Socio-economic status and fertility of couples examined for infertility, social status and fertility.

The clinical Fertility of 1000 couples consecutively examined for infertility during 1950-52 was assessed 20 years later by means of a questionnaire, and results were compared with their socio-economic class as defined by the Svalastoga classification. Examinations had included semen analysis performed in our laboratory. 51 couples with known sterility because of azoospermia were excluded. The questionnaire was returned by 691 (72.8%). Couples of higher classes obtained more children (p less than 0.01) than those of lower classes, and they obtained, consistently, their first child in shorter time (p less than 0.01). Semen analysis showed better parameters of spermatozoa motility in higher classes, but the morphology was poorer, and there was no relation to socio-economic class when the different characteristics of semen analysis were combined according to the Hammen classification system of semen quality. It is discussed that the better fertility prognosis of couples of higher socio-economic classes not explained by a difference in semen quality of the men may indirectly indicate that females of lower classes suffered from more severe gynaecological diseases and abnormalities combined with a reduced fertility potential.

The clinical value of morphological rating of human spermatozoa.

The clinical fertility of 1,077 men whose semen had been analyzed between 1950 and 1952, in terms of types of abnormal spermatozoa morphology according to the Hammen system with 14 types, was studied 20 years later by means of a questionnaire (785 replies i.e., 72.9%). There was a significant difference (P less than or equal to 0.01) between couples who obtained living children and the couples who did not, expressed as the mean percentages of spermatozoa with narrow heads, round heads, amorphous heads, irregular heads, abortive forms, double forms, staining abnormalities and vacuoles. The same tendency was found for piriform heads, small heads, belted heads and various rare heads. Giant head showed no difference, and pinhead was not represented. Piriform heads and narrow heads increased significantly more than the other types (P less than or equal to 0.01) with increasing total number of abnormal spermatozoa. There was no relation between any abnormal type and abortions and otherwise abnormal pregnancies. Detection of types of abnormal spermatozoa morphology does not seem to improve semen analysis in terms of predicting chance of pregnancy, and we prefer to use the percentage of morphologically normal spermatozoa, the inverse expression of abnormal spermatozoal morphology as a total, for routine semen analysis.

Relation between number of immobile spermatozoa and pregnancies obtained during a twenty-year follow-up period immobile spermatozoa and fertility.

The clinical fertility of 1077 men examined with semen analysis including detection of number of immobile spermatozoa during the years 1950-52 was studied twenty years later with a questionnaire replied by 785 (72.9%). There was a significant relation (p less than 0.01) between decreasing number of immobile spermatozoa and increasing chance of getting living children, but no relation to abortions and pathological pregnancies. Furthermore, decreasing number of immobile spermatozoa was correlated to shorter time-interval between attempt to impregnate and first pregnancy obtained (p less than 0.01). Mean values for those obtaining living children was 34.7% immobile spermatozoa compared with 38.2% for those not doing so. Over 80% immobile spermatozoa, fertility was considerably reduced, and the borderline between normal and reduced male fertility should therefore be defined to 80% immobile spermatozoa.

Interrelations among the characteristics of human semen, and a new system for classification of male infertility.

The clinical fertility of 1077 men who underwent semen analysis during the years 1950 to 1952 was studied 20 years later using questionnaires returned by 785 men (72.9%). Decreasing fertility was correlated with decreasing sperm count (P less than 0.01), with increasing numbers of immobile sperm (P less than 0.01), with poorer motility (P less than 0.01), and with increasing numbers of morphologically abnormal sperm (P less than 0.01). The characteristics mentioned were all interrelated (P less than 0.01), with correlation coefficients from 0.36 to 0.67. A new system for classification of male fertility potential is elaborated, using a combination of the four characteristics. This system expresses the fertility of the man and the couple as a percentage of the chance of obtaining living children.

Relation between spermatozoa motility and pregnancies obtained during a twenty-year follow-up period spermatozoa motility and fertility.

The clinical fertility of 1077 men with an infertility problem investigated with semen analysis including assessment of spermatozoa motility during the years 1950-52 was studied 20 years later using a questionnaire, replied by 785 (72.9%). Spermatozoa motility was assessed with a subjective method with four degrees--excellent, good, impaired and poor. There were significant correlations between better motility and number of living children (p less than 0.01) and to shortest time--interval to first pregnancy (p less than 0.001). Motility was not correlated to abortions and otherwise pathological pregnancies. With a poor motility there was still a fairly good chance of obtaining living children (32.7%) compared with 58.7% for an excellent motility), and it is therefore concluded, that assessment of spermatozoa motility is only suited for classification of slightly and modestly reduced male fertility, and not for classification of severely impaired fertility.

Has the fertility of Danish men declined through the years in terms of semen quality? A comparison of semen qualities between 1952 and 1972.

The semen analysis of 1,077 men examined in 1952 was compared with the semen analysis of 1,000 men examined in 1972 in order to assess if fertility in Danish men has declined during the period. The men on both occasions were examined because of a fertility problem. In 1952 6.2% of the men had azoospermia compared with 3.9% in 1972 (P less than 0.05). Between 1952 and 1972 there was a fall in sperm count (P less than 0.01, median 73.4, and 54.5 mill/ml), a deterioration in spermatozoa motility (P less than 0.001), an increase in number of abnormal spermatozoa (P less than 0.01, median 26.0%, and 44.8%), and a deterioration in fertility class according to the Hammen system (P less than 0.001). Semen volume and number of immobile spermatozoa did not change. This study of Danish men, like studies from other industrialized countries, indicates a fall in semen quality and male fertility since the early fifties.

Relation between morphologically abnormal spermatozoa and pregnancies obtained during a twenty-year follow-up period.

The clinical fertility of 1077 men investigated with semen analysis including detection of morphologically abnormal spermatozoa during the years 1950-52 was studied 20 years later using a questionnaire replied to by 785 (72.9%). There was a significant correlation (P less than 0.01) between increasing number of abnormal spermatozoa and decreasing chance of getting living children, but no relation to abortions and pathological pregnancies. Moreover, there was a significant correlation (P less than 0.01) to time-interval to first pregnancy. Median values for those obtaining living children was 25% abnormal spermatozoa compared with 28% for those not doing so. Up to 60% abnormal spermatozoa, fertility was not reduced, and the borderline between normal and reduced male fertility is therefore defined to be 60% morphologically abnormal spermatozoa.

Relation between sperm count and semen volume, and pregnancies obtained during a twenty-year follow-up period.

The clinical fertility of 1077 men investigated with sperm analysis including sperm count and semen volume during the years 1950-52 was studied 20 years later using a questionnaire, replied by 785 (72.9%). There was a significant correlation (P less than 0.01) between sperm count and number of living children, but no relation to abortions and pathological pregnancies. Furthermore, sperm count was correlated (P less than 0.01) to time interval from wish of pregnancy to pregnancy obtained. Of 53 men with sperm count less than or equal to 5 mill/ml 22.6% obtained living children compared with 52.2-63.1% living children in 730 men with sperm count greater than 5 mill/ml. Sperm count is concluded to be proper for fertility classification, and sperm count 5 mill/ml is found to be the clinically significant borderline of male infertility. There was no relation between semen volume and pregnancies obtained, however, there was a statistical relation (P less than 0.01) to time interval to pregnancy obtained. Semen volume is concluded not to be suited for fertility classification.

Hammen semen quality classification and pregnancies obtained during a twenty-year follow-up period.

The Hammen semen quality classification system is a fertility index with six qualities based on sperm count, assessment of sperm motility, number of immotile spermatozoa, number of abnormal sperm heads, and sperm viability. It was developed by Hammen during the 1940s. In the present study, the fertility of 1077 men classified during the years 1950 to 1952 was assessed after 20 years. There were significant correlations between those obtaining living children (P less than 0.01) and those with good semen quality, and between number of children obtained (P less than 0.001) and good semen quality. Moreover, the time interval between attempts to impregnate and obtainment of pregnancy was correlated (P less than 0.01). It is concluded that the Hammen semen classification system is suitable for assessing male clinical fertility.

Artificial insemination in Denmark by frozen donor semen supplied from a central bank.

A central semen bank in Denmark supplied deep-frozen semen. Selection of donors, freezing technique, and practical details about transport of specimens are described. In one of the gynaecological departments supplied with frozen semen, 22 out of 30 patients who had artificial insemination became pregnant. The advantages and disadvantages of using frozen semen are discussed.

PIP: The experience with the establishment of a central semen bank to serve gynecological departments in all of Denmark is described. In that the conception rate seems to be lower with frozen than with fresh semen, only ejaculates with a volume above 2 ml were accepted. Ejaculates were accepted in which 50% of the sperms remained mobile after trial freezing. Each ejaculate was frozen in portions of 0.5 ml and on the next day 1 of the portions was thawed out and examined for sperm motility. Of 200 donors about 50 had an initially acceptable semen volume and sperm count, but in only 1/2 of these was sperm motility satisfactory after a test freezing of semen. The semen was frozen immediately after liquefaction and always within 60 minutes of ejaculation. The method used was the 1 described by Perloff et al. (1964). Each gynecological clinic decided on the indications for artificial insemination. Insemination was usually done twice in each cycle, namely 2 days before and on the day of expected ovulation. Treatment was continued for a maxim of 9 cycles. Of the 30 women treated, 22 became pregnant. The mean treatment period before conception was 3.4 cycles, while the mean period of insemination for all patients was 4.5 cycles. 2 pregnancies ended in miscarriage, 10 patients were delivered of normal infants, and 10 are still pregnant.

[Letter: Sperm bank for sterilized males]. / Saedbank for steriliserede maend

PIP: In setting up a sperm bank for men who want to undergo sterilization, many technical requirements must be fulfilled. The sperm must be kept in liquid nitrogen at a temperature of -196 degrees C. The sperm remains viable up to 5 years after freezing. Not all sperm is suited for this procedure, however; 90% of the sperm samples offered by 200 men for a sperm bank had to be rejected because sperm quality was reduced after freezing and thawing.^ieng