ICSI outcome in patients with transient azoospermia with initially motile or immotile sperm in the ejaculate

Treatment of male infertility

Major difficulties exist in the accurate and meaningful diagnosis of male reproductive dysfunction, and our understanding of the epidemiology and etiology of male infertility has proven quite complex.The numerous spermatozoa produced in mammals and other species provides some degree of protection against adverse environmental conditions represented by physical and chemical factors that can reduce reproductive function and increase gonadal damage even resulting in testicular cancer or congenital malformations. The wide fluctuations of sperm production in men, both geographical and temporal, may reflect disparate environmental exposures, occurring on differing genetic backgrounds, in varying psychosocial conditions, and leading to the diversified observed outcomes.Sperm analysis is still the cornerstone in diagnosis of male factor infertility, indeed, individually compromised semen paramaters while adequately address therapeutic practices is progressively flanked by additional tests. Administration of drugs, IUI, correction of varicocele, and, to a certain extent, IVF although they may not be capable of restoring fertility itself often result in childbearing.

Microsurgical varicocelectomy for isolated asthenospermia

PURPOSE

Varicocele represents the most common cause of male infertility, and most reports indicate that varicocelectomy has a beneficial effect on male fertility and pregnancy outcome. We evaluated the clinical outcomes of infertile couples with varicocele and isolated asthenospermia who chose to undergo varicocelectomy as well as those who chose not to undergo the procedure.

MATERIALS AND METHODS

We performed a retrospective review of 118 consecutive infertile couples in whom the man presented with clinical varicocele and isolated asthenospermia (less than 50% motile sperm). All couples were presented with possible treatment options (observation, varicocelectomy, assisted reproductive technologies). The clinical characteristics and outcomes of 2 subgroups of men--those who elected to undergo surgery (varicocelectomy, 69) and those who did not (49)--were examined and compared.

RESULTS

Mean male and female patient age, duration of infertility and baseline total motile sperm count were not significantly different in the control and surgery groups. The mean total motile sperm count increased significantly after varicocelectomy (29.6 million preoperatively vs 39.0 million postoperatively, p <0.05). The spontaneous pregnancy rate was significantly higher in the surgery group compared to the control group (65% vs 32%, respectively, p <0.01). The combined spontaneous and intrauterine insemination pregnancy rate was also significantly higher in the surgery group compared to the control group (74% vs 36%, respectively, p <0.01). Use of in vitro fertilization/intracytoplasmic sperm injection was significantly higher in the control group compared to the surgery group (32% vs 11%, respectively, p <0.05).

CONCLUSIONS

Our data support the practice of varicocelectomy for the treatment of clinical varicocele and isolated asthenospermia.

Contributions of spermatozoa to embryogenesis: assays to evaluate their genetic and epigenetic fitness

During fertilization, spermatozoa contribute genetic and epigenetic factors that affect early embryogenesis. Genetic factors include a haploid genome with intact coding regions and regulatory regions for essential genes. The DNA must contain the proper copy number of essential genes, and cannot have increased single- or double- stranded DNA breaks. Epigenetic factors include a functional centrosome, proper packaging of the chromatin with protamines, modifications of histones, and imprinting of genes. Additionally, the fertilizing spermatozoon provides mRNAs and micro RNAs, which may contribute to the embryonic transcriptome and regulate embryonic gene expression. These epigenetic factors, directly or indirectly, affect the expression of genes in the developing embryo. Each of these contributions represents areas of potential sperm dysfunction, and they are the focus of ongoing research to develop assays which will allow further analysis of their clinical significance. This review briefly describes the current status of research into the genetic and epigenetic contributions of spermatozoa to embryogenesis, and the quest for clinical screening assays. The challenges to validation and clinical application of such testing are also discussed.