Diagnostic tools in male infertility--the question of sperm dysfunction

Sperm dysfunction is the single most common cause of infertility, yet what is remarkable is that, there is no drug a man can take or add to his spermatozoa in vitroto improve fertility. One reason for the lack of progress in this area is that our understanding of the cellular and molecular workings of the mature spermatazoon is limited. However, over the last few years there has been considerable progress in our knowledge base and in addressing new methods to diagnose sperm dysfunction. We review the current state of the field and provide insights for further development. We conclude that： （i） there is little to be gained from more studies identifying/categorizing various populations of men using a basic semen assessment, where an effort is required in making sure the analysis is performed in an appropriate high quality way; （ii） technological development is likely to bring the reality of sperm function testing closer to implementation into the clinical pathways. In doing this, these assays must be robust, cheap （or more appropriately termed cost effective）, easy to use and clinically useful; and （iii） clinical necessity, e.g., the need to identify the highest quality spermatozoon for injection is driving basic research forward. This is an exciting time to be an andrologist and, likely, a fruitful one.

Xenoesterogens and male infertility:myth or reality?

Aim: To evaluate the role of polychlorinated biphenyls (PCBs) as a potential environmental hazard in the deteriora-tion of male fertility. Methods: Fifty-three males were studied. After a thorough case history evaluation and rele-vant clinical and laboratory investigations, PCBs were estimated in the seminal plasma of 21 infertile men with 'Unex-plained Male Factor' and 32 fertile controls. Peak retention times of the eluants were compared with those of the com-mercially available standard PCB Mix, and the results confirmed spectrophotometrically. Seminal PCB concentrafonswere compared between i) fertile and infertile men and ii) men from different areas and diets. The relationship betweenPCB concentrations and measures of sperm quality such as the total motile sperm count, was assessed. Results:PCBs were detected in seminal plasma of infertile men but absent from controls. Sperm quantity and quality were sig-nificantly lower in infertile men compared to controls. The highest average PCB concentrations were found in fish-eat-ing urban dwellers, and followed in succession by fish-eating rural dwellers, non fish-eating urban dwellers and nonfish-eating mral dwellers. The total motile sperm counts were inversely proportional to the PCB concentrations and weresignificantly lower than those of the respective controls. Conclusion: PCBs may be instrumental in the deteriorationof sperm quantity and quality, a contaminated fish diet being the main source of exposure.(Asian J Androl 2000 Dec; 2: 263-269 )

英国HIV感染和生育保健的需求与供给

Objective: To collect data on the demand and provision of fertility care in HIV- infected couples in the United Kingdom and data on the etiology of subfertility in this population.Design: A postal questionnaire survey and audit of causes of infertility in HIV- infected women.Setting: Seventy- four Human Embryology and Fertilisation Authority- registered assisted conception units (ACUs) and 294 genitourinary medicine (GUM) clinics in the United Kingdom were sent questionnaires.Patient(s): Sixty- five HIV- infected women attending the Research Clinic at the Chelsea and Westminster ACU. Intervention(s): None. Main Outcome Measure(s): Number of ACUs treating HIV- infected patients and number of GUM clinics receiving requests for referral, as well as the etiology of subfertility in HIV infected women attending our clinic.Re-sult(s): Response rates from ACUs and GUM clinics were 93% and 63% , respectively.Fourteen ACUs (20% ) were treating HIV- infected men; of these, seven (10% ) performed sperm washing, but only two (3% ) tested sperm for HIV after processing, before use.Nine units (13% ) treated HIV- infected women, but only three ACUs (4% ) had separate laboratories for handling potentially infected gametes or embryos.Of the 15, 211 patients registered in 81 GUM clinics, 4% of the men and 16% of the women had requested advice on conceiving.An audit of the Chelsea and Westminster HIV fertility clinic demonstrated a 40% prevalence of tubal factor infertility in HIV- infected women.Conclusion(s): Demand is high, and set to increase, but current suboptimal practice in some centers is placing unaffected partners and the unborn child at risk of seroconversion.

＂One sperm, one embryo, one baby＂？

Dear Editor, The introduction of intracytoplasmic sperm injection （ICSI） technology has revolutionised the treatment of patients with severe oligozoospermia and azoospermia. A patient is usually considered oligozoospermic if his sperm concentration is less than 20 million mL^-1. A patient is labelled azoospermic according to the World Health Organisation guideline , if, on two different occasions, no spermatozoa can be detected by high-power microscopy after the seminal fluid has been centrifuged for 15 min at a centrifugation force of 3 000 × g or greater.

What will the future hold for artificial organs in the service of assisted reproduction: prospects and considerations

Assisted reproduction provides a wide spectrum of treatments and strategies addressing infertility.However,distinct groups of infertile patients with unexplained infertility,congenital disorders,and other complex cases pose a challenge in in vitro fertilization(IVF)practices.This special cohort of patients is associated with futile attempts,IVF overuse,and dead ends in management.Cutting edge research on animal models introduced this concept,along with the development of artificial organs with the aim to mimic the respective physiological functions in reproduction.Extrapolation on clinical application leads to the future use of infertility management in humans.To date,the successful clinical application of artificial reproductive organs in humans is not feasible because further animal model studies are required prior to clinical trials.The application of these artificial organs could provide a solution to infertility cases with no other options.This manuscript presents an overview on the current status,future prospects,and considerations on the potential clinical application of artificial ovary,uterus,and gametes in humans.This paper presents how the IVF practice landscape may be shaped and challenged in the future,along with the subsequent concerns in assisted reproductive treatments.

Sperm DNA fragmentation, recurrent implantation failure and recurrent miscarriage

Evidence is increasing that the integrity of sperm DNA may also be related to implantation failure and recurrent miscarriage （RM）. To investigate this, the sperm DNA fragmentation in partners of 35 women with recurrent implantation failure （RIF） following in vitro fertilization, 16 women diagnosed with RM and seven recent fathers （control） were examined. Sperm were examined pre- and post-density centrifugation by the sperm chromatin dispersion （SCD） test and the terminal deoxynucleotidyl transferase dUTP nick end labeling （TUNEL） assay. There were no significant differences in the age of either partner or sperm concentration, motility or morphology between three groups. Moreover, there were no obvious differences in sperm DNA fragmentation measured by either test. However, whilst on average sperm DNA fragmentation in all groups was statistically lower in prepared sperm when measured by the SCD test, this was not seen with the results from the TUNEL assay. These results do not support the hypothesis that sperm DNA fragmentation is an important cause of RIF or RM, or that sperm DNA integrity testing has value in such patients. It also highlights significant differences between test methodologies and sperm preparation methods in interpreting the data from sperm DNA fragmentation tests.