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Role of Local Immune Reaction in Primary Obstructive Male Infertility
Anil K. Sarda,Durgatosh Pandey,Shweta A. Bhalla,Nivedita Sarda
Al Ameen Journal of Medical Sciences , 2012,
Abstract: Objective: To find evidence of local immune reaction (cellular and, if possible, humoral) in patients of primary obstructive infertility and to extrapolate its role in the persistence of infertility even after a patent vasoepididymostomy. This was a prospective study in a tertiary hospital setting comparing epididymal histology and epididymal fluid antisperm antibody in men with primary obstructive infertility with those in men with proven fertility. Material and Methods: Twenty men with primary obstructive infertility in the study group and five men with proven fertility as controls were included in the study. While performing vasoepididymostomy on such patients, testicular and epididymal tissues were taken, and epididymal fluid was aspirated for estimation of antisperm antibodies. Testicular and epididymal histologies were studied under light microscopy for evidence of cellular immune response to obstruction. Antisperm antibodies in epididymal fluid were assayed by ELISA. Result(s): The cellular immune response as assessed by the presence of interstitial inflammatory cells and macrophages in epididymal histology was found in 12/20 patients. Testicular biopsies in all patients were normal. Humoral immune response as assessed by significant titres of antisperm antibodies in epididymal fluid was found in 14/20 patients. Evidence of local immune response (cellular or humoral or both) was found in 17/20 patients. Conclusion(s): Men with primary obstructive infertility develop local immune reaction in their epididymis secondary to obstruction. This factor may be responsible for the persistence of infertility even after a patent vasoepididymostomy.
The effect of semen analysis factors regarding IUI with male factor infertility
A. Ghaseminezhad,M. Akbarpour,S. Falahatkar,Z. Rezaee
Journal of Mazandaran University of Medical Sciences , 2008,
Abstract: Background and Purpose: There is evidence in literature that IUI is the first line treatment and the most cost-effective procedure for mild to moderate male factor sub-fertility, however, the relative influence of various semen characteristics with the likelihood of a successful outcome is controversial. This study is designed to show the correlation between semen parameters and the pregnancy rate in patients, with mild to moderate male factor sub-fertility and whose wives were normal and underwent hyper-stimulation, including IUI.Materials and Methods: From January 2005 to January of 2006, 95 couples with male factor infertility underwent 140 IUI cycles with husbands washed semen were included in this study .They were divided into two groups based on semen parameters, mild and moderate. Post- wash sperm parameters, type of infertility (primary and secondary), male/ female age and duration of infertility were evaluated and correlated with clinical pregnancy outcome.Results: The clinical pregnancy rate per cycle was 26 (18.5%); 15 (21.4%) in mild group, while 11(15.7%) in moderate group. The clinical pregnancy rate per couple was 27.3%.There were significant correlation between female age, duration of infertility, sperm concentration and progressive motility, and clinical pregnancy.Conclusion: Our findings suggest that post- wash sperm concentration and progressive motility, female age and duration of infertility are the most important factors for prediction of successful pregnancJ Mazand Univ Med Sci 2008; 18(65):10-18 (Persian)
Local Cell Mediated Immune Reaction in Primary Obstructive Male Infertility  [PDF]
Anil Kumar Sarda, Shweta Aggarwal Bhalla, Durgatosh Pandey, Shyama Jain
Surgical Science (SS) , 2011, DOI: 10.4236/ss.2011.21008
Abstract: Increased intra-epididymal pressure due to obstruction causes a breach in the epididymal lining exposing the highly antigenic sperms to the interstitium. When the exposure is small and intermittent, it is likely to induce a local humoral response which may affect sperm maturation and also react with the epididymal epithelium producing irreversible histological changes. The present study on 30 patients of primary obstructive infertility found direct and indirect evidence of the production of antisperm antibodies locally. ELISA for antisperm antibodies was positive in the epididymal fluid in 16/30 (53%) of the patients. Indirect evidence of the role of local antigen-antibody reaction in the epididymis is apparent in 22/30 (73%) patients who had a lymphocytic infiltrate. The local presence of antisperm antibodies in the epididymal fluid correlated well with the presence of lymphocytic infiltration in the interstitium (p < 0.05). In our study 16/30 patients had a positive ELISA for antisperm antibody and all these patients had interstitial lymphocytic infiltration. In addition eight patients with a negative ELISA also showed interstitial lymphocytic infiltration. Thus 22/30 (73%) patients had an evidence of a local immune reaction directly in the form of a positive ELISA for antisperm antibodies in the epididymal fluid and / or indirect evidence in the form of lymphocytic infiltrate in the interstitium. None of the five controls had either a positive ELISA or lymphocytic infiltrate, this difference was found to be statistically significant (p < 0.005).
Identification of male factor infertility using a novel semen quality score and reactive oxygen species levels
Nallella, Kiran P.;Sharma, Rakesh K.;Allamaneni, Shyam S. R.;Agarwal, Ashok;
Clinics , 2005, DOI: 10.1590/S1807-59322005000400010
Abstract: purpose: to determine whether patients with male factor infertility can be accurately identified by calculating a novel semen quality score and measuring levels of reactive oxygen species during routine infertility screening. methods: semen samples from 133 patients and 91 healthy donors were evaluated with manual and computer-assisted semen analysis. a principal component analysis model was employed to calculate a semen quality score. in brief, this score was calculated by base 10 logarithms multiplied by varying weights given to 9 sperm parameters. reactive oxygen species levels were measured using chemiluminescence assay. results: the semen quality score had a sensitivity of 80.45% and accuracy of 77% at a cutoff of 93.1 in identifying patients with male factor infertility. the area under the receiver operating characteristic curves for the semen quality score was 84.28% (95% ci: 65.22%-100%). reactive oxygen species levels [log10 (reactive oxygen species +1)] were significantly higher in male factor infertility patients. reactive oxygen species had a sensitivity of 83.47% and specificity of 60.52% with an accuracy of 75% at a cutoff of 1.25 in identifying male factor infertility patients. the area under the receiver operating characteristic curve for reactive oxygen species levels was 78.92% (95% ci: 72.60%-85.23%). semen quality scores were significantly and negatively correlated with reactive oxygen species levels in the donors and the male factor infertility patients. conclusions: the semen quality score and reactive oxygen species levels in semen samples appear to be strongly associated with male factor infertility. because both of these parameters are more sensitive than individual sperm parameters in identifying male factor infertility, they should be included in routine infertility screening.
The Correlation between Semen Parameters in Processed and Unprocessed Semen with Pregnancy Rate in Intrauterine Insemination in the Treatment of Male Factor Infertility  [cached]
Farid Dadkhah,Aram Nahabidian,G Ahmadi
Urology Journal , 2004,
Abstract: Purpose: Our aims were to determine the relation of semen parameters in processed and unprocessed semen samples with pregnancy rate in intrauterine insemination (IUI) in the treatment of male factor infertility. Materials and Methods: In a quasi experimental study, 412 couples with male factor infertility were studied. To treat male factor infertility, 561 IUI cycles were done. Results: Total pregnancy rate was 7.84% (44 in 561) per cycle. There was an inverse relationship between pregnancy rate and duration of infertility. Total sperm count after processing was higher in pregnant cycles than in non-pregnant ones (P < 0.05). The mean total motile sperms after processing for pregnant and non-pregnant cycles was 72.2 ± 78.8 and 53.2 ± 54.3, respectively (P < 0.05). Conclusion: IUI is a valuable method for the treatment of male factor infertility. The higher number of sperms, total motile sperms and IUI sessions, and lower duration of infertility, all have a positive relationship with pregnancy rate.
Severe male infertility after failed ICSI treatment-a phenomenological study of men's experiences
Marianne Johansson, Anna-Lena Hellstr?m, Marie Berg
Reproductive Health , 2011, DOI: 10.1186/1742-4755-8-4
Abstract: Eight men with obstructive azoospermia, who had terminated Swedish public health system ART treatment two years previously without subsequent childbirth, were interviewed using a descriptive phenomenological method.The essence of the phenomenon is expressed with a metaphor: climbing a mountain step by step with the aim of reaching the top, i.e. having a child and thus a family with a child. Four constituents are included (1) inadequacy followed by a feeling of redress (2) marginalisation, (3) chivalry (4) extension of life and starting a family as driving forces.Knowledge of men's experiences of their own infertility is important as a supporting measure to increase the quality of care of infertile couples. By adopting this facet of gender perspective in fertility treatment guidelines, care can hopefully be optimized.Reproduction and childbirth is one of the central themes of life [1], occurring when planned and wished in many but not all cases. The prevalence of infertility is debated. A recent study by Boivin et al. [2]reported that 9% of fertile-age couples suffer either primary or secondary infertility, a prevalence that is confirmed by the authors of this article [3]. Insemination with donor sperm was the only treatment for severe male-factor infertility before the in vitro fertilization (IVF) era [4]. However, while childlessness associated with female-factor infertility has often been solved by IVF, conventional IVF has not yielded the same successful outcome in cases of male-factor infertility [5]. Today, biological fatherhood is possible in certain cases of severe male-factor infertility due to the development of intracytoplasmatic sperm injection (ICSI) [6]. Azoospermia, i.e. the absence of sperm in the ejaculate, is seen in 10% of male-factor infertility cases [7]; it can be either obstructive or non-obstructive/testicular. Surgical sperm retrieval, i.e. spermatozoa collection from either the epididymis or the testis, is required to treat obstructive azoos
The Incriminating Role of Reactive Oxygen Species in Idiopathic Male Infertility: An Evidence Based Evaluation  [PDF]
L.C. Saalu
Pakistan Journal of Biological Sciences , 2010,
Abstract: The male factor is considered a major contributory factor to infertility. Apart from the conventional causes for male infertility such as varicocoele, cryptorchidism, infections, obstructive lesions, cystic fibrosis, trauma and tumours, a new and important cause has been identified as being responsible for the so-called idiopathic male infertility: oxidative stress. Oxidative Stress (OS) is a condition that occurs when the production of Reactive Oxygen Species (ROS) overwhelms the antioxidant defense produced against them. In male reproductive pathological conditions, the OS significantly impairs spermatogenesis and sperm function, which may lead to male infertility. Reactive Oxygen Species (ROS) known as free radicals are oxidizing agents generated as a result of metabolism of oxygen and have at least one unpaired electron that make them very reactive species. Spermatozoa generate Reactive Oxygen Species (ROS) in physiological amounts, which play a role in sperm functions during sperm capacitation, Acrosome Reaction (AR) and oocyte fusion, but they need to be controlled and their concentrations maintained at a level that is not deleterious to the cells. Administration of antioxidants in patients with ‘male factor’ infertility has begun to attract considerable interest. The main difficulty of such an approach is our incomplete understanding of the role of free radicals in normal and abnormal sperm function leading to male infertility. The purpose of the present review is to address the relationship between ROS and idiopathic male factor infertility.
Split ICSI/Insemination in Mild Male Factor Infertility: a Randomized Controlled Trial  [PDF]
Ashraf Moawad, a,c Hanaa Abou-Ria, a,d Mohamed Abd Elzaher , a Mohamed
Egyptian Journal of Hospital Medicine , 2011,
Abstract: Introduction: Intracytoplasmic sperm injection (ICSI) is a widely used adjunct to in vitro fertilization (IVF) for male-factor infertility when fertilization failure is suspected. In patients with borderline semen, the decision to choose either IVF or ICSI is critical because the chance of total fertilization failure after a conventional IVF or of performing an unnecessary ICSI procedure is hard to predict. Objective: The purpose of this study was to assess the value of the allocation of some eggs to ICSI and others to conventional insemination (Split ICSI/insemination) in IVF cycles in which semen parameters are subfertile. Design: It is prospective study. Materials and methods: Between August 2007 and April 2010, 190 patients had half of their eggs inseminated with ICSI and the other half inseminated with conventional IVF. Results: In this study, 76.3% of patients were fertilized by both IVF and ICSI, 21.6% of patients were fertilized only by ICSI while 2.1% of patients were not fertilized either by IVF or ICSI. Fertilization rate was significantly higher in oocytes injected by ICSI (63.7%) compared to oocyte inseminated by IVF (44.3%). In patients fertilized by both IVF and ICSI, although ICSI fertilization rate was higher (65.9%) than IVF fertilization rate (57.3%), yet there is no significant differences were observed. High grade embryos were significantly higher in oocytes injected by ICSI (75.9%) compared to oocyte inseminated by IVF (56.4%). Also, significantly more type 1 and 2 embryos developed after ICSI compared with IVF (77.3% vs. 56.4%) in the group of patients with fertilization after both IVF and ICSI. Conclusion: According to our findings, implementation of ICSI in couples with mild male factor infertility could improve fertilization rates and decrease the risk of complete fertilization failure. Additionally, split ICSI procedure provides valuable clinical information about fertilization potential for the couple and unnecessary use of ICSI procedure can be avoided in future cycles for patients who have achieved good fertilization in both IVF and ICSI.
Factores causales de infertilidad masculina: Contribución del factor endocrino Causes of male infertility: The contribution of endocrine factors  [cached]
Enzo Devoto C,Marcia Madariaga A,Ximena Lioi C
Revista médica de Chile , 2000,
Abstract: Background: Male infertility is responsible for 35% of infertile couples. Aim: To investigate the causes of male infertility and the relative importance of endocrine factors. Patients and methods: Patients referred to an andrology clinic due to an abnormal spermiogram were studied. A testitular examination, spermiogram and determination of FSH, LH, testosterone and prolactin were done to all. Testicular biopsy was done to patients with severe oligospermia or azoospermia. Causes of infertility were defined and classified as pretesticular, testicular, posttesticular or unclassified. Results: Two hundred fifty seven males were studied. In 3.5% of them, the cause of infertility was defined as pretesticular (that included hypothalamic and pituitary endocrine causes), in 66.9% it was classified as testicular, in 15.6% as posttesticular and in 14%, as unclassified. Thirty percent of infertility cases were idiopathic, 17.9% were associated to varicocele, 12.8% were associated to cryptorchidism, 8.9% to Klinefelter syndrome and 6.6% to exposure to toxic substances. In 50% of patients with cryptorchidism, this abnormality was found during the specialized andrological examination and referrals for surgical correction were made late. Two thirds of patients with Klinefelter syndrome were hypoandrogenic. Conclusions: Causes for male infertility should be investigated and diagnosed accurately. Primary hypoandrogenic testicular failures must be treated with hormone replacement therapy
Novel concepts in male infertility
Esteves, Sandro C.;Agarwal, Ashok;
International braz j urol , 2011, DOI: 10.1590/S1677-55382011000100002
Abstract: extraordinary advances have been achieved in the field of male infertility in the last decades. there are new concepts in sperm physiology and several modern tools for the assessment of spermatogenesis kinetics in vivo. new tests using molecular biology and dna damage assays allow the clinician to correctly diagnose men so far classified as having idiopathic male infertility. in the field of treatment, microsurgery has increased success rates either for reconstruction of the reproductive tract or the retrieval of spermatozoa for assisted conception. emerging evidence suggests that life-style and environmental conditions are of utmost importance in male fertility and subfertility. this review discusses several concepts that have changed over the last years, such as the duration of the spermatogenic cycle in humans, y-chromosome infertility, the reproductive potential of non-mosaic klinefelter syndrome men, the impact of paternal age and sperm dna in male infertility, the role of antioxidants in the treatment of infertile men, the predictive factors and techniques for sperm retrieval in non-obstructive azoospermia, and the microsurgical treatment of clinical varicoceles. whenever possible, levels of evidence are provided as suggested by the oxford center of evidence-based medicine.
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