***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: This prospect i ve study compared the diagnostic and predictive potential of  sperm morphology assessment s in a fertile vs. a subfertile population , evaluated in three different laboratories . The fertile population included 144 men who had recently fertilized their partners . As subfertile controls , 136 men with a history of subfertility for more than 12 months were used . All semen sample s ( 280 ) were evaluated in three different centres in a blind fashion , without any patient information . The evaluation of sperm morphology  was performed according to the criteria normally used in the different laboratories : WHO ( 1992 ) criteria for laboratory A , and Tygerberg strict criteria for laboratories B and C. Using ROC analysis , the predictive power of sperm morphology turned out to be different in the three laboratories ( area under ROC curve : 69 % for lab A , 72 % for lab B and 78 % for lab C ) . Using percentile 10 of the fertile population as the cut-off value for normality , we obtained the following results : 2 , 1 and 5 % for laboratories A , B and C , respectively . Using ROC analysis cut-off values with optimal specificity and sensitivity were 6 , 1 and 10 % , respectively . Although our data highlight a reasonable predictive power of sperm morphology in centres using different or the same criteria , cut-off values for normality were different , even when the same criteria were applied . These results stress the importance of st and ardization in sperm morphology evaluation and the need for examining a reference population in estimating the real threshold value in different laboratories OBJECTIVE To examine the effects of increased sperm DNA damage in relation to seminal oxidative stress in men with idiopathic and male factor infertility . Prospect i ve study . SETTING S Infertility clinic at a tertiary care academic institution . PATIENT(S ) Ninety-two infertile men with normal female partners . Sixteen fertile donors served as the control group . INTERVENTION(S ) St and ard semen analysis and assessment of levels of seminal oxidative stress . Assisted reproductive techniques in 33 of the 92 patients ( IUI [ n = 19 ] , IVF [ n = 10 ] , and intracytoplasmic sperm injection [ n = 4 ] ) . MAIN OUTCOME MEASURE(S ) Sperm DNA damage by sperm chromatin structure assay . Results were expressed as DNA fragmentation index . RESULT ( S ) Patients were classified as having either idiopathic ( n = 23 ) or male factor infertility ( n = 69 ) . Patients with idiopathic and male factor infertility had significantly higher DNA fragmentation index and oxidative stress compared with the case of fertile donors . A clinical pregnancy was achieved in 9 ( 27 % ) of 33 patients with assisted reproductive techniques . Significantly higher DNA fragmentation index and oxidative stress were found in men who failed to initiate a pregnancy after assisted reproductive techniques ( n = 24 ) , compared with the cases of those who succeeded and of the fertile donors . DNA fragmentation index was correlated positively with oxidative stress ( r = 0.27 ) , and negatively with fertilization ( r = -0.70 ) and embryo quality ( r = -0.70 ) . CONCLUSION ( S ) Sperm DNA damage is significantly increased in men with idiopathic and male factor infertility and in men who failed to initiate a pregnancy after assisted reproductive techniques . Such an increase may be related to high levels of seminal oxidative stress OBJECTIVE To assess the prognostic value of strict sperm morphology analysis in  intrauterine insemination with husb and 's sperm ( IUI ) cycles performed because of male infertility . DESIGN Prospect i ve study . SETTING Academic tertiary hospital . PATIENTS Seventy-four consecutive couples subjected to 271 IUI cycles because of male infertility . MAIN OUTCOME MEASURE Strict morphology analysis 1 month before the beginning of IUI following the criteria of Kruger et al. RESULTS Pregnancy and no pregnancy couples were similar regarding strict normal forms ( 2.85 % + /- 2.07 % versus 3.13 % + /- 2.63 % ) , slightly amorphous forms , and the morphology index ( 11.79 + /- 6.06 versus 12.04 + /- 7.13 ) . Pregnancy rates ( PRs ) were similar when normal forms were < 4 % ( 39.1 % ) or > 4 % ( 35.7 % ) . The PR , although higher in the group with morphology index > 10 % ( 41.4 % ) than in the group < 10 % ( 33.3 % ) , lacked statistical significance . In pure male infertility group , mean values of morphology were similar in pregnancy and nonpregnancy group . A not significant trend was detected toward higher PRs in morphology index > 10 % ( 50.0 % ) than in the group < 10 % ( 33.3 % ) . CONCLUSION Strict morphology analysis 1 month before the beginning of IUI is not a useful prognostic factor in IUI performed because of male infertility Abstract Purpose : The purpose of this study was to assess the predictive value of a modified form of Kruger 's strict criteria for sperm morphology for pregnancy outcomes after intrauterine insemination ( IUI ) and controlled ovarian hyperstimulation ( COH ) in the presence of normal sperm concentration and motility . Material s and Methods : A retrospective review of 42 couples undergoing COH/IUI was stratified by favorable or unfavorable sperm morphology . End points were pregnancy or failure of treatment as defined by four or more cycles of COH/IUI without pregnancy . Results : An unfavorable morphology ( < 4 % ) was highly predictive of failure during  COH-IUI  ( 94.45 % ; 17/18 ) . A normal PIF was a sensitive indicator of those patients who became pregnant ( 93.8 % ; 15/16 ) and had a fair specificity for failure to achieve pregnancy after four cycles of treatment ( 65.4 % ; 17/26 ) . Couples with a favorable sperm morphology were 28.3 times as likely to achieve a pregnancy within four cycles of treatment as those with unfavorable sperm morphology [ 95 % confidence limits , 3.2 to 250.5 ; P<0.001 ] . Conclusions : Abnormal strict morphologic assessment is both sensitive and specific for pregnancy outcomes in couples undergoing COH/IUI . Couples with persistently unfavorable sperm morphology should be counseled appropriately and would be better served by more aggressive treatment with in vitro fertilization and embryo transfer OBJECTIVE To develop a rapid , sensitive , and reproducible hypoosmotic swelling test kit for the assessment of plasma membrane integrity of human sperm in vitro . DESIGN Prospect i ve comparison of results with the World Health Organization ( WHO ) method , performed simultaneously . SETTING Infertility center in a major city in India . PATIENT(S ) Couples who presented for infertility evaluation . INTERVENTION(S ) The sperm tail-coiling pattern representing sperm plasma membrane integrity was analyzed by using different concentrations of NaCl and also with plain double distilled water ( ddH(2)O ) . Hypoosmotic swelling solution with 2 % NaCl in ddH(2)O equivalent to 68 Osm/L was selected for further analysis because it provided the highest and the qualitatively best type ( g ) of tail coiling among the various other options tried in comparison . MAIN OUTCOME MEASURE(S ) A rapid laboratory test kit for the assessment of plasma membrane integrity of sperm was developed that is equally sensitive and reproducible as that described in the WHO protocol . The test was vali date d by using different normal and subnormal semen sample s and in comparison with the st and ard WHO protocol . RESULT ( S ) After the screening with different hypoosmotic solutions by using semen sample s from fertile volunteers , NaCl ( 2 % ) provided the highest and the best types of typical tail coiling , characteristic of sperm with good plasma membrane integrity . The study was then extended to 60 normozoospermic semen sample s , which demonstrated a hypoosmotic swelling response of 69.5 % + /- 5.23 % and 71.5 % + /- 4.89 % , as per WHO or the present modified method , respectively ( coefficient of correlation , r = 0.741 ) . In 13 oligospermic and 18 teratozoospermic subjects , the hypoosmotic swelling response of sperm as per the new method were 36.4 % + /- 5.75 % and 34.2 % + /- 7.78 % , respectively , which were comparable to those obtained through the WHO method . There was a 15 % drop in viability of sperm after the hypoosmotic challenge ( 5 min ) , irrespective of the hypoosmotic solution used . No other morphological alterations in sperm were observed after the hypoosmotic challenge . CONCLUSION ( S ) The new test kit can be used routinely in laboratories for assessment of plasma membrane integrity of sperm in vitro OBJECTIVE To determine if a simple screening test of sperm recovery through a density gradient preparation and sperm survival after a 24-hour incubation is predictive of IUI success . DESIGN Prospect i ve nonr and omized descriptive study . SETTING Tertiary assisted reproductive technology center . PATIENT(S ) Four hundred fourteen couples undergoing IUI for male factor and unexplained infertility . INTERVENTION(S ) An advanced semen analysis , which consisted of a basic semen analysis , sperm processing through a density gradient preparation , and a 24-hour sperm incubation , was performed on all couples before beginning IUIs . MAIN OUTCOME MEASURE(S ) Cumulative and per cycle pregnancy rates ( PRs ) were calculated for routine semen parameters , number of sperm processed through density gradient , and percent motile sperm after a 24-hour incubation . RESULT ( S ) None of the basic semen analysis parameters accurately predicted IUI success . When the processed total motile sperm available for insemination was > or = 10 x 10(6 ) and their 24-hour survival was > or = 70 % , 89 % ( 162 of 182 ) of couples achieved a pregnancy with a 21.4 % ( 162 of 757 ) per cycle PR compared to a 2.8 % ( 11 of 403 ) per cycle PR and 4.7 % total PR when survival was < 70 % . With use of these cutoff values for the advanced semen analysis , the test had a sensitivity of 94 % and specificity of 86 % . CONCLUSION ( S ) The number of motile sperm available for insemination and especially their 24-hour survival are highly predictive of IUI success . This advanced semen analysis is an excellent screening test to evaluate couples considering IUI OBJECTIVE To evaluate levels of sperm nuclear DNA damage in infertile men with normal and abnormal st and ard semen parameters . DESIGN Prospect i ve study . SETTING Male infertility clinic . PATIENT(S ) Ninety-two men seeking infertility treatment and 16 fertile volunteers . INTERVENTION(S ) St and ard semen analysis was performed according to the World Health Organization guidelines . MAIN OUTCOME MEASURE(S ) Sperm DNA damage was assessed by  sperm chromatin structure assay and the results expressed as % DFI . RESULT ( S ) Of the 92 patients , 21 ( 23 % ) had normal st and ard sperm parameters ( concentration , motility , and normal sperm forms ) , while 71 ( 77 % ) had an abnormality in one or more of these parameters . The % DFI [ median ( 25th and 75th percentiles ) ] in infertile men with normal sperm parameters [ 23 ( 15 , 32 ) ] was significantly higher than fertile donors [ 15 ( 11 , 20 ) ] ( P=.02 ) , but not significantly different from infertile men with abnormal sperm parameters [ 28 ( 18 , 41 ) ] ( P=.27 ) . CONCLUSION ( S ) The results of this study indicate that a significant increase in SCSA-defined DNA damage can be found in sperm from infertile men with normal st and ard sperm parameters . Therefore , sperm DNA damage analysis may reveal a hidden abnormality of sperm DNA in infertile men classified as idiopathic based on apparently normal st and ard sperm parameters Summary . Artificial insemination with husb and 's semen into the cervical canal and uterine cavity ( high AIH ) was assessed by a r and omized controlled prospect i ve study in 46 couples whose infertility was due to failure of sperm mucus penetration , as defined by negative postcoital tests , after excluding all interfering female factors and men with sperm density < 1 × 106/ml . Seminal analysis was abnormal in 18 of the 46 men and sperm antibodies in semen were detected in 19 of the remaining 28 with normal seminal analysis . Overall , the cumulative conception rate after 6 months with AIH was 4·7 ( SE 3·8)% and without treatment was 6·6 ( SE 3·9)% . The results were unaffected by the findings on seminal analysis or by the presence or absence of sperm antibodies in semen . AIH appeared to be of no benefit 
    Output:
    
In couples treated with IUI , the clinical validity of SCSA is higher than that of sperm morphology alone , but not enough to introduce SCSA as a test in male infertility work-up