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Male Infertility Evaluation Using Oxidation-Reduction Potential and
Sperm DNA Fragmentation Test
American Center for Reproductive Medicine,
Cleveland Clinic, Cleveland, OH, USA
12th Annual Summer Mentorship in Reproductive Medicine
PhD Student
Faculty of Biology, University of Bucharest, Romania
Cătălina Barbăroșie
Limitations of routine
semen analysis
Intraindividual variability
Poorly standardized
Inconsistent semen
parameters
Missing information about sperm dysfunctions
Introduction
Advanced semen analysis(ASA)
Oxidation reduction potential (ORP)
DNA fragmentation:
• TUNEL assay
• COMET assay
• SCSA
• SCD test
Sperm function
Keel BA. Within- and between-subject variation in semen parameters in infertile men and normal semen donors. Fertil Steril. 2006 Jan;85(1):128-34.
Agarwal A, Bui AD. Oxidation-reduction potential as a new marker for oxidative stress: Correlation to male infertility. Investig Clin Urol. 2017 Nov;58(6):385-399.
Aim and Objectives
Aim
To evaluate the diagnostic and prognostic properties of
advanced semen tests
Objectives
To determine if advanced semen tests can:
• diagnose male infertility
• play a role in predicting fertilization and pregnancy
• be advantageous over conventional semen analysis
Materials and Methods
Inclusion criteria:
• Original articles
Exclusion criteria:
• Non-human studies
• Non-English studies
• Data prior to 8 years
• Reviews, Systematic
reviews, Meta-analysis
Systematic Literature Review
• PubMed database
• PRISMA checklist
2 sets of Keywords
• To analyze if CSA candiagnose male infertilityand fertility outcome
• To assess the diagnosticand prognostic value ofASA
Conventional Semen Analysis
• Semen Analysis
• Semen Parameters
• WHO
• Diagnosis or Prognosis
• ART
• In Vitro Fertilization
• ICSI
Advanced Semen Analysis
• Spermatozoa
• Oxidation-Reduction
• DNA Fragmentation
• Oxidative Stress
• Diagnosis or Prognosis
• ART
• In Vitro Fertilization
• ICSI
Results: Conventional Semen Analysis
Relevant factor predicting the pregnancy outcome
(Liu et al., 2016)
Concentration is higher in controls
(Belva et al. 2016)
Routine analysis is not enough to predict natural conception
(Redmond et al., 2013; Voncina et al., 2016)
Limitation: Only 4 articles analyzed
Results - ORP
Significant correlation between the ORP and the semen
parameters (Agarwal et al., 2016)
Good predictor of poor sperm quality (Agarwal et al., 2018)
Discriminant between fertile and infertile men (Agarwal et al.,
2017)
No studies have been done to assess its influence on fertility
outcomeComparison of ORP values in fertile and infertile men
0
2
4
6
8
10
12
14
16
OR
P [m
V/1
06
sp
erm
/mL]
Fertile men Infertile men
p = 0.021
Comparison of SDF using SCD assay in fertile
and infertile men
Results – Sperm DNA Fragmentation
SCD assay
• Higher embryo quality in those with low SDF (Kim et
al., 2019)
• Not associated with fertilization or pregnancy outcomes (Sun et al., 2018)
• The comparison of groups from all studies was not insignificant (Ribas-
Maynou et al., 2013; Zandieh et al., 2018)
Results – Sperm DNA Fragmentation
SCSA
• Predicts pregnancy outcomes (Venkatesh et al.,
2011)
• Can not predict pregnancy (Ribas‐Maynou et
al., 2013)
• Can predict live-birth rate (Xue, Wang et al. 2016)
• More studies are needed
Comparison of SDF using SCSA in fertile and
infertile men
10
15
20
25
30
35
DF
I (%
)
Fertile men Infertile men
p = 0.085
Results – Sperm DNA Fragmentation
COMET• Alkaline Assay – can
diagnose male infertility (Simon et al., 2011)
• Alkaline Assay – predicts fertility outcome in IVF pregnancies (Simon et al., 2011)
• Neutral Assay - does not distinguish between fertile and infertile men (Ribas‐Maynou et al., 2013)
Comparison of SDF using COMET assay in
fertile and infertile men
25
30
35
40
45
50
55
60
65
70
75
80
DF
I (%
)
Fertile men Infertile men
p = 0.05
Results – Sperm DNA Fragmentation
TUNEL• Can distinguish between
fertile and infertile men (Ribas-Maynou et al., 2014)
• Correlated with the RPL, blastulation and pregnancy outcomes (Bareh et al., 2016)
• Can predict natural conception (Bareh et al., 2016)
• The predictive value is low (Garolla et al., 2015)
Comparison of SDF using TUNEL assay in fertile
and infertile men
12
14
16
18
20
22
24
26
28
30
DF
I (%
)Fertile men Infertile me
p = 0.021
Conclusions
Limitations Strengths
ORP
Limitations Strengths
DNA Fragmentation
Thank You Very Much For Your Attention!
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