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 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 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

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 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

AIMTo study the occurrence of Y chromosome microdeletions in azoospermic patients with Klinefelter's syndrome (KFS).

METHODSBlood and semen samples were collected from azoospermic patients with KFS (n = 14) and a control group of men of proven fertility (n = 13). Semen analysis was done according to World Health Organization (WHO) guidelines. Blood samples were processed for karyotyping, fluorescent in situ hybridization (FISH) and measurement of plasma follicle stimulating hormone (FSH) by radioimmunoassay. To determine Y chromosome microdeletions, polymerase chain reaction (PCR) of 16 sequence tagged sites (STS) and three genes (DFFRY, XKRY and RBM1Y) was performed on isolated genomic DNA. Testicular fine needle aspiration cytology (FNAC) was done in selected cases.

RESULTSY chromosome microdeletions spanning the azoospermia factor (AZF)a and AZFb loci were found in four of the 14 azoospermic patients with KFS. Karyotype and FISH analysis revealed that, of the four cases showing Y chromosome microdeletion, three cases had a 47,XXY/46,XY chromosomal pattern and one case had a 46,XY/47,XXY/48,XXXY/48,XXYY chromosomal pattern. The testicular FNAC of one sample with Y chromosome microdeletion revealed Sertoli cell-only type of morphology. However, no Y chromosome microdeletions were observed in any of the 13 fertile men. All patients with KFS had elevated plasma FSH levels.

CONCLUSIONPatients with KFS may harbor Y chromosome microdeletions and screening for these should be a part of their diagnostic work-up, particularly in those considering assisted reproductive techniques.

Adolescent ; Adult ; Chromosome Deletion ; Chromosomes, Human, Y ; Electrophoresis, Gel, Two-Dimensional ; Genetic Loci ; Humans ; In Situ Hybridization, Fluorescence ; Karyotyping ; Klinefelter Syndrome ; complications ; genetics ; Male ; Mosaicism ; Oligospermia ; etiology ; genetics ; Seminal Plasma Proteins ; genetics ; Sequence Tagged Sites

Idiopathic oligoasthenoteratozoospermia (iOAT) affects approximately 30% of all infertile men. This mini-review discussed recent data in this field. Age, non-inflammatory functional alterations in post-testicular organs, infective agents (Chlamydia trachomatis, herpes virus and adeno-associated viruses), alterations in gamete genome, mitochondrial alterations, environmental pollutants and "subtle" hormonal alterations are all considered possible causes of iOAT. Increase of reactive oxygen species in tubules and in seminal plasma and of apoptosis are reputed to affect sperm concentration, motility and morphology. iOAT is commonly diagnosed by exclusion, nevertheless spectral traces of the main testicular artery may be used as a diagnostic tool for iOAT. The following can be considered therapies for iOAT: 1) tamoxifen citrate (20 mg/d) + testosterone undecanoate (120 mg/d) (pregnancy rate per couple/month [prcm]: 3.8%); 2) folic acid (66 mg/d) + zinc sulfate (5 mg/d); 3) L-carnitine (2 g/d) alone or in combination with acetyl-L-carnitine (1 g/d) (prcm: 2.3%); and 4) both carnitines = one 30 mg cinnoxicam suppository every 4 days (prcm: 8.5%). Alpha-blocking drugs improved sperm concentration but not morphology, motility or pregnancy rate. Tranilast (300 mg/d) increased sperm parameters and pregnancy rates in an initial uncontrolled study. Its efficacy on sperm concentration (but not on sperm motility, morphology or prcm) was confirmed in subsequent published reports. The efficacy of tamoxifen + testosterone undecanoate, tamoxifen alone, and recombinant follicle-stimulating hormone is still a matter for discussion.
Acetylcarnitine ; therapeutic use ; Animals ; Antioxidants ; therapeutic use ; Apoptosis ; physiology ; Autoimmunity ; Chlamydia Infections ; complications ; Chlamydia trachomatis ; Chromosome Deletion ; Chromosomes, Human, Y ; Diagnosis, Differential ; Environmental Pollutants ; adverse effects ; Folic Acid ; therapeutic use ; Follicle Stimulating Hormone, Human ; therapeutic use ; Genitalia, Male ; pathology ; Humans ; Inflammation ; complications ; Male ; Oligospermia ; diagnosis ; etiology ; therapy ; Reactive Oxygen Species ; adverse effects ; Recombinant Proteins ; therapeutic use ; Sperm Count ; Spermatozoa ; immunology ; Tamoxifen ; therapeutic use ; Zinc Sulfate ; therapeutic use

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

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

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