Decline in semen quality among infertile men in Brazil during the past 10 years

ABSTRACTPurpose:To investigate whether the semen quality of men undergoing conventional semen analysis is deteriorating over time.Materials and Methods:We analyzed and compared the sperm count, motility and morphology of 2300 semen samples provided by males undergoing conventional seminal analysis, from years 2000 to 2002 and 2010 to 2012. The incidences of severe oligozoospermia and azoospermia over time were also compared.Results:A total of 764 sperm samples were analyzed in 2000-2002 and 1536 in 20102012. Over time, the mean sperm concentration/ml decreased significantly from 61.7 million in 2000-2002 to 26.7 million in 2010-2012 (R2=11.4%, p<0.001), the total sperm concentration decreased significantly from 183.0 million to 82.8 million (R2=11.3%, p<0.001), and the percentage of normal forms decreased significantly from 4.6% to 2.7% (R2=9.8%, p<0.001). The incidence of severe oligozoospermia significantly increased from 15.7% to 30.3% (OR: 1.09, p<0.001) and the incidence of azoospermia increased from 4.9% to 8.5% (OR: 1.06, p=0.001).Conclusions:This study demonstrated a significant time-related decline in semen quality of infertile patients. This finding might have implications on fertility and emphasizes the need for further studies addressing subject's life-style in order to find and reduce the causative agents. Future prospective and multicenter studies including representative samples of the general population are needed to confirm whether semen quality is really declining.

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.

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.

High prevalence of AZFb microdeletion in Iranian patients with idiopathic non-obstructive azoospermia.

Background & objectives: Genetic factors contribute about 10 per cent of male infertility. Among these, genes in azoospermia factor (AZF) region including AZFa, AZFb, AZFc and AZFd on the long arm of Y chromosome are considered most important for spermatogenesis. Deletions in these regions are thought to be involved in some cases of male infertility associated with azoospermia or oligozoospermia. We studied the incidence of AZF deletions among Iranian infertile men with idiopathic non-obstructive azoospermia. Methods: A total of 100 Iranian azoospermic infertile men were selected for the molecular study of Y chromosome microdeletions. The presence of 13 sequence tagged site (STS) markers from AZF region was investigated using multiplex polymerase chain reaction (M-PCR). One hundred fertile men were also studied as control group. Results: Twelve (12%) patients showed Y chromosome microdeletions and among these, deletion in AZFb region was the most frequent (66.67%) followed by AZFc (41.67%), AZFd (33.33%) and AZFa (8.33%), respectively. Interpretation & conclusions: Because of relatively high incidence of Y chromosome microdeletions among Iranian azoospermic patients, molecular screening may be advised to infertile men before using assisted reproductive treatments.