1
|
Vashisht A, Gahlay GK. Understanding seminal plasma in male infertility: emerging markers and their implications. Andrology 2024; 12:1058-1077. [PMID: 38018348 DOI: 10.1111/andr.13563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/26/2023] [Accepted: 11/11/2023] [Indexed: 11/30/2023]
Abstract
Infertility affects a significant proportion of the reproductive-aged population, with male-associated factors contributing to over half of the cases. However, current diagnostic tools have limitations, leading to an underestimation of the true prevalence of male infertility. While traditional semen parameters provide some insights, they fail to determine the true fertility potential in a substantial number of instances. Therefore, it is crucial to investigate additional molecular targets responsible for male infertility to improve understanding and identification of such cases. Seminal plasma, the main carrier of molecules derived from male reproductive glands, plays a crucial role in reproduction. Amongst its multifarious functions, it regulates processes such as sperm capacitation, sperm protection and maturation, and even interaction with the egg's zona pellucida. Seminal plasma offers a non-invasive sample for urogenital diagnostics and has shown promise in identifying biomarkers associated with male reproductive disorders. This review aims to provide an updated and comprehensive overview of seminal plasma in the diagnosis of male infertility, exploring its composition, function, methods used for analysis, and the application of emerging markers. Apart from the application, the potential challenges of seminal plasma analysis such as standardisation, marker interpretation and confounding factors have also been addressed. Moreover, we have also explored future avenues for enhancing its utility and its role in improving diagnostic strategies. Through comprehensive exploration of seminal plasma's diagnostic potential, the present analysis seeks to advance the understanding of male infertility and its effective management.
Collapse
Affiliation(s)
- Ashutosh Vashisht
- Department of Molecular Biology and Biochemistry, Guru Nanak Dev University, Amritsar, Punjab, India
| | - Gagandeep Kaur Gahlay
- Department of Molecular Biology and Biochemistry, Guru Nanak Dev University, Amritsar, Punjab, India
| |
Collapse
|
2
|
Wang M, Zhou J, Long R, Mao R, Gao L, Wang X, Chen Y, Jin L, Zhu L. An overview of CFTR mutation profiles and assisted reproductive technology outcomes in Chinese patients with congenital obstructive azoospermia. J Assist Reprod Genet 2024; 41:505-513. [PMID: 38114870 PMCID: PMC10894795 DOI: 10.1007/s10815-023-03004-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 12/04/2023] [Indexed: 12/21/2023] Open
Abstract
PURPOSE The cystic fibrosis transmembrane conductance regulator (CFTR) is the most common causative gene attributed to congenital obstructive azoospermia (OA). The aim of this study was to conduct an epidemiological survey of congenital OA patients, to screen for CFTR mutations, and to follow their pregnancy outcomes in assisted reproductive technology (ART). METHODS This cohort study enrolled congenital OA patients undergoing ART and whole-exome sequencing from January 2018 to September 2023. Semen parameters, sex hormones, and seminal plasma biochemistry were evaluated. CFTR mutations identified in OA patients were analyzed. In addition, the laboratory outcomes, clinical outcomes, and neonatal outcomes were compared between OA patients carrying two CFTR mutations and the others after surgical sperm extraction-intracytoplasmic sperm injection (ICSI) treatment. RESULTS A total of 76 patients with congenital OA were enrolled. CFTR mutations were identified in 35 (46.1%) congenital OA patients. A total of 60 CFTR mutation sites of 27 types were identified, and 10 of them were novel. The average frequency was 1.71 (60/35) per person. The most common mutation was c.1210-11T > G (25%, 15/60). After ICSI treatment, there were no statistically significant differences in laboratory outcomes, clinical outcomes, and neonatal outcomes between OA patients carrying two CFTR mutations (n = 25) and other OA patients (n = 51). CONCLUSION Apart from the IVS9-5T mutation, the genetic mutation pattern of CFTR in Chinese OA patients is heterogeneous, which is significantly different from that of Caucasians. Although carrying two CFTR mutations or not had no effect on the pregnancy outcomes in OA patients after ICSI, genetic counseling is still recommended for such patients.
Collapse
Affiliation(s)
- Meng Wang
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Juepu Zhou
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Rui Long
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Ruolin Mao
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Limin Gao
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xiangfei Wang
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yinwei Chen
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Lei Jin
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
| | - Lixia Zhu
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
| |
Collapse
|
3
|
Lewin J, Lukaszewski T, Sangster P, Williamson E, McEleny K, Al Wattar BH, Yasmin E. Reproductive outcomes after surgical sperm retrieval in couples with male factor subfertility: a 10-year retrospective national cohort. Fertil Steril 2023; 119:589-595. [PMID: 36592648 DOI: 10.1016/j.fertnstert.2022.12.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 12/24/2022] [Accepted: 12/28/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To determine any significant differences in the reproductive outcome from intracytoplasmic sperm injection (ICSI) with surgical sperm retrieval (SSR) between cycles using fresh and cryopreserved sperm and between cycles using epididymal and testicular sperm. DESIGN A retrospective national cohort study using data from the UK Human Fertilisation and Embryology Authority, including all ICSI cycles performed in the United Kingdom over a 10-year period. SETTING Hospital. PATIENT(S) All nondonor ICSI cycles from 2008 to 2017 categorized by sperm source and cryopreservation status. INTERVENTION(S) Intracytoplasmic sperm injection with SSR using fresh or cryopreserved sperm and using ejaculated, testicular, and epididymal sperm. MAIN OUTCOME MEASURE(S) Live birth rate, pregnancy rate, and implantation rate. RESULT(S) We analyzed data from 214,649 ICSI cycles, including 199,818 cycles of ejaculated sperm, 5,646 cycles of epididymal sperm, and 9,185 cycles of testicular sperm. Live births rates per ICSI cycle were 28.5%, 30.6%, and 28.7% for ejaculated, epididymal, and testicular sperm cycles, respectively. Epididymal sperm cycles had a higher live birth rate than that of testicular sperm cycles (odds ratio [OR], 1.067; 95% confidence interval [CI], 1.014-1.123). This was despite a higher mean male age (42.5 vs. 40.6 years; 95% CI of difference, 1.81-1.85 years) and female age (34.3 vs. 34.0 years; 95% CI of difference, 0.32-0.34 years) in epididymal cycles than in testicular cycles. Implantation (61.2% vs. 58.0%; OR, 1.086; 95% CI, 1.041-1.133) and clinical pregnancy rates (34.3% vs. 31.3%; OR, 1.085; 95% CI, 1.039-1.132) were also higher in epididymal cycles than in testicular cycles. There were no statistically significant differences in outcomes between cycles using fresh sperm and those using cryopreserved sperm for SSR-ICSI. CONCLUSION(S) Our study indicates that reproductive outcomes of SSR-ICSI are at least comparable with those of ICSI using ejaculated sperm and does not support the preferential use of fresh sperm over cryopreserved sperm in SSR-ICSI. Births per SSR-ICSI cycle were higher for cycles using epididymal sperm than for cycles using testicular sperm; however, the differences were small, which may provide reassurance to patients undergoing these procedures. The results must be interpreted with caution because multivariable analysis was not possible because of aggregation of data.
Collapse
Affiliation(s)
- Jonathan Lewin
- Reproductive Medicine Unit, University College London Hospitals, London, United Kingdom; UCL Institute for Women's Health, University College London, London, United Kingdom
| | - Tomasz Lukaszewski
- Reproductive Medicine Unit, University College London Hospitals, London, United Kingdom
| | - Phillippa Sangster
- Reproductive Medicine Unit, University College London Hospitals, London, United Kingdom; Department of Urology, University College London Hospitals, London, United Kingdom
| | - Elizabeth Williamson
- Reproductive Medicine Unit, University College London Hospitals, London, United Kingdom
| | - Kevin McEleny
- Newcastle Fertility Centre, Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, United Kingdom
| | - Bassel H Al Wattar
- Reproductive Medicine Unit, University College London Hospitals, London, United Kingdom; UCL Institute for Women's Health, University College London, London, United Kingdom
| | - Ephia Yasmin
- Reproductive Medicine Unit, University College London Hospitals, London, United Kingdom; UCL Institute for Women's Health, University College London, London, United Kingdom.
| |
Collapse
|
4
|
Brant A, Schlegel PN. Modern surgical treatment of azoospermia. Curr Opin Urol 2023; 33:39-44. [PMID: 36301052 DOI: 10.1097/mou.0000000000001055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To review noteworthy research from the last 2 years on surgical management of azoospermia. RECENT FINDINGS The recommended treatments for nonobstructive and obstructive azoospermia have not appreciably changed. However, recent level-1 evidence has reinforced superiority of micro-dissection testicular sperm extraction over sperm aspiration in men with nonobstructive azoospermia, and several studies have identified genetic and other clinical factors that may aid in selecting candidates for testicular sperm extraction. Machine learning technology has shown promise as a decision support system for patient selection prior to sperm retrieval as well a tool to aid in sperm identification from testis tissue. SUMMARY Most men with obstructive azoospermia who desire fertility can be offered either surgical reconstruction or sperm retrieval. For men with nonobstructive azoospermia, sperm retrieval with microdissection testicular sperm extraction remains the gold standard treatment. Uncovering more genetic causes of nonobstructive azoospermia may aid in properly counseling and selecting patients for microdissection testicular sperm extraction. Neural networks and deep learning may have a future role in patient selection for surgical sperm retrieval and postprocedural sperm identification.
Collapse
Affiliation(s)
| | - Peter N Schlegel
- Department of Urology
- Center for Reproductive Medicine and Infertility, Weill Cornell Medical College, New York, New York, USA
| |
Collapse
|
5
|
Wu X, He X, Liu Q, Li H. The developmental miR-17-92 cluster and the Sfmbt2 miRNA cluster cannot rescue the abnormal embryonic development generated using obstructive epididymal environment-producing sperm in C57BL/6 J mice. Reprod Biol Endocrinol 2022; 20:164. [PMID: 36451157 PMCID: PMC9710060 DOI: 10.1186/s12958-022-01025-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 10/16/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Sperm, during epididymal transit, acquires microRNAs(miRNAs), which are crucial for embryonic development. However, whether sperm miRNAs influenced by an obstructive epididymal environment affect embryonic development remains unknown. METHOD The sham operation and vasectomy were performed in C57BL/6 J mice to create the control group (CON) and the obstructive epididymal environment group(OEE) group, respectively. The morphology of the testis and epididymis was observed using hematoxylin and eosin staining (HE staining) to establish the OEE mice model. The sperm quality test, intracytoplasmic sperm injection (ICSI), and epididymosomes fusion were employed to observe the effect of the obstructive epididymal environment on sperm and resultant embryonic development. The alteration of the sperm small RNA (sRNA) profile was analyzed by sRNA sequencing. RT-qPCR and DNA methylation were applied to observe the effect of obstructive epididymis on the expression of sperm miRNAs. The miRNAs microinjection was used to explore the impacts of sperm miRNAs on embryonic development. RESULTS We confirmed postoperative 8-week mice as the OEE mice model by examining the morphology of the testis and epididymis. In the OEE group, we observed that sperm quality degraded and the development potential of embryos was reduced, which can be saved by the normal epididymal environment. The sperm sRNA sequencing revealed that the expression of the developmental miR-17-92 cluster and the Sfmbt2 miRNA cluster was downregulated in the OEE group. The expression of these two miRNA clusters in epididymis was also downregulated and regulated by DNA methylation. However, the downregulation of either the miR-17-92 cluster or the Sfmbt2 miRNA cluster in normal zygotes did not impair embryonic development. CONCLUSION The obstructive epididymal environment influences sperm quality and resultant embryonic development, as well as the abundance of the developmental miR-17-92 cluster and the Sfmbt2 miRNA cluster in sperm, but these miRNA clusters are not the cause of abnormal embryonic development. It implies that epididymis is important in early embryonic development and may play a potential role in sperm epigenome.
Collapse
Affiliation(s)
- Xunwei Wu
- Institute of Reproductive Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Xiaomei He
- Institute of Reproductive Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Qian Liu
- Institute of Reproductive Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Honggang Li
- Institute of Reproductive Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
| |
Collapse
|
6
|
Yu X, Lu S, Yuan M, Ma G, Li X, Zhang T, Gao S, Wei D, Chen ZJ, Liu H, Zhang H. Does ICSI outcome in obstructive azoospermia differ according to the origin of retrieved spermatozoa or the cause of epididymal obstruction? A comparative study. Int Urol Nephrol 2022; 54:3087-3095. [PMID: 36059025 PMCID: PMC9606059 DOI: 10.1007/s11255-022-03350-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/19/2022] [Indexed: 11/28/2022]
Abstract
Purpose To determine whether ICSI outcomes are affected by sperm source or genital tract inflammatory status. Methods A retrospective cohort study was conducted in all consecutive obstructive azoospermia patients who underwent testicular sperm aspiration (TESA) or percutaneous epididymal sperm aspiration (PESA) and ICSI between February 1, 2017, and December 31, 2020. Couples were excluded if they were diagnosed with monogenic disease, abnormal karyotype, or had female uterine malformation. The primary objective was to determine whether ICSI outcomes are affected by the use of testicular or epididymal spermatozoa, and the secondary objective was to explore the effect of granulocyte elastase on ICSI outcomes using epididymal spermatozoa. Results Compared with TESA, inflammatory and non-inflammatory PESA patients exhibited a better high-quality embryo rate, with significant differences among the three groups (49.43 vs. 55.39% and 56.03%; odds ratio, 6.345 and 6.631; 95% confidence interval, 0.340–12.350, and 1.712–11.550; P = 0.038 and P = 0.008, respectively). The fertilization rate, clinical pregnancy rate, live birth delivery rate, and congenital anomaly birth rate were similar in patients who underwent TESA or PESA (with or without inflammation). Conclusions The high-quality embryo rate in PESA patients was higher than that in TESA patients. After successful pregnancy, ICSI outcomes did not differ between patients with obstructive azoospermia who experienced TESA or PESA and those with or without genital tract inflammation. Supplementary Information The online version contains supplementary material available at 10.1007/s11255-022-03350-x.
Collapse
Affiliation(s)
- Xiaochen Yu
- Center for Reproductive Medicine, Shandong University, Jinan, 250012, Shandong, China.,Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China.,Shandong Key Laboratory of Reproductive Medicine, Jinan, 250012, Shandong, China.,Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012, Shandong, China
| | - Shaoming Lu
- Center for Reproductive Medicine, Shandong University, Jinan, 250012, Shandong, China.,Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China.,Shandong Key Laboratory of Reproductive Medicine, Jinan, 250012, Shandong, China.,Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012, Shandong, China
| | - Mingzhen Yuan
- Center for Reproductive Medicine, Shandong University, Jinan, 250012, Shandong, China.,Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China.,Shandong Key Laboratory of Reproductive Medicine, Jinan, 250012, Shandong, China.,Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012, Shandong, China
| | - Gang Ma
- Center for Reproductive Medicine, Shandong University, Jinan, 250012, Shandong, China.,Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China.,Shandong Key Laboratory of Reproductive Medicine, Jinan, 250012, Shandong, China.,Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012, Shandong, China
| | - Xiao Li
- Center for Reproductive Medicine, Shandong University, Jinan, 250012, Shandong, China.,Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China.,Shandong Key Laboratory of Reproductive Medicine, Jinan, 250012, Shandong, China.,Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012, Shandong, China
| | - Taijian Zhang
- Center for Reproductive Medicine, Shandong University, Jinan, 250012, Shandong, China.,Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China.,Shandong Key Laboratory of Reproductive Medicine, Jinan, 250012, Shandong, China.,Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012, Shandong, China
| | - Shanshan Gao
- Center for Reproductive Medicine, Shandong University, Jinan, 250012, Shandong, China.,Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China.,Shandong Key Laboratory of Reproductive Medicine, Jinan, 250012, Shandong, China.,Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012, Shandong, China
| | - Daimin Wei
- Center for Reproductive Medicine, Shandong University, Jinan, 250012, Shandong, China.,Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China.,Shandong Key Laboratory of Reproductive Medicine, Jinan, 250012, Shandong, China.,Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012, Shandong, China
| | - Zi-Jiang Chen
- Center for Reproductive Medicine, Shandong University, Jinan, 250012, Shandong, China.,Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China.,Shandong Key Laboratory of Reproductive Medicine, Jinan, 250012, Shandong, China.,Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012, Shandong, China.,Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, 200135, China
| | - Hongbin Liu
- Center for Reproductive Medicine, Shandong University, Jinan, 250012, Shandong, China. .,Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China. .,Shandong Key Laboratory of Reproductive Medicine, Jinan, 250012, Shandong, China. .,Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012, Shandong, China.
| | - Haobo Zhang
- Center for Reproductive Medicine, Shandong University, Jinan, 250012, Shandong, China. .,Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, 250012, Shandong, China. .,Shandong Key Laboratory of Reproductive Medicine, Jinan, 250012, Shandong, China. .,Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, 250012, Shandong, China. .,The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China.
| |
Collapse
|
7
|
Zhang Z, Zhang Y, Zhang N. Clinical outcome of microsurgical vasoepididymostomy versus epididymal or testicular sperm retrieval combined with intracytoplasmic sperm injection in obstructive azoospermia males. Andrologia 2022; 54:e14458. [PMID: 35688176 DOI: 10.1111/and.14458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/20/2022] [Accepted: 03/09/2022] [Indexed: 01/10/2023] Open
Abstract
This purpose of the retrospective study was to compare the clinical outcome of microsurgical vasoepididymostomy (MVE) and sperm retrieval combined with intracytoplasmic sperm injection (ICSI) in the treatment of males with obstructive azoospermia. From February 2018 to December 2019, a total of 69 males with obstructive azoospermia underwent MVE while 351 males with obstructive azoospermia in their first ICSI cycles were enrolled. Patients in the MVE group achieved higher pregnancy rate and births delivered rate than those in ICSI group (pregnancy rate, 44.6% vs. 27.6% for MVE and ICSI, respectively; delivery rate, 38.5% versus 25.8% for MVE and ICSI, respectively). Besides, lower female age (<35 vs. ≥35 years old, OR 1.15, 95% CI = 1.08-1.21), higher sperm concentration and forward motility after MVE((sperm concentration, OR (95% CI) = 1.12 (1.08-1.23), sperm forward motility, OR (95% CI) = 1.10 (1.06-1.20)) were associated with higher probability of pregnancy. Based on these data, it has been found that MVE is the prior option for males with obstructive azoospermia suitable for the surgery, other than direct subjected to ICSI. More high quality studies are needed in the future due to the non-randomized design and the relative small size of this study.
Collapse
Affiliation(s)
- Zheng Zhang
- Department of Urology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, China
| | - Yong Zhang
- Department of Urology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, China
| | - Nan Zhang
- Department of Urology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang, China
| |
Collapse
|
8
|
Cirillo F, Costa P, Romano M, Negri L, Morenghi E, Albani E, Setti PEL. Is the lack of prior exposure to sperm antigens associated with worse neonatal and maternal outcomes? A 10 years single-center experience comparing ICSI-TESE pregnancies to ICSI pregnancies. Andrology 2022; 10:931-943. [PMID: 35485252 DOI: 10.1111/andr.13194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/07/2022] [Accepted: 04/25/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Nowadays pathogenesis of preeclampsia is still unknown. Among the different etiological hypotheses, some authors proposed that it might be due to an abnormal immunologic response to foreign fetal antigen derived from the father's sperm. Indeed, the fetus is considered a semi allograft, being one half paternally derived in its antigenicity, and the first pathogenic insult of preeclampsia may be an abnormal maternal immune response towards this semi-allogenic implant. In the context of Artificial Reproductive Techniques, it has been shown that the use of donor and surgically retrieved spermatozoa (e.g. Testicular Sperm Extraction) increases the risk of preeclampsia, confirming the protective effect of sperm exposure on maternal complications. OBJECTIVE Determining whether the lack of exposure to sperm antigens is associated with worse maternal and neonatal outcomes in pregnancies obtained through intracytoplasmic sperm injection after testicular sperm extraction for obstructive azoospermia. MATERIAL AND METHODS This is a single-center case-control retrospective study, focusing on all first pregnancies obtained through intracytoplasmic sperm injection after testicular sperm extraction for obstructive azoospermia at Humanitas Fertility Center between January 1st, 2010 and December 31st, 2019. Controls included patients that achieved their first pregnancy with intracytoplasmic sperm injection and ejaculated sperm, for a diagnosis other than azoospermia, in the same time period. Cases were matched with controls in a 1:2 ratio, considering female age, female BMI and year of controlled ovarian stimulation. The primary outcome measure was the delivery rate, defined as the number of deliveries divided by the total number of clinical pregnancies. Secondary outcome measures focused on maternal and neonatal complications, such as miscarriage rate, rate of main obstetric complications, prematurity rate and rate of congenital malformations. RESULTS By analyzing overall 113 pregnancies among cases and 214 pregnancies among controls, this study showed that the delivery rate was higher in controls with respect to cases (92.06% vs 84.07%, p = 0.026); among deliveries, live births were respectively 98.95% and 100%, while only one stillbirth occurred in cases. The first trimester miscarriage rate was higher in the cases than controls (13.27% vs 6.07%, p = 0.027), while no difference was found among rate of second trimester miscarriages, therapeutic abortions and ectopic pregnancies. There was no difference regarding the rate of maternal complications, including gestational hypertension, preeclampsia, HELLP syndrome, gestational diabetes, placenta previa, placental abruption and premature rupture of the membranes. Considering neonatal complications, it was shown that twins belonging to controls had a higher prematurity rate with respect to cases (65.79% vs 50.00%) but without a statistical relevance. Lastly, the rate of congenital malformations did not differ among the two groups. DISCUSSION This study showed that, once couples diagnosed with obstructive azoospermia achieve a pregnancy, they have a much higher risk of miscarriage in the first trimester in respect to non-azoospermic patients. Moreover, controls had a higher delivery rate in respect to cases; however, when the fetal status at birth was compared, no difference was found between live births and stillbirths. CONCLUSIONS Differently from the findings in the literature, no association with preeclampsia was found. This might be related to a collider bias/left truncation bias: since azoospermic patients are at higher risk of early termination of pregnancy, it results that they do not have the possibility to develop preeclampsia and other adverse outcomes. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Federico Cirillo
- Department of Gynecology- Division of Gynecology and Reproductive Medicine- Fertility Center, Humanitas Clinical and Research Center IRCCS-, via Manzoni 56, Rozzano, Milan, 20089, Italy
| | - Paola Costa
- Department of Gynecology- Division of Gynecology and Reproductive Medicine- Fertility Center, Humanitas Clinical and Research Center IRCCS-, via Manzoni 56, Rozzano, Milan, 20089, Italy
| | - Massimo Romano
- Department of Gynecology- Division of Gynecology and Reproductive Medicine- Fertility Center, Humanitas Clinical and Research Center IRCCS-, via Manzoni 56, Rozzano, Milan, 20089, Italy
| | - Luciano Negri
- Department of Gynecology- Division of Gynecology and Reproductive Medicine- Fertility Center, Humanitas Clinical and Research Center IRCCS-, via Manzoni 56, Rozzano, Milan, 20089, Italy
| | - Emanuela Morenghi
- Biostatistics Unit, Humanitas Clinical and Research Center IRCCS-, via Manzoni 56, Rozzano, Milan, 20089, Italy
| | - Elena Albani
- Department of Gynecology- Division of Gynecology and Reproductive Medicine- Fertility Center, Humanitas Clinical and Research Center IRCCS-, via Manzoni 56, Rozzano, Milan, 20089, Italy
| | - Paolo Emanuele Levi Setti
- Department of Gynecology- Division of Gynecology and Reproductive Medicine- Fertility Center, Humanitas Clinical and Research Center IRCCS-, via Manzoni 56, Rozzano, Milan, 20089, Italy
| |
Collapse
|
9
|
Cheng H, Yang S, Meng Q, Zheng B, Gu Y, Wang L, Song T, Xu C, Wang G, Han M, Shen L, Ding J, Li H, Ouyang J. Genetic analysis and intracytoplasmic sperm injection outcomes of Chinese patients with congenital bilateral absence of vas deferens. J Assist Reprod Genet 2022; 39:719-728. [PMID: 35119551 PMCID: PMC8995229 DOI: 10.1007/s10815-022-02417-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 01/27/2022] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Congenital bilateral absence of the vas deferens (CBAVD) is a major cause of obstructive azoospermia and male factor infertility. CBAVD is mainly caused by mutations in the genes encoding CFTR (cystic fibrosis transmembrane conductance regulator) and ADGRG2 (adhesion G protein-coupled receptor G2). This study aimed to describe CFTR and ADGRG2 variations in 46 Chinese CBAVD patients and evaluated sperm retrieval and assisted reproductive technology outcomes. METHODS The CFTR and ADGRG2 genes were sequenced and analyzed by whole-exome sequencing (WES), and variations were identified by Sanger sequencing. Bioinformatic analysis was performed. We retrospectively reviewed the outcomes of patients undergoing sperm retrieval surgery and intracytoplasmic sperm injection (ICSI). RESULTS In total, 35 of 46 (76.09%) patients carried at least one variation in CFTR, but no copy number variants or ADGRG2 variations were found. In addition to the IVS9-5 T allele, there were 27 CFTR variations, of which 4 variations were novel and predicted to be damaging by bioinformatics. Spermatozoa were successfully retrachieved in 46 patients, and 39 of the patients had their own offspring through ICSI. CONCLUSION There are no obvious hotspot CFTR mutations in Chinese CBAVD patients besides the IVS9-5 T allele. Therefore, WES might be the best detection method, and genetic counseling should be different from that provided to Caucasian populations. After proper counseling, all patients can undergo sperm retrieval from their epididymis or testis, and most of them can have their own children through ICSI.
Collapse
Affiliation(s)
- Hongbo Cheng
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, 215000 Jiangsu China ,Center for Reproduction and Genetics, NHC Key Laboratory of Male Reproduction and Genetics, Suzhou Municipal Hospital, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Shenmin Yang
- Center for Reproduction and Genetics, NHC Key Laboratory of Male Reproduction and Genetics, Suzhou Municipal Hospital, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Qingxia Meng
- Center for Reproduction and Genetics, NHC Key Laboratory of Male Reproduction and Genetics, Suzhou Municipal Hospital, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Bo Zheng
- Center for Reproduction and Genetics, NHC Key Laboratory of Male Reproduction and Genetics, Suzhou Municipal Hospital, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Yidong Gu
- Center for Reproduction and Genetics, NHC Key Laboratory of Male Reproduction and Genetics, Suzhou Municipal Hospital, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Luyun Wang
- Center for Reproduction and Genetics, NHC Key Laboratory of Male Reproduction and Genetics, Suzhou Municipal Hospital, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Tao Song
- Department of Andrology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu China
| | - Chunlu Xu
- Department of Andrology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu China
| | - Gaigai Wang
- Center for Reproduction and Genetics, NHC Key Laboratory of Male Reproduction and Genetics, Suzhou Municipal Hospital, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Mutian Han
- Center for Reproduction and Genetics, NHC Key Laboratory of Male Reproduction and Genetics, Suzhou Municipal Hospital, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Liyan Shen
- Center for Reproduction and Genetics, NHC Key Laboratory of Male Reproduction and Genetics, Suzhou Municipal Hospital, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Jie Ding
- Center for Reproduction and Genetics, NHC Key Laboratory of Male Reproduction and Genetics, Suzhou Municipal Hospital, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Hong Li
- Center for Reproduction and Genetics, NHC Key Laboratory of Male Reproduction and Genetics, Suzhou Municipal Hospital, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China.
| | - Jun Ouyang
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, 215000, Jiangsu, China.
| |
Collapse
|
10
|
Cai Z, Li H. Congenital Bilateral Absence of the Vas Deferens. Front Genet 2022; 13:775123. [PMID: 35222530 PMCID: PMC8873976 DOI: 10.3389/fgene.2022.775123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 01/19/2022] [Indexed: 01/23/2023] Open
Abstract
Congenital bilateral absence of the vas deferens (CBAVD) is clinically characterized by the absence of the bilateral vas deferens; the main clinical manifestation is infertility, accounting for 1–2% of male infertility cases. CBAVD may be accompanied by congenital abnormalities in the urogenital system and cystic fibrosis (CF)-related clinical manifestations. CBAVD can develop as a mild manifestation of CF or can be isolated. The main pathogenic mechanism of CBAVD is gene mutation, and CBAVD and CF have a common genetic mutation background. CFTR mutation is the main pathogenic cause of CBAVD and CF, and ADGRG2 mutation is the second most common cause. Although lack of the vas deferens in CBAVD patients causes infertility due to the inability to release sperm, the testes of CBAVD patients have spermatogenic function. Therefore, CBAVD patients can achieve fertility through sperm retrieval surgery and assisted reproductive technology (ART). However, gene mutations in CBAVD patients can have an impact on the ART outcome, and there is a risk of passing on gene mutations to offspring. For CBAVD patients and their spouses, performing genetic counseling (which currently refers mainly to CFTR mutation screening) helps to reduce the risks of genetic mutations being passed on to offspring and of offspring having CF with concomitant CBAVD.
Collapse
|
11
|
Fisher JS, Kim ED. Azoospermia: vasal agenesis. Asian J Androl 2022; 24:1-4. [PMID: 31621656 PMCID: PMC8788597 DOI: 10.4103/aja.aja_113_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- J Sam Fisher
- Department of Urology, University of Tennessee, Knoxville, TN 37920, USA
| | - Edward D Kim
- Department of Urology, University of Tennessee, Knoxville, TN 37920, USA
| |
Collapse
|
12
|
A cryoprotectant supplemented with pentoxifylline can improve the effect of freezing on the motility of human testicular sperm. ZYGOTE 2021; 30:92-97. [PMID: 34158133 DOI: 10.1017/s0967199421000368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This study examined the effect of a cryoprotectant with and without pentoxifylline supplementation on the motility and viability of human testicular sperm, both before and after freezing. Testicular samples were obtained from 68 patients with azoospermia who came to the Andrology Service of West China Second University Hospital, Sichuan University, for testicular biopsies from December 2019 to April 2020. All patients were assigned randomly to two groups: experimental, whose testicular sperm were added to the cryoprotectant with pentoxifylline, and the control, whose testicular sperm were added to the cryoprotectant without pentoxifylline. Both groups used the same freezing and thawing methods. Testicular sperm motility in the experimental group was significantly higher than that of the control group, both before and after cryopreservation. The recovery rate of sperm motility in the experimental group was significantly higher than that of the control group. The percentage of samples with motile testicular sperm in the experimental group was significantly higher than that of the control group after thawing. Sperm viability was unchanged between the experimental and control groups, both before and after freezing. Overall, a pentoxifylline-supplemented cryoprotectant can significantly improve the motility of testicular sperm before and after cryopreservation.
Collapse
|
13
|
Lopes LS, Baccaglini W, von Muhlen B, Placco Araujo Glina F, Albertini Daiuto S, Linck Pazeto C, Glina S. Does acquired obstructive azoospermia have less impact than congenital azoospermia on ICSI results? Systematic review and meta-analysis. Andrologia 2021; 53:e14096. [PMID: 33982319 DOI: 10.1111/and.14096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 04/16/2021] [Accepted: 04/20/2021] [Indexed: 12/21/2022] Open
Abstract
An electronic-based search was performed with MEDLINE bases through PubMed, Cochrane through Central, and Embase until August 2020 for the purpose of evaluating the impact of the aetiology of obstructive azoospermia on ICSI cycles. In the final analysis, there were 15 cohort studies included, comparing a group of patients with acquired azoospermia and others due to congenital bilateral absence of the vas deferens submitted to ICSI. Those 15 articles within 4,480 couples were analysed, and similar fertilisation rate (65.1% vs. 65.3%; p = .38), pregnancy rate per cycle (40.0% vs. 43.1%; p = .06) and live birth rate (29.6% vs. 30.0%;p = .76) were found between groups. Comparing specifically post-vasectomy azoospermia and congenital groups, both presented a similar fertilisation rate (62.4% vs. 53.4%, respectively; OR 1.10; 95% CI, 0.79, 1.54; p = .56; I2 = 89%) and pregnancy rate per cycle (39.4% vs. 35.6%, respectively; OR 1.26; 95% CI, 0.96, 1.66; p = .09; I2 = 0%). However, a higher live birth rate was identified in the congenital group compared to vasectomy group (28.4% × 19.5%; OR 1.54; 95% CI, 1.11, 2.15; p = .01; I2 = 0%). The reasons for that are unclear and factors such as couple age and sperm DNA fragmentation should be considered.
Collapse
Affiliation(s)
| | - Willy Baccaglini
- Department of Urology, Centro Universitário FMABC, Santo André, Brazil
| | - Bruno von Muhlen
- Department of Urology, Centro Universitário FMABC, Santo André, Brazil
| | | | | | | | - Sidney Glina
- Department of Urology, Centro Universitário FMABC, Santo André, Brazil.,Projeto Alfa, São Paulo, Brazil
| |
Collapse
|
14
|
Intra-Cytosplamic sperm injection outcomes with fresh and cryopreserved human epidydimal sperm from patients with obstructive azoospermia. Cryobiology 2021; 100:58-62. [PMID: 33831370 DOI: 10.1016/j.cryobiol.2021.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 02/23/2021] [Accepted: 03/26/2021] [Indexed: 02/05/2023]
Abstract
Techniques for the cryopreservation of epididymal sperm was are widely used in clinical practice. However, given the unique characteristics of sperm from patients with obstructive azoospermia, epididymal sperm cryopreservation is more difficult because of low count and weak motility; therefore, conventional methods of sperm cryopreservation may not result in the best outcomes. We used the micro-straw method to store small quantities of sperm obtained from patients with severe oligozoospermia or azoospermia and achieved successful deliveries in the previous study. This retrospective study of ICSI cycles included the first ICSI cycles of fresh or frozen/thawed epididymal sperm that were performed in patients suffering from obstructive azoospermia who were admitted to the CITIC-Xiangya Hospital of Reproduction and Genetics of China from June 1, 2015 to June 31, 2019. A total of 2441 patients with obstructive azoospermia were divided according to the use of fresh (n = 2342) or frozen/thawed (n = 99) epididymal sperm. The results showed that the fertilisation rate was higher with fresh epididymal sperm than that with frozen/thawed epididymal sperm (85.14% vs. 79.26%, respectively; p = 0.000). However, the rates of embryo cleavage, high-quality embryos, clinical pregnancy, miscarriage, singletons and birth defect were similar between fresh and frozen/thawed epididymal sperm (98.28% vs. 99.13%, 60.34% vs. 57.29%, 67.90% vs. 70.51%, 8.12% vs. 10.91%, 57.76% vs. 49.09%, 1.59% vs. 1.45%respectively; p = 0.088, 0.109, 0.628, 0.462,0.203 and 0.686). In addition, the short-term cryostorage of small quantities of epididymal sperm did not affect clinical outcomes. The results indicated that in cases of obstructive azoospermia, cryostorage of small quantities epididymal sperm is a reliable option.
Collapse
|
15
|
Pelzman DL, Hwang K. Genetic testing for men with infertility: techniques and indications. Transl Androl Urol 2021; 10:1354-1364. [PMID: 33850771 PMCID: PMC8039607 DOI: 10.21037/tau-19-725] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Genetic testing is an integral component in the workup of male infertility as genetic conditions may be responsible for up to 15% of all cases. Currently, three genetic tests are commonly performed and recommended by major urologic associations: karyotype analysis (KA), Y-chromosome microdeletion testing, and CFTR mutation testing. Despite widespread adoption of these tests, an etiology for infertility remains elusive in up to 80% of cases. Recent work has identified intriguing new targets for genetic testing which may soon see clinical relevance. This review will discuss the indications and techniques for currently offered genetic tests and briefly explore ongoing research directions within this field.
Collapse
Affiliation(s)
- Daniel L Pelzman
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Kathleen Hwang
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| |
Collapse
|
16
|
Persily JB, Vijay V, Najari BB. How do we counsel men with obstructive azoospermia due to CF mutations?-a review of treatment options and outcomes. Transl Androl Urol 2021; 10:1467-1478. [PMID: 33850781 PMCID: PMC8039579 DOI: 10.21037/tau-19-681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Obstructive azoospermia (OA) is a rare cause of male infertility, with Congenital Bilateral Absence of The Vas Deferens (CBAVD) being a major cause. A wealth of literature has established an irrefutable link between CFTR mutations and CBAVD, with CBAVD affecting almost all men with cystic fibrosis (CF) disease and a significant portion of men that are CFTR mutation carriers. In the past two decades, assisted reproductive technologies have made the prospect of fathering children a viable possibility in this subset of men, using a combination of sperm extraction techniques and intracystoplasmic sperm injection (ICSI). In order to assess techniques for sperm retrieval, as well as reproductive outcomes, a systemic search of the MEDLINE database was conducted for all articles pertaining to management options for CBAVD, and also all reports describing outcomes of these procedures in the CBAVD population. Both epididymal and testicular sperm extraction (TESE) are viable options for men with CBAVD, and though rigorous data are lacking, live birth rates range from 8% to 50% in most small retrospective series and subset analyses. In addition, there does not appear to be significant differences in the rate of live birth or complications and miscarriages between the various techniques, though further investigation into other factors that limit reproductive potential of men with CFTR mutations and CBAVD is warranted.
Collapse
Affiliation(s)
- Jesse B Persily
- Department of Urology, New York University Langone School of Medicine, New York, NY, USA
| | - Varun Vijay
- Department of Urology, New York University Langone School of Medicine, New York, NY, USA
| | - Bobby B Najari
- Department of Urology, New York University Langone School of Medicine, New York, NY, USA.,Department of Population Health, New York University Langone School of Medicine, New York, NY, USA
| |
Collapse
|
17
|
Yoon JC, Casella JL, Litvin M, Dobs AS. Male reproductive health in cystic fibrosis. J Cyst Fibros 2020; 18 Suppl 2:S105-S110. [PMID: 31679721 DOI: 10.1016/j.jcf.2019.08.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 08/11/2019] [Accepted: 08/11/2019] [Indexed: 10/25/2022]
Abstract
The impact of cystic fibrosis (CF) on male reproductive health is profound. The vast majority of men with CF are infertile due to obstructive azoospermia. Multiple factors associated with CF contribute to an increased prevalence of testosterone deficiency, which adversely affects muscle mass, bone density, and quality of life. This article reviews the pathophysiology, diagnosis, and management of infertility and testosterone deficiency that occur in men with CF. With improving survival of CF patients, these topics are becoming more significant in their clinical care.
Collapse
Affiliation(s)
- John C Yoon
- Division of Endocrinology, Diabetes, and Metabolism, Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, CA, USA.
| | - Julio Leey Casella
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Florida School of Medicine, Gainesville, FL, USA
| | - Marina Litvin
- Division of Endocrinology, Metabolism, and Lipid Research, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Adrian S Dobs
- Division of Endocrinology and Metabolism, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| |
Collapse
|
18
|
Blavier E, du Boulet B, Blion C, Bennaoum K, Rougier N, Tailland ML, Droupy S, Huberlant S. Fertility outcome after Intracytoplasmic Sperm Injection with surgically retrieved sperm. J Gynecol Obstet Hum Reprod 2020; 50:101940. [PMID: 33045447 DOI: 10.1016/j.jogoh.2020.101940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 09/25/2020] [Accepted: 10/06/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Surgically retrieved sperm samples and Intra Cytoplasmic Sperm Injection are indicated when we face severe sperm abnormalities such as azoospermia. The objective of this study was to assess the rates of clinical pregnancies and live births with sperm from testicular biopsies. DESIGN This was a retrospective descriptive study of all Intra Cytoplasmic Sperm Injection (ICSI) cycles performed with surgically retrieved sperm at the Nîmes University Hospital from January 1st, 2015 to December 31st, 2018. The main outcome was the clinical pregnancy rate. The secondary outcomes were the fertilization rate, the implantation rate and the live birth rate. RESULTS In all, 99 couples were treated at our center during this period and 164 ICSI cycles using surgically-collected sperm were performed. The men were 34.7 ± 7.4 years old on average at the time of undergoing testicular biopsy and the women were 32.15 ± 5.07 years at the time of ICSI. Out of 127 fresh embryo transfers, we observed 47 clinical pregnancies (37 %) and 45 live births (35.4 %). The average fertilization rate was 45 % and the implantation rate was 23.7 %. Among these infertile couples, 53 % obtained at least one clinical pregnancy and 42 % at least one live birth. CONCLUSION Testicular sperm extraction combined with ICSI is indicated in cases of male infertility linked with azoospermia or severe semen alteration. This technique offers couples a marvelous opportunity to have children with their own gametes.
Collapse
Affiliation(s)
- Emily Blavier
- Department of Gynecology Obstetrics, Nîmes University Hospital, France.
| | | | - Cyril Blion
- Department of Urology, Nîmes University Hospital, France
| | - Kamel Bennaoum
- Department of Urology, Nîmes University Hospital, France
| | - Nathalie Rougier
- Laboratory of Assisted Reproduction, Nîmes University Hospital, France
| | | | - Stéphane Droupy
- Department of Urology, Nîmes University Hospital, France; Laboratory of Assisted Reproduction, Nîmes University Hospital, France; University of Montpellier-Nîmes, France
| | - Stéphanie Huberlant
- Department of Gynecology Obstetrics, Nîmes University Hospital, France; Department of Urology, Nîmes University Hospital, France; Laboratory of Assisted Reproduction, Nîmes University Hospital, France; University of Montpellier-Nîmes, France
| |
Collapse
|
19
|
Vieira M, Glina FPA, Mizrahi FE, Perin PM, Mierzwa TC, Glina S. Is time since vasectomy more important as prognostic factor for pregnancy and live birth than female and laboratory variables when treating vasectomised man using ICSI? Andrologia 2020; 52:e13534. [DOI: 10.1111/and.13534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 12/17/2019] [Accepted: 01/11/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Marcelo Vieira
- Urology Department Centro Universitário de Saude ABC Santo André – Brazil Brazil
| | | | | | | | - Tiago Cesar Mierzwa
- Urology Department Centro Universitário de Saude ABC Santo André – Brazil Brazil
| | - Sidney Glina
- Urology Department Centro Universitário de Saude ABC Santo André – Brazil Brazil
| |
Collapse
|
20
|
Jin L, Li Z, Gu L, Huang B. Neonatal outcome of children born after ICSI with epididymal or testicular sperm: A 10-year study in China. Sci Rep 2020; 10:5145. [PMID: 32198466 PMCID: PMC7083972 DOI: 10.1038/s41598-020-62102-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 03/03/2020] [Indexed: 11/09/2022] Open
Abstract
Some studies show that children born after ICSI with non-ejaculated sperm are at increased risk of birth defects, other studies hold the opposite view. Does neonatal outcome including congenital malformations in children born after ICSI with percutaneous epididymal sperm aspiration (PESA) and testicular sperm aspiration (TESA) differ from neonatal outcome in children born after ICSI with ejaculated sperm? In this study, we examined the data from our IVF center from 2006 to 2016, to compare neonatal outcomes and rates of congenital malformations in children born after ICSI with different sperm origin. The results showed the clinical pregnancy rate and implantation rate of non-ejaculated sperm group were significantly higher (P < 0.001) than ejaculated sperm group. There were 775 clinical pregnancies from non-ejaculated sperm group and 2,486 clinical pregnancies from ejaculated sperm group. Most of the clinical pregnancy outcomes were comparable between non-ejaculated sperm group and ejaculated sperm group (p > 0.05): the miscarriage rate per transfer, ectopic pregnancy rate per clinical pregnancy, induced abortion rate per clinical pregnancy and fetal deaths per clinical pregnancy. However, the live delivery rate per transfer of non-ejaculated sperm group was significantly higher than that of ejaculated sperm group (45.4% vs 36.7%, P < 0.001). Moreover, the comparison between the epididymal sperm, testicular sperm and ejaculated sperm groups showed there were no difference in the incidence of congenital malformations of babies live birth. Among singleton gestation live births, there were more girls than boys in both non-ejaculated sperm and ejaculated sperm group. In conclusion, the present study clearly showed no statistical increased risk in neonatal outcomes of newborns were found in the ICSI treatment with epididymal or testicular sperm. It may provide information for consultation for ICSI treatment in PESA or TESA patients.
Collapse
Affiliation(s)
- Lei Jin
- Reproductive Medicine Center, Tongji Hospital, Tongji Medicine College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Zhou Li
- Reproductive Medicine Center, Tongji Hospital, Tongji Medicine College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Longjie Gu
- Reproductive Medicine Center, Tongji Hospital, Tongji Medicine College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Bo Huang
- Reproductive Medicine Center, Tongji Hospital, Tongji Medicine College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
| |
Collapse
|
21
|
Shih KW, Shen PY, Wu CC, Kang YN. Testicular versus percutaneous epididymal sperm aspiration for patients with obstructive azoospermia: a systematic review and meta-analysis. Transl Androl Urol 2019; 8:631-640. [PMID: 32038959 DOI: 10.21037/tau.2019.11.20] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background Intracytoplasmic sperm injection (ICSI) is a popular treatment for male infertility due to obstructive azoospermia (OA). Testicular sperm aspiration (TESA) and percutaneous epididymal sperm aspiration (PESA) are two common sperm retrieval approaches for ICSI among men with OA. However, the comparative efficacies of TESA and PESA have been debated for more than a decade and there has been no synthesis of the available evidence. This meta-analysis compared fertility outcomes between TESA and PESA among men with OA undergoing ICSI. Methods We searched Embase, PubMed, ScienceDirect, and Web of Science to identify studies comparing the effectiveness of TESA and PESA for ICSI. Study quality was assessed using the Newcastle-Ottawa scale. Data were pooled using a random-effects model. Outcomes were fertilization rate, implantation rate, pregnancy rate, and miscarriage rate. Results are expressed as odds ratio (OR) with 95% confidence intervals (CIs). Study heterogeneity was evaluated by the I-square (I2) statistic. Results Of 2,965 references retrieved, eight studies met eligibility criteria. These studies included 2,020 men receiving 2,060 ICSI cycles. The pooled results showed no significant differences in pregnancy and miscarriage rates between TESA and PESA groups, but TESA yielded a significantly higher implantation rate than PESA (OR =1.58, P=0.02, I2=24%). Conclusions TESA and PESA yielded similar pregnancy and miscarriage rates for couples receiving ICSI because of OA, but each demonstrated unique advantages and disadvantages. Further studies are required to evaluate safety outcomes and efficacy for specific clinical groups.
Collapse
Affiliation(s)
- Kuan-Wei Shih
- Department of Urology, Taipei Medical University Hospital, Taipei
| | - Ping-You Shen
- School of Medicine, College of Medicine, Taipei Medical University, Taipei
| | - Chien-Chih Wu
- Department of Urology, Taipei Medical University Hospital, Taipei.,Department of Education and Humanities in Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei
| | - Yi-No Kang
- Department of Education and Humanities in Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei.,Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei.,Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei.,Research Center of Big Data and Meta-analysis, Wan Fang Hospital, Taipei Medical University, Taipei
| |
Collapse
|
22
|
Lopes LS, Cury VN, Cha JD, Lampa Junior VM, Marques JL, Mizrahi FE, Figueiredo FWDS, Barbosa CP, Glina S. Do assisted reproduction outcomes differ according to aetiology of obstructive azoospermia? Andrologia 2019; 52:e13425. [DOI: 10.1111/and.13425] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 08/07/2019] [Accepted: 08/18/2019] [Indexed: 12/17/2022] Open
Affiliation(s)
- Leonardo Seligra Lopes
- Department of Urology Faculdade de Medicina do ABC Santo André Brazil
- Instituto Idéia Fértil de Saúde Reprodutiva Santo André Brazil
| | | | | | - Valdir Martins Lampa Junior
- Department of Urology Faculdade de Medicina do ABC Santo André Brazil
- Instituto Idéia Fértil de Saúde Reprodutiva Santo André Brazil
| | | | | | | | - Caio Parente Barbosa
- Instituto Idéia Fértil de Saúde Reprodutiva Santo André Brazil
- Department of Sexual and Reproductive Health and Population Genetics Faculdade de Medicina do ABC Santo André Brazil
| | - Sidney Glina
- Department of Urology Faculdade de Medicina do ABC Santo André Brazil
- Projeto Alfa São Paulo Brazil
| |
Collapse
|
23
|
Yang C, Zhou ZH, Zheng DN, Xu XF, Huang J, Lian Y, Qiao J. Sperm origins and concentration do not impact the clinical outcomes in intracytoplasmic sperm injection cycles. Asian J Androl 2019; 20:454-458. [PMID: 29798938 PMCID: PMC6116677 DOI: 10.4103/aja.aja_27_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
In the present study, we evaluated the impact of sperm origins and concentration on the clinical outcomes of intracytoplasmic sperm injection (ICSI) cycles. A total of 1201 ICSI cycles were retrospectively analyzed for male azoospermia or oligozoospermia between January 2015 and December 2015 in the Peking University Third Hospital. Patients were divided into three groups (Group 1 vs Group 2/3; surgically extracted sperm vs ejaculated sperms): Group 1 included 343 ICSI cycles and Group 2 analyzed 388 cycles on semen with sperm concentration <5 × 106 ml−1 (severe oligozoospermia group). Group 3 included 470 cycles with sperm concentration between 5 × 106 ml−1 and 15 × 106 ml−1 (mild oligozoospermia group). Fertilization rates, clinical pregnancy rates, and live birth rates were analyzed and compared among groups of different semen origins and concentrations on the oocyte retrieval day. Group 2 showed a lower fertilization rate than Group 3 (62.9% ± 21.6% vs 66.8% ± 22.1%,P < 0.05). There were no statistically significant differences in clinical pregnancy rate per transfer (51.3%, 46.7%, and 50.0%, respectively), live birth rate per transfer (44.4%, 40.9%, and 41.4%, respectively), accumulative live birth rate (58.3%, 51.0%, and 52.1%, respectively), twin birth rate (18.4%, 10.6%, and 12.6%, respectively), and birth defects rate (0, 0.3%, and 0.2%, respectively) among three groups. The results of this study indicated that sperm origins and concentration do not impact the clinical outcomes in ICSI cycles.
Collapse
Affiliation(s)
- Cen Yang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China.,Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproduction Technology, Beijing 100191, China.,Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing 100191, China
| | - Ze-Hong Zhou
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China.,Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproduction Technology, Beijing 100191, China.,Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing 100191, China
| | - Dan-Ni Zheng
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China.,Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproduction Technology, Beijing 100191, China.,Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing 100191, China
| | - Xiao-Fei Xu
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China.,Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproduction Technology, Beijing 100191, China.,Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing 100191, China
| | - Jin Huang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China.,Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproduction Technology, Beijing 100191, China.,Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing 100191, China
| | - Ying Lian
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China.,Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproduction Technology, Beijing 100191, China.,Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing 100191, China
| | - Jie Qiao
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China.,Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproduction Technology, Beijing 100191, China.,Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing 100191, China
| |
Collapse
|
24
|
da Rosa Filho RR, Angrimani DSR, Brito MM, Nichi M, Vannucchi CI, Lucio CF. Susceptibility of epididymal sperm against reactive oxygen species in dogs. Anim Biotechnol 2019; 32:92-99. [PMID: 31437098 DOI: 10.1080/10495398.2019.1657126] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
In order to add information to physiology of sperm maturation and help to underline future antioxidant supplementation treatment to epididymal sperm, the aim of this study was to evaluate susceptibility of caput, corpus and cauda epididymal sperm to different reactive oxygen species (ROS) in dogs. Epididymal sperm was separately collected from each segment (caput, corpus and cauda) and subjected to 4 different ROS-challenges: superoxide anion, hydrogen peroxide, hydroxyl radical, malondialdehyde (MDA) or maintained as control. After 30 min of incubation in each ROS, sperm was evaluated for sperm kinetics, plasma and acrossomal membrane integrity, mitochondrial activity and resistance to oxidative stress. Decreased total and progressive sperm motility and rapid velocity at epididymal corpus occurred after exposure to hydrogen peroxide, hydroxyl radical and MDA. However, for cauda epididymis, hydrogen peroxide and malondialdehyde promoted higher deleterious effect regarding sperm motility and velocity. Only at cauda epididymis MDA decreased sperm mitochondrial activity index and no kinetics alterations (motility or velocity) occurred after exposure to superoxide anion in corpus and cauda epididymis. In conclusion, corpus and cauda epididymal sperm are highly susceptible to deleterious effect of hydrogen peroxide, malondialdehyde and hydroxyl radical. In addition, epididymal canine sperm is relatively resistant to superoxide anion damage.
Collapse
Affiliation(s)
- Roberto R da Rosa Filho
- Department of Animal Reproduction - School of Veterinary Medicine and Animal Science, University of São Paulo, campus São Paulo, São Paulo, Brazil
| | - Daniel S R Angrimani
- Department of Animal Reproduction - School of Veterinary Medicine and Animal Science, University of São Paulo, campus São Paulo, São Paulo, Brazil
| | - Maíra M Brito
- Department of Animal Reproduction - School of Veterinary Medicine and Animal Science, University of São Paulo, campus São Paulo, São Paulo, Brazil
| | - Marcílio Nichi
- Department of Animal Reproduction - School of Veterinary Medicine and Animal Science, University of São Paulo, campus São Paulo, São Paulo, Brazil
| | - Camila I Vannucchi
- Department of Animal Reproduction - School of Veterinary Medicine and Animal Science, University of São Paulo, campus São Paulo, São Paulo, Brazil
| | - Cristina F Lucio
- Department of Animal Reproduction - School of Veterinary Medicine and Animal Science, University of São Paulo, campus São Paulo, São Paulo, Brazil
| |
Collapse
|
25
|
Miyaoka R, Orosz JE, Achermann AP, Esteves SC. Methods of surgical sperm extraction and implications for assisted reproductive technology success. Panminerva Med 2019; 61:164-177. [DOI: 10.23736/s0031-0808.18.03508-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
26
|
Blok JM, Roekel C, Oude Ophuis RJA, Lock TMTW. Open epididymal spermatozoa aspiration for obstructive azoospermia. Andrologia 2018; 51:e13218. [DOI: 10.1111/and.13218] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 11/07/2018] [Accepted: 11/20/2018] [Indexed: 11/27/2022] Open
Affiliation(s)
- Joost M. Blok
- Department of Urology University Medical Center Utrecht Utrecht The Netherlands
| | - Caren Roekel
- Department of Urology University Medical Center Utrecht Utrecht The Netherlands
| | - Ralph J. A. Oude Ophuis
- Department of Reproduction and Gynaecology University Medical Center Utrecht Utrecht The Netherlands
| | - Tycho M. T. W. Lock
- Department of Urology University Medical Center Utrecht Utrecht The Netherlands
| |
Collapse
|
27
|
Wang M, Wu Z, Hu Y, Wang Y, Tan Y, Xiang Y, Wang L, Jin L, Huang H. An adapted carrier for the cryopreservation of human testicular spermatozoa. Reprod Biomed Online 2018; 37:590-599. [PMID: 30366839 DOI: 10.1016/j.rbmo.2018.08.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 08/28/2018] [Accepted: 08/30/2018] [Indexed: 12/01/2022]
Abstract
RESEARCH QUESTION Does the adapted carrier Cryoplus improve the quality of cryopreserved spermatozoa compared with the use of conventional containers, and what is the effect of the adapted carrier on clinical outcomes? DESIGN Semen samples from 27 cases of oligozoospermia were used to investigate whether the adapted carrier improved cryopreserved sperm quality compared with the use of 0.25-ml straws and 2-ml cryogenic vials. Thirty testicular sperm samples were used to study the quality of testicular spermatozoa cryopreserved in the adapted carrier. The retrospective study included a further 104 men with azoospermia to investigate the clinical outcomes of testicular spermatozoa cryopreserved with the adapted carriers. Men with mostly obstructive azoospermia were included in this study. RESULTS The adapted carrier improved cryopreserved spermatozoa motility of semen samples compared with 2-ml cryogenic vials but not compared with 0.25-ml straws. No differences were found in cryopreserved sperm DNA fragmentation among the three carriers. Fertilization and good-quality embryo rates were similar in ICSI cycles using fresh or cryopreserved testicular spermatozoa. Additionally, no difference was evident between frozen-thawed embryo transfer cycles using fresh or cryopreserved testicular spermatozoa in clinical pregnancy, implantation, miscarriage, live birth rates or birth weight. CONCLUSIONS The adapted carrier improved the cryopreserved sperm motility compared with the effects of 2-ml cryogenic vials. The outcomes of intracytoplasmic sperm injection and frozen-thawed embryo transfer outcomes indicate that testicular spermatozoa cryopreserved using the adapted carrier is not inferior to fresh testicular spermatozoa. The use of the adapted carrier for cryopreserving human testicular spermatozoa especially from obstructive azoospermia is simple and effective.
Collapse
Affiliation(s)
- Min Wang
- Reproductive Medical Center, the International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200030, China..
| | - Zhengmu Wu
- Reproductive Medical Center, the International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Yuting Hu
- Reproductive Medical Center, the International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Yong Wang
- Reproductive Medical Center, the International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Yajing Tan
- Reproductive Medical Center, the International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Yuqian Xiang
- Reproductive Medical Center, the International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Li Wang
- Reproductive Medical Center, the International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Li Jin
- Reproductive Medical Center, the International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Hefeng Huang
- Reproductive Medical Center, the International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200030, China
| |
Collapse
|
28
|
de Souza DAS, Faucz FR, Pereira-Ferrari L, Sotomaior VS, Raskin S. Congenital bilateral absence of the vas deferens as an atypical form of cystic fibrosis: reproductive implications and genetic counseling. Andrology 2018; 6:127-135. [PMID: 29216686 PMCID: PMC5745269 DOI: 10.1111/andr.12450] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 09/02/2017] [Accepted: 11/07/2017] [Indexed: 01/19/2023]
Abstract
Congenital bilateral absence of the vas deferens (CBAVD) is found in 1% to 2% of males with infertility and is present in 6% of obstructive azoospermia cases. Nearly 95% of men with cystic fibrosis (CF, an autosomal recessive disorder) have CBAVD. There are genetic links between CBAVD and CF. Some mutations in the gene encoding cystic fibrosis transmembrane conductance regulator (CFTR) can lead to CBAVD as a monosymptomatic form of CF. With the use of assisted reproductive techniques (ART), especially testicular or epididymal sperm aspiration, intracytoplasmic sperm injection, and in vitro fertilization, it is possible that men with CBAVD can produce offspring. Therefore, genetic counseling should be offered to couples undergoing ART to discuss the probability of having offspring that carry CFTR gene mutations. The aim of this review was to present the main cause of CBAVD, to call attention to its implications for assisted reproduction, and to show the importance of genetic counseling for couples where men have CBAVD, as they can have offspring with a lethal disease.
Collapse
Affiliation(s)
- Denise Andréa Silva de Souza
- Group for Advanced Molecular Investigation (NIMA), School of Health and Biosciences, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Paraná, Brazil
- Functional Genomics Laboratory, Carlos Chagas Institute, Oswaldo Cruz Foundation, Curitiba, Paraná, Brazil
| | - Fábio Rueda Faucz
- Group for Advanced Molecular Investigation (NIMA), School of Health and Biosciences, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Paraná, Brazil
- Section on Endocrinology & Genetics, Program on Developmental Endocrinology & Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), NIH, Bethesda, MD 20892, USA
| | | | - Vanessa Santos Sotomaior
- Group for Advanced Molecular Investigation (NIMA), School of Health and Biosciences, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Paraná, Brazil
| | - Salmo Raskin
- Group for Advanced Molecular Investigation (NIMA), School of Health and Biosciences, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Paraná, Brazil
| |
Collapse
|
29
|
Hammoud I, Bailly M, Bergere M, Wainer R, Izard V, Vialard F, Selva J, Boitrelle F. Testicular Spermatozoa Are of Better Quality Than Epididymal Spermatozoa in Patients With Obstructive Azoospermia. Urology 2017; 103:106-111. [DOI: 10.1016/j.urology.2016.11.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 09/27/2016] [Accepted: 11/11/2016] [Indexed: 10/20/2022]
|
30
|
Jefferys AE, Griffith H, Wilson P, Gordon UD. Cohort study of perinatal outcomes of children born following surgical sperm recovery. HUM FERTIL 2016; 19:207-11. [PMID: 27662417 DOI: 10.1080/14647273.2016.1218071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
There is a relative paucity of data on perinatal outcomes following Intracytoplasmic Sperm Injection using surgically retrieved sperm. In this retrospective cohort study, data were collected on couples who conceived following Intracytoplasmic Sperm Injection using surgically retrieved sperm from 1996 to 2014. Outcome measures included live birth, miscarriage, congenital abnormality, birthweight, gestation at delivery, stillbirth and neonatal death. Outcome measures were compared according to male diagnosis and sperm source. Live birth rates were similar between groups (obstructive azoospermia 90%, non-obstructive azoospermia 83%, p = 0.55). There was a trend towards higher miscarriage rates in the non-obstructive azoospermia group (17% versus 9%, p = 0.45). Other perinatal outcomes were similar between groups. In those with obstructive azoospermia, live birth rates were similar regardless of source of sperm (epididymal 89%, testicular 91%, p = 0.79). Median gestation at delivery was earlier in the epididymal sperm group (39 weeks versus 40 weeks, p = 0.02). Other perinatal outcomes were unaffected by sperm source. Overall these results are reassuring, suggesting high live birth rates regardless of diagnosis or sperm source, although there may be higher miscarriage rates in cases of non-obstructive azoospermia. Other perinatal outcomes were not affected by diagnosis or sperm source.
Collapse
Affiliation(s)
- Amanda E Jefferys
- a Bristol Centre for Reproductive Medicine , Southmead Hospital , Bristol , UK
| | - Heather Griffith
- a Bristol Centre for Reproductive Medicine , Southmead Hospital , Bristol , UK
| | - Paul Wilson
- a Bristol Centre for Reproductive Medicine , Southmead Hospital , Bristol , UK
| | - Uma D Gordon
- a Bristol Centre for Reproductive Medicine , Southmead Hospital , Bristol , UK
| |
Collapse
|
31
|
Vieira M. Vasectomy Reversal must be the first step for a man who had a vasectomy and wants a children from a new marriage? Opinion: Yes. Int Braz J Urol 2015; 41:1043-5. [PMID: 26717115 PMCID: PMC4756927 DOI: 10.1590/s1677-5538.ibju.2015.06.03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Marcelo Vieira
- Membro Titular da Sociedade Brasileira de Urologia, Rio de Janeiro, Brasil.,Urologista do Projeto ALFA, São Paulo, Brasil
| |
Collapse
|
32
|
Absence bilatérale des canaux déférents : du diagnostic à l’assistance médicale à la procréation. Expérience de 3 centres. ACTA ACUST UNITED AC 2015; 43:367-74. [DOI: 10.1016/j.gyobfe.2015.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 03/11/2015] [Indexed: 01/15/2023]
|
33
|
Llabador MA, Pagin A, Lefebvre-Maunoury C, Marcelli F, Leroy-Martin B, Rigot JM, Mitchell V. Congenital bilateral absence of the vas deferens: the impact of spermatogenesis quality on intracytoplasmic sperm injection outcomes in 108 men. Andrology 2015; 3:473-80. [PMID: 25755137 DOI: 10.1111/andr.12019] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 01/21/2015] [Accepted: 01/22/2015] [Indexed: 11/30/2022]
Abstract
In azoospermic men with congenital bilateral absence of the vas deferens (CBAVD), it is not known whether the outcomes of intracytoplasmic sperm injection (ICSI) depend on the quality of testicular spermatogenesis (as determined histopathologically). We retrospectively studied the impact of spermatogenesis quality on ICSI outcomes in 108 azoospermic men with CBAVD consulting in a university hospital's department of andrology and reproductive biology. As part of an ICSI program, sperm samples were obtained from the epididymis [by microsurgical epididymal sperm aspiration (MESA); n = 47] or the testis [by testicular sperm extraction (TESE); n = 14] or both (MESA + TESE, n = 47). In the TESE group (i.e., TESE-only and MESA + TESE), spermatogenesis was normal in 21 of the 108 men (19.4%) and hypospermatogenesis occurred in 33 (30.5%). The fertilization rate was significantly lower in the hypospermatogenic group than in the normospermatogenesis group (65.6 and 72.9%, respectively; p = 0.02); this was also true for the embryo cleavage rate (88.6 and 92.1%, respectively; p = 0.007), and the proportion of embryos with fewer than 30% of enucleate fragments (79.5 and 86.9%, respectively; p = 0.02). Our study results showed that impaired spermatogenesis had a negative impact on certain early-stage biological outcomes of ICSI. In CBAVD, male factors are likely to exert a harmful effect on the early stages of embryo development.
Collapse
Affiliation(s)
- M A Llabador
- Institut de Biologie de la Reproduction-Spermiologie-CECOS, Hôpital Jeanne de Flandre, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - A Pagin
- Département de Toxicologie et Génopathies, Centre de Biologie Pathologie, Institut de Biochimie et Biologie Moléculaire, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - C Lefebvre-Maunoury
- Service de Médecine de la Reproduction et Gynécologie Endocrinienne, Hôpital Jeanne-de-Flandre, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - F Marcelli
- Département d'Andrologie, Hôpital Calmette, Lille, France
| | - B Leroy-Martin
- Institut de Biologie de la Reproduction-Spermiologie-CECOS, Hôpital Jeanne de Flandre, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | - J M Rigot
- Département d'Andrologie, Hôpital Calmette, Lille, France.,EA 4308 Gamétogenèse et Qualité du Gamète, Lille, France
| | - V Mitchell
- Institut de Biologie de la Reproduction-Spermiologie-CECOS, Hôpital Jeanne de Flandre, Centre Hospitalier Régional Universitaire de Lille, Lille, France.,EA 4308 Gamétogenèse et Qualité du Gamète, Lille, France
| |
Collapse
|
34
|
Oldereid NB, Hanevik HI, Bakkevig I, Romundstad LB, Magnus Ø, Hazekamp J, Hentemann M, Eikeland SN, Skrede S, Reitan IR, Tanbo TG. Pregnancy outcome according to male diagnosis after ICSI with non-ejaculated sperm compared with ejaculated sperm controls. Reprod Biomed Online 2014; 29:417-23. [PMID: 25131554 DOI: 10.1016/j.rbmo.2014.06.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 06/11/2014] [Accepted: 06/12/2014] [Indexed: 12/22/2022]
Abstract
The aim of this study was to describe pregnancy outcome in couples who had undergone ICSI using non-ejaculated sperm from men with non-obstructive azoospermia, obstructive azoospermia and aspermia compared with the outcome of ICSI with ejaculated sperm from men with severe oligozoospermia, treated during the same time period. This nationwide cohort study included all children born after ICSI with non-ejaculated sperm in Norway, from when the method was first permitted in Norway in April 2004 to the end of 2010, resulting in 420 pregnancies and a total of 359 children. In 235 of these children, the father was diagnosed with obstructive azoospermia, in 72 with non-obstructive azoospermia, in 31 with aspermia, and in 21 the male cause was unclassifiable. The control group consisted of 760 children from 939 pregnancies conceived by ICSI with ejaculated sperm. Sex ratio, birth weight, rate of pregnancy loss and congenital malformations were not significantly associated with sperm origin or the cause of male factor infertility.
Collapse
Affiliation(s)
- Nan B Oldereid
- Department of Gynaecology, Oslo University Hospital, 0424 Oslo, Norway;.
| | - Hans I Hanevik
- Fertilitetsklinikken Sør, Postbox 263, 3901 Porsgrunn, Norway
| | | | - Liv B Romundstad
- Department of Obstetrics and Gynecology, Fertility Clinic, St Olav's University Hospital, Trondheim, Norway;; Department of Public Health, NTNU, Trondheim, Norway
| | | | | | - Martha Hentemann
- Department of Obstetrics and Gynecology, University Hospital of Northern Norway, 9019 Tromsø, Norway
| | | | - Siren Skrede
- Department of Obstetrics and Gynaecology, Haukeland University Hospital, 5053 Bergen, Norway
| | | | - Tom G Tanbo
- Department of Gynaecology, Oslo University Hospital, 0424 Oslo, Norway;; Institute of Clinical Medicine, University of Oslo, 0424 Oslo, Norway
| |
Collapse
|
35
|
Hotaling J, Carrell DT. Clinical genetic testing for male factor infertility: current applications and future directions. Andrology 2014; 2:339-50. [PMID: 24711280 DOI: 10.1111/j.2047-2927.2014.00200.x] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Revised: 01/24/2014] [Accepted: 02/03/2014] [Indexed: 01/06/2023]
Abstract
Spermatogenesis involves the aggregated action of up to 2300 genes, any of which, could, potentially, provide targets for diagnostic tests of male factor infertility. Contrary to the previously proposed common variant hypothesis for common diseases such as male infertility, genome-wide association studies and targeted gene sequencing in cohorts of infertile men have identified only a few gene polymorphisms that are associated with male infertility. Unfortunately, the search for genetic variants associated with male infertility is further hampered by the lack of viable animal models of human spermatogenesis, difficulty in robustly phenotyping infertile men and the complexity of pedigree studies in male factor infertility. In this review, we describe basic genetic principles involved in understanding the genetic basis of male infertility and examine the utility and proper clinical use of the proven genetic assays of male factor infertility, specifically Y chromosome microdeletions, chromosomal translocations, karyotype, cystic fibrosis transmembrane conductance regulator mutation analysis and sperm genetic tests. Unfortunately, these tests are only able to diagnose the cause of about 20% of male factor infertility. The remainder of the review will be devoted to examining novel tests and diagnostic tools that have the potential to explain the other 80% of male factor infertility that is currently classified as idiopathic. Those tests include epigenetic analysis of the spermatozoa and the evaluation of rare genetic variants and copy number variations in patients. Success in advancing to the implementation of such areas is not only dependent on technological advances in the laboratory, but also improved phenotyping in the clinic.
Collapse
Affiliation(s)
- J Hotaling
- Department of Surgery (Urology), University of Utah School of Medicine, Salt Lake City, UT, USA
| | | |
Collapse
|
36
|
Association of cystic fibrosis transmembrane-conductance regulator gene mutation with negative outcome of intracytoplasmic sperm injection pregnancy in cases of congenital bilateral absence of vas deferens. Fertil Steril 2014; 101:1255-60. [PMID: 24559724 DOI: 10.1016/j.fertnstert.2014.01.033] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 12/23/2013] [Accepted: 01/21/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate intracytoplasmic sperm injection (ICSI) results with regard to congenital bilateral absence of vas deferens (CBAVD) versus non-CBAVD obstruction, cystic fibrosis transmembrane-conductance regulator (CFTR) mutations versus non-CFTR mutations, and miscarriages or stillbirths versus live births per embryo transferred. DESIGN Retrospective study with detailed chart review. SETTING Center for reproductive medicine. PATIENT(S) Nine hundred forty-five men with obstructive azoospermia. INTERVENTION(S) One thousand four hundred fourteen ICSI cycles classified as CBAVD versus non-CBAVD obstruction, CFTR mutations versus non-CFTR mutations, and miscarriages/stillbirths versus live births per embryo transferred. MAIN OUTCOME MEASURE(S) Frequency of CFTR mutations and rates of fertilization, good embryos, clinical pregnancy, miscarriages and stillbirths, ectopic pregnancy, and live births. RESULT(S) CFTR mutations were more prevalent in men with CBAVD than in those with non-CBAVD obstruction. The rate of miscarriages and stillbirths per embryo transferred was higher in men with CBAVD than in those with non-CBAVD obstruction, whereas the rate of live births per embryo transferred was lower in men with CBAVD than in those with non-CBAVD obstruction. The rate of miscarriages and stillbirths per embryo transferred was higher in men with CFTR mutations than in those with non-CFTR mutations. The frequency of CFTR mutations was higher in patients who experienced miscarriages/stillbirths than in those with live births. CONCLUSION(S) The frequency of CFTR mutations was higher in cases of CBAVD versus non-CBAVD obstruction. Possibly as a result of CFTR mutations, patients with CBAVD had a significantly increased risk of miscarriage and stillbirth and a reduced rate of live birth compared with patients with non-CBAVD.
Collapse
|
37
|
|
38
|
Peng J, Yuan Y, Zhang Z, Cui W, Song W, Gao B. Microsurgical vasoepididymostomy is an effective treatment for azoospermic patients with epididymal obstruction and prior failure to achieve pregnancy by sperm retrieval with intracytoplasmic sperm injection. Hum Reprod 2013; 29:1-7. [DOI: 10.1093/humrep/det385] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
39
|
Abstract
This article describes sperm retrieval procedures that may be performed in an office setting. Indications for sperm retrieval, preprocedural preparation, and anesthetic considerations are discussed. Vasal sperm aspiration, percutaneous epididymal sperm aspiration, microsurgical epididymal sperm aspiration, testicular sperm aspiration, conventional, and microdissection testicular sperm extraction are reviewed. Success and complication rates as well as factors that may influence success (histopathology, cancerous cause, Klinefelter syndrome, Y microdeletions, varicocele, and hormone administration) are reviewed.
Collapse
Affiliation(s)
- Kiranpreet K Khurana
- Department of Urology, Glickman Urological & Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue, Q10, Cleveland, OH 44195, USA
| | | |
Collapse
|
40
|
|
41
|
Miyaoka R, Esteves SC. Predictive factors for sperm retrieval and sperm injection outcomes in obstructive azoospermia: do etiology, retrieval techniques and gamete source play a role? Clinics (Sao Paulo) 2013; 68 Suppl 1:111-9. [PMID: 23503960 PMCID: PMC3583159 DOI: 10.6061/clinics/2013(sup01)12] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2012] [Accepted: 04/11/2012] [Indexed: 01/06/2023] Open
Abstract
Obstructive azoospermia is a relatively common male infertility condition. The main etiologies of obstructive azoospermia include congenital, surgical-derived, traumatic and post-infectious cases. Although seminal tract reconstruction is a cost-effective treatment in most cases, this approach may not be feasible or desired in some cases. In such cases, assisted reproduction techniques offer a method for achieving pregnancy, notably via sperm retrieval and intracytoplasmic sperm injection. This process requires several considerations and decisions to be made, including the cause and duration of obstruction, which sperm retrieval technique to use, and whether to use fresh or frozen-thawed sperm. We present a review of obstructive azoospermia and assisted reproduction techniques, highlighting the most relevant aspects of the decision-making process for use in clinical practice.
Collapse
Affiliation(s)
- Ricardo Miyaoka
- Referral Center for Male Reproduction, ANDROFERT - Andrology & Human Reproduction Clinic, Campinas, São Paulo, Brazil
| | | |
Collapse
|
42
|
Esteves SC, Lee W, Benjamin DJ, Seol B, Verza S, Agarwal A. Reproductive potential of men with obstructive azoospermia undergoing percutaneous sperm retrieval and intracytoplasmic sperm injection according to the cause of obstruction. J Urol 2012; 189:232-7. [PMID: 23174251 DOI: 10.1016/j.juro.2012.08.084] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Accepted: 06/22/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE We evaluated the retrieval rates and reproductive outcomes of percutaneous sperm retrieval according to the cause of obstructive azoospermia. MATERIALS AND METHODS We retrospectively studied the records of 146 men with obstructive azoospermia who underwent sperm retrieval for intracytoplasmic sperm injection. Patients were grouped by the cause of obstruction, including 32 with congenital bilateral absence of the vas deferens, 59 with vasectomy and 55 with obstruction due to post-infection disease. Sperm were retrieved percutaneously from the epididymis or testis. We compared retrieval rates and intracytoplasmic sperm injection outcomes, including neonatal results, in the groups of men with obstructive azoospermia. RESULTS The success of sperm retrieval was similar among the etiology groups, including 100% for congenital bilateral absence of the vas deferens, 96.6% for vasectomy and 96.3% for previous infection. Significantly fewer men in the congenital bilateral absence of the vas deferens group needed testicular aspiration compared to those in the post-infection and vasectomy groups (3.1% vs 23.6% and 30.5%, respectively, p <0.001). Sperm cryopreservation was possible in 26.7% of the cases and did not significantly differ among the groups. Live birth rates after sperm injection were similar in the congenital (34.4%), vasectomy (32.2%) and previous infection (36.4%) groups. Birth parameters, prematurity and low birth weight rates were comparable among the groups. CONCLUSIONS Percutaneous sperm retrieval is an effective method to retrieve sperm in men with obstructive azoospermia irrespective of the cause of obstruction. The chance of achieving a live birth and the profile of neonates born after sperm injection do not seem to be related to the cause of obstruction.
Collapse
|
43
|
Salama S, Boitrelle F, Albert M, Hammoud I, Huchon C, Wainer R, Selva J, Bailly M. Intérêt de la ponction épididymaire et de la biopsie testiculaire systématique dans la prise en charge de l’azoospermie obstructive. Basic Clin Androl 2012. [DOI: 10.1007/s12610-012-0202-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Résumé
Introduction
Dans l’azoospermie obstructive (AO), les taux d’extraction chirurgicale de spermatozoïdes sont élevés. Cependant, en ce qui concerne les issues des ICSI (Intra cytoplasmic Sperm Injection) chirurgicales, les données de la littérature divergent. Quels sont, dans notre équipe, les taux d’extraction de spermatozoïdes après aspiration épidydimaire (MESA) et après extraction testiculaire (TESE) dans l’AO ? Les taux de grossesses, les taux de fausses couches spontanées et d’accouchements diffèrent-ils en fonction de l’origine du sperme ?
Matériels et méthodes
L’étude a rétrospectivement inclus 48 couples dont l’homme présente une azoospermie obstructive pure et ayant bénéficié d’un prélèvement chirurgical de spermatozoïdes associant systématiquement MESA et TESE. Les ICSI ont été réalisées de manière asynchrone. À chaque fois que cela était possible, la première ICSI a été réalisée avec des spermatozoïdes épididymaires.
Résultats
Pour les 48 couples, 99 ICSI ont été réalisées. Quinze couples ont réalisé 24 ICSI-TESE car l’aspiration épididymaire était négative. Onze couples ont réalisé 20 ICSI-TESE car la qualité du prélèvement épididymaire n’était pas satisfaisante (vitalité spermatique réduite le plus souvent). Vingt-deux couples ont réalisé 22 ICSI-MESA en première intention puis en cas d’échec, 11 couples ont réalisé 12 ICSI-MESA et dix couples ont réalisé 20 ICSI-TESE. Alors que les nombres d’ovocytes injectés (7,1±4,1 vs 6,9 ±3,6 P: 0,8) et d’embryons obtenus (4,5±3,0 vs 4,7±2,7; P: 0,7) ne sont pas significativement différents dans les deux groupes d’ICSI, les nombres d’embryons de top qualité (2,4±1,9 vs 3,6±2,0 P: 0,005) et d’embryons congelés (0,9±1,8 vs 1,7±1,9 P: 0,04) sont significativement supérieurs dans le groupe TESE. Le nombre de grossesse par ponction est supérieur dans le groupe TESE (58,5 % vs 26,5 %, P: 0,002).
Conclusion
L’approche de notre centre a la particularité d’associer systématiquement un prélèvement testiculaire au prélèvement épididymaire chez tout homme présentant une azoospermie obstructive alors que la plupart des autres études rapportées se limitent à l’exploration épididymaire si cette dernière est positive lors de l’examen extemporané. Alors que classiquement, on rapporte 100% de positivité lors du prélèvement épididymaire chez l’homme atteint d’une azoospermie obstructive, dans notre étude, plus de la moitié des explorations épididymaires s’est avérée inexploitable. La qualité embryonnaire et les taux de grossesses sont meilleurs avec des spermatozoïdes testiculaires. L’association de ces 2 sites de prélèvement (MESA et TESE) peut être complémentaire et utile pour le couple et l’issue de sa prise en charge en AMP sans pour autant entraîner un sur-risque pour l’homme dans les suites de la chirurgie.
Collapse
|
44
|
Halliday J. Outcomes for offspring of men having ICSI for male factor infertility. Asian J Androl 2011; 14:116-20. [PMID: 22157986 DOI: 10.1038/aja.2011.71] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Since the introduction of intracytoplasmic sperm injection (ICSI) using single sperm isolated from testicular tissue in men with obstructive and non-obstructive azoospermia, or using ejaculated sperm in those with poor semen quality, there have been concerns that this might have adverse effects on the offspring compared to conventional in vitro fertilisation (IVF) and natural conceptions. ICSI is done for reasons other than male factor infertility, and on the whole has not been shown to have any more negative effects than those seen with IVF. There have however, been very few studies of ICSI with a focus on, or large enough numbers to examine, the specific outcomes associated with male factor infertility. From the limited information available in relation to the source of the sperm and aetiology of infertility in the presence of ICSI, there appears to be no increased risk of congenital malformations. There is, however, a small increase in both de novo and inherited chromosome abnormalities. In terms of growth and neurodevelopment, there are very few studies, and so far, no adverse outcomes have been found in young children whose fathers have a sperm defect. The origin of the sperm used in ICSI does not have a major influence on the early life outcomes for the offspring, but transgenerational and epigenetic effects remain unknown. When the male factor infertility is known or thought to be due to a Y-chromosome deletion, this information should be given to the young male offspring at a time that will ensure his own reproductive health and plans are optimized.
Collapse
Affiliation(s)
- Jane Halliday
- Public Health Genetics, Murdoch Children's Research Institute, Parkville, Vic., Australia.
| |
Collapse
|
45
|
Esteves SC, Miyaoka R, Agarwal A. Sperm retrieval techniques for assisted reproduction. Int Braz J Urol 2011; 37:570-83. [DOI: 10.1590/s1677-55382011000500002] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2011] [Indexed: 11/21/2022] Open
Affiliation(s)
- Sandro C. Esteves
- ANDROFERT, Andrology and Human Reproduction Clinic, Brazil; Glickman Urological and Kidney Institute, USA
| | - Ricardo Miyaoka
- ANDROFERT, Andrology and Human Reproduction Clinic, Brazil; Glickman Urological and Kidney Institute, USA
| | - Ashok Agarwal
- ANDROFERT, Andrology and Human Reproduction Clinic, Brazil; Glickman Urological and Kidney Institute, USA
| |
Collapse
|
46
|
Clinical outcomes and development of children born after intracytoplasmic sperm injection (ICSI) using extracted testicular sperm or ejaculated extreme severe oligo-astheno-teratozoospermia sperm: a comparative study. Fertil Steril 2011; 96:567-71. [DOI: 10.1016/j.fertnstert.2011.06.080] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Revised: 06/14/2011] [Accepted: 06/30/2011] [Indexed: 11/19/2022]
|
47
|
Nangia AK, Luke B, Smith JF, Mak W, Stern JE. National study of factors influencing assisted reproductive technology outcomes with male factor infertility. Fertil Steril 2011; 96:609-14. [PMID: 21733503 DOI: 10.1016/j.fertnstert.2011.06.026] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2011] [Revised: 06/08/2011] [Accepted: 06/09/2011] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To evaluate the outcomes of assisted reproductive technology (ART) cycles for male factor infertility, and method of sperm collection. DESIGN Historic cohort study. SETTING Clinic-based data. PATIENTS Cycles from the Society for Assisted Reproductive Technology Clinic Outcomes Reporting System database for 2004 to 2008 were limited to three groups: non-intracytoplasmic sperm injection (ICSI) and ICSI cycles for tubal ligation only; non-ICSI and ICSI cycles for male factor infertility only; and all cycles (regardless of infertility diagnosis) using ICSI only. INTERVENTION(S) AND MAIN OUTCOME MEASURE(S) Multivariate logistic regression was used to model the adjusted odds ratio (AOR) of clinical intrauterine gestation (CIG) and live birth (LB) rates for tubal ligation versus male factor infertility only; ICSI versus non-ICSI for male factor infertility only; and ICSI outcomes based on method of sperm collection. RESULT(S) Models for male factor infertility only versus tubal ligation only ICSI cycles had lower CIG (AOR 0.92) but not LB (AOR 0.87). No difference was seen for non-ICSI cycles. Within male factor infertility only cycles, ICSI had a worse outcome than non-ICSI for CIG (AOR 0.93) but not for LB (AOR 0.94). For all ICSI cycles with no male factor infertility and ejaculated sperm as the reference group, models showed better rates of CIG with male factor infertility ejaculated sperm (AOR 1.07) and with male factor infertility aspirated sperm (AOR 1.09). The LB rate was higher with male factor infertility ejaculated sperm only (AOR 1.04). CONCLUSION(S) The ICSI and sperm source influence CIG and LB rates in male factor infertility cases.
Collapse
Affiliation(s)
- Ajay K Nangia
- Department of Urology, University of Kansas Medical Center, Kansas City, Kansas 66160, USA.
| | | | | | | | | | | |
Collapse
|
48
|
Esteves SC, Miyaoka R, Agarwal A. Surgical treatment of male infertility in the era of intracytoplasmic sperm injection - new insights. Clinics (Sao Paulo) 2011; 66:1463-78. [PMID: 21915501 PMCID: PMC3161229 DOI: 10.1590/s1807-59322011000800026] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2011] [Revised: 04/15/2011] [Accepted: 04/19/2011] [Indexed: 01/18/2023] Open
Abstract
Assisted reproductive technology is an evolving area, and several adjuvant procedures have been created to increase a couple's chance of conceiving. For male infertility, the current challenges are to properly accommodate old and new techniques that are both cost-effective and evidence-based. In this context, urologists are expected to diagnose, counsel, provide medical or surgical treatment whenever possible and/or correctly refer male patients for assisted conception. Urologists are sometimes part of a multiprofessional team in an assisted reproduction unit and are responsible for the above-cited tasks as well as the surgical retrieval of sperm from either the epididymides or testicles. We present a comprehensive review of the surgical treatment options for infertile males, including the perioperative planning and prognostic aspects, with an emphasis on the role of microsurgery in the optimization of treatment results. This review also discusses current techniques for sperm retrieval that are used in association with assisted reproductive technology and includes sperm retrieval success rates according to the technique and the type of azoospermia. New insights are provided with regard to each surgical treatment option in view of the availability of assisted conception to overcome male infertility.
Collapse
|