• Clinical and Experimental Reproductive Medicine
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• v.37 no.3
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• pp.245-251
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• 2010

Objective: Human sperm nucleus DNA damage may negatively affect pregnancy outcome, and the spermatozoa of infertile men have more DNA damage than that of fertile men. The aim of this study was to evaluate the effect of microsurgical varicocelectomy on human sperm nucleus DNA integrity. Methods: We reviewed the medical records of 18 subfertile male patients who underwent microsurgical varicocelectomy at our hospital from April 2006 to April 2007. Varicocele was diagnosed by physical examination and Doppler ultrasound. Standard semen analysis was performed in 18 patients before and 4 months after microsurgical varicoceletcomy using a computer assisted semen analyzer. Sperm nucleus DNA integrity was assessed by a single-cell gel electrophoresis (comet assay). Results: No recurrence of varicocele was observed after 4 months later. The DNA fragmentation index improved after varicocelectomy compared with pre-operatively (19.3 versus 13.7%, respectively, p<0.05). Semen analysis parameters (total count, concentration, motile sperm, viability, strict morphology) increased after varicocelectomy, but the difference did not reach statistical significance. Conclusion: Our data suggest that microsurgical varicocelectomy can improve semen analysis parameters and human sperm nucleus DNA integrity in infertile men with varicocele.

• Clinical and Experimental Reproductive Medicine
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• v.35 no.4
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• pp.303-308
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• 2008

Purpose: The purpose of this study is to determine the effect of preoperative semen parameters on both seminal improvement and pregnancy rates following varicocelectomy. Methods: This survey was done in 278 patients who underwent microsurgical inguinal varicocelectomy from January 2001 until October 2006. By the total motile sperm counts (TMSC) before operation, the patients were stratified into three groups. Group A (mild oligoasthenospermia) was defined as above 20 million, group B (moderate oligoasthenospermia) was defined as between 5 and 20 million, and group C (severe oligoasthenospermia) was defined as below 5 million. Improvement rates of TMSC and pregnancy rates following varicocelectomy of each groups were compared. Results: The average TMSC of all the patients was 25.75 million before operation and after operation, it was 80.24 million, showing an average increase of 54.49 million (211.6%). To take a look at mean absolute increase (mean relative increase proportion), group A showed 67.90 million (131.2%), group B 62.20 million (482.5%) and group C 26.33 million (1841.2%). The patients with varicocele whose semen parameter is in bad condition show relatively a low mean absolute increase but high mean relative increase proportion. There was no significant difference in natural pregnancy rate among each groups (p=0.119, p=0.059). Conclusions: Even in the varicocele patient whose semen parameter was in bad condition before surgical operation. varicocelectomy could be chosen as the first treatment to male infertility.

• Clinical and Experimental Reproductive Medicine
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• v.15 no.1
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• pp.10-16
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• 1988

Artificial insemination with donor sperm(AID) or husband sperm(AIH) has been a major form of treatment for the infertile couples with severe male factors. The conception rate in oligoasthenoteratozoospermia is very low. Therefore the aim of this study was to examine those factors associated with improved success rate. The results are obtained as the follows; 1. The husband semenalysis(n=639) revealed normal findings in 32.2%. The abnormal findings included the oligospermia(18.5%), oligoasthenospermia(20.7%), oligoasthenotetatozoospermia(8.5%) and azoospermia(20.1 %). 2. The causes of abnormal semenalysis are idiopathic(most common), varicocele, congenital anomalies, vaso-vasostomy, etc.. 3. The semen washing to improve sperm motility and concentration was effective in case of over 20 ${\times}lO^6$/ml sperm count, but there was no significant improvement in case of be low 10-5${\times}lO^6$/ml sperm count. 4. The improvement of motility after cryopreservation depended on the initial sperm concentration. 5. The pregnancy rates following AIH are higher in normospermia than oligospermia.

• Clinical and Experimental Reproductive Medicine
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• v.39 no.4
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• pp.172-175
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• 2012

Objective: The aim of this study is to investigate the various causes of male infertility using multiple approaches. Methods: Nine-hundred-twenty infertile male patients were analyzed at their first visit with one physician between January 1 and December 31, 2009. All patients were subjected to physical examination and semen analysis and azoospermic patients underwent hormonal testing, chromosomal tests, and testicular biopsy. Semen analysis was based on the definition of the World Health Organization. Results: Among the 920 patients, 555 patients (60.3%) had semen results within the normal range, 269 patients (29.2%) within the abnormal range, and 96 (10.5%) were diagnosed with azoospermia. Varicoceles were diagnosed in 84 of the 555 normal-range patients (15.1%) and in 113 of the 269 abnormal-range patients (42.0%). Of the 96 patients with azoospermia, 24 patients (25%) were diagnosed with obstructive azoospermia, 68 patients (71%) with non-obstructive azoospermia, and 4 patients (4%) with retrograde ejaculation. Conclusion: Various causes of male infertility have been reported and diverse treatment methods can be adopted for each cause. In this regard, research must be conducted on a larger number of patients to accurately assess the various causes of infertility in Korean patients and to investigate various infertility treatment methods.

• 대한생식의학회:학술대회논문집
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• 2000.06a
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• pp.37-42
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• 2000

Objective: To determine whether particular semen characteristics in various clinical diagnoses of infertility are associated with high oxidative stress and whether any group of infertile men is more likely to have high seminal oxidative stress. Reactive oxygen species (ROS) play an important role in sperm physiological functions, but elevated levels of ROS or oxidative stress are related to male infertility. Design: Measurement of sperm concentration, motility, morphology, seminal ROS, and total antioxidant capacity (TAC) in patients seeking infertility treatment and controls. Setting: Male infertility clinic of a tertiary care center. Patient(s): One hundred sixty-seven infertile patients and 19 controls. Intervention(s): None. Main Outcome Measure(s): Semen characteristics, seminal ROS, and TAC in samples from patients with various clinical diagnoses and controls. Result(s): Fifteen patients (9.0%) were Endtz positive and 152(91.0%) Endtz negative. Sperm concentration, motility, and morphology were significantly reduced in all groups compared with the controls (P = .02), except in varicocele associated With infection group. Mean (${\pm}$SD) ROS levels in patient groups ranged from 2.2 ${\pm}$ 0.13 to 3.2 ${\pm}$ 0.35, signilicantly higher than controls (1.3 ${\pm}$ 0.3; P<.005). Patient groups had a significantly lower mean (${\pm}$SD) TAC from 1014.75 ${\pm}$ 79.22 to 1173.05 ${\pm}$ 58.07 than controls (1653 ${\pm}$ 115.28, P<.001), except ill the vaseclony reversal group (1532.02 ${\pm}$ 74.24). Sperm concentration was negatively correlated with ROS both overall and within all groups (P${\leq}$.007), with the exception of idiopathic infertility. Conclusion(s): Irrespective of the clinical diagnosis and semen characteristics, the presence of seminal oxidative stress in infertile men suggests its role in the pathophysiology of infertility. Medical or surgical treatments for infertility in these men should include strategies to reduce oxidative stress.

• 대한생식의학회:학술대회논문집
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• 2003.12a
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• pp.21-30
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• 2003

As a result of the technological advance provided by intracytoplasmic sperm injection (ICSI) in 1992, the evaluation and treatment of the infertile male has changed significantly. Many men who were previously thought to be irreversibly infertile have the potential to initiate their own biologic pregnancy. However, not all men having impaired semen parameter are ideal candidates for ICSI for numerous reasons including a lack of addressing the underlying problem causing the male infertility, unknown genetic consequences, and cost-effectiveness issues. In this era of ICSI, the fundamental approach to the male with suspected subfertility is unchanged and is based on a history, physical examination, and focused laboratory testing. The urologist should approach the patient with an intent to identify remediable causes of subfertility given the specific clinical situation. For instance, should a gentleman have his varicocele repaired or vasectomy reversed, or should he proceed directly with ICSI? If no factors can be improved in a timely manner, then ICSI should be considered using the available sperm. Examples of recent advances include the diagnosis and treatment of ejaculatory duct obstruction, indications and techniques for performing testis biopsy, and technique for sperm harvesting. In addition, potential genetic causes of male subfertility should be diagnosed and discussed with the patient. Cystic fibrosis gene mutation, karyotype abnormallities, and Y-chromosome microdeletions all have recently been identified as causative for male infertility in otherwise phenotypically normal men. With recently evolved diagnostic and therapeutic techniques now available for the infertile couple, even the most severe male factor problems in patients previously considered irreversibly infertile are now potentially treatable. The physician should be aware of the availability and limitations of these new and exciting reproductive technologies because they will allow him to provide timely and more effective therapy for the infertile couple. An understanding of these advances by all physicians is important as we progress into the $21^{st}$ century

• Clinical and Experimental Reproductive Medicine
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• v.21 no.3
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• pp.253-259
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• 1994

A clinical investigation was undertaken on primary male infertility patients of recent 5 years. The results obtained were as follow: 1. Suspective etiologic factors were: 1) testicular failure, 36.1 %; 2) varicocele, 18.7%; 3) endocrine abnormality, 13.5%; 4) obstruction, 13.5%; 5) idiopathic, 10.9%; 6) cryptorchidism, 2.6%; 7) necrospermia, 0.9%. 2. On semen analyses, azoospermia was found in 55.8%, single abnormal parameter in 21.5 %, and multiple/all abnormal parameter in 22.7% of the 163 cases. 3. For the evaluation of the sensitivity and specificity of noninvasive variables in predict in obstruction as the cause of azoospermia in patient who had undergone testicular biopsy, the testicular size and serum follicle-stimulating hormone(FSH) level revealed 100% of sensitivity. 4. Among the 43 patients with a testicular biopsy confirmed diagnosis there was a significant difference in testicular size, ejaculate volume(p<0.0001) and serum FSH(p<0.0001) between patients with testicular failure and those with ductal obstruction. 5. Of 93 treated patients with primary male infertility, 42 were managed by medical treatment including endocrine treament, retrograde ejaculation treatment, infection treatment and observation; 29 were managed by surgical treatment including varicocelectomy, vasovasostomy, vasoepididymostomy and TUR of ejaculatory duct; 20 were managed by sperm preparation treatment including artificial insemination(AI), electroejaculation plus AI and vibration ejaculation plus AI ; 2 were managed by microscopic epididymal sperm aspiration plus IVF, repectively. 6. 42 patients who could be followed-up, 21 patients(50%) impregnated their wives.

• Clinical and Experimental Reproductive Medicine
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• v.48 no.2
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• pp.97-104
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• 2021

Male infertility has a complex etiopathology, which mostly remains elusive. Although research has claimed that oxidative stress (OS) is the most likely underlying mechanism of idiopathic male infertility, the specific treatment of OS-mediated male infertility requires further investigation. Coenzyme Q10 (CoQ10), a vitamin-like substance, has been found in measurable levels in human semen. It exhibits essential metabolic and antioxidant functions, as well as playing a vital role in mitochondrial bioenergetics. Thus, CoQ10 may be a key player in the maintenance of biological redox balance. CoQ10 concentrations in seminal plasma directly correlate with semen parameters, especially sperm count and sperm motility. Seminal CoQ10 concentrations have been shown to be altered in various male infertility states, such as varicocele, asthenozoospermia, and medical or surgical regimens used to treat male infertility. These observations imply that CoQ10 plays an important physiological role in the maintenance and amelioration of semen quality. The present article thereby aimed to review the possible mechanisms through which CoQ10 plays a role in the regulation of male reproductive function, and to concisely discuss its efficacy as an ameliorative agent in restoring semen parameters in male infertility, as well as its impact on OS markers, sperm DNA fragmentation, pregnancy, and assisted reproductive technology outcomes.

• Journal of Genetic Medicine
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• v.7 no.2
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• pp.160-164
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• 2010

Structural abnormalities of the Y chromosome affect normal testicular differentiation and spermatogenesis. The present case showed a rare monocentric derivative Y chromosome with partial duplication of Yp including the SRY gene and deletion of Yq12 heterochromatin. The karyotype was 46,X,der(Y)(pter${\rightarrow}$q11.23::p11.2${\rightarrow}$pter).ish der(Y)(DYZ3+,DYZ1-,SRY++), confirmed through a FISH study. Even though the patient possessed an abnormal Y chromosome, testicular biopsy showed normal testicular volumes in the proband, with gonadal hormonal levels in the normal range but bilateral varicocele and hypospermatogenesis. We speculate that the abnormal Y chromosome arose from sister chromatids during Y chromosome recombination or intra chromosomal NAHR (non-allelic homologous recombination) during meiosis in the patient's father or in the very early stages of embryogenesis. The derivative Y chromosome might interfere in the meiotic stage of spermatogenesis, leading to the developmental arrest of germ cells. The present case illustrates that the infertility phenotype can have various causes. Also, it emphasizes the importance of accurate and various genetic analyses and could aid in male infertility treatment.