Diagnostic value of advanced semen analysis in evaluation of male infertility

Abstract

Couples who are unable to conceive within a year of regular, unprotected sexual intercourse are recommended to seek evaluation. In about 40% of the couples, infertility is caused by a male factor and by both partners in an additional 20% of couples. The underlying causes for male infertility are multifactorial, with about 20% of these cases being idiopathic (Ayaz et al., 2015; Louis et al., 2013). 1.1 | Overview of semen analysis and its implications According to the guidelines of the World Health Organization (WHO, 2010), the clinical evaluation of male patients includes a medical history, physical examination and at least two semen analyses. The conventional semen analysis is very important in identifying the severity of male factor infertility and guiding future analysis and treatment (Agarwal & Bui, 2017). It further includes the determination of volume, pH, colour, viscosity, liquefaction time, number of round cells, sperm total count, concentration, motility and normal sperm morphology. 1.2 | Limitations of semen analysis in predicting fertility status Although standard semen analysis remains the standard of care to initially evaluate male patients with infertility, a routine semen analysis does not accurately identify the aetiology of infertility or predict the reproductive success (Snow-Lisy & Sabanegh, 2013). Routine semen analysis yields variable results due to inter-and intra-observer variability, and it gives no information about sperm dysfunctions at cellular and molecular levels (Agarwal & Bui, 2017; Esteves, 2014). Moreover, the lower reference limits established by the WHO are not applicable to all men as values of semen parameters overlap in fertile and infertile men. Therefore, the exact cause of idiopathic and unexplained male infertility remains unknown, even after performing routine semen analysis (Hamada, Esteves, & Agarwal, 2011; Wallach et al., 1983). Normal semen parameters do not equate with a normal fertilisation potential of spermatozoa (Hamada et al., 2011; Lewis, 2007). As a consequence, more advanced tests are needed to accurately diagnose male infertility and predict pregnancy in couples trying to conceive naturally or couples undergoing assisted reproductive technologies (ART; Oehninger, Franken, & Ombelet, 2014).

Improvement of sperm morphology after surgical varicocele repair

“…In this study, the clinical effect of the varicocele surgical treatment was analysed with a more complex statistical approach than those used so far, including different parameters obtainable in clinical practice, and trying to overcome the limitations imposed by conventional semen analysis. 37 , 38 Indeed, more elaborate statistical approaches would be useful to analyse an outcome that could be described or measured with different variables (ie surgical varicocele correction efficacy measured through sperm number, motility, morphology (binary), morphology (detailed), fructose, citric acid, etc.). 39 , 40 Thus, we applied both logistic multivariate regression analysis and neural networks confirming the clinical efficacy of surgical restoration.…”

“…Orchitis and broad destruction of the testes were found in deceased COVID-19 patients, 35,37 while the pathological characteristics in survivors remain unknown. In this review, we summarize the current research focusing on the effects of COVID-19 on male reproduction from the following 3 aspects: detection of SARS-CoV-2 in the male reproductive tract, determination of the impact of COVID-19 on sperm quality and exploration of pathological changes in the testes of COVID-19 patients.…”

Improvement of Sperm Morphology After Surgical Varicocele Repair

“…In this study, the clinical effect of the varicocele surgical treatment was analysed with a more complex statistical approach than those used so far, including different parameters obtainable in clinical practice, and trying to overcome the limitations imposed by conventional semen analysis 35 . Indeed, more elaborate statistical approaches would be useful to analyse an outcome that could be described or measured with different variables (i.e.…”

Afterword: An update on clinical utility and diagnostic value of various andrological techniques

“…This special issue begins with two reviews that highlight the diagnostic value of conventional and advanced semen analysis, respectively (Barbăroșie, Agarwal, & Henkel, 2020; Baskaran, Finelli, Agarwal, & Henkel, 2020). Despite its shortcomings, routine semen analysis remains the primary evaluation performed to assess the fertility potential of a male.…”

“…While routine semen analysis gives an indication of testicular spermatogenesis, patency of the ductal system and glandular secretory activity, it is a poor predictor of reproductive outcome in couples trying to conceive either naturally or via assisted reproductive technology (ART). In their review, Barbăroșie and colleagues examined common sperm function techniques, including assays that evaluate physiological processes such as capacitation, acrosome reaction, sperm‐zona pellucida binding and sperm‐oocyte penetration (Barbăroșie et al, 2020). They also described tests that assess sperm maturity, vitality, sperm plasma membrane integrity, mitochondrial membrane potential and anti‐sperm antibodies.…”