Are specialized sperm function tests clinically useful in planning assisted reproductive technology?

CASE STUDY 40-year-old male patient and 32-year-old female partner, with a history of primary infertility of two years duration. The workup revealed idiopathic mild oligoasthenotheratozoospermia, and no apparent female infertility factors. The couple has failed three intrauterine insemination (IUI) cycles, planning more IUI cycles but also considering in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI).

Tratamiento con ácido fólico y zinc en hombres subfértiles: servicio de fertilidad Maternidad "Concepción Palacios" / Treatment with folic acid and zinc in subfertil men: service of fertility Maternidad “Concepcion Palacios”

Estudiar el efecto del tratamiento con ácido fólico y zinc, en pacientes masculinos subfértiles, con diagnóstico de astenospermia, oligospermia y/o teratospermia. Estudio prospectivo y descriptivo. Se administró tratamiento con ácido fólico (55 mg) y zinc (550 mg) diarios, por un período de 90 días, a pacientes con alteración de la motilidad, concentración y/o morfología espermática. Servicio de Fertilidad. Maternidad “Concepción Palacios ”. Caracas. Después de 90 días de tratamiento, la motilidad total aumento de 44,37 por ciento a 55,22 por ciento, (P=,0002). Las formas espermáticas normales pasaron de 54,11 por ciento a 55,46 por ciento (P=,0001) y las formas anormales disminuyeron e 44,29 por ciento a 4,25 (P=,0001). El tratamiento con ácido fólico y zinc, mejora significativamente la motilidad total y la morfología espermática, en el hombre sub-fértil.

Recovery of spermatogenesis after microsurgical subinguinal varicocele repair in azoospermic men based on testicular histology

OBJECTIVE: Analyze whether testicular histologic patterns from a group of azoospermic men with varicocele is predictive of treatment outcome after subinguinal microsurgical varicocele repair. MATERIALS AND METHODS: Seventeen azoospermic men underwent bilateral open single testis biopsy and microsurgical subinguinal repair of clinical varicoceles. RESULTS: Histopathology of testicular biopsies revealed hypospermatogenesis (HYPO) in 6 men, maturation arrest (MA) in 5, and Sertoli cell-only (SCO) in 6. Overall, presence of spermatozoa in the ejaculates was achieved in 47 percent (8/17) of men after varicocele repair, but only 35 percent (6/17) of them had motile sperm in their ejaculates. Only men with testicular histology revealing HYPO (5/6) or maturation arrest (3/5) had improvement after surgery. Median (25 percent - 75 percent percentile) postoperative motile sperm count for both groups were 0.9 X 106/mL (0.1-1.8 X 106/mL) and 0.7 X 106/mL (0.1-1.1), respectively (p = 0.87). The mean time for appearance of spermatozoa in the ejaculates was 5 months (3 to 9 months). One (HYPO) of 8 (12.5 percent) men who improved after surgery contributed to an unassisted pregnancy. Postoperative testicular biopsies obtained from patients who had no improvement after surgery revealed that testicular histology diagnosis remained unchanged. Successful testicular sperm retrieval for intracytoplasmic sperm injection (ICSI) was achieved in 4 of 9 (44.4 percent) individuals who did not improve after surgery, including 1 man with testicular histology exhibiting SCO. CONCLUSION: Microsurgical varicocele repair in nonobstructive azoospermic men with clinical varicoceles can result in sperm appearance in the ejaculate when hypospermatogenesis or maturation arrest is found on testicular histology diagnosis.

Testicular histopathological diagnosis as a predictive factor for retrieving spermatozoa for ICSI in non-obstructive azoospermic patients

OBJECTIVE: Histological testicular pattern has a predictive role in the possibility of finding spermatozoa for ICSI in cases of non-obstructive azoospermia because some individuals could show residual spermatogenic sites in the testis. The aim of this study was to evaluate the sperm retrieval rate in each of the histopathological groups (hypospermatogenesis-Hypo, spermatogenic maturation arrest-MA, Sertoli cell only-SCO and testicular hyalinization) in patients assisted in our clinic. MATERIALS AND METHODS: Retrospective study from March 1997 to October 2002. We analyzed 14 patients with mean age of 34.3 n 0.7, with non-obstructive azoospermia. All patients were submitted to previous diagnostic biopsy (Bx) elsewhere and came to our institution for treatment. After an average of 12 months (8 - 20), they were submitted to a new Bx procedure to retrieve sperm. RESULTS: Previous diagnostic Bx showed the following histopathological results: 5 patients with MA, 4 with Hypo and 5 SCO. In the following Bx (for sperm retrieval) spermatozoa was found in 33 percent of the procedures in patients with MA, 50 percent in patients with Hypo and 40 percent of the procedures in patients with SCO. CONCLUSION: Previous diagnostic Bx can help in patient counseling concerning the result of sperm retrieval.

The role of hypo-osmotic swelling test in recurrent abortions.

The role of male factors in abortions has not been studied extensively. We undertook this study to determine if there was any relationship between hypo-osmotic swelling test score and recurrent abortions. This was a cross-sectional case control study conducted at the semen analysis laboratory at a tertiary level referral centre. The male partners of 25 patients who had three or more first trimester abortions of unknown etiology were chosen as cases. Controls were 26 unmarried volunteers with unknown fertility potential to represent the entire population. The conventional seminal parameters were studied according to WHO guidelines. The HOS test score were obtained by the method advocated by Jayendran et al. There were no statistically significant differences in mean sperm count, percentage motility and morphology among the cases and controls. We found a low hypo-osmotic swelling test score among the cases [55.7 +/- 1.197 (SEM)] than the controls [69.3 +/- 1.143 (SEM)] which was statistically significant [P < 0.001]. The normal spermatozoal membrane is the prerequisite for the specialized cell-to-cell communications and cell-to-cell binding. In spite of apparently normal semen analysis, subtle membrane defects in the spermatozoa, which could be the cause of defective membrane functions in the embryo effecting miscarriages, can be elucidated by the hypo-osmotic swelling test.

Chromosome anomalies in normal androgenized infertile males

Chromosome anomalies are known to play a role in human infertility. Chromosome analysis of 103 normal androgenized infertile azoospermic [97.1%] or oligospermic [2.9%] males revealed that the frequency of chromosomal abnormalities was 8.7%. Two patients [1.94%] had a 46,XX chromosome complement, one patient [0.97%] had a 45,X karyotype, two patients [1.94%] had a 45,XY,t[13;14][p11;q11] karyotype, one patient [0.97%] had a 46,XY,inv[9][p12;q13] chromosome constitution, two patients [1.94%] had a 46,XY,del[Y][q12] karyotype, and one patient [0.97%] had a 45X/46,X+marker the nature of which was not clarified

Analisis ultraestructural del espermatozoide in individuos euspérmicos fértiles y oligozoospérmicos infértiles / An ultrastructural analysis of the spermatozoa in fertile euspermic and infertile oligospermic individuals

Sólo los espermatozoides estructurales y funcionalmente integros son capaces de transportarse desde el fondo de saco vaginal hasta la región ampular de de trompa de Falopio y fertilizar al ovocito homólogo. Por lo tanto, analizamos comparativamente mediante microscopia electrónica de transmisión, la integridad morfológica de los espermatozoides de nueve individuos oligozoospérmicos infértiles y de cinco individuos euspérmicos. Según nuestros resultados, en los espermatozoides de individuos oligozoospérmicos la proporción de acrosomas morfológicamente normales es menor que la observada en individuos fértiles (11.29 ñ 5.11 y 18.69 ñ 1.95%, rspectivamente). Asimismo, en los espermatozoides de indivíduos infértiles se encontraron hasta 4.2 veces menos núcleos ultraestructuralmente normales, en comparación con lo determinado en individuos fértiles. En contraste, a nivel de la pieza media no se observaron diferencias en la estructura fina entre ambos grupos. El análisis ultraestructural integral del espermatozoide (acrosoma, núcleo y pieza media) indicó que en individuos oligozoospérmicos infértiles 4.79 ñ 2.28% de los espermatozoides son ultraestructuralmente normales, en comparación con 17.35 ñ 3.39% en individuos euspérmicos fértiles. Po lo tanto, proponemos que en el análisis de semen de individuos oligozoospérmicos infértiles de etiología idiopática,e s necesario se incluya el análisis ultraestructural del sepermatozoide con la finalidad de obtener un diagnóstico y pronóstico más preciso para esta entidad nosológica