Original Article
Sperm Morphology, Motility, and Concentration in Fertile and Infertile Men
N Engl J Med 2001; 345:1388-1393November 8, 2001
- Abstract
Background
Although semen analysis is routinely used to evaluate the male partner in infertile couples, sperm measurements that discriminate between fertile and infertile men are not well defined.
Methods
We evaluated two semen specimens from each of the male partners in 765 infertile couples and 696 fertile couples at nine sites. The female partners in the infertile couples had normal results on fertility evaluation. The sperm concentration and motility were determined at the sites; semen smears were stained at the sites and shipped to a central laboratory for an assessment of morphologic features of sperm with the use of strict criteria. We used classification-and-regression-tree analysis to estimate threshold values for subfertility and fertility with respect to the sperm concentration, motility, and morphology. We also used an analysis of receiver-operating-characteristic curves to assess the relative value of these sperm measurements in discriminating between fertile and infertile men.
Results
The subfertile ranges were a sperm concentration of less than 13.5×106 per milliliter, less than 32 percent of sperm with motility, and less than 9 percent with normal morphologic features. The fertile ranges were a concentration of more than 48.0×106 per milliliter, greater than 63 percent motility, and greater than 12 percent normal morphologic features. Values between these ranges indicated indeterminate fertility. There was extensive overlap between the fertile and the infertile men within both the subfertile and the fertile ranges for all three measurements. Although each of the sperm measurements helped to distinguish between fertile and infertile men, none was a powerful discriminator. The percentage of sperm with normal morphologic features had the greatest discriminatory power.
Conclusions
Threshold values for sperm concentration, motility, and morphology can be used to classify men as subfertile, of indeterminate fertility, or fertile. None of the measures, however, are diagnostic of infertility.
Media in This Article
Figure 1
Percentage of Men from Infertile and Fertile Couples with Values in the Subfertile, Indeterminate, and Fertile Ranges for Sperm Concentration (Panel A), Percentage of Motile Sperm (Panel B), and Percentage of Sperm with Normal Morphologic Features (Panel C), as Defined by Classification-and-Regression-Tree Analysis.Table 1
Characteristics of Infertile and Fertile Couples from Nine Reproductive-Medicine Centers.Article Activity
- Article
Semen analysis is routinely used to evaluate the male partner in infertile couples1,2 and to assess the reproductive toxicity of environmental or therapeutic agents.3 Although widely used thresholds for normal semen measurements have been published by the World Health Organization (WHO),4-7 the available norms for sperm concentration, motility, and morphology fail to meet rigorous clinical, technical, and statistical standards. In recognition of these limitations, the nomenclature in the most recent WHO manual7 for semen evaluation was changed from “normal” to “reference” values. Two recent prospective studies of semen quality and fertility concluded that the current WHO reference values should be reconsidered.8,9
In this study, we sought to determine values for semen measurements that best discriminate between fertile and infertile men and to evaluate the relative value of standard semen measurements in distinguishing between fertile and infertile men.
Methods
Study Population
As part of a randomized clinical trial of intrauterine insemination and superovulation in the treatment of infertility at nine centers in the United States, we recruited infertile couples in which the female partners had normal results on fertility evaluation.10 All of these couples had been unable to conceive for at least 12 months; the mean duration of infertility was 43 months. The women were required to have regular menstrual cycles, a normal hysterosalpingogram, normal results on laparoscopy, and a luteal-phase endometrial-biopsy specimen that was histologically consistent with menstrual dating. The men were required to have some motile sperm in ejaculated semen specimens.10
Fertile men (controls) were recruited from prenatal classes at the same hospitals in which the infertile couples were recruited, as well as through local advertising. The partners of fertile men had to be pregnant or to have delivered a child within the previous two years. Fertile men were excluded only if they had a history of infertility (inability to conceive during 12 months of attempts), vasovasostomy, or varicocelectomy.
All the men were required to be between the ages of 20 and 55 years at the time of enrollment, and their partners were required to be between the ages of 20 and 40 years. The fertile couples were frequency-matched to the infertile couples according to the five-year age groups of both partners. Matching was performed within each clinical site, except in the case of one combination of age groups for which it was difficult to recruit participants — a male partner 20 to 25 years of age with a female partner 25 to 29 years of age. The matching of couples in this category was performed without regard to clinical site. In all, we studied 765 men from infertile couples and 696 men from fertile couples.
Semen Collection and Laboratory Evaluation
Written informed consent was obtained from all participants after recruitment. Semen samples were collected by masturbation at the clinical site, after the men had been asked to abstain from ejaculation for at least 48 hours before semen was collected. All semen analyses were performed manually within one hour after the sample was collected and included measurements of the volume of the ejaculate and determinations of the sperm concentration and the percentage of sperm with any evidence of flagellar movement (percentage motility). Details of these procedures have been published previously.11
Two semen specimens were obtained from each of the fertile men a mean of 16 days apart; 27 fertile men submitted samples more than 30 days apart. From infertile men, up to six semen samples were obtained — two before randomization and one for each of up to four treatment cycles.10 Of these specimens, we used the two obtained closest together in time; the mean number of days between the specimen collections was 41.5. The mean values for the sperm concentrations, the percentages of motile sperm, and the percentages of sperm with normal morphologic features in the two samples were used in the analysis.
Technicians from the nine clinical sites attended training sessions in semen analysis at the central laboratory at the University of California, Davis. The proficiency of the 26 technicians was tested at the clinical sites approximately twice each year with the use of blindly coded sperm suspensions and videotapes distributed by the central laboratory.
Semen smears were stained at the clinical sites by the Papanicolaou method and shipped to the central laboratory for assessment of sperm morphology by a single technician. Sperm were classified as having normal or abnormal morphologic features according to strict criteria.7 Either 200 or 300 sperm were analyzed per slide. Initially, 100 sperm from each of two different locations on the slide were analyzed. If the difference between the percentage of normal sperm in the two areas was 5 percentage points or less, the mean value was calculated. If the difference was more than 5 percentage points, an additional 100 sperm were evaluated from a third location, and the median of the three values was used.
The technician who assessed sperm morphology attended a training session conducted by Dr. Thinus Kruger, who developed the criteria that are used for strict assessments of morphology.7 A set of 65 slides from patients in the study, scored by Dr. Kruger, was used as the standard for purposes of quality control. The percentage of sperm with normal morphologic features was known to the technician for 10 of these slides but was unknown for the other 55 standard slides. Each day, the technician scored two of the slides whose morphologic values she knew and compared her results with the standard value; she then scored two unknown slides. Approximately every two months, the mean percentage of sperm with normal morphologic features for these 55 slides was compared with the mean percentage as scored by Dr. Kruger. The two mean values never differed by more than 1 percentage point, and the Spearman rank-correlation coefficient for the two data sets was always at least 0.92.
Statistical Analysis
Data were sent to the data coordinating center at Columbia University, where computerized checks for out-of-range values and errors in logic were performed. Data that did not meet the standards were sent back to the clinical sites for verification. Analyses were performed with the use of the SAS (version 6.12, SAS Institute, Cary, N.C.) and S-Plus (StatSci, Seattle) statistical packages.
Classification-and-regression-tree (CART)12 analysis was used to estimate thresholds for each sperm measurement that would discriminate between fertile men and infertile men. The CART algorithm uses an exhaustive search of all possible divisions of participants according to one of the continuous predictor variables to identify the division that results in the greatest improvement in the goodness of fit. In the present application, two thresholds were estimated for each sperm measurement; one became the threshold between the subfertile and indeterminate ranges, and the other became the threshold between the indeterminate and fertile ranges. We used the thresholds for discrimination defined by the CART analysis to create categorical variables for the measurements. We used logistic regression to estimate the association of fertility status (using 1 to indicate infertility and 0 to indicate fertility) with the various semen measurements.
We then calculated the sensitivity and specificity of the CART-defined thresholds for classifying infertility. The analysis of receiver-operating-characteristic curves,13,14 which defines tradeoffs between sensitivity and specificity along the spectrum of possible thresholds, was used to test whether each semen measurement discriminated between fertile and infertile men and to assess the relative performance of the three semen measurements in making this discrimination.
Results
The demographic characteristics of the study population are shown in Table 1Table 1
Characteristics of Infertile and Fertile Couples from Nine Reproductive-Medicine Centers.. Partners in fertile couples had higher educational levels than partners in infertile couples. Infertile couples were more likely to be white, to smoke, and to consume alcohol.There was considerable overlap between the sperm measurements for the fertile men and those for the infertile men. The mean (±SD) sperm concentration was 67±50×106 per milliliter in fertile men (median, 56×106 per milliliter) and 52±42×106 per milliliter in infertile men (median, 42×106 per milliliter). The mean percentage of sperm with motility was 54±13 percent in fertile men (median, 55 percent) and 49±15 percent in infertile men (median, 55 percent). The mean percentage of sperm with normal morphologic features was 14±5 percent in fertile men (median, 14 percent) and 11±6 percent in infertile men (median, 10 percent).
The results of the CART analysis for each sperm measurement are shown in Table 2Table 2
Fertile, Indeterminate, and Subfertile Ranges for Sperm Measurements from Classification-and-Regression-Tree Analysis and Corresponding Odds Ratios for Infertility.. The values that best defined infertility were a concentration of less than 13.5×106 per milliliter, less than 32 percent motility, and less than 9 percent normal morphologic features. The ranges associated with indeterminate fertility were concentrations of 13.5 to 48.0×106 per milliliter, 32 to 63 percent motility, and 9 to 12 percent normal morphologic features. The likelihood of infertility increased with decreasing sperm concentration, percentage with motility, or percentage with normal morphologic features (Table 2). For example, relative to a sperm concentration in the fertile range, the odds ratio for infertility was 1.5 (95 percent confidence interval, 1.2 to 1.8) for a sperm concentration in the indeterminate range and 5.3 (95 percent confidence interval, 3.3 to 8.3) for a sperm concentration in the subfertile range.The odds of infertility increased with an increasing number of sperm measurements in the subfertile range (Table 3Table 3
Odds Ratios for Infertility for Combinations of Sperm Measurements.). In comparison with an increase by a factor of 2 to 3 in the likelihood of infertility when one sperm measurement was in the subfertile range, there was an increase by a factor of 5 to 7 in the risk of infertility when two sperm measurements were subfertile, and an increase by a factor of 16 when all three measurements were subfertile. For example, when the percentage of sperm with normal morphologic features was in the fertile range but the percentage of motile sperm and the concentration were both in the subfertile range, the odds ratio for infertility was 5.5.The frequency distributions of fertile and infertile men with regard to sperm concentration, motility, and morphology, divided on the basis of the thresholds determined by the CART analysis, are shown in Figure 1Figure 1
Percentage of Men from Infertile and Fertile Couples with Values in the Subfertile, Indeterminate, and Fertile Ranges for Sperm Concentration (Panel A), Percentage of Motile Sperm (Panel B), and Percentage of Sperm with Normal Morphologic Features (Panel C), as Defined by Classification-and-Regression-Tree Analysis.. There was a marked excess of infertile men with values in the subfertile ranges of these semen measurements, and a corresponding excess of fertile men with values in the fertile ranges. Approximately equal proportions of fertile and infertile men had values in the indeterminate ranges of these variables.On the basis of the area under the receiver-operating-characteristic curve, each of the three measurements — the sperm concentration, percentage of motile sperm, and percentage of sperm with normal morphologic features — provided information that was helpful in discriminating between fertile and infertile men. The area under the curve for the percentage with normal morphologic features (0.66) was significantly greater than that for sperm concentration (0.60; P<0.001) and motility (0.59; P<0.001), whereas the areas under the curves for sperm concentration and motility were similar. The sensitivity and specificity of these measurements for identifying infertile men at various thresholds, including those defined by our CART analysis, are shown in Table 4Table 4
Sensitivity and Specificity of Sperm Measurements for Identifying Infertile Men at Various Thresholds.. Lowering the threshold for indeterminate fertility reduces the sensitivity of the measures (the likelihood of correctly identifying infertile men) but increases their specificity (the likelihood of correctly identifying fertile men).Discussion
The results of this study confirm that measurements of sperm concentration, motility, and morphology all provide useful information for diagnosing male infertility. Sperm morphology, as measured according to strict criteria, appears to be the most informative semen measurement for discriminating between fertile and infertile men. However, none of the measures, alone or in combination, can be considered diagnostic of infertility.
Several different approaches have been used to identify standards for normal semen measurements. Some focus on infertile couples, comparing those who conceive with those who do not.15,16 Others have compared fertile men with infertile men17-19 or have followed couples after they discontinued the use of contraception.8,9
Studies focusing on infertile couples undergoing treatment — i.e., those comparing couples who conceive with those who do not conceive15,16 — are limited by the inclusion of infertile couples only; in order to define the fertile ranges of semen measurements, fertile men must also be evaluated. Other reports have involved follow-up of couples who have discontinued their use of contraception.8,9 Although this approach has the advantage of prospectively defining couples as fertile and infertile, it requires large samples, since only 8 to 9 percent of couples are infertile.20 Moreover, in an unknown proportion of infertile couples, the woman is infertile. Two recent studies that used this approach concluded that a reevaluation of the existing standards for normal semen was needed,8,9 but neither study derived new standards.
A comparison of semen measurements between fertile and infertile men, which was our approach, was used in the 1950s by MacLeod and Gold.17,21,22 In these earlier studies, however, modern methods of semen evaluation were not used, and data were obtained from male partners in infertile couples regardless of the fertility status of the female partners. Nevertheless, the minimal standards for sperm concentration (20×106 per milliliter) and motility (40 percent motile cells) reported by MacLeod and Gold are near the values we derived. The standard for morphology (60 percent with normal morphologic features) cannot be compared with our results because a different scoring system was used.
In our study, sperm morphology was assessed by a single person with extensive training and substantial experience, and reliability was monitored on an ongoing basis. The application of our results in clinical laboratories would require the training of technicians and the implementation of tools for continuous calibration. The subfertile and fertile ranges for morphology (less than 9 percent and more than 12 percent with normal morphologic features, respectively) might appear to be so close that they would be hard to distinguish. With the system of training for technicians and the calibration methods we used, however, there were only 2 of the 65 quality-assurance slides for which the assessment of the percentage of normal sperm spanned the range from less than 9 percent to more than 12 percent in 14 readings during the course of the study. Although we assessed morphology according to strict criteria, our results do not necessarily imply that this method is superior to other approaches. Nevertheless, our results do provide a reference value for sperm morphology that is missing from the current WHO manual for semen evaluation.7
Instead of a single value for each semen measurement that presumably distinguishes between “normal” and “abnormal,” we estimated the best two values that allow for the delineation of three groups — fertile, indeterminate, and subfertile. We believe that this classification system is clinically meaningful23 and is appropriate to what is, biologically, a continuous function.
Our data suggest that caution must be used in interpreting the significance of any given subfertile or indeterminate semen measurement. Although low values for each measurement increase the likelihood that a male factor contributes to infertility, there was substantial overlap in the frequency distributions in our study. Thus, values for sperm concentration, motility, or morphology that are in the subfertile range do not exclude the possibility of normal fertility.
To facilitate recruitment, we defined fertility as pregnancy within the previous two years rather than current pregnancy. Even though we attempted to match the fertile and infertile couples according to age and geographic location, there were demographic differences between the two groups. There were also differences between the two groups in the interval between the collection of the two semen specimens. In addition, despite normal results on fertility evaluation of the female partner, there may have been unrecognized subclinical female factors contributing to the infertility of the infertile couples. Finally, confirmation of the validity of these thresholds for semen measurements in an independent sample of fertile and infertile men is needed.
Notwithstanding these limitations, our data from a large group of couples with well-documented fertility or infertility provide clinical standards for semen measurements that may be useful for diagnosing male-factor infertility and for distinguishing between subfertile, indeterminate, and fertile ranges. These thresholds can be applied in clinical practice and research, provided that there is strict quality control.
Supported by cooperative agreements (U10 HD26975, U10 HD26981, U01 HD27006, U10 HD27009, U10 HD27001, U10 HD27049, U10 HD33172, and U10 HD33173) with the National Institute of Child Health and Human Development.
We are indebted to Thinus F. Kruger, M.D., for scoring the set of sperm-morphology slides that were used for laboratory quality control, and to Catherine Treece, C.L.A., for analyzing the slides.
Source Information
From the University of Rochester, Rochester, N.Y. (D.S.G.); the University of California, Davis (J.W.O., C.K.B., S.T.N.); Columbia University, New York (P.F.-L., D.X.); the University of Pennsylvania Medical Center, Philadelphia (C.C.); Baylor College of Medicine, Houston (S.A.C., P.C.); the University of Alabama, Birmingham (M.P.S.); Brigham and Women's Hospital, Boston (J.A.H.); and the National Institutes of Health, Bethesda, Md. (D.L.V.).
Address reprint requests to Dr. Guzick at the Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Box 668, 601 Elmwood Ave., Rochester, NY 14642, or at david_guzick@urmc.rochester.edu.
Other members of the National Cooperative Reproductive Medicine Network are listed in the Appendix.
Appendix
In addition to the authors, other investigators in the National Cooperative Reproductive Medicine Network were as follows: Baylor College of Medicine, Houston — P. Casson, S. Lindsey; Brigham and Women's Hospital, Boston — K. Walsh, M. Rein; Columbia University, New York — R. Canfield, R. Coslit, P. Kringas, B. Levin, M.C. Paik, S. Schoenholtz; University of Alabama, Birmingham — R. Blackwell, E. Knochenhauer, K. Hammond, V. Willis; University of California, Davis — S. Boyers, J. Chang, R. Covell, K. Sweeney, L. Wisner; Kaiser Permanente, Santa Clara, Calif. — M. Colombo, J. D'Amico; University of Pennsylvania, Philadelphia — K. Timbers, J. Stansberry, L. Blasco, K. Walsh; University of Pittsburgh, Pittsburgh — J. Albert, S. Berga, M. Everson; University of Rochester, Rochester, N.Y. — G. Centola, W. Phipps, G. Santoriello; and the Data Safety and Monitoring Committee — J. Schreiber, S. Fowler, G. Colditz, T.L. Bush.
- References
References
1
Rowe PH, Comhaire FH, Hargreave TB, Mellows HJ. WHO manual for the standardized investigation and diagnosis of the infertile couple. Cambridge, England: Cambridge University Press, 1993.
2
Investigation of the infertile couple. Birmingham, Ala.: American Fertility Society, 1994.
3
Environmental Protection Agency 4
World Health Organization. WHO laboratory manual for the examination of human semen and semen-cervical mucus interaction. Singapore: Press Concern, 1980.
5
World Health Organization. WHO laboratory manual for the examination of human semen and semen-cervical mucus interaction. 2nd ed. Cambridge, England: Cambridge University Press, 1987.
6
World Health Organization. WHO laboratory manual for the examination of human semen and sperm-cervical mucus interaction. 3rd ed. Cambridge, England: Cambridge University Press, 1992.
7
World Health Organization. WHO laboratory manual for the examination of human semen and sperm-cervical mucus interaction. 4th ed. Cambridge, England: Cambridge University Press, 1999.
8
Bonde JP ,Ernst E ,Jensen TK , et al. Relation between semen quality and fertility: a population-based study of 430 first-pregnancy planners. Lancet 1998;352:1172-1177
CrossRef | Web of Science | Medline9
Zinaman MJ ,Brown CC ,Selevan SG ,Clegg ED . Semen quality and human fertility: a prospective study with healthy couples. J Androl 2000;21:145-153
Web of Science | Medline10
Guzick DS ,Carson SA ,Coutifaris C , et al. Efficacy of superovulation and intrauterine insemination in the treatment of infertility. N Engl J Med 1999;340:177-183
Full Text | Web of Science | Medline11
Overstreet JW, Brazil CK. Semen analysis. In: Lipshultz LI, Howards SS, eds. Infertility in the male. 3rd ed. St. Louis: Mosby–Year Book, 1997:487-90.
12
Breiman L, Friedman JH, Olshen RA, Stone CJ. Classification and regression trees. Belmont, Calif.: Wadsworth, 1984.
13
Metz CE . Basic principles of ROC analysis. Semin Nucl Med 1978;8:283-298
CrossRef | Web of Science | Medline14
Hanley JA ,McNeil BJ . The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 1982;143:29-36
Web of Science | Medline15
Dunphy BC ,Neal LM ,Cooke ID . The clinical value of conventional semen analysis. Fertil Steril 1989;51:324-329
Web of Science | Medline16
Polansky FF ,Lamb EJ . Do the results of semen analysis predict future fertility? A survival analysis study. Fertil Steril 1988;49:1059-1065
Web of Science | Medline17
MacLeod J ,Gold RZ . The male factor in fertility and infertility. II. Spermatozoon counts in 1000 men of known fertility and in 1000 cases of infertile marriage. J Urol 1951;66:436-449
Web of Science | Medline18
Zukerman Z ,Rodriguez-Rigau IJ ,Smith KD ,Steinberger E . Frequency distribution of sperm counts in fertile and infertile males. Fertil Steril 1977;28:1310-1313
Web of Science | Medline19
David G ,Jouannet P ,Martin-Boyce A ,Spira A ,Schwartz D . Sperm counts in fertile and infertile men. Fertil Steril 1979;31:453-455
Web of Science | Medline20
Stephen EH . Projections of impaired fecundity among women in the United States: 1995 to 2020. Fertil Steril 1996;66:205-209
Web of Science | Medline21
MacLeod J ,Gold RZ . The male factor in fertility and infertility. III. An analysis of motile activity in the spermatozoa of 1000 fertile men and 1000 men in infertile marriage. Fertil Steril 1951;2:187-204
Web of Science | Medline22
MacLeod J ,Gold RZ . The male factor in fertility and infertility. IV. Sperm morphology in fertile and infertile marriage. Fertil Steril 1951;2:394-414
Web of Science | Medline23
Overstreet JW, Davis RO. Methods and interpretation of semen analysis. In: Key WR, Chang RJ, Rebar RW, Soules M, eds. Infertility: evaluation and treatment. New York: W.B. Saunders, 1995:580-91.
- Citing Articles (196)
Citing Articles
1
Christopher De Jonge. (2012) Semen analysis: looking for an upgrade in class. Fertility and Sterility 97:2, 260-266
CrossRef2
Mona Bungum. (2012) Sperm DNA Integrity Assessment: A New Tool in Diagnosis and Treatment of Fertility. Obstetrics and Gynecology International 2012, 1-6
CrossRef3
Daniel R Franken, Sergio Oehninger. (2012) Semen analysis and sperm function testing. Asian Journal of Andrology 14:1, 6-13
CrossRef4
D. Milardi, G. Grande, D. Sacchini, A. L. Astorri, G. Pompa, A. Giampietro, L. De Marinis, A. Pontecorvi, A. G. Spagnolo, R. Marana. (2012) Male Fertility and Reduction in Semen Parameters: A Single Tertiary-Care Center Experience. International Journal of Endocrinology 2012, 1-6
CrossRef5
Hao Huang, Karl R. Hansen, Pamela Factor-Litvak, Sandra A. Carson, David S. Guzick, Nanette Santoro, Michael P. Diamond, Esther Eisenberg, Heping Zhang. (2012) Predictors of pregnancy and live birth after insemination in couples with unexplained or male-factor infertility. Fertility and Sterility
CrossRef6
C. L. R. Barratt, L. Bjorndahl, R. Menkveld, D. Mortimer. (2011) ESHRE special interest group for andrology basic semen analysis course: a continued focus on accuracy, quality, efficiency and clinical relevance. Human Reproduction 26:12, 3207-3212
CrossRef7
PETER J. STAHL, DORON S. STEMBER, PETER N. SCHLEGEL. (2011) Interpretation of the Semen Analysis and Initial Male Factor Management. Clinical Obstetrics and Gynecology 54:4, 656-665
CrossRef8
K. Oleszczuk, A. Giwercman, M. Bungum. (2011) Intra-individual variation of the sperm chromatin structure assay DNA fragmentation index in men from infertile couples. Human Reproduction 26:12, 3244-3248
CrossRef9
L.B. Håkonsen, M. Spano, J.P. Bonde, J. Olsen, A.M. Thulstrup, E. Ernst, C.H. Ramlau-Hansen. (2011) Exposures that may affect sperm DNA integrity: two decades of follow-up in a pregnancy cohort. Reproductive Toxicology
CrossRef10
Guixiang Ji, Aihua Gu, Yubang Wang, Cong Huang, Fan Hu, Yong Zhou, Ling Song, Xinru Wang. (2011) Genetic variants in antioxidant genes are associated with sperm DNA damage and risk of male infertility in a Chinese population. Free Radical Biology and Medicine
CrossRef11
S. Keshtgar, H. Fanaei, S. Bahmanpour, F. Azad, A. Ghannadi, M. Kazeroni. (2011) In vitro effects of α-tocopherol on teratozoospermic semen samples. Andrologiano-no
CrossRef12
Steven R Bayer, Michael M Alper. 2011. The infertility workup. , 19-34.
CrossRef13
Loa Nordkap, Ulla Nordström Joensen, Martin Blomberg Jensen, Niels Jørgensen. (2011) Regional differences and temporal trends in male reproductive health disorders: Semen quality may be a sensitive marker of environmental exposures. Molecular and Cellular Endocrinology
CrossRef14
Forouzan Absalan, Alireza Ghannadi, Marjaneh Kazerooni, Rostami Parifar, Fatemeh Jamalzadeh, Sahar Amiri. (2011) Value of sperm chromatin dispersion test in couples with unexplained recurrent abortion. Journal of Assisted Reproduction and Genetics
CrossRef15
P. M. Cirillo, B. A. Cohn, N. Y. Krigbaum, M. Lee, C. Brazil, P. Factor-Litvak. (2011) Effect of maternal coffee, smoking and drinking behavior on adult son's semen quality: prospective evidence from the Child Health and Development Studies. Journal of Developmental Origins of Health and Disease1-12
CrossRef16
Armand Zini, Gert Dohle. (2011) Are varicoceles associated with increased deoxyribonucleic acid fragmentation?. Fertility and Sterility
CrossRef17
Alberto Ferlin, Cinzia Vinanzi, Riccardo Selice, Andrea Garolla, Anna Chiara Frigo, Carlo Foresta. (2011) Toward a pharmacogenetic approach to male infertility: polymorphism of follicle-stimulating hormone beta-subunit promoter. Fertility and Sterility
CrossRef18
A. N. Yatsenko, D. S. O'Neil, A. Roy, P. A. Arias-Mendoza, R. Chen, L. J. Murthy, D. J. Lamb, M. M. Matzuk. (2011) Association of mutations in the zona pellucida binding protein 1 (ZPBP1) gene with abnormal sperm head morphology in infertile men. Molecular Human Reproduction
CrossRef19
Monis Bilal Shamsi, Syed Nazar Imam, Rima Dada. (2011) Sperm DNA integrity assays: diagnostic and prognostic challenges and implications in management of infertility. Journal of Assisted Reproduction and Genetics
CrossRef20
Lars Björndahl. (2011) What is normal semen quality? On the use and abuse of reference limits for the interpretation of semen analysis results. Human Fertility 14:3, 179-186
CrossRef21
Dean E. Morbeck, Phoebe H. Leonard, Amy L. Weaver, Katherine M. Shimek, Esther V.A. Bouwsma, Charles C. Coddington. (2011) Sperm morphology: classification drift over time and clinical implications. Fertility and Sterility
CrossRef22
A.G. Shayeb, K. Harrild, E. Mathers, S. Bhattacharya. (2011) An exploration of the association between male body mass index and semen quality. Reproductive BioMedicine Online
CrossRef23
Suresh C. Joshi, Preeti Sharma. (2011) Male reproductive toxicity of organophosphorous compounds: a review. Toxicological & Environmental Chemistry 93:7, 1486-1507
CrossRef24
N. Jørgensen, M. Vierula, R. Jacobsen, E. Pukkala, A. Perheentupa, H. E. Virtanen, N. E. Skakkebaek, J. Toppari. (2011) Recent adverse trends in semen quality and testis cancer incidence among Finnish men. International Journal of Andrology 34:4pt2, e37-e48
CrossRef25
T. L. Tollner, S. A. Venners, E. J. Hollox, A. I. Yudin, X. Liu, G. Tang, H. Xing, R. J. Kays, T. Lau, J. W. Overstreet, X. Xu, C. L. Bevins, G. N. Cherr. (2011) A Common Mutation in the Defensin DEFB126 Causes Impaired Sperm Function and Subfertility. Science Translational Medicine 3:92, 92ra65-92ra65
CrossRef26
R. Rybar, P. Prinosilova, V. Kopecka, J. Hlavicova, Z. Veznik, A. Zajicova, J. Rubes. (2011) The effect of bacterial contamination of semen on sperm chromatin integrity and standard semen parameters in men from infertile couples. Andrologiano-no
CrossRef27
Avigdor Klinger, Baruch Hain, Haim Yaffe, Oshrat Schonberger. (2011) Periodontal status of males attending an in vitro fertilization clinic. Journal of Clinical Periodontology 38:6, 542-546
CrossRef28
I.- W. Lee, P.-H. Kuo, M.-T. Su, L.-C. Kuan, C.-C. Hsu, P.-L. Kuo. (2011) Quantitative trait analysis suggests polymorphisms of estrogen-related genes regulate human sperm concentrations and motility. Human Reproduction 26:6, 1585-1596
CrossRef29
J. Hu, W. Zhu, W. Liu, L. Fan. (2011) Factors affecting fecundity among sperm donors: a multivariate analysis. Andrologia 43:3, 155-162
CrossRef30
Kamla Kant Shukla, Abbas Ali Mahdi, Vivek Mishra, Singh Rajender, Satya Narain Sankhwar, Devender Patel, Mukul Das. (2011) Withania somnifera improves semen quality by combating oxidative stress and cell death and improving essential metal concentrations. Reproductive BioMedicine Online 22:5, 421-427
CrossRef31
Alaa Hamada, Sandro C. Esteves, Ashok Agarwal. (2011) Unexplained male infertility. Human Andrology 1:1, 2-16
CrossRef32
A. Mitrović, P. Brkić, Tomislav Jovanović. (2011) The effects of hyperbaric oxygen treatment on vigility of spermatozoids: Preliminary report. Acta Physiologica Hungarica 98:1, 85-90
CrossRef33
James M. Hotaling, James F. Smith, Mitchell Rosen, Charles H. Muller, Thomas J. Walsh. (2011) The relationship between isolated teratozoospermia and clinical pregnancy after in vitro fertilization with or without intracytoplasmic sperm injection: a systematic review and meta-analysis. Fertility and Sterility 95:3, 1141-1145
CrossRef34
Gerhard Haidl. (2011) New WHO-reference limits—revolution or storm in a teapot?. Asian Journal of Andrology 13:2, 208-211
CrossRef35
Taha A. Abdel-Meguid, Ahmad Al-Sayyad, Abdulmalik Tayib, Hasan M. Farsi. (2011) Does Varicocele Repair Improve Male Infertility? An Evidence-Based Perspective From a Randomized, Controlled Trial. European Urology 59:3, 455-461
CrossRef36
Jan W. van der Steeg, Pieternel Steures, Marinus J.C. Eijkemans, J. Dik F. Habbema, Peter G.A. Hompes, Jan A.M. Kremer, Loes van der Leeuw-Harmsen, Patrick M.M. Bossuyt, Sjoerd Repping, Sherman J. Silber, Ben W.J. Mol, Fulco van der Veen. (2011) Role of semen analysis in subfertile couples. Fertility and Sterility 95:3, 1013-1019
CrossRef37
Armand Zini. (2011) Are sperm chromatin and DNA defects relevant in the clinic?. Systems Biology in Reproductive Medicine 57:1-2, 78-85
CrossRef38
Kathleen Hwang, Larry I. Lipshultz, Dolores J. Lamb. (2011) Use of Diagnostic Testing to Detect Infertility. Current Urology Reports 12:1, 68-76
CrossRef39
Luke Simon, Deborah Lutton, Joanne McManus, Sheena E.M. Lewis. (2011) Sperm DNA damage measured by the alkaline Comet assay as an independent predictor of male infertility and in vitro fertilization success. Fertility and Sterility 95:2, 652-657
CrossRef40
Craig S. Niederberger. (2011) Semen and the Curse of Cutoffs. The Journal of Urology 185:2, 381-382
CrossRef41
Mary Ellen Pavone, Jennifer E. Hirshfeld-Cytron, Ralph R. Kazer. (2011) The Progressive Simplification of the Infertility Evaluation. Obstetrical & Gynecological Survey 66:1, 31-41
CrossRef42
Roelof Menkveld, Cas AG Holleboom, Johann PT Rhemrev. (2011) Measurement and significance of sperm morphology. Asian Journal of Andrology 13:1, 59-68
CrossRef43
Ashish Gupta, Abbas Ali Mahdi, Mohammad Kaleem Ahmad, Kamla Kant Shukla, Shyam Pyari Jaiswer, Satya Narain Shankhwar. (2011) 1H NMR spectroscopic studies on human seminal plasma: A probative discriminant function analysis classification model. Journal of Pharmaceutical and Biomedical Analysis 54:1, 106-113
CrossRef44
Christopher LR Barratt, Steven Mansell, Catherine Beaton, Steve Tardif, Senga K Oxenham. (2011) Diagnostic tools in male infertility—the question of sperm dysfunction. Asian Journal of Andrology 13:1, 53-58
CrossRef45
Mona Bungum, Leif Bungum, Aleksander Giwercman. (2011) Sperm chromatin structure assay (SCSA): a tool in diagnosis and treatment of infertility. Asian Journal of Andrology 13:1, 69-75
CrossRef46
Aihua Gu, Guixiang Ji, Pengfei Zhu, Yong Zhou, Guangbo Fu, Yankai Xia, Ling Song, Shoulin Wang, Xinru Wang. (2010) Nucleotide excision repair polymorphisms, polycyclic aromatic hydrocarbon exposure, and their effects on sperm deoxyribonucleic acid damage and male factor infertility. Fertility and Sterility 94:7, 2620-2625.e5
CrossRef47
Radha A. Lewis, DeShawn Taylor, Melissa F. Natavio, Alexander Melamed, Juan Felix, Daniel Mishell. (2010) Effects of the levonorgestrel-releasing intrauterine system on cervical mucus quality and sperm penetrability. Contraception 82:6, 491-496
CrossRef48
Kathleen Hwang, Alexander N. Yatsenko, Carolina J. Jorgez, Sarmistha Mukherjee, Roopa Lata Nalam, Martin M. Matzuk, Dolores J. Lamb. (2010) Mendelian genetics of male infertility. Annals of the New York Academy of Sciences 1214:1, E1-E17
CrossRef49
Sara S. Morelli, Aimee Seungdamrong, David H. McCulloh, Peter G. McGovern. (2010) Abnormal sperm count and motility on semen analysis are not sufficiently predictive of abnormal Kruger morphology. Fertility and Sterility 94:7, 2882-2884
CrossRef50
K. Steger, M. C. O. Cavalcanti, H. C. Schuppe. (2010) Prognostic markers for competent human spermatozoa: fertilizing capacity and contribution to the embryo. International Journal of Andrologyno-no
CrossRef51
M. Brandes, C. J. C. M. Hamilton, J. O. M. van der Steen, J. P. de Bruin, R. S. G. M. Bots, W. L. D. M. Nelen, J. A. M. Kremer. (2010) Severity of oligo-asteno-teratozoospermia no longer determines overall success rate in male subfertility. International Journal of Andrologyno-no
CrossRef52
M. Hammadeh, M. Hamad, M. Montenarh, C. Fischer-Hammadeh. (2010) Protamine contents and P1/P2 ratio in human spermatozoa from smokers and non-smokers. Human Reproduction 25:11, 2708-2720
CrossRef53
Aihua Gu, Guixiang Ji, Yong Zhou, Yan Long, Xiangguo Shi, Guangbo Fu, Shoulin Wang, Ling Song, Xinru Wang. (2010) Polymorphisms of nucleotide-excision repair genes may contribute to sperm DNA fragmentation and male infertility. Reproductive BioMedicine Online 21:5, 602-609
CrossRef54
Mary K Samplaski, Ashok Agarwal, Rakesh Sharma, Edmund Sabanegh. (2010) New generation of diagnostic tests for infertility: Review of specialized semen tests. International Journal of Urology 17:10, 839-847
CrossRef55
Marij Smit, Johannes C. Romijn, Mark F. Wildhagen, Robertus F.A. Weber, Gert R. Dohle. (2010) Sperm chromatin structure is associated with the quality of spermatogenesis in infertile patients. Fertility and Sterility 94:5, 1748-1752
CrossRef56
P. Banerjee, B. Choi, L. K. Shahine, S. H. Jun, K. O'Leary, R. B. Lathi, L. M. Westphal, W. H. Wong, M. W. M. Yao. (2010) From the Cover: Deep phenotyping to predict live birth outcomes in in vitro fertilization. Proceedings of the National Academy of Sciences 107:31, 13570-13575
CrossRef57
Li-hong Zhang, Yi Qiu, Ke-hua Wang, Qiuju Wang, Guozhen Tao, Lei-guang Wang. (2010) Measurement of sperm DNA fragmentation using bright-field microscopy: comparison between sperm chromatin dispersion test and terminal uridine nick-end labeling assay. Fertility and Sterility 94:3, 1027-1032
CrossRef58
Ellen Peeters, Carl Spiessens, Raymond Oyen, Liesbeth De Wever, Dirk Vanderschueren, Freddy Penninckx, Marc Miserez. (2010) Laparoscopic Inguinal Hernia Repair in Men With Lightweight Meshes May Significantly Impair Sperm Motility. Annals of Surgery 252:2, 240-246
CrossRef59
Sreebala Sripada, John Townend, Doris Campbell, Linda Murdoch, Eileen Mathers, Siladitya Bhattacharya. (2010) Relationship between semen parameters and spontaneous pregnancy. Fertility and Sterility 94:2, 624-630
CrossRef60
Guadalupe Gallegos-Avila, Jesús Ancer-Rodríguez, Alberto Niderhauser-García, Marta Ortega-Martínez, Gilberto Jaramillo-Rangel. (2010) Multinucleation of spermatozoa and spermatids in infertile men chronically exposed to carbofuran. Reproductive Toxicology 29:4, 458-460
CrossRef61
Melanie Landay, Kristin A. Bendikson. 2010. Work-up of Infertility. , 429-432.
CrossRef62
Craig Niederberger. (2010) Male Infertility. The Journal of Urology 183:6, 2320-2323
CrossRef63
Joseph B. Stanford, Rafael T. Mikolajczyk, Courtney D. Lynch, Sara E. Simonsen. (2010) Cumulative pregnancy probabilities among couples with subfertility: effects of varying treatments. Fertility and Sterility 93:7, 2175-2181
CrossRef64
T. G. Cooper, E. Noonan, S. von Eckardstein, J. Auger, H. W. G. Baker, H. M. Behre, T. B. Haugen, T. Kruger, C. Wang, M. T. Mbizvo, K. M. Vogelsong. (2010) World Health Organization reference values for human semen characteristics. Human Reproduction Update 16:3, 231-245
CrossRef65
M.A. Coppola, K.L. Klotz, K.-a. Kim, H.Y. Cho, J. Kang, J. Shetty, S.S. Howards, C.J. Flickinger, J.C. Herr. (2010) SpermCheck(R) Fertility, an immunodiagnostic home test that detects normozoospermia and severe oligozoospermia. Human Reproduction 25:4, 853-861
CrossRef66
N. Jørgensen, E. Rajpert-De Meyts, K. M. Main, N. E. Skakkebaek. (2010) Testicular dysgenesis syndrome comprises some but not all cases of hypospadias and impaired spermatogenesis. International Journal of Andrology 33:2, 298-303
CrossRef67
Audra L. Gollenberg, Fan Liu, Charlene Brazil, Erma Z. Drobnis, David Guzick, James W. Overstreet, James B. Redmon, Amy Sparks, Christina Wang, Shanna H. Swan. (2010) Semen quality in fertile men in relation to psychosocial stress. Fertility and Sterility 93:4, 1104-1111
CrossRef68
Vincenzo Visco, Salvatore Raffa, Jlenia Elia, Michele Delfino, Norina Imbrogno, Maria Rosaria Torrisi, Fernando Mazzilli. (2010) Morphological sperm defects analyzed by light microscopy and transmission electron microscopy and their correlation with sperm motility. International Journal of Urology 17:3, 259-266
CrossRef69
Marij Smit, Odette G. Wissenburg, Johannes C. Romijn, Gert R. Dohle. (2010) Increased Sperm DNA Fragmentation in Patients With Vasectomy Reversal Has No Prognostic Value for Pregnancy Rate. The Journal of Urology 183:2, 662-665
CrossRef70
Aleksander Giwercman, Lars Lindstedt, Mattias Larsson, Mona Bungum, Marcello Spano, Richard J. Levine, Lars Rylander. (2010) Sperm chromatin structure assay as an independent predictor of fertility in vivo: a case-control study. International Journal of Andrology 33:1, e221-e227
CrossRef71
Niels E. Skakkebaek. (2010) Normal reference ranges for semen quality and their relations to fecundity. Asian Journal of Andrology 12:1, 95-98
CrossRef72
Charlene Brazil. (2010) Practical semen analysis: from A to Z. Asian Journal of Andrology 12:1, 14-20
CrossRef73
Allan A. Pacey. (2010) Quality assurance and quality control in the laboratory andrology. Asian Journal of Andrology 12:1, 21-25
CrossRef74
W. C. L. Ford. (2010) Comments on the release of the 5th edition of the WHO Laboratory Manual for the Examination and Processing of Human Semen. Asian Journal of Andrology 12:1, 59-63
CrossRef75
Xinliang Ding, Jie Zhang, Zenghui Bian, Yankai Xia, Chuncheng Lu, Aihua Gu, Yingchun Li, Ling Song, Shoulin Wang, Xinru Wang. (2010) Variants in the Eppin gene show association with semen quality in Han-Chinese population. Reproductive BioMedicine Online 20:1, 125-131
CrossRef76
J.A. Castilla, S. Zamora, M.C. Gonzalvo, J.D. Luna del Castillo, J.A. Roldan-Nofuentes, A. Clavero, L. Björndahl, L. Martínez. (2010) Sperm chromatin structure assay and classical semen parameters: systematic review. Reproductive BioMedicine Online 20:1, 114-124
CrossRef77
Roelof Menkveld. (2010) Clinical significance of the low normal sperm morphology value as proposed in the fifth edition of the WHO Laboratory Manual for the Examination and Processing of Human Semen. Asian Journal of Andrology 12:1, 47-58
CrossRef78
Ryan T. Schulte, Dana A. Ohl, Mark Sigman, Gary D. Smith. (2010) Sperm DNA damage in male infertility: etiologies, assays, and outcomes. Journal of Assisted Reproduction and Genetics 27:1, 3-12
CrossRef79
Jacques Auger. (2010) Assessing human sperm morphology: top models, underdogs or biometrics?. Asian Journal of Andrology 12:1, 36-46
CrossRef80
Dolores J. Lamb. (2010) Semen analysis in 21st century medicine: the need for sperm function testing. Asian Journal of Andrology 12:1, 64-70
CrossRef81
Fabian Engelbertz, Joanna B. Korda, Udo Engelmann, Markus Rothschild, Sibylle Banaschak. (2010) Longevity of spermatozoa in the post-ejaculatory urine of fertile men. Forensic Science International 194:1-3, 15-19
CrossRef82
Elizabeth Barbieri, Sonya Kashyap, Pak H. Chung. 2010. Infertility and In Vitro Fertilization. , 381-399.
CrossRef83
Thomas A. Molinaro, Alka Shaunik, Kathleen Lin, Mary D. Sammel, Kurt T. Barnhart. (2009) A strict infertility diagnosis has poor agreement with the clinical diagnosis entered into the Society for Assisted Reproductive Technology registry. Fertility and Sterility 92:6, 2088-2090
CrossRef84
Achard, Caroline, Courtillot, Carine, Lahuna, Olivier, Méduri, Géri, Soufir, Jean-Claude, Lière, Philippe, Bachelot, Anne, Benyounes, Hassani, Schumacher, Michael, Kuttenn, Frédérique, Touraine, Philippe, Misrahi, Micheline, . (2009) Normal Spermatogenesis in a Man with Mutant Luteinizing Hormone. New England Journal of Medicine 361:19, 1856-1863
Full Text85
Recai Pabuccu, Cemil Kaya, Gamze Sinem Cağlar, Efser Oztas, Hakan Satiroglu. (2009) Follicular-fluid anti-Mullerian hormone concentrations are predictive of assisted reproduction outcome in PCOS patients. Reproductive BioMedicine Online 19:5, 631-637
CrossRef86
Caroline Herr, Anja zur Nieden, Holger M. Koch, Hans-Christian Schuppe, Christian Fieber, Jürgen Angerer, Thomas Eikmann, Nikolaos I. Stilianakis. (2009) Urinary di(2-ethylhexyl)phthalate (DEHP)—Metabolites and male human markers of reproductive function. International Journal of Hygiene and Environmental Health 212:6, 648-653
CrossRef87
Sergey I. Moskovtsev, Jennifer Willis, John White, J. Brendan M. Mullen. (2009) Sperm DNA Damage: Correlation to Severity of Semen Abnormalities. Urology 74:4, 789-793
CrossRef88
P. Devroey, B.C.J.M. Fauser, K. Diedrich, . (2009) Approaches to improve the diagnosis and management of infertility. Human Reproduction Update 15:4, 391-408
CrossRef89
I. Tsarev, M. Bungum, A. Giwercman, J. Erenpreisa, T. Ebessen, E. Ernst, J. Erenpreiss. (2009) Evaluation of male fertility potential by Toluidine Blue test for sperm chromatin structure assessment. Human Reproduction 24:7, 1569-1574
CrossRef90
Claudia Lalancette, Adrian E. Platts, Graham D. Johnson, Benjamin R. Emery, Douglas T. Carrell, Stephen A. Krawetz. (2009) Identification of human sperm transcripts as candidate markers of male fertility. Journal of Molecular Medicine 87:7, 735-748
CrossRef91
J. Ricardo Loret de Mola. (2009) Obesity and Its Relationship to Infertility in Men and Women. Obstetrics and Gynecology Clinics of North America 36:2, 333-346
CrossRef92
R. Rybar, P. Markova, Z. Veznik, L. Faldikova, M. Kunetkova, A. Zajicova, V. Kopecka, J. Rubes. (2009) Sperm chromatin integrity in young men with no experiences of infertility and men from idiopathic infertility couples. Andrologia 41:3, 141-149
CrossRef93
M. Nitzschke, T. Strowitzki, M. Wolff. (2009) Spermiogramm und Seminalplasma. Gynäkologische Endokrinologie 7:2, 80-86
CrossRef94
X. Chen, W. Zhang, Y. Luo, X. Long, X. Sun. (2009) Predictive value of semen parameters in in vitro fertilisation pregnancy outcome. Andrologia 41:2, 111-117
CrossRef95
Ping-Chi Hsu, Ho-Yuan Chang, Yueliang Leon Guo, Yen-Chun Liu, Tung-Sheng Shih. (2009) Effect of smoking on blood lead levels in workers and role of reactive oxygen species in lead-induced sperm chromatin DNA damage. Fertility and Sterility 91:4, 1096-1103
CrossRef96
Ulla Nordström Joensen, Niels E Skakkebæk, Niels Jørgensen. (2009) Is there a problem with male reproduction?. Nature Clinical Practice Endocrinology & Metabolism 5:3, 144-145
CrossRef97
Thomas J. Walsh, Alex K. Wu, Mary S. Croughan, Paul J. Turek. (2009) Differences in the clinical characteristics of primarily and secondarily infertile men with varicocele. Fertility and Sterility 91:3, 826-830
CrossRef98
Stefano Palomba, Renato Pasquali, Francesco Orio, John E. Nestler. (2009) Clomiphene citrate, metformin or both as first-step approach in treating anovulatory infertility in patients with polycystic ovary syndrome (PCOS): a systematic review of head-to-head randomized controlled studies and meta-analysis. Clinical Endocrinology 70:2, 311-321
CrossRef99
Daniel H. Williams, Edward Karpman, James C. Sander, Philippe E. Spiess, Louis L. Pisters, Larry I. Lipshultz. (2009) Pretreatment Semen Parameters in Men With Cancer. The Journal of Urology 181:2, 736-740
CrossRef100
Petra Prinosilova, Thinus Kruger, Leyla Sati, Sinan Ozkavukcu, Lynne Vigue, Ertug Kovanci, Gabor Huszar. (2009) Selectivity of hyaluronic acid binding for spermatozoa with normal Tygerberg strict morphology. Reproductive BioMedicine Online 18:2, 177-183
CrossRef101
Ulla Nordström Joensen, Rossana Bossi, Henrik Leffers, Allan Astrup Jensen, Niels E. Skakkebæk, Niels Jørgensen. (2009) Do Perfluoroalkyl Compounds Impair Human Semen Quality?. Environmental Health Perspectives
CrossRef102
I. Galeraud-Denis, C. Travert, C. de Vienne, L. Said, A. Saad, S. Carreau. (2009) New insights about the evaluation of human sperm quality: the aromatase example. Folia Histochemica et Cytobiologica 47:5, S13-S17
CrossRef103
Nicoletta Tarozzi, Marco Nadalini, Davide Bizzaro, Lucia Serrao, Luca Fava, Giulia Scaravelli, Andrea Borini. (2009) Sperm–hyaluronan-binding assay: clinical value in conventional IVF under Italian law. Reproductive BioMedicine Online 19, 35-43
CrossRef104
Nour El-Hoda A. Zidan. (2009) Evaluation of the Reproductive Toxicity of Chlorpyrifos Methyl, Diazinon and Profenofos Pesticides in Male Rats. International Journal of Pharmacology 5:1, 51-57
CrossRef105
Robert L. Barbieri. 2009. Female Infertility. , 517-546.
CrossRef106
Paul J. Turek. 2009. Male Infertility. , 547-559.
CrossRef107
BW Mol, JW van der Steeg, HR Verhoeve, F van der Veen. 2008. How to conceive: evidence-based fertility investigation. , 205-214.
CrossRef108
Piyaphan Punyatanasakchai, Areephan Sophonsritsuk, Sawaek Weerakiet, Surapee Wansumrit, Deonthip Chompurat. (2008) Comparison of cryopreserved human sperm in vapor and liquid phases of liquid nitrogen: effect on motility parameters, morphology, and sperm function. Fertility and Sterility 90:5, 1978-1982
CrossRef109
Piotr Jedrzejczak, Grazyna Taszarek-Hauke, Jan Hauke, Leszek Pawelczyk, Antoni J. Duleba. (2008) Prediction of spontaneous conception based on semen parameters. International Journal of Andrology 31:5, 499-507
CrossRef110
Ahmad O. Hammoud, Mark Gibson, C. Matthew Peterson, A. Wayne Meikle, Douglas T. Carrell. (2008) Impact of male obesity on infertility: a critical review of the current literature. Fertility and Sterility 90:4, 897-904
CrossRef111
Juris Erenpreiss, Saad Elzanaty, Aleksander Giwercman. (2008) Sperm DNA damage in men from infertile couples. Asian Journal of Andrology 10:5, 786-790
CrossRef112
Wolfgang Weidner, Thorsten Diemer. (2008) Re: Reassessing the Value of Varicocelectomy as a Treatment for Male Subfertility with a New Meta-Analysis. European Urology 54:2, 465-466
CrossRef113
Vittore Verratti, Francesco Berardinelli, Camillo Di Giulio, Gerardo Bosco, Marisa Cacchio, Mario Pellicciotta, Michele Nicolai, Stefano Martinotti, Raffaele Tenaglia. (2008) Evidence that chronic hypoxia causes reversible impairment on male fertility. Asian Journal of Andrology 10:4, 602-606
CrossRef114
Aarnoud C van der Spoel, Richard Mott, Frances M Platt. (2008) Differential sensitivity of mouse strains to an N -alkylated imino sugar: glycosphingolipid metabolism and acrosome formation. Pharmacogenomics 9:6, 717-731
CrossRef115
Rim Saïdi, Elodie Gruel, Julie Roset-Blessman, Nathalie Mousset-Simeon, Sandrine Menon, Bertrand Mace, Nathalie Rives. (2008) Evaluation morphologique des spermatozoïdes. Andrologie 18:2, 158-167
CrossRef116
Alex K. Wu, Thomas J. Walsh, Surat Phonsombat, Mary S. Croughan, Paul J. Turek. (2008) Bilateral but not Unilateral Testicular Hypotrophy Predicts for Severe Impairment of Semen Quality in Men with Varicocele Undergoing Infertility Evaluation. Urology 71:6, 1114-1118
CrossRef117
Wayne J.G. Hellstrom, Marc Gittelman, Jonathan Jarow, Christopher Steidle, James McMurray, David Talley, Steven Watts, Carol L. Mitchell, James M. McGill. (2008) An Evaluation of Semen Characteristics in Men 45 Years of Age or Older after Daily Dosing with Tadalafil 20mg: Results of a Multicenter, Randomized, Double-Blind, Placebo-Controlled, 9-Month Study. European Urology 53:5, 1058-1065
CrossRef118
David A. Grimes, Laureen M. Lopez. (2008) Reply of the Authors: Reining in diversity—at what risk?. Fertility and Sterility 89:5, 1278-1279
CrossRef119
Howard H. Kim, Peter N. Schlegel. (2008) Endocrine Manipulation in Male Infertility. Urologic Clinics of North America 35:2, 303-318
CrossRef120
Ashok Agarwal, Frances Monette Bragais, Edmund Sabanegh. (2008) Assessing Sperm Function. Urologic Clinics of North America 35:2, 157-171
CrossRef121
A.-M. Andersson, N. Jørgensen, K. M. Main, J. Toppari, E. Rajpert-De Meyts, H. Leffers, A. Juul, T. K. Jensen, N. E. Skakkebæk. (2008) Adverse trends in male reproductive health: we may have reached a crucial ‘tipping point’. International Journal of Andrology 31:2, 74-80
CrossRef122
Tina Kold Jensen, Tomáš Sobotka, Martin A. Hansen, Anette Tønnes Pedersen, Wolfgang Lutz, Niels E. Skakkebæk. (2008) Declining trends in conception rates in recent birth cohorts of native Danish women: a possible role of deteriorating male reproductive health. International Journal of Andrology 31:2, 81-92
CrossRef123
Uwe Paasch, Andrea Salzbrunn, Hans Juergen Glander, Kai Plambeck, Harald Salzbrunn, Sonja Grunewald, Julia Stucke, Niels E. Skakkebæk, Niels Jørgensen. (2008) Semen quality in sub-fertile range for a significant proportion of young men from the general German population: a co-ordinated, controlled study of 791 men from Hamburg and Leipzig. International Journal of Andrology 31:2, 93-102
CrossRef124
Keith Jarvi, Eugene Dula, Margaret Drehobl, Jon Pryor, JoAnn Shapiro, Monica Seger. (2008) Daily Vardenafil for 6 Months Has No Detrimental Effects on Semen Characteristics or Reproductive Hormones in Men With Normal Baseline Levels. The Journal of Urology 179:3, 1060-1065
CrossRef125
Hector Pimentel, Craig Niederberger. (2008) A practical update on bulk semen analysis. Current Sexual Health Reports 5:1, 36-40
CrossRef126
Susan Benoff, Karen Auborn, Joel L. Marmar, Ian R. Hurley. (2008) Link between low-dose environmentally relevant cadmium exposures and asthenozoospermia in a rat model. Fertility and Sterility 89:2, e73-e79
CrossRef127
Sheena E. M. Lewis, Ishola Agbaje, Juan Alvarez. (2008) Sperm DNA Tests as Useful Adjuncts to Semen Analysis. Systems Biology in Reproductive Medicine 54:3, 111-125
CrossRef128
F. Dimitriadis, D. Giannakis, N. Pardalidis, K. Zikopoulos, E. Paraskevaidis, N. Giotitsas, V. Kalaboki, P. Tsounapi, D. Baltogiannis, I. Georgiou, M. Saito, T. Watanabe, I. Miyagawa, N. Sofikitis. (2008) Effects of phosphodiesterase 5 inhibitors on sperm parameters and fertilizing capacity. Asian Journal of Andrology 10:1, 115-133
CrossRef129
G.W. Schmidt, A.T. Broman, H.B. Hindman, Michael P. Grant. (2008) Vision Survival after Open Globe Injury Predicted by Classification and Regression Tree Analysis. Ophthalmology 115:1, 202-209
CrossRef130
Brian Robert Keegan, Sara Barton, Xavier Sanchez, Alan S. Berkeley, Lewis C. Krey, Jamie Grifo. (2007) Isolated teratozoospermia does not affect in vitro fertilization outcome and is not an indication for intracytoplasmic sperm injection. Fertility and Sterility 88:6, 1583-1588
CrossRef131
David A. Grimes, Laureen M. Lopez. (2007) “Oligozoospermia,” “azoospermia,” and other semen-analysis terminology: the need for better science. Fertility and Sterility 88:6, 1491-1494
CrossRef132
A. Hosseinzadeh Colagar ., G.A. Jorsaraee ., E. Tahmasbpour Marzony .. (2007) Cigarette Smoking and the Risk of Male Infertility. Pakistan Journal of Biological Sciences 10:21, 3870-3874
CrossRef133
Joel L. Marmar, Ashok Agarwal, Sushil Prabakaran, Rishi Agarwal, Robert A. Short, Susan Benoff, Anthony J. Thomas. (2007) Reassessing the value of varicocelectomy as a treatment for male subfertility with a new meta-analysis. Fertility and Sterility 88:3, 639-648
CrossRef134
Nathalie Sermondade, François Vialard, Marianne Bergere, Ibrahim Hammoud, Patrick Cavelot, Jacqueline Selva, Martine Albert. (2007) Evaluation de l’apport de la méthode d’observation des spermatozoïdes à fort grossissement en ICSI. Andrologie 17:3, 212-222
CrossRef135
Ashok Agarwal, Fnu Deepinder, Marcello Cocuzza, Rishi Agarwal, Robert A. Short, Edmund Sabanegh, Joel L. Marmar. (2007) Efficacy of Varicocelectomy in Improving Semen Parameters: New Meta-analytical Approach. Urology 70:3, 532-538
CrossRef136
Pollyana Maria F. Soares, Eduardo Ferreira Borba, Eloisa Bonfa, Jorge Hallak, André Luiz Corrêa, Clovis Artur A. Silva. (2007) Gonad evaluation in male systemic lupus erythematosus. Arthritis & Rheumatism 56:7, 2352-2361
CrossRef137
Randall B. Meacham, Geoffrey F. Joyce, Matthew Wise, Ashay Kparker, Craig Niederberger. (2007) Male Infertility. The Journal of Urology 177:6, 2058-2066
CrossRef138
Inge M.W. Ebisch, Régine P.M. Steegers-Theunissen, Fred C.G.J. Sweep, Gerhard A. Zielhuis, Anneke Geurts-Moespot, Chris M.G. Thomas. (2007) Possible role of the plasminogen activation system in human subfertility. Fertility and Sterility 87:3, 619-626
CrossRef139
M. Smit, G. R. Dohle, W. C. J. Hop, M. F. Wildhagen, R. F. A. Weber, J. C. Romijn. (2007) Clinical correlates of the biological variation of sperm DNA fragmentation in infertile men attending an andrology outpatient clinic. International Journal of Andrology 30:1, 48-55
CrossRef140
Gabor Huszar, Attila Jakab, Denny Sakkas, Ciler-Celik Ozenci, Sevil Cayli, Elena Delpiano, Sinan Ozkavukcu. (2007) Fertility testing and ICSI sperm selection by hyaluronic acid binding: clinical and genetic aspects. Reproductive BioMedicine Online 14:5, 650-663
CrossRef141
Anderson J.M. Andrade, Simone W. Grande, Chris E. Talsness, Christine Gericke, Konstanze Grote, Andrea Golombiewski, Anja Sterner-Kock, Ibrahim Chahoud. (2006) A dose response study following in utero and lactational exposure to di-(2-ethylhexyl) phthalate (DEHP): Reproductive effects on adult male offspring rats. Toxicology 228:1, 85-97
CrossRef142
Armand Zini, Jamie Libman. (2006) Sperm DNA damage: importance in the era of assisted reproduction. Current Opinion in Urology 16:6, 428-434
CrossRef143
Richard G. Bribiescas. (2006) On the evolution, life history, and proximate mechanisms of human male reproductive senescence. Evolutionary Anthropology: Issues, News, and Reviews 15:4, 132-141
CrossRef144
Matthew C. McCormack, Stewart McCallum, Barry Behr. (2006) A Novel Microfluidic Device for Male Subfertility Screening. The Journal of Urology 175:6, 2223-2227
CrossRef145
Peter Y Liu, Ronald S Swerdloff, Peter D Christenson, David J Handelsman, Christina Wang. (2006) Rate, extent, and modifiers of spermatogenic recovery after hormonal male contraception: an integrated analysis. The Lancet 367:9520, 1412-1420
CrossRef146
Fábio Firmbach Pasqualotto, Bernardo Passos Sobreiro, Jorge Hallak, Kelly Silveira Athayde, Eleonora Bedin Pasqualotto, Antônio Marmo Lucon. (2006) High percentage of abnormal semen parameters in a prevasectomy population. Fertility and Sterility 85:4, 954-960
CrossRef147
William A. Grobman, David M. Stamilio. (2006) Methods of clinical prediction. American Journal of Obstetrics and Gynecology 194:3, 888-894
CrossRef148
Kiran P. Nallella, Rakesh K. Sharma, Nabil Aziz, Ashok Agarwal. (2006) Significance of sperm characteristics in the evaluation of male infertility. Fertility and Sterility 85:3, 629-634
CrossRef149
D MAGAZZU, M COMELLI, A MARINONI. (2006) Are car drivers holding a motorcycle licence less responsible for motorcycle—Car crash occurrence?A non-parametric approach. Accident Analysis & Prevention 38:2, 365-370
CrossRef150
Niels E. Skakkebaek, Niels Jorgensen, Katharina M. Main, Ewa Rajpert-De Meyts, Henrik Leffers, Anna-Maria Andersson, Anders Juul, Elisabeth Carlsen, Gerda Krog Mortensen, Tina Kold Jensen, Jorma Toppari. (2006) Is human fecundity declining?. International Journal of Andrology 29:1, 2-11
CrossRef151
Niels Jorgensen, Camilla Asklund, Elisabeth Carlsen, Niels E. Skakkebaek. (2006) Coordinated European investigations of semen quality: results from studies of Scandinavian young men is a matter of concern. International Journal of Andrology 29:1, 54-61
CrossRef152
Vivian Lewis, John Queenan, Kathleen Hoeger, Joanne Stevens, David S. Guzick. (2006) Clomiphene citrate monitoring for intrauterine insemination timing: a randomized trial. Fertility and Sterility 85:2, 401-406
CrossRef153
Lucette van der Westerlaken, Nico Naaktgeboren, Harjo Verburg, Sandra Dieben, Frans M. Helmerhorst. (2006) Conventional in vitro fertilization versus intracytoplasmic sperm injection in patients with borderline semen: a randomized study using sibling oocytes. Fertility and Sterility 85:2, 395-400
CrossRef154
Shanna H. Swan. (2006) Semen quality in fertile US men in relation to geographical area and pesticide exposure. International Journal of Andrology 29:1, 62-68
CrossRef155
Bradley J. Van Voorhis. (2006) Outcomes From Assisted Reproductive Technology. Obstetrics & Gynecology 107:1, 183-200
CrossRef156
Willem Dhooge, Nicolas van Larebeke, Gudrun Koppen, Vera Nelen, Greet Schoeters, Robert Vlietinck, Jean-Marc Kaufman, Frank Comhaire. (2006) Serum Dioxin-Like Activity is Associated with Reproductive Parameters in Young Men from the General Flemish Population. Environmental Health Perspectives
CrossRef157
R. Winker, H. W. Rüdiger. (2006) Reproductive toxicology in occupational settings: an update. International Archives of Occupational and Environmental Health 79:1, 1-10
CrossRef158
Jakob Lackner, Georg Schatzl, Thomas Waldhör, Katharina Resch, Christian Kratzik, Michael Marberger. (2005) Constant decline in sperm concentration in infertile males in an urban population: experience over 18 years. Fertility and Sterility 84:6, 1657-1661
CrossRef159
Aldo Isidori, Maurizio Latini, Francesco Romanelli. (2005) Treatment of male infertility. Contraception 72:4, 314-318
CrossRef160
Marcus W. Jurema, Andrea D. Vieira, Brandon Bankowski, Carolina Petrella, Yulian Zhao, Edward Wallach, Howard Zacur. (2005) Effect of ejaculatory abstinence period on the pregnancy rate after intrauterine insemination. Fertility and Sterility 84:3, 678-681
CrossRef161
Nelly Mauras, Jennifer Bell, Banae G. Snow, Kevin L. Winslow. (2005) Sperm analysis in growth hormone-deficient adolescents previously treated with an aromatase inhibitor: Comparison with normal controls. Fertility and Sterility 84:1, 239-242
CrossRef162
Guido Ragni, Mariangela Arnoldi, Edgardo Somigliana, Alessio Paffoni, Maria Elena Brambilla, Liliana Restelli. (2005) Reproductive prognosis in male patients with azoospermia at the time of cancer diagnosis. Fertility and Sterility 83:6, 1674-1679
CrossRef163
Paul J Turek. (2005) Practical approaches to the diagnosis and management of male infertility. Nature Clinical Practice Urology 2:5, 226-238
CrossRef164
Uma Mahadevan, Jonathan P Terdiman, Jeffrey Aron, Steve Jacobsohn, Paul Turek. (2005) Infliximab and semen quality in men with inflammatory bowel disease. Inflammatory Bowel Diseases 11:4, 395-399
CrossRef165
Jeanne O’Brien, Armand Zini. (2005) Sperm DNA integrity and male infertility. Urology 65:1, 16-22
CrossRef166
F.H. van der Merwe, T.F. Kruger, S.C. Oehninger, C.J. Lombard. (2005) The Use of Semen Parameters to Identify the Subfertile Male in the General Population. Gynecologic and Obstetric Investigation 59:2, 86-91
CrossRef167
W.A. Robbins, D.A. Elashoff, L. Xun, J. Jia, N. Li, G. Wu, F. Wei. (2005) Effect of lifestyle exposures on sperm aneuploidy. Cytogenetic and Genome Research 111:3-4, 371-377
CrossRef168
B.J. Cohlen. (2005) Should We Continue Performing Intrauterine Inseminations in the Year 2004?. Gynecologic and Obstetric Investigation 59:1, 3-13
CrossRef169
Bruce Gottlieb, Rose Lombroso, Lenore K Beitel, Mark A Trifiro. (2005) Molecular pathology of the androgen receptor in male (in)fertility. Reproductive BioMedicine Online 10:1, 42-48
CrossRef170
S. I. Moskovtsev, J. Willis, A. Azad, J. B. M. Mullen. (2005) Sperm Dna Integrity: Correlation With Sperm Plasma Membrane Integrity In Semen Evaluated For Male Infertility. Systems Biology in Reproductive Medicine 51:1, 33-40
CrossRef171
De Yi Liu, Claire Garrett, H.W.Gordon Baker. (2004) Clinical application of sperm-oocyte interaction tests in in vitro fertilization–embryo transfer and intracytoplasmic sperm injection programs. Fertility and Sterility 82:5, 1251-1263
CrossRef172
V. Giuliani, C. Pandolfi, R. Santucci, F. Pelliccione, B. Macerola, R. Focarelli, F. Rosati, C. Della Giovampaola, F. Francavilla, S. Francavilla. (2004) Expression of gp20, a human sperm antigen of epididymal origin, is reduced in spermatozoa from subfertile men. Molecular Reproduction and Development 69:2, 235-240
CrossRef173
Rémy Slama, Tina Kold-Jensen, Thomas Scheike, Béatrice Ducot, Alfred Spira, Niels Keiding. (2004) How Would a Decline in Sperm Concentration Over Time Influence the Probability of Pregnancy?. Epidemiology 15:4, 458-465
CrossRef174
Hyungsuk Kim, John K Neubert, Anitza San Miguel, Ke Xu, Raj K Krishnaraju, Michael J Iadarola, David Goldman, Raymond A Dionne. (2004) Genetic influence on variability in human acute experimental pain sensitivity associated with gender, ethnicity and psychological temperament. Pain 109:3, 488-496
CrossRef175
Daniela Marinelli, Laura Gaspari, Paola Pedotti, Emanuela Taioli. (2004) Mini-review of studies on the effect of smoking and drinking habits on semen parameters. International Journal of Hygiene and Environmental Health 207:3, 185-192
CrossRef176
Laura Fenster, Kirsten Waller, Gayle Windham, Tanya Henneman, Meredith Anderson, Pauline Mendola, James W. Overstreet, Shanna H. Swan. (2003) Trihalomethane Levels in Home Tap Water and Semen Quality. Epidemiology 14:6, 650-658
CrossRef177
Inge M.W Ebisch, Waander L van Heerde, Chris M.G Thomas, Nathalie van der Put, Wai Yee Wong, Régine P.M Steegers-Theunissen. (2003) C677T methylenetetrahydrofolate reductase polymorphism interferes with the effects of folic acid and zinc sulfate on sperm concentration. Fertility and Sterility 80:5, 1190-1194
CrossRef178
Christine L Knox, John A Allan, Janet M Allan, W.Rohini Edirisinghe, Deborah Stenzel, Felicity A Lawrence, David M Purdie, Peter Timms. (2003) Ureaplasma parvum and Ureaplasma urealyticum are detected in semen after washing before assisted reproductive technology procedures. Fertility and Sterility 80:4, 921-929
CrossRef179
K. Asatiani, S. Eckardstein, M. Simoni, J. Gromoll, E. Nieschlag. (2003) CAG repeat length in the androgen receptor gene affects the risk of male infertility. International Journal of Andrology 26:5, 255-261
CrossRef180
C. Soler, J. J. de Monserrat, R. Gutierrez, J. Nunez, M. Nunez, M. Sancho, F. Perez-Sanchez, T. G. Cooper. (2003) Use of the Sperm-Class AnalyserR for objective assessment of human sperm morphology. International Journal of Andrology 26:5, 262-270
CrossRef181
WAYNE J.G. HELLSTROM, JAMES W. OVERSTREET, ALBERT YU, KHALIL SAIKALI, WEI SHEN, CHARLES M. BEASLEY, VISH S. WATKINS. (2003) Tadalafil has No Detrimental Effect on Human Spermatogenesis or Reproductive Hormones. The Journal of Urology 170:3, 887-891
CrossRef182
Shanna H. Swan, Robin L. Kruse, Fan Liu, Dana B. Barr, Erma Z. Drobnis, J. Bruce Redmon, Christina Wang, Charlene Brazil, James W. Overstreet, . (2003) Semen Quality in Relation to Biomarkers of Pesticide Exposure. Environmental Health Perspectives 111:12, 1478-1484
CrossRef183
Neal G. Mahutte, Aydin Arici. (2003) Failed fertilization: is it predictable?. Current Opinion in Obstetrics and Gynecology 15:3, 211-218
CrossRef184
Laura Gaspari, Seong-Sil Chang, Regina M. Santella, Seymour Garte, Paola Pedotti, Emanuela Taioli. (2003) Polycyclic aromatic hydrocarbon-DNA adducts in human sperm as a marker of DNA damage and infertility. Mutation Research/Genetic Toxicology and Environmental Mutagenesis 535:2, 155-160
CrossRef185
Robert Künzle, Michael D Mueller, Willy Hänggi, Martin H Birkhäuser, Heinz Drescher, Nick A Bersinger. (2003) Semen quality of male smokers and nonsmokers in infertile couples. Fertility and Sterility 79:2, 287-291
CrossRef186
Armand Zini, Marc Anthony Fischer, Sharon Sharir, Bobby Shayegan, Donna Phang, Keith Jarvi. (2002) Prevalence of abnormal sperm DNA denaturation in fertile and infertile men. Urology 60:6, 1069-1072
CrossRef187
Shanna H. Swan, Charlene Brazil, Erma Z. Drobnis, Fan Liu, Robin L. Kruse, Maureen Hatch, J. Bruce Redmon, Christina Wang, James W. Overstreet, . (2002) Geographic Differences in Semen Quality of Fertile U.S. Males. Environmental Health Perspectives 111:4, 414-420
CrossRef188
Craig S Niederberger. (2002) Understanding the epidemiology of fertility treatments. Urologic Clinics of North America 29:4, 829-840
CrossRef189
Richard D Williams. (2002) What’s new in urology. Journal of the American College of Surgeons 195:5, 663-674
CrossRef190
Peter J. Burrows, Christopher G. Schrepferman, Larry I. Lipshultz. (2002) Comprehensive office evaluation in the new millennium. Urologic Clinics of North America 29:4, 873-894
CrossRef191
(2002) Low and Very Low Birth Weight after Use of Assisted Reproductive Technology. New England Journal of Medicine 347:18, 1451-1452
Full Text192
W.-B. Schill, H.-C. Schuppe, W. Weid, M. Mannign. (2002) Proceedings of the 7th Andrology Symposium. Treatment of male infertility - viewpoints, controversies, perspectives. Giessen, Germany, 17 November 2001. Andrologia 34:5, 325-347
CrossRef193
G. Haidl. (2002) Andrologie im Zeitalter der assistierten Reproduktionstechniken*. Andrology in the era of assisted reproduction techniques. H<html_ent glyph="@amp;" ascii="&"/>G Zeitschrift fur Hautkrankheiten 77:9, 405-414
CrossRef194
Rémy Slama, Henri Leridon. (2002) How Much of the Decline in Sperm Counts Can Be Explained by Relaxed Reproductive Selection?. Epidemiology 13:5, 613-615
CrossRef195
Johannes LH Evers. (2002) Female subfertility. The Lancet 360:9327, 151-159
CrossRef196
Barbara Grajewski, Clinton Cox, Steven M. Schrader, William E. Murray, Richard M. Edwards, Terry W. Turner, James M. Smith, Donald P. Evenson, Stephen D. Simon, David L. Conover. (2002) Evidence That Non-Ionizing Radiation Alters Men???s Hormone Levels. Journal of Occupational and Environmental Medicine 44:4, 307
CrossRef
