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Background: It is well established that high-quality semen can lead to an improved fertilisation rate. Ejaculatory abstinence (EA) certainly can influence sperm quality such as volume, count, motility and morphology. However, very few studies have addressed the influence of EA on intracytoplasmic sperm injection (ICSI) outcome and especially in males with severe oligo-asthenoteratozoospermia (OAT) syndrome. Aim: This study was undertaken with the purpose of evaluating the advantage of shorter abstinence period (1-h sequential ejaculation) in males with severe OAT syndrome on total usable embryo rate and thereby emphasising the potential application of consecutive ejaculate. Study Setting and Design: This retrospective cohort study consisted of all the infertile couples undergoing ICSI cycle with the indicated seminal characteristics who had consulted the tertiary care hospital between January 2021 and July 2021. Materials & Methods: All couples in the study had idiopathic male infertility. Retrospectively, two groups were analysed, i.e., Group A with 56 subjects in which first semen sample was used for ICSI cycle and another Group B with 41 subjects in which second semen sample collected within a shorter abstinence period of 1 h was used. Statistical Analysis: The data were descriptively analysed using GraphPad Prism (vs. 9.2). Unpaired t-test and analysis of variance test were used to determine the significance. P < 0.05 was considered statistically significant. Results: The age of female subjects in Group A was 29.9 ± 3.5 years while it was 29.4 ± 3.4 years in Group B. Similarly, the age of male subjects was 32.2 ± 3.6 years and 31.9 ± 4.1 years in Group A and Group B, respectively, with no statistical differences in any gender between the groups (P > 0.05). Apart from initial progressive motility (P = 0.004), none of the parameters such as total volume, total sperm count and morphology were significantly different (P > 0.05) between Group A and samples of Group B. Similarly, parameters such as volume (P = 0.006) and post-wash motility (P < 0.001) were significantly different between Group A and samples of Group B. However, there was no significant difference in sperm count and morphology (P > 0.05). Grade 1 embryos on day 3 were 345 (62.8%) in Group A and 170 (54.3%) in Group B. Overall, the total usable embryos in Group A and Group B were 222 (40.4%) and 148 (47.3%), respectively (P > 0.05). Conclusion: With regard to compromised sperm parameters, our findings do suggest that the second ejaculate is quite relevant to 'in vitro' reproductive treatments and a simple request for a second consecutive ejaculate (shorter abstinence period of 1 h) could provide the same results in terms of fertilisation. We observed the increased chances of usable embryos in the second ejaculate group.
RESUMO
OBJECTIVE: Differentiating asthma from chronic obstructive pulmonary disease (COPD) is difficult. Steroid trial may be of help but has several pitfalls. The present study aims to assess the value of past clinical profile of asthma and its differential diagnosis from COPD in male smokers and thereby to formulate clinical parameters to diagnose bronchial asthma in such patients. PATIENTS AND METHODS: Male smokers who reported at the Respiratory Medicine Department of the National Institute of Medical Sciences (NIMS) Hospital, Jaipur, (India), with shortness of breath (SOB) and showing less than 12% postbronchodilator bronchial reversibility (BR) on spirometry were recruited. These patients were given oral prednisolone 1 mg/kg for two weeks. Post steroid (PS) spirometry was performed to ascertain BR. The past clinical history was recorded and analyzed to determine if it is of any use in differentiating asthma from COPD. RESULT: Out of 104 patients, four were lost to follow up, 52 were diagnosed as bronchial asthma, and the remaining 48 as COPD. It was revealed that past history of (H/O) seasonal variation, wheezing, eye allergy, nasal allergy, dust allergy, skin allergy, and family H/O asthma/allergy were positive in 50, 40, 34, 30, 18, 14, and 12 asthma patients as compared to 10, 8, 2, 4, 6, 0, and 0 in 48 COPD patients (P < 0.001). The odds ratio (OR) for diagnosing asthma was highest for the presence of any other two symptoms/variables, besides SOB, in the past (OR = 275, P < 0.0001). CONCLUSION: Past clinical history is of immense value in differentiating asthma from COPD in male smokers presenting with SOB and fixed airway obstruction.