Examining male infertility

Problems of male infertility can seem like minor issues within the larger realm of urology. But many male infertility diagnoses can be successfully treated, allowing the couple to conceive naturally or with minimal medical assistance. Some patients presenting with male infertility can have more significant disease. Treatments for male infertility will continue to progress, and as an increasing number of couples seek infertility services, the need to provide basic information grows as well.     

Varicoceles and male infertility

Approximately 15 percent of the postpubertal male population develops varicoceles, and one-third of men seen in fertility clinics have this lesion. Semen samples commonly show diminished sperm counts, decreased motility and immature cellular morphology. Treatment is usually surgical, although percutaneous methods are now available. Early diagnosis and treatment may prevent the testicular insult.     

Laboratory diagnosis of male infertility

Male infertility is best tested by determining the ability of sperm to reach the site of fertilization by semen analysis and by mucus-sperm interaction tests, and by determining the ability of the sperm to enter the egg by the hamster egg-human sperm penetration assay. If conducted in a careful fashion, the tests provide useful information for preparing a treatment plan.     

Contemporary genetics-based diagnostics of male infertility

Introduction Thousands of genes are implicated in spermatogenesis, testicular development and endocrine regulation of testicular function. The genetic contribution to male infertility is therefore considerable, and basic and clinical research in the last years found a number of genes that could potentially be used in clinical practice. Research has also been pushed by new technologies for genetic analysis. However, genetic analyses currently recommended in standard clinical practice are still relatively few.

Areas covered We review the genetic causes of male infertility, distinguishing those already approved for routine clinical application from those that are still not supported by adequate clinical studies or those responsible for very rare cause of male infertility. Genetic causes of male infertility vary from chromosomal abnormalities to copy number variations (CNVs), to single-gene mutations.

Expert opinion Clinically, the most important aspect is related to the correct identification of subjects to be tested and the right application of genetic tests based on clear clinical data. A correct application of available genetic tests in the different forms of male infertility allows receiving a better and defined diagnosis, has an important role in clinical decision (treatment, prognosis), and allows appropriate genetic counseling especially in cases that should undergo assisted reproduction techniques.     

Role of ultrasound in the assessment of male infertility

The use of ultrasonography has become an important component in the evaluation and treatment of male reproductive tract disorders. From the use of color flow Doppler ultrasonography for the assessment of varicoceles to transrectal ultrasonography combined with seminal vesiculography for the evaluation of ejaculatory duct obstruction, ultrasonography has practical clinical applications. In this article, the authors review the indications and use of ultrasonography in the assessment and treatment of the infertile male. The recent advances in diagnostic transrectal ultrasonography for ejaculatory duct obstruction, in particular, are emphasized. © 1996 John Wiley & Sons, Inc.     

Individualized homeopathic therapy for male infertility

This prospective observational pilot study investigated the effect of individualized homeopathy on male infertility based on sperm count, hormone values and general health. Forty-five subfertile men were treated with single homeopathic remedies for an average of 10.3 months. The drugs were prescribed on the basis of the overall symptomatic situation. The variables 'sperm density', 'percentage of sperm with good progressive motility' and 'density of sperm with good propulsive motility' improved significantly, especially in cases of oligoasthenozoospermia. The general health of patients improved significantly. The following factors emerged as positive predictors of therapy success: alcohol consumption below 30 g/day, non-smoking, the presence of less than five dental amalgam fillings, no exposure to noxious substances at the workplace and no previous inflammatory genital diseases. The factors stress, age above 36, high coffee consumption and long duration of unwanted childlessness did not have a negative impact on therapy outcome in this study. The rate of improvement in sperm count through homeopathic therapy is comparable to the improvement achieved by conventional therapy, so that individualized-homeopathic treatment may be considered a useful alternative to conventional treatment of subfertile men. For further investigation, a randomised, therapy-controlled clinical study with parallel group design would be useful (homeopathic therapy vs conventional andrological therapy).     

Recent advances in the treatment of male infertility.

The treatment of male infertility has been advanced by developments in the assays used to assess sperm function, methodologies for sperm preparation and augmentation of motility and potential fertilizing ability, and the various assisted reproductive techniques. These have made it possible for fertilization to be achieved even when apparently severe seminal deficits are encountered and have contributed to our knowledge regarding prefertilization and postfertilization events.     

The Chinese experience of male infertility.

The purpose of this study was to describe the lived experiences of Chinese men who were diagnosed as infertile. Thirty men who had experienced infertility were interviewed in or near the clinic of a large general teaching hospital located in Taiwan. The interviews were analyzed using content analysis. Five categories were generated from the interview data: emotional response after hearing the diagnosis; seeking possible explanations for the diagnosis; using alternative treatments other than those of Western medicine; stressfrom the discovery of the infertility secret by family, relatives, and friends; and grief for discontinuation of the family heritage. Men in this study described infertility as a frustrating and stressful experience. Findings from this study can add to the knowledge base on infertility and contribute to recommendations for improving the ways that health professionals guide, counsel, and support men who are infertile.     

Ethanol-induced male infertility: impairment of spermatozoa

Ethanol is generally regarded as a reproductive toxin. However, the mechanism(s) of ethanol-induced infertility remain poorly understood. As male fertility depends upon the ability of spermatozoa to fertilize ova, it was the purpose of the present study to examine the effects of chronic ethanol treatment on several parameters related to sperm fertility. Male C57Bl/6J mice of proven fertility were administered liquid diets as follows: 5% (v/v) ethanol for either 1) 5 weeks; 2) 10 weeks; 3) 20 weeks; or 4) 6% (v/v) ethanol for 5 weeks. After each treatment, epididymal spermatozoa were evaluated with respect to quantity, motility, morphology and the ability to fertilize. A biphasic effect on sperm content was noted: 5- and 10-week treatments with 5% ethanol increased content by 80 and 65%, respectively, whereas 20-week treatment with 5% ethanol and 5-week treatment with 6% ethanol decreased content by 52 and 71%, respectively. Although the proportion of motile spermatozoa was unaffected by ethanol, average forward progression velocity was reduced, the effect being dependent on ethanol dose and duration of exposure. Similarly, the frequency of abnormal spermatozoa was increased; 20-week treatment with 5% ethanol and 5-week treatment with 6% ethanol increased the frequency of sperm morphological anomalies by 50 and 40%, respectively. Fertility of spermatozoa was reduced as a function of ethanol dose and duration of exposure. The ability of sperm to fertilize mouse ova in vitro was reduced by 34% (P less than .02) and 62% (P less than .001) subsequent to 20-week treatment with 5% ethanol and 5-week treatment with 6% ethanol, respectively. An animal model has been developed which describes ethanol-induced male infertility. The degree of reproductive impairment varies with the amount of ethanol ingested, and the duration of ethanol exposure. The continuum of effects should make possible the evaluation of putative mechanisms of male sterility resulting from chronic ethanol consumption.     

NRF2启动子甲基化与男性不育

目的探讨抗氧化基因NRF2启动子上游CpG岛内408⁹94 bp位置处的甲基化水平与男性不育之间的关系。方法酚氯仿法手提精子DNA,建立重亚硫酸盐修饰精子DNA后克隆测序法(即BSP-克隆测序法),选择正常男性及不育中少、弱、畸精症男性患者每份精液样本DNA的抗氧化基因NRF2的三个片段,每个片段选择15994 bp位置处的甲基化水平与男性不育之间的关系。方法酚氯仿法手提精子DNA,建立重亚硫酸盐修饰精子DNA后克隆测序法(即BSP-克隆测序法),选择正常男性及不育中少、弱、畸精症男性患者每份精液样本DNA的抗氧化基因NRF2的三个片段,每个片段选择15²0个正确的克隆结果并比较其甲基化水平。结果不育男性少、弱精组和正常精液组其抗氧化基因NRF2启动子上游40820个正确的克隆结果并比较其甲基化水平。结果不育男性少、弱精组和正常精液组其抗氧化基因NRF2启动子上游408⁹94 bp处99%甲基化位点均为非甲基化状态,正常男性精子DNA第7个甲基化位点缺失率(18.14%)明显比少弱精组(24.9%)缺失率低(P<0.05)。结论虽然正常生育男性及不育男性少、弱精患者抗氧化基因NRF2启动子上游408994 bp处99%甲基化位点均为非甲基化状态,正常男性精子DNA第7个甲基化位点缺失率(18.14%)明显比少弱精组(24.9%)缺失率低(P<0.05)。结论虽然正常生育男性及不育男性少、弱精患者抗氧化基因NRF2启动子上游408⁹94 bp区均呈现非甲基化状态但其第7个甲基化位点缺失可能与精子成熟障碍有关。     

慢性前列腺炎与男性不育症关系的超声研究

目的探讨经直肠超声在诊断和评估慢性前列腺炎所致男性不育症中的价值。方法采用经直肠超声方法对76例由慢性前列腺炎所致男性不育症患者和30例正常对照者的前列腺液、精液和前列腺动脉进行检测,同时观察慢性前列腺炎的二维声像图改变。结果 (1)76例慢性前列腺炎患者中,34例(44.7%)表现为畸形精子症,24例(31.6%)表现为无力型精子症,18例(23.7%)表现为少精子症;(2)慢性前列腺炎的二维声像图主要表现为回声均匀型、回声欠均匀型、增大低回声型及结节钙化型四种类型;(3)与正常对照组比较,慢性前列腺炎致男性不育患者的前列腺尿道动脉收缩期峰值血流速度(PSV)及阻力指数(RI)显著升高,差异有统计学意义(P<0.01)。慢性前列腺炎组的前列腺包膜动脉PSV、舒张末血流速度(EDV)、RI与正常对照组比较,差异无统计学意义(P>0.05)。结论经直肠超声检查为慢性前列腺炎所致男性不育症提供了一种新的、安全可靠的诊断工具,有助于其病因的筛查。