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Tej P, Pareek C, Kalbande A, Bawaskar PA, Badge A, Nair N. Resolving Male Infertility: A Case Report on Treating Obstructive Azoospermia Using SpermMobil in Intracytoplasmic Sperm Injection Procedure. Cureus 2024; 16:e55323. [PMID: 38559533 PMCID: PMC10981844 DOI: 10.7759/cureus.55323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 03/01/2024] [Indexed: 04/04/2024] Open
Abstract
Infertility affects couples worldwide. Among these, obstructive azoospermia (OA) is a common cause. In some cases, the lack of spermatozoa in ejaculation results from blockages in the male reproductive tract. In this case study, we discuss an infertile male diagnosed with OA following three years of unsuccessful attempts at conception. The male had a history of bilateral inguinal hernia repair due to congenital bilateral absence of the vas deferens. Diagnostic assessments confirmed azoospermia. Microscopic epididymal sperm aspiration (MESA) was performed for sperm retrieval due to its efficacy and reduced postoperative pain, testicular atrophy, and decreased testosterone levels. The retrieved sperm was processed using SpermMobil media for intracytoplasmic sperm injection. Following successful fertilization, embryo transfers resulted in a positive pregnancy test. This case highlights the significance of specific treatment approaches for OA, specifically the effectiveness of MESA and SpermMobil in achieving successful outcomes in assisted reproduction technology for male infertility.
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Affiliation(s)
- Pavan Tej
- Clinical Embryology, School of Allied Health Sciences, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Charu Pareek
- Clinical Embryology, School of Allied Health Sciences, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Avanti Kalbande
- Obstetrics and Gynaecology, School of Allied Health Sciences, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pranita A Bawaskar
- Clinical Embryology, School of Allied Health Sciences, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ankit Badge
- Microbiology, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nancy Nair
- Clinical Embryology, School of Allied Health Sciences, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Bachelot G, Dhombres F, Sermondade N, Haj Hamid R, Berthaut I, Frydman V, Prades M, Kolanska K, Selleret L, Mathieu-D'Argent E, Rivet-Danon D, Levy R, Lamazière A, Dupont C. A Machine Learning Approach for the Prediction of Testicular Sperm Extraction in Nonobstructive Azoospermia: Algorithm Development and Validation Study. J Med Internet Res 2023; 25:e44047. [PMID: 37342078 DOI: 10.2196/44047] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 02/19/2023] [Accepted: 04/07/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Testicular sperm extraction (TESE) is an essential therapeutic tool for the management of male infertility. However, it is an invasive procedure with a success rate up to 50%. To date, no model based on clinical and laboratory parameters is sufficiently powerful to accurately predict the success of sperm retrieval in TESE. OBJECTIVE The aim of this study is to compare a wide range of predictive models under similar conditions for TESE outcomes in patients with nonobstructive azoospermia (NOA) to identify the correct mathematical approach to apply, most appropriate study size, and relevance of the input biomarkers. METHODS We analyzed 201 patients who underwent TESE at Tenon Hospital (Assistance Publique-Hôpitaux de Paris, Sorbonne University, Paris), distributed in a retrospective training cohort of 175 patients (January 2012 to April 2021) and a prospective testing cohort (May 2021 to December 2021) of 26 patients. Preoperative data (according to the French standard exploration of male infertility, 16 variables) including urogenital history, hormonal data, genetic data, and TESE outcomes (representing the target variable) were collected. A TESE was considered positive if we obtained sufficient spermatozoa for intracytoplasmic sperm injection. After preprocessing the raw data, 8 machine learning (ML) models were trained and optimized on the retrospective training cohort data set: The hyperparameter tuning was performed by random search. Finally, the prospective testing cohort data set was used for the model evaluation. The metrics used to evaluate and compare the models were the following: sensitivity, specificity, area under the receiver operating characteristic curve (AUC-ROC), and accuracy. The importance of each variable in the model was assessed using the permutation feature importance technique, and the optimal number of patients to include in the study was assessed using the learning curve. RESULTS The ensemble models, based on decision trees, showed the best performance, especially the random forest model, which yielded the following results: AUC=0.90, sensitivity=100%, and specificity=69.2%. Furthermore, a study size of 120 patients seemed sufficient to properly exploit the preoperative data in the modeling process, since increasing the number of patients beyond 120 during model training did not bring any performance improvement. Furthermore, inhibin B and a history of varicoceles exhibited the highest predictive capacity. CONCLUSIONS An ML algorithm based on an appropriate approach can predict successful sperm retrieval in men with NOA undergoing TESE, with promising performance. However, although this study is consistent with the first step of this process, a subsequent formal prospective multicentric validation study should be undertaken before any clinical applications. As future work, we consider the use of recent and clinically relevant data sets (including seminal plasma biomarkers, especially noncoding RNAs, as markers of residual spermatogenesis in NOA patients) to improve our results even more.
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Affiliation(s)
- Guillaume Bachelot
- Saint Antoine Research Center, L'Institut national de la santé et de la recherche médicale UMR 938, Sorbonne Université, Paris, France
- Service de Biologie de La Reproduction, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
- Laboratory in Medical Informatics and Knowledge Engineering in e-Health, L'Institut national de la santé et de la recherche médicale, Sorbonne University, Paris, France
| | - Ferdinand Dhombres
- Laboratory in Medical Informatics and Knowledge Engineering in e-Health, L'Institut national de la santé et de la recherche médicale, Sorbonne University, Paris, France
| | - Nathalie Sermondade
- Saint Antoine Research Center, L'Institut national de la santé et de la recherche médicale UMR 938, Sorbonne Université, Paris, France
- Service de Biologie de La Reproduction, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Rahaf Haj Hamid
- Service de Biologie de La Reproduction, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Isabelle Berthaut
- Service de Biologie de La Reproduction, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Valentine Frydman
- Service d'Urologie, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Marie Prades
- Service de Biologie de La Reproduction, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Kamila Kolanska
- Saint Antoine Research Center, L'Institut national de la santé et de la recherche médicale UMR 938, Sorbonne Université, Paris, France
- Service de Gynécologie Obstétrique et Médecine de la Reproduction, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Lise Selleret
- Service d'Urologie, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Emmanuelle Mathieu-D'Argent
- Saint Antoine Research Center, L'Institut national de la santé et de la recherche médicale UMR 938, Sorbonne Université, Paris, France
- Service de Gynécologie Obstétrique et Médecine de la Reproduction, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Diane Rivet-Danon
- Service de Biologie de La Reproduction, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Rachel Levy
- Saint Antoine Research Center, L'Institut national de la santé et de la recherche médicale UMR 938, Sorbonne Université, Paris, France
- Service de Biologie de La Reproduction, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Antonin Lamazière
- Saint Antoine Research Center, L'Institut national de la santé et de la recherche médicale UMR 938, Sorbonne Université, Paris, France
- Département de Métabolomique Clinique, Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Charlotte Dupont
- Saint Antoine Research Center, L'Institut national de la santé et de la recherche médicale UMR 938, Sorbonne Université, Paris, France
- Service de Biologie de La Reproduction, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
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Attini R, Cabiddu G, Ciabatti F, Montersino B, Carosso AR, Gernone G, Gammaro L, Moroni G, Torreggiani M, Masturzo B, Santoro D, Revelli A, Piccoli GB. Chronic kidney disease, female infertility, and medically assisted reproduction: a best practice position statement by the Kidney and Pregnancy Group of the Italian Society of Nephrology. J Nephrol 2023; 36:1239-1255. [PMID: 37354277 PMCID: PMC11081994 DOI: 10.1007/s40620-023-01670-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2023] [Indexed: 06/26/2023]
Abstract
Fertility is known to be impaired more frequently in patients with chronic kidney disease than in the general population. A significant proportion of chronic kidney disease patients may therefore need Medically Assisted Reproduction. The paucity of information about medically assisted reproduction for chronic kidney disease patients complicates counselling for both nephrologists and gynaecologists, specifically for patients with advanced chronic kidney disease and those on dialysis or with a transplanted kidney. It is in this context that the Project Group on Kidney and Pregnancy of the Italian Society of Nephrology has drawn up these best practice guidelines, merging a literature review, nephrology expertise and the experience of obstetricians and gynaecologists involved in medically assisted reproduction. Although all medically assisted reproduction techniques can be used for chronic kidney disease patients, caution is warranted. Inducing a twin pregnancy should be avoided; the risk of bleeding, thrombosis and infection should be considered, especially in some categories of patients. In most cases, controlled ovarian stimulation is needed to obtain an adequate number of oocytes for medically assisted reproduction. Women with chronic kidney disease are at high risk of kidney damage in case of severe ovarian hyperstimulation syndrome, and great caution should be exercised so that it is avoided. The higher risks associated with the hypertensive disorders of pregnancy, and the consequent risk of chronic kidney disease progression, should likewise be considered if egg donation is chosen. Oocyte cryopreservation should be considered for patients with autoimmune diseases who need cytotoxic treatment. In summary, medically assisted reproduction is an option for chronic kidney disease patients, but the study group strongly advises extensive personalised counselling with a multidisciplinary healthcare team and close monitoring during the chosen medically assisted reproduction procedure and throughout the subsequent pregnancy.
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Affiliation(s)
- Rossella Attini
- Department of Obstetrics and Gynecology SC2U, Sant'Anna Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Gianfranca Cabiddu
- Nephrology, Department of Medical Science and Public Health, San Michele Hospital, G. Brotzu, University of Cagliari, Cagliari, Italy
| | - Francesca Ciabatti
- Department of Obstetrics and Gynecology SC2U, Sant'Anna Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Benedetta Montersino
- Department of Obstetrics and Gynecology SC2U, Sant'Anna Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Andrea Roberto Carosso
- Department of Obstetrics and Gynecology SC2U, Sant'Anna Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Giuseppe Gernone
- UOSVD di Nefrologia e Dialisi ASL Bari. P.O. "S. Maria degli Angeli", Putignano, Italy
| | - Linda Gammaro
- Nephrology, Ospedale Fracastoro San Bonifacio, San Bonifacio, Italy
| | - Gabriella Moroni
- Nephrology and Dialysis Division, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Massimo Torreggiani
- Néphrologie et Dialyse, Centre Hospitalier Le Mans, 194 Avenue Rubillard, 72037, Le Mans, France
| | - Bianca Masturzo
- Division of Obstetrics and Gynaecology, Department of Maternal-Neonatal and Infant Health, Ospedale Degli Infermi, University of Turin, Biella, Italy
| | - Domenico Santoro
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, A.O.U. "G. Martino", University of Messina, 98125, Messina, Italy
| | - Alberto Revelli
- Department of Obstetrics and Gynecology SC2U, Sant'Anna Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Giorgina Barbara Piccoli
- Néphrologie et Dialyse, Centre Hospitalier Le Mans, 194 Avenue Rubillard, 72037, Le Mans, France.
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Ibis MA, Aydos K, Baltaci V, Aktuna S, Yaman O. Can PCNA and LIM15 gene expression levels predict sperm retrieval success in men with non-obstructive azoospermia? Rev Int Androl 2022; 20 Suppl 1:S31-S38. [PMID: 35570072 DOI: 10.1016/j.androl.2021.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 04/16/2021] [Indexed: 12/16/2022]
Abstract
INTRODUCTION AND OBJECTIVES It is necessary to be able to predict sperm retrieval before microdissection testicular sperm extraction (mTESE) in azoospermic men. This study established the importance of proliferating cell nuclear antigen (PCNA) and LIM15 gene expression levels in predicting the success of sperm retrieval by mTESE. MATERIALS AND METHODS One hundred and forty-three men who were diagnosed with non-obstructive azoospermia (NOA) were included in the study. Patients' age, total testosterone and follicle stimulating hormone values, testicular volume and testicular histology were recorded by prospectively. PCNA and LIM15 gene expression levels were determined by real-time PCR in the materials from both ejaculate and testicular specimens. RESULTS Testis volume and histology were the most important factors in predicting the sperm retrieval rate (SRR). The PCNA and LIM15 gene expression levels measured in testicular tissues and the LIM15 gene expression levels measured in ejaculate significantly correlated with the SRR in mTESE (p=0.038, p=0.022, and p=0.004, respectively). Although the PCNA gene expression level measured in ejaculate was higher in men with successful sperm retrieval, the difference was not statistically significant (p=0.061). According to the multivariate logistic regression analysis, testicular volume and LIM15 gene expression level in ejaculate were independent predictive parameters for sperm retrieval. CONCLUSION The data showed that LIM15 gene expression level in ejaculate is a useful molecular marker to predict the SRR before mTESE.
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Affiliation(s)
- Muhammed Arif Ibis
- Department of Urology, University of Health Sciences, Kecioren Training and Research Hospital, Ankara, Turkey.
| | - Kaan Aydos
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
| | - Volkan Baltaci
- Department of Medical Genetics, Yuksek Ihtisas University School of Medicine, Ankara, Turkey
| | - Suleyman Aktuna
- Department of Medical Genetics, Yuksek Ihtisas University School of Medicine, Ankara, Turkey
| | - Onder Yaman
- Department of Urology, Ankara University School of Medicine, Ankara, Turkey
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Pallotti F, Barbonetti A, Rastrelli G, Santi D, Corona G, Lombardo F. The impact of male factors and their correct and early diagnosis in the infertile couple's pathway: 2021 perspectives. J Endocrinol Invest 2022; 45:1807-1822. [PMID: 35349114 PMCID: PMC8961097 DOI: 10.1007/s40618-022-01778-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 02/24/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE The current clinical practice in reproductive medicine should pose the couple at the centre of the diagnostic-therapeutic management of infertility and requires intense collaboration between the andrologist, the gynaecologist and the embryologist. The andrologist, in particular, to adequately support the infertile couple, must undertake important biological, psychological, economical and ethical task. Thus, this paper aims to provide a comprehensive overview of the multifaceted role of the andrologist in the study of male factor infertility. METHODS A comprehensive Medline, Embase and Cochrane search was performed including publications between 1969 and 2021. RESULTS Available evidence indicates that a careful medical history and physical examination, followed by semen analysis, always represent the basic starting points of the diagnostic work up in male partner of an infertile couple. Regarding treatment, gonadotropins are an effective treatment in case of hypogonadotropic hypogonadism and FSH may be used in men with idiopathic infertility, while evidence supporting other hormonal and nonhormonal treatments is either limited or conflicting. In the future, pharmacogenomics of FSHR and FSHB as well as innovative compounds may be considered to develop new therapeutic strategies in the management of infertility. CONCLUSION To provide a high-level of care, the andrologist must face several critical diagnostical and therapeutical steps. Even though ART may be the final and decisive stage of this decisional network, neglecting to treat the male partner may ultimately increase the risks of negative outcome, as well as costs and psychological burden for the couple itself.
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Affiliation(s)
- F Pallotti
- Laboratory of Seminology-Sperm Bank "Loredana Gandini", Department of Experimental Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - A Barbonetti
- Andrology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - G Rastrelli
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Careggi Hospital-Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
| | - D Santi
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - G Corona
- Endocrinology Unit, Medical Department, Maggiore-Bellaria Hospital, Azienda-Usl Bologna, 40139, Bologna, Italy
| | - F Lombardo
- Laboratory of Seminology-Sperm Bank "Loredana Gandini", Department of Experimental Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
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Bastug Y, Tokuc E, Bastug N, Artuk I, Tosun C, Cakiroglu HS, Aykan S. Systemic immune-inflammation index, neutrophil-lymphocyte ratio and platelet-lymphocyte ratio are predictors of sperm presence in microdissection testicular sperm extraction. Andrologia 2022; 54:e14419. [PMID: 35266170 DOI: 10.1111/and.14419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/25/2022] [Accepted: 03/01/2022] [Indexed: 12/18/2022] Open
Abstract
The aim of this study is to evaluate the value of the haematologic inflammatory parameters in predicting sperm retrieval rates during microdissection testicular sperm extraction (micro-TESE).159 patients diagnosed with non-obstructive azoospermia were included in the study. After excluding the patients that do not fit the inclusion criteria, age, smoking status, body-mass index, serum luteinizing hormone, follicle-stimulating hormone, total testosterone levels and neutrophil, lymphocyte and platelet counts were recorded. Neutrophil-lymphocyte ratio, platelet-lymphocyte ratio and systemic immune-inflammation index were calculated. The primary outcome was defined as the presence of spermatozoa during the procedure and the association between the candidate predictors and primary endpoint were evaluated by logistic regression analysis. Then, a baseline model from age, smoking, body-mass index and hormonal levels was built. Ratios and indexes were included, respectively, and were compared by multivariate analyses. Each of all three parameters was an independent predictor of obtaining spermatozoa during micro-TESE procedure (all p < 0.001). Even though all three parameters were significant, neutrophil-lymphocyte ratio and systemic immune-inflammation index stood out as more powerful than platelet-lymphocyte ratio (p < 0.08, p < 0.08 respectively). Additionally, adding these parameters individually to the baseline model significantly empowered the predictive value (all p < 0.001). Using haematologic inflammatory parameters in the prediction of sperm presence during microdissection testicular sperm extraction may be helpful when consulting the patient with having a better foresight of the procedural outcomes.
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Affiliation(s)
- Yavuz Bastug
- Department of Urology, Haydarpasa Numune SUAM, University of Health Sciences, Istanbul, Turkey
| | - Emre Tokuc
- Department of Urology, Haydarpasa Numune SUAM, University of Health Sciences, Istanbul, Turkey
| | - Nesrin Bastug
- Department of Gynecology and Obstetrics and IVF Unit, Emsey Hospital, Istanbul, Turkey
| | - Ilker Artuk
- Department of Urology, Haydarpasa Numune SUAM, University of Health Sciences, Istanbul, Turkey
| | - Cagatay Tosun
- Department of Urology, Haydarpasa Numune SUAM, University of Health Sciences, Istanbul, Turkey
| | - Halime Sena Cakiroglu
- Department of Gynecology and Obstetrics, Zeynep Kamil SUAM, University of Health Sciences, Istanbul, Turkey
| | - Serdar Aykan
- Urology Clinic, Emsey Hospital, Istanbul, Turkey
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Özkan B, Coşkuner ER, Güdelci T. Predictive Factors and ICSI Results for Sperm Retrieval by Microdissection Testicular Sperm Extraction (micro-TESE) in Patients with Klinefelter Syndrome. Urology 2021; 161:59-64. [PMID: 34968572 DOI: 10.1016/j.urology.2021.12.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 12/08/2021] [Accepted: 12/13/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine the predictive factors for successful retrieval of sperm from testicles before microdissection-testicular sperm extraction (micro-TESE) in patients with Klinefelter syndrome (KS) in order to counsel these patients regarding the likelihood of findings sperm. MATERIALS AND METHODS The study is a retrospective analysis of the records of 67 men with KS between April 2016 and August 2020. Serum luteinizing hormone (LH), follicle stimulating hormone (FSH), testosterone, prolactin, and estradiol levels were investigated. Testicular volumes were measured by ultrasonography. TESE was noted as positive or negative. RESULTS There were 32 (47.8%) micro-TESE-negative patients and 35 (52.2%) m-TESE positive patients. The age of the micro-TESE-negative (34.9 ± 5.1 years) patient group was significantly higher than the micro-TESE-positive (32.3 ± 4.7 years) group (p = 0.035).The left testicular volume values were significantly higher in the micro-TESE-positive group (p = 0.019). FSH, LH, and prolactin levels were higher in m-TESE-negative patients compared to micro-TESE-positive patients, and testosterone levels and testicular volume were lower in micro-TESE-negative patients compared to micro-TESE-positive patients. However, these differences were not significant. As a result of intracytoplasmic sperm injection (ICSI) performed on 31 couples, 20 pregnancies and 16 live births were obtained (51.06%). CONCLUSION Among the parameters examined in this study, the age of the patient with KS may be predictive for micro-TESE success. Counseling should be given that some patients with KS may have a child via micro-TESE-ICSI.
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Affiliation(s)
- Burak Özkan
- Department of Urology, Mehmet Ali Aydinlar University, School of Medicine, Istanbul, Turkey.
| | - Enis Rauf Coşkuner
- Department of Urology, Mehmet Ali Aydinlar University, School of Medicine, Istanbul, Turkey
| | - Tansu Güdelci
- Department of Urology, Acibadem Maslak Hospital, Istanbul, Turkey
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Araujo SC, Bertolla RP. Protein markers of spermatogenesis and their potential use in the management of azoospermia. Expert Rev Proteomics 2021; 18:939-948. [PMID: 34812697 DOI: 10.1080/14789450.2021.2010548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Azoospermia, absence of sperm in the ejaculate is classified as obstructive (OA) and non-obstructive azoospermia (NOA). In OA, sperm are produced, but due to physical obstruction in the male reproductive tract, they are not released in the ejaculate. NOA, on the other hand, is defined as the absence of sperm in the ejaculate due to testicular dysfunction. In NOA, spermatogenesis is frequently preserved in specific sites, and proteomics studies have been employed in order to identify men with preserved spermatogenesis. AREAS COVERED Differential protein expression in patients with male infertility is an indicator of impaired spermatogenesis. Here, we reviewed proteins with a potential role as biomarkers of spermatogenesis that could help in the management of non-obstructive and obstructive azoospermia. The following keywords were used for bibliographic research: seminal plasma, proteomics, male infertility, nonobstructive, obstructive, azoospermia, oligospermia. EXPERT OPINION Biopsy is an invasive and potentially harmful technique for detecting spermatogenesis in men with OA and NOA. Seminal plasma proteins are highly promising as biomarkers for spermatogenesis. Current literature presents a number of potential candidate biomarkers for determining preserved spermatogenesis.
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Affiliation(s)
- Sophia Costa Araujo
- Department of Surgery, Division of Urology, Human Reproduction Section, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Ricardo Pimenta Bertolla
- Department of Surgery, Division of Urology, Human Reproduction Section, Universidade Federal de São Paulo, São Paulo, Brazil
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9
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Majzoub A, Arafa M, Clemens H, Imperial J, Leisegang K, Khalafalla K, Agarwal A, Henkel R, Elbardisi H. A systemic review and meta-analysis exploring the predictors of sperm retrieval in patients with non-obstructive azoospermia and chromosomal abnormalities. Andrologia 2021; 54:e14303. [PMID: 34729809 DOI: 10.1111/and.14303] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 10/20/2021] [Accepted: 10/25/2021] [Indexed: 01/10/2023] Open
Abstract
To identify the most prevalent chromosomal abnormalities in patients with non-obstructive azoospermia (NOA), consolidate their surgical sperm retrieval (SSR) rates and determine the significant predictors of positive SSR in this patient population. A systematic review and meta-analysis were performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Fifty-three studies including 2965 patients were identified through searching the PubMed database. Klinefelter Syndrome (KS) was the most prevalent chromosomal abnormality reported in 2239 cases (75.5%). Azoospermia factor c (AZFc) microdeletions were the second most common (18.6%), but men with these deletions had higher SSR rates than patients with KS (41.95% with AZFc vs. 38.63% with KS). When examining predictors of SSR in KS patients, younger age was a significant predictor of positive SSR in patients undergoing microsurgical testicular sperm extraction (micro-TESE). Higher testosterone was a favourable predictor in those undergoing micro-TESE and conventional TESE. Lower luteinizing hormone (LH) and follicular stimulating hormone (FSH) values were significantly associated with positive SSR with testicular sperm aspiration (TESA). No parameter predicted SSR rates in patients with AZFc microdeletions. Overall, genetic abnormalities have significant implications on SSR success in patients with NOA.
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Affiliation(s)
- Ahmad Majzoub
- Department of Urology, Hamad Medical Corporation, Doha, Qatar.,Clinical Urology, Weill Cornell Medicine -Qatar, Doha, Qatar
| | - Mohamed Arafa
- Department of Urology, Hamad Medical Corporation, Doha, Qatar.,Clinical Urology, Weill Cornell Medicine -Qatar, Doha, Qatar.,American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, Ohio, USA.,Andrology Department, Cairo University, Cairo, Egypt
| | - Hailey Clemens
- Department of Molecular and Developmental Biology, University of California Santa Barbara, Santa Barbara, California, USA
| | - Jacqueline Imperial
- Department of Biology, University of California San Francisco, San Francisco, California, USA
| | - Kris Leisegang
- School of Natural Medicine, Faculty of Community and Health Sciences, University of the Western Cape, Bellville, South Africa
| | | | - Ashok Agarwal
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ralf Henkel
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Metabolism, Digestion and Reproduction at, Imperial College London, London, UK.,Department of Medical Bioscience, University of the Western Cape, Bellville, South Africa.,LogixX Pharma, Theale, Berkshire, UK
| | - Haitham Elbardisi
- Department of Urology, Hamad Medical Corporation, Doha, Qatar.,Clinical Urology, Weill Cornell Medicine -Qatar, Doha, Qatar.,American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, Ohio, USA
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10
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Topuz B, Ebiloğu T, Sarıkaya S, Kaya E, Fidan U, Korkmaz C, Ceyhan ST, Bedir S, Gürdal M, Karataş ÖF. The timing of micro-TESE: what is the ideal age for male and female partner to bring a child to home? Rev Assoc Med Bras (1992) 2021; 67:958-965. [DOI: 10.1590/1806-9282.20210290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 06/04/2021] [Indexed: 11/21/2022] Open
Affiliation(s)
| | | | | | - Engin Kaya
- Gülhane Training and Research Hospital, Turkey
| | - Ulaş Fidan
- Gülhane Training and Research Hospital, Turkey
| | - Cem Korkmaz
- Gülhane Training and Research Hospital, Turkey
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11
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Tenuta M, Sesti F, Bonaventura I, Mazzotta P, Pofi R, Gianfrilli D, Pozza C. Use of contrast enhanced ultrasound in testicular diseases: A comprehensive review. Andrology 2021; 9:1369-1382. [PMID: 34043256 PMCID: PMC8640938 DOI: 10.1111/andr.13057] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 05/12/2021] [Accepted: 05/24/2021] [Indexed: 01/17/2023]
Abstract
Background Contrast‐enhanced ultrasound (CEUS) is a sonographic technique that increases the diagnostic accuracy of ultrasound and color Doppler ultrasound (CDUS) when studying testicular abnormalities. However, its role in clinical practice is still debatable because there are no accepted standards regarding how and when this technique should be used for patients with testicular disease. Objectives To perform a nonsystematic review of the current literature to highlight the strength and flaws of performing CEUS and to provide a critical overview of current research evidence on this topic. Materials and methods A thorough search of published peer‐reviewed studies in PubMed was performed using proper keywords. Results Strong enhancement of neoplastic lesions (both benign and malignant) during CEUS aids in differential diagnosis with non‐neoplastic lesions, which usually appears either nonenhanced or enhanced in a manner similar to that of the surrounding parenchyma. CEUS enhancement has a high predictive value in the identification of neoplastic lesions, whereas a similar or complete absence of enhancement may be interpreted as strong evidence of benignity, although there are exceptions. Literature on quantitative analysis is still scarce, though promising, particularly in distinguishing benign from malignant neoplasms. Furthermore, CEUS may be useful in many emergency situations, such as acute scrotum, blunt scrotal trauma, and focal infarction of the testis. Finally, CEUS can help increase the probability of sperm recovery in azoospermic males. Discussion and conclusion CEUS is a safe, easy‐to‐perform, and cost‐effective diagnostic tool that can provide a more accurate diagnosis in testicular lesions and acute scrotal disease. However, further studies with larger cohorts are required to refine the differential diagnosis between benign and malignant neoplasms. Finally, these preliminary results can instigate the development of innovative research on pre‐testicular sperm extraction to increase the chances of sperm recovery.
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Affiliation(s)
- Marta Tenuta
- Department of Experimental Medicine, Sapienza University, Rome, Italy
| | - Franz Sesti
- Department of Experimental Medicine, Sapienza University, Rome, Italy
| | | | - Paola Mazzotta
- Department of Experimental Medicine, Sapienza University, Rome, Italy
| | - Riccardo Pofi
- Department of Experimental Medicine, Sapienza University, Rome, Italy
| | | | - Carlotta Pozza
- Department of Experimental Medicine, Sapienza University, Rome, Italy
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12
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Kang C, Punjani N, Schlegel PN. Reproductive Chances of Men with Azoospermia Due to Spermatogenic Dysfunction. J Clin Med 2021; 10:jcm10071400. [PMID: 33807489 PMCID: PMC8036343 DOI: 10.3390/jcm10071400] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/24/2021] [Accepted: 03/26/2021] [Indexed: 12/31/2022] Open
Abstract
Non-obstructive azoospermia (NOA), or lack of sperm in the ejaculate due to spermatogenic dysfunction, is the most severe form of infertility. Men with this form of infertility should be evaluated prior to treatment, as there are various underlying etiologies for NOA. While a significant proportion of NOA men have idiopathic spermatogenic dysfunction, known etiologies including genetic disorders, hormonal anomalies, structural abnormalities, chemotherapy or radiation treatment, infection and inflammation may substantively affect the prognosis for successful treatment. Despite the underlying etiology for NOA, most of these infertile men are candidates for surgical sperm retrieval and subsequent use in intracytoplasmic sperm injection (ICSI). In this review, we describe common etiologies of NOA and clinical outcomes following surgical sperm retrieval and ICSI.
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13
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Abstract
Infertility affects 1 in 6 couples, and male factor infertility has been implicated as a cause in 50% of cases. Azoospermia is defined as the absence of spermatozoa in the ejaculate and is considered the most extreme form of male factor infertility. Historically, these men were considered sterile but, with the advent of testicular sperm extraction and assisted reproductive technologies, men with azoospermia are able to biologically father their own children. Non-obstructive azoospermia (NOA) occurs when there is an impairment to spermatogenesis. This review describes the contemporary management of NOA and discusses the role of hormone stimulation therapy, surgical and embryological factors, and novel technologies such as proteomics, genomics, and artificial intelligence systems in the diagnosis and treatment of men with NOA. Moreover, we highlight that men with NOA represent a vulnerable population with an increased risk of developing cancer and cardiovascular comorbodities.
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Affiliation(s)
- Tharu Tharakan
- Section of Investigative Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom
- Department of Urology, Imperial Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London, United Kingdom
| | - Rong Luo
- Section of Investigative Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Channa N Jayasena
- Section of Investigative Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Suks Minhas
- Department of Urology, Imperial Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London, United Kingdom
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14
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Lacey L, Henderson I, Hassan S, Hunter H, Sajjad Y, Akhtar MA. Can preoperative parameters predict successful sperm retrieval and live birth in couples undergoing testicular sperm extraction and intracytoplasmic sperm injection for azoospermia? MIDDLE EAST FERTILITY SOCIETY JOURNAL 2021. [DOI: 10.1186/s43043-021-00052-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
We aimed to determine if the success of TESE and live-birth following TESE-ICSI can be predicted from readily available preoperative parameters for couples with azoospermia. Our methodology was as follows, this was a cohort study of couples who attended the fertility service (from 2009-2019) at an NHS hospital in whom the male partner was diagnosed with azoospermia and required conventional TESE with multiple biopsies to obtain sperm. Of 414 men included, 223 had successful TESE and of those 178 have used sperm in ICSI cycle(s). Predictive models were developed using logistic regression. We assessed model performance by internally validated concordance statistics and calibration plots. Successful sperm retrieval was defined as the presence of motile sperm which survived the freeze-thaw process and live-birth defined as delivery after 34 weeks of gestation.
Results
Successful TESE was associated with higher male age and lower FSH. The TESE model discriminated well with a c statistic of 0.81 (0.77-0.85). Live-birth was associated with lower maternal age, earlier ICSI cycle, and lower testicular volume. The live-birth model also discriminated well with a c statistic of 0.70 (0.64-0.76).
Conclusions
These results support the pragmatic counselling of couples diagnosed with azoospermia about the chances of success of the TESE procedure and of biological parenthood prior to surgical intervention. The models help to discriminate between men who have a high or low chance of successful TESE and couples who have a higher chance of achieving a live-birth after successful TESE. This will allow couples to make a better assessment of the balance of risk versus benefit prior to commitment to surgical interventions.
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15
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Kulac T, Hekim N, Kocamanoglu F, Beyaz C, Gunes S, Asci R. Methylation patterns of methylenetetrahydrofolate reductase gene promoter in infertile males. Andrologia 2020; 53:e13942. [PMID: 33372270 DOI: 10.1111/and.13942] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/09/2020] [Accepted: 11/25/2020] [Indexed: 01/26/2023] Open
Abstract
Errors of folate/homocysteine pathways which are critical for transferring methyl groups have been suggested to affect male fertility. We aimed to evaluate the methylation patterns of the promoter of methylenetetrahydrofolate reductase (MTHFR) gene in infertile males and to investigate the association between MTHFR promoter methylation and success of sperm retrieval. Thirty-five nonobstructive azoospermic and 46 severe oligozoospermic patients constituted the study group and were compared with 49 fertile and/or normozoospermic men. The methylation status was analysed by methylation-specific polymerase chain reaction. MTHFR promoter methylation was detected in infertile men with NOA and SO in the ratio of 48.6% and 58.7%, respectively. Methylation was also observed in 51% of controls. MTHFR promoter was methylated in 65% of men with viable spermatozoon during TESE. No association was found regarding to the profile of MTHFR promoter methylation between both NOA and SO patients and controls (p = .621). There was no relation between the methylation status of MTHFR promoter and low motility and poor morphology (p = .682 and p = .413, respectively). No association was found between MTHFR promoter methylation and presence of viable spermatozoa (p = .382). Our data indicate that the promoter methylation of MTHFR gene may not be associated with male infertility.
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Affiliation(s)
- Tuba Kulac
- Department of Medical Biology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Neslihan Hekim
- Department of Medical Biology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Fatih Kocamanoglu
- Department of Urology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Cengiz Beyaz
- Department of Urology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Sezgin Gunes
- Department of Medical Biology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey.,Department of Multidisciplinary Molecular Medicine, Health Sciences Institute, Ondokuz Mayis University, Samsun, Turkey
| | - Ramazan Asci
- Department of Urology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey.,Department of Multidisciplinary Molecular Medicine, Health Sciences Institute, Ondokuz Mayis University, Samsun, Turkey
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