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1.
Silber SJ; Nagy Z; Devroey P; Tournaye H; Van Steirteghem AC 《Human reproduction (Oxford, England)》1997,12(11):2422-2428
The aim of the study was to determine whether a prior diagnostic testicle
biopsy can predict success or failure of testicular sperm extraction (TESE)
with intracytoplasmic sperm injection (ICSI) in patients with
non-obstructive azoospermia caused by testicular failure, and what is the
minimum threshold of sperm production in the testis which must be surpassed
for spermatozoa to reach the ejaculate. Forty- five patients with
non-obstructive azoospermia caused by testicular failure underwent
diagnostic testicle biopsy prior to a planned future TESE-ICSI procedure.
The diagnostic testicle biopsy was analysed quantitatively, and correlated
with the quantitative findings of spermatogenesis in patients with normal
spermatogenesis, as well as with the results of subsequent attempts at
TESE-ICSI. Men with non- obstructive azoospermia caused by germinal failure
had a mean of 0-6 mature spermatids/seminiferous tubule seen on a
diagnostic testicle biopsy, compared to 17-35 mature spermatids/tubule in
men with normal spermatogenesis and obstructive azoospermia. These findings
were the same for all types of testicular failure whether Sertoli cell
only, maturation arrest, cryptorchidism, or post-chemotherapy azoospermia.
Twenty-two of 26 men with mature spermatids found in the prior testis
biopsy had successful retrieval of spermatozoa for ICSI, 12 of their
partners became pregnant, and are either ongoing or delivered. The study
suggests that 4-6 mature spermatids/tubule must be present in the testis
biopsy for any spermatozoa to reach the ejaculate. More than half of
azoospermic patients with germinal failure have minute foci of
spermatogenesis which are insufficient to produce spermatozoa in the
ejaculate. Prior diagnostic testicle biopsy analysed quantitatively (for
the presence of mature spermatids) can predict subsequent success or
failure with TESE-ICSI. Incomplete testicular failure may involve a sparse
multi-focal distribution of spermatogenesis throughout the entire testicle,
rather than a regional distribution. Therefore, it is possible that massive
testicular sampling from many different regions of the testes may not be
necessary for successful TESE-ICSI.
相似文献
2.
Steger K Failing K Klonisch T Behre HM Manning M Weidner W Hertle L Bergmann M Kliesch S 《Human reproduction (Oxford, England)》2001,16(4):709-716
During spermiogenesis, histone-to-protamine exchange causes chromatin condensation. Spermatozoa from infertile men are known to exhibit an increased protamine-1 (PRM1) to protamine-2 (PRM2) protein ratio. Since patients undergoing testicular sperm extraction (TESE) followed by intracytoplasmic sperm injection (ICSI) reveal low fertilization rates, whether the outcome of ICSI could be related to the percentage of round spermatids expressing PRM1-mRNA and PRM2-mRNA was investigated. Applying in-situ hybridization, 55 testicular biopsies from men undergoing TESE/ICSI were investigated. The percentage of PRM1-mRNA and PRM2-mRNA positive spermatids was significantly (P < 0.0001) decreased in men with at least qualitatively normal spermatogenesis (PRM1-mRNA: 58.4 +/- 13.8%; PRM2-mRNA: 56.4 +/- 11.3%) and impaired spermatogenesis (PRM1-mRNA: 32.6 +/- 10.8%; PRM2-mRNA: 31.7 +/- 11.1%) compared with men with obstructive azoospermia and quantitatively normal spermatogenesis (PRM1-mRNA: 79.9 +/- 4.6%; PRM2-mRNA: 78.1 +/- 5.7%). A positive correlation (r(PRM1) = 0.733; r(PRM2) = 0.784; P < 0.001) was demonstrated between the score and the percentage of PRM1-mRNA and PRM2-mRNA positive spermatids. While successful fertilization was neither related to the score, nor to the percentage of PRM1-mRNA and PRM2-mRNA positive spermatids, a significant (P < 0.05) relationship was demonstrated between successful fertilization and the PRM1-mRNA to PRM2-mRNA ratio. Therefore, the PRM1-mRNA to PRM2-mRNA ratio in round spermatids may serve as a possible predictive factor for the outcome of ICSI. 相似文献
3.
Hammadeh ME al-Hasani S Doerr S Stieber M Rosenbaum P Schmidt W Diedrich K 《Human reproduction (Oxford, England)》1999,14(2):363-367
A significant association between male subfertility, imperfect spermiation and abnormal nuclear condensation has been suggested. The DNA content of spermatozoa might be responsible for inducing alterations in sperm morphology. The final nuclear shape, which is species-specific, depends on chromatin condensation during spermatogenesis as well as a precise organization of DNA within the nucleus. Many reports have described the association between disturbances in sperm chromatin condensation, morphology and male infertility. Chromatin condensation is achieved by gradual substitution of lysinerich somatic histones by testis-specific histone and finally by protamine. In this study two groups of patients were compared: the first consisted of 63 patients who had undergone intracytoplasmic sperm injection (ICSI) with freshly ejaculated spermatozoa whereas the second included 47 patients assigned to ICSI with testes biopsy-extracted spermatozoa. In both groups chromatin condensation was assessed by aniline blue staining and morphology evaluated according to strict criteria. The condensed chromatin and morphology of spermatozoa were significantly (P < 0.0001) less in the second group compared to the first. However the fertilization, cleavage, implantation and pregnancy rates were almost the same in both investigated groups. There was no significant difference between the two groups with respect to ICSI outcome. The percentage of chromatin condensation (nuclear maturity) and morphologically-normal spermatozoa were significantly higher (P < 0.0001) in the ejaculated spermatozoa than in those from testis biopsy but the ICSI outcome (fertilization, cleavage, implantation and pregnancy rates) was the same. In view of these results the fertilization capability and the embryo quality obtained using testis biopsy extracted spermatozoa is not influenced by chromatin condensation and sperm morphology in testicular sperm extraction (TESE)-ICSI programmes. Therefore, it could be said that neither chromatin condensation nor morphology of testis extracted sperm could predict the fertilization, implantation and pregnancy rate in TESE-ICSI programmes. 相似文献
4.
5.
Sousa M Cremades N Silva J Oliveira C Ferraz L Teixeira da Silva J Viana P Barros A 《Human reproduction (Oxford, England)》2002,17(7):1800-1810
BACKGROUND: A retrospective study was carried out on 159 treatment cycles in 148 secretory azoospermic patients to determine whether histopathological secretory azoospermic subgroups were predictive for gamete retrieval, and to evaluate outcome of microinjection using fresh or frozen-thawed testicular sperm and spermatids. METHODS: Sperm and spermatids were recovered by open testicular biopsy and microinjected into oocytes. Fertilization and pregnancy rates were assessed. RESULTS: In hypoplasia, 97.7% of the 44 patients had late spermatids/sperm recovered. In maturation-arrest (MA; 47 patients), 31.9% had complete MA, and 68.1% incomplete MA due to a focus of early (36.2%) or late (31.9%) spermiogenesis. Gamete retrieval was achieved in 53.3, 41.2 and 93.3% of the cases respectively. In Sertoli cell-only syndrome (SCOS; 57 patients), 61.4% were complete SCOS, whereas incomplete SCOS cases showed one focus of MA (5.3%), or of early (29.8%) and late (3.5%) spermiogenesis. Only 29.8% of the patients had a successful gamete retrieval, 2.9% in complete and 77.3% in incomplete SCOS cases. In total, there were 87 ICSI, 39 elongated spermatid injection (ELSI) and 33 round spermatid injection (ROSI) treatment cycles, with mean values of fertilization rate of 71.4, 53.6 and 17%, and clinical pregnancy rates of 31.7, 26.3 and 0% respectively. CONCLUSIONS: Histopathological subgroups were positively correlated with successful gamete retrieval. No major outcome differences were observed between testicular sperm and elongated spermatids, either fresh or frozen-thawed. However, injection of intact round-spermatids showed very low rates of fertilization and no pregnancies. 相似文献
6.
Sadeghi MR Lakpour N Heidari-Vala H Hodjat M Amirjannati N Hossaini Jadda H Binaafar S Akhondi MM 《Revue roumaine de morphologie et embryologie》2011,52(2):645-651
This study was done to evaluate the effect of sperm source on chromatin integrity and ICSI outcomes. One hundred and thirteen samples containing epididymal aspirates of 57 obstructive azoospermic men and 56-ejaculated semen of normozoospermic men were included in this study. Sperm chromatin status was evaluated by Chromomycin A3 (CMA3), Aniline Blue (AB) and Toluidine Blue (TB). Fertilization rate and embryo quality were recorded. In epididymal group the percentage of sperms stained with AB, CMA3 and TB were significantly higher compared to ejaculate group while fertilization rate (60.6% vs. 74.04%) was significantly lower. However, embryo quality was not significantly different between two groups. In addition, abnormal sperm chromatin condensation and DNA fragmentation were not correlated with fertilization rate and embryo quality. Our results highlight the role of epididymis in sperm maturation and confirm that ICSI using ejaculated sperm is the gold standard for treatment of infertile men. 相似文献
7.
Multiple pregnancies obtained by testicular spermatid injection in combination with intracytoplasmic sperm injection 总被引:18,自引:16,他引:2
Kahraman S; Polat G; Samli M; Sozen E; Ozgun OD; Dirican K; Ozbicer T 《Human reproduction (Oxford, England)》1998,13(1):104-110
Recent studies have shown that the injection of spermatid cells into the
human oocyte can result in normal fertilization, embryo development and
even delivery of live, healthy offspring. In our study, 23 azoospermic
cases with severe spermatogenetic defects in their testicular biopsy are
presented. The serum follicle stimulating hormone (FSH) concentrations and
histopathological results of these males have been documented and compared
in terms of fertilization and embryo development. The mean FSH value of the
azoospermic males was 15.8 +/- 2.3 mIU/l, ranging from 1.6 to 39 mIU/l.
Elongated spermatids were used in three cases only, as these more mature
forms were mostly present in the testicular sample. In the remaining 20
cases, only round spermatids were found for use in intracytoplasmic sperm
injection (ICSI). The fertilization rate with two pronuclei was 31.3%. The
fertilization rate was found to be as high as 71% in three patients in the
elongating and elongated spermatids group and as low as 25.6% in the round
spermatid group. A few immature, non-motile spermatozoa were seen in only
two cases from the elongated spermatid group. However, in the remaining
cases, no spermatozoa were observed. The number of pronuclear (PN) arrest
was quite high when only round spermatids were used (36.1%). Total
fertilization failure was observed in two cases from the round spermatid
group with Sertoli cell only and germ cell aplasia. A total of three
pregnancies was achieved in 23 cases (13.0%), two from the elongated
spermatid group and one from the round spermatid group. One biochemical
pregnancy with a round spermatid resulted in an early spontaneous abortion
and surprisingly, the remaining pregnancies were achieved with elongated
spermatids resulting in multiple pregnancies. One twin and one triplet
pregnancy were established following four embryo transfers in each patient.
The twin pregnancy resulted in a live birth with two healthy babies;
unfortunately, the triplet pregnancy ended in an abortion at 11 weeks. The
use of testicular spermatids in the treatment of non-obstructive
azoospermia may give hope by offering a novel treatment model. In cases
with very severe spermatogenetic defect, even multiple pregnancies can be
achieved with elongated spermatid cells by yielding a high implantation
rate. However, the efficiency of round spermatids in achieving
fertilization and pregnancy was disappointing.
相似文献
8.
BACKGROUND: Although ICSI is a useful technique, low elongated spermatid numbers frequently causes technical difficulties, especially in the case of azoospermic patients. Enrichment of elongated spermatids from the testis prior to ICSI may solve this problem. METHODS: To determine whether elongated spermatids had a characteristic phenotype suitable for purification, testicular cells prepared from 25-day-old mice (from spermatogonia to round spermatids) and adult mice (from spermatogonia to elongated spermatids) were compared by flow cytometry. After flow-cytometric cell sorting (FCS) based on their side (SSC) and forward scatter (FSC), purity of the elongated spermatids in the fractionated population was microscopically examined, and functional ability of purified elongated spermatids was assessed by ICSI. RESULTS: Elongated spermatids in testicular cells showed characteristic SSC and FSC phenotypes. In the purified population, approximately 70-80% of the cells were morphologically determined as elongated spermatids, in contrast to only 10% before sorting. Using ICSI, purified elongated spermatids supported full-term development similar to that of unsorted elongated spermatids. Furthermore, we succeeded in enriching the elongated spermatids from the infertile testis model by approximately 10-fold. CONCLUSIONS: Elongated spermatids with normal developmental ability can be efficiently purified by FCS based on SSC and FSC characteristics. 相似文献
9.
Chromosome analysis of epididymal and testicular sperm in azoospermic patients undergoing ICSI 总被引:8,自引:0,他引:8
Palermo GD Colombero LT Hariprashad JJ Schlegel PN Rosenwaks Z 《Human reproduction (Oxford, England)》2002,17(3):570-575
BACKGROUND: Although ICSI provides a way of treating azoospermic men, concern has been raised about the potential risk for transmission of genetic abnormalities to the offspring. We quantified the incidence of chromosomal abnormalities in epididymal and testicular sperm retrieved from azoospermic patients undergoing ICSI. METHODS: Individual testicular sperm were collected from testicular biopsies with an ICSI pipette, and epididymal sperm were retrieved by microsurgical epididymal sperm aspiration. Samples were processed by fluorescent in-situ hybridization (FISH) for chromosomes 18, 21, X and Y and the results compared with those from normal ejaculated samples. RESULTS: The overall aneuploidy rate of 11.4% in men with non-obstructive azoospermia was significantly higher (P = 0.0001) than the 1.8% detected in epididymal sperm from men with obstructive azoospermia and also the 1.5% found in ejaculated sperm. No significant difference was found between the epididymal and ejaculated samples. When the chromosomal abnormalities were analysed, gonosomal disomy was the most recurrent abnormality in both obstructive and non-obstructive azoospermic patients, while autosomal disomy was the most frequent in ejaculated sperm. CONCLUSIONS: Sperm of non-obstructive azoospermic men had a higher incidence of chromosomal abnormalities, of which sex chromosome aneuploidy was the most predominant. Genetic counselling should be offered to all couples considering infertility treatment by ICSI with testicular sperm. 相似文献
10.
Y Araki S Ogawa M Ohno M Yoshizawa M Motoyama S Araki I Aslam S Fishel 《Molecular human reproduction》1999,5(8):784-787
Human elongated spermatids from azoospermic patients were inserted into mouse oocytes by intracytoplasmic sperm injection (ICSI). The injection resulted in survival rates of 46.5% (180 out of 387) and activation rates of 36.1% (65 out of 180). The rate of two pronuclear (2PN) formation was 35.4% (23 out of 65). Only 34.8% (eight out of 23) metaphase chromosome spreads from 2PN zygotes could be analysed; however, all were of normal karyotype. Cytogenetic analysis at the first metaphase revealed that human elongated spermatid chromosomes were able to undergo replication in a heterogeneous environment. 相似文献
11.
To identify the predictive factors for testicular sperm extraction (TESE)
and to understand the pathology associated with TESE, we carried out a
prospective study in 40 consecutive men with azoospermia due to primary
gonadal failure. The main outcome measure was the retrieval of at least one
testicular spermatozoon. Endocrine and biophysical profiles, testicular
histology, Johnsen score and testicular spermatids were used as predictors
of sperm extraction. Spermatogenesis was quantified with the Johnsen score.
A variable pattern of spermatogenesis was common, being present in 20 (50%)
patients. Visualisation of testicular spermatids on testicular histology
showed a strong association with TESE (P < 0.0001). Statistically
significant differences were detected in plasma follicle stimulating
hormone (FSH) and testicular volume between patients who had
hypospermatogenesis and Sertoli cell-only or maturation arrest. There were
no significant differences in Johnsen score, biophysical and endocrine
profiles between the groups with successful and failed TESE. However, a
statistically significant trend occurred with changes in histological
pattern [chi2 for trend, P = 0.001; Pearson's coefficient (r) = 0.6],
Johnsen score (P = 0.022; r = 0.5), testicular volume (P = 0.01; r = 0.5)
and plasma FSH concentrations (P = 0.044; r = 0.4), albeit to a limited
degree. Difference in the interpretation of histological patterns with
different assessors was observed. The type of occupation or risk factors
for azoospermia showed no association with testicular pathology or TESE.
Variable histological patterns in different tubules in the same individual
may explain the poor correlation of TESE with endocrine and biophysical
profiles, Johnsen score and histological pattern. Differences in the amount
of tissue used for TESE and histopathology, and misinterpretation of
testicular histology rather than failure to quantify spermatogenesis may
explain the poor correlation between histological patterns and TESE.
Testicular spermatids predicted TESE. However, considerable overlap in
values means that no single variable can provide a perfect discrimination
between the groups with successful and failed TESE.
相似文献
12.
13.
Developmental potential of human spermatogenic cells co-cultured with Sertoli cells. 总被引:15,自引:0,他引:15
Mário Sousa Nieves Cremades Cláudia Alves Joaquina Silva Alberto Barros 《Human reproduction (Oxford, England)》2002,17(1):161-172
BACKGROUND: Development of an in-vitro culture system capable of supporting human early germ cell differentiation would be important for treatment of azoospermic patients. METHODS: Sertoli cells, spermatogonia and spermatocytes were isolated from testicular biopsies of 61 non-obstructive azoospermic patients, and co-cultured using Vero cell conditioned medium only or supplemented with recombinant (r)FSH or rFSH plus testosterone. Germ cell purity was checked by fluorescent in-situ hybridization (FISH) analysis. RESULTS: Best results were achieved with both hormones, which elicited 6.9% of meiosis index and 22.7% of differentiation into normal late spermatids after 2-3 weeks of culture. In-vitro matured spermatids were microinjected into oocytes to study their developmental potential. Round spermatids elicited 37.5% of fertilization and 28.6% blastocyst rates. Abnormal elongating and elongated spermatids enabled 8.3 and 27.3% fertilization rates respectively, but none achieved the blastocyst stage. Normal elongating and elongated spermatids elicited 30.5% fertilization and 42.9% of blastocyst rates. FISH analysis showed sex chromosome anomalies in all embryos, except in the case of morulae from normal late spermatids. CONCLUSIONS: Results suggest that meiosis and spermiogenesis can be resumed in vitro, with normal differentiated spermatids showing a low fertilization potential but regular rates of blastocyst formation. However, most of the embryos did not reach the morula stage and showed major sex chromosome abnormalities. 相似文献
14.
Human fertilization with round and elongated spermatids 总被引:2,自引:15,他引:2
Fishel S; Green S; Hunter A; Lisi F; Rinaldi L; Lisi R; McDermott H 《Human reproduction (Oxford, England)》1997,12(2):336-340
Human spermatids from ejaculate and testicular tissue have been utilized
for evaluating human fertilization by intracytoplasmic sperm injection
(ICSI) and, where possible, compared with spermatozoa utilizing sibling
oocytes. Round and elongated spermatids obtained from ejaculates were
either prepared through Percoll gradients or isolated and washed
individually using subzonal insemination needles (SUZI; 10- 14 microm
internal diameter). Seminiferous tubules obtained after biopsy were placed
into HEPES-buffered Earle's medium and dissected using 21-gauge needles.
Spermatogenic cells and spermatozoa were isolated and washed individually
using SUZI needles. Spermatozoa were subsequently injected into the ooplasm
using 5 microm (internal diameter) ICSI needles, whereas 8-9 microm
(internal diameter) needles were used for spermatid injection. Only
metaphase II oocytes (n = 207) were injected: 64 with round spermatids, 92
with elongated spermatids and 51 with spermatozoa; the fertilization rate
was 30, 24 and 67% respectively. There was a significant (P < 0.001)
increase in the fertilization rate using spermatozoa compared with
spermatids. The fertilization rate was not different between round and
elongated spermatids, although the fertilization rates for round and
elongated spermatids in the ejaculate were 33 and 18% respectively,
compared with 22 and 38% respectively when testicular spermatids were
utilized. In three patients sibling oocytes were used to compare round and
elongated spermatids found in the ejaculate with spermatozoa extracted from
seminiferous tubules. The fertilization rate was 24% for spermatids and 79%
for testicular spermatozoa. This result suggests that, should only
spermatids be available in the ejaculate, a testicular biopsy in the hope
of obtaining testicular spermatozoa would be worth while.
相似文献
15.
Successful pregnancy after spermatid injection 总被引:9,自引:7,他引:2
Bernabeu R; Cremades N; Takahashi K; Sousa M 《Human reproduction (Oxford, England)》1998,13(7):1898-1900
We present nine cases of spermatid intracytoplasmic injection for the
treatment of non-obstructive azoospermia. In eight cases, no elongated
spermatids or spermatozoa were found in previous spermiograms or testicular
biopsies. In these patients, treatment was performed using ejaculated (n =
6) and testicular (n = 2) retrieved round spermatids (Sa type). In cases
where ejaculated round spermatids were used, they were isolated on the day
before oocyte retrieval and left in culture for 24 h before
intracytoplasmic sperm injection (ICSI). No pregnancy was obtained in
either group, although culturing seemed to increase the fertilization rate.
In one other case, elongated spermatids were observed in the previous
spermiogram and thus a normal ICSI procedure was scheduled. However, on the
day of oocyte retrieval, no spermatids could be recovered from fresh
sequential ejaculates, and a testicular open biopsy was then performed.
Both round and elongated spermatids were found in the testicular tissue,
but only the more mature germinal cells (Sb2) were injected. From this
case, a normal pregnancy was obtained which resulted in the birth by
Caesarean section at 37 weeks of gestation of a normal healthy baby girl,
weighing 2700 g.
相似文献
16.
Seminal plasma nitrite/nitrate and intratesticular Doppler flow in fertile and infertile subjects 总被引:3,自引:0,他引:3
Battaglia C Giulini S Regnani G Di Girolamo R Paganelli S Facchinetti F Volpe A 《Human reproduction (Oxford, England)》2000,15(12):2554-2558
The objective of the present study was prospectively to evaluate the role of nitric oxide (NO) in modulating intratesticular blood flow and sperm function. A total of 56 males, undergoing assisted reproduction, were divided into three groups according to semen analysis: (i) normozoospermic (n = 16); (ii) oligozoospermic (n = 21); and (iii) azoospermic (n = 19). All the subjects were submitted to hormone analysis [luteinizing hormone, follicle stimulating hormone (FSH), growth hormone, testosterone, androstenedione, insulin], and to ultrasonographic (testicular volume) and Doppler (transmediastinal artery) evaluations. Plasma and seminal plasma nitrite/nitrate concentrations, and plasma insulin-like growth factor-I were assayed. All 56 patients completed the study. In normozoospermic patients, significantly greater testicular volume, lower transmediastinal resistances, and higher seminal plasma nitrite/nitrate concentrations were observed in comparison with both oligo- and azoospermic subjects. Testicular volume was inversely correlated with plasma FSH (r = -0.589; P = 0.005) and pulsatility index of transmediastinal artery (r = -0.402; P = 0.049). Furthermore, the seminal plasma nitrite/nitrate concentrations were inversely correlated with pulsatility index of transmediastinal artery (r = -0.511; P = 0.015). It was concluded that NO is involved in vascular modulation of testicular vessels and ultimately in sperm output. 相似文献
17.
Yamamoto Y Sofikitis N Mio Y Loutradis D Kaponis A Miyagawa I 《Human reproduction (Oxford, England)》2002,17(4):886-896
BACKGROUND: Klinefelter's syndrome is the most frequent chromosomal abnormality in infertile men. In this study, the chromosomes of round spermatids and spermatogonia/primary spermatocytes from men with non-mosaic Klinefelter's syndrome were examined, together with the Sertoli cell secretory function and sperm morphometry. METHODS: Twenty-four men with non-mosaic Klinefelter's syndrome and nine men with obstructive azoospermia underwent therapeutic testicular biopsy. When spermatozoa in the final filtrate were present, they were processed for sperm morphometry or ICSI. Sperm morphometry was evaluated by the maximal length and width of the sperm head, the length of the midpiece and the ratio of the acrosomal region to the total surface area of the head. When round spermatids were present, they were processed for fluorescent in-situ hybridization (FISH). FISH was also applied to fragments of seminiferous tubules. Sertoli cell secretory function was measured by the amount of androgen binding protein (ABP) secreted in vitro. RESULTS: More than 93% of the evaluated round spermatids were normal. The proportions of 24,XY and of 24,XX round spermatids to the total number were significantly larger in men with Klinefelter's syndrome than in obstructed azoospermic men. Men with Klinefelter's syndrome who had spermatozoa in their testicular tissue (n = 12) were positive for both 46,XY and 47,XXY spermatogonia in their seminiferous tubules. In contrast, men with Klinefelter's syndrome without spermatozoa in their testicular tissue (n = 12) were positive for 47,XXY spermatogonia but negative for 46,XY spermatogonia in their seminiferous tubules. ABP profiles were significantly smaller in men with Klinefelter's syndrome who were negative for spermatozoa compared with men who were positive. Four pregnancies were achieved and five healthy babies were born. CONCLUSIONS: This study suggests that few 46,XXY spermatogonia undergo meiosis with an XX pairing and a Y univalent type of pairing. Hyperhaploid round spermatids (24,XY and 24,XX) may be produced by meiosis of 47,XXY spermatogonia. Men with Klinefelter's syndrome who are negative for testicular spermatozoa have a greater degree of Sertoli cell secretory dysfunction compared with men with Klinefelter's syndrome who are positive for spermatozoa. There are several defects in sperm morphometry with functional significance in men with Klinefelter's syndrome. 相似文献
18.
Limiting testicular biopsy for intracytoplasmic sperm injection (ICSI) to
those with a high chance of having testicular spermatozoa has not been
possible because of the poor predictive value of current clinical and
laboratory methods. In order to predict testicular pathology and sperm
extraction, we characterised the semen of 28 men with azoospermia due to
gonadal failure in terms of the presence of spermatids using an
immunological method. The results were compared with the assessment of
testicular biopsies by histology and the extraction of spermatozoa into
culture medium. Washed cellular elements in the ejaculate were smeared on
microscope slides and fixed in 100% methanol, before incubation with
acrosome-specific monoclonal antibody (18.6), fluorescein
isothiocyanate-labelled anti-mouse goat IgG, and examination by
epifluorescent microscopy. Semen from men with oligozoospermia and
obstructive azoospermia served as positive and negative controls,
respectively. Twelve patients who had positive immunofluorescence (one or
more spermatids present) had spermatozoa retrieved from their testes (five
hypospermatogenesis, seven focal spermatogenesis), and 16 patients with
negative immunofluorescence (spermatids absent) had apparent Sertoli
cell-only syndrome (12) or maturation arrest histological pattern (four).
However, four patients with apparent Sertoli cell-only syndrome had
testicular spermatozoa present after extraction from the biopsy. Plasma
follicle stimulating hormone concentration and testicular volume did not
predict retrieval of seminal spermatids or testicular spermatozoa. We
conclude that the immunofluorescent localization of one or more spermatids
in the ejaculate can be used to predict the likelihood of obtaining
testicular spermatozoa for ICSI. However, in some patients with Sertoli
cell-only syndrome, spermatozoa could still be recovered in the absence of
apparent seminal spermatids.
相似文献
19.
The introduction of intracytoplasmic sperm injection (ICSI) has revolutionized treatment of male-factor infertility. Even with a single spermatozoon a pregnancy can be achieved. In cases of azoospermia due to obstruction or highly impaired spermatogenesis, spermatozoa can be retrieved directly from testicular tissue recovered by testicular biopsy followed by sperm extraction. The predictive value of histology from semi-thin sections of testicular biopsies was assessed in relation to testicular sperm extraction (TESE) results, using 1418 biopsy samples from 766 subfertile men which were evaluated simultaneously using a modified Johnsen score and an ordinal classification system for spermatozoa in TESE samples. In 655 men bilateral samples were available. Based on histological findings and TESE results, the quality of spermatogenesis in the right testes was significantly better than that in the left testes. There was a difference between the two sides in 35.7% of all patients for histology and 32.7% for TESE results. When best results from either testis were used for analysis, 76.9% of all men revealed spermatozoa in TESE preparations, although during histological evaluation of semi-thin sections only 64% of all men had shown mature spermatids. In a core group of 250 azoospermic men without anamnestic hints to obstruction and most likely to benefit from ICSI, TESE was successful in 62.8% men. Subdivision of this group dependent on follicle stimulating hormone (FSH) serum concentrations revealed that even in cases of increased FSH concentration, between 39.1 and 64.7% of men showed mature spermatids in their TESE samples. A subset of 70 azoospermic men from the main sample with symptoms and history suggestive of an obstruction and considered as positive controls showed a positive TESE result in all patients. The histology had failed to predict this in 2.9% of all cases. Nevertheless, in five men an early stage of testicular tumour (carcinoma in situ = CIS) was detected. Two of these males suffered from bilateral CIS. This reflects a prevalence of 0.7% testicular malignancy in the group of patients without a history of excurrent duct obstruction. The data demonstrate that a trial TESE with histology based on the semi-thin sectioning technique is a powerful diagnostic and therapeutic procedure, which justifies the invasive nature of sperm retrieval for ICSI. In addition, the results stress the importance of bilateral biopsies to gain optimal diagnostic and therapeutic results. 相似文献
20.
Bernardini L Gianaroli L Fortini D Conte N Magli C Cavani S Gaggero G Tindiglia C Ragni N Venturini PL 《Human reproduction (Oxford, England)》2000,15(10):2165-2172
The hypothesis that sperm aneuploidy and diploidy increase as a function of spermatogenesis impairment was addressed. Ejaculated semen samples from a series of men (n = 22) with very low total normal motile count (1 x 10(6)) was analysed in terms of sperm aneuploidy and diploidy by in-situ hybridization and compared with controls (n = 10). Germ cell aneuploidy was also analysed in an additional series of infertile patients presenting unexplained infertility (n = 3), congenital absence of the vas deferens (CAVD) (n = 6) and non-obstructive azoospermia (n = 3) undergoing IVF, microsurgical epididymal sperm aspiration (MESA)/ICSI and testicular sperm extraction (TESE)/ICSI cycles respectively. In-situ hybridization for chromosomes 1, 17, X and Y was performed on ejaculate, epididymal and testicular spermatozoa. Significantly higher sperm aneuploidy and diploidy rates where found (for the four chromosomes analysed) in spermatozoa from oligoasthenoteratozoospermia (OAT) over controls (18 versus 2.28% and 2.8 versus 0.13% respectively; P < 0.001). Testicular germ cells had even higher rates of sperm aneuploidy and diploidy. However, in this group it was difficult to determine whether the cells analysed were dysmorphic spermatozoa or spermatids. The data warrant further investigation on the cytogenetic abnormalities found in most germ cells identified in testicular tissue biopsies of azoospermic patients. 相似文献