In 26 patients with severe factor infertility (total spermatozoa per ejaculate 0.8-6.3 million) in vitro fertilisation was performed using a capillary tube culture system. Spermatozoa were concentrated and incubated with oocytes in a very small volume (10-20 microliters) within capillary tubes. In seven out of 26 patients (27%) at least one oocyte could be successfully fertilised (overall fertilisation rate 11.6%, 22/190 oocytes) and in two patients a pregnancy with the birth of a healthy child could be observed. If sperm progression was only of grade 2 or less no fertilisation could be observed in 10 patients with a total of 75 oocytes. The described capillary technique for in vitro fertilisation using very small volumes for sperm-oocyte culture may be useful in cases of severe oligozoospermia or before considering extreme therapies such as donor insemination of sperm microinjection.
Fertilization in Vitro ; instrumentation ; methods ; Humans ; Infertility, Male ; etiology ; therapy ; Male ; Oligospermia ; complications

OBJECTIVETo assess the diagnostic value of alpha-glycosidase for epididymal lump induced obstructive azoospermia.

METHODSSeventy-six infertile men with normal spermatogenic function were divided according to sperm density into a normal density group (n = 27), an oligospermia group (n = 21) and an obstructive azoospermia group (n = 28), and another 30 fertile males were included as normal controls. Semen plasma alpha-glycosidase, leucocyte count, sexual hormone levels and the diameters of the epididymal lumps were measured and their correlations were analyzed.

RESULTSalpha-Glycosidase in the obstructive azoospermia group was significantly lower than that of the other groups (P <0.05), and negatively correlated with epididymal volume (r = -0.417, P <0.05) and leucocyte count (r = -0.342, P <0.05).

CONCLUSIONAlpha-Glycosidase has been proved of diagnostic value for epididymal obstructive azoospermia.

Adult ; Epididymis ; Genital Diseases, Male ; complications ; diagnosis ; Humans ; Male ; Oligospermia ; diagnosis ; etiology ; Sperm Count ; Sperm Motility ; alpha-Glucosidases ; analysis

Adult ; Asthenozoospermia/complications* ; Azoospermia/surgery* ; Humans ; Male ; Microsurgery/methods* ; Oligospermia/complications* ; Orchiectomy ; Seminoma/surgery* ; Testicular Neoplasms/surgery* ; Ultrasonography, Doppler, Color/methods* ; Urologic Surgical Procedures, Male/methods* ; Varicocele/surgery*

AIMTo describe the reproductive outcome following intracytoplasmic sperm injection (ICSI) for male factor infertility associated with Crohn's disease and 6-mercaptopurine (6-MP) chemotherapy.

METHODSThe male partner of a couple suffered from severe Crohn's disease and received a 3-month course of 6-MP for this condition. Two spontaneous conceptions were established before 6-MP, although post-chemotherapy semen analysis found the sperm concentration to be 8,000/mL. In vitro fertilization (IVF) with ICSI and embryo transfer was performed.

RESULTSThe woman underwent an uncomplicated controlled ovarian hyperstimulation sequence using a combined rec-FSH+hMG protocol, following late luteal phase pituitary downregulation. This culminated in the retrieval of 18 oocytes, 11 of which were fertilized with ICSI. She later delivered a normal male infant without urogenital anomaly. Four nontransferred blastocysts were cryopreserved.

CONCLUSIONThis report describes the first successful birth after ICSI for severe oligozoospermia associated with Crohn's disease and 6-MP therapy. We outline salient features of Crohn's disease, 6-MP pharmacology, and their relevance to human fertility.

Adult ; Crohn Disease ; complications ; drug therapy ; Female ; Humans ; Immunosuppressive Agents ; administration & dosage ; Male ; Mercaptopurine ; administration & dosage ; Oligospermia ; complications ; therapy ; Pregnancy ; Pregnancy Outcome ; Sperm Injections, Intracytoplasmic

Epididymitis is the most common of all the intrascrotal inflammations. It is mainly a disease of adults, and only rarely affects the prepubertal child. 107 cases of epididymitis seen during the period from January 1975 to June 1978 were studied. Clinically and the following results were obtained. 1. Incidence of epididymitis is 14.72% of all urological diseases of all in patients. 2. Lateralization shows 35.5% in the Right, 43% in the Left and 21.5% in the both. 3. The site of invasions is the most popular in the tail(50.7%). 4. The etiologic factors are observed the infection(non-specific 37.7%. Tuberculosis 20.8%) trauma (post-surgical 13.8%, injury 10.8%), and idiopathic(16.9%). 5. The surgical procedure followed by epididymitis is the most common in the hydrocelectomy (22.2%), next in the vasectomy(16.7%). Of presenting symptom, painful epididymal swelling is observed in 37.1%, painless epididymal swelling 16.7 %, inguinal dragging pain 258 and fever 6.8%. 6. The operation indicated in the epididymal mass(35.5%), scrotal fistular and abscess formation(22.6%), severe scrotal pain(19.4%), recurrent infection(16.1%) and epididymorchitis(6.4%). 7. In 76 cases of them conservative management are performed and in 31 cases of them surgical management are performed. The surhical procedure is the most common in partial epididymectomy(19.4%). 8. The epididymal open biopsy for differential diagnosis on the scrotal swelling are performed in 26 cases of the outpatients. The tuberculous epididymitis is the most common(26.9%), 9. The postoperative complication is noted the further increased epididymal induration in 16.1%, oligospermia in 9.7%, persistent inguinal dragging pain in 6.6% and wound infection in 3.2%. 10. The duration of hospitalization are average 15 days but on the surgical cases, within 2-3weeks are noted in 38.7%. On the conservative management cases, more than 4 weeks are noted in 28.9%.
Abscess ; Adult ; Biopsy ; Child ; Diagnosis, Differential ; Epididymitis* ; Fever ; Hospitalization ; Humans ; Incidence ; Inflammation ; Male ; Oligospermia ; Outpatients ; Postoperative Complications ; Tuberculosis ; Urologic Diseases ; Wound Infection

OBJECTIVETo investigate the clinical efficacy and safety of Liuwu Shengjing Decoction (LWD) in treating oligospermia and asthenospermia.

METHODSOne hundred and fourteen patients were randomized into two groups, the treated group administrated with self-formulated LWD, and the control group administrated with Wuzi Yanzong Pill (WYP). All were treated for 3 months. Patients' semen was analyzed before and after treatment, and the therapeutic efficacy was evaluated.

RESULTSThe total effective rate was 94.8% in the treated group, with a partner pregnant rate of 8.6% (5/58), while in the control group, they were 85.7% and 5.4% (3/56) respectively. The efficacy in the treated group was better (P = 0.03). Patients' sperm count and viability of sperm were improved in both groups (P < 0.05 or P < 0.01), but the improvement in the treated group was superior (P < 0.05).

CONCLUSIONLWD could effectively improve the condition of male infertility with oligospermia and asthenospermia.

Adult ; Drugs, Chinese Herbal ; therapeutic use ; Humans ; Infertility, Male ; drug therapy ; etiology ; Male ; Oligospermia ; complications ; drug therapy ; Phytotherapy ; Sperm Motility ; drug effects ; Treatment Outcome ; Young Adult

OBJECTIVETo explore the association of spermatogenic arrest with the expression of AR and HSP90alpha.

METHODSThe two-step immunohistochemical method was used to examine the expression of AR and HSP90alpha in the testicular biopsy specimens of 57 infertile men with spermatogenic arrest, compared with those taken from 15 normal healthy men.

RESULTSAR was expressed in the nuclei of the spermatogonia, spermatocytes and round spermatids of the normal testicular biopsy, but the intensity of the AR expression showed difference in each type of cells. Furthermore, the high expression of AR in spermatogonia and spermatids was on the margin of the cytoplasm, and perinuclear (forming a ring-like structure) were very distinctive in the spermatogenic arrest testicular biopsy specimens. HSP90alpha was expressed in spermatogonia, spermatocytes, Sertoli cells, Leydig cells and myoid cells in the normal testicular tissues, but highly expressed in the testicular tissues with spermatogenic arrest. The immunostaining intensity of HSP90alpha showed significant difference (P < 0.05) between the two kinds of testicular tissues.

CONCLUSIONThe results indicate that the abnormal expression sites of AR may make the androgen receptor unable to mediate androgen into the nucleus, which may down-regulate the gene transcription activity of spermatogenic cells. It is possible that the high expression of HSP90alpha may lead to a dramatic decrease in AR stability and an increase in AR abiquitirylation.

Adult ; Case-Control Studies ; HSP90 Heat-Shock Proteins ; biosynthesis ; Humans ; Immunohistochemistry ; Infertility, Male ; etiology ; metabolism ; Male ; Oligospermia ; complications ; metabolism ; Receptors, Androgen ; biosynthesis ; Spermatogenesis ; Testis ; metabolism ; pathology

BACKGROUNDIn view of the high cure rates in patients with testicular germ cell tumors (TGCT), increasing clinical importance is attached to protection of fertility. Long-term infertility due to cytostatic therapy may be expected in more than 50% of the patients at a cumulative dose of cisplatin > 0.6 g/m2. The standard procedure for fertility protection in cancer patients includes cryopreservation of ejaculated spermatozoa. Considering that some patients have tumor-induced azoospermia, we examined the usefulness of testicular sperm extraction before therapy.

METHODA survey of the literature served as a basis for investigating biological and clinical aspects of the impact of chemotherapy on male fertility. A study of our patient population also enabled us to explore the option of extracting sperm from the contralateral healthy testis prior to treatment in 14 azoospermic patients with testicular germ cell tumors.

RESULTSWe were able to successfully recover haploid germ cells in 6/14 testicular biopsies from azoospermic patients with testicular germ cell cancer prior to treatment. Maturation arrest was found in 3/14 cases and Sertoli-cell-only syndrome in the rest. None of the patients had secondary healing or a treatment delay because of the testicular biopsy.

CONCLUSIONSince the post-therapeutic fertility status is difficult to predict in cancer patients, we think that TESE should be regarded as a general option prior to cancer treatment and offered to azoospermic cancer patients. New guidelines should be established in this connection.

Antineoplastic Agents ; adverse effects ; Germinoma ; complications ; drug therapy ; pathology ; Humans ; Infertility, Male ; chemically induced ; etiology ; therapy ; Male ; Oligospermia ; pathology ; Spermatozoa ; cytology ; drug effects ; Testicular Neoplasms ; complications ; drug therapy ; pathology

AIMTo evaluate the effect of chronic hypoxia on human spermatogenic parameters and their recovery time.

METHODSSeminological parameters of six male healthy mountain trekkers were evaluated in normoxia at sea level. After 26 days exposure to altitude (ranging from 2 000 m to 5 600 m, Karakorum Expedition) the same parameters were again evaluated after returning to sea level. These parameters were once again evaluated after 1 month and then again after 6 months.

RESULTSSperm count was found to be lower immediately after returning to sea level (P = 0.0004) and again after a month (P = 0.0008). Normal levels were reached after 6 months. Spermatic motility (%) shows no reduction immediately after returning to sea level (P = 0.0583), whereas after 1 month this reduction was significant (P = 0.0066). After 6 months there was a recovery to pre-hypoxic exposure values. Abnormal or immature spermatozoa (%) increased immediately after returning to sea level (P = 0.0067) and then again after 1 month (P = 0.0004). After 6 months there was a complete recovery to initial values. The total number of motile sperm in the ejaculate was found to be lower immediately after returning to sea level (P = 0.0024) and then again after 1 month (P = 0.0021). After 6 months there was a recovery to pre-hypoxic exposure values.

CONCLUSIONChronic hypoxia induces a state of oligospermia and the normalization of such seminological parameters at the restoration of previous normoxic conditions after 6 months indicate the influence of oxygen supply in physiological mechanisms of spermatogenesis and male fertility.

Adaptation, Physiological ; physiology ; Adult ; Aged ; Altitude ; Humans ; Hypoxia ; complications ; Infertility, Male ; etiology ; pathology ; physiopathology ; Male ; Middle Aged ; Mountaineering ; Oligospermia ; etiology ; pathology ; physiopathology ; Sperm Count ; Sperm Motility ; physiology ; Spermatogenesis ; physiology

OBJECTIVETo observe the pregnancy promoting effect of Bushen Shengjing Decoction (BSSJD) combined with intracytoplasmic sperm injection (ICSI) in treating male infertility with severe oligospermatism and azoospermia (SOA).

METHODSICSI were applied on 164 patients, among them, the 82 assigned to the TCM group were treated with additionally by BSSJD before injection for 2-3 months, and the other 82 assigned to the control group received ICSI alone. The density, motility, viability and deformity of sperm; semen level of reactive oxygen species (ROS); number of eggs retrieved, M II eggs and mean transplanted fetus; rates of fertilization, cleavage, available embryo and clinical pregnancy in the two groups were observed and compared.

RESULTSCompared with those in the control group, the density, motility and viability of sperm were higher, the deformity rate and ROS level were lower in the TCM group respectively (P<0.05). Moreover, higher rates of fertilization and clinical pregnancy were also shown in the TCM group (P<0.05).

CONCLUSIONBSSJD has the effects of decreasing semen level of ROS and improving the quality of sperm. It is also helpful for the natural fertilization ability of patients with SOA and raise the viability of their sperm to increase the ovarian fertilization rate and clinical pregnancy rate in ICSI cycles.

Adult ; Combined Modality Therapy ; Drugs, Chinese Herbal ; therapeutic use ; Embryo Transfer ; Female ; Humans ; Infertility, Male ; etiology ; therapy ; Male ; Oligospermia ; complications ; therapy ; Phytotherapy ; Sperm Injections, Intracytoplasmic ; Sperm Motility ; drug effects ; Spermatozoa ; drug effects ; pathology ; Young Adult