Ronald Carson

Presence of mature sperm in testicular parenchyma of men with nonobstructive azoospermia: Prevalence and predictive factors

OBJECTIVES Hitherto, patients with testicular dysfunction and azoospermia had to resort to adoption, donor sperm insemination, or child-free living. The realization that a proportion of such men harbor spermatozoa in their testicular parenchyma, combined with the ability of intracytoplasmic sperm injection (ICSI) to effect pregnancy with single sperm, has prompted male infertility clinicians to explore testicular sperm extraction (TESE) in this patient population. We sought to investigate the likelihood of finding spermatozoa during TESE from men presenting with nonobstructive azoospermia and to define if any factors existed that were predictive of eventual sperm presence or absence. METHODS Thirty patients with nonobstructive azoospermia underwent TESE and simultaneous formal testis biopsy, cytologic analysis, and wet preparation analysis. Tissue obtained from TESE was analyzed according to a rigorous protocol, followed by exhaustive searching by trained embryologists. RESULTS Twenty-one patients (70%) had spermatozoa found on testicular tissue analysis. Neither patient age nor follicle-stimulating hormone (FSH) level was predictive of the ability to find sperm. With regard to histologic pattern, 50% of men with Sertoli cell-only, 75% of patients with maturation arrest, and 100% of patients with spermatids seen on histologic analysis had sperm retrieved from their testicular tissue during TESE. Absence of sperm on cytologic smear and wet preparation analysis failed to predict the presence of sperm on formal testicular tissue analysis in 40% of patients. CONCLUSIONS Men with nonobstructive azoospermia may have mature spermatozoa present within their testicular parenchyma. Relying on these data, patients should not be excluded from TESE based on serum FSH level, age, prior histopathologic pattern, or cytology/wet preparation results. These figures will allow clinicians to counsel patients with nonobstructive azoospermia informatively regarding TESE and their chances of having testicular sperm retrieved.

Premature luteinization and in vitro fertilization outcome in gonadotropin/gonadotropin-releasing hormone antagonist cycles in women with polycystic ovary syndrome

OBJECTIVE To determine the incidence of premature luteinization in patients with polycystic ovary syndrome (PCOS) undergoing controlled ovarian hyperstimulation (COH) with exogenous gonadotropin/GnRH antagonist (GnRH-a); to compare clinical outcomes in patients with and without premature luteinization. DESIGN Retrospective case series. SETTING IVF clinic. PATIENT(S) Thirty-five treatment cycles in 30 patients with PCOS. INTERVENTION(S) Controlled ovarian hyperstimulation with gonadotropin/GnRH-a protocol. MAIN OUTCOME MEASURE(S) Premature luteinization defined as a P concentration of >/=1.3 ng/mL on the day of hCG administration; number of oocytes and two pronuclei (2PN) embryos; implantation and clinical pregnancy rates (PR). RESULT(S) The incidence of premature luteinization was 28%. Compared with those without premature luteinization, patients with premature luteinization had a higher number of oocytes retrieved (24.1 +/- 13.3 vs. 12.0 +/- 5.9) and greater number of mature oocytes (19.7 +/- 11.7 vs. 9.5 +/- 4.5), respectively. The number of good quality embryos and embryos transferred was not significantly different between groups. Although implantation rates (56% vs. 40%) and clinical PRs (36% vs. 30%) were higher in patients without premature luteinization, the differences were not statistically significant. CONCLUSION(S) The patients with PCOS with premature luteinization had a higher number of oocytes retrieved and mature oocytes, and similar clinical PRs as patients with PCOS without premature luteinization.

Absence of deleted in azoospermia (DAZ) genes in spermatozoa of infertile men with somatic DAZ deletions

OBJECTIVE To determine the presence or absence of the deleted in azoospermia (DAZ) gene clusters in the Y-bearing spermatozoa in semen of severely oligozoospermic men or in testicular biopsy samples of azoospermic men with somatic DAZ deletions. DESIGN Prospective study. SETTING Academic hospital. PATIENT(S) Nineteen patients attending our clinics for therapeutic intracytoplasmic injection of sperm. INTERVENTION(S) Peripheral blood lymphocytes were used to obtain somatic DNA for analysis using the polymerase chain reaction. Analysis of chromosomes X and Y and the detection of the DAZ gene clusters were carried out with the fluorescence in situ hybridization technique in spermatozoa remaining after intracytoplasmic sperm injection. MAIN OUTCOME MEASURE(S) Presence or absence of the DAZ gene clusters in matched somatic DNA and Y-bearing spermatozoa. RESULT(S) Seven patients appeared to have a somatic DAZ deletion. Three-color fluorescence in situ hybridization showed that all Y-bearing spermatozoa examined from these men carried the same deletion. CONCLUSION(S) The DAZ deletions present in the seven men would all have been transmitted if they had fathered sons through artificial fertilization techniques using the sperm cells examined in this study.