Clinical and Experimental Reproductive Medicine-CERM最新文献

Objective: The aim of this study was to observe the effect of clomiphene citrate on sperm parameters in infertile men diagnosed with idiopathic oligoasthenozoospermia.

Methods: This randomized controlled trial involved 50 infertile men diagnosed with idiopathic oligoasthenozoospermia, all of whom had normal serum testosterone and follicle-stimulating hormone levels. The participants were divided into two groups. The first group (n=25) received a daily dose of 50 mg of clomiphene citrate in tablet form for 3 months, while the second group (n=25) was given a placebo. Sperm concentration, sperm motility, and serum testosterone levels were measured at the start of the study and after 3 months of treatment. Changes in these parameters were then assessed and compared between the two groups.

Results: There was a significant increase in the mean sperm count (9.17±4.11 million/mL vs. 13.88±7.27 million/mL), progressive motility (14.67±7.03 vs. 21.42±11.9), total motile sperm count (3.53±3.08 million vs. 7.81±7.10 million), and mean serum testosterone levels (371.97±88.51 ng/dL vs. 805.94±290.77 ng/dL) in the clomiphene citrate group. In contrast, the changes in the placebo group were not significant. Post-treatment severe oligozoospermia was substantially lower in the clomiphene citrate group (odds ratio, 0.31) compared to the placebo group. Additionally, half of the participants in the clomiphene citrate group experienced a statistically significant upgrade in World Health Organization (WHO) sperm concentration categories, versus 27.3% in the placebo group.

Conclusion: Clomiphene citrate improves sperm count and motility, leading to upgrades in WHO sperm concentration categories in infertile men with idiopathic oligoasthenozoospermia.

Objective: Laser-assisted hatching (LAH) employs two distinct techniques: thinning and breaching. This study aimed to compare the clinical efficacy of combined thinning and breaching versus breaching alone in vitrified-warmed embryo or blastocyst transfer cycles.

Methods: In total, 110 vitrified-warmed day-3 embryo transfer cycles and 50 vitrified-warmed day-5 blastocyst transfer cycles were retrospectively selected. All transfers were performed between 2021 and 2022 at a university-based infertility center. Combined thinning and breaching involved thinning either one-quarter or one-sixth of the zona pellucida circumference combined with breaching at a single point.

Results: In vitrified-warmed day-3 embryo transfer cycles, the 'thinning and breaching' and 'breaching only' groups were similar regarding the median age of the woman (36 years vs. 37 years, respectively), number of embryos transferred (2 vs. 2), and embryo score (89 vs. 31.5). The clinical pregnancy rate (PR) (23.5% vs. 21.1%), embryo implantation rate (IR) (11.4% vs. 11.3%), and clinical miscarriage rate (25% vs. 37.5%) were also comparable between the two LAH groups. In vitrified-warmed day-5 blastocyst transfer cycles, the combination and breaching-only groups were similar in the median age of the woman (36 years vs. 36.5 years, respectively), number of blastocysts transferred (1 vs. 1), and blastocyst score (45 vs. 31.5). The clinical PR (45.5% vs. 42.9%), IR (35.4% vs. 33.3%), and clinical miscarriage rate (20% vs. 33.3%) were also similar between groups.

Conclusion: Breaching alone displayed similar efficacy to combined thinning and breaching in terms of clinical PR, IR, and miscarriage rate. Thus, breaching alone appears sufficient to achieve favorable pregnancy outcomes.

Objective: The aim of this study is to investigate the effects of granulocyte-macrophage colony-stimulating factor (GM-CSF) treatment on the autophagy process and sperm parameters in individuals with asthenoteratozoospermia.

Methods: Twenty semen samples from patients diagnosed with asthenoteratozoospermia were divided into control and treatment groups. Subsequently, 2 ng/mL of GM-CSF was added to the treatment group samples. All samples were then incubated for 1 hour. Post-incubation, the protein levels of light chain 3 II (LC3-II)/LC3-I and autophagy related 7 (Atg7), which are well-known autophagy markers, along with sperm motility, viability, and sperm DNA fragmentation, were analyzed in both study groups.

Results: Our study demonstrated significant increases in LC3-II/LC3-I and Atg7 levels, as well as in sperm motility, in the GM-CSF group compared to the control group (p<0.0001). Furthermore, GM-CSF treatment significantly reduced necrotic cell death in the GM-CSF group relative to the control group (p<0.01). There were no significant differences between the groups in terms of sperm viability and DNA fragmentation (p>0.05).

Conclusion: These results revealed that GM-CSF has the potential to significantly induce autophagy in sperm and enhance sperm motility in patients with asthenoteratozoospermia, without adversely affecting sperm viability and DNA integrity. These findings suggest that modifying autophagy with physiological and safe components like GM-CSF may become a promising therapeutic strategy for treating male infertility in the near future.

Adult stem cell therapy has emerged as a prominent area of interest in regenerative medicine, drawing attention from numerous researchers who are investigating its potential for treating degenerative diseases, especially those affecting the reproductive system. Despite the growing focus, critical elements such as the optimization of treatment parameters (e.g., transplantation [Tx] route, cell dosage) and enhancement of therapeutic efficacy are still areas of uncertainty. This review paper presents a thorough analysis of recent preclinical and clinical studies on adult stem cell therapy for ovarian dysfunction, specifically targeting conditions like polycystic ovary syndrome (PCOS). By examining these studies, the review seeks to clarify the current state of knowledge and pinpoint gaps in understanding, thereby establishing a robust foundation for future advancements in adult stem cell therapies aimed at ovarian dysfunction. Ultimately, this paper aims to offer valuable insights that could lead to improved treatment strategies in the field of reproductive system diseases.

Objective: This study emphasizes the role of oxidative stress in the pathogenesis of male infertility-including varicocele-and supports the utility of antioxidant supplementation. The aim of our study is to evaluate the effectiveness of multiantioxidant therapy in improving semen quality, reducing the DNA fragmentation index, and increasing pregnancy rates in oligoasthenozoospermic (OA) patients with different grades of varicocele.

Methods: We conducted a prospective study of infertile men with OA and varying grades of varicocele. Serum and semen samples were collected at baseline and after 6 months of treatment from subjects with varicocele grades 0, 1, 2, and 3. Sperm DNA damage, reproductive hormones, and pregnancy rates were evaluated.

Results: Significant differences in mean sperm count, total sperm count, sperm motility, and normal sperm morphology were observed among groups G1, G2, G3, and G4 (p<0.0001). Sperm DNA integrity improved significantly in patients with varicocele after oral antioxidant therapy. Pregnancy achieved by intrauterine insemination was observed in 11%, 9%, 1%, and 0.7% of couples in groups G1, G2, G3, and G4, respectively. Additionally, spontaneous pregnancy occurred in 6% and 3% of couples with varicocele grade 0 and grade 1, respectively, after multiantioxidant supplementation. No significant pregnancy rate was observed in groups G3 and G4.

Conclusion: Multiantioxidant therapy produced marked therapeutic benefits in patients with grade 0 and grade 1 varicocele and served as a useful adjuvant in managing varicocele-related infertility.

Objective: The choice between utilizing testicular or ejaculatory sperm for intracytoplasmic sperm injection (ICSI) in men with severe oligozoospermia or cryptozoospermia is a crucial aspect of managing male infertility. This study aimed to identify a predictive factor that could guide this decision-making process.

Methods: Seventy-five infertile men with severe oligozoospermia or cryptozoospermia were included in the analysis. On the day of ovum pick-up, these participants were divided into three groups (n=25 each) based on their sperm concentrations: cryptozoospermia, 0.1-1 million/mL and 1-5 million/mL. Patients in each group underwent ICSI, which involved the insemination of sibling oocytes using either ejaculated spermatozoa or testicular spermatozoa obtained via fine-needle aspiration. We evaluated the rates of fertilization, cleavage, high-quality embryo production, and blastocyst formation.

Results: In patients with sperm concentrations below 1 million/mL, testicular sperm demonstrated higher rates of fertilization (p<0.001), cleavage (p=0.01), high-quality embryo formation (p=0.003), and blastocyst development (p=0.04) compared to ejaculated sperm. In cases of cryptozoospermia, testicular sperm was associated with a higher fertilization rate (p<0.001) and a marginally higher rate of high-quality embryos (p=0.06). Conversely, in patients with sperm concentrations exceeding 1 million/mL, ejaculated sperm yielded superior outcomes.

Conclusion: This study underscores the significance of considering sperm concentration when advising on sperm retrieval techniques to improve ICSI outcomes in men diagnosed with severe oligozoospermia or cryptozoospermia. Further research is necessary to confirm predictive factors that assist in decision-making regarding the source of sperm, whether from ejaculate, testicular aspiration, or biopsies.

Objective: While obesity has been associated with poor reproductive outcomes, the specific factors affecting gametes remain unclear. Our primary objective was to assess the relationship between a couple's pre-pregnancy body mass index (BMI), the morphokinetic characteristics of embryos, and their potential for implantation. We analyzed standard semen parameters, sperm chromatin integrity, and oxidative stress levels in men undergoing assisted reproductive techniques (ART).

Methods: A total of 1,320 couples were categorized into nine different weight classes. Following the incubation of embryos in a time-lapse device, we evaluated embryo development and ART outcomes.

Results: Significant differences were observed in the percentage of sperm with normal morphology, as well as in the levels of reactive oxygen species, malondialdehyde, and total antioxidant capacity, between overweight and normal-weight men. Overweight men also showed a higher percentage of motile spermatozoa with altered chromatin. After adjusting for parental age and infertility causes, t5 and t8 durations were longer in obese women. In overweight men, t2 and t8 were delayed compared to those in normal-weight couples. Additionally, overweight couples experienced faster time of pronuclei appearance and time of pronuclei fading, along with longer t2, t5, and t8, compared to their normal-weight counterparts. Moreover, overweight males exhibited a lower fertility rate than normal-weight men. Overweight couples also demonstrated significantly lower rates of clinical pregnancy and fertilization, which correlated with higher miscarriage rates.

Conclusion: This time-lapse study revealed that the combined pre-pregnancy BMI of parents is associated with slower pre-implantation embryo development.

In cases of severe oligospermia and non-obstructive azoospermia, few spermatozoa with appropriate motility and viability are detected in epididymal and testicular samples. Sperm cryopreservation is performed to avoid multiple testis biopsies and to maintain samples. Consequently, various sperm retrieval methods are employed together with intracytoplasmic sperm injection. Common cryopreservation techniques are not ideal if there are few spermatozoa because sperm may be lost during the freezing and thawing procedures. Single sperm cryopreservation was first developed in 1997 and has since evolved in various aspects, including cryo-devices, freezing methods, cryoprotectants, and clinical and neonatal outcomes, as discussed in this comprehensive review. The CENTRAL, Embase, MEDLINE, PubMed, Scopus, and Web of Science databases were searched for relevant studies published during 1997-2023. Single sperm cryopreservation has been applied successfully for individuals with a limited number of spermatozoa. First, cryo-devices and their advantages and disadvantages are discussed. Furthermore, different aspects of this technique-including the use of testicular sperm rather than ejaculated sperm, proper cryoprotectants with ideal freezing outcomes, optimal cooling and warming rates, and testicular sperm selection prior to freezing-require more attention. This technique has been applied in clinical settings, and clinical outcomes have been reported using various carriers such as empty zonae pellucidae, straws, cell sleepers, cryotops, cryopieces, the sperm vitrification device (Sperm VD), and stripper tips. Furthermore, delivery rates have also been reported using this method. Nonetheless, more clinical trials are required to facilitate biological offspring through a practical platform.