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Query: UMLS:C0848676 (male subfertility)
 265 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Although IVF was developed for the treatment of tubal infertility, it is clear that it has a significant application in treatment of couples where the problem is one of male subfertility. This is particularly relevant because, despite the developments in reproductive medicine, in most males there is no identifiable cause for the poor semen quality. Therefore, for these men there is no efficacious method of treatment. Varicocele ligation and the use of agents such as clomiphene citrate, mesterolone empirical antibiotic therapy, and anabolic steroids have not been show to be beneficial when subject to controlled trials. The concept of improving the chance of fertilisation by taking the oocytes to the sperm in vitro is therefore the first feasible therapeutic option available to these subfertile couples. However, these possibilities should not obviate the need for a thorough assessment of the subfertile male and continuing research into the basis of male infertility. During the past decade new methods of sperm preparation, modified methods of insemination, and the use of microinjection have been developed. IVF is now a realistic option for couples if the male is subfertile. It has been suggested by some critics of these techniques that the brunt of the discomfort and risk has to be borne by the women where the problem appears to be solely with the male partner. Nevertheless, as having children is a 'couple' decision, prospective couples need to consider whether such procedures are acceptable to them.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The management of male subfertility by in vitro fertilisation techniques. 771

At present, there is general agreement that ovarian stimulation improves pregnancy rates after intra-uterine insemination (IUI). Also, ovulation induction with gonadotrophins is associated with higher success rates than clomiphene citrate in IUI cycles. However, the drawbacks to the use of gonadotrophin stimulation before IUI include the risks of ovarian hyperstimulation and multiple gestation, and the relative cost of a treatment cycle in a view of the medication costs and the need for increased monitoring by hormone assays and ultrasonographic measurements. In the present prospective randomized trial, the efficacy and safety of ovarian stimulation with clomiphene citrate (50 mg/day for 5 days) and IUI (clomiphene/IUI group) were compared with those of late low-dose pure follicle stimulating hormone (FSH, 75 IU/day from day cycle 7 until the leading follicle reached > 17 mm in diameter) and IUI (FSH/IUI group) in ovulatory women who were infertile because of unexplained infertility (n = 40) or male subfertility (n = 60). The mean length of treatment in the FSH group was 6.4 +/- 2.5 days. Multiple follicular development was seen in 25% of clomiphene-stimulated cycles but only in 8% of those treated with FSH. Pregnancy rate per cycle in clomiphene/IUI and FSH/IUI groups was 4% (4/98) and 13% (12/94) respectively (P = 0.02). All pregnancies obtained were singleton. There were two and one clinical abortions in the clomiphene/IUI (50%) and FSH/IUI (8%) groups respectively. No patient developed ovarian hyperstimulation syndrome. Use of our therapeutic scheme, which proved to be efficacious, safe and economic for ovarian stimulation in IUI cycles, is advocated before the institution of in-vitro fertilization (IVF) or gamete intra-Fallopian transfer (GIFT) therapy in infertile patients with patient Fallopian tubes. This late low-dose technique of administering pure FSH is suitable for use in offices without immediate access to oestradiol results.
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PMID:Late low-dose pure follicle stimulating hormone for ovarian stimulation in intra-uterine insemination cycles. 784 17

Recent studies report that superovulation combined with intrauterine insemination (IUI) is more successful than superovulation alone, IUI alone or superovulation with intracervical insemination in couples with male subfertility. Our study evaluated two superovulation protocols in the management of male factor infertility using IUI: (A) clomiphene citrate and human chorionic gonadotropin (HCG) and (B) human menopausal gonadotropin and HCG. Fifteen couples with severe oligoasthenozoospermia (OAS) were treated with protocol A in 54 cycles, and no pregnancies were achieved. Eight of the 15 couples with severe OAS subsequently received protocol B for 24 cycles and elicited no pregnancies. Thirty-seven couples with moderate OAS received protocol A for 169 cycles, and 2 pregnancies ensued (5.4% per couple and 1.12% per cycle). Twelve of the 35 nonpregnant couples with moderate OAS then received protocol B for 31 cycles, and 4 pregnancies were recorded (33.3% per couple and 12.9% per cycle).
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PMID:Superovulation and intrauterine insemination in the treatment of male factor infertility. 789 Feb 54

A case history of a couple where the infertility was due to retrograde ejaculation is presented; when conventional treatment with artificial insemination using sperm isolated from postejaculatory urine failed, IVF and GIFT technology was applied. This resulted in a pregnancy which unfortunately failed at 3 months, unrelated to the method of conception. This case report highlights the possible use of IVF/GIFT for yet another type of male subfertility.
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PMID:A case of successful use of reproductive technology for a couple with subfertility due to retrograde ejaculation, where artificial insemination had failed. 805 65

Microinsemination is a new method of treating sterility. It improves the chance of fertilization in cases of severe male subfertility and of unexplained infertility. Fertilization is assisted by opening the zona pellucida with a microneedle (PZD), by introducing a small number of sperms with a micropipette into the perivitelline space (SUZI) or by direct insertion of a spermatozoon into the ooplasm (ICSI). We report on the first delivery achieved by microinsemination (SUZI) at the University Hospital Zurich and, as far as we know, in Switzerland.
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PMID:[Micro-insemination--a novel treatment method for sterility in severe male subfertility]. 827 7

Despite the widespread clinical use of intrauterine insemination (IUI) in the treatment of male subfertility, its therapeutic value remains unclear. The objective of this review was to determine why its efficacy has not been consistently documented in the literature and to give strong evidence supporting the therapeutic merit of ovarian stimulation/IUI in male subfertility treatment. Because (i) this technique is much easier to perform and less expensive than assisted reproduction methods, and seems to be reasonably effective in controlled studies of a male subfertility treatment, and (ii) we may expect that financial resources available for the health care of infertility patients will be limited in the future, we believe that ovarian stimulation/IUI must become the first-line treatment in most cases of male factor subfertility, provided that the multiple gestation incidence can be reduced to an acceptable level.
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PMID:Intrauterine insemination: a first-step procedure in the algorithm of male subfertility treatment. 859 46

Treatment of couple infertility due to male subfertility by means of intra-uterine insemination (IUI) gives better results, in terms of per cycle and total cumulative pregnancy rate, if sperm preparation is performed using a discontinuous Percoll gradient than if centrifugation-resuspension is used. Also, the minimal semen requirements for successful IUI are lower with the former technique. Optimal epididymal function, with total alpha-glucosidase activity in seminal plasma > 83 IU/mL or Schorr stain result > 60%, is associated with a high probability of success of IUI [odds ratio (OR) = 11.1 and 9.4 respectively; p < 0.01]. If semen contains > 2.3 million white blood cells per mL or more than 13 million spermatozoa/mL with grade a motility the success rate is decreased (OR = 0.25 and 0.30 respectively; p < 0.05 and p < 0.01). It is concluded that IUI is a highly successful treatment in specific cases of male subfertility, provided that the correct technique of sperm preparation is used.
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PMID:Statement on intra-uterine insemination. 871 64

In contrast to the treatment of female infertility, therapies for male-factor subfertility were disappointing in the past. Specific therapeutic choices available were limited and patients were treated mostly empirically. However, no published results have been able to demonstrate any real benefits from these treatments. In 1992 a new procedure of assisted fertilisation was introduced for the treatment of severe male subfertility. The successful injection of one spermatozoa into an oocyte (intracytoplasmic sperm injection, ICSI) not only results in extremely good fertilisation and pregnancy rates but also leads to the conclusion that all quality parameters of an ejaculate which have been demanded so far are no longer of any value. Fertilisations and pregnancies can be achieved by this technique even with motionless spermatozoa, with spermatozoa which have not undergone acrosomal reaction, tailless spermatozoa, and morphologically aberrant and/or immature spermatozoa.
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PMID:[The intracytoplasmatic spermatozoa injection--the way out of the "male fertility crisis"?]. 903 66

The aim of this study was to determine characteristic malformations of sperm ultrastructure in patients with severe subfertility undergoing intracytoplasmic sperm injection (ICSI). Although light microscopy (LM) can reveal major abnormalities of the three parts of the spermatozoon (head, mid-piece and flagellum), the various cell organelles of the spermatozoon and their fine structure remain unevaluated by LM. Insight into the submicroscopic organization of the spermatozoon and its complex organellar system may contribute to a better understanding of the preconditions for success or failure of fertilization. An in-depth evaluation of semen quality by transmission electron microscopy (TEM) can improve the diagnosis of male subfertility and can give substantial information about the fertilizing competence of spermatozoa. Thus, in this study 56 ejaculated sperm samples from patients with severe male subfertility or previous failed attempts at in-vitro fertilization were assessed by LM and TEM prior to ICSI to evaluate the most important sperm defects causing extreme subfertility. LM analysis was performed according to World Health Organization criteria. It could be confirmed that severe head defects are mostly involved in long-term infertility and fertilizing failure in classical IVF treatments. The most frequent head defects are disorders of the nuclear membranes and the acrosomal cap and disorganization of the chromatin structure. These defects of sperm fine structure seem to be associated with dysfunctional sperm-oocyte recognition, binding and fusion with the oolemma. Chromatin alterations and signs of decondensation or karyolysis are frequently associated with a deterioration of the nuclear membranes and may be due to impaired spermiogenesis. However, our results and the success of ICSI proved that severe sperm defects have no predictive value and do not impair the fertilization process, and also that the maturity of spermatozoa does not play an important role. Fine structure analysis revealed the pleiomorphology and heterogeneity of human spermatozoa.
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PMID:Ultrastructure of gametes and intracytoplasmic sperm injection: the significance of sperm morphology. 966 74

Results were collected from 11 studies comparing intrauterine insemination (IUI) with intracervical insemination (ICI) of frozen donor semen, 10 studies comparing IUI with timed natural intercourse (NI) or ICI in couples with semen defects and seven studies comparing ICI with NI or ICI in couples with unexplained infertility. IUI significantly increased the pregnancy rate relative to favourably timed ICI in donor insemination (DI) with frozen semen both with and without gonadotrophin stimulation of the female partner (odds ratios (95% confidence interval) 1.92 (1.02-3.61) and 2.63 (1.52-4.54) respectively). The benefit of IUI tended to be less when the pregnancy rate for ICI was high and IUI had no benefit with fresh donor semen. Overall IUI was of significant benefit in the male factor couples compared with NI-ICI (odds ratio 2.20 (1.43-3.39) and the advantage appeared to be maintained when comparison was confined to properly timed ICI although the odds ratios were not significantly greater than 1. IUI had no benefit relative to favourably timed NI-ICI for couples with unexplained infertility; an apparent advantage overall was produced by studies where NI was late. None of the studies on male factor used a sperm function test to define male subfertility and three only included couples with good mucus penetration by sperm. The range of semen defects defined was such that many couples would have had a good chance of conceiving naturally given a normal female partner but nevertheless the overall pregnancy rate (4.8%) was considerably less than in the unexplained group (11.6%), suggesting that some sperm dysfunction was present. We conclude that the available evidence suggests that IUI is valuable for DI with cryopreserved semen and for couples with mild to moderately impaired semen quality and postulate that it overcomes failure to fertilize due to impaired mucus penetration and poor survival in the female reproductive tract.
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PMID:Intrauterine insemination: is it an effective treatment for male factor infertility? 969 11


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