scholarly journals Correlation of Sperm DNA Fragmentation Index With Seminal Plasma Biochemical Index and Semen Parameters in Infertile Men

2020 ◽  
Author(s):  
Xiao-Dong Mao ◽  
Xinyuan Yang ◽  
Feng Pan ◽  
Kang-Sheng Liu
Keyword(s):  
Survival Rate ◽  
Dna Fragmentation ◽  
Semen Quality ◽  
Semen Analysis ◽  
Sperm Concentration ◽  
Group Iii ◽  
Group I ◽  
Sperm Dna ◽  
Semen Volume ◽  
Sperm Survival

Abstract In general, routine semen analysis makes only limited predictions about a man's reproductive potential and is not always able to explain why he is infertile. In fact, many male infertility cases are caused by sperm DNA defects ,which routine semen quality analyses fail to detect. The relationship between sperm DFI, sperm parameters and their diagnostic value were analyzed and evaluated by observing the seminal parameters of infertile patients without accessory gonadal infection. Specimens of 151 cases were collected from infertile patients who visited the male department of STD and reproductive specialty clinic of our hospital from August 2018 to September 2019. SCD test was performed to measure the DNA fragmentation in native. The routine semen analysis was performed with a semen quality detection system (CFT-920, Jiangsu Ruiqi Life Science & Tech Dev .Co.Ltd) and supporting reagents. Seminal plasma malondialdehyde (MDA), and total antioxidant capacity (TAC) were assessed. Fructose(Fru) 、a-glucosidase (a-glu), and zinc (Zn) levels are quantitatively detected by kehua-310, a fully automated biochemical tester provided by Nanjing Xindibio. According to DFI level, there were 31 cases in group I (DFI ≤ 15%), 81 cases in group II (15% < DFI < 30%), and 39 cases in group III (DFI ≥ 30%). Compared with group II, there were significant differences in sperm survival rate, PR% and Fru by non-parametric test (Z = -2.16 -2. 43. − 2. 20,respectively,P < 0. 05). There were significant differences in sperm survival rate and PR% between group I and group III (t = 4. 32, 4.25, respectively, P < 0.01). Compared with group III, there were significant differences in sperm survival rate and PR% by non-parametric test (Z= -3. 26, -3. 50, respectively).Sperm DFI was negatively correlated with sperm survival rate and PR%(R=-0.56,-0.46,P < 0.01). DFI was positively correlated with MDA content (R = 0.42, P < 0.01) and negatively correlated with TAC (r=-0.40, P < 0.01).There was no correlation with age ,abstinence days, semen volume, sperm concentration, percentage of normal form sperm, Fru, a-Glu, Zn (R = 0. 15, 0. 05,0.03,-0.03, -0.2, -0.16,- 0.20, 0.03, 0.15, p > 0.05).The survival rate and PR% of sperm decreased significantly with the increase of DFI level, antioxidant can decrease the rate of DNA fragmentation, antioxidant can decrease the rate of DNA fragmentation. Semen volume and sperm concentration were mainly related to the secretion volume of accessory gonads and total sperm count, but no correlation was found between them and DFI.

scholarly journals Correlation of Sperm DNA Fragmentation Index With Seminal Plasma Biochemical Index and Semen Parameters in Infertile Men

2020 ◽  
Author(s):  
Kang-Sheng Liu ◽  
Xiao-Dong Mao ◽  
Feng Pan ◽  
Xinyuan Yang
Keyword(s):  
Survival Rate ◽  
Dna Fragmentation ◽  
Semen Quality ◽  
Semen Analysis ◽  
Sperm Concentration ◽  
Group Iii ◽  
Group I ◽  
Sperm Dna ◽  
Semen Volume ◽  
Sperm Survival

Abstract BackgroundAccording to world Health Organization guidelines, semen analysis by testing routine parameters is the main method for assessing male fertility.In general, routine semen analysis makes only limited predictions about a man's reproductive potential and is not always able to explain why he is infertile. In fact, many male infertility cases are caused by sperm DNA defects ,which routine semen quality analyses fail to detect.The relationship between sperm DFI , sperm parameters and their diagnostic value were analyzed and evaluated by observing the seminal parameters of infertile patients without accessory gonadal infection.MethodsSpecimens of 151 cases were collected from infertile patients who visited the male department of STD and reproductive specialty clinic of our hospital from August 2018 to September 2019. SCD test was performed to measure the DNA fragmentation in native. The routine semen analysis was performed with a semen quality detection system (WLJY-9000, Beijing Weili New century Science & Tech Dev .Co.Ltd) and supporting reagents. Seminal plasma malondialdehyde (MDA), and total antioxidant capacity (TAC) were assessed. Fructose(Fru) 、a-glucosidase (,a-glu), and zinc (Zn) levels are quantitatively detected by kehua-310, a fully automated biochemical tester provided by Nanjing Xindibio.ResultsAccording to DFI level, there were 31 cases in group I (DFI≤15%), 81 cases in group II (15% < DFI < 30%), and 39 cases in group III (DFI≥30%). Compared with group II, there were significant differences in sperm survival rate, PR% and Fru by non-parametric test (Z = -2.16 -2. 43. - 2. 20,respectively,P < 0. 05). There were significant differences in sperm survival rate and PR% between group I and group III (t = 4. 32, 4.25, respectively, P< 0.01). Compared with group III, there were significant differences in sperm survival rate and PR% by non-parametric test (Z= -3. 26, -3. 50, respectively).Sperm DFI was negatively correlated with sperm survival rate and PR%(R=-0.56,-0.46,P<0.01). DFI was positively correlated with MDA content (R=0.42, P<0.01) and negatively correlated with TAC (r=-0.40, P<0.01).There was no correlation with age ,abstinence days, semen volume, sperm concentration, percentage of normal form sperm, Fru, a-Glu, Zn (R= 0. 15, 0. 05,0.03,-0.03, -0.2, -0.16,- 0.20, 0.03, 0.15, p > 0.05).ConclusionThe survival rate and PR% of sperm decreased significantly with the increase of DFI level, antioxidant can decrease the rate of DNA fragmentation, antioxidant can decrease the rate of DNA fragmentation. Semen volume and sperm concentration were mainly related to the secretion volume of accessory gonads and total sperm count, but no correlation was found between them and DFI.

scholarly journals Can Utilization of Sperm DNA Fragmentation (SDA) Tests in Combination with Time Lapse Microscopy Help in Improving ICSI Implantation Rates in Unexplained Recurrent Implantation Failures Utilizing Double Stranded SDA as the Causative Factor for the same

2020 ◽  
Vol 4 (1) ◽  
Keyword(s):  
Dna Damage ◽  
Dna Fragmentation ◽  
Semen Analysis ◽  
Sperm Concentration ◽  
Time Lapse ◽  
Sperm Dna Fragmentation ◽  
Time Lapse Microscopy ◽  
Sperm Dna ◽  
Implantation Rates ◽  
Embryo Kinetics

Over 50% of intracytoplasmic sperm injection (ICSI) cycles don’t display implantation. Hence laboratories make their maximum efforts to select the best embryos as far as implantation enhancement is concerned. Further utilization of available technologies like time lapse recording have been made in a large number of artificial reproductive technology (ART) centres. Various studies that utilize embryo kinetics have implicated that time when embryo cleavage may prove to be an important factor that determines the implantation potential of an embryo. With this variety of algorithms mathematic wise have been used to forecast which the best embryos are for transfer. But the efficacy of these might be influenced by multiple confounding factors. Thus work on biomarkers that can forecast good ART warrants newer embryo selection basis. Regarding conventional ICSI, typical standard routine semen analysis involving sperm concentration, motility and morphology does not predict the implantation percentages in an ICSI cycle. Once sperm DNA fragmentation (SDA) methods were inducted they appeared to hold promise in forecasting good ART success. Although certain studies utilizing various techniques like TUNEL. SCSA, SCD proved a relation existed between DNA damage and implantation rates in ICSI but the same was contradicted by others. With this it was thought that bias between evaluation of ejaculate and motile sperm picked up for ICSI, as is known regarding absence of positive association of sperm motility and DNA fragmentation. Thus study by Casanovas et.al., tried to find if there is any correlation of single stranded (ssSDA) and double stranded (dsSDA) sperm DNA damage that might forecast ICSI success and utilizing Neutral Comet Assays along with help of time lapse technology they found that double stranded sperm influenced delay in embryo formation as seen by embryo kinetics and thus interfere with implantation rates. Reproduction of these findings might help in getting a standard for getting best embryos selected in ICSI utilizing SDA and time lapse microscopy.

THE EFFECT OF A 15-H PHOTOPERIOD ON REPRODUCTIVE FUNCTION IN BOARS AT 2, 3, 4 OR 5 MONTHS OF AGE

1981 ◽  
Vol 61 (4) ◽  
pp. 925-934 ◽  
Author(s):  
L. G. GREENBERG ◽  
J. P. MAHONE
Keyword(s):  
Seminal Plasma ◽  
Zinc Concentration ◽  
Semen Quality ◽  
Reproductive Function ◽  
Group Iv ◽  
Artificial Light ◽  
Group Iii ◽  
Group I ◽  
Semen Volume ◽  
Viable Sperm

The effects of supplemental lighting in stimulating reproductive function in prepuberal boars were studied using littermate boars divided equally into four groups (n = 9). All boars received natural daylight (9.2–12.8 h) until 2 mo of age, followed by artificial light given daily according to the following schedule: boars were exposed to a 15-h photoperiod beginning at the age of 2 (group I); 3 (group II); 4 (group III) or 5 mo (group IV). Libido scores of the four groups increased with age (P < 0.001). Seminal plasma protein (P < 0.01) and zinc concentration (P < 0.05), sperm-rich concentration, sperm-rich volume, total semen volume and total viable sperm increased (P < 0.05) with age in all four groups. The photoperiod treatment had no effect on semen quality on a per ejaculate basis between the groups; 15 h of light per day was not effective in accelerating the onset of puberty when administered from 2, 3, 4 or 5 mo of age onward.

scholarly journals Selective serotonin reuptake inhibitors and spermatogenesis

2021 ◽  
Vol 9 (2) ◽  
pp. 74-79
Author(s):  
M. N. Korshunov ◽  
E. S. Korshunova ◽  
Yu. V. Kastrikin ◽  
S. P. Darenkov
Keyword(s):  
Dna Fragmentation ◽  
Male Fertility ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Sperm Concentration ◽  
Semen Parameters ◽  
Sperm Dna Fragmentation ◽  
Normal Morphology ◽  
Sperm Dna ◽  
Semen Volume ◽  
The Mean

Introduction. According to the WHO data, depression is a common disease among women and men of reproductive age. One line of the correction of depressive disorders is selective serotonin reuptake inhibitors (SSRIs). The ingestions have shown that using SSRIs harms sperm quality. The literature date of evaluation of male fertility after discontinuation of antidepressants is quite limited.Purpose of the study. To evaluate the influence of Fluoxetine intake on semen parameters, sperm DNA fragmentation and hormonal status.Materials and methods. Twenty-five men (mean age - 35.2 ± 4.5 yo) with depression were included in the study. Fluoxetine (20 mg per day) was prescribed to all the patients for 12 wk. Semen parameters, sperm DNA fragmentation, sex hormones levels were measured before-after treatment and 3 mo behind discontinuation.Results. After 12 weeks of the treatment the mean semen volume decreased from 3.1 ± 0.7 to 2.9 ± 0.7 ml (p = 0.638), sperm concentration - from 39.4 ± 18.5 to 34.3 ± 16.8 mln/ml (p = 0.384), sperm motility decreased from 41.7 ± 7.6 to 35.5 ± 7.8% (p < 0.05), the mean percent of normal morphology form - from с 12.7 ± 2.8 to 10.7 ± 2.2% (p < 0.001). Sperm DNA fragmentation increased 16.2 ± 4.9 to 22.2 ± 4.3% (p < 0.001). The mean semen volume, sperm concentration, motility, percentage of normal morphology increased and reverted to the normal levels after 3 mounts of drug discontinuation. Sperm DNA fragmentation index decreased, and it had the values less than before the treatment that positively correlated with the reduction of depression's symptoms. It was not significant dynamics in hormonal parameters before and after the therapy.Conclusion. Using fluoxetine has a reversible negative effect on male fertility. It is important to inform the patients about the temporary side effects of SSRIs in fatherhood planning cases.

The effects of Pb on sperm parameters and sperm DNA fragmentation of men investigated for infertility

2020 ◽  
Vol 31 (4) ◽  
Author(s):  
G.U.S. Wijesekara ◽  
D.M.S. Fernando ◽  
S. Wijeratne
Keyword(s):  
Dna Fragmentation ◽  
Seminal Plasma ◽  
Sperm Concentration ◽  
Sperm Parameters ◽  
World Health ◽  
Sperm Dna Fragmentation ◽  
Progressive Motility ◽  
Sperm Dna ◽  
The Mean ◽  
Pb Concentration

AbstractBackgroundLead (Pb) is one of the metals most prevalent in the environment and is known to cause infertility and deoxyribonucleic acid (DNA) fragmentation. This study aimed to determine the association between seminal plasma Pb and sperm DNA fragmentation in men investigated for infertility.MethodsMale partners (n = 300) of couples investigated for infertility were recruited after informed consent was obtained. Sperm parameters were assessed according to the World Health Organization (WHO) guidelines. Seminal plasma Pb was estimated by atomic absorption spectrophotometry after digestion with nitric acid.ResultsIn Pb-positive and -negative groups the sperm parameters and sperm DNA fragmentation were compared using independent sample t-test and the Mann-Whitney U-test, respectively. The mean [standard deviation (SD)] age and duration of infertility were 34.8 (5.34) years and 45.7 (35.09) months, respectively, and the mean Pb concentration was 15.7 μg/dL. In Pb positives compared to Pb negatives the means (SD) of sperm count, progressive motility viability and normal morphology were lower (p > 0.05) but the DNA fragmentation was significantly higher 39.80% (25.08) than Pb negatives 22.65% (11.30). Seminal plasma Pb concentration and sperm DNA fragmentation had a positive correlation (r = 0.38, p = 0.03). A negative correlation was observed between sperm DNA fragmentation and sperm concentration, progressive motility, total motility and viability. When the DNA fragmentation was ≥30% sperm concentration and viability decreased (p < 0.05).ConclusionsPb in seminal plasma had a significant effect on sperm DNA fragmentation but not with other sperm parameters.

Do serum vitamin D levels correlate with semen analysis parameters and sperm DNA fragmentation?

2012 ◽  
Vol 98 (3) ◽  
pp. S47-S48
Author(s):  
L. Rubal ◽  
A.M. Hernandez ◽  
S. Ingles ◽  
M. Scrooc ◽  
K. Bendikson
Keyword(s):  
Vitamin D ◽  
Dna Fragmentation ◽  
Semen Analysis ◽  
Serum Vitamin ◽  
Sperm Dna Fragmentation ◽  
Serum Vitamin D ◽  
Sperm Dna ◽  
Vitamin D Levels

scholarly journals Effect and mechanisms of reproductive tract infection on oxidative stress parameters, sperm DNA fragmentation, and semen quality in infertile males

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Kang-Sheng Liu ◽  
Xiao-Dong Mao ◽  
Feng Pan ◽  
Rui Fang An
Keyword(s):  
Reproductive Medicine ◽  
Reproductive Tract ◽  
Group Iv ◽  
Semen Parameters ◽  
Group Iii ◽  
Reproductive Tract Infection ◽  
Group I ◽  
Sperm Dna ◽  
Group Ii ◽  
Elastase Level

AbstractRecent years have seen a rising incidence of male infertility, mostly caused by the decline of sperm quality. The ratio of infertile males to infertile females has escalated from 3:7 in 2013 to current 5:5, which turns male infertility into the research focus of reproductive medicine. This study aimed to clarify the effect of reproductive tract infection by ureaplasma urealyticum (UU) and chlamydia trachomatis (CT) on the DNA integrity and routine semen parameters of infertile males. A retrospective study was performed. A total of 259 infertile males who were treated at the Andrological Laboratory Examination and Reproductive Medicine Center in our hospital were analyzed. qRT-PCR was used to examine the infection status of CT and UU. According to the eligibility criteria, we evaluated the semen parameters and biochemical data of 253 men. Based on the results of PCR, the subjects were divided into four groups: Group I (CT positive, 63 cases), Group II (UU positive, 60 cases), Group III (CT positive and UU positive, 62 cases), and Group IV (no infection, 68 cases). DNA fragmentation index (DFI), sperm count, vitality and morphology, elastase level, seminal plasma malondialdehyde (MDA), and total antioxidant capacity (TAC) were assessed. Compared to Group IV, three groups (Group I, Group II and Group III) showed difference in semen volume, proportion of sperm with normal morphology, sperm motility, progressive motility, and vitality (P < 0.05). Compared to Group IV, Group II and Group III showed difference in DFI (P < 0.05). Compared to Group IV, Group II and Group III showed difference in elastase level (P < 0.05). VCL, VSL, VAP, WOB, ROS, TM, HDS showed differences between groups of abnormal/normal WBC (*P < 0.01).UU infection significantly increased the level of seminal leukocytes only in Group II, but not in the other three groups, indicating that UU is a factor to increase the level of seminal leukocytes. Compared with the normal leukocyte group, there were significant differences in total motility, forward motility and normal sperm ratio between the two groups. The proportion of sperm with abnormal morphology (mostly in the head) showed obvious difference between groups of high and normal seminal leukocytic levels. At the same time, in this study, SCGE and SCD verified that leukocytes could damage sperm DNA by increasing ROS, which ultimately affects male fertility.

Evaluating human sperm DNA integrity: relationship between 8-hydroxydeoxyguanosine quantification and the sperm chromatin structure assay

Zygote ◽  
2003 ◽  
Vol 11 (4) ◽  
pp. 367-371 ◽  
Author(s):  
Isabelle Oger ◽  
Christelle Da Cruz ◽  
Gilles Panteix ◽  
Yves Menezo
Keyword(s):  
Dna Fragmentation ◽  
Chromatin Structure ◽  
Inverse Relationship ◽  
Sperm Concentration ◽  
Sperm Chromatin ◽  
Sperm Chromatin Structure Assay ◽  
Fragmentation Index ◽  
Sperm Dna ◽  
Oxidative Products ◽  
Dna Fragmentation Index

In our work, we have used 8-hydroxy-deoxyguanosine (8-OH-dG), one of the major oxidative products of sperm DNA, in a population of patients consulting for infertility. We found an inverse relationship between sperm concentration and the log of the ratio of 8-OH-dG to dG (P<0.01). On the same patients' sperm samples, the sperm chromatin structure assay (SCSA) was performed. An inverse relationship was observed between the DNA fragmentation index and sperm concentration (P<0.001). There was also a positive relationship between SCSA and log 8-OH-dG/dG. This indicates that DNA fragmentation measured by the SCSA originates in part from oxidative products. In a few patients, antioxidant treatment decreased the DNA fragmentation index below the threshold of 30% that is crucial for subfertility.

scholarly journals Effects of Ficus syncomorus and Datura metel stem-bark extracts on the sperm characteristics of Yankasa rams

2020 ◽  
Vol 47 (2) ◽  
pp. 37-45
Author(s):  
J. O. Okpara ◽  
M. B Abudul ◽  
S. I Garba ◽  
O. V Adelowo ◽  
A. C Mbgojikwe
Keyword(s):  
Sperm Morphology ◽  
Stem Bark ◽  
Haematological Parameters ◽  
Group Iii ◽  
Datura Metel ◽  
Sperm Characteristics ◽  
Group I ◽  
Semen Volume ◽  
The Mean ◽  
Group Ii

Interest in medicinal plants for the management of myriad of conditions including reproductive disorders refractory to orthodox medicinal care is on the increase. Ficus syncomorus and Datura metel are two of such plants with folkloric evidence of aiding fertility in human. This study investigated the effect of aqueous stem-bark extracts (200 mg/kg) of F. syncomorus and D. metel respectively on the sperm characteristics of Yankasa rams. Twelve (12) matured (15 – 16 months) old rams were used in this study and randomly assigned into three (I, II, III) groups of four (4) animals each. Group I served as the control while II and III served as the treatment groups and received daily oral doses (200 mg/kg) of F. syncomorus and D. metel extracts respectively for 7 consecutive days. Semen was collected from all the groups at the end of the treatments using Electro-ejaculation method and evaluated by light microscopy. The mean semen volume (68.70+4.2 to 65.62+2.00) and percentage progressive motile cells significantly (p<0.05) reduced 7 days post treatment in group III (84.05+1.3) compared to the control (85.20+1.32) and the group II (86.56+0.40) animals. The mean sperm count, the percentage liveability and the haematological parameters and erythrocytic indices (10.81±0.24 for group 111 to 12.54±0.30 for group1) significantly (p<0.05) decreased in group III compared to the values in the control and group II rams. Abnormal sperm morphology (bent mid-piece, curved tail, headless tail, tailless head) significantly (p<0.05) increased in D. metel group (7.26+0.12) compared to F. syncomorus (5.02+0.04) and control groups (5.62+0.01) respectively. D. metel aquesous extract adversely affected sperm characteristics with significant effect on semen volume, sperm morphology and counts as well as haematological parameters. Exposure of animals to D. metel at the dose used may impair sperm fertilizing ability, thus leading to reduced ram fertility. While F. syncomorus extract appears a potential drug candidate for improving fertility.

O-207 Which infertile patients mostly deserve to have a sperm DNA fragmentation index done? Findings from a cross-sectional study

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
E Pozzi ◽  
L Boeri ◽  
L Candela ◽  
D Cignoli ◽  
G Colandrea ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Dna Fragmentation ◽  
Logistic Regression Analysis ◽  
Roc Curve ◽  
Sperm Concentration ◽  
Testicular Volume ◽  
Sperm Dna Fragmentation ◽  
Sperm Dna ◽  
Increased Risk

Abstract Study question Current scientific guidelines do not clearly suggest which patients would benefit the most from a sperm DNA fragmentation (SDF) test. Summary answer We aimed to investigate potential predictive factors for altered SDF in a homogenous cohort of white-European men presenting for primary couple’s infertility. What is known already High SDF has been associated with reduced fertilization rates, reduced chances of natural conception and an increased risk of early pregnancy loss. Study design, size, duration Data from 478 consecutive men with normal or altered SDF were analysed. Infertility was defined according to the WHO criteria. Semen analysis, SDF (according to SCSA) and serum hormones were measured in every patient. Health significant comorbidities were scored with the Charlson Comorbidity Index (CCI). Altered SDF was considered with a threshold of &gt; 30%. Participants/materials, setting, methods Descriptive statistics compared the overall characteristics of patients with normal SDF and altered SDF. Logistic regression analysis tested potential predictors of altered SDF. ROC curve was used to test the accuracy of the model in predicting SDF alteration Main results and the role of chance Of 478 patients, 253 (57.7%) had altered SDF. Median (IQR) age and BMI of the whole cohort were 38 (35-42) years and 25.1 (23.3-27.1) kg/m2 respectively. Patients with altered SDF were older (median (IQR) age: 39 (36-43) vs. 37 (34-38) years, p &lt; 0.0001), had lower sperm concentration (5 (1.1–18) vs. 17 x106/mL (6–38.8), p &lt; 0.0001), testicular volume (15.1 (12 –20) vs. 16.8 (12 – 25) Prader, p = 0.0005), and total motile sperm count (TMSC) (1.8 (0.21–10.71) vs. 11.8x106 (2–37.26), p &lt; 0.0001). Conversely, men with altered SDF had higher FSH (6.1 (3.85–9.7) vs. 4.8 (3.85 – 7.9) mIU/mL, p &lt; 0.0001) and prolactin levels (9.8 (7.43–14.04) vs. 8.3 (6.6–11.3) pg/mL, p = 0.0004) than those with normal SDF. At multivariable logistic regression analysis, patients’ age &gt;35 years (OR: 2.45, p = 0.0009), FSH &gt; 8.0 mIU/mL (OR: 2.23, p &lt; 0.0001) and lower TMSC (OR: 2.04, p = 0.002) were identified as indipendent predictors of altered SDF, after adjusting for testicular volume and CCI≥1. ROC curve (Figure 1) revealed that the model has a good predictive ability to identify patients with SDF alteration (AUC: 0.72, 95%CI: 0.67 - 0.77). Limitations, reasons for caution It is a retrospective analysis at a single, tertiary-referral academic centre, thus raising the possibility of selection biases. In spite of this, all patients have been consistently analysed over time with a rigorous follow-up, thus limiting potential heterogeneity in terms of data reporting Wider implications of the findings Primary infertile men older than 35 years, with high serum FSH and low TMSC at baseline are the ones who mostly deserve a SDF test over their diagnostic work-up and that would potentially benefit the most of certain treatments to improve SDF value, thus increasing chances of conceiving. Trial registration number Not applicable

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