Sheryl Toni Homa

Background: Identification of a preservation medium that accurately retains semen parameters would be advantageous for men requiring semen analysis by allowing them to produce sperm samples at home rather than on site or even facilitate ‘mail order’ semen analysis. Objectives: To evaluate the utility of a commercially available refrigeration medium for preserving human semen parameters for use in a diagnostic setting. Materials and Methods: In patients undergoing diagnostic semen analysis, extender was added to the remainder of each ejaculate following initial ‘ground truth’ testing. Samples were re‐assessed to determine effects of incubation time, temperature, volume of extender and speed of addition. Results: Total and progressive motility and vitality declined slowly at 2–5°C, with some motility remaining even after 4 days. The rate of motility and vitality decline was not consistent between samples, with samples outside the reference range being particularly prone to rapid decline. Varying extender conditions showed that even samples with initially good parameters exhibited inconsistent rates of decline in motility and vitality. This was partially ameliorated by incubation at 20–24°C compared to 2–5°C ( p < 0.001), while varying the speed of extender addition (dropwise vs. rapid) or the ratio of extender to initial sample had no effect. Discussion: Although semen refrigeration medium does allow sperm to retain some motility for several days, the high level of individual patient variability in the rate of decline precludes accurate reconstruction of initial semen parameters from extended samples. However, total sperm count can be accurately measured. Conclusions: There are many commercially available kits for semen analysis; however, the reliability of the results is questionable. Semen extenders could potentially be used for triage for samples within the reference range but where measurements from extended samples fall outside reference ranges, confirmation must be obtained from a fresh sample assayed according to WHO guidelines before any diagnosis can be made. Trial Registration: A Study Registration Number is not required as this was not a clinical trial

Shah R, et al. World J Mens Health. 2025 Jun;43:e41. https://doi.org/10.5534/wjmh.250039

The standard method for identification of male fertility status is a semen analysis. This is performed in fertility and pathology laboratories accredited by different bodies in the UK such as the HFEA or UKAS, and is based on whether they perform licenced clinical treatment or diagnostic testing. The WHO laboratory semen analysis criteria provide the most comprehensive guidance for best practice, yet this is not strictly adhered to. Our objective was to determine any differences in semen analyses between laboratories in the UK, based on the regulatory body they are registered with. A cross‐sectional survey was sent to NEQAS for andrology registrants (n = 184 laboratories), HFEA (n = 117 clinics), and individual ARCS members (n = 682). Most ARCS members are associated with NEQAS and/or the HFEA. A ∼50% laboratory response rate (n = 106 included responses) was found. Results were grouped based on accreditation: Group 1, UKAS accredited only (n = 38); Group 2, both UKAS accredited and HFEA licenced (n = 17); Group 3, HFEA licenced only (n = 42); and Group 4, no accreditation (n = 9). Over 85% of UKAS accredited laboratories (Groups 1 and 2) state they perform semen analysis according to WHO 2010 recommendations and adhere to best practice guidelines. A significantly fewer number of HFEA only laboratories (p < 0.01) adhere to both guidelines. Non‐HFEA laboratories (Groups 1 and 4) are almost all performing sperm counts according to WHO criteria, while p < 0.05; Neubauer chamber: p < 0.005). QC is implemented in most laboratories, however there is a significant difference (p < 0.01) between non‐UKAS (Groups 3 and 4) and UKAS laboratories (Groups 1 and 2). There is a significant difference in semen analysis performance between UKAS and HFEA laboratories with regards to implementation of best practice guidelines and QC procedures. This may have a detrimental effect on result accuracy and consequently lead to patient misdiagnosis and mismanagement.

Agarwal A, et al. World J Mens Health. 2024 Jan;42(1):202-215. https://doi.org/10.5534/wjmh.230076

Ghayda RA, et al. World J Mens Health. 2024 Jan;42(1):39-61. https://doi.org/10.5534/wjmh.230050

FarkouhAla’a, et al. World J Mens Health. 2023 Apr;41:e48. https://doi.org/10.5534/wjmh.230008

Agarwal A, et al. World J Mens Health. 2023 Apr;41:e43. https://doi.org/10.5534/wjmh.220282

An imbalance in the genitourinary microbiome is emerging as a contributing factor to male infertility. The purpose of this study was to determine whether there is an association between genitourinary microorganisms and seminal oxidative stress, sperm DNA fragmentation and semen parameters. It included 770 men attending for diagnostic testing for subfertility. Genitourinary microorganisms were identified in 43.0% men; 20.1% had microorganisms in semen; 18.7% in urine; and 5.8% had microorganisms in urine and semen. Enterococcus faecalis was the most prevalent organism in semen (22.0% samples; 61.5% organisms) with Ureaplasma spp. (16.9% samples; 53.3% organisms) and Gardnerella vaginalis (11.4% samples; 37.4% organisms) most prevalent in urine. Semen parameters were unaffected by microorganisms (p > 0.05). Seminal ROS were significantly higher in men with microorganisms compared to those without (p < 0.001), particularly when present in both urine and semen (p < 0.01). Microorganisms were associated with significantly higher DNA fragmentation, irrespective of whether they were in semen or urine (p < 0.001). An imbalance in the genitourinary microbiome is associated with DNA damage and oxidative stress which may have considerable consequences for achieving an ongoing pregnancy. This highlights the need for incorporating genitourinary microorganism screening for all men as part of diagnostic evaluation prior to undergoing treatment for infertility.

Klinefelter Syndrome (KS) is characterized by the presence of an extra X chromosome. It was first diagnosed in 1942 in a group of azoospermic men. KS is the most common chromosomal abnormality encountered in infertile men and accounts for more than 10% of the causes of azoospermia. Men who are azoospermic may still father children via testicular sperm extraction followed by intracytoplasmic sperm injection (ICSI). This review article summarizes the success rates of the available techniques for surgical sperm retrieval (SSR) in KS including conventional testicular sperm extraction (cTESE) and micro testicular sperm extraction (mTESE), as well as the risks of these procedures for future fertility. The evidence indicates that the SSR rate is as successful in non-mosaic men with KS as those with normal karyotypes, with retrieval rates of up to 55% reported. The influence of different factors that affect the chances of a successful outcome are discussed. In particular, the impact of aneuploidy rate, physical characteristics, co-morbidities, reproductive endocrine balance and the use of different hormone management therapies are highlighted. Evidence is presented to suggest that the single most significant determinant for successful SSR is the age of the patient. The success of SSR is also influenced by surgical technique and operative time, as well as the skills of the surgeon and embryology team. Rescue mTESE may be used successfully following failed TESE in KS patients in combination with hormone stimulation.

Seminal oxidative stress (OS) is a major contributing factor to male infertility. Semen analysis cannot identify reactive oxygen species (ROS), which can be measured using a chemiluminescence assay. Measurement of redox potential provides a more comprehensive assessment of OS, although the test has yet to be fully validated. This study aimed to validate the MiOX^sys analyser for measuring static oxidation–reduction potential (sORP). Results demonstrated that duplicate measurements must be taken, sensors must be batch tested, and sockets should be regularly changed to avoid inconsistency in measurement. Measurement of sORP using MiOX^sys exhibited good reproducibility across different operators (p = 0.469), analysers (p = 0.963) and days (p = 0.942). It is not affected by mechanical agitation (p = 0.522) or snap freezing and thawing (p = 0.823). The stability of sORP over time requires further verification, particularly in samples with high initial sORP. Measurement is temperature sensitive between 2 and 37°C, significantly increasing with increasing temperature (p = 0.0004). MiOX^sys is a more stable assay for assessing OS than chemiluminescence methods and permits greater flexibility for sample handling. MiOX^sys could be implemented to complement semen analysis as part of routine diagnostic testing for male infertility and may be useful in identifying contributing factors to idiopathic infertility.