Vasectomy Reversal | Vasectomy Reversals

Hey doc, do I have a normal semen sample? A very frequent question that will depend on what “normal” is defined as. The infertility community unfortunately keeps changing the definition of what's “normal” so we wanted to see if andrology labs were keeping up with the latest reference ranges for a “normal” semen analysis.

I decided to team up with my colleagues in Birmingham, Alabama; Gainesville, Florida; and Kansas City, Kansas to collect semen analysis reports from as many andrology labs as possible from around the USA. The project was masterminded and spearheaded by my colleague Dr. Ajay Nangia MD at the University of Kansas. We were able to collect reports from 111 labs from 31 different states. At the time of this research, the most up-to-date criteria (from the World Health Organization) were from the year 1999. We wondered how many of these labs were actually using those criteria. So, what did we find?

Overall, only 23% (less than 1 in 4 labs) reported all parameters with the most up-to-date reference values for “normal fertility”. If the semen analysis was done at an ART center, then 32% of these labs reported correctly; whereas, only 11% of non-ART labs reported parameters correctly. (Note: ART is Assisted Reproductive Technologies so those labs are the ones that do IVF/ICSI and Inseminations)

Bottomline: Less than 1 in 4 labs actually use the most up-to-date criteria for a semen analysis. This can be a problem since a man may be told they have an abnormal semen analysis when they actually may fall within the normal fertile range. To complicate matters, the criteria just got updated again in 2010 so if you are going to get a semen analysis, call ahead and make sure they are using the latest 2010 criteria. If you have any questions, touch base with your male fertility specialist who can make the appropriate adjustments in the interpretation of your semen analysis and explain what it means.

Reference: Penn, Winsperger, Smith, Parekattil, Kuang, Kolettis and Nangia 2011 Fertility and Sterility 95: 2320

Dr. Kuang teamed up with Dr. John Thomas from Vanderbilt University to provide an online update to help doctors from around the world with the the diagnosis and treatment of Varicoceles.
Click here to learn more.

Etoposide-Induced DNA Fragmentation & Mitochondrial Damage in Normal Ejaculated Sperm: A Putative In Vitro Model of Apoptosis

Objective: Alterations in apoptosis (programmed cell death) may be a contributing cause of abnormal semen samples in subsets of male infertility (e.g. varicocele). A need exists for a reliable cell model system that can reveal the molecular mechanisms of apoptosis in sperm. Etoposide is a chemotherapeutic agent that can induce DNA fragmentation and mitochondrial damage in somatic cells that are undergoind apoptosis. This study investigates whether etoposide can induce similar changes in normal ejaculated sperm as a putative model to study apoptosis in mature germ cells.

Design: Prospective experimental design

Materials and Methods: Multiple ejaculated semen samples from two normal donors were collected after at least 48 hours of abstinence between samples. Resuspended sperm pellets from each sample were treated with etoposide for 24 hours. Untreated sperm served as a negative control, while Jurkat cells were a positive control. DNA fragmentation was measured with terminal deoxynucleotidyltransferase dUTP nick end labeling (TUNEL) flow cytometry. Motility was manually measured by phase-contrast microscopy. Mitochondrial membrane integrity was assessed with Mitosensor dye (Clontech, Palo Alto, CA) and fluorescence microscopy. Mitochondrial swelling was visualized by electron microscopy. Statistics were performed as follows: a paired non-parametric two-tailed Wilcoxon ranked-sum test for motility and TUNEL positivity and a chi-squared test for mitochondrial membrane integrity.

Results: Etoposide-induced DNA fragmentation was reproducibly seen in multiple semen samples collected from two normal donors. After a 24 hour incubation at 50 ug/ml of etoposide, TUNEL positivity in treated sperm increased on average by 986% vs. 171% in the untreated samples [P=0.016]). As expected, all treated sperm were rendered completely non-motile whereas untreated sperm demonstrated only a 27% decrease in motility [P=0.016]. All treated sperm demonstrated mitochondrial membrane damage while this was only seen in 11% of untreated sperm [P<0.0001]. Mitochondrial swelling as seen by electron microscopy was associated with treated sperm.

Conclusion: Etoposide can reliably induce DNA fragmentation in ejaculated sperm from normal donors. It is associated with a complete absence of motility and mitochondrial damage. This cell system model can potentially provide molecular insights into apoptosis-related male infertility.
Click here for in the news
Click here for vasectomy reversal news
Click here for sfcm news
Click here for newsletter signup
Click here for the media