Ultrasound and infertility: diagnostic and therapeutic uses

Autophagy related gene expression status in patients diagnosed with azoospermia: A cross-sectional study

BACKGROUND

Autophagy affects various aspects of the male reproductive system. Any defects in this process may lead to azoospermia. However, the exact molecular mechanisms of the autophagy pathway have remained largely obscure. Therefore, the present study aimed to investigate levels of autophagy pathway gene expression (i.e. Lc3B, Beclin1, ATG5 and Bcl2) in azoospermic patients.

METHODS

The levels of Lc3B, Beclin1, ATG5 and Bcl2 mRNA expression in azoospermic patients and fertile males were evaluated by a real-time polymerase chain reaction technique. In addition, diagnostic evaluation based on the receiver-operating characteristic (ROC) curve was performed.

RESULTS

The results obtained showed the decreased expression of Lc3B, Beclin1 and ATG5 genes in infertile patients compared to the control group (p < 0.05), whereas Bcl2 expression was increased in samples (p < 0.05). A diagnostic evaluation by ROC curve and calculation of the area under the curve showed that, using a cut-off relative quantification of 4.550, 0.052, 0.056 and 0.012, the sensitivity of Lc3B, Beclin1, ATG5 and Bcl2 genes was 87.5%, 93.8%, 93.8% and 90%, respectively. In addition, a specificity of 76.7%, 76.7%, 93.3% and 81.2%, respectively, was observed.

CONCLUSIONS

As a first study, the current research suggests that an alteration in the expression of autophagy pathway genes may be associated with male infertility. Based on our finding, the increased expression of Bcl2 and formation of Becline1/Bcl2 complex, which inhibits Beclin1 recruitment, may lead to a decrease of the autophagy process in azoospermic patients. Accordingly, upon further investigation, the autophagy could be considered as an important aspect during spermatogenesis.

CD147 as an apoptosis regulator in spermatogenesis: deciphering its association with matrix metalloproteinases' pathway

CD147 plays an important role in germ cells migration and survival/apoptosis during the spermatogenesis process. However, to best of our knowledge, there is no report on the exact role of CD147 gene in the regulation of germ cells apoptosis through matrix metalloproteinases (MMPs). So, the current study aims to evaluate the role of CD147 gene expression in the regulation of germ cells apoptosis in conjunction with MMPs. Real-Time PCR was applied to investigate the expression of CD147, MMP2, MMP7, and MMP9 genes in the azoospermic patients and fertile males. Receiver-operating characteristic curve was used to interpret gene expression data. According to our results, a significant decrease in the expression of CD147 gene and an increase in MMPs genes expression were observed in infertile patients compared to fertile males. These results proved this fact that the CD147 gene has an important role in the regulation of germ cells apoptosis via a MMPs-dependent pathway.

Ejaculatory dysfunction

Ejaculatory dysfunction may occur after many different disorders ranging from traumatic spinal cord injury to diabetes mellitus. With an understanding of the many facets and nuances of the ejaculatory apparatus, both anatomic and neurologic, the well-versed clinician can proceed along a safe, efficient, and appropriate treatment algorithm to help affected men and their partners achieve parenthood.

Spectral Doppler sonography: a noninvasive method for predicting dyspermia

OBJECTIVES

Sonography is a noninvasive, office-based diagnostic tool often used for evaluation of subfertile men. Previous studies have suggested that a resistive index (RI) greater than 0.6 is associated with impaired spermatogenesis. We sought to validate this threshold in a urologic patient population presenting for infertility evaluation.

METHODS

We retrospectively reviewed 99 consecutive patients seen for nonobstructive male infertility at our institution. Patient demographics, semen analysis parameters, hormone profiles, lipid profiles, and penile and scrotal sonographic measurements were recorded. The RI was calculated from measurements of the peak systolic velocity and end-diastolic velocity. Ninety-one patients fit the inclusion criteria and were subsequently divided into 2 groups based on RI: group 1 with RI values of 0.6 or less (n = 49) and group 2 with RI values greater than 0.6 (n = 42).

RESULTS

Variables that were significantly different between the groups included age, total sperm count, percent motile sperm, total motile sperm, follicle-stimulating hormone, high-density lipoprotein, and testis volume. On the other hand, body mass index, forward progression, World Health Organization score, total testosterone, free testosterone, estradiol, total cholesterol, low-density lipoprotein, and triglycerides were not significantly different between the groups. A receiver operating characteristic curve revealed an area under the curve of 0.64 (confidence interval, 0.52-0.75; P = .025). At the threshold of greater than 0.6, the RI had specificity of 63.27% and a 1.56 likelihood ratio to predict total motile sperm less than 20 × 10(6) at spermatogenesis.

CONCLUSIONS

An intratesticular RI greater than 0.6 is associated with impaired spermatogenesis. This finding supports the use of testicular spectral Doppler sonography as a noninvasive tool for evaluation of testicular function.

Hypertrophic-congestive and fibro-sclerotic ultrasound variants of male accessory gland infection have different sperm output

INTRODUCTION

Male accessory gland infection (MAGI) exerts a negative influence on male fertility which depends upon its extension. Indeed, we have shown that patients with MAGI involving prostate, seminal vesicles and epididymis have worse sperm parameters compared with patients with prostatitis alone or prostate-vesiculitis. Similarly, MAGI extending bilaterally is associated with a worse sperm output. The aims of this study were to evaluate the prevalence of two different additional ultrasound (US) findings (hypertrophic- congestive and a fibro-sclerotic US form) and to evaluate their semen quality.

MATERIALS AND METHODS

One hundred infertile patients with MAGI, diagnosed according to the World Health Organization (WHO) 1993 criteria, were evaluated by scrotal and transrectal ultrasound scans. The control group consisted of 100 healthy, age-matched men.

RESULTS

The ultrasound examination confirms two separate US variants of MAGI: a hypertrophic-congestive (prevalence of 56%) and a fibro-sclerotic form (prevalence of 29%). Patients with hypertrophic-congestive MAGI showed higher sperm concentration, motility and normal forms, but also higher sperm leukocytes concentration and seminal reactive oxygen species compared to patients with fibro-sclerotic MAGI. However, all these parameters were significantly worse than those observed in the control group.

DISCUSSION

Infertile patients with hypertrophic-congestive MAGI have a better sperm quality compared with patients with fibrosclerotic MAGI; however, they showed higher oxidative stress in semen.

Ultrasonographic evaluation of patients with male accessory gland infection

MAGI is the inflammation of the accessory male glands that notoriously exerts a negative influence on male fertility. The diagnosis is integrated by clinical, laboratory and ultrasound evaluation. In particular, the ultrasound criteria were published in 1999. The aim of this study was to analyse the sensitivity and specificity of additional diagnostic ultrasound criteria as well as of conventional criteria in a selected category of infertile patients with MAGI. To accomplish this, 100 patients with MAGI were evaluated by scrotal and transrectal ultrasound by three different operators. The control group consisted of 100 age-matched healthy men. Statistical analysis was performed to evaluate sensitivity, specificity, positive and negative predictive values, and ROC curve analysis. The results showed that additional ultrasound criteria had a diagnostic accuracy similar to traditional criteria. The threshold value of two criteria for each diagnostic category (traditional and additional criteria) obtained high values of sensitivity and specificity. In conclusion, this study confirms the validity of the ultrasound criteria of MAGI previously published; in addition, it suggests the clinical utility of other indicators in clinical practice with good diagnostic accuracy and finally it establishes a clear threshold ultrasonographic value for the diagnosis of MAGI.

Value of frozen section analysis with suspected testicular malignancy

OBJECTIVES

To determine whether frozen section analysis (FSA) assists safe conservative surgery for men presenting with suspected testicular tumors.

METHODS

We performed a retrospective review of intraoperative testicular FSA used at a single university institution during an 11-year period. The exclusion criteria included lesions of paratesticular origin, size greater than 5 cm, and the known presence of elevated tumor markers or metastatic disease.

RESULTS

Eighty men underwent FSA, facilitating the diagnosis of germ cell malignancy in 51 (54.3%) of the 94 new cases encountered during this period. Malignancy was reported by FSA in 52 patients (65.0%), but was later revised in 3 to benign Leydig cell tumor after orchiectomy. Also, 2 of 27 specimens reported as benign by FSA were revised to malignant after analysis of paraffin-embedded tissue from the biopsies. Both were seminoma and required delayed orchiectomy. FSA was reported as "suspicious" (intratubular germ cell neoplasia with necrosis) in 1 patient, in whom orchiectomy was performed and malignancy confirmed. In total, orchiectomy was avoided in 25 cases (31.3%). The positive and negative predictive value for FSA in the diagnosis of testicular malignancy was 94.2% and 92.6%, respectively. Of 13 lesions 1 cm or less, 10 (76.9%) were benign. All 26 lesions greater than 3 cm were malignant. A clear correlation between lesion size and the diagnosis of malignancy was demonstrated.

CONCLUSIONS

FSA is a valuable tool assisting testicular preservation. Lesion size correlated with incidence of malignancy; therefore, FSA may be best used for small testicular lesions suitable for excision biopsy.