Rectourethral fistula: a rare cause of infertility

Rectourethral fistulas are rare, and infertility due to rectal ejaculation is extremely rare. We report a case of congenital rectourethral fistula presenting as infertility due to rectal ejaculation.     

Trichomonas vaginalis as a rare cause of male factor infertility at a hospital in East Anatolia

Trichomonas vaginalis is known as an important cause of sexually transmitted infection in developing countries. The prevalence and spectrum of Trichomonasis in men are less characterised. We analysed the presence of T. vaginalis in 80 infertile men using wet mount microscopy, Giemsa staining, culture and PCR methods. We found 2.5% positivity for T. vaginalis using PCR method. Wet mount microscopy was ineffective. Giemsa staining and culture tests were positive only in one patient. Both of our PCR‐positive patients were symptomatic. Our findings suggest that T. vaginalis should be considered for the aetiology of male factor infertility, although it is rare in developed countries.     

Herniotomy as a cause of male infertility

The article deals with 8 cases of iatrogenic obstruction of the vas deferens after herniotomy for inguinal hernia, the consequence of which was sterility. Anastomosis of the vas deferens was formed in 6 patients by means of precision microsurgical manipulations; the spermatological indices improved markedly in 3 of them, which was evidence of restored passage of the semen. To avoid injury to the spermatic cord, the author recommends microsurgical techniques in treatment of the hernial sac in children with congenital inguinal hernia.     

Exogenous testosterone: a preventable cause of male infertility

Main problem

Testosterone replacement therapy inhibits spermatogenesis, representing a problem for hypogonadal men of reproductive age.

Methods

A literature review of PubMed from 1990-2013. Semen analysis and pregnancy outcomes, time to recovery of spermatogenesis, serum and intratesticular testosterone levels were examined.

Results

Exogenous testosterone suppresses intratesticular testosterone production, which is an absolute prerequisite for normal spermatogenesis. Therapies that protect the testis involve human chorionic gonadotropin (hCG) therapy or selective estrogen receptor modulators (SERMs), but may also include low dose hCG with exogenous testosterone. SERMs, such as clomiphene citrate, are effective for maintaining testosterone production and represent a well-tolerated, oral therapy. Routine use of aromatase inhibitors is not recommended based on a lack of long-term data.

Conclusions

Exogenous testosterone supplementation decreases sperm production. Studies of hormonal contraception indicate that most men have a return of normal sperm production within 1 year after discontinuation. Clomiphene citrate is a safe and effective therapy for men who desire to maintain future potential fertility. Although less frequently used in the general population, hCG therapy with or without testosterone supplementation represents an alternative treatment.     

Osteosarcoma invading adrenal gland: rare cause of adrenal mass

Adrenal gland metastasis from osteogenic sarcoma is extremely rare and is an atypical location for metastasis. Vascular hepatic exclusion techniques and the use of venovenous bypass with cardiac surgical techniques may be required to resect large adrenal masses that have invaded the inferior vena cava to achieve curative resection. The use of newer chemotherapeutic agents and aggressive surgical resection have prolonged the survival of patients with osteosarcoma.     

Evaluation of the immunological cause of male infertility

Summary. The presence of antisperm antibodies was considered as one of the main causes of maleinfertility. This study was conducted on 776 semen samples of the male partners of infertile couples in order to evaluate the immunological factor. The detection of antisperm antibodies was performed by means of the direct Mixed Antiglobulin Reaction (MAR) test. A positive test was found in 35 samples. Hence, the prevalence of immunological infertility in this study is 4.5% among the male partners of infertile couples. Further explorations were performed on men with positive results, in order to detect the presence of antibodies in the sera by means of the indirect MAR tests, and sperm immobilization tests for quantitating the cytotoxic activity of the antibodies. The indirect MAR tests showed that 97% of the antibodies were present in sera, whereas 51% of the samples were cytotoxic. Routine semen analysis indicated that around 60% of the semen samples with antisperm antibodies were good. Semen culture showed that positive results were detected in 40% of samples. Clinical evaluations revealed that the presence of antisperm antibodies may have been the cause of long-standing infertility, on average 5 years, and were not all primary. Evaluations of all clinical and laboratory findings indicated that unilateral testis obstruction and male accessory gland infection were the main pathologies found.     

Y-microdeletions: a review of the genetic basis for this common cause of male infertility

The human Y-chromosome contains genetic material responsible for normal testis development and spermatogenesis. The long arm (Yq) of the Y-chromosome has been found to be susceptible to self-recombination during spermatogenesis predisposing this area to deletions. The incidence of these deletions is estimated to be 1/4,000 in the general population but has been found to be much higher in infertile men. Currently, Y-microdeletions are the second most commonly identified genetic cause of male infertility after Klinefelter syndrome. This has led to testing for these deletions becoming standard practice in men with azoospermia and severe oligospermia. There are three commonly identified Y-microdeletions in infertile males, termed azoospermia factor (AZF) microdeletions AZFa, AZFb and AZFc. With increased understanding and investigation of this genetic basis for infertility a more comprehensive understanding of these deletions has evolved, with several other deletion subtypes being identified. Understanding the genetic basis and pathology behind these Y-microdeletions is essential for any clinician involved in reproductive medicine. In this review we discuss the genetic basis of Y-microdeletions, the various subtypes of deletions, and current technologies available for testing. Our understanding of this issue is evolving in many areas, and in this review we highlight future testing opportunities that may allow us to stratify men with Y-microdeletion associated infertility more accurately     

Congenital adrenal hyperplasia: a rare cause of renal failure and a successful renal transplantation

Congenital adrenal hyperplasia belongs to a group of autosomal recessive disorders affecting steroid biosynthesis; a rare disease with a prevalence of 1 case per 16,000 population. A 30-year-old phenotypically male patient had been diagnosed with 11-β hydroxylase deficiency at the age of 16; presenting with ambiguous genitalia, growth retardation, presence of menstrual cycles, severe hypertension, hypokalemia and renal dysfunction. He developed endstage renal disease due to hypertension and was treated with hemodialysis for 3 y. After careful evaluation, he was approved to undergo renal transplantation. The patient has now finished 6th month after transplantation and is currently under follow-up at our outpatient clinic, having no problems related to the transplant. While early treatment to prevent hypertension is mandatory in patients with congenital adrenal hyperplasia, once renal failure occurs, renal transplantation may the best choice of treatment. In this study, we describe the first report of a successful renal transplantation in an adrenal hyperplasia.     

不育症患者精子超微结构的研究——精子头尾分离

对２例久治无效的不育症患者精液进行了透射电子显微镜观察。常规精液检查显示活动精子少于５０％，极少有快速前进运动。透射电镜观察结果表明，９０％以上的精子在其颈部水平头部与尾部分离，相互分离的头与尾分别被完整的细胞膜包绕。结果提示，精子的头尾分离畸形可能是２例患者不育的主要病因。     

A rare cause of infertility: intratesticular varicocele associated with ipsilateral extratesticular varicocele

Intratesticular varicocele is an uncommon condition with variable sonographic appearence and identified as dilated intratesticular veins lying from the mediastinum through testicular parenchyma. We present a case of a 20‐year‐old male, married and unable to conceive for 2 years. Routine scrotal sonography disclosed extratesticular varicocele which was associated with ipsilateral intratesticular varicocele. Colour Doppler ultrasonography should be the first choice modality of imaging to confirm the diagnosis. Detection of intratesticular varicocele is essential because it is one of the most common recoverable reasons of male infertility.     

Congenital bladder diverticulum in a 28-year-old male: A rare cause of urinary retention

Congenital vesical diverticulum causing urinary retention in adults is very uncommon. Herein we describe the case of a 28-year-old male patient presenting with retention of urine due to a large diverticulum. The mechanism by which a diverticulum causes retention is discussed along with the features which distinguish a congenital from an acquired vesical diverticulum.     

Aligamentous testicle. New clinicopathologic entity in genesis of male infertility and its treatment by orchiopexy.

Absent scrotal ligament or the aligamentous testicle is a clinicopathologic entity which plays an important role in the genesis of male infertility. Twenty-four cases of aligamentous testicle, collected from 300 idiopathic infertile subjects, were studied. Clinical, endocrine, semen, and testicular biopsies were performed. The criteria of diagnosis of the aligamentous testicle are outlined and the role in infertility is discussed. Eighteen infertile patients with aligamentous testicle were treated by orchiopexy aiming to create an artificial scrotal ligament. The technique is described. The results were satisfactory. Failures were due to bad selection of patients.     

Renal aplastic dysplasia and ipsilateral ectopic ureter obstructing the seminal via: a possible cause of male infertility

Few cases of unilateral renal agenesis associated with ipsilateral seminal vesicle ectasia or cyst have been reported. Two cases of unilateral renal aplastic dysplasia and ipsilateral ectopic ureter opening in the ejaculatory ducts associated with infertility secondary to bilateral obstruction of the seminal via are reported. Clinical and physical assessment including transrectal ultrasound and magnetic resonance imaging are proposed as a comprehensive algorithm for the diagnostic evaluation of the pelvic cystic masses.     

Endometriosis: a rare cause of appendicitis

Endometriosis is a relatively common disorder affecting about 15% females in the reproductive age group. It is a wellknown cause of infertility but endometriosis presenting as appendicitis is rare. We present a case of a 29 years old nulliparous lady in whom appendectomy was done for appendicitis and histopathological examination of the retrieved specimen revealed endometriosis.     

XX-male in a case of male infertility

A 26-year-old man with the chief complaint of male infertility for 3 years was referred to our clinic. Physical examination of the patient revealed normal male habitus except for a small testis. His semen analysis showed no sperm. Levels of plasma LH and FSH were high compared with normal ones but that of plasma testosterone was within the normal range. Histological examination of his testis showed no spermatogenesis. Chromosome analysis with peripheral blood revealed 46, XX. H-Y antigen could be detected by in vitro cytotoxicity tests. By the above findings, the diagnosis of XX-male was made. Literature dealing with this disease is scanty. Only 18 cases of XX-male including our case were collected in Japan. The etiology and clinical features of this disease are discussed in the present report.     

Immunologic infertility in the male

Summary There is increased awareness of the role of immunologic factors in the production of male infertility. It is important to recognize and identify the immunoglobulin class and to attempt to demonstrate the mechanisms by which these immunoglobulins exert their effect on the human spermatozoan. There is most likely a spectrum of effects which are seen at various points in the reproductive tract. The use of high and low dose steroids for immunosuppression as well as sperm washing provide the best forms of therapy currently available, but a more universally effective form of therapy needs to be developed.