Maturation arrest (MA) of spermatogenesis is diagnosed on histology as interruption of spermatogenesis before the final stage without impairment of Sertoli or Leydig cells. It is considered a condition of irreversible or absolute infertility. Varicocele, which represents impairment in the testicular venous drainage system, has been shown to be a bilateral disease. Malfunction of the valves increase the hydrostatic pressure in the testicular venous system that exceeds the pressure in the arterial system leading to hypoxia in the testicular microcirculation and in the seminiferous tubules, the sperm production site. Sperm production deteriorates, and ultimately progresses to azoospermia. Our prediction was that MA, if genetic factors are excluded, is the final stage of long standing hypoxia. This would indicate that MA is not always an independent disease entity, but may represent progressive process of deterioration of the testicular parenchyma beyond azoospermia. By histology and electron microscopy, our prediction confirmed, at least partially, that MA is associated with degenerative ischaemic changes in the seminiferous tubules. Adequate treatment of bilateral varicocele by microsurgery or super-selective sclerotherapy of the internal spermatic veins including associated network of venous bypasses, vertically oriented, may resume the flow of oxygenated blood. If irreversible damages did not occur and ischaemia is not too long standing, limited sperm production may be restored, at least partially.

OBJECTIVE: The aim of this study was to investigate possible differences in semen quality when samples were collected to be used on intracytoplasmic sperm injection (ICSI) cycles and samples collected for simple infertility evaluation purposes. DESIGN: Retrospective. MATERIALS AND METHODS: Semen samples were obtained from 617 male partners of women submitted for ICSI cycles treatment between January 2006 and December 2009. All samples were collected in the same room and evaluated by the same person. Semen specimens were collected after 3–5 days of abstinence and were analyzed for sperm concentration and percent progressive motility according to World Health Organization criteria and sperm morphology according to Tygerberg's strict criteria. Differences in semen parameters between sperm samples collected for instant use in ICSI cycles compared to previous sperm analysis in the same man were analyzed statistically. RESULTS: Sperm concentration was significantly lower (p= 0.03) in semen samples collected on the day of oocyte retrieval (17.2 ± 5.02) compared to those samples provided for previous seminal analysis for infertility evaluation (29.2 ± 9.1). Also, sperm motility decreased from the day of infertility investigation (52.7 ± 21.8) to the day of oocyte retrieval (31.7 ± 12.9; p = 0.04). On the other hand, no differences were found on sperm morphology according to the Tygerberg's strict criteria between the day of infertility investigation (5.1 ± 1.8) and the day of oocyte retrieval (4.3 ± 2.7; p= 0.08). CONCLUSION: Our results suggest that the decrease in semen quality is at least partly result of the acute psychological stress that is experienced by the patients who are requested to provide a semen sample at the day of in vitro fertilization. Due to this decrease in semen quality, semen cryopreservation may be suggested for men with severe oligospermia to overcome azoospermia/severe oligospermia on the day of ICSI procedure.

OBJECTIVE: The aim of this study was to compare intracytoplasmic morphologically selected sperm injection (IMSI) efficacy on male factor infertility cases based on WHO guideline from 1999 and WHO guideline from 2010.DESIGN: Prospective.MATERIALS AND METHODS: Enrolled patients were split into two groups: IMSI-Group (n=250), which underwent IMSI; and Control-Group (n=250), which underwent intracytoplasmic sperm injection (ICSI). The cycle's outcomes were compared among the groups. In a further analysis, two different groups of patients were analyzed separately: (i) oligoastenozoospermic patients according to the WHO reference values from 1999 and (ii) oligoastenozoospermic patients according to the reference values of 2010. Regression analysis was performed to assess the influence of IMSI on treatment outcomes.RESULTS: No significant differences were observed between the IMSI-group and ICSI-group for any evaluated variable, except for fertilization rate, which was significantly higher in IMSI group (68.0% vs 73.0%, p=0.013). When patients were considered oligoastenozoospermic according to the WHO guideline from 1999, a positive influence of the IMSI on the fertilization rate was also observed (OR: 1.3, CI: 0.7 – 2.1, p= 0.043). No impact of IMSI on the other variables was observed. Regarding oligoastenozoospermic patients according to the reference values from 2010, a close relationship between IMSI and fertilization rate (OR: 4.3, CI: 2.2 – 6.4, p=0.004) was noted. Moreover, considering these new reference values, the use of morphologically selected sperm was determinant to the likelihood of implantation (OR: 2.6, CI: 1.2 – 5.7, p=0.013) and pregnancy (OR: 1.67, CI: 0.8 – 3.0, p=0.045) occurrence.CONCLUSION: With the introduction of new cut-off points, oligoastenozoospermic males, who may largely be responsible for the subfertility of the couple, can be more accurately identified. Moreover, in those patients, IMSI treatment could result in improved outcomes. OBJECTIVE: The aim of this study was to compare intracytoplasmic morphologically selected sperm injection (IMSI) efficacy on male factor infertility cases based on WHO guideline from 1999 and WHO guideline from 2010. DESIGN: Prospective. MATERIALS AND METHODS: Enrolled patients were split into two groups: IMSI-Group (n=250), which underwent IMSI; and Control-Group (n=250), which underwent intracytoplasmic sperm injection (ICSI). The cycle's outcomes were compared among the groups. In a further analysis, two different groups of patients were analyzed separately: (i) oligoastenozoospermic patients according to the WHO reference values from 1999 and (ii) oligoastenozoospermic patients according to the reference values of 2010. Regression analysis was performed to assess the influence of IMSI on treatment outcomes. RESULTS: No significant differences were observed between the IMSI-group and ICSI-group for any evaluated variable, except for fertilization rate, which was significantly higher in IMSI group (68.0% vs 73.0%, p=0.013). When patients were considered oligoastenozoospermic according to the WHO guideline from 1999, a positive influence of the IMSI on the fertilization rate was also observed (OR: 1.3, CI: 0.7 – 2.1, p= 0.043). No impact of IMSI on the other variables was observed. Regarding oligoastenozoospermic patients according to the reference values from 2010, a close relationship between IMSI and fertilization rate (OR: 4.3, CI: 2.2 – 6.4, p=0.004) was noted. Moreover, considering these new reference values, the use of morphologically selected sperm was determinant to the likelihood of implantation (OR: 2.6, CI: 1.2 – 5.7, p=0.013) and pregnancy (OR: 1.67, CI: 0.8 – 3.0, p=0.045) occurrence. CONCLUSION: With the introduction of new cut-off points, oligoastenozoospermic males, who may largely be responsible for the subfertility of the couple, can be more accurately identified. Moreover, in those patients, IMSI treatment could result in improved outcomes.

Sertoli-cell-only (SCO) syndrome, or germ cell aplasia, is diagnosed on testicular biopsy when germ cells are seen to be absent without histological impairment of Sertoli or Leydig cells. It is considered a situation of irreversible infertility. Recent studies have shown that varicocele, a bilateral disease, causes hypoxia in the testicular microcirculation. Destruction of one-way valves in the internal spermatic veins (ISV) elevates hydrostatic pressure in the testicular venules, exceeding the pressure in the arteriolar system. The positive pressure gradient between arterial and venous system is reversed, causing hypoxia in the sperm production site. Sperm production deteriorates gradually, progressing to azoospermia. Our prediction was that, if genetic problems are excluded, SCO may be the final stage of longstanding hypoxia which deteriorates sperm production in a progressive process over time. This would indicate that SCO is not always an independent disease entity, but may represent deterioration of the testicular parenchyma beyond azoospermia. Our prediction is confirmed by histology of the seminiferous tubules demonstrating that SCO is associated with extensive degenerative ischaemic changes and destruction of the normal architecture of the sperm production site. Adequate treatment of bilateral varicocele by microsurgery or by selective sclerotherapy of the ISV resumes, at least partially, the flow of oxygenated blood to the sperm production site and restored sperm production in 4 out of 10 patients. Based on our findings the following statements can be made: (i) SCO may be related in part of the cases to persistent, longstanding testicular parenchymal hypoxia; (ii) germ cells may still exist in other areas of the testicular parenchyma; and (iii) if genetic problems are excluded, adequate correction of the hypoxia may restore very limited sperm production in some patients.

Objective: To evaluate zona pellucida birefringence (ZPB) in immature and mature oocytes collected after controlled ovarian stimulation and to assess the influence of ZPB on oocyte development.Design: Prospective study.Setting(s): Private assisted reproduction centre.Patient(s): Thirty patients undergoing intracytoplasmic sperm injection.Intervention(s): The ZPB of mature and immature oocytes was evaluated using a polarization imaging software module, and the oocytes were classified as high birefringence (HB) or low birefringence.Main Outcome Measure(s): The ZPB of in vivo and in vitro matured oocytes and its influence on spontaneous nuclear maturation in vitro, fertilization, and embryo quality.Result(s): The percentage of HB oocytes was higher in immature than in mature oocytes (40.1 vs. 23.6%). Among immature oocytes, an increased percentage of HB in prophase-I stage oocytes compared to metaphase I stage oocytes was also observed (50.7 vs. 25.0%). However, the percentage of HB oocytes did not change when comparing oocytes before and after in vitro maturation for both prophase I and metaphase I oocytes. No influence of ZPB was observed on the spontaneous in vitro maturation potential. Exclusively for metaphase II retrieved oocytes, a positive influence of ZPB on fertilization (odds ratio [OR], 1.78; 95% confidence interval [CI], 1.27-2.49) and embryo quality (OR, 2.28; 95% CI, 1.04-4.99) was noted.Conclusion(s): ZPB may be a useful tool to predict embryo quality for metaphase-II oocytes. Moreover, the completion of nuclear changes in the production of metaphase-II oocytes in vitro may not reflect their molecular maturity. (Fertil Steril (R) 2010;94:2050-3. (C) 2010 by American Society for Reproductive Medicine.)

You have accessJournal of UrologyModerated Poster, Tuesday, May 23, 2006, 3:30 - 5:30 pm1 Apr 20061412: The Source of Spermatozoa do not have Correlation with Early Embryo Development Edson Borges, Tatiana C. Bonetti, Patricia Guilherme, Christiany V. Locambo-Freitas, Tsutomu Aoki, Fabio Pasqualotto, and Assumpto Iaconelli Edson BorgesEdson Borges More articles by this author , Tatiana C. BonettiTatiana C. Bonetti More articles by this author , Patricia GuilhermePatricia Guilherme More articles by this author , Christiany V. Locambo-FreitasChristiany V. Locambo-Freitas More articles by this author , Tsutomu AokiTsutomu Aoki More articles by this author , Fabio PasqualottoFabio Pasqualotto More articles by this author , and Assumpto IaconelliAssumpto Iaconelli More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)33616-4AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "1412: The Source of Spermatozoa do not have Correlation with Early Embryo Development." The Journal of Urology, 175(4S), pp. 455–456 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 175Issue 4SApril 2006Page: 455-456 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Edson Borges More articles by this author Tatiana C. Bonetti More articles by this author Patricia Guilherme More articles by this author Christiany V. Locambo-Freitas More articles by this author Tsutomu Aoki More articles by this author Fabio Pasqualotto More articles by this author Assumpto Iaconelli More articles by this author Expand All Advertisement PDF DownloadLoading ...

Objective: To examine the outcome of assisted reproduction techniques (ART) using cryopreserved semen from patients with cancer.Design: Prospective.Setting: Therapeutic semen banking program at a tertiary healthcare center.Patient(s): Twenty-nine men with cancer who cryopreserved their sperm before treatment at our facility from 1982 to 2001 and withdrew their samples for assisted reproduction (IUI, IVF, or intracytoplasmic sperm injection [ICSI]).Intervention(s): Sperm bank records were used to identify the patients. Information on fertility potential indices was obtained from medical records and through interviews. Of the 29 patients, 9 had testicular cancer, 12 had Hodgkin's disease, and 8 had other types of cancer.Main Outcome Measure(s): Pregnancy and live births.Result(s): A total of 87 ART cycles (42 IUI, 26 IVF, and 19 ICSI) was performed. Of those cycles, 18.3% resulted in pregnancy (7% IUI, 23% IVF, and 37% ICSI), and 75% of the pregnancies resulted in a live birth (100% IUI, 83% IVF, and 57% ICSI). There was no significant difference in the outcomes when the results were stratified by type of ART and malignancy. None of the 11 infants who were born had congenital anomalies.Conclusion(s): Our findings emphasize the need for physicians to discuss the issue of semen cryopreservation with all men of reproductive age who have cancer before antineoplastic therapy is started. (C)2004 by American Society for Reproductive Medicine.

We did not find different rates neither for malformation, neonatal death nor paediatric pathologies. Seventy percent of Neonatal Intensive Care Unit (NICU) hospitalisations and more than 80% of deaths derived from multiple pregnancies (preterm deliveries are logically involved). Nevertheless, IVF singletons stay longer in NICU than non IVF ones. Sphincters control, acquisition of walk or speech were achieved at the same period in all groups but these data were submitted to parents subjectivity. Psychomotricity was prescribed in both groups with the same frequency but IVF children followed more often logopedy or physiotherapy cares. Conclusions: In the light of our results, we can conclude that IVF is as sure as non IVF conception in a short or long time evaluation. But expenses for IVF will remain greater for our societies as long as it provides a high rate of multiple pregnancies. on the resulting pregnancies and newborns, since 1986. For this study, all the pregnancies issued from ICSI performed between 1994 and 2001, for which data were available for the patient characteristics and the IVF cycle. a semen been used this 14,232 pregnancies, and 14,557 newborn. Among those, 9.1% were with non-ejaculated semen, 3.9% with fresh epididymal semen, 2.6% with fresh testicular sperm and 2.5% from frozen semen obtained from testis or epididymis. Those were compared and a comparison was also made with data of French registries on malformations. need to continue the data collection, to reach enough statistical power to be able to study individual malformations, and to produce tools for genetic counseling when non-ejaculated semen is used for ICSI. Comparisons made between the first and ejaculates and between the first and pooled ejaculates. Statistical evaluation was performed using a t-test and Chi-square test. In men (n characteristics between the ejaculates. we detected slight decrease in semen in count in the statistically different. In men (n 43), the motility and the motile sperm follicles at which time hCG was given. Sperm was prepared using a gradient centrifugation technique with IUI performed high up in the uterine fundus. Results: Of the 348 patient cycles randomized, 270 treatment cycles were initiated. Eighty one initiated cycles were cancelled leaving 189 completed randomized cycles from 75 patients for analysis. Pregnancy rates were not significantly different between groups. There were 20 pregnancies of the 96 short hCG-IUI interval cycles (21%) and 14 pregnancies of the 93 long hCG-IUI interval cycles (15%), [p=0.398, odds ratio = 0.673 with Cornfield’s 95% confidence limits of 0.297 – 1.518]. A sample size of 190 in this study has a power of 0.8 to detect an increase in pregnancy rates from 15 to 30% between groups with and alpha of 0.05. Conclusion: Pregnancy rates are the same after super-ovulation therapy whether IUI is done either after a short or long interval after hCG injection. and methods: Retrospectively all data of patients who started their first IVF or ICSI cycle at the university hospital Lübeck from January 1 st , 1994, until April 30 th , 2001 were included. Cycles of these patients until January 31st, 2002 were respected in this analysis. Data of 4102 in-vitro fertilization cycles performed under the conditions of the German embryo protection law in 2130 patients were analysed. Expected cumulative pregnancy rates were calculated by life-table analysis using the Kaplan-Meier procedure. Results: A real cumulative pregnancy rate of 31.2% was achieved after 4 cycles with an expected cumulative pregnancy rate (ECPR) of 53.3%. Age was a significant factor regarding pregnancy rates (ECPR after 4 cycles: 57.1% < 35 years, 44.8% ≥ 35 years, 35.4% ≥ 40 years). The number of oocytes retrieved and the cumulative embryo score decreased during the course of therapy caused by the increasing female age. When transferring two embryos compared to three embryos in patients < 35 years, the pregnancy rate per cycle was not different in the first two cycles, but was significantly lower in the third and fourth cycle (1 st cycle: 21.3% vs. 26.9%, 3rd cycle: 6.4% vs. 22.1%). In patients λ 35 years the pregnancy rate was higher after the transfer of three embryos from the first cycle. The drop-out rate of non-pregnant patients increased from 39.9% after the first cycle to 62.2% after the fourth cycle. The drop-out rate was not influenced by the patients’ age. The ROC curve indicated a SPA cutoff score of 3 (sensitivity 0.83; specificity values, 0.50; diagnostic accuracy, 0.64; positive predictor, 0.56; and negative predictor, 0.80). With this criterion, patients that passed the SPA had a pregnancy rate of 56%, where patients that failed the SPA had a pregnancy rate of 20%. Conclusion: Incorporating the SPA into the diagnostic work-up may facilitate the decision making process for the physician as well as the couple. In our laboratory, we found that the SPA score cut-off for a successful pregnancy following IUI is 3. Those couples that failed to reach the cutoff had a markedly lower pregnancy rate. In these situations, counseling patients to consider IVF-ET as the primary treatment may be an option. Fast tracking to IVF-ET for a particular couple with a poor SPA would offer a greater chance of pregnancy while reducing overall treatment cost and shortening the duration of treatment. Results: Regarding the adherence of health care professionals to recommen- dations related to the process of care, we found that: the indication of ovarian stimulation for the different diagnostic categories ranged from 62 to 85% and the adherence to recommendations related to the way of ovarian stimulation itself was between 24 and 55%. The adherence to recommendations related to cycle cancellation ranged between 79 and 93% and to recommendations related to cycle monitoring and timing ranged from 18 to 99% and form 46 to 90%, respectively. The percentages found for structure related indicators varied from 54 to 100. As outcome indicators varied in the 10 different hospitals the singleton livebirth rate per couple between 10-46% and the livebirth twin rate between 4-29%. Conclusions: The variation in adherence of health care professionals in the Netherlands to the clinical guideline IUI of the Dutch Society of Obstetrics and Gynaecology is very large. These results may help to develop effective strategies to implement the IUI-guideline and therefore improvement of patient care for IUI. Objective: The present study was to compare the efficacy of conventional IIU (c-IIU) versus Fallopian Sperm Perfusion (FSP) as a treatment for infertility. Design: Prospective, comparative, randomized study. Material/methods: a total of 362 patients were included from July to December 2003. They were divided into two groups. Group A: 307 patients who underwent c-IIU. Group B: 55 patients who underwent FSP. Women’s age and weight, hormonal profile on day 3 (FSH, LH, PRL), COH protocol, total motile count, and insemination quality. Statistical analysis, using SPSS 1, were performed with squared chi and ANOVA. Results: All variables showed no difference between groups. When analyzing pregnancy rate, we found no statistical difference (p=0.782) between c-IIU (55 pregnancies, 17.9%) and FSP (9 pregnancies, 16.3%). Mean pregnancy rate of both groups was 17.6%. Conclusion: Fallopian Sperm Perfusion show no advantages on pregnancy rate when compared with conventional IIU. Follicular monitoring was performed on days 10 to 12. HCG 10000 IU was administered when at least one leading follicle was larger than 20 mm. IUI was accomplished 24-36 hours after HCG injection and luteal phase supplement was achieved with micronized progesterone 200 mg transvaginally per day. Results: Group A consisted of 40 treatment cycles in 32 patients and Group B 20 cycles in 16 patients. The two groups had similar background patient and cycle characteristics. There was no statistic significance in number of stimulated follicles larger than 14 mm before HCG injection (3.7 ± 1.44 and 3.1 ± 1.42, respectively). But a significant increase in endometrial thickness (7.1 ± 1.47 and 12.5 ± 3.24 mm) on HCG day was found in TMX-treated patients (P < 0.005, t-test). The chemical pregnancy rates per treatment cycle were 22.5% (9/40) and 35.0% (7/20), which were not statistically significant. Five and one early pregnancy losses occurred in Group A and B, respectively, which resulted in an on-going pregnancy rate 10% (4/40) and 30% (6/20) in the two groups. The difference was statistically significant (P < 0.05, Chi-square). Conclusions: Although recruited follicle number and chemical pregnancy rate are both comparable, this study demonstrates that TMX therapy improves endometrial thickness and in particular, by decreasing miscarriage, increases on-going pregnancy rate in IUI patients with a thin endometrium in a previous cycle. From this study, TMX may be a promising alternative to CC in selected patients. of versus go- nadotropins on platelet and hemostatic in undergoing controlled hyperstimulation

Purpose: Ureaplasma urealyticum is a commensal of the lower genitourinary tract of many sexually active adults. The organism is more common in partners of infertile than fertile marriages. We conducted a prospective study at our tertiary care center to confirm a possible association between U. urealyticum and abnormal sperm function parameters.Materials and Methods: A total of 50 consecutive male patients seeking general urology consultation for lower urinary tract symptoms characteristic of chronic prostatitis were evaluated. Urine and semen localization cultures were performed with additional semen cultures for U. urealyticum, Chlamydia trachomatis and Mycoplasma hominis. Specimens from 21 healthy men were used as controls. Specimens were analyzed by a computer assisted semen analyzer, and verified manually for concentration, percent motility and morphology. Leukocytospermia was measured by the Endtz test. Semen specimens were also analyzed for reactive oxygen species (ROS), acrosome reaction and mannose binding assay.Results: Of the patients 17 had positive U. urealyticum cultures and the other cultures were negative. Patients with U. urealyticum had significantly higher ROS levels (log [ROS + 1] = 2.52 +/- 0.25) than those without U. urealyticum (1.49 +/- 0.20, p = 0.002) or controls (1.31 +/- 0.19, p = 0.002). Leukocytospermia was detected in only 1 of the 17 (6%) positive specimens and 4 (12%) negative specimens.Conclusions: Seminal ROS levels are elevated among patients with U. urealyticum. ROS induces lipid peroxidation, which reduces membrane fluidity and sperm fertilization capability, and may be the mechanism by which U. urealyticum impairs sperm function. Absence of leukocytospermia does not exclude U. urealyticum.