ICSI as an effective therapy for male factor with antisperm antibodies

This study was conducted to evaluate if in vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI) is an effective treatment for infertility complicated by the presence in the male partner of sperm autoantibodies. Over a 1-year study period comparisons of fertilization, pregnancy, and implantation rates were made in couples where the male partner was negative or weakly positive for sperm autoantibodies (<50%) (gr 1); autoantibodies were strongly positive (>80%) (gr 2); or autoantibodies were moderately positive (50-80%) (gr 3). Only patients having oocytes fertilized by ICSI were included. The fertilization, clinical pregnancy, implantation, and miscarriage rate for group 1 (n = 67) was 56, 43, 21, and 14%. Comparable values for group 2 (n = 20) were 55, 40, 23, and 25%, and for group 3 (n = 6) were 63, 33, 23, and 0%. IVF with ICSI demonstrates comparable fertilization, pregnancy, implantation, and miscarriage rates in female partners of males with and without sperm autoantibodies.     

非男性因素ICSI问题

自卵胞浆内单精子注射（ICSI）技术诞生以来,ICSI的应用从严重的男性不育扩展到非男性因素的不孕症,ICSI在辅助生殖技术中所占的比例逐年升高。在美国有50％的周期采用ICSI授精。对于非男性因素的ICSI指征问题学术界已讨论多年,但仍存在很大争议。本文从以下方面对非男性因素ICSI指征进行讨论。     

Laparoscopy for evaluation of cryptorchid testis.

Four male patients with a unilateral nonpalpable testis were considered for laparoscopy. Preoperative evaluation by computerized tomography and ultrasonography failed to demonstrate cryptorchid testis. Laparoscopy clearly identified the anatomy in all 4 cases. Two patients had an absent testis, 1 patient underwent orchiectomy for a dysmorphic testis, and 1 patients underwent orchiopexy for a testis located within the inguinal canal. Pediatric laparoscopy is an effective and safe adjunct in the management of cryptorchid testis.     

改良超长方案在卵巢低反应患者促排卵治疗中的应用

目的探讨卵巢低反应(POR)患者在体外受精-胚胎移植(IVF-ET)/卵胞浆内单精子注射(ICSI)助孕治疗过程中行改良超长方案和灵活拮抗剂方案对其妊娠结局的影响。方法回顾性分析2013年1月1日至2013年12月31日在本院生殖中心接受IVF/ICSI助孕治疗的515例POR患者的临床资料,根据促排卵方案不同分为改良超长方案组(A组,n=137)和拮抗剂方案组(B组,n=378)。比较两组患者卵巢刺激天数(Gn天数)、Gn用量、HCG日激素水平、子宫内膜情况、平均获卵率、优胚率、受精率、着床率、临床妊娠率、移植周期取消率、流产率及宫外孕发生率等。结果与拮抗剂方案组比较,改良超长方案组的Gn天数[(12.42±2.80)vs.(8.53±2.54)d]、Gn用量[(4 447.81±2 804.28)vs.(1 916.67±622.62)U]、HCG日子宫内膜厚度[(12.15±2.66)vs.(10.53±2.31)mm]、平均获卵数[(2.97±1.50)vs.(2.43±1.52)个]均显著增加(P均0.01),HCG日孕酮(P)水平[(0.46±0.27)vs.(0.56±0.26)nmol/L]、早发LH峰发生率(0vs.12.96%)、优胚率[(51.19±41.17)%vs.(63.72±38.74)%]、周期取消率(41.61%vs.53.17%)显著下降(P均0.05)。改良超长方案组的着床率(33.99%vs.15.15%)、临床妊娠率(48.75%vs.26.55%)显著高于拮抗剂方案组(P均0.01)。两组的流产率和宫外孕发生率比较无显著性差异(P0.05)。结论POR患者行促排卵治疗时,选择改良超长方案可能更有利于改善IVF/ICSI-ET结局,但药物使用成本相对较高。     

Cytogenic studies of cryptorchid testes.

Twenty-nine patients with unilateral or bilateral cryptochism underwent biopsies of the testis at the time of orchiopexy. Karyotype evaluation of fibroblasts obtained from tissue cultures of the biopsy specimen was completed counting a minimum of twenty-five cells. In 1 patient with multiple anomalies a 46,XYDq+ karyotype was identified. All other karyotypes were normal suggesting cryptorchism is not associated with abnormal testicular cytogenetics.     

A plea for a more physiological ICSI

Intracytoplasmic sperm injection (ICSI) can be considered the most 'revolutionary' in vitro insemination technique because it has efficiently allowed the treatment of male factor infertility. Although ICSI has been successfully and safely applied worldwide for almost 20 years, currently, we have no real knowledge regarding the hypothetical long-term side effects on ICSI adults, given the increased likelihood of spermatozoa with defective nuclear content fertilising the oocytes. The aim of this review article is to investigate the most recent advances of performing ICSI in the safest possible manner, thus, minimising the theoretical hazards of this procedure. To allow for substantiated recommendation which male gametes to choose for physiological ICSI an updated search was performed in Medline and Embase, from 1996 to June 2011. Recent technical advances allow operators to more or less simulate physiological conditions in the laboratory, reducing potential damage to the gametes. It seems possible to prevent fertilisation by DNA-damaged and chromosomal-unbalanced spermatozoa by selecting ICSI sperm by motility and/or maturation markers such as hyaluronic acid or other zona pellucida receptors. Furthermore, novel non-invasive imaging techniques can be valid tools for helping in the morphological selection of ICSI spermatozoa.     

精液常规参数与ICSI的指征

不孕不育与夫妇双方都有密切的关系,其中约50％与男方因素有关。近年来,辅助生殖技术（assisted reproductive technology,ART）的发展,特别是卵胞浆内单精子注射（ICSI）技术的出现及广泛应用,使一些以往无法治愈的男性不育患者获得了生育的机会,为男性不育的治疗开辟了新的途径。     

New era in sperm selection for ICSI

Spermatozoa contribute to approximately half of the genome of future progeny, and therefore, have a profound impact on embryo development post-fertilization. Sperm selection based on viability and normal morphology does not eliminate the chance for DNA damaged spermatozoa to be inseminated and may account for a considerable percentage of failed embryo development post-ICSI (Intra cytoplasmic sperm injection). Therefore, sperm selection based on functional sperm characteristics to preclude insemination of DNA damaged spermatozoa have paved the way for successful ICSI outcomes. In regard to this, different laboratories have introduced novel procedures to replace traditional or orthodox sperm selection methods. This review attempts to provide information on the scientific bases of each procedure, and pinpoint their advantages and disadvantages. In addition to data from our research, a systematic search on the literature, publications and presentations was carried out using such databases as PubMed and ISI-Web.     

Ultrastructure of Sertoli cells in cryptorchid goats

Sertoli cells of intra-abdominal testes from 25 naturally occurring, unilaterally cryptorchid, West African pygmy goats between the ages of 1-30 months were morphologically examined by light and transmission electron microscopy. Ultrastructurally, Sertoli cells in the intra-abdominal testes from 1-month-old goats were columnar and contained ovoid nuclei. The cytoplasm depicted clusters of rough endoplasmic reticulum cisternae (RER). In 3- to 4-month-old animals nucleolonemas of the Sertoli cells were associated with vesicles; the cytoplasm contained RER and areas of whorls of smooth endoplasmic reticulum. An abundance of lipid droplets was accompanied by lipofuscin granules in the cytoplasm. In 6- to 8-month-old goats RER cisternae presented circular or irregular profiles in the cells with an augmentation of cytoplasmic lipid droplets and lipofuscin granules. In 12- to 15-month-old animals intercellular spaces in the seminiferous epithelium exhibited focal expansions. Nuclear profiles of the Sertoli cells were irregular. In 24- to 30-month-old animals the Sertoli cells were in an advanced stage of degeneration.     

Long-term follow-up of fertility in cryptorchid patients

Sixty-four patients who had unilateral or bilateral orchiopexy for cryptorchism between 1950 and 1960 responded to a questionnaire. Marriage rates were the same as in a control group. Unilaterally cryptorchid patients had normal paternity rates and sperm concentrations on semen analysis. Only 2 of 15 bilaterally cryptorchid patients had fathered children, while severe oligospermia was present in all 10 who had semen analysis performed. Thirty per cent of pexed testes had a cosmetically poor result.     

Histopathological changes in adult cryptorchid testes

The histological specimens of 73 patients who presented with undescended testes after puberty were re-evaluated. None of the specimens revealed carcinoma in situ but in the specimens of 5 patients severe atypia was detected. None of the patients, including 5 with severe atypia, has shown any evidence of invasive testicular tumour during follow-up.     

时差监测培养系统在人未成熟卵母细胞体外成熟及其授精时机中的应用

目的观察时差监测培养系统在人未成熟卵母细胞体外成熟(IVM)中的应用,并探讨核成熟后最佳的授精时机。方法收集我生殖中心促排卵周期中捐赠用于科研的240枚GV期卵母细胞,应用时差监测培养系统联合IVM技术,观察卵母细胞核成熟的动力学参数,包括GV破裂时间、第一极体排出时间、MI持续和MⅡ静止的时间段。经过培养,对其中160枚卵母细胞根据第一极体排出后不同ICSI授精时间分为3组:3h组、3~6h组和6h组,比较各组的受精情况及胚胎发育情况。结果 240枚GV期卵母细胞体外成熟率为73.3%,平均GV破裂时间为实施IVM后的(7.0±0.3)h,MI持续平均时间为(14.9±0.2)h,第一极体排出平均时间为(22.7±0.5)h。不同授精时间3组的正常受精率、卵裂率和可利用胚胎率比较均无显著性差异(P0.05)。结论时差监测培养系统为未成熟卵母细胞IVM培养系统优化提供了新思路;第一极体排出后的3~6h实时ICSI可用胚胎率有增高的趋势,但其具体影响及最佳授精时间仍有待进一步研究探讨。     

Structural and ultrastructural modifications of cryptorchid human testes

Structural and ultrastructural modifications have been studied in cryptorchid testes. Biopsies were obtained from 15 patients between 2 and 39 years old, including 7 who had been treated previously by hormonal therapy without success. The most considerable observations were 1) the precocity of damage in germinal epithelium and in peritubular connective tissue, 2) the presence of frequent bilateral damage in cases of unilateral cryptorchidism and 3) the inefficacy of hormonal treatment (human chorionic gonadotropin) on the delay in maturation of tubular epithelium. These findings offer further information about the optimal time for surgical treatment of cryptorchidism, which in our opinion should be done when the patient is less than 2 years old.