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Sperm motion kinetics: a new perspective in evaluating infertility.
criteria and the hypo-osmotic swelling (HOS) test as predictors of sperm fertilization potential. Design: A comparison of 3 parameters to determine which of them is a better predictor of the fertilization potential of a given semen sample in the IVF model, namely the sperm velocity characteristics determined by computerised semen analysis, strict sperm morphology and the HOS test. Materials/Methods: Data from 58 couples attending the assisted conception unit for conventional in-vitro fertilization (IVF) treatment were analyzed. Simple linear regression and multiple stepwise regression analysis were performed taking the fertilization rate as the dependent variable and the following as independent variables: (1) female partner’s age, (2) number of human menopausal gonadotropin (hMG) ampoules, (3) sperm count, (4) grade A motility, (5) grade B motility, (6) grade C motility, (7) grade A ⫹ B motility, (8) mean sperm velocity, (9) linear velocity, (10) linearity index, (11) strict morphology and (12) the HOS test. The results were used to calculate the cut-off levels for the statistically significant predictors of fertilization. Results: Only the mean sperm velocity and the strict sperm morphology assessment showed significant correlation with the fertilization rate. The cut-off values were a mean sperm velocity of 16 mm/sec and a strict sperm morphology of 10%. A minimum sperm velocity of 13 mm/sec and a minimum strict sperm morphology of 2% were necessary to achieve fertilization in 50% of the oocytes. The results of the HOS test did not correlate with the fertilization rate. Conclusions: Sperm velocity and strict sperm morphology evaluation are good predictors of fertilization potential. The HOS test is not a good predictor of fertilization potential. Supported by: Alexandria Fertility Centre.
Comparison of sperm motion kinetic values [median and interquartile (25%, 75%)] between donors and patients. Patients—Normal Patients—Abnormal Donors semen parameters P semen parameters P Variables (n ⫽ 16) (n ⫽ 82) Value (n ⫽ 425) Value Motility VCL VSL VAP LIN ALH
82 (70, 88) 48 (41, 56) 29 (24, 36) 35 (29, 41) 56 (51, 59) 4 (4, 5)
73 (63, 83) 46.5 (37, 56) 27 (21, 32) 33 (26, 39) 53 (48, 58) 4 (4, 5)
0.007 0.36 0.047 0.15 0.02 0.9
45 (27, 65) 40 (30, 50) 21 (15.4, 29) 27 (19, 34) 51 (46, 56) 4 (4, 5)
0.0001 0.0001 ⬍0.0001 ⬍0.0001 ⬍0.0001 0.30
VCL: curvilinear velocity (m/s), VSL: straight-line velocity (m/s), VAP: average path velocity (m/s), LIN: linearity (%), ALH: amplitude of lateral head displacement (m). Conclusions: Significant differences were seen between patient and donor groups for all motion kinetic parameters except ALH. These cutoffs as estimated from donors adds precision to the routine semen analysis and can be a reliable predictor of fertility. Low values of VCL and LIN in patients with normal semen parameters (WHO reference range) in our study may be one of the reasons affecting their fertility. Sperm motion kinetic parameters obtained by CASA provide important information not given by routine semen analysis which may assist in an accurate evaluation of fertility. Supported by: A grant from the Cleveland Clinic Foundation. P-443 Gonadotropin releasing hormone (GnRH) stimulation test may predict pregnancy outcome after microsurgical varicocelectomy. M. A. Fischer, K. Khamel, K. Jarvi, A. Zini. Div of Urology, Mount Sinai Hosp, Toronto, ON, Canada.
P-442 Sperm motion kinetics: A new perspective in evaluating infertility. P. Ranganathan, L. Moyett, D. R. Nelson, A. Agarwal. The Cleveland Clinic Foundation, Cleveland, OH. Objective: Semen analysis is an indispensable tool in evaluating and treating infertility. Computer assisted semen analysis (CASA) is used frequently in most andrology laboratories. In addition to sperm concentration and motility, CASA provides information on sperm motion kinetics. Clinicians and urologists under utilize the motion kinetic values to evaluate and treat male infertility. This is due to the lack of standard cut-off values and reference ranges for motion kinetic parameters. We examined the sperm motion kinetics in patients evaluated for semen analysis to determine the 1) variations and trends in motion kinetics in patients, 2) compare their values to a group of healthy donors, and 3) establish cut-off values and reference ranges for these parameters. Design: Review of motion kinetic parameters in 507 patients and 16 donors (61 readings) who had their semen analyzed at our laboratory during 2000. Materials/Methods: Semen analysis was done on a CASA (HamiltonThorne Research, Beverly, MA; IVOS-version 10.9i). Results of sperm concentration and motility obtained by CASA were manually verified. Sperm motion characteristics: motility, curvilinear velocity (VCL), average path velocity (VAP), straight line velocity (VSL), linearity (LIN), and amplitude of lateral head movement (ALH) were analyzed and compared within patient groups [normal (n ⫽ 82), and abnormal semen parameters (n ⫽ 425)] and to donors (n ⫽ 16). Results: Patients with abnormal semen parameters had significantly lower motion kinetics compared to patients with normal semen parameters (P ⬍ 0.0001). Sperm motion kinetic cutoffs values of VCL ⬍ 32.6, VSL ⬍ 18.6, VAP ⬍ 23.5, LIN ⬍ 45, were arrived at using the tenth percentile values from donors. No cutoff to discriminate for ALH was found. When these cutoff values were applied to patient and donor groups (excluding ALH), 13.6% of donors and 65.4% of patients fell below cut off values for at least one of the four parameters. Even among oligoteratospermic patients (50% motility), 51% were below at least one of the four cutoffs, and over 40% were below the VCL, VSL, and VAP cutoffs.
FERTILITY & STERILITY威
Objective: Varicocoelectomy can improve sperm quality in up to 80% of treated patients. Unfortunately, there are no reliable factors that are predictive of successful variocoelectomy. This study is to examine the potential predictive value of a GnRH stimulation test in infertile men undergoing microsurgical varicocelectomy. Design: Retrospective chart review. Materials/Methods: The records of 49 infertile couples in which the man underwent microsurgical varicocelectomy between September 1998 and June 2000 were evaluated retrospectively. All of these men underwent a GnRH stimulation test before their surgery. Data on semen parameters, pregnancy rates and FSH response to GnRH stimulation were recorded. Results: Post-operative sperm concentration increased significantly compared to pre-varicocelectomy (18.6 ⫾ 6.8 vs. 26.1 ⫾ 26.0 ⫻ 106 per mL, P ⬍ .05). Overall, 37% (18/49) of the couples achieved a spontaneous pregnancy at a mean of 16 months follow-up (range 12–20 months). In our study population, the median FSH rise at 120 minutes following GnRH administration was 1.5⫻ baseline (range 1.1 to 5.0⫻). We observed a higher pregnancy rate in couples in which the man’s FSH response to GnRH stimulation was greater than 1.5⫻ compared to those in whom the FSH response was less than 1.5⫻ (45 vs. 9%, respectively, P ⫽ 0.08). Conclusions: Our data suggest that in couples in which the man undergoes varicocelectomy for treatment of varicocele, the FSH response to GnRH stimulation may be predictive of unassisted pregnancy outcome in this population. Additional studies are needed to validate these initial results. Supported by: Kidney Foundation of Canada/Fondation Canadienne Du Rein, Medical Research Council of Canada. P-444 Expression of aryl hydrocarbon receptor (AHR) and aryl hydrocarbon receptor nuclear translocator (ARNT) messenger ribonucleic acid in human spermatozoa. O. A. Khorram, M. Garthwaite, T. Golos, J. Jones. Harbor-UCLA Medical Ctr, Torrance, CA; Univ of Wisconsin, Madison, WI. Objective: Several studies have reported a decline in sperm quality worldwide. This has been attributed to exposure to toxins such as dioxin in
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Comparison of sperm motion kinetic values [median and interquartile (25%, 75%)] between donors and patients. Patients—Normal Patients—Abnormal Donors semen parameters P semen parameters P Variables (n ⫽ 16) (n ⫽ 82) Value (n ⫽ 425) Value Motility VCL VSL VAP LIN ALH
82 (70, 88) 48 (41, 56) 29 (24, 36) 35 (29, 41) 56 (51, 59) 4 (4, 5)
73 (63, 83) 46.5 (37, 56) 27 (21, 32) 33 (26, 39) 53 (48, 58) 4 (4, 5)
0.007 0.36 0.047 0.15 0.02 0.9
45 (27, 65) 40 (30, 50) 21 (15.4, 29) 27 (19, 34) 51 (46, 56) 4 (4, 5)
0.0001 0.0001 ⬍0.0001 ⬍0.0001 ⬍0.0001 0.30
VCL: curvilinear velocity (m/s), VSL: straight-line velocity (m/s), VAP: average path velocity (m/s), LIN: linearity (%), ALH: amplitude of lateral head displacement (m). Conclusions: Significant differences were seen between patient and donor groups for all motion kinetic parameters except ALH. These cutoffs as estimated from donors adds precision to the routine semen analysis and can be a reliable predictor of fertility. Low values of VCL and LIN in patients with normal semen parameters (WHO reference range) in our study may be one of the reasons affecting their fertility. Sperm motion kinetic parameters obtained by CASA provide important information not given by routine semen analysis which may assist in an accurate evaluation of fertility. Supported by: A grant from the Cleveland Clinic Foundation. P-443 Gonadotropin releasing hormone (GnRH) stimulation test may predict pregnancy outcome after microsurgical varicocelectomy. M. A. Fischer, K. Khamel, K. Jarvi, A. Zini. Div of Urology, Mount Sinai Hosp, Toronto, ON, Canada.
P-442 Sperm motion kinetics: A new perspective in evaluating infertility. P. Ranganathan, L. Moyett, D. R. Nelson, A. Agarwal. The Cleveland Clinic Foundation, Cleveland, OH. Objective: Semen analysis is an indispensable tool in evaluating and treating infertility. Computer assisted semen analysis (CASA) is used frequently in most andrology laboratories. In addition to sperm concentration and motility, CASA provides information on sperm motion kinetics. Clinicians and urologists under utilize the motion kinetic values to evaluate and treat male infertility. This is due to the lack of standard cut-off values and reference ranges for motion kinetic parameters. We examined the sperm motion kinetics in patients evaluated for semen analysis to determine the 1) variations and trends in motion kinetics in patients, 2) compare their values to a group of healthy donors, and 3) establish cut-off values and reference ranges for these parameters. Design: Review of motion kinetic parameters in 507 patients and 16 donors (61 readings) who had their semen analyzed at our laboratory during 2000. Materials/Methods: Semen analysis was done on a CASA (HamiltonThorne Research, Beverly, MA; IVOS-version 10.9i). Results of sperm concentration and motility obtained by CASA were manually verified. Sperm motion characteristics: motility, curvilinear velocity (VCL), average path velocity (VAP), straight line velocity (VSL), linearity (LIN), and amplitude of lateral head movement (ALH) were analyzed and compared within patient groups [normal (n ⫽ 82), and abnormal semen parameters (n ⫽ 425)] and to donors (n ⫽ 16). Results: Patients with abnormal semen parameters had significantly lower motion kinetics compared to patients with normal semen parameters (P ⬍ 0.0001). Sperm motion kinetic cutoffs values of VCL ⬍ 32.6, VSL ⬍ 18.6, VAP ⬍ 23.5, LIN ⬍ 45, were arrived at using the tenth percentile values from donors. No cutoff to discriminate for ALH was found. When these cutoff values were applied to patient and donor groups (excluding ALH), 13.6% of donors and 65.4% of patients fell below cut off values for at least one of the four parameters. Even among oligoteratospermic patients (50% motility), 51% were below at least one of the four cutoffs, and over 40% were below the VCL, VSL, and VAP cutoffs.
FERTILITY & STERILITY威
Objective: Varicocoelectomy can improve sperm quality in up to 80% of treated patients. Unfortunately, there are no reliable factors that are predictive of successful variocoelectomy. This study is to examine the potential predictive value of a GnRH stimulation test in infertile men undergoing microsurgical varicocelectomy. Design: Retrospective chart review. Materials/Methods: The records of 49 infertile couples in which the man underwent microsurgical varicocelectomy between September 1998 and June 2000 were evaluated retrospectively. All of these men underwent a GnRH stimulation test before their surgery. Data on semen parameters, pregnancy rates and FSH response to GnRH stimulation were recorded. Results: Post-operative sperm concentration increased significantly compared to pre-varicocelectomy (18.6 ⫾ 6.8 vs. 26.1 ⫾ 26.0 ⫻ 106 per mL, P ⬍ .05). Overall, 37% (18/49) of the couples achieved a spontaneous pregnancy at a mean of 16 months follow-up (range 12–20 months). In our study population, the median FSH rise at 120 minutes following GnRH administration was 1.5⫻ baseline (range 1.1 to 5.0⫻). We observed a higher pregnancy rate in couples in which the man’s FSH response to GnRH stimulation was greater than 1.5⫻ compared to those in whom the FSH response was less than 1.5⫻ (45 vs. 9%, respectively, P ⫽ 0.08). Conclusions: Our data suggest that in couples in which the man undergoes varicocelectomy for treatment of varicocele, the FSH response to GnRH stimulation may be predictive of unassisted pregnancy outcome in this population. Additional studies are needed to validate these initial results. Supported by: Kidney Foundation of Canada/Fondation Canadienne Du Rein, Medical Research Council of Canada. P-444 Expression of aryl hydrocarbon receptor (AHR) and aryl hydrocarbon receptor nuclear translocator (ARNT) messenger ribonucleic acid in human spermatozoa. O. A. Khorram, M. Garthwaite, T. Golos, J. Jones. Harbor-UCLA Medical Ctr, Torrance, CA; Univ of Wisconsin, Madison, WI. Objective: Several studies have reported a decline in sperm quality worldwide. This has been attributed to exposure to toxins such as dioxin in
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