Severe Oligoasthenospermia Research Articles

The Impact of Using Donor Sperm After ICSI Failure in Severe Oligozoospermia on Male Mental Health and Erectile Function.

To analyze the mental health and erectile function status of men using sperm donor during pregnancy after ICSI failure in severe oligoasthenospermia and to provide reference for clinical implementation of more targeted psychological intervention and nursing for this group. A total of 410 sterile men who received assisted pregnancy treatment in our hospital from December 2020 to December 2022 and met the inclusion and exclusion criteria were collected as the study subjects. Among them, 68 patients with severe oligoasthenospermia who used donor assisted pregnancy after ICSI failure were used as the study group. Sixty-eight patients with severe oligoasthenospermia who continued to receive ICSI assisted pregnancy were matched by propensity score 1:1 as control group. General data questionnaire, self-rating Anxiety Scale (SAS), self-rating Depression Scale (SDS), Chinese version of perceived Stress Scale (CPSS) and International Erectile Function Index Rating Scale (IIEF-5) were used to conduct a cross-sectional investigation to compare the mental health and erectile function status of the two groups. There were statistical differences in age and occupational status between the two groups before PSM (P < 0.05), but there was no statistical significance in social demographic data between the two groups after matching (P > 0.05). The incidence of anxiety, depression, stress and erectile dysfunction (ED) in the study group was higher than that in the control group, and there were statistical differences between the two groups (P < 0.05). The use of donor sperm to assist pregnancy has a great impact on the mental health and erectile function of infertile men. Medical personnel should pay attention to the mental health and erectile function of these men, and formulate targeted measures to help these patients actively cope with infertility, so as to improve the life and marriage quality of this group and improve their mental health status.

Comparison of the effects of sperm selection methods on assisted reproduction outcomes in male infertility

Objective: To compare physiological intracytoplasmic sperm injection (PICSI) and the hypoosmotic swelling test (HOST) sperm selection techniques in terms of embryo development, implantation rate and live birth rates in cases of severe or moderate oligoastheneospermia. Materials and Methods: The electronic material and files of cases admitted to the Medipol University IVF Centre between 2013 and 2022 were analyzed retrospectively. This research included a total of 143 cases with moderate or severe oligoasthenospermia, 80 cases with PICSI as sperm selection technique and 63 cases with HOST as sperm selection technique. Cases of severe or moderate oligoasthenospermia as defined by the World Health Organisation (WHO) are included in this study. The demographic parameters of both groups, including female age, paternal age, duration of infertility, AMH (anti-Mullerian hormone), body mass index (BMI), endometrial thickness, and the number of prior attempts, were analyzed. Implantation, pregnancy loss, and rates of live births were compared between two groups. Results: Female age, paternal age, AMH, endometrial thickness, BMI, and the number of previous trials were similar between the groups included in the study. There were not any significant differences between the groups in terms of fertilization (.18±6.92 vs 9.11±6.35, p=0.345), TQ-GQ blastocyst development (2.36±2.40 vs 1.64±2.35, p=0.097), and the number of embryos transferred (1.59±0.50 -1.76±0.44 p= 0.141). The live birth rates between the PICSI and HOST groups did not vary statistically (p=0.790), however, the rate of implantation was significantly higher in the HOST group (p=0.043). Sperm selection by PICSI or HOST method did not affect fertilization, TQ-GQ blastocyst development, and the rates of pregnancy loss and live birth. Conclusion: Although there were not any differences in embryo development, pregnancy loss, and live birth rates comparing the two methods, the HOST group had a higher implantation rate. Keywords: PICSI, HOST, Male infertlity, live birth

P-782 The influence of microfluidic preparation of spermatozoa for ICSI (intracytoplasmic sperm injection) in an unselected IVF population on fertilization rate, embryo-quality and pregnancy rate

Abstract Study question Does the microfluidic technique as a new preparation option for sperm in ICSI during IVF have a better outcome in fertilization, blastocysts and pregnancy rate? Summary answer The patients that had the sperm preparation for ICSI with the microfluidic sperm selection had similar results as with the gradient centrifugation selection. What is known already Semen analysis is a poor predictor of the fertilization potential of spermatozoa and a male factor may contribute to poor outcomes of IVF procedure despite a normal semen analysis. Traditionally, sperm processing is accomplished by density gradient centrifugation or swim-up methods but this have been shown in some studies to increase reactive oxygen species and induce sperm DNA fragmentation. The microfluidic sperm selection (ZyMot- ICSI) is based on the selection of the spermatozoa with the lowest DNA fragmentation rate but studies do not prove better clinical outcomes after this method. Study design, size, duration This is a prospective randomized study carried out in a university level fertility clinic in Oradea, Romania from January 2022 to December 2022, including 239 patients in total. The patients that underwent IVF-ICSI procedures for various indications were randomized in two groups: the control group swim-up technique was used for sperm selection for ICSI during IVF and the study group with the ZyMot-ICSI (microfluidic sperm selection technique) was used. Participants/materials, setting, methods We conducted a prospective trial comparing 119 couples that were allocated to the classic swim-up technique (control group) and 120 couples that were allocated with the microfluidic technique was used (study group) in our university level clinic to go through IVF. Inclusion criteria were couples with known infertility requiring IVF and willing to participate in the study. Exclusion criteria were: severe oligoasthenospermia (concentration &amp;lt; 5x10^6 spermatozoa/ml or motility &amp;lt;10%), oocyte or sperm donation. Main results and the role of chance The statistical analysis showed that there is no significant difference between the fertilization rate (study vs control p = 0.37 with absolute difference -1.182, 95% CI (-7.2, 5.4)) or blastocyst rate (study vs control p = 0.88 with absolute difference -0.5 95% (-6.5, 6)) nor is there a difference in clinical pregnancy. Even if microfluidic preparation of spermatozoa did not seem to improve the results it may be utilized more broadly for standard IVF, intrauterine insemination and could also improve workflow, decrease intervention by laboratory personal and provide more consistent incubation conditions. Limitations, reasons for caution The population studied was inclusive with unselected IVF indications and did not attempt to isolate male factor infertility cases or patients with a history of elevated sperm DNA fragmentation. Wider implications of the findings Microfluidic sperm preparation performs similarly to density gradient centrifugation in sperm preparation for IVF in an unselected population. Trial registration number Not applicable

(248) Utility of Fine-needle Vasography in Men with Obstructive Azoospermia

Abstract Introduction Obstructive azoospermia accounts for up to 14% of patients presenting for fertility evaluation. Fine-needle vasography (FNV) is a diagnostic procedure that can be performed to identify an obstruction proximal to the ejaculatory duct. Compared to traditional vasography, FNV utilizes a less-invasive method to perform imaging of the vas deferens and distal ejaculatory structures. Herein we report our experience performing FNV in a series of patients with suspected complete or near-complete obstruction. Objective To report our experience using FNV to identify a site of obstruction and determine candidacy for reconstructive procedures in patients presenting with suspected obstructive azoospermia or cryptozoospermia. Methods We report a multi-Institutional case series of patients with suspected complete or partial obstructive azoospermia. Patients that were included had azoospermia or severe oligoasthenospermia, presence of palpable vasa, testicles ≥12 ml, and FSH &amp;lt;7.6 IU/L. All patients underwent testicular biopsy prior to or at the time of FNV to confirm spermatogenesis. Fine-needle vasography was performed using a 25F angiocatheter, with radio-opaque dye visualized under fluoroscopy. Descriptive statistics are reported as median and interquartile range (IQR). Results A total of 16 patients underwent vasography between 2014 and 2022 with three surgeons. Twelve patients presented with azoospermia, and four with severe oligoasthenospermia. Median age at vasography was 35.0 (IQR 17) years. Median pre-vasography semen parameters were sperm concentration 0 million/mL (IQR 0.3), sperm motility 0% (IQR 1), semen volume 2.5 mL (IQR 2.5), and semen pH 8.0 (0.7). Median total testosterone was 445 ng/dL (IQR 433), and FSH 4.5 IU/L (IQR 3.6). Half of patients had a history of inguinal hernia repair, unilateral in two and bilateral in six cases. History of genitourinary infection was present in six (35.3%) patients. A total of 7 (44%) men were found to have distal obstruction on FNV, while 8 (50%) were offered epididymovasal reconstruction. Of the seven patients diagnosed with obstruction/atresia of the vas deferens within the inguinal canal and/or pelvis, only two were related to prior inguinal hernia repair. Of the eight men with prior inguinal hernia repairs, two were confirmed to have an obstruction at the level of the inguinal canal. Of the six patients with a history of genitourinary infection, four had an obstruction at the level of the epididymis (with normal FNV), while two had atresia of the vas deferens in the pelvis. Conclusions Fine-needle vasography is an effective, minimally-invasive way to identify the site of complete or partial obstruction in patients presenting with suspected obstructive azoospermia or severe oligoasthenospermia. It additionally permits identification of men who are candidates for epididymovasostomy reconstruction and helps to differentiate between ejaculatory duct obstruction and other causes of blockage. Disclosure No

Chromosomal abnormalities and clinical conditions associated with the male infertility among Emirati

Background: Male infertility is a global health issue that is poorly described in United Arab Emirates. Methods In this 10-year retrospective cross-sectional study, we retrieved data of 312 male patients attending Dubai Fertility Center in United Arab Emirates between January 2011 and January 2021. We identified the type and prevalence of chromosomal abnormalities and hormonal and semen abnormalities among Emirati infertile males as compared with regional and global populations. Results Total chromosomal abnormalities accounted for 13.9% and 8% among azoospermic Emiratis and total Emirati infertile males, respectively. Numerical chromosomal abnormalities causing male infertility were Klinefelter syndrome, 47,XXY (4.0%); Jacob syndrome, 47,XYY (0.8%); mosaic, 48,XXXY/47,XXY/46,XY (0.4%); and mosaic 47,XXY/46,XY (0.4%). Structural chromosomal abnormalities causing male infertility were Y chromosome microdeletion (1.2%), 46,XX/46,XY (0.4%), 46,XY,inv(5)(p15.1q11.2) (0.4%), and 45,XY,der(13;15)(q10;q10) (0.4%). About 59.0% of the Emirati cohort had azoospermia, whereas 28.46% were diagnosed with other conditions of spermatogenic failure as severe oligoasthenoteratozoospermia (7.63%), severe oligoasthenospermia (5.22%), severe oligozoospermia (4.41%), oligoasthenoteratozoospermia (3.6%), asthenozoospermia (2.4%), oligoasthenospermia (1.6%), oligozoospermia (2%), teratozoospermia (0.8%), asthenoteratozoospermia (0.4%), and aspermia (0.4%). As for male hormonal profile of the Emiratis, azoospermic males with chromosomal defects had higher testosterone abnormality (72.2% vs. 45.4%), interstitial-cell stimulating hormone abnormality (66.6% vs. 42.6%), follicle-stimulating hormone abnormality (72.2% vs. 41.5%), and inhibin B hormone abnormality (100% vs. 83.8%) as compared to azoospermic males without chromosomal abnormalities. Conclusion This is the first study to report conclusively the profiling of chromosomal abnormality among Emirati infertile males, which falls within the regional and global range, and to highlight the critical role of genetic testing and counseling for evaluating male infertility.

The relationship between TSH levels and clinical pregnancy outcomes for patients who undergo in vitro fertilization/intracytoplasmic sperm injection: a retrospective study.

BackgroundThyroid dysfunction is linked with adverse pregnancy outcomes, an upper limit of a normal thyroid-stimulating hormone (TSH) threshold of 4.12–4.5 mIU/L should be considered for subclinical hypothyroidism in the infertile female population. Whereas, it’s controversial whether or not the infertility thresholds for upper limit of TSH threshold of 2.5 mIU/L. In our study examines the correlation of optimal TSH levels and clinical pregnancy outcomes after fresh in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) embryo transfer cycles.MethodsPatients who underwent fresh IVF/ICSI embryo transfer cycles for the first time who presented between January 1, 2015 and December 31, 2017 at the Chongqing Institute of Reproductive and Genetic, Chongqing Health Center for Women and Children were enrolled. We excluded patients with ≥40 years, body mass index (BMI) ≤18 or ≥28 kg/m2, the man with severe oligoasthenospermia, women with poor ovarian reserve, and presence of endocrine disorders, uterine anomaly, sactosalpinx, abnormal thyroid function, preimplantation genetic diagnosis, and chromosomal abnormality or polymorphism. Baseline characteristics and clinical pregnancy outcomes were observed in our study. We detected between TSH levels and clinical pregnancy outcomes in patients undergoing IVF/ICSI by Receiver operating characteristic (ROC) curves and logical regression.ResultsA total of 6,088 patients who undergo IVF/ICSI were included. We first detected that the live birth rate had a statistically significant difference when the TSH level was 3 mIU/L. With the TSH ≤3 mIU/L group having a higher live birth rate than the TSH >3 mIU/L group (51.79% vs. 47.89%, P=0.024), meanwhile no significant difference were revealed between the early miscarriage rate (12.54% vs. 14.97%, P=0.091) and early clinical pregnancy rate (59.21% vs. 56.32%, P=0.114). There were no differences in pregnancy outcomes when the TSH threshold was at 3.5 or 4 mIU/L and no association was detected between TSH levels and clinical pregnancy outcomes in patients undergoing IVF/ICSI by ROC curves and logical regression.ConclusionsPatients undergoing IVF/ICSI with a serum TSH level ≤3 mIU/L may have a higher live birth rate rather than ≤2.5 or ≤4 mIU/L.

Mitochondrial DNA content reduction in the most fertile spermatozoa is accompanied by increased mitochondrial DNA rearrangement.

Is there an association between male fertility and spermatozoa mitochondrial DNA (mtDNA) copy number and genome rearrangements? Normal spermatozoa not only have a lower mtDNA copy number but also more DNA rearrangements than spermatozoa of men with severe oligoasthenospermia (SOA). While there is a consensus that mtDNA content is decreased in the most fertile spermatozoa, the role of mtDNA sequence alteration in male infertility is unclear. High-throughput sequencing, which allows an exhaustive analysis of mtDNA rearrangements and mutations, could be helpful in this context, but has yet to be used. This is an observational study of semen samples obtained from 44 men undergoing ART at an academic infertility centre in France, from October 2018 to November 2020. The men were classified into two groups: 20 men in the SOA group and 24 men with normal semen parameters in the control group. For each patient and control, mtDNA was isolated from sperm fractions from the 40% and 90% layers of the density gradient. The average mtDNA content of each sample was assessed using digital PCR. Deep sequencing was performed using next-generation sequencing. Signal processing and base calling were performed via the embedded pre-processing pipeline, the variants were analysed using an in-house workflow and a dedicated tool, based on soft-clipping, was used to study large mtDNA rearrangements. The distribution and the type of rearrangements and variants were compared between patients with SOA and controls on one hand, and between the 40% and 90% gradient layers, on the other hand. The mtDNA content of spermatozoa in the SOA group was significantly higher than in the control group (P < 0.0001). Moreover, mtDNA content was significantly higher in spermatozoa from the 40% layer (the most fertile spermatozoa) compared to the 90% layer, both in the SOA (P = 0.02) and the control group (P < 0.0001). The frequency of large mtDNA deletions and duplications was significantly higher in the control group (P = 0.002). Most of these rearrangements are potentially related to DNA breaks and their number was reduced by the removal of the linear mtDNA from the samples. Heteroplasmic variants were found more frequently in the SOA group (P = 0.05) and in the 40% layer (P = 0.03), but none had any obvious functional consequence. Our findings are novel and significant but should be verified in larger cohorts and other types of male infertility. Our findings suggest that sperm mtDNA rearrangements are not necessarily associated with mitochondrial dysfunction and male infertility. Instead, they seem to be concomitant with the process of mtDNA content reduction in the most potentially fertile spermatozoa. Furthermore, they refute the hypothesis that, in the case of mtDNA alteration, a compensatory mechanism allows an increase in mtDNA copy number to rectify the energy deficit. The increased frequency of mtDNA rearrangements in the most fertile spermatozoa is a novel result that offers new insight into the relation between sperm quality and mtDNA. This work was supported by Angers University Hospital (grant AOI CHU Angers 2018), Angers University and the French national research centres INSERM and CNRS. There are no competing interests. N/A.

Mutations in CFTR genes are associated with oligoasthenospermia in infertile men undergoing IVF

Cystic fibrosis transmembrane conductance regulator (CFTR) gene mutation has been clearly defined in congenital absence of the vas deferens (CAVD), which is an important cause of obstructive azoospermia. However, the association between oligoasthenospermia and CFTR gene mutation remains controversial. To confirm this issue, 151 infertile Chinese men were screened for CFTR mutation by NGS approach, including 18 CAVD patients, 72 patients with severe oligoasthenospermia and 61 controls with normal sperm parameters. Frequency of mutation in exons of CFTR gene were 66.7% in CAVD patients (12/18) (p<0.001) and 8.33% in severe oligoasthenospermic patients (6/72) (p<0.05), both of which were significantly more frequent than that in the controls (0/61). In terms of introns mutation of CFTR gene, there was no significant difference in frequency of 5T between oligoasthenospermic men (5/144, 3.47%) and the controls (4/122, 3.28%) (p=0.645). In addition, 6 novel mutations in exons of CFTR gene in this study (c.3736A>G, c.635T>G, c.482delA, c.1858C>T, c.2042A>T, c.1586A>C) have not been reported in the Cystic Fibrosis Mutation Database before. Thus, our study provides evidence that CFTR gene mutation may be the aetiology of severe oligoasthenospermia other than CAVD. It may be necessary to screen for CFTR mutations in men with severe oligoasthenospermia before receiving assisted reproductive technology.

Role of microsurgical varicocelectomy in the management of non-obstructive azoospermia with varicocele: our tertiary care centre experience

BackgroundVaricocele is an abnormal dilation and tortuosity of the internal spermatic veins within the pampiniform plexus of the spermatic cord. Varicocele is associated with progressive testicular damage and infertility. Azoospermia is associated with a varicocele in approximately 4–14% cases. For men with azoospermia or severe oligoasthenospermia, varicocele repair may result in modest improvement in semen quality which may have a significant advantage on couple’s fertility options. The aim of the study was to evaluate the role of microsurgical varicocelectomy in the men of non-obstructive azoospermia (NOA) with clinical varicocele.MethodsThis was a retrospective study conducted between August 2012 and January 2017, a backward review of 104 patients with the diagnosis of infertility and NOA with palpable varicocele that underwent microsurgical varicocelectomy at our institution was performed. In addition, microdissection testicular sperm extraction (MDTESE) results of these post-varicoceletomy patients were compared with the patients of NOA without varicocele.ResultsA total of 104 patients underwent varicocelectomy; out of these, 19 patients (18.26%) had sperm on sperm analysis post-operatively. Two of them had spontaneous pregnancy (10.5%), and 3 had children by intracytoplasmic sperm injection (15.78%). Out of the 85 patients who had MDTESE, 29 patients (34.11%) had sperms in their testis. The fertilization rate was 89.65%. Sperm retrieval rate (SRR) in NOA men with varicocele was 34.11% which was higher from those who had NOA without varicocele (24.03%). Live birth rate was 31.03% in NOA men who had varicocelectomy which was more in comparison to NOA men without varicocele (24%).ConclusionsIn NOA men with varicocele microsurgical varicocelectomy may have favourable effects which results in recovery of motile sperms in the post-operative ejaculate and also on spontaneous or assisted pregnancies, but it appears that this effect was more remarkable on MDTESE results when following successful intracytoplasmic sperm injection. Importantly, Sperm retrieval rate, pregnancy rate and subsequent live birth rate were higher in these patients in comparison to patients affected by NOA alone. In patients with NOA and coexisting varicocele, varicocelectomy can be considered to be essential to the overall reproductive outcome in these patients.

Metabolomic signature of the seminal plasma in men with severe oligoasthenospermia.

Male factor is incriminated in approximately 50% of cases of infertility. The metabolomic approach has recently been used in the assessment of sperm quality and male fertility. We analyzed the metabolomic signatures of the seminal plasma in 20 men with severe oligoasthenospermia (prewash total motile sperm count<5.106 ) (SOA) and compared it to 20 men with normal semen parameters, with a standardized approach of targeted and quantitative metabolomics using high-performance liquid chromatography, coupled with tandem mass spectrometry, and the Biocrates Absolute IDQ p180 kit. Among the 188 metabolites analyzed, 110 were accurately measured in the seminal plasma. A robust model discriminating the two populations (Q2(cum) = 55.2%) was obtained by OPLS-DA (orthogonal partial least-squares discriminant analysis), based on the drop in concentrations of 37 metabolites with a VIP (variable important for projection) greater than 1. Overall, in men with SOA, there was a significant decrease in: 17 phosphatidylcholines and four sphingomyelins; acylcarnitines, with free L-carnitine being the most discriminating metabolite; polyunsaturated fatty acids; six amino acids (glutamate, aspartate, methionine, tryptophan, proline, and alanine); and four biogenic amines (spermine, spermidine, serotonin, and alpha-aminoadipate). Our signature includes several metabolic changes with different impacts on the sperm quality: a change in phospholipid composition and the saturation of their fatty acids that is potentially linked to the deterioration of sperm membranes; a carnitine deficiency that can negatively impact the energy production via fatty acid oxidation and oxidative phosphorylation; and a decreased level of amino acids and biogenic amines that can lead to dysregulated metabolic and signaling pathways. We provide a global overview of the metabolic defects contributing to the structural and functional alteration of spermatozoa in severe oligoasthenospermia. These findings offer new insights into the pathophysiology of male factor infertility that could help to develop future specific treatments.

Understanding Male Infertility and Its Causes : A Review

Infertility is a distressing condition affecting 60-80 million couples all over the world. Infertility can be due to male factor, female factor or a combination of both of them. The male factor accounts for 40-50% of infertility and affects approximately 7% of all men. This paper covers the various etiologies attributing to male infertility, assessment of male factor and treatment options made available through years of research. The modifiable risk factors like obesity, smoking, alcohol intake and cell phone use should be looked for and addressed. Environmental factors like ionising radiations, pesticides and heavy metals should be avoided. The correctable causes should be identified. Antioxidants help in reducing oxidative stress and improving semen parameters. Surgical retrieval of sperms is an important technique in males with azoospermia and severe oligo asthenospermia.

Microlithiasis of Seminal Vesicles and Severe Oligoasthenospermia in Pulmonary Alveolar Microlithiasis (PAM): Report of An Unusual Sporadic Case.

Pulmonary alveolar microlithiasis (PAM) is classified as an elective dysmetabolic thesaurotic pneumoalveolitis and characterized by the presence within the alveoli of the lungs of myriad of tiny calculi. The classic presentation of the chest radiography is unmistakable with multiple small "sand-like" opacities diffusely involving both lung fields. We present a case of male infertility for hypoposia and severe oligoasthenospermia in a young patient with recurrent haematuria and small calcifications in the seminal vesicles similar to pulmonary microliths. PAM was diagnosed on routine chest radiography, com- puter tomography (CT), transbronchial biopsy and bronchoalveolar lavage (BAL).

S039: Is artery preservation varicocelectomy of better outcome than artery ligating technique in severe oligoasthenospermia?

S039: Is artery preservation varicocelectomy of better outcome than artery ligating technique in severe oligoasthenospermia?

MP68-09 EULERIAN VIDEO MAGNIFICATION: A NOVEL TECHNIQUE FOR IMPROVED SPERM SELECTION IN MEN WITH SEVERE OLIGOASTHENOSPERMIA

You have accessJournal of UrologyInfertility: Evaluation1 Apr 2014MP68-09 EULERIAN VIDEO MAGNIFICATION: A NOVEL TECHNIQUE FOR IMPROVED SPERM SELECTION IN MEN WITH SEVERE OLIGOASTHENOSPERMIA Gavin Langille, James Dupree, Jason Kovac, Ranjith Ramasamy, Dolores Lamb, and Larry Lipshultz Gavin LangilleGavin Langille More articles by this author , James DupreeJames Dupree More articles by this author , Jason KovacJason Kovac More articles by this author , Ranjith RamasamyRanjith Ramasamy More articles by this author , Dolores LambDolores Lamb More articles by this author , and Larry LipshultzLarry Lipshultz More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2188AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The absence of sufficient motile sperm in samples used for in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) can present a serious clinical problem for infertility specialists wishing to select viable sperm. Identification of optimal quality sperm can be especially challenging in men with oligoasthenospermia. Eulerian Video Magnification (EVM) is a technique that provides an opportunity to detect subtle movements in video feeds not appreciable to the unaided human eye. EVM is a computational algorithm that uses spatial and temporal variations present in video sources to enhance, in a spatially-multiscale manner, the variation of individual pixel values over time. In patients whose semen samples demonstrate significantly impaired motility by traditional light microscopy, EVM could be used to select viable motile sperm that would have been otherwise identified as non-motile using traditional light microscopic visualization. METHODS Using traditional light microscopy with 400x magnification, semen analysis (SA) samples from men demonstrating severe oligoasthenospermia (density < 1 million/ml and motility < 20%) were investigated. A high definition (HD) video camera was used to record video footage from three high-powered fields (HPF) per SA. Each video recording was scored twice for motility, first using the raw HD footage, and second after the video was processed using EVM previously developed at the Massachusetts Institute of Technology (http://people.csail.mit.edu/mrub/vidmag). Quantitation of motile sperm in each video recording was compared between the raw and EVM-enhanced images. RESULTS Video from eleven SA samples with three recordings each were analyzed. A total of 442 sperm were recorded across all samples. After processing with EVM, the number of additionally recognized motile/viable sperm increased by 14% (p<0.05). CONCLUSIONS EVM is a novel technique to identify viable sperm that would not have been recognized using traditional light microscopy. Using a micro-locator and micro-pipette, these sperm can then be retrieved for IVF-ICSI. Our data suggests that an additional 14% of retrieved ova can then be inseminated. Further studies are underway to refine this technique and to test the efficacy of the additional EVM-identified sperm in improving IVF-ICSI outcomes for the oligoasthenospermic patient. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e801 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Gavin Langille More articles by this author James Dupree More articles by this author Jason Kovac More articles by this author Ranjith Ramasamy More articles by this author Dolores Lamb More articles by this author Larry Lipshultz More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

A study of the effect of the FertilMate™ scrotum cooling patch on male fertility. SCOP trial (scrotal cooling patch) - study protocol for a randomised controlled trial

BackgroundMale infertility is a significant contributor to the need for fertility treatment. Treatment currently involves correcting any identifiable adverse lifestyle factors in men with suboptimal sperm parameters, and if these measures are unsuccessful, assisted conception is offered, which can be quite expensive. Raised scrotal temperature is one of the least studied but easily corrected risk factors for male infertility. In a recent review of the literature, sperm count, motility and morphology improved with scrotal cooling devices. The devices used to achieve testicular cooling were, however, not practical for day-to-day use. A potentially more practical device for scrotal cooling has recently been developed. The Babystart® FertilMate™ Scrotum Cooling Patch is a hydrogel pad which allows for comfortable application. The aims of this study were to investigate whether exposing the scrotum to lower temperatures by means of these new patches could improve semen parameters, thereby improving fertility, and to assess the feasibility of a clinical trial.Methods/designThis is a randomised controlled trial set in a university teaching hospital in the United Kingdom. The proposed sample size was 40 men with mild, moderate or severe oligoasthenospermia, of whom 20 would be randomised to wearing the scrotum cooling patch for 90 days and 20 men would be acting as controls and not wearing the patches. The primary outcome measure was the change in sperm concentration. Secondary outcome measures included the change in sperm volume, motility and morphology; endocrine parameters; metabolomic biomarkers; testicular volume and blood flow. Reasons for dropping out and non-compliance were also going to be noted and reported.DiscussionThe study started recruiting in October 2011 and as of November 2011 four men had been consented and were participating in the study. No operational challenges had been encountered at the time of the submission of this manuscript. Although the study also aimed to evaluate the feasibility of a definitive study, the change in sperm count after 90 days of wearing the scrotal cooling patches was made the primary outcome measure because a statistically significant improvement in sperm parameters with the scrotal patches would in itself be a definitive finding.Trial registrationCurrent Controlled Trials ISRCTN94041896

Letrozole and Cabergoline Co-administration in the Early Luteal Phase for Prevention of OHSS in a High Risk Patient Undergoing Ovarian Stimulation for IVF

Background: In the face of a high risk for OHSS situation, many strategies have been suggested to prevent it; however, none of the proposed strategies completely prevents OHSS. We report a case of a successful IVF pregnancy and complete prevention of OHSS in a patient at high risk of developing OHSS by co-administration of a dopamine agonist and an aromatase inhibitor during the early luteal phase of the cycle. Case: A 21-year-old patient with primary infertility, secondary to severe oligoasthenospermia of the male partner was stimulated with rec-FSH/GnRH antagonist protocol. Final oocyte maturation was achieved by administration of 5000 IU of HCG. Due to the high risk of OHSS, patient received directly post oocyte retrieval up to the day of embryo transfer, daily 5 mg Letrozole and 0.5 mg Cabergoline. One embryo was transferred on day 5 post oocyte retrieval.The patient did not develop any early nor late OHSS while a succesful ongoing pregnancy was achieved. Conclusion: Our findings suggest that the use of cabergoline and letrozole in the early luteal phase for the prevention of OHSS, in patients triggered with hCG, might be a potential new strategy. However their use and effect should be further investigated in prospective randomized studies.

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.

Rare association of multiple etiologies in a severe oligoasthenospermic male

We report a rare case of a 30 year old man diagnosed with severe oligoasthenospermia, where the infertile condition is traced back to a multiple etiologies. Routine semen analysis and sperm function tests followed by hormone analysis are carried out to diagnose the condition as well as the severity. The initial findings prompt us to perform Ultrasound scanning of testis and Trans Rectal Ultrasound Scanning (TRUS) to check the anatomical and functional status of the accessory reproductive organs. Semen analysis and sperm function tests provide an insight into the severity of the condition. The hormonal analysis, Ultrasound scanning of testis and TRUS of accessory reproductive glands confirms the association of hormonal imbalance, testis and accessory gland defects which results in the observed infertile condition with severe sperm defects. A thorough investigation of infertile subjects is essential for appropriate diagnosis and effective personalized treatment owing to the probability of multiple etiologies. Incomplete diagnosis can have adverse effects in treatment and Assisted Reproductive Techniques (ART).

Varicocele Repair in Patients With Nonobstructive Azoospermia: A Meta-Analysis

Multiple small case series have reported sperm in the ejaculate and spontaneous pregnancies in patients with nonobstructive azoospermia after varicocele repair. We hypothesized that men with favorable testicular histopathology on testis biopsy such as maturation arrest or hypospermatogenesis would have a higher probability of success than those with more ablative pathology, eg Sertoli-cell-only. A review of the literature on varicocele repair in patients with nonobstructive azoospermia was performed and 11 publications from the previous 20 years were evaluated. Histopathological data were presented in 8 publications, and were categorized as Sertoli-cell-only, maturation arrest and hypospermatogenesis. Maturation arrest was further differentiated by 4 publications. Early maturation arrest was defined as maturation ending at the secondary spermatocyte and late maturation arrest was defined as maturation ending at the spermatid without spermatozoa present. Success after repair was defined as having sperm in the ejaculate or spontaneous pregnancy. A total of 233 patients were analyzed. After varicocele repair 91 (39.1%) patients had motile sperm in the ejaculate and 14 spontaneous pregnancies were reported. Success rates in patients with maturation arrest (42.1%) or hypospermatogenesis (54.5%) were significantly higher than in those with Sertoli-cell-only (11.3%, p <0.001 in both groups). Patients with late maturation arrest had a higher probability of success (45.8%) than those with early maturation arrest (0%, p = 0.007). Infertile men with nonobstructive azoospermia can have improvement in semen analysis and achieve spontaneous pregnancy after repair of clinical varicoceles. This meta-analysis demonstrates that men with late maturation arrest and hypospermatogenesis have a higher probability of success and, therefore, histopathology should be considered before varicocele repair in men with nonobstructive azoospermia.

Electrical activation of oocytes after intracytoplasmic sperm injection: a controlled randomized study

To evaluate the electrical activation of oocytes in patients with previously failed or limited fertilization after intracytoplasmic sperm injection (ICSI) and in patients with possible failure of fertilization. Prospective randomized study. A private IVF center in Egypt. Two hundred forty-six patients with severe oligoasthenospermia or nonobstructive azoospermia with total teratospermia or totally immotile spermatozoa were selected for the study. Patients who previously had total failure or limited fertilization after ICSI also were included. Sibling oocytes were randomly divided after ICSI into two groups: the study group (n = 1,640) was subjected to electroactivation, and the control group (n = 1,435), to no electroactivation. Electroactivation was performed by using a double-square direct-current pulse. Embryo transfer was performed with the best available embryos. Fertilization rate, degeneration rate, and pregnancy outcome. Two hundred forty-one ICSI cycles were included in the study. The fertilization rate was statistically significantly higher in the electroactivated group as compared with in the control group (68% vs 60%, odds ratio = 1.397, 95% confidence interval = 1.197 to 1.629). The oocyte degeneration rate was not statistically significantly different between the two groups (5.9% vs 4.9%, odds ratio = 0.96, 95% confidence interval = 0.73 to 1.26). In total, 112 clinical pregnancies resulted (pregnancy rate = 46.5%). Total fertilization failure occurred in 5 cycles in the control group, and none failed in the study group. Oocyte electroactivation after ICSI significantly improved the fertilization rate in severe oligoasthenoteratospermia and nonobstructive azoospermia.