Approximately 10%-15% of couples are infertile, and a male factor is involved in almost half of these cases. This observation is due in part to defects in spermatogenesis, and the underlying causes, including genetic ...Approximately 10%-15% of couples are infertile, and a male factor is involved in almost half of these cases. This observation is due in part to defects in spermatogenesis, and the underlying causes, including genetic abnormalities, remain largely unknown. Until recently, the only genetic tests used in the diagnosis of male infertility were aimed at detecting the presence of microdeletions of the long arm of the Y chromosome and/or chromosomal abnormalities. Various other single-gene or polygenic defects have been proposed to be involved in male fertility. However, their causative effects often remain unproven. The recent evolution in the development of whole-genome-based techniques and the large-scale analysis of mouse models might help in this process. Through knockout mouse models, at least 388 genes have been shown to be associated with spermatogenesis in mice. However, problems often arise when translating this information from mice to humans.展开更多
For years, the management and treatment of male factor infertility has been ‘experience＇ and not ‘evidence＇ based. Although not evidence-based, current clinical practice involves extensive use of assisted reproduc...For years, the management and treatment of male factor infertility has been ‘experience＇ and not ‘evidence＇ based. Although not evidence-based, current clinical practice involves extensive use of assisted reproductive techniques （ART）. Where specific treatments are not indicated or have failed, ART have become popular adjunctive treatments for alleviating male factor infertility. According to the limited evidence available, intrauterine insemination （IUI） may be considered as a first-line treatment in a couple in which the female partner has a normal fertility status and at least 1 × 10^6 progressively motile spermatozoa are recovered after sperm preparation. If no pregnancy is achieved after 3-6 cycles of IUI, optimized in vitro fertilization （IVF） can be proposed. When less than 0.5× 106 progressively motile spermatozoa are obtained after seminal fluid processing or sperm are recovered surgically from the testis or epididymis, intracytoplasmic sperm injection （ICSI） should be performed. Although the outcome of no other ART has ever been scrutinized as much before, no large-scale ‘macroproblems＇ have as yet been observed after ICSI. Yet, ICSI candidates should be rigorously screened before embarking on IVF or ICSI, and thoroughly informed of the limitations of our knowledge on the hereditary aspects of male infertility and the safety aspects of ART.展开更多
Spermatogonial stem cell （SSC） transplantation is a promising technique to circumvent sterility in prepubertal boys undergoing gonadotoxic treatments. While the cryopreservation of spermatogonial stem cells is being...Spermatogonial stem cell （SSC） transplantation is a promising technique to circumvent sterility in prepubertal boys undergoing gonadotoxic treatments. While the cryopreservation of spermatogonial stem cells is being introduced in clinical practices worldwide, a lot of unanswered questions remain regarding their eventual transplantation. In this paper autologous and allogeneic SSC transplantations in the testes of sterilized macaques were performed and spermatogenesis could be restored from donor SSCs. The spermatozoa obtained were competent to fertilize oocytes. This report proves the feasability of SSC transplantation in a primate model, hence reinforcing the hope that this strategy will eventually find its way into clinical practice.展开更多
Infertility affects 10%–15%of couples worldwide.Of all infertility cases,20%–70%are due to male factors.In the past,men with severe male factor(SMF)were considered sterile.Nevertheless,the development of intracytopl...Infertility affects 10%–15%of couples worldwide.Of all infertility cases,20%–70%are due to male factors.In the past,men with severe male factor(SMF)were considered sterile.Nevertheless,the development of intracytoplasmic sperm injection(ICSI)drastically modified this scenario.The advances in assisted reproductive technology(ART),specifically regarding surgical sperm retrieval procedures,allowed the efficacious treatment of these conditions.Yet,before undergoing ICSI,male factor infertility requires careful evaluation of clinical and lifestyle behavior together with medical treatment.Epidemiologically speaking,women whose male partner is azoospermic tend to be younger and with a better ovarian reserve.These couples,in fact,are proposed ART earlier in their life,and for this reason,their ovarian response after stimulation is generally good.Furthermore,in younger couples,azoospermia can be partially compensated by the efficient ovarian response,resulting in an acceptable fertility rate following in vitro fertilization(IVF)techniques.Conversely,when azoospermia is associated with a reduced ovarian reserve and/or advanced maternal age,the treatment becomes more challenging,with a consequent reduction in IVF outcomes.Nonetheless,azoospermia seems to impair neither the euploidy rate at the blastocyst stage nor the implantation of euploid blastocysts.Based on the current knowledge,the assessment of male infertility factors should involve:(1)evaluation–to diagnose and quantify seminologic alterations;(2)potentiality–to determine the real possibilities to improve sperm parameters and/or retrieve spermatozoa;(3)time–to consider the available“treatment window”,based on maternal age and ovarian reserve.This review represents an update of the definition,prevalence,causes,and treatment of SMF in a modern ART clinic.展开更多
文摘Approximately 10%-15% of couples are infertile, and a male factor is involved in almost half of these cases. This observation is due in part to defects in spermatogenesis, and the underlying causes, including genetic abnormalities, remain largely unknown. Until recently, the only genetic tests used in the diagnosis of male infertility were aimed at detecting the presence of microdeletions of the long arm of the Y chromosome and/or chromosomal abnormalities. Various other single-gene or polygenic defects have been proposed to be involved in male fertility. However, their causative effects often remain unproven. The recent evolution in the development of whole-genome-based techniques and the large-scale analysis of mouse models might help in this process. Through knockout mouse models, at least 388 genes have been shown to be associated with spermatogenesis in mice. However, problems often arise when translating this information from mice to humans.
文摘For years, the management and treatment of male factor infertility has been ‘experience＇ and not ‘evidence＇ based. Although not evidence-based, current clinical practice involves extensive use of assisted reproductive techniques （ART）. Where specific treatments are not indicated or have failed, ART have become popular adjunctive treatments for alleviating male factor infertility. According to the limited evidence available, intrauterine insemination （IUI） may be considered as a first-line treatment in a couple in which the female partner has a normal fertility status and at least 1 × 10^6 progressively motile spermatozoa are recovered after sperm preparation. If no pregnancy is achieved after 3-6 cycles of IUI, optimized in vitro fertilization （IVF） can be proposed. When less than 0.5× 106 progressively motile spermatozoa are obtained after seminal fluid processing or sperm are recovered surgically from the testis or epididymis, intracytoplasmic sperm injection （ICSI） should be performed. Although the outcome of no other ART has ever been scrutinized as much before, no large-scale ‘macroproblems＇ have as yet been observed after ICSI. Yet, ICSI candidates should be rigorously screened before embarking on IVF or ICSI, and thoroughly informed of the limitations of our knowledge on the hereditary aspects of male infertility and the safety aspects of ART.
文摘Spermatogonial stem cell （SSC） transplantation is a promising technique to circumvent sterility in prepubertal boys undergoing gonadotoxic treatments. While the cryopreservation of spermatogonial stem cells is being introduced in clinical practices worldwide, a lot of unanswered questions remain regarding their eventual transplantation. In this paper autologous and allogeneic SSC transplantations in the testes of sterilized macaques were performed and spermatogenesis could be restored from donor SSCs. The spermatozoa obtained were competent to fertilize oocytes. This report proves the feasability of SSC transplantation in a primate model, hence reinforcing the hope that this strategy will eventually find its way into clinical practice.
文摘Infertility affects 10%–15%of couples worldwide.Of all infertility cases,20%–70%are due to male factors.In the past,men with severe male factor(SMF)were considered sterile.Nevertheless,the development of intracytoplasmic sperm injection(ICSI)drastically modified this scenario.The advances in assisted reproductive technology(ART),specifically regarding surgical sperm retrieval procedures,allowed the efficacious treatment of these conditions.Yet,before undergoing ICSI,male factor infertility requires careful evaluation of clinical and lifestyle behavior together with medical treatment.Epidemiologically speaking,women whose male partner is azoospermic tend to be younger and with a better ovarian reserve.These couples,in fact,are proposed ART earlier in their life,and for this reason,their ovarian response after stimulation is generally good.Furthermore,in younger couples,azoospermia can be partially compensated by the efficient ovarian response,resulting in an acceptable fertility rate following in vitro fertilization(IVF)techniques.Conversely,when azoospermia is associated with a reduced ovarian reserve and/or advanced maternal age,the treatment becomes more challenging,with a consequent reduction in IVF outcomes.Nonetheless,azoospermia seems to impair neither the euploidy rate at the blastocyst stage nor the implantation of euploid blastocysts.Based on the current knowledge,the assessment of male infertility factors should involve:(1)evaluation–to diagnose and quantify seminologic alterations;(2)potentiality–to determine the real possibilities to improve sperm parameters and/or retrieve spermatozoa;(3)time–to consider the available“treatment window”,based on maternal age and ovarian reserve.This review represents an update of the definition,prevalence,causes,and treatment of SMF in a modern ART clinic.
