Idiopathic semen quality abnormalities include idiopathic oligozoospermia, asthenospermia, teratospermia, azoospermia and idiopathic abnormal semen liquefaction. The possible causes of idiopathic semen quality abnormality include age, non-inflammatory function changes of subsidiary gonadal organs, infection, genetic abnormalities, sperm mitochondrial changes, effects of environmental pollutants, and subtle hormonal changes. The diagnosis of idiopathic oligozoospermia, asthenospermia, teratospermia and azoospermia require detailed inquiry of the case history, physical examination, semen analysis, determination of reproductive hormones, genetic and immunological examinations, and so on, to exclude possible known causes. The treatment of idiopathic oligozoospermia, asthenospermia, and teratospermia may involve the use of Western medicines, such as clomiphene citrate, tamoxifen, recombinant FSH, Andriol, compound zinc and selenium, L-carnitine, recombinant growth hormone and pentoxifylline, the application of traditional Chinese drugs, or the combination of traditional Chinese and Western medicine. Idiopathic azoospermia can be treated by assisted reproductive technology based on the medication of spermatogenesis-promoting drugs, and idiopathic abnormal semen liquefaction can be managed with traditional Chinese drugs, integrated traditional Chinese and Western medicine, or in vitro semen processing technology. With the development of diagnostic technology, it is expected that more specific therapeutic methods will be established for idiopathic semen quality abnormalities and their incidence will be reduced.
Asthenozoospermia ; diagnosis ; therapy ; Azoospermia ; diagnosis ; therapy ; Humans ; Male ; Oligospermia ; diagnosis ; therapy ; Semen Analysis

Ejaculatory duct obstruction (EDO) is an important cause of male infertility. Etiologically it can be either congenital or acquired. The diagnosis of EDO mainly depends on history, physical examination, semen analysis, and transrectal ultrasonography (TRUS). The semen of EDO patients is characterized by low ejaculate volume, oligospermia or azoospermia, low pH, and absence of fructose. Technetium (99Tc(m)) Sulphur Colloid Seminal Vesicle Scintigraphy is of great value in the differential diagnosis of functional, partial and complete obstruction. Definite diagnosis of EDO can be established by vasography, seminal vesicle aspiration and seminal vesiculography. Transurethral resection of the ejaculatory ducts (TURED), as the standard method of treatment for EDO, is effective for many of the patients. And the assistant reproductive technology (ART) is required if the procedure fails to restore the patient's fertility.
Azoospermia ; etiology ; therapy ; Ejaculatory Ducts ; pathology ; Humans ; Infertility, Male ; etiology ; therapy ; Male

Sperm cryopreservation has been widely used in assisted reproduction, but conventional techniques are not suitable for the cryopreservation of small numbers of sperm. The application of the single sperm cryopreservation technique has significantly improved the clinical treatment of cryptozoospermia and non-obstructive azoospermia. Ever since Cohen et al first developed the method of single sperm cryopreservation in 1997, constant efforts have been made to develop the carriers for this technique. In this review, we mainly discuss the existing methods and clinical outcomes of single sperm cryopreservation.
Azoospermia ; therapy ; Cryopreservation ; methods ; Heterozygote ; Humans ; Male ; Oligospermia ; therapy ; Reproduction ; Semen Preservation ; methods ; Spermatozoa

Clinically many patients with non-obstructive azoospermia cannot benefit from assisted reproductive technology for absence of spermatozoa. However, the achievement in the studies of spermatogonial stem cells has brought hope to this cohort. This article reviews the molecular mechanisms of the proliferation and differentiation of spermatogonial stem cells, in such aspects as related genes, growth factors, and so on.
Azoospermia ; therapy ; Cell Differentiation ; Cell Proliferation ; Humans ; Male ; Spermatogonia ; cytology ; Stem Cells ; cytology

OBJECTIVETo assess whether intracytoplasmic morphologically selected sperm injection (IMSI) of testicular sperm improves the clinical outcome in patients with azoospermia.

METHODSWe performed conventional intracytoplasmic sperm injection (ICSI) for 66 patients diagnosed with azoospermia and IMSI for another 39 using testicular sperm selected at high magnification ( x 6000), and comparatively analyzed the clinical outcomes of the two techniques.

RESULTSThere were no statistically significant differences between conventional ICSI and IMSI in the rates of pregnancy (51.52% vs. 56.41%) and implantation (30.67% vs. 35.29%), although the rate of early abortion was lower in the IMSI than in the ICSI group (4.50% vs. 11.76%).

CONCLUSIONIMSI of testicular sperm may effect a lower rate of early abortion than conventional ICSI in patients with azoospermia.

Adult ; Azoospermia ; therapy ; Female ; Humans ; Male ; Pregnancy ; Pregnancy Rate ; Sperm Injections, Intracytoplasmic ; methods ; Treatment Outcome

Men with non-obstructive azoospermia(NOA) can now be treated by using intra-oocyte round spermatid injection(ROSI) or elongated spermatid injection(ELSI). Spermatids can be retrieved from semen or from testis biopsy specimens. But the rates of fertilization and pregnancy with spermatids have been disappointing. Many problems limiting success rate and hindering a wide application of this technique still remain unresolved, including the incomplete maturation of spermatid nuclear, oocyte activation and identification of a live spermatid.
Azoospermia ; therapy ; Cryopreservation ; Female ; Humans ; Male ; Pregnancy ; Sperm Injections, Intracytoplasmic ; methods ; Spermatozoa ; cytology

OBJECTIVETo investigate the clinical value of artificial insemination by donor (AID).

METHODSWe retrospectively analyzed 480 cycles of AID among 258 infertile couples, who were divided according to the women's age into a < or = 30 yr group and a > or = 31 yr group.

RESULTSA total of 120 pregnancies were achieved in 480 AID cycles, with a cycle pregnancy rate of 25.00% and a cumulative pregnancy rate of 46.51%. In the natural cycles, the cycle pregnancy rate was 29.65% and the cumulative pregnancy rate was 51.00% in the < or = 30 yr group, significantly higher than 13.33% and 25.00% in the > or = 31 yr group (P < 0.05). In the ovulation induction cycles, no significant differences were found in the cycle and cumulative pregnancy rates between the two groups (24.02 and 48.86% versus 23.81 and 43.48% , P > 0.05). The cycle and cumulative pregnancy rates decreased with the increase of infertility duration and the women's age, but had no significant differences. In the first four cycles, the cycle pregnancy rates were 24.03, 24.94, 24.69 and 25.00% (P > 0.05), and the cumulative pregnancy rates were 24.03, 39.53, 45.74 and 46.51%, with significant differences between the first cycle and the other three (P < 0.01).

CONCLUSIONOvulation induction is superior to natural cycle in AID for older women. IVF/ICSI can be resorted to only after AID has failed three or four times.

Adult ; Azoospermia ; therapy ; Female ; Humans ; Insemination, Artificial, Heterologous ; Male ; Ovulation Induction ; Pregnancy ; Pregnancy Rate ; Retrospective Studies

OBJECTIVETo investigate the effects and clinical pregnancy outcomes of intracytoplasmic sperm insemination (ICSI) with microamount frozen-thawed sperm obtained by percutaneous epididymal sperm aspiration (PESA) or testicular sperm aspiration (TESA) in azoospermia patients.

METHODSWe divided 365 azoospermia patients treated by ICSI into an experimental group (n = 123) and a control group (n = 242) , the former with microamount frozen-thawed sperm, and the latter fresh sperm obtained by PESA or TESA. The rates of fertilization, good embryos, clinical pregnancy, miscarriage, ectopic pregnancy and multiple pregnancy were analyzed and compared between the two groups.

RESULTSWith PESA, the experimental group showed no statistically significant differences from the control group in the rates of fertilization (75.67% vs 76.49%), good embryos (64.96% vs 66.09%), clinical pregnancy (55.21% vs 57.22%), clinical miscarriage (13.21% vs 12.61%), ectopic pregnancy (3. 77% vs 5.41%) and multiple pregnancy (37.74% vs 37.84%) (P > 0.05); nor with TESA (74.41% vs 76.43%, 64.63% vs 66.35%, 46.81% vs 53.39%, 18.18% vs 14.55%, 4.55% vs 1.82%, 37.74% vs 37.84%, P > 0.05). The revival rate of the frozen-thawed sperm from PESA was 70.07%, not significantly different from that of TESA (62.67%) (P > 0.05).

CONCLUSIONICSI with frozen-thawed micro-amount sperm obtained by PESA or TESA is a safe, economic and effective method for the treatment of azoospermia. The techniques for reviving frozen sperm from PESA or TESA remain to be optimized, and whether these techniques may result in long-term genetic risks in the offspring deserves further investigation.

Adult ; Azoospermia ; therapy ; Female ; Humans ; Male ; Oligospermia ; therapy ; Pregnancy ; Pregnancy Rate ; Sperm Injections, Intracytoplasmic ; methods ; Sperm Retrieval

Advances in the oncology field have led to improved survival rates. Consequently, quality of life after remission is anticipated, which includes the possibility to conceive children. Since cancer treatments are potentially gonadotoxic, fertility preservation must be proposed. Male fertility preservation is mainly based on ejaculated sperm cryopreservation. When this is not possible, testicular sperm extraction (TESE) may be planned. To identify situations in which TESE has been beneficial, a systematic review was conducted. The search was carried out on the PubMed, Scopus, Google Scholar, and CISMeF databases from 1 January 2000 to 19 March 2020. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations were followed in selecting items of interest. Thirty-four articles were included in the systematic review, including 15 articles on oncological testicular sperm extraction (oncoTESE), 18 articles on postgonadotoxic treatment TESE and 1 article on both oncoTESE and postgonadotoxic treatment TESE. Testicular sperm freezing was possible for 42.9% to 57.7% of patients before gonadotoxic treatment and for 32.4% to 75.5% of patients after gonadotoxic treatment, depending on the type of malignant disease. Although no formal conclusion could be drawn about the chances to obtain sperm in specific situations, our results suggest that TESE can be proposed before and after gonadotoxic treatment. Before treatment, TESE is more often proposed for men with testicular cancer presenting with azoospermia since TESE can be performed simultaneously with tumor removal or orchiectomy. After chemotherapy, TESE may be planned if the patient presents with persistent azoospermia.
Child ; Humans ; Male ; Azoospermia/therapy* ; Testicular Neoplasms/therapy* ; Quality of Life ; Spermatozoa ; Testis ; Syndrome ; Sperm Retrieval ; Retrospective Studies

OBJECTIVETo sum up the experience in the treatment of obstructive azoospermia by intracytoplasmic sperm injection (ICSI).

METHODSWe retrospectively analyzed 107 cases of obstructive azoospermia treated by ICSI in our center from Jan. 2006 to Dec. 2008, and compared the rates of fertilization, cleavage and pregnancy between the patients with congenital bilateral absence of vas deferens (CBAVD) and those with non-CBAVD.

RESULTSA total of 949 oocytes were injected for the 107 patients undergoing ICSI, of which 678 (71.4%) were fertilized and 605 (89.2%) cleaved, with 44 pregnancies (41.4%). Of the 442 oocytes injected for the 49 patients with CBAVD, 308 (69.6%) were fertilized and 279 (90.6%) cleaved, with 27 pregnancies (55.1%), and of the 507 oocytes injected for the 58 cases induced by inflammation or surgery, 370 (72.9%) were fertilized and 326 (88.1%) cleaved, with 17 pregnancies (29.3%). The rate of pregnancy was significantly higher in the CBAVD than in the non-CBAVD group (P < 0.01), but there were no significant differences in the rates of fertilization and cleavage between the two groups (P > 0.05).

CONCLUSIONPESA or TESE combined with ICSI is an effective approach to the treatment of male infertility induced by obstructive azoospermia, which may achieve a higher rate of pregnancy in patients with CBAVD than in those with non-CBAVD. Inflammation or surgery may not only cause the obstruction of the deferent duct, but also affect sperm quality, and consequently reduce the potentiality of embryonic development.

Adult ; Azoospermia ; therapy ; Female ; Humans ; Male ; Middle Aged ; Pregnancy ; Pregnancy Rate ; Retrospective Studies ; Sperm Injections, Intracytoplasmic ; methods ; Treatment Outcome