The study aim is to evaluate the predictive rate of positive sperm retrieval of serum concentration of follicle-stimulating hormone (FSH), luteinizing hormone (LH), and testosterone (TT) in azoospermic patients presenting to High Institute of infertility diagnosis and assisted reproductive technologies. The study records of 65 azoospermic men with who underwent open testicular sperm extraction between February 2017 to April 2019 were studied. The patient’s age, hormonal profile for FSH, LH and TT and testicular histopathology were recorded. The sperm retrieval rate according to histological findings norm-spermatogenesis (NS), hypo-spermatogenesis (HS), maturation arrest (MA) and Sertoli cell-only syndrome (SCOS) were recorded as follows: 100%, 75%, 44.4%, and 28.6% respectively. The cutoff value of FSH was (≤ 14.56 mIU/L) with an accuracy level of 73.0%, a sensitivity (66.7 %) and a specificity (79.3 %). The cutoff value of the serum level of LH was (≤ 9.37 mIU/L) with an accuracy level of 78.4%, a sensitivity level of 77.7 % and a specificity level of 72.4 %.
For conception and the development of healthy embryos, sperm DNA integrity is crucial. According to a growing body of studies, there is a strong correlation between sperm DNA damage and male infertility. Among the new medicines being developed in the medical field, the application of Platelet Rich Plasma (PRP) in human reproduction has yet to be examined. A total of 100 semen samples were used in the current experimental investigation. From November 2020 to June 2021, the research was conducted at the High Institute for Infertility Diagnosis and Assisted Reproductive Technologies. Masturbation was used to get an ejaculated semen sample. After semen analysis, the samples were separated into two equal parts, one without autologous PRP and the other with 2% autologous PRP, with the DNA fragmentation assessed using the Sperm Chromatin Dispersion Test. There was highly significant reduction in DNA fragmentation index (p < 0.001). The mean sperm DNA integrity was reduced after adding PRP (33.85±16.73 vs 38.55±16.64), Mean (± SE). PRP has been shown to improve human sperm DNA integrity.
Background: Male obesity is associated with physiological changes that can negatively affect male fertility. Obese men have demonstrated a 3-fold increase in the prevalence of oligozoospermia when compared with men with normal Body Mass Index (BMI). Objective: To estimate the role of aromatase enzyme in decreasing sperm parameters in obese infertile men. Subjects, Materials and Methods: Seventy obese infertile male (patients) and twenty obese fertile male (control) are enrolled in this study. Seminal fluid analysis done according to criteria of WHO (2010). Results: A significant negative correlation was found between human cytochrome enzyme and sperm concentration, progressively motile sperm, non-progressively motile sperm, immotile sperm and normal morphology. Conclusion: The present study showed clearly that male obesity negatively impacts fertility through direct association between increased (BMI) and semen parameters. The results suggest that increased estrogen as a result of aromatization in the fatty tissue, reflected through the increase in human cytochrome enzyme (aromatase), may be an important mechanism for the hypoandrogenemia and altered sperm parameters.
The purpose of the study was to determine if age and body mass index in infertile men were associated with stress levels as determined by salivary stress biomarkers (cortisol and alpha-amylase). A cross-sectional study comprising 100 males with an infertility challenge was divided into 25 normozoospermia, 26 oligozoospermia, 21 asthenozoospermia, and 28 oligoasthenoteratozoospermia. Salivary cortisol and alpha-amylase were examined using the ELISA technique . The average age of the patient was 30.85±7.03, and their average BMI was 27.604±5. 7894. The infertile duration mean was 4.7896±3. 85932. The average amylase content in the saliva was 127.3721±40.0952, while the average cortisol content was 72.67±49.09. There are no discernible variations between the comparison mean of BMI and the duration of infertility. In the current investigation, there was no discernible relationship between SAA and age, BMI, or the length of infertility. Saliva cortisol and BMI in the oligoasthenoteratozoospermia group showed a substantial negative correlation (r = 0.483 & p = 0.009), although no significant link was seen with age, BMI, or length of infertility in the other study groups. There was no significant positive or negative correlation found between SAA level and the age and BMI of the four study groups, whereas salivary cortisol showed a substantial negative correlation with BMI in OAT and a non-significant correlation with age.
Hyaluronic acid (HA) is a polysaccharide, that composed in the extracellular matrix of the cumulus cells, and considered to take function in choosing mature spermatozoa. The Sperm-hyaluronic binding assay (HBA) is significant diagnostic instrument for suspected male infertility when examining the semen. The HBA slide supplies the ratio of mature binding sperm in the specimen. To evaluate sperm parameters, and to evaluate the (HBA Score percentage (%) before and after activation. Twenty-five infertile couples a sharer in this current study through their attendance to the Al Nahrain University. Males undergoing seminal fluid analysis were done according to (WHO 2010, and WHO 1999). Sperm parameters assessed and calculate the HBA Score% pre-and-post-direct swim-up technique, the results were statistically tested. In Post-activation there was considerable increment noticed in the progressive motility and morphology of spermatozoa, likewise significant improvement in the (HBA score %). Furthermore, considerable reduction in the concentration, agglutination of spermatozoa and round cells count, when compared to pre-activation. The mean of binding of spermatozoa to hyaluronan pre-activation (direct swim-up technique) was less than normal limit for normozoospermic males. However, it significantly improves post-activation.
Many men have reported erectile dysfunction as a consequence of COVID-19 infection. The underlying causes, whether related to hormonal changes or endothelial dysfunction, are not yet fully understood. This study aims to investigate the impact of COVID-19 on male sexual function and fertility, specifically focusing on erectile dysfunction. A cohort of 50 males who had no prior history of erectile dysfunction before contracting COVID-19 was assessed. The study analyzes the progression of these conditions over a 90-day period post-recovery from COVID-19, with a particular emphasis on age-related factors. All males were confirmed infected with COVID-19. Comprehensive medical histories were obtained from all participants, and physical examinations were conducted. The International Index of Erectile Function (IIEF-5) questionnaire was employed to assess erectile dysfunction. Assessments were performed at three separate intervals, 30, 60, and 90 days after their recovery from COVID-19. Participants consistently reported varying degrees of erectile dysfunction, which appeared to improve over time. Notably, the participants who reported erectile dysfunction tended to be older than those who did not, and this age-based distinction was highly significant (p = 0.004). In conclusion, this study highlights the impact of COVID-19 infection on male sexual function, with age and the time post-recovery emerging as significant factors contributing to these effects.
Intratesticular testosterone plays a crucial role in male reproductive function and overall health. Body Mass Index (BMI) and smoking are known lifestyle factors that can influence hormonal balances. Elevated BMI has been associated with alterations in testosterone levels, impacting male fertility and endocrine function. The aim was to examine the concurrent relationships between intratesticular testosterone, BMI, and smoking habits. Biopsies of the testicles were taken from 32 patients with non-obstructive azoospermia. Testicular sperm extraction (TESE) under spinal or general anesthesia was performed after a comprehensive history, physical examination, and investigations. After performing a minced biopsy and centrifuging the fluid, testicular fluid was extracted. The highest intratesticular testosterone levels were in normal patients and lowest levels in over weight patient; on the contrary the highest serum 17-hydroxyprogesterone levels were found in over weight patient and lowest levels in normal weight patients; There were insignificantly higher both intratesticular testosterone and 17-hydroxyprogesterone levels in non-smokers. In conclusion, the statistical analysis revealed that there is an insignificantly low correlation between intratesticular testosterone levels, BMI, and smoking.
Background : inflammasome protein govern the inflammatory process. The ele vation of NLRP3 inflammasome might be related to bad seminal fluid analysis results. Objectives: This study aimed to evaluate seminal plasma NLRP3 protein and its relation with seminal fluid analysis parameters before and after in vitro sperm activation. Patients and Methods: a total of 50 infertile patients were collected form higher institute of infertility diagnosis and assisted reproductive technique, there se men samples were processed for seminal fluid analysis before and after in vitro sperm activation. NLRP3 inflammasome protein were measured in seminal plas ma. Results: the mean level of NLRP3 protein was 5.12 ng/ml. the higher level of NLRP3 protein (4.5ng/ml) associated with lower sperm concentration, grade A, B, C and higher level of grade D motility. However, 50% of those patients have an improvement in their seminal fluid analysis after in vitro sperm activation. Conclusion: Elevation of NLRP3 protein in seminal plasma may be associated with the increased leukocytospermia, bad sperm quality and unresponsiveness to in vitro sperm activation among infertile male.
Swim up is the most popular technique of sperm preparation, in which sperm is selected on motility and ability to swim out the plasma of the semen. The goal of this research is to compare the influence of adding platelet rich plasma (PRP) and phosphate buffer saline in semen prepared by swim – up technique. This research included 119 semen sample evaluated according to sperms parameters stated in WHO and divided into 2 groups. The first group treated with equal quantity of phosphate buffer saline (250) μm contain 10% human serum albumin (HSA) while second group treated with equal quantity of phosphate buffer saline (250) μm contain 10% human serum albumin (HSA) and 2% platelet rich plasma. The samples are prepared by swim – up method. Applying swim up technique using-PBS+PRP (HAS) medium resulted in highest sperm parameters in a highly significant manner (p < 0.001). The values were far better in Swim -up PBS (HAS) with added 2% PRP than those produced by swim up –PBS (HAS) alone. The statistical analysis shows that the variations between Swim up-PBS (HAS) with addition 2% PRP media and swim -up PBS (HAS) were highly significant.
Azoospermic patients have the option of undergoing in vitro fertilization procedures, specifically intracytoplasmic sperm injection (ICSI), for which sperm is retrieved from the patient's own testicles and then injected directly into the oocyte. The aim of the study: evaluate the role of repeated sperm extraction by enzymatic and mechanical mincing techniques in azoospemic patients. A total of 32 males with non-obstructive azoospermia participated in the research. Testicular sperm extraction (TESE) was performed under spinal or general anesthesia after a comprehensive history, physical examination, and investigations. After that, the biopsies underwent through a series of mincing processes, both mechanical and enzymatic. Patients gave information including age, body mass index and previous biopsy attempts. In both enzymatic and mechanical methods there was no significant higher sperm recovery in patients with history of previous testicular biopsies (66.7% vs. 38.5%; p=0.209) and (66.7% vs. 30.8%; p=0.102) respectively. Patients who had undergone prior testicular biopsies had marginally higher sperm recovery rates using both enzymatic and mechanical techniques
Background:Defects in reproduction that may involve both the male & female partners result in the inability to procreate which is known as infertility. The use of assisted reproductive technologies (ART’s) has been increasing over the past three decades. Many efforts have been done to compensate for unsatisfac-tory results in in-vitro fertilization (IVF) procedures, so that patients undergo different ovarian stimulation protocols to control retrieval of multiple oocytes in a single cycle. Although ovarian stimulation has an important role in ART’s, it may also have detrimental effects on oocyte quality, embryo quality, and IVF outcomes. Objectives: To assess the effect of long agonist versus antagonist protocols on oocyte and embryo quality in IVF-Intracytoplasmic sperm injection (ICSI). Patients,Materials and Methods: This comparative study was done on the embryos of seventy one infertile fe-males who were undergoing Intracytoplasmic sperm injection (ICSI) treatment regardless to the presence or absence of previous trials. These patients were divided into two groups, 45 of them treated with agonist protocol and other 26 patients treated with antagonist protocol. First oocyte retrieved was used for further assessment. Of the 71 oocytes, there were eight immature oocytes (3 at germinal vesicle (GV) stage, 5 at metaphase I (MI) stage) and three abnormal oocytes, and these were excluded from the following ICSI treatment. Assessment and comparison of oocyte maturity, fertilization rate, cleavage rate and resulting embryo quality were done. Results:The results of the present study showed significant difference (p<0.05) in oocyte number and maturity but no significant (p>0.05) difference between the group treated with long agonist and those on antagonist protocol regarding fertilization rate, cleavage rate, and embryo quality. Conclusions:The type of protocol used in in-vitro fertilization has no detrimen-tal effect on oocyte or embryo quality.
Oligoasthenoteratozoospermia is a prevalent cause of male infertility. (iOAT). It is generally acknowledged that, due to the fact that spermatogenesis is a sex-hormone-dependent process, specific endocrine treatments might enhance or recover male fertility. The typical negative feedback of sex steroids is disrupted by anti-estrogen medication, leading to a rise in endogenous gonadotropin-releasing hormone secretion (FSH and LH) straight from the pituitary. The stimulation of Leydig cells in the testes by FSH and LH is thought to promote local testosterone synthesis, which in turn may improve spermatogenesis. The study sample consisted of 42 iOAT patients. Baseline seminal fluid analysis (SFA) and hormonal assessment (FSH, LH, prolactin, and testosterone) were taken. Each patient was given medical treatment with tamoxifen (20 mg/day) for three months. SFA, FSH, and testosterone were taken after three months. There was a significant increase in FSH, testosterone, sperm concentration, and progressive motility after treatment (p value <0.001), furthermore, there was no significant correlation between hormonal changes and changes in SFA study markers (p value > 0,05). Improvements in hormone levels following tamoxifen treatment for patients with idiopathic oligoasthenoteratospermia do not correlate with alterations in SFA markers.
One-half of the genome is delivered by the sperm, and a healthy sperm is needed for fertilization, fetal development, and child wellbeing. Abnormal sperm DNA can impact any of these processes. The measurement of sperm DNA fragmentation has been added to some medical andrology laboratories as a crucial addition to the standard analysis of the semen. Sperm DNA fragmentation has also been linked to male infertility including idiopathic male infertility. Some degree of controlled DNA nicking is essential for adequate DNA compaction, but excessive sperm DNA fragmentation is usually associated with reduced male fertility potential, reduced fertilization, poor embryo quality, recurrent pregnancy loss and poor assisted reproductive techniques outcomes. Semen samples from 50 infertile males (as 19 asthenozoospermia, 7 oligozoospermia, 13 normospermia and 11 combined defects) were analyzed for sperm DNA fragmentation. This study followed the World Health Organization 2010 guidelines to assess the sperm parameters. Sample were collected by masturbation and put in a 37 °C incubator to be liquefied, then they were placed in a centrifuge (3000 rpm for 10 min) to extract the pellet, which was used for assessment of DFI% by anillin blue staining. Negative significant correlation (p = 0.023) between morphologically normal sperms and DFI % was found in normozoospermia group. The objective of this study is to examine the correlation of DFI among different seminal fluid categories (normozoospermia, oligozoospermia, asthenozoospermia and, combined).
Background: it is important to study a history of the science to appreciate the past as a motive for hard work in the present for better future. In the other hand, the factors affecting pregnancy rate of frozen embryos are yet to be clarified at different embryonic developmental stages. Objectives: to record a brief history of embryo cryopreservation in Iraq and to study many clinical and embryological factors that might affect the pregnancy rate. Subjects, materials and Method: a cross-sectional study of many clinical and em-bryological variable, where120 frozen-thawed embryo transfer cycles enrolled in the study at the period from January 2017 till July 2018. The variables were sta-tistically analyzed first by one factor analysis comparing between pregnant and non-pregnant cases; then by multivariate logistic regression analysis to illustrate main factors without a possible confounder effect. Results: In one factor analysis, the following variables showed a significantly high effect on pregnancy rate (P value <0.001) which are women’s age, women’s weight, number of retrieved oocytes, mature oocytes and good quality embryos, developmental stage, E2 level, and endometrial thickness. While in multivariate logistic regression analysis the women’s weight, the number of retrieved oocytes and good quality embryos were the main factors. Conclusions: it is judiciously to consider these factors while managing infertile couples with embryo cryopreservation programs especially the modifiable fac-tors.
Stem cell factor (SCF) is one of the first growth factors derived from granulosa cells in the ovarian follicle plays a critical role in hematopoiesis and the generation of melanocytes and germ cells. SCF also serves an important role in the development of the interstitial cells of Cajal in the intestine and the learning functions in the hippocampal region of the brain. This study aimed to investigate the levels of SCF in follicular fluid (FF) and if it can be used as a potential marker for predicting oocyte, embryo quality, and pregnancy rate. A total of 44 infertile couples involved in the study. All of them underwent controlled ovarian hyperstimulation for the ICSI cycle. Antagonist protocol was used as an ovulation induction protocol. Patients were divided into two groups according to ICSI outcomes as pregnant (23 women) and non-pregnant (21 women) groups. A comparison was done in both groups based on the oocyte, embryo quality, and other ICSI cycle characteristics, and follicular fluid stem cell factor level. SCF level was measured by using an enzyme-linked immunosorbent assay. Our study showed lack of association between patients' characteristics which included (age, BMI, infertility duration, type of infertility, and causes of infertility, basal hormonal, stimulation characteristics levels), FF SCF level and the oocyte characteristics comparison (total number retrieved oocyte, germinal vesicle oocyte (GV), MI oocyte and MII oocytes, and the number of injected oocytes, fertilization rate, and embryo characteristics) between pregnant and non-pregnant groups. The present study showed that Mean follicular fluid SCF was significantly lower in pregnant women in comparison with that of non-pregnant women, 135.92±38.96 pg/ml versus 185.15±63.58 pg/ml, respectively (P=0.003). Raised SCF level in FF harms ICSI outcome.
For couples with a variety of male factor disorders, intracytoplasmic sperm injection has made pregnancy and motherhood possible. Two hundred-one males who had non-obstructive azoospermia or severe oligospermia were included in this study. One hundred forty trials of ICSI were done by using fresh sperms (fresh group n=140), while 61 trials of ICSI were done by using cryopreserved sperms (cryopreserved group n=61) to compare the conception rates between fresh and cryopreserved sperms used in intracytoplasmic sperm injection (ICSI). Twenty-five samples from each group were collected by doing a testicular biopsy. Pregnancy rates were higher using cryopreserved sperms as compared to fresh spermatozoa, 39.3% compared to 24.3% in the fresh group ( P .030), respectively. Binary logistic regression analysis showed that the odds ratio of achieving pregnancy with cryopreserved sperms was 2.022 higher than with fresh ( P .030). Cryopreservation has no negative effect on the pregnancy rate. Instead, it might improve the results of ICSI in comparison with a fresh sperm sample.
Background: Male obesity is associated with physiological changes that can negatively affect male fertility. Obese men have demonstrated a 3-fold increase in the prevalence of oligozoospermia when compared with men with normal Body Mass Index (BMI). Objective: To find the correlation between Aromatase enzyme with the following hormones (follicle stimulating hormone(FSH), Luteinizing hormone(LH), Estradiol(E2), and testosterone) in the obese infertile male. Subjects, Materials and Methods: Seventy obese infertile male (patients) and twenty obese fertile male (control) are enrolled in this study. Aromatase enzyme, FSH, LH, E2 and testosterone hormones were measured in their serum. All serum samples were measured by ELISA method. Results: Median human cytochrome enzyme level was significantly higher in patients than in control group, 87.55+ 12.48 pg./ml versus 56.95+9.88 pg./ml, P= 0.014. In patients group, a significant positive correlation was found between human cytochrome enzyme, FSH, and LH. Conclusions: The present study showed clearly that male obesity negatively affects fertility through changes in hormone levels. The results suggest that increased estrogen because of aromatization in the fatty tissue, reflected through the increase in human cytochrome enzyme (aromatase), may be an important mechanism for the hypoandrogenemia and altered sperm parameters.
Gonadotropin-releasing hormone antagonists are one of the GnRH analogs that were used in assisted reproductive technologies to produce prompt downregulation of pituitary gonadotropin secretion. During conventional antagonist protocol (CAP), exposure to high LH and E 2 occur that have the potential to worse clinical reproductive results. So the downregulation of pituitary secretion for short period during early follicular phase will result in synchrony in follicular developments and this will improve mature oocytes and total embryos numbers. 44 women as normal responders undergoing ICSI-ET cycles were randomized into two groups. The conventional group (CG) (n 30), gonadotropin started from menstrual cycle day 2 or 3 and continue until hCG trigger day, flexible protocol in which GnRH antagonists administered with follicular size (13-14 mm). In the sandwich group (SG) (n 14), a GnRH antagonist was administered for three days in which GnRH antagonists administered with follicular size (13-14 mm). Gonadotropin started from menstrual cycle day 3 and continue until hCG trigger day. Retrieved and MII oocyte mean numbers were significantly higher in SG than in CG ( P = 0.006, and 0.025), respectively. Embryos and frozen embryos mean total numbers were significantly higher in SG than in CG ( P = 0.004). SG patients have a higher pregnancy rate of 9/14 (64.3 %) than CG 12/30 (40.0 %) although not significant ( P =0.057). Early and short GnRH antagonists proved improvements in synchronization of follicular development, retrieved mature oocytes numbers, total embryos, frozen embryos, and pregnancy rates.
Non-obstructive azoospermia (NOA) is the absence of sperm in infertile men ejaculate as a result of significant spermatogenesis defects or hormonal malfunction. PRP intratesticular injection may be employed in assisted reproductive technology as a therapeutic effect for this problem. The aim is to assess the level of spermatogenesis and reproductive hormones after PRP autologous intratesticular injection. 50 non-abstructive azoospermia infertile men participated in the current study. The patients were given an intra-testicular injection of platelet-rich plasma using a 1 ml syringe; FSH LH hormonal levels were estimated; if there was no sperm count, the patient should be prepared for a testicular biopsy by the expert doctor. Small number of sperm may be discovered during a biopsy while the testes are being examined in the lab. The therapeutic benefits were seen in 15 patients 3-4 months after using autologous platelet-rich plasma. The results showed that there was a highly significant difference in FSH and LH hormonal levels after PRP injection P(0.001). PRP can help non-obstructive azoospermic infertile males with their testis' structural and functional dysfunction.
Background: Azoospermia is defined as the lack of sperm in male ejaculate and is suggested to be present in about 1 % of all males and to account for 10-15% of the causes of infertility in men. The development of intracytoplasmic sperm injection (ICSI) as an effective therapy. Embryo grading has gained special attention in published literature regarding its predictive role in pregnancy outcome following ICSI; however, substantial controversy is present that justified the carrying out of the present study. Objective: To study the association between embryo quality and pregnancy rate in women of males with azoospermia. Patients,Materials and Methods: This prospective cohort study included 60 patients with azoospermia, 15 male with obstructive type and 45 males with non-obstructive type.Those patients were randomly selected form the population of infertile couples who regularly visits the High Institute for Infertility Diagnosis and Assisted Reproductive Technologies and from Kamal Al-Samarrai Hospital -Center for Infertility Treatment and IVF. Results Pregnancy was encountered in 7 patients (23.33%). It was not statistically associated with type of azoospermia (P=0.388), also it was not affected by age and serum hormonal level, but highly determined by good quality of embryo. Quality of embryo was graded from 1 to 4. The lower the grade, the better the quality of the embryo was. Quality of embryo was not significantly correlated with type of azoospermia, age and hormonal levels. Conclusions Good quality of embryo is a significant predictor of positive pregnancy outcome in ICSI and the quality of embryo is not affected by age of male patient or type of azoospermia.