Male Infertility and Assisted Reproductive Technology: Lessons from the IVF

Abstract

Development in ART has been remarkable in the last decades. Several medical conditions affecting the male fertility status are now treated by ART, especially by the combination of in vitro fertilization and intracytoplasmic sperm injection. ICSI is now the treatment of choice of most untreatable causes of male infertility, including immunologic infertility, severe oligozoospermia and azoospermia. Sperm retrieval techniques have been optimized and microsurgery offers the possibility of collecting testicular spermatozoa even in the most difficult cases of non-obstructive azoospermia. Nonetheless, the reproductive potential of sperm from men with defective spermatogenesis is decreased in ART and such treatment modalities may carry an increased risk of transmitting genetic and epigenetic defect to the embryo. Efforts should be made to improve the male health status prior to embarking on ART because current evidence suggests that fertility optimization may improve treatment outcomes. Moreover, laboratory management of male infertility cases requires special attention. Spermatozoa collected from men with severely impaired spermatogenesis are often compromised and fragile. Adherence to state of the art laboratory techniques and quality control are recommended to avoid jeopardizing sperm fertilizing potential and the chances of achieving a live birth. In this study, we present and critically review our 10-year experience in the management of severe male factor infertility using ART.

Reproductive outcomes, including neonatal data, following sperm injection in men with obstructive and nonobstructive azoospermia: case series and systematic review

“…Luteal support with a once-daily transvaginal application of progesterone gel was initiated in the day of oocyte retrieval and continued up to the 12th gestational week. Oocyte and sperm retrieval, micromanipulation of gametes, embryo culture, and the transfer of embryos to the uterine cavity were conducted in clean room environments (20). …”

Micro-dissection testicular sperm extraction as an alternative for sperm acquisition in the most difficult cases of Azoospermia: Technique and preliminary results in India

“…Sperm immobilization was carried out by firmly touching the tip of injection pipette to the transition zone between mid-piece and sperm tail. [21] The injected oocytes were transferred to a closed culture system and incubated for 16-18 hours at 37°C and 5.5% CO 2 , until confirmation of fertilization. Fertilization was considered normal when oocytes with two pronuclei were seen.…”

Pentoxifylline treatment had no detrimental effect on sperm DNA integrity and clinical characteristics in cases with non-obstructive azoospermia

“…Cell suspensions were aspirated and transferred to a sterile centrifuge tube and diluted with 3 ml of fresh culture medium and centrifuged at 300 g for 10 min. The supernatant was discharged and the pellet was gently resuspended in 0.5-1.0 ml culture medium (Esteves and Schneider, 2011).…”