Azoospermic HIV-1 infected patients wishing to have children: proposed strategy to reduce HIV-1 transmission risk during sperm retrieval and intracytoplasmic sperm injection: Case Report.
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BACKGROUND: To date, assisted reproductive technology (ART) with sperm washing is offered to serodiscordant couples with an human immunodeficiency virus-1 (HIV-1) infected male partner in order to have a child while reducing the risk of transmission to the woman. However, ART programmes are not possible if the man is azoospermic. We report here the first birth following intracytoplasmic sperm injection (ICSI) using frozen epididymal spermatozoa obtained after surgical sperm retrieval in a HIV-1 infected man with obstructive azoospermia. METHODS; Sperm obtained by micro-epididymal sperm aspiration was frozen after density gradient preparation and tested for HIV-RNA and DNA. ICSI with frozen sperm was performed. RESULTS: A twin pregnancy was obtained following ICSI. Two healthy girls were born. Maternal HIV-1 RNA and HIV-1 serology were negative during pregnancy and at delivery. CONCLUSIONS: This case report demonstrates that ART is possible in azoospermic HIV-1 infected men. On the basis of current knowledge, we propose a strategy to reduce HIV-1 transmission risk during sperm retrieval and ICSI in couples where the man is HIV-1 infected and azoospermic. (+info)
Outcome of repeated micro-surgical testicular sperm extraction in patients with non-obstructive azoospermia.
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AIM: To evaluate the outcome of repetitive micro-surgical testicular sperm extraction (mTESE) attempts in non-obstructive azoospermia (NOA) cases, in relation to patients' initial testicular histology results. METHODS: A total of 68 patients with NOA in whom mTESE had been performed in previous intracytoplasmic sperm injection (ICSI) attempts were reviewed. RESULTS: Among the 68 patients with NOA, the first mTESE yielded mature sperm for ICSI in 44 (64%) (Sp(+)), and failed in the remaining 24 (36%) (Sp(-)). Following their first trial, 24 patients decided to undergo a second mTESE. Of these 24 patients, no spermatozoa were obtained in 5 patients, and Sp(+) but no fertilization/pregnancy were achieved in 19. In these 24 cases, mTESE was successively repeated for two (n = 24), three (n = 4) and four (n = 1) times. The second attempt yielded mature sperm in 3/5 patients from the Sp- group and 16/19 patients from the Sp(+) group. At the third and fourth trials, 4/4 and 1/1 of the original Sp(+) patients were Sp(+) again, respectively. Distribution of main testicular histology included Sertoli cell-only syndrome (16%), maturation arrest (22%), hypospermatogenesis (21%) and focal spermatogenesis (41%). Overall, in repetitive mTESE, 24/29 (82%) of the attempts were finally Sp(+). CONCLUSION: Repeated mTESE in patients with NOA is a feasible option, yielding considerably high sperm recovery rate. In patients with NOA, mTESE may safely be repeated one or more times to increase sperm retrieval rate, as well as to increase the chance of retrieving fresh spermatozoa to enable ICSI. (+info)
Azoospermia factor deletions in varicocele cases with severe oligozoospermia.
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BACKGROUND: Varicocele is the most common cause of male infertility. The etiology and pathophysiology of varicocele are multifactorial. When low sperm counts are associated with varicocele, varicocelectomy can partially restore spermatogenesis and fertility. Few recent studies have reported that in some varicocele cases, there may be an associated genetic etiology. Presence of a genetic factor like azoospermia factor microdeletions may lead to irreversible spermatogenic arrest in these cases, but very few reports support these findings. However, it is still not understood why some cases improve after varicocelectomy and why some cases show no improvement in semen parameters postoperatively. AIM: It is important to distinguish varicocele cases from Yq microdeletions as these cases have irreversible testicular damage and thus carry a poor prognosis after varicocelectomy. SETTINGS: Research and Referral tertiary care hospital. DESIGN: Prospective study. MATERIALS AND METHODS: Seventy-two infertile men with varicocele were referred for Yq microdeletion analysis from the infertility clinic of AIIMS and Army Research and Referral Hospital. Genomic DNA was isolated from blood and polymerase chain reaction microdeletion screening was done in these cases to determine the presence or deletion of AZF loci. RESULTS: In this study 7 (9.7%) varicocele cases harbored Yq microdeletion. The sperm count in cases which harbored Yq microdeletion was significantly lower than in cases without Yq microdeletion. CONCLUSION: Varicocele cases with Yq microdeletion do not show improvement in semen parameters post-varicocelectomy. Detection of Yq microdeletion determines prognosis and future management in such cases. (+info)
Expression and distribution of laminin chains in the testis for patients with azoospermia.
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The aim of our study was to investigate the relationships between the expression of laminin in the testis and spermatogenesis, and the basement membrane (BM) of testicular tubules in fertile and infertile men. Testicular tissue samples were collected from the testes of 9 patients with obstructive azoospermia (OA), 9 patients with maturation arrest (MA), and 15 patients with Sertoli cell-only syndrome (SCO). In testicular tissue, laminin was identified by staining with polyclonal antibodies. Serum follicle-stimulating hormone (FSH), lutenizing hormone (LH), and testosterone were determined by chemiluminescence assays. In seminal plasma, laminin was estimated using a double-antibody enzyme immunoassay. BM thickness was significantly correlated with testicular tubule diameter (r = -0.49, P = .004) and FSH (r = 0.52, P = .008). The beta2 chain of laminin was most expressed on the inner BM of testicular tubules. The laminin index for the beta2 chain in SCO was significantly higher than in OA (P < .0001) and MA (P = .03). The mean seminal laminin levels in SCO were significantly lower than in OA (P < .001). We demonstrated that overabundance of the beta2 chain of laminin is associated with increased BM thickness and is possibly related to spermatogenic dysfunction. (+info)
Bilateral epidiymal cysts in an alpaca male used for breeding.
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A 4-year-old alpaca stud was presented for examination of his reproductive tract. Ultrasonographic examination of the gonads revealed 2 cystic structures associated with the head of each epididymis. Biopsies of each testicle evidenced mild testicular degeneration. Histopathologic examination of the gonads revealed cystic efferent ductules in the head of each epididymis. (+info)
Ring chromosome 12 and severe oligospermia: a case report.
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OBJECTIVE: To describe an unusual presentation of ring chromosome 12, which manifested as severe azoospermia, resulting in male infertility. DESIGN: Case report. SETTING: In vitro fertilization center at a tertiary care hospital. PATIENT(S): A 27-year-old man diagnosed with unexplained azoospermia and ring chromosome 12 abnormality during a workup for primary infertility. INTERVENTION(S): In vitro fertilization with preimplantation genetic diagnosis. MAIN OUTCOME MEASURE(S): To confirm the importance of obtaining karyotypes in individuals with severe oligospermia. RESULT(S): Full-term pregnancy after IVF using donor sperm. CONCLUSION(S): Severe oligospermia and male infertility should be included in the spectrum of findings found in ring chromosome 12. (+info)
Quantification of DDX3Y, RBMY1, DAZ and TSPY mRNAs in testes of patients with severe impairment of spermatogenesis.
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Y chromosome microdeletion is the most important genetic cause of impairment of spermatogenesis. Nevertheless, a significant proportion of patients with spermatogenic failure do not have this condition. This study investigated the expression level of AZF genes, DDX3Y (DBY), RBMY1, DAZ and TSPY in testicular tissues of 42 subjects with impaired spermatogenesis compared with 33 with normal spermatogenesis. Histopathological evaluation was performed in all subjects and tissues were classified according to Johnsen Score. Transcript amounts were determined by quantitative-competitive RT-PCR. Patients with complete Sertoli cell-only syndrome (SCOS) did not exhibit RBMY1, DAZ and TSPY gene expression, however, we detected very low expression of DDX3Y transcript. Tissue samples with focal SCOS showed significantly decreased expression of all genes (P < 0.001). Maturation arrest and hypospermatogenesis tissues expressed significantly low levels of DDX3Y testicular transcript (P < 0.001), while the mRNA levels of the other genes were similar to that in tissues from the normal spermatogenesis group. Negative or diminished gene expression of DDX3Y, RBMY1, DAZ and TSPY in tissues samples with SCOS or focal SCOS reflects the absence or the lower number of germ cells, respectively. The finding that the testicular transcript of DDX3Y is significantly decreased in patients with severe spermatogenenic failure, especially in those presenting maturation arrest, suggests an important role of DDX3Y during spermatogenesis. (+info)
Fertility in male patients with advanced Hodgkin lymphoma treated with BEACOPP: a report of the German Hodgkin Study Group (GHSG).
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To date, there is little information on the impact of more aggressive treatment regimen such as BEACOPP (bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone) on the fertility of male patients with Hodgkin lymphoma (HL). We evaluated the impact of BEACOPP regimen on fertility status in 38 male patients with advanced-stage HL enrolled into trials of the German Hodgkin Study Group (GHSG). Before treatment, 6 (23%) patients had normozoospermia and 20 (77%) patients had dysspermia. After treatment, 34 (89%) patients had azoospermia, 4 (11%) had other dysspermia, and no patients had normozoospermia. There was no difference in azoospermia rate between patients treated with BEACOPP baseline and those given BEACOPP escalated (93% vs 87%, respectively; P > .999). After treatment, most of patients (93%) had abnormal values of follicle-stimulating hormone, whereas the number of patients with abnormal levels of testosterone and luteinizing hormone was less pronounced-57% and 21%, respectively. In univariate analysis, none of the evaluated risk factors (ie, age, clinical stage, elevated erythrocyte sedimentation rate, B symptoms, large mediastinal mass, extranodal disease, and 3 or more lymph nodes) was statistically significant. Male patients with HL are at high risk of infertility after treatment with BEACOPP. (+info)