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PubMed1983

Bacterial infection and male infertility: absence of immunoglobulin A with specificity for common Escherichia coli 0-serotypes in seminal fluid of infertile men.

We used an indirect solid phase radioimmunoassay to detect and quantitate immunoglobulin A (IgA) in male genital secretions with specificity for Escherichia coli (E. coli) antigen. We assayed the seminal fluid and expressed prostatic secretion (EPS) of a patient with chronic bacterial prostatitis (CBP) due to an 01 E. coli, the seminal fluid of 24 fertile men, and the seminal fluid of 62 men of infertile marriages. IgA directed apparently against the 0-antigen of the infecting E. coli was measurable in both the seminal fluid and EPS of the CBP patient. IgA in these specimens also bound to antigen in a mix of 8 common E. coli 0-serotypes that included an 01 E. coli. IgA with specificity for antigen in the mix of common E. coli 0-serotypes could not be detected in the seminal fluid of the fertile men or the men of infertile marriages. These data suggest that subclinical E. coli infections of the male reproductive tract are not commonly associated with infertility.

Adult↗

PubMed2005

Prevalence of chromosome defects in azoospermic and oligoastheno-teratozoospermic South Indian infertile men attending an infertility clinic.

The prevalence of chromosomal abnormalities in azoospermic and oligoastheno-teratozoospermic infertile men of South Indian origin undergoing assisted reproductive technologies was evaluated. In addition, the study aimed to investigate new abnormal karyotypes involving autosomes in azoospermia and sex chromosomes in oligoastheno-teratozoospermic individuals that are supposed to be rare. Metaphase chromosomes of 744 infertile men, including 272 men with azoospermia and 472 men with oligoastheno-teratozoospermia (OAT), were analysed using Giemsa-trypsin-Giemsa banding and fluorescence in-situ hybridization (FISH) wherever necessary. Chromosomal abnormalities were observed in 59 (7.9%) individuals of the total studied population. Among these, 30 out of 272 (11.0%) azoospermic men and 29 out of 472 (6.1%) infertile men with OAT showed chromosomal abnormalities. A strong and statistically significant association (OR = 1.89; P = 0.0235) of chromosomal abnormalities and sex chromosome abnormalities (OR = 4.29; P = 0.001) with azoospermia when compared with OAT was observed. In addition, six autosomal abnormalities associated with azoospermia and two abnormalities involving Y chromosome, which include a novel karyotype (mos 46,XY/51,XYYYYYY) in OAT individuals, were detected.

Adult↗

PubMed2002

Association of oestrogen receptor alpha polymorphisms and androgen receptor CAG trinucleotide repeats with male infertility: a study in 109 Greek infertile men.

This study was performed to examine the contribution of genetic polymorphism of oestrogen and androgen receptor (AR) genes in male infertility. We have studied in total 173 Greek men, 109 infertile patients and 64 controls (group A). Patients were divided in to three subgroups: group B (n=29) with idiopathic moderate oligospermia, group C (n=42) with azoospermia or idiopathic severe oligospermia and group D (n=38) with azoospermia or oligospermia of various known aetiologies. All patients and controls were genotyped for two polymorphisms of the oestrogen receptor alpha (ERalpha) gene and also for the (CAG)n repeat length polymorphism of the X-linked androgen receptor (AR)gene. The control group had statistically significant difference from group C regarding the XbaI polymorphism of ERalpha gene. Despite the fact that we did not observe any statistically significant differences in the mean and range of the CAG repeat number, the frequency of the higher repeats of the nucleotide repeat sequence (CAG)n of the AR gene was 2-4 times higher in groups B and C compared with the control group A. Our results indicate that both ERalpha and AR gene play significant role in male fertility. It is possible that a synergy may exist between unfavourable genotypes of these two genes in male infertility.

Adult↗

PubMed2002

Investigation of the infertile couple: should diagnostic laparoscopy be performed after normal hysterosalpingography in treating infertility suspected to be of unknown origin?

Traditionally, a diagnosis of unexplained infertility is established only when all standard clinical investigations yield normal results. When tubal patency has been established by hysterosalpingography (HSG), laparoscopy has been suggested as a mandatory step to preclude the existence of peritubal adhesions and endometriosis as causes of infertility. In women without a previous history suggestive of tubal disease and who have a normal HSG, it was demonstrated that the probability of clinically relevant tubal disease or endometriosis is very low and that laparoscopy does not seem justified or cost effective. In the minority of these cases, laparoscopy might reveal minimal or mild endometriosis or peritubal adhesions. In these cases, either surgery or medical treatment has not been proven to improve fecundity. With the current success rates of assisted reproductive technologies (ART) and the relatively low contribution of diagnostic laparoscopy to the decision-making process of treating patients with a normal HSG, we suggest that laparoscopy should be omitted in couples suspected of having unexplained infertility. These patients should be treated by 3-6 cycles of combined gonadotrophins and intrauterine insemination, and if unsuccessful switched to ART.

Endometriosis↗

PubMed2006

Luteinized unruptured follicle syndrome: incidence and recurrence rate in infertile women with unexplained infertility undergoing intrauterine insemination.

BACKGROUND: The objective of this study was to determine the incidence and recurrence rate of luteinized unruptured follicle (LUF) syndrome in women with unexplained infertility undergoing intrauterine insemination (IUI). METHODS: A total of 167 women with unexplained infertility who underwent 292 cycles of IUI were enrolled in the study. All patients were treated with clomiphene citrate, 50-150 mg/daily from day 5 to 9 of their menstrual cycle. Ultrasound examination to confirm ovulation was performed on the day of IUI (day 0) and every day thereafter for another 3 days (days 1, 2 and 3). A total of 69 women who failed to conceive in the first cycle and 56 women who failed to conceive in the second cycle underwent second and third cycles, respectively. RESULTS: Of the total 167 patients who underwent first cycle, 42 (25%) had LUF. The incidence of LUF was 56.5% in 69 patients who underwent a second cycle of IUI treatment, of whom 33 patients had LUF in the first cycle with recurrence rate of 78.6%. In 56 patients who underwent 3 consecutive cycles, the incidence of LUF was 58.9% and recurrence rate of 90%. No pregnancies were recorded in patients with LUF during the study period. CONCLUSION: The incidence and recurrence rate of LUF are significantly increased in subsequent cycles of IUI. In these patients, other options of infertility treatment might be justified.

Adult↗

PubMed2004

Access to infertility investigations and treatment for HIV+ people: a survey of Australian infertility clinics.

OBJECTIVE: To examine the availability in Australia of investigations and treatment of infertility for people infected with HIV. METHODS: The study was a questionnaire survey of all identified Australian IVF clinics undertaken in 2002. All clinics potentially offering investigations and treatments for IVF were contacted (52) and invited to return a survey concerning people infected with HIV. RESULTS: Thirty-one (59.6%) clinics responded. Fourteen (45.2%) clinics had seen 24 HIV+ patients in the past 12 months. Twenty (64.5%) clinics had a policy on HIV. In nearly all clinics (n=29), an HIV+ man or woman would be offered investigations; 28 clinics indicated they would offer investigations when both partners were positive. Treatments would be offered by 26 clinics if the man was HIV+, by 23 clinics if the woman was HIV+, and by 24 clinics if both were HIV+. CONCLUSIONS: Infertility treatment in Australia for HIV+ people is available. Couples will more than likely receive both investigations and treatment. There are marked differences between States and Territories in the numbers of HIV+ people reported seen at the clinics. IMPLICATIONS: There is currently variable access and policies with regard to infertility treatment for HIV+ people in Australia. It is likely that demand for these services will increase.

Ambulatory Care Facilities↗

PubMed2002

Sperm motility in the semen analysis affects the outcome of superovulation intrauterine insemination in the treatment of infertile Asian couples with male factor infertility.

OBJECTIVE: To ascertain the relationship between the initial and unprocessed sperm parameters and pregnancy rates in SOIUI, for Asian couples with male factor infertility. DESIGN: Retrospective study. SETTING: A large government tertiary-care women's hospital with 15,000 deliveries per year. POPULATION: One thousand four hundred and seventy nine couples undergoing 2846 cycles of SOIUI. METHODS: All couples enrolled in the SOIUI programme were analysed, comparing initial sperm parameters and the post-processed total motile sperm, against pregnancy rates per cycle. MAIN OUTCOME MEASURES: Pregnancy rates in relation to initial sperm parameters and post-processed total motile sperm. RESULTS: Ninety-three percent of the couples had male factor infertility. The average normal forms for these men was 14.7%. Overall pregnancy rate was 12.1% per completed SOIUI cycle. We found a significant drop in pregnancy rates if the percentage of motile sperms in the unprocessed sperm sample fell below 30%. We also found that insemination of at least 1 million motile sperm resulted in a significant increase in pregnancy rates. CONCLUSIONS: We recommend SOIUI as an effective treatment of suitable couples with male infertility, before embarking on IVF. However, if the initial percentage of motile sperm fell below 30%, or if after processing, the total motile sperm count was fewer than 1 million, these couples should consider in vitro fertilisation.

Adult↗

PubMed2002

Infertility: a sociological analysis of problems of infertility among women in a rural community in Nigeria.

This study highlighted the problems of infertility among-women in Ilora rural community. The result revealed that in spite of high fertility rate and high rate of pregnancy wastage, 8.7% out of the 400 women studied were found to be infertile. It is interesting to note that in a strictly polygamous environment, almost half of the women suffering from infertility were found to be the only wife of their respective husbands. The African concept as to the solution to the problems was also discussed, and highlighted in relation to awareness of possible hospital treatment of their conditions.

Adaptation, Psychological↗

PubMed1986

[Male infertility in Gabon. Comparison of spermatic parameters between fertile and infertile groups].

Aetiology of infertility in Central Africa remains largely controversial. The male factor has been less studied than the female factor. We present data obtained on spermatic parameters in comparison between fertile and infertile groups. Values obtained in fertile men are similar to those observed in European or American countries. Very low values of spermatozoa concentration, percentage of motile and morphologically normal forms were found in infertile male.

Fertility↗

PubMed1980

Infertility: a review of 291 infertile couples over eight years.

Two hundred and ninety-one infertile couples were studied over an 8-year period. Anovulation was the most common cause of infertility, being the causative factor in half of the patients. Ovulation induction with clomiphene or cyclic hormone therapy readily achieved pregnancy in the majority of these patients. The distribution of other etiologic factors was fairly uniform, but treatment was much less successful. Thorough evaluation of both partners is advised both for treatment purposes and as a more accurate guide to the prognosis for conception. Furthermore, even in the presence of oligospermia, ovulation induction may be successful in achieving a pregnancy.

Anovulation↗

PubMed1977

Levels of L-carnitine and L-O-acetylcarnitine in normal and infertile human semen: a lower level of L-O-acetycarnitine in infertile semen.

The level of total L-carnitine was determined in normal human seminal plasma and sperm. Most of the L-carnitine is concentrated in the seminal plasma and its level is about 10 times higher than that in blood plasma. About 50% of total L-carnitine in normal human seminal plasma exists in the form of acetylcarnitine. Similar studies were also carried out in oligospermic and azoospermic human seminal plasma. The level of L-O-acetylcarnitine in both types of infertile samples is significantly lower than that in normal samples. On the other hand, the level of free L-carnitine is the same in fertile and infertile seminal plasma.

Acetylcarnitine↗

PubMed1987

The diagnosis of male infertility--prospective time-specific study of conception rates related to seminal analysis and post-coital sperm-mucus penetration and survival in otherwise unexplained infertility.

Infertile women without any inherent female infertility factors and able to secrete normal cervical mucus were studied prospectively in relation to post-coital sperm-mucus penetration (PCT) and their partner's seminal analysis, excluding men with azoospermia. Time-specific cumulative conception rates calculated as for life-table analysis were related to each measured seminal variable on routine analysis of 2-3 samples (volume, density, proportion with progressive motility, and proportion with normal morphology); to various derivatives from combinations of these variables; to seminal findings after vital staining; and to the PCT results. The best seminal predictor of fertility was the motile normal sperm density (MNSD), the 18 month conception rates being 57.4% +/- 4.6 (SE) and 30.2% +/- 5.9 (ratio 1.9, P less than 0.001) above and below a derived threshold value of 4 x 10(6)/ml. The PCT led to rates of 55.6% +/- 4.3 and 14.9% +/- 5.1 (ratio 3.73, P less than 0.001) for positive and negative results, respectively. The PCT also gave rise to a significantly distinct intermediate poor-positive sub-group (conception rate 30.6% +/- 9.0). Seminal analysis (the MNSD) did not affect the conception rate associated with a positive PCT but helped to discriminate further with a negative PCT (conception rates 22.5% +/- 8.7 with an MNSD above 4 x 10(6)/ml versus 5.6% +/- 4.8 below, P less than 0.05). The PCT was the single best predictor of fertility but seminal analysis (the MNSD) was of additional value after a negative PCT.

Cervix Mucus↗

PubMed1986

Results of donor insemination related to specific male infertility and unsuspected female infertility.

Apparently normal but infertile women were treated by artificial insemination using fresh donor semen. In 228 couples in which the male partner was azoospermic the average monthly conception rate was 13.3% and the 12-month cumulative rate was 82.2% (SE 2.7%). In 116 couples in which the partner was oligospermic the monthly rate was 8.7% and the 12-month rate 66.6% (SE 5.0%, P less than 0.01). Previous smaller studies have given rise to conflicting or inconclusive results, but the reduced conception rates in the partners of oligospermic men in this large study suggests that unexplained female factors, discussed in the paper, contribute to their infertility in up to a third of patients.

Adult↗

PubMed1990

Sperm washing and intrauterine insemination for cervical factor, oligospermia, immunologic infertility and unexplained infertility.

The cumulative pregnancy rate was evaluated for 56 couples undergoing 227 intrauterine inseminations (IUIs) after sperm washing. The indications for IUI were cervical factor, oligospermia, immunologic infertility and unexplained infertility. The overall pregnancy rate was 21.4%, with a 0.289 cumulative probability of conception after six cycles. Within each category the pregnancy rates were 25% for cervical factor, 60% for women with antisperm antibodies, 20% for men with antisperm antibodies and 7% for oligospermia.

Clinical Trials as Topic↗

PubMed1999

Men with infertility caused by AZFc deletion can produce sons by intracytoplasmic sperm injection, but are likely to transmit the deletion and infertility.

Deletion of the AZFc region of the Y chromosome is the most frequent molecularly defined cause of spermatogenic failure. We report three unrelated men in whom azoospermia or severe oligozoospermia was caused by de-novo AZFc deletions, and who produced sons by intracytoplasmic sperm injection (ICSI). We employed polymerase chain reaction (PCR) assays to examine the Y chromosomes of their four infant sons. All four sons were found to have inherited the Y chromosome deletions. Such sons are likely to be infertile as adults. This likelihood should be taken into account when counselling couples considering ICSI to circumvent infertility due to severe oligozoospermia or non-obstructive azoospermia.

Adult↗

PubMed1984

Randomised trial of mesterolone versus vitamin C for male infertility. Scottish Infertility Group.

A prospective randomised trial was carried out to assess the effect of 9 months' treatment with either mesterolone or vitamin C in 368 men complaining of an infertile marriage. There was no significant difference in the wife's pregnancy rate between the two treatment groups. A separate analysis of the data was made to include only men with a low normal testosterone (less than 16 nmol/l) and low sperm density (less than 10 million/ml). This separate analysis was also restricted to men married to wives with normal test results for tubal patency and ovulation and again there was no difference in pregnancy rates between the two treatment groups. These results indicate that mesterolone therapy given in the absence of any defined endocrinopathy is of no benefit in promoting male fertility and furthermore we have been unable to find any subgroup who will respond. Improvements in the therapy of male infertility are only likely after a diagnosis has been defined.

Ascorbic Acid↗

PubMed2000

Inhibin A, inhibin B and activin A in follicular fluid of infertile women with tubal damage, unexplained infertility and emdometriosis.

PROBLEM: To measure and compare concentrations of inhibin A, inhibin B, activin A and oestradiol in the follicular fluid of women with endometriosis, tubal damage and unexplained infertility with oocyte quality and fertilising capacity. Also, to assess whether impaired follicular function in women with endometriosis might be related to altered inhibin or activin concentrations and whether this correlated. METHOD OF STUDY: Follicular fluids were collected from individual follicles during oocyte retrieval for in vitro fertilisation (IVF) in natural cycles. Inhibin A, inhibin B and activin A were measured using two-site enzyme immunoassay, and oestradiol was assayed by fluoro-immunometric method. RESULTS: Follicular fluid inhibin A levels were found to be significantly higher in women with endometriosis. Inhibin A was directly correlated with follicle size. There was no correlation between the levels of inhibin A, inhibin B, activin A and oocyte quality or fertilising capacity in the three groups of women. CONCLUSIONS: Follicular fluid concentration of inhibin A is elevated in follicles of women with endometriosis and is positively correlated with follicle maturation. However, we were unable to demonstrate any association between the follicular fluid concentrations of inhibin A, inhibin B, activin A or oestradiol and the quality and fertilisation capacity of oocytes in women with tubal damage, unexplained infertility or endometriosis.

Activins↗

PubMed2002

[Cytologic and immunologic prognosis of infertility. I. Prognostic significance of cytologic study of peritoneal fluid of infertile patients].

Cytological investigation of the peritoneal fluid from 110 patients was performed. The fluid was taken during laparoscopical surgery. Cytological patterns of the peritoneal fluid from women with tube-peritoneal infertility, myoma utery, and ovarian cysts in combination with infertility were described. Cytological data on the peritoneal fluid can serve one of the criteria of the state of reproductive organs and future prognostication in infertal patients.

Adult↗