Intracytoplasmic Sperm Injection In Men Research Articles

Outcome analysis of ICSI assisted pregnancy using testicular sperm versus ejaculated sperm in man with severe oligozoospermia in the same ART cycle: A case report.

Intracytoplasmic sperm injection (ICSI) has become the most common method for couples with male factor infertility, and source of sperm for the procedure have evolved over time. but few have examined testicular sperm extraction vs. ejaculated sperm use for severe oligozoospermia in the same assisted reproductive technology (ART) cycle. Here, we evaluated the clinical outcomes after ICSI with testicular sperm or ejaculated in man with severe oligozoospermia in the same ART cycle. A couple who had failed the first ART cycle with ejaculated sperm, using the freshly ejaculated sperm and testicular sperm for ICSI during the second ART cycle by lack of enough sperm to fertilize in an ICSI attempt. The patient was diagnosed with severe oligozoospermia, and routine semen analysis revealed sperm concentration is less than 2 million/mL. The patient using testicular sperm versus ejaculated sperm with ICSI assisted pregnancy in the same ART cycle. We found that superior cleavage rate, number of embryos transferred and blastocyst rate with the use of testicular rather than ejaculated sperm-ICSI in the couple. The results described here suggest that use of testicular sperm may improve biologic outcomes, especially for couples with male-partner oligozoospermia who previous ICSI failures. Our case report supported the efficacy of testicular sperm preference over ejaculated sperm for ICSI in men with severe male factor infertility. It is a paradigm shift concerning the use of ejaculated sperm as the preferable source of sperm for ICSI, add to the small amount of literature on testicular sperm extraction vs. ejaculated sperm use for severe oligozoospermia in the same ART cycle.

Selection of frozen-thawed stallion semen by microfluidic technology.

The use of microfluidic technology is increasing in artificial reproduction technologies: With a small amount of semen, it allows for the selection of sperm with the best characteristics of kinetics, morphology and chromatin integrity. The ZyMot Multi (850 μl) is the most popular device of ZyMot Fertility Inc. To date, it was proven to be a valid instrument for sperm selection for in vitro fertilization and intracytoplasmic sperm injection in men. The aim of this study was to test the efficacy of the ZyMot Multi (850 μl) for stallion semen. Frozen-thawed semen from 15 stallions that were previously classified as being of 'good fertility' (GF; n=8; pregnancy rate ≥ 40%) and 'poor fertility' (PF; n=7; pregnancy rate < 20%), respectively, was used. Each ejaculate was assessed before and after microfluid recovery for kinetics (CASA), membrane integrity (MI) (SYBR14/PI), membrane functionality (MF) (HOS test), acrosome integrity (Spermac Stain Kit), morphology (Spermac stain kit), mitochondrial membrane potential (MMP) (JC-1) and chromatin integrity (aniline blue staining). Sperm concentration was reduced after sperm recovery in both groups, but more markedly in frozen-thawed semen of PF stallions (p < .05). Microfluid recovery increased total motility, MI, MF and MMP. While there was a significant increase in the percentage of progressively motile sperm after sperm microfluid recovery, there was a decrease in DAP, DSL, VAP, VSL, LIN, WOB and ALH (p < .05). A slight increase (p < .05) was detected in beat-cross frequency. The present results suggest that the ZyMot Multi (850 μl) device selects a specific sperm population from any stallion ejaculate with motile sperm and could therefore be a valid tool for in vitro testing with the aim to predict the fertility of frozen-thawed stallion semen.

Correlation between Sperm Micro Ribonucleic Acid-34b and -34c Levels and Clinical Outcomes of Intracytoplasmic Sperm Injection in Men with Male Factor Infertility.

Few studies have examined the correlation between sperm miRNA levels and clinical outcomes of intracytoplasmic sperm injection (ICSI). In this study, we aimed to assess the correlation of sperm miR-34b, miR-34c, miR-122, and miR-429 levels with ICSI outcomes in men with teratozoospermia and asthenozoospermia. TaqMan microRNA quantitative polymerase chain reaction was used to evaluate the relative expression of miRNAs in sperm. The relative miRNA levels quantified using a comparative method found that the four miRNAs were not associated with fertilization rate and early embryo development. However, revels of miR-34b and miR-34c in teratozoospermia sperm of the live birth group were significantly higher than those in the non-live birth group. Receiver operating characteristic curve analysis revealed that the optimal cut-off delta cycle threshold values of miR-34b and miR-34c were 8.630 and 7.883, respectively. Statistical analysis found that the levels of miR-34b and the miR-34c in teratozoospermic and asthenozoospermic sperm above the thresholds were not associated with the fertilization rate and the high-quality embryo rate above 50%; however, they were more likely to exhibit higher implantation, pregnancy, and live birth rates. miR-34b and miR-34c were significantly associated with ICSI clinical outcomes in male factor infertility, especially teratozoospermia. Further validation is required before it becomes a clinically valid reference indicator.

P-003 Sperm retrieved by microdissection testicular sperm extraction (MD-TESE) is associated with altered sex ratio of offspring after intracytoplasmic sperm injection in men with non-obstructive azoospermia

Abstract Study question Does the sperm retrieved surgically by MD-TESE of men with Non-Obstructive Azoospermia affect the live birth sex ratio? Summary answer Our data indicates that sperm retrieved in men with non-obstructive azoospermia alters the sex ratio in favor of female offspring. What is known already Non-Obstructive Azoospermia is the most severe form of male infertility and is the most common cause of Azoospermia. Among the different surgical techniques, MD-TESE gives the highest rate of sperm retrieval and when combined with intracytoplasmic sperm injection (ICSI), live births had been achieved with variable success, Sex ratio of offspring can vary substantially due to several variables, however no studies have investigated the resultant birth sex ratio in this setting. Study design, size, duration Retrospective Cohort study. Data were collected between May 2009 and December 2019. A total of 100 consecutive men with non-obstructive Azoospermia underwent MD-TESE for sperm retrieval. 46 couples underwent ICSI and live birth rate, cumulative live birth rate and sex ratio of offspring analysed. Participants/materials, setting, methods One-hundred men underwent MD-TESE out of which 46 proceeded with ICSI. Demographic data including male and female age, testicular volumes and serum hormone values are given as mean ± SD with a range (minimum and maximum). Fertility outcomes including sperm retrieval, fertilization rate, number of embryos transferred, and live birth rates and cumulative live birth rates were recorded. Chi-square test was performed to compare the proportions. Main results and the role of chance Sperm retrieval was successful in 58%(58/100). Testicular volume and hormonal parameters did not vary among patients with positive or negative sperm retrieval. Histology gave best correlation with sperm retrieval. Hypospermatogenesis yielded the highest sperm retrieval 93%(26/29), followed by Maturation arrest 78%(7/9), then Hyalinosis 46% (6/13) and lastly Sertoli cell only 38%(19/50). 46 couples underwent ICSI cycles where the mean age of patients and their wives were 36.4 ± 3.7y and 33.0 ± 4.3y. Fertilization rate and mean number of transferred embryos were 51.4 % and 1.7. Live birth rate and Cumulative Live Birth rate per Embryo transfer were 60.5% (26/43) and 74.4% (32/43) and per started ICSI cycle were 56.5% (26/46) and 69.6% (32/46), with a twin rate of 15.3%(4/26). Mean gestational length and mean body weight at birth were 39.0 ± 1.4w and 3228.5 ± 5.5 g. Number of live offspring were 36 (Female: Male = 26:10) giving rise to sex ratio of 2.6 to1 in favor of female offspring (P &amp;lt; 0.05). There were no neonatal death, and one baby had phenylketonuria. Limitations, reasons for caution This is the first study to test the hypothesis of sex ratio variation related to the source of sperm; the strength of our study is that all procedures were performed by the same surgeon, so there are no operator-dependent differences. This finding needs to be confirmed in larger cohort studies. Wider implications of the findings It has been demonstrated that different stressors may alter the sex of the offspring. While in the present study the stressor is the parental hypogonadism associated with non-obstructive azoospermia, We hypothesise that testicular environment may direct spermatogenesis in favor of X carrying sperm around the time of sperm retrieval. Trial registration number N/A

MP31-04 DOES INTRACYTOPLASMIC MORPHOLOGICALLY SELECTED SPERM INJECTION IMPROVE LIVE BIRTH RATES COMPARED TO ICSI IN MEN WITH INFERTILITY AND RAISED SPERM DNA FRAGMENTATION?

You have accessJournal of UrologyInfertility: Therapy (MP31)1 Sep 2021MP31-04 DOES INTRACYTOPLASMIC MORPHOLOGICALLY SELECTED SPERM INJECTION IMPROVE LIVE BIRTH RATES COMPARED TO ICSI IN MEN WITH INFERTILITY AND RAISED SPERM DNA FRAGMENTATION? Runzhi Chen, Tharu Tharakan, Channa Jayasena, Sheena Lewis, Jaya Parikh, Meen-Yau Thum, James Nicopoullos, Tet Yap, and Suks Minhas Runzhi ChenRunzhi Chen More articles by this author , Tharu TharakanTharu Tharakan More articles by this author , Channa JayasenaChanna Jayasena More articles by this author , Sheena LewisSheena Lewis More articles by this author , Jaya ParikhJaya Parikh More articles by this author , Meen-Yau ThumMeen-Yau Thum More articles by this author , James NicopoullosJames Nicopoullos More articles by this author , Tet YapTet Yap More articles by this author , and Suks MinhasSuks Minhas More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002035.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There is conflicting evidence on the role of intracytoplasmic morphologically selected sperm injection (IMSI) in assisted reproductive technology (ART), and whether it increases live birth rates (LBR) compared to conventional intracytoplasmic sperm injection (ICSI). In particular, the role of IMSI on ART outcomes in infertile men with raised sperm DNA fragmentation (SDF) is controversial. METHODS: We performed a retrospective analysis of 2,693 ICSI and 765 IMSI cycles from a single institution. Primary outcome measures included fertilisation rate (FR), clinical pregnancy rate (CPR), miscarriage rate (MR), and live birth rates (LBR). Subgroup analysis was performed on couples who had undergone SDF testing with the Comet assay. Multiple regression analysis was performed to identify variables which may predict LBR in both the overall cohort of patients, and in the subgroup of patients with SDF data. An average Comet score (ACS) of ≥29% was used as the threshold for elevation, as previously defined. RESULTS: The LBR was comparable between ICSI and IMSI cycles in the overall study population; 18.1% and 21.0%, respectively. Subgroup analysis of men with a raised SDF (Table 1) demonstrated a lower MR (40.9% vs. 88.9%, p=0.003) and higher LBR (17.5% vs. 3.2%, p=0.003) in IMSI compared to ICSI cycles. No differences in clinical outcomes were observed between IMSI and ICSI cycles in men with a normal SDF. Multiple regression analysis revealed that IMSI significantly increased the probability of LBR (OR 7.052 [95% CI 1.826–27.237], p=0.005) in men with raised SDF. . . CONCLUSIONS: This study indicates that whilst IMSI may not be beneficial in the general infertile male population undergoing ART, it does improve LBR in men with raised SDF and male factor infertility. Source of Funding: N/A © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e556-e556 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Runzhi Chen More articles by this author Tharu Tharakan More articles by this author Channa Jayasena More articles by this author Sheena Lewis More articles by this author Jaya Parikh More articles by this author Meen-Yau Thum More articles by this author James Nicopoullos More articles by this author Tet Yap More articles by this author Suks Minhas More articles by this author Expand All Advertisement Loading ...

P–737 Effect of dietary patterns on clinical pregnancy and live birth outcomes in men and women receiving assisted reproductive technologies: a systematic review and meta-analysis

Abstract Study question Is there a relationship between dietary patterns and clinical pregnancy or live birth outcomes in men and women of reproductive age undergoing assisted reproductive technologies (ART)? Summary answer While the Mediterranean and pro-fertility diets show potential to improve fertility outcomes, the association between dietary patterns and ART success is currently inconsistent. What is known already The nutritional status of reproductive-aged couples can have a significant impact on fertility. While the consumption of individual foods and nutrients are known to influence reproductive success, the effect of dietary patterns on clinical pregnancy and live birth outcomes in people using assisted reproductive technologies (ART) is currently unknown. Study design, size, duration Six electronic databases were systematically searched for original research published in English between January 1978 and December 2020 reporting on the effect of pre-defined dietary patterns on either clinical pregnancy and/or live birth rates following invitro fertilisation or intracytoplasmic sperm injection in men and women aged 18–49 years. Screening of all retrieved articles was performed independently by two review authors. Eligible studies underwent quality assessment and qualitative and quantitative synthesis using random-effects model meta-analyses. Participants/materials, setting, methods Studies eligible for inclusion in this systematic review were cross-sectional, cohort, clinical trial, and randomised controlled trial study designs. Eligible participants were both males and females, aged 18–49 years, who were undergoing invitro fertilisation or intracytoplasmic sperm injection. Studies were excluded if their primary analysis assessed consumption of individual foods, food groups, vitamins, or minerals, rather than dietary patterns. Studies measuring proxy estimates of fertility status such as sperm quality or quantity were not included. Main results and the role of chance Twelve studies (11 prospective cohort studies, 1 randomised controlled trial) reporting on 3144 participants (92% female) were included in the review. Six studies were of positive methodological quality, and six were of neutral quality. Eleven studies used validated food frequency questionnaires to quantify dietary pattern adherence. In individual studies, three dietary patterns (Mediterranean diet, pro-fertility diet, Iranian traditional medicine diet) were associated with increased likelihood of achieving a clinical pregnancy, while two dietary patterns (pro-fertility diet, Mediterranean diet) were associated with increased probability of live birth. Meta-analyses of five Mediterranean diet cohort studies showed no association between dietary pattern and clinical pregnancy (OR 1.3; 95% CI: 0.73- 1.72, P = 0.59), and meta-analysis of three Mediterranean diet cohort studies found no relationship between dietary pattern and live birth (OR 1.51; 95% CI: 0.83–2.76, P = 0.18). Limitations, reasons for caution Males were under-represented in the included studies, and half of the studies were of neutral methodological quality. All studies completed dietary assessments at baseline only, however dietary assessments should ideally be undertaken at regular intervals throughout the duration of cohort studies, in the event that dietary patterns change over time. Wider implications of the findings: Further research utilising higher quality nutrition research methodologies is required to better understand the association between dietary patterns and fertility outcomes during assisted reproductive technologies. Trial registration number Not applicable

Use of testicular sperm for intracytoplasmic sperm injection in men with high sperm DNA fragmentation: a SWOT analysis.

Spermatozoa retrieved from the testis of men with high levels of sperm DNA fragmentation (SDF) in the neat semen tend to have better DNA quality. Given the negative impact of SDF on the outcomes of Assisted Reproductive Technology (ART), an increased interest has emerged about the use of testicular sperm for intracytoplasmic sperm injection (Testi-ICSI). In this article, we used a SWOT (strengths, weaknesses, opportunities, and threats) analysis to summarize the advantages and drawbacks of this intervention. The rationale of Testi-ICSI is bypass posttesticular DNA fragmentation caused by oxidative stress during sperm transit through the epididymis. Hence, oocyte fertilization by genomically intact testicular spermatozoa may be optimized, thus increasing the chances of creating a normal embryonic genome and the likelihood of achieving a live birth, as recently demonstrated in men with high SDF. However, there is still limited evidence as regards the clinical efficacy of Testi-ICSI, thus creating opportunities for further confirmatory clinical research as well as investigation of Testi-ICSI in clinical scenarios other than high SDF. Furthermore, Testi-ICSI can be compared to other laboratory preparation methods for deselecting sperm with damaged DNA. At present, the available literature supports the use of testicular sperm when performing ICSI in infertile couples whose male partners have posttesticular SDF. Due to inherent risks of sperm retrieval, Testi-ICSI should be offered when less invasive treatments for alleviating DNA damage have failed. A call for continuous monitoring is nonetheless required concerning the health of generated offspring and the potential complications of sperm retrieval.

Spermatogonial Stem Cells: A Current Update in the Management of Azoospermic Infertile Men

One of the management of azoospermia is utilizing Assisted Reproductive Technologies (ART) by Intra-Cytoplasmic Sperm Injection (ICSI) with sperm obtained from the epididymis or directly from testis. In some conditions such as hypogonadism or undescended testis, the sperm are not successfully obtained. Thus, it is considered to perform Spermatogonial Stem Cells (SSCs) culture to restore men fertility. The objective of this work was to systematically review and discuss articles dealing with the subject of SSCs as a current update of azoospermic management. To this purpose, a computerized search of PubMed database was performed on the general term such as “male infertility”, “azoospermia” and “human spermatogonial stem cells” and the articles obtained were evaluated and collected. SSCs are adult stem cells which capable to self-renewal, differentiate, transmit the material genetic to offspring. SSCs have a vital role in spermatogenesis and in vitro proliferation which could be utilized for azoospermic management. Some alternative of SSCs utilization followed by ICSI in men with azoospermia, the formation of artificial sperms and auto-transplantation of in vitro proliferated SSCs, are under the preclinical phase of development. SSCs utilization is the proper approach to manage the azoospermic infertile men who sperm couldn’t be obtained. The procedure of SSCs utilization such as culture method, including isolation, identification and tumor forming, should be investigated prior to clinical application.

Outcomes of intracytoplasmic sperm injection in men with oligoasthenotspermia and bacteriospermia

Outcomes of intracytoplasmic sperm injection in men with oligoasthenotspermia and bacteriospermia

The safety of intracytoplasmic sperm injection in men with hepatitis B.

IntroductionIn this study, we aimed to evaluate the safety of using different sources of sperm when male partners were infected with hepatitis B virus (HBV).Material and methodsA total of 338 couples receiving their first intracytoplasmic sperm injection (ICSI) cycle at the Department of Reproduction, Ren Ji Hospital, between 2007 and 2012 were enrolled if the female partner tested negative for HBV DNA, HBsAg, HBeAg, HBeAb and HBcAb. Couples were divided into HBV active infection (group B), convalescent infection (group C) and controls (group A). Subgroups were divided by source of sperm: ejaculated sperm and testicular sperm aspiration/percutaneous epididymal sperm aspiration (TESA/PESA) sperm.ResultsWhen using ejaculated sperm for ICSI, two pronuclear (2PN) fertilization rate, implantation rate, clinical pregnant rate, early miscarriage rate and live birth rate showed no significant difference between the three groups. However, in the three TESA/PESA groups, the early miscarriage rate was highest in men with active HBV infection (B2) (23.1%, p = 0.035). The 2PN fertilization rate and CPR were also lower in the active infection group (76.7%, 26.3%) than the convalescent infection (82.9%, 36.2%) and control group (78.2%, 50%), but the difference was not statistically significant. No malformed infant was found in any of these groups.ConclusionsWhen men have an active HBV infection, using TESA/PESA sperm may cause lower fertilization, a high miscarriage rate and a lower live birth rate, which indicates that HBV active infection may cause adverse effects on ICSI reproductive performance when using testicular or epididymal aspirated sperm.

Perspectives of infertile men on future stem cell treatments for nonobstructive azoospermia

Concerns have been expressed about the rapid introduction of new fertility treatments into clinical practice. Patients’ perspectives on new treatments and their introduction into clinical practice are unexplored. Two alternative treatments for testicular sperm extraction followed by intracytoplasmic sperm injection in men with nonobstructive azoospermia (NOA), the formation of artificial sperm and autotransplantation of in vitro proliferated spermatogonial stem cells, are in a preclinical phase of development. This study aimed to explore, prior to future clinical introduction, which treatment aspects are valued by NOA patients and would be taken into account in deciding to undergo these future treatment options. In-depth telephone interviews were conducted with 14 men with NOA. Interviews were transcribed, analysed with content analysis and data saturation was reached. Besides the obvious factors, success rates and safety, patients valued ‘the intensity of the procedure’, ‘the treatments’ resemblance to natural conception’ and ‘feeling cured’. Patients supported the development of these treatments and were eager to take part if such treatments would become available in the future. The patient’s perspective on innovative treatments can (co)direct reproductive research. More research into the patients’ perspectives on innovations and minimal thresholds to be met prior to their introduction into clinical practice is required.Many couples face infertility and seek help for their unwanted childlessness. For men who are infertile because they do not ejaculate sperm cells, the only treatment option is surgically retrieving sperm cells from their testis (testicular sperm extraction, TESE) and this surgery, as well as the subsequent fertilization of an oocyte via intracytoplasmic sperm injection (ICSI), is often unsuccessful. Researchers are currently developing two alternative treatment options for these men involving stem cells. However, concerns have been raised on the need to define when new treatments can be tested on humans. The views of patients who will potentially undergo these treatments need to be heard regarding the new treatments being developed and on when they would be prepared to take part in new treatments. Therefore, this study explored patients’ perspectives on current treatment (TESE–ICSI) and the two alternative treatment options by conducting in-depth interviews with 14 infertile men. Two researchers independently analysed the interview transcripts for common themes. Patients’ appreciation of alternative treatment options depended on the effectiveness and safety of treatments but also on the intensity of the treatment procedure, the resemblance to natural conception and on feeling cured. Patients supported the development of the proposed new treatment options potentially enabling them to father a child and they were eager to take part in (research on) these alternative treatments. These findings can codirect research on these new treatment options. Moreover, this research is a first step towards incorporating patients’ perspectives into defining when to introduce new technologies into clinical practice.

In vitro fertilization–intracytoplasmic sperm injection outcome in patients with a markedly high DNA fragmentation index (>50%)

To investigate differences in fertilization, clinical pregnancy, and miscarriage rates between men with a markedly high sperm DNA fragmentation index (DFI) (>50%) and those with low DFI (≤ 15%) in couples matched by female partner age and ovarian reserve as determined by antimüllerian hormone (AMH) level. Retrospective cohort study. University-affiliated fertility center. Men undergoing intracytoplasmic sperm injection (ICSI) cycles who had low (n = 114) or markedly high (n = 36) DNA damage. None. Sperm DNA damage evaluated by acridine orange flow cytometry and expressed as the DFI, with the potential confounders of ovarian reserve and age controlled for by multivariable logistic regression analysis. The fertilization and clinical pregnancy rates were not different between the two groups. We observed a trend toward a higher miscarriage rate with the high DFI group, but it did not reach statistical significance. Intracytoplasmic sperm injection in men with a high DFI with sperm selected by movement and morphology characteristics resulted in a similar pregnancy rate compared with the controls with a normal DFI. However, the trend observed of an increase in miscarriages suggests that any potential negative impact may appear later in development. Future studies involving a larger cohort may determine if the miscarriage trend reaches statistical significance.

Factors influencing intracytoplasmic sperm injection (ICSI) outcome in men with azoospermia

What's known on the subject? and What does the study add? The management of patients with non‐obstructive azoospermia (NOA) and some cases of obstructive azoospermia involves testicular sperm extraction (TESE or micro‐dissection TESE) combined with intracytoplasmic sperm injection (ICSI). Several studies have investigated the effect of the male age, the cause of azoospermia, testicular histopathology, the type of sperm used, and the use of pentoxyphilline, on the ICSI cycle outcome in men with azoospermia. The present study showed that none of these factors influenced the ICSI outcome in men with azoospermia, thus once sperm is found in an azoospermic male, no other male factor seems to influence the ICSI outcome. To our knowledge this is the first study to comment on the outcome of ICSI in men with NOA based on testicular histopathology. Objectives To access the effect of: male age, the cause of azoospermia (obstructive azoospermia vs non‐obstructive azoospermia [NOA]), testicular histopathology, the type of sperm used (fresh vs frozen‐thawed), and the use of pentoxyphilline on the intracytoplasmic sperm injection (ICSI) cycle outcome in men with azoospermia. To our knowledge this is the first study to comment on the outcome of ICSI in men with NOA based on testicular histopathology. Patients and Methods A retrospective analysis of 137 testicular sperm extraction‐ICSI cycles performed between 2001–2010, involving 103 men with azoospermia, with 26 couples having repeat cycles. Results Analysis of the results did not show any statistically significant differences in the fertilization, embryo cleavage, clinical pregnancy, live birth and miscarriage rates in relation to the male age, cuase of azoospermia, testicular histopathology, type of sperm used and the use of pentoxyphilline. Conclusion Once sperm is found in a man with azoospermia, no other male factor seems to influence the ICSI outcome.

Screening for partial AZFa microdeletions in the Y chromosome of infertile men: is it of clinical relevance?

To evaluate the frequency of complete and partial AZFa Y-chromosome microdeletions among infertile Israeli men. To review the published frequencies and histologic findings of AZFa deletions. Retrospective study. Academic medical center. A total of 1,260 infertile Israeli men. Literature review (2000-2010) of reports on men with AZFa deletions and their testicular findings. The DNA of 1,260 infertile men was evaluated for AZF microdeletions. The DNA of 657 of them with undetected microdeletions was analyzed for partial AZFa deletion in the USP9Y and DDX3Y genes using sequence-tagged sites beyond EAA/EMQN recommendations. The frequency of complete and partial AZFa microdeletions. Availability of sperm cells for intracytoplasmic sperm injection in men with complete/partial microdeletions. Two men had complete AZFa deletion (a frequency of 0.28% among nonobstructive azoospermic men). None had partial AZFa deletions. The likelihood of finding sperm cells in men with complete AZFa deletions is negligible. Complete AZFa deletion is rare and usually associated with azoospermia and absence of sperm cells in testicular tissue. The low frequency of partial AZFa deletions and the inconsistent prospects for spermatogenesis reported in the literature question the need for routine assessment of microdeletions in genes, such as USP9Y or DDX3Y.

Alternate indications for varicocele repair: non-obstructive azoospermia, pain, androgen deficiency and progressive testicular dysfunction

Varicocele repair is indicated for infertile men with clinical varicoceles. Some men with scrotal pain, low testosterone, non-obstructive azoospermia, and who are at risk for testicular dysfunction may also benefit from varicocelectomy.

Predictors of Sperm Recovery and Azoospermia Relapse in Men With Nonobstructive Azoospermia After Varicocele Repair

In this study we determined the recoverability and sustainability of motile sperm in semen of men with nonobstructive azoospermia after varicocelectomy as related to different variables. Men with documented infertility for more than 1 year, with nonobstructive azoospermia and clinically palpable varicoceles were included in this prospective noncontrolled study. Participants underwent simultaneous subinguinal microsurgical varicocelectomy and testicular biopsies. Preoperative as well as initial and late followup semen analyses were performed. Outcomes of sperm recovery and relapse of azoospermia were correlated with the variables of patient age, infertility duration, varicocele grade, laterality, follicle-stimulating hormone, testicular volume and testicular histology. The study included 31 men with a mean ± SD age of 34.9 ± 8.7 years and mean followup of 19.3 ± 3.3 months. Hypospermatogenesis, late maturation arrest, early maturation arrest and Sertoli-cell-only were observed in 13, 6, 2 and 10 patients, respectively. Overall, sperm recovery was evident in 10 of 31 (32.3%) patients (persistent recovery 19.4%, intermittent recovery 6.5%, relapse 6.5%). Sperm were recovered in patients with hypospermatogenesis (7 of 13, 53.8%) and late maturation arrest (3 of 6, 50%). No sperm were recovered in those with early maturation arrest or Sertoli-cell-only. Among the variables only histological patterns demonstrated a significant correlation with recovery (rho = 0.504, p = 0.004). None of variables was significantly correlated with relapse. Bilateral varicocele repair demonstrated a strong yet nonsignificant negative correlation with relapse (rho = -0.612, p = 0.06). Varicocelectomy could recover motile sperm in men with nonobstructive azoospermia, palpable varicoceles and hypospermatogenesis or late maturation arrest. No sperm was recovered with early maturation arrest or Sertoli-cell-only. Recovery might be persistent or intermittent, or involve relapse of azoospermia. Testicular histology was the sole parameter significantly correlated with recovery and no predictors of relapse could be identified. This prognostic role of testicular biopsy is imperative in couple counseling.

The relationship between isolated teratozoospermia and clinical pregnancy after in vitro fertilization with or without intracytoplasmic sperm injection: a systematic review and meta-analysis

We conducted a systematic review and meta-analysis of data from the literature from the years 1986 to 2009 using teratozoospermia and fertilization or IVF or in vitro fertilization as the keywords. A total of 31 studies were identified, and 4 met the inclusion criteria. Isolated teratozoospermia was not associated with a statistically significantly decreased probability of pregnancy with assisted reproduction.

A sperm viability test using SYBR-14/propidium iodide flow cytometry as a tool for rapid screening of primary ciliary dyskinesia patients and for choosing sperm sources for intracytoplasmic sperm injection

Spermatozoa viability tests based on dual-color flow cytometry after staining with Sybr-14/propidium iodide were performed on 44 men with complete asthenospermia for primary ciliary dyskinesia (PCD) screening, and seven were identified with PCD by electron microscopy of ultrastructural ciliary defects. Six PCD patients underwent eight intracytoplasmic sperm injection therapy cycles using ejaculated sperm or testicular sperm, obtaining a mean fertilization rate of 46.6%, with three healthy babies born and one in utero at the time of writing.

Sperm Retrieval and Intracytoplasmic Sperm Injection in Men With Nonobstructive Azoospermia, and Treated and Untreated Varicocele

We evaluated the impact of varicocelectomy on the sperm retrieval success rate using microsurgical testicular sperm extraction and intracytoplasmic sperm injection in men with clinical varicocele and nonobstructive azoospermia. The study included 96 men with complete nonobstructive azoospermia with a history of clinical unilateral or bilateral varicocele. Of the patients 66 previously underwent successful varicocelectomy and 30 had any grade of varicocele at sperm extraction. Mean patient age was 34.8 and 32.3 years in the treated and untreated groups respectively. There were no differences in mean follicle-stimulating hormone, testicular volume, infertility duration or female partner age between the 2 groups. The proportion of female factor problems in the 2 groups was similar. The distribution of varicocele grade in the treated and untreated groups was not different. The sperm retrieval rate was significantly higher in the treated group (53% vs 30%, OR 2.63, 95% CI 1.05-6.60, p = 0.036). There was no significant difference in the normal 2PN fertilization rate (63.9% vs 53.6%). The rate of high quality embryos and mean number of transferred embryos were similar in the groups. The clinical pregnancy rate in the treated and untreated groups was 31.4% and 22.2%, respectively (p >0.05). Our results suggest that varicocele repair significantly increased the sperm retrieval rate in patients with clinical varicocele and nonobstructive azoospermia.

Factors affecting successful outcome from ICSI in men following previous vasectomy

There are conflicting reports as to whether the interval between vasectomy and surgical sperm retrieval (SSR) for intra-cytoplasmic sperm injection (ICSI) is related to clinical pregnancy (CPR), and live birth (LBR), rates. This study aimed to evaluate factors that may influence the outcome of ICSI in males with secondary azoospermia due to previous vasectomy. We analysed the medical records of 198 azoospermic males following vasectomy who underwent percutaneous epididymal sperm aspiration (PESA) and/or testicular sperm extraction (TeSE), between 1997 and 2005 by a single urologist, and whose sperm was subsequently frozen for use in an IVF treatment programme on their partner's behalf. Hundred and forty-four (73%) males had a positive PESA, and the remaining 54 (27%) had a positive TeSE. Forty-four percent of males with no clinical evidence of epididymal distension still had epididymal sperm retrieved successfully. Hundred and twenty-eight patients proceeded with ICSI, and a total of 237 cycles were performed. The CPR and LBR overall were 29 and 27%, respectively. Using logistic regression there was no association between time since vasectomy and CPR (P = 0.17) or LBR (P = 0.31). A history of an attempted reversal of vasectomy did not negatively affect retrieval rates or CPR and LBR. The success of SSR and the outcome of ICSI, using frozen sperm, are independent of male age and time since vasectomy. Epididymal sperm may be retrieved in over 40% of men in whom there is no clinical evidence of epididymal distension.