A case of oligoasthenoteratozoospermia with AZFc deletion and persistent oxidative stress
The patient was a 35-year-old man, presented with primary infertility of five years duration. The patient had no history of testicular injury, vericocele, torsion or hydrocele, cancer chemotherapy, and chronic infectious disease. Physical examination revealed normal vital signs with a BMI of 24.5 kg/m2, scrotally placed testis (32 ml total volume), bilaterally palpable vas deferens, and normal masculine habitus with no signs of gross abnormalities. The female had normal ovulatory cycle and normal hysterosalpingography (confirmed by ultrasound examination of the ovaries during the ovulatory phase and ovulatory progesterone plasma concentrations on day 21). Reproductive hormone tests revealed that the level of serum luteinizing hormone (LH), testosterone, and prolactin were within normal range, whereas the level of follicle-stimulating hormone (FSH) was slightly elevated [].\nSemen evaluation was conducted twice according to established protocols, separated by a three-week interval. Seminal plasma lipid peroxides, vitamins A, vitamin E, ascorbic acid, fructose, corrected fructose, total lipids, cholesterol, phospholipids, and triglycerides were measured as described elsewhere.[] Values for sperm count, morphology, and motility were low []. Seminal plasma levels of lipid peroxides and protein carbonyl group (PCG) were elevated, whereas vitamin A, vitamin E, superoxide dismutase (SOD), and catalase were lower than the normal limit. The level of vitamin C was within normal limits []. These findings were confirmed by a second set of tests performed on a different occasion. In view of these findings, a presumptive diagnosis of oligoteratoasthenozoospermia (OAT) associated with oxidative stress was made.\nThe patient was prescribed Anoxee supplement once-daily for a period of two months followed by Mucuna pruriens seeds powder at the dose of five gm/day orally for three months to alleviate the oxidative stress. We have earlier demonstrated effectiveness of M. pruriens in treatment of oxidative stress associated male infertility.[]\nAt the end of therapy, the laboratory analyses were repeated []. None of the parameters under investigation showed a desired improvement. Before deciding upon further treatment, molecular analyses of Y-chromosome were carried out according to the guidelines suggested by European Academy of Andrology (EAA).[] The results revealed intact AZFa and AZFb, whereas AZFc was completely deleted []. Further analyses using another set of primers confirmed the b2/b4 deletion pattern of AZFc. The two markers sY254 and sY255 are specific to the DAZ (deleted in azoospermia) gene, which is normally present in four copies in AZFc region.[] The analysis suggested that abnormal sperm production was associated with AZFc deletion.