Introduction of intracytoplasmic sperm injection (ICSI) offered an effective therapy for males with infertility including those with azoospermia. The novel techniques for sperm retrieval from the epididymis (percutaneous epididymal sperm aspiration [PESA]) and testis (testicular sperm aspiration [TESE]) have been successfully combined with ICSI. This is the first preliminary report on ICSI with ejaculated sperm (80 cycles), PESA/ICSI (40 cycles), and TESE/ICSI (40 cycles) in Iran. The study population comprised 160 consecutive young males with primary infertility admitted to Research and Clinical Center for Infertility in Yazd, Iran. Eighty subjects (mean ± SD of age: 34.0 ± 4.4 years) could produce ejaculates while in the rest who had obstructive azoospermia, the sperm was obtained by PESA or TESE. All wives were treated for ovarian stimulation and oocytes were retrieved 34 to 36 hours after human chorionic gonadotropin (HCG) injections. Sperm parameters of count, motility, and morphology were analyzed and ICSI was performed 2 to 3 hours after the incubation of the processed sperm. The rate of fertilization and embryo development and transfer were subsequently evaluated. The results showed that the fertilization rate for the groups whose sperms had been obtained by ejaculation, PESA, and TESE was 72.1%, 73.6%, and 51.3%, respectively. The mean number of embryo transfers for the aforementioned groups was 3.0, 3.8, and 2.6, respectively. The parameters of sperm count and morphology were similar in the ejaculate and PESA groups. They were, however, lower in TESE samples (p < 0.01). The results confirm that PESA and TESE are very effective for obtaining adequate numbers of sperms to successfully treat male infertility including obstructive azoospermia.

Background: Testicular cancer (TC) is usually diagnosed after manifestation of an overt tumour. Tumour formation is preceded by a pre-invasive and asymptomatic stage, carcinoma in situ (CIS) testis, except for very rare subtypes. The CIS cells are located within seminiferous tubules but can be exfoliated and detected in ejaculates with specific CIS markers.Materials and Methods: We have built a high throughput framework involving automated immunocytochemical staining, scanning microscopy and in silico image analysis allowing automated detection and grading of CIS-like stained objects in semen samples. In this study, 1175 ejacu- lates from 765 subfertile men were tested using this framework.Results: In 5⁄765 (0.65%) cases, CIS-like cells were identified in the ejaculate. Four of these had bilateral testicular biopsies performed and CIS was histologically confirmed in three. In total, 63 bilateral testicular biopsy were performed in conjunction with analysis of the ejaculates because of infertility work-up. Histological analysis of the biopsies for the presence of CIS yielded a test sensitivity of 0.67 and a specificity of 0.98. In addition, ejaculates from 45 patients with clinical signs of an overt TC were investigated and yielded a slightly lower sensitivity (0.51), possibly because of obstruction.Conclusion: We conclude that this novel non-invasive test com- bining automated immunocytochemistry and advanced image analysis allows identification of TC at the CIS stage with a high specificity, but a negative test does not completely exclude CIS. On the basis of the results, we propose that the assay could be offered to subfertile men and other patients who are at increased risk of TC.

Background: Posterior urethral valve presenting in adulthood is uncommon. This can be an unusual cause of primary male infertility as a result of abnormalities in sexual function.Case Presentation: This report describes a 40 year old man who presented to us on account of inability to impregnate his wife after 2 years of marriage. History revealed poor stream of urine since childhood and passage of scanty ejaculate during intercourse. A micturating cystourethrogram revealed dilated posterior urethra in keeping with posterior urethral valves. Endoscopic valve ablation was done with subsequent improvement in ejaculate volume and urine stream. His spouse achieved pregnancy thereafter.Conclusion: In this report, it was found that adult posterior urethral valve though uncommon may be a cause of male infertility. Restoration of fertility potential can be achieved following valve ablation.