Infertility, ICSI, and the Epididymis
It is estimated that about 30 to 40% of couples seeking fertility treatments are diagnosed with male factor infertility. These males have a range of gonadal dysfunctions that includes azoospermia (i.e., no sperm in the ejaculate), oligozoospermia (i.e., sperm count less than 20 million/ml), asthenozoospermia (i.e., sperm motility less than 50%) and teratozoospermia (i.e., sperm with normal morphology less than 30%). The group of patients with azoospermia represents about 25% of the total and, of these, about 30% have an obstructive process (obstructive azoospermia) while the remaining have a primary testicular failure (non-obstructive azoospermia). In the obstructive azoospermia group, about 25% have congenital bilateral absence of the vas deferens (CBAVD), while the incidence among all infertile males is about 2% (approximately 16,000 males are affected by CBAVD in USA) (Patrizio and Leonard, 2000). Other obstructive conditions are represented by vasectomy, failed vasectomy reversal operations, post-inflammatory scarring of the epididymis, inoperable ejaculatory ducts blockage or distal vasal obstructions and functional obstructions seen in patients after extensive retroperitoneal lymph-node dissections.
KeywordsCystic Fibrosis Cystic Fibrosis Transmembrane Conductance Regulator Intracytoplasmic Sperm Injection Cystic Fibrosis Transmembrane Regulator Cystic Fibrosis Transmembrane Conductance Regulator Mutation
Unable to display preview. Download preview PDF.
- Goldstein M.and Girardi S (1997) Vasectomy and vasectomy reversal. Curr .Therap. Endocrinol. Metab.6: 371–380.Google Scholar
- Haidl G, Badura B, Hinsch KD, et al (1993) Disturbance of sperm flagellae due to failure of epididymal maturation and their possible relationship to phospholipids. Hum.Reprod.7: 1070–1073.Google Scholar
- National Health and Nutrition Examination Survey (U.S.) (1987) Epidemiologic Follow up study (NHANES). Hyattsville MD: U.S. Department of Health and Human Services.Google Scholar
- Patrizio P and Salameh WA (1998) Expression of the cystic fibrosis transmembrane conductance regulator (CFTR) mRNA in normal and pathological adult human epididymis. J Reprod Fertil.53: 261–70Google Scholar
- Patrizio P and Leonard DGB (2000) Mutations in the Cystic Fibrosis gene and Congenital absence of the vas deferens.In“Results and Problems in Cell Differentiation, Vol.28 McElreavy (ed):The genetic basis of male infertility. Springer-Verlag, HeidelbergGoogle Scholar
- Setchell BP and Hinton BT (1981) The effects of spermatozoa of changes in the composition of luminal fluid as it passes along the epididymis. Prog.Reprod.Biol.8: 58–66Google Scholar
- Skudlarek MD, Orgebin-Crist M-C, Tulsiani DRP (1991) Aspargine-linked glycoprotein biosynthesis in rat epididymis: presence of a mannosidase II-like enzyme. Biochemical J.277: 213–221.Google Scholar
- Tournaye H, Devroey P, Liu J, Nagy Z,Lissens W, Van Steirteghem A (1994) Microsurgical epididymal sperm aspiration and intracytoplasmic sperm injection: a new effective approach to infertility as a result of congenital bilateral absence of the vas deferens. Fertil Steril.61: 1045–51PubMedGoogle Scholar
- Wong PYD (1990) Electrolyte and fluid transport in the epididymis. In Epithelial secretion of water and electrolytes, pp 333–347. Ed.Young P and Wong PYD. Springer-Verlag,Berlin.Google Scholar