Variation in antimüllerian hormone concentration during the menstrual cycle may change the clinical classification of the ovarian response.

OBJECTIVE: To assess the variability of antimüllerian hormone (AMH) concentrations in women with "adequate ovarian reserve" during unstimulated menstrual cycles and to determine the impact on clinical classifications. DESIGN: Pilot cohort study. SETTING: Private fertility clinic. PATIENT(S): Twelve consecutive women (aged 29 to 43 years) referred to a fertility service, with AMH measurements repeated throughout unstimulated cycle, and who had at least one AMH measurement indicating "adequate ovarian reserve." INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): AMH concentrations assessed in 82 serum samples from 12 women compared against the published cutoffs for reduced ovarian reserve and for risk of excessive response to ovarian stimulation. RESULT(S): Over half the women (7 of 12) were reclassified as a result of testing AMH concentrations at different phases of the menstrual cycle. Over one-third (4 or 5 of 12) crossed a cutoff for reduced ovarian reserve; 2 of 12 crossed cutoffs predicting hyperstimulation. There was a statistically significant change in AMH concentration according to the day of the cycle, with a negative trend of the median AMH concentration from the follicular to luteal phase. The maximum change in median AMH concentration over cycle was 7.9 pmol/L, and the mean difference between the maximum and minimum AMH was 6.7 pmol/L. CONCLUSION(S): In this pilot study, the AMH concentration varied during menstrual cycle, and the clinical classification of the ovarian response was altered.

The density of human semen and the validation of weight as an indicator of volume: a multicentre study.

A multi-centre study was undertaken to: a/ determine the density of human semen, and b/ assess the validity of measuring semen volume either volumetrically or gravimetrically. Semen samples from four clinical categories (azoospermia following vasectomy, azoospermia without vasectomy, oligozoospermia (<20x10(6)/ml) and normozoospermia (>/=20x10(6)/ml)) had similar densities (one-way ANOVA: F(3,180)=1.25, not significant), being close to 1.0 g/ml when taken to one decimal place. Measurement of semen volume was then made with either a graduated pipette or by weighing and assuming a density of 1 g/ml. A comparison of the two methods gave an excellent correlation, with a gradient of 1.0571 and a coefficient of determination (R(2)) of 0.98 (p<0.0001). However, it was noted that the aspiration of the ejaculate in to a graduated pipette underestimated the volume by approximately 0.2 ml, but in an inconsistent manner making the use of a set correction factor inappropriate. The estimation of volume to one decimal place by weighing the collection container before and after ejaculation, assuming a density of 1 g/ml, would seem to be a viable alternative although the density of a small number of samples may deviate from this assumption. Whilst the relatively small underestimation of volume with a pipette is unlikely to have clinical significance, the known reporting of inaccurate results by a laboratory is contrary to the philosophy and key principles of quality management.

The benefits and limitations of the sperm quality analyzer IIB in assessing porcine sperm motility.

The Sperm Quality Analyzer (SQA) IIB, a member of the SQA-II family of machines which uses the scatter of light by sperm as an indicator of sperm motility, was systematically evaluated as a means of analyzing objectively the motility of porcine epididymal sperm. The sperm motility (%) and the Sperm Motility Index (SMI) are calculated by the machine using pre-programmed algorithms designed for human sperm. The machine performed well and was able to detect changes in sperm motility under experimental conditions. However, two major limitations of this machine were identified, (i) the readings obtained were influenced by the concentration of the sperm suspension despite the actual sperm motility remaining constant, and (ii) the machine was unable to differentiate between progressive and non-progressive motility. It should therefore be recognized that (a) the sperm concentration must be kept constant in studies in vitro if differences between treatment groups are to be identified, and (b) the inability to separate progressive motility from that of total motility will restrict the usefulness of this and similar machines to studies monitoring changes in total motility alone.

Semen analysis: its place in modern reproductive medical practice.

Semen analysis is the most important laboratory investigation for men when assessing the infertile couple. Advances in in vitro fertilisation (IVF) techniques, particularly intracytoplasmic sperm injection (ICSI) involving the direct injection of a single spermatozoon into an egg, have not diminished the role of semen analysis in modern reproductive practice. Semen analysis is the most basic laboratory investigation undertaken and is descriptive in terms of semen volume, appearance, viscosity, sperm concentration, sperm motility and morphology. Since the results are used by clinicians to choose appropriate treatment options, a reliable service is imperative. It is crucial that the laboratory is experienced in the performance of semen analyses to ensure an accurate result. To ensure a quality semen analysis service, laboratories must participate in internal and external quality assurance activities, incorporate rigorous training protocols for technical staff and use reliable procedures. The World Health Organization laboratory manual for the examination of human semen and sperm cervical mucous interaction, clearly describes the variables that need to be assessed and the methods of analysis and quality assurance to be used.

Are body fluctuating asymmetry and the ratio of 2nd to 4th digit length reliable predictors of semen quality?

BACKGROUND: Recent attention has been paid to patterns of fluctuating asymmetry (FA) in paired bilateral traits and the extent to which they reflect phenotypic and genetic quality. The FA-fertility hypothesis proposes that FA may be a reliable indicator of ejaculate quality in humans and other animals. The common control by the Hox genes of the differentiation of both the urogenital system and the appendicular skeleton in vertebrates has been proposed as an explanation for the recent finding that FA, and the second to fourth digit ratios (2D:4D) are both associated with semen quality in men. METHODS: A group of 50 men was evaluated for FA, calculated by the sum of three different body FAs, 2D:4D ratios, and seminal parameters of masturbatory semen samples. RESULTS: Composite FA had a significant effect on semen parameters; the 2D:4D ratios did not predict semen quality. CONCLUSIONS: Comparison of our data with previous studies suggests that the putative relationship between semen quality and 2D:4D may have been driven by the inclusion of severely oligozoospermic men within the original subject group. Our sample included men with equally high 2D:4D ratios but who had normal semen. Thus, the 2D:4D ratio may not reliably indicate poor semen quality although FA might.