Pituitary hyperplasia with Sertoli cell-only and 47,XYY syndromes: an uncommon triad

2020 ◽  
Vol 13 (5) ◽  
pp. e233100
Author(s):  
Amelle Geurim Ra ◽  
Paul Jeffrey Evans ◽  
Anshu Awasthi ◽  
Upendram Srinivas-Shankar

We report the case history of a 32-year-old man with no phenotypical abnormalities who presented with infertility. Semen analysis revealed azoospermia and testicular biopsy confirmed Sertoli cell-only (SCO) syndrome. Karyotyping revealed 47,XYY and pituitary hyperplasia was found on MRI pituitary. In our patient, 47,XYY karyotype is likely to have given rise to SCO syndrome that in turn resulted in pituitary hyperplasia. The patient was evaluated by various members of the multidisciplinary team including the pituitary surgeon, endocrinologist and andrologist. The patient’s partner successfully delivered a healthy baby via in vitro fertilisation with donor sperm. This triad of diagnoses (SCO syndrome, 47,XYY karyotype and pituitary hyperplasia) has not been reported previously. SCO syndrome should be considered in the presence of azoospermia, elevated follicle-stimulating hormone, low inhibin-B and normal testosterone levels. Our case report also highlights the importance of excluding genetic causes of infertility even when the patient has no phenotypical abnormalities.

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
C Olmed. Illueca ◽  
E Veiga ◽  
E Ferrer ◽  
M Fernández ◽  
A Mauri ◽  
...  

Abstract Study question Must be all the activity made in in vitro fertilization (IVF) laboratories keep in mind to size its staff? Summary answer To create a staff calculator based on number of cycles carry on, assisted reproduction techniques, quality controls, administration management, weekend duties, labour regulations and holidays. What is known already In a bibliographic search about staff in human reproduction labs there is no mention about de number of embryologists recommended for every cycle done. Only that it will be according to the workload. Other guidelines establish that every embryologist could assume 150 IVF cycles/year. However, here is a downward tendency in the work that an embryologist can assume. Alikani established a maximum of 100 cycles/year for every embryologist (Alikani et al, 2014). Study design, size, duration Seven senior embryologists working in different IVF centres, three public and 4 privates, take part lead in this Multicentre study during 2019 and 2020. We made a survey to create a calculator for staff using the mean time spent in every lab by each embryologist of the centre to do any IVF procedure and measured three times each one. Participants/materials, setting, methods Different lab procedures and activities related with quality control, time spent to do them, and witnessing were included in the survey. For the calculations it was considered an embryologist with a full-time contract working 1744 hours / year according to current labour agreement in Spain. The times included in the calculations for each task were those corresponding to the 95th percentile. For the calculation, the program used was Microsoft Office Excel. Main results and the role of chance In the IVF laboratory many gametes and embryos from different couples are manipulated daily. The maintenance of traceability could be affected by not having the right staff and lead to dramatic consequences for the patients and the centre. Workload or overload caused by non-suitable staff number also affects the embryologist having a direct impact on his health. The results of the survey carried out showed the time needed by embryologist to perform the different procedures necessary for an IVF treatment, being a classic IVF cycle (8.11 hours), also taking into account the time spent in managing documentation, preparing the cycle and databases. An ICSI with Time lapse needs 10.27 hours and an ICSI-PGD cycle 13.91 hours. To all off this, 1.81 hours should be added for every vitrification support needed and the time to control more than 200 critical steps, including equipment control and culture parameters. The time spent in semen analysis (including managing documentation, cycle preparation and databases) or intrauterine insemination with a partner sperm was 2.7 hours. For donor sperm an additional hour for the management involved is required. The time required to perform and cryopreserve a testicular biopsy and seminal cryopreservation was 4 and 3.7 hours, respectively. Limitations, reasons for caution The study was made taking account of Spanish regulations, quality standards and recommendations and should be adapted to the foreigner’s regulations. Wider implications of the findings: New advance staff calculator allows laboratories estimate minimum number of embryologist necessary for a particular public or private laboratory without compromise neither security nor success in their results. Nevertheless, we recommended a minimum of two qualified embryologists in every lab, whatever it was the workload. Trial registration number none


2019 ◽  
Vol 27 (3) ◽  
pp. 509-518
Author(s):  
Michelle M Taylor-Sands

Abstract In September 2018, the Federal Court of Australia found that a Victorian woman did not need her estranged husband’s consent to undergo in vitro fertilisation treatment (IVF) using donor sperm. The woman, who was 45 years of age, made an urgent application to the Court for permission to undergo IVF using donor sperm. In a single judge ruling, Griffiths J held that the requirement in the Assisted Reproductive Treatment Act 2008 (Vic) (‘ART Act’) for a married woman to obtain the consent of her husband discriminated against the woman in question on the basis of her marital status in contravention of the Commonwealth Sex Discrimination Act 1984 (Cth) (‘SD Act’). His Honour declared the Victorian law in this instance ‘invalid and inoperable’ by operation of section 109 of the Commonwealth Constitution to the extent it was inconsistent with the Commonwealth law. Although the declarations by the Federal Court were limited in their terms to the circumstances of the case, the judgment raises broader issues about equity of access to assisted reproductive treatment (ART) in Victoria. The issue of partner consent as a barrier to access to ART was specifically raised by an independent review of the ART Act in Victoria. The Victorian Government released an interim report late last year as a first stage of the review, which canvasses some options for reform. This raises a broader question as to whether prescriptive legislation imposing detailed access requirements for ART is necessary or even helpful.


2017 ◽  
Vol 18 (1) ◽  
pp. 21-26 ◽  
Author(s):  
Maged M Yassin ◽  
Abdel Monem H Lubbad ◽  
Ahmed Z Taha ◽  
Mohammed M Laqqan ◽  
Samar M Abu Jamiea

Aim: To assess serum testosterone and gonadotropins in Sertoli cell only syndrome patients from Gaza Strip.Methods: Based on testicular biopsy, a cross section of 74 Sertoli cell only syndrome patients were enrolled in the study. Age matched 44 fertile men were served as controls. Patients and controls were questioned for their medical history. Blood samples were drawn and serum testosterone, luteinizing hormone (LH), and follicle stimulating hormone (FSH) were determined by enzyme-linked immunosorbent assay. Data were computer analyzed using SPSS/PC, version 18.0.Results: Varicocele and hormonal problems were significantly more frequent among patients than controls (P<0.05). Serum testosterone was significantly lower in patients compared to controls (1.7±1.3 versus 5.0±2.2 ng/ml, P=0.000). In contrast, LH and FSH were significantly higher in patients than controls (12.8±9.7 and 20.8±14.8 mlU/ml versus 6.3±3.1 and 7.7±3.9 mlU/ml, P=0.000, respectively). Hypergonadotrophic hypogonadism and hypogonadotrophic hypogonadism patients showed lower levels of testosterone compared to the normal reference value (0.9±0.5 and 0.5±0.4 ng/ml versus 2.0-7.0 ng/ml). Higher levels of LH and FSH were recorded in hypergonadotrophic hypogonadism (24.5±2.6 and 37.4±6.7 mlU/ml) compared to the reference values of 2.0-13.0 and 2.5-10.0 mlU/ml, respectively whereas LH and FSH levels were lower in hypogonadotrophic hypogonadism (0.6±0.4 and 0.6±0.5 mlU/ml, respectively). In this context, all hypergonadotrophic hypogonadism and hypogonadotrophic hypogonadism patients showed abnormal levels of testosterone, LH and FSH.Conclusions: Abnormal levels of serum testosterone, LH and FSH, particularly in hypergonadotrophic hypogonadism and hypogonadotrophic hypogonadism were identified in infertile men with Sertoli cell only syndrome from Gaza Strip.J MEDICINE January 2017; 18 (1) : 21-26


2019 ◽  
Vol 01 (04) ◽  
pp. 154-160 ◽  
Author(s):  
Romy Ehrlich ◽  
M. Louise Hull ◽  
Jane Walkley ◽  
Gavin Sacks

The intravenous fat emulsion, intralipid, has been hypothesised to be an effective and safe treatment for repeated in vitro fertilisation (IVF), implantation failure and pregnancy loss. This exploratory, retrospective cohort study determined pregnancy outcomes and documented adverse events associated with intralipid use. Ninety-three women were identified as having received intralipid for a history of repeated unsuccessful IVF cycles and pre-viable pregnancy loss in two Australian IVF units that independently recruited between October 2014 and July 2016. Pregnancy outcomes and adverse events were recorded in fresh and frozen embryo transfer cycles in which the infusion was administered. The 93 women who received intralipid had a clinical pregnancy rate of 40.0%, compared with 35.0% in 651 age-matched controls undergoing IVF, which was not significantly different. The intralipid group had a livebirth rate of 35.7%. Apart from flushing, which was experienced by one individual, there were no adverse events associated with intralipid use. As a prelude to definitive evidence of benefit, we did not identify a safety concern or reduced pregnancy rates in intralipid users compared to controls. Indeed, these outcomes were better than expected in a poor prognosis group. This data supports an argument for large, randomised controlled trials to determine the benefit of intralipid in the treatment of recurrent implantation failure or miscarriage.


2017 ◽  
Vol 63 (4) ◽  
pp. 332-335 ◽  
Author(s):  
Leonardo de Souza Alves ◽  
Francisco Batista de Oliveira

Summary Introduction: Varicocele disease is well-known cause of infertility in men. The presence of spermatic varices veins create a hostile environment to spermatogenesis. It results in reduced quality of the sperm production and in some cases can determine a total absence of sperm. The varicocelectomy procedure in patients with non-obstructive azoospermia (NOA) can raise the rates of sperm in the semen analysis. A positive rate for sperm, even if very low, may be sufficient to enable the capture of sperm intended for in-vitro fertilization without the use of donor sperm. Objetive: To evaluate the raise of sperm in NOA patients with varicocele disease who were submitted to a bilateral procedure to recovery sperm production. Method: We analized the sperm results of 25 NOA patients who undergone to a bilateral varicocelectomy procedure. Results: From a total of 25 patients, three (12%) recovered sperm count four months after procedure. One year after the procedure, five (20%) patients recovered sperm production. Conclusion: Patients with varicocele disease and azoospermia, without genetic changes or obstruction of the spermatic tract, should undergo surgical procedure to recover sperm.


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