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Cryopreservation of human semen can cause DNA damages, which compromise the fertilization and normal embryo development. The present study showed that the antioxidant resveratrol prevents these damages both in fertile and infertile men. The addition of ascorbic acid before cryopreservation can reduce DNA damages only in infertile men. Although further studies are needed, the present work showed that resveratrol could be considered in human cryopreservation procedures to avoid/minimize DNA damages and preserve sperm integrity.

This cohort study evaluated whether rescue spontaneous maturation (RSM) could be a valid method to increase the number of embryos available for transfer and whether transfers with RSM-derived embryos would contribute to clinical outcomes of poor-responder patients in ovarian stimulation cycles. The study included 440 patients undergoing intracytoplasmic sperm injection cycles in which fewer than five metaphase II (MII) oocytes and at least one immature oocyte were retrieved after follicle aspiration. Patients were allocated into two groups based on the injected oocytes' nuclear maturation status: MII group (n=330), in which only embryos derived from MII oocytes were transferred, and RSM group (n=110), in which at least one embryo derived from an RSM oocyte was transferred. No differences between the MII and RSM groups were observed for pregnancy (16.7% versus 16.5%) or miscarriage (25.5% versus 29.4%) rates, respectively. The RSM group had a higher number of transferred embryos (1.87+/-1.24 versus 2.35+/-1.22; P

RESUMO OBJETIVO: o objetivo deste estudo foi avaliar os parâmetros laboratoriais e clínicos de pacientes submetidos à reprodução humana assistida, associando técnicas de processamento seminal para eliminação de partículas virais da amostra de sêmen em casais nos quais o homem é infectado pelo vírus da imunodeficiência humana adquirida (HIV). MÉTODOS: foram avaliados 11 ciclos de injeção intracitoplasmática de espermatozóide (ICSI) realizados em casais nos quais os homens eram infectados pelo HIV (Grupo HIV), e 35 ciclos de ICSI nos quais se utilizaram espermatozóides doados (Grupo Controle). As amostras de sêmen dos doadores foram submetidas à análise seminal completa, processamento seminal (lavagem) e criopreservação. Os homens do Grupo HIV receberam antibioticoterapia prévia e realizou-se análise seminal, lavagem e gradiente descontínuo de densidade antes da criopreservação. As amostras foram avaliadas para carga viral e a ICSI foi realizada quando não houve detecção do HIV. RESULTADOS: quanto aos resultados da análise seminal, os grupos se mostraram comparáveis em relação à concentração e motilidade progressiva dos espermatozóides. Entretanto, a porcentagem de espermatozóides morfologicamente normais foi maior no Grupo Controle (14,3%) comparado ao HIV (5,8%; p=0,002). Na avaliação dos parâmetros embrionários, as taxas de fertilização normal (Controle: 74,7% e HIV: 71,7; p=0,838) e de bons embriões (Controle: 42,4% e HIV: 65,1%; p=0,312) foram semelhantes. Por outro lado, o Grupo Controle apresentou melhores resultados clínicos que o HIV (gestação continuada: 52,9 e 12,5%; p=0,054; implantação: 42,6 e 10,4%; p=0,059, respectivamente), apesar de as diferenças não serem estatisticamente significantes. Após o nascimento, não houve soroconversão das mães e das crianças nascidas. CONCLUSÕES: a associação de técnicas de processamento seminal para eliminação do HIV de amostras seminais não interferiu nos parâmetros laboratoriais de ciclos de reprodução humana assistida. Por outro lado, demonstrou excelentes resultados na obtenção de gametas seguros para casais sorodiscordantes.

Objective To describe three cases of azoospermia in patients with oligospermia after clomiphene citrate (CC) intake. Design Case report. Setting(s) Academic medical center. Patient(s) Three patients with oligospermia. Intervention(s) Three oligospermic men used CC, resulting in azoospermia. Main Outcome Measure(s) Semen analysis after CC use and after discontinuation of CC. Result(s) Three patients were sent to our clinic for investigation of their azoospermia after use of CC. They had severe oligozoospermia (sperm concentrations of 3.4, 2.8, and 4.1 × 10 6 /mL, respectively) before treatment with CC. These patients were re-evaluated with two new semen analyses, showing azoospermia. After 3 months without use of the drug, the mean sperm concentration was 2.5 ± 1.1 × 10 6 /mL. Conclusion(s) The benefits of empiric treatment with CC must be balanced with the possible undesirable effects, such as azoospermia.

Objective To study the effect of freeze–thaw on embryos derived from intracytoplasmic sperm injection (ICSI) using surgically retrieved and ejaculated spermatozoa. Design Retrospective study. Setting Private IVF center. Patient(s) Three hundred eighty-three patients undergoing frozen–thawed ET cycles. Intervention(s) Testicular sperm aspiration (TESA) or percutaneous epididymal sperm aspiration (PESA) were the sperm surgical retrieval methods used for ICSI. Embryos resulting from ICSI using surgically retrieved and ejaculated spermatozoa were frozen, thawed, and transferred. Main Outcome Measure(s) Post-thaw survival, implantation, and pregnancy rates. Result(s) No differences were found between the ejaculated sperm and TESA/PESA groups in terms of post-thaw survival rate (68.4% vs. 66.1%, respectively), pregnancy rate (20.1% vs. 16.1%), and implantation rate (10.6% vs. 12.7%). Similar results were found for those variables when comparing TESA and PESA groups. Conclusion(s) Cleavage embryos arising from ICSI cycles using testicular and epididymal spermatozoa can be frozen with survival, pregnancy, and implantation rates comparable to those obtained with ejaculated spermatozoa.

e12084 Background: Breast cancer is a heterogeneous and complex disease. TNBC is characterized by intrinsic aggressive tumour biology resulting in poor prognosis. AR is one of the newly emerging bi...

Objective To evaluate whether swine oocytes are useful for training new technicians in a human reproduction laboratory. Design Prospective study. Setting Graduate school in assisted reproductive techniques (ART) in Brazil. Patient(s) Students in a human reproduction laboratory. Intervention(s) Medium-sized follicles were aspirated from prepubertal gilts' ovaries and collected at a slaughterhouse. Oocytes were retrieved from the follicular fluid. Twenty-one students trained during four periods of 20 hours each were evaluated as to their ability to perform micromanipulation and were compared with a group of well-trained professionals (control group). Main Outcome Measure(s) Students' ability in oocyte retrieval, oocyte manipulation, and intracytoplasmic sperm injection during and after the 80 hours of training. Result(s) Students were able to retrieve, on average, 23.8 oocytes per ovary. Their micromanipulation skills substantially increased, reaching an oocyte retrieval rate of 77.2%, compared with 84.9% in the control group after the training period. Although the oocyte damage rate gradually decreased, from 52.0% after 20 hours of training to 5.4% after 80 hours, these figures were still above the control group oocyte damage rate by 0.3%, which was a statistically significant level. Regarding intracytoplasmic sperm injection, within 40 hours, no students were able to perform a single injection; and by the end of 80 hours, they achieved an average of 4.0 oocytes per hour, whereas the control group injected 20.6 oocytes per hour, a statistically significant difference. Conclusion(s) Swine ovaries may be a useful tool in the spectrum of training techniques for unskilled assisted reproductive techniques laboratory professionals.

Objective To assess fertilization, implantation, and pregnancy rates in patients undergoing ICSI using fresh and cryopreserved sperm from ejaculated semen samples. Design Retrospective study. Setting Academic and private medical centers. Patient(s) One hundred fifty-eight patients. Intervention(s) Intracytoplasmic sperm injection. Main Outcome Measure(s) Fertilization, implantation, and pregnancy rates were evaluated; 61 cycles of ICSI were performed with cryopreserved and 79 cycles of ICSI were performed with fresh spermatozoa. Also, we divided the outcomes according to the semen characteristics, normozoospermia, oligozoospermia, asthenozoospermia, and oligoasthenozoospermia. Result(s) Overall, normal-fertilization rates were higher using fresh sperm (73.8%) compared with cryopreserved sperm (68.7%). Cycles performed in patients with normozoospermia or oligozoospermia had similar fertilization, implantation, and pregnancy rates using fresh or cryopreserved sperm. When asthenozoospermic and oligoasthenozoospermic semen samples were used, the normal-fertilization rate was higher with fresh sperm compared with cryopreserved sperm. However, implantation and pregnancy rates were similar in fresh and cryopreserved sperm samples from patients with asthenozoospermia or oligoasthenozoospermia. Conclusion(s) Semen with abnormalities in the motility may be more susceptible to sperm cryopreservation damage, resulting in lower fertilization rates. However, once the oocyte is fertilized, implantation and pregnancy rates are similar to those in patients with oligozoospermia and normozoospermia.

OBJETIVO: avaliar a influência do período de abstinência sexual sobre os parâmetros espermáticos em homens inférteis, assim como determinar a melhora na qualidade seminal após mistura dos ejaculados. MÉTODOS: estudo retrospectivo no qual se avaliou um grupo de 88 homens com oligozoospermia (n=25), astenozoospermia (n=43) ou oligoastenozoospermia (n=20), cujas parceiras foram submetidas à inseminação intra-uterina entre setembro de 2002 e dezembro de 2004. Foram excluídos da análise casais nos quais os homens apresentavam análise seminal normal ou mulheres com alterações sugestivas de infertilidade. Cada homem produziu duas amostras seminais em período curto de tempo (30 minutos a 1 hora). Foram avaliados o volume seminal, a concentração total de espermatozóides móveis e o percentual de motilidade espermática. Para todos os parâmetros avaliados foram comparadas a primeira e a segunda amostra seminal coletadas. Além disso, a concentração total de espermatozóides móveis foi comparada entre a primeira amostra coletada e a união das amostras. A avaliação estatística foi realizada usando o teste t e o teste chi2. RESULTADOS: em homens oligozoospérmicos não houve diferença nas características seminais entre a primeira e a segunda amostra seminal (p>0,05). A concentração total de espermatozóides móveis aumentou significativamente na segunda amostra em comparação à primeira amostra em homens astenozoospérmicos (42,4±6,8 vs 51,5±7,2x10(6) espermatozóides/mL) e oligoastenozoospérmicos (11,1±7,4 vs 14,35±7,2x10(6) espermatozóides/mL (p0.05). The total motile sperm count increased significantly in the second sample in comparison to the first sample in asthenozoospermic (42.4±6.8 vs 51.5±7.2x10(6) sperm/mL) and oligoasthenozoospermic men (11.1±7.4 vs 14.35±7.2x10(6) sperm/mL (p

OBJECTIVE To assess hormone levels, testicular volume, and semen characteristics of fertile men of various age groups. PATIENTS AND METHODS The records of 889 men who sought a vasectomy between September 1999 and March 2003 were reviewed. Patients were divided into five groups by age; we evaluated semen volume, sperm concentration, motility, morphology and complex sperm motion variables. Follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone levels and both testicular volumes were compared. RESULTS There were no differences among the groups in the levels of LH, testosterone, or right and left testicular volumes. There were differences among the five groups in FSH levels, semen volume, sperm concentration and motility. Normal morphology according to the World Health Organisation criteria was significantly lower in patients aged >45 years. From a linear regression analysis, semen volume, sperm concentration and motility decreased by 0.01 mL, 2.1%, and 0.27%, respectively, per year, and the FSH level increased by 0.27%. CONCLUSIONS Sperm concentration and motility decrease and FSH levels increase with age. Normal sperm morphology decreases from 45 years old. Thus, the ageing effect should be considered when proposing standard values for semen characteristics in routine semen analysis.

Correlate semen analysis, hormones, and testicular volume with the number of veins ligated.Patients were divided into three groups: Group 1 (or = 5 veins), Group 2 (6-10 veins), and Group 3 (10 veins). We evaluated testicular volume, hormonal levels, sperm concentration, and motility before and after the surgical procedure.In Group 1, even though there was an improvement in both testicular volume and sperm concentration; testosterone levels and sperm motility did not improve with surgery. In Group 2, no changes were detected in the both testicular volumes, in sperm concentration, motility, and testosterone levels. In Group 3, an improvement was seen in the right testicle volume, testosterone levels, and sperm concentration. Follicle-stimulating hormone levels decreased following the surgical procedure in all groups.Patients with more than 10 ligated veins have better chances to improve sperm concentration. FSH levels decreased in all groups of patients.

CONTEXT AND OBJECTIVE: Recent studies have shown regional and population differences in semen characteristics. The objective was to establish reference values for semen analysis and to verify the effect that age, length of sexual abstinence, seasonality, smoking habits and coffee consumption have on fertile individuals’ semen characteristics. DESIGN AND SETTING: Prospective study in the Urology Division, Hospital das Clínicas, Universidade de São Paulo. METHODS: Between September 1999 and August 2002, 500 fertile men requesting a vasectomy for sterilization purposes were asked to provide a semen sample before the vasectomy. We evaluated the effects of age, sexual abstinence, seasonality, smoking and coffee consumption on semen characteristics. RESULTS: Compared with World Health Organization values, 87.2% of the patients presented sperm morphology below the normal level. A significant decline in semen volume, sperm motility and sperm morphology in patients over 45 years of age was observed. In patients with 5 days or more of abstinence, there was reduced sperm motility. The lowest values for sperm concentration, motility and morphology were observed in summer and the highest in winter. No differences in semen parameters relating to smoking were detected. Patients who drank six or more cups of coffee per day presented higher sperm motility. CONCLUSIONS: Our sample had a very low percentage of normal sperm morphology. Only sperm morphology showed a high abnormality rate. Differences in semen parameters with regard to age, length of sexual abstinence, seasonality and coffee consumption were identified. No differences relating to smoking were detected. CONTEXTO E OBJETIVO: Estudos recentes têm demonstrado diferenças regionais e populacionais quanto a características do sêmen. O objetivo foi estabelecer valores de referência para análise seminal e verificar o efeito da idade, tempo de abstinência sexual, sazonalidade, hábito de fumar e consumo de cafeína sobre as características do sêmen de indivíduos férteis. TIPO DE ESTUDO E LOCAL: Estudo prospectivo, na Divisão de Clínica Urológica do Hospital das Clínicas, Universidade de São Paulo. MÉTODOS: Entre setembro de 1999 e agosto de 2002, 500 homens férteis requisitando vasectomia com propósitos de esterilização voluntária foram solicitados a coletar uma amostra de sêmen antes da vasectomia. Avaliamos efeitos da idade, abstinência sexual, sazonalidade, consumo de cigarros e café nas características seminais. RESULTADOS: Quando comparados aos valores da Organização Mundial de Saúde, 87,2% dos pacientes apresentavam morfologia espermática abaixo do normal. Foi observado declínio significativo do volume seminal, motilidade e morfologia em pacientes acima de 45 anos. Em pacientes com cinco dias ou mais de abstinência, houve redução da motilidade. Valores mais baixos para concentração, motilidade e morfologia espermática foram observados no verão e os mais elevados no inverno. Não houve diferenças nos parâmetros seminais estudados de acordo com o hábito de fumar. Com relação ao consumo de café, pacientes que ingeriam seis ou mais xícaras/dia apresentaram maior motilidade espermática. CONCLUSÃO: Houve baixa porcentagem de morfologia espermática normal. Apenas a morfologia espermática apresentou alto percentual de anormalidade se levado em consideração o padrão descrito pela Organização Mundial de Saúde. Foram identificadas diferenças nos parâmetros seminais de acordo com a idade, tempo de abstinência sexual, sazonalidade e consumo de café. Não houve diferenças de acordo com o hábito de fumar.

Our aim was to assess the suppression of spermatogenesis and sperm retrieval rate after testicular sperm extraction (TESE) or testicular sperm aspiration (TESA) in adult rats with surgically induced cryptorchidism.Adult rats were submitted to TESE and TESA procedures after 15 days of induced cryptorchidism. After spermatozoa retrieval, the testicles were extracted, weighed and a morphological analysis by conventional light microscopy was done. The numbers of spermatozoa retrieved in both TESA and TESE were rated and compared.Histological analysis of the testicles revealed Sertoli cell-only syndrome in 60% of the testicles, and maturation arrest in the remaining cryptorchid testicles. Significant differences were seen in the number of spermatozoa retrieved (P0.05) between cryptorchidic and control rats. When sperm retrieval techniques were compared, no differences were detected in the number of spermatozoa obtained (P0.05).It seems that a 15 day period of cryptorchidism is enough to induce spermatogenesis disorders. No differences were detected in the number of spermatozoa retrieved in the right or left testicles, irrespective of the testicular pole. Furthermore, and even more importantly, no differences in the retrieval rate were seen between the two techniques.

Objective To assess fertilization, pregnancy, and miscarriage rates after intracytoplasmic sperm injection (ICSI) with epididymal or testicular spermatozoa from different types of azoospermia. Design Retrospective study. Setting Academic medical center and private fertility center. Patient(s) Two hundred twelve patients underwent 257 ICSI cycles. Intervention(s) Cycles of ICSI were divided into four groups according to the etiology of azoospermia: A (nonobstruction), B (postvasectomy), C (congenital obstruction), and D (obstruction due to infection). Testicular sperm aspiration and percutaneous epididymal sperm aspiration were the sperm retrieval methods used for ICSI. Main outcome measure(s) Fertilization, pregnancy, and miscarriage rates. Result(s) Normal fertilization rates were higher in groups C (67.7%) and B (64.1%) compared with groups A (47.3%) and D (58.9%). Although lower pregnancy rates were seen in group A, no statistical differences were detected among groups. However, the miscarriage rate was higher in group A (45.6%) compared with groups B (25.25%), C (24%), and D (22.58%). Conclusion(s) Although no differences were detected in the pregnancy rates across groups, fertilization and implantation rates were higher in patients with congenital obstruction of the seminal path. The pregnancy rate was higher and the miscarriage rate lower when epididymal sperm was used compared with testicular sperm.

Infertility affects up to 15% of the sexually active population, and in 50% of cases, a male factor is involved, either as a primary problem or in combination with a problem in the female partner. Because many commonly encountered drugs and medications can have a detrimental effect on male fertility, the medical evaluation should include a discussion regarding the use of recreational and illicit drugs, medications, and other substances that may impair fertility. With the knowledge of which drugs and medications may be detrimental to fertility, it may be possible to modify medication regimens or convince a patient to modify habits to decrease adverse effects on fertility and improve the chances of achieving a successful pregnancy. Concern is growing that male sexual development and reproduction have changed for the worse over the past 30 to 50 years. Although some reports find no changes, others suggest that sperm counts appear to be decreasing and that the incidence of developmental abnormalities such as hypospadias and cryptorchidism appears to be increasing, as is the incidence of testicular cancer. These concerns center around the possibility that our environment is contaminated with chemicals - both natural and synthetic - that can interact with the endocrine system. A infertilidade afeta até 15% da população sexualmente ativa e em 50% dos casos, o fator masculino está envolvido, como problema primário ou em combinação com causas de origem feminina. Como muitas drogas comumente encontradas e medicações podem ter efeitos deletérios na infertilidade masculina, a avaliação médica deve incluir uma discussão sobre o uso de drogas recreacionais e ilícitas, medicamentos e outras substâncias podem prejudicar a fertilidade. Com o conhecimento de quais drogas e medicamentos podem ser prejudiciais à fertilidade talvez seja possível mudar os hábitos ou a posologia das medicações para diminuir os efeitos adversos na fertilidade e aumentar as chances de engravidar com sucesso. Preocupações referentes ao desenvolvimento sexual masculino e reprodução tem mudado para a pior nos últimos 30-50 anos. Embora alguns relatos não demonstrem modificações, outros sugerem que a concentração espermática esteja diminuindo e que a incidência de anormalidades do desenvolvimento como hipospádia e criptorquidia parecem estar aumentando, assim como a incidência de câncer de testículo. Estas preocupações sobre a possibilidade do ambiente estar contaminado com substâncias químicas - naturais ou sintéticas - que podem interagir com o sistema endócrino.

The development of intracytoplasmic sperm injection spawned new methods of sperm retrieval for men with obstructive azoospermia who did not want to undergo reconstruction of the seminal tract. There is a wide array of different procedures that may be performed in these cases, for instance percutaneous epididymal sperm aspiration (PESA) and microepididymal sperm aspiration. However, concerns regarding the presence of sperm in a second PESA attempt due to possible fibrosis have been suggested by many authors. We evaluate if it is worthwhile to repeat percutaneous epididymal sperm aspiration.The records of 20 patients (23 attempts) who underwent repeat PESA from January 1996 to September 2000 for assisted reproductive technique purposes were reviewed. In all patients the repeat procedure was performed on the same side as the previous PESA. Data were collected on patient age, presence of motile sperm during PESA, epididymal side, pregnancies and abortion rates.Mean patient age +/- SD was 32.4 +/- 5.6 years. One patient was excluded from our analysis due to lack of information on the chart regarding the side of the procedure. Repeat PESA was performed in the right epididymis in 12 attempts and in the left in 10. Of the remaining 19 patients 14 (73.68%) did not and 5 (26.3%) have sperm in the epididymal fluid. In these 5 patients 8 repeat PESA procedures were performed (3 procedures in 1 and motile sperm was always found (8 of 22 attempts, 36.4%). Three patients achieved pregnancy with the motile sperm retrieved from the repeat PESA (3 of 8 repeat attempts, 37.5%). No abortions were detected.More than a third of repeat PESA attempts resulted in the presence of motile sperm. Before performing testicular sperm aspiration or extraction in patients who have undergone previous PESA without achieving pregnancy, repeat PESA may be done. Further attempts should be added in the future to confirm these results.

The incidence of vasal injury during inguinal herniorrhaphy is estimated at 0.5%. We sought to assess the patency rates and long-term fertility outcome after microsurgical repair of vasal obstruction related to prior inguinal herniorrhaphy. METHODS: Twenty procedures were performed on 13 men diagnosed with infertility and vasal injury secondary to previous inguinal herniorrhaphy. Eight of these men had undergone bilateral and 5 unilateral inguinal herniorrhaphy. Twelve procedures were vasovasostomies, 3 were crossover vasovasostomies, 2 were vasoepididymostomies, and 3 were crossover vasoepididymostomies. Eight patients were azoospermic, 2 were severely oligospermic (

To evaluate gonadal function in male adolescents and young men with juvenile onset systemic lupus erythematosus (SLE).Four young men with SLE underwent clinical and laboratory evaluation, testicular ultrasound, follicle stimulating hormone, luteinizing hormone, prolactin, testosterone, and anti-sperm antibody determination. The semen analyses were performed according to the WHO guidelines and Kruger strict criteria. All patients were asked to provide 3 semen samples over a period of 2 months. A new sample was collected 6 months later.The median disease duration was 6.6 years. The median age at initial ejaculation was 13.5 years. All 4 patients had severe disease with renal involvement (WHO class IV or V). The SLICC/ACR damage index at the time of study entry ranged between 0 and 3. The patients' Tanner stage was P5G5; all reported normal erection and libido. Gonadal evaluation by thorough examination of the genitalia and ultrasound was normal. Anti-sperm antibodies were negative in all patients. Only one patient showed high FSH and LH levels. The initial and final semen evaluations of the 4 patients were abnormal (azoospermia, oligoastenoteratospermia, or teratospermia). One patient was receiving azathioprine and 2 were receiving cyclophosphamide at the time of study entry.Although these patients had normal sexual activity and normal external genitalia, their fertility was decreased based on the sperm abnormalities. Serial semen analyses in larger study populations will be necessary to clarify the degree and duration of sperm abnormalities in male patients with SLE in general.

We assessed fertilization, pregnancy and miscarriage rates in patients with obstructive and nonobstructive azoospermia who underwent intracytoplasmic sperm injection.From June 1996 to March 2000, 166 consecutive patients (198 intracytoplasmic sperm injection cycles) with azoospermia were studied. Of these 198 cycles 68 were performed due to nonobstructive azoospermia using testicular spermatozoa and 130 were performed due to obstructive azoospermia using epididymal spermatozoa.The normal (2 pronuclei) and abnormal (1 plus 3 pronuclei) fertilization rates for obstructive and nonobstructive azoospermia were 60.5% and 16.6%, and 54% and 16.4%, respectively (p0.05). The pregnancy rate per cycle, pregnancy rate per patient and abortion rate were 30%, 39.8% and 28% for obstructive azoospermia, and 22%, 28.3% and 40% for nonobstructive azoospermia (p0.05). The normal and abnormal fertilization rates were 58.7% and 21.4% for percutaneous epididymal sperm aspiration (PESA), 62.3% and 10.4% for PESA plus testicular sperm aspiration (TESA), and 57.3% and 14.5% for TESA, respectively (p0.05). The pregnancy rate per cycle, pregnancy rate per patient and abortion rate were 34.6%, 54.5% and 11.1% for PESA, 37.5%, 37.5% and 33.3% for PESA plus TESA, and 26.1%, 31% and 41% for TESA, respectively (PESA versus PESA plus TESA p0.05, and PESA and PESA plus TESA versus TESA p0.05). Epididymal or testicular motile sperm resulted in a lower abortion rate than epididymal or testicular immotile sperm (p = 0.03).No differences were noted in the fertilization and embryo transfer rates irrespective of etiology (obstructive versus nonobstructive) and type of spermatozoa (epididymal versus testicular). Testicular sperm retrieval results in lower fertilization and pregnancy rates as well as higher abortion rates than epididymal sperm retrieval.

All men with testicular cancer may opt for banking sperm if they wish to retain the ability to have children.

Objectives. An association between prostatitis and male infertility has been suspected, yet is poorly understood. Prostatitis is often associated with granulocytes in the prostatic fluid that generate reactive oxygen species (ROS), known to impair male fertility. We compared ROS, the total antioxidant capacity (TAC), and a novel index of oxidative stress (ROS-TAC score) in patients with chronic prostatitis and in healthy controls. Methods. Semen specimens from 36 men with chronic prostatitis (National Institutes of Health category IIIa), 8 men with prostatodynia (National Institutes of Health category IIIb), and 19 controls attending our urologic clinic were examined according to the World Health Organization criteria. Leukocytospermia was measured by the Endtz test (myeloperoxidase assay). ROS and TAC production was measured by chemiluminescence assay. A composite ROS-TAC score was also calculated in patients and controls. Results. The sperm concentration, percentage of motility, and morphology among the groups did not differ. The mean ± standard error log-transformed ROS level was significantly higher in patients with leukocytospermia (3.2 ± 0.6) than in patients without leukocytospermia (1.8 ± 0.2; P = 0.04) and controls (1.3 ± 0.3, P = 0.01). TAC was significantly lower in patients with or without leukocytospermia (859.69 ± 193.0 and 914.9 ± 65.2, respectively) than in controls (1653.98 ± 93.6, P = 0.001). The mean ROS-TAC score of controls (50.0 ± 4.1) was significantly higher than those of patients with chronic prostatitis and leukocytospermia (8.2 ± 9.2) and those without leukocytospermia (34.2 ± 2.9; P Conclusions. Men with chronic prostatitis or prostatodynia have seminal oxidative stress, irrespective of their leukocytospermia status. These observations may help shed light on the long-standing controversy surrounding prostatitis and infertility.

There is growing evidence that oxidative stress significantly impairs sperm function, and plays a major role in the aetiology The imbalance between reactive oxygen species (ROS) of defective sperm function. This may lead to the onset of production and total antioxidant capacity (TAC) in seminal male infertility via mechanisms involving the induction of fluid indicates oxidative stress and is correlated with male peroxidative damage to the plasma membrane (Jones et al., infertility. A composite ROS‐TAC score may be more 1979; Aitken and Clarkson, 1987; Iwasaki and Gagnon, 1992; strongly correlated with infertility than ROS or TAC alone. Aitken and Fischel, 1994; Sharma and Agarwal, 1996; Griveau We measured ROS, TAC, and ROS‐TAC scores in semen and Le Lannou, 1997). Both spermatozoa and seminal plasma from 127 patients and 24 healthy controls. Of the patients, possess antioxidant systems capable of counteracting the harm56 had varicocele, eight had varicocele with prostatitis, 35 ful affects of ROS. Studies have demonstrated that infertile had vasectomy reversals, and 28 had idiopathic infertility. men are more likely than fertile ones to have depressed total ROS levels were higher among infertile men, especially antioxidant capacity (TAC) and lower levels of individual those with varicocele with prostatitis (mean K SE, 3.25 K antioxidants (Smith et al., 1996; Lewis et al., 1995, 1997). 0.89) and vasectomy reversals (2.65 K 1.01). All infertile The production of abnormal levels of ROS is thought to be groups had significantly lower ROS‐TAC scores than con- involved in many aspects of male infertility, where spermatozoa trol. ROS‐TAC score identified 80% of patients and was are rendered dysfunctional by lipid peroxidation and altered significantly better than ROS at identifying varicocele and membrane function, together with impaired metabolism, moridiopathic infertility. The 13 patients whose partners later phology, motility, and fertility (Cummins et al., 1994). Men achieved pregnancies had a mean ROS‐TAC score of whose spermatozoa produce excessive ROS are less likely 47.7 K 13.2, similar to controls but significantly higher to impregnate their wives through natural intercourse. The than the 39 patients who remained infertile (35.8 K 15.0; incidence of spontaneous pregnancy is negatively correlated P < 0.01). ROS‐TAC score is a novel measure of oxidative with the generation of ROS in approximately 50% of oligozoostress and is superior to ROS or TAC alone in discriminat- spermic patients who exhibit increased ROS production (Aitken ing between fertile and infertile men. Infertile men with et al., 1991). male factor or idiopathic diagnoses had significantly lower Various clinical diagnoses are unable to determine the ROS‐TAC scores than controls, and men with male factor underlying cause of sperm dysfunction and pathophysiology diagnoses that eventually were able to initiate a successful of infertility. Since oxidative stress has been demonstrated to pregnancy had significantly higher ROS‐TAC scores than play a key role in male infertility, it is imperative to identify those who failed. measures that would help predict, with accuracy, if oxidative

To evaluate seminal oxidative stress in men after vasectomy reversal and to determine whether seminal oxidative stress could predict fertility after vasectomy reversal.Measurement of seminal reactive oxygen species (ROS) and total antioxidant capacity (TAC) in normal donors, men who were fertile after vasectomy reversal, and men who were infertile after vasectomy reversal.A male infertility clinic of a tertiary care center.Thirty men who underwent vasectomy reversal and 17 normal donors.None.Semen characteristics, seminal ROS, and TAC were measured with chemiluminescence assays in samples from donors and reversal patients.Mean adjusted seminal ROS (log [ROS+1]) was higher in infertile reversal patients (2.38+/-0.25) than in normal donors (1.30+/-0.14). Seminal ROS was also higher in all (fertile and infertile reversal combined) reversal patients than in donors. Total antioxidant capacity did not differ between groups. The ROS-TAC score, a composite index of seminal oxidative stress, was a significant predictor of fertility. A ROS-TAC score of 45 or greater had a positive predictive value of 73% in predicting fertility.Seminal oxidative stress is associated with vasectomy reversal. The ROS-TAC score is a possible predictor of infertility after vasectomy reversal.After undergoing sterilization through vasectomy, a considerable number of men request a reversal of the procedure to restore their fertility. While advances in surgical technique have resulted in patency rates of 71-97%, there exists a 26-72% chance of persistent infertility following a reversal procedure. Knowing that oxidative stress is an important cause of male infertility, the authors explored whether such stress was found after vasectomy reversal and if a measure of oxidative stress could predict infertility after such procedures. 30 fertile and infertile men who underwent vasectomy reversal and 17 normal donors at a male infertility clinic were recruited for the study. Mean adjusted seminal reactive oxygen species (ROS) was higher among infertile reversal patients than in normal donors. Seminal ROS was also higher in all reversal patients than in donors, although total antioxidant capacity (TAC) did not differ between groups. The ROS-TAC score, a composite index of seminal oxidative stress, was a significant predictor of fertility. A ROS-TAC score of 45 or greater had a positive predictive value of 73% in predicting fertility. Seminal oxidative stress is therefore associated with vasectomy reversal and the ROS-TAC score is a possible predictor of infertility after vasectomy reversal.

Introduction and Objective: Cigarette smoke is a known somatic cell mutagen and carcinogen and it is known to adversely affect male reproductive health. Even though studies have shown the harmful effets of smoking on sperm quality, a handful of studies have found no association between smoking and sperm function or sperm nuclear DNA damage. Superoxide dismutase (SOD) and catalase are important antioxidant enzymes that can quench excess free radicals such as: superoxide anion and hydrogen peroxide respectively. The objective of our study was to evaluate and correlate the seminal antioxidant enzymatic activity (SOD and catalase levels) among fertile and infertile men who are cigarette smokers. Methods: The Institutional Review Board approved this study. Ten fertile donors and 112 infertile patients were included in the study. Semen analysis was performed according to the World Health Organization guidelines and sperm morphology according to Kruger strict criteria. Superoxide dismutase and catalase levels were determined with a spectrophotometer. Results: A significant difference was noted in the number of cigarettes smoked/day between infertile (4.8 ± 0.9) and fertile men (1.5 ± 0.5; p = 0.03). Significantly lower levels of SOD (14.67 ± 12.27 and 38.03 ±21.65) and catalase (14.87 ± 16.95 and 34.03 ± 20.65) were seen in infertile patients compared to fertile donors (P

While the idea of freezing human male gametes has been experimented since the late 1700's, it was not until 50 years ago that human sperm were frozen, and later thawed in such a way that they could fertilize an egg and initiate development. In the past several decades the technology of cryopreservation, or maintaining life in a frozen state, has advanced considerably. With the use of modern techniques, cryopreservation of sperm to preserve an individual's ability to reproduce has become successful, safe, and widely available. In the past several decades the technology of cryopreservation, or maintaining life in a frozen state, has advanced considerably preserving the ability of sperm to maintain its fertilizing potential.