ABSTRACT
OBJECTIVE: To reevaluate the number of semen analyses necessary to establish whether further male infertility testing is necessary. STUDY DESIGN: The results of three consecutive semen analyses for infertility evaluations were retrospectively reviewed. A male factor was defined by an abnormal semen analysis if either the first specimen of three (single-sample screening) or two of the three specimens (multiple-sample screening) met World Health Organization criteria. Males considered abnormal by multiple-sample screening underwent sophisticated andrologic evaluation. RESULTS: A single-sample conventional semen analysis obtained from 209 males demonstrated a diagnostic accuracy of 10.4% false negatives and a sensitivity of 89.6% when compared to that of multiple-sample analysis. Andrologic evaluation of abnormal males by multiple-sample screening confirmed that 9 of the 11 men with normal first specimens were abnormal; all others were confirmed as abnormal. CONCLUSION: Analysis of multiple semen specimens provides a reliable screen in the evaluation of male factor infertility when the goal is to minimize the false negative rate of screening tests.
Subject(s)
Infertility, Male/diagnosis , Mass Screening/methods , Semen/physiology , False Negative Reactions , Humans , Infertility, Male/etiology , Infertility, Male/physiopathology , Male , Mass Screening/standards , Predictive Value of Tests , Retrospective Studies , Semen/cytology , Sensitivity and Specificity , Spermatozoa/cytology , Spermatozoa/physiology , World Health OrganizationABSTRACT
BACKGROUND: Fusobacterium nucleatum and Capnocytophaga species are common oral pathogens and infrequent causes of systemic infection in patients with compromised immunity or disrupted mucosal integrity. The isolation of both organisms from a clinical specimen suggests an oral source of infection. CASE: A 23-year-old black woman was admitted at 24 weeks' gestation in preterm labor. She subsequently developed signs of clinical chorioamnionitis, including fever, fetal tachycardia, and uterine tenderness. Bacteriologic studies of the amniotic fluid and subchorionic placental cultures yielded F nucleatum and Capnocytophaga species. On review of the patient's history, a temporal relation was noted between orogenital contact and the onset of clinical infection. Thorough evaluation of the patient, including dental examination, did not reveal an obvious source of infection. However, significant periodontal disease was identified in her partner. CONCLUSION: The concomitant finding of these two organisms in the patient's amniotic fluid and a history of periodontal disease in her partner suggests that chorioamnionitis may have been due to an ascending infection after orogenital contact.