Search

Purpose: Compliance with post-vasectomy semen analysis could be improved with the availability of a simple, rapid and accurate home test. SpermCheck Vasectomy®, a highly sensitive lateral flow immunochromatographic diagnostic device, was designed to detect extreme oligospermia or azoospermia in men after vasectomy. We report the results of clinical and consumer testing of SpermCheck. Materials and Methods: A prospective, noncomparative observational study assessed the ability of SpermCheck Vasectomy to predict post-vasectomy sperm counts obtained using a hemacytometer procedure based on standard World Health Organization methodology. Consumer studies evaluated ease of use. Results: A cohort of 144 post-vasectomy semen samples was tested in the clinical trial. SpermCheck was 96% accurate in predicting whether sperm counts were greater or less than a threshold of 250,000 sperm per ml, a level associated with little or no risk of pregnancy. Sensitivity was 93% (95% CI 79% to 98%) and specificity was 97% (91% to 99%). The positive predictive value of the test was 93% (79% to 98%), and most importantly the negative predictive value was 97% (91% to 99%). The test gave a positive result 100% of the time at sperm concentrations of 385,000/ml or greater. Consumer studies with 109 lay volunteers showed that SpermCheck was easy to use. Volunteers obtained the correct or expected test result in every case and the correct response rate on a 20 question survey about the test was 97%. Conclusions: SpermCheck Vasectomy, a simple and reliable immunodiagnostic test that can provide evidence of vasectomy success or failure, offers a useful alternative to improve compliance with post-vasectomy sperm monitoring. It is currently the only Food and Drug Administration approved test for this purpose.

Stem cells possess enormous therapeutic potential in tissue replacement. To study stem cells further, they must be isolated. Techniques are available for enrichment and study of hematopoietic stems cells, but thus far, techniques for purification of spermatogonial stem cells have not been described. Enrichment techniques for hematopoietic stem cells include the use of fluorescence-activated cell sorter analysis with Hoechst 33342 and rhodamine 123 (Rho) dyes. Use of Hoechst dye to isolate spermatogonial stem cells has been unsuccessful in our laboratory, and our results have conflicted with those from other laboratories. Taking advantage of the differential staining of the Rho dye, we report a novel method to enrich murine spermatogonial stem cells. Testicular cells are harvested from cryptorchid ROSA26 male mice. Populations of these cells are then stained with the Hoechst and Rho dyes, allowing them to be sorted by flow cytometry into a side population (SP) of Hoechst low-intensity cells and populations of low (Rho low ) or high (Rho hi ) fluorescent intensity. Sterile recipients, W/W v mice, with an intrinsic germ cell deficiency were transplanted with the Hoechst SP cells, Rho low , Rho hi , and nonsorted donor cells. No spermatogonial stem cell colonies were derived from the Hoechst SP cells. The number of spermatogonial stem cell colonies from transplanted Rho low cells showed a 17- and 20-fold enrichment over those of Rho hi and nonsorted cells, respectively. male reproductive tract, sperm, spermatogenesis, testis

There is a male factor involved in up to half of all infertile couples. Potential etiologies in male factor infertility are many and require thorough evaluation for their accurate identification. A complete medical history in conjunction with a focused examination can allow for an appropriate choice of laboratory and imaging studies. The semen analysis is a crucial first step, but by no means is it sufficient to determine a specific etiology or dictate therapy. A systematic approach is necessary to help guide the work-up and rule out less likely causes. The etiologies discussed within this article are tremendously broad, and the prognosis for any given couple depends, in large part, on the etiology. Without a firm understanding of the genetics, anatomy, physiology, and complex interplay of the male reproductive system, the evaluation becomes an inefficient exercise that often fails to define the precise etiology. Couples with male factor infertility need a systematic approach with the efficiency of ultimate treatment determined largely by the physician's ability to identify the specific cause of the man's reproductive failure.

Normal spermatogenesis is a complex process that depends on many factors. Genetics plays a major role in many of these factors including providing a normal hormonal milieu, the development of the testis and ductal system, and control of the stepwise maturation of sperm in the testis. The Y chromosome plays a key role in testis determination and control of spermatogenesis. Understanding how these genes work together can elucidate of the exact cause of infertility in some patients once thought to have idiopathic infertility. It is not only important that patients understand the cause of their infertility. Using sperm from these men to attain pregnancies by assisted reproductive techniques will probably result in infertile male offspring. Additional consequences are currently unknown but are the topic of research investigations.

This chapter summarizes normal immune function and its relationship to immunologic infertility. The normal immune system identifies and destroys antigen within the body. The humoral immune system is suited to the destruction of whole, extracellular antigens, including most bacteria, larger parasites, and viruses. Antispermatogenic autoantigens induce autoimmunity to the germinal epithelium, resulting in a specific decline in sperm production due to germ cell destruction. Tail-directed sperm antibodies are more likely to impair motility and cause agglutination, sperm head-directed antibodies may preferentially affect zona binding and fertilization, as suggested by immobilization and penetration assays. Corticosteroids prevent the chemotaxis of inflammatory cells, impede cytokine release, decrease antibody production, and even weaken antigen-antibody association. Intrauterine insemination (IUI) is suited for treatment of infertility when there is evidence of cervical mucus problem, whether it is due to antibodies or not, as demonstrated by the inability of sperm to penetrate the cervical mucus.

Stem cells possess enormous therapeutic potential in tissue replacement. To study stem cells further, they must be isolated. Techniques are available for enrichment and study of hematopoietic stems cells, but thus far, techniques for purification of spermatogonial stem cells have not been described. Enrichment techniques for hematopoietic stem cells include the use of fluorescence-activated cell sorter analysis with Hoechst 33342 and rhodamine 123 (Rho) dyes. Use of Hoechst dye to isolate spermatogonial stem cells has been unsuccessful in our laboratory, and our results have conflicted with those from other laboratories. Taking advantage of the differential staining of the Rho dye, we report a novel method to enrich murine spermatogonial stem cells. Testicular cells are harvested from cryptorchid ROSA26 male mice. Populations of these cells are then stained with the Hoechst and Rho dyes, allowing them to be sorted by flow cytometry into a side population (SP) of Hoechst low-intensity cells and populations of low (Rho(low)) or high (Rho(hi)) fluorescent intensity. Sterile recipients, W/W(v) mice, with an intrinsic germ cell deficiency were transplanted with the Hoechst SP cells, Rho(low), Rho(hi), and nonsorted donor cells. No spermatogonial stem cell colonies were derived from the Hoechst SP cells. The number of spermatogonial stem cell colonies from transplanted Rho(low) cells showed a 17- and 20-fold enrichment over those of Rho(hi) and nonsorted cells, respectively.

There is a male factor involved in up to half of all infertile couples. Potential etiologies in male factor infertility are many and require thorough evaluation for their accurate identification. A complete medical history in conjunction with a focused examination can allow for an appropriate choice of laboratory and imaging studies. The semen analysis is a crucial first step, but by no means is it sufficient to determine a specific etiology or dictate therapy. A systematic approach is necessary to help guide the work-up and rule out less likely causes. The etiologies discussed within this article are tremendously broad, and the prognosis for any given couple depends, in large part, on the etiology. Without a firm understanding of the genetics, anatomy, physiology, and complex interplay of the male reproductive system, the evaluation becomes an inefficient exercise that often fails to define the precise etiology. Couples with male factor infertility need a systematic approach with the efficiency of ultimate treatment determined largely by the physician's ability to identify the specific cause of the man's reproductive failure.

There is a male factor involved in up to half of all infertile couples. Potential causes of male factor infertility are many and require thorough evaluation for their accurate elucidation. A complete medical history in conjunction with a focused examination can allow for an appropriate choice of laboratory and imaging studies. The semen analysis is a crucial first step, but it is by no means sufficient to determine cause or dictate therapy. A systematic approach is necessary to help guide the evaluation and exclude less likely causes. The causes discussed within this article are broad, and the prognosis for any given couple depends, in large part, on the cause of the infertility. Without a firm understanding of the genetics, anatomy, physiology, and their interactions necessary to permit full functioning of the male reproductive system, the evaluation becomes an inefficient exercise that often fails to elucidate the precise cause of infertility. Treatment success relies not just on a clinical diagnosis but on a determination of the cause of the male factor infertility. Therefore, couples with a component of male factor infertility need a systematic evaluation directed at the male partner to maximize their reproductive potential.

Many aspects of male fertility are influenced by genetics. Over 150 genes have been shown to be associated with infertility in mouse models, although translation of these findings to human male infertility has been slow. Nevertheless, it is likely that a significant number of these gene deletions may be associated with human infertility. There is much that we do not understand about the molecular basis of human male infertility; patients should be advised of this caveat. Genetic disorders in humans can lead to impaired spermatogenesis, defective sperm function, and defects in delivery of sperm. It is critical for the urologist who evaluates and treats infertile couples to have a working knowledge of these disorders. An understanding of the genetic basis of male infertility allows for the appropriate counseling of patients about treatment options and risks to their potential offspring.

As childbirth is delayed and divorce rates remain high, urologists will continue to see more and more infertile couples. It is imperative that urologists understand at least the basic aspects of the female evaluation. Fundamental information can be obtained from a simple, directed history. Risk factors for female infertility can be identified in a matter of minutes, and the reproductive endocrinologist can then carry out a complete female evaluation simultaneously with the male evaluation. Most female infertility problems can be classified as ovulatory, anatomic, or cervical. Signs of decreasing ovarian reserve with age can be ascertained easily with a history and perhaps the determination of a day-3 serum FSH level. Finally, a basic understanding of the female evaluation allows meaningful discourse between the urologist and the reproductive endocrinologist, leading to a more effective treatment plan for the infertile couple.

Inguinal vasal obstruction (IVO) is an uncommon and potentially unrecognized cause of azoospermia in the male infertility patient. Consequently, the true incidence of vasal obstruction is unknown. Known causes of IVO usually are related to inguinal herniorrhaphy and may result from iatrogenic vasal ligation or injury, vascular compromise, or extrinsic compression. Recently, we have identified a group of patients with IVO associated with polypropylene mesh used in inguinal herniorrhaphy. Inguinal herniorrhaphy is the operation most commonly performed by general surgeons with approximately 750,000 performed annually in the United States.1 An estimated 80% of these hernia operations involve placement of a knitted polypropylene monofilament mesh prosthesis to patch the defect in the floor of the inguinal canal.2 A “tension-free” repair is created and the spermatic cord is carefully placed on top of the mesh before closing.3 Subsequently, the prosthetic mesh induces an acute inflammatory reaction followed by a chronic foreign-body fibroblastic response that creates scar tissue and imparts strength to the floor.4–7 Clinically, open hernia repairs using the tension-free technique with polypropylene mesh have been shown to result in fewer recurrences than repairs using nonmesh methods.8 Laparoscopic hernia repairs using mesh apparently provide reports similar to those of open repairs but long-term data have not been reported.9 Regardless of surgical technique, little clinical information is available regarding the long-term effects of the polypropylene mesh on the vas deferens and other structures within the spermatic cord. One possible reason is that most men undergoing hernia repairs tend to be older and not concerned about maintaining their reproductive potential.7 However, with its widespread acceptance and ease of placement, polypropylene mesh repair is being offered increasingly to younger patients whose fertility status may well be an issue in the future. Although the estimated incidence of injury to the vas deferens is 0.3% in adult hernia repairs,10 only 1 case has been reported in the literature attributing secondary infertility to hernia repair with mesh.11 We report on a multiinstitutional experience of inguinal vasal obstruction related to tension-free herniorrhaphy using polypropylene mesh.