Novel concepts in male factor infertility: clinical and laboratory perspectives

Abstract

In recent years, the management of male factor infertility has undergone important changes with the introduction of novel concepts, advanced testing, and therapeutic interventions. This review highlights some of these changes and discusses their impact to routine clinical practice. First, we discuss the recent changes in the World Health Organization (WHO) laboratory methods and reference values for the examination of human semen. Second, we examine the role of sperm chromatin integrity tests in light of increasing evidence of the detrimental effect of sperm DNA fragmentation on reproductive outcomes. Third, we summarize the main findings of varicocele-related infertility and the outcomes of microsurgical varicocele repair to different case scenarios. Lastly, we critically discuss the current management of men with nonobstructive azoospermia seeking fertility and the new opportunities that emerged to help these men achieve biological fatherhood.

Multiple signaling pathways in Sertoli cells: recent findings in spermatogenesis

“…Abnormal quality and insufficient quantity of sperm are the primary causes of male infertility, most of which are clinically manifested as oligozoospermia, asthenozoospermia, teratospermia, or azoospermia 142 . Azoospermia is classified as obstructive azoospermia and nonobstructive azoospermia 143 , the latter of which is a major course for male infertility and affects 10-15% of infertile men 144 . The microarray analysis on testicular biopsy samples from azoospermic men detected over-activation of the MAPK signaling pathway in SCs 145 .…”

Reproductive outcomes of testicular versus ejaculated sperm for intracytoplasmic sperm injection among men with high levels of DNA fragmentation in semen: systematic review and meta-analysis

“…Probes or dyes are used to identify DNA breaks with the aid of fluorescence microscopy, optical microscopy, or flow cytometry according to the method type. Regardless of the analytic method, DNA fragmentation is more common in sperm of infertile men than of fertile counterparts (14)(15)(16)(17). Among couples undergoing ICSI, high SDF in the neat semen is found in $30% of men (18) and is usually associated with abnormal conventional semen parameters (19,20).…”

Use of Annexin V based Sperm Selection in Assisted Reproduction

“…However, sometimes thresholds are not able to discriminate between fertile and infertile patients, and have a poor predictive power for the outcome of embryo development [11]. In recent years, the management of male factor has undergone important changes with the introduction of novel concepts, such as sperm apoptosis, and the need of new tests for diagnosis and therapeutic interventions [12]. To this end, some apoptotic markers have been proposed in semen, such as activation of caspases, disruption of mitochondrial transmembrane potential (MMP), externalization of phosphatidyl-serine (PS), and increased DNA fragmentation [13,14].…”