In Vitro Fertilization IVF

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     Unfortunately, there are many cases of patients with infertility, which cannot be explained after a series of tests and which doesn’t have an obvious systemic cause.
     In many cases of oligospermia or asthenospermia the genetic deficiencies or biochemical unbalances responsible for this condition are completely unknown.
     Varicocele is an abnormal condition described as the dilatation of the scrotal pampiniform plexus, the result of a congenital dysfunction of the spermatic vein valves. The high incidence of varicocele in the body left side is explained by the anatomical asymmetry of vein-reno-gonadal axis.
     There is lot of controversies in the scientific world related to the fact that varicocele causes masculine infertility and the treatment of this condition influences the percent of pregnancies. Recent studies show that over 9 thousands of infertile men also suffer from varicocele leading to the conclusion that this condition may trigger masculine infertility.
     Antispermatic antibodies alter semen’s transport within the feminine genital tract and interfere with the sperm-egg phenomena, although not all antibodies affect sperm motility and pregnancy percentage. Recent infertility related investigations focus on the sperm A-type immunoglobulin antibodies and on antibodies connected with sperm membrane. They can be determined with the aid MAR or of the immune-bead test. In the cases of infertile men antispermatic antibodies prevails in a proportion of 3 up to 20%, and their presence in of 75% in the cases of patients who suffered a vasectomy or a vasovasostomy. The cause of immunologic infertility is theoretically unknown, but one of the generally accepted hypotheses is that testicular and epididymal infection or inflammation leads to the immunologic development of spermatic antigens.
     The thermal effect upon the testicles can have an important role in the sperm development and further upon the possibility of fertilization. The normal scrotal temperature is 2-3 degrees under the average body temperature, and this temperature difference is required for testicular good output. Another explanation for the infertility associated with varicocele and cryptorchidism is the elevated scrotal temperature. Also, healthy men who spend a lot of time in a sauna, have a reduced number of sperm. After some diseases associated with fever, there is also the possibility of temporarily low sperm quality caused by damaged gonadotropine secretion.
     Endocrine dysfunctions, both encountered in male and female patients, characterized by an altered LH pulsatile secretion, also cause infertility. LH pulsatile frequency is usually normal in infertile men, but a selective rise of the FSH circulatory level can be observed associated with increased LH pulsatile amplitude. In female patients who suffer from hypogonadism, an isolated FHS deficit has been observed caused by a mutation of the β subunit of the gene in one codon termination. The same genetic abnormality can appear in men and also can be responsible for masculine infertility.
     Furthermore we shall analyze the main steps in the clinical and pathological evaluation of the infertile men.

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