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Ashok Agarwal

Publications and source records attributed to Ashok Agarwal.

At least 19 recordsLinked to original sources
PubMed2026

Reassessing Semen Analysis: Clinical Insights Beyond Sperm Count and Motility.

BACKGROUND: Semen analysis (SA), recognized by the World Health Organization (WHO) as the cornerstone of male infertility evaluation, remains indispensable in reproductive medicine. However, advances in assisted reproductive technology (ART) and artificial intelligence (AI) have highlighted the limitations of relying solely on conventional semen parameters. OBJECTIVE: To critically review the evolving clinical role of SA by integrating conventional assessment with emerging functional, molecular, and computational approaches that improve diagnostic accuracy and individualized patient care. METHODS: A narrative review of contemporary evidence was conducted, focusing on conventional semen parameters, biofunctional sperm testing, omics technologies, AI-assisted analysis, and broader clinical applications of SA. RESULTS: Conventional parameters, including sperm concentration, motility, and morphology, remain essential but inadequately reflect fertilizing capacity. Adjunctive assessments, including oxidative stress biomarkers and sperm DNA fragmentation, provide valuable insights into sperm function and reproductive potential. Omics technologies, including genomics, transcriptomics, proteomics, and metabolomics, deepen mechanistic understanding, while AI enhances diagnostic precision, reproducibility, and standardization. Beyond infertility evaluation, SA also supports male contraceptive assessment, natural conception, ART, and patient counseling. CONCLUSIONS: Integrating conventional SA with functional, molecular, and AI-driven diagnostics provides a comprehensive framework for evaluating male fertility, advancing precision reproductive medicine and personalized clinical management.

cryopreservation↗
PubMed2006

Automation is the key to standardized semen analysis using the automated SQA-V sperm quality analyzer.

OBJECTIVE: To evaluate the performance of the automated semen quality analyzer system for assessing sperm quality. DESIGN: Double-blind prospective study. SETTING: Tertiary care hospital. PATIENT(S): Fifty healthy men donated semen samples. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Precision, accuracy and agreement between automated and manual semen analysis methods was assessed for sperm concentration, motility, morphology, and known concentrations of latex bead quality control media. RESULT(S): A good agreement was seen between the results of sperm concentration reported by the SQA-V automated analyzer (Spermalite/SQA-V; Medical Electronic Systems Ltd, Caesarea Industrial Park, Israel) and those obtained manually. A similar linearity was seen when the SQA-V results were compared with the manual data and also when the manual results of individual operators were compared with each other. The automated assessment of morphology showed high sensitivity (89.9%) for identifying percent normal morphology, and the precision of the SQA-V was considerably higher when compared with the manual method. The interoperator variability for manual assessment was significant. The automated analysis was quick compared with the manual method. CONCLUSION(S): The SQA-V can be used interchangeably with manual semen analysis methods for examining sperm concentration and motility. The automated SQA-V analyzer is more precise and shows the ability to accurately classify normal versus abnormal sperm morphology.

Diagnosis, Computer-Assisted↗
PubMed2006

Oxidative stress in an assisted reproductive techniques setting.

OBJECTIVE: The manipulation of gametes and embryos in an in vitro environment when performing assisted reproductive techniques (ART) carries the risk of exposure of these cells to supraphysiological levels of reactive oxygen species (ROS). The main objective of this review is to provide ART personnel with all the necessary information regarding the development of oxidative stress in an ART setting, as well as the sources of ROS and the mechanisms of oxidative stress-induced damage during ART procedures. The impact of oxidative stress on ART outcome and the different strategies designed to prevent it are also discussed. DESIGN: Review of international scientific literature. A question-and-answer format was adopted in an attempt to convey comprehensive information in a simple yet focused manner. RESULT(S): The pO(2) to which gametes and the embryo are normally exposed in vivo is significantly lower than in vitro. This results in increased production of ROS. Increase in levels of ROS without a concomitant rise in antioxidant defenses leads to oxidative stress. Lipid, protein, and DNA damage have all been associated with oxidative stress. This may ultimately result in suboptimal ART success rates. CONCLUSION(S): Many modifiable conditions exist in an ART setting that may aid in reducing the toxic effects of ROS.

Embryo, Mammalian↗
PubMed2006

Role of total antioxidant capacity in the differential growth of human embryos in vitro.

OBJECTIVE: The objective of this study was to examine the relationship of early human embryonic development parameters with day 1 culture media total antioxidant levels (day 1 TAC). DESIGN: Prospective study. SETTING: Patients undergoing assisted reproduction (ART) in a teaching hospital. PATIENT(S): Patients undergoing conventional IVF (n = 153; 167 cycles) and intracytoplasmic sperm injection (ICSI; n = 105; 116 cycles) were included. Both fertilization and early cultures were performed in human tubal fluid (HTF) with 5% serum substitute supplement. INTERVENTION(S): Levels of total antioxidants in the central well (sample) and the outer well (control) of each embryo culture dish were measured. MAIN OUTCOME MEASURE(S): Fertilization rate and embryo quality at days 3 and 5 were recorded for each cycle. Age, parity, and demographic features were also compared. RESULT(S): After controlling for all demographic and clinical variables, day 1 TAC was related to fertilization rates in both groups of patients. Day 1 TAC was significantly related to high (>7) day 3 cell number, low (<10%) fragmentation rate, and blastocyst development rate in both conventional IVF and ICSI cycles. Day 1 TAC was related to pregnancy in ICSI but not conventional IVF cycles. CONCLUSION(S): Day1 TAC appears to be an important biochemical marker for early embryonic growth. Decreased embryonic fragmentation, enhanced cleavage rate, and increased blastocyst development rate may be partially related to day 1 TAC in the culture media. Whether this relationship is a cause or effect needs further assessment.

Adult↗
PubMed2006

Inhibin B is a better marker of spermatogenesis than other hormones in the evaluation of male factor infertility.

OBJECTIVE: To assess the role of inhibin B in the evaluation of male factor infertility. DESIGN: Prospective study. SETTING: Reproductive endocrinology clinic. PATIENT(S): Seventy-five patients with infertility problems (mean age 31.2 +/- 7.5 years) and 12 controls (32.1 +/- 8.8 years) with proven fertility. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Semen analysis was performed according to World Health Organization guidelines. Testicular volume was assessed with the Prader's orchidometer. Serum levels of inhibin B (pg/mL), LH (mIU/mL), FSH (mIU/mL), prolactin (micro IU/mL), and testosterone (nmol/L) were assessed. RESULT(S): The mean +/- SEM inhibin B and testosterone levels were significantly lower in the patients than in the controls (inhibin B: 116.4 +/- 11.7 vs. 181.2 +/- 20.9, P=.008; testosterone: 13.6 +/- 0.9 vs. 25.1 +/- 2.9, P=.008). In general, sperm count and testicular volume in the patients were significantly and positively correlated with inhibin B (sperm count: r = 0.476, P<.0001; testicular volume, right: r = 0.57, P=.0001; left: r = 0.53, P=.0001); the inhibin B-FSH index was negatively correlated with FSH. Inhibin B was more strongly correlated with testicular volume and semen parameters than FSH. Inhibin B in the patients was negatively correlated with FSH (r = -0.723, P=.0001) and LH (r = -0.52, P=.0001) and was positively correlated with testosterone (r = 0.4, P=.0013). CONCLUSION(S): Inhibin B measurement is a better marker of fertility status than FSH and LH. Concentration of inhibin B in patients with infertility may provide useful information on spermatogenesis and possibly serve as a more direct marker of spermatogenesis than FSH.

Adult↗
PubMed2006

Magnetic-activated cell sorting before cryopreservation preserves mitochondrial integrity in human spermatozoa.

Superparamagnetic annexin-V conjugated microbeads are able to eliminate spermatozoa with externalized phosphatidylserine, a membrane feature of apoptotic cells as well as spermatozoa with deteriorated plasma membrane. Our objective was to evaluate the effects of annexin-V Magnetic-Activated Cell Sorting (MACS) in cryopreservation-thawing protocols and on integrity of sperm mitochondrial transmembrane potential and mitochondrial integrity survival rate (MSR). Mature spermatozoa of 10 healthy donors were prepared by density gradient centrifugation and divided into 2 aliquots afterwards. The first one was subjected to annexin-V MACS followed by cryopreservation and thawing, while the second was cryopreserved-thawed without MACS to serve as control. Annexin-negative sperm separated by MACS showed significantly higher levels of intact mitochondria following cryopreservation-thawing (45.4+/-8.6%) compared to sperm that were not separated (15.8+/-4.6%, p<0.01). Separating a distinctive population of non-apoptotic spermatozoa with intact membranes may optimize cryopreservation-thawing outcome. MACS using annexin-V microbeads enhances the percentage of spermatozoa with intact transmembrane mitochondrial potential and mitochondrial integrity survival rates following cryopreservation.

Annexin A5↗
PubMed2006

Significance of sperm characteristics in the evaluation of male infertility.

OBJECTIVE: To compare sperm characteristics among: patients undergoing infertility evaluation, patients with male factor infertility (MFI), healthy sperm donors, and men with proven fertility; to examine the overlap of sperm characteristics in all four of these groups; and to identify good discriminators of fertility versus infertility among sperm characteristics. DESIGN: Retrospective study. SETTING: Male infertility clinic at a tertiary care hospital. PATIENT(S): Proven fertile men (n = 56), normal donors (n = 91), men presenting for infertility evaluation (n = 406), and MFI patients (n = 166). INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Routine semen analysis. RESULT(S): Using current World Health Organization (WHO) reference values, a large group of MFI patients presented with higher sperm concentration (27.5 x 10(6) to 99.2 x 10(6)), resulting in broader overlap with fertile men and poor sensitivity (0.48). Similarly, percentage normal morphology (%) using Tygerberg's strict criteria was low in most of the MFI patients (sensitivity 0.83), almost half of the fertile men also presented with abnormal morphology (specificity 0.51). Of all the variables examined, sperm motility (%) was superior, having minimum overlap range (lower and upper cut-off values 46% and 75%) and high sensitivity (0.74) and specificity (0.90). Areas under curve were higher for motility (0.90) and concentration (0.84) compared with morphology (WHO 0.65 and Tygerberg's strict criteria 0.74). CONCLUSION(S): Sperm motility and concentration provide more accurate information than morphology (WHO and Tygerberg's criteria) during infertility evaluation. Redefining the reference values for concentration and morphology may significantly increase the importance of routine semen analysis.

Case-Control Studies↗
PubMed2006

Reactive oxygen species as an independent marker of male factor infertility.

OBJECTIVE: To determine the abnormal patterns of reactive oxygen species (ROS) production in male factor infertility (MFI) patients and to define the ROS reference values in such patients. DESIGN: A retrospective study. SETTING: Male infertility clinic at a tertiary healthcare center. PATIENT(S): We examined 132 MFI patients (all normal sperm parameters, n = 24, and all abnormal sperm parameters, n = 38) and 34 healthy donors. INTERVENTION(S): Routine semen analysis, measurement of ROS. MAIN OUTCOME MEASURE(S): Sperm parameters, ROS levels (10(4) cpm/20 x 10(6) sperm). RESULT(S): Normal, healthy donors had significantly higher (P<.0001) sperm concentration, motility, and morphology compared with all MFI patients. Univariate analysis indicated a significant association between MFI and log (ROS + 1) (odds ratio [OR] = 3.84), besides sperm parameters and age. A multivariate model using logistic regression analysis also indicated an independent association of log ROS with MFI (OR = 4.25). The ROS cutoff values of 1.2-1.4 had a sensitivity of 0.70-0.78 with a corresponding specificity of 0.82. However, at a cutoff point of 1.2, the OR was 68.6, which increased with an increase in the cutoff. CONCLUSION(S): High ROS is an independent marker of MFI, irrespective of whether these patients have normal or abnormal semen parameters. We suggest the inclusion of ROS measurement as part of idiopathic infertility evaluation. Treatment with antioxidants may be beneficial in such patients.

Adult↗
PubMed2006

Relationship between epidemiological features and aetiology of male infertility as diagnosed by a comprehensive infertility service provider.

This study examined the relationship between demographic features and aetiological causes of male infertility. Primary infertility was the presentation in 78% of patients. The incidence of varicocele was the highest (31%), whereas only 4.6% had vasectomy reversal and 7.4% of men were diagnosed with idiopathic infertility. Using the chi-squared test, there was no significant difference in the incidence of different causes of infertility among different ethnic groups (White, African-American, Asian, Hispanic, and other). Furthermore, there was no increased incidence of infertility aetiology with any particular occupation, race, religion, smoking or alcohol intake. In this study population, there was no association between the various risk factors (occupation, smoking, alcohol intake, and race) and the aetiologies of infertility. The proportion of patients diagnosed with idiopathic infertility was significantly less than reported in the literature.

Alcohol Drinking↗
PubMed2006

Relationship between oxidative stress, varicocele and infertility: a meta-analysis.

Varicocele is one of the leading causes of male infertility, and is present in almost 40% of infertile males. Recent understanding of the role of oxidative stress in male reproduction has led some researchers to postulate oxidative stress as the possible cause of sperm dysfunction in varicocele patients. The objective of the present study was to examine the published literature on the role of oxidative stress in patients with varicocele as the aetiology of their infertility. Twenty-three human studies were identified after an extensive search dealing with the role of oxidative stress in varicocele-associated infertility. Out of these studies, four were selected that measured similar types of reactive oxygen species (ROS) by a similar method of measurement. The data were then entered in the RevMan software for analysis. The overall estimate showed that patients have significantly higher concentrations of ROS than controls, with the mean difference being 0.73 (95% CI 0.40, 1.06, P < 0.0001). This translated to an ROS concentration of 4.37 x 10(4) cpm/20 x 10(6) spermatozoa/ml on the linear scale. Total antioxidant capacity levels were found to be significantly lower in the infertile varicocele patients, with 386 fewer trolox equivalents than the controls (95% CI -556.56-216.96, P < 0.00001). From the results, it can be concluded that there is increased oxidative stress in varicocele patients; however, more studies are needed to confirm this finding.

Antioxidants↗
PubMed2006

Evaluation of sperm recovery following annexin V magnetic-activated cell sorting separation.

Magnetic-activated cell sorting (MACS) using paramagnetic annexin V-conjugated microbeads eliminates spermatozoa with externalized phosphatidylserine, which is considered one of the features of apoptosis. The objective of this study was to evaluate sperm recovery following the use of MACS as a sperm preparation technique. Mature spermatozoa were separated and divided into two fractions: the first was prepared by density gradient centrifugation (DGC) and MACS, while the second was prepared by DGC only. Following MACS, the percentage of cells collected in the annexin-negative fraction was significantly higher than the annexin-positive fraction and the sperm recovery rate was 73.8 +/- 12.1%. In conclusion, the integration of MACS with DGC can be considered as an effective sperm preparation technique that does not lead to significant cell loss. Separating a distinctive population of non-apoptotic spermatozoa with intact membranes may optimize the outcome of assisted reproduction.

Annexin A5↗
PubMed2006

Impact of ovarian endometrioma on assisted reproduction outcomes.

The effects of ovarian endometrioma on fertility outcomes with IVF and embryo transfer have been causally related to poor outcomes. The objective of this meta-analysis was to evaluate the ovarian reserve and ovarian responsiveness to ovarian stimulation and assisted reproduction outcomes in patients with ovarian endometrioma. The odds for clinical pregnancy were not affected significantly in patients with ovarian endometrioma compared with controls, with an overall odds ratio of 1.07 from three studies [95% CI: (0.63, 1.81), P = 0.79]. The overall pregnancy rate was similar with an estimated odds ratio of 1.17 [95% CI: (0.85, 1.60), P = 0.34]. Decreased ovarian responsiveness to ovarian stimulation in patients with ovarian endometrioma may be due to a reduced number of follicles in these patients compared with controls (P = 0.002). Prospective randomized controlled trials are needed to assess whether surgical treatment versus no surgical treatment improves pregnancy outcomes in patients with ovarian endometrioma undergoing assisted reproduction cycles.

Endometriosis↗
PubMed2006

Role of oxidative stress in endometriosis.

Endometriosis is a chronic pleomorphic disorder with pelvic or systemic manifestations, and is characterized by the presence of endometrial glands and stroma. In the United States, the prevalence of the disease is estimated to range from 2 to 50% in women of reproductive age. No single theory can explain the histogenesis and the pleomorphic manifestations of endometriosis. Endometriosis is being reported in younger age women and manifesting with increasing severity, hence the need to understand the role of oxidative stress (OS) in endometriosis. The presence of elevated concentrations of free radicals and lowered antioxidant potential leads to OS. The development of OS in the local peritoneal environment may be one of the links in the chain of events leading to endometriosis. Redox levels may modulate the severity and the dynamics of endometriosis and progression of the disease. OS has been implicated in infertility associated with endometriosis. Recent literature reviewed investigates the role of molecular mechanisms and genetic pathways that may modulate cellular response to OS. Antioxidant supplementation, immunomodulators, and selective progesterone receptor modulators with antioxidant effects have been investigated as possible treatments for endometriosis, but compelling evidence on the benefits of the various modalities is lacking. Results of the limited number of animal and human trials need to be corroborated by larger randomized controlled trials.

Animals↗
PubMed2006

The role of free radicals and antioxidants in reproduction.

PURPOSE OF REVIEW: This review summarizes the role of free radicals and oxidative stress in the pathophysiology of human reproduction. RECENT FINDINGS: An extensive review of the literature on the role of oxidative stress in influencing assisted reproduction and its outcome is described in this article. Free radicals or reactive oxygen species mediate their action through many of the proinflammatory cytokines and this mechanism has been proposed as a common underlying factor for endometriosis, ovarian cancer, polycystic ovary disease, and various other pathologies affecting the female reproductive process, as highlighted in this review. Oxidative stress, sperm DNA damage, and apoptosis have been implicated in male infertility. Elevated reactive oxygen species levels correlate with the poor fertility outcomes seen in the assisted reproductive technology setting. SUMMARY: Oxidative stress has been implicated in male and female infertility, including fetal dysmorphogenesis, abortions, and intrauterine growth restriction. Accurate evaluation of seminal oxidative stress by standardized assays may help in the diagnosis and management of male infertility. There is evidence in the literature on the beneficial effects of oral antioxidant supplementation in male infertility. Current ongoing trials will provide answers on the safety and effectiveness of antioxidants in improving maternal and fetal outcomes. Further studies need to be conducted to determine if antioxidant supplementation will prevent fetal developmental defects in high-risk pregnancy with diabetes.

Antioxidants↗
PubMed2006

Adolescent varicocele: association with somatometric parameters.

INTRODUCTION: The developmental changes that occur as a result of puberty have been hypothesized to be important causes of varicocele. Various somatometric parameters were known to affect the occurrence of varicocele during the growth period. We conducted this study in order to examine these relationships and to determine the incidence of varicocele in adolescent males. PATIENTS AND METHODS: We evaluated 1,200 healthy males aged 0-19 years for varicocele and correlated it with the following somatometric parameters: age, height, body mass index (BMI), pubic hair distribution, penile length and testicular volume. RESULTS: Adolescent varicocele was found in 5.6% of the participants. The 13- to 19-year age-group had the highest incidence of varicocele (10.5%). Logistic regression analysis showed that the incidence was positively correlated with age, height and penile length (odds ratio 1.61, 1.04 and 1.37, respectively) and negatively correlated with left testicular volume, BMI and pubic hair distribution (odds ratio 0.87, 0.87 and 0.47, respectively). CONCLUSION: Varicocele was more prevalent in tall boys with a lower BMI, who had quickly progressed through puberty. Our observations suggest that varicocele is associated with various somatometric parameters.

Adolescent↗