A live birth resulting from a fourth cesarean scar pregnancy after combined hysteroscopic and laparoscopic uterine repair: A case report and literature review

Cesarean scar pregnancy(CSP)is a rare form of ectopic pregnancy that is defined as a pregnancy sac located within the scar of a previous cesarean section.Recurrent cesarean scar pregnancy(RCSP)is even more uncommon,1 with Hasegawa et al reporting the first RCSP in 2005.2 RCSP is a high-risk pregnancy condition with potential complications that include heavy bleeding,uterine rupture,and maternal shock.The exact incidence rates for CSP and RCSP are unknown,although the incidence of CSP is 1/2656–1/1800 of the total number of cesarean sections,and the incidence of RCSP can reach 6.9%–34.3%.3,4,5 With the promulgation of the second and third child policies in China,an increasing number of patients now manifest fertility needs after cesarean section.With improvements in examination methods and awareness of CSP,we also suspect that the rates of CSP and RCSP may be even higher.Unfortunately,there is no standard treatment for CSP.We herein report a case in which the patient was treated by combined hysteroscopic and laparoscopic uterine repair without scar resection during the third RCSP,and the fourth RCSP occurred 6 months later;the patient then selected expectant management.The outcome was a successful cesarean section delivery of a live baby at 34 weeks of gestation,and the uterus was successfully preserved.Placental pathology was examined after delivery and revealed that the chorionic villi penetrated deeply into the myometrium.

Double versus single homologous intrauterine insemination for male factor infertility： a systematic review and meta-analysis

Male factor infertility affects 30%-50% of infertile couples worldwide, and there is an increasing interest in the optimal management of these patients. In studies comparing double and single intrauterine insemination （IUI）, a trend towards higher pregnancy rates in couples with male factor infertility was observed. Therefore, we set out to perform a meta-analysis to examine the superiority of double versus single IUI with the male partner＇s sperm in couples with male factor infertility. An odds ratio （OR） of 95% confidence intervals （CIs） was calculated for the pregnancy rate. Outcomes were analysed by using the ManteI-Haesel or DerSimonian-Laird model accordingto the heterogeneity of the results. Overall, five trials involving 1125 IUI cycles were included in the meta-analysis. There was a two-fold increase in pregnancies after a cycle with a double IUI compared with a cycle with a single IUI （OR. 2.0; 95% CI. 1.07-3.75; P〈O.03）. Nevertheless, this result was mainly attributed to the presence of a large trial that weighted as almost 50% in the overall analysis. Sensitivity analysis, excluding this large trial, revealed only a trend towards higher pregnancy rates among double IUI cycles （OR. 1.58; 95% CI. 0.59-4.21）, but without statistical significance （P=0.20）. Our systematic review highlights that the available evidence regarding the use of double IUI in couples with male factor infertility is fragmentary and weak. Although there may be a trend towards higher pregnancy rates when the number of IUIs per cycle is increased, further large and well-designed randomized trials are needed to provide solid evidence toide current clinical practice.

Faster Healing Process by Sparing Intramural Myoma’s Pseudocapsule during Laparoscopic Myomectomy Compared with Removing It during Open Myomectomy

Uterine fibroids are the most common benign tumours in the reproductive system. They are proliferations of smooth muscle cells of the myometrium containing a large quantity of extracellular matrix and they are surrounded by a pseudo capsule of compressed areolar tissue and smooth muscle cells. They can cause various symptoms such as menorrhage, pain and infertility and therefore they can be a traumatic experience for several women. The treatment of choice is myomectomy. In the past, myomectomy was performed by relatively atraumatic techniques, which involved stretching the myoma from its pseudocapsule to extract the fibroid directly from the surrounding fibromuscular tissue, breaking up the fibrous bridge. Modern laparoscopic intracapsular myomectomy (LIM), however, leaves the fibrovascular network surrounding the myoma (namely the “fibroid neurovascular bundle”) intact which reduces the bleeding and/or uterine musculature trauma, and spares the neuropeptide fibers of the pseudocapsule. In this observational study, we compare the two techniques-laparoscopic intracapsular myomectomy (LIM) and conventional abdominal myomectomy (CAM) regarding the longterm uterine healing and a significantly faster healing process of the uterine incision was achieved by LIM compared to CAM.

Chronic cornual ectopic pregnancy presenting as large cornual mass after in vitro fertilization-embryo transfer:A case report

Chronic cornual ectopic pregnancy is rare.A 37-year-old woman,G1P0,presented with cornual mass,mild vaginal bleeding,and low serum human chorionic gonadotropin.Cornuostomy and cornual repair were performed by laparoscopy.With atypical symptoms,chronic cornual ectopic pregnancy is a challenge for the gynecologists to make accurate diagnosis and effective treatment.

Prevention,diagnosis,and management of interstitial pregnancy:A review of the literature

Objective:The incidence of interstitial pregnancy(IP)has increased by using assisted reproductive technology,especially after ipsilateral salpingectomy.This review aimed to examine the current state of prevention,risk factors,diagnosis,and management of IP,based on the current literature.Data sources:We searched PubMed for English language articles published up to June 2018.The search terms included interstitial pregnancy,ectopic pregnancy or cornual pregnancy,angular pregnancy,and combinations of these terms.Study selection:Articles were obtained and reviewed to analyze risk factors,diagnosis,prevention,and management of IP.Results:Ipsilateral salpingectomy is the main high-risk factor of IP,especially after in vitro fertilization.Cornual suture at the time of salpingectomy helps to reduce the IP rate.Laparoscopic cornuostomy appears to be an effective treatment in intact cases,although it sometimes needs to be combined with methotrexate therapy in ruptured cases complicated by persistent disease.

Outcomes of patients who have undergone laparoscopic abdominal cerclage:A retrospective study

Objective:This study aims to evaluate the surgical morbidity and obstetric outcomes following in-pregnancy or pre-pregnancy laparoscopic abdominal cerclage(LAC)for patients who were diagnosed with refractory cervical insufficiency or had a short cervix.Methods:A retrospective study was conducted on patients undergoing LAC between May 2017 and May 2019 at the Department of Obstetrics and Gynecology,Sir Run Run Shaw Hospital.The patients were diagnosed with refractory cervical insufficiency based upon a previous failed transvaginal cervical cerclage(TVC),or had a short cervix who were considered unsuitable for a TVC after a previous cervical procedure.All patients were followed-up after surgery with transperineal ultrasonography until May 2020.Subsequently,surgical and obstetric data were collected and analyzed.Results:In total,44 patients underwent LAC,with 8 patients in-pregnancy and 36 pre-pregnancy.For the patient with pre-pregancy LAC,the pregnancy rate was 80.6%(29/36),including 3 patients with first-trimester loss,1 patient with an ectopic pregnancy,and 25 patients with a delivery.For the remaining 7 patients,3 did not conceive,and another 4 had no pregnancy plans.All the patients with in-pregnancy LAC had a delivery.The“take-home baby”rate was 89.2%(33/37),with a live-birth rate of 100%and a neonatal survival rate of 100%for both patients with in-pregnancy and pre-pregnancy LAC.For patients with in-pregnancy LAC,75.0%(6/8)patients delivered at≥37 wk of gestation,12.5%(1/8)delivered between 34 and 36^(+6)wk,and 12.5%(1/8)delivered between 28 and 33^(+6)wk.For patients with pre-pregnancy LAC,80.0%(20/25)patients delivered at≥37 wk of gestation,16.0%(4/25)delivered between 34 and 36^(+6)wk,and 4.0%(1/25)delivered between 28 and 33^(+6)wk.No adverse-event intra-operative or post-operative sequelae were noted.Conclusions:LAC is an effective and safe procedure that results in remarkable obstetric outcomes for women with refractory cervical insufficiency,or with a short cervix who are considered unsuitable for a TVC.The success rate of in-pregnancy or pre-pregnancy LAC depends on a full evaluation of patients,a proper peri-operative management and close follow-up.

Laparoscopic coring-type resection of noncommunicating broadly attached rudimentary horn with recurrent large ovarian endometriomas:A report of two cases

Rudimentary horn of the uterus is a rare congenital malformation that is characterized by significant anatomic variability.We report two cases involving women who presented with a broadly attached rudimentary horn and large ovarian endometriomas that were innovatively treated by laparoscopic coring-type dissection of the rudimentary horn of the uterus.This novel surgical approach ensured the integrity of the myometrium of the unicornuate uterus and avoided uterine rupture during pregnancy and ipsilateral ovarian function impairment.

Abdominal pregnancy secondary to iatrogenic uterine perforation: A case report and literature review

Abdominal pregnancy is a rare and life-threatening form of ectopic pregnancy.It is defined as an ectopic pregnancy in a region of the peritoneal cavity that does not include the fallopian tubes,ovaries,or their associated ligamentous structures.Many abdominal pregnancies are caused by secondary implantation in the peritoneal cavity after tubal abortion,rupture,or uterine rupture.Here,we report a case of abdominal pregnancy resulting from iatrogenic uterine perforation during the induced abortion of an early intrauterine pregnancy,which had been misdiagnosed as a ruptured corpus luteum cyst due to the sudden rupture of the abdominal gestational sac,complicating intra-abdominal hemorrhage.The true diagnosis was missed by vaginal ultrasound and confirmed by laparoscopic exploration.We discuss the details of the case management and review the relevant literature.©2023 Zhejiang University.

Successful delivery of unicornuate uterus pregnancy after laparoscopic cervical cerclage: A case report

There are few reports of the successful delivery of unicornuate uterus pregnancy after laparoscopic cervical cerclage.Here,we report a 32-year-old woman,gravida 2 para 1,who had been admitted for unicornuate uterus pregnancy by a thawed frozen blastocyst transplantation.She accepted laparoscopic cervical cerclage for cervical insufficiency and delivered successfully via caesarean section at 35^(+3) weeks.Cervical cerclage may be used as an effective method of preventing abortion in unicornuate uterus pregnancy,while surgery by laparoscopy would be a better choice for patients with poor cervical condition.Obstetricians should pay due attention to complications such as uterine rupture for these highrisk patients.

随机对比两种不同囊胚分级系统

A more detailed blastocyst grading system provides a better selection of blastocysts with the highest implantation potential. Grading systems will help to decrease the number of blastocysts to be transferred without compromising high implantation and pregnancy rates.

The cervical function and pregnancy outcomes after hysteroscopic resection of the complete uterine septum,duplicate cervix and vaginal septum

Objective:To evaluate cervical function and pregnancy outcomes after hysteroscopic resection of the complete uterine septum,duplicate cervix and vaginal septum with Metzenbaum scissors.Methods:Between January 2010 and December 2016,13 patients admitted to the Department of Obstetrics and Gynecology of Sir Run Run Shaw Hospital with complete uterine septum,duplicate cervix and vaginal septum,were enrolled into this study.The cervical and corporal septum was cut by Metzenbaum scissors,and residual septum was cut by micro scissors under hysteroscopy.The vaginal septum was cut with the unipolar electric knife.Results:The operation time was about 10±1.31 min.All the 13 patients present normal uterine cavities without scar formation under hysteroscopy at 3 months after operation,there was mild adhesions between anterior and posterior intrauterine wall on 2 cases.After operation,there were 13 pregnancies naturally conceived in 11 patients,10 deliveries.The live birth rate was 76.92%,the early miscarriage rate was 23.08%.The cesarean section ratewas 30%,the vaginal delivery ratewas 70%,and all were term births.Conclusion:The operation was simple,convenient,and fast,without any complications and cervical insufficiency.It was easy to have vaginal deliveries.

Effect of modified laparoscopic salpingectomy on ovarian reserve:Changes in the serum antimüllerian hormone levels

Objective:To retrospectively estimate the impact of modified laparoscopic salpingectomy on the ovarian reserve in infertile women.Methods:There were 74 infertile women undergone modified laparoscopic salpingectomy from June 2016 to January 2017,and their levels of serum antimüllerian hormone,basal follicle-stimulating hormone and estradiol were reviewed retrospectively.Results:No significant change was detected in serum antimüllerian hormone at 3 months after surgery compared to preoperative level(p=0.857).Similar changes were observed for the basal follicle-stimulating hormone(p=0.102)and estradiol(p=0.233)level.Conclusions:Our results revealed that modified laparoscopic salpingectomy might be a valuable treatment for hydrosalpinx before in vitro fertilization.

Factors associated with the incidence of ectopic pregnancy in women undergoing assisted reproductive treatment

Background:Ectopic pregnancy(EP)is a common complication in women undergoing assisted reproductive treatment,but the underlying causes for this remain unclear.This study aimed to explore factors affecting the incidence of EP in in vitro fertilization(IVF)/intracytoplasmic sperm injection(ICSI).Methods:This was a retrospective study on the incidence of EP in IVF/ICSI cycles between January 1,2013 and December 31,2017.Patient age,infertility diagnosis(tubal factor or not),primary or secondary infertility,type of cycle(frozen-thawed or fresh),type of embryo(s)transferred(cleavage embryo or blastocyst),number of embryos transferred(one,two,or three),previous history of EP,and endometrial combined thickness were analyzed to explore their relationships with the incidence of EP.Based on clinical typing results,the patients were divided into an EP group or a non-EP group.Categorical variables were analyzed using Chi-squared test or Fisher exact test.Logistic regression analysis was performed to explore their associations with the incidence of EP.Results:The percentage of patients with primary infertility in EP group was significantly lower than that in non-EP group(31.3%vs.46.7%,χ^2=26.032,P<0.001).The percentage of patients with tubal infertility in EP group was also significantly higher than that in non-EP group(89.2%vs.63.6%,χ^2=77.410,P<0.001).The percentages of patients with transfer of cleavage-stage embryo or blastocyst(91.4%vs.84.4%,χ^2=10.132,P=0.001)and different endometrial combined thickness(ECT)(χ^2=18.373,P<0.001)differed significantly between EP and non-EP groups.For patients who had a previous history of one to four EPs,the percentage of patients undergoing transfer of a cleavage-stage embryo was significantly higher in EP group than that in non-EP group(92.2%vs.77.6%,χ^2=13.737,P<0.001).In multivariate logistic regression analysis,tubal infertility was strongly associated with EP(adjusted odds ratio:3.995,95%confidence interval:2.706-5.897,P<0.001).Conclusions:In IVF/ICSI cycles,transfer of a blastocyst-stage embryo,especially for patients with a previous history of EP,reduced the rate of EP.Tubal infertility was strongly associated with EP.

Outcome of conservative treatment and subsequent assisted reproductive technology for patients with early-stage endometrial adenocarcinoma and poor fertility potential

Conservative treatment with high doses of progestin is an alternative to standard hysterectomy for young patients with early-stage endometrial adenocarcinoma who desire to preserve their fertility. Here we report a patient with well-differentiated early-stage endometrial adenocarcinoma and poor fertility potential who failed to become pregnant in two in vitro fertilization-embryo transfer cycles and suffered a relapse after conservative treatment. This case illustrates that assessment of fertility potential is critical at the time of initial evaluation and conservative treatment planning for patients with endometrial adenocarcinoma.

Advanced Role of Hippo Signaling in Endometrial Fibrosis： Implications for Intrauterine Adhesion

Objective： Intrauterine adhesion （IUA） is a major health problem that causes infertility, menstrual irregularities, and recurrent pregnancy losses in women. Unfortunately, treatments for IUA are limited, and there are currently no effective strategies for preventing IUA recurrence. In this review, we introduced the role of Hippo signaling in the normal endometrium and IUA and described the mechanisms by which the Hippo pathway integrates with the Wnt and transforming growth factor-β （TGF-β） signaling pathways to form an intricate network governing the development of fibrosis. Data Sources： Original research articles in English that were published until July 2017 were collected from the PubMed database. Study Selection： Literature search was conducted using the search terms ＂endometrial fibrosis OR fibrosis AND or OR intrauterine adhesion OR Asherman syndrome OR IUA,＂ ＂Hippo AND or OR Hippo/TAZ,＂ ＂TGF-β,＂ and ＂Wnt.＂ Related original research articles were included in the comprehensive analysis. Results： Endometrial fibrosis is recognized as a key pathological event in the development of IUA, which is characterized by epithelial/fibroblast-myofibroblast transition. Myofibroblasts play crucial roles in the pathogenesis of fibrous scarring, and myofibroblast differentiation can be triggered by multiple signaling pathways. H ippo signaling is a critical regulator of the epithelial/fibroblast-myofibroblast transition and α-smooth muscle actin, which exhibits a specific spatiotemporal expression in the endometrium. Conclusions： Hippo signaling plays a critical role in fibrous diseases and participates in cross talks with Wnt and TGF-β signaling. Our findings not only contributed to knowledge on the pathogenesis of endometrial fibrosis, but can also serve as a useful resource for developing specific molecular inhibitors for IUA treatment and prevention.

Outcome of in vitro fertilization in endometriosis-associated infertility： a 5-year database cohort study

Background Endometriosis affects natural fertility through various approaches, and in vitro fertilization （IVF） is a good treatment. But the IVF result of endometriosis patients is still under debate. We investigated the effect of endometriosis on IVF by analyzing the data from a single reproductive center. Methods A retrospective, database-searched cohort study was performed. Relevant information was collected from the electronic records of women who underwent IVF/intracytoplasmic sperm injection between January 2006 and December 2010 in the Assisted Reproductive Unit of Sir Run Run Shaw Hospital. Patients with endometriosis were enrolled the study group. The rest of the women formed the control group. The main outcome was the clinical pregnancy rate. Secondary outcomes were oocytes retrieved number, fertilization rate, high-quality embryo rate, number of high-quality embryo for embryo transplantation, and implantation embryo/high-quality embryo ratio （IE/HQE ratio）. Comparisons were performed by the z2-test and independent t-test. Results The endometriosis group （n=177） had a markedly lower oocytes retrieved number, fertilization rate, implantation rate, and clinical pregnancy rate （7.6_＋5.1, 63.6%, 27.7%, and 45.2%, respectively） compared with the non-endometriosis group （n=4267; 11.8＋7.3, 68.4%, 36.2%, and 55.2%, respectively）. Stratified analysis showed that this difference was found in the subgroup younger than 35-years old, while only fertilization rate and implantation rate were different in the elder subgroup. The ratio of high-quality embryos transferred is lower in endometriosis group （53.7% vs. 71.8%, P 〈0.05）, but there is no difference in IE/HQE ratio between two groups. There is no significant difference in fertilization rate, implantation rate, and clinical pregnancy rate between mild and severe endometriosis patients. Conclusions Endometriosis patients suffer a decreasing IVF pregnancy rates mainly caused by reducing oocytes number and fertilization rate, regardless of the severity of the disease. Appropriate intracytoplasmic sperm injection manipulation might improve the outcomes of IVF.

A frozen-thawed embryo transfer program improves the embryo utilization rate

Background Frozen-thawed embryo transfer （FET） is the most common way to prevent serious late ovarian hyperstimulation syndrome and increase the cumulative pregnancy rate. We evaluated the effectiveness of an FET program for improving the embryo implantation and clinical pregnancy rates, and ultimate embryo utilization rate in infertility treatment. Methods Patients undergoing in vitro fertilisation （IVF） cycles from January 2006 to June 2008 were enrolled, including 179 patients who had undergone the first FET cycle after controlled ovarian hyperstimulation （COH） in which all embryos were frozen （group C1） and 1306 patients who had COH with fresh embryo transfer （ET） （group T1）. Logistic regression was used to model the embryo implantation and clinical pregnancy rates based on the mother＇s age, numbers of oocytes retrieved, embryos transferred and high-quality embryos transferred. The embryo implantation and clinical pregnancy rates were also compared between two groups after adjusting for age, the numbers of oocytes retrieved and the numbers of embryos transferred. Results Logistic regression analysis confirmed that embryo implantation and clinical pregnancy rates in group C1 were both significantly higher than those in group T1 after adjusting for confounding factors （43.6% vs 29.0%, 63.1% vs 47.0%, respectively; P 〈0.01）. The embryo implantation and clinical pregnancy rates were consistently higher in group C1 by comparing the age groups ≥35 or 〈35 years. The clinical pregnancy rates for the numbers of oocytes retrieved per cycle being ≥15 or 〈15 were higher in group C1, as was the embryo implantation rate. These differences were statistically significant for oocyte numbers 〉15 （P 〈0.05）. The embryo implantation and clinical pregnancy rates in group C1 were both significantly higher than in group T1 when two or three embryos were transferred （P 〈0.05）. Conclusion A program of freezing all embryos and performing FET improved the rates of embryo implantation and clinical pregnancy, and ultimately enhanced the embryo utilization rate.

Endostatin inhibits hypertrophic scarring in a rabbit ear model

Objective： The present study was designed to use an in vivo rabbit ear scar model to investigate the efficacy of systemic administration of endostatin in inhibiting scar formation. Methods： Eight male New Zealand white rabbits were randomly assigned to two groups. Scar model was established by making six full skin defect wounds in each ear. For the intervention group, intraperitoneal injection of endostatin was performed each day after the wound healed （about 15 d post wounding）. For the control group, equal volume of saline was injected. Thickness of scars in each group was measured by sliding caliper and the scar microcirculatory perfusion was assessed by laser Doppler flowmetry on Days 15, 21, 28, and 35 post wounding. Rabbits were euthanatized and their scars were harvested for histological and proteomic analyses on Day 35 post wounding. Results： Macroscopically, scars of the control group were thicker than those of the intervention group. Significant differences between the two groups were observed on Days 21 and 35 （p〈0.05）. Scar thickness, measured by scar elevation index （SEI） at Day 35 post wounding, was significantly reduced in the intervention group （1.09±0.19） compared with the controls （1.36±0.28）. Microvessel density （MVD） observed in the intervention group （1.73±0.94） was significantly lower than that of the control group （5.63±1.78） on Day 35. The distribution of collagen fibers in scars treated with endostatin was relatively regular, while collagen fibers in untreated controls were thicker and showed disordered alignment. Western blot analysis showed that the expressions of type I collagen and Bcl-2 were depressed by injection of endostatin. Conclusions： Our results from the rabbit ear hypertrophic scar model indicate that systemic application of endostatin could inhibit local hypertrophic scar formation, possibly through reducing scar vascularization and angiogenesis. Our results indicated that endostatin may promote the apoptosis of endothelial cells and block their release of platelet-dedved growth factor （PDGF） and fibroblast growth factor （FGF）, thereby controlling collagen production by fibroblasts. Blood vessel-targeted treatment may be a promising strategy for scar therapy.

In situ delivery of apoptotic bodies derived from mesenchymal stem cells via a hyaluronic acid hydrogel:A therapy for intrauterine adhesions

Stem cell-based and stem cell-derived exosome-based therapies have shown promising potential for endometrial regeneration and the clinical treatment of intrauterine adhesions(IUAs).Evidence shows that apoptosis occurs in a majority of grafted stem cells,and apoptotic bodies(ABs)play a critical role in compensatory tissue regeneration.However,the therapeutic potential of AB-based therapy and its mechanism have not been explored in detail.Here,a cell-free therapeutic strategy was developed by incorporating mesenchymal stem cell-derived ABs into a hyaluronic acid(HA)hydrogel to achieve endometrial regeneration and fertility restoration.Specifically,we found that the ABs could induce macrophage immunomodulation,cell proliferation,and angiogenesis in vitro.The HA hydrogel promoted the retention of ABs and facilitated their continuous release.In a murine model of acute endometrial damage and a rat model of IUAs,in situ injection of the AB-laden HA hydrogel could efficiently reduce fibrosis and promote endometrial regeneration,resulting in the fertility restoration.Consequently,ABs show good potential as therapeutic vesicles,and the AB-laden HA hydrogel appears to be a clinically feasible and cell-free alternative for endometrial regeneration and IUA treatment.

AMP-activated kinase in human spermatozoa： identification, intracellular localization, and key function in the reRulation of sperm motility

AMP-activated kinase （AMPK）, a protein that regulates energy balance and metabolism, has recently been identified in boar spermatozoa where regulates key functional sperm processes essential for fertilization. This work＇s aims are AMPK identification, intracellular localization, and their role in human spermatozoa function. Semen was obtained from healthy human donors. Sperm AMPK and phospho-Thr172-AMPK were analyzed by Western blotting and indirect immunofluorescence. High- and low-quality sperm populations were separated by a 40%-80% density gradient. Human spermatozoa motility was evaluated by an Integrated Semen Analysis System （ISAS） in the presence or absence of the AMPK inhibitor compound C （CC）. AMPK is localized along the human spermatozoa, at the entire acrosome, midpiece and tail with variable intensity, whereas its active form, phospho-Thr172-AMPK, shows a prominent staining at the acrosome and sperm tail with a weaker staining in the midpiece and the postacrosomal region. Interestingly, spermatozoa bearing an excess residual cytoplasm show strong AMPK staining in this subcellular compartment. Both AMPK and phospho-Thr172-AMPK human spermatozoa contents exhibit important individual variations. Moreover, active AMPK is predominant in the high motility sperm population, where shows a stronger intensity compared with the low motility sperm population. Inhibition of AMPK activity in human spermatozoa by CC treatment leads to a significant reduction in any sperm motility parameter analyzed： percent of motile sperm, sperm velocities, progressivity, and other motility coefficients. This work identifies and points out AMPK as a new molecular mechanism involved in human spermatozoa motility. Further AMPK implications in the clinical efficiency of assisted reproduction and in other reproductive areas need to be studied.