Semen Analysis of Total Motile Sperm Count Based on the 1999 and 2010 WHO Criteria.

OBJECTIVE: Approximately 15% of the couples suffer from infertility. Half of the cases of infertility are due to male factors. Several sperm function tests have been proposed to evaluate male fertility, but sperm analysis is still the first and most important diagnostic test for male infertility. The prognostic value of semen characteristics such as concentration, morphology and motility markers are often confused with male infertility. Evaluation of seminal parameters and classification for normality remains a frequent topic of discussion. METHODS: This study evaluated 477 semen samples from men undergoing investigation or infertility treatment between 2011 and 2015. RESULTS: The spermograms of 401 patients were deemed abnormal based on the 1999 World Health Organization (WHO) criteria; the number changed to 223 when the spermograms were assessed based on the 2010 WHO criteria and to 200 when Total Motile Sperm Count (TMSC) was used as the criterion. Sperm morphology was the item in the criteria that most significantly changed spermogram classification. Normality parameters became less rigid from 1999 to 2010, thereby significantly changing the proportion of individuals no longer described as infertile/subfertile. CONCLUSIONS: The classification based on TMSC could not differentiate between fertile and infertile subjects for not taking sperm morphology into account. Nevertheless, it may be helpful in cases where intrauterine insemination is indicated.

Fatores perinatais associados a recém-nascidos de termo com pH<7,1 na artéria umbilical e índice de Apgar <7,0 no 5º minuto / Perinatal factors associated with pH<7.1 in umbilical artery and Apgar 5 min <7.0 in term newborn

OBJETIVO: Avaliar os fatores perinatais associados a recém-nascidos de termo com pH<7,1 na artéria umbilical e índice de Apgar no 5º min<7,0. MÉTODOS: Estudo retrospectivo com delineamento caso-controle, realizado após revisão dos prontuários de todos os nascimentos ocorridos entre setembro/1998 e março/2008, no Hospital Geral de Caxias do Sul. Foi considerado fator de inclusão os recém-nascidos de termo que apresentaram índice de Apgar no 5º min <7,0 e pH de artéria umbilical <7,1. Na análise univariada foi utilizado o teste t de Student e Mann-Whitney para as variáveis contínuas, o teste do c² para as variáveis dicotômicas e estimativa de risco pelo odds ratio (OR). Foi utilizado um valor de p<0,05 como estatisticamente significativo. RESULTADOS: De um total de 15.495 nascimentos consecutivos observaram-se 25 neonatos (0,16%) de termo com pH<7,1 na artéria umbilical e índice de Apgar no 5º min <7,0. Apresentaram associação significativa com o evento acidótico a apresentação pélvica (OR=12,9; p<0,005), parto cesáreo (OR=3,5; p<0,01) e cardiotocografia intraparto alterada (OR=7,8; p<0,02). Dentre as características fetais, associaram-se o déficit de base (-15,0 versus -4,5; p<0,0001), necessidade de internação em unidade de terapia intensiva neonatal (OR=79,7; p<0,0001) e necessidade de reanimação (OR=12,2; p<0,0001). CONCLUSÃO: Baixo índice de Apgar no 5º min de vida associado a pH<7,1 na artéria umbilical pode predizer desfechos neonatais desfavoráveis.

PURPOSE: To assess perinatal factors associated with term newborns with pH<7.1 in the umbilical artery and 5th min Apgar score<7,0. METHODS: Retrospective case-control study carried out after reviewing the medical records of all births from September/1998 to March/2008, that occurred at the General Hospital of Caxias do Sul. The inclusion criterion was term newborns who presented a 5th min Apgar score <7.0 and umbilical artery pH<7.10. In the univariate analysis, we used the Student's t-test and the Mann-Whitney test for continuous variables, the c² test for dichotomous variables and risk estimation by the odds ratio (OR). The level of significance was set at p<0.05. RESULTS: Of a total of 15,495 consecutive births, 25 term neonates (0.16%) had pH<7.1 in the umbilical artery and a 5th min Apgar score <7.0. Breech presentation (OR=12.9, p<0.005), cesarean section (OR=3.5, p<0.01) and modified intrapartum cardiotocography (OR=7.8, p<0.02) presented a significant association with the acidosis event. Among the fetal characteristics, need for hospitalization in the neonatal intensive care unit (OR=79.7, p <0.0001), need for resuscitation (OR=12.2, p <0.0001) and base deficit were associated with the event (15.0 versus -4.5, p<0.0001). CONCLUSION: Low Apgar score at the 5th min of life associated with pH<7.1 in the umbilical artery can predict adverse neonatal outcomes.