1. Improving ART OUTCOME:Looking beyond SFA in male factor infetility
Dr Ekwempu C.C (MBBS;FWACS)
Consultant OB/Gyn
Fertility /endocrinology unit
Jos University teaching Hospital

2. Introduction Infertility is a cause of emotional and economic stress
Male factor detected in 40-50% of cases in our environment
ART has significantly improved the outlook for many couples
Failure rate is still unacceptably high
Causes of failure unexplained

3. Investigation for male factor infertility
History taking
Examination
Seminal fluid analysis
Endocrine tests
Genetic testing

4. Seminal fluid analysis(WHO reference limits)
Volume- 1.5mls (95% CI )
Sperm concentration- 15 million(12-16)
Total sperm number- 39 million/ejaculate(33-46)
Morphology -4% normal forms(3-4) using “strict” Tygerberg method
Progressive motility-32%(31-34)
Total motility(progressive+non progressive-40%(38-42)

5. Seminal fluid analysis(contd.)
Not always a good predictor of fertility
Bond JP et al. Lancet 1998
Guzick et al . NEJ 2001
Lack of sperm does not indicate lack of sperm production

6. Other specialized test
Sperm autoantibody testing
Semen biochemistry(semen fructose)
Sperm- cervical mucus interaction tests
Acrosome reaction
Zona free hamster oocyte penetration test
Human Zona pellucida binding test
Sperm reactive oxygen species generation
Sperm chromatin/DNA assays

7. Endocrine tests
Serum Testosterone
LH/FSH

8. Genetic testing Genetic abnormalities:
Detects deletions and microdeletions
Translocations
Lead to dysfunctional sperms that impact on male fertility and pregnancy outcome

9. Current indications for genetic testing
Sperm concentration <5million/ml
Azoospermia with testicular atrophy in a couple considering ivf
Oligo or azoospermia with absence of one vas deferens on physical examination
Azoospermia with evidence of normal spermatogenesis
Family history of genetic disorders

10. Oxidative stress
The imbalance between ROS and natural antioxidants=oxidative stress
ROS associated with poor semen quality and male infertility

11. Oxidative stress tests
Seek to detect ROS, total antioxidant capacity(TAC), and lipid peroxidation.
Chemiluminiscence and flow cytometry
Enhanced chemiluminiscence assays

12. Drawbacks Specialised testing is expensive
Adds to the already high cost of fertility treatment
Not readily available in our environment
Doesn’t significantly improve pregnancy rates

13. recommendations
Proper history taking and thorough physical examination cannot be overemphasized
Urological involvement
Use of antioxidants(Showel et. al cochrane databse 2012.)
donor sperm: prevents transmission of genetic defects

14. THANK YOU