Semen quality and infertility status can be identified through measures of oxidation-reduction potential.

Standard analyses for evaluating semen quality require technical expertise and are interpretive in nature. Oxidative stress (OS) alters many of the semen parameters; thus, a measure of OS could be an indicator of semen quality. Static oxidation-reduction potential (sORP) is a universal measure of OS traditionally used in environmental applications but is increasingly used in biomedical studies. sORP was measured to determine how well it associates with semen quality and if it differentiates semen from infertile patients and fertile donors. All study participants (Infertile, n = 365 and Fertile, n = 50) underwent standard semen analyses, and sORP was measured in unprocessed semen. In infertile patients, sORP increased with decreased total sperm number, motility and morphology. sORP values were higher in samples with abnormal quality (low number, motility and/or normal morphology) compared with those of normal quality. Infertile patients had higher sOPR values compared to fertile donors. A sORP cut-off value of 1.38 mV/106  sperm/ml can differentiate normal from abnormal semen samples, while a cut-off value of 1.41 mV/106 sperm/ml, can differentiate between infertile and fertile semen samples. In conclusion, sORP provides a quick and unbiased indicator of semen quality that can be a beneficial addition to semen analysis to determine semen quality and fertility status.

ICSI outcome in patients with high DNA fragmentation: Testicular versus ejaculated spermatozoa.

Sperm DNA fragmentation (SDF) has emerged as an important biomarker in the assessment of male fertility potential with contradictory results regarding its effect on ICSI. The aim of this study was to evaluate intracytoplasmic sperm injection (ICSI) outcomes in male patients with high SDF using testicular versus ejaculated spermatozoa. This is a prospective study on 36 men with high-SDF levels who had a previous ICSI cycle from their ejaculates. A subsequent ICSI cycle was performed using spermatozoa retrieved through testicular sperm aspiration. Results of the prior ejaculate ICSI were compared with those of the TESA-ICSI. The mean (SD) SDF level was 56.36% (15.3%). Overall, there was no difference in the fertilization rate and embryo grading using ejaculate and testicular spermatozoa (46.4% vs. 47.8%, 50.2% vs. 53.4% respectively). However, clinical pregnancy was significantly higher in TESA group compared to ejaculated group (38.89% [14 of 36] vs. 13.8% [five of 36]). Moreover, 17 live births were documented in TESA group, and only three live births were documented in ejaculate group (p < .0001). We concluded that the use of testicular spermatozoa for ICSI significantly increases clinical pregnancy rate as well as live-birth rate in patients with high SDF.

A multicenter study to evaluate oxidative stress by oxidation-reduction potential, a reliable and reproducible method.

Seminal oxidative stress (OS) is well-known to affect male fertility status. The discrepancy in OS measurement has hindered its clinical use as a quality indicator for semen. Some tests measured single markers of oxidants or reductants, leading to lack of standardization of results. Oxidation-reduction potential (ORP) is a better representative for OS as it provides an overall measure of the activity of both oxidants and reductants. ORP assessment by MiOXSYS has been introduced as a measure of OS with high specificity in differentiating fertile from infertile semen samples. This is a retrospective study comparing data from semen analysis and ORP measurements between two andrology laboratories in the USA and Qatar over a period of 12 months. The same protocol was followed by both laboratories. The USA dataset contained 194 patients and 51 fertile donors, while the Qatar dataset contained 400 patients and 50 fertile donors. In both datasets and in the combined dataset, the infertile group had significantly lower sperm concentration, total and progressive motility, and normal morphology as well as higher ORP levels compared to fertile men (p < 0.05). When comparing data from both centers, the infertile group showed significant difference between both datasets regarding progressive motility and morphology (p < 0.001). Also, the percentage of patients with abnormal semen volume, sperm count, total and progressive motility were significantly different between both datasets (p < 0.05). ORP levels showed no significant difference between both datasets (p < 0.08). ROC analysis indicated that ORP cutoff value of 1.42 mV/106 /mL in the USA group, Qatar group, and combined dataset can accurately differentiate fertile from infertile semen groups. Although other semen parameters showed significant differences between the two centers, ORP remained consistent in both datasets individually or in combined data. This proves its reproducibility and reliability.

Varicocele among infertile men in Qatar.

Objective of this retrospective study was to assess the presence and clinical grade of varicocele among Qatari and non-Qatari men evaluated for infertility. Diagnosis of varicocele was performed clinically and confirmed via colour Doppler ultrasonography. A total of 455 infertile male patients (mean age 36.3 ± 7.6 years) were divided into either Qatari (n = 91, mean age 37.3 ± 9.1 years) or non-Qatari (n = 364, mean age 36.0 ± 7.1 years) groups. Among all patients, 43.1% (n = 196) were confirmed to have varicocele, of which 40 were Qatari and 156 non-Qatari. Among all patients, 171 (37.6%) presented with left-sided varicocele and 25 (5.5%) with bilateral varicocele. Of the 196 patients with varicocele, grade I was given to 40 (20.4%), grade II to 68 (34.7%) and grade III to 88 (44.9%). Grade II and III varicocele were seen significantly more frequently than grade I among all patients and non-Qatari patients (p < .05). Grade II varicocele was seen more frequently than grades I or III among Qatari patients, but difference was not significant. Grade III was seen significantly more frequently than grade I among patients with secondary infertility (p < .05). Varicocele is an important health issue in Qatar among both Qatari and non-Qatari men.

Does the number of veins ligated during varicococele surgery influence post-operative semen and hormone results?

Varicocele is a well-established cause of male subfertility, which is directly proportional to its clinical grade. Although newer ultrasonic grading systems have taken into account the existence of pampiniform venous plexi, little is known about the clinical significance of the number of veins ligated during surgery. Very few undersized studies reported an influence which triggered the need to evaluate such association. This is a retrospective study of 378 patients who underwent left microsurgical subinguinal varicocoelectomy. Semen analyses and blood hormone studies performed pre-operatively were compared to those executed 6 months after surgery. Patients were divided into abnormal semen and normal semen groups based on their initial semen results. They were also subdivided according to the number of veins ligated intraoperatively into three groups: <5, 5-10, and >10 veins. Sperm count, total motility, and progressive motility were significantly increased in 62, 60.3, and 53.3% of patients post-operatively (p = 0.001), respectively. No significant differences in hormone levels were detected overall. Of the 378 patients, 332 had an abnormal semen analysis, while the remaining 46 patients had a normal result. Sperm count, total motility, and progressive motility significantly increased after varicocoelectomy in patients with an abnormal initial semen analysis (p = 0.001). In 48.7% of patients, 5-10 veins were ligated during surgery, whereas 28.3% had >10 and 23% had <5 ligated veins. No statistically significant differences were noted in the initial or the follow-up results among the number of vein subgroups. Varicocele ligation improves patients' fertility potential. This improvement, however, is not influenced by the number of veins ligated intraoperatively. Clinical grading maintains its superiority in the evaluation of varicocele patients.

Outcome of microsurgical testicular sperm extraction in familial idiopathic nonobstructive azoospermia.

The aim of the study was to evaluate the sperm retrieval rate by microsurgical testicular sperm extraction (TESE) in familial idiopathic nonobstructive azoospermia (NOA). One hundred and nineteen patients with idiopathic NOA who underwent microsurgical TESE over the past 5 years were included. Patients were then divided into two groups; Group 'A' with familial idiopathic NOA (11 families with two brothers in each family, 22 patients) and Group 'B' with nonfamilial idiopathic NOA (97 patients). Clinical data as well as data of microsurgical TESE were recorded. In Group 'A', the sperm retrieval rate was 9.1% (2/22 patients) compared to 45.4% in Group 'B' (44/97 patients) (P ≤ 0.05). The two patients in Group 'A' with successful sperm retrieval belonged to one family. The histopathological diagnosis was the same in the brothers in each family. It can be concluded that the testicular sperm retrieval rate in familial idiopathic NOA is significantly lower than in nonfamilial idiopathic NOA.