BACKGROUND Semen quality is taken as a surrogate measure of male fecundity in clinical andrology, male fertility, reproductive toxicology, epidemiology and pregnancy risk assessments. Reference intervals for values of semen parameters from a fertile population could provide data from which prognosis of fertility or diagnosis of infertility can be extrapolated. METHODS Semen samples from over 4500 men in 14 countries on four continents were obtained from retrospective and prospective analyses on fertile men, men of unknown fertility status and men selected as normozoospermic. Men whose partners had a time-to-pregnancy (TTP) of < or =12 months were chosen as individuals to provide reference distributions for semen parameters. Distributions were also generated for a population assumed to represent the general population. RESULTS The following one-sided lower reference limits, the fifth centiles (with 95th percent confidence intervals), were generated from men whose partners had TTP < or = 12 months: semen volume, 1.5 ml (1.4-1.7); total sperm number, 39 million per ejaculate (33-46); sperm concentration, 15 million per ml (12-16); vitality, 58% live (55-63); progressive motility, 32% (31-34); total (progressive + non-progressive) motility, 40% (38-42); morphologically normal forms, 4.0% (3.0-4.0). Semen quality of the reference population was superior to that of the men from the general population and normozoospermic men. CONCLUSIONS The data represent sound reference distributions of semen characteristics of fertile men in a number of countries. They provide an appropriate tool in conjunction with clinical data to evaluate a patient's semen quality and prospects for fertility.

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World Health Organization reference values for human semen characteristics

Endometriosis

Critical care in pregnancy is a field that remains unevenly researched. Although there is a body of evidence to guide many recommendations in critical care, limited research specifically addresses obstetric critical care. The purpose of this document is to review the available evidence, propose strategies for care, and highlight the need for additional research. Much of the review will, of necessity, focus on general principles of critical care, extrapolating where possible to obstetric critical care.

/pdf/acog-practice-bulletin-2e7yp8vork.pdf

Acog practice bulletin

ACOG practice bulletin: Clinical management guidelines for obstetrician-gynecologists

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(07)60712-0.pdf

Antiplatelet agents for prevention of pre-eclampsia: a meta-analysis of individual patient data

Congenital anomalies of the müllerian system

The use of an extraamniotic catheter balloon, inflated above the internal cervical os, has been advocated as a nonpharmacological, mechanical method of cervical ripening before induction of labor. Additional measures may include applying traction on the catheter, or the infusion of normal saline (1 ml/min) via the catheter's port into the extraamniotic space. The results of catheter balloon cervical ripening are reviewed from 13 published reports and a departmental series of 190 pregnancies with unfavorable cervix, encompassing nearly 1000 patients. A mean change in cervical score of at least 3 points, was noted in most studies after balloon expulsion or removal. The present series and other studies suggest that oxytocin use for induction and/or augmentation of labor is increased after balloon ripening, compared with its use in spontaneous labor or after cervical ripening by prostaglandins. In 11 studies, catheter balloon ripening was compared with cervical ripening by other mechanical, or pharmacological (i.e., oxytocin or prostaglandins) methods. Of these, eight were prospective and randomized-controlled and three were case-controlled studies. It is suggested that ripening efficacy by catheter balloon is similar, or better, than other methods; but there is no significant difference in the mode of delivery or perinatal outcome. This review also suggests that cervical ripening with extraamniotic catheter balloon has the advantages of simplicity, low cost, reversibility, and lack of systemic or serious side effects.

Ripening of the Unfavorable Cervix With Extraamniotic Catheter Balloon: Clinical Experience and Review

The aim of this study was to evaluate diagnostic profiles for the assessment of semen analysis data with respect to male fertility potential. Semen samples taken from 208 patients of known fertility and suspected infertility were studied by conventional semen analysis methods. The data throw doubt upon the validity of an approach based on the number of deviations from the normal standard values defined by the World Health Organization. The alternative approach of a specific semen characteristic (particularly morphology) as the major predictor of fertility produced no beneficial results. However, the semen analysis index based on semen volume, sperm count, percentage motility and normal forms resulted in a high accuracy of classification but for only 44% of the cases, with 3% false negatives and 10% false positives using cut-off indices of > or = 0.6 and < or = -1.0 for defining 'fertile' and 'infertile' zones, respectively. In conclusion, it is emphasized that there are a number of specific semen analysis variables, each expressing a different aspect of male fertility potential which, when combined in correct proportion, do provide the optimal evaluation of the male fertility status. However, in order to increase the prognostic potential of the semen sample, new and meaningful parameters must be discovered.

Estimating fertility potential via semen analysis data

Results of in vitro fertilization and embryo transfer by combined long-acting gonadotropin-releasing hormone analog D-Trp-6-luteinizing hormone-releasing hormone and gonadotropins.

Eliahu Caspi

Papers

Congenital anomalies of the müllerian system

Ripening of the Unfavorable Cervix With Extraamniotic Catheter Balloon: Clinical Experience and Review

Estimating fertility potential via semen analysis data

Results of in vitro fertilization and embryo transfer by combined long-acting gonadotropin-releasing hormone analog D-Trp-6-luteinizing hormone-releasing hormone and gonadotropins.

Ripening the highly unfavorable cervix with extra-amniotic saline instillation or vaginal prostaglandin E2 application.