Complaints Of Infertility Research Articles

A Case Report on Primary Infertility

Introduction: All womens want to become mothers. Infertility is defined as unable to or failure to conceive within one or more years of regular unprotected coitus. Primary infertility denotes patients who have never conceived.
 Clinical Findings: The main symptom of primary infertility is the inability to get pregnant. A menstrual cycle is not continued. That's too long (35 days or more), too short (less than 21 days), irregular or absent results of patients not ovulating. Late menstrual cycle, pain in menstrual cycle, infertility, there might be no other signs or symptoms.
 Diagnostic Evaluation: serological test, semen test in her husband, sonography, hysteroscopy, laparoscopy.
 Investigation of BHCG value: BHCG value greater than 25 indicates positive results.
 Therapeutic Intervention: Inj. Chorion(Human chorionic gonadotropin) 500 IU, Inj. Filgastrium(Neupogen) 300IU every third day, Inj. Lomoh 20mg Alternate day, Tab. Esrobet 2mg×TDS, Tab. Ecosprin 150mg×OD.
 Outcomes: After In-vitro fertilization treatment patients show improvement. Patients can be pregnant,with the help of In-vitro fertilization treatment.
 Conclusion: My patient was admitted in gynaecology ward no. 08, AVBRH (Acharya Vinoba Bhave Rural Hospital) with case of primary infertility and complaints of infertility, late menstrual cycle and repeated abortion after IVF (In-vitro fertilization) treatment patient condition improved and got pregnant. ET(Embryo transfer) was done on 15/11/2021.

Efficacy of Terminalia chebula) and exercise in management of obesity (Sthaulya) — A case report

Obesity or is one of the lifestyle disorders rapidly increasing in the community; due to rigorously changing dietary habits and behavioural pattern. is a state of increased ofmeta data i.e. abnormal and /or excessive fat accumulation that may impair health of an individual. A married woman aged 29 years, presented to the clinic with complaint of infertility, loss of appetite and increased body weight. Regular walking exercise, as medicine along with counseling for diet restrictions made her lose 7.15% of her body weight with BMI reduction up to 2.94 units. Obesity is a public health problem with multiple risk factors and so its management is also very complex. Essential calorie intake coupled with appropriate adequate physical exercise and proper adherence to Ayurved guidelines for (daily regimen) can reduce rising problem of obesity in society.

Monozygotic adult twins with nonmosaic Klinefelter syndrome with different results of sperm retrieval

Klinefelter syndrome and monozygotic twins are both rare. The reports of monozygotic twins with Klinefelter syndrome to have undergone fertility treatment are uncommon. This case report describes a case of 30-year-old monozygotic adult twin brothers diagnosed with nonmosaic Klinefelter syndrome following the complaint of infertility. The result of semen analysis showed cryptozoospermia (very low sperm count) and azoospermia (zero sperm count) with physical findings and lifestyles being very similar. They both underwent microtesticular sperm extraction. One had successful sperm retrieval and achieved pregnancy through intracytoplasmic sperm injection, whereas the other did not. Testicular pathological findings showed Sertoli cell-only syndrome. To the best of our knowledge, this is the first report on monozygotic adult twins both of whom underwent microtesticular sperm extraction and resulted in different outcomes.

Comparison of Laparoscopic Findings with Tuberculosis Polymerase Chain Reaction in the Diagnosis of Genital Tuberculosis Among Subfertile Women

Background: Female genital tuberculosis (FGTB) is an important cause of infertility. The Fallopian tubes are involved in almost 90% of the cases. Materials and Methods: All 50 participants were women with complaints of infertility to whom FGTB was suspected as a cause of infertility or women with infertility of unknown etiology. After selecting the patient according to inclusion criteria, women were posted for diagnostic laparoscopy and endometrial aspirate/biopsy was sent for TB polymerase chain reaction (TB PCR). Results: In our study, infertile women who had clinical and hysterosalpingography findings suggestive of genital TB underwent endometrial biopsy for TB PCR and hysterolaparoscopy for further evaluation. Among them, 7 (14%) endometrial TB PCR-positive cases were found in the study. Clinical and hysterolaparoscopy findings in these cases were carefully reviewed, although laparoscopic findings were suggestive of TB in 9 (18%) women. Conclusion: Direct visualization of the female genital tract by laparoscopy is most confirmatory and should be considered for starting the antitubercular treatment on the basis of laparoscopic findings.

SPERM DNA FRAGMENTATION TEST IN ADDITION TO GENERAL SEMEN TEST MAY LEAD TO ELUCIDATION OF POTENTIAL FACTORS FOR PREDICTING IVF OUTCOMES

Female factors are very important in determining the success of in vitro fertilization (IVF). However, many reports have shown that male factors also affect the success or failure of IVF. Therefore, the sperm evaluation is important, semen examination criteria based on conventional methods alone is not a primary factor of consideration for determining IVF embryonic potential, pregnancy rates, and miscarriage rates after transplantation. We performed and analyzed the sperm DNA fragmentation index (DFI) and general semen test based on the WHO criteria and compared the two using semen factors. This study was conducted from June 2020 to December 2020. A total of 134 male patients with the main complaint of infertility who requested semen testing were included. We evaluate sperm motility using an automatic sperm analyzer based on the WHO criteria and sperm morphology via the Kruger test (general semen tests). DFI and general semen test were conducted in accordance with the WHO criteria, and correlations between the two tests were investigated. The WHO criteria were set as the cutoff value for each of the following factors: fluid volume, concentration, motility, and normal morphology, and compared with the DFI results. The mean age of the 134 patients at the time of the sperm tests was 38.8±6.0 years (range=26-52 years). The subjects had a mean DFI of 15.6±11.5% and the DFI increased with age (r=0.2319, p<0.01). In contrast, the concentration, motility, and normal morphology decreased as the DFI increased (concentration; r=-0.1992, p<0.05; motility; r=-0.2672, p<0.01; normal morphology; r=-0.2881, p<0.001). Patients who satisfied the WHO criteria in terms of sperm concentration, motility, and normal morphology had a significantly lower DFI than the group that did not satisfy the criteria (concentration p<0.05; motility p<0.01; normal morphology p<0.01). Therefore, evaluation with a general semen test based on the WHO criteria should be regarded as a qualitative evaluation of all factors other than fluid volume. Male infertility due to DFI should be suspected when in vitro fertilization results are poor despite normal semen findings based on the WHO criteria. The results of this study suggest that the DFI test may be an important evaluation in follow-up semen analyses.

Evaluation of depression and sleep disorders in the preoperative and postoperative period in stage 4 endometriosis patients

ObjectivesEndometriosis is a disease that significantly affects the quality of life of patients. Continuous pelvic pain seen in patients disrupts their well-being. The aim of this study is to examine the changes in depression and sleep disorders in patients with endometriosis before and after the operation. Study DesignForty-two women aged 18–49 with an indication for operation due to the diagnosis of stage 4 endometriosis and without a known psychiatric disorder were included in the study. Pittsburgh Sleep Quality Index and Beck Depression Inventory were used to compare sleep quality and mood of endometriosis patients before and after surgery. ResultsThe mean age of the patients was 33.8 ± 7.6. The mean BMI of the patients was 24.6 ± 4.1. Endometrioma diameter was 248.42 ± 95.7 cm3 in patients with poor sleep quality, while it was 296.11 ± 271.53 cm3 in patients with good sleep quality, and a significant difference was observed (p < 0.05). Poor sleep quality and severe depression were significantly higher in patients with infertility complaints. It was observed that sleep quality was not significantly correlated with bilateral endometrioma, a nodule in the Douglas, sacrouterine tenderness and mean ASRM scores (p > 0.05). A significant decrease in depression complaints and a significant increase in sleep quality were observed in patients who underwent stage-4 endometriosis surgery (p < 0.05). ConclusionWe showed that there was a significant increase in sleep quality and a significant decrease in depression symptoms in patients who underwent stage-4 endometriosis surgery. Since endometriosis affects the social life of patients in many ways, it is necessary to increase the knowledge and experience about the treatment of endometriosis with larger studies to be done. We believe that surgical treatment can reduce social problems and increase the quality of life of endometriosis patients.

Diagonostic parameters of polycystic ovarian syndrome in outpatient setting

Background: Polycystic ovarian syndrome (PCOS) is one of the most common endocrinopathy in reproductive age women. PCOS has complex etiopathology, diverse clinical presentation and diagnostic criteria.&#x0D; Objective: Objective of this study was to find out the determinant clinical feature and investigations for improving diagnostic accuracy and assessment of PCOS, thereby evolving opportunity for proper treatment.&#x0D; Methods: This prospective cross sectional observational study was conducted in Islami Bank hospital, Khulna, from January 2017 to February 2020. Women seeking gynecological consultation in outdoor with at least one complaint of oligomenorrhoea, hirsutism, weight gain or infertility were enrolled for study. Subjects were selected on the basis of inclusion and exclusion criteria. A structured proforma, based on relevant history, laboratory work up, risk factors and co morbidities were prepared before-hand. Diagnosis of PCOS was based on Rotterdam criteria, 2003. The clinical manifestations of PCOS, frequency of different sub phenotypes and associated morbidities were measured as outcome.&#x0D; Results: Total study population was 202. Age of subjects were in between 13- 37 years. Thirty seven (18%) were adolescent, one hundred forty (65.7%) patients were overweight and obese. Majority of cases were married. Complaint of infertility was present in 125 (61.9%) cases. Oligomenorrhoea, hirsutism, poly cystic ovary was present in 145 (71.8%), 137 (67%), and 130 (64.4%) patients respectively. LH/FSH ratio &gt;2 in 45 (22.3%) cases, Serum free testosterone &gt;0.79 ngm/ml were associated with hirsutism. PCOS with clinical sub phenotypes A, B, C, and D were 38(18.9%), 72 (35.6%), 27 (13.4%) and 65 (32.2%) cases respectively. Case morbidities were Hypertension 75 (37.1%), Diabetes mellitus 18 (8.9%) and Metabolic syndrome 44 (20.1%). Link with Hypothyroidism Hyperprolactinemia were identified in 47 (19%) cases.&#x0D; Conclusion: Oligo-anovulatory woman with hyperandrogenism with or without poly cystic ovary were diagnosed as a largest group of PCOS-A and B sub phenotypes. Infertility, hypothyroidism, hypertension, diabetes mellitus, metabolic syndrome and endometerial hyperplasia were common.&#x0D; Bang Med J Khulna 2020: 53 : 17-22

Case Report on Hypothyroidism in Infertile Woman with IVF Conception

Introduction: Hypothyroidism affects 2–4% of women in their reproductive years. Anovulatory cycles, luteal phase defects, hyperprolactinemia, and sex hormone imbalances are all symptoms of sex hormone imbalances are all consequences of hypothyroidism on fertility.&#x0D; Main Symptoms/or Important Clinical Findings: A 33 years old female admitted in AVBRH on date 19/1/2021 with chief complaint of infertility with hypothyroidism since 8 year, pain in abdomen, irregular menses. &#x0D; Obstetric History: Patient had obstetric history of menarche start age of 15 year and flow of bleeding in slow/light. After irregular menses, she received IVF cycle and she was conceived the pregnancy in 1st IVF cycle.&#x0D; The Main Diagnoses, Therapeutic Intervention, and Outcome: After physical examination and investigation, doctor was detected a case of primary infertility with hypothyroidism. Patient was treated with tab.thyronom50 mg drug to reduce the symptoms of hypothyroidism.&#x0D; Nursing perspective: Administered flued replacement i.e. DNS, RL, monitored fetal heart rate and vital sign per 4 hourly.&#x0D; Conclusion: Pregnancy conceived with in vitro fertilization increasing the more risk of gestational hypothyroidism as well as fetal complication. Treatment and management improves the outcome of pregnancy.

Diagnostic Hysterolaparoscopy in the Evaluation of Female Factor Infertility: A Cross-sectional Study at a Tertiary Care Hospital in Central India

ABSTRACT Background Infertility is a worldwide problem affecting people of all geographical location and socioeconomic status. It is estimated that globally 60–80 million couples suffer from infertility every year. The main objective of the study is to detect the diagnostic efficacy of hysterolaparoscopy in evaluating the tubal, uterine, ovarian, and pelvic pathologies causing infertility and also compare the findings of a hysterosalpingogram with diagnostic laparoscopy in evaluating the tubal factor infertility. Materials and methods This hospital-based cross-sectional study included an evaluation of 1,456 couples presenting with complaints of infertility at the Outpatient Department of Government Medical College, Nagpur during the period of February 2016 to September 2018. After thorough gynecological examination and investigations, 130 infertile women were posted for diagnostic hysterolaparoscopy. All the data were collected on predesigned proforma and the results were tabulated and raw percentages calculated to describe the results. Results Among the 130 infertile women, 102 women (78.46%) had primary and 28 (21.53%) had secondary infertility. The maximum number of patients belonged to the age group of 26–30 years (39.23%). About 56% of patients were in the active marriage life of 3–5 years duration. Most of them had multiple factors affecting their fertility. Out of the 130 infertile women, 32 patients (24.62%) had uterine factors, 44 patients (33.84%) had peritoneal factors, 67 patients (51.5%) had ovarian factors, and 89 patients (68.46%) had tubal factors. Only eight patients (6.15%) had normal findings in laparoscopy. Out of the 130 patients, 122 (93.84%) had more than one factor causing infertility. About 26.15% of patients had positive findings in diagnostic hysteroscopy. Conclusion Hysterolaparoscopy provides both a panoramic view of the pelvic reproductive anatomy and also a magnified view of the pelvic organs and peritoneal surfaces. It is generally regarded as the most reliable tool in the diagnosis of tubal pathology and other intra-abdominal causes of infertility because of the correctable abnormalities like endometriosis, adnexal adhesions, and septate uterus which are usually missed, are usually identified that helps in formulating a specific plan of management. How to cite this article Selvaraj P, Parpillewar M, Fidvi J. Diagnostic Hysterolaparoscopy in the Evaluation of Female Factor Infertility: A Cross-sectional Study at a Tertiary Care Hospital in Central India. Int J Infertil Fetal Med 2020;11(2):37–41.

Reducing the waiting time to initiation of infertility treatment at a tertiary care centre in India

BackgroundIn a low-resource and high-volume setting, it is often felt that patient care cannot be improved within the limitations of existing infrastructure and resources. However, the use of a systematic...

Determine Cyp17a1 and Ki67 Expressions in Pcos Induced Rat Model Treated with Sepia pharaonis Ink Extract Proves Effective

Background: The present study aims to evaluate the therapeutic action of Sepia pharaonis ink extract in experimentally induced polycystic ovary syndrome (PCOS) rat model and perform Immunohistochemistry to confirm the findings.Methods: The female rats were grouped into 5 consisting of six animals each. Only water was given to the control group. For inducing PCOS, Letrozole 1mg/kg.b.wt was administered to the subsequent four groups for 21 days. To the third group, an allopathic drug, clomiphene citrate 1mg/kg was given for 19 days after PCOS induction. The SPIE was subjected to lyophilisation to make a black powder and next two groups were administered orally with two different dosages of SPIE (100mg and 200mg respectively) mixed with water after PCOS induction. Vaginal smears were taken from all groups till 21 days and then treatment was started with clomiphene citrate (CC) and SPIE. After 21 days, vaginal smears were taken from all groups till ovulation was induced. The test drug effects were studied using ovary weight both right and left, body weight, hormonal levels, histopathology of ovary and Immunohistochemistry. Result: PCOS group showed rapid increase in the ovarian weight when compared to control and was reduced by CC and SPIE treatment. The levels of progesterone and estradiol were found lower and testosterone levels were found higher in PCOS rats which were favourably altered. Vaginal smears coincided with the histopathology and immunohistochemistry findings. SPIE can be used as a therapeutic drug for PCOS in future, reduce infertility complaint of females and prevent early inception of diabetes mellitus.

Effect of Myo-inositol and N-acetyl-L-cysteine on processed human spermatozoa for use in modern methods of fertility treatment

Background and aims: Today, the prevalence of structural and functional disorders of sperm and subsequently the possibility of occurrence of autism, spontaneous abortion, and infertility has increased dramatically. This study aimed to investigate the potential effects of myoinositol and N-acetyl-L-cysteine (NAC) on the improvement of processed spermatozoa indices. Methods: In this study, 63 patients with male factor infertility were studied in Hazrat Zahra Infertility Center of Shahrekord. To do liquefaction, the semen sample was incubated at 37°C for 20 minutes. The Density Gradient Centrifugation protocol was used to process sperm. The processed sperm samples were incubated at 37°C for 20 minutes in four groups of control, myo-inositol (2 mg/mL), NAC antioxidant (10 Mm/L) and myo-inositol+NAC. All biological parameters of sperm were evaluated using Makler slide, SQA-V sperm analyzer gold version 2.48, TUNEL assay, and Toluidine blue staining. Results: In the present study, 63 men aged 22-58 years with infertility complaints were studied. The NAC group and the myo-inositol group exhibited significantly higher motility in comparison with the control group (P&lt;0.001). The NAC group also had a significantly higher number of TUNEL-negative cells and a lower number of TUNEL-positive cells than the control group (P&lt;0.01), but in other variables, the differences were not statistically significant. The morphology, S0, S1, S2 and staining types in the intervention groups did not show any significant difference compared to those in the control group (P &gt; 0.05). Conclusion: NAC and myo-inositol were able to improve certain indices such as sperm motility and integrity; therefore, the quality of sperm could be improved by these drugs to treat infertility.

Evaluation of Uterine Temperament in Iranian Infertile Women using a Quantitative Instrument for Uterine Temperament Detection.

Background:The temperament is a basic concept of maintaining health in Traditional Persian Medicine. The two main grouping of temperament is hot/cold and wet/dry. Many female disorders include infertilities are diagnosed and treated based on the dystemperament therapies. This report describes design of a questionnaire for uterine temperament detection and its use to evaluate the uterine temperament of a population of infertile women.Methods:The uterine temperament parameters derived from main textbooks were used to design a questionnaire which its validity and reliability was proven by statistical methods. The questionnaire was then used to detect the uterine temperament of 54 infertile females. Also full history and physical exam and vaginal sonography was performed in the 3rd day of the menstrual cycle for all study participants.Results:The mean age was 30.92 ± 5.53 years old. Mean uterine temperament score was 3.21 ± 0.53 for hotness and 4.28 ± 1 for wetness. Mean general body temperament was 138.88 ± 17.61. The general body temperament hotness/coldness was significantly correlated with the uterus hotness/coldness (r = 0.0842); while the wetness/dryness temperament of the body and uterus were not correlated. Moreover, uterus temperament was not correlated with the size of the uterus and ovaries in sonography, but pelvic width was correlated with hot uterine temperament (r = 0.354, P = 0.0145).Conclusions:In the present study, the most prevalent achieved temperament was cold and wet in patients with infertility complaint. Moreover, the hot/cold temperament of body and pelvic width were correlated with uterus temperament. This may propose new prevention and also treatment methods in the field of infertility, which needs to be further evaluated.

Association of hypothyroidism and polycystic ovary syndrome (PCOS)

Association of hypothyroidism and polycystic ovary syndrome (PCOS) - IJCBR- Print ISSN No: - 2394-6369 Online ISSN No:- 2394-6377 Article DOI No:- 10.18231/j.ijcbr.2019.087, International Journal of Clinical Biochemistry and Research-Int J Clin Biochem Res

Role of Chromohysteroscopy in Evaluation of Endometrial Pathology Using Methylene Blue Dye.

Chromohysteroscopy is expected to help in diagnosing subtle endometrial pathologies which could be missed on conventional hysteroscopy and also help in targeting biopsy from endometrium. To study staining pattern of endometrium in patients undergoing chromohysteroscopy andto evaluate and compare the histopathology of chromohysteroscopy-guided endometrial biopsy with conventional endometrial sampling. This was a cross-sectional study conducted during the period of 18 months in Department of Obstetrics and Gynaecology, ESI PGIMSR, New Delhi, India, from September 2016 to February 2018. Totally, 60 women with complaints of infertility, failed intrauterine insemination (IUI), recurrent spontaneous abortions (RSA), heavy menstrual bleeding (HMB), intermenstrual bleeding (IMB) and postmenopausal bleeding (PMB) meeting inclusion criteria were evaluated and enrolled in the study. In patients with normal looking endometrium on hysteroscopy, methylene blue dye was administered through the hysteroscopic inlet. Tissue samples were obtained from stained areas followed by blind endometrial sampling immediately. The results of chromohysteroscopy-guided biopsy from light- and dark-blue-stained areas and blind biopsy were compared. Mean age of the study group was 37 years, with mean BMI of 24 kg/m2. There were 24 cases of HMB, 9 of IMB, 7 of PMB, 15 of infertility, 2 of failed IUI and 3 with RSA. On chromohysteroscopy, 39(65%) cases showed light-stained endometrium (group I) and 21(35%) showed dark-stained endometrium (group II). Comparison was done between histopathology obtained through chromohysteroscopy and blind endometrial sampling. The diagnostic accuracy of chromohysteroscopy-guided endometrial biopsy in evaluation of endometrial pathology was 86.67% with sensitivity of 91.67%, specificity of 85.41%, PPV of 61.12% and NPV of 97.61% (P <0.001). Chromohysteroscopy was able to detect endometrial pathology which was missed on conventional hysteroscopy and detected more cases of endometrial pathology than blind endometrial sampling.

MON-612 Familial Dysalbuminemic Hyperthyroxinemia Cases in Five Unrelated Japanese Families and the Influences on Free T4 Measurement

Familial dysalbuminemic hyperthyroxinemia (FDH) is caused by abnormal human serum albumin (HSA) with an increased thyroxine (T4) affinity leading to euthyroid hyperthyroxinemia. In Japanese FDH patients with the HSAR218P mutation, not only one-step but also two-step immunoassays for free T4 (FT4) can yield false-positive results. Therefore, it is difficult to distinguish FDH from syndrome of inappropriate secretion of TSH, even when multiple assays are used. Patient 1 was a 29-year-old pregnant woman. A radiographic examination and hormone stimulation test were not performed. We suspected that the patient had FDH because of her family history such as abnormal thyroid function and hyperthyroxinemia (Total T4 level was greater than the measurement sensitivity). Genetic analysis using direct sequencing for HSA revealed that she was consistent with FDH. She experienced a normal delivery. Other patients were performed the thyroid test with Chief complaints of infertility or depression and their thyroid function abnormalities were pointed out. Thyroid function tests revealed elevated FT4 and FT3 levels; their TSH level was within the reference range in all patients. To investigate T4 to HSA binding, gel filtration high-performance liquid chromatography was used for the biochemical analyses. Furthermore, FT4 was measured in FDH patients using one-step method LUMIPULSE (Fujirebio) using T3 as an antigen and an anti-T4 antibody as a label. The genomic analysis revealed a heterozygous missense mutation in HSA(R218P). In FDH patient sera, the albumin effluent corresponded to the peaks for total T4 (TT4); approximately 60% of the T4 in the effluent was detected as FT4. Mean FT4 level measured with LUMIPULSE was 1.28 ng/dL within the reference value range. In the FDH patients, a relatively larger quantity of T4 was bound to abnormal HSA. This bound T4 was measured as FT4 during the analysis. When thyroid function abnormality without clinical findings is observed, it is considered preferable to understand the antigen and antibody to be used and to select measurement method.

Case Report: Female Circumcision and Infertility

This is a case report of a married couple came to the clinic with a complaint of infertility. On examination of the vulva, there was adhesion of labia minora forming a fibrous septum against proper sexual vaginal intercourse. Past history indicated a female circumcision done before marriage. Other parameters of investigations were within the normal values. Cutting the septum and suturing the raw edges on either side were done under anesthesia and sterilization precautions. Pregnancy occurred within three months of the procedure. It is concluded that female circumcision could result in infertility through adhesions of the edges of the wound.

A rare case report of familial koilonychia with azoospermia

We report a case of a middle-aged male patient presenting with complaints of infertility. On examination and history-taking, familial koilonychia was reported without any association with ectodermal, systemic, or orthopedic defects. His iron profile was within normal limits. Hemoglobin was in normal limit. KOH smear taken from the nail showed no fungal growth. Family history of three generations revealed males suffering with familial koilonychias with infertility. Patients admitted with azoospermia should be asked about family history of koilonychia and pedigree analysis should be done.

Results of intracytoplasmic sperm injection performed with sperm retrieved by microscopic testicular sperm extraction in azoospermic patients.

The absence of any sperm in the ejaculate is called azoospermia and it is detected in 1% of males and 10-15% of those with infertility complaints. Azoospermia may be due to obstructive (OA) and non-obstructive (NOA) causes. Today, healthy pregnancies can be achieved in azoospermic patients by intracytoplasmic sperm injection (ICSI) performed using sperm retrieved from microscopic testicular sperm extraction (m-TESE). In this study, we examined the sperm retrieval rates with m-TESE in azoospermic patients, the results of ICSI in OA and NOA patients with sperm and the underlying testicular pathologies in patients without sperm. Patients who underwent m-TESE at IVF unit of our hospital between January 2005 and April 2017 were retrospectively reviewed. A total of 342 azoospermic patients (117 OA and 225 NOA cases) with regular follow-up were included in the study. In these cases, sperm retrieval and clinical pregnancy rates after ICSI were compared. In the m-TESE procedure, motile sperm was found in all of the OA patients and in 52.4% (118/225) of the NOA patients. Clinical pregnancy rate in the OA group was 29.9% (35/117) and live birth rate was 25.6% (30/117). In the NOA group, the clinical pregnancy rate was 27.1% (32/118) and the live birth rate was 23.7% (27/118). Histopathologic evaluation was made in 107 cases in the NOA group with no testicular sperm, revealing that 59 cases with germ-cell aplasia (sertoli-cell only syndrome), 42 cases with maturation arrest, and 6 cases with hypospermatogenesis. Postoperative hematoma developed in 3 of m-TESE cases and subsided with conservative treatment. If motile sperm is retrieved with m-TESE application in azoospermic patients, pregnancy resulting in one live birth in about 4 couples who undergo ICSI application can be achieved. In the presence of motile sperm, live birth rates are similar between OA and NOA case with very low complication rates.

Diagnostic evaluation of sexual dysfunction in the male partner in the setting of infertility: a committee opinion

It is the responsibility of the clinician to assess for the presence of erectile dysfunction, ejaculatory dysfunction, or diminished libido related to hypoandrogenism among men presenting with a primary complaint of infertility. Referral to a reproductive urologist or other appropriate specialist with requisite expertise in the evaluation and treatment of such conditions is often warranted.