The possibility of achieving a pregnancy with just one spermatozoon has led to the evolution of a... more The possibility of achieving a pregnancy with just one spermatozoon has led to the evolution of a number of methods aiming to obtain sperm from testicular tissue. This achievement now offers men with azoospermia a reasonable chance of fathering their own children. The choice of the best testicular sperm retrieval technique has always been a challenge. There has been a trend to use percutaneous needle aspiration but controlled studies have demonstrated that open testicular biopsy is necessary to obtain the best results, particularly in non-obstructive azoospermia. Since azoospermic men are at risk of specific genetic defects, careful genetic testing and counselling prior to treatment should be considered to allow the couple to make an informed decision as to whether or not to use the husband sperm. The recovery of sperm may not always be successful particularly in non-obstructive azoospermic men, an event that encompasses important emotional and financial implications. Unfortunately, no clinical or laboratory test can clearly predict success with sperm retrieval procedures.
The patient cohort of this study was composed of a carefully selected group of 47 men suffering f... more The patient cohort of this study was composed of a carefully selected group of 47 men suffering from non-obstructive azoospermia scheduled for ICSI with the use of testicular sperm. Participants were selected based upon previous testicular biopsy after semen analysis showing ...
High numbers of embryos transferred during assisted reproduction have become implicated as the ca... more High numbers of embryos transferred during assisted reproduction have become implicated as the cause of higher than normal twinning and multiple gestation rates following this form of therapy. However, reducing the number to a single embryo transferred has been shown to carry unfavourable results in the first cycle, but with similar cumulative live birth rates. This study tested the theory by performing a randomized controlled trial of elective single embryo transfer (SET) versus double embryo transfer (DET) in young women, and follow them up for 1 year to determine the result of cryo-embryo transfer cycles in the two cohorts. The results showed that the probability of a live birth was not significantly different between the two groups, but with a higher rate of twins in the DET group. In addition, during the 1-year follow-up period, the live birth, clinical pregnancy and multiple pregnancy rates were also similar, and in line with the results of the randomized trial. In conclusion, the results of this prospective randomized trial and 1-year follow-up show that in young women, elective SET should be the first line of choice. Even so, these results should be confirmed by larger randomized studies.
To assess seminal plasma anti-Müllerian hormone (AMH) level relationships in fertile and infertil... more To assess seminal plasma anti-Müllerian hormone (AMH) level relationships in fertile and infertile males. Methods: Eighty-four male cases were studied and divided into four groups: fertile normozoospermia (n = 16), oligoasthenoteratozoospermia (n = 15), obstructive azoospermia (OA) (n = 13) and non-obstructive azoospermia (NOA) (n = 40). Conventional semen analysis was done for all cases. Testicular biopsy was done with histopathology and fresh tissue examination for testicular sperm extraction (TESE) in NOA cases. NOA group was subdivided according to TESE results into unsuccessful TESE (n = 19) and successful TESE (n = 21). Seminal plasma AMH was estimated by enzyme linked immunosorbent assay (ELISA) and serum follicular stimulating hormone (FSH) was estimated in NOA cases only by radioimmunoassay (RIA). Results: Mean seminal AMH was significantly higher in fertile group than in oligoasthenoteratozoospermia with significance (41.5 ± 10.9 pmol/L vs. 30.5 ± 10.3 pmol/L, P < 0.05). Seminal AMH was not detected in any OA patients. Seminal AMH was correlated positively with testicular volume (r = 0.329, P = 0.005), sperm count (r = 0.483, P = 0.007), sperm motility percent (r = 0.419, P = 0.021) and negatively with sperm abnormal forms percent (r = -0.413, P = 0.023). Nonsignificant correlation was evident with age (r = -0.155, P = 0.414) and plasma FSH ( r = -0.014, P = 0.943). In NOA cases, seminal AMH was detectable in 23/40 cases, 14 of them were successful TESE (57.5%) and was undetectable in 17/40 cases, 10 of them were unsuccessful TESE (58.2%). Conclusion: Seminal plasma AMH is an absolute testicular marker being absent in all OA cases. However, seminal AMH has a poor predictability for successful testicular sperm retrieval in NOA cases. (Asian J Androl 2007 Mar; 9: 265-270)
To assess heme oxygenase-1 (HO-1) activity in the cavernous tissue of sildenafil citrate-treated ... more To assess heme oxygenase-1 (HO-1) activity in the cavernous tissue of sildenafil citrate-treated rats. Methods: One hundred and ninety-two Sprague-Dawley male rats, divided into four equal groups, were investigated. Group 1, the control group, received regular animal chow; group 2 received sildenafil citrate by intragastric tube; group 3 received sildenafil and HO inhibitor (zinc protoporphyrin, ZnPP); and group 4 received sildenafil and nitric oxide synthase (NOS) inhibitor L-nitroarginine methyl ester (L-NAME). Twelve rats from each group were killed after 0.5 h, 1 h, 2 h and 3 h of drug administration. Then HO-1 activity, cGMP levels and NOS enzymatic activity in the cavernous tissues were estimated. Results: In cavernous tissue, HO-1 activity, NOS enzymatic activity and cGMP concentration increased significantly in sildenafil-treated rats compared to other groups throughout the experiment. Rats receiving either HO or NOS inhibitors showed a significant decrease in these parameters. HO-1 cavernous tissue activity and NOS enzymatic activity demonstrated a positive significant correlation with cGMP levels (r = 0.646, r = 0.612 respectively; P < 0.001). Conclusion: The actions of PDE5 inhibitor sildenafil citrate in the cavernous tissue are partly mediated through the interdependent relationship between both HO-1 and NOS activities. (Asian J Androl 2007 May; 9: 377-381)
The possibility of achieving a pregnancy with just one spermatozoon has led to the evolution of a... more The possibility of achieving a pregnancy with just one spermatozoon has led to the evolution of a number of methods aiming to obtain sperm from testicular tissue. This achievement now offers men with azoospermia a reasonable chance of fathering their own children. The choice of the best testicular sperm retrieval technique has always been a challenge. There has been a trend to use percutaneous needle aspiration but controlled studies have demonstrated that open testicular biopsy is necessary to obtain the best results, particularly in non-obstructive azoospermia. Since azoospermic men are at risk of specific genetic defects, careful genetic testing and counselling prior to treatment should be considered to allow the couple to make an informed decision as to whether or not to use the husband sperm. The recovery of sperm may not always be successful particularly in non-obstructive azoospermic men, an event that encompasses important emotional and financial implications. Unfortunately, no clinical or laboratory test can clearly predict success with sperm retrieval procedures.
The patient cohort of this study was composed of a carefully selected group of 47 men suffering f... more The patient cohort of this study was composed of a carefully selected group of 47 men suffering from non-obstructive azoospermia scheduled for ICSI with the use of testicular sperm. Participants were selected based upon previous testicular biopsy after semen analysis showing ...
High numbers of embryos transferred during assisted reproduction have become implicated as the ca... more High numbers of embryos transferred during assisted reproduction have become implicated as the cause of higher than normal twinning and multiple gestation rates following this form of therapy. However, reducing the number to a single embryo transferred has been shown to carry unfavourable results in the first cycle, but with similar cumulative live birth rates. This study tested the theory by performing a randomized controlled trial of elective single embryo transfer (SET) versus double embryo transfer (DET) in young women, and follow them up for 1 year to determine the result of cryo-embryo transfer cycles in the two cohorts. The results showed that the probability of a live birth was not significantly different between the two groups, but with a higher rate of twins in the DET group. In addition, during the 1-year follow-up period, the live birth, clinical pregnancy and multiple pregnancy rates were also similar, and in line with the results of the randomized trial. In conclusion, the results of this prospective randomized trial and 1-year follow-up show that in young women, elective SET should be the first line of choice. Even so, these results should be confirmed by larger randomized studies.
To assess seminal plasma anti-Müllerian hormone (AMH) level relationships in fertile and infertil... more To assess seminal plasma anti-Müllerian hormone (AMH) level relationships in fertile and infertile males. Methods: Eighty-four male cases were studied and divided into four groups: fertile normozoospermia (n = 16), oligoasthenoteratozoospermia (n = 15), obstructive azoospermia (OA) (n = 13) and non-obstructive azoospermia (NOA) (n = 40). Conventional semen analysis was done for all cases. Testicular biopsy was done with histopathology and fresh tissue examination for testicular sperm extraction (TESE) in NOA cases. NOA group was subdivided according to TESE results into unsuccessful TESE (n = 19) and successful TESE (n = 21). Seminal plasma AMH was estimated by enzyme linked immunosorbent assay (ELISA) and serum follicular stimulating hormone (FSH) was estimated in NOA cases only by radioimmunoassay (RIA). Results: Mean seminal AMH was significantly higher in fertile group than in oligoasthenoteratozoospermia with significance (41.5 ± 10.9 pmol/L vs. 30.5 ± 10.3 pmol/L, P < 0.05). Seminal AMH was not detected in any OA patients. Seminal AMH was correlated positively with testicular volume (r = 0.329, P = 0.005), sperm count (r = 0.483, P = 0.007), sperm motility percent (r = 0.419, P = 0.021) and negatively with sperm abnormal forms percent (r = -0.413, P = 0.023). Nonsignificant correlation was evident with age (r = -0.155, P = 0.414) and plasma FSH ( r = -0.014, P = 0.943). In NOA cases, seminal AMH was detectable in 23/40 cases, 14 of them were successful TESE (57.5%) and was undetectable in 17/40 cases, 10 of them were unsuccessful TESE (58.2%). Conclusion: Seminal plasma AMH is an absolute testicular marker being absent in all OA cases. However, seminal AMH has a poor predictability for successful testicular sperm retrieval in NOA cases. (Asian J Androl 2007 Mar; 9: 265-270)
To assess heme oxygenase-1 (HO-1) activity in the cavernous tissue of sildenafil citrate-treated ... more To assess heme oxygenase-1 (HO-1) activity in the cavernous tissue of sildenafil citrate-treated rats. Methods: One hundred and ninety-two Sprague-Dawley male rats, divided into four equal groups, were investigated. Group 1, the control group, received regular animal chow; group 2 received sildenafil citrate by intragastric tube; group 3 received sildenafil and HO inhibitor (zinc protoporphyrin, ZnPP); and group 4 received sildenafil and nitric oxide synthase (NOS) inhibitor L-nitroarginine methyl ester (L-NAME). Twelve rats from each group were killed after 0.5 h, 1 h, 2 h and 3 h of drug administration. Then HO-1 activity, cGMP levels and NOS enzymatic activity in the cavernous tissues were estimated. Results: In cavernous tissue, HO-1 activity, NOS enzymatic activity and cGMP concentration increased significantly in sildenafil-treated rats compared to other groups throughout the experiment. Rats receiving either HO or NOS inhibitors showed a significant decrease in these parameters. HO-1 cavernous tissue activity and NOS enzymatic activity demonstrated a positive significant correlation with cGMP levels (r = 0.646, r = 0.612 respectively; P < 0.001). Conclusion: The actions of PDE5 inhibitor sildenafil citrate in the cavernous tissue are partly mediated through the interdependent relationship between both HO-1 and NOS activities. (Asian J Androl 2007 May; 9: 377-381)
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