Multicentric, prospective observational data show sperm capacitation predicts male fertility, and cohort comparison reveals a high prevalence of impaired capacitation in men questioning their fertility.
Journalreproductive biomedicine online3.218Date
2020 May 01
5 months ago
Journal Article
2020-Jul / 41 : 69-79
Sharara F 1, Seaman E 2, Morris R 3, Schinfeld J 4, Nichols J 4, Sobel M 4, Lee A 4, Somkuti S 4, Hirshberg S 4, Budinetz T 4, Barmat L 4, Palermo G 5, Rosenwaks Z 5, Bar-Chama N 6, Bodie J 7, Nichols J 8, Payne J 8, McCoy T 8, Tarnawa E 8, Whitman-Elia G 8, Weissmann L 9, Doukakis M 10, Hurwitz J 10, Leondires M 10, Murdock C 10, Ressler I 10, Richlin S 10, Williams S 10, Wosnitzer M 11, Butcher M 12, Kashanian J 13, Ahlering P 14, Aubuchon M 14, Ostermeier GC 15, Travis AJ 16
  • 2. New Jersey Urology, Millburn NJ, USA.
  • 3. IVF1, Naperville IL, USA.
  • 4. Abington Reproductive Medicine, Abington PA, USA.
  • 5. Weill Cornell Medicine, Ronald O. Perelman & Claudia Cohen Center for Reproductive Medicine, New York NY, USA.
  • 6. RMA New York, New York NY, USA.
  • 7. Department of Urology, University of Minnesota, Minneapolis MN, USA.
  • 8. Piedmont Reproductive Endocrinology Group, Greenville SC, USA.
  • 9. South Jersey Fertility Center, Marlton NJ, USA.
  • 10. RMA Connecticut, Norwalk CT, USA.
  • 11. Yale New Haven Health/Northeast Medical Group, Fairfield CT, USA.
  • 12. Park Nicollet Sexual Medicine & Male Infertility Clinic, St Louis Park MN, USA.
  • 13. Weill Cornell Medicine, Urology, New York NY, USA.
  • 14. MCRM Fertility, Chesterfield MO, USA.
  • 15. Androvia LifeSciences, Mountainside NJ, USA.
  • 16. Master of Public Health Program, Cornell University, Ithaca NY. Electronic address: [email protected]
RESEARCH QUESTIONS: Can a previously defined relationship between sperm capacitation and the probability of a man generating pregnancy within three cycles, prospectively predict male fertility in diverse clinical settings? A second study asked, what is the prevalence of impaired sperm fertilizing ability in men questioning their fertility (MQF), and does this relate to traditional semen analysis metrics?
DESIGN: In the multicentric, prospective observational study, data (n = 128; six clinics) were analysed to test a published relationship between the percentage of fertilization-competent, capacitated spermatozoa (Cap-Score) and probability of generating pregnancy (PGP) within three cycles of intrauterine insemination. Logistic regression of total pregnancy outcomes (n = 252) assessed fit. In the cohort comparison, Cap-Scores of MQF (n = 2155; 22 clinics) were compared with those of 76 fertile men.
RESULTS: New outcomes (n = 128) were rank-ordered by Cap-Score and divided into quintiles (25-26 per group); chi-squared testing revealed no difference between predicted and observed pregnancies (P = 0.809). Total outcomes (n = 252; 128 new + 124 previous) were pooled and the model recalculated, yielding an improved fit (P < 0.001). Applying the Akaike information criterion found that the optimal model used Cap-Score alone. Cap-Scores were performed on 2155 men (with semen analysis data available for 1948). To compare fertilizing ability, men were binned by PGP (≤19%, 20-29%, 30-39%, 40-49%, 50-59%, ≥60%). Distributions of PGP and the corresponding Cap-Scores were significantly lower in MQF versus fertile men (P < 0.001). Notably, 64% of MQF with normal volume, concentration and motility (757/1183) had PGP of 39% or less (Cap-Scores ≤31), versus 25% of fertile men.
CONCLUSIONS: Sperm capacitation prospectively predicted male fertility. Impaired capacitation affects many MQF with normal semen analysis results, informing diagnosis versus idiopathic infertility.
Keywords: Andrology Assisted reproduction Diagnostic Infertility Pregnancy Real world data Real world evidence
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