The diagnosis of male adnexitis is difficult and the influence of this condition on fertility is still a matter of debate. With the intention to define diagnostic criteria a comprehensive study of biochemical and morphological features of semen, plus culture for microorganisms, was performed in patients who were assessed for infertility during a four year period. The following parameters were considered of diagnostic value: a) history of urogenital infection and/or abnormal rectal palpation. b) significant alterations in the expressed prostatic fluid and/or urinary sediment after prostatic massage. c) 1. Uniform growth of more than 10(3) pathogenic bacteria, or more than 10(4) non-pathogenic bacteria per ml, in culture of diluted seminal plasma. c) 2. Presence of more than 10(6) (peroxidase positive) leucocytes per ml of ejaculate. c) 3. Signs of disturbed secretory function of the prostate or seminal vesicles. The diagnosis of infection is accepted if either of the following combinations if found: a + b, a + c (1 or 2 or 3), b + c (1 or 2 or 3), c1 + c2, c1 + c3, c2 + c3.
We have retrospectively analysed the sperm characteristics of 416 consecutive healthy young men who presented themselves in the past 19 years as candidate sperm donors. Ejaculate volume increased slightly (P = 0.067), and average sperm concentration decreased (P = 0.035) by 12.4 x 10(6)/ml over the observation period, so that sperm count per ejaculate remained unchanged (P = 0.91). In contrast, sperm morphology (r = - 0.23, P < 0.0001), rapid progressive motility (r = - 0.42, P < 0.0001) and total motility (r = - 0.33, P < 0.0001) presented an important and time-related decrease. When a quadratic model was used rather than a linear one to analyse the data on rapid progressive motility, there appeared to have been no further decline since 1990. The average proportion of spermatozoa with normal morphology decreased from 39.2% in the period 1977-1980 to 26.6% in 1990-1995 (P < 0.0001), and the mean percentage of spermatozoa with rapid progressive motility decreased from 52.7 to 31.7% (P < 0.0001). The percentage of candidate donors with sperm characteristics below the 5th percentile cut-off value of a normal fertile population increased from 13 to 54% during the observation period (P < 0.0001). Since the technique of semen analysis has remained essentially unchanged in-so-far as has been practically possible, as has the method of recruitment of candidate sperm donors, the observed deterioration of sperm characteristics is considered to reflect degeneration of sperm production among men aged between 20 and 40 years.
Receiver operating characteristic curves and accuracy parameters were computed for traditional sperm characteristics (concentration, motility, morphology) and the number of peroxidase negative cells, and the concentration of adenosine triphosphate (ATP) in semen from populations of fertile and infertile men, and men who achieved a pregnancy after varicocele treatment. The percentage and concentration per millilitre of spermatozoa with rapid linear progressive motility, and the ATP concentration, provided the best discrimination between fertile and treated fertile from infertile men. The misclassification rate was higher for sperm morphology, total progressive motility and viability, whereas sperm concentration and the total sperm count per ejaculate had the worst discriminating power. The number of peroxidase negative cells per 100 spermatozoa was highly specific in identifying men who achieved pregnancy after varicocele treatment. The lower limit of normality of sperm characteristics was remarkably different between fertile men and men achieving pregnancy after treatment or during infertility work-up.
Rapid developments have occurred in the management of couple infertility due to a male factor. These have stimulated renewed interest in semen analysis, which has become more correct, more reliable and more informative. The so-called basic semen analysis, which includes subjective estimation of sperm concentration, motility and morphology, has largely become obsolete. It has been replaced by several alternative techniques such as the home testing of semen by the man himself, the elaboration of methods and equipments for the exact assessment of conventional sperm characteristics, and the measurement of new parameters evaluating the functional state and capacity of spermatozoa, accessory sex glands and seminiferous epithelium. The present paper covers the following items: (i) conventional methods of semen analysis, (ii) the resazurin test and home fertility scoring, (iii) advanced methods for the objective assessment of conventional sperm characteristics and motility parameters.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.