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Diagnostic Tests in the Evaluation of Male Infertility

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Andrological Evaluation of Male Infertility

Abstract

Semen analysis remains the most important initial diagnostic tool in the evaluation of male fertility. It not only provides valuable information for creating a management strategy, it also offers insight into the patient’s overall prognosis. However, semen analysis leaves the clinician on many occasions with unanswered questions. For this reason, efforts were made to help establish new diagnostic modalities capable of addressing specific queries. Sperm viability, genetic function, and fertilizing ability can be assessed with viability studies, sperm DNA fragmentation, and acrosome reaction, respectively. In this chapter, we aim to present a practical guide on different diagnostic modalities used in the evaluation of male infertility.

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References

  1. Karamanou M, Poulakou-Rebelakou E, Tzetis M, Androutsos G. Anton van Leeuwenhoek (1632-1723): father of micromorphology and discoverer of spermatozoa. Rev Argent Microbiol. 2010;42(4):311–4.

    CAS  PubMed  Google Scholar 

  2. Cooper TG, Noonan E, von Eckardstein S, Auger J, Baker HW, Behre HM, et al. World Health Organization reference values for human semen characteristics. Hum Reprod Update. 2010;16(3):231–45.

    Article  PubMed  Google Scholar 

  3. Devroey P, Van Steirteghem A. A review of ten years experience of ICSI. Hum Reprod Update. 2004;10(1):19–28.

    Article  CAS  PubMed  Google Scholar 

  4. Nagy ZP, Liu J, Joris H, Verheyen G, Tournaye H, Camus M, et al. The result of intracytoplasmic sperm injection is not related to any of the three basic sperm parameters. Hum Reprod. 1995;10(5):1123–9.

    CAS  PubMed  Google Scholar 

  5. Nallella KP, Sharma RK, Aziz N, Agarwal A. Significance of sperm characteristics in the evaluation of male infertility. Fertil Steril. 2006;85(3):629–34.

    Article  PubMed  Google Scholar 

  6. The optimal evaluation of the infertile male: AUA best practice statement. [Internet]. American Urological Association, Inc. 2010.

    Google Scholar 

  7. Taha EA, Ezz-Aldin AM, Sayed SK, Ghandour NM, Mostafa T. Smoking influence on sperm vitality, DNA fragmentation, reactive oxygen species and zinc in oligoasthenoteratozoospermic men with varicocele. Andrologia. 2014;46(6):687–91.

    Article  CAS  PubMed  Google Scholar 

  8. Van Thiel DH, Gavaler JS, Lester R, Goodman MD. Alcohol-induced testicular atrophy. An experimental model for hypogonadism occurring in chronic alcoholic men. Gastroenterology. 1975;69(2):326–32.

    PubMed  Google Scholar 

  9. Fronczak CM, Kim ED, Barqawi AB. The insults of illicit drug use on male fertility. J Androl. 2012;33(4):515–28.

    Article  CAS  PubMed  Google Scholar 

  10. Jensen TK, Bonde JP, Joffe M. The influence of occupational exposure on male reproductive function. Occup Med (Lond). 2006;56(8):544–53.

    Article  Google Scholar 

  11. Carlsen E, Petersen JH, Andersson AM, Skakkebaek NE. Effects of ejaculatory frequency and season on variations in semen quality. Fertil Steril. 2004;82(2):358–66.

    Article  PubMed  Google Scholar 

  12. Sunanda P, Panda B, Dash C, Padhy R, Routray P. Effect of age and abstinence on semen quality: a retrospective study in a teaching hospital. Asian Pac J Reprod. 2014;3(2):134–41.

    Article  Google Scholar 

  13. Aziz N. The importance of semen analysis in the context of azoospermia. Clinics. 2013;68 Suppl 1:35–8.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Keel BA. How reliable are results from the semen analysis? Fertil Steril. 2004;82(1):41–4.

    Article  PubMed  Google Scholar 

  15. Cooper TG, Yeung CH. Computer-aided evaluation of assessment of “grade a” spermatozoa by experienced technicians. Fertil Steril. 2006;85(1):220–4.

    Article  PubMed  Google Scholar 

  16. Kruger TF, Acosta AA, Simmons KF, Swanson RJ, Matta JF, Oehninger S. Predictive value of abnormal sperm morphology in in vitro fertilization. Fertil Steril. 1988;49(1):112–7.

    Article  CAS  PubMed  Google Scholar 

  17. Coetzee K, Kruge TF, Lombard CJ. Predictive value of normal sperm morphology: a structured literature review. Hum Reprod Update. 1998;4(1):73–82.

    Article  CAS  PubMed  Google Scholar 

  18. Keegan BR, Barton S, Sanchez X, Berkeley AS, Krey LC, Grifo J. Isolated teratozoospermia does not affect in vitro fertilization outcome and is not an indication for intracytoplasmic sperm injection. Fertil Steril. 2007;88(6):1583–8.

    Article  PubMed  Google Scholar 

  19. Mortimer D. Semen microbiology and virology. Practical laboratory andrology. Oxford: Oxford University Press; 1994. pp. 127–33.

    Google Scholar 

  20. Ricci G, Presani G, Guaschino S, Simeone R, Perticarari S. Leukocyte detection in human semen using flow cytometry. Hum Reprod. 2000;15(6):1329–37.

    Article  CAS  PubMed  Google Scholar 

  21. Krieger JN, Nyberg Jr L, Nickel JC. NIH consensus definition and classification of prostatitis. JAMA. 1999;282(3):236–7.

    Article  CAS  PubMed  Google Scholar 

  22. Villegas J, Schulz M, Vallejos V, Henkel R, Miska W, Sanchez R. Indirect immunofluorescence using monoclonal antibodies for the detection of leukocytospermia: comparison with peroxidase staining. Andrologia. 2002;34(2):69–73.

    Article  CAS  PubMed  Google Scholar 

  23. Collins JA, Crosignani PG. Unexplained infertility: a review of diagnosis, prognosis, treatment efficacy and management. Int J Gynaecol Obstet. 1992;39(4):267–75.

    Article  CAS  PubMed  Google Scholar 

  24. Moghissi KS, Wallach EE. Unexplained infertility. Fertil Steril. 1983;39(1):5–21.

    Article  CAS  PubMed  Google Scholar 

  25. Sigman M, Jarow JP. Endocrine evaluation of infertile men. Urology. 1997;50(5):659–64.

    Article  CAS  PubMed  Google Scholar 

  26. Coppola MA, Klotz KL, Kim KA, Cho HY, Kang J, Shetty J, et al. SpermCheck Fertility, an immunodiagnostic home test that detects normozoospermia and severe oligozoospermia. Hum Reprod. 2010;25(4):853–61.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Ortega C, Verheyen G, Raick D, Camus M, Devroey P, Tournaye H. Absolute asthenozoospermia and ICSI: what are the options? Hum Reprod Update. 2011;17(5):684–92.

    Article  CAS  PubMed  Google Scholar 

  28. Guzick DS, Overstreet JW, Factor-Litvak P, Brazil CK, Nakajima ST, Coutifaris C, et al. Sperm morphology, motility, and concentration in fertile and infertile men. N Engl J Med. 2001;345(19):1388–93.

    Article  CAS  PubMed  Google Scholar 

  29. Ford CE, Jones KW, Miller OJ, Mittwoch U, Penrose LS, Ridler M, et al. The chromosomes in a patient showing both mongolism and the Klinefelter syndrome. Lancet. 1959;1(7075):709–10.

    Article  CAS  PubMed  Google Scholar 

  30. Aitken RJ, Clarkson JS, Fishel S. Generation of reactive oxygen species, lipid peroxidation, and human sperm function. Biol Reprod. 1989;41(1):183–97.

    Article  CAS  PubMed  Google Scholar 

  31. Agarwal A, Sharma RK, Nallella KP, Thomas Jr AJ, Alvarez JG, Sikka SC. Reactive oxygen species as an independent marker of male factor infertility. Fertil Steril. 2006;86(4):878–85.

    Article  CAS  PubMed  Google Scholar 

  32. Alvarez JG, Touchstone JC, Blasco L, Storey BT. Spontaneous lipid peroxidation and production of hydrogen peroxide and superoxide in human spermatozoa. Superoxide dismutase as major enzyme protectant against oxygen toxicity. J Androl. 1987;8(5):338–48.

    Article  CAS  PubMed  Google Scholar 

  33. Agarwal A, Saleh RA. Role of oxidants in male infertility: rationale, significance, and treatment. Urol Clin North Am. 2002;29(4):817–27.

    Article  PubMed  Google Scholar 

  34. Agarwal A, Allamaneni SS, Nallella KP, George AT, Mascha E. Correlation of reactive oxygen species levels with the fertilization rate after in vitro fertilization: a qualified meta-analysis. Fertil Steril. 2005;84(1):228–31.

    Article  CAS  PubMed  Google Scholar 

  35. Agarwal A, Makker K, Sharma R. Clinical relevance of oxidative stress in male factor infertility: an update. Am J Reprod Immunol. 2008;59(1):2–11.

    Article  CAS  PubMed  Google Scholar 

  36. Ghiselli A, Serafini M, Maiani G, Azzini E, Ferro-Luzzi A. A fluorescence-based method for measuring total plasma antioxidant capability. Free Radic Biol Med. 1995;18(1):29–36.

    Article  CAS  PubMed  Google Scholar 

  37. Winston GW, Regoli F, Dugas Jr AJ, Fong JH, Blanchard KA. A rapid gas chromatographic assay for determining oxyradical scavenging capacity of antioxidants and biological fluids. Free Radic Biol Med. 1998;24(3):480–93.

    Article  CAS  PubMed  Google Scholar 

  38. Regoli F, Winston GW. Quantification of total oxidant scavenging capacity of antioxidants for peroxynitrite, peroxyl radicals, and hydroxyl radicals. Toxicol Appl Pharmacol. 1999;156(2):96–105.

    Article  CAS  PubMed  Google Scholar 

  39. Bastos EL, Romoff P, Eckert CR, Baader WJ. Evaluation of antiradical capacity by H2O2-hemin-induced luminol chemiluminescence. J Agric Food Chem. 2003;51(25):7481–8.

    Article  CAS  PubMed  Google Scholar 

  40. Popov IN, Lewin G. Photochemiluminescent detection of antiradical activity: II. Testing of nonenzymic water-soluble antioxidants. Free Radic Biol Med. 1994;17(3):267–71.

    Article  CAS  PubMed  Google Scholar 

  41. Mahfouz R, Sharma R, Sharma D, Sabanegh E, Agarwal A. Diagnostic value of the total antioxidant capacity (TAC) in human seminal plasma. Fertil Steril. 2009;91(3):805–11.

    Article  PubMed  Google Scholar 

  42. Erenpreiss J, Spano M, Erenpreisa J, Bungum M, Giwercman A. Sperm chromatin structure and male fertility: biological and clinical aspects. Asian J Androl. 2006;8(1):11–29.

    Article  CAS  PubMed  Google Scholar 

  43. Evenson DP, Jost LK, Marshall D, Zinaman MJ, Clegg E, Purvis K, et al. Utility of the sperm chromatin structure assay as a diagnostic and prognostic tool in the human fertility clinic. Hum Reprod. 1999;14(4):1039–49.

    Article  CAS  PubMed  Google Scholar 

  44. Lewis SE, John Aitken R, Conner SJ, Iuliis GD, Evenson DP, Henkel R, et al. The impact of sperm DNA damage in assisted conception and beyond: recent advances in diagnosis and treatment. Reprod Biomed Online. 2013;27(4):325–37.

    Article  CAS  PubMed  Google Scholar 

  45. Sun JG, Jurisicova A, Casper RF. Detection of deoxyribonucleic acid fragmentation in human sperm: correlation with fertilization in vitro. Biol Reprod. 1997;56(3):602–7.

    Article  CAS  PubMed  Google Scholar 

  46. Mitchell LA, De Iuliis GN, Aitken RJ. The TUNEL assay consistently underestimates DNA damage in human spermatozoa and is influenced by DNA compaction and cell vitality: development of an improved methodology. Int J Androl. 2011;34(1):2–13.

    Article  CAS  PubMed  Google Scholar 

  47. Singh NP, McCoy MT, Tice RR, Schneider EL. A simple technique for quantitation of low levels of DNA damage in individual cells. Exp Cell Res. 1988;175(1):184–91.

    Article  CAS  PubMed  Google Scholar 

  48. Fernandez JL, Muriel L, Rivero MT, Goyanes V, Vazquez R, Alvarez JG. The sperm chromatin dispersion test: a simple method for the determination of sperm DNA fragmentation. J Androl. 2003;24(1):59–66.

    CAS  PubMed  Google Scholar 

  49. Bungum M, Humaidan P, Spano M, Jepson K, Bungum L, Giwercman A. The predictive value of sperm chromatin structure assay (SCSA) parameters for the outcome of intrauterine insemination, IVF and ICSI. Hum Reprod. 2004;19(6):1401–8.

    Article  CAS  PubMed  Google Scholar 

  50. Zini A, Jamal W, Cowan L, Al-Hathal N. Is sperm DNA damage associated with IVF embryo quality? A systematic review. J Assist Reprod Genet. 2011;28(5):391–7.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Zini A, Boman JM, Belzile E, Ciampi A. Sperm DNA damage is associated with an increased risk of pregnancy loss after IVF and ICSI: systematic review and meta-analysis. Hum Reprod. 2008;23(12):2663–8.

    Article  CAS  PubMed  Google Scholar 

  52. Practice Committee of the American Society for Reproductive Medicine. The clinical utility of sperm DNA integrity testing: a guideline. Fertil Steril. 2013;99(3):673–7.

    Article  Google Scholar 

  53. Abou-Haila A, Tulsiani DR. Mammalian sperm acrosome: formation, contents, and function. Arch Biochem Biophys. 2000;379(2):173–82.

    Article  CAS  PubMed  Google Scholar 

  54. Jamil K, White IG. Induction of acrosomal reaction in sperm with ionophore A23187 and calcium. Arch Androl. 1981;7(4):283–92.

    Article  CAS  PubMed  Google Scholar 

  55. Tesarik J, Mendoza C, Carreras A. Effects of phosphodiesterase inhibitors caffeine and pentoxifylline on spontaneous and stimulus-induced acrosome reactions in human sperm. Fertil Steril. 1992;58(6):1185–90.

    Article  CAS  PubMed  Google Scholar 

  56. Osman RA, Andria ML, Jones AD, Meizel S. Steroid induced exocytosis: the human sperm acrosome reaction. Biochem Biophys Res Commun. 1989;160(2):828–33.

    Article  CAS  PubMed  Google Scholar 

  57. Suarez SS, Wolf DP, Meizel S. Induction of the acrosome reaction in human spermatozoa by a fraction of human follicular fluid. Gamete Res. 1986;14:107.

    Article  Google Scholar 

  58. Sanchez R, Toepfer-Petersen E, Aitken RJ, Schill WB. A new method for evaluation of the acrosome reaction in viable human spermatozoa. Andrologia. 1991;23(3):197–203.

    Article  CAS  PubMed  Google Scholar 

  59. Talbot P, Chacon RS. A triple-stain technique for evaluating normal acrosome reactions of human sperm. J Exp Zool. 1981;215(2):201–8.

    Article  CAS  PubMed  Google Scholar 

  60. Kohn FM, Mack SR, Schill WB, Zaneveld LJ. Detection of human sperm acrosome reaction: comparison between methods using double staining, Pisum sativum agglutinin, concanavalin A and transmission electron microscopy. Hum Reprod. 1997;12(4):714–21.

    Article  CAS  PubMed  Google Scholar 

  61. Lee MA, Trucco GS, Bechtol KB, Wummer N, Kopf GS, Blasco L, et al. Capacitation and acrosome reactions in human spermatozoa monitored by a chlortetracycline fluorescence assay. Fertil Steril. 1987;48(4):649–58.

    Article  CAS  PubMed  Google Scholar 

  62. Talbot P, Chacon RS. A new technique for evaluating normal acrosome reactions of human sperm. J Cell Biol. 1979;83:2089.

    Google Scholar 

  63. Wolf DP, Boldt J, Byrd W, Bechtol KB. Acrosomal status evaluation in human ejaculated sperm with monoclonal antibodies. Biol Reprod. 1985;32(5):1157–62.

    Article  CAS  PubMed  Google Scholar 

  64. Fenichel P, Hsi BL, Farahifar D, Donzeau M, Barrier-Delpech D, Yehy CJ. Evaluation of the human sperm acrosome reaction using a monoclonal antibody, GB24, and fluorescence-activated cell sorter. J Reprod Fertil. 1989;87(2):699–706.

    Article  CAS  PubMed  Google Scholar 

  65. Vasan SS. Semen analysis and sperm function tests: how much to test? Indian J Urol. 2011;27(1):41–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  66. Bachtell NE, Conaghan J, Turek PJ. The relative viability of human spermatozoa from the vas deferens, epididymis and testis before and after cryopreservation. Hum Reprod. 1999;14(12):3048–51.

    Article  CAS  PubMed  Google Scholar 

  67. Jeyendran RS, Van der Ven HH, Perez-Pelaez M, Crabo BG, Zaneveld LJ. Development of an assay to assess the functional integrity of the human sperm membrane and its relationship to other semen characteristics. J Reprod Fertil. 1984;70(1):219–28.

    Article  CAS  PubMed  Google Scholar 

  68. Jager S, Kremer J, van Slochteren-Draaisma T. A simple method of screening for antisperm antibodies in the human male. Detection of spermatozoal surface IgG with the direct mixed antiglobulin reaction carried out on untreated fresh human semen. Int J Fertil. 1978;23(1):12–21.

    CAS  PubMed  Google Scholar 

  69. Bronson R, Cooper G, Rosenfeld D. Sperm antibodies: their role in infertility. Fertil Steril. 1984;42(2):171–83.

    Article  CAS  PubMed  Google Scholar 

  70. Hansen KB, Hjort T. Immunofluorescent studies on human spermatozoa. II. Characterization of spermatozoal antigens and their occurrence in spermatozoa from the male partners of infertile couples. Clin Exp Immunol. 1971;9(1):21–31.

    CAS  PubMed  PubMed Central  Google Scholar 

  71. Zanchetta R, Busolo F, Mastrogiacomo I. The enzyme-linked immunosorbent assay for detection of the antispermatozoal antibodies. Fertil Steril. 1982;38(6):730–4.

    Article  CAS  PubMed  Google Scholar 

  72. Haas Jr GG, Cines DB, Schreiber AD. Immunologic infertility: identification of patients with antisperm antibody. N Engl J Med. 1980;303(13):722–7.

    Article  PubMed  Google Scholar 

  73. Haas Jr GG, Cunningham ME. Identification of antibody-laden sperm by cytofluorometry. Fertil Steril. 1984;42(4):606–13.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Urology, Cleveland Clinic, Cleveland, OH, USA

    Ahmad Majzoub MD & Edmund Sabanegh Jr. MD

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  1. Ahmad Majzoub MD
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  2. Edmund Sabanegh Jr. MD
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Correspondence to Ahmad Majzoub MD .

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Editors and Affiliations

  1. Cleveland Clinic, American Center for Reproductive Medicine, Cleveland, Ohio, USA

    Ashok Agarwal

  2. Cleveland Clinic, American Center for Reproductive Medicine, CLEVELAND, Ohio, USA

    Sajal Gupta

  3. Cleveland Clinic, American Center for Reproductive Medicine, Cleveland, Ohio, USA

    Rakesh Sharma

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Majzoub, A., Sabanegh, E. (2016). Diagnostic Tests in the Evaluation of Male Infertility. In: Agarwal, A., Gupta, S., Sharma, R. (eds) Andrological Evaluation of Male Infertility. Springer, Cham. https://doi.org/10.1007/978-3-319-26797-5_1

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  • DOI: https://doi.org/10.1007/978-3-319-26797-5_1

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