Semen analysisWHO19806 ys5th edition: 2010Lower reference limits (5th

centiles and their 95% confidence intervals)

Pregnancy during 12mOther groupsNo guarantee

Motility4 A

3 B

2 C

1 D

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

MotilityProgressive motility (PR)

Non-Progressive motility (NP)

Immotile (IM)

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%

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

characteristics.

Lower reference limit Parameter1.5( 1.4–1.7) Semen volume )mL(

39( 33–46 )40 Total sperm number )106 per ej(15( 12–16 )20 Sperm concentration )106 per

mL(40( 38–42) Total motility )PR+NP, %(32( 31–34) Progressive motility )PR, %(

58( 55–63 )75 Vitality )live spermatozoa, %(4( 3.0–4.0 )14 Sperm morphology )normal

forms, %( ≥7.2 pH

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

Extra testicular factorsDrugs, Chemotherapy, RT

Cigarette smoking (accumulation of toxic agents including the products of cigarette smoke such as cadmium)

Genital tract inflammation,

VaricoceleTesticular hyperthermiaAndrogen deprivation at the

testicular level> 40yTesticular tumorsFebrile DisUTIHormonal factors, (FSH, T)

Environmental FactorsOccupational Exposure

(chemical, thermal)Cell phone Lap Top, Wi FiAgriculture, toxinsAir Pollution (traffic workers)HeatSmoking

IndicationsPredicting ART outcomeIdiopathic InfertilityMen older than 40yExposure to toxins and chemical

agentsHigh risk groups (Testicular

tumor, Varicocele, Smoking, alcohol or opium abuse, )

Abortion

Aniline blueToluidine blueSCSACommet assayCMA3Tunel

The effectiveness of IVF in unexplained infertility: a systematic Cochrane review

Zabeena Pandian1,3, Siladitya Bhattacharya1, Dimitrios Nikolaou1, Luke Vale2 and Allan 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

There was no signifcant difference in clinical pregnancy rates between IVF and expectant management.

There was no evidence of a difference in live birth rates between IVF and IUI 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 signifcantly higher compared with GIFT (OR 2.14, 95% CI 1.08 to 4.22) as were the multiple pregnancy rates (OR 6.25, 95% CI 1.70 to 23.00).

CONCLUSIONS: The effectiveness of IVF in

unexplained infertility remains unproven.

Larger trials with adequate power are warranted.

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

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

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.

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.

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.