RESUMO
OBJECTIVE: To determine whether age thresholds for elements of semen quality exist. DESIGN: Retrospective analysis (covariance and point-change analysis) of results of 4,822 semen analyses and 259 fluorescence in situ hybridization (FISH) analyses. SETTING: Reference laboratory within an infertility clinic. PATIENT(S): A total of 5,081 men aged 16.5-72.3 years. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Ejaculate volume, sperm concentration, sperm motility, sperm motion parameters, strict morphology, and results of FISH analysis. RESULT(S): Measured parameters of ejaculates did not change before 34 years of age. Immediately thereafter, total sperm numbers (and total motile) declined. Sperm concentration and the proportion of sperm of normal morphology declined after 40 years. Sperm motility and progressive parameters of motile sperm fell after 43 years and ejaculate volume after 45 years. The ratio of Y:X-bearing sperm in ejaculates decreased only after 55 years. CONCLUSION(S): Our findings project a declining likelihood of pregnancy following intercourse with men >34 years old, independent from the woman's age and increasing with advancing age. Age-related mechanisms associated with this oligoasthenoteratozoospermic progression are discussed.
Assuntos
Envelhecimento/patologia , Idade Paterna , Análise do Sêmen , Espermatozoides/patologia , Adolescente , Adulto , Fatores Etários , Idoso , Envelhecimento/genética , Análise de Variância , Forma Celular , Cromossomos Humanos X , Cromossomos Humanos Y , Feminino , Fertilidade , Humanos , Hibridização in Situ Fluorescente , Infertilidade Masculina/genética , Infertilidade Masculina/patologia , Infertilidade Masculina/fisiopatologia , Análise dos Mínimos Quadrados , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Gravidez , Resultado da Gravidez , Estudos Retrospectivos , Fatores de Risco , Análise do Sêmen/métodos , Contagem de Espermatozoides , Motilidade dos Espermatozoides , Adulto JovemRESUMO
OBJECTIVE: To evaluate whether day-3 embryo morphology predicts euploidy. DESIGN: Retrospective. SETTING: Private IVF center. PATIENT(S): Subjects (n = 144) undergoing in vitro fertilization and preimplantation genetic diagnosis (PGD). INTERVENTION(S): Translate day-3 embryo characteristics into a standardized score. MAIN OUTCOME MEASURE(S): Day-3 embryo morphology score and PGD fluorescence in situ hybridization results for chromosomes: 13, 15, 16, 17, 18, 21, 22, X, and Y. RESULT(S): Of 1,043 biopsied blastomeres, 67% (n = 696) were chromosomally abnormal. Women with advanced maternal age (AMA) were 1.3 times more likely to have chromosomal errors (95% CI 1.1-1.4) than younger subjects (<38 years old). Morphology predicted PGD results in the AMA group (n = 553), but not in younger women. Fragmentation predicted euploidy in both the younger and the AMA group, but cell number did not. CONCLUSION(S): Day-3 embryo morphology selects for euploidy among AMA subjects but not among younger women who may have other factors responsible for embryo dysmorphism. However, cellular fragmentation is a sensitive proxy for selecting chromosomally normal embryos in both age groups. It is unclear that PGD-aneuploidy screening is a better tool for selecting which embryos to transfer than the standard approach of using day-3 embryo features, particularly among older women, a group for whom this technology is targeted.