Severe Oligozoospermic Men Research Articles

Severe sperm DNA fragmentation may persist for up to 3 years after cytotoxic therapy in patients affected by Hodgkin lymphoma and non-Hodgkin lymphoma.

Does sperm DNA recover from damage in all men after 2 years from the end of cytotoxic treatments? The current indication of 2 years waiting time for seeking natural pregnancy after cytotoxic treatment may not be adequate for all men, since severe sperm DNA damage is present in a proportion of subjects even after this timeframe. Data in the literature on sperm DNA fragmentation (SDF) in lymphoma patients after cytotoxic treatments are scarce. The largest longitudinal study evaluated paired pre- and post-therapy (up to 24 months) semen samples from 34 patients while one study performed a longer follow-up (36 months) in 10 patients. The median/mean SDF values >24 months after therapy did not show significant differences but the studies did not explore the proportion of patients with severe DNA damage and the analysis was done on frozen-thawed samples. In this study, 53 Hodgkin lymphoma (HL) and 25 non-Hodgkin lymphoma (NHL) post-pubertal patients were included over a recruitment period of 10 years (2012-2022). Among them, 18 subjects provided paired semen samples for SDF analysis at the three time points. SDF was evaluated in patients before (T0) and after 2 (T2) and 3 years (T3) from the end of, cytotoxic treatments (chemotherapy alone or in combination with radiotherapy). A cohort of 79 healthy, fertile, and normozoospermic men >18 years old served as controls (recruited between 2016 and 2019). SDF was evaluated on fresh semen samples (i.e. spermatozoa potentially involved in natural conception) from patients and controls using TUNEL (terminal deoxynucleotidyl transferase dUTP nick end labeling) assay coupled with flow cytometry. SDF median values were compared between groups: (i) HL and NHL patients versus controls at the three time points; (ii) HL versus NHL patients at baseline; and (iii) patients at T0 versus T2 and T3. Severe DNA damage (SDD) was defined for SDF levels above the 95th percentile of controls (50%) and the proportion of patients with SDD at all time points was established. At T0, patients displayed higher median SDF than controls, reaching statistical significance in the NHL group: 40.5% [IQR: 31.3-52.6%] versus 28% [IQR: 22-38%], P < 0.05. Comparing SDF pre-treatment to that post-treatment, HL patients exhibited similar median values at the three time points, whereas NHL showed significantly lower values at T3 compared to T0: 29.2% [IQR: 22-38%] versus 40.5% [IQR: 31.3-52.6%], P < 0.05. The proportion with SDD in the entire cohort at T2 was 11.6% and 13.3% among HL and NHL patients, respectively. At T3, only one in 16 NHL patients presented SDD. TUNEL assay requires at least 5 million spermatozoa to be performed; hence, severe oligozoospermic men were not included in the study. Although our cohort represents the largest one in the literature, the relatively small number of patients does not allow us to establish precisely the frequency of SDD at T2 which in our study reached 11-13% of patients. Our data provide further insights into the long-term effects of cytotoxic treatments on the sperm genome. The persistent severe DNA damage after 2 years post-treatment observed in some patients suggests that there is an interindividual variation in restoring DNA integrity. We propose the use of SDF as a biomarker to monitor the treatment-induced genotoxic effects on sperm DNA in order to better personalize pre-conceptional counseling on whether to use fresh or cryopreserved spermatozoa. This work was supported by grants from the Istituto Toscano Tumori (ITT), Fondazione Ente Cassa di Risparmio di Firenze, the European Commission-Reproductive Biology Early Research Training (REPROTRAIN). C.K., G.F., V.R., and A.R.-E. belong to COST Action CA20119 (ANDRONET) which is supported by the European Cooperation in Science and Technology (www.cost.eu). The authors declare no conflict of interest. N/A.

Human chorionic gonadotropin therapy in hypogonadic severe-oligozoospermic men and its effect on semen parameters.

ObjectiveThis study aimed to evaluate whether human chorionic gonadotropin (hCG) therapy is beneficial for improving semen parameters and clinical hypogonadism symptoms in hypogonadic oligozoospermic or severe oligozoospermic men with low or borderline testosterone levels. MethodsA weekly dose of 250 μg (equivalent to approximately 6,500 IU) of hCG was administered subcutaneously for 3–6 months to 56 hypogonadic oligozoospermic or severe oligozoospermic men. Semen, biochemical, and genetic analyses were performed before the start of treatment followed by analyzing semen parameters every 3 months after the start of therapy. We grouped participants into responders and non-responders depending on positive changes in semen parameters. ResultsOut of 56 men, 47 (83.93%) responded, while 9 (16.07%) did not. Upon statistical analysis, it was found that age did not affect the overall outcomes (p=0.292); however, men with higher body mass index (BMI; 28.09±3.48 kg/m2) showed better outcomes than those with low BMI (25.33±3.06 kg/m2) (p=0.042). The duration of therapy (in months) was higher in non-responders than in responders (p=0.020). We found significant improvements in sperm concentration (p=0.006) and count (p=0.005) after 3 months of therapy. Sperm motility and progressive motility were also found to be higher in responders, but did not show statistically significant changes.ConclusionWe conclude that hCG therapy can be beneficial in men with hypogonadic oligozoospermia or severe oligozoospermia.

Chromosomal aneuploidies and associated rare genetic syndromes involved in male infertility

Background and objectives: Recent investigations have reported more than 70 genetic syndromes involved in male infertility; however, the majority of these syndromes are extremely rare. We aimed to report the most common chromosomal abnormalities and associated rare genetic syndromes in the context of human male infertility. Materials and Methods: We performed a review of published articles considering the most common chromosomal aneuploidies and rare genetic syndromes associated with male infertility on PubMed, Web of Science, and Scopus. Results: Chromosomal abnormalities are frequently found in infertile men, with an incidence rate of 2-15%. The chromosomal aberrations include the sex and autosomal chromosome abnormalities, as well as numerical and structural defects in chromosomes. There are various rare genetic syndromes involved in male infertility that are caused by structural and numerical abnormalities in chromosomes. Klinefelter syndrome is the most common type of sex chromosome aneuploidy in infertile males. Besides, Y chromosome microdeletions, particularly in azoospermia factor regions, serve as the second most common genetic cause of impaired spermatogenetic in infertile men. These molecular genetic abnormalities not only can be inherited, but also they may transmit to the next generation through assisted reproductive techniques and result in the birth of boys with higher risk of congenital abnormalities and infertility. Despite the normal secondary male sexual characteristics, some patients are azoospermic or severe oligozoospermic men. Therefore, identification of these molecular genetic factors and rare genetic disorders is essential in men with unexplained infertility. Discussion and conclusion: Since most of molecular genetic abnormalities can be transmitted to the next generation, identification of these rare genetic disorders is crucial for men with unexplained infertility. It is also essential for clinicians and physicians of reproductive medicine and andrologists to initiate genetic evaluation, aneuploidy screening and counseling prior to any therapeutic procedures.

Polymorphism of CAG Repeats in Exon 1 of the Androgen Receptor Gene in Russian Men with Various Forms of Pathozoospermia

CAGn polymorphism in exon 1 of the androgen receptor (AR/HUMARA) gene is associated with pathozoospermia and male infertility, but its effect on spermatogenesis and male fertility is not well understood. The article presents the results of a study of CAG repeats polymorphism of the AR gene in Russian patients with pathozoospermia (n = 591), fertile men (n = 286), and normozoospermic men/control (n = 131). Comparative analysis showed no significant differences in frequencies of “medium” (n = 19–25), “long” (n ≥ 26), and “short” (n ≤ 18) alleles between groups of patients with various forms of pathozoospermia. Statistically significant (p < 0.01) differences were found between the group with severe oligozoospermia and the control for the prevalence of “long” and “short” CAG alleles, as well as for the frequency of CAGn = 25 allele between azoospermic (18.1%) and severe oligozoospermic (2.6%) men.

Spermatogenic failure and the Y chromosome.

The Y chromosome harbors a number of genes essential for testis development and function. Its highly repetitive structure predisposes this chromosome to deletion/duplication events and is responsible for Y-linked copy-number variations(CNVs) with clinical relevance. The AZF deletions remove genes with predicted spermatogenic function en block and are the most frequent known molecular causes of impaired spermatogenesis (5-10% of azoospermic and 2-5% of severe oligozoospermic men). Testing for this deletion has both diagnostic and prognostic value for testicular sperm retrieval in azoospermic men. The most dynamic region on the Yq is the AZFc region, presenting numerous NAHR hotspots leading to partial losses or gains of the AZFc genes. The gr/gr deletion (a partial AZFc deletion) negatively affects spermatogenic efficiency and it is a validated, population-dependent risk factor for oligozoospermia. In certain populations, the Y background may play a role in the phenotypic expression of partial AZFc rearrangements and similarly it may affect the predisposition to specific deletions/duplication events. Also, the Yp contains a gene array, TSPY1, with potential effect on germ cell proliferation. Despite intensive investigations during the last 20years on the role of this sex chromosome in spermatogenesis, a number of clinical and basic questions remain to be answered. This review is aimed at providing an overview of the role of Y chromosome-linked genes, CNVs, and Y background in spermatogenesis.

AB024. Interpretation for Y chromosomal microdeletions of EAA/EMQN 2013 guideline

After the Klinefelter syndrome, Y chromosomal microdeletions are the second most frequent genetic cause of male infertility. The European Academy Andrology (EAA) and the European Molecular genetics Quality Network (EMQN) revised the new 2014 laboratory guidelines on Sep 2013 based on 1999 and 2004 editions according to 12 years clinical accumulation and specialist consensus. The new guideline emphasizes: (I) the Y chromosomal microdeletions region in azoospermic and severe oligozoospermic men mainly is azoospermia factor (AZF) region, include AZFa, AZFb, AZFbc, AZFc and AZFabc, only the microdeletions of relevant region have the specific clinical manifestation; (II) the guideline think the supposed AZFd region by some experts and recommended by some commercial diagnostic kits does not exist. The gr/gr deletion in AZFc region is a genetic risk factor for sperm production, but the clinical implications is not confirmed, not be recommended as the routine detection item; (III) the guideline still recommended the classical 6 sits detection, excessively high number of markers do not improve the sensitivity of the test, may even complicate the interpretation of the results, the method based on two multiplex polymerase chain reactions remains fully valid and appropriate for accurate diagnosis of AZF deletions; (IV) the performance of 12 years EQA scheme indicate that participating laboratories has demonstrated an improvement on reporting practice and decreasing diagnostic error rates by improve the performance. In Chinese infertility men, the frequency of Y chromosomal microdeletions occurrence is in high level, as 11.5%. We suggest the AZF diagnostic should be the routine detection item for azoospermic and severe oligozoospermic men, call on domestic AZF detection laboratory join the EQA scheme and complete the performance of Y chromosome microdeletions detection.

EAA/EMQN best practice guidelines for molecular diagnosis of Y-chromosomal microdeletions: state-of-the-art 2013.

The molecular diagnosis of Y-chromosomal microdeletions is a common routine genetic test which is part of the diagnostic workup of azoospermic and severe oligozoospermic men. Since 1999, the European Academy of Andrology (EAA) and the European Molecular Genetics Quality Network (EMQN) have been actively involved in supporting the improvement of the quality of the diagnostic assays by publication of the laboratory guidelines for molecular diagnosis of Y-chromosomal microdeletions and by offering external quality assessment trials. The present revision of the 2004 laboratory guidelines summarizes all the clinical novelties related to the Y chromosome (classic, partial and gene-specific deletions, genotype–phenotype correlations, methodological issues) and provides an update on the results of the quality control programme. These aspects also reflect the consensus of a large group of specialists present at a round table session during the recent Florence-Utah-Symposium on ‘Genetics of male infertility’ (Florence, 19–21 September, 2013). During the last 10 years the gr/gr deletion has been demonstrated as a significant risk factor for impaired sperm production. However, the screening for this deletion type in the routine diagnostic setting is still a debated issue among experts. The original basic protocol based on two multiplex polymerase chain reactions remains fully valid and appropriate for accurate diagnosis of complete AZF deletions and it requires only a minor modification in populations with a specific Y chromosome background. However, in light of novel data on genotype–phenotype correlations, the extension analysis for the AZFa and AZFb deletions is now routinely recommended. Novel methods and kits with excessively high number of markers do not improve the sensitivity of the test, may even complicate the interpretation of the results and are not recommended. Annual participation in an external quality control programme is strongly encouraged. The 12-year experience with the EMQN/EAA scheme has shown a steep decline in diagnostic (genotyping) error rate and a simultaneous improvement on reporting practice.

Citogenetic and molecular genetic studies in infertility in East Hungary

In developed countries 10-15% of the couples are affected by infertility. In half of them genetic factors can be identified. We studied genetic alterations in infertility in Hungarian patients. Cyogenetic analyses were performed in 195 females and 305 males. In 17 females FMR1 mutations, in 150 males Y microdeletions, and aneuploidy were studied in the sperm of 28 males. In a carrier male sperm meiotic segregation was studied. The most common aberrations in females were X chromosome aneuploidia and inversion (3.6%), while the same in males Klinefelter-syndrome (3.3%) and autosomal translocations (2%). In two females FMR1 premutation was found. While Y microdeletions were identified only in azoospermic and severe oligozoospermic men, partial microdeletions could also be detected in normozoospermic males. A higher aberration rate was found in cases with abnormality in both the number and motility of sperm. In a male patient with 46,XY,t(3;6)(q21;q23) karyotype, 53.2% of spem carried unbalanced chromosome assortment. Knowledge of abnormalities may help in genetic counseling and choosing the most effective reproduction technique.

DNA methylation at imprinted genes and DNA fragmentation in sperm of men diagnosed with severe oligozoospermia and azoospermia

(1) To evaluate DNA methylation (DM) at imprinted genes in men affected by severe oligozoospermia, azoospermia and fertile men undergoing vasectomy reversal (VR). 2) To study the correlation between aberrant DM and DNA fragmentation (DF) levels in each study group. DM and DF were evaluated in sperm from each study group. All samples were collected with patients' consent. Ejaculate sperm from severe oligozoospermic men (SO, N=13) and fertile men with normal semen parameters (N=20) were obtained. Testicular sperm from men with non-obstructive azoospermia (NOA, N=6), VR (N=5) and epididymis sperm from obstructive azoospermic (OA, N=11) men were picked using a micromanipulator. DM status of differentially methylated regions (DMRs) at imprinted genes (H19, GTL2, LIT1, and MEST)was detected in sperm. The one-way ANOVA and T-test were used to compare the means of control as well as study groups. Mean DM at LIT1 and MEST was significantly greater in SO group than fertile control group (9.7% vs 5.2%, P=0.005; and 13.5% vs 7.0%, P=0.009; respectively). NOA (9.82% vs 4.93 % P=0.004), OA (8.26% vs 4.93%, P=0.039) and VR (18.26% vs 4.93%) groups show significantly higher DM levels at LIT1 than fertile men. Mean DM at H19 was significantly lower in VR (77.93% vs 88.48%) and NOA (82.01% vs 88.48%) groups compared to fertile control group. Also, the rate of DF was significantly greater in all study groups compared to the controls (VR 56.24 %, OA 71.43%, SO 60.69%, NOA 66.81% vs 27.4%, P=0.0001). No significant correlations of DM and DF at H19 GTL2 MEST and LIT1 were detected in the groups. LIT1 was susceptible to have higher rate of imprinting abnormalities in sperm of all study groups. Testicular sperm (NOA and VR) had abnormal DM levels at H19 and LIT1. Fertile men with vasectomy showed significantly higher DM and DF levels than fertile control group. DF was highest in epididymis sperm among the study groups.

Influence of Methylenetetrahydrofolate Reductase C677T Gene Polymorphisms in Algerian Infertile Men with Azoospermia or Severe Oligozoospermia

The C677T allele of the methylenetetrahydrofolate reductase (MTHFR) gene has been suggested to represent a risk factor for male infertility. To confirm this association, the distribution of the single-nucleotide polymorphism C677T was investigated in idiopathic infertile Algerian patients with nonobstructive azoospermia (NOA) or severe oligoasthenoteratozoospermia (OAT). A case-control study was carried out, including 74 idiopathic infertile Algerian patients with NOA (n=46) or severe OAT (n=28) and 84 fertile men as controls. Polymorphism C677T was studied by polymerase chain reaction-restriction fragment length polymorphism, and the results were statistically analyzed. The frequency of genotypes MTHFR 677CC, 677CT, and 677TT in idiopathic infertile men with NOA was 43.48%, 41.30%, and 15.22%; 39.29%, 50%, and 10.71% regarding the severe oligozoospermic men; and 42.86%, 45.24%, and 11.90% in the control group. The data suggest that the C677T MTHFR polymorphism is not a risk factor for idiopathic male subfertility in an Algerian population.

Altered DNA methylation patterns in sperm from oligozoospermic men

Investigate methylation changes in sperm DNA from infertile men. We characterized methylation changes in sperm DNA isolated from men with idiopathic oligozoospermic and normospermic controls. Human spermatozoa samples were collected in both Hopital Tenon and Laboratoire Eylau. Spermatozoa were separated from somatic cells and subjected to DNA isolation. Genomic DNA was bisulfite converted. We have investigated by PCR and cloning the methylation pattern H19 (Maternally expressed, methylated in sperm) in spermatozoa of oligozoospermic men. Genome-wide DNA methylation patterns at promoter elements from sperm DNA was analyzed on selected cases using the MeDIP (Methyl-DNA Immunoprecipitation) based technique. 3microg of genomic DNA were submitted to immunoprecipitation with an antibody directed against 5-methylCyosine.The immunoprecipitated and Input DNA samples were labeled and hybridized to 2.1 M deluxe human promoter array. Methylation status of H19 was analyzed in spermatozoa DNA from 294 men (119 normospermic [>20x106 spz/ ml], 116 mild oligozoospermic [5-20x106 spz /ml] and 59 severe oligozoospermic [<5x106 spz/ ml]). Hypomethylation of H19-DMR was found in 16 mild oligozoospermic (13.8%, P=2.7.10-5) men and 19 severe oligozoospermic (32%, P=5.7.10-11) men, respectively. MeDIP analysis in sperm of oligozoospermic men revealed global DNA methylation changes. These included the promoter elements of a series of imprinted genes as well as over a hundred genes involved in spermatogenesis. Mature sperm from 20% of oligozoospermic men have altered DNA methylation patterns. The degree of hypomethylation increased with reduced sperm counts and may be genome-wide. It remains to be determined if oligozoospermic men with sperm DNA methylation changes are at a higher risk for IVF failure. These aberrant epigenetic changes may also have serious health implications for children conceived using such sperm by IVF.

Methylenetetrahydrofolate Reductase Polymorphisms Are Related to Male Infertility in Brazilian Men

The objective of this study was to analyze the distribution of the methylenetetrahydrofolate reductase (MTHFR) C677T and A1298C polymorphisms in idiopathic infertile Brazilian patients with nonobstructive azoospermia (NOA) or severe oligozoospermia and fertile Brazilian men as controls to explore the possible association of these polymorphisms and male infertility. A case-control study was carried out, including 156 idiopathic infertile Brazilian patients with NOA (n=49) or severe oligozoospermia (n=107) and 233 fertile men as controls. Polymorphisms C677T and A1298C were studied by quantitative polymerase chain reaction and the results were statistically analyzed. The frequency of genotypes MTHFR 677CC, 677CT, and 677TT in idiopathic infertile men with NOA were 55.1%, 30.6%, and 14.3% (p=0.0305); 50.6%, 42.0%, and 7.5% (p=0.0006) regarding the severe oligozoospermic men; and 71.7%, 53.0%, and 5.6% in the control group. As for polymorphism A1298C, regarding the NOA group, the frequencies of the 1298AA, 1298AC, and 1298CC genotypes were 53.0%, 28.6%, and 18.4% (p=0.0132); 42.0%, 44.9%, and 13.1% (p=0.0188) among the severe oligozoospermic group; and 55.8%, 38.2%, and 6.0% (14/233) in the control group. The data suggest that MTHFR C677T and A1298C could be important genetic factors predisposing to infertility in Brazilian infertile men.

Who should be screened for chromosomal abnormalities before ICSI treatment?

Guidelines on karyotyping infertile men before ICSI treatment are not consistent. Most guidelines recommend chromosomal screening in azoospermic and severe oligozoospermic men, because they are assumed to have the highest risk of abnormalities. We performed a retrospective cohort study in azoospermic men and men eligible for ICSI. We determined the prevalence of chromosomal abnormalities in relation to sperm concentration and compared our data to studies in the literature. A high prevalence of chromosomal abnormalities in azoospermic men was found, but no difference in the prevalence of abnormalities was seen between different sperm concentration categories in non-azoospermic men. This raises the question of who should be screened for chromosomal abnormalities before ICSI treatment. Considering the costs and benefits, we would propose limiting screening to infertile couples with non-obstructive azoospermia.

Prevalence of Y microdeletions in azoospermic and severe oligozoospermic men in Southern Italy: Application of a rapid capillary electrophoresis method

Male infertility is correlated with several genetic and non-genetic conditions. Microdeletions of Y chromosome are one of the most frequent genetic defects associated with male infertility. Evaluating this in infertile patients is important to assess an etiological diagnosis and possible prognosis of infertility, as well as to address clinical decision during treatment of infertility by intracytoplasmatic sperm injection, where the probability of success depends on the type and the number of deleted regions (azoospermia factor regions). To improve genetic counseling, it is useful to characterize Yq regions by a rapid and accurate method. In the current study, we evaluated the diagnostic efficiency and the time required of an in-house automated capillary electrophoresis method for Y microdeletions screening and applied it to estimate the prevalence of Y microdeletions in 100 infertile males affected by azoospermia or severe oligozoospermia (sperm count <5x10(6)/ml) and in 100 fertile male controls. In south Italian infertile men, the overall frequency of Y microdeletions was 9% (12.7% in azoospermic and 4.5% in severe oligozoospermic men). In conclusion, we think that the abovementioned procedure is suitable for the routine characterization of Y microdeletions.

Analysis by fluorescence in situ hybridization (FISH) of the relationship between gonosomic aneuploidy and the results of assisted reproduction in men with severe oligozoospermia

The aim of this study was to analyse the frequency of sex-chromosomal aneuploidy in human spermatozoa of severe oligozoospermic men undergoing intracytoplasmic sperm injection (ICSI), to evaluate the impact of these chromosomal anomalies on the results of the ICSI. Fluorescence in situ hybridization (FISH) with direct label fluorescence DNA probes specific for chromosome X, Y and 18 was performed on decondensed spermatozoa from fresh ejaculates of 12 patients with severe oligozoospermia undergoing ICSI. A total of 500 spermatozoa were analysed per donor. The rate of gonosomal aneuploidy was significantly increased in the patients compared with normal donors (3.5% and 0.8% respectively). The sex-chromosomal anomalies due to meiosis I (XY) are less important than the anomalies caused by meiosis II (XX or XY), but the difference was not statistically significant. There was a negative correlation between the rate of aneuploidy and the percentage of spermatozoa with normal morphology (r = -0.71; P < 0.05). The correlation was negative between the percentage of gonosomic aneuploidy and the rate of fertilization (r = -0.7; P < 0.001). Our results suggest an increased rate of gonosomic aneuploidy in the patients with oligozoospermia compared with the normal population. This aneuploidy, although it decreases the rate of fertilization, does not seem to affect the rate of cleavage, nor the embryonic quality.

Molecular analysis of the androgen receptor gene in Hong Kong Chinese infertile men.

To investigate the relationship between CAG repeat length in the androgen receptor gene and impaired spermatogenesis in Hong Kong Chinese population. The CAG repeat region was amplified by polymerase chain reaction (PCR) in 85 nonobstructive azoospermic or severe oligozoospermic men, and 45 fertile males. The number of CAG repeat was analyzed by DNA sequencing. Serum FSH, LH, and testosterone levels were also determined in these men. Among nonobstructive azoospermic males, three men (5.7%) possessed short CAG repeats (< 16), and three (5.7%) other men possessed long CAG repeats (> 30). Short CAG repeats (< 16) were also found in two severe oligozoospermic males (6.3%). The incidence of infertile men with short or long CAG repeats is significantly higher in the azoospermic group (p = 0.03) but not in the severe oligozoospermic group (p = 0.17) when compared with the fertile controls Our data suggest an association between CAG repeat lengths and impaired spermatogenesis in azoospermic males in our population.

New treatment of idiopathic severe oligozoospermia with mast cell blocker: results of a single-blind study

To determine whether mast cell blocker (tranilast) improves fertility and/or semen parameters in severe oligozoospermia. Placebo-controlled single-blind clinical study. Nagoya University Hospital Andrology Clinic, Nagoya, Japan. Fifty men with sperm density < 5 x 10(6) sperm/mL, normal serum gonadotropins, and T, and a fertile partner were enrolled in this study. Patients were prescribed randomly 300 mg/d tranilast or a placebo, three tablets per day, for 3 months. Semen and blood samples were collected before and after therapy. Semen parameters, serum gonadotropins, T, and PRL were evaluated before and after therapy. The pregnancy rate (PR) in the mast cell blocker group was 28.6% compared with 0% in the placebo group. There was a statistical difference in the PR between groups. The mast cell blocker group had significantly higher levels of sperm density, sperm motility, and total motile sperm count. There were no differences between the mast cell blocker and placebo groups in seminal volume and normal sperm morphology. The authors conclude that mast cell blocker is clinically useful for the treatment of idiopathic severe oligozoospermic men.

Tamoxifen treatment in male infertility. I. Effect on spermatozoa

To evaluate the effects of tamoxifen treatment on sperm density, motility, vitality, and morphology. Placebo-controlled, randomized study. Outpatient department. Patients were assigned to two comparable groups: group A (n = 122) was treated with 10 mg tamoxifen twice daily for a period of 3 months and group B (n = 117) was given placebo for the same period of time, following a previously randomized design. In every patient sperm density, motility, viability, and morphology were evaluated 3 months after cessation of treatment. Mean sperm density in group A improved significantly with a more pronounced improvement in severe oligozoospermic men. Sperm density was found significantly improved compared with group B. Dead spermatozoa in group A significantly decreased after tamoxifen treatment and were also found significantly decreased compared with group B. It is concluded that tamoxifen exerts a beneficial effect on sperm density and number of live spermatozoa but it has no substantial effect in sperm motility and morphology.