Infertilidad masculina: causas y diagnóstico / Male infertility: causes y diagnosis

En una pareja con infertilidad, la evaluación masculina es fundamental por dos razones principales. En primer lugar, es la única causa de infertilidad en el 20% de las parejas y en el 50% se encuentra asociada a una causa de infertilidad femenina; en segundo lugar, existe evidencia de la relación entre infertilidad masculina y comorbilidades, como enfermedades cardiovasculares, oncológicas, reumatológicas e incluso con aumento de la mortalidad. Por esto, los pacientes deben ser evaluados por urólogos-andrólogos entrenados que permitan llegar al diagnóstico etiológico, como también buscar comorbilidades asociadas. Una correcta historia clínica, examen físico, espermiograma y exámenes complementarios permitirán obtener el diagnóstico etiológico y por lo tanto el tratamiento adecuado. Las causas genéticas de infertilidad son al menos el 15% de las etiologías, aumentando hasta el 25% en casos de azoospermia. A través del desarrollo y avance en biología molecular, en el futuro se podrán identificar otras causas genéticas que actualmente son categorizadas como infertilidad de origen idiopático.

When treating infertility, a study of the male partner is necessary for two main reasons: 1) In 20% of cases of infertility there is only a male root cause and in addition, in 50% of the cases the root cause is associated with the male and the female. 2) There is supporting and growing evidence that male infertility is related to comorbidities, including cardiovascular disease, cancer, rheumatologic disease, and even mortality. A thorough clinical history, physical examination, semen analysis and auxiliary tests will help us identify the cause and the correct treatment. Near 15% of male infertility are attributed to genetic causes, and this goes up to 25% in cases of azoospermia. With evolving advances and development of molecular biology, some causes of male infertility currently classified as idiopathic, will be specifically identified and categorized.

Distribution of TCM syndrome types and their correlation semen parameters in infertility patients with varicocele / 中华男科学杂志

Objective@#To explore the distribution of Traditional Chinese Medicine (TCM) syndrome types and their relationship with semen parameters in infertility male patients with varicocele (VC).@*METHODS@#Using Questionnaire on Clinical Symptoms of Varicocele-Caused Male Infertility, we made an investigation among 147 infertility male patients with VC, determined the types of their TCM syndromes, obtained their semen parameters, and analyzed the distribution of the TCM syndrome types and their correlation with semen parameters.@*RESULTS@#Of the TCM syndrome types identified, kidney deficiency and stagnated heat constituted the largest proportion (34.7%), and the mixed type accounted for a significantly higher percentage than the simple type (P < 0.05). The patients with kidney deficiency and stagnated heat, compared with those with other syndrome types, had a dramatically lower sperm concentration (［21.62 ± 9.25］ vs ［28.88 ± 12.92］ ×10⁶/ml, P < 0.01), but a higher percentage of morphologically abnormal sperm (［98.33 ± 0.15］% vs ［96.27 ± 0.18］%, P < 0.05) and DNA fragmentation index (［19.72 ± 3.17］% vs ［10.96 ± 3.82］%, P < 0.01). No statistically significant differences were observed in the percentage of progressively motile sperm among different TCM syndrome types.@*CONCLUSIONS@#Kidney deficiency and stagnated heat is a main TCM syndrome type in infertility male patients with varicocele and correlated with sperm concentration, the percentage of morphologically abnormal sperm and DNA fragmentation index.

Evaluación del factor masculino mediante espermograma más práctico y económico / Sperm Analysis for Assessing Male Factor More Practical and Economical

Es aceptado que la infertilidad se evalúa cuando una pareja no logra embarazarse después de 12 meses de coitos regulares sin protección, problema que afecta a un alto porcentaje de parejas en el mundo. Generalmente, el diagnóstico y tratamiento de la infertilidad se enfoca solo desde el punto de vista femenino, por la obvia relación con el embarazo; sin embargo, con la evidencia existente el problema debe ser abordado como una alteración de pareja(AU)

It is accepted that infertility is evaluated when a couple does not become pregnant after 12 months of regular unprotected intercourse. This problem affects a large percentage of couples worldwide. Generally, diagnosis and treatment of infertility approaches only the female point of view, for the obvious connection with the pregnancy. However, this problem must be addressed with the actual evidence as an alteration in the couple(AU)

Fragmentación del ADN espermático e infertilidad masculina / Fragmentation of sperm DNA and male infertility

La integridad del ADN de los espermatozoides, es un indicador importante de la fertilidad, se utiliza como una variable adicional para evaluar, junto al espermograma, la calidad de una muestra seminal. En el presente trabajo se describen algunos aspectos de interés relacionados con la fragmentación del ADN espermático, cuya etiología es multifactorial y está relacionada con factores intrínsicos, como el empaquetamiento anormal de la cromatina durante la espermiogénesis, la apoptosis defectuosa antes de la eyaculación y la producción excesiva de especies reactivas del oxígeno; y con factores extrínsecos, como son los cambios en los hábitos de vida, la exposición a agentes tóxicos, así como la edad avanzada. La fragmentación está asociada al deterioro de las variables seminales, además afecta la fertilidad natural y la realizada por tratamientos de reproducción asistida, por lo que la implementación en los laboratorios de Andrología, de la tecnología para detectar si el ADN de los espermatozoides está íntegro o fragmentado, incorpora un nuevo conocimiento en el estudio de los hombres con trastornos de fertilidad, lo que contribuye a mejorar el diagnóstico y pronóstico de la infertilidad masculina. Para realizar este trabajo se revisaron 122 artículos, de los cuales 84 cumplieron con los criterios de calidad esperados. La búsqueda se realizó a través de los buscadores habituales(AU)

Sperm DNA´s integrity is an important indicator of fertility and it is used as an additional variable to evaluate the quality of a seminal sample, together with the spermogram. This paper describes some interesting aspects related to the fragmentation of sperm DNA, whose etiology is multifactorial and is related to intrinsic factors, such as the abnormal packing of chromatin during spermiogenesis, defective apoptosis before ejaculation, and the excessive production of oxygen´s reactive species; and with extrinsic factors, such as changes in life habits, exposure to toxic agents, as well as aging. Fragmentation is associated with the deterioration of seminal variables, it also affects natural fertility and that produced by assisted reproduction treatments, so the implementation in the andrology laboratories of the technology to detect if the DNA of the sperm is intact or fragmented incorporates a new knowledge in the study of men with fertility disorders, which contributes to improve the diagnosis and prognosis of male infertility. To carry out this work, 122 articles were reviewed, of which 84 met the expected quality criteria. The search was made through the usual search engines(AU)

Infertilidade masculina decorrente de microdeleções no cromossomo Y / Male infertility caused by microdeletions on Y chromosome

Objetivo: Abordar a infertilidade masculina causada pela microdeleção no cromossomo Y e apresentar possíveis tratamentos por meio das técnicas de reprodução humana assistida. Métodos: Levantamento de dados da literatura científica na área da medicina reprodutiva. Resultados: Quando comparadas com outras causas de infertilidade, as microdeleções do cromossomo Y são relativamente frequentes. O cromossomo Y é essencial para a determinação sexual masculina e no seu braço longo há regiões responsáveis pela espermatogênese. São elas AZFa, AZFb e AZFc. Essas regiões podem ser deletadas e por conter múltiplos genes essenciais para a espermatogênese podem causar infertilidade masculina. Graças aos avanços da medicina, hoje vários casos de infertilidade são tratáveis por meio das técnicas de reprodução assistida. Dentre as técnicas, a MSOME se destaca por ser uma metodologia que seleciona apenas espermatozoides morfologicamente normais para serem usados na inseminação e aumentar as chances de gestação. Conclusões: A infertilidade masculina tem aumentado consideravelmente nos últimos anos e as causas genéticas são uma das grandes consequências disso. As microdeleções do cromossomo Y podem causar desde uma oligozoospermia leve a uma azoospermia, a depender da região AZF afetada. Para as causas mais leves, o casal pode recorrer a algumas técnicas de reprodução assistida e para as causas mais graves a solução para o casal pode ser usar gametas doados.(AU)

Objective: Address male infertility caused by microdeletions on Y chromosome and present possible treatment through assisted human reproduction techniques. Methods: Survey data from the scientific literature in the field of reproductive medicine. Results: When compared with other causes of infertility, the microdeletions on Y chromosome are the relatively frequent. The Y chromosome is essential for male sex determination and there are in his long arm regions responsible for spermatogenesi, it's they AZFa, AZFb and AZFc. Such regions may be deleted causing male infertility by contain multiple genes essential for spermatogenesis. Thanks to advances in medicine, now several cases of infertility are treatable through assisted reproduction techniques. Among the techniques, the MSOME stands out as a methodology that selects only morphologically normal sperm to be used in insemination increasing the chances of pregnancy. Conclusions: Male infertility has increased considerably in recent years and the genetic causes are one ofthe major consequences ofthis. Y chromosome microdeletions can cause mild oligozoospermia or azoospermia depending on the AZF region affected. For lighter causes, the couple may use some assisted reproductive techniques and to the most serious causes the solution to the couple is using donated gametes.(AU)

Age and education influence the performance of elderly women on the dual-task Timed Up and Go test / Idade e educação influenciam o desempenho de mulheres idosas no teste Timed Up and Go com dupla tarefa

Gait variability is related to functional decline in the elderly. The dual-task Timed Up and Go Test (TUG-DT) reflects the performance in daily activities. Objective To evaluate the differences in time to perform the TUG with and without DT in elderly women with different ages and levels of education and physical activity. Method Ninety-two elderly women perfomed the TUG at usual and fast speeds, with and without motor and cognitive DT. Results Increases in the time to perform the TUG-DT were observed at older ages and lower educational levels, but not at different levels of physical activity. More educated women performed the test faster with and without DT at both speeds. When age was considered, significant differences were found only for the TUG-DT at both speeds. Conclusion Younger women with higher education levels demonstrated better performances on the TUG-DT. .

Alterações da marcha são indícios de declínio funcional em idosos. O TUG com dupla tarefa (TUG-DT) reflete o desempenho das atividades do cotidiano. Objetivo Avaliar as diferenças no tempo de execução do TUG com e sem DT em idosas com diferentes faixas etárias, e níveis de escolaridade e atividade física. Método Noventa e duas idosas foram avaliadas pelo TUG nas velocidades usual e máxima, sem e com DT cognitiva e motora. Resultados Houve aumento no tempo de execução do TUG-DT em idosas com maior faixa etária e menor escolaridade, mas não para diferentes níveis de atividade física. Aquelas com maior escolaridade realizaram o teste mais rápido com e sem DT nas duas velocidades. Com relação à faixa etária, foram obervadas diferenças apenas nos testes com DT nas duas velocidades. Conclusão Idosas mais jovens com maior escolaridade demonstraram um melhor desempenho no TUG com DT. .

Semen parameters from 2002 to 2013 in Korea young population: A preliminary report

PURPOSE: To analyze the differences of semen parameters in Korean young population for three periods from 2002 to 2013. MATERIALS AND METHODS: A total of 516 semen samples were collected from Korean men presenting for infertility, varicoceles or other infectious problems for three periods from 2002 to 2012: January 2002-December 2003, January 2007-December 2008, and January 2012-December 2013. A standard World Health Organization procedure for semen analysis was performed for assessment of semen concentration, volume, motility, morphology, and pH. RESULTS: A total of 160, 162, 194 men constituted the study populations in 2002 to 2003, in 2007 to 2008, and in 2012 to 2013, respectively. The overall sperm parameter results suggested a statistically significant difference between 2002 to 2003 and 2012 to 2013 except pH. However, considering the data from 2007 to 2008, there were no trends in changes in overall semen parameters. Negative correlations were observed in all semen parameters with increasing age in all patients, except for pH. In addition, semen volume, motility, and morphology had higher negative correlation coefficients with age, from 2002 to 2013, serially. CONCLUSIONS: There were no significant changes in the semen parameters of Korean men from 2002 to 2013. In addition, semen volume, motility, and morphology showed higher negative correlation coefficients with age from 2002 to 2013, serially.

Clinical relevance of routine semen analysis and controversies surrounding the 2010 World Health Organization criteria for semen examination

Semen analysis is the corner stone of infertility evaluation as it provides information on the functional status of the seminiferous tubules, epididymis and accessory sex glands. The methods on how the human semen should be evaluated are provided by the World Health Organization, which periodically releases manuals that include specific protocols and reference standards. In 2010, the WHO published new criteria for human semen characteristics that were markedly lower than those previously reported. In this review initially it is discussed the limitations of semen analysis as a surrogate measure of a man’s ability to father a pregnancy. Secondly, it is analyzed methodology issues that could explain why the newly released reference values were different from those earlier reported. Thirdly, it is speculated on the likely effects of the 2010 WHO criteria in the management of male infertility. Due to the several inherent limitations of semen analysis as a surrogate marker of male infertility, physicians should exercise caution when interpreting results. A template for semen analysis reports that incorporates the distribution of the semen characteristics of recent fathers in centiles rather than solely the minimum thresholds could aid clinicians to better understand how a given patient results compare with the reference population. Importantly, a male infertility evaluation must go far beyond a simple semen analysis, as it has to be complemented with a proper physical examination, a comprehensive history taking, and relevant endocrine, genetic, and other investigations.

The application of chromosome abnormality chip detection in male infertility / Aplicación de la detección de la anormalidad del cromosoma mediante biochips genéticos en la infertilidad masculina

OBJECTIVE: To discuss the application of microarray technology in the diagnosis of male infertility. METHODS: Sixteen loci, including a sex-determining region on the Y chromosome, were investigated by polymerase chain reaction (PCR) in infertile male patients. Chromosome abnormality chip with 180 000 probes was used to detect small deletion, small amplification and loss of heterozygosity. RESULTS: By PCR, nine of 103 infertile patients were found to have sequence-tagged site microdeletions. Microdeletions were not observed in control samples. The deletions detected by PCR were present in six azoospermic men (6/44, 13.6%) and in three oligoasthenoteratozoospermic (OATS) men (3/59, 5%). The overall frequency of microdeletions in infertile men was 8.7% (9/103). Chromosome abnormality chip detection 500+ detected more amplification or deletion in 51 infertile patients and the overall frequency of microdeletions in infertile men was 49.5% (51/103). CONCLUSION: Chromosome abnormality chip detection system provides a sensitive, economic and high-throughput method for detecting the deletion or amplification of genomic DNA sequences of infertile patients. Not only can it identify Yq deletions, but it can also find other chromosome abnormalities and facilitate the understanding of male infertility.

OBJETIVO: Analizar la aplicación de la tecnología de los microarreglos en el diagnóstico de la infertilidad masculina. MÉTODOS: Dieciséis loci, incluyendo una región determinante del sexo en el cromosoma Y, fueron investigados mediante reacción en cadena de la polimerasa (RCP) en pacientes hombres con problemas de infertilidad. Un biochip de la anormalidad cromosómica, con 180000 sondas, fue utilizado a fin de detectar pequeñas delecciones, pequeñas amplificaciones y pérdidas de heterocigosidad. RESULTADOS: Por medio de la RCP, se halló que nueve de 103 pacientes con infertilidad presentaban microdelecciones de sitios de secuencia marcada. Las microdelecciones no fueron observadas en las muestras de control. Las delecciones detectadas mediante RCP, estuvieron presentes en seis hombres azoospérmicos (6/44, 13.6%) y en tres hombres con oligoastenoteratozoospermia (OAT) (3/59, 5%). La frecuencia general de las microdelecciones en los hombres infértiles fue 8.7% (9/103). La detección con biochip de la anormalidad cromosómica de 500+ detectó más amplificación y delección en 51 pacientes, y la frecuencia general de microdelecciones en los hombres infértiles fue 49.5% (51/103). CONCLUSIÓN: El sistema de detección de la anormalidad del cromosoma mediante biochips genéticos representa un método sensible, económico, y de alto rendimiento, para detectar la delección o amplificación de las secuencias genómicas de ADN de pacientes infértiles. Este método puede no sólo identificar las delecciones Yq, sino también hallar otras anormalidades cromosómicas, facilitando así la comprensión de la infertilidad en los hombres.

Diferencias del estado redox entre espermatozoides y plasma seminal en adultos jóvenes / Difference of redux status between spermatozoa and seminal plasma in young adults

Introducción: Las especies reactivas del oxígeno y el estrés oxidativo desempeñan un papel fundamental en la infertilidad masculina. Sin embargo, estas especies oxidantes también han sido asociadas con los procesos de capacitación de los gametos masculinos cuando son generadas a bajos niveles y de manera controlada. Actualmente los biomarcadores redox son introducidos en el diagnóstico clínico de la infertilidad masculina en el mundo, como una herramienta complementaria a los parámetros del espermiograma. Sin embargo, en Cuba, esta metodología aún no se encuentra extendida a los servicios de salud. Objetivo: El objetivo del presente trabajo fue caracterizar el estado redox de espermatozoides y el líquido seminal de sujetos aparentemente sanos, a través de la determinación de una serie de biomarcadores de estrés oxidativo. Los niveles de malonildialdehído, la actividad de las enzimas antioxidantes superóxido dismutasa y catalasa, así como los niveles de glutatión reducido, el potencial de peroxidación y la capacidad reductora fueron determinados mediante técnicas espectrofotométricas. Métodos: Se analizaron 40 muestras de semen de sujetos aparentemente sanos, las cuales fueron obtenidas mediante masturbación sin el empleo de lubricantes y con al menos tres días de abstinencia eyaculatoria. En el estudio se incluyeron sujetos de 20 a 35 años, aparentemente sanos según exámenes de laboratorio clínico y con paternidad probada. Resultados: Los resultados demostraron que existen diferencias significativas (p< 0,05) entre los marcadores evaluados en el líquido seminal con respecto al espermatozoide, lo cual sugiere la existencia de un estado redox diferenciado entre ambos compartimentos. Conclusiones: Estos hallazgos demuestran la necesidad de evaluar el nivel de estrés oxidativo tanto en las células sexuales como en el fluido que las contiene. Ello contribuirá, sin lugar a dudas, a un diagnóstico más eficaz e integral de la capacidad fértil del hombre

Background: Reactive oxygen species and oxidative stress play a fundamental role in male infertility. However, these oxidizing species have also been associated with the process of capability of male gametes when they are generated at low levels and in a controlled manner. Currently, redox biomarkers are introduced in the clinical diagnosis of male infertility in the world as a complementary tool to the spermiogram parameters. However, in Cuba, this methodology is not yet extended to health services. Objective: The objective of this study was to characterize the redox status of spermatozoa and seminal fluid of apparently healthy subjects through the identification of a number of biomarkers of oxidative stress. Methods: 40 samples of semen of apparently healthy subjects were analyzed, which were obtained by masturbation without the use of lubricants and with at least 3 days of ejaculatory abstinence. The study included subjects from 20 to 35 years of age, who were apparently healthy according to both laboratory tests and paternity test results. Results: The results showed that there are significant differences (p<0, 05) between the markers evaluated in the seminal fluid and the spermatozoon which suggests the existence of a differentiated redux status between the two compartments. Conclusions: These findings demonstrate the need to evaluate the level of oxidative stress in both sexual cells and the fluid that contains them. It will contribute, with no doubt, to a more effective and comprehensive diagnosis of man's fertility

The epidemiology and etiology of azoospermia

The misconception that infertility is typically associated with the female is commonly faced in the management of infertile men. It is uncommon for a patient to present for an infertility evaluation with an abnormal semen analysis report before an extensive female partner workup has been performed. Additionally, a man is usually considered fertile based only on seminal parameters without a physical exam. This behavior may lead to a delay in both the exact diagnosis and in possible specific infertility treatment. Moreover, male factor infertility can result from an underlying medical condition that is often treatable but could possibly be life-threatening. The responsibility of male factor in couple's infertility has been exponentially rising in recent years due to a comprehensive evaluation of reproductive male function and improved diagnostic tools. Despite this improvement in diagnosis, azoospermia is always the most challenging topic associated with infertility treatment. Several conditions that interfere with spermatogenesis and reduce sperm production and quality can lead to azoospermia. Azoospermia may also occur because of a reproductive tract obstruction. Optimal management of patients with azoospermia requires a full understanding of the disease etiology. This review will discuss in detail the epidemiology and etiology of azoospermia. A thorough literature survey was performed using the Medline, EMBASE, BIOSIS, and Cochrane databases. We restricted the survey to clinical publications that were relevant to male infertility and azoospermia. Many of the recommendations included are not based on controlled studies.

Coleta de esperma infértil em laboratório: prática médica ou sexual? / Infertile sperm collection in hospital laboratories: sexual or medical practice?

Os protocolos de assistência médica à procriação comportam um exame biológico do esperma, realizado graças à masturbação praticada em locais inadequados para uma prática geralmente considerada erótica. Realizou-se investigação etnográfica em dois grandes hospitais parisienses. Os homens e as mulheres que participaram manifestaram reações subjetivas, associando constrangimento, vergonha, desagrado e nojo diante da prática da masturbação nesse contexto. A confusão entre os registros médico e sexual, as dificuldades para des-sexualizar uma prática que permanece como tabu e a natureza estéril do esperma produzido nessas circunstâncias seriam a causa das reações emocionais experimentadas em relação ao esperma, quando este é produzido no contexto médico.

The protocols of medical assistance to procreation involve a biological examination of sperm, conducted through masturbation practiced in inappropriate places for a practice generally considered erotic. We conducted ethnographic research in two major Parisian hospitals. The men and women who participated expressed subjective reactions, involving embarrassment, shame, disgust and disgust on the practice of masturbation in this context. The confusion between the medical and sexual records, difficulty in de-sexualize a practice that remains taboo, and the sterile nature of sperm produced in such circumstances would be the cause of emotional reactions experienced in relation to sperm when it is produced in the medical context.

Unexplained Male infertility: diagnosis and Management

Unexplained male infertility is a diagnosis reserved for men in whom routine semen analyses results are within normal values and physical as well as endocrine abnormalities were ruled out. In addition to erectile problems and coital factors, immunologic causes and sperm dysfunction may contribute to such condition. New etiologies of unexplained male infertility include low level leukocytospermia and mitochondrial DNA polymerase gene polymorphism. Contemporary andrology may reveal cellular and sub-cellular sperm dysfunctions which may explain subfertility in such cases, thus aiding the clinician to direct the further work-up, diagnosis and counseling of the infertile male. The objective of this article is to highlight the concept of unexplained male infertility and focuses on the diagnosis and treatment of this condition in the era of modern andrology and assisted reproductive techniques. Extensive literature review was performed using the search engines: Pubmed, Science-direct, Ovid and Scopus.

Alteraciones del espermiograma en pacientes asistidos en la Unidad de Biología de la Reproducción de la Universidad de Chile / Alterations in the semen analysis of patients attending the reproductive biology unit at the University of Chile

En Chile, 10 a 15 por ciento de las parejas son consideradas como infértiles y el factor masculino es responsable en un 50 por ciento de los casos. El espermiograma, es un examen fundamental para el diagnóstico inicial de parejas infértiles. Objetivo: Determinar cambios en cuatro parámetros del espermiograma de mayor valor diagnóstico, según edad, estableciendo el parámetro alterado de mayor frecuencia. Métodos: Se realizo un estudio descriptivo retrospectivo de una muestra de 100 pacientes atendidos por problemas de fertilidad entre los años 2004 y 2009, clasificándolos en cuatro grupos etarios. Resultados: Al evaluar la concentración espermática, el 33 por ciento presenta: 5 baja concentración. El 86 por ciento de los pacientes presento astenozoospermia. El 81 por ciento de los pacientes presento anormalidad en la morfología espermática. La viabilidad espermática fue anormal en el 8 por ciento de los pacientes, siendo significativamente más alto en el grupo etario de mayor edad. Conclusiones: Los parámetros estudiados muestran un alto porcentaje de anormalidad en la población en estudio. Al comparar entre grupos, el grupo de mayor edad (sobre los 47 &los) presenta un aumento significativo del- porcentaje de alteraciones en morfología, motilidad y viabilidad respecto a los otros grupos etarios, estableciéndose la edad como un factor negativo en la calidad espermática. La movilidad corresponde al parámetro mas frecuentemente alterado seguido por la morfología espermática a medida que el varón consultante envejece.

In Chile, 10 to 15 percent of the couples are considered as infertile. Since the male factor is responsible of 50 percent of the cases, spermogram is an essential test for initial diagnosis of the infertile couple. Objective: To analyze the frequency of change in four spermogram parameters -according to age- to determine their diagnostic value. Method: A descriptive retrospective study of spermogram data from 100 patients -subdivided in four age groups- analyzed in our Unit for fertility problems between 2004 and 2009 was performed. Results: In sperm count, 33 percenr showed an abnormally low concentration. An 86 percent of the patients has astenozoospermia. 81 percent of the patients showed abnormal sperm morphology. Sperm viability was subnormal in 8 percent of the patients, being significantly higher in the oldest group. Conclusions: The seminal parameters analyzed revealed a high percentage of anomalies in the studied population. The oldest group had significant percentages of anomalies in sperm motility, morphology and viability, thus corroborating that age is a negative factor that affects semen quality. Sperm motility was the most frequently altered parameter followed by sperm morphology in the population under study.

Does inhibin-B help us to confidently refuse diagnostic testicular biopsy in azoospermia?

In the recent years, the use of laboratory blood factors such as FSH and inhibin-B for the assessment of spermatogenesis in different studies has increased; of course, the conflicting results have also been achieved. To investigate if the measurement of inhibin-B can help surgeon to reduce unnecessary diagnostic testicular biopsies in males with azoospermia. This cross-sectional study was done during July 2006 to September 2007 on 41 patients with azoospermia. FSH and inhibin-B were measured and bilateral open testicular biopsy was performed for all patients. Sperm was seen in 29% of biopsies that in 100% of these samples inhibin-B was more than 100 pg/mL and FSH was less than twice the normal [p=0.001]. Inhibin-B had significant correlation inversely with testicular fibrosis and Sertoli cell only syndrome [p=0.043 and p=0.011, respectively] and directly with incomplete spermatocytic maturation arrest and obstructive azoospermia [p=0.027 and p=0.013, respectively]. FSH was only correlated with obstructive azoospermia [p=0.001]. We suggest that if FSH is less than twice the normal, inhibin-B should be measured and if its level is less than 100 pg/mL, we can cancel about the half of unnecessary diagnostic testicular biopsies

Evaluación y estandarización de la calidad del espermiograma: nuevos límites inferiores de referencia / Evaluation and standardization of the quality of semen: new lower reference limit

El análisis seminal o espermiograma es uno de los parámetros más usados en la evaluación de la fertilidad masculina. La OMS (WHO, 2010), presentó el 5 Manual para el examen y procesamiento del semen humano, documento que fue analizado durante el primer taller de estandarización del análisis seminal (PLEAS), realizado en Santiago de Chile, mayo del 2010. Posteriormente se aplicaron los nuevos valores indicados como "límite de referencia inferior" (LIR), en el estudio del análisis seminal realizados por varios autores (2003 al 2010). Los resultados obtenidos indican que el 81 por ciento de los investigadores latino americanos creen que el nuevo manual estandariza mejor la concentración espermática, un 96 por ciento está de acuerdo con la nueva subclasificación en la motilidad espermática en progresiva (A), no progresiva (B) e inmóviles (C). El 68 por ciento estima que el mejor instrumental de recuento es la cámara de Neubauer. Respecto a los controles de calidad solo el 18 por ciento realiza controles de calidad externa. El 100 por ciento de los investigadores estima conveniente realizar continuos talleres de estandarización. Respecto a la aplicación de los LIR en las poblaciones en estudio, todos ellos cumplirían con los estándares actuales para ser considerada una población con capacidad de fertilidad. Sin embargo varios autores opinan que una nueva versión del manual OMS, debe realizarse urgentemente para estandarizar mejor la concentración espermática (15 millones por mL) y la morfología según criterios estrictos (4 por ciento), valores de referencia que consideran muy bajos.

Spermogram or semen analysis is one of the most used parameters in the evaluation of male fertility. WHO (2010) presented the 5th Manual for review and processing of human semen, a document that was discussed during the first workshop of standardization of semen analysis (PLEAS), held in Santiago de Chile, May 2010. Subsequently applied the new values expressed in "lower referencelimit" (LRL) for semen in several analysis studies conducted by various authors (2003 to 2010). The results indicate that 81 percent of Latin American researchers believe the new manual standardizes best sperm concentration, 96 percent agree with the new subclassification in progressive sperm motility (A), non-progressive (B) and immobile (C). 68 percent determined that the best instruments for the sperm countis the Neubauer haemocytometerchamber. Regarding quality control only 18 percent performed external quality control. 100 percent of researchers believe it is appropriate to conducton going standardization workshops. Regarding the application of LRL in the study populations (2003-2010), 100 percent comply with the standards to be considered a population with fertility capacity. However, several authors argue that a new version of the WHO manual, must be re-done urgently to better standardize sperm concentration (15 million/mL) and morphology according to strict criteria (4 percent), reference values considered very low.

An update on the clinical assessment of the infertile male

Male infertility is directly or indirectly responsible for 60 percent of cases involving reproductive-age couples with fertility-related issues. Nevertheless, the evaluation of male infertility is often underestimated or postponed. A coordinated evaluation of the infertile male using standardized procedures improves both diagnostic precision and the results of subsequent management in terms of effectiveness, risk and costs. Recent advances in assisted reproductive techniques (ART) have made it possible to identify and overcome previously untreatable causes of male infertility. To properly utilize the available techniques and improve clinical results, it is of the utmost importance that patients are adequately diagnosed and evaluated. Ideally, this initial assessment should also be affordable and accessible. We describe the main aspects of male infertility evaluation in a practical manner to provide information on the judicious use of available diagnostic tools and to better determine the etiology of the most adequate treatment for the existing condition.

Infección por Chlamydia trachomatis / Chlamydia trachomatis infection

Determinar la prevalencia de la infección por Chlamydia trachomatis en una población de parejas infértiles. Validar la eficacia del diagnóstico de anticuerpos anti Chlamydia para tratar, prevenir y controlar la infección por C. trachomatis. Justificar la necesidad de implementar el monitoreo de rutina para administrar el tratamiento oportuno de la infección por C. trachomatis. Se determinó la prevalencia de la infección por Chlamydia trachomatis en 4 619 pacientes, 2607 mujeres y 2012 hombres en edades reproductivas, entre 1999 y 2008 por problemas de infertilidad. Se detectaron anticuerpos anti-Chlamydia trachomatis (IgG, IgA e IgM) por SeroELISA (Savyon Diagnostics Ltd.) de 1999 a 2005; desde 2006 hasta 2008 se utilizó el kit InmunoComb II (Orgenics). Centro de fertilidad UNIFERTES, Caracas, Venezuela. Se encontró una prevalencia en mujeres de 25,40 ± 6,26 por ciento; y en los hombres de 31,12 ± 2,88 por ciento. La prevalencia de la infección por C. trachomatis en parejas infértiles es alta y no ha disminuido en los últimos 10 años. Se recomienda implementar en Venezuela un monitoreo de rutina para el diagnóstico de C. trachomatis, incluyendo su determinación en el control ginecológico anual y en las evaluaciones urológicas a hombres jóvenes, a fin de prevenir que la infección pase a ser crónica

To determine the prevalence of Chlamydia trachomatis infection in infertile couples. To evaluate the efficiency of the Chlamydia trachomatis screening programs. To establish the need of implementing the routine early diagnosis and opportune treatment of the infection. Prevalence of Chlamydia trachomatis infection was determined in 4619 patients, 2607 women and 2012 men in reproductive agesbetween 1999 and 2008. Anti-chlamydia and C.trachomatis antobodies (IgG, IgA and IgM) were detected by SeroELISA (Savyon Diagnostics Ltd.) from 1999 to 2005; and by the ImmunoComb II kit (Orgenics) from 2006 to 2008. Fertility clinic UNIFERTES in Caracas, Venezuela. A prevalence of 25,40 ± 6,26 percent was found in women and a prevalence of 31,12 ± 2,88 percent was found in men. Prevalence of the C. trachomatis infection in infertile couples is high and has not decreased over the last 10 years. Implementation of routine screening programs for C. trachomatis detection is recommended, including its assessment in annual gynecological controls, as well as in urologic evaluations in young men, in order to prevent the infection from being chronic