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The purposes of the study were to compare treatment-related stresses of couples undergoing IVF or ICSI treatment (ejaculated, epididymal or testicular spermatozoa) and to identify sex differences and risk factors for depression. A one-year cohort of couples was retrospectively sent questionnaires on infertility and treatment-related distress and depression (Depression Scale, D-S). Two hundred and eighty-one women and 281 men (61% of those eligible) were included. As determined by analysis of the medical charts, successful couples were more likely to participate. Treatment-related distress was generally higher for women than for men. Treatment by ICSI carried additional burdens for the men: they reported a greater subjective responsibility for the infertility, impact of childlessness on daily life, treatment-related stresses (particularly for MESA/TESE) and time demands. Even when clinical differences between treatments (e.g. age, previous treatments) were controlled statistically, depression scores did not differ. Independent of the treatment, women were significantly more depressed than their age-matched female controls from the general population and their husbands. The men only reported marginally elevated depression scores compared to their controls. Meaningful characteristics were identified that could guide clinicians to give psychological support to those couples at risk for depression, e.g. an unsuccessful treatment outcome, repeated treatment cycles, a low socioeconomic status, foreign nationality, or, for women, a lack of partner support.

The acrosome reaction was determined in aliquots from ejaculates of 74 patients undergoing in-vitro fertilization at the University of Giessen, Germany, by means of the triple-stain technique. The percentage of acrosome-reacted spermatozoa after low-temperature induction of the acrosome reaction was not significantly related with the fertilization rate (H test, P = 0.693, SJ test, P = 0.366). However, all patients showing < 13.0% acrosome-reacted spermatozoa had poor fertilization rates. Highly significant differences between patients could be detected by correlating the inducibility of the acrosome reaction with the fertilization rate (H test, P = 0.018; SJ test, P = 0.004); patients with high fertilization rates showed a corresponding high inducibility of acrosome reactions. From our results, it is evident that percentages of acrosome-reacted spermatozoa < 13.0% or an inducibility of the acrosome reaction of < 7.5% are indicative of subfertility.

Tail stump syndrome, which may be associated with primary ciliary dyskinesia, is also associated with morphological defects of the flagellum resulting in severe asthenozoospermia. Until recently, these morphological anomalies caused definite male infertility. Today, however, new methods such as micromanipulation techniques provide a rational therapy for this patient group. A pregnancy followed by living offspring was achieved following the intracytoplasmic injection of immotile spermatozoa from a patient with tail stump syndrome.