CHROMOSOMAL DISORDERS SUCH AS KLEINFELTER'S (CLASSIC 47XXY), MIXED GONADAL DYSGENESIS,CHROMOSOMAL TRANSLOCATIONS AND XYY OFFSPRING OF SUBFERTILE MEN

Genetic concerns for the subfertile male in the era of ICSI
Edward D. Kim 1, Farideh Z. Bischoff 2, Larry I. Lipshultz 1, Dolores J. Lamb 1 3 *
1Scott Department of Urology, Baylor College of Medicine, Houston, TX, U.S.A.
2Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, U.S.A.
3Department of Cell Biology, Baylor College of Medicine, Houston, TX, U.S.A.

email: Dolores J. Lamb (dlamb@bcm.tmc.edu)

*Correspondence to Dolores J. Lamb, Scott Department of Urology, Baylor College of Medicine, 1 Baylor Plaza, Room 440E, Houston, TX 77030, U.S.A.

Keywords
ICSI • male infertility • genes • genetic defects


Abstract
The treatment of severe male factor infertility has seen remarkable advances in the last five years with the introduction and widespread use of intracytoplasmic sperm injection (ICSI). Although ICSI represents one of the most important advances in the treatment of the subfertile male, significant concerns exist regarding the potential for transmission of abnormal genes to the offspring because many of the natural barriers to conception have been bypassed. Because these couples were not able to conceive prior to ICSI, the long-term genetic consequences in these offspring are largely undefined at this time. Genetic abnormalities related to male infertility need to be considered in terms of being (1) causative for male infertility and (2) potentially transmissible to the offspring. Reasons for pursuing a genetic evaluation include (1) establishing a diagnosis, (2) establishing a possible genetic origin, (3) clarifying the pattern of inheritance, and (4) providing information on natural history, variation and expression. The three most common known genetic factors related to male infertility are cystic fibrosis gene mutations leading to congenital absence of the vas deferens, Y-chromosome microdeletions leading to spermatogenic impairment, and karyotype abnormalities. When congenital bilateral absence of the vas deferens with azoospermia is encountered, cystic fibrosis transmembrane conductance regulator (CFTR) gene mutations are commonly the underlying cause. When testicular failure is manifest by azoospermia or severe oligoszoospermia, Y-chromosome microdeletions may be present in approximately 10-15 per cent of otherwise normal appearing men. Karyotyping can uncover potentially transmissible genetic abnormalities in the infertile male including structural chromosomal disorders such as Klinefelter's (classic 47, XXY), mixed gonadal dysgenesis, chromosomal translocations and XYY syndromes. Finally, potential male infertility genes in animal models are reviewed. Without question, advances in clinical and basic research raise scientific and social issues that must be addressed. Copyright © 1998 John Wiley & Sons, Ltd.



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Digital Object Identifier (DOI)

10.1002/(SICI)1097-0223(199812)18:13<1349::AID-PD504>3.0.CO;2-# About DOI




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