1
|
Dittmar F, Rosellen J, Reiser L, Fritzenwanker M, Hauptmann A, Diemer T, Schuppe HC, Wagenlehner F, Pilatz A. Comprehensive evaluation of hematospermia in patients with acute epididymitis compared to patients with isolated hematospermia. Andrology 2024; 12:1001-1011. [PMID: 37401133 DOI: 10.1111/andr.13489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/20/2023] [Accepted: 06/26/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Among the most commonly known causes of hematospermia are infections in the genitourinary tract, but no study exists that has comprehensively investigated hematospermia in patients with acute epididymitis. OBJECTIVES To assess the impact of hematospermia in patients with acute epididymitis and its association with clinical, microbiological, and semen parameters. MATERIALS AND METHODS Since May 2007, a total of 324 sexually active patients with acute epididymitis were recruited in a prospective cohort study. Patients received a comprehensive medical and sexual history, and clinical, sonographic, laboratory, and microbiological diagnostics. Antibiotic therapy was given according to European Association of Urology guidelines. Semen analysis was offered 14 days after the first presentation and initiation of therapy. Since 2013, a separate control group of 56 patients presenting with isolated hematospermia (= no other urogenital symptoms) was prospectively recruited, and differences between the groups were statistically evaluated. RESULTS Of 324 patients with acute epididymitis, 50 patients (15%) had self-reported hematospermia. This occurred with a median of 24 h before the onset of scrotal symptoms and was associated with significantly elevated prostate-specific antigen levels compared to 274 patients without hematospermia (3.1 vs. 1.8 ng/ml, p < 0.01). The two most common etiological pathogens were Escherichia coli and Chlamydia trachomatis, and the bacterial spectrum was comparable in both epididymitis subgroups (p = 0.859). Semen analysis at 14 days still showed hematospermia in 24% of patients associated with massive leukocytospermia. Compared to the hematospermia control group, the two epididymitis subgroups showed significantly increased inflammation markers (pH, leukocytes, and elastase), reduced sperm concentration, and reduced levels of alpha-glucosidase and zinc (always p < 0.01). DISCUSSION AND CONCLUSION In sexually active patients who develop acute epididymitis, self-reported hematospermia is evident in 15% of patients as early as one day before the onset of scrotal symptoms. Conversely, none of the 56 patients presenting with isolated hematospermia developed epididymitis within the next 4 weeks.
Collapse
Affiliation(s)
- Florian Dittmar
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen, Giessen, Germany
| | - Jens Rosellen
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen, Giessen, Germany
| | - Leo Reiser
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen, Giessen, Germany
| | - Moritz Fritzenwanker
- Institute for Medical Microbiology, Justus Liebig University Giessen, Giessen, Germany
| | - Arne Hauptmann
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen, Giessen, Germany
| | - Thorsten Diemer
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen, Giessen, Germany
| | - Hans-Christian Schuppe
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen, Giessen, Germany
| | - Florian Wagenlehner
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen, Giessen, Germany
| | - Adrian Pilatz
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen, Giessen, Germany
| |
Collapse
|
2
|
Fontana L, Sirchia SM, Pesenti C, Colpi GM, Miozzo MR. Non-invasive biomarkers for sperm retrieval in non-obstructive patients: a comprehensive review. Front Endocrinol (Lausanne) 2024; 15:1349000. [PMID: 38689732 PMCID: PMC11058837 DOI: 10.3389/fendo.2024.1349000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 04/01/2024] [Indexed: 05/02/2024] Open
Abstract
Recent advancements in reproductive medicine have guided novel strategies for addressing male infertility, particularly in cases of non-obstructive azoospermia (NOA). Two prominent invasive interventions, namely testicular sperm extraction (TESE) and microdissection TESE (micro-TESE), have emerged as key techniques to retrieve gametes for assisted reproduction technologies (ART). Both heterogeneity and complexity of NOA pose a multifaceted challenge to clinicians, as the invasiveness of these procedures and their unpredictable success underscore the need for more precise guidance. Seminal plasma can be aptly regarded as a liquid biopsy of the male reproductive tract, encompassing secretions from the testes, epididymides, seminal vesicles, bulbourethral glands, and prostate. This fluid harbors a variety of cell-free nucleic acids, microvesicles, proteins, and metabolites intricately linked to gonadal activity. However, despite numerous investigations exploring potential biomarkers from seminal fluid, their widespread inclusion into the clinical practice remains limited. This could be partially due to the complex interplay of diverse clinical and genetic factors inherent to NOA that likely contributes to the absence of definitive biomarkers for residual spermatogenesis. It is conceivable that the integration of clinical data with biomarkers could increase the potential in predicting surgical procedure outcomes and their choice in NOA cases. This comprehensive review addresses the challenge of sperm retrieval in NOA through non-invasive biomarkers. Moreover, we delve into promising perspectives, elucidating innovative approaches grounded in multi-omics methodologies, including genomics, transcriptomics and proteomics. These cutting-edge techniques, combined with the clinical and genetics features of patients, could improve the use of biomarkers in personalized medical approaches, patient counseling, and the decision-making continuum. Finally, Artificial intelligence (AI) holds significant potential in the realm of combining biomarkers and clinical data, also in the context of identifying non-invasive biomarkers for sperm retrieval.
Collapse
Affiliation(s)
- Laura Fontana
- Medical Genetics Unit, Aziende Socio Sanitarie Territoriali (ASST) Santi Paolo e Carlo, Milan, Italy
- Medical Genetics, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Silvia M. Sirchia
- Medical Genetics, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Chiara Pesenti
- Medical Genetics Unit, Aziende Socio Sanitarie Territoriali (ASST) Santi Paolo e Carlo, Milan, Italy
| | - Giovanni Maria Colpi
- Next Fertility Procrea, International Center for Assisted Reproductive Technology, Lugano, Switzerland
| | - Monica R. Miozzo
- Medical Genetics Unit, Aziende Socio Sanitarie Territoriali (ASST) Santi Paolo e Carlo, Milan, Italy
- Medical Genetics, Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| |
Collapse
|
3
|
Kanetkar SR, Mohite S, Kadam RS, Gupta N, Vadhel CR. Effect of Tobacco Use on Semen in Infertile Male. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2024; 16:S412-S414. [PMID: 38595366 PMCID: PMC11001042 DOI: 10.4103/jpbs.jpbs_635_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 08/25/2023] [Accepted: 09/01/2023] [Indexed: 04/11/2024] Open
Abstract
Background/Objective/Methods Infertility is one of the major global public health issues. In a social setup like India, there is a strong emphasis on childbearing, which leads to economic and psychological stress and trauma. Various studies have shown that worldwide, there is a decline in the quality of semen. Many environmental, nutritional, and lifestyle factors are responsible for the reduced semen quality. The methods of this study are the source of data, the method of collection of data, and statistical analysis. Results Semen analysis is an important diagnostic test in the assessment of infertility in male partners. Ninety-eight semen samples were analyzed from the patients who presented with the complaint of infertility over a period of 2 years (June 2018-May 2020). Conclusion Based on our analysis, it can be inferred that an escalation in the intensity of tobacco consumption is directly associated with a proportional decline in sperm count and motility and a notable increase in liquefaction time.
Collapse
Affiliation(s)
- Sujata R. Kanetkar
- Department of Pathology, Krishna Institute of Medical Sciences, Krishna Vishwa Vidyapeeth, Karad, Maharashtra, India
| | - Sushant Mohite
- Department of Pathology, Krishna Institute of Medical Sciences, Krishna Vishwa Vidyapeeth, Karad, Maharashtra, India
| | - Rohit S. Kadam
- Department of Pathology, Krishna Institute of Medical Sciences, Krishna Vishwa Vidyapeeth, Karad, Maharashtra, India
| | - Nilesh Gupta
- Department of pathology, Faculty of Pharmacy, Medi-Caps University, Rau, Indore, Madhya Pradesh, India
| | - Chirag R Vadhel
- Department of Anatomy, SAL Institute of Medical Sciences, Ahmadabad, Gujarat, India
| |
Collapse
|
4
|
Wang M, Zhou J, Long R, Mao R, Gao L, Wang X, Chen Y, Jin L, Zhu L. An overview of CFTR mutation profiles and assisted reproductive technology outcomes in Chinese patients with congenital obstructive azoospermia. J Assist Reprod Genet 2024; 41:505-513. [PMID: 38114870 PMCID: PMC10894795 DOI: 10.1007/s10815-023-03004-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 12/04/2023] [Indexed: 12/21/2023] Open
Abstract
PURPOSE The cystic fibrosis transmembrane conductance regulator (CFTR) is the most common causative gene attributed to congenital obstructive azoospermia (OA). The aim of this study was to conduct an epidemiological survey of congenital OA patients, to screen for CFTR mutations, and to follow their pregnancy outcomes in assisted reproductive technology (ART). METHODS This cohort study enrolled congenital OA patients undergoing ART and whole-exome sequencing from January 2018 to September 2023. Semen parameters, sex hormones, and seminal plasma biochemistry were evaluated. CFTR mutations identified in OA patients were analyzed. In addition, the laboratory outcomes, clinical outcomes, and neonatal outcomes were compared between OA patients carrying two CFTR mutations and the others after surgical sperm extraction-intracytoplasmic sperm injection (ICSI) treatment. RESULTS A total of 76 patients with congenital OA were enrolled. CFTR mutations were identified in 35 (46.1%) congenital OA patients. A total of 60 CFTR mutation sites of 27 types were identified, and 10 of them were novel. The average frequency was 1.71 (60/35) per person. The most common mutation was c.1210-11T > G (25%, 15/60). After ICSI treatment, there were no statistically significant differences in laboratory outcomes, clinical outcomes, and neonatal outcomes between OA patients carrying two CFTR mutations (n = 25) and other OA patients (n = 51). CONCLUSION Apart from the IVS9-5T mutation, the genetic mutation pattern of CFTR in Chinese OA patients is heterogeneous, which is significantly different from that of Caucasians. Although carrying two CFTR mutations or not had no effect on the pregnancy outcomes in OA patients after ICSI, genetic counseling is still recommended for such patients.
Collapse
Affiliation(s)
- Meng Wang
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Juepu Zhou
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Rui Long
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Ruolin Mao
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Limin Gao
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xiangfei Wang
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yinwei Chen
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Lei Jin
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
| | - Lixia Zhu
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
| |
Collapse
|
5
|
Wyrwoll MJ, van der Heijden GW, Krausz C, Aston KI, Kliesch S, McLachlan R, Ramos L, Conrad DF, O'Bryan MK, Veltman JA, Tüttelmann F. Improved phenotypic classification of male infertility to promote discovery of genetic causes. Nat Rev Urol 2024; 21:91-101. [PMID: 37723288 DOI: 10.1038/s41585-023-00816-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 09/20/2023]
Abstract
An increasing number of genes are being described in the context of non-syndromic male infertility. Linking the underlying genetic causes of non-syndromic male infertility with clinical data from patients is important to establish new genotype-phenotype correlations. This process can be facilitated by using universal nomenclature, but no standardized vocabulary is available in the field of non-syndromic male infertility. The International Male Infertility Genomics Consortium aimed at filling this gap, providing a standardized vocabulary containing nomenclature based on the Human Phenotype Ontology (HPO). The "HPO tree" was substantially revised compared with the previous version and is based on the clinical work-up of infertile men, including physical examination and hormonal assessment. Some causes of male infertility can already be suspected based on the patient's clinical history, whereas in other instances, a testicular biopsy is needed for diagnosis. We assembled 49 HPO terms that are linked in a logical hierarchy and showed examples of morphological features of spermatozoa and testicular histology of infertile men with identified genetic diagnoses to describe the phenotypes. This work will help to record patients' phenotypes systematically and facilitate communication between geneticists and andrologists. Collaboration across institutions will improve the identification of patients with the same phenotypes, which will promote the discovery of novel genetic causes for non-syndromic male infertility.
Collapse
Affiliation(s)
- Margot J Wyrwoll
- Institute of Reproductive Genetics, University of Münster, Münster, Germany
| | | | - Csilla Krausz
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, University Hospital of Careggi (AOUC), Florence, Italy
| | - Kenneth I Aston
- Andrology and IVF Laboratory, Department of Surgery (Urology), University of Utah, Salt Lake City, UT, USA
| | - Sabine Kliesch
- Centre of Reproductive Medicine and Andrology, Department of Clinical and Surgical Andrology, University of Münster, Münster, Germany
| | - Robert McLachlan
- Department of Clinical Research, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
| | - Liliana Ramos
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Donald F Conrad
- Department of Genetics, Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, OR, USA
| | - Moira K O'Bryan
- School of BioSciences and Bio21 Institute, The University of Melbourne, Parkville, Victoria, Australia
| | - Joris A Veltman
- Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Frank Tüttelmann
- Institute of Reproductive Genetics, University of Münster, Münster, Germany.
| |
Collapse
|
6
|
Colpi GM, Caroppo E. Partial Epididymal Obstruction as a Cause of Idiopathic Oligozoospermia: A Reproductive Urologist's Perspective following 35 Years of Surgical and Clinical Experience. J Clin Med 2024; 13:382. [PMID: 38256519 PMCID: PMC10816178 DOI: 10.3390/jcm13020382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/03/2024] [Accepted: 01/08/2024] [Indexed: 01/24/2024] Open
Abstract
The role of partial epididymal obstruction as contributing to the development of oligozoospermia has been neglected for decades. In the early 1970s, however, Robert Schoysman, a gynecological surgeon devoted to the surgical and medical management of male factor infertility, dedicated many efforts to study such a pathology and its possible effects on male fertility. Following the studies of this pioneer in the field, we concentrated our attention to the patterns of partial and complete epididymal obstruction during surgical scrotal exploration, once made possible even in oligozoospermic men by diagnostic and therapeutic interventions, such as vasovesciculography or seminal tract washout test, at present considered obsolete and no longer feasible in light of the current guidelines. Interestingly, we found signs of partial epididymal obstruction in about 30% of oligozoospermic men with normal testicular volume and serum FSH level as well as normal spermatogenesis at testis biopsy. We, then, compared the findings of scrotal ultrasound with those of scrotal exploration and found that the ultrasound abnormalities of the epididymis were highly predictive of anatomic alteration of the gland. In the present study, we report our experience, together with a historical review of the literature, on this topic.
Collapse
Affiliation(s)
- Giovanni M. Colpi
- Next Fertility Procrea, Andrology and IVF Center Unit, 6900 Lugano, Switzerland
| | - Ettore Caroppo
- Asl Bari, Andrology Outpatients Clinic, 70014 Conversano (Ba), Italy;
| |
Collapse
|
7
|
Klees C, Alexandri C, Demeestere I, Lybaert P. The Role of microRNA in Spermatogenesis: Is There a Place for Fertility Preservation Innovation? Int J Mol Sci 2023; 25:460. [PMID: 38203631 PMCID: PMC10778981 DOI: 10.3390/ijms25010460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/24/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024] Open
Abstract
Oncological treatments have dramatically improved over the last decade, and as a result, survival rates for cancer patients have also improved. Quality of life, including concerns about fertility, has become a major focus for both oncologists and patients. While oncologic treatments are often highly effective at suppressing neoplastic growth, they are frequently associated with severe gonadotoxicity, leading to infertility. For male patients, the therapeutic option to preserve fertility is semen cryopreservation. In prepubertal patients, immature testicular tissue can be sampled and stored to allow post-cure transplantation of the tissue, immature germ cells, or in vitro spermatogenesis. However, experimental techniques have not yet been proven effective for restoring sperm production for these patients. MicroRNAs (miRNAs) have emerged as promising molecular markers and therapeutic tools in various diseases. These small regulatory RNAs possess the unique characteristic of having multiple gene targets. MiRNA-based therapeutics can, therefore, be used to modulate the expression of different genes involved in signaling pathways dysregulated by changes in the physiological environment (disease, temperature, ex vivo culture, pharmacological agents). This review discusses the possible role of miRNA as an innovative treatment option in male fertility preservation-restoration strategies and describes the diverse applications where these new therapeutic tools could serve as fertility protection agents.
Collapse
Affiliation(s)
- Charlotte Klees
- Research Laboratory on Human Reproduction, Faculty of Medicine, Université Libre de Bruxelles (ULB), 1070 Brussels, Belgium; (C.K.); (C.A.); (I.D.)
| | - Chrysanthi Alexandri
- Research Laboratory on Human Reproduction, Faculty of Medicine, Université Libre de Bruxelles (ULB), 1070 Brussels, Belgium; (C.K.); (C.A.); (I.D.)
| | - Isabelle Demeestere
- Research Laboratory on Human Reproduction, Faculty of Medicine, Université Libre de Bruxelles (ULB), 1070 Brussels, Belgium; (C.K.); (C.A.); (I.D.)
- Fertility Clinic, HUB-Erasme Hospital, 1070 Brussels, Belgium
| | - Pascale Lybaert
- Research Laboratory on Human Reproduction, Faculty of Medicine, Université Libre de Bruxelles (ULB), 1070 Brussels, Belgium; (C.K.); (C.A.); (I.D.)
| |
Collapse
|
8
|
Nam CS, Campbell KJ, Acquati C, Bole R, Adler A, Collins DJ, Collins E, Samplaski M, Anderson-Bialis J, Andino JJ, Asafu-Adjei D, Gaskins AJ, Bortoletto P, Vij SC, Orwig KE, Lundy SD. Deafening Silence of Male Infertility. Urology 2023; 182:111-124. [PMID: 37778476 DOI: 10.1016/j.urology.2023.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/07/2023] [Accepted: 09/23/2023] [Indexed: 10/03/2023]
Abstract
Think about 6 loved ones of reproductive age in your life. Now imagine that 1 of these 6 individuals is suffering from infertility. Perhaps they feel alone and isolated, unable to discuss their heartbreak with their closest friends, family, and support network. Suffering in silence. In this editorial, we discuss the infertility journey through the lens of the patients, the providers, and the scientists who struggle with infertility each and every day. Our goal is to open a dialogue surrounding infertility, with an emphasis on dismantling the longstanding societal barriers to acknowledging male infertility as a disease. Through education, communication, compassion, and advocacy, together we can all begin to break the deafening silence of male infertility.
Collapse
Affiliation(s)
- Catherine S Nam
- Department of Urology, University of Michigan, Ann Arbor, MI
| | | | - Chiara Acquati
- Graduate College of Social Work, University of Houston, Houston, TX; Department of Clinical Sciences, Tilman J. Fertitta Family College of Medicine, University of Houston, Houston, TX; Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Raevti Bole
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Ava Adler
- Lerner Research Institute, Cleveland Clinic, Cleveland, OH
| | - David J Collins
- Department of Urology, University of Southern California, Los Angeles, CA
| | - Erica Collins
- Department of Urology, University of Southern California, Los Angeles, CA
| | - Mary Samplaski
- Department of Urology, University of Southern California, Los Angeles, CA
| | | | - Juan J Andino
- Department of Urology, University of California Los Angeles, Los Angeles, CA
| | - Denise Asafu-Adjei
- Department of Urology, Department of Parkinson School of Health Sciences and Public Health, Loyola University Chicago Stritch School of Medicine, Chicago, IL
| | | | - Pietro Bortoletto
- Boston IVF, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Sarah C Vij
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Kyle E Orwig
- Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Scott D Lundy
- Glickman Urological and Kidney Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, OH.
| |
Collapse
|
9
|
Pozza C, Tenuta M, Sesti F, Bertolotto M, Huang DY, Sidhu PS, Maggi M, Isidori AM, Lotti F. Multiparametric Ultrasound for Diagnosing Testicular Lesions: Everything You Need to Know in Daily Clinical Practice. Cancers (Basel) 2023; 15:5332. [PMID: 38001591 PMCID: PMC10670367 DOI: 10.3390/cancers15225332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/20/2023] [Accepted: 10/24/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Ultrasonography (US) represents the gold standard imaging method for the assessment of testicular lesions (TL). The gray-scale (GSUS) and color-Doppler (CDUS) ultrasound examination allow sonographers to investigate the size, margins, echotexture, and vascular features of TLs with the aim to differentiate benign from malignant lesions. Recently, the use of contrast-enhanced US (CEUS) and sonoelastography (SE) has led to further improvements in the differential diagnosis of TL. Although GSUS and CDUS are often sufficient to suggest the benign or malignant nature of the TL, CEUS can be decisive in the differential diagnosis of unclear findings, while SE can help to strengthen the diagnosis. The contemporary combination of GSUS, CDUS, CEUS, and SE has led to a new diagnostic paradigm named multiparametric US (mp-US), which is able to provide a more detailed characterization of TLs than single techniques alone. This narrative and pictorial review aimed to describe the mp-US appearance of several TLs. METHODS An extensive Medline search was performed to identify studies in the English language focusing on the mp-US evaluation of TLs. RESULTS A practical mp-US "identity card" and iconographic characterization of several benign and malignant TLs is provided herein. CONCLUSIONS The mp-US characterization of TL reported herein can be useful in daily clinical practice.
Collapse
Affiliation(s)
- Carlotta Pozza
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy; (C.P.); (M.T.); (F.S.); (A.M.I.)
| | - Marta Tenuta
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy; (C.P.); (M.T.); (F.S.); (A.M.I.)
| | - Franz Sesti
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy; (C.P.); (M.T.); (F.S.); (A.M.I.)
| | - Michele Bertolotto
- Department of Radiology, Ospedale Di Cattinara, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy;
| | - Dean Y. Huang
- Department of Imaging Sciences, Faculty of Life Sciences and Medicine, School of Biomedical Engineering and Imaging Sciences, King’s College London, London WC2R 2LS, UK; (D.Y.H.); (P.S.S.)
| | - Paul S. Sidhu
- Department of Imaging Sciences, Faculty of Life Sciences and Medicine, School of Biomedical Engineering and Imaging Sciences, King’s College London, London WC2R 2LS, UK; (D.Y.H.); (P.S.S.)
| | - Mario Maggi
- Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, 50139 Florence, Italy;
| | - Andrea M. Isidori
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy; (C.P.); (M.T.); (F.S.); (A.M.I.)
| | - Francesco Lotti
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy
| |
Collapse
|
10
|
Faix A, Methorst C, Lamazou F, Vialard F, Huyghe E. [Assessment of the man in the infertile couple]. Prog Urol 2023; 33:588-612. [PMID: 38012906 DOI: 10.1016/j.purol.2023.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 09/19/2023] [Accepted: 09/22/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Among couples consulting for infertility, there is a male component, either alone or associated with a female aetiology in around one in 2 cases. MATERIAL AND METHODS Bibliographic search in PubMed using the keywords "male infertility", "diagnosis", "management" and "evaluation" limited to clinical articles in English and French prior to 1/01/2023. RESULTS The AFU recommends: (1) a complete medical history including: family history, patient history affecting fertility, lifestyle habits (toxicity), treatments, symptoms, sexual dysfunctions; (2) a physical examination including: BMI, signs of hypogonadism, secondary sexual characteristics, scrotal examination (volume and consistency of testes, vas deferens, epididymal or testicular nodules, presence of varicocele); (3) two spermograms, if abnormal on the first; (4) a systematic scrotal ultrasound,± an endorectal ultrasound depending on the clinic; (5) a hormonal work-up (testosterone, FSH; if testosterone is low: LH assay to differentiate between central or peripheral hypogonadism); (6) karyotype if sperm concentration≤10 million/mL; (7) evaluation of Y chromosome microdeletions if concentration≤1 million/mL; (8) evaluation of the CFTR gene in cases of suspected bilateral or unilateral agenesis of the vas deferens and seminal vesicles. The role and usefulness of direct and indirect tests to assess the effects of oxidative stress on sperm DNA will also be explained. CONCLUSION This review complements and updates the AFU/SALF 2021 recommendations.
Collapse
Affiliation(s)
- A Faix
- Clinique Saint-Roch, 560, avenue du Colonel-Pavelet-dit-Villars, 34000 Montpellier, France
| | - C Methorst
- Service de médecine de la reproduction, hôpital des 4-villes, Saint-Cloud, France
| | - F Lamazou
- Clinique Pierre-Cherest, Paris, France
| | - F Vialard
- Service de génétique, CHU de Poissy Saint-Germain, UVSQ, Poissy, France
| | - E Huyghe
- Département d'urologie, hôpital de Rangueil, CHU de Toulouse, Toulouse, France; Service de médecine de la reproduction, hôpital Paule-de-Viguier, CHU de Toulouse, Toulouse, France; UMR DEFE, Inserm 1203, université de Toulouse, université de Montpellier, Toulouse, France.
| |
Collapse
|
11
|
Zitzmann M, Schubert M, Sansone A, Kliesch S. Spontaneous alterations in semen parameters are associated with age, accessory gland function and the FSHB c.-211G>T variant. Andrology 2023; 11:1386-1397. [PMID: 36908159 DOI: 10.1111/andr.13426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/08/2023] [Accepted: 03/02/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND There is a strong within-subject alteration of semen parameters in men with infertility. However, it remains unknown in which subgroup variations are likely to occur and which semen parameters are affected. OBJECTIVE To evaluate parameters associated with spontaneous alterations in semen analysis. PATIENTS AND METHODS We retrospectively selected 3456 men with infertility without known causes affecting spermatogenesis or sperm output for analysis of repeated ejaculate samples. Exclusion criteria comprised sperm concentration <1 million/mL, abnormal follicle-stimulating hormone or low testosterone, and low bitesticular volume (<10 mL). Grouped linear two-level nested mixed-effect models were applied. The analyzed parameters included abstinence time, bitesticular volume, age, accessory gland markers, follicle-stimulating hormone, and FSHB c.-211 variants. RESULTS Groups include A (n = 397): ≥1.0 to <5.0 million/mL, B (n = 708): ≥5.0 to <15.0 million/mL, and C (n = 2351): ≥15.0 million/mL. Groups A, B, and C: changes in ejaculate volume were associated with alterations in total sperm count and motility (p < 0.003). Changes were, controlled for abstinence time (p < 0.001), related to α-glucosidase, fructose, or zinc (p = 0.005-0.02). Group A + B: fluctuations in follicle-stimulating hormone level influenced sperm concentration/count (p = 0.004-0.02), albeit only in men with FSHB c.-211 GG (p = 0.007-0.02). T-allele carriers did not show changes in follicle-stimulating hormone levels (p > 0.1). Group B: age <50 years (p = 0.007-0.01) and normal bitesticular volume (p = 0.008-0.02) were associated with spontaneous increases in sperm concentration, count, and motility. CONCLUSION Semen parameters exhibit intra-individual alterations associated with organic, hormonal, and genetic variables. Changes are pronounced in younger men with normal bitesticular volume and oligozoospermia to almost normozoospermia. The effect is modulated by abstinence time, accessory gland function, and fluctuations in follicle-stimulating hormone level, which is bound to FSHB c.-211G>T variant. Judgment of semen analysis should be based on two semen samples, with abstinence times between 4 and 5 days. As a future perspective, it might be investigated whether younger men with normal bitesticular volume who are unable to elicit increases in serum follicle-stimulating hormone (FSHB c.-211 genotype of GT/TT) benefit from improving accessory gland function and increasing follicle-stimulating hormone.
Collapse
Affiliation(s)
- Michael Zitzmann
- Department of Clinical and Surgical Andrology, Centre for Reproductive Medicine and Andrology, University Hospital Münster, Münster, Germany
| | - Maria Schubert
- Department of Clinical and Surgical Andrology, Centre for Reproductive Medicine and Andrology, University Hospital Münster, Münster, Germany
| | - Andrea Sansone
- Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Sabine Kliesch
- Department of Clinical and Surgical Andrology, Centre for Reproductive Medicine and Andrology, University Hospital Münster, Münster, Germany
| |
Collapse
|
12
|
Abdulai R, Akwetey SA, Ogunbode OO, Aboagye B. Consequences of Type-2 diabetes mellitus and Malaria co-morbidity on sperm parameters in men; a case-control study in a district hospital in the Ashanti Region of Ghana. PLoS One 2023; 18:e0286041. [PMID: 37768924 PMCID: PMC10538753 DOI: 10.1371/journal.pone.0286041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/08/2023] [Indexed: 09/30/2023] Open
Abstract
Type-2 diabetes mellitus (T2DM) and malaria infection are highly prevalent in Africa particularly, in the Sub-Saharan Region. A greater number of people in the Ghanaian population who have T2DM are also reported to harbor malaria parasites. This study aimed to investigate the influence of T2DM & Malaria co-morbidity on sperm parameters among patients in the Ashanti Region of Ghana. This hospital-based cross-sectional analytic case-control study comprised 254 adult male study participants comprising 80 T2DM & Malaria co-morbidity, 80 T2DM only, and 94 normal controls. A blood sample (10mL) was drawn from each participant to measure FBG, HbA1c levels, Testosterone levels, Total cholesterol, and determination of Malaria parasite density. Seminal fluid was also collected from each participant for semen analysis. Sperm kinetics of the T2DM & Malaria co-morbidity group particularly; total motility, rapid progressive motility, and slow progressive motility were negatively affected compared to both T2DM only (p<0.0001) and the Normal control (p<0.0001). Normal sperm morphology was significantly affected in the co-morbidity group compared to T2DM only (p<0.0001). Sperm vitality was also statistically significantly reduced in the T2DM & Malaria co-morbidity than in T2DM only (t (64) = -8.62; p<0.001). There was a significant decline in testosterone levels in the T2DM & Malaria co-morbidity group than in the T2DM only (p<0.0001) and the control (p <0.0001). In conclusion, T2DM and malaria infection have a stronger propensity to alter sperm morphology and lower sperm motility and vitality.
Collapse
Affiliation(s)
- Ratif Abdulai
- Pan African University Institute of Life and Earth Sciences-Including Health and Agriculture, University of Ibadan, Ibadan, Nigeria
- Department of Obstetrics and Gynaecology, College of Medicine, University of Ibadan/University College Hospital, Ibadan, Nigeria
| | - Samuel Addo Akwetey
- Department of Clinical Microbiology, School of Medicine, University for Development Studies, Tamale, Ghana
| | - Olayinka Oladunjoye Ogunbode
- Pan African University Institute of Life and Earth Sciences-Including Health and Agriculture, University of Ibadan, Ibadan, Nigeria
- Department of Obstetrics and Gynaecology, College of Medicine, University of Ibadan/University College Hospital, Ibadan, Nigeria
| | - Benjamin Aboagye
- Department of Forensic Sciences, School of Biological Sciences, College of Agriculture and Natural Sciences, University of Cape Coast, Cape Coast, Ghana
| |
Collapse
|
13
|
Facondo P, Delbarba A, Pezzaioli LC, Ferlin A, Cappelli C. Osteoporosis in men with hypogonadism because of ApoA-I Leu75Pro amyloidosis under long-term testosterone therapy. Andrology 2023; 11:1077-1085. [PMID: 36624081 DOI: 10.1111/andr.13376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 12/11/2022] [Accepted: 12/22/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Apo A-I Leu75Pro amyloidosis is a rare systemic hereditary disease, whose hallmark and earliest involvement is testicular impairment, characterized by hypogonadism and macrorchidism; renal and hepatic involvement are the other characteristics. OBJECTIVE To evaluate for the first time the prevalence of osteopenia, osteoporosis and vertebral fractures (VFs) in men with this form of amyloidosis affected by hypogonadism and under long-term testosterone replacement therapy (TRT). MATERIALS AND METHODS Retrospective study on 50 men >50 years (median age 64.5) with dual-energy X-ray absorptiometry (DXA), hormonal, and biochemical data available at least 3 years after the start of TRT. Serum gonadal hormones and bone markers, lumbar and femoral DXA-scan with morphometric assay for evaluation of VFs were assessed. RESULTS At 7.5 years from start of TRT, lumbar and/or femoral osteopenia and osteoporosis were found in 54% and 10% of patients, respectively. Of the men who had the morphometric assay performed, five of 34 (14.7%) had VFs. Compared to patients with normal bone mineral density, men with osteopenia and osteoporosis were older, had lower body mass index, higher sex hormone binding globulin and showed more frequently renal involvement. Multiorgan involvement, without different TRT dosage, was associated with lower testosterone levels. DISCUSSION AND CONCLUSION Men with hypogonadism because of Apo A-I Leu75Pro amyloidosis under long-term TRT had a high burden of low bone mass (64%) and VFs (almost 15%). Osteopenia-osteoporosis was more frequently observed in older patients with multi-organ disease, which might contribute to impair bone health beyond hypogonadism.
Collapse
Affiliation(s)
- Paolo Facondo
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Andrea Delbarba
- Unit of Endocrinology and Metabolism, ASST Spedali Civili, Brescia, Italy
| | | | - Alberto Ferlin
- Unit of Andrology and Reproductive Medicine, Department of Medicine, University of Padova, Brescia, Italy
| | - Carlo Cappelli
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Unit of Endocrinology and Metabolism, ASST Spedali Civili, Brescia, Italy
| |
Collapse
|
14
|
Chen Z, Hong Z, Wang S, Qiu J, Wang Q, Zeng Y, Weng H. Effectiveness of non-pharmaceutical intervention on sperm quality: a systematic review and network meta-analysis. Aging (Albany NY) 2023; 15:204727. [PMID: 37199654 DOI: 10.18632/aging.204727] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 04/22/2023] [Indexed: 05/19/2023]
Abstract
Infertility affects about 10% of the world's population and has been recognized by the WHO as a global public health problem. The aim of this network meta-analysis was to investigate the efficacy of non-pharmaceutical interventions on sperm quality. All randomized clinical trials (RCTs) from the PubMed, MEDLINE, Embase, China national knowledge infrastructure (CNKI), Wanfang database, and Cochrane Library databases evaluating the effectiveness of non-pharmaceutical interventions on semen parameters using network meta-analyses. Results of the ω-3 fatty acid, lycopene, acupuncture, and vitamin suggested evident advantages in improving sperm concentration (MD, 9.93 (95% CI, 7.21 to 12.65)), (MD, 8.79 (95% CI, 2.67 to 14.91)), (MD, 5.40 (95% CI, 2.32 to 8.49)) and (MD, 3.82 (95% CI, 0.70 to 6.94) respectively). Acupuncture has a significant advantage over placebo in improving sperm total motility (MD, 17.81 (95% CI, 10.32 to 25.29)), and the effect of lycopene was obviously greater than that of placebo (MD, 19.91 (95% CI, 2.99 to 36.83)). Lycopene, Coenzyme Q10 (CoQ10), acupuncture, ω-3 fatty acid, and vitamin suggested significant advantages in improving sperm forward motility (MD, 8.64 (95% CI, 1.15 to 16.13), MD, 5.28 (95% CI, 2.70 to 7.86), MD, 3.95 (95% CI, 3.23 to 4.67), MD, 3.50 (95% CI, 2.21 to 4.79)) and (MD, 2.38 (95% CI, 0.96 to 3.80) respectively). This review establishes that non-pharmaceutical interventions, particularly acupuncture, exercise, lycopene, ω-3 fatty acids, CoQ10, zinc, vitamins, selenium, carnitine, or foods rich in these supplements, profitably improve sperm quality that may be used to treat male infertility.
Collapse
Affiliation(s)
- Zilong Chen
- Shenzhen Traditional Chinese Medicine Hospital, Guangdong 518000, China
- The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Guangdong 518000, China
| | - Zhiming Hong
- Shenzhen Traditional Chinese Medicine Hospital, Guangdong 518000, China
- The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Guangdong 518000, China
| | - Shengjie Wang
- Shenzhen Traditional Chinese Medicine Hospital, Guangdong 518000, China
- The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Guangdong 518000, China
| | - Junfeng Qiu
- Shenzhen Traditional Chinese Medicine Hospital, Guangdong 518000, China
- The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Guangdong 518000, China
| | - Quan Wang
- Shenzhen Traditional Chinese Medicine Hospital, Guangdong 518000, China
- The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Guangdong 518000, China
| | - Yangling Zeng
- Shenzhen Traditional Chinese Medicine Hospital, Guangdong 518000, China
- The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Guangdong 518000, China
| | - Haowei Weng
- Shenzhen Traditional Chinese Medicine Hospital, Guangdong 518000, China
- The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Guangdong 518000, China
| |
Collapse
|
15
|
Fanni SC, Febi M, Colligiani L, Volpi F, Ambrosini I, Tumminello L, Aghakhanyan G, Aringhieri G, Cioni D, Neri E. A first look into radiomics application in testicular imaging: A systematic review. FRONTIERS IN RADIOLOGY 2023; 3:1141499. [PMID: 37492385 PMCID: PMC10365019 DOI: 10.3389/fradi.2023.1141499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/27/2023] [Indexed: 07/27/2023]
Abstract
The aim of this systematic review was to evaluate the state of the art of radiomics in testicular imaging by assessing the quality of radiomic workflow using the Radiomics Quality Score (RQS) and the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). A systematic literature search was performed to find potentially relevant articles on the applications of radiomics in testicular imaging, and 6 final articles were extracted. The mean RQS was 11,33 ± 3,88 resulting in a percentage of 31,48% ± 10,78%. Regarding QUADAS-2 criteria, no relevant biases were found in the included papers in the patient selection, index test, reference standard criteria and flow-and-timing domain. In conclusion, despite the publication of promising studies, radiomic research on testicular imaging is in its very beginning and still hindered by methodological limitations, and the potential applications of radiomics for this field are still largely unexplored.
Collapse
|
16
|
Zafar MI, Mills KE, Baird CD, Jiang H, Li H. Effectiveness of Nutritional Therapies in Male Factor Infertility Treatment: A Systematic Review and Network Meta-analysis. Drugs 2023; 83:531-546. [PMID: 36943634 DOI: 10.1007/s40265-023-01853-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Nutritional therapies are effective alternative treatments for male infertility or subfertility. These are cost-effective and easily implementable, unlike other advanced invasive treatments. Even moderate improvements in sperm quality could improve spontaneous pregnancy. OBJECTIVE We aimed to compare the effectiveness of all nutritional therapies in male infertility/subfertility treatment and ranked their efficacy based on type and etiology. We intend to aid clinicians with an evidence-based approach to affordable and safer initial infertility treatment for those who mainly do not wish to have other advanced invasive treatments or could not afford or have access to them. METHODS We included 69 studies with 94 individual study arms identified from bibliographic databases and registries. We included studies in adult men with proven infertility or subfertility that investigated nutritional or dietary supplement therapies compared with control or placebo and at least reported on a sperm parameter. We undertook a network meta-analysis and performed a pairwise meta-analysis on all sperm parameter outcomes and meta-regression. No language or date restriction was imposed. A systematic article search was concluded on August 29, 2022. RESULTS Our network meta-analysis is the first to compare all dietary interventions in a single analysis, sub-grouped by intervention type and type of infertility. L-Carnitine with micronutrients, antioxidants, and several traditional herbal supplements showed statistically and clinically significant improvement in sperm quality. Meta-regression identified that improvement in the sperm count, motility and morphology translated into increased pregnancy rates (p < 0.001; p < 0.001; p < 0.002, respectively). In particular, L-carnitine with micronutrient therapy (risk ratio [RR]: 3.60, 95% CI 1.86, 6.98, p = 0.0002), followed by zinc (RR 5.39, 95% CI 1.26, 23.04, p = 0.02), significantly improved pregnancy rates. Men with oligozoospermia (RR 4.89), followed by oligoasthenozoospermia (RR 4.20) and asthenoteratozoospermia (RR 3.53), showed a significant increase in pregnancy rates. CONCLUSION We ranked nutritional therapies for their ability to improve sperm quality in men with infertility. Nutritional therapies, particularly L-carnitine alone or combined with micronutrients, significantly improved sperm parameters and pregnancy rates even under severe conditions. We believe these affordable solutions may be valuable for people without access to or who do not wish to undergo more invasive and costly fertility treatments.
Collapse
Affiliation(s)
- Mohammad Ishraq Zafar
- Institute of Reproductive Health/Center of Reproductive Medicine, Tongji Medical College, Huazhong University of Science and Technology, 13 Hang Kong Road, Wuhan, 430030, China
- Reproductive Medicine Center, Fourth Affiliated Hospital Zhejiang University School of Medicine, Yiwu, China
| | - Kerry E Mills
- Department of Science and Technology, University of Canberra, Bruce 2617, Canberra, Australia.
- TruDataRx, White River Junction, Vermont, USA.
| | | | - Huahua Jiang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Honggang Li
- Institute of Reproductive Health/Center of Reproductive Medicine, Tongji Medical College, Huazhong University of Science and Technology, 13 Hang Kong Road, Wuhan, 430030, China.
- Wuhan Huake Reproductive Hospital, Wuhan, China.
| |
Collapse
|
17
|
Biswas S, Mita MA, Afrose S, Hasan MR, Islam MT, Rahman MA, Ara MJ, Chowdhury MBA, Meem HN, Mamunuzzaman M, Ahammad T, Ashik IU, Ibrahim MM, Imam MT, Hossain MA, Saleh MA. Integrated Computational Approaches for Inhibiting Sex Hormone-Binding Globulin in Male Infertility by Screening Potent Phytochemicals. Life (Basel) 2023; 13:476. [PMID: 36836833 PMCID: PMC9966787 DOI: 10.3390/life13020476] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/01/2023] [Accepted: 01/18/2023] [Indexed: 02/11/2023] Open
Abstract
Male infertility is significantly influenced by the plasma-protein sex hormone-binding globulin (SHBG). Male infertility, erectile dysfunction, prostate cancer, and several other male reproductive system diseases are all caused by reduced testosterone bioavailability due to its binding to SHBG. In this study, we have identified 345 phytochemicals from 200 literature reviews that potentially inhibit severe acute respiratory syndrome coronavirus 2. Only a few studies have been done using the SARS-CoV-2 inhibitors to identify the SHBG inhibitor, which is thought to be the main protein responsible for male infertility. In virtual-screening and molecular-docking experiments, cryptomisrine, dorsilurin E, and isoiguesterin were identified as potential SHBG inhibitors with binding affinities of -9.2, -9.0, and -8.8 kcal/mol, respectively. They were also found to have higher binding affinities than the control drug anastrozole (-7.0 kcal/mol). In addition to favorable pharmacological properties, these top three phytochemicals showed no adverse effects in pharmacokinetic evaluations. Several molecular dynamics simulation profiles' root-mean-square deviation, radius of gyration, root-mean-square fluctuation, hydrogen bonds, and solvent-accessible surface area supported the top three protein-ligand complexes' better firmness and stability than the control drug throughout the 100 ns simulation period. These combinatorial drug-design approaches indicate that these three phytochemicals could be developed as potential drugs to treat male infertility.
Collapse
Affiliation(s)
- Suvro Biswas
- Miocrobiology Laboratory, Department of Genetic Engineering and Biotechnology, University of Rajshahi, Rajshahi 6205, Bangladesh
| | - Mohasana Akter Mita
- Department of Genetic Engineering and Biotechnology, University of Rajshahi, Rajshahi 6205, Bangladesh
| | - Shamima Afrose
- Department of Genetic Engineering and Biotechnology, University of Rajshahi, Rajshahi 6205, Bangladesh
| | - Md. Robiul Hasan
- Department of Genetic Engineering and Biotechnology, University of Rajshahi, Rajshahi 6205, Bangladesh
| | - Md. Tarikul Islam
- Department of Genetic Engineering and Biotechnology, University of Rajshahi, Rajshahi 6205, Bangladesh
| | - Md. Ashiqur Rahman
- Department of Genetic Engineering and Biotechnology, University of Rajshahi, Rajshahi 6205, Bangladesh
| | - Mst. Jasmin Ara
- Department of Genetic Engineering and Biotechnology, University of Rajshahi, Rajshahi 6205, Bangladesh
| | | | - Habibatun Naher Meem
- Department of Genetic Engineering and Biotechnology, University of Rajshahi, Rajshahi 6205, Bangladesh
| | - Md. Mamunuzzaman
- Department of Genetic Engineering and Biotechnology, University of Rajshahi, Rajshahi 6205, Bangladesh
| | - Tanvir Ahammad
- Department of Genetic Engineering and Biotechnology, University of Rajshahi, Rajshahi 6205, Bangladesh
| | - Istiaq Uddin Ashik
- Department of Genetic Engineering and Biotechnology, University of Rajshahi, Rajshahi 6205, Bangladesh
| | - Munjed M. Ibrahim
- Department of Pharmaceutical Chemistry, College of Pharmacy, Umm Al-Qura University, Makkah 21955, Saudi Arabia
| | - Mohammad Tarique Imam
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdul Aziz University, Al Kharj, Pin 11942, Saudi Arabia
| | - Mohammad Akbar Hossain
- Department of Pharmacology and Toxicology, Faculty of Medicine in Al-Qunfudah, Umm Al-Qura University, Makkah 28814, Saudi Arabia
| | - Md. Abu Saleh
- Miocrobiology Laboratory, Department of Genetic Engineering and Biotechnology, University of Rajshahi, Rajshahi 6205, Bangladesh
| |
Collapse
|
18
|
Sun J, Li M, Xiong Y, Zhai L, Zhao J. Oxidative Stress Mediated by N6-Methyladenosine Methylation Contributes to High-Fat Diet Induced Male Reproductive Dysfunction. Mol Nutr Food Res 2023; 67:e2101052. [PMID: 36738079 DOI: 10.1002/mnfr.202101052] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 10/26/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To determine the mechanism of oxidative stress mediated by N6-methyladenosine (m6A) methylation contributing to high fat diet-induced reproductive dysfunction. RESULTS In vivo, compared with those in the Control group, the sperm count and sperm motility decrease significantly; the testosterone, luteinizing hormone levels, hyaluronidase, acrosomal enzyme levels, and total antioxidant capacity decrease significantly; malondialdehyde increases significantly in the DIO and DIO-R groups. The expression of nuclear factor erythroid 2-related factor 2 (Nrf2), superoxide dismutase 1 (SOD1), and NAD(P)H quinone dehydrogenase 1 (NQO1) decreases significantly in the DIO and DIO-R groups; m6A levels in testis tissue in the DIO and DIO-R groups increase; the enrichment of m6A-modified Nrf2 mRNA in testis in the DIO group and DIO-R group increases significantly. Also the m6A regulatory proteins increase significantly in the DIO group and DIO-R group. In vitro, compared to palmitic acid treated cells, the reactive oxygen species (ROS) level significantly decreases in STM2457, S-Adenosylhomocysteine treated cells and YTHDC2, YTHDF2 gene silence cells; however, Nrf2 expression increases in all treated cells. In addition, m6A expression decreases. CONCLUSIONS Oxidative stress mediates by methylation of m6A may contribute to high fat diet-induced male reproductive dysfunction.
Collapse
Affiliation(s)
- Jingyi Sun
- Department of Pharmacology, Shenyang Pharmaceutical University, No.103, Wenhua Rd, Shenhe Dist, Shenyang, 110016, China
| | - Mujiao Li
- Department of Pharmacology, Shenyang Pharmaceutical University, No.103, Wenhua Rd, Shenhe Dist, Shenyang, 110016, China
| | - Yuting Xiong
- Department of Pharmacology, Shenyang Pharmaceutical University, No.103, Wenhua Rd, Shenhe Dist, Shenyang, 110016, China
| | - Lingling Zhai
- Department of Maternal and Child Health, School of Public Health, China Medical University, No.77 Puhe Road, Shenbei District, Shenyang, 110122, China
| | - Jian Zhao
- Department of Pharmacology, Shenyang Pharmaceutical University, No.103, Wenhua Rd, Shenhe Dist, Shenyang, 110016, China
| |
Collapse
|
19
|
Uzunov AV, Meca DC, Secară DC, Munteanu O, Constantin AE, Vasilescu D, Mehedinţu C, Varlas VN, Cîrstoiu MM. Investigaţii actuale în medicina reproductivă – review al literaturii. GINECOLOGIA.RO 2023. [DOI: 10.26416/gine.39.1.2023.7786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
|
20
|
Sperm culture and bacterial susceptibility to antibiotics in a large andrological population: prevalence and impact on seminal parameters. Int Microbiol 2023; 26:69-79. [PMID: 36001166 PMCID: PMC9810678 DOI: 10.1007/s10123-022-00273-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 08/10/2022] [Accepted: 08/12/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND The aim of this study was to evaluate (i) the prevalence of subjects with a positive sperm culture (SC) for bacteria in subjects with or without genitourinary tract inflammation (GTI); (ii) the actual distribution of the species analysed, according to Gram stain; (iii) the impact on sperm parameters; and (iv) the actual bacterial susceptibility to antibiotics. METHODS A total of 930 subjects (18-55) years, were retrospectively studied. All the patients underwent SC and in the case of positive tests (CFU > 106), a microbiological susceptibility analysis. The subjects studied were subdivided into group A (n = 452), with subjective signs of GTI; group B (n = 478), male partners of infertile couples; and group C, 30 healthy normospermic subjects. In group B and in the control group, a semen analysis was performed. RESULTS Overall, the prevalence of positive SC was 21.5% (200/930). The prevalence of positive SC in group A (113/200; 56.5%) was significantly higher vs. group B (87/200; 43.5%; p = 0.01) and control group (1/30; 3.3%; p = 0.0001). In subjects with GTI, the prevalence of asthenozoospermic (96/285; 33.7%) and oligo-asthenozoospermic (98/285; 34.4%) was significantly higher vs. normospermic, oligo-astheno-teratozoospermic, oligozoospermic and azoospermic subjects (22/285 (7.7%), 48/285 (16.8%), 15/285 (5.3%) and 6/285 (2.1%), respectively; p = 0.001). Finally, Enterococcus faecalis (Gram-positive) and Escherichia coli (Gram-negative) showed the highest prevalence of antibiotic resistance. CONCLUSIONS The prevalence of positive SC is higher in GTI subjects; however, the SC could also be positive in subjects without GTI. Commonly used antibiotics have an increasing risk of being useless for the treatment of bacterial infections. Finally, the diagnosis of GTIs is important also for male fertility.
Collapse
|
21
|
Ejaculate for Microbiological Culture: To Wash or Not To Wash? Microbiol Spectr 2022; 10:e0326922. [PMID: 36321892 PMCID: PMC9769719 DOI: 10.1128/spectrum.03269-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Bacteria can be associated with male infertility. Antibacterial substances (e.g., zinc-containing proteins, antimicrobial peptides) in ejaculates might impair the growth of bacteria in culture. We therefore wanted to test if removing antibacterial substances by washing the ejaculate could improve the detection of bacteria in culture. All ejaculates from patients ≥18 years old, which were obtained for routine diagnostics to assess male infertility were included in this study (no exclusion criteria were applied). Test samples were diluted with 2 mL sterile 0.45% saline, vortexed, and centrifuged (5 min; 7.5 × g). After the removal of 2 mL of the supernatant and resuspension, 10 μL of the pellet was used for aerobic and anaerobic culture. Control samples were cultured identically but without washing. Species identification was done with matrix-assisted laser desorption ionization-time of flight mass spectrometry. A total of 186 samples were included. The data set was stratified into five groups (Gram-negative rods [GNR], anaerobes [AN], Enterococcus spp. [EC], coagulase-negative staphylococci [CNS], and viridans streptococci [VS]). Compared to the control arm, the test arm revealed significant lower proportions for CNS (59.1% versus 44.6%, P < 0.01) and VS (53.8% versus 41.9%, P = 0.03). Similarly, slightly lower proportions of GNR (16.1% versus 15.1%, P = 0.89), AN (19.9% versus 17.2%, P = 0.5), and EC (25.3% versus 23.1%, P = 0.63) were observed. The medians of CFU were lower in test samples compared to the control samples (6.5 × 103 versus 2.5 × 103, P < 0.01) for any bacterial growth. Lower colony counts were also observed for individual bacterial groups. In conclusion, preculture washing of ejaculates results in a decrease in total bacteria count and culture-positive samples. IMPORTANCE This study compares two methods for processing ejaculate samples from men undergoing investigations for infertility. The method of sample washing and centrifugation was compared to the standard method of direct inoculation and culture. The study hypothesis was that preprocessing of samples may increase bacterial yield by removing bactericidal substances from semen. However, we found that washing ejaculate samples before microbiological culture did not improve the detection of bacteria and led to a reduction in colony counts.
Collapse
|
22
|
Effect of High-Fructose Diet-Induced Metabolic Syndrome on the Pituitary-Gonadal Axis in Male Rats. Biomedicines 2022; 10:biomedicines10123009. [PMID: 36551765 PMCID: PMC9776103 DOI: 10.3390/biomedicines10123009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/17/2022] [Accepted: 11/21/2022] [Indexed: 11/24/2022] Open
Abstract
Plasma testosterone levels have been found to decrease in older insulin-resistant male patients. Both lower total testosterone levels and a higher incidence of metabolic syndrome have also been reported. The aim of this study was to investigate the effects of high-fructose diet-induced diabetes on both the testosterone release by Leydig cells and the activity of the hypothalamus-pituitary-gonadal (HPG) axis in male rats. Male rats were fed with either standard chow (control group) or a high-fructose diet (fructose-fed group) for 21 weeks. Hyperglycemia, hyperinsulinemia, and hypertension were observed in the fructose-fed group. Moreover, plasma testosterone and LH levels decreased in the fructose-fed group compared to the control group. Sperm motility was also reduced by 15% in the fructose-fed rats. In contrast, the basal release of testosterone from rat Leydig cells was not altered by fructose feeding. Moreover, in vitro studies showed that the testosterone release, in response to different stimulants, including forskolin (an adenylyl cyclase activator, 10-5 M), 8-Br-cAMP (a permeable analog of cAMP, 10-5 M), A23187 (a calcium ionophore, 10-5 M), or 25-hydroxy-cholesterol (water-soluble cholesterol, 10-5 M), did not significantly differ between the fructose-fed and control groups. Interestingly, the release of testosterone in response to human chorionic gonadotropin (hCG, 0.05 IU/mL) was enhanced by eightfold in the control group, but elevenfold in the fructose-fed group. LH receptor expression in rat Leydig cells was also increased. Moreover, LH secretion from the anterior pituitary was altered in the fructose diet-fed group. These results suggest that fructose diet-fed rats have lower plasma testosterone levels, which can lead to a higher sensitivity of hCG in Leydig cells.
Collapse
|
23
|
Clemmensen PJ, Brix N, Schullehner J, Gaml-Sørensen A, Toft G, Tøttenborg SS, Ebdrup NH, Hougaard KS, Hansen B, Sigsgaard T, Kolstad HA, Bonde JPE, Ramlau-Hansen CH. Nitrate in Maternal Drinking Water during Pregnancy and Measures of Male Fecundity in Adult Sons. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14428. [PMID: 36361307 PMCID: PMC9656746 DOI: 10.3390/ijerph192114428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/26/2022] [Accepted: 10/28/2022] [Indexed: 06/16/2023]
Abstract
Animal studies indicate deleterious effects of nitrate exposure on fecundity, but effects in humans are unknown, both for the prenatal and postnatal periods. We aimed to investigate if exposure to nitrate in maternal drinking water during the sensitive period of fetal life is associated with measures of fecundity in the adult sons. In a sub-analysis, the potential effects of nitrate exposure in adulthood were investigated. This cohort included 985 young adult men enrolled in The Fetal Programming of Semen Quality Cohort (FEPOS). Semen characteristics, testes volume and reproductive hormones were analyzed in relation to nitrate concentration in maternal drinking water, using a negative binomial regression model. The nitrate concentration in drinking water was obtained from monitoring data from Danish waterworks that were linked with the mothers' residential address during pregnancy. The median nitrate concentration in maternal drinking water was 2 mg/L. At these low exposure levels, which are far below the World Health Organization's (WHO) guideline value of 50 mg/L, we did not find indications of harmful effects of nitrate on the investigated measures of male fecundity.
Collapse
Affiliation(s)
| | - Nis Brix
- Department of Public Health, Aarhus University, 8000 Aarhus, Denmark
- Department of Clinical Genetics, Aarhus University Hospital, 8200 Aarhus, Denmark
| | - Jörg Schullehner
- Department of Public Health, Aarhus University, 8000 Aarhus, Denmark
- Geological Survey of Denmark and Greenland, 8000 Aarhus, Denmark
- Danish Big Data Centre for Environment and Health (BERTHA), Aarhus University, 8000 Aarhus, Denmark
| | | | - Gunnar Toft
- Steno Diabetes Center Aarhus, Aarhus University Hospital, 8200 Aarhus, Denmark
| | - Sandra Søgaard Tøttenborg
- Department of Occupational and Environmental Medicine, Copenhagen University Hospital—Bispebjerg and Frederiksberg Hospital, 2400 Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, 1014 Copenhagen, Denmark
| | | | - Karin Sørig Hougaard
- Department of Public Health, University of Copenhagen, 1014 Copenhagen, Denmark
- National Research Centre for the Working Environment, 2100 Copenhagen, Denmark
| | - Birgitte Hansen
- Geological Survey of Denmark and Greenland, 8000 Aarhus, Denmark
| | - Torben Sigsgaard
- Department of Public Health, Aarhus University, 8000 Aarhus, Denmark
- Danish Big Data Centre for Environment and Health (BERTHA), Aarhus University, 8000 Aarhus, Denmark
- Centre for Integrated Register-Based Research, Aarhus University (CIRRAU), 8000 Aarhus, Denmark
| | - Henrik Albert Kolstad
- Department of Occupational Medicine, Aarhus University Hospital, 8200 Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, 8200 Aarhus, Denmark
| | - Jens Peter Ellekilde Bonde
- Department of Occupational and Environmental Medicine, Copenhagen University Hospital—Bispebjerg and Frederiksberg Hospital, 2400 Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, 1014 Copenhagen, Denmark
| | | |
Collapse
|
24
|
Fallara G, Tang S, Pang KH, Pozzi E, Belladelli F, Schifano N, Capogrosso P, Alnajjar HM, Montorsi F, Salonia A, Castiglione F, Muneer A. Treatment of Persistent or Recurrent Varicoceles: A Systematic Review. Eur Urol Focus 2022:S2405-4569(22)00250-4. [DOI: 10.1016/j.euf.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/18/2022] [Accepted: 11/03/2022] [Indexed: 11/27/2022]
|
25
|
Lotti F, Frizza F, Balercia G, Barbonetti A, Behre HM, Calogero AE, Cremers J, Francavilla F, Isidori AM, Kliesch S, La Vignera S, Lenzi A, Marcou M, Pilatz A, Poolamets O, Punab M, Godoy MFP, Quintian C, Rajmil O, Salvio G, Shaeer O, Weidner W, Maseroli E, Cipriani S, Baldi E, Degl'Innocenti S, Danza G, Caldini AL, Terreni A, Boni L, Krausz C, Maggi M. The European Academy of Andrology (EAA) ultrasound study on healthy, fertile men: An overview on male genital tract ultrasound reference ranges. Andrology 2022; 10 Suppl 2:118-132. [PMID: 35930758 PMCID: PMC9828651 DOI: 10.1111/andr.13260] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 07/29/2022] [Accepted: 07/29/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND So far, male genital tract color-Doppler ultrasound (MGT-CDUS) was not standardized. Recently, the European Academy of Andrology (EAA) published the results of a multicenter study assessing the CDUS characteristics of healthy-fertile men (HFM) to obtain normative parameters. OBJECTIVES To report the EAA US study (i) standard operating procedures (SOPs) for assessing MGT-CDUS, (ii) main MGT-CDUS normative parameters, and (iii) compare the EAA and previously published "normal" CDUS values. METHODS A cohort of 248 HFM (35.3 ± 5.9 years) was studied, evaluating MGT-CDUS before and after ejaculation following SOPs. RESULTS SOPs for MGT-CDUS assessment are summarized here. All subjects underwent scrotal CDUS and 188 men underwent transrectal ultrasound before and after ejaculation. The main CDUS reference ranges and characteristics of the HFM-MGT are reported here. The mean testicular volume was ∼17 mL. The lower limit for right and left testis was 12 and 11 mL, defining testicular hypotrophy. The upper limit for epididymal head, body, tail, and vas deferens was 11.5, 5, 6, and 4.5 mm, respectively. Testicular and epididymal arterial reference ranges are reported. The EAA varicocoele classification is reported. CDUS-varicocoele was detected in ∼37% of men. Prostate mean volume was ∼25 mL, while lower and upper limits were 15 and 35 mL, defining hypotrophy and enlargement, respectively. Prostate arterial reference ranges are reported. Prostate calcifications and inhomogeneity were frequent; midline prostatic cysts were rare and small. Ejaculatory duct abnormalities were absent. The upper limit for periprostatic venous plexus was 4.5 mm. Lower and upper limits of seminal vesicles (SV) anterior-posterior diameter were 6 and 16 mm, defining hypotrophy or dilation, respectively. Seminal vesicle volume and ejection fraction reference ranges are reported. SV-US abnormalities were rare. Deferential ampullas upper limit was 6 mm. A discussion on the EAA and previously published "normal" CDUS values is reported here. CONCLUSIONS The EAA findings will help in reproductive and general male health management.
Collapse
Affiliation(s)
- Francesco Lotti
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”University of FlorenceFlorenceItaly
| | - Francesca Frizza
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”University of FlorenceFlorenceItaly
| | - Giancarlo Balercia
- Endocrinology Unit, Ospedali Riuniti AnconaPolytechnic University of MarcheAnconaItaly
| | - Arcangelo Barbonetti
- Andrology Unit, Department of Life, Health and Environmental SciencesUniversity of L'AquilaL'AquilaItaly
| | - Hermann M. Behre
- Center for Reproductive Medicine and AndrologyMartin Luther University Halle‐WittenbergHalleGermany
| | - Aldo E. Calogero
- Department of Clinical and Experimental MedicineUniversity of CataniaCataniaItaly
| | - Jann‐Frederik Cremers
- Department of Clinical and Surgical Andrology, Centre of Reproductive Medicine and AndrologyMünster University HospitalMünsterGermany
| | - Felice Francavilla
- Andrology Unit, Department of Life, Health and Environmental SciencesUniversity of L'AquilaL'AquilaItaly
| | - Andrea M. Isidori
- Department of Experimental MedicineSapienza University of RomeRomeItaly
| | - Sabine Kliesch
- Department of Clinical and Surgical Andrology, Centre of Reproductive Medicine and AndrologyMünster University HospitalMünsterGermany
| | - Sandro La Vignera
- Department of Clinical and Experimental MedicineUniversity of CataniaCataniaItaly
| | - Andrea Lenzi
- Department of Experimental MedicineSapienza University of RomeRomeItaly
| | - Marios Marcou
- Center for Reproductive Medicine and AndrologyMartin Luther University Halle‐WittenbergHalleGermany
| | - Adrian Pilatz
- Department of Urology, Pediatric Urology and AndrologyJustus Liebig UniversityGiessenGermany
| | | | - Margus Punab
- Andrology UnitTartu University HospitalTartuEstonia
| | - Maria Fernanda Peraza Godoy
- Andrology Department, Fundació Puigvert, Universitat Autònoma de BarcelonaInstituto de Investigaciones Biomédicas Sant Pau (IIB‐Sant Pau)BarcelonaSpain
| | - Claudia Quintian
- Andrology Department, Fundació Puigvert, Universitat Autònoma de BarcelonaInstituto de Investigaciones Biomédicas Sant Pau (IIB‐Sant Pau)BarcelonaSpain
| | - Osvaldo Rajmil
- Andrology Department, Fundació Puigvert, Universitat Autònoma de BarcelonaInstituto de Investigaciones Biomédicas Sant Pau (IIB‐Sant Pau)BarcelonaSpain
| | - Gianmaria Salvio
- Endocrinology Unit, Ospedali Riuniti AnconaPolytechnic University of MarcheAnconaItaly
| | - Osama Shaeer
- Department of Andrology, Kasr El Aini Faculty of MedicineCairo UniversityCairoEgypt
| | - Wolfgang Weidner
- Department of Urology, Pediatric Urology and AndrologyJustus Liebig UniversityGiessenGermany
| | - Elisa Maseroli
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”University of FlorenceFlorenceItaly
| | - Sarah Cipriani
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”University of FlorenceFlorenceItaly
| | - Elisabetta Baldi
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”University of FlorenceFlorenceItaly
| | - Selene Degl'Innocenti
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”University of FlorenceFlorenceItaly
| | - Giovanna Danza
- Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”University of FlorenceFlorenceItaly
| | | | | | - Luca Boni
- Clinical Trials Coordinating CenterToscano Cancer InstituteUniversity Hospital CareggiFlorenceItaly
| | - Csilla Krausz
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”University of FlorenceFlorenceItaly
| | - Mario Maggi
- Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”University of FlorenceFlorenceItaly
| |
Collapse
|
26
|
Neves da Silva HV, Meller RL, Ogundipe EA, Rochon PJ. Varicoceles: Overview of Treatment from a Radiologic and Surgical Perspective. Semin Intervent Radiol 2022; 39:490-497. [PMID: 36561940 PMCID: PMC9767781 DOI: 10.1055/s-0042-1757939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
A testicular varicocele is the result of the expansion of the venous pampiniform plexus of the scrotum. Often painless, a significant number of patients experience orchialgia, swelling, testicular atrophy, and abnormalities in spermatic parameters. Treatment of symptomatic varicocele involves a radiologic or surgical intervention to obstruct the reflux of venous drainage. Testicular anatomy, diagnostic evaluation and imaging, options for surgical intervention, and a step-by-step description of retrograde embolization and antegrade scrotal sclerotherapy are discussed. Furthermore, included is an overview of postprocedural management and patient outcomes for radiological interventions, and the most up-to-date evidence on the efficacy of varicocele treatments as well as how they compare to each other.
Collapse
Affiliation(s)
- Helio V. Neves da Silva
- Vascular and Interventional Radiology, University of Colorado School of Medicine, Aurora, Colorado
| | - Robert L. Meller
- Vascular and Interventional Radiology, University of Colorado School of Medicine, Aurora, Colorado
| | - Eniola A. Ogundipe
- Vascular and Interventional Radiology, University of Colorado School of Medicine, Aurora, Colorado
| | - Paul J. Rochon
- Vascular and Interventional Radiology, Modern Vascular of Denver, Thornton, Colorado
| |
Collapse
|
27
|
Pallotti F, Barbonetti A, Rastrelli G, Santi D, Corona G, Lombardo F. The impact of male factors and their correct and early diagnosis in the infertile couple's pathway: 2021 perspectives. J Endocrinol Invest 2022; 45:1807-1822. [PMID: 35349114 PMCID: PMC8961097 DOI: 10.1007/s40618-022-01778-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 02/24/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE The current clinical practice in reproductive medicine should pose the couple at the centre of the diagnostic-therapeutic management of infertility and requires intense collaboration between the andrologist, the gynaecologist and the embryologist. The andrologist, in particular, to adequately support the infertile couple, must undertake important biological, psychological, economical and ethical task. Thus, this paper aims to provide a comprehensive overview of the multifaceted role of the andrologist in the study of male factor infertility. METHODS A comprehensive Medline, Embase and Cochrane search was performed including publications between 1969 and 2021. RESULTS Available evidence indicates that a careful medical history and physical examination, followed by semen analysis, always represent the basic starting points of the diagnostic work up in male partner of an infertile couple. Regarding treatment, gonadotropins are an effective treatment in case of hypogonadotropic hypogonadism and FSH may be used in men with idiopathic infertility, while evidence supporting other hormonal and nonhormonal treatments is either limited or conflicting. In the future, pharmacogenomics of FSHR and FSHB as well as innovative compounds may be considered to develop new therapeutic strategies in the management of infertility. CONCLUSION To provide a high-level of care, the andrologist must face several critical diagnostical and therapeutical steps. Even though ART may be the final and decisive stage of this decisional network, neglecting to treat the male partner may ultimately increase the risks of negative outcome, as well as costs and psychological burden for the couple itself.
Collapse
Affiliation(s)
- F Pallotti
- Laboratory of Seminology-Sperm Bank "Loredana Gandini", Department of Experimental Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - A Barbonetti
- Andrology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - G Rastrelli
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Careggi Hospital-Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
| | - D Santi
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - G Corona
- Endocrinology Unit, Medical Department, Maggiore-Bellaria Hospital, Azienda-Usl Bologna, 40139, Bologna, Italy
| | - F Lombardo
- Laboratory of Seminology-Sperm Bank "Loredana Gandini", Department of Experimental Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
| |
Collapse
|
28
|
Sihag P, Tandon A, Pal R, Bhatt S, Sinha A, Sumbul M. Sonography in male infertility: a useful yet underutilized diagnostic tool. J Ultrasound 2022; 25:675-685. [PMID: 35038143 PMCID: PMC9402860 DOI: 10.1007/s40477-021-00646-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 12/01/2021] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To assess the utility of comprehensive sonographic examination including scrotal sonography, Testicular Doppler and Transrectal Ultrasound (TRUS) to evaluate the male reproductive system and differentiate between obstructive (OG) and non-obstructive (NOG) causes of azoospermia. METHODS 30 infertile men with azoospermia and 30 control subjects with normospermia underwent sonographic evaluation. FNAC/biopsy findings were used for assigning a final diagnosis of obstructive or non-obstructive azoospermia. Qualitative and quantitative imaging parameters were retrospectively compared between the groups using Chi-square/Fisher's exact test and unpaired t-test, respectively. P < 0.05 was considered significant. RESULTS Ectasia of rete testis/epididymal tubules, altered epididymal echogenicity, dilated terminal vas deferens were significantly more common in OG while inhomogeneous testicular echo-texture and reduced testicular vascularity were more common in NOG (P < 0.05). Testicular volume and epididymal head size were significantly higher in OG than in NOG and controls (18.2 ml/10 mm Vs 8.2 ml/7.2 mm and 13.4 ml/8.8 mm respectively; P < 0.05); while Resistive Index (RI) of intra-testicular vessels was higher in NOG as compared to OG and controls (0.65 vs 0.54 and 0.52 respectively; P < 0.05). On ROC curve analysis, cut-off values of testicular volume (AUC: 0.939; P < 0.001), epididymal head size (AUC: 0.772; P = 0.001) and testicular RI (AUC: 0.761; P = 0.001) to differentiate between the groups were 12.1 ml (sensitivity-94.4%; specificity-83.3%), 9 mm (sensitivity-66.7%; specificity-71%) and 0.62 (sensitivity-62%; specificity-100%) respectively. CONCLUSION Comprehensive sonographic evaluation can be used to differentiate obstructive from non-obstructive infertility and should be routinely incorporated in the diagnostic workup of infertile men with azoospermia.
Collapse
Affiliation(s)
- Prateek Sihag
- Department of Radio-Diagnosis, All India Institute of Medical Sciences, Bilaspur, Himachal Pradesh, India.
| | - Anupama Tandon
- Department of Radio-Diagnosis, University College of Medical Sciences and GTB Hospital, New Delhi, India
| | - Raj Pal
- Department of Radio-Diagnosis, University College of Medical Sciences and GTB Hospital, New Delhi, India
| | - Shuchi Bhatt
- Department of Radio-Diagnosis, University College of Medical Sciences and GTB Hospital, New Delhi, India
| | - Arpita Sinha
- Department of Radio-Diagnosis, University College of Medical Sciences and GTB Hospital, New Delhi, India
| | - Murtaza Sumbul
- Department of Radio-Diagnosis, University College of Medical Sciences and GTB Hospital, New Delhi, India
| |
Collapse
|
29
|
Krishan A, Vukina J, Pearce I, Modgil V. Male factor infertility: A contemporary overview of investigation, diagnosis and management. JOURNAL OF CLINICAL UROLOGY 2022. [DOI: 10.1177/20514158221078474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Infertility, defined as the failure to achieve a clinical pregnancy after 1 year of regular, unprotected sexual intercourse, is a public health issue of global concern. It affects up to 12% of couples worldwide. While traditionally, research and treatment have focused on female causes of infertility, male factors contribute to up to 70% of cases and therefore deserve appropriate recognition. The purpose of this comprehensive review is to detail the diagnostic work-up, investigations and management of male factor infertility. We discuss much-debated pathologies, such as varicocele, and novel investigations, including sperm DNA fragmentation and reactive oxygen species. Level of evidence: Not applicable
Collapse
Affiliation(s)
- Anil Krishan
- University Hospitals Birmingham NHS Foundation Trust, UK
| | - Josip Vukina
- University of Pittsburgh School of Medicine, USA
| | - Ian Pearce
- Manchester University NHS Foundation Trust, UK
| | - Vaibhav Modgil
- Manchester University NHS Foundation Trust, UK
- Department of Urology, Manchester Royal Infirmary, UK
| |
Collapse
|
30
|
Lotti F, Frizza F, Balercia G, Barbonetti A, Behre HM, Calogero AE, Cremers JF, Francavilla F, Isidori AM, Kliesch S, La Vignera S, Lenzi A, Marcou M, Pilatz A, Poolamets O, Punab M, Godoy MFP, Quintian C, Rajmil O, Salvio G, Shaeer O, Weidner W, Maseroli E, Cipriani S, Baldi E, Degl'Innocenti S, Danza G, Caldini AL, Terreni A, Boni L, Krausz C, Maggi M. The European Academy of Andrology (EAA) ultrasound study on healthy, fertile men: Prostate-vesicular transrectal ultrasound reference ranges and associations with clinical, seminal and biochemical characteristics. Andrology 2022; 10:1150-1171. [PMID: 35735741 PMCID: PMC9544532 DOI: 10.1111/andr.13217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/01/2022] [Accepted: 06/18/2022] [Indexed: 11/28/2022]
Abstract
Background Transrectal ultrasound (TRUS) parameters are not standardized, especially in men of reproductive age. Hence, the European Academy of Andrology (EAA) promoted a multicenter study to assess the TRUS characteristics of healthy‐fertile men (HFM) to establish normative parameters. Objectives To report and discuss the prostate and seminal vesicles (SV) reference ranges and characteristics in HFM and their associations with clinical, seminal, biochemical parameters. Methods 188 men (35.6 ± 6.0 years) from a cohort of 248 HFM were studied, evaluating, on the same day, clinical, biochemical, seminal, TRUS parameters following Standard Operating Procedures. Results TRUS reference ranges and characteristics of the prostate and SV of HFM are reported herein. The mean PV was ∼25 ml. PV lower and upper limits were 15 and 35 ml, defining prostate hypotrophy and enlargement, respectively. PV was positively associated with age, waistline, current smoking (but not with T levels), seminal volume (and negatively with seminal pH), prostate inhomogeneity, macrocalcifications, calcification size and prostate arterial parameters, SV volume before and after ejaculation, deferential and epididymal size. Prostate calcifications and inhomogeneity were frequent, while midline prostatic cysts were rare and small. Ejaculatory duct abnormalities were absent. Periprostatic venous plexus size was positively associated with prostate calcifications, SV volume and arterial peak systolic velocity. Lower and upper limits of SV anterior‐posterior diameter after ejaculation were 6 and 16 mm, defining SV hypotrophy or dilation, respectively. SV total volume before ejaculation and delta SV total volume (DSTV) positively correlated with ejaculate volume, and DSTV correlated positively with sperm progressive motility. SV total volume after ejaculation was associated negatively with SV ejection fraction and positively with distal ampullas size. SV US abnormalities were rare. No association between TRUS and time to pregnancy, number of children or history of miscarriage was observed. Conclusions The present findings will help in better understanding male infertility pathophysiology and the meaning of specific TRUS findings.
Collapse
Affiliation(s)
- Francesco Lotti
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Francesca Frizza
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Giancarlo Balercia
- Endocrinology Unit, Ospedali Riuniti Ancona, Polytechnic University of Marche, Ancona, Italy
| | - Arcangelo Barbonetti
- Andrology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Hermann M Behre
- Center for Reproductive Medicine and Andrology, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Aldo E Calogero
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Jann-Frederik Cremers
- Department of Clinical and Surgical Andrology, Centre of Reproductive Medicine and Andrology, Münster University Hospital, Münster, Germany
| | - Felice Francavilla
- Andrology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Andrea M Isidori
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Sabine Kliesch
- Department of Clinical and Surgical Andrology, Centre of Reproductive Medicine and Andrology, Münster University Hospital, Münster, Germany
| | - Sandro La Vignera
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Andrea Lenzi
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Marios Marcou
- Center for Reproductive Medicine and Andrology, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Adrian Pilatz
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University, Giessen, Germany
| | - Olev Poolamets
- Andrology Unit, Tartu University Hospital, Tartu, Estonia
| | - Margus Punab
- Andrology Unit, Tartu University Hospital, Tartu, Estonia
| | | | - Claudia Quintian
- Andrology Department, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Osvaldo Rajmil
- Andrology Department, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Gianmaria Salvio
- Endocrinology Unit, Ospedali Riuniti Ancona, Polytechnic University of Marche, Ancona, Italy
| | - Osama Shaeer
- Department of Andrology, Kasr El Aini Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Wolfgang Weidner
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University, Giessen, Germany
| | - Elisa Maseroli
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Sarah Cipriani
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Elisabetta Baldi
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Selene Degl'Innocenti
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Giovanna Danza
- Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | | | | | - Luca Boni
- Clinical Trials Coordinating Center, Toscano Cancer Institute, University Hospital Careggi, Florence, Italy
| | - Csilla Krausz
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Mario Maggi
- Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| |
Collapse
|
31
|
Ferlin A, Calogero AE, Krausz C, Lombardo F, Paoli D, Rago R, Scarica C, Simoni M, Foresta C, Rochira V, Sbardella E, Francavilla S, Corona G. Management of male factor infertility: position statement from the Italian Society of Andrology and Sexual Medicine (SIAMS) : Endorsing Organization: Italian Society of Embryology, Reproduction, and Research (SIERR). J Endocrinol Invest 2022; 45:1085-1113. [PMID: 35075609 DOI: 10.1007/s40618-022-01741-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 01/05/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE Infertility affects 15-20% of couples and male factors are present in about half of the cases. For many aspects related to the diagnostic and therapeutic approach of male factor infertility, there is no general consensus, and the clinical approach is not uniform. METHODS In the present document by the Italian Society of Andrology and Sexual Medicine (SIAMS), endorsed by the Italian Society of Embryology, Reproduction, and Research (SIERR), we propose evidence-based recommendations for the diagnosis, treatment, and management of male factor infertility to improve patient and couple care. RESULTS Components of the initial evaluation should include at minimum medical history, physical examination, and semen analysis. Semen microbiological examination, endocrine assessment, and imaging are suggested in most men and recommended when specific risk factors for infertility exist or first-step analyses showed abnormalities. Full examination including genetic tests, testicular cytology/histology, or additional tests on sperm is clinically oriented and based on the results of previous investigations. For treatment purposes, the identification of the specific cause and the pathogenetic mechanism is advisable. At least, distinguishing pre-testicular, testicular, and post-testicular forms is essential. Treatment should be couple-oriented, including lifestyle modifications, etiologic therapies, empirical treatments, and ART on the basis of best evidence and with a gradual approach. CONCLUSION These Guidelines are based on two principal aspects: they are couple-oriented and place high value in assessing, preventing, and treating risk factors for infertility. These Guidelines also highlighted that male infertility and in particular testicular function might be a mirror of general health of a man.
Collapse
Affiliation(s)
- A Ferlin
- Department of Medicine, Unit of Andrology and Reproductive Medicine, University of Padova, Via Giustiniani 2, 35121, Padua, Italy.
| | - A E Calogero
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - C Krausz
- Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', University of Florence, Florence, Italy
| | - F Lombardo
- Department of Experimental Medicine, Laboratory of Seminology-Sperm Bank "Loredana Gandini", University of Rome "La Sapienza", Rome, Italy
| | - D Paoli
- Department of Experimental Medicine, Laboratory of Seminology-Sperm Bank "Loredana Gandini", University of Rome "La Sapienza", Rome, Italy
| | - R Rago
- Department of Gender, Parenting, Child and Adolescent Medicine, Physiopathology of Reproduction and Andrology Unit, Sandro Pertini Hospital, Rome, Italy
| | - C Scarica
- European Hospital, Centre for Reproductive Medicine, Rome, Italy
| | - M Simoni
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - C Foresta
- Department of Medicine, Unit of Andrology and Reproductive Medicine, University of Padova, Via Giustiniani 2, 35121, Padua, Italy
| | - V Rochira
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - E Sbardella
- Department of Experimental Medicine, University of Rome "La Sapienza", Rome, Italy
| | - S Francavilla
- Department of Life, Health and Environmental Sciences, Unit of Andrology, University of L'Aquila, L'Aquila, Italy
| | - G Corona
- Medical Department, Endocrinology Unit, Maggiore-Bellaria Hospital, Azienda Usl, Bologna, Italy
| |
Collapse
|
32
|
Bellastella G, Carotenuto R, Caiazzo F, Longo M, Cirillo P, Scappaticcio L, Carbone C, Arcaniolo D, Maiorino MI, Esposito K. Varicocele: An Endocrinological Perspective. FRONTIERS IN REPRODUCTIVE HEALTH 2022; 4:863695. [PMID: 36303641 PMCID: PMC9580708 DOI: 10.3389/frph.2022.863695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 02/24/2022] [Indexed: 12/02/2022] Open
Abstract
Varicocele affects 15% of male population but it is more frequently identified in patients searching medical care for infertility. The impact of varicocele on semen production and fertility is known, but the relationship between clinical varicocele and impaired hormonal production is not clear. In published literature there are some studies regarding hormonal alterations in patients with varicocele but no review in which all the hormonal findings are explained. The aim of this review is to evaluate, by most common search engine, what is known about hormonal alterations in varicocele-bearing patients, to verify if a cause-effect relationship is documented and to give a useful contribution to in clinical management of this kind of patients. We found contradictory results about hormonal status from literature. Some studies confirmed a decrease of testosterone levels and higher FSH and LH levels that normalize after varicocelectomy, others found lower than normal levels of dihydrotestosterone due to decreased activity of epididymal 5-α-reductase. Lower circulating Anti-Müllerian Hormone levels, accompanied by a decreased Inhibin-B level, were reported as indicators of the decreased Sertoli cells function in varicocele-bearing adult patients. The finding of higher basal 17-OH-progesterone concentrations in patients with varicocele was explained by some authors with a testicular C-17,20-lyase deficiency. There is no doubt that varicocele could led to hormonal alterations. This review proposes that the impaired free sexual steroid levels are the result of a slight, deep-rooted defect in the testes of a certain amount of men with varicocele but further multicentre, randomized controlled studies remain mandatory to better clarify the hormonal features of patients with varicocele and to assess the utility of hormonal evaluation for establishing the duration of varicocele and for better identifying patients who need surgical correction.
Collapse
Affiliation(s)
- Giuseppe Bellastella
- Unit of Endocrinology and Metabolic Diseases, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli,”Naples, Italy
- *Correspondence: Giuseppe Bellastella
| | - Raffaela Carotenuto
- Unit of Endocrinology and Metabolic Diseases, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli,”Naples, Italy
| | - Francesco Caiazzo
- Unit of Endocrinology and Metabolic Diseases, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli,”Naples, Italy
| | - Miriam Longo
- Unit of Endocrinology and Metabolic Diseases, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli,”Naples, Italy
| | - Paolo Cirillo
- Unit of Endocrinology and Metabolic Diseases, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli,”Naples, Italy
| | - Lorenzo Scappaticcio
- Unit of Endocrinology and Metabolic Diseases, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli,”Naples, Italy
| | - Carla Carbone
- Unit of Endocrinology and Metabolic Diseases, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli,”Naples, Italy
| | - Davide Arcaniolo
- Urology Unit, Department of Woman Child and of General and Specialist Surgery, University of Campania “Luigi Vanvitelli,”Naples, Italy
| | - Maria Ida Maiorino
- Unit of Endocrinology and Metabolic Diseases, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli,”Naples, Italy
| | - Katherine Esposito
- Unit of Endocrinology and Metabolic Diseases, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli,”Naples, Italy
| |
Collapse
|
33
|
Cheng H, Yang S, Meng Q, Zheng B, Gu Y, Wang L, Song T, Xu C, Wang G, Han M, Shen L, Ding J, Li H, Ouyang J. Genetic analysis and intracytoplasmic sperm injection outcomes of Chinese patients with congenital bilateral absence of vas deferens. J Assist Reprod Genet 2022; 39:719-728. [PMID: 35119551 PMCID: PMC8995229 DOI: 10.1007/s10815-022-02417-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 01/27/2022] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Congenital bilateral absence of the vas deferens (CBAVD) is a major cause of obstructive azoospermia and male factor infertility. CBAVD is mainly caused by mutations in the genes encoding CFTR (cystic fibrosis transmembrane conductance regulator) and ADGRG2 (adhesion G protein-coupled receptor G2). This study aimed to describe CFTR and ADGRG2 variations in 46 Chinese CBAVD patients and evaluated sperm retrieval and assisted reproductive technology outcomes. METHODS The CFTR and ADGRG2 genes were sequenced and analyzed by whole-exome sequencing (WES), and variations were identified by Sanger sequencing. Bioinformatic analysis was performed. We retrospectively reviewed the outcomes of patients undergoing sperm retrieval surgery and intracytoplasmic sperm injection (ICSI). RESULTS In total, 35 of 46 (76.09%) patients carried at least one variation in CFTR, but no copy number variants or ADGRG2 variations were found. In addition to the IVS9-5 T allele, there were 27 CFTR variations, of which 4 variations were novel and predicted to be damaging by bioinformatics. Spermatozoa were successfully retrachieved in 46 patients, and 39 of the patients had their own offspring through ICSI. CONCLUSION There are no obvious hotspot CFTR mutations in Chinese CBAVD patients besides the IVS9-5 T allele. Therefore, WES might be the best detection method, and genetic counseling should be different from that provided to Caucasian populations. After proper counseling, all patients can undergo sperm retrieval from their epididymis or testis, and most of them can have their own children through ICSI.
Collapse
Affiliation(s)
- Hongbo Cheng
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, 215000 Jiangsu China ,Center for Reproduction and Genetics, NHC Key Laboratory of Male Reproduction and Genetics, Suzhou Municipal Hospital, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Shenmin Yang
- Center for Reproduction and Genetics, NHC Key Laboratory of Male Reproduction and Genetics, Suzhou Municipal Hospital, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Qingxia Meng
- Center for Reproduction and Genetics, NHC Key Laboratory of Male Reproduction and Genetics, Suzhou Municipal Hospital, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Bo Zheng
- Center for Reproduction and Genetics, NHC Key Laboratory of Male Reproduction and Genetics, Suzhou Municipal Hospital, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Yidong Gu
- Center for Reproduction and Genetics, NHC Key Laboratory of Male Reproduction and Genetics, Suzhou Municipal Hospital, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Luyun Wang
- Center for Reproduction and Genetics, NHC Key Laboratory of Male Reproduction and Genetics, Suzhou Municipal Hospital, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Tao Song
- Department of Andrology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu China
| | - Chunlu Xu
- Department of Andrology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu China
| | - Gaigai Wang
- Center for Reproduction and Genetics, NHC Key Laboratory of Male Reproduction and Genetics, Suzhou Municipal Hospital, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Mutian Han
- Center for Reproduction and Genetics, NHC Key Laboratory of Male Reproduction and Genetics, Suzhou Municipal Hospital, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Liyan Shen
- Center for Reproduction and Genetics, NHC Key Laboratory of Male Reproduction and Genetics, Suzhou Municipal Hospital, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Jie Ding
- Center for Reproduction and Genetics, NHC Key Laboratory of Male Reproduction and Genetics, Suzhou Municipal Hospital, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Hong Li
- Center for Reproduction and Genetics, NHC Key Laboratory of Male Reproduction and Genetics, Suzhou Municipal Hospital, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China.
| | - Jun Ouyang
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou, 215000, Jiangsu, China.
| |
Collapse
|
34
|
Cai Z, Li H. Congenital Bilateral Absence of the Vas Deferens. Front Genet 2022; 13:775123. [PMID: 35222530 PMCID: PMC8873976 DOI: 10.3389/fgene.2022.775123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 01/19/2022] [Indexed: 01/23/2023] Open
Abstract
Congenital bilateral absence of the vas deferens (CBAVD) is clinically characterized by the absence of the bilateral vas deferens; the main clinical manifestation is infertility, accounting for 1–2% of male infertility cases. CBAVD may be accompanied by congenital abnormalities in the urogenital system and cystic fibrosis (CF)-related clinical manifestations. CBAVD can develop as a mild manifestation of CF or can be isolated. The main pathogenic mechanism of CBAVD is gene mutation, and CBAVD and CF have a common genetic mutation background. CFTR mutation is the main pathogenic cause of CBAVD and CF, and ADGRG2 mutation is the second most common cause. Although lack of the vas deferens in CBAVD patients causes infertility due to the inability to release sperm, the testes of CBAVD patients have spermatogenic function. Therefore, CBAVD patients can achieve fertility through sperm retrieval surgery and assisted reproductive technology (ART). However, gene mutations in CBAVD patients can have an impact on the ART outcome, and there is a risk of passing on gene mutations to offspring. For CBAVD patients and their spouses, performing genetic counseling (which currently refers mainly to CFTR mutation screening) helps to reduce the risks of genetic mutations being passed on to offspring and of offspring having CF with concomitant CBAVD.
Collapse
|
35
|
Rafiee B, Bagher Tabei SM. The effect of N-acetyl cysteine consumption on men with abnormal sperm parameters due to positive history of COVID-19 in the last three months. Arch Ital Urol Androl 2021; 93:465-467. [PMID: 34933532 DOI: 10.4081/aiua.2021.4.465] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 10/12/2021] [Indexed: 11/22/2022] Open
Abstract
Male infertility is an important factor accounting for 40-50% of infertility cases that may be due to disturbance in one of the parameters as concentration, motility and morphology observed in one or two semen analysis with an interval of 1 and 4 weeks. COVID-19 may affect male fertility through virus division, cytotoxic effects on testicular tissue and immunopathological effect. N-acetyl cysteine (NAC) improved sperm concentration and acrosome reaction while reducing reactive oxygen species (ROS) and oxidation of sperm DNA. This interventional study was conducted on 200 men who were referred to private infertility clinics for female factor (their previous semen analysis was normal) and got COVID-19 infection in the last 3 months showing an impairment of the latest semen analysis due to COVID. Men were placed in two groups of control (n = 100) and intervention (NAC consumption). Subjects who got COVID-19 infection had a significant impairment of sperm quality (sperm concentration, sperm motility, and normal sperm morphology) compared to their semen analysis evaluated before the COVID-19 infection. NAC consumption significantly improved sperm total motility, sperm morphology and sperm concentration. COVID-19 infection has a negative effect on sperm parameters. NAC supplementation may have positive effect on sperm parameters.
Collapse
Affiliation(s)
- Bahare Rafiee
- Department of Reproductive Biology, School of Advanced medical Sciences and Applied Technologies, Shiraz.
| | | |
Collapse
|
36
|
Diagnostic and therapeutic workup of male infertility: results from a Delphi consensus panel. Int J Impot Res 2021:10.1038/s41443-021-00511-x. [PMID: 34853436 DOI: 10.1038/s41443-021-00511-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/16/2021] [Accepted: 11/22/2021] [Indexed: 12/11/2022]
Abstract
Male factor infertility (MFI) is a rising issue worldwide with significant socioeconomic costs and negative psychological consequences for the couple. Current guidelines provide recommendations for its diagnosis and treatment but several gaps in the management of MFI are encountered in clinical practice due to the lack of available evidence in published literature. Uncertainty in the management of MFI cases leads to a high degree of variability in therapeutic approaches. We planned a Delphi consensus method to provide insights and help bridge the gaps that separate clinical guidelines from real-world practice. The Advisory Board collected 41 statements on debated topics in the management of MFI, each including multiple items designed as a 5-point Likert scale. The questionnaire was sent by e-mail to a panel of Italian experts for a first round of voting; members of the panel were later invited to a second round of voting, preceded by discussion of the "hot topics" identified in the first round. At both rounds of the Delphi consensus 68 experts participated to the voting process. After the first round 25 statements were identified as hot topics, and these underwent the second round of voting. Consensus was reached on many, but not all cases, leaving vagueness on few debated topics where decisions are unsupported by clinical studies or driven by controversial results. In conclusion, indications emerging from this large panel of experts may help guide the management of male factor infertility in clinical practice. Studies are needed to address unanswered questions left by cases for whom no consensus was reached.
Collapse
|
37
|
Ahmed AT. Utility of shear wave ultrasound elastography in evaluation of testicular stiffness in patients with varicocele. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-021-00651-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Testicular varicocele is the most frequent cause of male infertility. The study aimed at evaluation of testicular stiffness in patients with varicocele measured by shear wave ultrasound elastography (SWE) in correlation to patient semen analysis (total sperm count) and varicocele grade. This case–control study involved 50 patients (40 patients with bilateral testicular varicocele and 10 patients with unilateral Lt. testicular varicocele of different grades) and 25 healthy controls. All participants underwent physical examination, semen analysis (patient group subdivided in two groups: group A; normospermic and group B; oligospermic), scrotal grey scale and Doppler ultrasound, and shear wave ultrasound elastography with measurement of mean testicular stiffness. Evaluation of testicular stiffness and correlation to varicocele grade and semen analysis (total sperm count) were done.
Results
The mean testicular stiffness value measured by SWE in patients with testicular varicocele was greater than that of healthy controls (7.46 ± 1.64 kPa vs. 3.84 ± 0.62 kPa, P < 0.001). The mean testicular stiffness value in group B exceeded that of group A (8.57 ± 1.53 kPa vs. 6.34 ± 1.76 kPa, P = 0.001). A moderate positive correlation was found between mean testicular stiffness value and the varicocele grade (P = 0.01) which was more evident in group B than in group A (P = 0.01).
Conclusions
Testicular ultrasound SWE is a quantitative noninvasive imaging method which helps in the assessment of testicular parenchymal changes due to varicocele. Higher testicular stiffness values were found in testes of patients with varicocele, more in oligospermic patients than the testes of healthy controls. Testicular stiffness is moderately correlated to varicocele grade.
Collapse
|
38
|
De Santi B, Spaggiari G, Granata AR, Romeo M, Molinari F, Simoni M, Santi D. From subjective to objective: A pilot study on testicular radiomics analysis as a measure of gonadal function. Andrology 2021; 10:505-517. [PMID: 34817934 PMCID: PMC9299912 DOI: 10.1111/andr.13131] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 11/16/2021] [Accepted: 11/19/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The connection between testicular ultrasound (US) parameters and testicular function, including both spermato- and steroidogenesis has been largely suggested, but their predictive properties are not routinely applied. Radiomics, a new engineering approach to radiological imaging, could overcome the visual limit of the sonographer. OBJECTIVES This study is aimed at extracting objective testicular US features, correlating with testicular function, including both spermato- and steroidogenesis, using an engineering approach, in order to overcome the operator-dependent subjectivity. MATERIALS AND METHODS Prospective observational pilot study from December 2019 to December 2020 on normozoospermic subjects and patients with semen variables alterations, excluding azoospermia. All patients underwent conventional semen analysis, pituitary-gonadal hormones assessment, and testicular US, performed by the same operator. US images were analyzed by Biolab (Turin) throughout image segmentation, image pre-processing, and texture features extraction. RESULTS One hundred seventy US testicular images were collected from 85 patients (age 38.6 ± 9.1 years). A total of 44 first-order and advanced features were extracted. US inhomogeneity defined by radiomics significantly correlates with the andrologist definition, showing for the first time a mathematical quantification of a subjective US evaluation. Thirteen US texture features correlated with semen parameters, predicting sperm concentration, total sperm number, progressive motility, total motility and morphology, and with gonadotropins serum levels, but not with total testosterone serum levels. Classification analyses confirmed that US textural features predicted patients' classification according to semen parameters alterations. CONCLUSIONS Radiomics texture features qualitatively describe the testicular parenchyma with objective and reliable quantitative parameters, reflecting both the testicular spermatogenic capability and the action of pituitary gonadotropins. This is an innovative model in which US texture features represent a mirror of the pituitary-gonadal homeostasis in terms of reproductive function.
Collapse
Affiliation(s)
- Bruno De Santi
- Biolab, Department of Electronics and Telecommunications, Politecnico di Torino, Turin, Italy
| | - Giorgia Spaggiari
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Ospedale Civile of Baggiovara, Modena, Italy
| | - Antonio Rm Granata
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Ospedale Civile of Baggiovara, Modena, Italy
| | - Marilina Romeo
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Ospedale Civile of Baggiovara, Modena, Italy.,Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Filippo Molinari
- Biolab, Department of Electronics and Telecommunications, Politecnico di Torino, Turin, Italy
| | - Manuela Simoni
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Ospedale Civile of Baggiovara, Modena, Italy.,Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Daniele Santi
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Ospedale Civile of Baggiovara, Modena, Italy.,Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| |
Collapse
|
39
|
Vogiatzi P, Pouliakis A, Sakellariou M, Athanasiou A, Athanasiou A, Colaghis A, Finelli R, Loutradis D, Henkel R, Agarwal A. Male Age and Progressive Sperm Motility Are Critical Factors Affecting Embryological and Clinical Outcomes in Oocyte Donor ICSI Cycles. Reprod Sci 2021; 29:883-895. [PMID: 34782988 DOI: 10.1007/s43032-021-00801-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 11/05/2021] [Indexed: 11/28/2022]
Abstract
This retrospective cohort study aimed to explore whether paternal age and semen quality parameters affect the embryological and clinical outcomes of ICSI with oocyte donation. A total of 339 oocyte donation (OD)-ICSI cycles were categorized into four groups according to the semen parameter profiles of the male counterparts: normozoospermia (NS, n = 184), oligozoospermia (OS, n = 41), asthenozoospermia (AS, n = 50), and oligoasthenozoospermia (OAS, n = 64). The effect of age, total sperm count, and progressive motility was separately analyzed for reproductive outcomes and compared between the study groups: fertilization, blastulation, and top-quality embryo rate, biochemical and clinical pregnancy, live birth, and miscarriage. A negative correlation between male age and fertilization rate was observed (rs = - 0.23, p < 0.0001), while male age was a significant factor for biochemical pregnancy (p = 0.0002), clinical pregnancy (p = 0.0017), and live birth (p = 0.0038). Reduced total sperm count and lowered progressive motility led to poorer fertilization rates (rs = 0.19 and 0.35, respectively, p < 0.0001) and affected embryo quality (rs = 0.13, p = 0.02, and rs = 0.22, p < 0.0001, respectively). OD-ICSI cycles with asthenozoospermia had significantly lowered success rates in biochemical pregnancy, clinical pregnancy, and live birth (p < 0.05). Our study demonstrated that both advanced male age and reduced progressive motility of spermatozoa exert a significant negative influence on the outcome of assisted reproduction, even in controlled procedures with gamete selection and optimization such as in OD-ICSI. Improvement in treatment strategies and male fertility evaluation requires incorporation of such evidence to obtain better prognosis towards personalized management.
Collapse
Affiliation(s)
- Paraskevi Vogiatzi
- IVF Athens Reproduction Center, 5 Kifissias Avenue, 151 23, Maroussi, Greece. .,Andromed Health & Reproduction, Fertility Diagnostics Laboratory, 3 Mesogion Str, 15126, Maroussi, Greece.
| | - Abraham Pouliakis
- Second Department of Pathology, "Attikon" University Hospital, National and Kapodistrian University of Athens, 1 Rimini Street, 12462, Athens, Greece
| | - Maria Sakellariou
- IVF Athens Reproduction Center, 5 Kifissias Avenue, 151 23, Maroussi, Greece
| | | | | | - Alexandros Colaghis
- IVF Athens Reproduction Center, 5 Kifissias Avenue, 151 23, Maroussi, Greece
| | - Renata Finelli
- American Center for Reproductive Medicine, Cleveland Clinic, 10681 Carnegie Avenue, Cleveland, OH, 44195, USA
| | - Dimitrios Loutradis
- First Department of Obstetrics and Gynecology, "Alexandra" Maternity Hospital, National and Kapodistrian University of Athens, 80 Vassilissis Sophias Avenue, 115 28, Athens, Greece
| | - Ralf Henkel
- American Center for Reproductive Medicine, Cleveland Clinic, 10681 Carnegie Avenue, Cleveland, OH, 44195, USA.,Department of Metabolism, Digestion and Reproduction, Imperial College London, London, SW7 2BX, UK.,Department of Medical Bioscience, University of the Western Cape, Robert Sobukwe Road, Bellville, 7535, South Africa
| | - Ashok Agarwal
- American Center for Reproductive Medicine, Cleveland Clinic, 10681 Carnegie Avenue, Cleveland, OH, 44195, USA
| |
Collapse
|
40
|
Al Khayal AM, Balaraj FK, Alferayan TA, Al Sait MA, Abumelha SM, Alrabeeah KA. Empirical therapy for male factor infertility: Survey of the current practice. Urol Ann 2021; 13:346-350. [PMID: 34759644 PMCID: PMC8525490 DOI: 10.4103/ua.ua_22_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 11/02/2020] [Indexed: 11/04/2022] Open
Abstract
Background Empirical therapy is sometimes used by urologists who desire to improve the outcomes for infertility patients. However, the literature on empirical therapies is scarce. Therefore, we aimed to assess the clinical practice of urologists regarding the use of empirical therapy in the treatment of infertility patients. Methodology An online survey using Google Forms was used to collect data during the Saudi Urological Association Annual Meeting, February 2019. Additional data were gathered electronically in March and April 2019 and sent to respondents. The study was closed in May 2019. No incentives were provided to the respondents. Results A total of 96 (80%) urologists participated in the survey, of whom 69.8% were consultants, and 20.8% were andrology-trained urologists. Empirical therapy was used by 86.5% of urologists for patients with idiopathic oligoasthenoteratozoospermia. The most commonly used empirical therapies were zinc, L-canitine, clomiphene citrate, and L-arginine. The main factors that influenced the selection of empirical therapy were follicle-stimulating hormone, total testosterone, and luteinizing hormone levels. Conclusion Empirical therapy was used by more than three-quarters of the participants for idiopathic male infertility. There were no clear guidelines for the ideal therapy to be considered for individual patients while treating empirically. Our concern is that urologists use a wide variety of medications without significant data to support these medications.
Collapse
Affiliation(s)
- Abdullah M Al Khayal
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Department of Surgery, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Department of Surgery, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Faisal K Balaraj
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Department of Surgery, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Department of Surgery, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Turki A Alferayan
- Department of Surgery, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mutaz A Al Sait
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Department of Surgery, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Department of Surgery, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Saad M Abumelha
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Department of Surgery, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Department of Surgery, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Khalid A Alrabeeah
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Department of Surgery, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Department of Surgery, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| |
Collapse
|
41
|
Ralph O, Shroff N. Prolactinoma: A rare, important and treatable cause of male infertility. JOURNAL OF CLINICAL UROLOGY 2021. [DOI: 10.1177/2051415818821562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Infertility as a result of hyperprolactinemia from a functional prolactinoma is a rare yet treatable cause of morbidity. As in this case, if infertility is the presenting symptom, then urology is only the first specialty needed along the road of effective treatment, highlighting the role of the multidisciplinary team. What made this case so interesting was the almost immediate return to fertility on tumour resection (as shown by the resulting pregnancy) and the emphasis the patient placed on his fertility, above all other concerns. It shows that in complex cases such as these, medical and surgical specialities have to work together to achieve the outcome that is in the best interests of the patient. We present the case of a 33-year-old man who presented with anejaculation and a loss of fertility that lead to significant patient distress. After surgery and hormone replacement, the patient showed an increase in sperm count, normal morphology and density. This report will highlight the journey that the patient underwent from diagnosis through investigations and surgery in order to re-establish fertility. The aim of this case report is to highlight the need to consider hyperprolactinemia as a cause of reversible male infertility and to show the potentially short-term positive impact of effective treatment. The report provides fertility data to quantify this improvement after both endocrinology and then neurosurgical intervention. This case is a wonderful example of the success a multidisciplinary approach can have in the treatment of a complex, rare condition. Level of evidence: Case report – level 5
Collapse
Affiliation(s)
- Oliver Ralph
- Department of Urology, University College London Hospital, UK
| | - Nikita Shroff
- Department of Urology, University College London Hospital, UK
| |
Collapse
|
42
|
Reda A, Veys K, Kadam P, Taranta A, Rega LR, Goffredo BM, Camps C, Besouw M, Cyr D, Albersen M, Spiessens C, de Wever L, Hamer R, Janssen MC, D'Hauwers K, Wetzels A, Monnens L, van den Heuvel L, Goossens E, Levtchenko E. Human and animal fertility studies in cystinosis reveal signs of obstructive azoospermia, an altered blood-testis barrier and a subtherapeutic effect of cysteamine in testis. J Inherit Metab Dis 2021; 44:1393-1408. [PMID: 34494673 PMCID: PMC9291572 DOI: 10.1002/jimd.12434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/02/2021] [Accepted: 09/07/2021] [Indexed: 01/04/2023]
Abstract
Cystinosis is an inherited metabolic disorder caused by autosomal recessive mutations in the CTNS gene leading to lysosomal cystine accumulation. The disease primarily affects the kidneys followed by extra-renal organ involvement later in life. Azoospermia is one of the unclarified complications which are not improved by cysteamine, which is the only available disease-modifying treatment. We aimed at unraveling the origin of azoospermia in cysteamine-treated cystinosis by confirming or excluding an obstructive factor, and investigating the effect of cysteamine on fertility in the Ctns-/- mouse model compared with wild type. Azoospermia was present in the vast majority of infantile type cystinosis patients. While spermatogenesis was intact, an enlarged caput epididymis and reduced levels of seminal markers for obstruction neutral α-glucosidase (NAG) and extracellular matrix protein 1 (ECM1) pointed towards an epididymal obstruction. Histopathological examination in human and mouse testis revealed a disturbed blood-testis barrier characterized by an altered zonula occludens-1 (ZO-1) protein expression. Animal studies ruled out a negative effect of cysteamine on fertility, but showed that cystine accumulation in the testis is irresponsive to regular cysteamine treatment. We conclude that the azoospermia in infantile cystinosis is due to an obstruction related to epididymal dysfunction, irrespective of the severity of an evolving primary hypogonadism. Regular cysteamine treatment does not affect fertility but has subtherapeutic effects on cystine accumulation in testis.
Collapse
Affiliation(s)
- Ahmed Reda
- Laboratory of Pediatric Nephrology, Department of Development and RegenerationKU LeuvenLeuvenBelgium
- Biology of the Testis (BITE) Laboratory, Department of Reproduction, Genetics and Regenerative MedicineVrije Universiteit Brussel (VUB)BrusselsBelgium
| | - Koenraad Veys
- Laboratory of Pediatric Nephrology, Department of Development and RegenerationKU LeuvenLeuvenBelgium
- Department of PediatricsUniversity Hospitals LeuvenLeuvenBelgium
| | - Prashant Kadam
- Biology of the Testis (BITE) Laboratory, Department of Reproduction, Genetics and Regenerative MedicineVrije Universiteit Brussel (VUB)BrusselsBelgium
| | - Anna Taranta
- Renal Diseases Research UnitGenetics and Rare Diseases Research Area, Bambino Gesù Children's Hospital, IRCCSRomeItaly
| | - Laura Rita Rega
- Renal Diseases Research UnitGenetics and Rare Diseases Research Area, Bambino Gesù Children's Hospital, IRCCSRomeItaly
| | - Bianca M. Goffredo
- Laboratory of Pediatric Medicine, Laboratory of Metabolic DiseasesBambino Gesù Children's Hospital—IRCCSRomeItaly
| | - Chelsea Camps
- Laboratory of Pediatric Nephrology, Department of Development and RegenerationKU LeuvenLeuvenBelgium
| | - Martine Besouw
- Department of Pediatric NephrologyUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
| | - Daniel Cyr
- Laboratory for Reproductive ToxicologyInstitut National de la Recherche Scientifique, Centre Armand‐Frappier Santé Biotechnologie, Université du QuébecQuebecCanada
| | | | - Carl Spiessens
- Fertility Center, Department of GynaecologyUniversity Hospitals LeuvenLeuvenBelgium
| | | | - Robert Hamer
- Department of RadiologyRadboud UMCNijmegenNetherlands
| | | | | | - Alex Wetzels
- Department of Internal MedicineRadboud UMCNijmegenNetherlands
| | - Leo Monnens
- Department of Internal MedicineRadboud UMCNijmegenNetherlands
| | - Lambertus van den Heuvel
- Laboratory of Pediatric Nephrology, Department of Development and RegenerationKU LeuvenLeuvenBelgium
- Department of Internal MedicineRadboud UMCNijmegenNetherlands
| | - Ellen Goossens
- Biology of the Testis (BITE) Laboratory, Department of Reproduction, Genetics and Regenerative MedicineVrije Universiteit Brussel (VUB)BrusselsBelgium
| | - Elena Levtchenko
- Laboratory of Pediatric Nephrology, Department of Development and RegenerationKU LeuvenLeuvenBelgium
- Department of PediatricsUniversity Hospitals LeuvenLeuvenBelgium
| |
Collapse
|
43
|
Minhas S, Bettocchi C, Boeri L, Capogrosso P, Carvalho J, Cilesiz NC, Cocci A, Corona G, Dimitropoulos K, Gül M, Hatzichristodoulou G, Jones TH, Kadioglu A, Martínez Salamanca JI, Milenkovic U, Modgil V, Russo GI, Serefoglu EC, Tharakan T, Verze P, Salonia A. European Association of Urology Guidelines on Male Sexual and Reproductive Health: 2021 Update on Male Infertility. Eur Urol 2021; 80:603-620. [PMID: 34511305 DOI: 10.1016/j.eururo.2021.08.014] [Citation(s) in RCA: 223] [Impact Index Per Article: 74.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 08/20/2021] [Indexed: 12/19/2022]
Abstract
CONTEXT The European Association of Urology (EAU) has updated its guidelines on sexual and reproductive health for 2021. OBJECTIVE To present a summary of the 2021 version of the EAU guidelines on sexual and reproductive health, including advances and areas of controversy in male infertility. EVIDENCE ACQUISITION The panel performed a comprehensive literature review of novel data up to January 2021. The guidelines were updated and a strength rating for each recommendation was included that was based either on a systematic review of the literature or consensus opinion from the expert panel, where applicable. EVIDENCE SYNTHESIS The male partner in infertile couples should undergo a comprehensive urological assessment to identify and treat any modifiable risk factors causing fertility impairment. Infertile men are at a higher risk of harbouring and developing other diseases including malignancy and cardiovascular disease and should be screened for potential modifiable risk factors, such as hypogonadism. Sperm DNA fragmentation testing has emerged as a novel biomarker that can identify infertile men and provide information on the outcomes from assisted reproductive techniques. The role of hormone stimulation therapy in hypergonadotropic hypogonadal or eugonadal patients is controversial and is not recommended outside of clinical trials. Furthermore, there is insufficient evidence to support the widespread use of other empirical treatments and surgical interventions in clinical practice (such as antioxidants and surgical sperm retrieval in men without azoospermia). There is low-quality evidence to support the routine use of testicular fine-needle mapping as an alternative diagnostic and predictive tool before testicular sperm extraction (TESE) in men with nonobstructive azoospermia (NOA), and either conventional or microdissection TESE remains the surgical modality of choice for men with NOA. CONCLUSIONS All infertile men should undergo a comprehensive urological assessment to identify and treat any modifiable risk factors. Increasing data indicate that infertile men are at higher risk of cardiovascular mortality and of developing cancers and should be screened and counselled accordingly. There is low-quality evidence supporting the use of empirical treatments and interventions currently used in clinical practice; the efficacy of these therapies needs to be validated in large-scale randomised controlled trials. PATIENT SUMMARY Approximately 50% of infertility will be due to problems with the male partner. Therefore, all infertile men should be assessed by a specialist with the expertise to not only help optimise their fertility but also because they are at higher risk of developing cardiovascular disease and cancer long term and therefore require appropriate counselling and management. There are many treatments and interventions for male infertility that have not been validated in high-quality studies and caution should be applied to their use in routine clinical practice.
Collapse
Affiliation(s)
- Suks Minhas
- Department of Urology, Imperial Healthcare NHS Trust, Charing Cross Hospital, London, UK.
| | | | - Luca Boeri
- Department of Urology, Foundation IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Paolo Capogrosso
- Department of Urology and Andrology, Ospedale di Circolo and Macchi Foundation, Varese, Italy
| | - Joana Carvalho
- CPUP: Center for Psychology of Porto University, Faculty of Psychology and Educational Sciences, Porto University, Porto, Portugal
| | - Nusret Can Cilesiz
- Department of Urology, Taksim Training & Research Hospital, Istanbul, Turkey
| | - Andrea Cocci
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, University of Florence, Florence, Italy
| | - Giovanni Corona
- Endocrinology Unit, Medical Department, Maggiore-Bellaria Hospital, Bologna, Italy
| | - Konstantinos Dimitropoulos
- Academic Urology Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK; Department of Urology, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
| | - Murat Gül
- School of Medicine, Department of Urology, Selcuk University, Konya, Turkey
| | | | - Thomas Hugh Jones
- Centre for Diabetes and Endocrinology, Barnsley Hospital NHS Trust, Barnsley, UK
| | - Ates Kadioglu
- Department of Urology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | | | - Uros Milenkovic
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Vaibhav Modgil
- Manchester Andrology Centre, Manchester Royal Infirmary, Manchester University Hospitals NHS Foundation Trust, UK
| | - Giorgio Ivan Russo
- Urology Section, Department of Surgery, University of Catania, Catania, Italy
| | - Ege Can Serefoglu
- Department of Urology, Biruni University School of Medicine, Istanbul, Turkey
| | - Tharu Tharakan
- Department of Urology, Imperial Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - Paolo Verze
- Department of Medicine and Surgery, Scuola Medica Salernitana, University of Salerno, Fisciano, Italy
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
| | | |
Collapse
|
44
|
Andrade DL, Viana MC, Esteves SC. Differential Diagnosis of Azoospermia in Men with Infertility. J Clin Med 2021; 10:3144. [PMID: 34300309 PMCID: PMC8304267 DOI: 10.3390/jcm10143144] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 12/12/2022] Open
Abstract
The differential diagnosis between obstructive and nonobstructive azoospermia is the first step in the clinical management of azoospermic patients with infertility. It includes a detailed medical history and physical examination, semen analysis, hormonal assessment, genetic tests, and imaging studies. A testicular biopsy is reserved for the cases of doubt, mainly in patients whose history, physical examination, and endocrine analysis are inconclusive. The latter should be combined with sperm extraction for possible sperm cryopreservation. We present a detailed analysis on how to make the azoospermia differential diagnosis and discuss three clinical cases where the differential diagnosis was challenging. A coordinated effort involving reproductive urologists/andrologists, geneticists, pathologists, and embryologists will offer the best diagnostic path for men with azoospermia.
Collapse
Affiliation(s)
- Danilo L Andrade
- Department of Medical Physiopathology (Postgraduate Program), State University of Campinas (UNICAMP), Campinas 13083-887, SP, Brazil
| | - Marina C Viana
- Department of Surgery (Residency Program), Division of Urology, State University of Campinas (UNICAMP), Campinas 13083-887, SP, Brazil
| | - Sandro C Esteves
- ANDROFERT, Andrology & Human Reproduction Clinic, Campinas 13075-460, SP, Brazil
- Department of Surgery, Division of Urology, State University of Campinas (UNICAMP), Campinas 13083-887, SP, Brazil
| |
Collapse
|
45
|
Zhu W, Jiang L, Pan C, Sun J, Huang X, Ni W. Deoxyribonucleic acid methylation signatures in sperm deoxyribonucleic acid fragmentation. Fertil Steril 2021; 116:1297-1307. [PMID: 34253331 DOI: 10.1016/j.fertnstert.2021.06.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 05/05/2021] [Accepted: 06/10/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To evaluate Deoxyribonucleic acid (DNA) methylation patterns in sperm from men with differential levels of sperm DNA fragmentation index (DFI). DESIGN Prospective study. SETTING University-affiliated reproductive medicine center. PATIENT(S) A total of 278 male patients consulting for couple infertility were recruited from the First Affiliated Hospital of Wenzhou Medical University. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Genome-wide DNA methylation analysis was performed using Infinium MethylationEPIC BeadChip on spermatozoal DNA from 20 male patients. Differentially methylated regions (DMRs) were identified and validated using targeted bisulfite amplicon sequencing in spermatozoal DNA from 266 males. RESULT(S) Unsupervised hierarchical clustering analysis revealed three main clusters corresponding to sperm DFI levels (low, medium, or high). Between-cluster comparisons identified 959 (medium-low), 738 (high-medium), and 937 (high-low) DMRs. Sixty-six DMRs were validated in the 266-sample cohort, of which nine CpG fragments corresponding to nine genes (BLCAP, DIRAS3, FAM50B, GNAS, MEST, TSPAN32, PSMA8, SYCP1, and TEX12) exhibited significantly altered methylation in those with high DFI (≥25%) compared with those with low DFI (<25%). CONCLUSION(S) We identified and validated a distinct DNA methylation signature associated with sperm DNA damage in a large, unselected cohort. These results indicate that sperm DNA damage may affect DNA methylation patterns in human sperm.
Collapse
Affiliation(s)
- Weijian Zhu
- Central Laboratory, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Lei Jiang
- Central Laboratory, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Chengshuang Pan
- Reproductive Medicine Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Junhui Sun
- Reproductive Medicine Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Xuefeng Huang
- Reproductive Medicine Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Wuhua Ni
- Reproductive Medicine Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China.
| |
Collapse
|
46
|
Pozzi E, Boeri L, Candela L, Capogrosso P, Cazzaniga W, Fallara G, Cignoli D, Belladelli F, Cornelius J, Abbate C, Papaleo E, Viganò P, Minhas S, Mattei A, Montorsi F, Salonia A. Infertile couples still undergo assisted reproductive treatments without initial andrological evaluation in the real-life setting: A failure to adhere to guidelines? Andrology 2021; 9:1843-1852. [PMID: 34169669 DOI: 10.1111/andr.13071] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/04/2021] [Accepted: 06/23/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The EAU Guidelines on Male Sexual and Reproductive Health state that both partners of the infertile couple should undergo simultaneous investigation. OBJECTIVES To assess the prevalence and the characteristics of infertile men who were referred for an andrological evaluation after failed attempts of Assisted Reproductive Technology (ART) with those who were evaluated at the beginning of their infertility pathway at a single academic centre over a 17-year period. MATERIALS AND METHODS Data of 3213 primary infertile couples assessed between 2003 and 2020 were analysed. Descriptive statistics compared the overall characteristics of male partners of couples with (+ART) or without (-ART) previous ART prior to andrological consultation. Logistic regression models analysed variables associated with +ART. Local polynomial regression models explored the probability of +ART over the analysed time frame. RESULTS Of all, 493 (15.3%) participants were +ART. Patients and female partners' age were higher in +ART couples (all p≤0.04). Sperm concentration, progressive sperm motility and normal sperm morphology were lower in +ART than in -ART patients (all p<0.001), along with a greater percentage of non-obstructive azoospermia in +ART compared to -ART men (p<0.0001). At univariable analysis, patient age and partner age >35 years and a less recent assessment were associated with +ART status (all p≤0.04). Male age and less recent years of assessment were also independent predictors of +ART, after accounting for partner's age >35 years (all p<0.01). A not significant decrease of this pattern was observed throughout the last 7 years at local polynomial regression models. DISCUSSION Overall awareness towards the importance of a comprehensive evaluation for the male partner of every infertile couple should therefore be further strengthened. CONCLUSIONS Approximately 15% of couples still undergo ART without any initial andrological evaluation in the real-life setting. A not significant decrease in this trend was observed over most recent years. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Edoardo Pozzi
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Luca Boeri
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,Department of Urology, Foundation IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Luigi Candela
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,University Vita-Salute San Raffaele, Milan, Italy
| | - Paolo Capogrosso
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,Department of Urology and Andrology, Ospedale di Circolo and Macchi Foundation, Varese, Italy
| | - Walter Cazzaniga
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,University Vita-Salute San Raffaele, Milan, Italy
| | - Giuseppe Fallara
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,University Vita-Salute San Raffaele, Milan, Italy
| | - Daniele Cignoli
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,University Vita-Salute San Raffaele, Milan, Italy
| | - Federico Belladelli
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Julian Cornelius
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Costantino Abbate
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Enrico Papaleo
- Division of Genetics and Cell Biology, Reproductive Sciences Laboratory, IRCCS Ospedale San Raffaele, Milan, Italy.,Obstetrics and Gynaecology Department, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Paola Viganò
- Division of Genetics and Cell Biology, Reproductive Sciences Laboratory, IRCCS Ospedale San Raffaele, Milan, Italy.,Obstetrics and Gynaecology Department, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Suks Minhas
- Department of Urology, Imperial Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - Agostino Mattei
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Francesco Montorsi
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,University Vita-Salute San Raffaele, Milan, Italy
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,University Vita-Salute San Raffaele, Milan, Italy
| |
Collapse
|
47
|
Spaggiari G, M Granata AR, Santi D. Testicular ultrasound inhomogeneity is an informative parameter for fertility evaluation. Asian J Androl 2021; 22:302-308. [PMID: 31274478 PMCID: PMC7275802 DOI: 10.4103/aja.aja_67_19] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Testicular volume (TV) is proposed to be a positive predictor of male fertility status, because of the relation known between the TV and the seminiferous tubule content. Independently of the measurement methodology, the role of TV and testicular ultrasound (US) assessments is still debated in andrological clinical practice. In this retrospective cohort study, we evaluated TV and testis US role in the diagnostic workup of andrological patients. All consecutive outpatients undergoing single-operator testis US (Modena, Italy) from March 2012 to March 2018 were enrolled, matching sonographic, hormonal, and seminal data. A total of 302 men were referred and evaluated for gynecomastia, suspected hypogonadism, couple infertility (CI), or sexual dysfunction. In the hypogonadal group, TV was lower compared to that in other groups (P < 0.001), and a significant, direct correlation between TV and testosterone level was observed in nonandrogen-treated patients (R = 0.911, P < 0.001), suggesting that testicular size could be related to the testosterone-secreting compartment. In the CI group, normozoospermic patients showed higher TV compared to men with impaired semen quality (P = 0.003) and azoospermia (P = 0.003). However, TV was not able to discriminate between patients presenting normal and altered semen quality. On the contrary, testis US inhomogeneity was more frequent in patients with impaired sperm quality (55.0%; P = 0.007) and azoospermia (40.0%; P = 0.012), compared to patients with normozoospermia (5%), identifying thereby the sonographic pattern as an informative parameter of the fertility status. Therefore, in the CI workup, US evaluation seems to be more informative than the TV assessment alone.
Collapse
Affiliation(s)
- Giorgia Spaggiari
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena 41126, Italy.,Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Ospedale Civile of Baggiovara, Modena 41126, Italy
| | - Antonio R M Granata
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Ospedale Civile of Baggiovara, Modena 41126, Italy
| | - Daniele Santi
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena 41126, Italy.,Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Ospedale Civile of Baggiovara, Modena 41126, Italy
| |
Collapse
|
48
|
Are Infertile Men Less Healthy Than Fertile Men? An Analysis of the National Survey for Family Growth. Urology 2021; 156:134-140. [PMID: 34129892 DOI: 10.1016/j.urology.2021.05.054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/09/2021] [Accepted: 05/28/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To characterize the general health status of infertile men in the United States using a nationally representative sample of men. METHODS Using the National Survey for Family Growth from 2011 to 2017, infertile subgroups were created using a range of inclusion criteria. Univariate and multivariate analyses were conducted comparing these men to fertile men. RESULTS Using population estimates, 6.5 million men with reduced fertility potential were compared to 26 million fertile men. After controlling for demographic and healthcare utilization factors, these groups did not have significantly different rates of key medical co-morbidities, including cancer, obesity, and overall disability. Looking at the subset of men who had received a specific infertility diagnosis, estimated as a population of nearly 600,000 men, this pattern held, in that there were no significant differences in the rates of medical co-morbidities. Notably, the rate of male infertility evaluation among potentially infertile men was only 50%. These findings also persisted after a propensity-matched analysis. CONCLUSION In this cohort, there was no significant relationship between infertility and specific medical co-morbidities. We must consider the influence of sample selection as we continue to investigate the relationship between medical co-morbidities and reduced fertility potential. Given the persistent low rates of infertility evaluation, even among men who seek medical advice to conceive, we must continue to search for ways to characterize the infertile male population while simultaneously working to improve access.
Collapse
|
49
|
Cantisani V, Di Leo N, Bertolotto M, Fresilli D, Granata A, Polti G, Polito E, Pacini P, Guiban O, Del Gaudio G, Dolcetti V, DʼAndrea V, Di Pierro GB, Verrengia M, Drudi FM, Catalano C. Role of multiparametric ultrasound in testicular focal lesions and diffuse pathology evaluation, with particular regard to elastography: Review of literature. Andrology 2021; 9:1356-1368. [PMID: 34114745 DOI: 10.1111/andr.13067] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/18/2021] [Accepted: 05/28/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Ultrasound is the main requested technique for the assessment of traumatic, vascular, neoplastic, and inflammatory testicular pathology. Moreover, the role of ultrasound has broadened over the years along with the introduction of new techniques, such as contrast enhanced ultrasound and ultrasound elastography. OBJECTIVE An updated representation of the pre-existing Literature evidence for multiparametric ultrasound imaging with particular regard to elastography, in the evaluation of focal and diffuse testicular pathologies, has been presented. METHODS The search was performed in PubMed, Cochrane, EMBASE, Web of Science and Scopus databases from the earliest available article (1977) until January 2021. Based on the evidence of the Literature, the current role of US imaging for focal and diffuse testicular pathologies has been reported and illustrated, with emphasis on examination technique, classification, and pitfalls. RESULTS Multiparametric Ultrasound has a recognized role for testicle focal and diffuse disease. Elastography is nowadays recognized as an essential part of the multiparametric ultrasound examination. However, in the setting of testicular pathology this method showed some promising results in the setting of varicocoele and for focal lesions characterization. In the remaining field its role is still under debate. DISCUSSION B-mode ultrasound and color Doppler ultrasound have been for a long time the diagnostic gold standard for testicular pathologies. The introduction of both contrast enhanced ultrasound and elastography in the last two decades has brought to the emergence of the multiparametric ultrasound concept. These methods are currently able to increase diagnostic confidence especially for testicular lesions characterization, with different relevance depending on the pathology under consideration. CONCLUSION Multiparametric ultrasound testis assessment, with specific regard to elastography is nowadays recommended for focal and diffuse disease evaluation. Further and larger studies are however needed to validate these results and to understand if the role of elastography in testicular pathology may be broadened.
Collapse
Affiliation(s)
- Vito Cantisani
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Nicola Di Leo
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Michele Bertolotto
- Department of Radiology, Ospedale di Cattinara, University of Trieste, Trieste, Italy
| | - Daniele Fresilli
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Antonio Granata
- Department of Nephrology and Dialysis, San Giovanni di Dio Hospital, Agrigento, Italy
| | - Giorgia Polti
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Eleonora Polito
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Patrizia Pacini
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Olga Guiban
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Giovanni Del Gaudio
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Vincenzo Dolcetti
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Vito DʼAndrea
- Department of Surgical Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Giovanni Battista Di Pierro
- Department of Maternal-Infant and Urological Sciences, Policlinico Umberto I Hospital, Sapienza University of Rome, Rome, Italy
| | | | - Francesco Maria Drudi
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Carlo Catalano
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| |
Collapse
|
50
|
Lotti F, Bertolotto M, Maggi M. Historical trends for the standards in scrotal ultrasonography: What was, what is and what will be normal. Andrology 2021; 9:1331-1355. [PMID: 34089245 DOI: 10.1111/andr.13062] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Ultrasonography is the gold standard imaging method for scrotal investigation. Colour Doppler ultrasonography, contrast-enhanced ultrasonography and sonoelastography allow sonographers to assess size, echotexture, vascular features and stiffness of the scrotal organs and abnormalities. Scrotal ultrasonography has been used to investigate male reproductive health, scrotal pain, masses and trauma. However, ultrasonography thresholds/classifications used to distinguish normal and pathologic features of the scrotal organs have changed over time, and have not yet been fully standardized. OBJECTIVES To evaluate historical trends for the standards in scrotal ultrasonography: what was, what is and what will be normal. METHODS An extensive Medline search was performed identifying the most relevant studies in the English language from inception to date. RESULTS We provide here (i) a brief overview of the history of ultrasonography, (ii) current indications for scrotal ultrasonography and (iii) previous and current normal values, cut-offs and classifications of the main colour-Doppler ultrasonography parameters/characteristics of the scrotal organs, as derived from recent guidelines and evidence-based studies. In addition, we report recommendations and the clinical utility of contrast-enhanced ultrasonography and sonoelastography. Finally, we discuss critical issues needing further evidence and future directions to fill in the current gaps. DISCUSSION Several studies on scrotal ultrasonography are available. However, guidelines/recommendations dealing with specific ultrasonography applications have been published only in recent years. More recently, the European Academy of Andrology published evidence-based scrotal colour-Doppler ultrasonography reference ranges/normative parameters derived from a cohort of healthy, fertile men. In addition, a standardization of the methodology to evaluate qualitative and quantitative colour-Doppler ultrasonography parameters was reported. Other international societies reported indications, methodological standards, clinical utility and limitations of contrast-enhanced ultrasonography and sonoelastography. CONCLUSIONS To date, colour-Doppler ultrasonography normative values for the scrotal organs are available. However, a wide international consensus on assessment and classification of several ultrasonography parameters is still lacking. An alignment of the world societies on these issues is advocated.
Collapse
Affiliation(s)
- Francesco Lotti
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
| | - Michele Bertolotto
- Department of Radiology, Cattinara Hospital, University of Trieste, Trieste, Italy
| | - Mario Maggi
- Endocrinology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
| |
Collapse
|