The diagnosis and treatment of male infertility, excluding assisted conception, are limited because of, but not limited to, poor understanding of sperm post-testicular development and storage. Many may think that sperm dysfunction is only self-contained in the sperm cell itself as a result of defective spermatogenesis. However, it can also be a consequence of inadequate epididymal maturation following disorders of the epididymis. Improper epididymal functions can disturb semen parameters and sperm DNA integrity, result in high leucocyte concentrations and high numbers of immature germ cells and debris or even cause idiopathic infertility. To date, the data are limited regarding critical markers of sperm maturation and studies that can identify such markers for diagnosis and managing epididymal dysfunction are scarce. Therefore, this article aims to draw attention to recognise a disturbed epididymal environment as a potential cause of male infertility.

Purpose Blastocysts contain a large amount of fluid in the blastocoel, which may pose a risk for ice crystal formation during vitrification. This study aimed to evaluate the effectiveness of laser-induced artificial shrinkage of blastocoel before vitrification on clinical outcome. Methods Patients were divided into two groups: a control group with untreated, expanded blastocysts (n = 115) and a study group with blastocoel artificially eliminated by a laser pulse prior to vitrification (n = 309). Blastocyst survival, clinical pregnancy, and implantation rates were compared. Result(s) The survival rate was significantly higher in the study group compared with the control group (97.3 and 74.9 %, respectively; p > 0.01). The clinical pregnancy and implantation rates of the study group were significantly higher (p < 0.01) than that of the control group (clinical pregnancy, 67.2 vs. 41.1 %; implantation, 39.1 vs. 24.5 %. Conclusion(s) This study demonstrated that the removal of blastocoel fluid before vitrification by laser pulse of in vitroproduced human blastocysts significantly improves blastocyst survival, clinical pregnancy, and implantation rates.

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Artificial oocyte activation (AOA) has been previously suggested as a means to overcome the problem of total fertilization failure, which affects about 1-3% of the intracytoplasmic sperm injection (ICSI) cycles. A preliminary study on the application of chemical AOA was conducted using A23187 Ca(2+) ionophore to improve embryonic development in four women with a history of complete fertilization arrest and inability to transit to cleavage stage during previous ICSI trials. Data indicated that activated oocytes resulted in better fertilization, embryonic development and clinical pregnancy in one of the four couples. Therefore, ICSI combined with AOA using Ca(2+) ionophore may be useful in selected patients with cleavage failure, and may help the zygotes to reach more advanced developmental stages.

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Severe oligoasthenoteratozoospermia (OAT) refers to impaired count, motility and abnormal sperm morphology of infertile men associated with high chromosomal abnormalities. The objective of the present study was to define a management protocol for severe OAT cases and discover new routes to improve their basic semen parameters. We have applied a therapeutic treatment protocol in a cohort of 210 infertile men diagnosed with extreme severe idiopathic OAT. This therapeutic treatment based on modifying the lifestyle factors combined with antioxidant treatment for 6 months in severe OAT to study its effect on basic semen parameter. Basic semen parameters were assessed before and after applying the therapeutic treatment strategy. Sperm concentration, percentage of total motility and progressive motility were significantly increased after applying the therapeutic treatment (p = .006, p = .001 and p = .001 respectively). On the other hand, abnormal sperm morphology was significantly reduced after therapy (p < .01). In conclusion, the present results suggested that antioxidative supplement in combination with modifying the lifestyle factors in a cumulative treatment period significantly improves the basic semen parameters.

Insulin supplementation of single-step embryo culture medium from day 0 through day 5 or 6 improved clinical pregnancy rate and human embryo development. However, these findings need further confirmation through a multicenter randomized controlled trial that may include other patient populations and different culture media.