M.P.V. holds a fellowship award from the Canadian Institutes of Health Research (CIHR). The economic analysis performed by M.P.C. was supported by an unrestricted grant from Ferring Pharmaceutical.

No abstract

Background Sperm DNA damage is associated with male infertility, lower pregnancy rates and pregnancy loss. Objective The primary aim of our study was to evaluate the prevalence of sperm DNA damage in younger and older men with normozoospermia. Design, Setting and Participants We obtained semen from 277 consecutive non-azoospermic men presenting for sperm DNA testing. Outcome Measurements and Statistical Analysis The main outcome measures included sperm % DNA fragmentation index (%DFI, using sperm chromatin structure assay), sperm concentration, motility and morphology, and, paternal age.Results and Limitations Sperm % DFI was positively correlated with paternal age (r=0.20, P<0.001) and inversely correlated % progressive motility (r=−0.16, P=0.01). Sperm %DFI was significantly higher in older (≥40 years) compared to younger (<40 years) normozoospermic men (17±13 vs. 12±8, respectively P=0.008), whereas, sperm concentration, progressive motility and morphology were not significantly different in these two groups. Moreover, the prevalence of high levels of sperm DNA damage (>30 % DFI) was significantly higher in older compared to younger normozoospermic men (17 % vs. 3 %, respectively, P<0.001). Conclusion The data indicate that a conventional semen analysis can often fail to detect a defect in spermatogenesis (high %DFI) in older men and suggest that infertile couples with advanced paternal age, including those with normal semen parameters, should consider sperm DNA testing as part of the couple evaluation.

No abstract

Purpose : To examine the reproductive performance of hepatitis B (HBV) and C (HCV) discordant couples following IVF-ET. Methods : A retrospective cohort study of 25 IVF-ET cycles in HBV and HCV discordant couples was performed. Thirteen patients in the study cohort were discordant for HBV (10 males and 3 females), and 12 (9 males and 3 females) for HCV. Twenty-seven consecutive age matched patients comprised the control group. All patients underwent controlled ovarian hyperstimulation using the long downregulation protocol followed by IVF or ICSI. Results : Patients in the three groups (HBV, HCV, and controls) had similar ages, and day 3 FSH concentrations. Despite comparable response to COH, and similar fertilization, and cleavage rates in the three groups, couples discordant for HBV or HCV had significantly poorer implantation and pregnancy rates (7.7%, 0% respectively) compared with controls (41%). Conclusions : Despite comparable response to COH, HBV and HCV positive discordant couples, have significantly lower implantation and pregnancy rates compared with age-matched controls.