SummaryPrevious reports indicated that hyperinsulinaemic men may exhibit a higher percentage of poorly compacted DNA in their spermatozoa and less success in an IVF programme (Andrologia, 45, 2003, 18; Andrologia, 2014 Andrologia, , doi: 10.1111. The aim of this study was to investigate the effect of metformin (Glucophage ® ) and antioxidant treatment (StaminoGro ® ) on the semen parameters of hyperinsulinaemic men. Nineteen hyperinsulinaemic male patients were treated for 3 months with metformin alone (Group A), and fifteen patients used metformin in combination with the nutritional supplement (Group B). Combined data of the two groups (pre-and post-treatment) differ significantly regarding sperm morphology (P = 0.0003) and CMA 3 (P < 0.0001) values. The improvement in sperm morphology after treatment was similar for the two respective groups (P < 0.05). The morphological normal sperm forms increased from the mean percentage of 3.9 to 5.5% and from 4.2 to 5.5% for Group A and B respectively. Where a combination of metformin and the supplement were used (Group B), the combination treatment proved to be superior in obtaining enhanced chromatin packaging quality although not statistically significant (P = 0.5929) when compared with the metformin (Group A) group. The chromatin packaging quality in Group B improved with 10% while the improvement in Group A was approximately 8.3%. Therefore, infertile hyperinsulinaemic men can benefit from metformin treatment and should be advised on the use of nutritional supplements with antioxidant properties.

Selecting the best spermatozoa for intracytoplasmic spermatozoa injection (ICSI) has recently been a topic of great interest among embryologists. The study aimed to evaluate the relationship between the spermatozoa-hyaluronan-binding assay (HBA), routine semen analysis results and fertilisation rates as recorded during conventional ICSI therapy. Ninety-one patients undergoing conventional ICSI treatment in the Medfem Fertility Clinic in Johannesburg (South Africa) were included in the study. A total of 797 oocytes were injected of which 457 oocytes fertilised (57.3%, range 0-100%). None of the semen parameters correlated with the fertilisation rates (Table 2). HBA scores, however, revealed a highly significant association (p ≤ 0.0001) with the fertilisation rates. The HBA scores also correlated significantly with the biochemical pregnancy values (Spearman r = 0.24, P = 0.02, 95% CI 0.039-0.43); however, the HBA scores did not correlate with the clinical pregnancy rates (Spearman r = 0.14, P = 0.16, 95% CI -0.06 to 0.34). No correlation was recorded between HBA and the standard semen parameters. The study showed that HBA is significantly associated with fertilisation in conventional ICSI. The HBA scores were also significantly associated with the fertilisation rates and biochemical pregnancies.

The IVF outcome of a group of hyperinsulinaemic men (group B) was compared with a group of IVF males with normal insulin levels (group A). The participating females in the study groups were younger than 38 years old, had blocked Fallopian tubes and/or endometriosis, had normal insulin levels and produced five or more ova on stimulation. The male participants in both groups were normozoospermic with motility above 50% and sperm morphology between 5 and 13% normal forms (G-pattern according to Tygerberg strict criteria). The two groups did not differ statistically in terms of age or semen parameters (P = 0.39; P < 0.05).The group of men that presented with normal insulin levels had a higher fertilisation rate (79.15% versus 74.57%) and superior embryo quality on day 3 (55.77% versus 50.39%) than the group that presented with hyperinsulinaemia, but these differences were not statistically significant (P = 0.28, P = 0.40; P < 0.05). The clinical pregnancy rate of the group with normal insulin was significantly higher than that of the hyperinsulinaemic group, 57.9% versus 31.8% respectively (P = 0.03). The results suggest that hyperinsulinaemia had a negative impact on IVF outcome and patients should be advised accordingly.

Summary:The aim of this study was to investigate the prevalence of hyperinsulinaemia in a group of normozoospermic donors and the influence of insulin levels on in vitro fertilization (IVF) outcome. Fasting insulin and two hour post eating insulin levels were determined for a group of thirty four sperm donors. They were divided into three groups according to their insulin profiles.The association between insulin levels and embryo quality was determined in a clinical study for the different groups. The prevalence of raised insulin in the donor group was 44% with a 95% 2 confidence interval of 27.2% and 62.1%. Donors with normal insulin levels produced more good quality blastocysts in the IVF program than those with abnormal insulin levels. These differences were not statistically significant (P=0.8638). Embryo quality in an IVF program may be influenced by male insulin levels. The role of insulin in male fertility needs to be investigated.

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