Altered Sperm Analysis, Where are we Now? The Reality of the Reproductive Medicine Unit of a Tertiary University Center

ABSTRACT

Background

In the last decades, a substantial decline in sperm counts has been described. We aim to evaluate clinical outcomes of treatment strategies in patients referred to andrology due to abnormal sperm parameters.

Materials and methods

Observational descriptive study performed at one country's largest public reproductive unit during 5 years (2015–2019). Patients were selected according to the World Health Organization (WHO) criteria for sperm analysis.

Results

A total of 670 patients were included, with a median age of 35 (18–54) years old. During the infertility investigation, 15 patients were diagnosed with Klinefelter syndrome and two with a disorder of sexual development (46, XX). Three malignant testicular tumors were identified. Among treatments applied—varicocele correction was the most frequent (31.49%, n = 210), followed by antioxidant therapy (11.04%, n = 74). Posttreatment sperm analysis was obtained in 255 cases, demonstrating an improvement in 58.04% ( n = 148), including normalization in 6.67% ( n = 17) of men. An assisted reproductive technique (ART) was performed in 45.97% ( n = 308), with a clinical pregnancy rate per initiated cycle of 26.92% ( n = 91). Among azoospermic patients (19.55%, n = 131), there was a higher exposure to heat ( p = 0.02) and a higher prevalence of previous testicular surgery ( p = 0.002), and orchitis ( p = 0.022). Varicocele was more frequent in non-azoospermic patients ( p = 0.007), while Y chromosome microdeletions and chromosomal alterations were mostly found in azoospermic patients ( p = 0.004 and p < 0.001, respectively).

Conclusion

Even in patients with a poor prognosis a priori, improvements in sperm parameters or sperm retrieval might be achieved after treatment, namely low-grade varicocele correction.

Clinical significance

An adequate investigation of male infertility can improve reproductive outcomes and contribute to an early diagnosis/secondary prevention of tumors.

How to cite this article

Ferro B, Sousa F, Carvalho A, et al. Altered Sperm Analysis, Where are we Now? The Reality of the Reproductive Medicine Unit of a Tertiary University Center. Int J Infertil Fetal Med 2023;14(2):85-93.