No Sperm Motility

The treatment of male factor infertility was revolutionized in 1992 when Palermo and co-workers introduced intracytoplasmic sperm injection (ICSI).  With ICSI, embryologists use a micromanipulator to inject sperm directly into the egg (that has been retrieved as part of an IVF cycle).  It was now possible for men with severe male factor to father a child.  ICSI can be used even in cases where the wife produces more eggs than the husband sperm!  Using high magnification, an oval appearing motile sperm is selected for ICSI.  When a sperm is motile, it indicates that it is viable and therefore is capable of fertilizing the egg.
But, what is to be done when there are no motile sperm?  This condition is called “absolute asthenozoospermia” and affects 1 in 5000 men.  Ortega et al. discussed this very issue in a recent issue of the journal Human Reproduction Update (Vol. 17, No.5, pp 684 – 692, 2011).  Here is a summary of their findings.

Causes of zero sperm motility (absolute azoospermia)

The two main causes of absolute azoospermia in ejaculated sperm are

1) ultrastructural defects in the sperm.  This includes immotile-cilia syndrome (normal semen volume, sperm count and variable morphology, but motility is zero).  Electron microscopy of sperm is done to confirm this diagnosis.

2) necrozoospermia (where all sperm are dead).  This in turn can be due to genital infections, oxidative stress, cryopreservation, antisperm antibodies, certain metabolic disorders affecting ATP production, environmental pollutants exposure, delayed epididymal transport or prolonged periods of anejaculation.  Each one of these entities needs to be diagnosed and treated appropriately.
When testicular sperm aspiration (TESA) is done, that sperm is usually immotile due to metabolic sperm immaturity or attachment to Sertoli cells.

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The sperm have to be very quick to get where they are going, and in some cases if they are not strong enough swimmers, they will perish before they ever reach the egg. The vagina is not the most friendliest host for sperm, so sperm motility issues can cause massive problems when trying to conceive.

HUHU......takutnyee...

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