Re: A Systematic Review and Standardized Clinical Validity Assessment of Male Infertility Genes.

available http://www.ncbi. nlm.nih. gov/pubmed/30865283 Editorial Comment: A great body of evidence in the medical literature demonstrates relationships between genes and male infertility. This review of the literature identifies 78 genes linked to 92 conditions of male reproductive dysfunction. As semen analysis is such a poor predictor of male reproductive potential, it would be wonderful to have a panel of genes that could serve as a diagnostic tool for the urologist evaluating a patient struggling to father biological offspring. I look forward to seeing infertility genes being surveyed in the clinic for evaluation of male fertility. Craig Niederberger, MD Re: Double-Stranded Sperm DNA Damage is a Cause of Delay in Embryo Development and Can Impair Implantation Rates A. Casanovas, J. Ribas-Maynou, S. Lara-Cerrillo, A. R. Jimenez-Macedo, O. Hortal, J. Benet, J. Carrera and A. Garcı́a-Peir o Unitat d’Endocrinologia Ginecol ogica, Centro de Infertilidad Masculina y An alisis de Barcelona, and Unitat de Biologia Cellular i Gen etica M edica, Departament de Biologia Cellular, Fisiologia i Immunologia, Facultat de Medicina, Universitat Aut onoma de Barcelona, Barcelona, Spain Fertil Steril 2019; 111: 699e707.e1. doi: 10.1016/j.fertnstert. 2018.11. 035 Abstract available at http://www.ncbi. nlm.nih. gov/pubmed/30826116available at http://www.ncbi. nlm.nih. gov/pubmed/30826116 Editorial Comment: Assessment of sperm DNA integrity and its relationship to reproductive outcomes has been inconsistent in the scientific literature, with some studies promoting linkages and others disputing them. A large part of this inconsistency is likely due to the many ways in which sperm DNA structure can be measured, and another factor is undoubtedly whether we are asking the right questions. These investigators correlated 2 different forms of the comet assay, the alkaline protocol that shows single strand DNA breaks and the neutral protocol that reveals double strand DNA breaks, to embryo development as displayed via time-lapse imaging. They observed that in classifying double strand DNA breaks into low and high range, embryo development in second polar body extrusion, T4, T8, morula and starting blastocyst differed, supporting a conclusion that double strand damage delays embryo development. While time-lapse imaging in in vitro fertilization is a relatively new technology that is itself debated, these results indicate possible clinical usefulness for the comet assay in predicting embryo development. Craig Niederberger, MD Re: Inconsistent Adoption of World Health Organization V (2010) Semen Analysis Reference Ranges in the United States Eight Years after Publication K. C. Lewis, I. Lam, J. Nieb, G. Lam, A. S. Desai, D. J. Mazur, B. Kahn, M. K. Keeter, A. Tatem, M. Hehemann, B. T. Frainey, J. N. Bennett and R. E. Brannigan Department of Urology, Northwestern University Feinberg School of Medicine and Loyola Medicine Chicago Stritch School of Medicine, Chicago, Illinois, Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, and Department of Urology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana Urology 2019; 126: 96e101. doi: 10.1016/j.urology. 2018.09. 041 Abstract available at http://www.ncbi. nlm.nih. gov/pubmed/30605693 854 MALE INFERTILITY Copyright © 2019 American Urological Association Education and Research, Inc. Unauthorized reproduction of this article is prohibited. Editorial Comment: It feels like it was just yesterday but it was in 2010 that the World Health Organization semen analysis reference ranges put aside consensus derived ranges for actual statistics. Up until that point a group of people sitting around a table determined that, for example, 20 million sperm per milliliter represented a clinically useful threshold below which a man would probably be infertile. The problem, of course, was that there was so much overlap in bulk seminal parameters that the drawing of a line between fertile and infertile for any bulk semen parameter was an arbitrary exercise in how many infertile men one might inadvertently guess were fertile. The fifth edition of the World Health Organization semen analysis reference ranges laid bare how a urologist might best counsel a couple seeking to conceive and wondering whether they had a problem. So given the cold, clear data, how did we do in counseling our patients? Sadly, not well. About twothirds of laboratories adopted the new standards, while more than a third did not. It’s hard to say to a patient, “I think that you have a problem but I’m not sure. ” This honest assessment of how semen laboratories communicate semen analysis results to patients ultimately states just that. Craig Niederberger, MD