title: Identification of male factor infertility using a novel semen quality score and reactive oxygen species levels.
abstract: OBJECTIVE
  To determine whether patients with male factor infertility can be accurately identified by calculating a novel semen quality score and measuring levels of reactive oxygen species during routine infertility screening.
  
  
  METHODS
  Semen samples from 133 patients and 91 healthy donors were evaluated with manual and computer-assisted semen analysis. A principal component analysis model was employed to calculate a semen quality score. In brief, this score was calculated by base 10 logarithms multiplied by varying weights given to 9 sperm parameters. Reactive oxygen species levels were measured using chemiluminescence assay.
  
  
  RESULTS
  The semen quality score had a sensitivity of 80.45% and accuracy of 77% at a cutoff of 93.1 in identifying patients with male factor infertility. The area under the receiver operating characteristic curves for the semen quality score was 84.28% (95% CI: 65.22%-100%). Reactive oxygen species levels [log10 (reactive oxygen species +1)] were significantly higher in male factor infertility patients. Reactive oxygen species had a sensitivity of 83.47% and specificity of 60.52% with an accuracy of 75% at a cutoff of 1.25 in identifying male factor infertility patients. The area under the receiver operating characteristic curve for reactive oxygen species levels was 78.92% (95% CI: 72.60%-85.23%). Semen quality scores were significantly and negatively correlated with reactive oxygen species levels in the donors and the male factor infertility patients.
  
  
  CONCLUSIONS
  The semen quality score and reactive oxygen species levels in semen samples appear to be strongly associated with male factor infertility. Because both of these parameters are more sensitive than individual sperm parameters in identifying male factor infertility, they should be included in routine infertility screening.
authors.affiliation: Center for Advanced Research in Human Reproduction, Infertility, and Sexual Function, Glickman Urological Institute, Cleveland, Ohio, USA.
authors.forename: Kiran P
authors.initials: KP
authors.lastname: Nallella
authors.forename: Rakesh K
authors.initials: RK
authors.lastname: Sharma
authors.forename: Shyam S R
authors.initials: SS
authors.lastname: Allamaneni
authors.forename: Ashok
authors.initials: A
authors.lastname: Agarwal
mesh_terms: D016022:Case-Control Studies; D006801:Humans; D007248:Infertility, Male / Q000175:diagnosis*; D008163:Luminescent Measurements; D008297:Male; D011237:Predictive Value of Tests; D017382:Reactive Oxygen Species / Q000032:analysis*; D012661:Semen; D012680:Sensitivity and Specificity; D013076:Sperm Count; D013081:Sperm Motility / Q000502:physiology*; D013094:Spermatozoa / Q000502:physiology*
chemical_list: D017382:Reactive Oxygen Species