Increased levels of sperm ubiquitin correlate with semen quality in men from an andrology laboratory clinic population. (1/22)

BACKGROUND: Ubiquitin, a house-keeping protein that marks other proteins for proteasomal degradation, tags defective sperm during epididymal passage. To establish ubiquitin as a biomarker of human infertility, the present study examines the relationships between sperm ubiquitin content and clinical semen parameters among men from an infertility clinic population with varied aetiologies. METHODS: Anti-ubiquitin immunoreactivity was measured by flow cytometric sperm-ubiquitin tag immunoassay (SUTI) in sperm samples of 28 infertility patients and 15 fertile donors. Semen analyses were performed by computer-assisted semen analysis and World Health Organization morphology. RESULTS: Median values of ubiquitin-induced fluorescence had a strong negative correlation with sperm count (r = -0.63, P = 0.0003) and a positive correlation with % abnormal morphology (r = 0.55, P = 0.01). Infertility patients (n = 28) had significantly higher levels of sperm ubiquitin. Out of 28 patients, six reported possible occupational exposures to solvents, three were current smokers and six were ex-smokers. Within the patient group, men with known male factor infertility, those with self-reported occupational exposure to solvents and current smokers had the highest sperm ubiquitin levels. When men with jobs involving potential occupational exposure to solvents were combined with current smokers, the highest correlations were found between sperm ubiquitin and motility (r = -0.74), count (r = -0.82) and % sperm abnormalities (r = 0.73). CONCLUSIONS: Increased sperm ubiquitin was inversely associated with sperm count, motility and % normal morphology, supporting the use of ubiquitin as a biomarker of human semen quality. SUTI assay confirmed poor semen quality in all men with poor clinical semen parameters, but also was high in some patients with seemingly good clinical semen parameters. Occupational exposure to solvents and smoking may have contributed to high levels of sperm ubiquitin in some of these patients.  (+info)

Clinical andrology--still a major problem in the treatment of infertility. (2/22)

This paper highlights the need for formal training in andrology amongst those clinicians who are today managing the problem of infertility in the male. As all infertility now appears to be treated mainly by gynaecologists who have often had no teaching in the subject of andrology, suggestions are made as to how this situation can be improved and rectified. Specific training is needed for those gynaecologists involved in the management of male infertility and it is urged that training courses in clinical andrology are set up for this purpose.  (+info)

Is quality assurance in semen analysis still really necessary? A clinician's viewpoint. (3/22)

Quality assurance in semen analysis is now a standard procedure in most andrology laboratories. This communication is now questioning its value in any clinical situation and as a consequence asks whether the effort and the expense of such a process is really worthwhile. It concludes that semen analysis needs only to be performed competently without the need for costly and time-consuming forms of quality assurance.  (+info)

Does the potential for selection bias in semen quality studies depend on study design? Experience from a study conducted within an infertility clinic. (4/22)

BACKGROUND: The low participation rates in human semen quality studies raises concern for the potential of differential participation based on semen quality (or a surrogate). To explore the potential for differential participation, we compared semen analysis results from study subjects with those of non-study subjects. METHODS: We obtained semen analysis results from 235 study subjects and retrospectively obtained results from a subset of 235 infertility clinic patients that were not study subjects but met the same eligibility criteria. The study was conducted at the Massachusetts General Hospital Infertility Clinic. All semen samples (study subjects and non-study subjects) were analysed for sperm concentration and motility by computer-aided semen analysis (CASA), and morphology was assessed using strict criteria. Semen analysis parameters for the non-study subjects were compared with the semen analysis results from study subjects. RESULTS: For all semen characteristics (sperm concentration, total sperm count, sperm motility and morphology), there were only marginal (non-significant) differences between study subjects and non-study subjects. CONCLUSIONS: Among men from an infertility clinic, we found no strong evidence of differential participation based on semen quality. This is reassuring since the potential for selection bias is of concern in semen quality studies. However, the potential for selection bias in other study designs remains unclear.  (+info)

Quality specifications for seminal parameters based on the state of the art. (5/22)

BACKGROUND: The aim of this study was to calculate the analytical goal for seminal parameters based on the state of the art, and then to compare these specifications with those previously obtained by our group based on biological variation. METHODS: All data used for analysis were derived from the Spanish programme of external quality control on semen analysis. Over 90 laboratories participated from 1999 to 2003. Using graphs of the state of the art, we also determined the numbers of laboratories that achieved quality specifications. RESULTS: The total allowable error calculated using state of the art graphs is similar to that calculated using biological variation for concentration and total motility. However, it is much higher for morphology and rapidly progressive motility. Over 80% of the laboratories achieved the minimum quality specification based on biological variation for concentration, total and progressive motility. However, only approximately 30% of the laboratories achieved the minimum quality specification based on biological variation for morphology and rapidly progressive motility. CONCLUSIONS: The study enabled us to identify the state of the art of analytical performance for seminal parameters, and revealed the difficulty inherent in meeting the quality specifications based on biological variation.  (+info)

Is quality assurance in semen analysis still really necessary? A spermatologist's viewpoint. (6/22)

In a provocative article to this Journal, Anne Jecquier, an eminent andrologist who, more than 20 years ago, was a prime mover in suggesting the need for quality assurance (QA) in andrology laboratories, has now proposed that the QA schemes may no longer be needed. Here I reply to that proposition, largely by agreeing that, since the QA schemes have brought about higher technical standards in laboratories, Anne Jecquier's assertion is possibly true. However, vigilance is still needed in discriminating between unproductive investment of time and energy in the refinement of tests that may offer little information about fertility, and maintaining technical standards such that where necessary they provide the requisite information. Thus, although it may not matter in practice whether a sperm concentration is estimated as 100 or 200 x 10(6)/ml, distinguishing between 25 and 100 x 10(6)/ml would probably influence a clinician's treatment decisions. Anne Jecquier also suggested that sperm function tests have limited predictive value in terms of fertility assessment. While I agree that this is largely true at present, I also argue that these tests are probably not developed to their full potential. I am optimistic that tests to distinguish and quantify the population of fertilization-competent sperm within an ejaculate will eventually become available.  (+info)

Lack of compliance by UK andrology laboratories with World Health Organization recommendations for sperm morphology assessment. (7/22)

BACKGROUND: Sperm morphology is known to correlate with the probability of conception both in vitro and in vivo, but the assessment of sperm morphology in the laboratory remains problematic. The 4th edition (1999) of the World Health Organization (WHO) Laboratory Manual has attempted to improve matters by giving rigorous recommendations regarding sperm morphology assessment. However, it is unknown how well these recommendations have been implemented in practice. METHODS: A survey of the methods used to undertake the assessment of sperm morphology during semen analysis was undertaken in 37 laboratories in the UK. RESULTS: In total, only two laboratories (5%) were compliant with all current WHO guidelines regarding morphology assessment, including methods of staining and observation, classifying and sampling methods, and the participation in internal and external quality control programmes. CONCLUSION: These results illustrate an urgent need for education and training initiatives to encourage laboratories to become compliant with current WHO guidelines for sperm morphology assessment.  (+info)

Is quality assurance in semen analysis still really necessary? A view from the andrology laboratory. (8/22)

Quality assurance (QA) is a fundamental part of laboratory medicine, of which internal and external QA (proficiency testing) is an important part. In a recent debate article published in Human Reproduction, it was argued that it was no longer necessary for semen analysis to be subject to QA, primarily because it is now being performed robustly and there is little evidence that it has any real clinical value. In response to this argument, it is suggested here that although there may have been some improvements in the training of laboratory scientists, recent studies have shown that the techniques of semen analysis are still poorly implemented at many locations. Moreover, as the impact of the introduction of QA into the andrology laboratory begins to take effect, there are a growing number of studies showing that the results of semen analysis do correlate well with natural conception and some assisted reproductive technologies. However, since the processes of QA are central to the principles of total quality management, which in turn underpins the process of laboratory accreditation, QA needs to remain in the andrology (and embryology) laboratory so that they can achieve the same accredited status as medical laboratories in other disciplines.  (+info)