ICSI outcomes in men undergoing TESE for azoospermia and impact of maternal age

This retrospective study compared clinical outcomes in men with obstructive and nonobstructive azoospermia after ICSI following testicular sperm extraction and the influence of maternal age. Fertilisation rates, embryo quality, pregnancy rates, miscarriage rates and live birth rates were evaluated. Men with obstructive azoospermia (OA) had significantly higher rates of diploid fertilisation and clinical pregnancy than men with nonobstructive azoospermia (NOA), but miscarriage rates and live birth rates were not significantly different. The higher rates of fertilisation, embryo quality and clinical pregnancy in men with OA were statistically significant when their female partners were <35 years but results were similar in both groups when female partners ≥35 years. Although the OA group had better overall quality embryos than the NOA group when maternal age was <35 years, embryologists can select the morphologically better embryos for transfer, eliminating the effect of embryo quality differences present in these two groups. Understanding more about factors that affect TESE/ICSI outcomes will not only help us predict patients' outcomes but it can help us educate and better counsel our patients.     

服棉酚者和其他原因所致的无精症患者血中促性腺激素与甾体激素的变化

本文比较了正常男子(Ⅰ组)、各种无精症患者(包括棉酚服用者。Ⅱ组)、原因不明的无精症者(Ⅲ组)以及Klinefelter 综合征患者(Ⅳ)血浆中FSH、LH、PRL、T、E_2和F 的变化。结果所有无精症患者的平均FSH、LH 水平明显高于Ⅰ组(P<0.001),但PRL、T、E_2及F 的平均值与Ⅰ组无区别(P>0.05)Ⅱ、Ⅲ组患者FSH 水平升高者与正常者各为50%,其余各组明显高于正常。Ⅲ组的LH 及T/LH 比值仍在正常范围内,但T、E_2及F 的平均值升高,PRL 降低;其余各组LH 与FSH 平行升高,T 及T/LH比值明显低于Ⅰ组(P<0.001),但E_2、F 及PRL 则在正常范围内。本实验证实,避孕剂量的棉酚并不损害睾丸合成T 的功能。FSH 过高说明生精上皮损害过度。本文还提出了一些控制棉酚用量的客观指标。     

THE FIRST SUCCESSFUL PREGNANCY FOLLOWING INJECTION OF TESTICULAR ROUND SPERMATID IN IRAN

The authors report the healthy delivery of the first successful round spermatid injection in Iran. The male was a 40-year-old with nonobstructive azoospermia whose previous testicular biopsy revealed only round spermatids. The wife was a 29-year-old healthy woman.     

Reversible azoospermia in a patient treated with triazolam

This is a report of a 26-year-old schizophrenic man treated with triazolam, levomepromazine, trifluoperazine and biperiden, who showed complete absence of spermatozoa in seminal analysis with normal plasma hormone levels. Sperm count reached 151 ± 10⁶/ml after 6 months of triazolam withdrawal. A reversible effect of triazolam is suggested at the level of the germinal cells which are differentiating, without affecting the stem cells.     

五子衍宗丸和金匮肾气丸对动物生精功能影响的比较研究

目的：研究五子衍宗和金匮肾气两种经典补肾中药的作用机理。方法：利用白消安小鼠无精子症动物模型，给予两种中药单一和联合灌胃给药78天（2个生精周期），以造模后自然恢复、二甲基亚砜溶媒和正常动物为3种对照。结果：两种中药对睾丸生精能力影响的明显不同表现为，五子衍宗主要作用于睾丸的生精上皮细胞，金匮肾气主要作用于睾丸的间质细胞。结论：两种经典补肾中药均具有较强的、明确的促进生精功能恢复的作用。     

Utility of micro-TESE in the most severe cases of non-obstructive azoospermia

The use of intracytoplasmic sperm injection (ICSI) has been a major breakthrough in the treatment of male infertility. Even patients with non-obstructive azoospermia (NOA) may benefit from the ICSI technique to father a child as long as spermatogenesis is present. There are several techniques to recover testicular sperm in patients with NOA. However, retrieval of spermatozoa is unfortunately still only successful in a subset of patients with NOA, and the most superior sperm retrieval method is still under debate. A more recent technique, microdissection testicular sperm extraction (MD-TESE) with an operative microscope collecting larger and more opaque seminiferous tubules, is a non-blind sperm retrieval technique with theoretical benefits. The MD-TESE procedure seems to be feasible, effective, and safe in NOA patients but also more technically demanding and time-consuming compared with conventional blind techniques. In the present report, we describe our clinical experience and results from our first 159 MD-TESE procedures. The probability to retrieve sperm with the MD-TESE technique is high in NOA cases where earlier sperm retrieval with blind methods such as needle aspiration, percutaneous needle biopsy, or conventional TESE has failed.     

先天性双侧输精管缺如伴生精功能障碍一例

先天性双侧输精管缺如（congenital bilateral absence of vas deferens,CBAVD）是梗阻性无精子症的常见原因之一,睾丸生精功能一般正常,除了常见的囊性纤维化穿膜传导调节蛋白（cystic fibrosis transmembrane conductance regulator,CFTR）基因突变外,黏附G蛋白耦联受体G2（adhesion G protein-coupled receptor G2,ADGRG2）基因突变以及拷贝数变异也被认为是CBAVD的发病机制。本文报告1例CBAVD伴生精功能障碍的病例,睾丸组织病理学提示唯支持细胞综合征。全外显子组测序未发现该患者CFTR、ADGRG2以及无精子症相关基因存在致病变异,拷贝数变异分析也未发现有意义的拷贝数变异。该病例的确切遗传学病因尚未可知。CBAVD与生精功能障碍并存的临床现象,提示无精子症遗传病因的复杂性。     

FROM ZERO TO ONE HUNDRED MILLION IN SIX MONTHS: THE TREATMENT OF AZOOSPERMIA IN CONGENITAL ADRENAL HYPERPLASIA

In the majority of the 25% of couples in which a male factor is responsible for their infertility, no identifiable pathology is found. It is unusual to be faced with an etiology that is readily amenable to successful treatment without the eventual dependence on assisted reproductive techniques for pregnancy. The diagnosis of congenital adrenal hyperplasia has variable implications on fertility. A case is presented of azoospermia in a man diagnosed with classical non-salt-losing congenital adrenal hyperplasia. Within 9 months of treatment with dexamethasone, his sperm count had risen to above 100 million per milliliter, enough to overcome very poor morphology and a naturally conceived pregnancy ensued. The pregnancy is ongoing. Although an increase in sperm count has been shown in such cases, the degree of improvement in semen parameters is unique, especially in an azoospermic patient.     

Azoospermia factor microdeletions: occurrence in infertile men with azoospermia and severe oligozoospermia from China

Azoospermia factor (AZF) microdeletions are the most frequent genetic cause of male infertility after Klinefelter's syndrome. Although some assisted reproductive techniques such as intracytoplasmic sperm injection (ICSI) have been successfully introduced to clinical treatment for infertile males, the AZF microdeletions might be transmitted from infertile fathers to their male offspring during these procedures. Thus, it is important to carefully evaluate AZF microdeletions in infertile males before assisted reproductive techniques are performed. In this article, we aimed to investigate the frequencies of AZF microdeletions in 137 infertile males with azoospermia and severe oligozoospermia from Jilin province of China and analyse the relationship between the levels of reproductive hormones and AZF microdeletions. Result analysis showed that AZF microdeletions were present in 8 (8.70%) azoospermic males and 3 (6.67%) severely oligozoospermic males. The most frequent microdeletions were detected in the AZFc region, followed by AZFb + c, AZFb and AZFa. And there was no significant correlation between the AZF microdeletion and the levels of reproductive hormones. These findings reinforce the necessity of AZF microdeletion testing among infertile males prior to employment of assisted reproduction techniques in Jilin province of China.     

Nutritional and metabolic requirements of early cleavage stage embryos and blastocysts

During preimplantation human embryo development there is an increase in the synthesis of macromolecules and a demand for energy. Consequently, the metabolic requirements of the human embryo change as development proceeds from the zygote to the blastocyst stage. Evidence from a number of species indicates that before activation of the embryonic genome, human and other mammalian embryos have a preference for oxidizable energy substrates, particularly pyruvate, non-essential amino acids and glutamine. After embryonic genome activation, glucose and essential amino acids become increasingly important. As such, there is a switch in energy metabolism during preimplantation development from one based principally on aerobic respiration, to another based on oxidative metabolism and aerobic glycolysis.