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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.
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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
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Garolla A, Grande G, Palego P, Canossa A, Caretta N, Di Nisio A, Corona G, Foresta C. Central role of ultrasound in the evaluation of testicular function and genital tract obstruction in infertile males. Andrology 2021; 9:1490-1498. [PMID: 34085393 PMCID: PMC8596694 DOI: 10.1111/andr.13060] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 05/25/2021] [Accepted: 05/27/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Scrotal color Doppler ultrasonography and transrectal ultrasonography provide crucial information about the clinical status of testes and male accessory glands. OBJECTIVE To analyze the impact of ultrasound in the evaluation of infertile males. MATERIALS AND METHODS A total of 1120 records from infertile men were retrospectively evaluated (from January 2016 up to June 2020). Data on physical examination, semen analysis, sperm culture, scrotal color Doppler ultrasonography and transrectal ultrasonography, as well as sex hormones were analyzed. Among them, 238 reports from oligozoospermic/azoospermic infertile patients (P) fulfilling the inclusion criteria were considered for data analysis. Patients were subdivided into two groups according to follicle-stimulating hormone (FSH) values (Pa with FSH < 8 U/L and Pb with FSH ≥ 8 U/L). Sixty-three fertile volunteers (mean ± SD years) were enrolled as controls (C). RESULTS A higher prevalence of ultrasound abnormalities was recorded in P compared to C. Pb group had significantly lower bitesticular volume compared to Pa and C. Pa had a higher prevalence of transrectal ultrasonography abnormalities than Pb (69.9% vs. 38.4%), whereas Pb had a higher prevalence of abnormalities at scrotal color Doppler ultrasonography (60.0% vs. 28.3%, both p < 0.01). Bitesticular volume was inversely proportional to the number of altered seminal parameters and able to predict gonadotropin levels. A bitesticular volume <17 cc was associated with a higher risk of azoospermia (odds ratio = 1.799). Intratesticular vascularization was inversely correlated with gonadotropin levels and directly correlated with sperm count. A higher prevalence of prostate and seminal vesicle alterations was detected in patients and in Pa group, when compared with Pb group. DISCUSSION AND CONCLUSION Ultrasound abnormalities are correlated with seminal parameters and may guide the clinician in the diagnostic workflow of male infertility, suggesting spermatogenesis impairment or genital tract obstructions.
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Affiliation(s)
- Andrea Garolla
- Unit of Andrology and Reproductive Medicine, Department of Medicine, University of Padova, Padova, Italy
| | - Giuseppe Grande
- Second Division of Medicine, ULSS2 Marca Trevigiana, "Ca' Foncello" Regional Hospital, Treviso, Italy
| | - Pierfrancesco Palego
- Unit of Andrology and Reproductive Medicine, Department of Medicine, University of Padova, Padova, Italy
| | - Andrea Canossa
- Unit of Andrology and Reproductive Medicine, Department of Medicine, University of Padova, Padova, Italy
| | - Nicola Caretta
- Unit of Andrology and Reproductive Medicine, Department of Medicine, University of Padova, Padova, Italy
| | - Andrea Di Nisio
- Unit of Andrology and Reproductive Medicine, Department of Medicine, University of Padova, Padova, Italy
| | - Giovanni Corona
- Endocrinology Unit, Medical Department, Azienda-Usl Maggiore-Bellaria Hospital, Bologna, Italy
| | - Carlo Foresta
- Unit of Andrology and Reproductive Medicine, Department of Medicine, University of Padova, Padova, Italy
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Rudnik-Schöneborn S, Messner M, Vockel M, Wirleitner B, Pinggera GM, Witsch-Baumgartner M, Murtinger M, Kliesch S, Swoboda M, Sänger N, Zschocke J, Tüttelmann F. Andrological findings in infertile men with two (biallelic) CFTR mutations: results of a multicentre study in Germany and Austria comprising 71 patients. Hum Reprod 2021; 36:551-559. [PMID: 33374015 DOI: 10.1093/humrep/deaa348] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 11/16/2020] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION When should cystic fibrosis transmembrane conductance regulator (CFTR) mutation analysis be recommended in infertile men based on andrological findings? SUMMARY ANSWER CFTR mutation analysis is recommended in all men with unexplained azoospermia in the presence of normal gonadotropin levels. WHAT IS KNOWN ALREADY While 80-97% of men with congenital bilateral absence of the vas deferens (CBAVD) are thought to carry CFTR mutations, there is uncertainty about the spectrum of clinical and andrological abnormalities in infertile men with bilallelic CFTR mutations. This information is relevant for evidence-based recommendations to couples requesting assisted reproduction. STUDY DESIGN, SIZE, DURATION We studied the andrological findings of patients with two CFTR mutations who were examined in one of the cooperating fertility centres in Germany and Austria. In the period of January till July 2019, the completed and anonymized data sheets of 78 adult male patients were returned to and analysed by the project leader at the Institute of Human Genetics in Innsbruck, Austria. PARTICIPANTS/MATERIALS, SETTING, METHODS Minimum study entry criteria were the presence of two (biallelic) CFTR mutations and results of at least one semen analysis. Andrological assessments were undertaken by standardized data sheets and compared with normal reference values. Seventy-one patients were eligible for the study (n = 30, 42% from Germany, n = 26, 37% from Austria, n = 15, 21% other nations). MAIN RESULTS AND THE ROLE OF CHANCE Gonadotropin levels (FSH, LH) were normal, 22% of patients had reduced testosterone values. Mean right testis volume was 23.38 ml (SD 8.77), mean left testis volume was 22.59 ml (SD 8.68) and thereby statistically increased compared to normal (P < 0.01). although the means remained in the reference range of 12-25 ml. Semen analysis revealed azoospermia in 70 of 71 (99%) patients and severe oligozoospermia <0.1 × 106/ml in one patient. Four semen parameters, i.e. ejaculate volume, pH, α-glucosidase and fructose values, were significantly reduced (P < 0.01). Only 18% of patients had a palpatory and sonographically diagnosed CBAVD, while in 31% the diagnosis of CBAVD was uncertain, in 12% patients, the vas deferens was present but hypoplastic, and in 39% the vas deferens was normally present bilaterally. Seminal vesicles were not detectable in 37% and only unilaterally present in 37% of patients. Apart from total testes volume, clinical findings were similar in patients with two confirmed pathogenic CFTR mutations (Group I) compared with patients who carried one pathogenic mutation and one CFTR variant of unknown significance (Group II). LIMITATIONS, REASONS FOR CAUTION We could not formally confirm the in trans position of genetic variants in most patients as no family members were available for segregation studies. Nonetheless, considering that most mutations in our study have been previously described without other rare variants in cis, and in view of the compatible andrological phenotype, it is reasonable to assume that the biallelic genotypes are correct. WIDER IMPLICATIONS OF THE FINDINGS Our study reveals that CFTR mutation analysis has a broader indication than just the absence of the vas deferens. We recommend to completely sequence the CFTR gene if there is a suspicion of obstructive azoospermia, and to extend this analysis to all patients with unexplained azoospermia in the presence of normal gonadotropin levels. STUDY FUNDING/COMPETING INTEREST(S) German Research Foundation Clinical Research Unit 'Male Germ Cells: from Genes to Function' (DFG CRU326, grants to F.T.). There are no conflicts of interest to declare. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- S Rudnik-Schöneborn
- Institute of Human Genetics, Medical University Innsbruck, Innsbruck, Austria
| | - M Messner
- Institute of Human Genetics, Medical University Innsbruck, Innsbruck, Austria
| | - M Vockel
- Institute of Human Genetics, University of Münster, Münster, Germany
| | - B Wirleitner
- NEXTCLINIC, IVF Centres Prof. Zech, Bregenz, Bregenz, Austria
| | - G-M Pinggera
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
| | | | - M Murtinger
- NEXTCLINIC, IVF Centres Prof. Zech, Bregenz, Bregenz, Austria
| | - S Kliesch
- Department of Clinical and Surgical Andrology, Centre of Reproductive Medicine and Andrology, University Hospital Münster, Münster, Germany
| | - M Swoboda
- VivaNeo Kinderwunschzentrum Dr. Loimer GmbH, Wels-Thalheim, Austria
| | - N Sänger
- Clinic of Gynecological Endocrinology, University of Bonn, Bonn, Germany
| | - J Zschocke
- Institute of Human Genetics, Medical University Innsbruck, Innsbruck, Austria
| | - F Tüttelmann
- Institute of Reproductive Genetics, University of Münster, Münster, Germany
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Bertolotto M, Cantisani V, Drudi FM, Lotti F. Varicocoele. Classification and pitfalls. Andrology 2021; 9:1322-1330. [PMID: 34038625 PMCID: PMC8596817 DOI: 10.1111/andr.13053] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/09/2021] [Accepted: 05/18/2021] [Indexed: 11/26/2022]
Abstract
Background Varicocoeles have been considered for a long time potentially correctable causes for male infertility, even though the correlation of this condition with infertility and sperm damage is still debated. Objective To present a summary of the evidence evaluation for imaging varicocoeles, to underline the need for a standardized examination technique and for a unique classification, and to focus on pitfalls in image interpretation. Methods Based on the evidence of the literature, the current role of ultrasound (US) imaging for varicocoeles has been reported and illustrated, with emphasis on examination technique, classification, and pitfalls. Results US is the imaging modality of choice. It is widely used in Europe, while in other countries clinical classification of varicocoeles is considered sufficient to manage the patient. A number of US classifications exist for varicocoeles, in which the examinnation is performed in different ways. Discussion An effort toward standardization is mandatory, since lack of standardization contributes to the confusion of the available literature, and has a negative impact on the understanding of the role itself of imaging in patients with varicocoeles. Conclusion Use of the Sarteschi/Liguori classification for varicocoeles is recommended, since it is the most complete and widely used US scoring system available today. Tubular extratesticular structures resembling varicocoeles, either at palpation or at US, should be identified and correctly characterized.
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Affiliation(s)
- Michele Bertolotto
- Department of Radiology, University of Trieste, Ospedale di Cattinara, Trieste, Italy
| | - Vito Cantisani
- Department of Radiology, University Sapienza of Rome, Policlinico Umberto I, Roma, Italy
| | - Francesco Maria Drudi
- Department of Radiology, University Sapienza of Rome, Policlinico Umberto I, Roma, Italy
| | - Francesco Lotti
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Azienda Ospedaliero-Universitaria Carreggi, Firenze, Italy
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Kizilkan Y, Duran MB, Senel S, Yikilmaz TN, Akbelen B, Toksoz S. The effect of ejaculation time on varicose vein diameter and reflux level. Andrologia 2021; 53:e14090. [PMID: 33913191 DOI: 10.1111/and.14090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/31/2021] [Accepted: 04/11/2021] [Indexed: 11/29/2022] Open
Abstract
The aim of this study was to investigate whether the time interval between ejaculation and scrotal Doppler ultrasonography affects the results of the varicose vein diameter and reflux time. Age, medication use, operation history, physical examination and semen analysis findings, varicose vein diameters and the presence of reflux and reflux time were evaluated prospectively in the patients older than 18 years of age who presented to the urology outpatient clinic with infertility and underwent scrotal Doppler ultrasonography and semen analysis. The time interval between the two scrotal Doppler ultrasonography for semen analysis was noted, the two results were compared. The patients were divided into four groups according to the time interval between ejaculation and scrotal Doppler ultrasonography. The study included 81 varicocele cases, with 57 left-sided and 12 bilateral varicocele. The varicose vein diameters were significantly larger after ejaculation than before ejaculation (p < .001). Similarly, the reflux time after ejaculation in all patients was significantly higher in scrotal Doppler ultrasonography performed before and after ejaculation at rest and during Valsalva manoeuvre (p < .001). In conclusion, the results of the present study suggest that a waiting time of at least 90 min must be allowed between ejaculation and scrotal Doppler ultrasonography.
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Affiliation(s)
| | - Mesut Berkan Duran
- Department of Urology, Samsun Training and Research Hospital, Samsun, Turkey
| | - Samet Senel
- Department of Urology, Ankara City Hospital, Ankara, Turkey
| | | | - Behcet Akbelen
- Department of Radiology, Hatay State Hospital, Hatay, Turkey
| | - Serdar Toksoz
- Department of Urology, Hatay State Hospital, Hatay, Turkey
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56
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Diagnostic accuracy of resistive index of capsular and intratesticular branches of testicular arteries in infertile men with oligoasthenospermia: A case-control study. Biomedicine (Taipei) 2021; 10:18-22. [PMID: 33854930 PMCID: PMC7735981 DOI: 10.37796/2211-8039.1036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 04/27/2020] [Indexed: 11/01/2022] Open
Abstract
Introduction Male infertility accounts for nearly 50% of couples' infertility. Only a few studies evaluate the diagnostic accuracy of resistive index (RI) of testicular arteries using color Doppler imaging to identify male infertility. The aim of this study was to investigate the diagnostic accuracy of RI of the capsular and intratesticular branches of testicular arteries in infertile men with oligoasthenospermia and its comparison with normal men. Material and methods In a case-control study, 30 patients with oligoasthenospermia (case group) and 30 healthy controls who meet the inclusion criteria, were selected. For all patients, RI was measured using color Doppler ultrasonography in upper and lower testicular poles. Also, testicular volumes were measured for all participants. Results Mean RI of the intratesticular artery (0.624 ± 0.051 versus 0.509 ± 0.054; P < 0.001) and capsular artery (0.663 ± 0.057 versus 0.557 ± 0.055; P < 0.001) were significantly higher in the case group compared to control group. The frequency of abnormal RI of intratesticular artery in the control (13.3%) and case (66.7%) groups were significantly different (OR: 13.0; 95% CI: 3.44-47.59; P < 0.001). The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and overall accuracy (OA) of intratesticular artery RI were 66.67%, 86.67%, 83.33%, 72.22%, and 76.67%, respectively. The frequency of abnormal RI of capsular artery was 23.3% in the control group and 90.0% in the case group (OR: 29.57; 95% CI: 6.85-127.63; P < 0.001). The sensitivity, specificity, PPV, NPV and OA of capsular artery RI were 90.0%, 76.67%, 79.41%, 88.46% and 83.33%, respectively. Conclusion The results of this study indicated that assessing testicular Doppler RI of capsular and intratesticular branches of the testicular arteries, as a bio-imaging biomarker, may be a valuable non-invasive and simple complementary diagnostic modality with a high diagnostic value in identifying infertile men with oligoasthenospermia.
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La Vignera S, Crafa A, Condorelli RA, Barbagallo F, Mongioì LM, Cannarella R, Compagnone M, Aversa A, Calogero AE. Ultrasound aspects of symptomatic versus asymptomatic forms of male accessory gland inflammation. Andrology 2021; 9:1422-1428. [PMID: 33818914 PMCID: PMC8596874 DOI: 10.1111/andr.13014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/19/2021] [Accepted: 04/01/2021] [Indexed: 01/23/2023]
Abstract
Background The ultrasound (US) evaluation of the male sex accessory gland inflammation (MAGI) helps the clinicians to understand the severity of this condition, allowing them to distinguish the uncomplicated form (prostatitis) from the complicated ones (prostate‐vesiculitis and prostate‐vesiculitis‐epididymitis), as well as the unilateral from the bilateral forms, the fibrosclerotic and the hypertrophic‐congestive form. Objective This retrospective study aimed to evaluate the US features of MAGI patients with active symptoms compared to patients without sexual, voiding, and ejaculatory dysfunction. Materials/Methods To achieve this aim, an analysis of the prevalence of MAGI US criteria was carried out on a very large series of over 500 patients diagnosed with MAGI classified according to the different symptom profile evaluated through a dedicated questionnaire (previously conceived and published by our group) arbitrarily named “structured interview about MAGI” (SI‐MAGI) for sexual, voiding, and ejaculatory disorders reported by these patients. Results The results of this study revealed that US criteria most frequently detected in patients with severe urinary symptoms were the presence of areas of high echogenicity (almost exclusively in the periurethral prostatic zone) together with the presence of single or multiple areas of acinar ectasia of the prostate. The presence of seminal vesicles with polycyclic areas within the glandular lumen separated by hyperechoic septa represented US criterion most frequently detected in patients with severe spontaneous or post‐ejaculate pain. Finally, US criterion most frequently detected in patients with severe sexual dysfunction was the dilation of the periprostatic venous plexus, suggesting the hypothesis of a possible alternative therapeutic approach. Conclusion The data of the present study suggest that symptoms may associate with US signs in patients with MAGI. Also, specific US signs may associate with specific symptoms. Further studies are needed to understand whether patients with specific US signs may in turn benefit from a personalized therapeutic choice.
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Affiliation(s)
- Sandro La Vignera
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Andrea Crafa
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Rosita A Condorelli
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Federica Barbagallo
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Laura M Mongioì
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Rossella Cannarella
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Michele Compagnone
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Antonio Aversa
- Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Aldo E Calogero
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
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Maseroli E, Comeglio P, Corno C, Cellai I, Filippi S, Mello T, Galli A, Rapizzi E, Presenti L, Truglia MC, Lotti F, Facchiano E, Beltrame B, Lucchese M, Saad F, Rastrelli G, Maggi M, Vignozzi L. Testosterone treatment is associated with reduced adipose tissue dysfunction and nonalcoholic fatty liver disease in obese hypogonadal men. J Endocrinol Invest 2021; 44:819-842. [PMID: 32772323 PMCID: PMC7946690 DOI: 10.1007/s40618-020-01381-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 07/31/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE In both preclinical and clinical settings, testosterone treatment (TTh) of hypogonadism has shown beneficial effects on insulin sensitivity and visceral and liver fat accumulation. This prospective, observational study was aimed at assessing the change in markers of fat and liver functioning in obese men scheduled for bariatric surgery. METHODS Hypogonadal patients with consistent symptoms (n = 15) undergoing 27.63 ± 3.64 weeks of TTh were compared to untreated eugonadal (n = 17) or asymptomatic hypogonadal (n = 46) men. A cross-sectional analysis among the different groups was also performed, especially for data derived from liver and fat biopsies. Preadipocytes isolated from adipose tissue biopsies were used to evaluate insulin sensitivity, adipogenic potential and mitochondrial function. NAFLD was evaluated by triglyceride assay and by calculating NAFLD activity score in liver biopsies. RESULTS In TTh-hypogonadal men, histopathological NAFLD activity and steatosis scores, as well as liver triglyceride content were lower than in untreated-hypogonadal men and comparable to eugonadal ones. TTh was also associated with a favorable hepatic expression of lipid handling-related genes. In visceral adipose tissue and preadipocytes, TTh was associated with an increased expression of lipid catabolism and mitochondrial bio-functionality markers. Preadipocytes from TTh men also exhibited a healthier morpho-functional phenotype of mitochondria and higher insulin-sensitivity compared to untreated-hypogonadal ones. CONCLUSIONS The present data suggest that TTh in severely obese, hypogonadal individuals induces metabolically healthier preadipocytes, improving insulin sensitivity, mitochondrial functioning and lipid handling. A potentially protective role for testosterone on the progression of NAFLD, improving hepatic steatosis and reducing intrahepatic triglyceride content, was also envisaged. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02248467, September 25th 2014.
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Affiliation(s)
- E Maseroli
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Department of Experimental Clinical and Biomedical Sciences "Mario Serio", University of Florence, Viale Pieraccini 6, 50134, Florence, Italy
| | - P Comeglio
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Department of Experimental Clinical and Biomedical Sciences "Mario Serio", University of Florence, Viale Pieraccini 6, 50134, Florence, Italy
| | - C Corno
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Department of Experimental Clinical and Biomedical Sciences "Mario Serio", University of Florence, Viale Pieraccini 6, 50134, Florence, Italy
| | - I Cellai
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Department of Experimental Clinical and Biomedical Sciences "Mario Serio", University of Florence, Viale Pieraccini 6, 50134, Florence, Italy
| | - S Filippi
- Interdepartmental Laboratory of Functional and Cellular Pharmacology of Reproduction, University of Florence, Viale Pieraccini 6, 50134, Florence, Italy
| | - T Mello
- Gastroenterology Unit, Department of Experimental Clinical and Biomedical Sciences "Mario Serio", University of Florence, Viale Pieraccini 6, 50134, Florence, Italy
| | - A Galli
- Gastroenterology Unit, Department of Experimental Clinical and Biomedical Sciences "Mario Serio", University of Florence, Viale Pieraccini 6, 50134, Florence, Italy
| | - E Rapizzi
- Endocrinology Unit, Department of Experimental Clinical and Biomedical Sciences "Mario Serio", University of Florence, Viale Pieraccini 6, 50134, Florence, Italy
| | - L Presenti
- General, Bariatric and Metabolic Surgery Unit, Santa Maria Nuova Hospital, , Piazza Santa Maria Nuova, 1, 50122, Florence, Italy
| | - M C Truglia
- General, Bariatric and Metabolic Surgery Unit, Santa Maria Nuova Hospital, , Piazza Santa Maria Nuova, 1, 50122, Florence, Italy
| | - F Lotti
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Department of Experimental Clinical and Biomedical Sciences "Mario Serio", University of Florence, Viale Pieraccini 6, 50134, Florence, Italy
| | - E Facchiano
- General, Bariatric and Metabolic Surgery Unit, Santa Maria Nuova Hospital, , Piazza Santa Maria Nuova, 1, 50122, Florence, Italy
| | - B Beltrame
- General, Bariatric and Metabolic Surgery Unit, Santa Maria Nuova Hospital, , Piazza Santa Maria Nuova, 1, 50122, Florence, Italy
| | - M Lucchese
- General, Bariatric and Metabolic Surgery Unit, Santa Maria Nuova Hospital, , Piazza Santa Maria Nuova, 1, 50122, Florence, Italy
| | - F Saad
- Medical Affairs, Bayer AG, Kaiser-Wilhelm-Allee 1, 51373, Leverkusen, Germany
| | - G Rastrelli
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Department of Experimental Clinical and Biomedical Sciences "Mario Serio", University of Florence, Viale Pieraccini 6, 50134, Florence, Italy
| | - M Maggi
- Endocrinology Unit, Department of Experimental Clinical and Biomedical Sciences "Mario Serio", University of Florence, Viale Pieraccini 6, 50134, Florence, Italy
- I.N.B.B. (Istituto Nazionale Biostrutture E Biosistemi), Viale delle Medaglie d'Oro 305, 00136, Rome, Italy
| | - L Vignozzi
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Department of Experimental Clinical and Biomedical Sciences "Mario Serio", University of Florence, Viale Pieraccini 6, 50134, Florence, Italy.
- I.N.B.B. (Istituto Nazionale Biostrutture E Biosistemi), Viale delle Medaglie d'Oro 305, 00136, Rome, Italy.
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La Vignera S, Crafa A, Condorelli RA, Barbagallo F, Mongioì LM, Cannarella R, Compagnone M, Aversa A, Calogero AE. Ultrasound evaluation of patients with male accessory gland inflammation: a pictorial review. Andrology 2021; 9:1298-1305. [PMID: 33794059 PMCID: PMC8596784 DOI: 10.1111/andr.13011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/17/2021] [Accepted: 03/25/2021] [Indexed: 01/23/2023]
Abstract
Male accessory gland infection/inflammation (MAGI) is a major cause of male infertility. The importance of ultrasound evaluation in these patients is highly controversial, although evidence of its relevance has increased in recent years. Ultrasound criteria are an important element for confirming the clinical diagnosis. Furthermore, they help to localize the anatomical site or sites of the inflammatory process and in assessing its extension which, in turn, have different consequences on the seminological and symptomatic aspects. This article summarizes the clinical interpretations related to ultrasound aspects in patients with MAGI and the possible effects on the seminological, microbiological, endocrinologic, urological, sexological, and internist aspects.
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Affiliation(s)
- Sandro La Vignera
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Andrea Crafa
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Rosita A Condorelli
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Federica Barbagallo
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Laura M Mongioì
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Rossella Cannarella
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Michele Compagnone
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Antonio Aversa
- Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Aldo E Calogero
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
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Tan H, Wu G, Wang S, Lawless J, Sinn A, Chen D, Zheng Z. Prenatal exposure to atrazine induces cryptorchidism and hypospadias in F1 male mouse offspring. Birth Defects Res 2021; 113:469-484. [PMID: 33463082 PMCID: PMC7986601 DOI: 10.1002/bdr2.1865] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 12/03/2020] [Accepted: 12/21/2020] [Indexed: 12/22/2022]
Abstract
The main objective of the present study was to determine whether prenatal exposure to atrazine could affect testicle descent and penile masculinization. Atrazine has been demonstrated with a variety of endocrine disrupting activities and reproductive toxicities. However, the effects of prenatal atrazine exposure on male offspring's genital malformation, such as hypospadias and cryptorchidism, remain poorly understood. In this study, pregnant ICR mice were gavaged from gestational day 12.5-16.5 with different doses of atrazine. Although no sign of systemic toxicity was observed in F1 male pups, prenatal exposure to 100 mg/kg/day atrazine affected penile morphology, urethral meatus position and descent of testis, and reduced anogenital distance and penile size in postnatal day 21 F1 male pups. The comparative study with an androgen receptor (AR) antagonist vinclozolin suggested that these effects of atrazine on male genital development may not be through antagonism of AR. The results also revealed that atrazine exposure significantly reduced maternal serum testosterone levels, decreased AR nuclear translocation, and altered the expression levels of developmental gene networks in developing penis of mice. Atrazine exposure also affected the expression of insulin-like 3 (Insl3) and steroidogenic gene expression in developing reproductive tract. Therefore, our data indicate that prenatal atrazine exposure can induce hypospadias in F1 mice, likely through disruption of testosterone production, decreasing genomic androgen action, and then altering expression of developmental genes during sexual differentiation. Our data also suggest that prenatal atrazine exposure can induce cryptorchidism in F1 mice, possibly through down regulation of Insl3.
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Affiliation(s)
- Hongli Tan
- Department of PhysiologySchool of Medicine, Southern Illinois University CarbondaleCarbondaleIllinoisUSA
- School of Environment and Guangdong Key Laboratory of Environmental Pollution and HealthJinan UniversityGuangzhouChina
| | - Guohui Wu
- Department of PhysiologySchool of Medicine, Southern Illinois University CarbondaleCarbondaleIllinoisUSA
- Jiangxi Key Laboratory of Maxillofacial Plastic Surgery and ReconstructionJiangxi Provincial People's HospitalNanchangChina
| | - Shanshan Wang
- Department of PhysiologySchool of Medicine, Southern Illinois University CarbondaleCarbondaleIllinoisUSA
| | - John Lawless
- Department of PhysiologySchool of Medicine, Southern Illinois University CarbondaleCarbondaleIllinoisUSA
| | - Austin Sinn
- Department of PhysiologySchool of Medicine, Southern Illinois University CarbondaleCarbondaleIllinoisUSA
| | - Da Chen
- School of Environment and Guangdong Key Laboratory of Environmental Pollution and HealthJinan UniversityGuangzhouChina
| | - Zhengui Zheng
- Department of PhysiologySchool of Medicine, Southern Illinois University CarbondaleCarbondaleIllinoisUSA
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Hu JY, Huang WL, Gao Y, Yang Z, Ding L, Xie Y, Xie XY, Hu HT, Wang Z. Preliminary investigation of the diagnostic value of shear wave elastography in evaluating the testicular spermatogenic function in patients with azoospermia. Andrologia 2021; 53:e14039. [PMID: 33682169 DOI: 10.1111/and.14039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 01/30/2021] [Accepted: 02/17/2021] [Indexed: 12/15/2022] Open
Abstract
To assess the diagnostic value of shear wave elastography (SWE) for evaluating the histological spermatogenic function of azoospermic males, 91 patients with azoospermia who underwent standardised greyscale ultrasound and SWE examinations followed by testicular biopsy were retrospectively recruited. Spermatogenic function was classified by biopsy as normal testicular spermatogenesis (n = 61), hypospermatogenesis (n = 18), spermatogenesis arrest (n = 6) and Sertoli cell-only syndrome (n = 6). Significant differences in testicular size and SWE values were observed between these 4 groups (p < .01). The mean SWE value had good discrimination power (AUC = 0.79) with a cut-off value of 1.55 KPa, a sensitivity of 0.58, specificity of 0.85, positive predictive value (PPV) of 0.36 and negative predictive value (NPV) of 0.93. Testicular volume had an AUC of 0.75. With a cut-off value of 8.41 ml, the testicular volume had a sensitivity of 0.58, specificity of 0.92, PPV of 0.54 and NPV of 0.93. The mean SWE value and testicular volume efficiently discriminated patients with normal spermatogenesis and hypospermatogenesis from patients with Sertoli cell-only syndrome and spermatogenesis arrest.
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Affiliation(s)
- Jia-Ying Hu
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Wan-Ling Huang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yong Gao
- Reproductive Medicine Centre, The Key Laboratory for Reproductive Medicine of Guangdong Province, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zheng Yang
- Department of Pathology, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Li Ding
- Department of Pathology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yun Xie
- Department of Andrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiao-Yan Xie
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Hang-Tong Hu
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhu Wang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Lotti F, Marchiani S, Corona G, Maggi M. Metabolic Syndrome and Reproduction. Int J Mol Sci 2021; 22:ijms22041988. [PMID: 33671459 PMCID: PMC7922007 DOI: 10.3390/ijms22041988] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/08/2021] [Accepted: 02/11/2021] [Indexed: 02/06/2023] Open
Abstract
Metabolic syndrome (MetS) and infertility are two afflictions with a high prevalence in the general population. MetS is a global health problem increasing worldwide, while infertility affects up to 12% of men. Despite the high prevalence of these conditions, the possible impact of MetS on male fertility has been investigated by a few authors only in the last decade. In addition, underlying mechanism(s) connecting the two conditions have been investigated in few preclinical studies. The aim of this review is to summarize and critically discuss available clinical and preclinical studies on the role of MetS (and its treatment) in male fertility. An extensive Medline search was performed identifying studies in the English language. While several studies support an association between MetS and hypogonadism, contrasting results have been reported on the relationship between MetS and semen parameters/male infertility, and the available studies considered heterogeneous MetS definitions and populations. So far, only two meta-analyses in clinical and preclinical studies, respectively, evaluated this topic, reporting a negative association between MetS and sperm parameters, testosterone and FSH levels, advocating, however, larger prospective investigations. In conclusion, a possible negative impact of MetS on male reproductive potential was reported; however, larger studies are needed.
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Affiliation(s)
- Francesco Lotti
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, 50139 Florence, Italy; (F.L.); (S.M.)
| | - Sara Marchiani
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, 50139 Florence, Italy; (F.L.); (S.M.)
| | - Giovanni Corona
- Endocrinology Unit, Medical Department, Maggiore-Bellaria Hospital, Azienda-Usl Bologna, 40139 Bologna, Italy
- Correspondence:
| | - Mario Maggi
- Endocrinology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, 50139 Florence, Italy;
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Abstract
Due to rising human infertility, sperm motility has been an important subject. Among the hundreds of millions of sperms on the journey up the oviducts, only a few excellent travelers will reach the eggs. This journey is affected by many factors, some of which include sperm quality, sperm density, fluid rheology and chemotaxis. In addition, the sperm swimming through different body tracks and fluids involves complex sperm flagellar, complex fluid environment, and multi-sperm and sperm-wall interactions. Therefore, this topic has generated substantial research interest. In this paper, we present a review of computational studies on sperm swimming from an engineering perspective with focus on both simplified theoretical methods and fluid–structure interaction methods. Several open issues in this field are highlighted.
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64
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Lin Z, Lin R, Wu H, Wu L, Zeng J, Xu J, Dong F. Elastography for the differential diagnosis of malignant versus benign testicular lesions: a meta-analysis. Ultrasonography 2021; 40:465-473. [PMID: 33966362 PMCID: PMC8446503 DOI: 10.14366/usg.20191] [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: 11/28/2020] [Accepted: 02/02/2021] [Indexed: 12/20/2022] Open
Abstract
PURPOSE The aim of this study was to evaluate the value of elastography in the differential diagnosis of benign versus malignant testicular lesions. METHODS The PubMed, Cochrane Library, and Embase databases were searched for relevant studies. The diagnostic accuracy of elastography was evaluated using pooled sensitivity, specificity, likelihood ratio, post-test probability, diagnostic odds ratio, and by summarizing the area under the hierarchical summary receiver operating characteristic (HSROC) curve. RESULTS Seven studies with 568 lesions were included. The pooled sensitivity and specificity were 87% (95% confidence interval [CI], 81% to 92%) and 81% (95% CI, 65% to 90%), respectively. The pooled estimates of the positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 4.48 (95% CI, 2.37 to 8.47), 0.16 (95% CI, 0.10 to 0.25), and 28.11 (95% CI, 11.39 to 69.36), respectively. The area under the HSROC curve was 90% (95% CI, 88% to 93%). CONCLUSION Elastography is useful for assessing the stiffness of testicular lesions and for differentiating benign from malignant lesions. Elastography can be an effective supplement to conventional ultrasonography.
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Affiliation(s)
- Ziwei Lin
- Department of Ultrasound, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical College of Jinan University, Shenzhen People's Hospital, Shenzhen, China
| | - Rui Lin
- Department of Ultrasound, Shenzhen Luohu Maternity and Child Healthcare Hospital, Shenzhen, China
| | - Huaiyu Wu
- Department of Ultrasound, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical College of Jinan University, Shenzhen People's Hospital, Shenzhen, China
| | - Linghu Wu
- Department of Ultrasound, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical College of Jinan University, Shenzhen People's Hospital, Shenzhen, China
| | - Jieying Zeng
- Department of Ultrasound, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical College of Jinan University, Shenzhen People's Hospital, Shenzhen, China
| | - Jinfeng Xu
- Department of Ultrasound, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical College of Jinan University, Shenzhen People's Hospital, Shenzhen, China
| | - Fajin Dong
- Department of Ultrasound, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical College of Jinan University, Shenzhen People's Hospital, Shenzhen, China
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Agarwal A, Baskaran S, Parekh N, Cho CL, Henkel R, Vij S, Arafa M, Panner Selvam MK, Shah R. Male infertility. Lancet 2021; 397:319-333. [PMID: 33308486 DOI: 10.1016/s0140-6736(20)32667-2] [Citation(s) in RCA: 424] [Impact Index Per Article: 141.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 08/13/2020] [Accepted: 08/19/2020] [Indexed: 02/06/2023]
Abstract
It is estimated that infertility affects 8-12% of couples globally, with a male factor being a primary or contributing cause in approximately 50% of couples. Causes of male subfertility vary highly, but can be related to congenital, acquired, or idiopathic factors that impair spermatogenesis. Many health conditions can affect male fertility, which underscores the need for a thorough evaluation of patients to identify treatable or reversible lifestyle factors or medical conditions. Although semen analysis remains the cornerstone for evaluating male infertility, advanced diagnostic tests to investigate sperm quality and function have been developed to improve diagnosis and management. The use of assisted reproductive techniques has also substantially improved the ability of couples with infertility to have biological children. This Seminar aims to provide a comprehensive overview of the assessment and management of men with infertility, along with current controversies and future endeavours.
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Affiliation(s)
- Ashok Agarwal
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA.
| | - Saradha Baskaran
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Neel Parekh
- Department of Urology, Cleveland Clinic, Cleveland, OH, USA
| | - Chak-Lam Cho
- SH Ho Urology Center, Department of Surgery, Chinese University of Hong Kong, Hong Kong
| | - Ralf Henkel
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA; Department of Medical Bioscience, University of Western Cape, Bellville, South Africa; Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Sarah Vij
- Department of Urology, Cleveland Clinic, Cleveland, OH, USA
| | - Mohamed Arafa
- Male Infertility Unit, Urology Department, Hamad Medical Corporation, Doha, Qatar; Andrology Department, Cairo University, Cairo, Egypt
| | | | - Rupin Shah
- Department of Urology, Lilavati Hospital and Research Center, Mumbai, India
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Sharma A, Minhas S, Dhillo WS, Jayasena CN. Male infertility due to testicular disorders. J Clin Endocrinol Metab 2021; 106:e442-e459. [PMID: 33295608 PMCID: PMC7823320 DOI: 10.1210/clinem/dgaa781] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Indexed: 12/13/2022]
Abstract
CONTEXT Male infertility is defined as the inability to conceive following 1 year of regular unprotected intercourse. It is the causative factor in 50% of couples and a leading indication for assisted reproductive techniques (ART). Testicular failure is the most common cause of male infertility, yet the least studied to date. EVIDENCE ACQUISITION The review is an evidence-based summary of male infertility due to testicular failure with a focus on etiology, clinical assessment, and current management approaches. PubMed-searched articles and relevant clinical guidelines were reviewed in detail. EVIDENCE SYNTHESIS/RESULTS Spermatogenesis is under multiple levels of regulation and novel molecular diagnostic tests of sperm function (reactive oxidative species and DNA fragmentation) have since been developed, and albeit currently remain as research tools. Several genetic, environmental, and lifestyle factors provoking testicular failure have been elucidated during the last decade; nevertheless, 40% of cases are idiopathic, with novel monogenic genes linked in the etiopathogenesis. Microsurgical testicular sperm extraction (micro-TESE) and hormonal stimulation with gonadotropins, selective estrogen receptor modulators, and aromatase inhibitors are recently developed therapeutic approaches for men with the most severe form of testicular failure, nonobstructive azoospermia. However, high-quality clinical trials data is currently lacking. CONCLUSIONS Male infertility due to testicular failure has traditionally been viewed as unmodifiable. In the absence of effective pharmacological therapies, delivery of lifestyle advice is a potentially important treatment option. Future research efforts are needed to determine unidentified factors causative in "idiopathic" male infertility and long-term follow-up studies of babies conceived through ART.
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Affiliation(s)
- Aditi Sharma
- Section of Endocrinology and Investigative Medicine, Imperial College London, UK
| | - Suks Minhas
- Department of Urology, Charing Cross Hospital, London, UK
| | - Waljit S Dhillo
- Section of Endocrinology and Investigative Medicine, Imperial College London, UK
| | - Channa N Jayasena
- Section of Endocrinology and Investigative Medicine, Imperial College London, UK
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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, Peraza Godoy MF, 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: Scrotal ultrasound reference ranges and associations with clinical, seminal, and biochemical characteristics. Andrology 2021; 9:559-576. [PMID: 33244893 DOI: 10.1111/andr.12951] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/19/2020] [Accepted: 11/23/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Scrotal color Doppler ultrasound (CDUS) still suffers from lack of standardization. Hence, the European Academy of Andrology (EAA) has promoted a multicenter study to assess the CDUS characteristics of healthy fertile men (HFM) to obtain normative parameters. OBJECTIVES To report and discuss the scrotal organs CDUS reference ranges and characteristics in HFM and their associations with clinical, seminal, and biochemical parameters. METHODS A cohort of 248 HFM (35.3 ± 5.9years) was studied, evaluating, on the same day, clinical, biochemical, seminal, and scrotal CDUS following Standard Operating Procedures. RESULTS The CDUS reference range and characteristics of the scrotal organs of HFM are reported here. CDUS showed a higher accuracy than physical examination in detecting scrotal abnormalities. Prader orchidometer (PO)- and US-measured testicular volume (TV) were closely related. The US-assessed TV with the ellipsoid formula showed the best correlation with the PO-TV. The mean TV of HFM was ~ 17 ml. The lowest reference limit for right and left testis was 12 and 11 ml, thresholds defining testicular hypotrophy. The highest reference limit for epididymal head, tail, and vas deferens was 12, 6, and 4.5 mm, respectively. Mean TV was associated positively with sperm concentration and total count and negatively with gonadotropins levels and pulse pressure. Subjects with testicular inhomogeneity or calcifications showed lower sperm vitality and concentration, respectively, than the rest of the sample. Sperm normal morphology and progressive motility were positively associated with epididymal head size/vascularization and vas deferens size, respectively. Increased epididymis and vas deferens sizes were associated with MAR test positivity. Decreased epididymal tail homogeneity/vascularization were positively associated with waistline, which was negatively associated with intratesticular vascularization. CDUS varicocele was detected in 37.2% of men and was not associated with seminal or hormonal parameters. Scrotal CDUS parameters were not associated with time to pregnancy, number of children, history of miscarriage. CONCLUSIONS The present findings will help in better understanding male infertility pathophysiology, improving its management.
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Affiliation(s)
- F Lotti
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - F Frizza
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - G Balercia
- Endocrinology Unit, Ospedali Riuniti Ancona, Polytechnic University of Marche, Ancona, Italy
| | - A Barbonetti
- Andrology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - H M Behre
- Center for Reproductive Medicine and Andrology, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - A E Calogero
- Department of Clinical and Experimental Medicine, University of Catania, Italy
| | - J F Cremers
- Department of Clinical and Surgical Andrology, Centre of Reproductive Medicine and Andrology, Münster University Hospital, Münster, Germany
| | - F Francavilla
- Andrology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - A M Isidori
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - S Kliesch
- Department of Clinical and Surgical Andrology, Centre of Reproductive Medicine and Andrology, Münster University Hospital, Münster, Germany
| | - S La Vignera
- Department of Clinical and Experimental Medicine, University of Catania, Italy
| | - A Lenzi
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - M Marcou
- Center for Reproductive Medicine and Andrology, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - A Pilatz
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University, Giessen, Germany
| | - O Poolamets
- Andrology Unit, Tartu University Hospital, Tartu, Estonia
| | - M Punab
- Andrology Unit, Tartu University Hospital, Tartu, Estonia
| | - M F Peraza Godoy
- Andrology Department, Fundació Puigvert, Universitat Autònoma de Barcelona, Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | - O Rajmil
- Andrology Department, Fundació Puigvert, Universitat Autònoma de Barcelona, Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | - G Salvio
- Endocrinology Unit, Ospedali Riuniti Ancona, Polytechnic University of Marche, Ancona, Italy
| | - O Shaeer
- Department of Andrology, Kasr El Aini Faculty of Medicine, Cairo University, Cairo, Egypt
| | - W Weidner
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University, Giessen, Germany
| | - E Maseroli
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - S Cipriani
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - E Baldi
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - S Degl'Innocenti
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - G Danza
- Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - A L Caldini
- Department of Laboratory, Careggi Hospital, Florence, Italy
| | - A Terreni
- Department of Laboratory, Careggi Hospital, Florence, Italy
| | - L Boni
- Clinical Trials Coordinating Center, Toscano Cancer Institute, University Hospital Careggi, Florence, Italy
| | - C Krausz
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - M Maggi
- Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
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Garolla A, Pizzol D, Carosso AR, Borini A, Ubaldi FM, Calogero AE, Ferlin A, Lanzone A, Tomei F, Engl B, Rienzi L, De Santis L, Coticchio G, Smith L, Cannarella R, Anastasi A, Menegazzo M, Stuppia L, Corsini C, Foresta C. Practical Clinical and Diagnostic Pathway for the Investigation of the Infertile Couple. Front Endocrinol (Lausanne) 2021; 11:591837. [PMID: 33542705 PMCID: PMC7851076 DOI: 10.3389/fendo.2020.591837] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 11/25/2020] [Indexed: 01/23/2023] Open
Abstract
Capsule This expert opinion summarizes current knowledge on risk factors for infertility and identifies a practical clinical and diagnostic approach for the male and female partners of an infertile couple aimed to improve the investigation and management of fertility problems. Background Infertility represents an important and growing health problem affecting up to 16% of couples worldwide. In most cases, male, female, or combined factor can be identified, and different causes or risk factors have been related to this condition. However, there are no standardized guidelines on the clinical-diagnostic approach of infertile couples and the recommendations concerning infertility are sometimes lacking, incomplete, or problematic to apply. Objective The aim of this work is to provide an appropriate clinical and diagnostic pathway for infertile couples designed by a multidisciplinary-team of experts. The rationale is based on the history and physical examination and then oriented on the basis of initial investigations. This approach could be applied in order to reduce variation in practice and to improve the investigation and management of fertility problems. Methods Prominent Italian experts of the main specialties committed in the ART procedures, including gynecologists, andrologists, embryologists, biologists, geneticists, oncologists, and microbiologists, called "InfertilItaly group", used available evidence to develop this expert position. Outcomes Starting from the individuation of the principal risk factors that may influence the fertility of females and males and both genders, the work group identified most appropriate procedures using a gradual approach to both partners aimed to obtain a precise diagnosis and the most effective therapeutic option, reducing invasive and occasionally redundant procedures. Conclusions This expert position provides current knowledge on risk factors and suggests a diagnostic workflow of infertile couples. By using this step-by-step approach, health care workers involved in ART, may individuate a practical clinical management of infertile couples shared by experts.
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Affiliation(s)
- Andrea Garolla
- Section of Andrology and Reproductive Medicine & Centre for Male Gamete Cryopreservation, Department of Medicine, University of Padova, Padova, Italy
| | - Damiano Pizzol
- Section of Andrology and Reproductive Medicine & Centre for Male Gamete Cryopreservation, Department of Medicine, University of Padova, Padova, Italy
- Italian Agency for Development Cooperation, Public Health, Jerusalem, Israel
| | - Andrea Roberto Carosso
- Department of Surgical Sciences, Gynecology and Obstetrics 1, Physiopathology of Reproduction and IVF Unit, S. Anna Hospital, University of Torino, Torino, Italy
| | - Andrea Borini
- 9.baby, Family and Fertility Center, Tecnobios Procreazione, Bologna, Italy
| | | | - Aldo Eugenio Calogero
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Alberto Ferlin
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Antonio Lanzone
- Department of Woman’s Health Sciences of the Child and Public Health, Unit of Obstetrics Pathology, University Clinic Foundation “A Gemelli” IRCCS, Rome, Italy
- Clinic of Obstetrics and Gynecology, Catholic University Sacro Cuore, Rome, Italy
| | - Francesco Tomei
- Assisted Reproductive Unit, Santa Maria degli Angeli Hospital, Pordenone, Italy
| | - Bruno Engl
- Donna Salus, Center for Women’s Health and Fertility, Bolzano, Italy
| | - Laura Rienzi
- GENERA Centre for Reproductive Medicine, Clinica Valle Giulia, Rome, Italy
| | - Lucia De Santis
- IVF Unit, Gynaecological-Obstetric Department, IRCCS San Raffaele Hospital, Vita-Salute University, Milan, Italy
- Italian Society of Embryology, Reproduction and Research (SIERR), Giarre, Italy
| | - Giovanni Coticchio
- 9.baby, Family and Fertility Center, Tecnobios Procreazione, Bologna, Italy
| | - Lee Smith
- The Cambridge Centre for Sport & Exercise Sciences, Anglia Ruskin University, Cambridge, United Kingdom
| | - Rossella Cannarella
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Attilio Anastasi
- Center for Physiopathology of Human Reproduction, Delta Hospital, Lagosanto, Italy
| | - Massimo Menegazzo
- Section of Andrology and Reproductive Medicine & Centre for Male Gamete Cryopreservation, Department of Medicine, University of Padova, Padova, Italy
| | - Liborio Stuppia
- Department of Psychological, Health and Territorial Sciences, School of Medicine and Health Sciences, “G. d’Annunzio” University, Chieti, Italy
- Center for Advanced Studies and Technology (CAST), “G. d’Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - Christian Corsini
- Section of Andrology and Reproductive Medicine & Centre for Male Gamete Cryopreservation, Department of Medicine, University of Padova, Padova, Italy
| | - Carlo Foresta
- Section of Andrology and Reproductive Medicine & Centre for Male Gamete Cryopreservation, Department of Medicine, University of Padova, Padova, Italy
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Abd Elrahman MM, El Makawy AI, Hassanane MS, Alam SS, Hassan NHA, Amer MK. Assessment of correlation between asthenozoospermia and mitochondrial DNA mutations in Egyptian infertile men. J Genet Eng Biotechnol 2021; 19:11. [PMID: 33459881 PMCID: PMC7813956 DOI: 10.1186/s43141-020-00111-0] [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: 10/05/2020] [Accepted: 12/25/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Asthenozoospermia is a chief reason for male seminal pathologies with an impression of around 19% of infertile patients. Spermatozoa mitochondrial DNA variations seem to link with low sperm motility. The objective of the study was to assess the relation between mitochondrial mutations and male sterility, especially in asthenozoospermia. The patient semen samples were investigated by studying the sperm physical characters; motility, viability, and morphological parameters were then classified into normozoospermia and asthenozoospermia. In addition, the level of malondialdehyde (MDA) as a bio-indicator of lipid peroxidation, seminal fructose, and total antioxidant capacity (TAC) were estimated. For molecular analysis, DNA from the semen samples was extracted using a DNA extraction kit. ND1, ND2, and ATPase6 genes were amplified by using a specific primer. After the purification procedure, each PCR product was sequenced to identify the single nucleotide polymorphisms (SNPs) in selected genes. RESULTS A significant negative correlation between seminal plasma malondialdehyde levels and sperm motility was detected. Meanwhile, TAC analysis revealed significantly lower activity (p ≤ 0.05) in the sample of asthenozoospermic than in normozoospermic men. As regards the seminal plasma fructose, there was no significant difference in the fructose level of normozoospermia and asthenozoospermia cases. At the molecular level, 31 diverse nucleotide substitutions were recognized in mitochondrial DNA. Only ten (10) mutations led to amino acid transformation: four have deleterious effects, four are benign, and the other two have conflicting effectiveness. CONCLUSIONS This study is the first in Egypt that is concerned with studying the relationship between the mitochondrial DNA mutations in human spermatozoa of asthenozoospermic patients and fertility. The results displayed scientific indications evidenced that there is an association between mitochondrial mutations and male infertility.
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Affiliation(s)
- Mohamed M Abd Elrahman
- Cell Biology Dept. , Division of Genetic Engineering and Biotechnology Research, National Research Centre, 33 El Bohouth St., Dokki, P.O.12622, Giza, Egypt
| | - Aida I El Makawy
- Cell Biology Dept. , Division of Genetic Engineering and Biotechnology Research, National Research Centre, 33 El Bohouth St., Dokki, P.O.12622, Giza, Egypt.
| | - Mohamed S Hassanane
- Cell Biology Dept. , Division of Genetic Engineering and Biotechnology Research, National Research Centre, 33 El Bohouth St., Dokki, P.O.12622, Giza, Egypt
| | - Sally S Alam
- Cell Biology Dept. , Division of Genetic Engineering and Biotechnology Research, National Research Centre, 33 El Bohouth St., Dokki, P.O.12622, Giza, Egypt
| | - Nagwa H A Hassan
- Zoology Dept., Faculty of Science, Ain Shams University, Cairo, Egypt
| | - Medhat K Amer
- Surgery Andrology and infertility Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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Imaging in scrotal trauma: a European Society of Urogenital Radiology Scrotal and Penile Imaging Working Group (ESUR-SPIWG) position statement. Eur Radiol 2021; 31:4918-4928. [DOI: 10.1007/s00330-020-07631-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/16/2020] [Accepted: 12/11/2020] [Indexed: 02/08/2023]
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71
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D’Andrea S, Martorella A, Castellini C, Cordeschi G, Totaro M, Parisi A, Francavilla F, Necozione S, Francavilla S, Barbonetti A. Clinical and seminal parameters associated with testicular microlithiasis and its severity in males from infertile couples. Hum Reprod 2021; 36:891-898. [DOI: 10.1093/humrep/deaa354] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 10/27/2020] [Indexed: 12/30/2022] Open
Abstract
Abstract
STUDY QUESTION
Is there an association of testicular microlithiasis (TM) and its severity with testicular dysfunction in men from infertile couples?
SUMMARY ANSWER
The presence of ≥5 testis microcalcifications per sonogram at the scrotal ultrasonography (US) of infertile males was associated with a more severe testicular dysfunction as compared to males with limited, or without, TM.
WHAT IS KNOWN ALREADY
TM, representing an incidental finding in the scrotal US, is associated with male infertility and a higher risk for testicular cancer as compared to that in infertile males without TM. Still, there are unresolved questions on the relation between TM severity and testicular dysfunction in infertile men, as well as on the identification of risk factors for TM.
STUDY DESIGN, SIZE, DURATION
This study was an observational, retrospective, case-control investigation involving males who underwent clinical evaluation, measurement of reproductive hormones, seminal analysis and scrotal US as part of diagnostic work-up for couple infertility at an andrology clinic, between January 2004 and December 2018. One hundred patients, out of the 2112 scored men, were found to have TM during the US evaluation. One hundred male partners from 100 infertile couples without TM, comprising the control group, were selected through a matched analysis by age and date of evaluation to reduce the confounding effect of both age and technique variability all along the long period of observation.
PARTICIPANTS/MATERIALS, SETTING, METHODS
TM was defined as limited TM (LTM) or classical TM (CTM), when the maximum number of hyperecogenic spots per sonogram was <5 or ≥5, respectively. CTM, LTM and control groups were compared for clinical variables, serum levels of FSH, LH, and total testosterone, as well for semen parameters and scrotal US features.
MAIN RESULTS AND THE ROLE OF CHANCE
After the exclusion of cases with testicular nodules to eliminate the possible confounding effect of testis cancer on testicular dysfunction, cases with CTM showed a lower mean testis volume (P = 0.03) and a lower sperm concentration (P = 0.03) as compared to the other two groups. A higher FSH level was observed in the CTM group compared to the LTM group (P = 0.02) and in controls (P = 0.009). The multiple logistic regression analysis showed that only a smaller testicle volume exhibited an independent significant association with a higher odds of detecting CTM (odds ratio = 0.84, 95% CI: 0.75–0.94; P = 0.02). No significant differences were observed between groups in the prevalence of risk factors for testicular cancer, or in the prevalence of conditions associated with TM.
LIMITATIONS, REASONS FOR CAUTION
The retrospective design of the study did not allow conclusions to be drawn about the possible underlying links in the associations of TM with defective spermatogenesis.
WIDER IMPLICATIONS OF THE FINDINGS
Males from infertile couples who exhibit a reduced testicular volume should undergo scrotal US, independent of sperm parameters, to exclude CTM and, eventually, testis cancer, although the association of CTM and current or future testis cancer risk is not yet clear. Evidence is provided here demonstrating that the presence of LTM has no clinical relevance in males from infertile couples.
STUDY FUNDING/COMPETING INTEREST(S)
Investigation was funded by Ministero dell’Università e della Ricerca, PRIN 2018, Italy. The authors have not declared any competing interests.
TRIAL REGISTRATION NUMBER
N/A
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Affiliation(s)
- S D’Andrea
- Andrology Unit, Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
| | - A Martorella
- Andrology Unit, Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
| | - C Castellini
- Andrology Unit, Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
| | - G Cordeschi
- Andrology Unit, Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
| | - M Totaro
- Andrology Unit, Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
| | - A Parisi
- Andrology Unit, Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
| | - F Francavilla
- Andrology Unit, Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
| | - S Necozione
- Epidemioloy Division, Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
| | - S Francavilla
- Andrology Unit, Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
| | - A Barbonetti
- Andrology Unit, Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
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Ates F, Durmaz MS, Sara HI, Kara T. Comparison of testicular vascularity via superb microvascular imaging in varicocele patients with contralateral normal testis and healthy volunteers. J Ultrasound 2021; 25:59-65. [PMID: 33409864 PMCID: PMC8964885 DOI: 10.1007/s40477-020-00553-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 12/13/2020] [Indexed: 11/27/2022] Open
Abstract
PURPOSE In this study, we aimed to determine vascular changes in the testes in patients with varicocele using the two-dimensional color superb microvascular imaging vascular index (2DcSMIVI) and compared them with those of the normal contralateral testes of the same patients as well as the normal testes of control subjects without varicocele. METHODS A total of 114 participants and 228 testes were included in the study. 63 patients with varicocele and 51 asymptomatic volunteers were included. In total, 70 testes with varicocele (group A), 56 normal contralateral testes (Group B), and 102 bilateral normal testes were classified (Group C). Participants' testicular volume and 2DcSMIVI values were obtained via superb microvascular imaging. Testes with varicocele were graded according to Sarteschi classification. RESULTS Statistically significant differences in mean testicular volume were observed among the three groups. The volume and 2DcSMIVI values of the varicocele side testes were significantly lower than those of groups B and C. Significant differences were also observed between Sarteschi grade and 2DcSMIVI values in group A. CONCLUSION We can determine impaired microcirculation of varicocele side testes quantitatively with the 2DcSMIVI technique, and obtained VI values can be used effectively in diagnosis and follow-up of the damage in testes. Our results show that 2DcSMIVI values can play a significant role in the evaluation of testicular blood flow as a predictive sign of testicular damage.
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Affiliation(s)
- Fatih Ates
- Department of Radiology, Medicine Faculty, Selçuk University, Konya, Turkey.
| | | | - Halil Ibrahim Sara
- Departments of Radiology, University of Health Sciences, Dr. Abdurrahman Yurtaslan, Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Turgay Kara
- Department of Radiology, Medicine Faculty, Sutcu İmam University, Kahramanmaraş, Turkey
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Garolla A, Petre GC, Francini-Pesenti F, De Toni L, Vitagliano A, Di Nisio A, Grande G, Foresta C. Systematic Review and Critical Analysis on Dietary Supplements for Male Infertility: From a Blend of Ingredients to a Rationale Strategy. Front Endocrinol (Lausanne) 2021; 12:824078. [PMID: 35185789 PMCID: PMC8854851 DOI: 10.3389/fendo.2021.824078] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 12/30/2021] [Indexed: 12/16/2022] Open
Abstract
CONTENT Dietary supplements (DS) for male infertility marketed in Italy were evaluated for composition, concentration of ingredients, and recommended daily dose. A systematic review of literature identified ingredients potentially effective on sperm parameters and their minimal effective daily dose (mED). OBJECTIVE This study was conducted in order to critically evaluate the composition and efficacy of DS marketed in Italy. DESIGN SETTING AND PARTICIPANTS This was a systematic review of randomized controlled trials. EVIDENCE ACQUISITION A formula allowed us to classify the expected efficacy of each DS, based on composition. Each DS was scored and included into three classes of expected efficacy: high, low, and none. EVIDENCE SYNTHESIS Among 24 supplements, 3 (12.5%) fall in high, 9 (37.5%) in lower, and 12 (50.0%) in no expected efficacy class. DS composition showed 36 substances, 18 with no literature on male fertility and 18 showing positive effect on sperm parameters, thus considered potentially active ingredients (PAI). All DS were mixtures of ingredients, containing from 2 to 17 different substances. Fifteen supplements (65.2%) contained at least 1 ingredient without evidence of efficacy and 21 formulations had PAI dosed below mED. Some PAI were associated to the improvement of specific sperm parameters. CONCLUSIONS DS were usually blends of many substances that are frequently employed at negligible dose or without any evidence of efficacy on male reproduction. Some ingredients have been demonstrated to be effective on specific sperm parameters by RCTs. We report a list of ingredients with potential efficacy on specific sperm parameters, aimed to allow a tailored use of DS. PATIENT SUMMARY The market of DS for male infertility offers products with potential efficacy in the improvement of sperm parameters but also many with uncertain effects. Based on current scientific literature, our study can help in the choice of DS that are more likely to be effective on specific sperm alterations, so providing the best supplementation for each patient.
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Affiliation(s)
- Andrea Garolla
- Unit of Andrology and Reproductive Medicine & Centre for Male Gamete Cryopreservation, Department of Medicine, University of Padova, Padova, Italy
- *Correspondence: Andrea Garolla,
| | - Gabriel Cosmin Petre
- Unit of Andrology and Reproductive Medicine & Centre for Male Gamete Cryopreservation, Department of Medicine, University of Padova, Padova, Italy
| | | | - Luca De Toni
- Unit of Andrology and Reproductive Medicine & Centre for Male Gamete Cryopreservation, Department of Medicine, University of Padova, Padova, Italy
| | - Amerigo Vitagliano
- Department of Women and Children’s Health, University of Padua, Padua, Italy
- Unit of Obstetrics and Gynecology, Madonna della Navicella Hospital, Venice, Italy
| | - Andrea Di Nisio
- Unit of Andrology and Reproductive Medicine & Centre for Male Gamete Cryopreservation, Department of Medicine, University of Padova, Padova, Italy
| | - Giuseppe Grande
- Unit of Andrology and Reproductive Medicine & Centre for Male Gamete Cryopreservation, Department of Medicine, University of Padova, Padova, Italy
| | - Carlo Foresta
- Unit of Andrology and Reproductive Medicine & Centre for Male Gamete Cryopreservation, Department of Medicine, University of Padova, Padova, Italy
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Letkiewicz S, Pilis K, Ślęzak A, Pilis A, Pilis W, Żychowska M, Langfort J. Eight Days of Water-Only Fasting Promotes Favorable Changes in the Functioning of the Urogenital System of Middle-Aged Healthy Men. Nutrients 2020; 13:nu13010113. [PMID: 33396948 PMCID: PMC7824351 DOI: 10.3390/nu13010113] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/16/2020] [Accepted: 12/29/2020] [Indexed: 12/03/2022] Open
Abstract
The aim of this study was to determine whether, after 8 days of water-only fasting, there are changes in the efficiency of the lower urinary tract, the concentration of sex hormones, and the symptoms of prostate diseases in a group of middle-aged men (n = 14). For this purpose, before and after 8 days of water-only fasting (subjects drank ad libitum moderately mineralized water), and the following somatic and blood concentration measurements were made: total prostate specific antigen (PSA-T), free prostate specific antigen (PSA-F), follicle stimulating hormone (FSH), luteotropic hormone (LH), prolactin (Pr), total testosterone (T-T), free testosterone (T-F), dehydroepiandrosterone (DHEA), sex hormone globulin binding (SHGB), total cholesterol (Ch-T), β-hydroxybutyrate (β-HB). In addition, prostate volume (PV), volume of each testis (TV), total volume of both testes (TTV), maximal urinary flow rate (Qmax), and International Prostate Symptom Score (IPSS) values were determined. The results showed that after 8 days of water-only fasting, Qmax and IPSS improved but PV and TTV decreased significantly. There was also a decrease in blood levels of PSA-T, FSH, P, T-T, T-F, and DHEA, but SHGB concentration increased significantly. These results indicate that 8 days of water-only fasting improved lower urinary tract functions without negative health effects.
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Affiliation(s)
- Sławomir Letkiewicz
- Department of Health Sciences, Jan Długosz University in Częstochowa, 42-200 Częstochowa, Poland; (S.L.); (A.Ś.); (A.P.); (W.P.)
- Urological and Andrological Clinic “Urogen”, 42-600 Tarnowskie Góry, Poland
| | - Karol Pilis
- Department of Health Sciences, Jan Długosz University in Częstochowa, 42-200 Częstochowa, Poland; (S.L.); (A.Ś.); (A.P.); (W.P.)
- Correspondence: ; Tel.: +48-34-365-5983 or +48-508-204-403
| | - Andrzej Ślęzak
- Department of Health Sciences, Jan Długosz University in Częstochowa, 42-200 Częstochowa, Poland; (S.L.); (A.Ś.); (A.P.); (W.P.)
| | - Anna Pilis
- Department of Health Sciences, Jan Długosz University in Częstochowa, 42-200 Częstochowa, Poland; (S.L.); (A.Ś.); (A.P.); (W.P.)
| | - Wiesław Pilis
- Department of Health Sciences, Jan Długosz University in Częstochowa, 42-200 Częstochowa, Poland; (S.L.); (A.Ś.); (A.P.); (W.P.)
| | - Małgorzata Żychowska
- Faculty of Physical Education, Department of Sport, Kazimierz Wielki University in Bydgoszcz, 85-091 Bydgoszcz, Poland;
| | - Józef Langfort
- Institute of Sport Sciences, The Jerzy Kukuczka Academy of Physical Education, 40-065 Katowice, Poland;
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Huang WL, Ding L, Yao JH, Hu HT, Gao Y, Xie XY, Lu MD, Deng CH, Xie Y, Wang Z. Testicular quantitative ultrasound: A noninvasive monitoring method for evaluating spermatogenic function in busulfan-induced testicular injury mouse models. Andrologia 2020; 53:e13927. [PMID: 33355959 DOI: 10.1111/and.13927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/08/2020] [Accepted: 11/12/2020] [Indexed: 12/19/2022] Open
Abstract
Busulfan-induced testicular injury mouse models are commonly used for experiments on spermatogonial stem cell transplantation, treatments for azoospermia due to spermatogenic failure and preserving male fertility after chemotherapy. Here, we investigated the value of testicular quantitative ultrasound for evaluating spermatogenic function in this model. In this study, testicular ultrasound was performed on mice from day 0 to 126 after busulfan treatment (n = 48), and quantitative data, including the testicular volume, mean pixel intensity and pixel uniformity, were analysed. The results revealed that from day 0 to 36, the testicular volume was positively associated with the testicle-to-body weight ratio (r = .92). On day 63, the pixel uniformity, which remained stable from day 0 to 36, declined significantly compared with that on day 36 (p < .01). On day 126, when the whole progression of spermatogenesis could be observed in most tubules, the mean pixel intensity also returned to normal (p > .05). In conclusion, testicular quantitative ultrasound could be used as a noninvasive and accurate monitoring method for evaluating spermatogenic function in busulfan-induced testicular injury mouse models.
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Affiliation(s)
- Wan-Ling Huang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Li Ding
- Department of Pathology, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jia-Hui Yao
- Department of Andrology, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Hang-Tong Hu
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yong Gao
- Reproductive Medicine Center, the Key Laboratory for Reproductive Medicine of Guangdong Province, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiao-Yan Xie
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Ming-De Lu
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Chun-Hua Deng
- Department of Andrology, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yun Xie
- Department of Andrology, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Zhu Wang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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Research-supported mobile applications and internet-based technologies to mediate the psychological effects of infertility: a review. Reprod Biomed Online 2020; 42:679-685. [PMID: 33487558 DOI: 10.1016/j.rbmo.2020.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 11/09/2020] [Accepted: 12/08/2020] [Indexed: 12/27/2022]
Abstract
Infertility is a chronic condition commonly accompanied by psychological and emotional distress. A significant contributor to the discontinuation of infertility treatment is the psychological burden of treatment. Many individuals experiencing infertility report high levels of depression and anxiety. Unfortunately, barriers to traditional individual and couples counselling include stigmatization, finances, trepidation, challenges of travel and uncertainty. New technology, such as mobile applications and internet-based programmes, may be a feasible option for reducing the emotional distress of infertility diagnoses and treatments. This review focuses on current and developing technologies designed to decrease emotional distress in individuals with infertility.
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Abstract
PURPOSE OF REVIEW Several studies suggest a strong association between leptin, obesity, and infertility with respect to the hypothalamic-pituitary-gonadal (HPG) axis, androgen regulation, and sperm production, but the direct mechanistic association between these is still largely unexplored. This review focuses on understanding the association between leptin, obesity, and male infertility. RECENT FINDINGS Obesity is linked to fertility dysfunction in both genders. Obesity in men may affect their fertility by impaired spermatogenesis, reduced testosterone levels, erectile dysfunction, and poor libido by putatively targeting the HPG and hypothalamic-pituitary-adrenal axes. Leptin plays key roles in many metabolic functions, including reproduction. High concentrations of leptin have been found in infertile men with disorders affecting the testicular parenchyma, including nonobstructive azoospermia, oligozoospermia, and oligo-astheno-teratozoospermia. Additionally, serum leptin levels have negative associations with serum testosterone levels and sperm parameters and positive associations with serum follicle-stimulating hormone and luteinizing hormone levels and abnormal sperm morphology. SUMMARY Excessive leptin production may be a significant contributor to the development of androgen insufficiency and reduced reproductive function in obese men. Understanding the relation between leptin, obesity, and reproduction may shed light on future targeted treatments for male infertility.
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Huyghe E, Boitrelle F, Methorst C, Mieusset R, Ray PF, Akakpo W, Koscinski I, Chalas C, Rives N, Plotton I, Robin G, El Osta R, Hennebicq S, Eustache F, Marcelli F, Lejeune H. [AFU and SALF recommendations for the evaluation of male infertility]. Prog Urol 2020; 31:131-144. [PMID: 33309127 DOI: 10.1016/j.purol.2020.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/20/2020] [Accepted: 09/10/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND The aim of these Association Française d'Urologie (AFU) and Société d'Andrologie de Langue Française (SALF) common recommendations are to provide practice guidelines for the French Urological and Andrological community regarding the evaluation of infertile men. MATERIAL AND METHODS Literature search in PubMed using the keywords "male infertility", "diagnosis", "management" and "evaluation" limited to clinical articles in English and French prior to 1/01/2020. To inform the level of evidence, the HAS grading system (2013) was applied. RESULTS Concerning the evaluation of infertile men, the AFU and the SALF recommend : (1) a systematic interview exploring the family history, the fertility history of the man outside the couple, the patient's personal history that may have an impact on his fertility, lifestyle habits, treatments, symptoms and possible sexual difficulties of the couple; (2) a general physical examination to assess signs of hypogonadism and secondary sexual characters; (3) a scrotal physical examination performed by an urologist or andrologist to assess (i) the testes for volume and consistency, (ii) vas deferens and epididymes for total or partial absence or nodules, and (iii) presence of varicoceles; (4) Performing two semen analyses, according to World Health Organization guidelines, if the first one has at least one abnormaly; (5) a scrotal ultrasound as part of routine investigation, that can be completed with an endorectal pelvic ultrasound according to the clinic; (6) an endocrine evaluation with at least a Testosterone and FSH serum determination; (7) Karyotype analysis in infertile men with a sperm concentration ≤10 106/mL; (8) assessment of Yq microdeletions in infertile men with a sperm concentration ≤1 106/mL; (9) Cystic fibrosis transmembrane conductance regulator gene evaluation in case of suspicion for bilateral or unilateral congenital agenesis of vas deferens and seminal vesicles. The interest of tests analyzing DNA fragmentation (TUNEL, SCSA) is still under investigation. CONCLUSION These guidelines can be applied in routine clinical practice in all infertile men.
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Affiliation(s)
- Eric Huyghe
- Département d'Urologie, Transplantation Rénale et Andrologie, CHU de Toulouse, site de Rangueil, Toulouse, France; Médecine de la Reproduction, CHU de Toulouse, site de Paule de Viguier, Toulouse, France.
| | - Florence Boitrelle
- Service de gynécologie-obstétrique, CHI Poissy/Saint-Germain-en-Laye, Poissy, France
| | | | - Roger Mieusset
- Médecine de la Reproduction, CHU de Toulouse, site de Paule de Viguier, Toulouse, France
| | - Pierre F Ray
- Service de Biologie, Génétique de la reproduction, CHU de Grenoble, France
| | - William Akakpo
- Service d'Urologie, Hôpital universitaire de la Pitié Salpêtrière, APHP, Paris, France
| | | | - Céline Chalas
- Service d'Histologie, embryologie, cytologie, Hôpital Cochin, APHP, Paris, France
| | - Nathalie Rives
- Laboratoire de Biologie de la Reproduction, CECOS, CHU de Rouen, France
| | - Ingrid Plotton
- Service de médecine de la reproduction, Hôpital Femme Mère Enfant, HCL, Bron, France
| | - Geoffroy Robin
- Service de gynécologie, Médecine de la reproduction, Hôpital Jeanne de Flandres, CHRU de Lille, France
| | | | | | | | | | - Hervé Lejeune
- Service de médecine de la reproduction, Hôpital Femme Mère Enfant, HCL, Bron, France
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Delbarba A, Facondo P, Fisogni S, Izzi C, Maffezzoni F, Pezzaioli LC, Di Lodovico E, Facchetti F, Cappelli C, Scolari F, Ferlin A. Testicular Involvement is a Hallmark of Apo A-I Leu75Pro Mutation Amyloidosis. J Clin Endocrinol Metab 2020; 105:5897040. [PMID: 32841328 DOI: 10.1210/clinem/dgaa587] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/19/2020] [Indexed: 01/19/2023]
Abstract
CONTEXT Apo A-I Leu75Pro is a rare hereditary form of amyloidosis that mainly involves the kidney, the liver, and the testis. OBJECTIVE To define the characteristics of organ damage and testis impairment in the largest cohort collected to date of men with Apo A-I Leu75Pro amyloidosis. DESIGN, SETTING, AND PATIENTS Retrospective study from a prospectively collected database of 129 male subjects >18 years with Apo A-I Leu75Pro amyloidosis from a reference center at the University Hospital of Brescia, Italy. MAIN OUTCOME MEASURES We evaluated liver and renal function, scrotal ultrasound, reproductive hormone levels, testis biopsy, hypogonadal symptoms, and fertility. RESULTS Progressive involvement of testis, kidney, and liver was observed in 96/129 (74.4%) cases. Testis impairment was found in 88/129 patients (68.2%), liver in 59 (45.7%) and renal in 50 (38.8%). Testis damage was often the first manifestation of the disease and the only dysfunction in 30% of younger patients (<38 years). Testicular involvement was characterized mainly by primary (73/88 patients, 83.0%) and subclinical (8/88, 9.1%) hypogonadism. Almost all (85/88, 96.6%) also had high follicle-stimulating hormone, suggesting a primary global damage of endocrine and spermatogenic functions, and 30% of them did not conceive. Macroorchidism was found in 53/88 (60.2%) patients, especially in men <54 years (30/33, 90.9%). Apo A-I amyloid deposits were found in Sertoli cells, germinal epithelium, and vessel walls. CONCLUSION In men with Apo A-I Leu75Pro amyloidosis, testicular involvement is the hallmark of the disease, characterized by global primary testicular dysfunction and macroorchidism due to amyloid deposits.
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Affiliation(s)
- Andrea Delbarba
- Unit of Endocrinology and Metabolism, ASST Spedali Civili Brescia, Brescia, Italy
| | - Paolo Facondo
- Department of Clinical and Experimental Sciences, Unit of Endocrinology and Metabolism, University of Brescia and ASST Spedali Civili Brescia, Brescia, Italy
| | - Simona Fisogni
- Department of Molecular and Translational Medicine, Pathology Unit, University of Brescia and ASST Spedali Civili Brescia, Brescia, Italy
| | - Claudia Izzi
- Prenatal Diagnosis Unit, Department of Obstetrics and Gynecology, ASST Spedali Civili, Brescia, Italy
- Division of Nephrology and Dialysis, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia and ASST Spedali Civili Brescia, Brescia, Italy
| | - Filippo Maffezzoni
- Unit of Endocrinology and Metabolism, ASST Spedali Civili Brescia, Brescia, Italy
| | - Letizia Chiara Pezzaioli
- Department of Clinical and Experimental Sciences, Unit of Endocrinology and Metabolism, University of Brescia and ASST Spedali Civili Brescia, Brescia, Italy
| | - Elena Di Lodovico
- Department of Clinical and Experimental Sciences, Unit of Endocrinology and Metabolism, University of Brescia and ASST Spedali Civili Brescia, Brescia, Italy
| | - Fabio Facchetti
- Department of Molecular and Translational Medicine, Pathology Unit, University of Brescia and ASST Spedali Civili Brescia, Brescia, Italy
| | - Carlo Cappelli
- Department of Clinical and Experimental Sciences, Unit of Endocrinology and Metabolism, University of Brescia and ASST Spedali Civili Brescia, Brescia, Italy
| | - Francesco Scolari
- Division of Nephrology and Dialysis, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia and ASST Spedali Civili Brescia, Brescia, Italy
| | - Alberto Ferlin
- Department of Clinical and Experimental Sciences, Unit of Endocrinology and Metabolism, University of Brescia and ASST Spedali Civili Brescia, Brescia, Italy
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Abstract
Male infertility secondary to oligozoospermia is surprisingly common. Although a majority of cases are idiopathic, oligozoospermia can be caused by endocrine dysfunction, anatomic abnormalities, medications, or environmental exposures. The work-up includes excluding reversible factors such as hormonal deficiency, medication effects, and retrograde ejaculation and identifying any underlying genetic syndrome and treating reversible medical causes. If no reversible cause is found, appropriate referrals to urology and assisted reproductive technology should be initiated. Lastly, clinicians should be aware of and respond to the psychological and general health ramifications of a diagnosis of oligozoospermia as part of the comprehensive care of men and couples struggling with a diagnosis of infertility.
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Affiliation(s)
- Jeremy T Choy
- Divisions of Endocrinology, Metabolism and Nutrition, University of Washington School of Medicine, Seattle, WA, US
- Men’s Health Clinic, University of Washington School of Medicine, Seattle, WA, US
| | - John K Amory
- General Internal Medicine; Department of Medicine, the Department of Urology, University of Washington School of Medicine, Seattle, WA, US
- Correspondence and Reprint Requests: John K. Amory MD, MPH, MSc, Professor of Medicine, University of Washington, Box 356429, 1959 NE Pacific St., Seattle, WA 98195. E-mail:
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81
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La Vignera S, Condorelli RA, Duca Y, Mongioi LM, Cannarella R, Giacone F, Calogero AE. FSH therapy for idiopathic male infertility: four schemes are better than one. Aging Male 2020; 23:750-755. [PMID: 30942139 DOI: 10.1080/13685538.2019.1590696] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE The aim of this article is to propose an algorithm that aids the clinician to choose the best therapeutic scheme of follicle-stimulating hormone (FSH) in the treatment of men with idiopathic infertility, based on testicular volume (TV) and serum total testosterone concentrations; highlighting the potential role of additional therapy with hCG in a sequential temporal scheme. MATERIALS AND METHODS We subdivided patients in four clinical groups: patients with normal TV and serum testosterone concentrations (A); patients with normal TV and reduced serum testosterone concentrations (B); patients with reduced TV and serum testosterone concentration (C); patient with low TV e normal serum testosterone concentrations (D). Then, we administered to each group a specific therapeutic scheme. Group A: treated with FSH alone for at least 3 months; group B: treated with hCG alone twice a week for 3 months and addition of FSH for poor responders (unmodified sperm parameters); group C: treated ab initio with FSH and hCG until the pregnancy was reached; group D: treated with FSH alone for 3 months and addition of hCG for moderate poor responders (increased TV but unmodified sperm parameters) or second cycle of FSH for 3 months for severe poor responders (unmodified TV and sperm parameters). After 6 months we evaluated the therapeutic response in term of sperm parameters normalization rate, spontaneous pregnancy rate, and sperm DNA fragmentation normalization rate. RESULTS 40% of patients became normozoospermic after treatment, while 30% achieved spontaneous pregnancy. B was the group that best responded to treatment in terms of normalization of seminal parameters; while the highest spontaneous pregnancy rate was obtained from the D group. B group also obtained the highest sperm DNA fragmentation normalization rate. CONCLUSIONS To date, no reliable predictors of response to treatment with FSH exist, but TV and serum testosterone concentrations can help the clinician to choose the best therapeutic scheme for men with idiopathic infertility. The groups treated with a sequential temporal scheme (B and D groups) showed better clinical results compared with two groups treated with conventional schemes (A and C groups).
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Affiliation(s)
- Sandro La Vignera
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Rosita A Condorelli
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Ylenia Duca
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Laura M Mongioi
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Rossella Cannarella
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Filippo Giacone
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Aldo E Calogero
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
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82
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D'Andrea S, Castellini C, Minaldi E, Totaro M, Felzani G, Francavilla S, Francavilla F, Barbonetti A. Testosterone, level of the lesion and age are independently associated with prostate volume in men with chronic spinal cord injury. J Endocrinol Invest 2020; 43:1599-1606. [PMID: 32248510 DOI: 10.1007/s40618-020-01243-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 03/29/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Although men with spinal cord injury (SCI) exhibit a prostate volume significantly smaller compared to age-matched able-bodied men, the independent association of lower prostate volume with its putative determinants has never been analyzed in this population. This study was designed to identify variables independently associated with prostate volume in men with chronic SCI. METHODS In this cross-sectional study, prostate volume of 138 men with chronic (> 1 years) SCI, aged 54.5 (25th-75th percentile: 36.0-66.0) years, was evaluated with trans-rectal ultrasonography. All patients underwent a complete neurological exam, as well as biochemical and hormonal assessment, including total testosterone (TT) levels. Free testosterone levels were calculated (cFT) by the Vermeulen formula. RESULTS The median prostate volume was 23.4 mL. At the univariate analysis, a larger prostate volume was associated with higher TT (p = 0.00001) and cFT (p = 0.001), SCI level below T12 (p = 0.007), more advanced age (p = 0.04), lower body mass index (p = 0.04), higher functional independence score (p = 0.06), higher values of prostate-specific antigen (p = 0.12) and shorter duration of the injury (p = 0.21). However, at the multiple regression analyses, an independent and positive association only persisted between the prostate volume with either TT or cFT levels, and, to a lesser extent, with age and a level of spinal lesion below T12. A prostate volume below the median value was observed in 91.4% (32/35) of patients with both androgen deficiency (TT < 264 ng/dL) and spinal lesion level ≥ T12, but only in 16.5% (2/12) of patients with both normal androgen levels and spinal lesion level below T12 (p < 0.001). CONCLUSIONS Our data indicate that lower testosterone levels and, to a lesser extent, a younger age and a spinal lesion level ≥ T12 represent the only variables exhibiting an independent association with a smaller prostate volume in men with SCI.
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Affiliation(s)
- S D'Andrea
- Andrology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, Piazzale Tommasi 1, 67100, L'Aquila, Italy
- Spinal Unit, San Raffaele Institute of Sulmona, Sulmona, Italy
| | - C Castellini
- Andrology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, Piazzale Tommasi 1, 67100, L'Aquila, Italy
| | - E Minaldi
- Andrology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, Piazzale Tommasi 1, 67100, L'Aquila, Italy
| | - M Totaro
- Andrology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, Piazzale Tommasi 1, 67100, L'Aquila, Italy
| | - G Felzani
- Spinal Unit, San Raffaele Institute of Sulmona, Sulmona, Italy
| | - S Francavilla
- Andrology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, Piazzale Tommasi 1, 67100, L'Aquila, Italy
| | - F Francavilla
- Andrology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, Piazzale Tommasi 1, 67100, L'Aquila, Italy
| | - A Barbonetti
- Andrology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, Piazzale Tommasi 1, 67100, L'Aquila, Italy.
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83
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Cannarella R, Musso N, Condorelli RA, Musmeci M, Stefani S, La Vignera S, Calogero AE. Combined Effects of the FSHR 2039 A/G and FSHR -29 G/A Polymorphisms on Male Reproductive Parameters. World J Mens Health 2020; 39:516-525. [PMID: 33151046 PMCID: PMC8255408 DOI: 10.5534/wjmh.200070] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/29/2020] [Accepted: 09/07/2020] [Indexed: 01/15/2023] Open
Abstract
PURPOSE The aim of this study was to evaluate the combined effect of FSHR 2039 A/G and FSHR -29 G/A single nucleotide polymorphisms (SNPs) on the male reproductive function in a cohort of Sicilian men. MATERIALS AND METHODS One-hundred thirty Sicilian men were enrolled and underwent blood withdrawal for hormone measurement and FSHR 2039 A/G and FSHR -29 G/A SNP genotyping, testicular volume evaluation by ultrasound scan, and semen analysis. A meta-analysis of the FSHR -29 G/A SNP, evaluated in a previous study of the Sicilian population was done. RESULTS No genotype of the FSHR 2039 A/G SNP correlated with serum follicle-stimulating hormone (FSH) levels, testicular volume, sperm concentration, and total sperm count. In contrast, normozoospermic men with FSHR -29 GG and FSHR -29 GA genotypes had significantly lower sperm concentrations compared to men with the FSHR -29 AA genotype. The other sperm parameters did not show any significant difference. The meta-analysis showed no significant difference in serum FSH levels, testicular volume, sperm concentration, and total sperm count between FSHR -29 GG and FSHR -29 AA in Sicilian men. No difference was found even when the two SNPs were evaluated in combination. However, this combination was present, as expected, only in a low proportion (3.8%) of the men studied. CONCLUSIONS The SNPs FSHR 2039 A/G and FSHR -29 G/A in combination did not seem to have any effect on male reproductive function in a cohort of Sicilian men. The effect of these SNPs has only been studied in granulosa cells so far. Further studies on their role in Sertoli cells are needed.
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Affiliation(s)
- Rossella Cannarella
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.
| | - Nicolò Musso
- Department of Biomedical and Biotechnological Science, BIOMETEC, University of Catania, Catania, Italy
| | - Rosita A Condorelli
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Marco Musmeci
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Stefania Stefani
- Department of Biomedical and Biotechnological Science, BIOMETEC-Sect. of Microbiology, University of Catania, Catania, Italy
| | - Sandro La Vignera
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Aldo E Calogero
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
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84
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Yoo J, Je BK, Choo JY. Ultrasonographic Demonstration of the Tissue Microvasculature in Children: Microvascular Ultrasonography Versus Conventional Color Doppler Ultrasonography. Korean J Radiol 2020; 21:146-158. [PMID: 31997590 PMCID: PMC6992447 DOI: 10.3348/kjr.2019.0500] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 09/25/2019] [Indexed: 12/26/2022] Open
Abstract
Microvascular ultrasonographic imaging is the most recent and unique Doppler ultrasound technique. It uses an advanced clutter filter that can remove clutter artifacts and preserve the low-velocity microvascular flow signal. The potential advantages of microvascular ultrasonography are its superiority in detection and visualization of the small blood vessels in tissues, providing radiologists with more information on the vascular structures. Therefore, it has shown particular value in the clinical fields. The aim of this study was to provide microvascular ultrasonographic images for the tissue microvasculature, including the brain, thyroid gland, kidney, urinary bladder, small bowel, ovary, testis, lymph node, and hemangiomas in children, focusing on the comparison with conventional color Doppler ultrasonographic images.
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Affiliation(s)
- Joonghyun Yoo
- Department of Radiology, Korea University Hospital, Ansan, Korea
| | - Bo Kyung Je
- Department of Radiology, Korea University Hospital, Ansan, Korea.
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85
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Ultrasound evaluation of varicoceles: systematic literature review and rationale of the ESUR-SPIWG Guidelines and Recommendations. J Ultrasound 2020; 23:487-507. [PMID: 32720266 PMCID: PMC7588576 DOI: 10.1007/s40477-020-00509-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 07/11/2020] [Indexed: 02/02/2023] Open
Abstract
Although often asymptomatic and detected incidentally, varicocele is a relatively common problem in patients who seek medical attention for infertility problems. Ultrasound (US) is the imaging modality of choice for evaluation, but there is no consensus on the diagnostic criteria, classification, and examination technique. In view of this uncertainty, the Scrotal and Penile Imaging Working Group of the European Society of Urogenital Radiology (ESUR-SPIWG) undertook a systematic review of the available literature on this topic, to use as the basis for evidence-based guidelines and recommendations. This paper provides the results of the systematic review on which guidelines were constructed.
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86
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Pozza C, Kanakis G, Carlomagno F, Lemma A, Pofi R, Tenuta M, Minnetti M, Tarsitano MG, Sesti F, Paoli D, Anzuini A, Lenzi A, Isidori AM, Gianfrilli D. Testicular ultrasound score: A new proposal for a scoring system to predict testicular function. Andrology 2020; 8:1051-1063. [PMID: 32445591 PMCID: PMC7497152 DOI: 10.1111/andr.12822] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/12/2020] [Accepted: 05/14/2020] [Indexed: 12/18/2022]
Abstract
Background Testicular ultrasound (US) is routinely employed in the evaluation of reproductive and sexual function. However, its use for characteristics other than testicular volume is hampered by a lack of information on the prognostic value of its findings, which to date have only been incorporated in a score proposed by Lenz et al in 1993. Objectives We sought to explore whether testicular US examination can predict the quality of spermatogenesis and provide information on testicular endocrine function. Materials and methods We retrospectively reviewed 6210 testicular US examinations, finally selecting examinations from 2230 unique men. The following variables were considered: bitesticular volume and testicular asymmetry, parenchymal echotexture, echogenicity and presence of microlithiasis, solid lesions and varicocoele. Concurrent fasting hormonal data were available for 1160 men, while 979 had a semen sample available from the same day as the US examination. Results We derived a new US score, termed TU score, that can predict both impaired spermatogenesis (AUC 0.73, sensitivity 72%, specificity 61%, P < .001) and hypogonadism (AUC 0.71, sensitivity 71%, specificity 53%, P < .001) more accurately than the Lenz's score. In a multivariate analysis, a reduced sperm composite index (defined as total spermatozoa × total motility × normal forms) was independently predicted by bitesticular volume and by inhomogeneous echotexture, while hypogonadism was independently predicted also by reduced echogenicity and presence of microlithiasis. Discussion and conclusions We describe the testicular US characteristics that are independently associated with impaired spermatogenesis and hypogonadism and propose the TU score as a simple screening method for use in subjects referred for testicular US.
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Affiliation(s)
- Carlotta Pozza
- Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy
| | - George Kanakis
- Department of Endocrinology, Athens Naval & VA Hospital, Athens, Greece
| | | | - Andrea Lemma
- Department of Obstetrical and Gynaecological Sciences and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Riccardo Pofi
- Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Marta Tenuta
- Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Marianna Minnetti
- Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Maria G Tarsitano
- Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Franz Sesti
- Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Donatella Paoli
- Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Antonella Anzuini
- Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Andrea Lenzi
- Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Andrea M Isidori
- Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Daniele Gianfrilli
- Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy
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87
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Raison N, Warrington J, Alnajjar HM, Muneer A, Ahmed K. The role of partial orchidectomy in the management of small testicular tumours: Fertility and endocrine function. Andrology 2020; 8:988-995. [PMID: 32167663 DOI: 10.1111/andr.12786] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 01/31/2020] [Accepted: 03/10/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Radical orchidectomy in patients who are subsequently diagnosed with benign testicular tumours represents an overtreatment due to the deleterious effects on endogenous testosterone, fertility and body image. For these reasons, the option of partial orchidectomy (PO) should be considered in certain groups of patients. Patients with bilateral tumours (synchronous or metachronous) or a solitary testis where the lesion is no greater than 30% of the volume of the testis could be considered for a PO. Evidence has shown that PO is effective for small testicular masses with excellent survival and recurrence rates. OBJECTIVES Highlight the feasibility of maintaining post-operative fertility or normal semen parameters and endocrine function following PO. MATERIALS AND METHODS Data for this review were obtained through a search of the PubMed database. Papers were required to be in English and focus on adult human males. RESULTS Eligible and relevant papers were assessed for data regarding fertility, semen parameters and endocrine function following PO for a small testicular mass (STM). CONCLUSION It is possible to preserve both fertility and endocrine function after PO. Although patients may still require adjuvant radiotherapy for concomitant intratubular germ cell neoplasia (ITGCN) which results in subfertility, endocrine function is still conserved. However, it is possible to postpone radiotherapy and continue with clinical surveillance for the purposes of fertility preservation.
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Affiliation(s)
- Nicholas Raison
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, London, UK
| | - Jake Warrington
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, London, UK
| | - Hussain M Alnajjar
- Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Asif Muneer
- NIHR Biomedical Research Centre, University College London Hospital, London, UK
| | - Kamran Ahmed
- MRC Centre for Transplantation, Guy's Hospital Campus, King's College London, London, UK.,Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK.,Department of Urology, Kings College Hospital, Kings Health Partners, London, UK
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88
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From the Argonauts Mythological Sailors to the Argonautes RNA-Silencing Navigators: Their Emerging Roles in Human-Cell Pathologies. Int J Mol Sci 2020; 21:ijms21114007. [PMID: 32503341 PMCID: PMC7312461 DOI: 10.3390/ijms21114007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/01/2020] [Accepted: 06/01/2020] [Indexed: 12/27/2022] Open
Abstract
Regulation of gene expression has emerged as a fundamental element of transcript homeostasis. Key effectors in this process are the Argonautes (AGOs), highly specialized RNA-binding proteins (RBPs) that form complexes, such as the RNA-Induced Silencing Complex (RISC). AGOs dictate post-transcriptional gene-silencing by directly loading small RNAs and repressing their mRNA targets through small RNA-sequence complementarity. The four human highly-conserved family-members (AGO1, AGO2, AGO3, and AGO4) demonstrate multi-faceted and versatile roles in transcriptome’s stability, plasticity, and functionality. The post-translational modifications of AGOs in critical amino acid residues, the nucleotide polymorphisms and mutations, and the deregulation of expression and interactions are tightly associated with aberrant activities, which are observed in a wide spectrum of pathologies. Through constantly accumulating information, the AGOs’ fundamental engagement in multiple human diseases has recently emerged. The present review examines new insights into AGO-driven pathology and AGO-deregulation patterns in a variety of diseases such as in viral infections and propagations, autoimmune diseases, cancers, metabolic deficiencies, neuronal disorders, and human infertility. Altogether, AGO seems to be a crucial contributor to pathogenesis and its targeting may serve as a novel and powerful therapeutic tool for the successful management of diverse human diseases in the clinic.
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89
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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, Peraza Godoy MF, 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: clinical, seminal and biochemical characteristics. Andrology 2020; 8:1005-1020. [DOI: 10.1111/andr.12808] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 04/16/2020] [Accepted: 04/27/2020] [Indexed: 12/20/2022]
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 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 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
| | | | - Margus Punab
- Andrology Unit Tartu University Hospital Tartu Estonia
| | - Maria Fernanda Peraza Godoy
- Andrology Department Fundació Puigvert Universitat Autònoma de Barcelona Instituto de Investigaciones Biomédicas Sant Pau (IIB‐Sant Pau) Barcelona Spain
| | - Osvaldo Rajmil
- Andrology Department Fundació Puigvert Universitat Autònoma de Barcelona Instituto de Investigaciones Biomédicas Sant Pau (IIB‐Sant Pau) 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
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90
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Infertility: Practical Clinical Issues for Routine Investigation of the Male Partner. J Clin Med 2020; 9:jcm9061644. [PMID: 32486230 PMCID: PMC7356539 DOI: 10.3390/jcm9061644] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/25/2020] [Accepted: 05/27/2020] [Indexed: 02/06/2023] Open
Abstract
About one-fifth of couples has fertility problems in Western countries. Male factors are present in about half of them, either alone or in combination with female causes. Therefore, both partners should be evaluated simultaneously. The fertility status and/or specific conditions of each partner influence the clinical and treatment approach. This article summarizes in a practical way when, how, and why the male partner of an infertile couple should be investigated. The available evidence and international guidelines were used, interpreting, discussing, and expanding them from personal decades-long experience in this field. The aim is to delineate the most appropriate clinical approach for the male partner of infertile couples, considering traditional and emerging technologies and laboratory analyses in the context of their clinical significance. Components of the initial evaluation in men without known risk factors for infertility should include at minimum medical history, physical examination, and semen analysis. Semen microbiological examination, endocrine assessment, scrotal ultrasound, and transrectal ultrasound are suggested in most men and are mandatory when specific risk factors for male infertility are known to be present or when the initial screening demonstrated abnormalities. Full examination, including genetic tests, testicular histology, or additional tests on sperm, is clinically oriented and/or suggested after the results of initial investigations.
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91
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Garolla A, Petre GC, Francini-Pesenti F, De Toni L, Vitagliano A, Di Nisio A, Foresta C. Dietary Supplements for Male Infertility: A Critical Evaluation of Their Composition. Nutrients 2020; 12:nu12051472. [PMID: 32438678 PMCID: PMC7284793 DOI: 10.3390/nu12051472] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/15/2020] [Accepted: 05/18/2020] [Indexed: 12/16/2022] Open
Abstract
Dietary supplements (DS) represent a possible approach to improve sperm parameters and male fertility. A wide range of DS containing different nutrients is now available. Although many authors demonstrated benefits from some nutrients in the improvement of sperm parameters, their real effectiveness is still under debate. The aim of this study was to critically review the composition of DS using the Italian market as a sample. Active ingredients and their minimal effective daily dose (mED) on sperm parameters were identified through a literature search. Thereafter, we created a formula to classify the expected efficacy of each DS. Considering active ingredients, their concentration and the recommended daily dose, DS were scored into three classes of expected efficacy: higher, lower and none. Twenty-one DS were identified. Most of them had a large number of ingredients, frequently at doses below mED or with undemonstrated efficacy. Zinc was the most common ingredient of DS (70% of products), followed by selenium, arginine, coenzyme Q and folic acid. By applying our scoring system, 9.5% of DS fell in a higher class, 71.4% in a lower class and 19.1% in the class with no expected efficacy. DS marketed in Italy for male infertility frequently includes effective ingredients but also a large number of substances at insufficient doses or with no reported efficacy. Manufacturers and physicians should better consider the scientific evidence on effective ingredients and their doses before formulating and prescribing these products.
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Affiliation(s)
- Andrea Garolla
- Unit of Andrology and Reproductive Medicine & Centre for Male Gamete Cryopreservation, Department of Medicine, University of Padova, 35128 Padova, Italy; (G.C.P.); (L.D.T.); (A.D.N.); (C.F.)
- Correspondence:
| | - Gabriel Cosmin Petre
- Unit of Andrology and Reproductive Medicine & Centre for Male Gamete Cryopreservation, Department of Medicine, University of Padova, 35128 Padova, Italy; (G.C.P.); (L.D.T.); (A.D.N.); (C.F.)
| | | | - Luca De Toni
- Unit of Andrology and Reproductive Medicine & Centre for Male Gamete Cryopreservation, Department of Medicine, University of Padova, 35128 Padova, Italy; (G.C.P.); (L.D.T.); (A.D.N.); (C.F.)
| | - Amerigo Vitagliano
- Department of Women and Children’s Health, University of Padua, 35122 Padua, Italy;
- Unit of Obstetrics and Gynecology, Madonna della Navicella Hospital, Chioggia, 30015 Venice, Italy
| | - Andrea Di Nisio
- Unit of Andrology and Reproductive Medicine & Centre for Male Gamete Cryopreservation, Department of Medicine, University of Padova, 35128 Padova, Italy; (G.C.P.); (L.D.T.); (A.D.N.); (C.F.)
| | - Carlo Foresta
- Unit of Andrology and Reproductive Medicine & Centre for Male Gamete Cryopreservation, Department of Medicine, University of Padova, 35128 Padova, Italy; (G.C.P.); (L.D.T.); (A.D.N.); (C.F.)
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92
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Turner KA, Rambhatla A, Schon S, Agarwal A, Krawetz SA, Dupree JM, Avidor-Reiss T. Male Infertility is a Women's Health Issue-Research and Clinical Evaluation of Male Infertility Is Needed. Cells 2020; 9:cells9040990. [PMID: 32316195 PMCID: PMC7226946 DOI: 10.3390/cells9040990] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/13/2020] [Accepted: 04/14/2020] [Indexed: 02/06/2023] Open
Abstract
Infertility is a devastating experience for both partners as they try to conceive. Historically, when a couple could not conceive, the woman has carried the stigma of infertility; however, men and women are just as likely to contribute to the couple’s infertility. With the development of assisted reproductive technology (ART), the treatment burden for male and unexplained infertility has fallen mainly on women. Equalizing this burden requires reviving research on male infertility to both improve treatment options and enable natural conception. Despite many scientific efforts, infertility in men due to sperm dysfunction is mainly diagnosed by a semen analysis. The semen analysis is limited as it only examines general sperm properties such as concentration, motility, and morphology. A diagnosis of male infertility rarely includes an assessment of internal sperm components such as DNA, which is well documented to have an impact on infertility, or other components such as RNA and centrioles, which are beginning to be adopted. Assessment of these components is not typically included in current diagnostic testing because available treatments are limited. Recent research has expanded our understanding of sperm biology and suggests that these components may also contribute to the failure to achieve pregnancy. Understanding the sperm’s internal components, and how they contribute to male infertility, would provide avenues for new therapies that are based on treating men directly for male infertility, which may enable less invasive treatments and even natural conception.
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Affiliation(s)
- Katerina A. Turner
- Department of Biological Sciences, University of Toledo, Toledo, OH 43606, USA;
| | - Amarnath Rambhatla
- Department of Urology, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI 48202, USA;
| | - Samantha Schon
- Division of Reproductive Endocrinology & Infertility, Department of Obstetrics and Gynecology, University of Michigan Medical School, L4000 UH-South, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, USA;
| | - Ashok Agarwal
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH 44195, USA;
| | - Stephen A. Krawetz
- Department of Obstetrics and Gynecology, Center for Molecular Medicine and Genetics, C.S. Mott Center for Human Growth and Development, Wayne State University School of Medicine, Detroit, MI 48201, USA;
| | - James M. Dupree
- Department of Urology and Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI 48019, USA;
| | - Tomer Avidor-Reiss
- Department of Biological Sciences, University of Toledo, Toledo, OH 43606, USA;
- Department of Urology, College of Medicine and Life Sciences, University of Toledo, Toledo, OH 43614, USA
- Correspondence:
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93
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Farkas B, Boldizsar F, Bohonyi N, Farkas N, Marczi S, Kovacs GL, Bodis J, Koppan M. Comparative analysis of abdominal fluid cytokine levels in ovarian hyperstimulation syndrome (OHSS). J Ovarian Res 2020; 13:25. [PMID: 32138790 PMCID: PMC7057507 DOI: 10.1186/s13048-020-00624-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 02/17/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Ovarian hyperstimulation syndrome (OHSS) is a rare, yet severe, iatrogenic complication of ovulation induction therapy during assisted reproductive procedures. Our group previously detected atypical cells in the ascitic fluid of OHSS patients, although no malignancy developed during follow up. Here, the aim was to perform a comparative analysis of the cytokines present in the abdominal fluid of patients affected by OHSS versus patients with advanced ovarian cancer, a benign adnexal mass, or ovarian endometriosis. METHODS This prospective, non-randomized study was conducted at the Clinical Center of the University of Pecs Department of Obstetrics and Gynecology/Reproductive Center between October 2016 and March 2018. Abdominal fluid samples were obtained from 76 patients and subjected to Luminex analysis. The samples were collected from patients with OHSS (OHSS; n = 16), advanced ovarian cancer (OC; n = 22), a benign adnexal mass (BAM; n = 21), or ovarian endometriosis (EM; n = 17). Data were subjected to the non-parametric Kruskal-Wallis test and Spearman's rank correlation coefficient to identify statistical differences between the four study groups. RESULTS Leukocytosis and hemoconcentration were detected in the peripheral blood of OHSS patients. Abdominal fluid analysis further revealed significantly higher levels of interleukin (IL)-6, IL-8, IL-10, and transforming growth factor (TGF)-β in both the OHSS and OC groups compared to the BAM and EM groups. The highest concentration of vascular endothelial growth factor (VEGF) was detected in the OC group, while a significantly lower level was detected in the OHSS group. Moreover, VEGF levels in OC and OHSS groups were significantly elevated compared to the levels in the BAM and EM groups. CONCLUSIONS Vasoactive and hematogenic cytokines were present at higher levels in both the OHSS and OC abdominal fluid samples compared to the fluid samples obtained from the peritoneal cavity of the BAM patients. It is possible that these cytokines play an important role in the formation of ascites.
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Affiliation(s)
- Balint Farkas
- Department of Obstetrics and Gynecology, University of Pecs, School of Medicine, 17 Edesanyak Str., Pecs, Hungary. .,Member of the HAS-UP Human Reproduction Scientific Research Group, Hungarian Academy of Sciences (HAS), Pecs, Hungary.
| | - Ferenc Boldizsar
- Department of Immunology and Biotechnology, University of Pecs, School of Medicine, Pecs, Hungary
| | - Noemi Bohonyi
- Department of Obstetrics and Gynecology, University of Pecs, School of Medicine, 17 Edesanyak Str., Pecs, Hungary
| | - Nelli Farkas
- School of Medicine, Institute of Bioanalysis, University of Pecs, Pecs, Hungary
| | - Saska Marczi
- Laboratory of Molecular and HLA Diagnostics, University Hospital Osijek, Clinical Institute of Transfusion Medicine, Osijek, Croatia.,Department of Medical, Chemistry, Biochemistry and Clinical Chemistry, University of Osijek, Faculty of Medicine, Osijek, Croatia
| | - Gabor L Kovacs
- Member of the HAS-UP Human Reproduction Scientific Research Group, Hungarian Academy of Sciences (HAS), Pecs, Hungary.,Szentágothai Research Center, University of Pecs, Pecs, Hungary.,Department of Laboratory Medicine, Faculty of Medicine, University of Pecs, Pecs, Hungary
| | - Jozsef Bodis
- Department of Obstetrics and Gynecology, University of Pecs, School of Medicine, 17 Edesanyak Str., Pecs, Hungary.,Member of the HAS-UP Human Reproduction Scientific Research Group, Hungarian Academy of Sciences (HAS), Pecs, Hungary
| | - Miklos Koppan
- Department of Obstetrics and Gynecology, University of Pecs, School of Medicine, 17 Edesanyak Str., Pecs, Hungary
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94
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Can We Clinically Distinguish Anejaculation From Retrograde Ejaculation in Patients on α1A-Blockers Therapy for Lower Urinary Tract Symptoms? Urology 2020; 139:129-133. [PMID: 32032683 DOI: 10.1016/j.urology.2020.01.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 01/20/2020] [Accepted: 01/22/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate the physiopathology of ejaculatory disorders (EjD) and discriminate between retrograde ejaculation (REj) and anejaculation (AEj) induced by α1A-blockers, through the association between the mean postorgasm seminal vesicle volume and the presence of sperm in midstream urine, in patients with moderate-to-severe lower urinary tract symptoms (LUTS) secondary to benign prostatic enlargement. MATERIALS AND METHODS Therapy-naïve male patients with LUTS and without previous EjD were treated with α1A-blockers. Pre- and post-treatment EjD were investigated through question 4 of the 4-item Male Sexual Function questionnaire and the Male Sexual Health Questionnaire for Ejaculatory Dysfunction Short Form (MSHQ-EjD-SF). After 12 weeks, postorgasm urine was collected for sperm count and seminal vesicle volume was calculated through transrectal ultrasound. RESULTS All 42 patients reported with EjD after treatment with α1A-blockers: 4-item Male Sexual Function questionnaire and MSHQ-EjD-SF Q4 scores were significantly higher (P <.001) and MSHQ-EjD-SF Q1-3 score was significantly lower (P <.001) than before. Postorgasm seminal vesicle volume was significantly higher in patients with postorgasm sperm-negative urine (AEj), and lower in patients with postorgasm sperm-positive urine (REj; P <.001). CONCLUSION We clearly demonstrated an association between the presence of sperm in the midstream urine and seminal vesicle volume after orgasm, strongly confirming and differentiating the hypothesis of a dual etiology for EjD (REj vs AEj) secondary to α1A-blockers therapy for LUTS.
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95
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Wang H, An M, Liu Y, Hu K, Jin Y, Xu S, Chen B, Lu M. Genetic diagnosis and sperm retrieval outcomes for Chinese patients with congenital bilateral absence of vas deferens. Andrology 2020; 8:1064-1069. [PMID: 32020786 DOI: 10.1111/andr.12769] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 01/21/2020] [Accepted: 02/03/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Congenital bilateral absence of the vas deferens (CBAVD) is a frequent cause of obstructive azoospermia. CBAVD is mainly caused by mutations in the CFTR (cystic fibrosis transmembrane conductance regulator) gene and is also related to the X-linked ADGRG2 (adhesion G protein-coupled receptor G2) gene. Genetic screening and counseling strategies for Chinese CBAVD populations remain controversial because the genetic background of CBAVD in Chinese population is largely unknown. OBJECTIVES In this study, we aimed to study the mutation spectrum of CFTR and ADGRG2 in a group of CBAVD patients and to evaluate sperm retrieval outcomes in a subset of CBAVD patients. MATERIALS AND METHODS Next-generation targeted sequencing was used to identify mutations in the CFTR and ADGRG2 genes in 38 CBAVD patients. In addition, we followed and analyzed nine of the 38 patients who were undergoing sperm retrieval surgery. RESULTS In total, 27 of 38 (71.05%) patients carried at least one likely pathogenic or pathogenic mutation in CFTR or ADGRG2. In addition to the IVS9-5T allele, 15 CFTR and 1 ADGRG2 mutations were identified, including 4 novel mutations. CFTR hot-spot mutations were not identified in our study. Spermatozoon was successfully obtained in all nine patients who underwent MESA or TESE surgery, but most patients had spermatozoa with relatively low motility and high abnormality rates. DISCUSSION AND CONCLUSION Except for the IVS9-5T allele, hot-spot mutations of CFTR may not exist in Chinese CBAVD patients. Therefore, next-generation targeted sequencing for whole CFTR and ADGRG2 gene may be the appropriate genetic testing method, and genetic counseling may be different from Caucasian populations. We observed a high success rate of sperm retrieval with relatively low motility and high abnormality rates in Chinese CBAVD patients. However, this is only a weak conclusion due to the small sample size.
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Affiliation(s)
- Hongxiang Wang
- Department of Urology and Andrology, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Miao An
- CarrierGene Biotechnologies Co., Ltd, Shanghai, China
| | - Yidong Liu
- Department of Urology and Andrology, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Kai Hu
- Department of Urology and Andrology, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yan Jin
- Department of Urology and Andrology, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Shiran Xu
- Department of Urology and Andrology, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Bin Chen
- Department of Urology and Andrology, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Mujun Lu
- Department of Urology and Andrology, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
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96
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Nowicka-Bauer K, Nixon B. Molecular Changes Induced by Oxidative Stress that Impair Human Sperm Motility. Antioxidants (Basel) 2020; 9:antiox9020134. [PMID: 32033035 PMCID: PMC7070831 DOI: 10.3390/antiox9020134] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 01/30/2020] [Accepted: 01/31/2020] [Indexed: 12/19/2022] Open
Abstract
A state of oxidative stress (OS) and the presence of reactive oxygen species (ROS) in the male reproductive tract are strongly correlated with infertility. While physiological levels of ROS are necessary for normal sperm functioning, elevated ROS production can overwhelm the cell's limited antioxidant defenses leading to dysfunction and loss of fertilizing potential. Among the deleterious pleiotropic impacts arising from OS, sperm motility appears to be particularly vulnerable. Here, we present a mechanistic account for how OS contributes to altered sperm motility profiles. In our model, it is suggested that the abundant polyunsaturated fatty acids (PUFAs) residing in the sperm membrane serve to sensitize the male germ cell to ROS attack by virtue of their ability to act as substrates for lipid peroxidation (LPO) cascades. Upon initiation, LPO leads to dramatic remodeling of the composition and biophysical properties of sperm membranes and, in the case of the mitochondria, this manifests in a dissipation of membrane potential, electron leakage, increased ROS production and reduced capacity for energy production. This situation is exacerbated by the production of cytotoxic LPO byproducts such as 4-hydroxynonenal, which dysregulate molecules associated with sperm bioenergetic pathways as well as the structural and signaling components of the motility apparatus. The impact of ROS also extends to lesions in the paternal genome, as is commonly seen in the defective spermatozoa of asthenozoospermic males. Concluding, the presence of OS in the male reproductive tract is strongly and positively correlated with reduced sperm motility and fertilizing potential, thus providing a rational target for the development of new therapeutic interventions.
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Affiliation(s)
- Karolina Nowicka-Bauer
- Institute of Human Genetics, Polish Academy of Sciences, 60-479 Poznan, Poland
- Correspondence:
| | - Brett Nixon
- Priority Research Centre for Reproductive Science, School of Environmental and Life Sciences, Discipline of Biological Sciences, University of Newcastle, Callaghan, Newcastle, NSW 2308, Australia;
- Hunter Medical Research Institute, Pregnancy and Reproduction Program, New Lambton Heights, Newcastle, NSW 2305, Australia
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Liu B, Shen LJ, Zhao TX, Sun M, Wang JK, Long CL, He DW, Lin T, Wu SD, Wei GH. Automobile exhaust-derived PM 2.5 induces blood-testis barrier damage through ROS-MAPK-Nrf2 pathway in sertoli cells of rats. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2020; 189:110053. [PMID: 31862514 DOI: 10.1016/j.ecoenv.2019.110053] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 11/30/2019] [Accepted: 12/03/2019] [Indexed: 06/10/2023]
Abstract
Particulate matter with an aerodynamic diameter of less than 2.5 μm (PM2.5) derived from automobile exhaust can lead to serious male spermatogenesis dysfunction, but its specific molecular mechanism is unclear. In this experiment, we focused on the blood-testis barriers (BTB) and explored the intracellular mechanisms underlying the fertility toxicity of PM2.5 originating from automobile exhaust in the primary cultured Sertoli cells(SCs) of rats. After PM2.5 exposure, excessive reactive oxygen species (ROS) and increased apoptosis of SCs were detected. The expression of the BTB related proteins including ZO-1, Occludin, N-cadherin and β-catenin were significantly decreased and the spatial arrangement of F-actin was completely disordered through Immunofluorescence and Western blots tests. The phosphorylation of Jun N-terminal kinase (JNK), extracellular signal regulatory kinase (ERK), p38 mitogen-activated protein kinase (MAPK) were upregulated and nuclear factor (erythroid-derived 2) -like 2-related factor (Nrf2) was downregulated respectively. However, combined utilization of vitamin C and E were observed to prevent the increase of ROS generation, reduce celluar apoptosis, increase the expression of BTB related proteins, reconstructed the spatial arrangement of F-actin as well as improved the Nrf2 expression and attenuated the phosphorylation of the MAPK kinases and cleaved caspase-3 levels. Furthermore, ERK inhibitor (SCH772984), JNK inhibitor (SP600125) and p38 MAPK inhibitor (SB203580) obviously up-regulated BTB-related proteins expression as well as activated Nrf2 expression at varying degrees, indicating that ROS-MAPKs-Nrf2 is involved in the signaling pathway that leads to PM2.5-induced spermatogenesis dysfunction. These findings indicate that PM2.5 derived from automobile exhaust causes oxidative stress, which in turn causes cellular apoptosis of SCs and damage of the blood-testis barrier, resulting male spermatogenesis dysfunction, in which ROS-MAPK-Nrf-2 pathways may play a key role.
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Affiliation(s)
- Bin Liu
- Department of Urology, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Children's Hospital of Chongqing Medical University, Chongqing, 400014, P.R China; Department of Pediatric Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, P.R China
| | - Lian-Ju Shen
- Department of Urology, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Children's Hospital of Chongqing Medical University, Chongqing, 400014, P.R China; Pediatric Research Institute, Children's Hospital of Chongqing Medical University, Chongqing, 400014, P.R China
| | - Tian-Xin Zhao
- Department of Urology, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Children's Hospital of Chongqing Medical University, Chongqing, 400014, P.R China
| | - Mang Sun
- Department of Urology, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Children's Hospital of Chongqing Medical University, Chongqing, 400014, P.R China
| | - Jun-Ke Wang
- Department of Urology, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Children's Hospital of Chongqing Medical University, Chongqing, 400014, P.R China
| | - Chun-Lan Long
- Department of Urology, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Children's Hospital of Chongqing Medical University, Chongqing, 400014, P.R China; Pediatric Research Institute, Children's Hospital of Chongqing Medical University, Chongqing, 400014, P.R China
| | - Da-Wei He
- Department of Urology, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Children's Hospital of Chongqing Medical University, Chongqing, 400014, P.R China; Pediatric Research Institute, Children's Hospital of Chongqing Medical University, Chongqing, 400014, P.R China
| | - Tao Lin
- Department of Urology, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Children's Hospital of Chongqing Medical University, Chongqing, 400014, P.R China; Pediatric Research Institute, Children's Hospital of Chongqing Medical University, Chongqing, 400014, P.R China
| | - Sheng-de Wu
- Department of Urology, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Children's Hospital of Chongqing Medical University, Chongqing, 400014, P.R China; Pediatric Research Institute, Children's Hospital of Chongqing Medical University, Chongqing, 400014, P.R China.
| | - Guang-Hui Wei
- Department of Urology, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Children's Hospital of Chongqing Medical University, Chongqing, 400014, P.R China; Pediatric Research Institute, Children's Hospital of Chongqing Medical University, Chongqing, 400014, P.R China.
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Tanaka T, Kobori Y, Terai K, Inoue Y, Osaka A, Yoshikawa N, Shimomura Y, Suzuki K, Minami T, Iwahata T, Onota S, Yamamoto A, Sugimoto K, Okada H. Seminal oxidation-reduction potential and sperm DNA fragmentation index increase among infertile men with varicocele. HUM FERTIL 2020; 25:142-146. [PMID: 31955637 DOI: 10.1080/14647273.2020.1712747] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Varicocele is a common cause of male infertility. It is reported that low sperm concentration, motility and morphology are indicative of increased sperm DNA fragmentation index (DFI) in men with varicocele. Although research has been conducted into the relationship between varicocele and DFI, little is known about seminal oxidation-reduction potential (ORP) in varicocele patients. We assessed the relationship between varicocele with seminal ORP and sperm DFI in both fertile and infertile men. This prospective case-control study compared the findings from infertile men with varicocele to those of men with normal spermatogenesis without varicocele. Semen samples were collected and assessed using the WHO (2010) guidelines. ORP was measured (mV) and normalized to sperm concentration (mV/106 sperm/mL). DFI was measured using the sperm chromatin structure assay (SCSA) method. For group comparisons, only samples with a concentration >1 × 106 sperm/mL were included. Infertile men with varicocele had significantly lower mean sperm concentration, motility and total sperm count. Conversely, infertile men with varicocele had a significantly higher mean serum FSH level, and higher ORP and DFI values than fertile controls. ORP was higher in patients with varicocele and positively correlated with DFI (p < 0.01). ORP and DFI showed significant negative correlations with semen parameters (sperm concentration, motility and total sperm count) in infertile men with a varicocele.
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Affiliation(s)
- Takashi Tanaka
- Department of Reproduction Center, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Yoshitomo Kobori
- Department of Reproduction Center, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Kazutaka Terai
- Department of Reproduction Center, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Yasuyuki Inoue
- Department of Reproduction Center, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Akiyoshi Osaka
- Department of Reproduction Center, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Naoki Yoshikawa
- Department of Reproduction Center, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Yukihito Shimomura
- Department of Reproduction Center, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Keisuke Suzuki
- Department of Reproduction Center, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Tetsuji Minami
- Department of Reproduction Center, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Toshiyuki Iwahata
- Department of Reproduction Center, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Shin Onota
- Department of Reproduction Center, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Atsushi Yamamoto
- Department of Reproduction Center, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Kouhei Sugimoto
- Department of Reproduction Center, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Hiroshi Okada
- Department of Reproduction Center, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
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Deshpande PS, Gupta AS. Causes and Prevalence of Factors Causing Infertility in a Public Health Facility. J Hum Reprod Sci 2019; 12:287-293. [PMID: 32038077 PMCID: PMC6937760 DOI: 10.4103/jhrs.jhrs_140_18] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 04/15/2019] [Accepted: 11/01/2019] [Indexed: 11/25/2022] Open
Abstract
Background: Infertility causes change according to local demographics. There is thus the need to find the causes of infertility in context to local population to aid and direct management strategies accordingly. Aims: The aims were to study the causes of infertility and to calculate the proportion of the individual factors contributing to it in the population coming to a tertiary level public health facility. Setting and Design: This cross-sectional, observational study was done in an infertility clinic in a medical college and government hospital. Materials and Methods: The study comprised 120 couples who came for infertility evaluation and treatment. Cause of infertility in the couple was assigned on the basis of history and examination findings. The prevalence of each cause was evaluated. Statistical Analysis: Results were tabulated, and the prevalence of individual factors was calculated. Intratable analysis was done using SPSS 16.0. Results: Primary infertility (57.5%) was more prevalent than secondary infertility (42.5%). Female factor accounted for 46.6% of the cases with polycystic ovarian syndrome (PCOS) being the leading cause (46%). Infertility was seen equally in lean and obese PCOS cases. Infectious causes such as pelvic inflammatory disease and tuberculosis were significantly associated with tubal factor infertility (P = 0.001). Infertility causes changed as the age of marriage increased. In couples married for less than 5 years, PCOS was the main cause whereas later,male factor and unexplained infertility were the most common causes seen. Male factor contributed to 20% of the cases of infertility, and both tobacco and alcohol consumption were significantly associated with abnormal semen reports (P = 0.001). Conclusion: Causes of infertility vary according to the age of the couples and age of marriage. Although PCOS remains the main cause, infections are a major cause of tubal factor infertility, and tobacco and alcohol worsen the male factor. One-third of the cases still remain unexplained.
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Affiliation(s)
- Priyanka Sanjay Deshpande
- Department of Obstetrics and Gynaecology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Alka ShantiPrakash Gupta
- Department of Obstetrics and Gynaecology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
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