IVF outcome with cryopreserved testicular sperm.

The introduction of intracytoplasmic sperm injection and the use of spermatozoa extracted from the testicles have changed the option for conception for azoospermic patients. The purpose of the present study was to evaluate the IVF outcome after using cryopreserved testicular sperm samples in comparison with fresh ones. A total of 667 in vitro fertilisation cycles with fresh or cryopreserved testicular sperm obtained by an open biopsy and testicular needle aspiration were evaluated. Sperm motility was present in 70.9% of the cycles in Group-I, 77.8% cycles in Group-II and in 83.3% In Group-III (NS). The fertilisation rates were similar in the three study groups (50%, 48.6% and 54.8% respectively). The pregnancy rates were 26.7%, 22.2% and 16.3% respectively (NS). The delivery rate, however, was significantly lower in Group-III (4.1%) than in Group-I and -II (18.4% and 15.9%, respectively, P < 0.05). The IVF results after use of cryopreserved testicular sperm are comparable with those obtained with the fresh specimens. Lack of sperm motility before cryopreservation does not exclude favourable outcome and therefore testicular sperm freezing is feasible whenever there are enough sperm cells in the extracted testicular tissue.

Analysis of spermatogenesis in non-obstructive azoospermic and virtually azoospermic men with known testicular pathology.

It is widely thought that human testicles affected by unilateral pathology will have greater impairment of spermatogenesis than the otherwise unaffected testis. This study reviewed records of non-obstructive azoospermic (NOA) and virtually azoospermic (NOVA) men with associated testicular pathology who underwent testicular fine needle aspiration (FNA) mapping. Concentration of spermatozoa found in each testis was analysed to discern sperm-lateralization patterns in affected and unaffected testes. A total of 1098 FNA sites from 56 men (32 varicocele, 16 cryptorchidism, three epididymo-orchitis, two mumps orchitis, three torsion) were analysed. Overall, 38 patients (68%) had spermatozoa detected in at least one testis. Most men (68%) had equal proportions of FNA sites showing spermatozoa from both testes, 29% had more spermatozoa from the unaffected testis and 3% had more spermatozoa from the affected testis. Significantly fewer sperm-positive sites were observed on the affected (272 out of 752) than unaffected side (164 out of 346) (P < 0.0001, chi-squared test). When assessed by FNA mapping, most NOA and NOVA men with known unilateral testis pathology will have equal proportions of spermatozoa in both testes. However, when sperm production differs between sides, the unaffected side is much more likely to have spermatozoa. This information may be used to refine sperm-retrieval strategies in selected patients.

A stable isotope-mass spectrometric method for measuring human spermatogenesis kinetics in vivo.

PURPOSE: Currently it is thought to take 60 to 70 days to produce and ejaculate human sperm. This estimate is derived mainly from a single older, descriptive, kinetic analysis of spermatogenesis. We developed a noninvasive method to assess germ cell turnover time accurately in vivo using stable isotope labeling and gas chromatography/mass spectrometry analyses. We confirmed the postulated length of a normal cycle of spermatogenesis. MATERIALS AND METHODS: A total of 11 men with normal sperm concentrations ingested (2)H(2)O daily for 3 weeks. Semen samples were collected every 2 weeks for up to 90 days. Label incorporation into sperm DNA was quantified by gas chromatography/mass spectrometry, allowing calculation of the percent of new cells present. A cycle of sperm production was determined as the lag time until labeled sperm appeared in the ejaculate. RESULTS: Labeled sperm were detected after a mean +/- SD of 64 +/- 8 days (range 42 to 76). In 1 subject the time lag was 42 days but it was at least 60 in all other subjects. In most subjects plateau labeling in sperm was not attained. In 2 subjects the rise and fall of the labeling curve was steep and reached greater than 85% new cells, suggesting rapid washout of old sperm in the epididymal reservoir. CONCLUSIONS: This direct kinetic assessment confirms a course of spermatogenesis that is on the shorter side of traditional estimates based on prior analyses. In addition, the variability observed in healthy men suggests that characteristics such as the epididymal reservoir effect may influence the modeling of in vivo spermatogenesis.

Traumatic testicular dislocation: a case report and review of published reports.

Testicular dislocation after blunt scrotal trauma is a rare event. Its diagnosis depends on the awareness of the physician of its possible occurrence. It is usually a late finding during treatment of a motorcyclist brought to the emergency room because of multitrauma injury and is sometimes demonstrated in an abdominal computed tomography scan. We describe a typical case and discuss the chain of events leading toward the correct diagnosis and treatment based on a review of published reports.