compared with those having abnormal parameters (11.1% +/- 3.7% versus 23.1% +/- 1.8%, respectively, P <0.001). Only 1 (8%) of the 13 men with normal semen parameters had elevated sperm DD (greater than 30%, verified on two separate analyses) compared with 13 (17%) of the 75 infertile men with abnormal semen parameters (P >0.05). None of the fertile controls had elevated sperm DD. We observed significant inverse correlations between the sperm DD and sperm motility, morphology, and concentration (P <0.001). CONCLUSIONS Our data show that sperm DD negatively correlates with standard semen parameters and that an isolated abnormality of sperm DD, a marker of sperm DNA integrity, is uncommon in infertile men. Additional studies are needed to support the notion that isolated abnormalities of sperm DNA integrity may represent a new diagnosis for men with unexplained infertility.

Human sperm DNA integrity: correlation with sperm cytoplasmic droplets.

OBJECTIVES To examine the retention of sperm cytoplasmic droplets (CD) and DNA denaturation (DD) in semen from fertile and infertile men. METHODS Semen samples were obtained from consecutive nonazoospermic men presenting for infertility evaluation (n = 101) and fertile men presenting for vasectomy (n = 13). The standard semen parameters (sperm concentration, motility, and morphology), sperm DD, and sperm CD were monitored. Sperm DD was evaluated by flow cytometry analysis of acridine orange-treated spermatozoa and expressed as the percentage of spermatozoa demonstrating denatured DNA. RESULTS The mean (+/-SE) percentages of spermatozoa with CD and DD were significantly higher in infertile than in fertile men (sperm CD 15.7% +/- 0.8% versus 4.8% +/- 0.7% and sperm DD 22.0% +/- 1.5% versus 10.8% +/- 1.8%, respectively). Sperm CD and DD were positively correlated (r = 0.59). Also, sperm CD and DD values correlated inversely with the standard semen parameters. CONCLUSIONS Our data demonstrate that the retention of sperm CD correlates positively with sperm DD and that significantly higher sperm DD and CD are found in infertile than in fertile men. These data suggest that the enhanced susceptibility of sperm DNA to denaturation is associated with the abnormal disposal of residual sperm cytoplasm in the testis and/or epididymis.

Cost-effectiveness analysis reveals microsurgical varicocele repair is superior to percutaneous embolization in the treatment of male infertility.

INTRODUCTION Varicoceles are a common cause of male infertility; repair can be accomplished using either surgical or radiological means. We compare the cost-effectiveness of the gold standard, the microsurgical varicocele repair (MV), to the options of a nonmicrosurgical approach (NMV) and percutaneous embolization (PE) to manage varicocele-associated infertility. METHODS A Markov decision-analysis model was developed to estimate costs and pregnancy rates. Within the model, recurrences following MV and NMV were re-treated with PE and recurrences following PE were treated with repeat PE, MV or NMV. Pregnancy and recurrence rates were based on the literature, while costs were obtained from institutional and government supplied data. Univariate and probabilistic sensitivity-analyses were performed to determine the effects of the various parameters on model outcomes. RESULTS Primary treatment with MV was the most cost-effective strategy at

Retrieval and cryopreservation of sperm from spermatocele fluid

5402 CAD (Canadian)/pregnancy. Primary treatment with NMV was the least costly approach, but it also yielded the fewest pregnancies. Primary treatment with PE was the least cost-effective strategy costing about

PD13-04 RESULTS OF A NORTH AMERICAN SURVEY ON THE CHARACTERISTICS OF MEN BEING ASSESSED IN MALE INFERTILITY CLINICS: THE ANDROLOGY RESEARCH CONSORTIUM

7300 CAD/pregnancy. Probabilistic sensitivity analysis reinforced MV as the most cost-effective strategy at a willingness-to-pay threshold of >

Catalase-like and superoxide dismutase-like activities in human seminal plasma

4100 CAD/pregnancy. CONCLUSIONS MV yielded the most pregnancies at acceptable levels of incremental costs. As such, it is the preferred primary treatment strategy for varicocele-associated infertility. Treatment with PE was the least cost-effective approach and, as such, is best used only in cases of surgical failure.

Use of alternative and hormonal therapies in male infertility

OBJECTIVES To evaluate the amount, motility, and viability of sperm in fluid aspirated from naturally occurring spermatoceles and to investigate the effect of cryopreservation of sperm retrieved from spermatoceles. Assisted reproductive technologies have led to successful pregnancies and deliveries using sperm harvested from the epididymis and/or testis of infertile men. METHODS Aspiration of spermatocele fluid and analysis of the fluid obtained was performed on 20 patients before elective spermatocelectomy. Randomly selected samples (n = 5) were washed using a 70% Percoll gradient, and repeated semen analysis was performed. The washed specimens were cryopreserved in liquid nitrogen, and repeated semen analysis was performed on the thawed specimens. RESULTS All spermatoceles (n = 20) had viable sperm present (count range 54 x 10(4) to 326 x 10(6)) and 16 (80%) of 20 contained motile sperm. The average percentage of motile sperm was 5%. The average sperm motility and average percent viability of sperm recovered after Percoll gradient improved compared with sperm in the initial spermatocele aspirates (motility 5%, range 0% to 25% and viability 36%, range 2% to 91% before Percoll vs. motility 13%, range 2% to 38% and viability 39%, range 10% to 92% after Percoll). Sperm retrieved after cryopreservation demonstrated reduced motility and viability; however, motile and viable sperm were recovered from all washed and cryopreserved samples. CONCLUSIONS Our results suggest that spermatocele fluid may contain sufficient numbers of sperm for use with assisted reproductive technologies. Motile and viable sperm can be recovered after cryopreservation and storage of sperm obtained from a spermatocele. Spermatocele fluid may be an additional source of sperm for assisted reproductive technologies.

Is there a role for anterior zone sampling as part of saturation trans-rectal ultrasound guided prostate biopsy?

INTRODUCTION AND OBJECTIVES: The influence of parental demographics on fertility and birth outcomes is a topic of great interest to both epidemiologists and the lay public. Given logistics and certainty of exposures, data on all births in the US is often reported at the maternal level. While paternal characteristics are also known to influence birth outcomes, generational trends of paternal characteristics of child births within the United States have been poorly characterized. We sought to summarize the demographics of fathers in the US over the past 4 decades as well as describe the patterns of missing paternal data on birth certificates. METHODS: We evaluated 158,621,397 U.S. births spanning from 1973 to 2015 using data from the National Vital Statistics System of the Centers for Disease Control. Paternal, maternal and infant characteristics were analyzed and paternal ages of all births and first births were presented over time along with the mean difference in age between parents. Characteristics of births with known and unknown paternity were also compared. RESULTS: There has been a significant increase in mean paternal age among whites, blacks and asians over the past 40 years. In 1973, the mean paternal age for all births was 27.6, and 24.6 for first births, rising to 31.4 and 29.1, respectively, in 2015. Paternal age increased for all races combined and each race individually. However, interracial differences in mean age were apparent with asians > whites > blacks. The mean age difference between parents was similar over the past 40 years. In 1973, the mean parental age difference was 2.8 years’2.7 years for whites, 3.2 years for blacks and 4.2 years for asians. In 2015, the mean overall difference was 2.5 years with the difference between asian fathers and their partners decreasing the most to 3.2 years. Of all the recorded births in 1973, 91.3% had knowledge of paternal identity. This fell to 85.5% of fathers identified in 1991 and resides at 88.4% in 2015. Over the past decade, mothers younger than 20 years had the lowest proportion of reported paternal identity at 67.7% with black mothers under 20 at 50.4%. Overall, births without paternal identity were more likely associated with young, black mothers who reported less weight gain during pregnancy, and lower birth weight children. CONCLUSIONS: Overall, paternal age is rising in the US in parallel with maternal age, a trend encompassing all races. The proportion of missing paternal data is also increasing in recent years. Given the association between paternal factors and birth characteristics, further understanding of these trends is necessary.