Abstract Study question Is there any impact of the pandemic period on semen parameters? Summary answer Both total and progressive sperm motility as well as sperm morphology were impaired during COVID-19 pandemic. What is known already Male fertility could be affected by many environmental conditions. The COVID-19 pandemic has led to many dramatic consequences on human lives (psychological, financial level…). However, little information is available on the impact of the emergent COVID-19 on male fertility. Study design, size, duration This was a cohort study comparing semen parameters before and during the two first COVID-19 waves in infertile Tunisian patients. Participants/materials, setting, methods Were included in the current study 90 patients followed in the consultation of the department of Cytogenetics and Reproductive Biology (Monastir, Tunisia) for hypofertility. Each of the included patients has already a spermogram before the COVID-19 pandemic and a spermogram during the COVID-19 pandemic allowing the comparison of semen parameters for each patient so that he was considered as his own control. Patients who received medication (antibiotics, antioxidants…) were excluded from the current study. Main results and the role of chance Among standard semen parameters, we have shown a significant decrease in both total and progressive sperm motility during COVID-19 pandemic (p < 0.0001 and p = 0.001 respectively). The observed decrease 30 min after ejaculation was maintained 2 hours and 4 hours after ejaculation. Furthermore, we observed an impairment in sperm morphology. Indeed, the percentage of morphologically abnormal spermatozoa raises from 90.99±7.37% to 93.67±4.54% (p < 0.0001). The remaining semen parameters was similar between the two compared timepoints except a slight decrease in sperm count during the pandemic (p = 0.079). Multivariate analysis didn’t show among clinical and epidemiological characteristics any associated factor with the observed decrease in semen quality. Limitations, reasons for caution The included patients didn’t have any COVID-19 symptoms on the day of sperm collection. However, as we have no proof of negative PCR test, the observed impairment in semen quality could be not only the consequence of psychological stress but may be also induced by a latent infection. Wider implications of the findings Even in patients with no proof of COVID-19 infection, the pandemic seems to have a real impact on hypofertile men as sperm motility and morphology were significantly impaired. It would be preffered to control semen parameters away from such period before referring patients to assisted reproduction. Trial registration number Not Applicable
Abstract Study question The aim of the study was to investigate risk factors for sperm DNA fragmentation to determine which factors influence significantly the sperm DNA fragmentation. Summary answer Obesity seems to lead to higher risk of sperm DNA damage in Tunisian subfertile men. What is known already A positive association between lifestyle conditions, varicocele, advanced age and exposure to toxicants and DNA fragmentation has been documented. Study design, size, duration It’s a retrospective case control study. 61 Patients registered from October 2018 to December 2021 were divided into two groups: group “C” with good quality sperm DNA (n = 20) and group “F” with fragmented sperm DNA (n = 41). Participants/materials, setting, methods DNA fragmentation was measured using terminal deoxynucleotidyltransferase dUTP nick and labeling assay. The Odds Ratio (OR) and their 95% CI were calculated using univariate logistic regression in order to quantify the association between the variable of interest “Sperm DNA fragmentation” and the various risk factors: lifestyle conditions (e.g. tobacco smoking, alcohol consumption, and obesity), age, professional exposure to high temperature and toxic products and urological history (e.g. varicocele, testicular hypotrophy or hypertrophy). Main results and the role of chance Our results showed that tobacco, professional exposure to high temperature and toxic products and urological history are risk factors that may alter sperm DNA with an odds ratio (OR) of 2.1, 1.9 and 1.5, respectively. Interestingly, we demonstrated that obesity seems to be the most significant risk factor of DNA fragmentation with an OR of 4.2 (p = 0.002). Limitations, reasons for caution Further studies are needed to investigate the mechanism by which obesity occur sperm DNA damage. Wider implications of the findings Our finding are in accordance with several retrospective studies demonstrating that obesity is liable to sperm DNA damage Trial registration number not applicable
The aim of this study was to evaluate the live birth rate (LBR) after frozen-thawed Day 5 (D5) and Day 6 (D6) blastocyst transfers.LBR following frozen-thawed blastocyst transfer is significantly lower with D6 than with D5 blastocyst regardless of embryo quality.During fresh embryo transfer cycles, pregnancy rates (PR) are significantly higher when transferring blastocysts expanded on D5 compared with slow developing blastocysts (D6). In programmed thawed blastocyst transfer (TBT) cycles, the same clinical outcomes should be expected when transferring D5 or D6 blastocysts because of endometrial/embryonic synchronization due to hormonal priming of endometrial receptivity. However, the impact of delayed blastocyst expansion at D6 on clinical outcomes remains unclear. Some reports have shown higher PRs after D5 TBT compared with those of D6, while others have shown equivalent TBT outcomes after D5 and D6 cryopreserved blastocysts transfers.This retrospective cohort follow-up study included 1347 single autologous frozen-thawed blastocyst transfers performed between January 2012 and December 2015 at a tertiary care university hospital.All of the patients scheduled for TBT were allocated to two groups according to the day of blastocyst expansion: on D5 (n = 994) or on D6 (n = 353). The primary outcome was LBR per embryo transfer in the first blastocyst thawing cycle. Secondary outcomes were clinical pregnancy rate (cPR), early miscarriage rate and neonatal outcomes following TBT for the two groups. Statistical analyses were conducted using univariate and multivariate logistic regression model.The LBR was significantly increased in the D5 group compared to the D6 group [294/994 (29.6%) versus 60/353 (17.0%); P < 0.001]. The cPR was also higher when blastocysts were vitrified on D5 compared with those vitrified on D6 [429/994 (43.2%) versus 95/353 (26.9%); P < 0.001]. No significant differences were found between groups in terms of early miscarriage rate (P = 0.862). More good-quality embryos (defined as an B3-B4 or B5 embryo ≥BB according to the grading scale proposed by Gardner) were transferred in the D5 group than in the D6 group [807 (81.2%) versus 214 (60.6%); P < 0.001]. However, a comparison of TBT cycles with equal embryo quality (good versus low) also supported the superiority of D5 blastocysts. Concerning neonatal outcomes, the D5 group infants had a lower mean birth weight compared to those of the D6 group (P = 0.001). In addition, a significantly shorter gestational age at birth is reported in the D5 blastocyst group as compared to the D6 group (P = 0.004). After multivariate logistic regression taking into account potential confounders such as the women's age, number of previous IVF/ICSI procedures, the day of the blastocyst vitrification (D5 or D6) and embryo quality, blastocyst expansion at D6 was independently associated with a significant decrease in LBR compared to D5 expanded-blastocysts (OR 0.52; 95% CI 0.38-0.72; P < 0.001).The poor predictive value of the morphological approach in embryo selection could constitute a limitation in this study. However, blastocyst quality was evaluated similarly in both groups.The LBR following frozen-thawed blastocyst transfer was significantly lower with D6 than with D5 blastocysts, regardless of their quality. These results could affect cryopreservation procedures as they suggest that the use of D5-expanded blastocysts for TBT may be preferred in order to shorten the time of conceiving.No specific funding was obtained for this study. None of the authors have any competing interests to declare.Not applicable.
The emergence and the spread of coronavirus disease (COVID-19) induced by the SARS-CoV-2 virus has multiple consequences in all countries around the world. Male germ cells of infertile patients which are shown to be vulnerable to many environmental conditions, could be particularly vulnerable to such an exceptional pandemic situation. We aimed through the current study to investigate the potential variations in sperm quality of infertile patients during the COVID-19 pandemic in Tunisia.This was a cohort study including 90 infertile patients addressed to Laboratory of Cytogenetics and Reproductive Biology of Monastir Department of Maternity and Neonatology in Monastir, during the two first COVID-19 waves in Tunisia and who already have a spermogram before the pandemic period.We have pointed out a significant decrease in both total and progressive sperm motility during COVID-19 pandemic (p<0.0001 and p = 0.001 respectively). The percentage of morphologically abnormal spermatozoa increased from 90.99±7.38 to 93.67±4.55% during the pandemic (p< 0.001). The remaining sperm parameters were similar between the two compared timepoints. Interestingly, the univariate analysis didn't show any other associated factor to the observed impairment in sperm mobility and morphology.These data highlight the severe impact of the pandemic of the male reproductive health of hypofertile patients. Delaying infertility investigations and management after pandemic waves is recommended to hope a better gamete quality and hence to improve conception potential.
