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Objective: To evaluate rates and reasons for treatment discontinuation in couples with male factor infertility and who failed to conceive., Design: Retrospective study., Setting: Male Sterility Center, University Hospital., Patient(s): A total of 407 couples consulting for male factor infertility and who discontinued treatment without conceiving., Intervention(s): None., Main Outcome Measure(s): Treatment, reasons for dropout, and reproductive outcomes after discontinuation., Result(s): Of the 407 patients, 218 (54%) had had fertility treatment (medical or surgical), and 189 (46%) underwent assisted reproductive techniques (ART) (intrauterine insemination [IUI], in vitro fertilization [IVF], or intracytoplasmic sperm injection [ICSI]). The main reasons for dropout were painfulness of treatment (15% for patients with non-ART treatment vs. 32% for patients who had undergone ART), its ineffectiveness (12% vs. 26%), and separation of the couple (18% vs. 7%). Of the 407 patients, 27% consulted in another fertility center, 8% succeeded in having a child by ART with male partner sperm, 1% by ART with donor sperm, and 11% through adoption., Conclusion(s): About half of the couples consulting for male factor infertility discontinued fertility treatment, and of those who discontinued only a fifth finally succeeded in having a child. Although support is available to couples during fertility care, ART is a physical and psychological burden., (Copyright © 2013 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To investigate the effects of a mild induced testicular and epididymal hyperthermia (+2°C) on sperm chromatin integrity in men., Design: Experimental prospective study., Setting: University hospital., Patient(s): Five healthy fertile volunteers., Intervention(s): Testicular and epididymal hyperthermia was induced by maintaining the testes at inguinal position with the support of specially designed underwear 15 ± 1 hours daily for 120 consecutive days., Main Outcome Measure(s): Classic semen characteristics. Sperm DNA fragmentation index (DFI) and high DNA stainability (HDS) were analyzed by sperm chromatin structure assay., Result(s): Compared with baseline values, sperm DFI and HDS were significantly increased as early as day (D) 20 and D34, respectively, and remained elevated during the entire period of hyperthermia. Percentages of motile and viable spermatozoa decreased as early as D20 and D34, respectively, and total sperm count decreased at D34 during hyperthermia and remained low during the entire hyperthermia period. All studied parameters returned to respective baseline values at D73 after cessation of hyperthermia., Conclusion(s): Mild induced testicular and epididymal hyperthermia largely impaired sperm chromatin integrity, which appeared before any changes in sperm output. These findings may have clinical implications in male contraception, infertility, and assisted reproductive technology., (Copyright © 2012 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To report parameters in semen samples and sperm deoxyribonucleic acid integrity in a fertile volunteer presenting a 2-day fever of 39 degrees -40 degrees C., Design: Case report., Setting: University-affiliated teaching hospital., Intervention(s): None., Patient(s): Semen samples from a fertile volunteer of proven fertility were obtained and analyzed before the febrile illness episode and at days 15, 37, 58, 79, and >180 after the fever., Main Outcome Measure(s): Semen parameters (total sperm count, motility a+b, and vitality), sperm protamination state, measured by sperm chromatin structure assay (SCSA) and apoptotic activities, measured by terminal uridine nick-end labeling (TUNEL) assay., Results: Total sperm count significantly decreased at days 15, 37, and 58 after the fever and returned to normal by day 79 after the fever. The percentage of motility significantly decreased at days 15 and 37 after the fever and returned to normal by day 58. Vitality score also showed a slight, although not statistically significant, decrease after the fever. The DNA fragmentation index (DFI, a SCSA parameter), which defines abnormal chromatin structure, significantly increased by 24% and 36% at days 15 and 37 after the fever, respectively, and decreased to 15% and 8% when reaching days 58 and 79 after the fever. High DNA stainability (HDS, a SCSA parameter) also significantly increased at day 37 after the fever. On the other hand, sperm DNA fragmentation, as measured by TUNEL assay, increased up to 23% by day 15 after the fever but this was not statistically significant., Conclusion(s): This report demonstrates that a febrile episode can have marked effects on semen parameters and sperm DNA integrity. These results are particularly important for the counseling of infertile couples and in relation to assisted reproductive techniques (ART).

Objective: To report parameters in semen samples and sperm DNA integrity in a healthy fertile volunteer over a 10-year period., Design: Case report., Setting: University-affiliated teaching hospital., Intervention(s): None., Patient(s): Semen samples from a nonsmoking healthy male volunteer of proven fertility aged from 40 to 50 years were collected and analyzed over a decade., Main Outcome Measure(s): Semen parameters (sperm count, total sperm count, percentage of progressive motility grades a+b, morphology, and percentage of living spermatozoa) and sperm DNA integrity, measured by sperm chromatin structure assay (SCSA) and terminal uridine nick-end labeling (TUNEL) assay., Result(s): Median (min-max) value of total sperm count was 330 (126-511) million. Motility and vitality presented a median of 50% (40%-75%) and 78% (53%-92%), respectively. Among semen parameters, morphology and vitality showed the lowest within-subject coefficient of variation (CV(W)) and the total sperm count the highest (8.1% and 12.0% vs. 34.9%). Median values of DNA fragmentation index (DFI) and high DNA stainability (HDS) were 12.7% (7.9%-16.5%) and 6.5% (5.5%-8.2%), respectively. Sperm DNA fragmentation presented a median value of 8.9%, a minimum value of 1.4% and maximum value of 18.6%. Compared with TUNEL data, SCSA parameters (DFI and HDS) showed less variation over the data collection period (47.4% vs. 22.4% and 13.0%, respectively)., Conclusion(s): Our data show that in this healthy fertile volunteer, semen parameters and sperm DNA integrity remained normal, and no trend was observed over the study period. More interestingly, in this subject aged from 40 to 50 years old, sperm nucleus status presented less than 20% of sperm DNA fragmentation over a decade.

Objective: To evaluate the influence of sperm defects on embryo quality., Design: Retrospective study., Setting: In vitro fertilization center., Patients: Embryo transfers (710) from IVF attempts for tubal disease (626) or male infertility (84)., Main Outcome Measures: Embryo morphology as a function of causes of infertility, semen, and follicular growth parameters. Embryos were classified into three groups according to their morphology., Results: Transfers of embryos with good morphology were associated to a higher pregnancy rate (34%) than those with intermediate (24%) and poor (10%) morphology. Transfers of embryos with a poor morphology were more frequent (26 of 84 versus 114 of 626) and those with a fair aspect were less frequent (24 of 84 versus 229 of 626) in male infertility than in tubal disease. Embryos with a poor morphology were associated with lower percentage of morphologically normal sperms (62% +/- 19% versus 67% +/- 18%; means +/- SD) and a higher percentage of abnormalities of the postacrosomial region (29% +/- 15% versus 18% +/- 7%). Moreover, sperms with counts < 10 x 10(6)/mL were associated with a lower percentage of embryos with good morphology (18% versus 37%) than sperms with counts > or = 10 x 10(6)/mL., Conclusion: Embryo quality is influenced by the semen quality and especially by sperm head abnormalities, suggesting an important role of the male gamete on the early stages of embryogenesis.

Temperature of the undescended testis, measured in its cryptorchid location during surgical procedure for orchidopexy in 46 boys, 13- to 180-months-old, was significantly higher (34.4 +/- 0.9 degrees C) than that of the contralateral normally descended testicle (33.2 +/- 1.2 degrees C; P < 0.001). Temperature significantly declined from the Bogros' space (35.3 +/- 0.5 degrees C) to the inguinal canal (34.7 +/- 0.7 degrees C) and from the latter to the empty scrotal cavity (31.1 +/- 1.8 degrees C). The physiological descent of the testicle is associated with a marked cooling of its thermal environment. When this process is interrupted for any reason, temperature of the cryptorchid testis is significantly increased. This rise in temperature could be either a concomitant or a main factor for the impairement of testicular functions associated with cryptorchidism.

In order to provide a contraceptive method in man, an attempt at inhibition of spermatogenesis was made by means of thermogenesis induced by artificial cryptorchidism. This experimental protocol consists of pushing up the testicles into the inguinal canal and keeping them there, each day during waking hours, by means of an adapted athletic supporter. Fourteen men volunteered for this protocol during a 6- to 12-month period. They all had a normal semen analysis before starting the experiment. The total sperm count, the sperm count per milliliter, the motility, the motile sperm count per milliliter, and the total motile sperm count dropped significantly after the first or second month; they reached their lowest values after the sixth month and remained stable during the next 6 months. At that time the average values reached were a total sperm count of 12 to 34 X 10(6)/ejaculate, a sperm count of 3 to 10 X 10(6)/ml, a motility of 21% to 34%, a motile sperm count of 1 to 3 X 10(6)/ml, and a total motile sperm count of 4 to 12 X 10(6)/ejaculate.

In a diurnal artificial cryptorchidism (AC) experiment intended to provide a male contraceptive method, oligoasthenozoospermia was found as early as the fourth month, accompanied by an increase in the mean percentage of abnormally shaped spermatozoa. A detailed morphologic study concerning 19 volunteers exposed for 6 to 24 months demonstrated that the overall increase of the mean percentage of abnormally shaped spermatozoa resulted from the percentage increase of elongated, thin, and irregular heads and of bent tails. This increase is probably caused by the rise in environmental testicular temperature induced by AC. A return to baseline values was observed within 12 months after the end of the experiment.

Scrotal temperatures, testicular volumes, and sperm characteristics were studied in 150 infertile, nonazoospermic men and in 37 fertile men, used as a control group. The mean scrotal temperature values of the infertile men were significantly greater than those observed in the fertile men (+0.4 degrees C for the right; +0.5 degrees C for the left). In the infertile men, it was found that the higher the scrotal temperature, the more alterated the sperm characteristics. The only clinical element that seemed to be linked to the existence of scrotal hyperthermia in the infertile men was testicular hypotrophy. Although the scrotal temperatures of the infertile men with varicocele were significantly higher than those of the fertile men, they did not significantly differ from those of the infertile men without varicocele. No other specific pathologic factor, infectious or surgical urogenital history was found to be responsible for the scrotal hyperthermia observed in the infertile men.