Semen quality and waiting time to pregnancy explored using association mining

Abstract

Background Assessment of semen quality is a key pillar in the evaluation of men from infertile couples. Usually, semen parameters are interpreted individually because the interactions between parameters are difficult to account for. Objectives To determine how combinations of classical semen parameters and female partner age were associated with waiting time to pregnancy (TTP). Materials and methods Semen results of 500 fertile men, information of TTP, and partner age were used for regressions and to detect breaking points. For a modified Association Rule Mining algorithm, semen parameters were categorized as High, Medium, and Low. Results Men ≤32.1 years and women ≤32.9 years had shorter TTP than older. Decreasing TTP was associated with increasing level of individual semen parameters up to threshold values: sperm concentration 46 mill/mL, total sperm count 179 mill, progressive motility 63%, and normal morphology 11.5%. Using association mining, approximately 100 combinations of semen parameters and partner age were associated with TTP. TTP ≤ 1 month often co‐occurred with high percentages of progressive motility (≥62%) and morphologically normal spermatozoa (≥10.5%). Furthermore, TTP ≤ 1 did not tend to appear with lower percentages of these two semen parameters or high partner age (≥32 years). However, high percentages of motile or normal spermatozoa could not compensate for sperm concentration ≤42 mill/mL or total sperm count ≤158 mill. The prolonging effect of high partner age could not be compensated for by the man's semen quality. Discussion and Conclusion Using association mining, we observed that TTP was best predicted when combinations of semen parameters were accounted for. Sperm counts, motility, and morphology were all important, and no single semen parameter was inferior. Additionally, female age above 32 years had a negative impact on TTP that could not be compensated for by high semen parameters of the man.

Semen Thresholds of Normality Established by the WHO Do Not Reveal Genome Instability—A Potential Occult Male Factor

“…Although the mean semen parameters in the SN group were well above the WHO lower reference limits [6], they were lower (and significantly for morphology) than the means observed in the F group. According to Herrera, a single parameter is not superior or inferior to the others in predicting fertility chances [44]. Coban suggested that diminished sperm quality/morphology is a potential origin for aneuploidy in early embryos [45].…”

An evaluation of changes over time in the semen parameters data used for the World Health Organization semen analysis reference ranges

“…For example, the abstinence period used was 2–7 days, a length chosen for practical reasons; however, a more reliable measurement of daily sperm output would likely be achieved using a shorter abstinence period of 2–3 days 45 . The reference population used in the studies included men with a time to pregnancy of 12 months; however, this is not a homogenous group, and couples nearing the end of the time frame might suffer from relative male factor subfertility 46 . Finally, it is possible that with the increase in use of fertility treatment, more and more men with sperm parameters below the 5th percentile undergo fertility treatment and are not represented in the “fertile” population, thereby skewing the results over time.…”

Improving standard practices in studies using results from basic human semen examination

“…Importantly, from a clinical point of view, semen parameters should also be interpreted with the other parameters of semen examination. [26][27][28] For example, sperm count below the reference limits could suggest a testicular problem in producing sperm but also obstruction of the seminal tract when associated with low semen volume and pH. 29 Semen examination is the first analysis for the male partner of an infertile couple, and it will guide the subsequent diagnostic workup.…”

“…Combined with information on ejaculatory abstinence time, variation in both sperm number and sperm motility can be better understood. Importantly, from a clinical point of view, semen parameters should also be interpreted with the other parameters of semen examination 26–28 . For example, sperm count below the reference limits could suggest a testicular problem in producing sperm but also obstruction of the seminal tract when associated with low semen volume and pH 29 …”