Diagnosis of Partial Retrograde Ejaculation in Non-Azoospermic Infertile Men with Low Semen Volume.

In non-azoospermic patients with low semen volume (LSV), looking for partial retrograde ejaculation (PRE) by searching sperm in the postejaculatory urine (PEU) is required. The use of a retro-ejaculatory index (R-ratio) was suggested to define PRE, but none of the studies indicated a specific threshold above which PRE must be considered. Our objective was to propose a threshold value for the R-ratio as indicative of PRE in patients with LSV selected to be devoid of any known causes or risk factors for retrograde ejaculation or LSV. Among our data base (2000-2009) including 632 patients with PEU, 245 male patients from infertile couples who had had a first semen analysis with LSV (< 2mL) and a second semen analysis associated with PEU, were selected on the previous criteria. A prospective control group was randomly constituted (2007-2008) of 162 first consulting male patients from infertile couples, with a normal semen volume (≥ 2mL) on a first semen analysis and who accepted to collect PEU with their usual second semen analysis, selected on the previous criteria. To define an R-ratio threshold indicative of PRE, we used a ROC curve analysis and a regression tree based on a classification and regression tree (CART) algorithm. Of the 245 LSV patients, 146 still presented low semen volume (< 2 mL) on the second semen analysis. From the use of the CART algorithm, two low (1.5% and 2.8%) and two high R-values (7.1% and 8.3%) were defined, according to the lower reference limit for semen volume of 2.0 mL (WHO 1999) or 1.5 mL (WHO 2010) respectively. As only one or no patient with normal semen volume was observed above the two high R-values, we suggest an R-value higher than the range of [7.1-8.3]% as indicative of PRE until confirmation by a prospective multicenter study

Semen and post ejaculatory urine characteristics as function of the R-value thresholds obtained from the CART procedure in 162 patients with normal semen volume (NSV) and 146 patients with observed low semen volume < 2 mL (LSV).

<p>Values are mean ± SD (median); 1.5% and 7.1%, thresholds values of R determined by the CART procedure on the 308 (162 plus 146) patients; % corresponds to number of patients/total number of patients with NSV or LSV. Three ranges of R-value classified patients: 80% of NSV patients (129/162) and 27% of LSV patients (39/146) were under an R-value of 1.5%, 20% of NSV and 38% of LSV were comprised between 1.5% and 7.1%, and less than 1% of NSV and 35% of LSV had an R-value ≥ 7.1%. R (%), [uTSC divided by (uTSC plus sTSC)] multiplied by 100 uVolume, urine volume (ml) uSC, urine sperm count (10⁶/ml) uTSC, urine total sperm count (uVolume multiplied by uSC; 10⁶) Abst Delay, abstinence delay (days) sVolume, semen volume (ml) sSC, semen sperm count (10⁶/ml) sTSC, semen total sperm count (sVolume multiplied by sSC; 10⁶) TAS, total amount of sperm (uTSC plus sTSC; 10⁶) ^a p < 0.05 between 129 NSV and 39 LSV ^b p < 0.05 between 32 NSV and 56 LSV ^c p < 0.05 between 129 NSV (R < 1.5%) and 32 NSV (1.5 ≤ R < 7.1%) ^d p < 0.05 between 39 LSV (R < 1.5%) and 56 LSV (1.5 ≤ R < 7.1%) ^e p < 0.05 between 56 LSV (1.5 ≤ R < 7.1%) and 51 LSV (R ≥ 7.1%) ^f p < 0.05 between 39 LSV (R < 1.5%) and 51 LSV (R ≥ 7.1%)</p

Distribution of patients according to R-values and semen volume.

<p>Reference lines were drawn on x-axis to represent WHO lower reference limits for semen volume (1.5 mL [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0168742#pone.0168742.ref020" target="_blank">20</a>] and 2 mL [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0168742#pone.0168742.ref016" target="_blank">16</a>]) and on y-axis to represent low and high R-value thresholds obtained from CART procedure (1.5% and 2.8%, 7.1% and 8.3% respectively). + (green), 146 patients with observed low semen volume (<2 mL) × (red), 99 patients with normalized semen volume (≥ 2 mL) * (blue), 162 patients with normal semen volume (≥ 2 mL).</p

Post ejaculatory urine and semen characteristics in the 162 patients with normal semen volume (NSV), 99 patients with normalized semen volume (NzedSV) and 146 patients with observed low semen volume (LSV) according to WHO 1999 [16].

<p>Post ejaculatory urine and semen characteristics in the 162 patients with normal semen volume (NSV), 99 patients with normalized semen volume (NzedSV) and 146 patients with observed low semen volume (LSV) according to WHO 1999 [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0168742#pone.0168742.ref016" target="_blank">16</a>].</p

Optimal R-value thresholds obtained from ROC plot for the 162 patients with normal semen volume (NSV; ≥2 mL) versus 146 patients with observed low semen volume (<2 mL) and 82 patients with observed low semen volume (<1.5 mL).

<p>Optimal R-value thresholds obtained from ROC plot for the 162 patients with normal semen volume (NSV; ≥2 mL) versus 146 patients with observed low semen volume (<2 mL) and 82 patients with observed low semen volume (<1.5 mL).</p

Flowchart and design of the study.

<p>Flowchart and design of the study.</p

The spectrum of renal involvement in male patients with infertility related to excretory-system abnormalities: Phenotypes, genotypes, and genetic counseling

International audienceBackground: While reproductive technologies are increasingly used worldwide, epidemiologic, clinical and genetic data regarding infertile men with combined genital tract and renal abnormalities remain scarce, preventing adequate genetic counseling. Methods: In a cohort-based study, we assessed the prevalence (1995-2014) and the clinical characteristics of renal disorders in infertile males with genital tract malformation. In a subset of 34 patients, we performed a detailed phenotype analysis of renal and genital tract disorders. Results: Among the 180 patients with congenital uni- or bilateral absence of vas deferens (CU/BAVD), 45 (25 %) had a renal malformation. We also identified 14 infertile men with combined seminal vesicle (SV) and renal malformation but no CU/BAVD. Among the 34 patients with detailed clinical description, renal disease was unknown before the assessment of the infertility in 27 (79.4 %), and 7 (20.6 %) had chronic renal failure. Four main renal phenotypes were observed: solitary kidney (47 %); autosomal-dominant polycystic kidney disease (ADPKD, 0.6 %); uni- or bilateral hypoplastic kidneys (20.6 %); and a complex renal phenotype associated with a mutation of the HNF1B gene (5.8 %). Absence of SV and azoospermia were significantly associated with the presence of a solitary kidney, while dilatation of SV and necroasthenozoospermia were suggestive of ADPKD. Conclusion: A dominantly inherited renal disease (ADPKD or HNF1B-related nephropathy) is frequent in males with infertility and combined renal and genital tract abnormalities (26 %). A systematic renal screening should be proposed in infertile males with CU/BAVD or SV disorders