Clinical management of male infertility in assisted reproduction: ICSI and beyond

Abstract

The advent of in vitro fertilization and its augmentation with intracytoplasmic sperm injection (ICSI) has allowed a large number of couples suffering from moderate to severe male infertility, and also presenting with female pathologies, to achieve their reproductive dreams. Notwithstanding the existence of fundamental questions about the pathophysiological mechanisms leading to sperm dysfunction, and still unanswered concerns about health risks following ICSI, it appears that overall ICSI is safe and here to stay. Although on one hand ICSI possibly hampered advances of the knowledge in some areas of gamete biology and interaction, on the other it definitely gave impulse to studies designed to unveil the sperm contributions during and beyond fertilization, including the normalcy of the DNA/chromatin as well as molecular mechanisms of genetic/epigenetic control and nuclear organization status. In all, almost entering the fourth decade of assisted reproductive technologies, we should continue monitoring the safety of the technique and long-term development of offspring, whereas at the same time prioritizing areas of research addressing these fundamental questions.

Inhibiting Sperm Pyruvate Dehydrogenase Complex and Its E3 Subunit, Dihydrolipoamide Dehydrogenase Affects Fertilization in Syrian Hamsters

“…These studies point out that the failure to complete the fertilization process, syngamy or early cleavage could be the result of an early paternal effect. To validate and resolve this further in the context of humans, research on understanding the functional role of the male gamete beyond penetration, and unraveling the underlying causes of sperm pathology need to be carried out extensively [43], [44].…”

Unexplained Male infertility: diagnosis and Management

“…Sperm DNA damage is a broad term that accounts for many defects in the DNA structure including: single or double DNA strand breaks, base deletion or modification, inter-strand or intra-strand cross-linkage, and DNA-protein crosslinkage (64). Post-meiotically initiated abortive apoptosis, unresolved strand breaks during spermiogenesis, and oxidative stress have all been implicated as potential sources of this damage (65).…”

Semen analysis and sperm function testing

“…Assisted reproduction programmes either use ICSI as the first line of approach or as an alternative therapy after repeated failed intrauterine insemination or IVF attempts. 93,94 This clinical approach is directly due to the additional costs that are involved in sperm functional tests. Genetic and DNA integrity seem to be the most important functional parameters to successful fertilisation and embryo development.…”