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Stallmeyer B, Dicke AK, Tüttelmann F. How exome sequencing improves the diagnostics and management of men with non-syndromic infertility. Andrology 2024. [PMID: 39120565 DOI: 10.1111/andr.13728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 07/07/2024] [Accepted: 07/24/2024] [Indexed: 08/10/2024]
Abstract
Male infertility affects approximately 17% of all men and represents a complex disorder in which not only semen parameters such as sperm motility, morphology, and number of sperm are highly variable, but also testicular phenotypes range from normal spermatogenesis to complete absence of germ cells. Genetic factors significantly contribute to the disease but chromosomal aberrations, mostly Klinefelter syndrome, and microdeletions of the Y-chromosome have remained the only diagnostically and clinically considered genetic causes. Monogenic causes remain understudied and, thus, often unidentified, leaving the majority of the male factor couple infertility pathomechanistically unexplained. This has been changing mostly because of the introduction of exome sequencing that allows the analysis of multiple genes in large patient cohorts. As a result, pathogenic variants in single genes have been associated with non-syndromic forms of all aetiologic sub-categories in the last decade. This review highlights the contribution of exome sequencing to the identification of novel disease genes for isolated (non-syndromic) male infertility by presenting the results of a comprehensive literature search. Both, reduced sperm count in azoospermic and oligozoospermic patients, and impaired sperm motility and/or morphology, in asthenozoospermic and/or teratozoospermic patients are highly heterogeneous diseases with well over 100 different candidate genes described for each entity. Applying the standardized evaluation criteria of the ClinGen gene curation working group, 70 genes with at least moderate evidence to contribute to the disease are highlighted. The implementation of these valid disease genes in clinical exome sequencing is important to increase the diagnostic yield in male infertility and, thus, improve clinical decision-making and appropriate genetic counseling. Future advances in androgenetics will continue to depend on large-scale exome and genome sequencing studies of comprehensive international patient cohorts, which are the most promising approaches to identify additional disease genes and provide reliable data on the gene-disease relationship.
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Affiliation(s)
- Birgit Stallmeyer
- Centre of Medical Genetics, Institute of Reproductive Genetics, University of Münster, Munster, Germany
| | - Ann-Kristin Dicke
- Centre of Medical Genetics, Institute of Reproductive Genetics, University of Münster, Munster, Germany
| | - Frank Tüttelmann
- Centre of Medical Genetics, Institute of Reproductive Genetics, University of Münster, Munster, Germany
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2
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Jiao ZY, Li MR, Zhuo L, Fang YY, Pan JY, Hong K. Sperm retrieval rate and patient factors in azoospermia factor c microdeletion azoospermia: a systematic review. BJU Int 2024; 134:6-12. [PMID: 37942695 DOI: 10.1111/bju.16205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
OBJECTIVE To reveal the overall sperm retrieval rate (SRR) and range in patients with azoospermia factor c (AZFc) microdeletion azoospermia by microdissection testicular sperm extraction (mTESE) and discuss the differences of preoperative patient factors among studies with various SRRs. PATIENTS AND METHODS We searched PubMed, Web of Science and Embase until February 2023. All studies reporting SRRs by mTESE and required parameters of patients with AZFc microdeletions were included. The primary outcome was the SRR and, if available, the pregnancy rate (PR) and live-birth rate (LBR) after intracytoplasmic sperm injection were also investigated as secondary outcomes. RESULTS Eventually 11 cohort studies were included in this review. A total number of 441 patients underwent mTESE and in 275 of them sperm was obtained, reaching an overall SRR of 62.4%. The SRRs among studies had a wide range from 25.0% to 85.7%. The studies reporting higher SRRs generally had older mean ages, and higher follicle-stimulating hormone and testosterone levels. Only four studies provided practical data on pregnancies and live-born children of patients with AZFc microdeletions, so the overall PR and LBR were unavailable. CONCLUSIONS The overall SRR of patients with AZFc microdeletion azoospermia was 62.4%. The effect of patient factors in SR needs further evidence in future work.
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Affiliation(s)
- Zhong-Yu Jiao
- Department of Urology, Peking University Third Hospital, Beijing, China
- Peking University Health Science Center, Beijing, China
| | - Mao-Ran Li
- Department of Urology, Peking University Third Hospital, Beijing, China
- Peking University Health Science Center, Beijing, China
| | - Lin Zhuo
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Yang-Yi Fang
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Jia-Yuan Pan
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Kai Hong
- Department of Urology, Peking University Third Hospital, Beijing, China
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
- National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital), Beijing, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
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3
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Krausz C, Navarro-Costa P, Wilke M, Tüttelmann F. EAA/EMQN best practice guidelines for molecular diagnosis of Y-chromosomal microdeletions: State of the art 2023. Andrology 2024; 12:487-504. [PMID: 37674303 DOI: 10.1111/andr.13514] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 08/11/2023] [Indexed: 09/08/2023]
Abstract
Testing for AZoospermia Factor (AZF) deletions of the Y chromosome is a key component of the diagnostic workup of azoospermic and severely oligozoospermic men. This revision of the 2013 European Academy of Andrology (EAA) and EMQN CIC (previously known as the European Molecular Genetics Quality Network) laboratory guidelines summarizes recent clinically relevant advances and provides an update on the results of the external quality assessment program jointly offered by both organizations. A basic multiplex PCR reaction followed by a deletion extension analysis remains the gold-standard methodology to detect and correctly interpret AZF deletions. Recent data have led to an update of the sY84 reverse primer sequence, as well as to a refinement of what were previously considered as interchangeable border markers for AZFa and AZFb deletion breakpoints. More specifically, sY83 and sY143 are no longer recommended for the deletion extension analysis, leaving sY1064 and sY1192, respectively, as first-choice markers. Despite the transition, currently underway in several countries, toward a diagnosis based on certified kits, it should be noted that many of these commercial products are not recommended due to an unnecessarily high number of tested markers, and none of those currently available are, to the best of our knowledge, in accordance with the new first-choice markers for the deletion extension analysis. The gr/gr partial AZFc deletion remains a population-specific risk factor for impaired sperm production and a predisposing factor for testicular germ cell tumors. Testing for this deletion type is, as before, left at the discretion of the diagnostic labs and referring clinicians. Annual participation in an external quality control program is strongly encouraged, as the 22-year experience of the EMQN/EAA scheme clearly demonstrates a steep decline in diagnostic errors and an improvement in reporting practice.
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Affiliation(s)
- Csilla Krausz
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, University Hospital Careggi, Florence, Italy
| | - Paulo Navarro-Costa
- EvoReproMed Lab, Environmental Health Institute (ISAMB), Associate Laboratory TERRA, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
- Gulbenkian Science Institute, Oeiras, Portugal
| | - Martina Wilke
- Department of Clinical Genetics, Erasmus MC, Rotterdam, The Netherlands
| | - Frank Tüttelmann
- Institute of Reproductive Genetics, University of Münster, Münster, Germany
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4
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Brant A, Schlegel PN. Microdissection Testicular Sperm Extraction. Semin Reprod Med 2023; 41:267-272. [PMID: 38262439 DOI: 10.1055/s-0043-1777833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
Nonobstructive azoospermia (NOA) is among the most common causes of male infertility. For men with NOA seeking fertility treatment, microdissection testicular sperm extraction (microTESE) is the best option for retrieving sperm, which can be used with in vitro fertilization-intracytoplasmic sperm injection to achieve pregnancy in their partner. With the aid of the operating microscope, microTESE allows for thorough evaluation of the testis tissue and selection of seminiferous tubules that appear most capable of sperm production. Rates of success with microTESE vary depending on the underlying cause of NOA and the center at which the procedure is performed. Not all patients are candidates for microTESE, and those who are candidates should be counseled on the likelihood of sperm retrieval and the potential for changes in postoperative testis function.
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Affiliation(s)
- Aaron Brant
- Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York
| | - Peter N Schlegel
- Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York
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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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Carpinello OJ, Marinaro J, Hill MJ, Decherney AH, Devine K, Chason R. Karyotypic abnormalities and Y chromosome microdeletions: How do these impact in vitro fertilization outcomes, and how common are they in the modern in vitro fertilization practice? F S Rep 2021; 2:300-307. [PMID: 34553155 PMCID: PMC8441560 DOI: 10.1016/j.xfre.2021.06.001] [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: 02/11/2021] [Revised: 05/10/2021] [Accepted: 06/04/2021] [Indexed: 11/29/2022] Open
Abstract
Objective To examine the outcomes of in vitro fertilization with intracytoplasmic sperm injection (IVF-ICSI) in couples in whom the male partner has a karyotypic abnormality or Y chromosome microdeletion (YCM). Design Retrospective cohort. Setting Single infertility center. Patient(s) Couples treated with IVF-ICSI from January 2014 to April 2019 with male factor infertility, sperm concentration of <5 × 106 sperm/mL, and results for karyotype and/or YCM panel. Intervention(s) In vitro fertilization with intracytoplasmic sperm injection. Main Outcome Measure(s) In couples in whom the male partner had a karyotypic abnormality or YCM: live birth rate/ongoing pregnancy rate, lack of partner sperm for fertilization, complete fertilization failure, cycle cancellation, and no embryos for transfer. The prevalence of karyotypic abnormalities and YCMs in the IVF population was calculated. Result(s) The live birth rate/ongoing pregnancy rate for those using partner sperm was 51.4% per transfer. However, 8.5% of cycles that intended to use partner sperm and 22.2% of cycles that intended to use surgically extracted partner sperm had no sperm available. Of cycles that created embryos with partner sperm, 12.5% had no embryo to transfer. The prevalence of karyotypic abnormalities was similar to previous reports (6.0%), while that of YCMs was lower (4.4%). Azoospermia factor a and b mutations were not represented in this population. Conclusion(s) It is reasonable to attempt IVF-ICSI with partner sperm in patients with genetic causes of male infertility. Patients should be counseled regarding the possibility of no sperm being available from the male partner, poor/failed fertilization, and genetic implications for potential offspring. Contingency plans, including IVF with donor sperm backup or oocyte cryopreservation, need to be made for these scenarios.
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Affiliation(s)
- Olivia J Carpinello
- Program in Reproductive Endocrinology and Gynecology, Eunice Kennedy Shriver NICHD, National Institutes of Health, Bethesda, Maryland
| | - Jessica Marinaro
- MedStar Georgetown University Hospital, Department of Urology, Washington, D.C
| | - Micah J Hill
- Program in Reproductive Endocrinology and Gynecology, Eunice Kennedy Shriver NICHD, National Institutes of Health, Bethesda, Maryland
| | - Alan H Decherney
- Program in Reproductive Endocrinology and Gynecology, Eunice Kennedy Shriver NICHD, National Institutes of Health, Bethesda, Maryland
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Ernandez J, Berk B, Han T, Abou Ghayda R, Kathrins M. Evaluating the quality of reported outcomes for microsurgical TESE in men with non-obstructive azoospermia: A methodological analysis. Andrology 2021; 9:1108-1118. [PMID: 33675583 DOI: 10.1111/andr.12997] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/22/2021] [Accepted: 02/25/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Publications of microsurgical testicular sperm extraction (mTESE) techniques and outcomes are heterogeneous, which may limit creation of best surgical practices. OBJECTIVE To study the quality and heterogeneity of published mTESE outcomes via a methodological analysis. MATERIALS/METHODS A systematic methodological analysis of all published literature on the use of mTESE in men with non-obstructive azoospermia from 1999 to the July 2020 was performed. PubMed and MEDLINE searches were performed using the search terms "microdissection TESE OR microsurgical TESE." Publications were evaluated on their reporting of pre-operative factors, intraoperative techniques, surgical and clinical outcomes, and adverse events. RESULTS Fifty-five studies met inclusion criteria. Surgical technique and sperm retrieval rates were the most reported criteria. Reporting on the presence of an embryologist intraoperatively was observed in approximately 30% of articles, while other procedural details including method of sperm quantification, quantity retrieved, and number of cryopreserved vials were observed in fewer than 10% of articles. Clinical outcomes, including pregnancy rates and live birth rates, were reported in fewer than 40% of the articles. Fetal outcomes including fetal and neonatal anomalies were rarely reported. Fetal growth restriction, preterm delivery, small or large for gestational age, and NICU admissions were never reported. CONCLUSION There are inconsistencies in reporting quality of mTESE outcomes, specifically a lack of information on the quantity and quality of sperm retrieved, the role of embryology intraoperatively, and clinical outcomes, such as live birth rate and fetal anomalies. These gaps may guide development of standardized reporting guidelines to better assess and compare clinical outcomes across institutions and maintain focus on couples-centric fertility outcomes in future mTESE studies.
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Affiliation(s)
| | - Brittany Berk
- Division of Urology, Brigham and Women's Hospital, Boston, MA, USA
| | - Tracy Han
- Division of Urology, Brigham and Women's Hospital, Boston, MA, USA
| | - Ramy Abou Ghayda
- Department of Urology, Case Western Reserve University, Cleveland, OH, USA
| | - Martin Kathrins
- Division of Urology, Brigham and Women's Hospital, Boston, MA, USA
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Yuen W, Golin AP, Flannigan R, Schlegel PN. Histology and sperm retrieval among men with Y chromosome microdeletions. Transl Androl Urol 2021; 10:1442-1456. [PMID: 33850779 PMCID: PMC8039602 DOI: 10.21037/tau.2020.03.35] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
In this review of Y chromosome microdeletions, azoospermia factor (AZF) deletion subtypes, histological features and microTESE sperm retrieval rates are summarized after a systematic literature review. PubMed was searched and papers were identified using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Approximately half of infertile couples have a male factor contributing to their infertility. One of the most common genetic etiologies are Y chromosome microdeletions. Men with Y chromosome microdeletions may have rare sperm available in the ejaculate or undergo surgical sperm retrieval and subsequent intracytoplasmic sperm injection to produce offspring. Azoospermia or severe oligozoospermia are the most common semen analysis findings found in men with Y chromosome microdeletions, associated with impaired spermatogenesis. Men with complete deletions of azoospermia factor a, b, or a combination of any loci have severely impaired spermatogenesis and are nearly always azoospermic with no sperm retrievable from the testis. Deletions of the azoospermia factor c or d often have sperm production and the highest likelihood of a successful sperm retrieval. In men with AZFc deletions, histologically, 46% of men demonstrate Sertoli cell only syndrome on biopsy, whereas 38.2% have maturation arrest and 15.7% have hypospermatogenesis. The microTESE sperm retrieval rates in AZFc-deleted men range from 13-100% based on the 32 studies analyzed, with a mean sperm retrieval rate of 47%.
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Affiliation(s)
- Wallace Yuen
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Andrew P Golin
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Ryan Flannigan
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada.,Department of Urology, Weill Cornell Medicine, New York, NY, USA
| | - Peter N Schlegel
- Department of Urology, Weill Cornell Medicine, New York, NY, USA
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9
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Golin AP, Yuen W, Flannigan R. The effects of Y chromosome microdeletions on in vitro fertilization outcomes, health abnormalities in offspring and recurrent pregnancy loss. Transl Androl Urol 2021; 10:1457-1466. [PMID: 33850780 PMCID: PMC8039589 DOI: 10.21037/tau-19-672] [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] [Indexed: 12/20/2022] Open
Abstract
Male factor infertility accounts for approximately 50% of all infertility evaluations. A common cause of severe oligozoospermia and azoospermia is Y chromosome microdeletions (YCMs). Men with these genetic microdeletions must typically undergo assisted reproductive technology (ART) procedures to obtain paternity. In this review, we performed a thorough and extensive search of the literature to summarize the effects of YCMs on in vitro fertilization (IVF) outcomes, health abnormalities in offspring and recurrent pregnancy loss (RPL). The PubMed database was searched using specific search terms and papers were identified using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Sperm retrieval amongst men with complete AZFa and/or AZFb deletions is extremely rare and thus data on ARTs is largely unavailable. In AZFc-deleted men undergoing assisted reproduction, the collective fertilization rate (FR) is 59.8%, the clinical pregnancy rate is 28.6% and the live birth rate is 23.4%. When successful, the YCM is always transmitted to the male offspring and the deletion size either remains unchanged or widens. YCMs generally result in decreased fertilization, clinical pregnancy and live birth rates compared to men with intact Y chromosomes during ART interventions. There is a minimal or absent association of YCMs with abnormalities in the offspring or RPL.
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Affiliation(s)
- Andrew P Golin
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Wallace Yuen
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Ryan Flannigan
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
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10
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Zhou Y, Deng CC, Liu WJ, Liu H, Zheng HB, Tang YG, Zhang XZ, Deng JH. Reproductive outcomes of intracytoplasmic sperm injection using testicular sperm and ejaculated sperm in patients with AZFc microdeletions: a systematic review and meta-analysis. Asian J Androl 2021; 23:495-500. [PMID: 33605899 PMCID: PMC8451498 DOI: 10.4103/aja.aja_1_21] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Studies have explored the assisted reproductive technology (ART) outcomes of Y-chromosome azoospermia factor c (AZFc) microdeletions, but the effect of sperm source on intracytoplasmic sperm injection (ICSI) remains unknown. To determine the ART results of ICSI using testicular sperm and ejaculated sperm from males with AZFc microdeletions, we searched Embase, Web of Science, and PubMed to conduct a systematic review and meta-analysis. The first meta-analysis results for 106 cycles in five studies showed no significant differences in the live birth rate between the testicular sperm group and the ejaculated sperm group (risk ratio: 0.97, 95% confidence interval [CI]: 0.73–1.28, P = 0.82). The second meta-analysis of 106 cycles in five studies showed no difference in the abortion rate between the testicular sperm group and ejaculated sperm group (risk ratio: 1.06, 95% CI: 0.54–2.06, P = 0.87). The third meta-analysis of 386 cycles in seven studies showed no significant difference in clinical pregnancy rates between the testicular sperm group and the ejaculated sperm group (risk ratio: 1.24, 95% CI: 0.66–2.34, P = 0.50). Inevitable heterogeneity weakened our results. However, our results indicated that testicular sperm and ejaculated sperm yield similar ART outcomes, representing a meaningful result for clinical treatment. More properly designed studies are needed to further confirm our conclusions.
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Affiliation(s)
- Yu Zhou
- Department of Urology, The First Affiliated Hospital, Jinan University, Guangzhou 510630, China.,NHC Key Laboratory of Male Reproduction and Genetics, Family Planning Research Institute of Guangdong Province, Guangzhou 510600, China
| | - Cun-Can Deng
- NHC Key Laboratory of Male Reproduction and Genetics, Family Planning Research Institute of Guangdong Province, Guangzhou 510600, China.,Digestive Diseases Center, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen 518107, China
| | - Wu-Jiang Liu
- NHC Key Laboratory of Male Reproduction and Genetics, Family Planning Research Institute of Guangdong Province, Guangzhou 510600, China
| | - Huang Liu
- NHC Key Laboratory of Male Reproduction and Genetics, Family Planning Research Institute of Guangdong Province, Guangzhou 510600, China
| | - Hou-Bin Zheng
- NHC Key Laboratory of Male Reproduction and Genetics, Family Planning Research Institute of Guangdong Province, Guangzhou 510600, China
| | - Yun-Ge Tang
- NHC Key Laboratory of Male Reproduction and Genetics, Family Planning Research Institute of Guangdong Province, Guangzhou 510600, China
| | - Xin-Zong Zhang
- NHC Key Laboratory of Male Reproduction and Genetics, Family Planning Research Institute of Guangdong Province, Guangzhou 510600, China
| | - Jun-Hong Deng
- Department of Andrology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou 510180, China
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11
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Zhang HL, Zhao LM, Mao JM, Liu DF, Tang WH, Lin HC, Zhang L, Lian Y, Hong K, Jiang H. Sperm retrieval rates and clinical outcomes for patients with different causes of azoospermia who undergo microdissection testicular sperm extraction-intracytoplasmic sperm injection. Asian J Androl 2021; 23:59-63. [PMID: 32341210 PMCID: PMC7831829 DOI: 10.4103/aja.aja_12_20] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The aim of our study was to compare the sperm retrieval rates (SRRs) and clinical outcomes of patients with different causes of azoospermia who underwent microdissection testicular sperm extraction-intracytoplasmic sperm injection (micro-TESE-ICSI). We conducted a retrospective study at the Reproductive Medicine Center of Peking University Third Hospital in Beijing, China, from January 2014 to December 2017. This study examined 769 patients with nonobstructive azoospermia who underwent 347 cycles of micro-TESE-ICSI. Patients with azoospermia were classified into Group A (Klinefelter syndrome, n = 284, 125 cycles), Group B (azoospermia Y chromosome factor c [AZFc] microdeletion, n = 91, 64 cycles), Group C (cryptorchidism, n = 52, 39 cycles), Group D (previous mumps and bilateral orchitis, n = 23, 23 cycles), and Group E (idiopathic azoospermia, n = 319, 96 cycles). Clinical characteristics, SRR, embryonic development, and pregnancy outcomes of the patients were compared between all groups. Patients in Group D had the highest and most successful SRR. The average SRR for all patients was 46.0%. The rates of clinical pregnancy, implantation, and live birth in Group D were 78.3%, 65.0%, and 74.0%, respectively, which were higher than those in all other groups (P < 0.05). Group B patients had the lowest clinical pregnancy, implantation, and live birth rates of all groups (P < 0.05). No differences were found in the miscarriage rate or birth defects among the groups (P > 0.05). Patients with orchitis had the highest SRR and best clinical outcomes. Although AZFc microdeletion patients had a higher SRR, their clinical outcomes were worse.
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Affiliation(s)
- Hong-Liang Zhang
- Department of Urology, Peking University Third Hospital, Beijing 100191, China.,Department of Reproductive Medicine Center, Peking University Third Hospital, Beijing 100191, China.,Department of Andrology, Peking University Third Hospital, Beijing 100191, China.,Department of Human Sperm Bank, Peking University Third Hospital, Beijing 100191, China
| | - Lian-Ming Zhao
- Department of Urology, Peking University Third Hospital, Beijing 100191, China.,Department of Reproductive Medicine Center, Peking University Third Hospital, Beijing 100191, China.,Department of Andrology, Peking University Third Hospital, Beijing 100191, China
| | - Jia-Ming Mao
- Department of Urology, Peking University Third Hospital, Beijing 100191, China.,Department of Reproductive Medicine Center, Peking University Third Hospital, Beijing 100191, China.,Department of Andrology, Peking University Third Hospital, Beijing 100191, China
| | - De-Feng Liu
- Department of Urology, Peking University Third Hospital, Beijing 100191, China.,Department of Reproductive Medicine Center, Peking University Third Hospital, Beijing 100191, China.,Department of Andrology, Peking University Third Hospital, Beijing 100191, China
| | - Wen-Hao Tang
- Department of Urology, Peking University Third Hospital, Beijing 100191, China.,Department of Reproductive Medicine Center, Peking University Third Hospital, Beijing 100191, China.,Department of Andrology, Peking University Third Hospital, Beijing 100191, China.,Department of Human Sperm Bank, Peking University Third Hospital, Beijing 100191, China
| | - Hao-Cheng Lin
- Department of Urology, Peking University Third Hospital, Beijing 100191, China.,Department of Reproductive Medicine Center, Peking University Third Hospital, Beijing 100191, China.,Department of Andrology, Peking University Third Hospital, Beijing 100191, China
| | - Li Zhang
- Department of Reproductive Medicine Center, Peking University Third Hospital, Beijing 100191, China
| | - Ying Lian
- Department of Reproductive Medicine Center, Peking University Third Hospital, Beijing 100191, China
| | - Kai Hong
- Department of Urology, Peking University Third Hospital, Beijing 100191, China.,Department of Reproductive Medicine Center, Peking University Third Hospital, Beijing 100191, China.,Department of Andrology, Peking University Third Hospital, Beijing 100191, China
| | - Hui Jiang
- Department of Urology, Peking University Third Hospital, Beijing 100191, China.,Department of Reproductive Medicine Center, Peking University Third Hospital, Beijing 100191, China.,Department of Andrology, Peking University Third Hospital, Beijing 100191, China.,Department of Human Sperm Bank, Peking University Third Hospital, Beijing 100191, China
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12
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Birowo P, Tendi W, Rasyid N, Turek PJ, Sini IR, Rizal M. Successful Targeted Testicular Sperm Extraction Using Microsurgical Technique (microTESE) Following Fine Needle Aspiration (FNA) Mapping in a Non-Obstructive Azoospermia (NOA) Patient: A Case Report. J Reprod Infertil 2020; 22:65-69. [PMID: 33680887 PMCID: PMC7903663 DOI: 10.18502/jri.v22i1.4997] [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] [Indexed: 11/24/2022] Open
Abstract
Background: Management for male infertility can be difficult for some cases. Surgical intervention has long been thought as the last resort to help married couples to conceive. The current guideline recommends testicular sperm extraction with micro-surgery technique (microTESE) in severe cases of male infertility. However, the success rate still varies. Thus, a new strategy was needed to further increase the sperm retrieval success rate. Case Presentation: A 39-year-old male with a history of failed sperm extraction, non-obstructive azoospermia (NOA) and Y-chromosomal microdeletion came to the fertility center to undergo sperm retrieval. Fine needle aspiration (FNA) Mapping was performed prior to microTESE to increase the accuracy of sperm retrieval. After further examination with laser assisted immotile sperm selection (LAISS), five spermatozoa were found. Conclusion: The combination of FNA Mapping and microTESE increases the chance of a successful sperm extraction.
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Affiliation(s)
- Ponco Birowo
- Department of Urology, Cipto Mangunkusumo Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.,Indonesian Reproductive Science Institute, Bunda General Hospital, Jakarta, Indonesia
| | - William Tendi
- Department of Urology, Cipto Mangunkusumo Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.,Indonesian Reproductive Science Institute, Bunda General Hospital, Jakarta, Indonesia
| | - Nur Rasyid
- Department of Urology, Cipto Mangunkusumo Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | | | - Ivan Rizal Sini
- Indonesian Reproductive Science Institute, Bunda General Hospital, Jakarta, Indonesia
| | - Muhammad Rizal
- Indonesian Reproductive Science Institute, Bunda General Hospital, Jakarta, Indonesia
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13
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Kuroda S, Usui K, Sanjo H, Takeshima T, Kawahara T, Uemura H, Yumura Y. Genetic disorders and male infertility. Reprod Med Biol 2020; 19:314-322. [PMID: 33071633 PMCID: PMC7542010 DOI: 10.1002/rmb2.12336] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 06/08/2020] [Accepted: 06/13/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND At present, one out of six couples is infertile, and in 50% of cases, infertility is attributed to male infertility factors. Genetic abnormalities are found in 10%-20% of patients showing severe spermatogenesis disorders, including non-obstructive azoospermia. METHODS Literatures covering the relationship between male infertility and genetic disorders or chromosomal abnormalities were studied and summarized. MAIN FINDINGS RESULTS Genetic disorders, including Klinefelter syndrome, balanced reciprocal translocation, Robertsonian translocation, structural abnormalities in Y chromosome, XX male, azoospermic factor (AZF) deletions, and congenital bilateral absence of vas deferens were summarized and discussed from a practical point of view. Among them, understanding on AZF deletions significantly changed owing to advanced elucidation of their pathogenesis. Due to its technical progress, AZF deletion test can reveal their delicate variations and predict the condition of spermatogenesis. Thirty-nine candidate genes possibly responsible for azoospermia have been identified in the last 10 years owing to the advances in genome sequencing technologies. CONCLUSION Genetic testing for chromosomes and AZF deletions should be examined in cases of severe oligozoospermia and azoospermia. Genetic counseling should be offered before and after genetic testing.
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Affiliation(s)
- Shinnosuke Kuroda
- Department of Urology, Reproductive CentreYokohama City University Medical CentreKanagawaJapan
- Department of Medical GeneticsYokohama City University Medical CentreKanagawaJapan
| | - Kimitsugu Usui
- Department of Urology, Reproductive CentreYokohama City University Medical CentreKanagawaJapan
| | - Hiroyuki Sanjo
- Department of Urology, Reproductive CentreYokohama City University Medical CentreKanagawaJapan
| | - Teppei Takeshima
- Department of Urology, Reproductive CentreYokohama City University Medical CentreKanagawaJapan
| | - Takashi Kawahara
- Department of Urology and Renal TransplantationYokohama City University Medical CentreKanagawaJapan
| | - Hiroji Uemura
- Department of Urology and Renal TransplantationYokohama City University Medical CentreKanagawaJapan
| | - Yasushi Yumura
- Department of Urology, Reproductive CentreYokohama City University Medical CentreKanagawaJapan
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14
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Salvarci A, Gurbuz AS, Balasar M. Evaluation from a different perspective of 10-year results of infertile males with Y chromosome AZFc microdeletions compared with a control group. Andrologia 2020; 52:e13572. [PMID: 32237082 DOI: 10.1111/and.13572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 02/22/2020] [Accepted: 02/28/2020] [Indexed: 11/30/2022] Open
Abstract
AZFc microdeletions will be evaluated upon being divided into partial and complete subgroups. The association of deletions with reactive oxidative stress (ROS) and sperm DNA fragmentation (SDFI) and the impact of their coexistence on fertility starting from the pregnancy process until live birth will be presented. Semen analyses, microbiological results, hormones, ROS and sperm TUNEL tests were checked. Preimplantation genetic testing (PGT) was planned for relevant patients. Intracytoplasmic sperm injection (ICSI) was applied. Their embryo fragmentation was monitored via time lapse. Their results were compared with those with no AZF deletion and no other genetic problems. Azoospermia rate was 71.5%, m-TESE success rate was 25%, pregnancy rate was 26% and live child rate was 2.2%. No difference was detected between the partial and total groups in terms of ROS and SDFI rates and no difference was identified with the control group. Better results were obtained in terms of live child rate in patients with partial AZFc and low ROS/SDFI. Spermatozoon was retrieved in AZFc deletions and pregnancy, and live child was identified. No AZFc impact was observed on ROS and SDFI in the results compared with the control groups in terms of their coexistence.
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Affiliation(s)
- Ahmet Salvarci
- Department of Urology, Novafertile IVF Centers and Medicana Hospital of KTO School of Medicine, Konya, Turkey
| | - Ali Sami Gurbuz
- Department of Obstetrics and Gynecology, Novafertile IVF Centers and Medicana Hospital of KTO School of Medicine, Konya, Turkey
| | - Mehmet Balasar
- Department of Urology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
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15
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Akbarzadeh Khiavi M, Jalili A, Safary A, Gharedaghchi Z, Mirinezhad SK, Mehdizadeh A, Rahmani SA. Karyotypic abnormalities and molecular analysis of Y chromosome microdeletion in Iranian Azeri Turkish population infertile men. Syst Biol Reprod Med 2019; 66:140-146. [PMID: 31687839 DOI: 10.1080/19396368.2019.1682083] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Infertility is one of the major health-threatening problems in communities which may lead to psychological problems among couples. Y chromosome abnormalities and microdeletions have recently been considered as one of the male infertility factors. The aim of this study was to evaluate different chromosomal disorders and azoospermia factor b (AZFb), AZFc and AZFd microdeletions in idiopathic non-obstructive oligo or azoospermia infertile men. One hundred infertile (78 azoospermia and 22 oligospermia) and 100 fertile men were included in this study. Luteinizing hormone (LH) and follicle stimulating hormone (FSH) levels were evaluated by electrochemiluminescence. Karyotyping was performed according to standard methods and interpreted using the International System for Human Cytogenetic Nomenclature (ISHCN) recommendation. For Y chromosome microdeletion analysis, a multiplex polymerase chain reaction (PCR) was performed using STS primers. Higher FSH (24.32 ± 15.32 versus 8.02 ± 3.37, p < 0.0001) and LH (14.97 ± 8.26 versus 5.42 ± 2.73, p < 0.0001) were observed in infertile patients compared to their fertile counterpart. Additionally, 14% of infertile patients exhibited abnormal karyotype. The frequency of Y chromosome microdeletions in azoospermic and oligospermic patients was 32.05% (25/78) and 0% (0/22), respectively. Additionally, in azoospermic patients, the highest microdeletion frequency was related to the AZFc region (80%). Our data indicate the presence of chromosomal changes in the most infertile men, suggesting karyotype and molecular analysis of Y chromosome microdeletions for genetic counseling before assisted reproduction.Abbreviations: ART: assisted reproductive technology; AZF: azoospermia factor; DAZ: deleted in azoospermia; FCS: fetal calf serum; FSH: follicle stimulating hormone; LH: luteinizing hormone; PCR: polymerase chain reaction; SRY: sex-determining region Y; STS: sequence-tagged sites.
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Affiliation(s)
- Mostafa Akbarzadeh Khiavi
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Research Center for Pharmaceutical Nanotechnology, Biomedicine Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Akbar Jalili
- Department of Molecular Biology, Faculty of Basic Science, Ahar Branch, Islamic Azad University, Ahar, Iran
| | - Azam Safary
- Research Center for Pharmaceutical Nanotechnology, Biomedicine Institute, Tabriz University of Medical Sciences, Tabriz, Iran.,Connective Tissue Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ziba Gharedaghchi
- Department of Biology, Rasht Branch, Islamic Azad University, Rasht, Iran
| | - Seyed Kazem Mirinezhad
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Amir Mehdizadeh
- Endocrine Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Comprehensive Health Lab, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Seyyed Ali Rahmani
- Department of Clinical Biochemistry and Genetics, Tabriz University of Medical Sciences, Tabriz, Islamic Republic of Iran
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16
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Abur U, Gunes S, Ascı R, Altundag E, Akar OS, Ayas B, Karadag Alpaslan M, Ogur G. Chromosomal and Y-chromosome microdeletion analysis in 1,300 infertile males and the fertility outcome of patients with AZFc microdeletions. Andrologia 2019; 51:e13402. [PMID: 31650616 DOI: 10.1111/and.13402] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 07/05/2019] [Accepted: 07/24/2019] [Indexed: 01/22/2023] Open
Abstract
The present study investigated the frequency of chromosome aberrations and AZF microdeletions in infertile patients with nonobstructive azoospermia (NOA) or severe oligozoospermia. Additionally, the effect of the AZFc microdeletions on the success of microdissection testicular sperm extraction (microTESE) and intracytoplasmic sperm injection (ICSI) methods were evaluated. Peripheral blood samples were received from 1,300 infertile men with NOA and severe oligozoospermia. Karyotyping and FISH analysis were performed according to standard methods. AZF microdeletions were analysed using multiplex polymerase chain reaction or GML Y-chromosome Microdeletion Detection System consisting of 14 markers. The chromosomal aberrations and the AZF microdeletions frequency among 1,300 infertile men were 10.6% and 4.0% respectively. Either ejaculated spermatozoa or microTESE was performed on only in 19 out of 26 patients with AZFc deletions. Of the 19 patients, four had severe oligozoospermia and 15 had NOA. In eight out of 15 NOA patients, testicular mature spermatozoa were obtained (53.3%) and then ICSI was applied to mature oocytes. After undergoing ICSI treatment, clinical pregnancy and live birth outcome rates were found to be 37.5% and 25% respectively. These results suggest that infertile patients with AZFc microdeletion could achieve successful fertilisation pregnancies with the help of assisted reproductive technology.
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Affiliation(s)
- Ummet Abur
- Department of Medical Genetics, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Sezgin Gunes
- Department of Medical Biology and Genetics, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Ramazan Ascı
- Department of Urology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Engin Altundag
- Department of Medical Genetics, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Omer S Akar
- Department of Medical Genetics, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Bulent Ayas
- Department of Histology-Embryology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | | | - Gonul Ogur
- Department of Medical Genetics, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
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