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A scientometric analysis of research publications on male infertility and assisted reproductive technology

Agarwal A, Panner Selvam MK, Baskaran S, Finelli R, Leisegang K, Barbăroșie C, et al.

Andrologia, 2021 Feb;53(1):e13842.
PMID: 33236365 DOI: 10.1111/and.13842

Assisted reproductive technologies (ART) are considered as one of the primary management options to address severe male factor infertility. The purpose of this study was to identify the research trends in the field of male infertility and ART over the past 20 years (2000-2019) by analysing scientometric data (the number of publications per year, authors, author affiliations, journals, countries, type of documents, subject area and number of citations) retrieved using the Scopus database. We used VOS viewer software to generate a network map on international collaborations as well as a heat map of the top scientists in this field. Our results revealed a total of 2,148 publications during this period with Cleveland Clinic Foundation contributing the most (n = 69). The current scientometric analysis showed that the research trend on ART has been stable over the past two decades. Further in-depth analysis revealed that density gradient centrifugation (46%) and intracytoplasmic sperm injection (59.2%) are the most reported techniques for sperm separation and ART, respectively. Additionally, azoospermia was the most studied clinical scenario (60.6%), with majority of articles reporting pregnancy rate (47.25%) as the primary reproductive outcome for ART. This study provides insight into the current focus of research in the area of male infertility and ART as well as the areas that require further research in future.

Matched MeSH terms: Pregnancy Rate
Fulltext Prognostic factors influencing pregnancy rate after stimulated intrauterine insemination

Tay PY, Raj VR, Kulenthran A, Sitizawiah O

Med J Malaysia, 2007 Oct;62(4):286-9.
PMID: 18551930 MyJurnal

To determine the prognostic factors such as age, diagnosis, number of cycle attempts and semen parameters on the pregnancy rate of controlled ovarian hyperstimulation (COH) /intrauterine insemination (IUI). Three hundred and seventeen women who underwent 507 consecutive COH/IUI cycles were recruited from 1st January 2002 to 31st December 2005 inclusively. This retrospective study was done in University Malaya Medical Centre, a tertiary care academic centre. The main outcome measure was pregnancy rate according to age, infertility diagnosis, duration of infertility, semen parameters, and the number of treatment cycles. The overall pregnancy rates were 16.9% per cycle and 25.9% per couple. Pregnancy rates decreased with advancing maternal age. Pregnancy rate was also significantly lower in patient with postwash total motile sperm count (TMSC) < or = 20 million/ml compared to those with TMSC >20 million/ml. The cumulative pregnancy rates varied greatly by diagnosis from 16% for patients with male factor infertility to 60% for patients with ovulatory disorder. Pregnancies among patients with male infertility, tubal factors infertility and endometriosis were achieved during the first three cycles. There is a clear age-related decline in fecundity associated with COH/IUI treatment. Women of > 40 years old, couple with postwash TMSC < or = 20 million/ml, severe endometriosis and tubal factors have a particularly poor prognosis.

Matched MeSH terms: Pregnancy Rate/trends*
Fulltext Predictors of intrauterine insemination success

Zainul MR, Ong FB, Omar MH, Ng SP, Nurshaireen A, Rahimah MD, et al.

Med J Malaysia, 2006 Dec;61(5):599-607.
PMID: 17623962 MyJurnal

Intrauterine insemination (IUI) remains a therapeutic option within means of the majority of infertile couples in Malaysia. Therefore additional information on predictors of IUI success in the local context would provide a more concrete basis for counseling patients on expectations and treatment options. A retrospective analysis of 297 couples who underwent 445 IUI cycles from Jan 2005-Mar 2006 was undertaken. Four fifths were Malay with a mean paternal and maternal age of 35.53 +/- 5.82 (range 24-59) and 33.02 +/- 4.69 (range 21-46) years respectively. Causes of infertility were idiopathic (50%), endometriosis (17%) and anovulation/polycystic ovarian syndrome (15%). Almost 10% were oligoastenoteratozoospermic with another 23% oligozoospermic or astenozoospermic. Combined male and female factors occurred in 26%. A pregnancy rate (PR) of 9.4% per cycle; 14.1% per couple with a cumulative PR of 36.7% per 4 cycles was achieved. Those who became pregnant were significantly younger (31.29 +/- 4.43 vs. 33.21 +/- 4.68 years, p = 0.011) and had more follicles (13.95 +/- 9.72 vs. 11.43 +/- 6.67, p = 0.029) at the time of insemination. PR depreciated with maternal age and semen quality. Maternal and paternal age was inversely correlated to the number of follicles recruited (r = -0.30, p < 0.0005) and progressive sperm motility (r = -0.125, p = 0.013) respectively.

Matched MeSH terms: Pregnancy Rate*
Fulltext Associated factors affecting the successful pregnancy rate of intrauterine insemination at International Islamic University Malaysia (IIUM) Fertility Centre

Azantee YW, Murad ZA, Roszaman R, Hayati MY, Norsina MA

Med J Malaysia, 2011 Aug;66(3):195-8.
PMID: 22111439 MyJurnal

The aim was to determine pregnancy rate and its associated factors in Intrauterine Insemination (IUI) at IIUM Fertility Centre.

Matched MeSH terms: Pregnancy Rate
Anastrozole is a dose-specific superovulator and favors implantation in rats: a prospective study

Mwakikunga A, Hosie MJ

Cell Tissue Res, 2016 Apr;364(1):209-17.
PMID: 25971929 DOI: 10.1007/s00441-015-2180-1

An alternative superovulator to replace clomiphene citrate (CC) is needed as it is unsuitable for women with polycystic ovarian syndrome and is associated with low pregnancy rates. Anastrozole is an effective superovulator, but has not been well researched. The aim of this study was to determine the optimal dose of anastrozole as a superovulator and ascertain its effects on implantation and uterine ultrastructure during early pregnancy in Wistar rats using scanning electron microscopy. The uterine morphological characteristics which were studied in day 1 and 6 pregnant rats include microvilli density, length, surface "beads", surface glycocalyx, cell borders and apices, uterine surface fording and large surface protrusions. A significant increase in implantation sites is seen in the 15 mg/kg anastrozole group, compared to control. Day 1 and 6 anastrozole groups have similar morphology to the control and different to the CC group. At day 6, large surface protrusions are mostly noted but not limited to anastrozole-treated rats; anastrozole also appears to retain glycocalyx to some extent. The increased number of implantation sites in the 15 mg/kg anastrozole group suggests that this dose superovulates and favors implantation. Anastrozole is probably dose-/species-specific and additionally the surface uterine morphology suggests that anastrozole is implantation friendly.

Matched MeSH terms: Pregnancy Rate
Fulltext Effects of timed artificial insemination following estrus synchronization in postpartum beef cattle

Malik A, Wahid H, Rosnina Y, Kasim A, Sabri M

Open Vet J, 2012;2(1):1-5.
PMID: 26623282

The objectives of this study were to evaluate estrus response and pregnancy rates resulting from timed artificial insemination (AI) following estrus synchronization using CIDR in postpartum beef cattle. A total of 100 cows were randomly divided into three groups. Groups 1, 2 and 3 were artificially inseminated at 48-50 h (n=30), 53-55 h (n=30) and 58-60 h (n=40) after CIDR removal, respectively. Estrus synchronization was carried out using a CIDR containing 1.38 mg progesterone. All cows were given 2 mg estradiol benzoate, intramuscularly on the day of CIDR insertion (D 0). The CIDR was removed after 8 days and 125 μg of prostaglandin F2α (PGF2α) was injected intramuscularly. One day after CIDR removal all cows were given 1 mg of estradiol benzoate intramuscularly (D 9). Cows were observed visually for estrus after removal of CIDR. Between 30 and 32 days after timed AI, pregnancy was determined using transrectal ultrasonography. The first estrus observation which is approximately 32 h after CIDR removal showed no significant difference (P>0.05) among the three groups. The onset response of estrus after 32 h removal of CIDR was less than 10% in all three groups 6.6% (G1), 6.8% (G2) and 7.3% (G3). Furthermore, percentages of estrus response (D 10) following CIDR removal were 76.6%, 75.0% and 77.5%. The difference between on D 9 and D 10 estrus response were statistically significant (P<0.05). The pregnancy rates were 23.3% (G1), 26.6% (G2) and 37.5% (G3), which were not significant (P>0.05).

Matched MeSH terms: Pregnancy Rate
Fulltext Tubal Ectopic Pregnancy: Do Our Women Benefit From Laparoscopic Surgery?

Lim, K.J., Omar, M.H., Jamil, M.A., Ng, S.P.

International Medical Journal Malaysia, 2006;5(2):1-8.
MyJurnal

Introduction: Operative laparoscopy is the gold standard approach for treatment of tubal pregnancy. Although benefits of this approach are well established, data on its uptake trend in Malaysia is largely unknown. Objective: This study aims to determine the operative laparoscopy uptake in management of tubal pregnancy at a busy tertiary hospital and whether the benefits associated with laparoscopic surgery was achieved. Materials and Methods: This prospective observational study was conducted on all women admitted for tubal pregnancy at Hospital Sultanah Aminah, Johor Bahru, a public tertiary hospital over a period of 12 months. The on-call team was responsible for the surgical approach. Patient’s clinical presentation, operative laparoscopic uptake, factors affecting the choice of approach and duration of hospitalization were analyzed. Results: The tubal pregnancy rate was 7.6 per 1000 deliveries. Twenty- seven of the 138 cases (20%) had hypovolemic shock, requiring urgent laparotomy and were excluded from study. The operative laparoscopy rate for stable tubal pregnancy was only 42.3% (47 of 111 cases). Women managed laparoscopically were associated with a significantly higher pre-operative hemoglobin level, mostly nullipara and had surgery performed during office hours. They waited longer for their surgery but were discharged earlier compared to the laparotomy group. There was no difference in the duration of hospitalization. Conclusions: Less than half of all hemodynamically stable tubal pregnancies in our hospital had operative laparoscopy. The current laparoscopy uptake rate can be further improved.

Matched MeSH terms: Pregnancy Rate
Fulltext First year experience in assisted reproductive technology (ART) services at IIUM Kuantan

Ahmad Murad, Z., Roszaman, R., Azantee, Y.W., Hayati, M.Y., Norsina, M.A., Siti, K.

International Medical Journal Malaysia, 2013;12(1):3-10.
MyJurnal

Introduction: To analyze the ART outcome and factors associated with successful ART treatment for infertile couples in a newly set up medical university IVF centre. Methods: A six-month cohort study of patients undergoing their first assisted reproductive technique cycle was conducted at IIUM fertility centre, Kuantan (from 15th June until 31st Dec 2009). Outcome measures include clinical pregnancy rate, ongoing pregnancy rate, take home baby rate and complications rate. Results: Fifty-five first cycles of IVF/ICSI were studied. Mean embryo per transfer was 2.1±0.8. Four patients were pregnant (23.5%) from a single embryo transfer (SET). Clinical pregnancy rate was 30.9% (17/55). Ongoing pregnancy rate was 23.6% (13/55) and take home baby rate was 21.8% (12/55). There was only one twin pregnancy. Nine patients (16.4%) had OHSS whereby 77.8% were mild and 22.2% were moderate. Conclusion: Take home baby rate at the IIUM fertility centre is comparable to most established ART centres in Malaysia considering that this is only the first year of operation.

Matched MeSH terms: Pregnancy Rate
Fulltext Demographic determinants and outcome of in vitro fertilization (IVF) services in Saudi Arabia

Almaslami F, Aljunid SM, Ghailan K

J Int Med Res, 2018 Apr;46(4):1537-1544.
PMID: 29350090 DOI: 10.1177/0300060517749329

Objectives To assess the demographic characteristics and outcomes of couples undergoing in vitro fertilisation (IVF) treatment at a private hospital in Al Qassim district, Saudi Arabia. Methods For this retrospective study, information was extracted from the hospital electronic database and IVF unit medical records. Results 2259 couples underwent 2703 IVF/ICSI cycles during 2014 to 2016. The utilization rate was approximately 1000 cycle per million of inhabitants. Mean ages ± standard deviation (SD) for women and men were 32.9 ± 5.7 and 39.2 ± 7.4 years, respectively. More couples were diagnosed with secondary infertility (55.2%) than primary infertility (44.8%). Male factor was the commonest single indication for IVF (36.2%). Mean ± SD infertility duration was 4.70 ± 4.03 years. Overall, 949 couples had a successful pregnancy. Age-specific pregnancy rates (PR) were highest for women <35 years (39.8%) and lowest for women >40 years (11.6%). Male age and infertility duration had no effect on PR but sperm source (fresh vs. frozen) and female age had significant impacts. However, fresh sperm was used in 90.6% cycles whereas frozen sperm was used in 9.4% cycles. Conclusions IVF treatment outcomes in the Al Qassim district are within the boundaries of average international success rates. Infertile couples seeking IVF services should be counselled with regard to important prognostic factors.

Matched MeSH terms: Pregnancy Rate
Neither male age nor semen parameters influence clinical pregnancy or live birth outcomes from IVF

Mariappen U, Keane KN, Hinchliffe PM, Dhaliwal SS, Yovich JL

Reprod Biol, 2018 Dec;18(4):324-329.
PMID: 30503182 DOI: 10.1016/j.repbio.2018.11.003

Advanced age is an increasing trend for both males and females seeking in vitro fertilization (IVF). This retrospective cohort study investigated the outcomes of 1280 IVF-related treatment cycles, selecting the first treatment for couples utilizing autologous gametes and who underwent single fresh embryo transfer. Males aged 40-49 years had a 52% reduction in normal sperm motility, while it was markedly reduced by 79% at 50 years or older. However, neither semen parameters nor male age were predictive of clinical pregnancy or live birth chance. In a combination of age groups, cases with Younger Females had the greatest chance of successful outcomes and this was independent of having a younger or older male partner. Specifically, Young Female-Young Male combinations (≤ 35 years) were the most likely to succeed in achieving a clinical pregnancy or live birth (OR 2.84, p 35 years, respectively) had a similar increased chance (OR 2.07, p

Matched MeSH terms: Pregnancy Rate*
A study of the acceptability and effectiveness of Norplant (R) contraceptive implants in Kuala Lumpur, Malaysia

Arshat H, Rachagan SP, Kwa Siew Kim, Ang Eng Suan, Karim HA, Ismail MT

Malays J Reprod Health, 1990 Jun;8(1):21-9.
PMID: 12316341
Matched MeSH terms: Pregnancy Rate*
Study of rigevidon for oral contraception in a family planning clinic in Kota Bahru, Kelantan

Ang Eng Suan, Karim HA

Malays J Reprod Health, 1990 Jun;8(1):31-7.
PMID: 12316342
Matched MeSH terms: Pregnancy Rate*
The impact of endometrioma on IVF/ICSI outcomes: a systematic review and meta-analysis

Hamdan M, Dunselman G, Li TC, Cheong Y

Hum. Reprod. Update, 2015 Nov-Dec;21(6):809-25.
PMID: 26168799 DOI: 10.1093/humupd/dmv035

Endometriosis is a disease known to be detrimental to fertility. Women with endometriosis, and the presence of endometrioma, may require artificial reproductive techniques (ART) to achieve a pregnancy. The specific impact of endometrioma alone and the impact of surgical intervention for endometrioma on the reproductive outcome of women undergoing IVF/ICSI are areas that require further clarification. The objectives of this review were as follows: (i) to determine the impact of endometrioma on IVF/ICSI outcomes, (ii) to determine the impact of surgery for endometrioma on IVF/ICSI outcome and (iii) to determine the effect of different surgical techniques on IVF/ICSI outcomes.

Matched MeSH terms: Pregnancy Rate
Fulltext Affordable ART for developing countries: a cost benefit comparison of low dose stimulation versus high dose GnRH antagonist protocol

Noorashikin M, Ong FB, Omar MH, Zainul-Rashid MR, Murad AZ, Shamsir A, et al.

J Assist Reprod Genet, 2008 Jul;25(7):297-303.
PMID: 18654847 DOI: 10.1007/s10815-008-9239-9

Low dose stimulation (LS) is emerging as an alternative regime in assisted reproductive technology (ART). This study aimed to compare the cost-effectiveness of LS to the high dose GnRH antagonist (Atg) regime.

Matched MeSH terms: Pregnancy Rate
Embryo culture conditions are significantly improved during uninterrupted incubation: A randomized controlled trial

Alhelou Y, Mat Adenan NA, Ali J

Reprod Biol, 2018 Mar;18(1):40-45.
PMID: 29279181 DOI: 10.1016/j.repbio.2017.12.003

A parallel group superiority prospective randomised controlled trial was devised to compare the culture characteristics of human pre-implantation stage embryos during uninterrupted culture in a time lapse incubator (TLI) versus the conventional model of interrupted culture in a standard incubator (SI) under low oxygen tension using a single step medium. 221 patients aged 35-and-under, 124 patients aged between 36 and 39 and 86 patients aged 40-and-over years were randomised and cultured either in a SI or in a TLI. Patients in the three age groups were distributed between the TLI and SI in a 1:1 ratio. The development of embryos on days 2, 3 and 5, and the clinical pregnancy and implantation rates were recorded. The fertilisation rate, development of day 2 and clinical pregnancy rates were similar in both treatments but the 8-cell development rate in all age groups combined (p = 0.016), blastocyst development rate (p = 0.0022) and the implantation rate (p = 0.0022) was significantly higher for the uninterrupted culture. These findings demonstrated significant differences between the two incubation groups. It also indicated less efficacious embryonic development with age in both treatments which appeared more pronounced in the conventional incubator. In conclusion uninterrupted culture is superior compared to the interrupted incubation culture system.

Matched MeSH terms: Pregnancy Rate
Effect of antioxidants on post thaw microscopic, oxidative stress parameter and fertility of Boer goat spermatozoa in Tris egg yolk glycerol extender

Memon AA, Wahid H, Rosnina Y, Goh YM, Ebrahimi M, Nadia FM

Anim. Reprod. Sci., 2012 Dec;136(1-2):55-60.
PMID: 23182473 DOI: 10.1016/j.anireprosci.2012.10.020

This study was conducted to determine the effect of antioxidants on standard semen parameters, lipid peroxidation and fertility of Boer goat semen after cryopreservation. Ejaculates from four bucks were collected, evaluated and pooled at 37°C. The pooled semen was diluted with Tris citric acid fructose for washing. Semen samples, which were diluted with a Tris-based extender containing the antioxidant ascorbic acid (8.5mg/ml), butylated hydroxytoluene (2mM), cysteine (5mM) and hypotaurine (10mM) and an extender without antioxidant supplementation were cooled to 4°C and frozen in 0.25 straws with programmable freezer and finally stored in liquid nitrogen. Data (10 replicates) were analyzed by one-way analysis of variance. Mean (±SEM) progressive motility was significantly higher in ascorbic acid than other supplement groups and control samples (P>0.05). Best values were observed in ascorbic acid followed by BHT, cysteine, and hypotaurine. Antioxidant supplementation in extender showed significant (P<0.05) better values than the control group for sperm membrane integrity, acrosome integrity and viability. The ability of antioxidants to reduce the lipid peroxidation (LPO) after freeze thawing was measured by the formation of malondialdehyde (MDA) using the thiobarbituric acid method. Results showed that addition of antioxidants significantly reduced the rate of LPO in comparison to control (P<0.05). Ascorbic acid exhibited better values (1.27±0.28), than butylated hydroxytoluene, cysteine and hypotaurine 1.32±0.42, 2.27±0.16 and 2.38±0.17 respectively, which are significantly better than control (3.52±0.54). Higher pregnancy rate was observed with ascorbic acid followed by butylated hydroxtolune, hypotaurine and cysteine. However, differences in the fertility rate were non-significant with hypotaurine, cysteine and control groups.

Matched MeSH terms: Pregnancy Rate
Fulltext The impact of luteal supplement on pregnancy outcome following stimulated IVF cycles

Tay PYS, Lenton EA

Med J Malaysia, 2005 Jun;60(2):151-7.
PMID: 16114155

This is a prospeve randomised study designed to clarify the impact of various luteal support regimes (HCG and progesterone) on progesterone profiles and pregnancy outcomes. This study involved subjects undergone down regulated. stimulated IVF cycles using various types of luteal support, namely: Cyclogest (n=35). Crinone gel (n=36), various doses of Utrogestan (n=55) and HCG (n=35). Various doses of Utrogestan (administered vaginally), Crinone gel (progesterone administered vaginally) and Cyclogest (progesterone administered rectally) supplementation induced similar end plasma progesterone concentrations ranging from 26 to 32 mmnl/l. These progesterone regimes produced no significant differences. Hence, the impact of exogenous proge,terone supplement was relatively trivial and did not 'stabilise' the sub-optimal luteal phase. In contrast, two small HCG injections during the early and mid-luteal phase possessed a much greater ability to 'stabilise' progesterone profiles. Despite this additional advantage, implantation and pregnancy rates with either HCG or progesterone supplements were similar. Although none of these forms of luteal support adequately 'normalised' luteal progesterone profiles, this did not appear to be detrimental to the process of implantation.

Matched MeSH terms: Pregnancy Rate
Fulltext Assessing the status of intrauterine insemination before forming a medically assisted conception unit

Omar MH, Ong FB, Adeeb NN, Sharif JM, Nasri N, Yassin MJ

Med J Malaysia, 1999 Mar;54(1):65-71.
PMID: 10972007

A survey in 1996 of our female patients suggest that the three commonest causes of infertility were endometriosis, anovulation and idiopathic which comprises of about 70% of all the patients. In the male patients, sperm morphology evaluation by critical criteria showed that abnormal morphology was present in 71% while 87% of all the semen analysis were abnormal. The objective of this study was to assess the status of IUI before proceeding to formulate patient protocols for IVF in a tertiary infertility referral unit. A retrospective study of patients data was done from Jan 1995 to Dec 1996. Ovarian stimulation by clomiphene for anovulatory and idiopathic patients was performed on couples with at least one patent fallopian tube. Ovulation induction was by an intramuscular injection of 5000 i.u of HCG after follicular maturation. IUI was performed approximately 36-40 hours later. A total of 74 couples received 114 treatment cycles producing a total of 9 conceptions. The conception rate of IUI was therefore 7.89% per cycle and 12.16% per couple with the cumulative pregnancy rate of 28.21%. Associated success features of IUI found in this study were the age of the woman and the semen parameters of the husband.

Matched MeSH terms: Pregnancy Rate
Maternal thyroid function in women undergoing controlled ovarian hyperstimulation during in-vitro fertilization and its relation to reproductive outcome

Abdul Karim AK, Azrai Abu M, Chelliah B, Mohd Razi ZR, Omar MH, Othman H, et al.

Minerva Ginecol, 2017 Oct;69(5):431-437.
PMID: 28447444 DOI: 10.23736/S0026-4784.17.04069-2

BACKGROUND: We conducted a study to evaluate the changes in thyroid function during controlled ovarian hyperstimulation (COH) and its association with the outcome of assisted reproductive technique (ART).
METHODS: This is a prospective cohort study done in University Hospital Fertility Clinic for one year duration. A total of 88 euthyroid women who underwent COH as part of planned in-vitro fertilization (IVF) were invited to participate in this study. Serum thyroid function of each women will be monitored before stimulation (T1), day 10-13 of cycle (T2), during oocyte retrieval (T3), one week following embryo transfer (T4), and at four weeks after embryo transfer (T5). Reproductive outcome of IVF will be observed and documented.
RESULTS: Nine women had ongoing singleton pregnancy, seven suffered from miscarriage, while the rest had implantation failure. Serum thyroid-stimulating hormone (TSH) and free thyroxine (fT4) increased throughout stimulation, peaking at 32-36 hours after hCG administration compared to baseline (1.250 vs. 1.740 mIU/L and 13.94 vs. 15.25 pmol/L). It remains elevated until one week following embryo transfer. The increment of serum TSH exceeded the upper limit, acceptable for first trimester (<1.60 mIU/L). However, the evolution of serum TSH and fT4 did not significantly differ with pregnancy outcome.
CONCLUSIONS: In euthyroid women, thyroid function changed significantly during COH, but these changes were not different between the three reproductive outcomes. Thus, we do not suggest continuous thyroid function monitoring during COH.

Matched MeSH terms: Pregnancy Rate
Fulltext Eurycoma longifolia Jack in managing idiopathic male infertility

Tambi MI, Imran MK

Asian J Androl, 2010 May;12(3):376-80.
PMID: 20348942 DOI: 10.1038/aja.2010.7

This study investigated the effect of treatment with the proprietary standardized, water-soluble extract of the root of the Malaysian plant, Eurycoma longifolia Jack, which is thought to enhance male fertility with regard to higher semen volumes, sperm concentrations, the percentage of normal sperm morphology and sperm motility in male partners of sub-fertile couples with idiopathic infertility. A total of 350 patients were given 200 mg of the extract daily and follow-up semen analyses were performed every 3 months for 9 months. Of these 350 patients, 75 patients completed one full cycle of 3 months. Follow-up semen analyses in these patients showed significant improvement in all semen parameters. The proprietary extract of Eurycoma longifolia Jack significantly improved the sperm quality in these patients, allowing for 11 (14.7%) spontaneous pregnancies.

Matched MeSH terms: Pregnancy Rate

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