The Andrology Blog

The Science & Medicine of Male Reproduction

Ultrasound Guided Testis Fine Needle Aspiration.

Testicular sperm is healthy and can be used for ICSI.  A percutaneous approach offers some advantages over the open approach, namely in the faster recovery and less pain.

The testis aspiration retrieval when used with ultrasound guidance is safe.

When combined with color flow doppler, retrieval rates approach the open technique.

Finally, this approach is good for the couple who is unsure about whether to proceed with ovarian stimulation prior to IVF-ICSI or to proceed with donor IUI.

Placebo-controlled, double-blind, cross-over trial of glutathione therapy in male infertility

Published in the journal Human Reproduction:

A. Lenzi1, F. Culasso2, L. Gandini, F. Lombardo and F. Dondero

Glutathione therapy was used for 2 months in a placebo-controlled double-blind cross-over trial of 20 infertile patients with dyspermia associated with unilateral varicocele (VAR) or germ-free genital tract inflammation (INF). The patients received either glutathione (group 1) or placebo (group 2) for 2 months, then they crossed over to the alternative treatment for a further 2 months. The patients were randomly and blindly assigned to treatment (one i.m. injection every other day of either 600 mg glutathione or an equal volume of a placebo preparation). The standard semen analysis and the computer-assisted sperm motility analyses were carried out before treatment and during the trial. Statistical cross-over analysis, case-control study and treatment efficacy test were carried out on groups 1 and 2 and differences in the effects of therapy between VAR and INF patients with varicocele or inflammation were tested. Glutathione therapy demonstrated a statistically significant positive effect on sperm motility, in particular on the percentage of forward motility, the kinetic parameters of the computerized analysis and on sperm morphology. The findings of this study indicate that glutathione therapy could represent a possible therapeutical tool for both of the selected andrological pathologies.

The result of intracytoplasmic sperm injection is not related to any of the three basic sperm parameters

From the authors below and published in the journal Human Reproduction.

Z.P. Nagy1,2, J. Liu1, H. Joris1, G. Verheyen1, H. Tournaye1, M. Camus1, M.-P. Derde3, P. Devroey1 and A.C. Van Steirteghem1

High success rates have been reported for the use of intracytoplasmic sperm injection (ICSI) in alleviating essentially andrological infertility. However, neither the relationship between any of the sperm parameters and the result of ICSI nor the minimal sperm requirements for ICSI have been investigated so far. In this paper, our objective was therefore to study the relationship between three basic sperm parameters (total sperm count, sperm motility and morphology) and the outcome of ICSI by retrospective analyses of fertilization, embryo development and pregnancy rates in 966 micro-injection cycles, performed with ejaculated semen. The results showed that there was no important influence from either the type or the extent of sperm impairment on the outcome of ICSI. Even in the most extreme cases of male-factor infertility, where cryptozoospermia or total astheno- or total teratozoospermia was diagnosed in the initial semen sample, high fertilization and pregnancy rates were obtained by ICSI. Only one condition had a strongly negative influence on the result of ICSI: where an immotile (presumably dead) spermatozoon was injected into the oocyte. Thus the only ultimate criterion for successful ICSI is the presence of at least one living spermatozoon per oocyte in the pellet of the treated semen sample used for micro-injection.

Hypoosmotic Swelling (HOS) Assay

Hypoosmotic Swelling (HOS) Assay

Sperm with a physically intact and functionally active membrane will respond to changes in osmolality. This property of the sperm is utilized in the HOS assay which has been shown to correlate highly with the ability of sperm to fertilize intact human oocytes in vitro. It also appears to predict in vitro fertilizing capacity of spermatozoa more reliably than the standard sperm parameters.

Dr S

Healthy sperm post-vasectomy

This always seems to come up in discussions with patients and embryologists with whom I work:

  • After a vasectomy, where can the healthiest sperm be found?

The answer is the testicle.  Sperm located in the epididymis after a vasectomy is often damaged and non-functional.  A normal epididymis has many functions that include sperm maturation, transport, and development.  After a vasectomy, this critical epididymal functions get disrupted. The testicle, on the other hand, continues to produce healthy sperm as if nothing ever happened.  This testicular sperm can be used for ICSI.

After a vasectomy, testicular sperm can be retrieved with a simple, painless, in-office procedure.

Dr S

This is a microscopic image of a testicular biopsy specimen

This is a microscopic image of a testicular biopsy specimen

What is the essence of a male?

All males of all species have the same biological feature in common. This feature is truly what makes a male a male. Here it is:

Males make small sized gametes.

Gametes are reproductive cells, like sperm or egg. In all species of life from the human to the toad to the sunflower, females have large sex cells and males have small ones.

A common question: can sperm from a retrieval be used for IUI?

Many people ask me this question. The answer is no. Here is why:
1: Not enough motile sperm from a TESE
2: Not enough good quality sperm from a PESA or MESA
3: Simply does not work

For better results, try either having a vasectomy reversal or a sperm retrieval in conjunction with an IVF cycle.

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