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Query: UNIPROT:P56851 (epididymal)
 11,273 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Among the most popular techniques of assisted reproduction for the treatment of male subfertility and infertility are intrauterine insemination, in vitro fertilization and intracytoplasmic sperm injection. The objective of these techniques is to bring more functional spermatozoa closer to the oocyte in order to promote fertilization. These techniques are thus not a cure per se and are only indicated when no specific or effective treatment is available for the male partner, when this treatment has failed or when the improvement of the female fertility status has also failed. While for moderate oligoasthenozoospermia, intrauterine insemination has proved to be a valid treatment, the outcome after conventional in vitro fertilization is limited because of a high incidence of complete fertilization failure. Since the introduction of intracytoplasmic sperm injection, a reliable method has become available in order to achieve fertilization in vitro. Apart from well from ejaculated spermatozoa, epididymal or testicular spermatozoa too can be used successfully for intracytoplasmic sperm injection. The surgical retrieval of spermatozoa for intracytoplasmic sperm injection has therefore become a routine technique in clinical andrology. Although these techniques have been implemented in everyday infertility practice within a few years of their introduction, many concerns about safety continue to exist. Intracytoplasmic sperm injection must be applied with caution, only when no other treatment option is available and when an appropriate prospective follow-up of the offspring is available.
Baillieres Best Pract Res Clin Endocrinol Metab 2000 Sep
PMID:Management of male infertility by assisted reproductive technologies. 1109 84

Currently approved male-directed contraceptive methods include condoms and vas occlusion. Vas occlusion is very effective but is intended to be non-reversible. Condoms have a relatively high failure rate, at least partially due to compliance problems and are not accepted by many couples. The only other male-oriented methods in clinical trials utilize the administration of testosterone alone or its combination with another gonadotropin-suppressing agent such as a progestin or a gonadotropin-releasing hormone antagonist. Studies published in the 1990s demonstrated that a testosterone-containing hormonal contraceptive method suppressed spermatogenesis to azoospermia in most men and severe oligozoospermia in the remaining. The contraceptive efficacy after treatment with testosterone alone was comparable to that of female hormonal methods. Having proven that reversible male contraception is a reality, present trials are attempting to identify the best androgen delivery system and the most effective androgen plus progestin preparation. It is likely that the first marketed male hormonal contraceptive method will be a long-acting (injectable or implant) combination of an androgen plus a progestin. Research is continuing to identify other target areas for male contraceptive development, including agents with post-testicular and epididymal sites of action.
Best Pract Res Clin Obstet Gynaecol 2002 Apr
PMID:Male contraception. 1204 62

Fertility restoration following sterilization has improved over the past 20 years, stemming from the use of microsurgical techniques, greater skill, experience, and more careful patient selection. For women, the most important factor in predicting a favorable outcome for a tuboplasty is the amount and quality of the tube remaining. Estimates of 3 out of 4 to 1 out of 5 women desiring reversal are candidates for the procedure. Less destructive sterilization methods, e.g., rings or clips in the isthmic portion of the tube, suggest greater chances for success. Electrocoagulation is the most difficult technique to reverse. Eligibility requirements are stringent for women and begin with an assessment of general and reproductive health. Invasive diagnostic procedures may be necessary to determine the degree of tubal damage. Extensive pelvic adhesions and/or fibrial occlusions may be associated with any type of midtubal sterilization. 1 physician has established the following criteria for reversal: presence of fimbria or 2 cm of infundibulum and 50% of the ampulla must be intact. Pregnancy rates decrease with increased destruction of the ampulla. The pregnancy rate following reversal varies with the type of sterilization procedure; rates of 64% and 82% are reported. For men, the critical factor in successful reversal is the length of time between the vasectomy and vasovasostomy, rather than the length of the vas. A shorter interval reduces the opportunity for epididymal damage. A 75% pregnancy rate and a 90% return of a normal, motile sperm count are reported. Sperm granuloma found at the vasectomy site is a favorable factor, indicating the absence of epididymal damage. However, in some cases an epididymovasostomy can bypass an epididymal rupture, increasing chances of fertility restoration in patients vasectomized 10 or more years ago. In 1 study, normal sperm count and motility was restored in 80% of the patients. Men with high levels of antibodies before surgery may have sperm with less motility afterwards. Sperm antibodies are present in 50-62% of vasectomized men studied. After surgery, sperm counts may improve with time as damaged nerves mend. Best reversal candidates are men whose vasectomies were performed less than 10 years ago and who had only a small segment of vas removed, well away from the epididymis. Although success rates for reversals are improving, family doctors should not necessarily recommend sterilization more frequently.
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PMID:Restoring fertility after sterilization. Sexual medicine today: special report. 1226 59

Infertility affects 13-18% of couples and growing evidence from clinical and epidemiological studies suggests an increasing incidence of male reproductive problems. The pathogenesis of male infertility can be reflected by defective spermatogenesis due to pituitary disorders, testicular cancer, germ cell aplasia, varicocele and environmental factors or to defective sperm transport due to congenital abnormalities or immunological and neurogenic factors. Recent studies suggest an increased incidence of genetic disorders related to male infertility which may affect different levels, interfering with germ cell generation and maturation or leading to the production of non-functional spermatozoa. The identification of genetic causes of male infertility raises the issue of the transmission of defects to the offspring, a situation that is becoming more important given the increasing use of intracytoplasmic sperm injection (ICSI), a procedure in which the natural selection of the spermatozoa is by-passed. Fertilization can occur in vitro using ejaculated, epididymal or testicular spermatozoa, either fresh or frozen-thawed, providing opportunities hitherto not possible for men to be genetic fathers.
Best Pract Res Clin Obstet Gynaecol 2003 Apr
PMID:Male infertility. 1275 96