The predictive value of sperm motility parameters obtained by computer-assisted semen analysis (CASA) was evaluated for the fertility of men from general population. In a prospective study with couples stopping use of contraception in order to try to conceive, CASA was performed on semen samples from 358 men. A recently developed CASA system, Copenhagen Rigshospitalet Image house sperm Motility Analysis System (CRISMAS) was used for assessment of motility parameters. This system has an editing function which allows correction of tracks made by the computer. Probably due to this function, the concentration assessment made by CRISMAS was very close to that made by the technician (median difference <5%) in all concentration ranges. Correlation between CASA parameters and fertility of normal couples (measured as probability of achieving pregnancy) was examined by the Cox regression model. In univariate models ln(sperm concentration) [beta = 0.331, risk ratio (RR) = 1.392, P = 0.0001], ln(total sperm count) (beta = 0.252, RR = 1.286, P = 0.0007) and percentage motile spermatozoa (beta = 0.014, RR = 1.014, P = 0.0004) were most significant predictors for fertility. In a multivariate analysis ln(sperm concentration) (beta = 0.268, RR = 1.307, P = 0.0016) and percentage motile spermatozoa (beta = 0.010, RR = 1.010, P = 0.011) but even more significantly the combined parameter, ln(concentration of motile spermatozoa) (beta = 0.329, RR = 1.389, P = 0.0001), were the only parameters of predictive value for fertility of men in the general population. In conclusion, these parameters obtained by CASA measurements can be used for prediction of fertility potential in normal men. This appears to be the first study showing the value of CASA in prediction of fertility in the general male population.

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The purpose of this study was to assess whether patients with tubal infertility and a hydrosalpinx have a reduced implantation rate after in-vitro fertilization. The study included 741 patients who had 1190 consecutive oocyte aspirations. The presence or absence of hydrosalpinges was assessed by transvaginal ultrasonography on day 2 of all cycles. In 62 patients treated in 104 cycles a hydrosalpinx was diagnosed, whereas 493 patients treated in 813 cycles had no hydrosalpinx and eight patients treated in 16 cycles had uncertain hydrosalpinx. The results show that the presence of a hydrosalpinx is associated with a reduced pregnancy rate per aspiration (19.2 versus 32.6%; P < 0.01), reduced implantation rate (2.9 versus 10.3%, P < 0.0005), reduced delivery rate per aspiration (5.8 versus 20.9%, P < 0.0005), reduced delivery rate per embryo transfer (6.6 versus 22.8%, P < 0.0005) and increased early pregnancy loss (70 versus 36%, P < 0.005). Among 178 patients with unexplained infertility or other infertility factors treated with 257 aspirations the results were similar to those in patients with tubal infertility without a hydrosalpinx. In conclusion, the presence of a hydrosalpinx does not impair the number of embryos transferred but seems to impair the implantation process. We hypothesize that this may be due to leakage of fluid into the uterine cavity which may disturb the receptivity of the endometrium and/or the developing embryos.

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