Seminal duct obstruction may result in obstructive azoospermia (OA) and severe oligoasthenoteratozoospermia (OAT) (<0.5 million/mL) (Nordhoff et al., 2015). Cases of partial OA and OAT can be treated effectively by microsurgical anastomosis (Goldstein and Kim, 2013) to obtain successful surgical reversal. However, microsurgical vasovasostomy (VV) (Dickey et al., 2015) and vasoepididymostomy (VE) (Peng et al., 2017) are not suitable for patients with atypical OA and poor epididymis conditions or unpredictable obstruction of the distal vas deferens. For those patients, cross anastomosis may be applied instead of routine VE or VV. A single-center, retrospective, comparison study was conducted, which assessed the usefulness of the cross VV (CVV) in the scrotum for indication and efficacy. A total of 77 cases with OA or OAT were included, and 20 cases implemented cross anastomosis, including unilateral CVV (UCVV) in 4 cases, unilateral VE plus CVV (UVE+CVV) in 11 cases, and unilateral VV-based CVV (UVV+CVV) in 5 cases. The other 57 cases received no cross-matching anastomosis. The patency and natural pregnancy rates in one year were 75.0% and 50.0%, respectively, in the UCVV group; 54.5% and 27.3%, respectively, in the UVE+CVV group; and 60.0% and 40.0%, respectively, in the UVV+CVV group. The CVV in the scrotum in the selected patients with OA and severe OAT could yield good results. We regard the CVV in the scrotum as an efficacious operation with a lower risk of injury in cases of atypical OA.
Adult ; Anastomosis, Surgical ; Azoospermia/surgery* ; Epididymis/pathology* ; Female ; Humans ; Infertility/surgery* ; Male ; Oligospermia/surgery* ; Pregnancy ; Pregnancy Rate ; Retrospective Studies ; Scrotum/surgery* ; Treatment Outcome ; Vas Deferens ; Vasovasostomy/methods* ; Young Adult

We performed this meta-analysis to evaluate the predictive value of different parameters in the sperm retrieval rate (SRR) of microdissection testicular sperm extraction (TESE) in patients with nonobstructive azoospermia (NOA). All relevant studies were searched in PubMed, Web of Science, EMBASE, Cochrane Library, and EBSCO. We chose three parameters to perform the meta-analysis: follicle-stimulating hormone (FSH), testicular volume, and testicular histopathological findings which included three patterns: hypospermatogenesis (HS), maturation arrest (MA), and Sertoli-cell-only syndrome (SCOS). If there was a threshold effect, only the area under the summary receiver operating characteristic curve (AUSROC) was calculated. Otherwise, the pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and the diagnostic odds ratio (DOR) were also calculated. Twenty-one articles were included in our study finally. There was a threshold effect among studies investigating FSH and SCOS. The AUSROCs of FSH, testicular volume, HS, MA, and SCOS were 0.6119, 0.6389, 0.6758, 0.5535, and 0.2763, respectively. The DORs of testicular volume, HS, and MA were 1.98, 16.49, and 1.26, respectively. The sensitivities of them were 0.80, 0.30, and 0.27, while the specificities of them were 0.35, 0.98, and 0.76, respectively. The PLRs of them were 1.49, 10.63, and 1.15, respectively. And NLRs were 0.73, 0.72, and 0.95, respectively. All the investigated factors in our study had limited predictive value. However, the histopathological findings were helpful to some extent. Most patients with HS could get sperm by microdissection TESE.
Adult ; Azoospermia/therapy* ; Follicle Stimulating Hormone/blood* ; Humans ; Male ; Microdissection ; Oligospermia/pathology* ; Predictive Value of Tests ; Sensitivity and Specificity ; Sertoli Cell-Only Syndrome/pathology* ; Sperm Maturation ; Sperm Retrieval ; Spermatozoa ; Testis/pathology* ; Threshold Limit Values

OBJECTIVE: Azoospermia owing to testicular disorders is the most severe manifestation of male infertility. The main concern for patients with nonobstructive azoospermia (NOA) is the probability of successful sperm retrieval following testicular sperm extraction (TESE). Therefore, the goal of this study was to determine predictive factors correlated with sperm retrieval. METHODS: We assessed the testicular histopathological patterns, the choice of TESE surgical procedure, hormone levels, and chromosomal abnormalities in patients with NOA (n=170). The histopathology specimens were analyzed based on the histopathological patterns of hypospermatogenesis, maturation arrest, and Sertoli cell-only syndrome. RESULTS: The mean rate of sperm retrieval was 48.8%. The rate of sperm retrieval was significantly higher in the hypospermatogenesis group than in the other groups (p<0.001). There was a positive correlation between micro-TESE (vs. conventional TESE) and the sperm retrieval rate (odds ratio, 8.077; p<0.01). A logistic regression model demonstrated that high levels of follicle-stimulating hormone (FSH) and small testicular volume were significantly associated with lower chances of successful sperm retrieval. CONCLUSION: Some parameters, including testicular histopathology patterns, FSH levels, testicular volume, and method of TESE surgery, may be able to predict the chances of obtaining spermatozoa in patients with NOA. However, despite the efficiency of some predictive models, the hope of retrieving any functioning spermatozoa may be sufficient to disregard predictive factors of the success of intracytoplasmic sperm injection in these patients.
Azoospermia* ; Chromosome Aberrations ; Follicle Stimulating Hormone ; Hope ; Humans ; Infertility, Male ; Logistic Models ; Male ; Methods ; Oligospermia ; Pathology ; Sertoli Cell-Only Syndrome ; Sperm Injections, Intracytoplasmic ; Sperm Retrieval* ; Spermatozoa*

OBJECTIVE: To evaluate the fertility of infertile males of large samples by the routine semen examination, and to provide a scientific basis for clinical treatment of male infertility and improve efficacy. METHODS: We collected 16 835 semen specimens of infertile man in our hospital (the infertility group), and 1 567 semen specimens of sperm donating candidates from the sperm bank of our hospital (the control group). Semen routine examination was performed by computer-assisted semen analysis (CASA) technology, and the data of semen routine examination were analyzed statistically. RESULTS: The infertile patients with semen abnormalities in our hospital mainly suffered asthenospermia. The proportion of azoospermia, asthenospermia and oligoasthenospermia in the infertility group was higher than that in the control group, while the proportion of oligozoospermia was lower than that in the control group (P<0.001). CONCLUSION Azoospermia, asthenospermia and oligoasthenospermia are related to infertility, but simply oligozoospermia is not necessarily related to infertility.
Asthenozoospermia ; Azoospermia ; China ; Humans ; Infertility, Male ; epidemiology ; Male ; Oligospermia ; Semen Analysis ; Sperm Count ; Spermatozoa ; pathology

OBJECTIVETo study the effects of Wuzi Yanzong Pills (WYP) on sperm mitochondrial membrane potential (MMP) and its ultrastructure in oligo-asthenozoospermia model rats.

METHODSOligo-asthenozoospermia models were made in 50 male rats weighing 200 - 220 g by intragastric administration of Tripterygium Glucosides at 30 mg per kg per d for 8 weeks, and then equally allocated to a model control, a Huangjing Zanyu Capsule (HZC) control, a low-dose WYP, a medium-dose WYP, and a high-dose WYP group. Another 10 age-matched normal male rats were included as normal controls. The rats in the model and normal control groups were given intragastrically distilled water at 10 ml/kg, those in the HZC group administered HZC at 3.01 g/kg, and those in the low-, medium- and high-dose WYP groups medicated with WYP at 2.30, 4.60 and 9.20 g/kg, respectively, once daily for 30 days. At 30 minutes after the last administration, we detected the sperm MMP by JC-1 fluorescent staining and flow cytometry, and examined the sperm ultrastructure under the JEM-1230 transmission electron microscope.

RESULTSJC-1 + % and its fluorescence intensity were (33.77 +/- 6.19)% and 1 468 +/- 496 in the model control, (56.34 +/- 10.35)% and 3 277 +/- 895 in the HZC control, (40.80 +/- 10.40)% and 2 016 +/- 767 in the low-dose WYP, (59.40 +/- 6.51)% and 3 897 +/- 643 in the medium-dose WYP, and (60.71 +/- 7.81)% and 3 371 +/- 647 in the high-dose WYP group, significantly reduced in comparison with (70.80 +/- 4.92)% and 4 360 +/- 945 in the normal control group (P < 0.05), but remarkably higher in the medium- and high-dose WYP groups than in the model controls (P < 0. 05). After modeling, the sperm membrane was loose and degenerated, the mitochondria swelling, variously sized and with incomplete membrane, and the axonemal structure unclear or ruptured. After 30 days of WYP administration, compared with the model control group, the rats exhibited integrated sperm membrane and mitochondrial membrane, reduced mitochondrial swelling and basically normal axonemal and microtubular structures.

CONCLUSIONTripterygium Glucosides could decrease the sperm mitochondrial membrane potential and damage the mitochondrial structure, while WYP could significantly increase the sperm mitochondrial membrane potential and reduce the sperm mitochondrial structure damage. The protection of the integrity of sperm mitochondrial structure and function is one of the mechanisms of WYP acting on oligo-asthenozoospermia.

Animals ; Asthenozoospermia ; pathology ; physiopathology ; Drugs, Chinese Herbal ; pharmacology ; Male ; Membrane Potential, Mitochondrial ; drug effects ; Oligospermia ; pathology ; physiopathology ; Rats ; Rats, Sprague-Dawley ; Spermatozoa ; drug effects ; physiology ; ultrastructure

OBJECTIVETo investigate the effects of Yijing Recipe on sperm apoptosis and mitochondrial membrane potential (MMP) in patients with idiopathic oligoathenoteratospermia.

METHODSUsing the self-control method, we examined sperm apoptosis and MMP in 30 patients with oligoathenoteratospermia before and after treated with Yijing Recipe.

RESULTSThe rates of early sperm apoptosis (AV +/PI -) and MMP loss were significantly reduced after treatment as compared with pre-medication ([2.86 +/- 1.47]% vs [4.26 +/- 2.79]% and [21.77 +/- 13.46]% vs [41.73 +/- 20.30]%, P<0.05). No statistically significant difference was observed in the sperm death rate (PI+) before and after treatment ([34.10 +/- 16.26]% vs [30.21 +/- 13.50]%, P>0.05).

CONCLUSIONYijing Recipe can reduce early sperm apoptosis and improve MMP, which may be one of the mechanisms underlying its efficacy on oligoathenoteratospermia.

Adult ; Apoptosis ; drug effects ; Asthenozoospermia ; drug therapy ; pathology ; physiopathology ; Drugs, Chinese Herbal ; therapeutic use ; Humans ; Infertility, Male ; drug therapy ; pathology ; physiopathology ; Male ; Membrane Potential, Mitochondrial ; drug effects ; Oligospermia ; drug therapy ; pathology ; physiopathology ; Phytotherapy ; Semen Analysis ; Sperm Motility ; Spermatozoa

OBJECTIVETo compare the proteomic differences between normal and necrozoospermic human spermatozoa.

METHODSWe isolated proteins from 30 ejaculates of 10 healthy donors and 3 specimens of a necrozoospermia patient by two-dimensional gel electrophoresis (2-DE), analyzed their 2-DE maps and identified some differentially expressed proteins by mass spectrometry.

RESULTSA total of (905 +/- 57) and (792 +/- 28) proteins were isolated from the spermatozoal maps of the normal and necrozoospermic men, respectively, and 178 found to be differentially expressed in that of the necrozoospermia patient. The 6 missing protein spots in the necrozoospermic map were identified as sperm protein (human, accession No. 060904), zinc finger protein 174 (AW-1), F-actin capping protein alpha-3 subunit, testis-specific inhibitor of apoptosis, death domain receptor 3 soluble form (fragment) and peptide similar to the activator of CREM in the testis.

CONCLUSIONSix missing protein spots were identified in the necrozoospermic spermatozoal map which may be associated with the development of necrozoospermia.

Electrophoresis, Gel, Two-Dimensional ; Humans ; Male ; Mass Spectrometry ; Oligospermia ; metabolism ; pathology ; Peptide Mapping ; Proteome ; analysis ; Proteomics ; methods ; Spermatozoa ; metabolism ; pathology

OBJECTIVETo observe the changes of sperm chromatin in patients with oligo-astheno-teratozoospermia (OAT) syndrome after treated by integrated Chinese and Western medicine.

METHODSSixty patients with OAT syndrome were treated by integrated Chinese and Western medicine for 3 months. Their sperm samples were collected before and after the treatment, subjected to acridine orange staining and analyzed by fluorescent microscopy, flow cytometry and sperm routine detection.

RESULTSSignificant differences were shown in the master-group sperm signals (P < 0.01) and at and COMPalphat (P < 0.05) by flow cytometry, as well as in the green and the red groups (P < 0.05) by fluorescent microscopy before and after the treatment. Changes in sperm concentration, motility, vitality and deformity were noted after the treatment, with statistic difference between pre- and post-treatment (P < 0.05) except in forward sperm concentration.

CONCLUSIONTreatment by integrated Chinese and Western medicine can improve sperm chromatin in patients with OAT syndrome. Flow cytometry, along with fluorescent microscopy and sperm routine detection, plays an important role in the evaluation of male infertility therapy.

Adult ; Chromatin ; metabolism ; Combined Modality Therapy ; Flow Cytometry ; Humans ; Male ; Medicine, Chinese Traditional ; Microscopy, Fluorescence ; Oligospermia ; therapy ; Sperm Count ; Sperm Motility ; Spermatozoa ; metabolism ; 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