• Clinical and Experimental Reproductive Medicine
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• 제21권3호
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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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• 제47권1호
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• pp.61-67
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• 2020

Objective: In this study, specimens from testicular biopsies of men with nonobstructive azoospermia (NOA) were used to investigate whether RNF8 gene could serve as a biomarker to predict the presence of sperm in these patients. Methods: Testicular biopsy specimens from 47 patients were classified according to the presence of sperm (positive vs. negative groups) and investigated for the expression of RNF8. The level of RNF8 gene expression in the testes was compared between these groups using reverse-transcription polymerase chain reaction. Results: The expression level of RNF8 was significantly higher in testicular samples from the positive group than in those from the negative group. Moreover, the area under the curve of RNF8 expression for the entire study population was 0.84, showing the discriminatory power of RNF8 expression in differentiating between the positive and negative groups of men with NOA. A receiver operating characteristic curve analysis showed that RNF8 expression had a sensitivity of 81% and a specificity of 84%, with a cutoff level of 1.76. Conclusion: This study points out a significant association between the expression of RNF8 and the presence of sperm in NOA patients, which suggests that quantified RNF8 expression in testicular biopsy samples may be a valuable biomarker for predicting the presence of spermatozoa in biopsy samples.

• Journal of Yeungnam Medical Science
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• 제38권1호
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• pp.53-59
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• 2021

Background: There are no guidelines for the optimal incubation time or temperature to improve pregnancy outcomes in testicular sperm extraction-intracytoplasmic sperm injection (TESE-ICSI) cycles. We aimed to evaluate whether a 24-hour in vitro culture of testicular spermatozoa affects pregnancy outcomes in TESE-ICSI cycles. Methods: This was a retrospective study of 83 TESE-ICSI cycles using testicular spermatozoa in 46 couples with male partners suffering from nonobstructive or obstructive azoospermia. Sperm retrieval was performed either on the oocyte retrieval (OR) day (65 cycles in 33 couples; group A) or on the day before OR (18 cycles in 13 couples; group B) followed by in vitro culture for 24 hours. The clinical characteristics and pregnancy outcomes, including the number of retrieved oocytes, fertilization rates, embryo transfer rates, implantation and clinical pregnancy rates, were compared between the two groups. Results: There were no differences in terms of clinical characteristics except for the levels of luteinizing hormone (LH) in males. Group B had higher LH levels than group A (4.56±1.24 IU/L vs. 3.67±1.07 IU/L, p= 0.017). Group B showed higher fertilization rate (72.4%±32.1% vs. 59.2%±21.7%, p=0.045), implantation rate (35.0%±34.1% vs. 14.0%±21.5%, p=0.010), pregnancy rate per cycle (80% vs. 39%, p=0.033), and clinical pregnancy rate per cycle (80% vs. 37.5%, p=0.024) than those of group A. Conclusion: Testicular sperm retrieval performed on the day before OR followed by in vitro culture can potentially improve pregnancy outcomes.

• Clinical and Experimental Reproductive Medicine
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• 제48권1호
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• pp.85-90
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• 2021

We present data from three Caucasian men with Zinner syndrome who attended our center for the treatment of primary couple's infertility. Each patient was scheduled for conventional testicular sperm extraction (cTESE) and cryopreservation. Sperm analysis confirmed absolute azoospermia. Patient 1 had right and left testis volumes of 24 mL and 23 mL, respectively; left seminal vesicle (SV) agenesis, severe right SV hypotrophy with right renal agenesis. Follicle-stimulating hormone (FSH) was 3.2 IU/L. Patient 2 exhibited right and left testis volumes of 18 mL and 16 mL, respectively; a left SV cyst of 32 × 28 mm, ipsilateral kidney absence, and right SV agenesis. FSH was 2.8 IU/L. Patient 3 showed a testicular volume of 10 mL bilaterally, a 65 × 46 mm left SV cyst, right SV enlargement, and left kidney agenesis. FSH was 32.0 IU/L. Sperm retrieval was successful in all patients. Nevertheless, cTESE should be performed on the day of oocyte retrieval.

• Clinical and Experimental Reproductive Medicine
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• 제49권1호
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• pp.62-69
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• 2022

Objective: This study aimed to describe a distinct subpopulation of azoospermic patients with isolated elevation of follicle-stimulating hormone (iFSH) and poor outcomes of microdissection testicular sperm extraction (microTESE). Methods: A retrospective analysis of microTESE outcomes was conducted among 565 patients with non-obstructive azoospermia (NOA). Testicular pathology was assessed by the dominant histological pattern and Bergmann-Kliesch score (BKS). Descriptive statistics were presented for the iFSH subgroup. Inhibin B levels, the sperm retrieval rate (SRR), and BKS were compared in iFSH patients and other NOA patients. Results: The overall SRR was 33.3% per microTESE attempt. The median BKS was 0.6 (interquartile range, 0-2). Of all NOA patients, 132 had iFSH, and microTESE was successful only in 11 of those cases, with an SRR of 8.3%, while the total SRR in other NOA patients was 38.1% (p<0.001). iFSH had a sensitivity of 32.1% (95% confidence interval [CI], 27.4%-36.8%) and specificity of 94.1% (95% CI, 90.8-97.5%) as a predictor of negative microTESE outcomes. Conclusion: Patients with iFSH may harbor a distinct testicular phenotype with total loss of the germ cell population and poor outcomes of surgical sperm retrieval.

• Clinical and Experimental Reproductive Medicine
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• 제35권4호
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• pp.293-301
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• 2008

목 적: 비폐쇄성 무정자증 환자에서 고환의 조직병리학적 진단에 따라 고환조직내 정자채취술 (Testicular sperm extraction, TESE) 후 난자세포질내 정자주입술 (Intracytoplsmic sperm injection, ICSI)의 체외수정시술 결과를 알아보고자 하였다. 연구방법: 비폐쇄성 무정자증으로 고환조직내 정자채취술 후 난자세포질내 정자주입술을 이용하여 배아 이식을 시행한 122주기를 분석하였다. 고환의 조직병리학적 진단에 따라 Germ-cell aplasia (GA, 40주기), Maturation arrest (MA, 32주기) and severe hypospermatogenesis (S-HS, 50주기)로 구분하여 체외수정시술 결과를 비교하였으며, 이들 결과를 난자세포질내 정자주입술을 이용한 폐쇄성 무정자증 환자의 체외수정시술 결과와 비교하였다. 결 과: 고환조직내 정자채취술 후 난자세포질내 정자주입술시 수정율은 각각 58.1% in GA, 42.2% in MA and 48.0% in S-HS로 조직병리학적 진단에 따른 차이는 없었으며, 폐쇄성 무정자증 환자의 72.9%에 비해 유의하게 낮은 수정율을 보였다 (p<0.001). 고환조직내 정자채취술시 채취된 정자 (spermatozoa, 94주기)로 난자세포질내 정자주입술을 시행한 주기의 배아 이식 후 임신율은 각각 22.6% in GA, 29.4% in MA와 26.1% in S-HS이었으며, 출생률은 각각 16.1%, 29.4%와 19.6%로 조직병리학적 진단에 따른 차이는 없었다. 정자세포 (spermatid, 16주기)를 사용하여 난자세포질내 정자주입술을 시행한 주기의 임신율은 각각 0.0% (0/3 주기), 9.1% (1/11주기)와 0.0% (0/2주기)이었으며, 출생률은 각각 0.0%이었다. 정모세포 (spermatocyte, 12주기)를 사용한 주기의 임신율은 각각 0.0% (0/6주기), 0.0% (0/4주기)와 0.0% (0/2주기)이었으며, 출생률도 각각 0.0%이었다. 결 론: 비폐쇄성 무정자증환자의 배아이식을 시행한 주기에서 고환의 조직병리학적 진단에 따른 난자세포질내 정자주입술시 수정율은 차이가 없었으며, 폐쇄성 무정자증 환자에 비해 유의하게 낮은 수정율을 보였다. 비폐쇄성 무정자증환자에서 고환조직내 정자채취술시 정자를 채취하여 난자세포질내 정자주입술을 시행한 주기의 체외수정시술 결과는 고환의 조직병리학적 진단에 따라 차이를 보이지 않는다.

• Journal of Genetic Medicine
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• 제5권2호
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• pp.139-144
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• 2008

무정자증을 보이는 40세 남성과 3대에 걸쳐 정상 생식력과 표현형을 보이는 38세 산모의 가계에서 동원체를 포함한 X 염색체의 역위를 경험한 바, 이를 문헌고찰과 함께 보고하고자 한다. 첫 번째 증례의 남성 환자는 정상범위의 LH, prolactin, estradiol, testosterone 혈중농도를 보였으나 FSH는 20 mIU/mL을 보여 정상수치보다 높았다. 조직학적 소견으로는 정소 내 제 1, 제 2 정모세포의 발달이 정지되어 있었지만 Y 염색체의 sY84, sY129, sY134, sY254, sY255, SRY 부위에 대한 미세결실은 없었다. 그 외 특이할 만한 임상적 소견은 보이지 않았다. 환자의 말초혈액으로부터 세포유전학적 검사로 GTL-분염법 판독을 한 결과, 46,Y,inv(X)(p22.1q27)로 나타났다. 두 번째 증례의 산모와 그 태아는 각각 46,X,inv(X)(p22.11q27.2), 46,X,inv(X)(p22.1q27)의 핵형이 관찰되었다. 이 산모의 가계는 본 연구실에서 친언니의 산전진단 시 언니, 언니의 태아, 환자의 아버지가 각각 46,X,inv(X)(p22.11q27.2), 46,Y,?inv(X), 46,Y,inv(X)(p22.11q27.2)의 형태로 inv(X)가 관찰된 기록이 있었고 대상자 모두 inv(X)로 인한 특징적인 임상적 증상은 보이지 않았다. 또한 RBG-분염법을 통해 관찰한 X 염색체의 비활성화는 언니의 inv(X) 비활성화 비율이 4.1%, 환자는 69.5%로 혈액세포 내에서의 X 염색체의 비활성화 비율은 서로 다르게 관찰되었다. 따라서 이 가계의 inv(X)는 특정 유전자의 손상이 없는 균형적 역위이며, X염색체의 역위현상으로 인한 비정상 표현형이나 생식기능의 결함은 관찰되지 않았다. 그러나 증례 1의 남성의 경우 세포유전학적으로 동일한 위치에 절단점을 가졌으나 생식세포의 발달과정의 결함이 관찰되었으며, 절단점 주변에 위치한 중요한 유전인자들의 손상 가능성이 제기되었다.

• Clinical and Experimental Reproductive Medicine
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• 제36권1호
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• pp.55-61
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• 2009

목 적: 폐쇄성 무정자증 (obstructive azoospermia) 환자와 정자형성저하증 (hypospermatogenesis) 환자의 고환 정자를 이용한 체외수정 및 배아이식술의 결과를 비교, 분석하고자 하였다. 연구방법: 2003년 1월부터 2006년 12월까지 체외수정 및 배아이식술을 위해 고환조직 정자채취술을 시행한 폐쇄성 무정자증 환자 155명 (241주기)과 정자형성저하증 환자 28명 (34주기)을 대상으로 하였다. 고환조직 정자채취술과 세포질내 정자주입술을 실시한 후 수정률, 착상률, 임신율, 출산율을 비교하였으며, 통계적 분석은 t-test와 ${\chi}^2$-test를 사용하였다. 결 과: 정자형성저하증 환자의 고환정자 회수 결과, 신선고환을 사용한 21주기 중 1주기에서는 정자를 회수하지 못하였으나, 정자를 확인하고 고환조직 동결보존 후 융해한 13주기에서 모두 정자를 회수할 수 있었다. 수정률은 정자형성저하증 환자보다 폐쇄성 무정자증 환자에서 통계적으로 유의하게 높았다 (75.6 % vs. 62.6%, p<0.001). 난할 배아 발생률도 정자형성저하증 환자보다 폐쇄성 무정자증 환자에서 통계적으로 유의하게 높았다 (66.8% vs. 54.8% p<0.001). 그러나 우수배아 형성률, 임상적 임신율, 착상률, 출산율에는 차이가 없었다. 결 론: 정자형성저하증 환자의 고환정자를 사용하여 세포질내 정자주입술을 실시할 경우 수정률과 초기 난할율은 폐쇄성 무정자증 환자보다 낮지만, 정상적으로 발달한 배아를 이식할 경우 임신율, 착상률, 그리고 출산율에는 영향을 미치지 않는 것으로 사료된다.

• Clinical and Experimental Reproductive Medicine
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• 제23권1호
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• pp.7-9
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• 1996

Here, A forty year old patient is presented, showing azoospermia following vasovasostomy. The bilateral testicular biopsies were performed to confirm whether ductal obstruction due to vasovasostomy or testicular failure existed. The finding of biopsy was spermatogenic arrest. After completion of medical testicular stimulation with clomiphene citrate and pentoxifilline for 3 months, repeat vasovasostomy was performed. Semenanaylsis revealed normal sperm parameters after operation. Necessity of testicular biopsy before deciding repeat vasovasostomy, accuracy of testicular biopsy, efficacy of testicular stimulation in the patient with spermatogenic arrest and effect of testicular biopsy on testicular fuction are discussed.

• 대한생식의학회:학술대회논문집
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• 대한불임학회 1997년도 제34차 추계 학술대회
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• pp.50.2-51
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• 1997