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Venianaki AP, Barbagianni MS, Fthenakis GC, Galatos AD, Gouletsou PG. Ultrasonography of Testicular Maturation and Correlation with Body Growth and Semen Evaluation in Beagle Dog Model. Vet Sci 2024; 11:270. [PMID: 38922017 PMCID: PMC11209051 DOI: 10.3390/vetsci11060270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 05/31/2024] [Accepted: 06/06/2024] [Indexed: 06/27/2024] Open
Abstract
This prospective study investigated the ultrasonographic appearance of the canine testis from birth to adulthood. Eight purpose-bred laboratory Beagle-breed dogs were monitored from 4 to 40 weeks of life. The following parameters were evaluated every two weeks: bodyweight and height, scrotal and testicular volume, ultrasonographically measured testicular volume, echogenicity, heterogeneity, blood-flow score, ratio of the grayscale intensity value of the testis to the capsule, ejaculate volume, motility, viability, and number of spermatozoa. A correlation analysis was carried out between the various measurements obtained. Fertility was achieved in the 36th week of life. The echogenicity of the testicular parenchyma increased with age, and subsequently to the 30th week of life remained constant. The heterogeneity of the testicular parenchyma, as was evaluated by the standard deviation of the values of grayscale intensity of the parenchyma, also increased with age and was >19 at the onset of fertility. The ratio of grayscale intensity of testicular parenchyma had values < 200 at maturity. A colour Doppler evaluation first detected blood flow in the testis in the 22nd week. After the 32nd week, distinct signals were visible. In the 36th week, >80% of the testes imaged had visible vessels. A significant correlation was found between all the evaluation methods. The findings of the study may help clinicians detect the onset of fertility in dogs, especially when semen evaluation is not feasible; however, their applicability in all breeds or individuals might possibly vary due to genetic, physiological, and developmental differences. In summary, the study ultrasonographically explores the testicular maturity in dogs, with the aim to improve clinical assessments and health management in these animals.
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Affiliation(s)
- Athina P. Venianaki
- Clinic of Obstetrics and Reproduction, Faculty of Veterinary Science, School of Health Sciences, University of Thessaly, Trikalon 224, 43100 Karditsa, Greece; (A.P.V.); (G.C.F.)
| | - Mariana S. Barbagianni
- Clinic of Surgery, Faculty of Veterinary Science, School of Health Sciences, University of Thessaly, 43100 Karditsa, Greece; (M.S.B.); (A.D.G.)
| | - George C. Fthenakis
- Clinic of Obstetrics and Reproduction, Faculty of Veterinary Science, School of Health Sciences, University of Thessaly, Trikalon 224, 43100 Karditsa, Greece; (A.P.V.); (G.C.F.)
| | - Apostolos D. Galatos
- Clinic of Surgery, Faculty of Veterinary Science, School of Health Sciences, University of Thessaly, 43100 Karditsa, Greece; (M.S.B.); (A.D.G.)
| | - Pagona G. Gouletsou
- Clinic of Obstetrics and Reproduction, Faculty of Veterinary Science, School of Health Sciences, University of Thessaly, Trikalon 224, 43100 Karditsa, Greece; (A.P.V.); (G.C.F.)
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Pedersen MRV, Otto PO, Fredslund M, Smedegaard C, Jensen J, McEntee MF, Loft MK. Ultrasound assessment of testicular volume - An interobserver variability study. J Med Imaging Radiat Sci 2023; 54:692-698. [PMID: 37838500 DOI: 10.1016/j.jmir.2023.09.001] [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: 07/31/2023] [Revised: 09/02/2023] [Accepted: 09/06/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND Ultrasonography measurement of the testicles and subsequent calculation of the testicular volume is recommended as a part of a standard scrotal ultrasound examination. The interobserver variability of testicular volume measurement has implications for surgical recommendations. Therefore, this study aimed to investigate the interobserver variability in the measurement of testicular volume. METHODS Interobserver variability was established by comparing testicular measurements performed by two observers on the same patient during the same clinical appointment. The observers were blinded to each other's measurements. Testicular volume was calculated using the Lambert formula: length x width x height x 0.71. A total of three observers, A, B and C, participated in the study. The observers had between 4 to 20 years' experience with scrotal ultrasound examinations. RESULTS In total, 24 patients' were included (48 testicles). The patient´s mean age was 43 years (range 19-75 years). The overall mean right testicular volume was 19.8 ml (range 7.3-31.6 ml), and the left was 20.1 ml (range 7.1-36.1 ml). The interclass correlation coefficient (ICC) between observer A and B was excellent (ICC= 0.98, CI:0.92-0.99), between observer A and C, was excellent (ICC=0.91, CI: 0.77-0.97) and between B and C good (ICC=0.82, CI:0.51-0.93). CONCLUSION Variability in estimating testicular volume is low, with interobserver agreement ranging from good to excellent. Ultrasound provides a highly reproducible tool to determine testicular volume.
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Affiliation(s)
- Malene Roland Vils Pedersen
- University Hospital of Southern Denmark, Department of Radiology, Vejle Hospital, Beriderbakken 4, Vejle, Denmark; University Hospital of Southern Denmark, Department of Radiology, Kolding hospital, Sygehusvej 24, Kolding, Denmark; University of Southern Denmark, Institute of Regional Health, Campusvej 55, Odense, Denmark.
| | - Peter Obel Otto
- University Hospital of Southern Denmark, Department of Radiology, Vejle Hospital, Beriderbakken 4, Vejle, Denmark
| | - Mads Fredslund
- University Hospital of Southern Denmark, Department of Radiology, Vejle Hospital, Beriderbakken 4, Vejle, Denmark
| | - Claus Smedegaard
- University Hospital of Southern Denmark, Department of Radiology, Vejle Hospital, Beriderbakken 4, Vejle, Denmark
| | - Janni Jensen
- Odense University Hospital, Department of Radiology, J. B Winsløwsvej 4, Odense, Denmark; Research and Innovation Unit of Radiology, University Hospital of Southern Denmark
| | - Mark F McEntee
- University Hospital of Southern Denmark, Department of Radiology, Vejle Hospital, Beriderbakken 4, Vejle, Denmark; University of Southern Denmark, Institute of Regional Health, Campusvej 55, Odense, Denmark; University College Cork, School of Medicine, Discipline of Medical Imaging and Radiation Therapy, Ireland
| | - Martina Kastrup Loft
- University Hospital of Southern Denmark, Department of Radiology, Vejle Hospital, Beriderbakken 4, Vejle, Denmark; University Hospital of Southern Denmark, Department of Radiology, Kolding hospital, Sygehusvej 24, Kolding, Denmark
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Riviere E, Rossi SP, Tavalieri YE, Muñoz de Toro MM, Calandra RS, Mayerhofer A, Matzkin ME, Frungieri MB. Pleiotropic actions of melatonin in testicular peritubular myoid cells of immature Syrian hamsters. Biochim Biophys Acta Gen Subj 2022; 1866:130187. [PMID: 35691458 DOI: 10.1016/j.bbagen.2022.130187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/30/2022] [Accepted: 06/04/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Peritubular myoid cells are emerging as key regulators of testicular function in adulthood. However, little is known about the role of testicular peritubular myoid cells (TPMCs) in the development of the male gonad. We found that, compared to testes of young adult hamsters, gonads of 21 day-old animals show increased melatonin concentration, seminiferous tubular wall thickening and a heterogeneous packaging of its collagen fibers thus raising the question whether melatonin may be involved in the regulation of TPMCs. METHODS We established primary cultures of TPMCs from immature hamsters (ihaTPMCs), which we found express melatonergic receptors. RESULTS Exogeneous melatonin decreased the levels of inflammatory markers (NLRP3 inflammasome, IL1β) but increased the expression of cyclooxygenase 2 (COX2, key enzyme mediating prostaglandin synthesis) and of the glial cell line-derived neurotrophic factor (GDNF) in ihaTPMCs. Melatonin also stimulated ihaTPMCs proliferation and the expression of extracellular matrix proteins such as collagen type I and IV. Furthermore, collagen gel contraction assays revealed an enhanced ability of ihaTPMCs to contract in the presence of melatonin. CONCLUSION Melatonin regulates immune and inflammatory functions as well as contractile phenotype of the peritubular wall in the hamster testis. GENERAL SIGNIFICANCE If transferable to the in vivo situation, melatonin-dependent induction of ihaTPMCs to produce factors known to exert paracrine effects in other somatic cell populations of the gonad suggests that the influence of melatonin may go beyond the peritubular wall and indicates its contribution to testicular development and the establishment of a normal and sustainable spermatogenesis.
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Affiliation(s)
- Eugenia Riviere
- Instituto de Biología y Medicina Experimental, IBYME-CONICET, Ciudad de Buenos Aires C1428ADN, Argentina
| | - Soledad P Rossi
- Instituto de Biología y Medicina Experimental, IBYME-CONICET, Ciudad de Buenos Aires C1428ADN, Argentina; Cátedra de Bioquímica Humana, Facultad de Medicina, Universidad de Buenos Aires, Ciudad de Buenos Aires C1121ABG, Argentina
| | - Yamil E Tavalieri
- Instituto de Salud y Ambiente del Litoral (ISAL, UNL-CONICET), Facultad de Bioquímica y Ciencias Biológicas, Universidad Nacional del Litoral, Santa Fe 3000, Argentina
| | - Mónica M Muñoz de Toro
- Instituto de Salud y Ambiente del Litoral (ISAL, UNL-CONICET), Facultad de Bioquímica y Ciencias Biológicas, Universidad Nacional del Litoral, Santa Fe 3000, Argentina
| | - Ricardo S Calandra
- Instituto de Biología y Medicina Experimental, IBYME-CONICET, Ciudad de Buenos Aires C1428ADN, Argentina
| | - Artur Mayerhofer
- Cell Biology, Anatomy III, Faculty of Medicine, Biomedical Center Munich (BMC), Ludwig-Maximilian-University (LMU), 82152 Martinsried, Germany
| | - María E Matzkin
- Instituto de Biología y Medicina Experimental, IBYME-CONICET, Ciudad de Buenos Aires C1428ADN, Argentina; Cátedra de Bioquímica Humana, Facultad de Medicina, Universidad de Buenos Aires, Ciudad de Buenos Aires C1121ABG, Argentina
| | - Mónica B Frungieri
- Instituto de Biología y Medicina Experimental, IBYME-CONICET, Ciudad de Buenos Aires C1428ADN, Argentina; Cátedra de Química, Ciclo Básico Común, Ciudad de Buenos Aires C1405CAE, Argentina.
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Çolak E, Özkan B. Ultrasonographic measurements of the testicular volume in Turkish boys aged 0-8 years and comparison with international references. J Pediatr Endocrinol Metab 2022; 35:489-495. [PMID: 35170878 DOI: 10.1515/jpem-2021-0635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 01/31/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Proper diagnosis and follow-up of children with testicular disorders depend on the presence of adequate references for testicular volume. The objective of this study was to determine the testicular volume by ultrasound in Turkish boys aged between 0 and 8 years. METHODS A total of 320 boys with bilaterally descended testes underwent scrotal ultrasound examinations. The testicular volume (mL) was calculated by the empirical formula of Lambert (V=L × T × AP × 0.71) and the formula for an ellipsoid (V=L × T × AP × π/6). The testicular volume was compared with children's age, and Z-score data for weight, height, and BMI. The age-specific 3rd, 10th, 25th, 50th, 75th, 90th, and 97th percentiles of the testicular volume were produced and compared with the international references. RESULTS The median (IQR) volume of the right and left testis were 0.75 (0.57-0.99) and 0.72 (0.56-0.98) mL (formula of Lambert), respectively; and 0.56 (0.42-0.73) and 0.53 (0.41-0.72) mL, (formula for an ellipsoid), respectively. The age-specific median of the average volume of the right and left testis estimated by the Lambert equation in the first five years was measured between 0.63 and 0.71 mL, followed by an increase to about 1.31 mL at the age of 8. This increase was highly statistically significant (p<0.0001). No significant association was found between the Z-scores for weight, height, and BMI of boys and the testicular volumes. CONCLUSIONS This study provides the first national ultrasound-based estimates for testicular volume in Turkish boys aged 0-8 years.
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Affiliation(s)
- Edis Çolak
- Department of Radiology, University of Health Sciences Dr. Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Izmir, Turkey
| | - Behzat Özkan
- Department of Pediatric Endocrinology and Metabolism, University of Health Sciences Dr. Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Izmir, Turkey
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Catford SR, Halliday J, Lewis S, O'Bryan MK, Handelsman DJ, Hart RJ, McBain J, Rombauts L, Amor DJ, Saffery R, McLachlan RI. Reproductive function in men conceived with in vitro fertilization and intracytoplasmic sperm injection. Fertil Steril 2022; 117:727-737. [PMID: 35120745 DOI: 10.1016/j.fertnstert.2021.12.026] [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: 08/13/2021] [Revised: 12/21/2021] [Accepted: 12/22/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the semen quality and reproductive hormones of men conceived by in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) compared with men conceived without assisted reproductive technology (ART). DESIGN Cohort study. SETTING IVF centers in Victoria and the Western Australian Raine Study. PATIENT(S) Men conceived with IVF/ICSI and men conceived without ART aged 18-25 years. INTERVENTION(S) Clinical review. MAIN OUTCOME MEASURE(S) The primary outcome was the prevalence of severe oligozoospermia (sperm concentration, <5 million/mL). The secondary outcomes were total sperm count, total and progressive motility, total motile count, normal morphology, and serum testosterone, luteinizing hormone (LH) and follicle-stimulating hormone (FSH). RESULTS There was no difference in the prevalence of severe oligozoospermia between 120 men conceived with IVF/ICSI and 356 men conceived without ART (9% vs. 5.3%). Men conceived with IVF/ICSI had similar sperm concentration, total sperm count, and total motile count but lower mean total (55.3% vs. 60.6%) and progressive (44.7% vs. 53.9%) sperm motility with higher mean normal morphology (8.5% vs. 5.4%). Differences in progressive motility (ß, -9.9; 95% confidence interval [CI], -16.7 - -3.0), normal morphology (ß, 4.3; 95% CI, 3.0-5.7), and proportion with abnormal morphology (adjusted odds ratios, 0.1; 95% CI, 0.04-0.5) remained significant after adjusting for confounders. Men conceived with IVF/ICSI had lower mean FSH (3.3 IU/L) and LH (3.9 IU/L) levels and higher mean testosterone levels (19.1 nmol/L) than controls (4.2 IU/L, 11.0 IU/L, and 16.8 nmol/L). CONCLUSION This study of men conceived with IVF/ICSI found similar sperm output to men conceived without ART. Overall, the results are reassuring.
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Affiliation(s)
- Sarah R Catford
- Hudson Institute of Medical Research, Melbourne, Australia; Department of Obstetrics and Gynecology, Monash University, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia.
| | - Jane Halliday
- Murdoch Children's Research Institute, Melbourne, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Australia
| | - Sharon Lewis
- Murdoch Children's Research Institute, Melbourne, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Australia
| | - Moira K O'Bryan
- The School of BioSciences, Faculty of Science, University of Melbourne, Melbourne, Australia
| | - David J Handelsman
- ANZAC Research Institute, University of Sydney and Department of Andrology, Concord Hospital, Sydney, Australia
| | - Roger J Hart
- Division of Obstetrics and Gynecology, University of Western Australia, Perth, Australia; Fertility Specialists of Western Australia, Perth, Australia
| | - John McBain
- Department of Obstetrics and Gynecology, University of Melbourne, Melbourne, Australia; Melbourne IVF, East Melbourne, Australia; Department of Obstetrics and Gynecology, The Royal Women's Hospital, Melbourne, Australia
| | - Luk Rombauts
- Department of Obstetrics and Gynecology, Monash University, Melbourne, Australia; Monash IVF Group Pty Ltd, Melbourne, Australia
| | - David J Amor
- Murdoch Children's Research Institute, Melbourne, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Australia
| | - Richard Saffery
- Murdoch Children's Research Institute, Melbourne, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Australia
| | - Robert I McLachlan
- Hudson Institute of Medical Research, Melbourne, Australia; Department of Obstetrics and Gynecology, Monash University, Melbourne, Australia; Monash IVF Group Pty Ltd, Melbourne, Australia
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Spaggiari G, M Granata AR, Santi D. Testicular ultrasound inhomogeneity is an informative parameter for fertility evaluation. Asian J Androl 2021; 22:302-308. [PMID: 31274478 PMCID: PMC7275802 DOI: 10.4103/aja.aja_67_19] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Testicular volume (TV) is proposed to be a positive predictor of male fertility status, because of the relation known between the TV and the seminiferous tubule content. Independently of the measurement methodology, the role of TV and testicular ultrasound (US) assessments is still debated in andrological clinical practice. In this retrospective cohort study, we evaluated TV and testis US role in the diagnostic workup of andrological patients. All consecutive outpatients undergoing single-operator testis US (Modena, Italy) from March 2012 to March 2018 were enrolled, matching sonographic, hormonal, and seminal data. A total of 302 men were referred and evaluated for gynecomastia, suspected hypogonadism, couple infertility (CI), or sexual dysfunction. In the hypogonadal group, TV was lower compared to that in other groups (P < 0.001), and a significant, direct correlation between TV and testosterone level was observed in nonandrogen-treated patients (R = 0.911, P < 0.001), suggesting that testicular size could be related to the testosterone-secreting compartment. In the CI group, normozoospermic patients showed higher TV compared to men with impaired semen quality (P = 0.003) and azoospermia (P = 0.003). However, TV was not able to discriminate between patients presenting normal and altered semen quality. On the contrary, testis US inhomogeneity was more frequent in patients with impaired sperm quality (55.0%; P = 0.007) and azoospermia (40.0%; P = 0.012), compared to patients with normozoospermia (5%), identifying thereby the sonographic pattern as an informative parameter of the fertility status. Therefore, in the CI workup, US evaluation seems to be more informative than the TV assessment alone.
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Affiliation(s)
- Giorgia Spaggiari
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena 41126, Italy.,Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Ospedale Civile of Baggiovara, Modena 41126, Italy
| | - Antonio R M Granata
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Ospedale Civile of Baggiovara, Modena 41126, Italy
| | - Daniele Santi
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena 41126, Italy.,Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Ospedale Civile of Baggiovara, Modena 41126, Italy
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Lotti F, Bertolotto M, Maggi M. Historical trends for the standards in scrotal ultrasonography: What was, what is and what will be normal. Andrology 2021; 9:1331-1355. [PMID: 34089245 DOI: 10.1111/andr.13062] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/27/2021] [Accepted: 05/28/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Ultrasonography is the gold standard imaging method for scrotal investigation. Colour Doppler ultrasonography, contrast-enhanced ultrasonography and sonoelastography allow sonographers to assess size, echotexture, vascular features and stiffness of the scrotal organs and abnormalities. Scrotal ultrasonography has been used to investigate male reproductive health, scrotal pain, masses and trauma. However, ultrasonography thresholds/classifications used to distinguish normal and pathologic features of the scrotal organs have changed over time, and have not yet been fully standardized. OBJECTIVES To evaluate historical trends for the standards in scrotal ultrasonography: what was, what is and what will be normal. METHODS An extensive Medline search was performed identifying the most relevant studies in the English language from inception to date. RESULTS We provide here (i) a brief overview of the history of ultrasonography, (ii) current indications for scrotal ultrasonography and (iii) previous and current normal values, cut-offs and classifications of the main colour-Doppler ultrasonography parameters/characteristics of the scrotal organs, as derived from recent guidelines and evidence-based studies. In addition, we report recommendations and the clinical utility of contrast-enhanced ultrasonography and sonoelastography. Finally, we discuss critical issues needing further evidence and future directions to fill in the current gaps. DISCUSSION Several studies on scrotal ultrasonography are available. However, guidelines/recommendations dealing with specific ultrasonography applications have been published only in recent years. More recently, the European Academy of Andrology published evidence-based scrotal colour-Doppler ultrasonography reference ranges/normative parameters derived from a cohort of healthy, fertile men. In addition, a standardization of the methodology to evaluate qualitative and quantitative colour-Doppler ultrasonography parameters was reported. Other international societies reported indications, methodological standards, clinical utility and limitations of contrast-enhanced ultrasonography and sonoelastography. CONCLUSIONS To date, colour-Doppler ultrasonography normative values for the scrotal organs are available. However, a wide international consensus on assessment and classification of several ultrasonography parameters is still lacking. An alignment of the world societies on these issues is advocated.
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Affiliation(s)
- Francesco Lotti
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
| | - Michele Bertolotto
- Department of Radiology, Cattinara Hospital, University of Trieste, Trieste, Italy
| | - Mario Maggi
- Endocrinology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
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Kanbar M, de Michele F, Giudice MG, Desmet L, Poels J, Wyns C. Long-term follow-up of boys who have undergone a testicular biopsy for fertility preservation. Hum Reprod 2021; 36:26-39. [PMID: 33259629 DOI: 10.1093/humrep/deaa281] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/18/2020] [Indexed: 12/14/2022] Open
Abstract
STUDY QUESTION What is the long-term reproductive health outcome of patients who have undergone testicular sampling for fertility preservation (FP) before and during the pubertal transition period? SUMMARY ANSWER In long-term follow-up after testicular sampling for FP, hormonal data showed that 33% of patients had primary seminiferous tubule insufficiency (high FSH) while semen analyses showed 52% of patients having a severe reduction in total sperm counts or complete absence of ejaculated sperm. WHAT IS KNOWN ALREADY During childhood and adolescence, both treatments for cancer and benign haematological diseases that require a bone marrow transplantation, can be detrimental to spermatogenesis by depleting the spermatogonial stem cell population. A testicular biopsy prior to chemotherapy or radiotherapy, even though still an experimental procedure, is now recommended for FP by European and USA oncofertility societies if performed within an institutional research setting. While short-term follow-up studies showed little to no post-operative complications and a normal testicular development after 1 year, data regarding the long-term follow-up of boys who have undergone this procedure are still lacking. STUDY DESIGN, SIZE, DURATION This is a longitudinal retrospective cohort study that reports on the long-term follow-up of pre- and peri-pubertal boys who have undergone a testicular biopsy for FP between May 2005 and May 2020. All the patients included in this study were referred to our programme by haematologists-oncologists who are part of a regional multi-centric collaborative care pathway. PARTICIPANTS/MATERIALS, SETTING, METHODS Of the 151 boys referred to our FP programme, 139 parents/legal guardians accepted that their child undergo a testicular biopsy. Patient characteristics (i.e. age at biopsy, urogenital history, pubertal status at diagnosis), indications (disease type and dosage of gonadotoxic treatments), operative and post-operative data (biopsy volume, surgical complications), anatomopathological analyses (presence/absence of spermatogonia, Johnsen score) and reproductive data (semen analyses, FSH, LH, testosterone levels) were collected from the institutions' FP database and medical records or from the 'Brussels Health Network'. Cumulative alkylating agent treatment was quantified using the cyclophosphamide equivalent dose (CED). Patients who were 14 years or older at the time of the follow-up and in whom the testicular tissue was shown to contain spermatogonia were included in the reproductive outcome analysis. Comparison of the sperm count findings (absence/presence of spermatozoa) and FSH levels (high (≥10 IU/l)/normal) between patients who were either pre- (Tanner 1) or peri-pubertal (Tanner >1) at the time of the biopsy was done using the Mann-Whitney U or Fisher's tests. A multiple logistic regression was used to study the relationship between the hormone reproductive outcome (high versus normal FSH), as a proxy marker for fertility, and both the pubertal status (Tanner 1 versus Tanner >1) and Johnsen score at the time of the biopsy, while adjusting for CED. MAIN RESULTS AND THE ROLE OF CHANCE A testicular biopsy was performed in 139 patients either before (129/139) or after (10/139) the start of a gonadotoxic treatment. Post-operative complications occurred in 2.1% (3/139). At the time of the procedure, 88% (122/139) of patients were pre-pubertal and 12% (17/139) were peri-pubertal. The presence of spermatogonia was documented in 92% (128/139) of cases. Follow-up data were available for 114 patients after excluding 23 deceased and two patients lost to follow-up. A paediatric endocrinologist's follow-up including clinical examination and data on reproductive hormones was available for 57 patients (age ≥14) and 19 (33%) of these were found to have high FSH levels (20 ± 8.8 IU/l). There were 37 patients who had returned to the reproductive specialist's consultation for post-treatment fertility counselling and results on semen analysis were available in 27 of these cases; 14/27 (52%) had severely impaired semen parameters including 8 who were azoospermic. Among patients who received an alkylating agent-based treatment (n = 42), a peri-pubertal status (Tanner >1) at the time of diagnosis/biopsy was found to be associated with a higher risk of having primary testicular failure (defined by an FSH ≥ 10 IU/l) after treatment completion with an OR of 6.4 (95% CI 1.22-33.9; P = 0.03). Of all the patients, 2.6% had already fulfilled their wish to build a family or were actively seeking parenthood. LIMITATIONS, REASONS FOR CAUTION Although this is the largest cohort with follow-up data providing proxy markers of the reproductive potential of boys in whom a testicular biopsy for FP was performed before puberty or during the pubertal transition period, the amount of data provided is limited, and originating from a single programme. Further data collection to confirm the observations in other settings is therefore awaited. WIDER IMPLICATIONS OF THE FINDINGS Testicular sampling for FP should be offered to boys at risk of losing their fertility (and is recommended for those at high risk) as part of ethically approved research programmes. Long-term follow-up data on increasing numbers of boys who have undergone an FP procedure will help improve patient care in the future as patient-specific factors (e.g. urogenital history, age at gonadotoxic therapy) appear to influence their reproductive potential after gonadotoxic therapies. STUDY FUNDING/COMPETING INTEREST(S) FNRS-Télévie, the Salus Sanguinis Foundation and the Belgian Foundation against Cancer supported the studies required to launch the FP programme. The authors declare that they have no conflict of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- M Kanbar
- Andrology Lab, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels 1200, Belgium.,Department of Gynecology-Andrology, Cliniques Universitaires Saint-Luc, Brussels 1200, Belgium
| | - F de Michele
- Department of Gynecology-Andrology, Cliniques Universitaires Saint-Luc, Brussels 1200, Belgium
| | - M G Giudice
- Andrology Lab, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels 1200, Belgium.,Department of Gynecology-Andrology, Cliniques Universitaires Saint-Luc, Brussels 1200, Belgium
| | - L Desmet
- Louvain Institute of Data Analysis and Modeling in economics and statistics (LIDAM), Louvain-la-Neuve 1348, Belgium
| | - J Poels
- Andrology Lab, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels 1200, Belgium.,Department of Gynecology-Andrology, Cliniques Universitaires Saint-Luc, Brussels 1200, Belgium
| | - C Wyns
- Andrology Lab, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels 1200, Belgium.,Department of Gynecology-Andrology, Cliniques Universitaires Saint-Luc, Brussels 1200, Belgium
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Lotti F, Frizza F, Balercia G, Barbonetti A, Behre HM, Calogero AE, Cremers JF, Francavilla F, Isidori AM, Kliesch S, La Vignera S, Lenzi A, Marcou M, Pilatz A, Poolamets O, Punab M, Peraza Godoy MF, Rajmil O, Salvio G, Shaeer O, Weidner W, Maseroli E, Cipriani S, Baldi E, Degl'Innocenti S, Danza G, Caldini AL, Terreni A, Boni L, Krausz C, Maggi M. The European Academy of Andrology (EAA) ultrasound study on healthy, fertile men: Scrotal ultrasound reference ranges and associations with clinical, seminal, and biochemical characteristics. Andrology 2021; 9:559-576. [PMID: 33244893 DOI: 10.1111/andr.12951] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/19/2020] [Accepted: 11/23/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Scrotal color Doppler ultrasound (CDUS) still suffers from lack of standardization. Hence, the European Academy of Andrology (EAA) has promoted a multicenter study to assess the CDUS characteristics of healthy fertile men (HFM) to obtain normative parameters. OBJECTIVES To report and discuss the scrotal organs CDUS reference ranges and characteristics in HFM and their associations with clinical, seminal, and biochemical parameters. METHODS A cohort of 248 HFM (35.3 ± 5.9years) was studied, evaluating, on the same day, clinical, biochemical, seminal, and scrotal CDUS following Standard Operating Procedures. RESULTS The CDUS reference range and characteristics of the scrotal organs of HFM are reported here. CDUS showed a higher accuracy than physical examination in detecting scrotal abnormalities. Prader orchidometer (PO)- and US-measured testicular volume (TV) were closely related. The US-assessed TV with the ellipsoid formula showed the best correlation with the PO-TV. The mean TV of HFM was ~ 17 ml. The lowest reference limit for right and left testis was 12 and 11 ml, thresholds defining testicular hypotrophy. The highest reference limit for epididymal head, tail, and vas deferens was 12, 6, and 4.5 mm, respectively. Mean TV was associated positively with sperm concentration and total count and negatively with gonadotropins levels and pulse pressure. Subjects with testicular inhomogeneity or calcifications showed lower sperm vitality and concentration, respectively, than the rest of the sample. Sperm normal morphology and progressive motility were positively associated with epididymal head size/vascularization and vas deferens size, respectively. Increased epididymis and vas deferens sizes were associated with MAR test positivity. Decreased epididymal tail homogeneity/vascularization were positively associated with waistline, which was negatively associated with intratesticular vascularization. CDUS varicocele was detected in 37.2% of men and was not associated with seminal or hormonal parameters. Scrotal CDUS parameters were not associated with time to pregnancy, number of children, history of miscarriage. CONCLUSIONS The present findings will help in better understanding male infertility pathophysiology, improving its management.
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Affiliation(s)
- F Lotti
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - F Frizza
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - G Balercia
- Endocrinology Unit, Ospedali Riuniti Ancona, Polytechnic University of Marche, Ancona, Italy
| | - A Barbonetti
- Andrology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - H M Behre
- Center for Reproductive Medicine and Andrology, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - A E Calogero
- Department of Clinical and Experimental Medicine, University of Catania, Italy
| | - J F Cremers
- Department of Clinical and Surgical Andrology, Centre of Reproductive Medicine and Andrology, Münster University Hospital, Münster, Germany
| | - F Francavilla
- Andrology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - A M Isidori
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - S Kliesch
- Department of Clinical and Surgical Andrology, Centre of Reproductive Medicine and Andrology, Münster University Hospital, Münster, Germany
| | - S La Vignera
- Department of Clinical and Experimental Medicine, University of Catania, Italy
| | - A Lenzi
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - M Marcou
- Center for Reproductive Medicine and Andrology, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - A Pilatz
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University, Giessen, Germany
| | - O Poolamets
- Andrology Unit, Tartu University Hospital, Tartu, Estonia
| | - M Punab
- Andrology Unit, Tartu University Hospital, Tartu, Estonia
| | - M F Peraza Godoy
- Andrology Department, Fundació Puigvert, Universitat Autònoma de Barcelona, Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | - O Rajmil
- Andrology Department, Fundació Puigvert, Universitat Autònoma de Barcelona, Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | - G Salvio
- Endocrinology Unit, Ospedali Riuniti Ancona, Polytechnic University of Marche, Ancona, Italy
| | - O Shaeer
- Department of Andrology, Kasr El Aini Faculty of Medicine, Cairo University, Cairo, Egypt
| | - W Weidner
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University, Giessen, Germany
| | - E Maseroli
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - S Cipriani
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - E Baldi
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - S Degl'Innocenti
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - G Danza
- Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - A L Caldini
- Department of Laboratory, Careggi Hospital, Florence, Italy
| | - A Terreni
- Department of Laboratory, Careggi Hospital, Florence, Italy
| | - L Boni
- Clinical Trials Coordinating Center, Toscano Cancer Institute, University Hospital Careggi, Florence, Italy
| | - C Krausz
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - M Maggi
- Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
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10
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Cai D, Wu S, Li Y, Chen Q. Validity of measurements of testicular volume obtained by a built-in software of ultrasound systems: with formula recommended by updated guidelines as reference. J Ultrason 2020; 20:e181-e184. [PMID: 33365154 PMCID: PMC7705484 DOI: 10.15557/jou.2020.0030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 08/10/2020] [Indexed: 11/22/2022] Open
Abstract
Aim: To investigate the validity of measurement of testicular volume acquired by a built-in software in different ultrasound systems with reference to the updated guidelines. Materials and methods: Archives of 1,976 patients who had undergone scrotal ultrasound evaluation were reviewed. A total of 973 patients with 1,909 testes, who had undergone ultrasound measurement of the testicular volume, were included in the study, and 1,003 patients were excluded. The age of enrolled patients ranged from 17 to 66 years (median age of 39 years). The ultrasound systems included Siemens Sonoline S2000, Philips EPIQ5, GE Logiq E9, Hitachi Aloka prosoundα7, Mindray DC-8 and Mindray Resona7. The transducers have imaging frequencies of 5–14 MHz. Validity of the measurement of testicular volume acquired by a built-in software in different ultrasound systems was assessed with reference to the formula that Volume (V) = Length (L) × Width (W) × Height (H) × 0.71, recommended by the updated guidelines, by recalculating the original numbers using a calculator. Results: The values obtained by the built-in software of Mindray DC-8 and Mindray Resona7 ultrasound systems and measurements recalculated on a computer were all in concordance; and the values obtained by the built-in software of Siemens Sonoline S2000, Philips EPIQ5, GE Logiq E9, and Hitachi Aloka prosoundα7 ultrasound systems and measurements recalculated on computer were all discordant. The same testicular measurements calculated with different formulas (V = L×W×H×0.71 vs. V = L×W×H×0.52) produced 26.76% difference. Conclusion: Values of testicular volume obtained by some ultrasound systems are not accurate with reference to the formula recommended by the updated guidelines.
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Affiliation(s)
- Dongyan Cai
- Department of Ultrasound, The First Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Size Wu
- Department of Ultrasound, The First Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Ya Li
- Department of Ultrasound, The First Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Qingfang Chen
- Department of Ultrasound, The First Affiliated Hospital of Hainan Medical University, Haikou, China
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11
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Diagnosis and hormonal treatment of male infertility. Actas Urol Esp 2020; 44:321-327. [PMID: 32241672 DOI: 10.1016/j.acuro.2019.10.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 10/28/2019] [Indexed: 11/22/2022]
Abstract
Male infertility is a frequently observed medical condition that is related to the functioning of extremely complex organs such as the pituitary gland and the gonads. The diagnosis and proper management of infertile men is challenging for modern medicine, given the high expectations and demands of current patients, mainly due to the economic and emotional expenses aroused by this "relationship issue". In many cases, patients should receive therapies aimed at improving the functioning of that complex hormonal axis, instead of treating their underlying problem; thus, seeking to optimize the production of gametes with better conditions and improve fertilization rates without requiring assisted procedures.
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12
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Madsen A, Oehme NB, Roelants M, Bruserud IS, Eide GE, Viste K, Bjerknes R, Almås B, Rosendahl K, Sagen JV, Mellgren G, Juliusson PB. Testicular Ultrasound to Stratify Hormone References in a Cross-Sectional Norwegian Study of Male Puberty. J Clin Endocrinol Metab 2020; 105:5607532. [PMID: 31697832 DOI: 10.1210/clinem/dgz094] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 10/07/2019] [Indexed: 02/08/2023]
Abstract
CONTEXT Testicular growth represents the best clinical variable to evaluate male puberty, but current pediatric hormone references are based on chronological age and subjective assessments of discrete puberty development stages. Determination of testicular volume (TV) by ultrasound provides a novel approach to assess puberty progression and stratify hormone reference intervals. OBJECTIVE The objective of this article is to establish references for serum testosterone and key hormones of the male pituitary-gonadal signaling pathway in relation to TV determined by ultrasound. DESIGN, SETTING, AND PARTICIPANTS Blood samples from 414 healthy Norwegian boys between ages 6 and 16 years were included from the cross-sectional "Bergen Growth Study 2." Participants underwent testicular ultrasound and clinical assessments, and serum samples were analyzed by liquid chromatography tandem-mass spectrometry and immunoassays. MAIN OUTCOME MEASURES We present references for circulating levels of total testosterone, luteinizing hormone, follicle-stimulating hormone, and sex hormone-binding globulin in relation to TV, chronological age, and Tanner pubic hair stages. RESULTS In pubertal boys, TV accounted for more variance in serum testosterone levels than chronological age (Spearman r = 0.753, P < .001 vs r = 0.692, P < .001, respectively). Continuous centile references demonstrate the association between TV and hormone levels during puberty. Hormone reference intervals were stratified by TV during the pubertal transition. CONCLUSIONS Objective ultrasound assessments of TV and stratification of hormone references increase the diagnostic value of traditional references based on chronological age or subjective staging of male puberty.
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Affiliation(s)
- André Madsen
- Hormone Laboratory, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Ninnie B Oehme
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - Mathieu Roelants
- Environment and Health, Department of Public Health and Primary Care, KU Leuven, University of Leuven, Leuven, Belgium
| | - Ingvild S Bruserud
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - Geir Egil Eide
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Kristin Viste
- Hormone Laboratory, Haukeland University Hospital, Bergen, Norway
| | - Robert Bjerknes
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
| | - Bjørg Almås
- Hormone Laboratory, Haukeland University Hospital, Bergen, Norway
| | - Karen Rosendahl
- Department of Radiology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Jørn V Sagen
- Hormone Laboratory, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Gunnar Mellgren
- Hormone Laboratory, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Petur B Juliusson
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway
- Department of Health Registries, Norwegian Institute of Public Health, Bergen, Norway
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13
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Anyanwu LJC, Sowande OA, Asaleye CM, Saleh MK, Mohammad AM, Onuwaje M, Olajide TA, Talabi AO, Elusiyan JBE, Adejuyigbe O. Testicular volume: correlation of ultrasonography, orchidometer and caliper measurements in children. AFRICAN JOURNAL OF UROLOGY 2020. [DOI: 10.1186/s12301-020-0016-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Testicular size assessment is an important and initial technique for the evaluation of gonadal function. Our study aims to determine the correlation between paediatric testicular volumes measured with the orchidometer, high-resolution ultrasonography (US) and intra-operative measurements using calipers.
Results
This is a prospective observational study of 127 boys presenting to our institution with non-emergent scrotal conditions between January 2007 and October 2008. Volume estimates of both testes were measured using the Prader orchidometer. The patient was then sent to a radiologist who measured the testicular volumes using US, being blinded to the orchidometer estimates. At surgery, the testicular dimensions on the side of the pathology were obtained with a vernier caliper. The testicular volumes by US and caliper were calculated using the formula 0.71 × Length × Width × Height. The relationship between the measured volumes was determined using Pearson’s correlation statistic and Student’s t test. The level of significance for all analysis was set at p < 0.05. Their ages ranged from 18 days to 13 years (median 3 years). There was significant correlation between testicular volumes (for both sides, i.e. right and left) measured with the orchidometer and US (r = 0.544; 0.537, p < 0.001), significant correlation between testicular volumes measured with the orchidometer and caliper (r = 0.537; 0.638, p < 0.001) and also significant correlation between volumes measured by US and caliper (r = 0.382; 0.829, p < 0.01).
Conclusion
Prader orchidometer testicular volume estimates correlate significantly with US estimates in children. In resource-constrained settings, it could be used for an accurate and quick testicular volume assessment.
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14
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Portela JMD, Heckmann L, Wistuba J, Sansone A, van Pelt AMM, Kliesch S, Schlatt S, Neuhaus N. Development and Disease-Dependent Dynamics of Spermatogonial Subpopulations in Human Testicular Tissues. J Clin Med 2020; 9:jcm9010224. [PMID: 31947706 PMCID: PMC7019285 DOI: 10.3390/jcm9010224] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 01/03/2020] [Accepted: 01/10/2020] [Indexed: 12/22/2022] Open
Abstract
Cancer therapy and conditioning treatments of non-malignant diseases affect spermatogonial function and may lead to male infertility. Data on the molecular properties of spermatogonia and the influence of disease and/or treatment on spermatogonial subpopulations remain limited. Here, we assessed if the density and percentage of spermatogonial subpopulation changes during development (n = 13) and due to disease and/or treatment (n = 18) in tissues stored in fertility preservation programs, using markers for spermatogonia (MAGEA4), undifferentiated spermatogonia (UTF1), proliferation (PCNA), and global DNA methylation (5mC). Throughout normal prepubertal testicular development, only the density of 5mC-positive spermatogonia significantly increased with age. In comparison, patients affected by disease and/or treatment showed a reduced density of UTF1-, PCNA- and 5mC-positive spermatogonia, whereas the percentage of spermatogonial subpopulations remained unchanged. As an exception, sickle cell disease patients treated with hydroxyurea displayed a reduction in both density and percentage of 5mC- positive spermatogonia. Our results demonstrate that, in general, a reduction in spermatogonial density does not alter the percentages of undifferentiated and proliferating spermatogonia, nor the establishment of global methylation. However, in sickle cell disease patients’, establishment of spermatogonial DNA methylation is impaired, which may be of importance for the potential use of this tissues in fertility preservation programs.
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Affiliation(s)
- Joana M. D. Portela
- Center of Reproductive Medicine and Andrology, Institute of Reproductive and Regenerative Biology, Albert-Schweitzer-Campus 1, Building D11, 48149 Münster, Germany; (J.M.D.P.); (L.H.); (J.W.); (A.S.); (S.S.)
- Center for Reproductive Medicine, Amsterdam Research Institute Reproduction and Development, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands;
| | - Laura Heckmann
- Center of Reproductive Medicine and Andrology, Institute of Reproductive and Regenerative Biology, Albert-Schweitzer-Campus 1, Building D11, 48149 Münster, Germany; (J.M.D.P.); (L.H.); (J.W.); (A.S.); (S.S.)
| | - Joachim Wistuba
- Center of Reproductive Medicine and Andrology, Institute of Reproductive and Regenerative Biology, Albert-Schweitzer-Campus 1, Building D11, 48149 Münster, Germany; (J.M.D.P.); (L.H.); (J.W.); (A.S.); (S.S.)
| | - Andrea Sansone
- Center of Reproductive Medicine and Andrology, Institute of Reproductive and Regenerative Biology, Albert-Schweitzer-Campus 1, Building D11, 48149 Münster, Germany; (J.M.D.P.); (L.H.); (J.W.); (A.S.); (S.S.)
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - Ans M. M. van Pelt
- Center for Reproductive Medicine, Amsterdam Research Institute Reproduction and Development, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands;
| | - Sabine Kliesch
- Center of Reproductive Medicine and Andrology, Department of Clinical and Surgical Andrology, Albert-Schweitzer-Campus 1, Building D11, 48149 Münster, Germany;
| | - Stefan Schlatt
- Center of Reproductive Medicine and Andrology, Institute of Reproductive and Regenerative Biology, Albert-Schweitzer-Campus 1, Building D11, 48149 Münster, Germany; (J.M.D.P.); (L.H.); (J.W.); (A.S.); (S.S.)
| | - Nina Neuhaus
- Center of Reproductive Medicine and Andrology, Institute of Reproductive and Regenerative Biology, Albert-Schweitzer-Campus 1, Building D11, 48149 Münster, Germany; (J.M.D.P.); (L.H.); (J.W.); (A.S.); (S.S.)
- Correspondence:
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15
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Matzkin M, Valchi P, Riviere E, Rossi S, Tavalieri Y, Muñoz de Toro M, Mayerhofer A, Bartke A, Calandra R, Frungieri M. Aging in the Syrian hamster testis: Inflammatory-oxidative status and the impact of photoperiod. Exp Gerontol 2019; 124:110649. [DOI: 10.1016/j.exger.2019.110649] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 05/30/2019] [Accepted: 06/30/2019] [Indexed: 12/16/2022]
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16
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Welliver C, Cardona-Grau D, Elebyjian L, Feustel PJ, Kogan BA. Surprising interobserver and intra-observer variability in pediatric testicular ultrasound volumes. J Pediatr Urol 2019; 15:386.e1-386.e6. [PMID: 31104998 DOI: 10.1016/j.jpurol.2019.04.016] [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] [Received: 01/09/2019] [Accepted: 04/13/2019] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Testicular volume (TV) can be obtained by either scrotal ultrasound (SU) or orchidometer. Scrotal ultrasound allows for a more objective measurement; however, the interobserver and intra-observer variability of TV measurements has not been rigorously studied. OBJECTIVE The authors measured intra-observer and interobserver variability of SU TV measurements in pediatric patients to assess the reliability and reproducibility of SU. Special attention was paid to how often a 20% discrepancy in TV was noted as this has previously been utilized as an indication for varicocelectomy. DESIGN Patients with an indication for SU or undergoing an ultrasound for another reason were prospectively recruited. Two different urologic specific ultrasound technicians (A and B) performed SU to assess interobserver variability. A second measurement was taken by technician A within 90 days to assess intra-observer variability (A vs A1). The technicians were blinded to other ultrasound results. RESULTS Fourteen patients (28 testes, 56 volume measurements) were included in the intra-observer group and 17 patients (34 testes, 68 volume measurements) in the interobserver group. The mean time to repeat intra-observer ultrasound measurements (range) was 46 days (23-84). Mean age (range) in the intra-observer group was 14.3 years (11-19) and 14.1 years (11-19) in the interobserver group. Indication for ultrasound was varicocele (n = 6), scrotal pain (4), hydronephrosis (3), hydrocele (2), epididymal cyst (2), posterior urethral valves (1), and testis asymmetry (1). Utilizing Bland-Altman analysis and plots, variability was seen in both intra-observer and interobserver measurements. The mean values for testicular sizes for technician A and technician B were 13.0 ± 9.7 cm3 vs 13.8 ± 9.9 cm3, respectively. The mean values for TV measurement for technician A's first and second measurements (A, A1) were 14.3 ± 9.7 cm3 and 14.8 ± 8.9 cm3, respectively. An errant 20% difference in TV measurements for the same testis was seen in 25% (7 of 28) of intra-observer measurements and 35% (12 of 34) of interobserver measurements. These 20% differences were more common with a lower body mass index (odds ratio, OR = 0.74, p = 0.01) in the interobserver group, and lower TV was a predictor in the intra-observer group (OR: 0.82, p = 0.009). CONCLUSIONS Variability exists in both interobserver and intra-observer measurements of TV by dedicated urologic ultrasonographers, and greater than 20% of differences in measured TV in same testicles occurred in over 25% of cases. Caution should be exercised in basing operative decisions and scientific studies on limited measurements of TV.
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Affiliation(s)
- C Welliver
- Albany Medical College, Division of Urology, Department of Surgery, Albany, NY, 12208, USA; Albany Stratton Veterans Affairs Medical Center, Albany, NY, 12208, USA.
| | - D Cardona-Grau
- Arnold Palmer Hospital for Children, Orlando, FL, 32806, USA
| | - L Elebyjian
- Albany Medical College, Division of Urology, Department of Surgery, Albany, NY, 12208, USA
| | - P J Feustel
- Department of Anesthesiology, Albany Medical College, Albany, NY, USA
| | - B A Kogan
- Albany Medical College, Division of Urology, Department of Surgery, Albany, NY, 12208, USA
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17
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Zeller R, Meyer-Lindenberg A, Walter B, Leykam C, Flock U, Reese S, Otzdorff C. Semen parameters and testicular dimensions in small breed dogs below ten-kilogram bodyweight. Reprod Domest Anim 2019; 54:1244-1250. [PMID: 31278887 DOI: 10.1111/rda.13504] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 07/01/2019] [Indexed: 11/28/2022]
Abstract
Because of few available data on semen parameters in small breed dogs, the study aimed to analyse semen and measure testes of dogs ≤10.0 kg bodyweight. Semen was collected from 41 fertile stud dogs, which were divided based on bodyweight: group 1 ≤ 5.0 kg and group 2 between 5.1 and 10.0 kg. Median values for ejaculate volume (group 1: x ~ 1.2 ml; group 2: x ~ 2.2 ml), total sperm output (group 1: x ~ 110.7 × 106 ; group 2: x ~ 215.1 × 106 ) and testicular volume (group 1: left testicle x ~ 2.8 ml, right testicle x ~ 2.7 ml; group 2: left testicle x ~ 5.5 ml, right testicle x ~ 5.0 ml) were lower in group 1 compared to dogs of group 2 (p = .001; p = .001; both testes: p < .001). There was no difference in sperm concentration (p = .985). Based on these results, introduction of an additional weight group to the commonly used reference values is recommended, since values for ejaculate volume, total sperm output and testicular dimensions for dogs ≤5.0 kg bodyweight differed significantly from values of dogs with a bodyweight from 5.1 to 10.0 kg.
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Affiliation(s)
- Romy Zeller
- Clinic of Small Animal Surgery and Reproduction, Center for Clinical Veterinary Medicine, Ludwig Maximilians University, Munich, Germany
| | - Andrea Meyer-Lindenberg
- Clinic of Small Animal Surgery and Reproduction, Center for Clinical Veterinary Medicine, Ludwig Maximilians University, Munich, Germany
| | - Beate Walter
- Clinic of Small Animal Surgery and Reproduction, Center for Clinical Veterinary Medicine, Ludwig Maximilians University, Munich, Germany
| | - Christian Leykam
- Clinic of Small Animal Surgery and Reproduction, Center for Clinical Veterinary Medicine, Ludwig Maximilians University, Munich, Germany
| | - Ulrike Flock
- Clinic of Small Animal Surgery and Reproduction, Center for Clinical Veterinary Medicine, Ludwig Maximilians University, Munich, Germany
| | - Sven Reese
- Veterinary Department, Institute of Veterinary Anatomy, Histology and Embryology, Ludwig Maximilians University, Munich, Germany
| | - Christiane Otzdorff
- Clinic of Small Animal Surgery and Reproduction, Center for Clinical Veterinary Medicine, Ludwig Maximilians University, Munich, Germany
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18
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Busch AS, Tüttelmann F, Cremers JF, Schubert M, Nordhoff V, Schüring AN, Zitzmann M, Gromoll J, Kliesch S. FSHB -211 G>T Polymorphism as Predictor for TESE Success in Patients With Unexplained Azoospermia. J Clin Endocrinol Metab 2019; 104:2315-2324. [PMID: 30668782 DOI: 10.1210/jc.2018-02249] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 01/16/2019] [Indexed: 02/13/2023]
Abstract
CONTEXT Testicular sperm extraction (TESE) followed by assisted reproductive techniques often remains the only therapeutic option for men with azoospermia due to spermatogenic failure. Reproductive parameters, such as gonadotropin levels and testicular volume or histopathology, contribute to the prediction of sperm retrieval rate (SRR) in TESE. However, there is an eminent lack of noninvasive predictive factors for TESE outcome. OBJECTIVE To clarify the impact of three common genetic variants affecting FSH and its cognate receptor on testicular histopathology patterns and SRR in TESE. DESIGN We evaluated the association of the single-nucleotide polymorphisms (SNP) FSHB -211G>T (rs10835638), FSHR -29G>A (rs1394205), and FSHR c.2039A>G (rs6166) with testicular histopathology and SRR in patients with azoospermia. SETTING Tertiary referral center for andrology. PATIENTS OR OTHER PARTICIPANTS Men (n = 1075) with azoospermia who underwent TESE (grouped by clinical pathologies). INTERVENTION(S) All participants underwent TESE. MAIN OUTCOME MEASURE(S) Testicular histopathology, SRR, and reproductive hormone levels. RESULTS FSHB -211G>T was significantly associated with reduced chances of sperm retrieval in patients with unexplained azoospermia. Indicating an additional mechanism, the association of the SNP with SSR could not be solely attributed to decreased FSH levels. CONCLUSION A common genetic factor was significantly associated with SRR in TESE. In perspective, a calculator or score including the noninvasive parameters FSH level, testicular volume, and FSHB haplotype should be considered to estimate the chances for sperm retrieval in men with azoospermia.
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Affiliation(s)
- Alexander Siegfried Busch
- Centre of Reproductive Medicine and Andrology, Institute of Reproductive and Regenerative Biology, University of Münster, Albert-Schweitzer-Campus 1, Gebäude D11, Münster, Germany
- Department of Growth and Reproduction & International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Blegdamsvej, Copenhagen, Denmark
| | - Frank Tüttelmann
- Institute of Human Genetics, University of Münster, Vesaliusweg, Münster, Germany
| | - Jann-Frederik Cremers
- Centre of Reproductive Medicine and Andrology, Department of Clinical and Surgical Andrology, University of Münster, EAA Training Center, Albert Schweitzer Campus, Germany
| | - Maria Schubert
- Centre of Reproductive Medicine and Andrology, Department of Clinical and Surgical Andrology, University of Münster, EAA Training Center, Albert Schweitzer Campus, Germany
| | - Verena Nordhoff
- Centre of Reproductive Medicine and Andrology, Institute of Reproductive and Regenerative Biology, University of Münster, Albert-Schweitzer-Campus 1, Gebäude D11, Münster, Germany
| | - Andreas N Schüring
- Department of Gynecology and Obstetrics, UKM Fertility Center, University of Münster, Albert-Schweitzer-Campus, Gebäude, Münster, Germany
| | - Michael Zitzmann
- Centre of Reproductive Medicine and Andrology, Department of Clinical and Surgical Andrology, University of Münster, EAA Training Center, Albert Schweitzer Campus, Germany
| | - Jörg Gromoll
- Centre of Reproductive Medicine and Andrology, Institute of Reproductive and Regenerative Biology, University of Münster, Albert-Schweitzer-Campus 1, Gebäude D11, Münster, Germany
| | - Sabine Kliesch
- Centre of Reproductive Medicine and Andrology, Department of Clinical and Surgical Andrology, University of Münster, EAA Training Center, Albert Schweitzer Campus, Germany
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Srinivas R, Thomas RJ, Sebastian T, Kurian JJ. Testicular Volume in a Cohort of Prepubertal Indian Children. J Indian Assoc Pediatr Surg 2019; 24:192-196. [PMID: 31258269 PMCID: PMC6568151 DOI: 10.4103/jiaps.jiaps_100_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Context: There are orchidometer-based testicular volume nomograms for Indian children; however, accurate and reliable values measured by ultrasound are lacking. Aims: The aim of this study was to (1) measure the testicular volumes of boys from birth to 8 years and generate reference values and (2) to identify factors if any that may influence variation in testicular volumes. Settings and Design: This was a prospective observational study conducted on 320 children in the Department of Pediatric Surgery, Christian Medical College, Vellore, India. Subjects and Methods: A total of 320 boys without any genital abnormalities were studied. The testes were scanned using a linear transducer, and the length, width, and depth of each testis were recorded. Testicular volume was calculated using Lambert's equation – length × width × depth × 0.71. Statistical Analysis Used: Mean testicular volumes and standard deviation for every year of age were calculated. The centile values for testicular volume were computed using R software. Results: Age-specific nomogram of each testis was created separately. Interobserver variability of the measurement was shown to be up to 0.3 ml. No difference was demonstrated in the testicular volumes between the right and left testis. No correlation was found between body weight and body mass index with testicular volume. From the data on differences in size between the two sides, a volume differential index of 27% corresponds to the 95th centile. Conclusions: Reference values have been created for testicular volumes in prepubertal Indian children that could be used to assess the effects of disease and surgical interventions in this age group.
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Affiliation(s)
- Rohith Srinivas
- Department of Paediatric Surgery, Christian Medical College, Vellore, Tamil Nadu, India
| | - Reju Joseph Thomas
- Department of Paediatric Surgery, Christian Medical College, Vellore, Tamil Nadu, India
| | - Tunny Sebastian
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
| | - Jujju Jacob Kurian
- Department of Paediatric Surgery, Christian Medical College, Vellore, Tamil Nadu, India
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20
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Prior M, Stewart J, McEleny K, Dwyer AA, Quinton R. Fertility induction in hypogonadotropic hypogonadal men. Clin Endocrinol (Oxf) 2018; 89:712-718. [PMID: 30194850 DOI: 10.1111/cen.13850] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 08/18/2018] [Accepted: 09/05/2018] [Indexed: 12/17/2022]
Abstract
Men with hypogonadotropic hypogonadism (HH) are typically azoospermic, and yet HH is one of the few treatable forms of male infertility. Sperm induction protocols using gonadotrophins aim to replicate the natural endocrine control of spermatogenesis. Previously virilised men with adult-onset HH and normal testicular volume respond well to monotherapy in which human chorionic gonadotrophin (hCG) acts as a long-acting LH-analogue stimulating spermatogenesis. However, this approach is rarely successful for men with congenital HH (CHH) (eg, Kallmann syndrome), for whom combined gonadotrophin therapy (hCG + follicle-stimulating hormone [FSH]) is an absolute requirement to maximise fertility potential. Key baseline predictors of successful spermatogenesis-induction include prior spontaneous testicular development (ie, testicular volume [TV] > 4 mL), serum inhibin B (IB ) concentration >60 pg/mL and no history of maldescended testes (cryptorchidism).
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Affiliation(s)
- Matthew Prior
- Newcastle Fertility Centre at LIFE, Newcastle-upon-Tyne Hospitals, Newcastle upon Tyne, UK
| | - Jane Stewart
- Newcastle Fertility Centre at LIFE, Newcastle-upon-Tyne Hospitals, Newcastle upon Tyne, UK
| | - Kevin McEleny
- Newcastle Fertility Centre at LIFE, Newcastle-upon-Tyne Hospitals, Newcastle upon Tyne, UK
| | - Andrew A Dwyer
- William F. Connell School of Nursing, Boston College, Chestnut Hill, Boston, Massachusetts
| | - Richard Quinton
- Institute of Genetic Medicine, University of Newcastle-upon-Tyne, Newcastle upon Tyne, UK
- Department of Endocrinology, Newcastle-upon-Tyne Hospitals, Newcastle upon Tyne, UK
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21
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Ultrasound-based measurements of testicular volume in 6- to 16-year-old boys - intra- and interobserver agreement and comparison with Prader orchidometry. Pediatr Radiol 2018; 48:1771-1778. [PMID: 29980860 DOI: 10.1007/s00247-018-4195-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 06/01/2018] [Accepted: 06/21/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Prader orchidometry has been the standard method for evaluating testicular size. As this technique is subjective and tends to overestimate the testicular volume, ultrasound (US) has been proposed as more reliable. OBJECTIVE To evaluate the intra- and interobserver agreement of US measurements of testicular volume and to compare US with the Prader orchidometer. MATERIALS AND METHODS Dimensions of the right testicle were measured using US in 57 boys ages 6.5 to 16.4 years (mean: 12.0 years). The measurements were performed twice by one main observer and once by a second observer. A third observer estimated testicular volume using a Prader orchidometer. Agreement was investigated with Bland-Altman plots, summarized as the mean and standard deviation (SD) of differences, 95% limits of agreement and technical error of measurement. RESULTS Mean intra-observer difference of testicular volume was 2.2%, SD=9.2% (limits of agreement: -20.3 to 15.9%) and technical error of measurement 6.5%. The mean interobserver difference was 4.8%, SD=20.7% (limits of agreement: -35.7 to 45.3%) and technical error of measurement 14.6%. Comparing US and orchidometer volumes required conversion that was nonlinear and volume dependent, estimated as VolOM = 1.96×VolUS0.71. The mean difference after transformation was 0.7% with an SD of 18.0% (limits of agreement: -34.5 to 35.9%). CONCLUSION Our results showed a small mean intra- and interobserver difference that indicates the potential of US for measurement of testicular volume at group level. The intra-observer error was limited, which justifies its use in longitudinal follow-up of testicular development in an individual child, but the larger interobserver variability indicates the need for good standardization of methods. Agreement between the two methods requires a power transformation.
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22
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Colpi GM, Francavilla S, Haidl G, Link K, Behre HM, Goulis DG, Krausz C, Giwercman A. European Academy of Andrology guideline Management of oligo-astheno-teratozoospermia. Andrology 2018; 6:513-524. [DOI: 10.1111/andr.12502] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 04/18/2018] [Accepted: 04/18/2018] [Indexed: 12/14/2022]
Affiliation(s)
- G. M. Colpi
- Department of Andrology and IVF; San Carlo Clinic; Paderno-Dugnano/Milano Italy
| | - S. Francavilla
- Department of Life, Health and Environmental Sciences; University of L’ Aquila; L’ Aquila Italy
| | - G. Haidl
- Department of Dermatology/Andrology Unit; University of Bonn; Bonn Germany
| | - K. Link
- Department of Translational Medicine and Reproductive Medicine Centre; Lunds University and Skane University Hospital; Malmö Sweden
| | - H. M. Behre
- Center for Reproductive Medicine and Andrology; University Hospital; Martin Luther University Halle-Wittenberg; Halle Germany
| | - D. G. Goulis
- Unit of Reproductive Endocrinology; 1st Department of Obstetrics and Gynecology; Medical School; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - C. Krausz
- Department of Experimental and Clinical Biomedical Sciences ‘Mario Serio’; Centre of Excellence DeNothe; University of Florence; Florence Italy
| | - A. Giwercman
- Department of Translational Medicine and Reproductive Medicine Centre; Lunds University and Skane University Hospital; Malmö Sweden
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Ragab MW, Cremers JF, Zitzmann M, Nieschlag E, Kliesch S, Rohayem J. A history of undescended testes in young men with Klinefelter syndrome does not reduce the chances for successful microsurgical testicular sperm extraction. Andrology 2018; 6:525-531. [DOI: 10.1111/andr.12503] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 03/28/2018] [Accepted: 04/19/2018] [Indexed: 12/01/2022]
Affiliation(s)
- M. W. Ragab
- Department of Clinical and Surgical Andrology; Center of Reproductive Medicine and Andrology; University of Münster; Münster Germany
- Department of Clinical and Surgical Andrology; Cairo University; Cairo Egypt
| | - J.-F. Cremers
- Department of Clinical and Surgical Andrology; Center of Reproductive Medicine and Andrology; University of Münster; Münster Germany
| | - M. Zitzmann
- Department of Clinical and Surgical Andrology; Center of Reproductive Medicine and Andrology; University of Münster; Münster Germany
| | - E. Nieschlag
- Department of Clinical and Surgical Andrology; Center of Reproductive Medicine and Andrology; University of Münster; Münster Germany
| | - S. Kliesch
- Department of Clinical and Surgical Andrology; Center of Reproductive Medicine and Andrology; University of Münster; Münster Germany
| | - J. Rohayem
- Department of Clinical and Surgical Andrology; Center of Reproductive Medicine and Andrology; University of Münster; Münster Germany
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24
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Heckmann L, Langenstroth-Röwer D, Pock T, Wistuba J, Stukenborg JB, Zitzmann M, Kliesch S, Schlatt S, Neuhaus N. A diagnostic germ cell score for immature testicular tissue at risk of germ cell loss. Hum Reprod 2018; 33:636-645. [DOI: 10.1093/humrep/dey025] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 01/24/2018] [Indexed: 02/06/2023] Open
Affiliation(s)
- L Heckmann
- Centre of Reproductive Medicine and Andrology, Institute of Reproductive and Regenerative Biology, Albert-Schweitzer-Campus 1, Building D11, 48149 Münster, Germany
| | - D Langenstroth-Röwer
- Centre of Reproductive Medicine and Andrology, Institute of Reproductive and Regenerative Biology, Albert-Schweitzer-Campus 1, Building D11, 48149 Münster, Germany
| | - T Pock
- Centre of Reproductive Medicine and Andrology, Institute of Reproductive and Regenerative Biology, Albert-Schweitzer-Campus 1, Building D11, 48149 Münster, Germany
| | - J Wistuba
- Centre of Reproductive Medicine and Andrology, Institute of Reproductive and Regenerative Biology, Albert-Schweitzer-Campus 1, Building D11, 48149 Münster, Germany
| | - J -B Stukenborg
- Department of Women's and Children's Health, NORDFERTIL Research Lab Stockholm, Paediatric Endocrinology Unit, Q2:08, Karolinska Institutet and Karolinska University Hospital, SE-17176 Stockholm, Sweden
| | - M Zitzmann
- Centre of Reproductive Medicine and Andrology, Department of Clinical and Surgical Andrology, Albert-Schweitzer-Campus 1, Building D11, 48149 Münster, Germany
| | - S Kliesch
- Centre of Reproductive Medicine and Andrology, Department of Clinical and Surgical Andrology, Albert-Schweitzer-Campus 1, Building D11, 48149 Münster, Germany
| | - S Schlatt
- Centre of Reproductive Medicine and Andrology, Institute of Reproductive and Regenerative Biology, Albert-Schweitzer-Campus 1, Building D11, 48149 Münster, Germany
| | - N Neuhaus
- Centre of Reproductive Medicine and Andrology, Institute of Reproductive and Regenerative Biology, Albert-Schweitzer-Campus 1, Building D11, 48149 Münster, Germany
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25
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Ruiz-Olvera SF, Rajmil O, Sanchez-Curbelo JR, Vinay J, Rodriguez-Espinosa J, Ruiz-Castañé E. Association of serum testosterone levels and testicular volume in adult patients. Andrologia 2017; 50. [PMID: 29235139 DOI: 10.1111/and.12933] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2017] [Indexed: 01/14/2023] Open
Abstract
A retrospective observational study was undertaken to gain new insight into the relationship between total testicular volume and levels of serum testosterone, luteinising hormone, follicle-stimulating hormone, prolactin and clinical variables. A total of 312 men with sexual dysfunction or infertility were divided into groups A and B (156 each) on the basis of basal plasma testosterone ≤5 nmol/L of ≥12 nmol/L respectively. Group A was subclassified in A1 (primary hypogonadism) and A2 (secondary hypogonadism). There were significant differences in total testicular volume between group A (15.33 ± 11.94 ml) and group B (36.74 ± 6.9; p < .001) and also between subgroup A1 (11.07 ± 8.49 ml) and subgroup A2 (23.62 ± 13.04 ml; p < .001). Only 13.5% of patients in group B had a total testicular volume <30 ml. Differences in all studied parameters were found between group A and group B. There were no variations when comparing age, body mass index and testosterone in groups A1 and A2 . The use of total testicular volume and body mass index together for predicting testosterone levels yields a sensitivity and specificity of 85.3% and 86.5% respectively. Logistic regression analysis, univariate and multivariate models, using the measurement of total testicular volume resulted in a high capacity to predict testosterone levels.
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Affiliation(s)
- S F Ruiz-Olvera
- Department of Andrology, Fundació Puigvert, Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Autonomous University of Barcelona, Barcelona, Spain
| | - O Rajmil
- Department of Andrology, Fundació Puigvert, Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Autonomous University of Barcelona, Barcelona, Spain
| | - J-R Sanchez-Curbelo
- Department of Andrology, Fundació Puigvert, Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Autonomous University of Barcelona, Barcelona, Spain
| | - J Vinay
- Department of Andrology, Fundació Puigvert, Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Autonomous University of Barcelona, Barcelona, Spain
| | - J Rodriguez-Espinosa
- Biochemistry Department, Hospital Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Autonomous University of Barcelona, Barcelona, Spain
| | - E Ruiz-Castañé
- Department of Andrology, Fundació Puigvert, Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Autonomous University of Barcelona, Barcelona, Spain
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26
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Jacobson DL, Johnson EK. Varicoceles in the pediatric and adolescent population: threat to future fertility? Fertil Steril 2017; 108:370-377. [DOI: 10.1016/j.fertnstert.2017.07.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 06/21/2017] [Accepted: 07/13/2017] [Indexed: 11/28/2022]
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Abstract
Male infertility can be diagnosed by evaluation of the (female and) male history with respect to risk factors, and includes scrotal sonography, hormone and semen measurements. In severe male factor infertility, genetic testing is indicated. Treatment options vary between preventive, medical or surgical strategies depending on the underlying diagnosis. Assisted reproductive techniques may be applied as a consequence of the couple's infertility profile.
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Affiliation(s)
- S Kliesch
- Department of Clinical and Surgical Andrology, Centre of Reproductive Medicine and Andrology, WHO Collaborating Center for Research in Male Fertility, Training Center of the European Academy of Andrology, University Clinics of Muenster, 48149, Münster, Deutschland.
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28
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Brêtas S, Tatsuo ES, Brêtas MOO, Brêtas CO. Measurement of testicular volume in Wistar rats using a caliper and ultrasonography in experimental surgery. Acta Cir Bras 2017; 31:479-85. [PMID: 27487283 DOI: 10.1590/s0102-865020160070000008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Accepted: 06/04/2016] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To compare the measurement of the testicular volume of Wistar rats using a caliper and ultrasonography. METHODS Forty Wistar rats were randomly assigned into four groups. A tensile force of 1.6 Newton (N) and 1.0 N was applied to the right spermatic cord in group I and group II, respectively. Group III was the sham group, and group IV served as a control. The initial and final testicular volumes were measured using a caliper and ultrasonography and compared. A significance level of 5% was used. RESULTS The Kappa coefficient was equal to 0.292 (p = 0.006). The Pearson correlation coefficient obtained for the percent reduction in the right testicular volume using ultrasonography and a caliper was equal to 0.696 (p < 0.001). CONCLUSION There was reasonable agreement and a significant positive correlation between the percent reduction in the right testicular volume using ultrasonography and a caliper.
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Affiliation(s)
- Salomão Brêtas
- Fellow PhD degree, Postgraduate Program in Sciences Applied to Surgery and Ophthalmology, School of Medicine, Universidade Federal de Minas Gerais (UFMG), Brazil. Concept, design, and intellectual content of the study; manuscript preparation; technical procedures
| | - Edson Samesima Tatsuo
- PhD, Full Professor, Department of Surgery, School of Medicine, UFMG, Belo Horizonte-MG, Brazil. Concept, design, and intellectual content of the study; manuscript preparation; critical revision
| | - Monica Odete Oliveira Brêtas
- MD, Fellow, Audit and Regulation Mechanisms in Health, Fundação Unimed, Universidade Gama Filho (UGF), Rio de Janeiro-RJ, Brazil. Acquisition and interpretation of data
| | - Caroline Oliveira Brêtas
- Graduate student, Medical Sciences, Escola Superior de Ciências da Santa Casa de Misericórdia de Vitória (EMESCAM), Vitória-ES, Brazil. Acquisition and interpretation of data, technical procedures
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Rohayem J, Luberto A, Nieschlag E, Zitzmann M, Kliesch S. Delayed treatment of undescended testes may promote hypogonadism and infertility. Endocrine 2017; 55:914-924. [PMID: 28070708 DOI: 10.1007/s12020-016-1178-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 11/10/2016] [Indexed: 10/20/2022]
Abstract
CONTEXT Undescended testes at birth may be caused by testosterone deficiency during fetal development. It is unclear whether the process of failed descent contributes to permanent endocrine impairment. OBJECTIVES To evaluate the impact of age at treatment of undescended testes on endocrine and spermatogenic testicular function in middle-aged men. PATIENTS AND METHODS Reproductive hormone and semen data of 357 men with previously undescended testes were evaluated with respect to age at correction of testicular position and compared to those of 709 controls with eutopic testes at birth and normozoospermia. RESULTS Men with undescended testes had higher mean Luteinizing Hormone levels (p < 0.0001) and lower mean testosterone levels (p = 0.003) compared to controls. They also had lower bi-testicular volumes, higher Follicle Stimulating Hormone levels, and lower sperm concentrations (all p < 0.0001). Lowest mean sperm concentrations were found in subjects with bilateral undescended testes. Normal sperm concentrations were found in 21 % of cases (in 27 % of men with unilateral and in 12 % with bilateral undescended testes), while oligozoospermia was diagnosed in 44 %, and azoospermia in 35 % (in 28 % with unilateral, 46 % with bilateral undescended testes). Subjects with reduced semen quality had higher gonadotropin levels than those with normozoospermia. Age at correction (median: 6 years (1-39)) was inversely correlated with bi-testicular volumes and sperm concentrations, and positively correlated with FSH and LH, but not with serum testosterone. CONCLUSION Latent, rarely decompensated hypogonadism is a potential long-term consequence of undescended testes, besides infertility and testicular cancer, preferentially affecting subjects with delayed or unsuccessful correction of testicular position. Impaired Leydig cell function is likely to contribute to compromised fertility. These observations support correction of cryptorchidism during early infancy.
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Affiliation(s)
- Julia Rohayem
- Center of Reproductive Medicine and Andrology, Department of Clinical Andrology, University of Muenster, Albert-Schweitzer-Campus 1, Building D11, D-48149, Muenster, Germany
| | - Alessandra Luberto
- Center of Reproductive Medicine and Andrology, Department of Clinical Andrology, University of Muenster, Albert-Schweitzer-Campus 1, Building D11, D-48149, Muenster, Germany
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Università, 4, 41121, Modena, MO, Italy
| | - Eberhard Nieschlag
- Center of Reproductive Medicine and Andrology, Department of Clinical Andrology, University of Muenster, Albert-Schweitzer-Campus 1, Building D11, D-48149, Muenster, Germany
| | - Michael Zitzmann
- Center of Reproductive Medicine and Andrology, Department of Clinical Andrology, University of Muenster, Albert-Schweitzer-Campus 1, Building D11, D-48149, Muenster, Germany
| | - Sabine Kliesch
- Center of Reproductive Medicine and Andrology, Department of Clinical Andrology, University of Muenster, Albert-Schweitzer-Campus 1, Building D11, D-48149, Muenster, Germany.
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Fedder J. Prevalence of small testicular hyperechogenic foci in subgroups of 382 non-vasectomized, azoospermic men: a retrospective cohort study. Andrology 2017; 5:248-255. [PMID: 28061524 PMCID: PMC5363684 DOI: 10.1111/andr.12291] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 08/20/2016] [Accepted: 09/01/2016] [Indexed: 12/03/2022]
Abstract
Testicular hyperechogenic foci (THF) are associated with Klinefelter's syndrome, cryptorchidism, infertility, and testicular germ cell neoplasia. The aims of the study were to evaluate THF in relation to etiology of azoospermia and to Sertoli cell dysfunction. The structures inside the scrotum of consecutive non‐vasectomized, azoospermic were examined by ultrasonography, and hormone (FSH, LH, testosterone, and prolactin), and genetic analyses (karyotype, Y microdeletions, and CFTR mutations) were performed. At testicular ultrasonography, patients were graduated into: pronounced THF (>7 THF per transducer field), distributed universally (uTHF) or collected in plaques (pTHF), borderline THF (bTHF; 3–7 THF per transducer field), or no THF (<3 THF per transducer field). Diagnostic testicular biopsy was taken open or with TruCut needle (14G). THF status was sufficiently described in 382 of 449 potential participants, and testicular histology was available in 300 cases. Presence of ultrasonographically detectable THF was compared to presence of testicular microlithiasis (TM) detected histologically. Sertoli cell dysfunction was investigated in a subgroup using a three‐stage immunoperoxidase technique for detection of cytokeratin‐18 (CK‐18). The prevalence of THF was 13.4%. uTHF was found in 11 men (2.9%), the pattern was bilateral in four while other four had bTHF in the other testis. pTHF was detected in eight cases (2.1%), and except for one case with Klinefelter's syndrome, pTHF was in all cases occurring unilaterally. bTHF was detected in 32 cases (8.4%), bilaterally in 17 (53%). Pronounced THF was significantly associated with testicular malignancy. CK‐18 was detected in more azoospermic men with sperm production in ≤50% seminiferous tubules than in azoospermic men with spermatogenesis in ≥90% of seminiferous tubules and normal controls (p < 0.05). Unfortunately, TM detected histologically was not detected in any patient expressing THF, and neither THF nor TM was detected in any of the patients examined for CK‐18. Sertoli cell dysfunction was not associated with testicular microlithiasis or hyperechogenic foci.
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Affiliation(s)
- J Fedder
- Centre of Andrology and Fertility Clinic, Odense University Hospital, Odense, Denmark
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Rohayem J, Hauffa BP, Zacharin M, Kliesch S, Zitzmann M. Testicular growth and spermatogenesis: new goals for pubertal hormone replacement in boys with hypogonadotropic hypogonadism? -a multicentre prospective study of hCG/rFSH treatment outcomes during adolescence. Clin Endocrinol (Oxf) 2017; 86:75-87. [PMID: 27467188 DOI: 10.1111/cen.13164] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 05/19/2016] [Accepted: 07/22/2016] [Indexed: 12/22/2022]
Abstract
CONTEXT/OBJECTIVE Testosterone treatment for pubertal induction in boys with hypogonadotropic hypogonadism (HH) provides virilization, but does not induce testicular growth or fertility. Larger studies evaluating the outcomes of gonadotropin replacement during adolescence have not been reported to date; whether previous testosterone substitution affects testicular responses is unresolved. We aimed to assess the effects of human chorionic gonadotropin (hCG) and recombinant FSH (rFSH) in boys and adolescents with HH with respect to a) testicular growth, b) spermatogenesis, c) quality of life (QoL) and to identify factors influencing therapeutic success. DESIGN/SETTING A prospective case study was conducted in 26 paediatric endocrine centres PATIENTS/INTERVENTIONS: HCG and rFSH were administered until cessation of testicular growth and plateauing of spermatogenesis to (1) prepubertal HH boys with absent or early arrested puberty (group A) and to (2) HH adolescents who had previously received full testosterone replacement (group B). OUTCOME MEASURES Bi-testicular volumes (BTVs), sperm concentrations and QoL. RESULTS Sixty (34 A/26 B) HH patients aged 14-22 years were enrolled. BTVs rose from 5 ± 5 to 34 ± 3 ml in group A vs 5 ± 3 to 32 ± 3 ml in group B, with normal final BTVs (≥24 ml) attained in 74%/70% after 25/23 months in A/B, respectively. Sperm in the ejaculate were found in 21/23(91%)/18/19(95%), with plateauing concentrations after 31/30 months of hCG and 25/25 months of combined treatment in A/B. Sperm concentrations were normal (≥15 mill/ml) in 61%/32%, with mean concentrations of 40 ± 73 vs 19 ± 38 mill/ml in A/B (n.s.). Outcomes were better in patients without bilateral cryptorchidism, with non-congenital HH causes, higher baseline BTVs, and higher baseline inhibin B and AMH levels. QoL increased in both groups. CONCLUSIONS HCG/rFSH replacement during adolescence successfully induces testicular growth and spermatogenesis, irrespective of previous testosterone replacement, and enhances QoL.
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Affiliation(s)
- Julia Rohayem
- Center of Reproductive Medicine and Andrology, Clinical Andrology, University of Münster, Muenster, Germany
| | - Berthold P Hauffa
- Children's Hospital Essen, Department of Paediatric Endocrinology and Diabetes, University Duisburg-Essen, Essen, Germany
| | | | - Sabine Kliesch
- Center of Reproductive Medicine and Andrology, Clinical Andrology, University of Münster, Muenster, Germany
| | - Michael Zitzmann
- Center of Reproductive Medicine and Andrology, Clinical Andrology, University of Münster, Muenster, Germany
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Varimo T, Miettinen PJ, Känsäkoski J, Raivio T, Hero M. Congenital hypogonadotropic hypogonadism, functional hypogonadotropism or constitutional delay of growth and puberty? An analysis of a large patient series from a single tertiary center. Hum Reprod 2016; 32:147-153. [PMID: 27927844 DOI: 10.1093/humrep/dew294] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 10/19/2016] [Accepted: 10/28/2016] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION What diagnoses underlie delayed puberty (DP) and predict its outcome? SUMMARY ANSWER A multitude of different diagnoses underlie DP, and in boys a history of cryptorchidism, small testicular size and slow growth velocity (GV) predict its clinical course. WHAT IS KNOWN ALREADY DP is caused by a variety of underlying etiologies. Hormonal markers can be used in the differential diagnosis of DP but none of them have shown complete diagnostic accuracy. STUDY DESIGN, SIZE, DURATION Medical records of 589 patients evaluated for DP in a single tertiary care center between 2004 and 2014 were retrospectively reviewed. PARTICIPANTS/MATERIALS, SETTING, METHODS Clinical and biochemical data of 174 boys and 70 girls who fulfilled the criteria of DP were included in the analyses. We characterized the frequencies of underlying conditions and evaluated the predictive efficacy of selected clinical and hormonal markers. MAIN RESULTS AND THE ROLE OF CHANCE Thirty etiologies that underlie DP were identified. No markers of clinical value could be identified in the girls, whereas a history of cryptorchidism in the boys was associated with an increase in the risk of permanent hypogonadism (odds ratio 17.2 (95% CI; 3.4-85.4, P < 0.001)). The conditions that cause functional hypogonadotropic hypogonadism were more frequent in boys with a GV below 3 cm/yr than in those growing faster (19% vs 4%, P < 0.05). In this series, the most effective markers to discriminate the prepubertal boys with constitutional delay of growth and puberty (CDGP) from those with congenital hypogonadotropic hypogonadism (CHH) were testicular volume (cut-off 1.1 ml with a sensitivity of 100% and a specificity of 91%), GnRH-induced maximal LH (cut-off 4.3 IU/L; 100%, 75%) and basal inhibin B (INHB) level (cut-off 61 ng/L; 90%, 83%). LIMITATIONS, REASONS FOR CAUTION The main limitation of the study is the retrospective design. WIDER IMPLICATIONS OF THE FINDINGS Prior cryptorchidism and slow GV are two important clinical cues that may help clinicians to predict the clinical course of DP in boys, whereas markers of similar value could not be identified in girls. In prepubertal boys, testicular size appeared as effective as INHB and GnRH-induced LH levels in the differential diagnosis between CHH and CDGP. STUDY FUNDING/COMPETING INTERESTS This study was supported by the Academy of Finland (268356), Foundation for Pediatric Research (7495), Sigrid Juselius Foundation (2613) and the Finnish Medical Foundation (011115). The authors have no competing interests to report. TRIAL REGISTRATION NUMBER Not applicable.
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Affiliation(s)
- Tero Varimo
- Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Päivi J Miettinen
- Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Programs Unit, Molecular Neurology, and Biomedicum Stem Cell Center, University of Helsinki, Helsinki, Finland
| | - Johanna Känsäkoski
- Faculty of Medicine, Department of Physiology, University of Helsinki, Helsinki, Finland
| | - Taneli Raivio
- Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland .,Faculty of Medicine, Department of Physiology, University of Helsinki, Helsinki, Finland
| | - Matti Hero
- Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Belva F, Bonduelle M, Roelants M, Michielsen D, Van Steirteghem A, Verheyen G, Tournaye H. Semen quality of young adult ICSI offspring: the first results. Hum Reprod 2016; 31:2811-2820. [PMID: 27707840 DOI: 10.1093/humrep/dew245] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 08/25/2016] [Accepted: 08/31/2016] [Indexed: 12/14/2022] Open
Abstract
STUDY QUESTION What is the semen quality of young adult men who were conceived 18-22 years ago by ICSI for male infertility? SUMMARY ANSWER In this cohort of 54 young adult ICSI men, median sperm concentration, total sperm count and total motile sperm count were significantly lower than in spontaneously conceived peers. WHAT IS KNOWN ALREADY The oldest ICSI offspring cohort worldwide has recently reached adulthood. Hence, their reproductive health can now be investigated. Since these children were conceived by ICSI because of severe male-factor infertility, there is reasonable concern that male offspring have inherited the deficient spermatogenesis from their fathers. Previously normal pubertal development and adequate Sertoli and Leydig cell function have been described in pubertal ICSI boys; however, no information on their sperm quality is currently available. STUDY DESIGN, SIZE, DURATION This study was conducted at UZ Brussel between March 2013 and April 2016 and is part of a large follow-up project focussing on reproductive and metabolic health of young adults, between 18 and 22 years and conceived after ICSI with ejaculated sperm. Results of both a physical examination and semen analysis were compared between young ICSI men being part of a longitudinally followed cohort and spontaneously conceived controls who were recruited cross-sectionally. PARTICIPANTS/MATERIALS, SETTING, METHOD Results of a single semen sample in 54 young adult ICSI men and 57 spontaneously conceived men are reported. All young adults were individually assessed, and the results of their physical examination were completed by questionnaires. Data were analysed by multiple linear and logistic regression, adjusted for covariates. In addition, semen parameters of the ICSI fathers dating back from their ICSI treatment application were analysed for correlations. MAIN RESULTS AND THE ROLE OF CHANCE Young ICSI adults had a lower median sperm concentration (17.7 million/ml), lower median total sperm count (31.9 million) and lower median total motile sperm count (12.7 million) in comparison to spontaneously conceived peers (37.0 million/ml; 86.8 million; 38.6 million, respectively). The median percentage progressive and total motility, median percentage normal morphology and median semen volume were not significantly different between these groups. After adjustment for confounders (age, BMI, genital malformations, time from ejaculation to analysis, abstinence period), the statistically significant differences between ICSI men and spontaneously conceived peers remained: an almost doubled sperm concentration in spontaneously conceived peers in comparison to ICSI men (ratio 1.9, 95% CI 1.1-3.2) and a two-fold lower total sperm count (ratio 2.3, 95% CI 1.3-4.1) and total motile count (ratio 2.1, 95% CI 1.2-3.6) in ICSI men compared to controls were found. Furthermore, compared to men born after spontaneous conception, ICSI men were nearly three times more likely to have sperm concentrations below the WHO reference value of 15 million/ml (adjusted odds ratio (AOR) 2.7; 95% CI 1.1-6.7) and four times more likely to have total sperm counts below 39 million (AOR 4.3; 95% CI 1.7-11.3). In this small group of 54 father-son pairs, a weak negative correlation between total sperm count in fathers and their sons was found. LIMITATIONS, REASONS FOR CAUTION The main limitation is the small study population. Also, the results of this study where ICSI was performed with ejaculated sperm and for male-factor infertility cannot be generalized to all ICSI offspring because the indications for ICSI have nowadays been extended and ICSI is also being performed with non-ejaculated sperm and reported differences may thus either decrease or increase. WIDER IMPLICATIONS OF THE FINDINGS These first results in a small group of ICSI men indicate a lower semen quantity and quality in young adults born after ICSI for male infertility in their fathers. STUDY FUNDING/COMPETING INTERESTS This study was supported by Methusalem grants and by grants from Wetenschappelijk Fonds Willy Gepts, all issued by the Vrije Universiteit Brussel (VUB). All co-authors except M.B. and H.T. declared no conflict of interest. M.B. has received consultancy fees from MSD, Serono Symposia and Merck. The Universitair Ziekenhuis Brussel (UZ Brussel) and the Centre for Medical Genetics have received several educational grants from IBSA, Ferring, Organon, Shering-Plough and Merck for establishing the database for follow-up research and organizing the data collection. The institution of H.T. has received research grants from the Research Fund of Flanders (FWO), an unconditional grant from Ferring for research on testicular stem cells and research grants from Ferring, Merck, MSD, Roche, Besins, Goodlife and Cook for several research projects in female infertility. H.T. has received consultancy fees from Finox, Abbott and ObsEva for research projects in female infertility.
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Affiliation(s)
- F Belva
- Centre for Medical Genetics, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090 Brussels, Belgium
| | - M Bonduelle
- Centre for Medical Genetics, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090 Brussels, Belgium
| | - M Roelants
- Environment and Health/Youth Health Care, Department of Public Health and Primary Care, Kapucijnenvoer 35, 3000 Leuven, Belgium
| | - D Michielsen
- Department of Urology, Universitair Ziekenhuis (UZ Brussel), Laarbeeklaan 101, 1090 Brussels, Belgium
| | - A Van Steirteghem
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090 Brussels, Belgium
| | - G Verheyen
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090 Brussels, Belgium
| | - H Tournaye
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090 Brussels, Belgium
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Abstract
BACKGROUND Reference values are necessary in clinical practice in order to correctly evaluate testicular volume and detect disorders. OBJECTIVES The objective of this prospective cross-sectional study was to evaluate reference values for testicular volume dependent on age, height, and weight in boys aged 0-18 years. MATERIAL AND METHODS During their inpatient stay, the testes of 174 boys, who were free of disease or therapy that might influence testicular development, were examined by sonography. High resolution ultrasound transducers ranging from 7.5-14 MHz were used for evaluation. The testicular volume was calculated by the ellipsoid formula: length • width • height • (π/6). RESULTS The subject age ranged from 0-18 years (average 7.1 ± 5.3 years). At the age of 0-8 years, the left testicular volume (1.2 ml) was less than the right testicular volume (1.3 ml). At the age of 13 years, the testicular volume of all subjects was over 3 ml. Left testicular volume of boys aged 16.5-18 years ranged from 7 to 22 ml and the right testicular volume ranged from 6 to 22 ml. CONCLUSION Reference value tables of testicular volume dependent on age, and for the first time dependent on weight and height in boys aged from 0-18 years were compiled. Tables of testicular length, width, and height dependent on age are provided.
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Rohayem J, Nieschlag E, Zitzmann M, Kliesch S. Testicular function during puberty and young adulthood in patients with Klinefelter's syndrome with and without spermatozoa in seminal fluid. Andrology 2016; 4:1178-1186. [PMID: 27611179 DOI: 10.1111/andr.12249] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 06/09/2016] [Accepted: 06/13/2016] [Indexed: 02/05/2023]
Abstract
Patients with Klinefelter's syndrome experience progressive testicular degeneration resulting in impaired endocrine function and azoospermia. What proportion of adolescents develop testosterone deficiency during puberty and how many have spermatozoa in their semen is unclear to date. We aimed to investigate testicular function during puberty and young adulthood in patients with Klinefelter's syndrome and to assess testosterone effects in target tissues. The clinical data of 281 patients with non-mosaic Klinefelter's syndrome aged 10-25 years without previous testosterone replacement were reviewed. In late pubertal adolescents, semen analyses were evaluated, and testicular volumes, hormone and haemoglobin (Hb) levels, the number of CAG repeats and final height data were compared to those of 233 age-matched controls with pubertal gynaecomastia. Spontaneous pubertal virilisation to Tanner stages IV-V occurred. Serum T levels ≥10 nmol/L were reached in 62% of patients with Klinefelter's syndrome and in 85% of controls at ages 15-25 (TKFS : 12.2 ± 5.4 vs. TC : 16.6 ± 7.2 nmol/L). LHKFS levels were elevated >10 U/L in 84%, and normal in all controls (LHKFS : 18.6 ± 12.2 vs. LHC : 3.5 ± 1.6 U/L). In nine of 130 (7%) adolescents with Klinefelter's syndrome, spermatozoa (oligozoospermia) were found in semen; all had T levels >7 nmol/L and eight of nine had LH levels ≤18 U/L, while their hormone levels, number of CAG repeats and testicular volumes were not different from those of adolescents with azoospermia. Controls had normal sperm concentrations in 73% (46/63). Semen volumesKFS were normal in 55% vs. 78% in controls; HbKFS was normal in 89% (HbC : 97%). Mean final heightKFS was 185 ± 8 cm vs. 181 ± 7 cm in controls. Hypergonadotropic hypogonadism develops during early puberty in adolescents with Klinefelter's syndrome and remains compensated in over 60% during ages 15-25, with sufficient testosterone secretion for spontaneous accomplishment of pubertal development. Spermatozoa in semen are rare and associated with T levels >7 nmol/L. Parameters reflecting androgen deficiency in target tissues may help to optimise timing of testosterone substitution, which should preferably not be initiated before fertility status has been clarified.
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Affiliation(s)
- J Rohayem
- Department of Clinical Andrology, Center of Reproductive Medicine and Andrology, University of Muenster, Muenster, Germany
| | - E Nieschlag
- Department of Clinical Andrology, Center of Reproductive Medicine and Andrology, University of Muenster, Muenster, Germany
| | - M Zitzmann
- Department of Clinical Andrology, Center of Reproductive Medicine and Andrology, University of Muenster, Muenster, Germany
| | - S Kliesch
- Department of Clinical Andrology, Center of Reproductive Medicine and Andrology, University of Muenster, Muenster, Germany
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Rohayem J, Sinthofen N, Nieschlag E, Kliesch S, Zitzmann M. Causes of hypogonadotropic hypogonadism predict response to gonadotropin substitution in adults. Andrology 2016; 4:87-94. [DOI: 10.1111/andr.12128] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 10/01/2015] [Accepted: 10/19/2015] [Indexed: 11/28/2022]
Affiliation(s)
- J. Rohayem
- Centre of Reproductive Medicine and Andrology; Department of Clinical Andrology; University of Muenster; Muenster Germany
| | - N. Sinthofen
- Centre of Reproductive Medicine and Andrology; Department of Clinical Andrology; University of Muenster; Muenster Germany
| | - E. Nieschlag
- Centre of Reproductive Medicine and Andrology; Department of Clinical Andrology; University of Muenster; Muenster Germany
- Center of Excellence in Genomic Medicine Research; King Abdulaziz University; Jeddah Saudi Arabia
| | - S. Kliesch
- Centre of Reproductive Medicine and Andrology; Department of Clinical Andrology; University of Muenster; Muenster Germany
| | - M. Zitzmann
- Centre of Reproductive Medicine and Andrology; Department of Clinical Andrology; University of Muenster; Muenster Germany
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Santi D, Granata ARM, Simoni M. FSH treatment of male idiopathic infertility improves pregnancy rate: a meta-analysis. Endocr Connect 2015; 4:R46-58. [PMID: 26113521 PMCID: PMC4512277 DOI: 10.1530/ec-15-0050] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 06/25/2015] [Indexed: 01/17/2023]
Abstract
INTRODUCTION The aim of this study is to comprehensively evaluate whether FSH administration to the male partner of infertile couples improves pregnancy rate, spontaneously and/or after assisted reproductive techniques (ART). METHODS Meta-analysis of controlled clinical trials in which FSH was administered for male idiopathic infertility, compared with placebo or no treatment. Randomization was not considered as an inclusion criterion. RESULTS We found 15 controlled clinical studies (614 men treated with FSH and 661 treated with placebo or untreated). Concerning the type of FSH, eight studies used recombinant FSH, whereas seven studies used purified FSH. Nine studies evaluated spontaneous pregnancy rate, resulting in an overall odds ratio (OR) of about 4.5 (CI: 2.17-9.33). Eight studies evaluated pregnancy rate after ART, showing a significant OR of 1.60 (CI: 1.08-2.37). Sub-dividing studies according to the FSH preparations (purified/recombinant), pregnancy rate improvement remained significant for each preparation. Eleven studies considered sperm quality after FSH treatment, finding a significant improvement of sperm concentration (2.66×10(6)/ml, CI: 0.47-4.84), but not of concentration of sperm with progressive motility (1.22×10(6)/ml, CI: -0.07 to 2.52). Three trials evaluated testicular volume, showing a non-significant increase in men treated (1.35 ml, CI: -0.44 to 3.14). CONCLUSION The results of controlled clinical trials available in the literature indicate an improvement of pregnancy rate after FSH administration to the male partner of infertile couples, both spontaneously and after ART. However, the heterogeneity of studies, the high risk of bias and the lack of precise criteria to guide FSH administration limit the strength of these results. Future studies should be designed to identify the markers of FSH response which are helpful in the decision-making process. Meanwhile, the use of FSH in the treatment of male infertility should be cautious.
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Affiliation(s)
- D Santi
- Unit of EndocrinologyDepartment of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, ItalyUnit of EndocrinologyAzienda USL of Modena, NOCSAE, Via P. Giardini 1355, 41126 Modena, Italy Unit of EndocrinologyDepartment of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, ItalyUnit of EndocrinologyAzienda USL of Modena, NOCSAE, Via P. Giardini 1355, 41126 Modena, Italy
| | - A R M Granata
- Unit of EndocrinologyDepartment of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, ItalyUnit of EndocrinologyAzienda USL of Modena, NOCSAE, Via P. Giardini 1355, 41126 Modena, Italy
| | - M Simoni
- Unit of EndocrinologyDepartment of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, ItalyUnit of EndocrinologyAzienda USL of Modena, NOCSAE, Via P. Giardini 1355, 41126 Modena, Italy Unit of EndocrinologyDepartment of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, ItalyUnit of EndocrinologyAzienda USL of Modena, NOCSAE, Via P. Giardini 1355, 41126 Modena, Italy
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Kurtz MP, Migliozzi M, Rosoklija I, Zurakowski D, Diamond DA. Accuracy of orchidometry in boys with varicocele. J Pediatr Urol 2015; 11:185.e1-5. [PMID: 25910796 DOI: 10.1016/j.jpurol.2015.02.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 02/20/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Orchidometric evaluation of the testis has been proposed as a cost-effective alternative to measurement of the testis with high-frequency linear ultrasound, which may be costly in terms of hospital resources and patient time. It is known from animal experiments, autopsy series, and small clinical studies that, under ideal conditions, orchidometry may approximate ultrasound measurement. However, little is known of the effectiveness of orchidometry in the clinical setting in a large sample of adolescents with varicocele. OBJECTIVE We sought to analyze the performance characteristics of Rochester orchidometry and its agreement with ultrasound testis volumes in boys with varicocele. STUDY DESIGN Our institutional varicocele database was analyzed from March 2000 to May 2013, including all boys with Rochester orchidometric measurement and ultrasound-based volume measurement performed on the same day. The Lambert formula (L*W*H*0.71) was used to calculate ultrasound volumes. Seven-hundred and twenty measurements were included: 360 of the left testis, and 360 of the right testis. Each subject was included once; in the event of serial measurements the earliest measurement was analyzed. Bland-Altman plots with 95% limits of agreement were used to compare orchidometry and ultrasound measurements. Analysis was performed with JMP, v11 Pro. RESULTS Age at exam ranged from 11.2 to 18.5 years (median 15.8). With respect to varicocele grade, 183 (50.8%) were grade III, 113 (31.4%) were grade II, 42 (11.7%) were grade I, 12 (0.3%) were bilateral, and 10 (0.3%) were ungraded. Mean ultrasound left testis volume was 13.6 cc (SD 6.6) and mean right testis volume was 15.1 cc (SD 6.9). Eleven surgeons performed the orchidometric measurements; one surgeon performed 71% of the exams. Mean overestimation on the right was 2.0 cc (SD 4.2) and on the left was 1.9 cc (SD 4.1); each was highly statistically significant (p < 0.0001, paired t test). Error was correlated with testis size, implying a greater degree of overestimation with increasing volume (p < 0.01, Pearson's correlation 0.09). Amount of volume overestimation and variability was not significantly different for right and left testis. Sensitivity and specificity of Rochester orchidometry to detect a testis volume differential (TVD) of 20% were 33% (95% CI 23-42%) and 96% (95% CI 92-97%), respectively. Testis size, varicocele grade, or examining surgeon had no effect on sensitivity or specificity. DISCUSSION We have shown in a large series of boys with adolescent varicocele that in clinical practice there is a modest degree of overestimation of testis volume on average (1.9-2.0 cc), although there is a large range of volume estimation, such that the 95% confidence interval ranges are quite wide, from approximately 6 cc lower than the true volume to 10 cc greater than the true volume. Furthermore, the low sensitivity (33%) of orchidometry for 20% testis volume differential renders this a suboptimal screening tool for this clinical parameter, which has been shown to be associated with semen analysis outcomes. Knowledge of the performance characteristics of orchidometry is similarly important for research, as factors such as the prevalence of testis volume differential are then dependent on the modality of measurement. Lastly, that this was conducted over a long time course with several surgeons involved suggests that these data reflect real-world application of orchidometry. CONCLUSIONS Appropriate caution should be exercised when relying solely on orchidometric evaluation of the testis. Rochester orchidometry in general appears to overestimate testis size, and there is wide variability in the estimation. In clinical practice, the sensitivity of Rochester orchidometry is modest in detecting a 20% testis volume differential; this difference would be missed in approximately two out of three of boys screened with orchidometry alone.
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Affiliation(s)
- Michael P Kurtz
- Department of Urology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Matthew Migliozzi
- Department of Urology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ilina Rosoklija
- Division of Urology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - David Zurakowski
- Department of Anesthesia, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - David A Diamond
- Department of Urology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
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Rohayem J, Fricke R, Czeloth K, Mallidis C, Wistuba J, Krallmann C, Zitzmann M, Kliesch S. Age and markers of Leydig cell function, but not of Sertoli cell function predict the success of sperm retrieval in adolescents and adults with Klinefelter's syndrome. Andrology 2015; 3:868-75. [PMID: 26235799 DOI: 10.1111/andr.12067] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 04/13/2015] [Accepted: 05/30/2015] [Indexed: 01/31/2023]
Abstract
Microsurgical testicular sperm extraction (mTESE), combined with intracytoplasmic sperm injection (ICSI) represents a chance for azoospermic men with Klinefelter's syndrome (KS) to father children. The objective of this study was to identify predictive factors for the success of mTESE from adolescents and adults with KS. The clinical data of 50 late pubertal adolescents (13-19 years) and 85 adult patients (20-61 years) with non-mosaic KS, who underwent mTESE, were analysed with respect to factors, potentially predictive of active spermatogenesis; specifically a history of cryptorchidism, age, testicular volumes, serum levels of LH, FSH, testosterone (T) and estradiol at the time of surgery. Inhibin B, AMH and INSL3 were additionally analysed in the adolescents. A younger age and a near-compensated Leydig cell function were associated with higher success of sperm retrieval via mTESE: In adolescents ≥15-19 years, spermatozoa were retrieved in 45%, compared to 31% in adults; in adolescents aged 13-14 years, spermatozoa were collected in only 10%. Adolescents with an LH ≤17.5 U/L, along with a T level ≥7.5 nmol/L had the best success rate (54%), which fell to 44% with higher LH, whereas those with low T (<7.5 nmol/L), irrespective of LH had no sperm retrieval. In adults with T levels above and LH below these thresholds, the success rate was 51%, falling to 19%, if LH was higher. When T was lower than threshold, the rate was 17%. No association between testicular volumes, serum levels of FSH, Inhibin B, AMH, estradiol and mTESE success was found. A history of cryptorchidism was associated with lower retrieval rates. A window of opportunity for an approximate 50% chance to retrieve spermatozoa via mTESE exists for young, late pubertal KS patients between age 15 and young adulthood, when Leydig cell function is at its best. In these cases, referral to a centre of expertise should be considered.
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Affiliation(s)
- J Rohayem
- Department of Clinical Andrology, Center of Reproductive Medicine and Andrology, University of Muenster, Muenster, Germany
| | - R Fricke
- Department of Clinical Andrology, Center of Reproductive Medicine and Andrology, University of Muenster, Muenster, Germany
| | - K Czeloth
- Department of Clinical Andrology, Center of Reproductive Medicine and Andrology, University of Muenster, Muenster, Germany
| | - C Mallidis
- Center of Reproductive Medicine and Andrology, Institute of Reproductive and Regenerative Biology, University of Muenster, Muenster, Germany
| | - J Wistuba
- Center of Reproductive Medicine and Andrology, Institute of Reproductive and Regenerative Biology, University of Muenster, Muenster, Germany
| | - C Krallmann
- Department of Clinical Andrology, Center of Reproductive Medicine and Andrology, University of Muenster, Muenster, Germany
| | - M Zitzmann
- Department of Clinical Andrology, Center of Reproductive Medicine and Andrology, University of Muenster, Muenster, Germany
| | - S Kliesch
- Department of Clinical Andrology, Center of Reproductive Medicine and Andrology, University of Muenster, Muenster, Germany
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Sorokin I, Welliver C, Elebyjian L, Feustel PJ, McCullough A. Interinstitutional Variability in Testicular Volumes and Varicocele Presence by Ultrasound: Surprising Discrepancies and Implications for Clinical Decision Making. Urology 2015; 85:1079-1084. [DOI: 10.1016/j.urology.2015.02.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 01/20/2015] [Accepted: 02/16/2015] [Indexed: 11/16/2022]
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Peixoto GCX, Silva MA, Lima GL, Campos LB, Paiva ALC, Paula VV, Ricarte ARF, Silva AR. Use of Non-invasive Methods for Evaluating the Testicular Biometry in Collared Peccaries (Pecari tajacuLinnaeus, 1758). Anat Histol Embryol 2015; 45:60-6. [DOI: 10.1111/ahe.12171] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Accepted: 01/11/2015] [Indexed: 11/28/2022]
Affiliation(s)
- G. C. X. Peixoto
- Laboratory of Animal Germplasm Conservation; Universidade Federal Rural do Semi-Árido - UFERSA; Mossoró RN Brazil
| | - M. A. Silva
- Laboratory of Animal Germplasm Conservation; Universidade Federal Rural do Semi-Árido - UFERSA; Mossoró RN Brazil
| | - G. L. Lima
- Laboratory of Animal Germplasm Conservation; Universidade Federal Rural do Semi-Árido - UFERSA; Mossoró RN Brazil
| | - L. B. Campos
- Laboratory of Animal Germplasm Conservation; Universidade Federal Rural do Semi-Árido - UFERSA; Mossoró RN Brazil
| | - A. L. C. Paiva
- Laboratory of Animal Germplasm Conservation; Universidade Federal Rural do Semi-Árido - UFERSA; Mossoró RN Brazil
| | - V. V. Paula
- Laboratory of Animal Germplasm Conservation; Universidade Federal Rural do Semi-Árido - UFERSA; Mossoró RN Brazil
| | - A. R. F. Ricarte
- Laboratory of Animal Germplasm Conservation; Universidade Federal Rural do Semi-Árido - UFERSA; Mossoró RN Brazil
| | - A. R. Silva
- Laboratory of Animal Germplasm Conservation; Universidade Federal Rural do Semi-Árido - UFERSA; Mossoró RN Brazil
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Anogenital distance as a measure of human male fertility. J Assist Reprod Genet 2014; 32:479-84. [PMID: 25533333 DOI: 10.1007/s10815-014-0410-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 12/11/2014] [Indexed: 10/24/2022] Open
Abstract
PURPOSE In humans, recent studies have correlated anogenital distance (AGD) in adult men to testicular function. While studies of a group of men suggest an association, the utility of AGD in an infertility evaluation remains uncertain. We sought to determine the utility of AGD to predict male fertility. METHODS Between 2010 and 2011, men were recruited at a urology clinic to participate. AGD was measured using digital calipers in men being evaluated at a urology clinic. ANOVA and ROC analyses were used to determine correlations between AGD, fatherhood status, and semen parameters. RESULTS In all, 473 men were included in the analysis with a mean age of 43 ± 13 years. Anogenital distance was significantly longer in men with higher sperm concentration, total sperm count, and total motile sperm count. In order to evaluate the discriminating ability of AGD, ROC curves were created comparing AGD and total testis volume. The area under the curve (AUC) was significantly larger for total testis volume compared to AGD when evaluating fertility (0.71 vs 0.63, p = 0.02). Similarly, there was a trend towards a higher AUC for testis volume compared to AGD for sperm concentration and total sperm count. Stratification of men with long/short AGD and large/small testes also did not improve the predictive value of AGD. CONCLUSIONS While AGD is associated with sperm production on a population level, at the individual level the distinction based AGD alone cannot accurately estimate the efficiency of spermatogenesis.
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Lotti F, Maggi M. Ultrasound of the male genital tract in relation to male reproductive health. Hum Reprod Update 2014; 21:56-83. [DOI: 10.1093/humupd/dmu042] [Citation(s) in RCA: 189] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Johansen ML, Anand-Ivell R, Mouritsen A, Hagen CP, Mieritz MG, Søeborg T, Johannsen TH, Main KM, Andersson AM, Ivell R, Juul A. Serum levels of insulin-like factor 3, anti-Müllerian hormone, inhibin B, and testosterone during pubertal transition in healthy boys: a longitudinal pilot study. Reproduction 2014; 147:529-35. [DOI: 10.1530/rep-13-0435] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Insulin-like factor 3 (INSL3) is a promising marker of Leydig cell function with potentially high clinical relevance. Limited data of INSL3 levels in relation to other reproductive hormones in healthy pubertal boys exist. In this study, we aimed to evaluate longitudinal serum changes in INSL3 compared with LH, FSH, testosterone, inhibin B, and anti-Müllerian hormone (AMH) during puberty in healthy boys. Ten boys were included from the longitudinal part of the COPENHAGEN Puberty Study. Pubertal evaluation, including testicular volume, was performed and blood samples were drawn every 6 months for 5 years. Serum concentrations of testosterone were determined by a newly developed LC–MS/MS method, and serum concentrations of INSL3, AMH, inhibin B, FSH, and LH respectively were determined by validated immunoassays. The results showed that serum INSL3 levels increased progressively with increasing age, pubertal onset, and testicular volume. In six of the ten boys, LH increased before the first observed increase in INSL3. In the remaining four boys, the increase in LH and INSL3 was observed at the same examination. The increases in serum concentrations of LH, testosterone, and INSL3 were not parallel or in ordered succession and varied interindividually. We demonstrated that INSL3 concentrations were tightly associated with pubertal onset and increasing testicular volume. However, the pubertal increases in LH, INSL3, and testosterone concentrations were not entirely parallel, suggesting that INSL3 and testosterone may be regulated differently. Thus, we speculate that INSL3 provides additional information on Leydig cell differentiation and function during puberty compared with traditional markers of testicular function.
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Rastrelli G, Corona G, Lotti F, Boddi V, Mannucci E, Maggi M. Relationship of Testis Size and LH Levels with Incidence of Major Adverse Cardiovascular Events in Older Men with Sexual Dysfunction. J Sex Med 2013; 10:2761-73. [DOI: 10.1111/jsm.12270] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Kocoglu H, Alan C, Cakır DU, Malkoc E, Cosansu K, Kırılmaz B, Ertung Y, Ersay AR. Association between serum inhibin-B levels and coronary artery disease in aging males. Arch Med Sci 2013; 9:796-801. [PMID: 24273559 PMCID: PMC3832817 DOI: 10.5114/aoms.2013.34410] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Revised: 05/22/2012] [Accepted: 07/12/2012] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Atherosclerosis is a systemic disorder. It is a frequent leading cause of coronary artery disease (CAD). Similarly, atherosclerotic vascular alterations could lead to testicular arterial blood flow reduction and impairment of testicular function with age. Inhibin-B has been validated as a valuable serum marker of testicular functions and its correlation with testicular volume was shown in some studies done before. The purpose of this study is to investigate the association between serum inhibin-B levels and CAD in elderly men. MATERIAL AND METHODS Between March 2009 and March 2010, fifty-two 50-80-year-old consecutive patients with Gensini score over 20 and ejection fraction (EF) > 50% were included in the study as the CAD group. Fifty healthy men without any cardiac disease history were recruited as the control group. All patients in the CAD group who had indications for coronary artery angiography underwent selective coronary artery angiography. RESULTS Inhibin-B, total testosterone and testicular volume levels were found to be significantly lower in the CAD group in comparison with the control group (p = 0.004, p < 0.0001, and p = 0.001 respectively). CONCLUSIONS In this study, although no correlation was found in CAD patients between Gensini score and inhibin-B or testicular volume, inhibin-B levels and testicular volume were significantly lower in patients with CAD than in healthy men. In order to fully assess the relationship between serum inhibin-B levels and CAD, multi-centered prospective and longitudinal studies must be done in elderly male patients.
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Affiliation(s)
- Hasan Kocoglu
- Department of Urology, Canakkale Military Hospital, Turkey
| | - Cabir Alan
- Department of Urology, Medicine Faculty, Canakkale Onsekiz Mart University, Turkey
| | - Dilek Ulker Cakır
- Department of Biochemistry, Medicine Faculty, Çanakkale Onsekiz Mart University, Turkey
| | - Ercan Malkoc
- Department of Urology, Corlu Military Hospital, Turkey
| | | | - Bahadır Kırılmaz
- Department of Cardiology, Medicine Faculty, Canakkale Onsekiz Mart University, Turkey
| | - Yunus Ertung
- Department of Urology, Medicine Faculty, Canakkale Onsekiz Mart University, Turkey
| | - Ahmet Resit Ersay
- Department of Urology, Medicine Faculty, Canakkale Onsekiz Mart University, Turkey
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Abstract
Male subfertility is common, and it causes significant duress to couples. Although the most common cause of male subfertility is idiopathic failure of spermatogenesis, a significant percentage of male subfertility is medically treatable. Compared to reproductive specialists, endocrinologists may see a population of men that have a higher prevalence of treatable causes of subfertility including sexual disorders, endocrinopathies, obesity, drugs, and ejaculatory dysfunction. Seminal fluid analysis is the most important diagnostic study, and at least 2 samples should be analyzed. All patients with sperm concentrations < 10 million/mL due to idiopathic spermatogenic defects should be referred for genetic counseling and karyotyping; most experts also recommend that these patients be tested for Y chromosomal microdeletions. For most men with low sperm concentrations due to gonadotropin deficiency, gonadotropin therapy effectively increases spermatogenesis. The endocrinologist must recognize when to use medical therapy to stimulate spermatogenesis and when to refer for consideration of assisted reproductive technology.
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Affiliation(s)
- Bradley D Anawalt
- University of Washington Medical Center, Department of Medicine, 1959 NE Pacific Street, Seattle, Washington 98195, USA.
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Serefoglu EC, Saitz TR, La Nasa JA, Hellstrom WJ. Adolescent varicocoele management controversies. Andrology 2013; 1:109-15. [PMID: 23258638 DOI: 10.1111/j.2047-2927.2012.00004.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Revised: 06/18/2012] [Accepted: 07/05/2012] [Indexed: 11/28/2022]
Abstract
Varicocoele is defined as excessive dilatation of the pampiniform venous plexus of the spermatic cord. Varicocoele frequently appears during early puberty and is recognized to be the most common surgically correctable cause of male infertility. However, the actual incidence in adolescents, pathophysiology and the association with male factor infertility all remain somewhat controversial. The most accurate diagnostic technique for identifying young men who will benefit from surgical treatment has yet to be established. Observations of testicular asymmetry and deteriorating semen quality helped establish current guidelines and recommendations for surgical treatment. Further studies, comparing observation with surgical intervention, are needed to refine the current indications for varicocoele repair in the adolescent male.
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Affiliation(s)
- E C Serefoglu
- Department of Urology, Tulane University School of Medicine, New Orleans, LA 70112, USA
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