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Saffati G, Thompson LN, Starke N, Khera M, Muthigi A. Can semen analysis be utilized as a screening tool for overall health in young men? Int J Impot Res 2024:10.1038/s41443-024-00949-9. [PMID: 38951639 DOI: 10.1038/s41443-024-00949-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 06/18/2024] [Accepted: 06/25/2024] [Indexed: 07/03/2024]
Abstract
Traditionally, semen analysis has been viewed solely as a tool for assessing male fertility. However, emerging research suggests that abnormal semen parameters may serve as indicators of broader health issues beyond reproductive function. Studies have revealed significant associations between abnormal semen parameters and an increased risk of chronic diseases such as prostate cancer, diabetes, ischemic heart disease, and metabolic disorders. These findings challenge the conventional understanding and position semen analysis as a potential screening tool for overall male health. The correlation between abnormal semen parameters and conditions like erectile dysfunction further underscores the multifaceted implications of semen quality. This suggests that abnormal semen parameters may be a risk factor for poorer overall health and a higher likelihood of developing comorbidities over time. Given these compelling associations, there is a growing call to integrate semen analysis into routine health assessments for young men, particularly in conjunction with established general health screenings. This proactive approach aligns with a preventative healthcare paradigm, facilitating early detection of underlying health concerns and timely interventions. However, overcoming cultural, logistical, and cost-related barriers is crucial for the successful implementation of this shift in reproductive health.
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Affiliation(s)
- Gal Saffati
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA.
| | - Laura N Thompson
- Department of Urology, Houston Methodist Hospital, Houston, TX, USA
| | - Nathan Starke
- Department of Urology, Houston Methodist Hospital, Houston, TX, USA
| | - Mohit Khera
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Akhil Muthigi
- Department of Urology, Houston Methodist Hospital, Houston, TX, USA
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Aznavour Y, Navarrete F, Badreddine J, Simon PHG, Gowda V, Rhodes S, Ghayda RA. Geographic Differences in Semen Quality among a Cohort of American Men Using Mail-in Sperm Testing Kits. World J Mens Health 2023; 41:920-927. [PMID: 36792088 PMCID: PMC10523125 DOI: 10.5534/wjmh.220184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/23/2022] [Accepted: 11/06/2022] [Indexed: 01/27/2023] Open
Abstract
PURPOSE To evaluate the relationship between regional geography and sperm parameters in a cohort of American men using at-home mail-in semen collection kits with no previous self-reported history of male factor infertility. MATERIALS AND METHODS In this study, 5,822 men from six different regions of the United States (Northeast, Southeast, Midwest, West, Pacific, and Southwest) who self-requested semen analysis between 2019 and 2021 were enrolled. RESULTS Across the entire cohort, the mean sperm concentration was 43.79±55.43 ×106 sperm/mL; total sperm count 138.93±149.96 ×106 sperm/mL; total motile sperm 54.73±81.90 ×106/ejaculate; total motility 30.18%±22.87%; progressive motility 21.61%±17.32%; sperm with normal morphology 8.79%±8.87%. Patients from the West region displayed lower median sperm concentration, total motile sperm, and total motility than men from the other four regional areas. A lower median total sperm count, and lower median progressive motility were also detected among patients in the Southwest region. Conversely, higher results were detected in patients from the Midwest (higher median total motile sperm, total and motility) and from the Northeast (higher median sperm concentration and total sperm count) regions. Men from the Southeast (OR, 1.3168; 95% CI, 1.1142-1.5563) and Southwest (OR, 1.3145; 95% CI, 1.0735-1.6096) regions were more likely to have oligozoospermia than those living elsewhere. CONCLUSIONS This study provides the most comprehensive and up-to-date report on semen parameter variability among a cohort of men living in six different regions of the continental USA. This study will pave the way into a deeper discussion of the interplay between geography, social determinants of fertility care and semen quality.
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Affiliation(s)
| | | | - Jad Badreddine
- Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | | | - Vrushab Gowda
- Give Legacy, Inc., Boston, MA, USA
- Department of Medicine, University of North Carolina Hospitals, Chapel Hill, NC, USA
| | - Stephen Rhodes
- Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Ramy Abou Ghayda
- Give Legacy, Inc., Boston, MA, USA
- Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
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Pelzman D, Dederer G, Joolharzadeh P, Morrill C, Orwig K, Pulaski H, Hwang K. Effect of Distance From Fertility Center on Utilization of Fertility Preservation Referral in Men. JCO Oncol Pract 2023:OP2200789. [PMID: 36927066 DOI: 10.1200/op.22.00789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
PURPOSE Fertility preservation (FP) is underutilized in males with cancer or other diseases requiring gonadotoxic therapies. We sought to evaluate whether patient distance from FP center affected rates of providing a semen analysis after referral. MATERIALS AND METHODS We performed a retrospective analysis of all males who were referred for FP at a single institution between 2013 and 2021. A multiple logistic regression model was conducted with semen sample submission as the variable of interest. Predictor variables were disease type, distance, and payment method. Secondary outcomes were number of semen samples submitted and number of vials collected. RESULTS Records of 461 males referred to our center were analyzed. Of these patients, 326 (71%) provided a semen sample after referral and 135 (30%) did not. Further distance from our center was associated with lower odds of submitting a semen sample (OR, 0.85; 95% CI, 0.75 to 0.97; P < .05). For patients who submitted at least one sample, distance did not affect the total number of samples submitted but was associated with a small increase in total vials cryopreserved. CONCLUSION Men referred for FP exhibit a high rate of sperm cryopreservation. Further distance from FP center was associated with decreased odds to provide semen sample after referral. Our model estimated a 15% decrease in odds of collection with every doubling of distance from our center. Efforts must be made to improve FP utilization for patients traveling far distances, but distance alone should not preclude referral.
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Affiliation(s)
| | - Gregory Dederer
- Department of Statistics, University of Pittsburgh, Pittsburgh, PA
| | - Pouya Joolharzadeh
- Department of Obstetrics, Gynecology, and Reproductive Sciences, UPMC, Pittsburgh, PA.,Current address: Department of Medicine, Washington University School of Medicine in St Louis, St Louis, MO
| | | | - Kyle Orwig
- Department of Obstetrics, Gynecology, and Reproductive Sciences, UPMC, Pittsburgh, PA
| | - Hanna Pulaski
- Department of Obstetrics, Gynecology, and Reproductive Sciences, UPMC, Pittsburgh, PA.,Current address: PathAI, Boston, MA
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Sharara FI, Ostermeier GC, Travis AJ. Defects in sperm capacitation/fertilizing ability are equally prevalent across ages in men seeking fertility assistance. Reprod Biomed Online 2023; 46:179-187. [PMID: 36371338 DOI: 10.1016/j.rbmo.2022.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 09/06/2022] [Accepted: 09/14/2022] [Indexed: 01/31/2023]
Abstract
RESEARCH QUESTION How do capacitation ability, measured by Cap-Score™, and traditional semen analysis measures (volume, concentration, motility) change with age in men questioning their fertility (MQF)? DESIGN Cap-Score and semen analysis measures were obtained from MQF (n = 2652; multicentric design: 35 reproductive endocrinologist prescribers, n = 16 clinics). Morphology was not included due to differences among clinics. A Mann-Whitney test was used to compare Cap-Scores between MQF and men with known recent paternity (n = 76). The following age groups were constructed for MQF: 20-24, 25-29, 30-34, 35-39, 40-44, 45-49 and 50+. Associations between semen analysis, Cap-Score and age groups were evaluated using mixed-model analysis of variance to identify possible influence of Cap-Score collection kit type (n = 763 collected at home; n = 1889 collected at clinics). RESULTS MQF had reduced capacitation ability (mean ± SE; 29.25 ± 0.15 versus 35.34 ± 0.88; P < 0.001). No change in Cap-Score (P = 0.916) or concentration (P = 0.926) was detected with age group. In contrast, both volume (P = 0.008) and % motility (P < 0.001) declined with age. CONCLUSIONS Men presenting because of difficulties in generating pregnancy showed equivalent reductions in capacitation ability regardless of age. In contrast, motility and volume declined with age. These data suggest that capacitation ability is a more sensitive indicator of male fertility across age groups than traditional semen analysis and should not be reserved for older men. Importantly, these data do not address whether sperm fertilizing ability declines in the general population as men age. Instead, they indicate that if men are having difficulty conceiving, no matter what their age, then defects in sperm fertilizing ability are equally likely to be the cause.
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Affiliation(s)
- Fady I Sharara
- Virginia Center for Reproductive Medicine, Reston VA, USA.
| | | | - Alexander J Travis
- Androvia LifeSciences, Mountainside NJ, USA; Department of Public and Ecosystem Health, Cornell University, Ithaca NY, USA
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Jesse E, Thirumavalavan N, Loeb A. Increase in Direct-to-Consumer Telemedicine in Urology. CURRENT SEXUAL HEALTH REPORTS 2022; 14:119-127. [PMID: 35966236 PMCID: PMC9362147 DOI: 10.1007/s11930-022-00332-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2022] [Indexed: 11/29/2022]
Abstract
Purpose of Review Direct-to-consumer telemedicine has vastly expanded in recent years, and urologic conditions are a common target for these companies. We aim to identify the urologic conditions being treated by direct-to-consumer telemedicine platforms and review the feasibility of adherence to evidence-based practice guidelines via this relatively new healthcare model. Recent Findings Erectile dysfunction, premature ejaculation, testosterone deficiency, and male infertility are being treated with direct-to-consumer telemedicine. Such platforms treating erectile dysfunction perform modestly in practice guideline adherence. Guidelines-based treatment of other urologic conditions via telemedicine is feasible, however, the treatment of these conditions through popular direct-to-consumer telemedicine platforms is largely unstudied. Summary The impact of direct-to-consumer telemedicine on the field of urology is vast and likely to continue to grow. Future studies should inspect direct-to-consumer telemedicine companies’ practice patterns and treatment outcomes to ensure the field’s standards of care are being met. Guidelines specific to the treatment of various urologic conditions via telemedicine are needed.
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Affiliation(s)
- Erin Jesse
- Urology Institute, University Hospitals Cleveland Medical Center Case Western Reserve University, 11100 Euclid Avenue Lakeside Building Suite, Cleveland, OH 4954 USA
| | - Nannan Thirumavalavan
- Urology Institute, University Hospitals Cleveland Medical Center Case Western Reserve University, 11100 Euclid Avenue Lakeside Building Suite, Cleveland, OH 4954 USA
| | - Aram Loeb
- Urology Institute, University Hospitals Cleveland Medical Center Case Western Reserve University, 11100 Euclid Avenue Lakeside Building Suite, Cleveland, OH 4954 USA
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Abstract
PURPOSE OF REVIEW The purpose of this review article is to discuss the impact of Coronavirus Disease 2019 (COVID-19) on the evolution of telemedicine use for urology office visits. RECENT FINDINGS The COVID-19 pandemic has caused a dramatic change in the delivery of healthcare. Fraught with numerous barriers previously, the need for healthcare delivery during a time of social distancing and increased healthcare requirements drove the adoption of telemedicine forward. This 'trial period' over the last year has allowed us to appreciate the potential utility of telehealth-associated services in practice and consider its role even after the pandemic. Multiple studies equating its utility to in-person visits whereas simultaneously providing added convenience and cost-related savings have been published in the urologic literature. Permanent regulatory changes will need to be implemented to allow us the flexibility to use telehealth in the future. SUMMARY It is clear that telemedicine is an effective strategy for delivery of healthcare under the right circumstances. Although it initially started to fill a need out of necessity, it can help us effectively deliver healthcare as long as the regulations surrounding telemedicine allow us to continue to use it. This period has been challenging for healthcare delivery and led to policy changes that served as a catalyst to help us better understand this previously underutilized resource.
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Affiliation(s)
- Mohit Butaney
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan, USA
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Potential Pitfalls of Reproductive Direct-to-Consumer Testing. F S Rep 2022; 3:3-7. [PMID: 35386504 PMCID: PMC8978065 DOI: 10.1016/j.xfre.2022.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/25/2022] [Accepted: 01/26/2022] [Indexed: 11/22/2022] Open
Abstract
The availability of direct-to-consumer (DTC) testing has dramatically increased over the past 2 decades, particularly those targeted at reproduction and fertility. Several ethical concerns exist with regard to DTC tests, including the lack of governmental regulation and consumer protection, standardized laboratory methodology, and clinical validity and actionability. Physicians must familiarize themselves with the pitfalls of DTC tests to best aid patients in interpreting DTC test results and guide them toward evidence-based treatment plans.
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Tradewell MB, Cazzaniga W, Pagani RL, Reddy R, Boeri L, Kresch E, Morgantini LA, Ibrahim E, Niederberger C, Salonia A, Ramasamy R. Algorithms for Predicting the Probability of Azoospermia from Follicle Stimulating Hormone: Design and Multi-Institutional External Validation. World J Mens Health 2022; 40:600-607. [PMID: 35118840 PMCID: PMC9482862 DOI: 10.5534/wjmh.210138] [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: 07/26/2021] [Revised: 10/01/2021] [Accepted: 11/10/2021] [Indexed: 11/15/2022] Open
Abstract
Purpose To predict the probability of azoospermia without a semen analysis in men presenting with infertility by developing an azoospermia prediction model. Materials and Methods Two predictive algorithms were generated, one with follicle stimulating hormone (FSH) as the only input and another logistic regression (LR) model with additional clinical inputs of age, luteinizing hormone, total testosterone, and bilateral testis volume. Men presenting between 01/2016 and 03/2020 with semen analyses, testicular ochiodemetry, and serum gonadotropin measurements collected within 120 days were included. An azoospermia prediction model was developed with multi-institutional two-fold external validation from tertiary urologic infertility clinics in Chicago, Miami, and Milan. Results Total 3,497 participants were included (n=Miami 946, Milan 1,955, Chicago 596). Incidence of azoospermia in Miami, Milan, and Chicago was 13.8%, 23.8%, and 32.0%, respectively. Predictive algorithms were generated with Miami data. On Milan external validation, the LR and quadratic FSH models both demonstrated good discrimination with areas under the receiver-operating-characteristic (ROC) curve (AUC) of 0.79 and 0.78, respectively. Data from Chicago performed with AUCs of 0.71 for the FSH only model and 0.72 for LR. Correlation between the quadratic FSH model and LR model was 0.95 with Milan and 0.92 with Chicago data. Conclusions We present and validate algorithms to predict the probability of azoospermia. The ability to predict the probability of azoospermia without a semen analysis is useful when there are logistical hurdles in obtaining a semen analysis or for reevaluation prior to surgical sperm extraction.
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Affiliation(s)
- Michael B Tradewell
- Department of Urology, Jackson Health System, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Walter Cazzaniga
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Università Vita-Salute San Raffaele, Milano, Italy
| | - Rodrigo L Pagani
- Department of Urology, University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | - Rohit Reddy
- Department of Urology, Jackson Health System, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Luca Boeri
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Università Vita-Salute San Raffaele, Milano, Italy
| | - Eliyahu Kresch
- Department of Urology, Jackson Health System, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Luca A Morgantini
- Department of Urology, University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | - Emad Ibrahim
- Department of Urology, Jackson Health System, University of Miami Miller School of Medicine, Miami, FL, USA.,Department of Neurological Surgery, University of Miami Miller School of Medicine and Jackson Health System, Miami, FL, USA
| | - Craig Niederberger
- Department of Urology, University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Università Vita-Salute San Raffaele, Milano, Italy
| | - Ranjith Ramasamy
- Department of Urology, Jackson Health System, University of Miami Miller School of Medicine, Miami, FL, USA.
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Video Visits are Practical for the Follow-up and Management of Established Male Infertility Patients. Urology 2021; 154:158-163. [PMID: 34022261 DOI: 10.1016/j.urology.2021.03.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/15/2021] [Accepted: 03/31/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To study the use of video visits for male infertility care prior to the COVID-19 pandemic METHODS: We reviewed video visits for male infertility patients completed at a tertiary academic center in southeast Michigan. These patients had follow-up after an initial in-person evaluation. We designed this retrospective case series to describe the diagnostic categories seen through telehealth, management steps completed during video visits, and to understand whether additional in-person care was required within 90 days of video visits. In addition, we estimated time and cost savings for patients attributed to video visits. RESULTS Most men seen during video visits had an endocrinologic (29%) or anatomic (21%) cause for their infertility. 73% of video visits involved reviewing results; 30% included counseling regarding assistive reproductive technologies; and 25% of video visits resulted in prescribing hormonally active medications. The two patients (3%) who were seen in clinic after their video visit underwent a varicocelectomy in the interim. No patients required an unplanned in-person visit. From a patient perspective, video visits were estimated to save a median of 97 minutes (IQR 64-250) of travel per visit. Median cost savings per patient- by avoiding travel and taking time off work for a clinic visit-were estimated to range from $149 (half day off) to $252 (full day off). CONCLUSION Video visits for established male infertility patients were used to manage different causes of infertility while saving patients time and money. Telehealth for established patients did not trigger additional in-person evaluations.
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Masterson TA, Patel P. Clinical implications of home-based sperm testing. Fertil Steril 2021; 115:882. [PMID: 33750619 DOI: 10.1016/j.fertnstert.2021.01.054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Thomas A Masterson
- Department of Urology, University of Miami Miller School of Medicine, Miami, Florida
| | - Premal Patel
- Section of Urology, University of Manitoba, Winnipeg, Manitoba, Canada.
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