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Semen analysis

Semen analysis. WHO 1980 6 ys 5 th edition: 2010 Lower reference limits (5th centiles and their 95% confidence intervals) Pregnancy during 12m Other groups No guarantee. Motility. A>25% A+B>50% Systematic (manual method) :

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Semen analysis

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  1. Semen analysis • WHO • 1980 • 6 ys • 5th edition: 2010 • Lower reference limits (5th centiles and their 95% confidence intervals) • Pregnancy during 12m • Other groups • No guarantee

  2. Motility

  3. A>25% A+B>50% Systematic (manual method) : Grade a → rapid progressive motility ( ≥25 µm/s at 37 0C ) Grade b → slow progressive motility ( 5-25µm/s at 37 0C) Grade c → non progressive motility (<5 µm/s ) Grade d → immotile

  4. Motility • Progressive motility (PR) • Non-Progressive motility (NP) • Immotile (IM)

  5. Sperm morphology classification systems Normal reference range 1) Macleod >60% 2) WHO manual 2nd edition >50% 3) WHO manual 3rd edition>30% 4) ASCP (American society clinical pathology ) >80% 5) Strict (menkveld & kruger ) / WHO manual 4th edition>14% 6) WHO 2010 >4%

  6. Lower reference limits (5th centiles and their 95% confidence intervals) for semen characteristics.

  7. DNA Damage/Fragmentation • may result from intra- or extra-testicular factors • can occur at any step of spermatogenesis • may result from aberrant chromatin packaging during spermiogenesis, defective apoptosis before ejaculation or excessive production of reactive oxygen species (ROS) in the ejaculate

  8. Extra testicular factors • Drugs, Chemotherapy, RT • Cigarette smoking (accumulation of toxic agents including the products of cigarette smoke such as cadmium) • Genital tract inflammation,

  9. Varicocele • Testicular hyperthermia • Androgen deprivation at the testicular level • > 40y • Testicular tumors • Febrile Dis • UTI • Hormonal factors, (FSH, T)

  10. Environmental Factors • Occupational Exposure (chemical, thermal) • Cell phone • Lap Top, WiFi • Agriculture, toxins • Air Pollution (traffic workers) • Heat • Smoking

  11. Indications • Predicting ART outcome • Idiopathic Infertility • Men older than 40y • Exposure to toxins and chemical agents • High risk groups (Testicular tumor, Varicocele, Smoking, alcohol or opium abuse, ) • Abortion

  12. Aniline blue • Toluidine blue • SCSA • Commet assay • CMA3 • Tunel

  13. The effectiveness of IVF in unexplained infertility: asystematic Cochrane review • ZabeenaPandian1,3, Siladitya Bhattacharya1, Dimitrios Nikolaou1, Luke Vale2 andAllan Templeton1 • 1Department of Obstetrics & Gynaecology, Aberdeen Maternity Hospital and 2Health Services Research Unit, University of • Human Reproduction Vol.18, No.10 pp. 2001±2007, 2003

  14. There was no signifcantdifference in clinical pregnancy ratesbetween IVF and expectant management. • There was no evidence of a difference in live birth rates between IVF andIUI either without (OR 1.96, 95% CI 0.88 to 4.36) or with (OR 1.15, 95% CI 0.55 to 2.42) ovarian stimulation. • Clinical pregnancy rates with IVF were signifcantlyhigher compared with GIFT (OR 2.14, 95% CI 1.08 to 4.22) aswere the multiple pregnancy rates (OR 6.25, 95% CI 1.70 to 23.00).

  15. CONCLUSIONS: • The effectiveness of IVF in unexplainedinfertility remains unproven. • Larger trials with adequate power arewarranted.

  16. Male infertility and environmental exposure to lead and cadmium • Susan Benoff, Asha Jacob, Ian R.Hurley • North Shore University Hospital. New York • Human Reproduction Update 2000. vol.6, No.2pp 107-121

  17. Role of sperm chromatin abnormalities and DNA damage in male infertility A.Agarwal1 and Tamer M.Said Center for Advanced Research in Human Reproduction, Infertility, and Sexual Function, Glickman Urological Institute, The Cleveland Clinic Foundation, Cleveland, Ohio, USA Human Reproduction Update, Vol.9, No.4 pp. 331±345, 2003

  18. Sperm DNA integrity is essential for the accurate transmission of genetic information. • Any form of sperm chromatin abnormalities or DNA damage may result in male infertility • in-vivo fecundity decreases progressively when >30% of the spermatozoa are identified as having DNA damage.

  19. The clinical signifcance of this assessment lies in its association not only with natural conception rates, but also with assisted reproduction success rates. • Also, it has a serious impact on the offspring and is highly prognostic in the assessment of fertility in cancer patients.

  20. Therefore, screening for sperm DNA damage may provide useful information in cases of male idiopathic infertility and in those men pursuing assisted reproduction. Treatment should include methods for prevention of sperm DNA damage.

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