Severe Oligoasthenozoospermia Research Articles

Isolated teratozoospermia: revisiting its relevance in male infertility: a narrative review.

Basic semen analysis is the first step in the evaluation of male infertility. It includes an assessment of sperm morphology which is believed to reflect on overall spermatogenesis and sperm function. Teratozoospermia, defined as abnormal sperm morphology, is frequently present in association with severe oligoasthenozoospermia, but isolated teratozoospermia (in the presence of normal counts and motility) is a poorly understood clinical entity with conflicting implications in terms of fertility potential and treatment strategies. The following paper aims to: (I) discuss the classification of sperm morphology, causes, and molecular mechanism of teratozoospermia; (II) analyze the clinical significance and potential treatment options of isolated teratozoospermia as a cause of male infertility and a predictor of fertility outcome; and (III) provide a SWOT (strengths, weaknesses, opportunities, and threats) analysis based on the existing literature on this topic. A comprehensive search from database inception to 25 April 2023 was conducted in PubMed for relevant papers relating to isolated teratozoospermia in male infertility. Finally, seven systematic reviews/reviews/meta-analyses and 81 original articles were synthesized into the current narrative review. Classification of sperm morphology has evolved significantly since the first edition of the World Health Organization (WHO) Manual of Human Semen Analysis. Kruger's strict criteria are the most used classification and have been shown to correlate with fertility outcomes. There are many causes of teratozoospermia including genetic and environmental factors and physical conditions like varicocele. Teratozoospermia correlates with sperm DNA damage, elevated oxidative stress, low antioxidant function, and apoptotic alterations, which can result in impaired spermatozoa function and lower pregnancy rates. However, the clinical correlation between teratozoospermia and assisted reproductive technology (ART) outcome shows conflicting data with recent meta-analyses suggesting that isolated teratozoospermia was not associated with poor fertility outcomes from ART and that intrauterine insemination (IUI) can be an effective option even in the presence of teratozoospermia. There is very limited data on effective therapeutic options to treat idiopathic isolated teratozoospermia. The opportunity for future research is huge to fill the gap in the medical literature on this topic. Contemporary literature on isolated teratozoospermia shows conflicting results in terms of its actual clinical implication in male infertility and the utility of available treatment options. Further research is warranted on this clinical entity to improve sperm function and future paternity.

#305 : Preparation of Epididymal/Testicular Spermatozoa; Technical Aspects and Its Impact on Success

Background and Aims: The introduction of ICSI 30 years ago paved the way for epididymal/testicular spermatozoa to be used to fertilise oocytes in couples undergoing ART. Currently, spermatozoa is recovered from the epididymis or testis using varying approaches, including micro-surgery and fine-needle aspiration, mostly in men with obstructive and nonobstructive azoospermia. The samples delivered to the laboratory for processing are of varying quality with regards to amount of material/tissue, presence of spermatozoa, and other cells. The success of processing the tissue can have a direct impact on the outcome of the subsequent ICSI and our aim for this review was to identify ways to improve the preparation techniques for epididymal/testicular samples. Ethics approval was obtained from WSLHD HREC Ref 5583QA. Methods: The review included 527 ICSI cycles for 311 patients (2016-2022) where epididymal/testicular spermatozoa had been used. Approaches for sample preparation included mini-gradient centrifugation and removal of red blood cells using erythrocyte lysis buffer (ELB). In cases with severe oligoasthenozoospermia (105 cycles, 79 patients), a phosphodiesterase inhibitor (PI) was added to induce motility. Results: Employing mini-gradient centrifugation or adding ELB did not result in lost spermatozoa for any cases, but vastly reduced sample debris allowing for easier identification of spermatozoa. Fertilisation rate after ICSI was 57.9±1.2%. Motile spermatozoa were found and injected in all 105 samples after addition of PI and the fertilisation rate after ICSI was 55.3±2.7. To date cycles with PI have resulted in 26 live births with no abnormalities and all infants were of appropriate weight for gestational age. Conclusions: Employing precise preparation techniques for epididymal/testicular samples is paramount to allow for timely identification of motile spermatozoa for ICSI and assure optimal overall outcome. Sharing and discussing successful approaches with the wider embryology community allows for discussion and refining of techniques which can benefit all.

Role of Ayurvedic Panchakarma Treatment in Male Infertility (Severe Oligoasthenozoospermia)

Infertility is one of the global burning issues which affects the couple socially and individually in a negative way. There are numerous etiological factors that play a significant role to it e.g. like hormonal variations, structural abnormality, functional disorders, psychological factors etc. In Ayurveda a separate department (Tantra) known as sexual invigoration (Vajeekarana) is mentioned by Charak Samhita and Sushrut Samhita to address this problem. The study patient reported with oligozoospermia (low sperm count) and Asthenozoospermia (low sperm motility). Where medicinal treatment (shaman chikitsa) and purification therapy (shodhana chikitsa) i.e. panchakarma especially Intra Urethral Uttar Basti (IUUB) is the management. After 4 months of treatment, his condition is improved from severe oligoasthenozoospermia to normozoospermia. Ayurvedic Panchakarma treatment is safe and effective approach for oligoasthenozoospermia.

Male Infertility in Brazzaville: Prevalence and Sperm Abnormalities Patterns

Background: Male infertility affects 7% of males worldwide (i.e. 30 million of men). The diagnosis of the condition is based firstly on the semen analysis which can show various types of abnormalities. In Congo, data on male infertility are poor. This study aimed to determine the prevalence of male infertility in Brazzaville and to provide the profile of the semen parameters from a cohort of infertile men living at Brazzaville. Material and Methods: We studied semens of three hundred and forty-four (344) congolese men affected by infertility. The work was based on medical data to research medical history and the semen to performed the spermogram and spermocytogram in way to precise the sperm parameters, Results: The prevalence of male infertility found was 9% and the average age was 39 years old. Medical history highligts mostly the notion of chronic infection, varicoceles and surgery of the genital tract. The most identified sperm abnormalities were moderate asthenozoospermia followed by severe oligoasthenozoospermia and azoospermia. Conclusion: The prevalence shows that male infertility is not rare in Brazzaville. As the condition seemed to be related to the infectious, tumoral and professional causes, a complete investigation (based on sperm analysis, biochemical markers and genetic tests) is needed to clarify the etiologies.

Prevalence of Sperm Abnormalities and Factors Associated with Male Infertility in Douala, Cameroon

Introduction: Sperm abnormalities are common causes of male infertility in Cameroon. The causes of these abnormalities are multifactional. We described the prevalence of sperm abnormalities and to assess its associated risk factors among infertile participants visiting four hospitals in Douala. This multicentre descriptive study was carried out from the January 1rst 2010 to the December 31rst 2020 in four hospitals in Douala. The study enrolled 94 infertile participants aged between 25 to 53 years. Information from each consented participant was collected using a structure questionnaire. Following clinical examination, participants were referred for three consecutive spermograms. Data on the results of spermogram, demographic and clinical variables were summarized as frequencies and percentages using SPSS version 20. The frequency and percentage of each variable were presented on tables. This study enrolled 94 participants aged between 25 to 53 years (mean 39.21±10 years). Concerning the sperm abnormalities, most participants had Severe Oligoasthenozoospermia (62.7%), followed by those having severe Oligoasthenozoospermia with necrozoospermia (13.8%). The majority (60.6%) of them had Chlamydia trachomatis (titre IgG > 128) followed by 12.7% of others who had a varicocele. Severe Oligoasthenozoospermia was the most prevalent sperm abnormality and Chlamydia trachomatis was the most prevalent infectious risk factor. In Cameroon, the rate of male infertility is increasing but can be prevented by sustainable health education programme targeting exposure to socio-behavioural risk factors favouring sperm abnormalities.

Does a Very Short Length of Abstinence Improve Assisted Reproductive Technique Outcomes in Infertile Patients with Severe Oligo-Asthenozoospermia?

In recent years, a growing number of studies seem to support the beneficial effects of a very short abstinence period on sperm parameters, especially in patients with oligo-asthenozoospermia (OA). On this basis, the aim of this study was to evaluate the effects of a short period of abstinence (1 h) on intracytoplasmic sperm injection (ICSI) outcomes in infertile patients with severe OA. We performed a retrospective study on 313 ICSI cycles in which couples were divided into two different groups based on sperm parameters of the male partners. Group 1 included normozoospermic men or male partners with a mild OA (n = 223). Group 2 included male partners with severe OA (n = 90). They were asked to provide a second consecutive ejaculation after 1 h from the first one. The best ejaculate was used to perform ICSI. We found a significant increase of total (p < 0.001) and progressive motility (p < 0.001) in the second ejaculate of patients of Group 2 compared with those of the first one. Spermatozoa of the second ejaculate were chosen for ICSI for all patients in Group 2. We found statistically significant improvement of clinical pregnancy rate (p = 0.001) and embryo quality (p = 0.003) in couples in Group 2 compared to those of Group 1. No statistically significant difference was found in fertilization, implantation, live birth delivery, and miscarriage rates between the two groups. Therefore, a second semen sample collected after a very short time-interval in patients with severe OA allowed us to obtain significantly higher clinical pregnancy rate with improved embryo quality compared to normozoospermic men or patients with mild OA. Fertilization, implantation, live birth delivery, and miscarriage rates were similar between the two groups. The present study shows that a second consecutive ejaculate could represent a simple strategy to obtain better sperm parameters and assisted reproductive technology (ART) outcomes in infertile patients with mild-severe OA.

Investigating the Role of the microRNA-34/449 Family in Male Infertility: A Critical Analysis and Review of the Literature.

There is a great body of evidence suggesting that in both humans and animal models the microRNA-34/449 (miR-34/449) family plays a crucial role for normal testicular functionality as well as for successful spermatogenesis, regulating spermatozoa maturation and functionality. This review and critical analysis aims to summarize the potential mechanisms via which miR-34/449 dysregulation could lead to male infertility. Existing data indicate that miR-34/449 family members regulate ciliogenesis in the efferent ductules epithelium. Upon miR-34/449 dysregulation, ciliogenesis in the efferent ductules is significantly impaired, leading to sperm aggregation and agglutination as well as to defective reabsorption of the seminiferous tubular fluids. These events in turn cause obstruction of the efferent ductules and thus accumulation of the tubular fluids resulting to high hydrostatic pressure into the testis. High hydrostatic pressure progressively leads to testicular dysfunction as well as to spermatogenic failure and finally to male infertility, which could range from severe oligoasthenozoospermia to azoospermia. In addition, miR-34/449 family members act as significant regulators of spermatogenesis with an essential role in controlling expression patterns of several spermatogenesis-related proteins. It is demonstrated that these microRNAs are meiotic specific microRNAs as their expression is relatively higher at the initiation of meiotic divisions during spermatogenesis. Moreover, data indicate that these molecules are essential for proper formation as well as for proper function of spermatozoa per se. MicroRNA-34/449 family seems to exert significant anti-oxidant and anti-apoptotic properties and thus contribute to testicular homeostatic regulation. Considering the clinical significance of these microRNAs, data indicate that the altered expression of the miR-34/449 family members is strongly associated with several aspects of male infertility. Most importantly, miR-34/449 levels in spermatozoa, in testicular tissues as well as in seminal plasma seem to be directly associated with severity of male infertility, indicating that these microRNAs could serve as potential sensitive biomarkers for an accurate individualized differential diagnosis, as well as for the assessment of the severity of male factor infertility. In conclusion, dysregulation of miR-34/449 family detrimentally affects male reproductive potential, impairing both testicular functionality as well as spermatogenesis. Future studies are needed to verify these conclusions.

Novel association of PhosphoSerine PHosphatase (PSPH) gene mutations with male infertility identified through whole exome sequencing of South Indians

Male infertility (MI) is mainly caused by spermatogenic failure, and despite long years of assisted reproductive therapy, a significant number of cases remain idiopathic. Oligoasthenozoospermia (OA) is one of the most severe idiopathic MI forms, conditioned with decreased sperm motility and count. However, its pathology remains unclear, but few genetic factors have been identified. The main aim of this study was to find genetic variations in spermatogenic genes with severe OA. Semen and blood samples were collected from 250 MI subjects. Semen analysis, karyotyping, and Y microdeletion was performed to retain purely idiopathic MI cases (n = 247). 40 OA cases were identified, of which four severe cases were subjected to whole-exome sequencing, bioinformatics analyses, and pathway analysis, followed by validation of pathogenic variants in the remaining 36 OA cases through Sanger sequencing. We identified six variants in exon5 of gene PSPH, of which four variants were predicted to be pathogenic and two damaging mutations in exon4. In this study, we propose the novel role of the PSPH gene in their different mechanistic pathways. Detailed pathway analysis of enzyme PSPH involved in l-serine biosynthesis demonstrated that its dysfunction could cause a decrease in sperm count and sperm motility. The hypothesized function of PSPH in eliciting OA has been described.

Obstetric and perinatal outcomes of intracytoplasmic sperm injection versus conventional in vitro fertilization in couples with nonsevere male infertility

To determine whether intracytoplasmic sperm injection (ICSI) is associated with improved outcomes compared with conventional invitro fertilization (IVF) for patients with nonsevere male factor infertility. Retrospective cohort. University-affiliated reproductive endocrinology unit. Couples who received their first-cycle embryo transfer without severe oligoasthenozoospermia (OA) between January 2012 and December 2016 were included in this study. Six subgroup analyses were performed according to the proposed indications for the use of ICSI as follows: non-male factor infertility, advanced maternal age (≥38 years), unexplained infertility, low oocyte yield (≤6), mild OA, and moderate OA. Live birth rates and selected perinatal outcomes. ICSI resulted in live birth rates similar to those achieved with IVF (41.68% vs. 44.31%). There were no significant differences in the incidences of gestational diabetes mellitus, hypertension disorder of pregnancy, placental previa, postpartum hemorrhage, cesarean delivery, fetal macrosomia, small for gestational age, large for gestational age, neonatal intensive care unit (NICU) admission, and congenital anomalies between the two groups. Subgroup analyses showed that ICSI resulted in a lower rate of NICU admission in couples with moderate OA. Our results suggested that routine use of ICSI for all causes of infertility did not result in better pregnancy and perinatal outcomes compared with conventional IVF in the first cycle. ICSI might be associated with a lower risk of NICU admission when used in couples with moderate OA. Large prospective studies are required to validate our current findings.

Alteration of Cholesterol Sulfate/Seminolipid Ratio in Semen Lipid Profile of Men With Oligoasthenozoospermia.

The reduction of sperm motility and count, or oligoasthenozoospermia, is one of the major causes of reduced fertility or infertility in men. Lipid composition of spermatozoa is important in determining their functional characteristics, in particular on motility, acrosomal exocytosis or fusogenic properties of the sperm. Here we investigated the levels of semen lipids in 11 infertile patients with severe oligoasthenozoospermia and 9 normozoospermic subjects with normal motility values. Sperm polar and neutral lipids were analyzed by thin-layer chromatography (TLC) and matrix-assisted laser desorption and ionization time-of-flight mass spectrometry (MALDI-TOF/MS). Semen of patients with oligoasthenozoospermia showed a reduction of the degree of fatty acid unsaturation in the phospholipids chains that might affect the membrane fluidity. Furthermore, a significant higher cholesterol sulfate/seminolipid ratio was found in semen of oligoasthenozoospermic patients than in subjects with normal motility values, suggesting a critical role of sulfolipids in semen quality. The results may facilitate the understanding of the role of lipids on male fertility and offer interesting perspectives to find innovative treatments for oligoasthenozoospermia.

Prevalence of anti-sperm antibodies and relationship of degree of sperm auto-immunization to semen parameters and post-coital test outcome: a retrospective analysis of over 10 000 men.

What is the prevalence and the relationship of anti-sperm antibodies (ASA), screened by means of IgG-mixed anti-globulin reaction (MAR) test, to semen quality and post-coital test (PCT) outcome? A 100% positive IgG-MAR test, detected in 2% of the study population, was associated with lower sperm output and progressive motility, and was the sole determinant of higher prevalence of a negative PCT outcome. Although ASA may affect sperm fertilizing ability and the IgG-MAR test is recommended by the World Health Organization (WHO) as an integral part of semen analysis for screening the occurrence of ASA, the prevalence and clinical relevance of positive MAR test results remain controversial. A retrospective analysis of 12 296 consecutive men who attended a university/hospital andrology clinic for the evaluation of fertility potential was carried out. Immunological screening with the IgG-MAR test was performed on all ejaculates as an integral part of semen analysis. Positive samples (≥10%) were further tested for IgA-ASA. The prevalence of positive IgG-MAR tests results, along with the relationship of the degree of sperm auto-immunization to semen parameters and PCT outcome, were analyzed. After excluding semen samples showing azoospermia or severe oligo-asthenozoospermia, the prevalence of a positive IgG-MAR test in the remaining 10 025 men was 4%, 3.4% and 2%, with 10%, 50% and 100% thresholds, respectively. The 100%-positive MAR tests exhibited significantly higher consistency over time, and were significantly associated with higher prevalence of a mixed pattern (i.e. when the majority of sperm exhibited beads attached on both the head and along the tail) of positivity as well as with the concomitant occurrence of IgA-ASA. Additionally, the 100%-positive MAR tests were significantly associated with a lower median value of the total number of spermatozoa and progressive motility, compared to samples with a lower degree of positivity or negative samples. In the PCT performed in 120 couples, where ASA were detected in the male partner, the 100%-positive MAR tests were significantly associated with a higher prevalence of negative PCT outcome, in comparison to the lower degree of positivity, independent of, and without any significant contribution from, other determinants (semen and cervical mucus quality). Only surrogate infertility-related end-points were analyzed in the present study. However, since the impairment of sperm penetration through the cervical mucus represents the primary mechanism of ASA-interference with fertility, PCT outcome may represent a suitable clinical end-point. The present study, being the largest reported to date, provides a reliable estimate of ASA prevalence. Moreover, it indicates that a 50%-positive MAR test, which is suggested by WHO as the clinically-relevant threshold, also includes patients with a degree of sperm auto-immunization that contributes to couple infertility only in the presence of other causal factors; conversely, the 100%-positive MAR test can represent the sole determinant of couple infertility, as it was the sole significant predictor of the highly prevalent negative PCT outcome. The study was supported by the University of L'Aquila, Italy. The authors declare no competing interests. N/A.

XRCC1 deficiency correlates with increased DNA damage and male infertility

High fidelity DNA repair is critical to sustain the genomic integrity and quality of developing germ cells. Deficiencies in DNA repair machinery may result in increased DNA damage in germ cell leading to abnormal spermatogenesis and infertility. X-ray repair cross-complementing group 1 (XRCC1) is a testis enriched protein that plays a crucial role in the DNA base excision repair (BER) pathway. The aim of this study was to analyze the level of XRCC1 transcript and protein in infertile men and its association with DNA damage in sperm. A total of eighty infertile patients with different infertile phenotypes (Azoospermia, n = 30; Severe oligozoospermia, n = 25; Severe oligoasthenozoospermia, n = 25) and age-matched controls (normal spermatogenesis [NS], n = 15 and fertile controls, n = 10) were recruited. γ-H2 AX protein levels were analyzed to estimate the DNA damage in sperm. XRCC1 transcript levels in cases and controls were determined by qRT-PCR. XRCC1 and γ-H2 AX proteins were immunohistochemically analyzed in testicular biopsy sections obtained from NOA patients and OA controls. The determination of XRCC1 and γ-H2 AX protein levels was performed with Western blots. The results revealed reduced expression of XRCC1 mRNA and protein in infertile individuals as compared to controls (p < 0.001). γ-H2 AX levels were significantly increased in infertile cases as compared to controls, indicating increased DNA damage in infertile men. The results indicate decreased expression of the XRCC1 gene in infertile patients which may be one of the factors associated with impaired spermatogenesis and infertility.

Comparison of conventional slow freeze versus permeable cryoprotectant-free vitrification of abnormal semen sample: A randomized controlled trial

Background:The cryopreservation of semen samples by slow freezing remains as standard protocol. Recently, vitrification of spermatozoa was successfully reported with superior outcome. Till date, there is no randomized trial comparing the two different protocols.Aim:The aim of the present study is to evaluate the slow freezing with vitrification of the subfertile men spermatozoa to evaluate the progressive motility, vitality, and chromatin integrity.Setting:The study was conducted at University teaching hospital.Design:Study design involves randomized control trial.Materials and Methods:Twenty subfertile men with semen characteristics of severe oligoasthenozoospermia (SOA) and very SOA (VSOA) randomized to undergo slow freezing and vitrification protocol and cryopreserved at 1-month and 6-month storage interval, postthawed or warmed, samples were assessed for progressive motility, vitality, and hyaluronan binding. SPSS version 14 software was used for statistical analysis.Results:The SOA samples at 1 month revealed significantly higher motility (42% [22%–74%] vs. 7% [1%–13%]; P = 0.015) and vitality (57% [45%–78%] vs. 34.5% [27–42]; P < 0.001) following vitrification compared to slow-freeze method. For Very severe oligoasthenozoospermia (VSOA), the motility was significantly higher following vitrification (14.5% [2%–32%] vs. 2.5% [0%–4%]; P = 0.007). At 6 months, no statistically significant difference in motility was found between the two groups for Severe Oligoasthenozoospermia (SOA) samples (27% [13%–62%] vs. 8% [0%–11%]; P = 0.066), but motility was significantly higher following vitrification for VSOA samples (12.5% [3%–32%] vs. 2% [1%–5%]; P = 0.019). The hyaluronan-binding assay was comparable in both the groups at 6 months.Conclusions:The current study found the vitrification method involving the use of only nonpermeable cryoprotectants for cryopreservation of abnormal semen sample to be an effective alternative to the conventional slow-freeze technique.

Microscopic varicocelectomy as a treatment option for patients with severe oligospermia.

PurposeMany studies have shown improved semen parameters after varicocele surgery; however, the benefit in terms of improved pregnancy rates and live births is still disputed in cases of severe oligoasthenozoospermia (OAS). The present study evaluated the outcome of microscopic subinguinal varicocelectomy in terms of the spontaneous pregnancy rate in patients with severe OAS.Materials and MethodsThis was a retrospective, observational, analytic study of 56 men with OAS who underwent microscopic varicocelectomy at our center between 2008 and 2015. The subjects were followed for a mean period of 12.4 months. Outcome was compared among groups of men with mild (sperm concentration, 10.2–19 million/mL), moderate (5.7–9.5 million/mL), and severe (<5 million/mL) OAS who were operated on during the same period.ResultsA total of 13 of 35 men (37.1%) with severe OAS achieved spontaneous pregnancy. Mean sperm density increased from 2.29 million/mL preoperatively to 14.09 million/mL postoperatively. The mean time to pregnancy from the date of surgery was 8.5 months. The spontaneous pregnancy rate in men with mild and moderate OAS was 62.5% and 46.2%, respectively.ConclusionsAlthough pregnancy rates after varicocele surgery are lower preoperatively in men with severe OAS than in men with mild or moderate OAS, the spontaneous pregnancy rate of 37.1% still compares very favorably with outcomes after a single attempt at in vitro fertilization.

Complete Azoospermia Factor b Deletion of Y Chromosome in an Infertile Male With Severe Oligoasthenozoospermia: Case Report and Literature Review

To report on a male patient with complete deletion of azoospermia factor b (AZFb) who presented with severe oligoasthenozoospermia, but who successfully fathered a child via intracytoplasmic sperm injection (ICSI). Karyotype analysis of peripheral blood lymphocytes was performed by standard G-banding. Y chromosome microdeletions were detected by multiplex polymerase chain reaction amplification using AZF-specific, sequence-tagged site markers. The ICSI procedure was performed using ejaculated motile spermatozoa. Cytogenetic analysis of the patient revealed a normal male karyotype, 46,XY. Multiplex polymerase chain reaction screening showed complete deletion of AZFb demonstrated by the absence of specific sequence-tagged site markers sY121, sY127, sY134, and sY143. Following successful ICSI, an ultrasound scan of the patient's partner revealed a single pregnancy with cardiac activity. A healthy boy was born by cesarean section at 38 weeks of gestation. Genetic testing 2 years later revealed that the infant had inherited his father's AZFb deletion. Evidence from this case supports the fact that carriers of AZFb deletions can sometimes produce spermatozoa and father a son with the same AZFb deletion. This possibility reinforces the need for genetic counseling in patients with Y chromosome microdeletions.

Reproductive outcomes in patients with severe OAT/NOA pretreated with FSHr 25 UI and TESE compared with obstructive azoospermia testicular biopsy outcomes: private center experience

To analyzed reproductive outcomes of patients diagnosed with severe oligoasthenozoospermia or non-obstructive azoospermia, preatreated with 25 UI of FSHr every 3rd day for a period of 8 weeks and ICSI-TESE and compared with outcomes obtained in patients with obstructive azoospermia.

A practical approach to diagnosing and treating infertility by the generalist in obstetrics and gynecology

To present a diagnostic and treatment paradigm for infertility designed for the obstetrician gynecologist generalist.Simple methods of tubal evaluation, e.g., the hysterosalpingogram (HSG) and post-coital test to evaluate both male and cervical factor are discussed. Treating paradigms will be discussed for ovulatory disorders and luteal phase defects. The role of the OB/GYN generalist on performing surgery in the modem era will be mentioned.If an HSG shows a unilateral hydrosalpinx the generalist should consider performing the unilateral salpingectomy since the advent of in vitro fertilization-embryo transfer (IVF-ET) with a de-emphasis on surgery has made the reproductive endocrinologist/infertility specialist (REI) less skillful in laparoscopic surgery. The REI rarely performs tuboplasty today. Not only does the exclusive treatment in the luteal phase with progesterone save the women money and side effects (including multiple births), but may actually improve pregnancy rates compared to the usual technique of follicle stimulating drugs plus intrauterine insemination.Because the generalist will not be tempted to suggest therapies, e.g., IVF-ET because this effective therapy is the best option for the financial success of the REI, but at the expense of financial depletion of the patient, there is plenty of room for generalists taking over as the first line physicians for infertility rather than just a referral service. Reproductive endocrinologists/infertility will almost invariably perform IUI each month even if not doing IVF which is also profitable to the REI, but costly in time and money to the patient. In contrast, the generalist, aimed with the knowledge that IUI does not improve pregnancy rates if the post-coital test is normal, will save the patient and/or the insurance money if the woman conceives. Obviously certain circumstances, e.g., bilateral blocked fallopian tubes or very severe oligoasthenozoospermia (but not teratozoospermia) will prompt an immediate referral to an REI.

Influencia de la actividad física en los parámetros seminales y su relación con los resultados reproductivos de un ciclo de fertilización in vitro

IntroductionThe impact of physical activity on semen quality or reproductive capacity has been evaluated only in specific situations, such as those associated with intense or prolonged exercise or certain occupations. Therefore, the aim of this study is to analyze the relationship of physical activity with semen quality or reproductive parameters in men from couples to be submitted to a cycle of in-vitro fertilization (IVF). Material and methodsExploratory, prospective and observational study involving 102 males from couples who underwent an IVF cycle. Physical activity was assessed by a questionnaire that included daily activities and sports. ResultsAlmost two-thirds (61.8%) of the men carried out regular exercise an average of 3.27±4.2hours per week. Men with severe oligoasthenozoospermia practiced less sports activities, with there being a positive relationship between physical activity and total number of spermatozoa (r=.439, P=.001) and progressive motility (r=.467, P=.002). As regards reproductive outcomes, an association was observed between the presence of more high quality embryos and walking (r=.344, P=.032) or swimming (r=.371, P=.018) and the percentage of cryopreserved embryos and gymnastics practice (r=.384, P=.027). DiscussionIn our population, physical activity might have a positive effect on the semen quality of infertile couples who have undergone an IVF cycle, although this is not reflected by a significant improvement of reproductive outcomes.

Comment choisir le spermatozoïde en ICSI ?

The selection of the individual spermatozoon in ICSI is routinely performed by the observation of its motility and morphology. However, in case of severe oligoasthenozoospermia or non-obstructive azoospermia needing the use of testicular sperm, other methods are necessary to help the embryologist making this choice. According to some authors, sperm processing before ICSI seems to limit the DNA fragmentation index, and in this way improve ICSI outcomes. Moreover, IMSI is potentially a good option in some specific indications such as severe teratozoospermia, or repeated ICSI failures. Other methods based on sperm structure, as sperm head birefringence observation, or based on its function, like the hyaluronic acid or zona pellucida binding capacity, could be of interest, but still need to be confirmed. Finally, in case of akinetozoospermia, the use of functional tests, such as pentoxifylline test, HOS-test, or to a lesser extent laser touch, makes the selection of viable spermatozoa easier. Nevertheless, studies on larger series have to be conducted to evaluate and precise the interest of each of these methods and their indications, before considering an application on larger scale.

Indenopyride derivative RTI-4587-073(l): A candidate for male contraception in stallions

The objective of this study was to determine whether an indenopyridine derivative RTI-4587-073(l) was a good candidate for male contraception in horses. We hypothesized that a single administration of RTI-4587-073(l) causes significant suppression of testicular function in stallions without affecting sexual behavior. Three Miniature horse stallions received a single dose of 12.5 mg/kg RTI-4587-073(l) orally (group “treated”), whereas three other Miniature horse stallions received placebo only (group “control”). Semen was collected and evaluated from all stallions twice a week for three baseline weeks and 13 post-treatment weeks. Sexual behavior was video-recorded and analyzed. Testicular dimensions were measured using ultrasonography, and blood samples were drawn for endocrine evaluation once before treatment and once a week during the post-treatment period. Single administration of RTI-4587-073(l) caused severe oligoasthenozoospermia (low sperm number and low motility), shedding large numbers of immature germ cells in semen, and increased FSH concentrations in treated stallions. These effects were fully reversible within ∼71 days. However, libido and copulatory behavior remained unchanged throughout the entire experiment. We concluded that RTI-4587-073(l) was a promising candidate for male contraceptive in domestic stallions. Further research should be performed to test this compound for fertility control in wildlife and humans.