Male infertility and androgen receptor gene mutations: clinical features and identification of seven novel mutations

Authors

  • Alberto Ferlin,

    1. University of Padova, Department of Histology, Microbiology and Medical Biotechnologies, Centre for Male Gamete Cryopreservation, Padova, Italy
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  • Cinzia Vinanzi,

    1. University of Padova, Department of Histology, Microbiology and Medical Biotechnologies, Centre for Male Gamete Cryopreservation, Padova, Italy
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  • Andrea Garolla,

    1. University of Padova, Department of Histology, Microbiology and Medical Biotechnologies, Centre for Male Gamete Cryopreservation, Padova, Italy
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  • Riccardo Selice,

    1. University of Padova, Department of Histology, Microbiology and Medical Biotechnologies, Centre for Male Gamete Cryopreservation, Padova, Italy
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  • Daniela Zuccarello,

    1. University of Padova, Department of Histology, Microbiology and Medical Biotechnologies, Centre for Male Gamete Cryopreservation, Padova, Italy
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  • Carla Cazzadore,

    1. University of Padova, Department of Histology, Microbiology and Medical Biotechnologies, Centre for Male Gamete Cryopreservation, Padova, Italy
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  • Carlo Foresta

    1. University of Padova, Department of Histology, Microbiology and Medical Biotechnologies, Centre for Male Gamete Cryopreservation, Padova, Italy
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Prof Carlo Foresta, University of Padova, Department of Histology, Microbiology and Medical Biotechnologies, Centre for Male Gamete Cryopreservation, Via Gabelli 63, 35127 Padova, Italy. Tel.: +39 0498212639; Fax: +39 0498213222; E-mail: carlo.foresta@unipd.it

Summary

Objective  Androgens and a functioning androgen receptor (AR) are essential for development and maintenance of the male phenotype and spermatogenesis. Consistent with this, mutations in the AR gene cause a variety of defects related to androgen insensitivity, ranging from complete feminization to phenotypic males with infertility. The aim of his study was to analyse the prevalence of AR gene mutations in male infertility and to clarify the genotype-phenotype relation.

Design  Males with infertility were recruited consecutively at the Centre for Male Gamete Cryopreservation at the University of Padova from January 1996 to January 2005.

Patients  One thousand five hundred and seventeen men with < 10 million sperm/ml and 310 age-matched normozoospermic controls.

Methods  Screening for AR gene mutation was done by DHPLC and sequencing, and reproductive hormone concentrations were measured.

Results  We found 20 mutations in 26 of 1517 patients (1·7%) and no mutations in controls. A high number of mutations localized in exon 1 of the AR gene coding for the transactivation domain of the protein. Of 20 mutations, 7 represent novel mutations. With respect to men without AR mutations, subjects with AR mutations have lower ejaculate volume, higher testosterone levels, higher oestradiol levels, and higher androgen sensitivity index. However, the ranges for these variables were highly overlapping between men with and without AR gene mutations. Also clinical manifestations of AR mutations are not unique and 22 men had only spermatogenic impairment.

Conclusions  AR gene mutations are quite frequent in unselected infertile men but no specific hormonal or clinical data could be used to preselect patients at risk of mutations.

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