Normal sperm parameters per se do not reliably account for fertility: A case–control study in the real‐life setting

Abstract

A proportion of men are infertile despite having normal medical history/physical examination and normal semen analysis. We aimed to assess whether normal sperm parameters per se account for male factor fertility. 1,957 infertile men were compared with 103 age-comparable fertile controls. Semen analysis was based on 2010 World Health Organization reference criteria. Of all, 12.1% of infertile men and 40.8% of fertile men presented with normal sperm parameters. Among fertile men, 36.9% had isolated sperm abnormalities and 22.3% men showed two or more concomitant sperm abnormalities. Serum total testosterone was higher in infertile men with normal sperm parameters compared to those with ≥2 sperm abnormalities or azoospermia, but similar to those with isolated sperm abnormalities (p ≤ .001). Circulating hormones were similar among sperm parameters groups in fertile men. At multivariable analyses, testicular volume (OR 1.12, p ≤ .001) and FSH (OR 0.8, p ≤ .001) were associated with normal sperm parameters. Overall, the longer the infertility period, the greater the number of sperm parameters abnormalities (p < .01). In conclusion, we found that 12% of infertile men and only 41% of fertile men present with normal sperm parameters. Normal sperm parameters per se do not reliably account for fertility in the real-life setting.

Infertile couples still undergo assisted reproductive treatments without initial andrological evaluation in the real‐life setting: A failure to adhere to guidelines?

“…Hence, the tendency of only concentrating on female reproductive health has a major impact on the success rates of ART when it comes to evaluate both partners. 34 Taking together these observations, we have investigated the trends of infertile men presenting for their first andrological evaluation after previous ART (one or even more cycles), assessing potential differences with a cohort of patients belonging to infertile couples that, conversely, have been not submitted to (any) ART throughout the same time frame. Of major clinical importance, we found that approximately 15% of couples presented for a first andrological evaluation after previous failed attempts of ART (one or even more) during the entire 17-year time frame.…”

“…Furthermore, even men with normal semen parameters may not be able to achieve a successful physiological pregnancy due to underlying semen abnormalities (i.e., oxidative stress). 34 The evaluation of the male partner of every infertile couple is important for a number of reasons. First, even though a semen analysis has been considered historically the cornerstone to establishing the reproductive potential of the male, several studies have shown that a significant proportion of men are infertile despite having normal sperm analyses.…”

“…First, even though a semen analysis has been considered historically the cornerstone to establishing the reproductive potential of the male, several studies have shown that a significant proportion of men are infertile despite having normal sperm analyses. [34][35][36] Of clinical relevance, a recent study comparing sperm parameters from 1,957 infertile men with those from 103 agecomparable fertile controls showed that 12% of infertile men and only 41% of fertile men had normal sperm parameters. 34 Moreover, among fertile men, 36.9% had isolated sperm abnormalities and 22.3% of men had two or more concomitant sperm abnormalities.…”

“…Furthermore, even men with normal semen parameters may not be able to achieve a successful physiological pregnancy due to underlying semen abnormalities (i.e., oxidative stress) 34 . This further highlights the importance of specialistic andrological evaluation of infertile couples.…”

Correlation among isolated teratozoospermia, sperm DNA fragmentation and markers of systemic inflammation in primary infertile men

“…Important limitations of those studies were the small samples size and the lack of information about the fertility status of the normozoospermic control groups. This significance of this study relies on: i) the large cohort of infertile men evaluated by a single expert uro/andrologist with a comprehensive diagnostic work-up; and, ii) the presence of a control group of fertile men with either normal and abnormal semen analyses [56], including iTZS, thus recapitulating the everyday clinical practice. Of utmost importance, this study is novel since it is the first to comprehensively compare infertile men according to isolated sperm abnormalities.…”