Evaluation of sperm nuclear integrity in patients with different percentages of decapitated sperm in ejaculates.

The decapitated sperm defect is a rare type of teratozoospermia responsible for male infertility. Spermatozoa from patients affected by this syndrome are used for intracytoplasmic sperm injection (ICSI) although little is known about their DNA integrity. This study evaluated sperm nuclear alterations in four patients and ten fertile men (control group). Sperm samples were examined by light, transmission electron and high-magnification contrast microscopy and analysed after terminal deoxynucleotidyltransferase-mediated dUTP nick end labelling, aniline blue staining and fluorescence in-situ hybridization. Spermatozoa from patients presented varying degrees of decapitation, along with morphological and ultrastructural head abnormalities. Whereas the proportion of spermatozoa with fragmented DNA and numerical chromosome abnormalities was similar in patients 1-3 and controls, the percentage of spermatozoa with hypocondensed chromatin was higher in patients 1-3 than in fertile men. Patient 4 presented a distinct phenotype, with an increased proportion of flagellated spermatozoa with DNA strand breaks as well as increased aneuploidy and diploidy rates compared with controls and with patients 1-3. No successful pregnancy resulted from ICSI although embryos were obtained for three patients. The morphological defects and the nuclear alterations observed in spermatozoa of patients with the decapitated sperm syndrome may have contributed to ICSI failures.

Beneficial effects of varicocele embolization on semen parameters.

BACKGROUND: The value of varicocele repair and the latter's impact on semen parameters are still subject to debate. METHODS: We analyse changes over time in initially abnormal sperm parameters and serum concentrations of testosterone, FSH and inhibin B after embolization treatment of males with high-grade varicocele. From 2007 to 2012, we recruited 47 male infertile patients with clinically visible left varicocele in the resting patient and at least one abnormal semen parameter. Sperm parameters and serum levels of total testosterone, FSH and inhibin B were measured prior to retrograde embolization (M0) and then 3 (M3) and 6 (M6) months afterwards. RESULTS: At M0, the median sperm concentration was 5.78 [0.84-37.70] × 10(6)/ejaculate. The mean ± SD sperm progressive motility, vitality and percentage of normal sperm were respectively, 21.83 ± 16.48%, 61.88 ± 15.98% and 12.88 ± 7.15%. The corresponding values at M3 were significantly higher (38.75 [3.96-95] × 10(6)/ejaculate, 29.32 ± 14.21%, 69.14 ± 14.86% and 19.03 ± 11.02%, respectively). The mean percentage of spermatozoa with a thin head was significantly lower at M6 (6.35 ± 5.29%) than at M0 (14.03 ± 13.09%). The mean serum testosterone, FSH and inhibin B levels did not change significantly over time. CONCLUSIONS: Embolization treatment in men with clinically visible left varicocele, abnormal sperm parameters and documented infertility is associated with a significant improvement in semen parameters including sperm head morphology.

INTRODUCTION: L'intérêt du traitement de la varicocèle clinique et son impact sur les paramètres spermatiques sont de nos jours toujours débattus. MÉTHODES: Nous avons analysé l'évolution dans le temps des paramètres spermatiques et les concentrations sériques de testostérone, FSH et inhibine B d'hommes infertiles ayant une varicocèle de haut grade traitée par embolisation rétrograde. De 2007 à 2012, 47 patients ayant une varicocèle clinique de grade 3 et au moins un paramètre de sperme anormal ont été recrutés. Les paramètres spermatiques et les taux de testostérone totale, de FSH et d'inhibine B sérique ont été mesurés avant embolisation (M0) et 3 (M3) et 6 (M6) mois après embolisation. RÉSULTATS: La numération spermatique médiane initiale de la population était de 5,78 [0,84-37,70] × 106 /éjaculat. Les moyennes ± déviation standard de la mobilité progressive, la vitalité et le pourcentage de spermatozoïdes normaux étaient respectivement de 21,83 ± 16,48%, 61,88 ± 15,98% et 12,88 ± 7,15%. A M3, les valeurs étaient significativement plus élevées (38,75 [3,96-95] × 106/éjaculat, 29,32 ± 14,21%, 69,14 ± 14,86% et 19,03 ± 11,02% respectivement). Le pourcentage moyen de spermatozoïdes à tête amincie était significativement plus faible à M6 (6,35 ± 5,29%) qu'à M0 (14,03 ± 13,09%). Les taux sériques moyens de la testostérone, FSH et inhibine B étaient comparables tout au long de la prise en charge des patients. CONCLUSION: L'embolisation de la varicocèle de haut grade chez les hommes ayant au moins un paramètre spermatique anormal est associée à une amélioration significative des paramètres spermatiques et notamment des spermatozoïdes à tête amincie.

[Assessment of azoospermia and histological evaluation of spermatogenesis]. / Bilan d'une azoospermie et évaluation histologique de la spermatogenèse.

Azoospermia may be obstructive (blockage of the genital ducts) or non-obstructive (a lack of testicular production). The distinction is based on an ensemble of clinical, spermiological, hormonal, ultrasound, genetic and histological data. Azoospermia is the main indication for testicular biopsy for therapeutic and diagnostic purposes. Testicular spermatozoids are processed in the reproductive biology laboratory (simultaneously with oocyte retrieval or not) for in vitro fertilization with intra-cytoplasmic sperm injection. The histological study of spermatogenesis is usually performed on a testicular biopsy sample taken at the same time and provides additional diagnostic information on infertility. Histological alterations in the testicular tissues are frequently observed in azoospermic men. In non-obstructive azoospermia, three histological situations prevail: hypospermatogenesis, Sertoli-cell-only syndrome and germ cell arrest. One can distinguish between pure forms (in which all the seminiferous tubules have the same appearance) and mixed forms (in which the tubules' aspects are heterogeneous). Hypospermatogenesis is highly prevalent in azoospermia and is characterized by a low, basal level of spermatozoid production. The prevalence of Sertoli-cell-only syndrome varies from 27 to 68% and the mean spermatozoid recovery rate is between 16 and 33%. Germ cell arrests are rare phenotypes and have a poor prognosis for spermatozoid recovery. Overall, histological examination (still the only way to fully describe spermatogenesis) must be qualitative and quantitative, with the adoption of a standardized, universally understood terminology. It is essential to compare the histological data with (i) recovery of testicular spermatozoids, (ii) clinical, ultrasound, hormonal and genetic data and (iii) the outcome of IVF/ICSI procedures.

Outcome of ICSI with ejaculated spermatozoa in a series of men with distinct ultrastructural flagellar abnormalities.

BACKGROUND: Severe sperm motility impairment results in human infertility, which can be overcome by ICSI. Whether some particular, possibly genetic, flagellar abnormalities can influence embryonic development is a matter of debate. METHODS: Analysis of ultrastructural flagellar abnormalities and ICSI outcomes with ejaculated spermatozoa in a series of 21 infertile patients with asthenozoospermic or dyskinetic spermatozoa due to a primary and specific flagellar abnormality was carried out. RESULTS: Patients were sorted into six categories according to flagellar ultrastructural defects. Oocyte fertilization occurred in the 21 couples with a mean 2PN fertilization rate reaching 61.85%. No difference was observed in the kinetics of in vitro development or in the morphological quality of the embryos between the different types of flagellar abnormalities. Pregnancy occurred in 12 couples (57.1%) and delivery in nine couples (42.86%). Both the implantation rate and the clinical pregnancy rate per cycle were lower in type III abnormalities and in patients with an initial sperm motility less than 5%. CONCLUSIONS: The rate of ICSI success may be influenced by the type of flagellar abnormality. ICSI provides a suitable solution for patients with sperm flagellar defects but raises the question of the consequences of a specific (and primary flagellar) abnormality on oocyte fertilization, on embryo and fetal development as well as on live birth.