Serum Sperm Antibodies in Cases of Azoospermia: Comparative Diagnostic Value of Separate and Combined, Agglutination, Immobilization and Cytotoxic Serological Tests

To study the diagnostic value of various serological tests in the detection of serum sperm antibodies a group of 50 patients with azoospermia was studied. Cases were divided by testicular biopsy into: 32 obstructive and 16 non obstructive cases. Tests applied included a microagglutination and a macroagglutination test as well as 2 complement dependent tests; a sperm cytotoxic and a sperm immobilization tests. Applied separately the macroagglutination was the most sensitive test but used together, more cases were detected. Because of this and the different value and significance of each test, it is advisable to use more than one test in the investigations of cases of male infertility.     

睾丸组织Johnsen评分对非梗阻性无精子症患者取精成功率的预测

目的探讨睾丸组织病理学Johnsen评分是否可以作为非梗阻性无精子症患者取精成功的预测因素.方法选取2008年6月至2011年6月来院就诊的非梗阻性无精子症患者513例.所有患者均行详细的病史采集、体格检查、实验室检查、睾丸活检及活检组织病理学检查等.患者随访1~3年,其主要包括患者是否进一步行睾丸取精术以及取精的结果.结果总计有399例患者接受了活检同侧的睾丸取精术,其中睾丸穿刺取精成功112例,而穿刺取精失败的患者通过进一步接受睾丸显微取精术,成功取精44例.通过分析睾丸取精成功的预测因素后发现,当Johnsen评分≥7时,非梗阻性无精子症患者睾丸取精的成功率将显著提升.结论睾丸组织病理学Johnsen评分≥7可能是睾丸取精成功的预测因素.     

先天性输精管缺如的临床特点与诊疗策略

目的:探讨先天性输精管缺如(CAVD)的临床特点,提高其诊断和治疗水平。方法:分析81例CAVD患者的临床诊治资料,总结其临床特点、诊断和治疗方法。结果:79例因不育就诊,从有生育要求到确诊平均经过4.8年;2例术中探查发现。先天性双侧输精管缺如(CBAVD)40例,先天性单侧输精管缺如(CUAVD)25例,节段性输精管缺如16例。74例患者的配偶接受辅助生殖治疗,其中12例接受卵细胞胞质内单精子注射(ICSI)治疗,4例成功妊娠。结论:CAVD患者多以不育就诊。CBAVD均表现为梗阻性无精子症;CUAVD和节段性缺如者可表现为少精子症、弱精子症或梗阻性无精子症。本病诊断多无困难,但常因体检不仔细而漏诊。CAVD治疗的原则主要是恢复患者的生育能力,可借助辅助生殖技术(ART)进行治疗。     

Assessment of seminal plasma laminin in fertile and infertile men

Aim： To assess laminin levels in the seminal plasma of infertile and fertile men, and to analyze the correlation of laminin levels with sperm count, age, sperm motility and semen volume. Methods： One hundred and twenty-five recruited men were equally divided into five groups according to their sperm concentration and clinical examination： fertile normozoospermia, oligoasthenozoospermia, non-obstructive azoospermia （NOA）, obstructive azoospermia （OA） and congenital bilateral absent vas deferens （CBAVD）. The patients＇ medical history was investigated and patients underwent clinical examination, conventional semen analysis and estimation of seminal plasma laminin by radioimmunoassay. Results： Seminal plasma laminin levels of successive groups were： 2.82 ± 0.62, 2.49 ± 0.44, 1.77 ± 0.56, 1.72 ± 0.76, 1.35 ± 0.63 U/mL, respectively. The fertile normozoospermic group showed the highest concentration compared to all infertile groups with significant differences compared to azoospermic groups （P 〈 0.05）. Testicular contribution was estimated to be approximately one-third of the seminal laminin. Seminal plasma laminin demonstrated significant correlation with sperm concentration （r = 0.460, P 〈 0.001） and nonsignificant correlation with age （r = 0.021, P = 0.940）, sperm motility percentage （r = 0.142, P = 0.615） and semen volume （r = 0.035, P = 0.087）. Conelusion： Seminal plasma laminin is derived mostly from prostatic and testicular portions and minimally from the seminal vesicle and vas deferens. Estimating seminal laminin alone is not conclusive in diagnosing different cases of male infertility.     

不育男性精浆总抗氧化能力与精子运动功能的关系

目的:研究不育男性精浆总抗氧化能力(TAC)与精子运动能力和方式之间的关系,探讨精浆TAC水平在男性生育中的临床意义。方法:113例精子密度正常的不育男性,28例正常生育男性作为对照组。精液于37℃液化后采用计算机辅助精液分析(CASA)系统进行精液常规分析,采用比色法进行精浆TAC分析。结果:正常生育组精浆TAC为(19.82±6.33)U,不育男性精子密度正常组精浆TAC为(14.37±8.45)U,不育男性精子密度正常组与正常生育组比较存在显著性差异(P<0.01)。精浆TAC与a级精子百分率(r=0.208,P<0.05)和(a+b)级精子百分率(r=0.231,P<0.05)呈显著正相关,精浆TAC与精子运动参数中的前向性(r=0.200,P<0.05)、直线性(r=0.208,P<0.05)、曲线速度(r=0.189,P<0.05)、直线速度(r=0.210,P<0.05)、平均移动速度(r=0.215,P<0.05)及鞭打频率(r=-0.248,P<0.01)之间有显著的相关性,其中前向性、直线性、直线速度、曲线速度、平均移动速度与TAC呈正相关(P<0.05),而鞭打频率与TAC呈负相关(P<0.01)。精浆TAC与摆动性、侧摆幅度、平均移动角度之间无显著相关。结论:精浆中TAC水平与精子运动能力和运动方式密切相关,适宜的精浆TAC为精子运动提供了良好的外部环境,精浆中过低的TAC水平与精子运动能力下降和运动方式改变有关,可能是引起男性不育的病因之一。精浆中TAC分析可为探讨男性不育的发病机制以及临床用药提供依据。     

Beta-endorphin in serum and seminal plasma in infertile men

Aim:To access beta-endorphin levels in serum as well as seminal plasma in different infertile male groups.Methods:Beta-endorphin was estimated in the serum and seminal plasma by enzyme-linked immunosorbent assay(ELISA)method in 80 infertile men equally divided into four groups:non-obstructive azoospermia(NOA),obstructive azoosper-mia(OA),congenital bilateral absent vas deferens(CBVAD)and asthenozoospermia.The results were compared tothose of 20 normozoospermic proven fertile men.Results:There was a decrease in the mean levels of beta-endorphin in the seminal plasma of all successive infertile groups(mean±SD:NOA 51.30±27.37,OA 51.88±9.47,CBAVD 20.36±13.39,asthenozoospermia 49.26±12.49 pg/mL,respectively)compared to the normozoospermicfertile control(87.23±29.55 pg/mL).This relation was not present in mean serum level of beta-endorphin betweenfour infertile groups(51.09±14.71,49.76±12.4,33.96±7.2,69.1±16.57 pg/mL,respectively)and the fertilecontrol group(49.26±31.32 pg/mL).The CBVAD group showed the lowest seminal plasma mean level of beta-endorphin.Testicular contribution of seminal beta-endorphin was estimated to be approximately 40%.Seminal beta-endorphin showed significant correlation with the sperm concentration(r=0.699,P=0.0188)and nonsignificantcorrelation with its serum level(r=0.375,P=0.185)or with the sperm motility percentage(r=0.470,P=0.899).Conclusion:The estimation of beta-endorphin alone is not conclusive to evaluate male reproduction as there aremany other opiates acting at the hypothalamic pituitary gonadal axis.(Asian J Androl 2006 Nov;8:709-712)     

Seminal fibronectin in fertile and infertile males

This study aimed to assess seminal plasma fibronectin in fertile and infertile males. Ninety infertile males were investigated; asthenozoospermia (n = 27), asthenoteratozoospermia (n = 30), oligoasthenoteratozoospermia (n = 33) compared with 20 healthy fertile controls. They were subjected to semen analysis, seminal plasma fibronectin estimation by radial immune diffusion, serum testosterone (T) and follicle stimulating hormone (FSH) estimation by ELISA. There was significant increase of seminal plasma fibronectin among different infertile groups compared with the controls. Significant negative correlation was elicited between seminal fibronectin and sperm count, sperm motility grades A, B, A + B, sperm velocity, linear velocity, linearity index, sperm normal forms and serum T. Seminal fibronectin showed significant positive correlation with grade D sperm motility and serum FSH. ROC curve analysis discriminating controls and other infertile groups demonstrated criteria value of < 674 mg l(-1) (sensitivity 100% and specificity 96.4%). It is concluded that increased seminal fibronectin is associated with decreased sperm count and sperm motility.     

Uniform testicular maturation arrest: a unique subset of men with nonobstructive azoospermia

PURPOSE: We evaluated the clinical characteristics of men with uniform testicular maturation arrest and nonobstructive azoospermia or severe oligospermia, including the frequency of genetic defects and outcome of intracytoplasmic sperm injection with or without testicular sperm extraction. MATERIALS AND METHODS: We identified a group of 32 men with nonobstructive azoospermia or severe oligospermia, uniform maturation arrest (single spermatogenic pattern on biopsy), and normal follicle-stimulating hormone (7.6 IU/l or less). These patients were identified from 150 intracytoplasmic sperm injection candidates with severe oligospermia (less than 10,000/cc) and 600 men with nonobstructive azoospermia undergoing attempted testicular sperm extraction-intracytoplasmic sperm injection between November 1995 and September 2006. These patients were characterized based on the frequency of genetic anomalies (karyotype or Y chromosome microdeletions). Rates of sperm retrieval by testicular sperm extraction, fertilization and pregnancy after ICSI were measured. RESULTS: Genetic anomalies were more common (45%) in men with uniform maturation arrest and normal follicle-stimulating hormone than other men with nonobstructive azoospermia (17%) undergoing testicular sperm extraction at our center (p <0.001). They had a lower sperm retrieval rate with testicular sperm extraction compared to other nonobstructive azoospermia patients (41% vs 60%, p = 0.05). Fertilization rate (37%) and clinical pregnancy (13%) were significantly less common than in other men with nonobstructive azoospermia (54% and 49%, respectively, p <0.01). CONCLUSIONS: Patients with uniform maturation arrest and normal follicle-stimulating hormone are a clinically definable subgroup of men with nonobstructive azoospermia that have different treatment outcomes. They have a higher incidence of chromosomal abnormalities and Y chromosome microdeletions compared to other men with nonobstructive azoospermia. Despite having normal follicle-stimulating hormone and typically normal testicular volume, sperm retrieval may be difficult and the chance of successful pregnancy is limited.     

Histology and sperm retrieval among men with Y chromosome microdeletions

In this review of Y chromosome microdeletions, azoospermia factor (AZF) deletion subtypes, histological features and microTESE sperm retrieval rates are summarized after a systematic literature review. PubMed was searched and papers were identified using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Approximately half of infertile couples have a male factor contributing to their infertility. One of the most common genetic etiologies are Y chromosome microdeletions. Men with Y chromosome microdeletions may have rare sperm available in the ejaculate or undergo surgical sperm retrieval and subsequent intracytoplasmic sperm injection to produce offspring. Azoospermia or severe oligozoospermia are the most common semen analysis findings found in men with Y chromosome microdeletions, associated with impaired spermatogenesis. Men with complete deletions of azoospermia factor a, b, or a combination of any loci have severely impaired spermatogenesis and are nearly always azoospermic with no sperm retrievable from the testis. Deletions of the azoospermia factor c or d often have sperm production and the highest likelihood of a successful sperm retrieval. In men with AZFc deletions, histologically, 46% of men demonstrate Sertoli cell only syndrome on biopsy, whereas 38.2% have maturation arrest and 15.7% have hypospermatogenesis. The microTESE sperm retrieval rates in AZFc-deleted men range from 13-100% based on the 32 studies analyzed, with a mean sperm retrieval rate of 47%.     

Can inhibin-B predict the outcome of microsurgical epididymal sperm aspiration in patients with suspected primary obstructive azoospermia？

Aim： To evaluate whether inhibin-B can predict the outcome of a microsurgical epidymal sperm aspiration （MESA） procedure in patients with suspected primary obstructive azoospermia （OA） and if inhibin-B can replace testicular biopsy in the diagnostic work-up of these patients. Methods： Inhibin-B levels and testicular biopsy scores were related to the outcome of MESA in 43 patients with suspected primary OA. MESA was considered to be successful when epididymal sperm could be identified during the procedure. Results： Spermatozoa were present in the epididymal aspirate in 28 out of the 43 patients （65%）. lnhibin-B values were not significantly different in patients with successful or unsuccessful MESA. The modified Johnsen score, however, was significantly lower in patients with unsuccessful MESA （P = 0.003）. A rete testis obstruction or epididymal malfunctioning was found in 15% of patients with suspected primary OA, reflected by unsuccessful MESA despite normal inhibin-B levels and normal testicular histology. Conclusion： Inhibin-B cannot replace testicular biopsy as a diagnostic tool in the work-up of patients with suspected primary OA. Testicular biopsy is useful in identifying patients with spermatogenic arrest, who might have normal inhibin-B values.     

Prostatitis and Male Infertility: A Pilot Study. Possible Increase in Sperm Motility with Antibacterial Chemotherapy

The cytology and bacteriology of urethral urine specimens and expressed prostatic secretions were examined in 24 infertile men suspected of having chronic prostatitis. Lencocytes were found and commensal bacteria cultured from most subjects but these were unrelated to clinical features, seminal characteristics or the outcome of treatment. Infection with pathogenic bacteria was not found in any subject. Despite this, there was a significant increase in sperm motility after antibacterial treatment, principally with erythromycin or cotrimoxazole, and three pregnancies coincided with the improvement.
It is concluded that antibacterial therapy may improve fertility in patients with low sperm motility, but more investigation is necessary before the role of genital tract infection in male infertility can be placed in its proper perspective.     

Clinical management of infertile men with nonobstructive azoospermia

The clinical management of men with nonobstructive azoospermia (NOA) seeking fertility has been a challenge for andrologists, urologists, and reproductive medicine specialists alike. This review presents a personal perspective on the clinical management of NOA, including the lessons learned over 15 years dealing with this male infertility condition. A five-consecutive-step algorithm is proposed to manage such patients. First, a differential diagnosis of azoospermia is made to confirm/establish that NOA is due to spermatogenic failure. Second, genetic testing is carried out not only to detect the males in whom NOA is caused by microdeletions of the long arm of the Y chromosome, but also to counsel the affected patients about their chances of having success in sperm retrieval. Third, it is determined whether any intervention prior to a surgical retrieval attempt may be used to increase sperm production. Fourth, the most effective and efficient retrieval method is selected to search for testicular sperm. Lastly, state-of-art laboratory techniques are applied in the handling of retrieved gametes and cultivating the embryos resulting from sperm injections. A coordinated multidisciplinary effort is key to offer the best possible chance of achieving a biological offspring to males with NOA.     

Outcome of varicocele repair in men with nonobstructive azoospermia: systematic review and meta-analysis

The objective of this systemic review was to evaluate the benefit of repairing clinical varicocele in infertile men with nonobstructive azoospermia (NOA). The surgically obtained sperm retrieval rate (SRR) and pregnancy rates following assisted reproductive technology (ART) with the use of retrieved testicular sperm were the primary outcomes. The secondary outcomes included the presence of viable sperm in postoperative ejaculate to avoid the testicular sperm retrieval and pregnancy rates (both assisted and unassisted) using postoperative ejaculated sperm. An electronic search to collect the data was performed using the MEDLINE and EMBASE databases until April 2015. Eighteen studies were included in this systematic review and accounted for 468 patients who were diagnosed with NOA and varicocele. These patients were subjected to either surgical varicocele repair or percutaneous embolization. Three controlled studies evaluating sperm retrieval outcomes indicated that in patients who underwent varicocelectomy, SRR increased compared to those without varicocele repair (OR: 2.65; 95% CI: 1.69–4.14; P < 0.001). Although pregnancy rates with the use of testicular sperm favored the varicocelectomy group, results were not statistically significant (clinical pregnancy rate OR: 2.07; 95% CI: 0.92–4.65; P = 0.08; live birth rate OR: 2.19; 95% CI: 0.99–4.83; P = 0.05). The remaining fifteen studies reported postoperative semen analysis results. In 43.9% of the patients (range: 20.8%–55.0%), sperm were found in postoperative ejaculates. Pregnancy rates for unassisted and assisted (after IVF/ICSI) were 13.6% and 18.9% in the group of men with sperm in postoperative ejaculates, respectively. Our findings indicate that varicocelectomy in patients with NOA and clinical varicocele is associated with improved SRR. In addition, approximately 44% of the treated men will have enough sperm in the ejaculate to avoid sperm retrieval. Limited data on pregnancy outcomes with both postoperative ejaculated sperm and harvested testicular sperm preclude any firm conclusion with regard to the possible increased fertility potential in treated individuals. In conclusion, the results of our study indicate that infertile men with NOA and clinical varicocele benefit from varicocelectomy. Given the low/moderate quality of evidence available, it is advisable that doctors discuss with their patients with NOA the risks and benefits of varicocele repair.     

精浆转铁蛋白含量与不育的关系

为探讨精浆转铁蛋白 (Tf)含量与男性生育力的关系 ,采用速率散射比浊法 ,对 2 0例正常生育男性和 96例不育男性精浆Tf含量进行了测定 ,同时做精子密度、精子活动率及精子顶体完整率 (PIA)分析。结果表明少精子组 (精子密度 <2 0× 10 6/ml)精浆Tf含量较生育组与正常密度组 (精子密度≥ 2 0× 10 6/ml)显著低 (P <0 .0 1) ;精浆Tf含量与精子活动率无关 ;正常精子密度的不育患者精子PIA <80 %组精浆Tf的含量显著低于PIA≥ 80 %组(P <0 .0 1)。提示精浆Tf含量的下降与男性生育力有关     

Frequency of Y chromosome microdeletions and chromosomal abnormalities in infertile Thai men with oligozoospermia and azoospermia

Aim： To investigate the possible causes of oligozoospermia and azoospermia in infertile Thai men, and to find the frequencies of Y chromosome microdeletions and cytogenetic abnormalities in this group. Methods： From June 2003 to November 2005, 50 azoospermic and 80 oligozoospermic men were enrolled in the study. A detailed history was taken for each man, followed by general and genital examinations. Y chromosome microdeletions were detected by multiplex polymerase chain reaction （PCR） using 11 gene-specific primers that covered all three regions of the azoospermic factor （AZFa, AZFb and AZFc）. Fifty men with normal semen analysis were also studied. Karyotyping was done with the standard G- and Q-banding. Serum concentrations of follicle stimulating hormone （FSH）, luteinizing hormone （LH）, prolactin （PRL） and testosterone were measured by electrochemiluminescence immunoassays （ECLIA）. Results： Azoospermia and oligozoospermia could be explained by previous orchitis in 22.3%, former bilateral cryptorchidism in 19.2%, abnormal karyotypes in 4.6% and Y chromosome microdeletions in 3.8% of the subjects. The most frequent deletions were in the AZFc region （50%）, followed by AZFb （33%） and AZFbc （17%）. No significant difference was detected in hormonal profiles of infertile men, with or without microdeletions. Conclusion： The frequencies of Y chromosome microdeletions and cytogenetic abnormalities in oligozoospermic and azoospermic Thai men are comparable with similarly infertile men from other Asian and Western countries.     

Probability to retrieve testicular spermatozoa in azoospermic patients

Aim: The degree of probability to retrieve spermatozoa from testicular tissue for intracytoplasmic sperm injection intooocytes is of interest for counselling of infertility patients. We investigated the relation of sperm retrieval to clinical dataand histological pattern in testicular biopsies from azoospermic patients. Methods: In 264 testicular biopsies from142 azoospermic patients, the testicular tissue was shredded to separate the spermatozoa, histological semi-thin sec-tions of which were then evaluated using Johnsen score. Results: The retrieval of spermatozoa correlated signifi-cantly (P < 0.001) with the testicular volume (r = 0.49), the FSH concentration ( r = -0.66), the maximum score(r = 0.85) and the mean Johnsen score (r = 0.81). In the multivariate regression analysis the successful testicularsperm extraction showed the closest relationship to the maximum score. The testicular volume correlated significantlywith the mean Johnsen score ( r = 0.64, P < 0. 001), and the basal serum FSH concen