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PubMedDate not supplied

The diagnosis and treatment of male infertility in the new millennium.

Treatment of male infertility accomplished far-reaching advances in the past decade. Semen analysis has given rise to sperm function tests. Microsurgery, e.g., reversal of vasectomy, has reached new heights in sperm retrieval directly from the testis/epididymis and in intracytoplasmic sperm injection (ICSI). Furthermore, genetic testing-for an ever-widening range of anomalies-is the norm in modern clinical practice. This review of what is possible, and now even common, in male infertility treatment focuses on sperm function, and then deficits/anomalies and their treatment; and testicular function and dysfunction, with descriptions of hormonal and surgical techniques that now offer fatherhood to men with types of infertility that strongly imply the need for genetic counseling.

Genetic Linkage↗
PubMed1996

Procreation after death or mental incompetence: medical advance or technology gone awry?

OBJECTIVE: To review our experience with semen retrieval in men who are incompetent or dead and to formulate general medical, legal, and ethical guidelines for practitioners. DESIGN: Case series and literature review. SETTING: Academic. PATIENT(S): Seven incompetent or neurologically dead individuals in whom sperm retrieval was requested. INTERVENTION(S): Electroejaculation. RESULT(S): Seminal emission was induced in the two men who underwent electroejaculation. Sperm suitable for cryopreservation was obtained in one of these men. Review of the legal and ethical implications of such procedures led to development of general guidelines for determining whether gamete retrieval should be performed when requested. Issues of procreational autonomy, consideration of the decedent's wishes, and assurance of the well-being of any new life created were considered most strongly in the formation of these guidelines. CONCLUSION(S): Although the retrieval of sperm from deceased or incompetent individuals may be achieved readily, it is incumbent upon the practitioner to consider the legal and moral implications of these procedures before proceeding.

Adolescent↗
PubMed2001

Sperm extraction at orchiectomy for testis cancer.

OBJECTIVE: To evaluate the value of aspirating sperm from the vas and epididymis at orchiectomy in azoospermic patients. DESIGN: Retrospective clinical study. SETTING: Tertiary care academic hospital. PATIENT(S): Three patients with known azoospermia who presented with testicular masses suspected to be cancerous. INTERVENTION(S): At orchiectomy, immediately after ligation of the spermatic cord, the contents of the epididymis and vas deferens were extracted into preserving media. MAIN OUTCOME MEASURE(S): Fertility rate. RESULT(S): Sperm retrieval was successful in all three patients. The mean total sperm count was 2.3 x 10(6)/mL with 20% motility. Intracytoplasmic injection of sperm harvested by using this method was successful in two couples, one of which delivered a healthy infant. CONCLUSION(S): Sperm can be aspirated from the vas deferens and epididymis at orchiectomy for preservation. In azoospermic patients, this procedure may salvage enough sperm for successful use in micromanipulation techniques. It may be worthwhile to perform sperm aspiration during orchiectomy for testis cancer in any patient with known or suspected infertility.

Cryopreservation↗
PubMed2000

Testicular sperm extraction by Trucut needle and milking of seminiferous tubules: a technique with high yield and patient acceptability.

OBJECTIVE: To assess the sperm yield and patient acceptability of Trucut needle testicular biopsy followed by seminiferous tubule milking. DESIGN: Prospective case analysis. SETTING: The Regional Fertility Center, Royal Maternity Hospital, Belfast, Northern Ireland, United Kingdom. PATIENT(S): Forty-one males with obstructive azoospermia (normal testicular volume and FSH and LH levels). INTERVENTION(S): Trucut needle testicular biopsies under local anesthetic with milking of the seminiferous tubules. MAIN OUTCOME MEASURE(S): Quantitation of sperm retrieved per biopsy core and patient follow-up by questionnaire. RESULT(S): A mean of 105,634 sperm (range, 5,000-427,800) were retrieved, and the mean biopsy weight was 9.17 mg. Twenty-six subjects found the biopsy painless and 15 were pain-free after biopsy. CONCLUSION(S): The Trucut needle can be used in combination with seminiferous tubule milking to obtain large numbers of sperm in men with obstructive azoospermia.

Anesthesia, Local↗
PubMed1995

In vitro retrieval of epididymal sperm: a new approach to achievement of pregnancy for post-testicular azoospermia.

OBJECTIVE: To determine the efficacy of in vitro retrieval of epididymal sperm for pregnancy induction for obstructive azoospermia patients. DESIGN: Patients were divided into three groups as follows: [1] ductal obstruction with previous epivasostomy (group I); [2] ductal obstruction with previous epididymitis (group II); and [3] ductal obstruction without previous epivasostomy or epididymitis (group III). SETTING: A university teaching hospital. PATIENTS: Twenty infertile males with obstructive azoospermia. INTERVENTIONS: Epididymides were detached surgically just after harvest of oocytes from corresponding wives and severed into three pieces (caput, corpus, and cauda). Each piece was dissected and squeezed in Ham's F-10 medium to retrieve the sperm. After completion of sperm preparation, IVF of their wives' oocytes and zygote intrafallopian transfer followed. RESULTS: Overall pregnancy rate by in vitro retrieval of epididymal sperm was 35% (7 of 20). The rate for group I was 0%, or 0 of 6; for group II the rate was 0%, or 0 of 3; and for group III it was 63.6%, or 7 of 11. CONCLUSIONS: In vitro retrieval of epididymal sperm can be a new method for inducing pregnancy in surgically incorrectable obstructive azoospermia.

Epididymis↗
PubMed2004

[Inhibin B, predictive factor for testicular sperm recovery?].

Serum inhibin B is a glycoprotein of gonadal origin secreted by the sertoli cells and its secretion is regulated by interaction with the germ cells. Its role as a marker of spermatogenesis is clearly established. Therefore, its role as predictor for finding sperm by surgical testicular sperm retrieval in non-obstructive azoospermia was evaluated as in these patients sperm will only be recovered in half the cases. Our results together with a review of the reports published so far, show that although inhibin B is more accurate in predicting the result of sperm recovery, it cannot predict the outcome of a testicular sperm recovery in patients with non-obstructive azoospermia.

Humans↗
PubMed2005

Non-obstructive azoospermia and maturation arrest with complex translocation 46,XY t(9;13;14)(p22;q21.2;p13) is consistent with the Luciani-Guo hypothesis of latent aberrant autosomal regions and infertility.

OBJECTIVE: To describe clinical and histological features observed in the setting of an unusual complex translocation involving three autosomes (9, 13, and 14) identified in an otherwise healthy male referred for infertility consultation. MATERIALS AND METHODS: The patient was age 30 and no family history was available (adopted). Total azoospermia was confirmed on multiple semen analyses. Peripheral karyotype showed a 46,XY t(9;13;14)(p22:q21.2;p13) genotype; no Y-chromosome microdeletions were identified. Cystic fibrosis screening was negative. Bilateral testis biopsy revealed uniform maturation arrest and peritubular fibrosis. RESULTS: Formal genetic counseling was obtained and the extant literature reviewed with the couple. Given the low probability of obtaining sperm on testicular biopsy, as well as the high risk of any retrieved sperm having an unbalanced genetic rearrangement, the couple elected to proceed with fertility treatment using anonymous donor sperm for insemination. CONCLUSION: Although genes mapped to the Y-chromosome have been established as critical to normal testicular development and spermatogenesis, certain autosomal genes are now also recognized as important in these processes. Here we present clinical evidence to support the Luciani-Guo hypothesis (first advanced in 1984 and refined in 2002), which predicts severe spermatogenic impairment with aberrations involving chromosomes 9, 13, and/or 14, independent of Y-chromosome status. Additional study including fluorescent in situ hybridization and molecular analysis of specific chromosomal regions is needed to characterize more fully the contribution(s) of these autosomes to male testicular development and spermatogenesis.

Journal Article↗
PubMed2000

Treatment of infertility due to anejaculation in the male with electroejaculation and intracytoplasmic sperm injection.

PURPOSE: We tested the hypothesis that spinal cord injury and/or anejaculation affects the outcome of intracytoplasmic sperm injection (ICSI). MATERIALS AND METHODS: From November 1993 to October 1998 we obtained and prospectively reviewed data on 34 ICSI cycles using electroejaculated sperm, 620 male factor infertility ICSI cycles using normal ejaculated sperm and 120 cases of obstructive azoospermia, in which microsurgical epididymal aspiration and testicular sperm extraction-ICSI were done in 93 and 27, respectively. RESULTS: A total of 34 ICSI cycles were performed in 17 couples with male infertility due to anejaculation secondary to spinal cord injury in 10 patients and retroperitoneal lymph node dissection in 5, and idiopathic in 2. In all 17 couples at least 3 previous intrauterine insemination cycles had failed. After electroejaculation 11 men had oligozoospermia and 6 normal sperm density. Median sperm retrieval volume plus or minus standard deviation was 1.9 +/- 1.9 ml., median sperm concentration 70.7 +/- 60.2 x 106 sperm per ml., median motility 10.7% +/- 10.8% and median forward progression 2.3 +/- 0.5 (scale 1 to 4). In the anejaculation group ICSI resulted in a median fertilization of 60% +/- 28%, 15% pregnancies per cycle and 29% pregnancies per couple. In the control group of 620 ICSI cycles from ejaculated specimens obtained from male patients with infertility median fertilization was 58% +/- 26%, and there were 39% pregnancies per cycle and 47% pregnancies per couple. The rate of pregnancies per embryo transfer and per couple was higher in the control than in the electroejaculation-ICSI group (p <0.05). However, there was no statistically significant difference in the fertilization rate. CONCLUSIONS: ICSI or in vitro fertilization is a viable alternative for patients with anejaculation in whom intrauterine insemination failed. While the fertilization rate is similar in these couples, the pregnancy rate is significantly lower than that achieved with ejaculated specimens from patients with severe male factor infertility. ICSI is a viable alternative for a patient with anejaculation in whom intrauterine insemination or in vitro fertilization failed.

Adult↗
PubMed2005

Tuberculous epididymitis and fertility in North Jordan.

OBJECTIVES: To describe the clinical characteristics of tuberculous epididymitis and its effect on male subfertility in a general hospital in the north of Jordan. METHODS: A retrospective case study of the hospital records of patients with genitourinary tuberculosis managed at Princess Basma Teaching Hospital in Irbid, North Jordan during the period of 1994-2001. RESULTS: Of the 16 patients with genitourinary tuberculosis, 9 were found to have tuberculous epididymitis. The mean age was 41.2 years. The main presentation was an insidious onset of painful scrotal swelling, mostly on the left side. Mean duration of symptoms was 10.6 weeks. Most patients had no history of previous tuberculosis and no Mycobacterium Tuberculosis in their urine. Six months of anti-tuberculous chemotherapy was effective, combined with surgery for scrotal abscesses. Although all patients recovered, the results on fertility are considerable. CONCLUSION: Isolated tuberculous epididymitis is the most common form of genitourinary tuberculosis. A 6-month course of anti-tuberculous chemotherapy is effective in combination with surgery for large scrotal abscesses. The fertility outcome is of concern. Sperm retrieval and cryopreservation have to be considered for potential intra-cytoplasmic sperm injection.

Adult↗
PubMed1997

Percutaneous technique for aspiration of sperm from the epididymis and testicle.

Percutaneous sperm aspiration from the epididymis (PESA) or testicle (TESA) may be used as a diagnostic technique to confirm sperm production and as a method to harvest sperm for use in intracytoplasmic sperm injection (ICSI). We performed 43 PESA/TESA procedures in men considered to have nonreconstructible obstructive azoospermia. This short outpatient procedure was performed using a butterfly needle under intravenous i.v. sedation and local anesthesia. In 17 diagnostic aspirations, diagnoses of normal spermatogenesis, maturation arrest, and germ cell aplasia were established. In 26 therapeutic sperm aspirations for use with ICSI, adequate samples of sperm were obtained and residual sperm was cryopreserved. In the ICSI cycles, fertilization and pregnancy rates of 59% and 32%, respectively, were obtained. PESA/TESA is a minimally invasive sperm retrieval technique and appears to be an effective alternative to microsurgical epididymal sperm aspiration, which is more invasive, costly, and technically more difficult. There have been no acute or chronic complications in this patient population, including nine men who underwent a second successful procedure.

Anesthesia, Local↗
PubMed2005

Successful pregnancy achieved by intracytoplasmic sperm injection using cryopreserved electroejaculate sperm in a couple both with spinal cord injury: a case report.

Anejaculation and poor semen quality are 2 major causes of infertility in men with spinal cord injury (SCI). The low motility of retrieved sperm often results in use of intracytoplasmic sperm injection (ICSI) to achieve fertilization. Pregnancy is a challenging event for women with SCI. Herein we report a pregnancy after ICSI with cryopreserved electroejaculate sperm for a couple both with SCI. The husband had T10 paraplegia with a neurogenic bladder. He underwent 2 electroejaculations. The concentration of sperm was 0.1 x 10(6)/mL to 0.3 x 10(6)/mL, with a motility of 5% to 20%. ICSI was considered the best choice for the couple. His wife had L2 paraplegia with cauda equina syndrome. She underwent controlled ovarian hyperstimulation, and 10 oocytes were retrieved. Eight mature oocytes were injected using thawed sperm, which resulted in 5 normal zygotes. Conception was achieved by the transfer of 4 embryos into the uterus. A healthy female baby was delivered vaginally at 39 weeks of gestation. This woman had never undergone any other assisted reproductive technology (ART) procedures. With the advancement of ART and prenatal care, this couple achieved a successful pregnancy. The use of cryopreserved electroejaculated sperm for ICSI can avoid the inconvenience or cost to the patient of repeated electroejaculations.

Adult↗
PubMed1994

A modern view of male infertility.

It is archaic to view male factor infertility today separately from in vitro fertilization (IVF) and treatment of the female partner. Oligoasthenozoospermia may be an inherited condition (most likely on the Y chromosome), and is refractory to any treatment of the male including hormones and varicocelectomy. IVF technology is the only justifiable approach for achieving a pregnancy in these couples. The reasons for this view and the suggested modern approach to couples with oligoasthenozoospermia are outlined in this review. However, obstructive azoospermia is different as it can be successfully corrected with microsurgery in over 90% of men. When it cannot be corrected, as in congenital absence of vas, microsurgical sperm retrieval combined with IVF can still be highly effective in producing pregnancy with sperm from the husband. The most important arena for research into male infertility in the next decade will be to map out the deletions on the Y chromosome that might result in defective spermatogenesis, and which probably cause most cases of non-obstructive male factor infertility.

Female↗
PubMed1993

Evidence for a novel adenylyl cyclase in human epididymal sperm.

Since cAMP is considered to play a major role in the acquisition of maturation and fertilizing capacity of mammalian sperm, we investigated the expression of cAMP-synthesizing adenylyl cyclase (AC) in sperm retrieved directly from the human epididymis. Particulate fractions were prepared from purified epididymal sperm samples and AC was monitored by the direct conversion of ATP into cAMP. We report that in great contrast to human ejaculated sperm and other mammalian sperm cells, the human epididymal sperm do not express a Mn(2+)-sensitive AC. However, a functional AC was readily detectable in these sperm cells in the presence of saturating concentrations of Ca2+ (50mM) and bicarbonate (HCO3-, 50mM), a combination that causes maximal activation in human ejaculated sperm. Using these conditions, human epididymal sperm AC showed similar capacity to generate cAMP compared to human ejaculated sperm AC. When assays were performed in the presence of Mg2+ and a saturating concentration of GMP-P(NH)P (50 microM), the hydrolysis-resistant GTP analog, and forskolin (100 microM), no activity was detected indicating that the epididymal sperm AC differs from that in somatic cells. These data demonstrate that human epididymal sperm contain an AC that is unique and different from the enzyme system described in somatic cells and other mammalian sperm cells, including human ejaculated sperm.

Adenylyl Cyclases↗
PubMed2000

Percutaneous epididymal sperm aspiration in a man with congenital bilateral absence of the vas deferens undergoing an assisted reproduction program.

Surgical retrieval of spermatozoa for in-vitro fertilisation (IVF) programs for severely oligospermic men has been in use for several years now. In the recent 2 to 3 years, clinicians have begun to move towards non-surgical methods of retrieving sperm in certain selected groups of men. Percutaneous epididymal sperm aspiration (PESA) has had good results in terms of number of sperm obtained, as well as the fertilisation and pregnancy rates. The first reported use of such a technique in Singapore is described.

Adult↗
PubMed2004

Frequent structural chromosome aberrations in immotile human sperm exposed to culture media.

BACKGROUND: The influence of culture media or centrifugation on chromosomes of immotile human sperm was examined using ICSI into mouse oocytes. METHODS: In experiment 1, immotile and motile human sperm retrieved directly from ejaculates were injected into mouse oocytes. In experiment 2, immotile human sperm were exposed to seminal plasma or one of four kinds of culture media (HEPES-BWW, modified-BWW, modified-human tubal fluid (HTF) and Dulbecco's phosphate-buffered saline) for 1.5-2.5 h at 18 degrees C in air before microinjection. In experiment 3, immotile human sperm were centrifuged along with HEPES-BWW before microinjection. In experiment 4, frozen-thawed immotile human sperm washed with seminal plasma or HEPES-BWW were injected into mouse oocytes. The hybrid oocytes were prepared for chromosome slides at first cleavage metaphase and were then examined cytogenetically. RESULTS: In experiment 1, there was no significant difference in the incidences of structural chromosome aberrations between motile and immotile sperm (4.3% versus 5.8%). In experiment 2, culture media caused more frequent structural chromosome aberrations (14.3-32.6%) in immotile sperm than did seminal plasma (5.4%). In experiment 3, structural chromosome aberrations were found in 48.1% of the centrifuged immotile sperm, and a live/dead sperm viability test intimated that the aberrant sperm were probably dead. In experiment 4, the incidence of structural chromosome aberrations in frozen-thawed immotile sperm was significantly higher in HEPES-BWW (62.2%) than in seminal plasma (17.2%). CONCLUSIONS: The results indicate that immotile sperm do not have significantly more DNA lesions than motile sperm, although DNA of immotile sperm appears to be vulnerable to damage caused by different culture media.

Animals↗
PubMed2005

Unilateral intrauterine insemination with prostatic fluid-sensitized frozen caudal epididymal sperm in beagle dogs.

The effects of the absence or presence of prostatic fluid (PF) during cauda epididymal sperm retrieval were assessed as regards semen quality after freezing semen in egg yolk Tris-fructose citrate solution (EYT-FC). Epididymal spermatozoa from the left testis of each of 10 dogs was retrieved into PF, whereas that from the right testis into EYT-FC only. At sperm recovery, the only difference between the two groups was that the incidence of spermatozoa with cytoplasmic droplets (immature sperm) was lower in the PF group (P < 0.01). In contrast, after freezing-thawing, (mean +/- S.E.) sperm motility (32.0 +/- 1.4 versus 12.5 +/- 2.0%, P < 0.01) and viability (58.2 +/- 3.5 versus 41.8 +/- 5.6%, P < 0.05) were higher in the PF group than in the EYT-FC group, respectively. Furthermore, 25.6 +/- 2.7% spermatozoa in the PF group were still motile after being maintained at 20 degrees C for 6 h. The incidence of immature spermatozoa post-thaw was lower compared to that after recovery in the EYT-FC group (P < 0.01), but was still higher than that in the PF group (P < 0.05). Frozen-thawed spermatozoa (2 x 10(8)) were used for unilateral intrauterine AI. The conception rate of PF-unsensitized sperm was 20% (2/10), but that of PF-sensitized sperm was 80% (8/10; P < 0.01). Therefore, sperm recovered in PF and frozen-thawed were of good quality. Sensitization of epididymal sperm with PF before freezing clearly improved the conception rate to AI of spermatozoa derived from the cauda epididymus.

Acrosome↗
PubMed2002

Comparison of the ICSI outcome of ejaculated sperm with normal, abnormal parameters and testicular sperm.

OBJECTIVE(S): To compare fertilization rates, quality of embryos, pregnancy rates (PRs) and outcome of pregnancies in intracytoplasmic sperm injection (ICSI) using sperm from ejaculates of normal and abnormal semen and testicular sperm of non-obstructive azoospermia. STUDY DESIGN: Four hundred fifty-four patients who underwent 454 ICSI cycles were evaluated retrospectively. Patients were divided into three groups according to the quality and source of sperm. Patients in group 1 underwent 133 cycles of ICSI using ejaculated normal semen, group 2 underwent 235 cycles using ejaculated abnormal semen, and group 3 underwent 86 cycles using testicular sperm. RESULTS: The parameters were compared among the groups with respect to cycles induced by long (n = 160) and short (n = 294) protocol. In group 3, the fertilization and PRs were significantly lower than in all other groups (51.3 and 10.6% in the long protocol cycles, 53.3 and 5.1% in the short protocol cycles, respectively). There was no significant difference in the outcome of pregnancies in respect to abortion rates between different groups. CONCLUSION(S): The fertilizing ability of sperm in ICSI is highest with ejaculated sperm and lowest with sperm extracted by testicular biopsy. Also, the clinical PRs are significantly lower in ICSI with sperm from testicular biopsy. However, the outcomes of pregnancies are not affected by using surgically retrieved sperm from ejaculated semen.

Adult↗
PubMed2000

[Postmortem sperm procurement--juridical and Halachic aspects].

The ability to fertilize human ova with sperm retrieved soon after death has been utilized in Israel and in other countries. However, postmortem sperm procurement (PMSP) has significant Halachic, juridical and ethical implications with regard to both the action of sperm and its implications for mother and offspring. In specific situations, and with reliable supervision aimed at preventing sperm interchange, Halacha may allow the procedure, while the juridical approach in such a situation is not as yet well established. As for Halacha, even if a son is born, the widowed mother will still be obligated by the Halacha of yibum (marrying the deceased husband's brother). The child's rights as heir, aspects of implications for its future life, or even social aspects of PMSP, all are factors to be seriously considered before PMSP is performed, without bias by temporary emotions. Thus, PMSP should be reserved for only very special circumstances, and only after consultation with the appropriate medical, Halachic, juridical and ethical experts.

Bioethics↗