On average, the menopause occurs at the age of 50 years,1 with 1 % of women continuing to menstruate beyond the age of 60 years and 1% whose menopause occurs before 40 years. Arbitrarily, a menopause before the age of 40 years is defined as 'premature'. Premature ovarian failure may be caused by any process which reduces the number of oocytes within the ovary. In the embryo, germ cells first appear in the urogenital ridge. These germ cells then migrate to the primitive ovary. Once within the ovary, the germ cells multiply to form 3.5 million potential oocytes in each ovary (Fig. 1). From this time, oocytes are held in suspended animation - meiosis - until required for ovulation perhaps 40 years later. If a woman were to ovulate every month throughout her reproductive life, then she would use fewer than 500 eggs - a tiny proportion of the original 7 million (0.007%). Thus, if a woman were to prevent ovulation, say by taking the combined oral contraceptive

/pdf/premature-ovarian-failure-27iznvee62.pdf

Premature ovarian failure

Severe oligozoospermia resulting from deletions of azoospermia factor gene on Y chromosome

The onset of clinical assisted reproduction, a quarter of a century ago, required the isolation of motile spermatozoa. As the indication of assisted reproduction shifted from mere gynaecological indications to andrological indications during the years, this urged andrological research to understand the physiology of male germ cell better and develop more sophisticated techniques to separate functional spermatozoa from those that are immotile, have poor morphology or are not capable to fertilize oocytes. Initially, starting from simple washing of spermatozoa, separation techniques, based on different principles like migration, filtration or density gradient centrifugation evolved. The most simple and cheapest is the conventional swim-up procedure. A more sophisticated and most gentle migration method is migration-sedimentation. However, its yield is relatively small and the technique is therefore normally only limited to ejaculates with a high number of motile spermatozoa. Recently, however, the method was also successfully used to isolate spermatozoa for intracytoplasmic sperm injection (ICSI). Sperm separation methods that yield a higher number of motile spermatozoa are glass wool filtration or density gradient centrifugation with different media. Since Percoll® as a density medium was removed from the market in 1996 for clinical use in the human because of its risk of contamination with endotoxins, other media like IxaPrep®, Nycodenz, SilSelect®, PureSperm® or Isolate® were developed in order to replace Percoll®. Today, an array of different methods is available and the selection depends on the quality of the ejaculates, which also includes production of reactive oxygen species (ROS) by spermatozoa and leukocytes. Ejaculates with ROS production should not be separated by means of conventional swim-up, as this can severely damage the spermatozoa. In order to protect the male germ cells from the influence of ROS and to stimulate their motility to increase the yield, a number of substances can be added to the ejaculate or the separation medium. Caffeine, pentoxifylline and 2-deoxyadenosine are substances that were used to stimulate motility. Recent approaches to stimulate spermatozoa include bicarbonate, metal chelators or platelet-activating factor (PAF). While the use of PAF already resulted in pregnancies in intrauterine insemination, the suitability of the other substances for the clinical use still needs to be tested. Finally, the isolation of functional spermatozoa from highly viscous ejaculates is a special challenge and can be performed enzymatically to liquefy the ejaculate. The older method, by which the ejaculate is forcefully aspirated through a narrow-gauge needle, should be abandoned as it can severely damage spermatozoa, thus resulting in immotile sperm.

/pdf/sperm-preparation-for-art-22vrp3ut6i.pdf

Sperm preparation for ART.

Preface 1. The medical and cultural history of testosterone and the testes Eberhard Nieschlag and Susan Nieschlag 2. Testosterone: biosynthesis, transport, metabolism and (non-genomic) actions C. Marc Luetjens and Gerhard F. Weinbauer 3. Pathophysiology of the androgen receptor Olaf Hiort, R. Werner and Michael Zitzmann 4. Methodology for measuring testosterone, DHT and SHBG in a clinical setting Manuela Simoni, Flaminia Fanelli, Laura Roli and Uberto Pagotto 5. The behavioral correlates of testosterone John Bancroft 6. The role of testosterone in spermatogenesis Liza O'Donnell and Robert I. McLachlan 7. Androgens and hair: a biological paradox with clinical consequences Valerie Anne Randall 8. Testosterone and bone Dirk Vanderschueren, Mieke Sinnesael, E. Gielen, F. Claessens and S. Boonen 9. Androgens effects on the skeletal muscle Shalender Bhasin, Ravi Jasuja, Carlo Serra, Rajan Singh, Thomas W. Storer, Wen Guo, Thomas G. Travison and Shezad Basaria 10. Testosterone and cardiovascular disease Kevin S. Channer and T. Hugh Jones 11. Testosterone, obesity, diabetes and the metabolic syndrome T. Hugh Jones and Kevin S. Channer 12. Testosterone and erection Mario Maggi and Hermann M. Behre 13. Testosterone and the prostate John T. Isaacs and Samuel R. Denmeade 14. Clinical use of testosterone in hypogonadism and other conditions Eberhard Nieschlag and Hermann M. Behre 15. Testosterone preparations for clinical use in males Hermann M. Behre and Eberhard Nieschlag 16. Androgens in male senescence Jean-Marc Kaufman, Guy T'Sojen and Alex Verleulen 17. Androgen therapy in non-gonadal disease David J. Handelsman 18. Review of guidelines on diagnosis and treatment of testosterone deficiency Ronald S. Swerdloff and Christina C. L. Wang 19. Pathophysiology of estrogen action in men Vincenzo Rochira, Daniele Santi and Cesare Carani 20. Dehydroepiandrosterone (DHEA) and androstenedione Bruno Allolio, Wiebke Arlt and Stefanie Hahner 21. The state-of-the-art in the development of selective androgen receptor modulators (SARMs) Ravi Jasuja, M. Zacharov and Shalender Bhasin 22. The essential role of testosterone in hormonal male contraception Eberhard Nieschlag and Hermann M. Behre 23. Testosterone use in women Susan R. Davis 24. Detection of illegal use of androgens and SARMs Wilhelm Schanzer and Mario Thevis 25. Clinical effects of doping with anabolic steroids Elena Vorona and Eberhard Nieschlag Index.

Testosterone : action, deficiency, substitution

A retrospective analysis of results from 114 initiated in-vitro fertilization cycles utilizing pronuclear embryo transfer is presented. Patients were unselected for age or infertility criteria, constituted a continuous series and were grouped according to response to stimulation (Group 1, ideal; Group 2, suboptimal) or ovarian reserve (Group 3, poor). At 16-18 h post-insemination, embryos were scored for alignment of pronuclei and nucleoli and the appearance of the cytoplasm, generating an embryo score (ES). Transfers were performed 24-26 h post-insemination using two to six embryos with the highest ES. A corrected score was calculated (total score/number of embryos; CS). A total of 114 initiated cycles resulted in 97 oocyte retrievals with 38 clinical pregnancies (39%; 15% implantation). Pregnancy rates were significantly different between the three groups; 37 pregnancies in Group 1 (55% clinical pregnancy; 20% implantation), none in Group 2 and one in Group 3 (6%; 2% implantation: P 15 resulted in a 28% implantation; 65% delivery rate. CS <14 resulted in four pregnancies, one delivered. The data show that oocyte quality and pronuclear embryo morphology are related to implantation and that pronuclear embryos can be successfully selected for embryo transfer.

The successful use of pronuclear embryo transfers the day following oocyte retrieval.

Pregnancy with sperm aspiration from the proximal head of the epididymis: a new treatment for congenital absence of the vas deferens.

Conventional methods of semen preparation for IVF, such as swim-up sedimentation, regular Percoll gradients, are not very effective in the treatment of severe oligoasthenozoospermia (total motile count less than 5 X 10(6)). For these cases, a new method of sperm preparation consisting of a reduced volume of a discontinuous Percoll gradient (mini-Percoll) has been utilized. The results obtained were analysed by comparing mini-Percoll versus resuspension in two groups of patients with severe male factor infertility. In the mini-Percoll group, a statistically significant improvement (P less than 0.001) was obtained in the post-treatment seminal parameters of motility, progression and proportion of normal forms. In the resuspension group (n = 12), only eight of 108 oocytes inseminated were fertilized (7%), while in the mini-Percoll group (n = 29), 124 out of 336 oocytes were fertilized (40%) (P less than 0.001). Furthermore, in the mini-Percoll group, a higher pregnancy rate (25 versus 7%) and low abortion rate (22 versus 33%) were observed. Although more studies are necessary to confirm these preliminary data, mini-Percoll seems to be a valid laboratory tool for semen samples of extremely poor quality.

T. Ord

Papers

Pregnancy with sperm aspiration from the proximal head of the epididymis: a new treatment for congenital absence of the vas deferens.

Mini-Percoll: a new method of semen preparation for IVF in severe male factor infertility

New treatment for infertility due to congenital absence of vas deferens.

Two births after microsurgical sperm aspiration in congenital absence of vas deferens.

Pregnancy With Sperm Aspiration From the Proximal Head of the Epididymis: A New Treatment for Congenital Absence of the Vas Deferens