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Sonigo C, Robin G, Boitrelle F, Fraison E, Sermondade N, Mathieu d'Argent E, Bouet PE, Dupont C, Creux H, Peigné M, Pirrello O, Trombert S, Lecorche E, Dion L, Rocher L, Arama E, Bernard V, Monnet M, Miquel L, Birsal E, Haïm-Boukobza S, Plotton I, Ravel C, Grzegorczyk-Martin V, Huyghe É, Dupuis HGA, Lefebvre T, Leperlier F, Bardet L, Lalami I, Robin C, Simon V, Dijols L, Riss J, Koch A, Bailly C, Rio C, Lebret M, Jegaden M, Fernandez H, Pouly JL, Torre A, Belaisch-Allart J, Antoine JM, Courbiere B. [First-line management of infertile couple. Guidelines for clinical practice of the French College of Obstetricians and Gynecologists 2022]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2024; 52:305-335. [PMID: 38311310 DOI: 10.1016/j.gofs.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 01/25/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVE To update the 2010 CNGOF clinical practice guidelines for the first-line management of infertile couples. MATERIALS AND METHODS Five major themes (first-line assessment of the infertile woman, first-line assessment of the infertile man, prevention of exposure to environmental factors, initial management using ovulation induction regimens, first-line reproductive surgery) were identified, enabling 28 questions to be formulated using the Patients, Intervention, Comparison, Outcome (PICO) format. Each question was addressed by a working group that had carried out a systematic review of the literature since 2010, and followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) methodology to assess the quality of the scientific data on which the recommendations were based. These recommendations were then validated during a national review by 40 national experts. RESULTS The fertility work-up is recommended to be prescribed according to the woman's age: after one year of infertility before the age of 35 and after 6months after the age of 35. A couple's initial infertility work-up includes a single 3D ultrasound scan with antral follicle count, assessment of tubal permeability by hysterography or HyFOSy, anti-Mullerian hormone assay prior to assisted reproduction, and vaginal swabbing for vaginosis. If the 3D ultrasound is normal, hysterosonography and diagnostic hysteroscopy are not recommended as first-line procedures. Chlamydia trachomatis serology does not have the necessary performance to predict tubal patency. Post-coital testing is no longer recommended. In men, spermogram, spermocytogram and spermoculture are recommended as first-line tests. If the spermogram is normal, it is not recommended to check the spermogram. If the spermogram is abnormal, an examination by an andrologist, an ultrasound scan of the testicles and hormonal test are recommended. Based on the data in the literature, we are unable to recommend a BMI threshold for women that would contraindicate medical management of infertility. A well-balanced Mediterranean-style diet, physical activity and the cessation of smoking and cannabis are recommended for infertile couples. For fertility concern, it is recommended to limit alcohol consumption to less than 5 glasses a week. If the infertility work-up reveals no abnormalities, ovulation induction is not recommended for normo-ovulatory women. If intrauterine insemination is indicated based on an abnormal infertility work-up, gonadotropin stimulation and ovulation monitoring are recommended to avoid multiple pregnancies. If the infertility work-up reveals no abnormality, laparoscopy is probably recommended before the age of 30 to increase natural pregnancy rates. In the case of hydrosalpinx, surgical management is recommended prior to ART, with either salpingotomy or salpingectomy depending on the tubal score. It is recommended to operate on polyps>10mm, myomas 0, 1, 2 and synechiae prior to ART. The data in the literature do not allow us to systematically recommend asymptomatic uterine septa and isthmoceles as first-line surgery. CONCLUSION Based on strong agreement between experts, we have been able to formulate updated recommendations in 28 areas concerning the initial management of infertile couples.
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Affiliation(s)
- Charlotte Sonigo
- Service de médecine de la reproduction et préservation de la fertilité, hôpital Antoine-Béclère, 157, rue de la Porte-Trivaux, 92140 Clamart, France; Faculté de médecine, université Paris-Sud Saclay, 63, rue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France
| | - Geoffroy Robin
- Service d'assistance médicale à la procréation et préservation de la fertilité, CHU de Lille, Lille, France
| | - Florence Boitrelle
- Service de biologie de la reproduction, préservation de fertilité, CECOS, CHI de Poissy, Poissy, France; INRAe, ENVA, BREED, UVSQ, université Paris Saclay, Jouy-en Josas, France
| | - Eloïse Fraison
- Département médecine de la reproduction, CHU Lyon, hôpital Femme-Mère-Enfant, 59, boulevard Pinel, 69500 Bron, France
| | - Nathalie Sermondade
- Service de biologie de la reproduction CECOS, hôpital Tenon, AP-HP, Sorbonne université, 75020 Paris, France; Inserm US938, centre de recherche Saint-Antoine, Sorbonne université, 75012 Paris, France
| | - Emmanuelle Mathieu d'Argent
- Service de gynécologie-obstétrique et médecine de la reproduction, Dmu Origyne, hôpital Tenon, GHU Sorbonne université, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - Pierre-Emmanuel Bouet
- Service de gynécologie-obstétrique, centre hospitalier universitaire d'Angers, 4, rue Larrey, 49000 Angers, France
| | - Charlotte Dupont
- Service de biologie de la reproduction - CECOS, hôpital Tenon, AP-HP, Sorbonne université, 75012 Paris, France
| | - Hélène Creux
- Centre AMP, polyclinique Saint-Roch, 550, avenue du Colonel-André-Pavelet, 34070 Montpellier cedex, France
| | - Maeliss Peigné
- Service de médecine de la reproduction et préservation de la fertilité, hôpital Jean-Verdier-Béclère, avenue du 14-Juillet, Bondy, France
| | - Olivier Pirrello
- Service d'aide médicale à la procréation, centre médicochirurgical obstétrique (CMCO), CHU de Strasbourg, 19, rue Louis-Pasteur, 67303 Schiltigheim, France
| | - Sabine Trombert
- Laboratoire Cerba, 6-11, rue de l'Équerre, 95310 Saint-Ouen L'Aumône, France
| | - Emmanuel Lecorche
- Laboratoire Cerba, 6-11, rue de l'Équerre, 95310 Saint-Ouen L'Aumône, France
| | - Ludivine Dion
- Département de gynécologie-obstétrique et reproduction humaine - CECOS, hôpital Sud, CHU de Rennes, 16, boulevard de Bulgarie, 35000 Rennes, France
| | - Laurence Rocher
- Service de radiologie diagnostique et interventionnelle, site Bicêtre, hôpitaux Paris Sud, 94270 Le Kremlin-Bicêtre, France; Université Paris Sud, 63, rue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France; Service hospitalier Frédéric-Joliot, imagerie par résonance magnétique médicale et multimodalités, CNRS UMR8081, université Paris Sud, 4, place du Gal-Leclerc, 91401 Orsay cedex, France
| | - Emmanuel Arama
- Service de radiologie diagnostique et interventionnelle, site Bicêtre, hôpitaux Paris Sud, 94270 Le Kremlin-Bicêtre, France; Université Paris Sud, 63, rue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France; Service hospitalier Frédéric-Joliot, imagerie par résonance magnétique médicale et multimodalités, CNRS UMR8081, université Paris Sud, 4, place du Gal-Leclerc, 91401 Orsay cedex, France
| | - Valérie Bernard
- Service de chirurgie gynécologique, gynécologie médicale et médecine de la reproduction, centre Aliénor d'Aquitaine, CHU Pellegrin, Bordeaux, France
| | - Margaux Monnet
- Département de gynécologie médicale, maternité régionale de Nancy, hôpitaux universitaires de Nancy, Nancy, France
| | - Laura Miquel
- Service d'assistance médicale à la procréation, pôle Femmes-Parents-Enfants, hôpital de la Conception, AP-HM, 147, boulevard Baille, 13005 Marseille, France
| | - Eva Birsal
- Service d'assistance médicale à la procréation, pôle Femmes-Parents-Enfants, hôpital de la Conception, AP-HM, 147, boulevard Baille, 13005 Marseille, France
| | | | - Ingrid Plotton
- Service d'hormonologie, endocrinologie moléculaire et maladies rares, CPBE, groupement hospitalier Lyon-Est, Lyon-Bron, France; Université Claude-Bernard, Lyon 1, Lyon, France; Unité Inserm 1208, Lyon, France
| | - Célia Ravel
- Département de gynécologie-obstétrique et reproduction humaine - CECOS, hôpital Sud, CHU de Rennes, 16, boulevard de Bulgarie, 35000 Rennes, France
| | - Véronika Grzegorczyk-Martin
- Centre d'assistance médicale à la procréation et de préservation de la fertilité, clinique Mathilde, 76100 Rouen, France
| | - Éric Huyghe
- Département d'urologie, hôpital de Rangueil, CHU de Toulouse, Toulouse, France; Service de médecine de la reproduction, hôpital Paule-de-Viguier, CHU de Toulouse, Toulouse, France; Inserm 1203, UMR DEFE, université de Toulouse, université de Montpellier, Montpellier, France
| | - Hugo G A Dupuis
- Service d'urologie et d'andrologie, CHU - hôpitaux de Rouen, CHU Charles-Nicolle, 76031 Rouen, France
| | - Tiphaine Lefebvre
- Service de médecine et biologie de la reproduction - gynécologie médicale, centre hospitalier universitaire de Nantes, 38, boulevard Jean-Monnet, 44093 Nantes, France
| | - Florence Leperlier
- Service de médecine et biologie de la reproduction - gynécologie médicale, centre hospitalier universitaire de Nantes, 38, boulevard Jean-Monnet, 44093 Nantes, France
| | - Léna Bardet
- Service de gynécologie-obstétrique et médecine de la reproduction, Dmu Origyne, hôpital Tenon, GHU Sorbonne université, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - Imane Lalami
- Service de gynécologie-obstétrique et de médecine de la reproduction, grand hôpital de l'Est Francilien - site de Meaux, 6-8, rue Saint-Fiacre, 77100 Meaux, France
| | - Camille Robin
- Service d'assistance médicale à la procréation et préservation de la fertilité, CHU de Lille, Lille, France
| | - Virginie Simon
- Unité fonctionnelle de gynécologie endocrinienne, service de gynécologie médicale, orthogénie et sexologie, hôpital Jeanne-de-Flandre, CHU de Lille, avenue Eugène-Avinée, 59037 Lille cedex, France
| | - Laura Dijols
- Service de médecine de la reproduction et préservation de la fertilité, hôpital Bretonneau, CHU de Tours, Tours, France
| | - Justine Riss
- Service d'aide médicale à la procréation, centre médicochirurgical obstétrique (CMCO), CHU de Strasbourg, 19, rue Louis-Pasteur, 67303 Schiltigheim, France
| | - Antoine Koch
- Service d'aide médicale à la procréation, centre médicochirurgical obstétrique (CMCO), CHU de Strasbourg, 19, rue Louis-Pasteur, 67303 Schiltigheim, France
| | - Clément Bailly
- Service de biologie de la reproduction CECOS, hôpital Tenon, AP-HP, Sorbonne université, 75020 Paris, France; Inserm US938, centre de recherche Saint-Antoine, Sorbonne université, 75012 Paris, France
| | - Constance Rio
- Service de gynécologie-obstétrique, centre hospitalier universitaire d'Angers, 4, rue Larrey, 49000 Angers, France
| | - Marine Lebret
- Service de gynécologie-obstétrique, CHU Charles-Nicolle, 37, boulevard Gambetta, 76000 Rouen, France
| | - Margaux Jegaden
- Faculté de médecine, université Paris-Sud Saclay, 63, rue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France; Département de chirurgie gynécologique et obstétrique, hôpital Bicêtre, GHU-Sud, AP-HP, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Hervé Fernandez
- Faculté de médecine, université Paris-Sud Saclay, 63, rue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France; Département de chirurgie gynécologique et obstétrique, hôpital Bicêtre, GHU-Sud, AP-HP, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Jean-Luc Pouly
- Service de gynécologie chirurgicale, CHU Estaing, 1, place Lucie-et-Raymond-Aubrac, 63003 Clermont-Ferrand, France
| | - Antoine Torre
- Centre d'assistance médicale à la procréation clinicobiologique, centre hospitalier Sud Francilien Corbeil-Essonnes, 40, avenue Serge-Dassault, 91106 Corbeil-Essonnes, France
| | - Joëlle Belaisch-Allart
- Service de médecine de la reproduction, pôle Femme-Enfant, Centre hospitalier des 4 villes, rue Charles-Lauer, 92210 Saint-Cloud, France
| | - Jean-Marie Antoine
- Service de gynécologie-obstétrique et médecine de la reproduction, Dmu Origyne, hôpital Tenon, GHU Sorbonne université, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - Blandine Courbiere
- Service d'assistance médicale à la procréation, pôle Femmes-Parents-Enfants, hôpital de la Conception, AP-HM, 147, boulevard Baille, 13005 Marseille, France; IMBE, CNRS, IRD, Aix-Marseille université, Avignon université, Marseille, France.
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Bachelot G, Dhombres F, Sermondade N, Haj Hamid R, Berthaut I, Frydman V, Prades M, Kolanska K, Selleret L, Mathieu-D'Argent E, Rivet-Danon D, Levy R, Lamazière A, Dupont C. A Machine Learning Approach for the Prediction of Testicular Sperm Extraction in Nonobstructive Azoospermia: Algorithm Development and Validation Study. J Med Internet Res 2023; 25:e44047. [PMID: 37342078 DOI: 10.2196/44047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 02/19/2023] [Accepted: 04/07/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Testicular sperm extraction (TESE) is an essential therapeutic tool for the management of male infertility. However, it is an invasive procedure with a success rate up to 50%. To date, no model based on clinical and laboratory parameters is sufficiently powerful to accurately predict the success of sperm retrieval in TESE. OBJECTIVE The aim of this study is to compare a wide range of predictive models under similar conditions for TESE outcomes in patients with nonobstructive azoospermia (NOA) to identify the correct mathematical approach to apply, most appropriate study size, and relevance of the input biomarkers. METHODS We analyzed 201 patients who underwent TESE at Tenon Hospital (Assistance Publique-Hôpitaux de Paris, Sorbonne University, Paris), distributed in a retrospective training cohort of 175 patients (January 2012 to April 2021) and a prospective testing cohort (May 2021 to December 2021) of 26 patients. Preoperative data (according to the French standard exploration of male infertility, 16 variables) including urogenital history, hormonal data, genetic data, and TESE outcomes (representing the target variable) were collected. A TESE was considered positive if we obtained sufficient spermatozoa for intracytoplasmic sperm injection. After preprocessing the raw data, 8 machine learning (ML) models were trained and optimized on the retrospective training cohort data set: The hyperparameter tuning was performed by random search. Finally, the prospective testing cohort data set was used for the model evaluation. The metrics used to evaluate and compare the models were the following: sensitivity, specificity, area under the receiver operating characteristic curve (AUC-ROC), and accuracy. The importance of each variable in the model was assessed using the permutation feature importance technique, and the optimal number of patients to include in the study was assessed using the learning curve. RESULTS The ensemble models, based on decision trees, showed the best performance, especially the random forest model, which yielded the following results: AUC=0.90, sensitivity=100%, and specificity=69.2%. Furthermore, a study size of 120 patients seemed sufficient to properly exploit the preoperative data in the modeling process, since increasing the number of patients beyond 120 during model training did not bring any performance improvement. Furthermore, inhibin B and a history of varicoceles exhibited the highest predictive capacity. CONCLUSIONS An ML algorithm based on an appropriate approach can predict successful sperm retrieval in men with NOA undergoing TESE, with promising performance. However, although this study is consistent with the first step of this process, a subsequent formal prospective multicentric validation study should be undertaken before any clinical applications. As future work, we consider the use of recent and clinically relevant data sets (including seminal plasma biomarkers, especially noncoding RNAs, as markers of residual spermatogenesis in NOA patients) to improve our results even more.
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Affiliation(s)
- Guillaume Bachelot
- Saint Antoine Research Center, L'Institut national de la santé et de la recherche médicale UMR 938, Sorbonne Université, Paris, France
- Service de Biologie de La Reproduction, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
- Laboratory in Medical Informatics and Knowledge Engineering in e-Health, L'Institut national de la santé et de la recherche médicale, Sorbonne University, Paris, France
| | - Ferdinand Dhombres
- Laboratory in Medical Informatics and Knowledge Engineering in e-Health, L'Institut national de la santé et de la recherche médicale, Sorbonne University, Paris, France
| | - Nathalie Sermondade
- Saint Antoine Research Center, L'Institut national de la santé et de la recherche médicale UMR 938, Sorbonne Université, Paris, France
- Service de Biologie de La Reproduction, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Rahaf Haj Hamid
- Service de Biologie de La Reproduction, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Isabelle Berthaut
- Service de Biologie de La Reproduction, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Valentine Frydman
- Service d'Urologie, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Marie Prades
- Service de Biologie de La Reproduction, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Kamila Kolanska
- Saint Antoine Research Center, L'Institut national de la santé et de la recherche médicale UMR 938, Sorbonne Université, Paris, France
- Service de Gynécologie Obstétrique et Médecine de la Reproduction, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Lise Selleret
- Service d'Urologie, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Emmanuelle Mathieu-D'Argent
- Saint Antoine Research Center, L'Institut national de la santé et de la recherche médicale UMR 938, Sorbonne Université, Paris, France
- Service de Gynécologie Obstétrique et Médecine de la Reproduction, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Diane Rivet-Danon
- Service de Biologie de La Reproduction, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Rachel Levy
- Saint Antoine Research Center, L'Institut national de la santé et de la recherche médicale UMR 938, Sorbonne Université, Paris, France
- Service de Biologie de La Reproduction, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Antonin Lamazière
- Saint Antoine Research Center, L'Institut national de la santé et de la recherche médicale UMR 938, Sorbonne Université, Paris, France
- Département de Métabolomique Clinique, Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Charlotte Dupont
- Saint Antoine Research Center, L'Institut national de la santé et de la recherche médicale UMR 938, Sorbonne Université, Paris, France
- Service de Biologie de La Reproduction, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
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Arian I, Dumbraveanu I, Ghenciu V, Machidon D, Ernu I, Ceban E. Histological and immunohistochemical outcomes after microdissection TESE in contrast with hormonal profile, testis volume and genetics in patients with azoospermia. J Med Life 2023; 16:144-152. [PMID: 36873127 PMCID: PMC9979170 DOI: 10.25122/jml-2022-0336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/08/2023] [Indexed: 03/07/2023] Open
Abstract
A limited number of individuals with non-obstructive azoospermia (NOA) may recover spermatozoa through traditional testicular sperm extraction (TESE) techniques. There is an ongoing debate over the effectiveness of microdissection TESE compared to standard TESE methods. Microdissection TESE (micro-TESE) techniques enable the identification of spermatogenesis foci in non-obstructive forms of azoospermia. Only histological examination can provide an objective and definitive assessment of the testicular phenotype. This study aimed to evaluate the correlation between histopathological findings after microdissection TESE (micro-TESE) and the predictive role of various factors in determining the success of sperm retrieval. We evaluated 24 patients with azoospermia who underwent micro-TESE and considered the patient's hormonal profile, testis ultrasound, genetic evaluation, histology, and immunohistology (PLAP antibody) of collected testis biopsies. The preoperative blood FSH level, in conjunction with other parameters, may aid in the prediction of micro-TESE success. Sensitivity increases, and specificity decreases with higher FSH levels. Furthermore, testicular volume and FSH levels are typically normal in patients with maturation arrest. In conclusion, hormones, ultrasound evaluation of the testicles, testis volume, and available genetic tests have a predictive value in differentiating obstructive azoospermia (OA) from NOA with various sensitivity and specificity rates. Histological and immunohistochemical evaluation establishes the testicular phenotype accurately and guides patient management.
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Affiliation(s)
- Iurii Arian
- Department of Urology and Surgical Nephrology, Nicolae Testemiţanu State University of Medicine and Pharmacy, Chisinau, Moldova.,Laboratory of Andrology, Functional Urology and Sexual Medicine, Nicolae Testemiţanu State University of Medicine and Pharmacy, Chisinau, Moldova
| | - Ion Dumbraveanu
- Department of Urology and Surgical Nephrology, Nicolae Testemiţanu State University of Medicine and Pharmacy, Chisinau, Moldova.,Laboratory of Andrology, Functional Urology and Sexual Medicine, Nicolae Testemiţanu State University of Medicine and Pharmacy, Chisinau, Moldova
| | - Victoria Ghenciu
- Laboratory of Andrology, Functional Urology and Sexual Medicine, Nicolae Testemiţanu State University of Medicine and Pharmacy, Chisinau, Moldova
| | - Daniela Machidon
- Laboratory of Andrology, Functional Urology and Sexual Medicine, Nicolae Testemiţanu State University of Medicine and Pharmacy, Chisinau, Moldova
| | - Ion Ernu
- Laboratory of Andrology, Functional Urology and Sexual Medicine, Nicolae Testemiţanu State University of Medicine and Pharmacy, Chisinau, Moldova
| | - Emil Ceban
- Department of Urology and Surgical Nephrology, Nicolae Testemiţanu State University of Medicine and Pharmacy, Chisinau, Moldova.,Laboratory of Andrology, Functional Urology and Sexual Medicine, Nicolae Testemiţanu State University of Medicine and Pharmacy, Chisinau, Moldova
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Kati B, Gonel A, Ordek E, Pelit ES, Ciftci H. Do inflammatory markers such as
NLRP3
and
IL1
‐β have an effect on the prediction of testicular sperm extraction success in infertile men? Andrologia 2022; 54:e14572. [DOI: 10.1111/and.14572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 07/21/2022] [Accepted: 08/11/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
- Bulent Kati
- Faculty of Medicine, Urology Department Harran University Sanliurfa Turkey
| | - Ataman Gonel
- Faculty of Medicine, Biochemistry Department Harran University Sanliurfa Turkey
| | - Eser Ordek
- Faculty of Medicine, Urology Department Harran University Sanliurfa Turkey
| | - Eyyup Sabri Pelit
- Faculty of Medicine, Urology Department Harran University Sanliurfa Turkey
| | - Halil Ciftci
- Faculty of Medicine, Urology Department Harran University Sanliurfa Turkey
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Non-invasive Molecular Biomarkers for Predicting Outcomes of Micro-TESE in Patients with Idiopathic Non-obstructive Azoospermia. Expert Rev Mol Med 2022; 24:e22. [PMID: 35659383 DOI: 10.1017/erm.2022.17] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Ghanem MA, Adawi EA, Ghanem AM, Safan MA, Ghanem AA. Retinal vessel diameters: Can they predict future risk of infertility in patients with varicocele? Arch Ital Urol Androl 2022; 94:70-74. [PMID: 35352529 DOI: 10.4081/aiua.2022.1.70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/22/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The objective of this study was to assess the relationship between retinal vessel diameters, such as retinal arteriolar diameter, retinal venular diameter, and arteriolar/venular ratio (AVR), as clinical parameters of fertility in varicocele patients. MATERIALS AND METHODS Sixty-eight (68) infertile varicocele men with abnormal semen parameters and sixty-one (61) varicocele normozoospermic men were included in the study. Moreover, fifty-eight (58) healthy normozoospermic men without varicocele were enrolled as a control group. For each participant, retinal vascular diameters were measured from the digital retinal photographs as a central retinal arteriolar equivalent (CRAE), central retinal venular equivalent (CRVE), and AVR. In addition, hormones (total testosterone and FSH), and semen parameters were assessed and correlated with retinal vessel diameters. RESULTS The mean CRAE, CRVE, and AVR values were 147.8 ± 15.8 μm, 198.3 ± 39.3 μm, and 0.61 ± 0.01 in infertile varicocele patients, respectively. Significant difference of CRAE, CRVE, and AVR were found when comparing infertile varicocele patients with both varicocele and control normozoospermic male groups (p = 0.01, p = 0.006, and p = 0.007; respectively). Larger retinal venular caliber and smaller AVR ratio showed a significant inverse correlation with both sperm parameters and hormones (total testosterone and FSH) (p < 0.05). No significant correlations were found between CRAE with both sperm parameters and hormonal values (total testosterone and FSH) (p > 0.05). CONCLUSIONS Infertile patients with varicocele showed a significant relationship with the retinal vascular diameter (CRVE and AVR ratio). This finding supports recommendation for regular eye examinations in the varicocele population.
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Affiliation(s)
- Mazen A Ghanem
- Departments of Urology, Jazan University, KSA and Menoufia University.
| | | | | | - Manal A Safan
- Medical Biochemistry and Molecular Biology, Menoufia University.
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Li J, Hu T, Wang Y, Fu Y, Wang F, Hu R. Development a nomogram to predict fertilisation rate of infertile males with borderline semen by using semen parameters combined with AMH and INHB. Andrologia 2021; 53:e14182. [PMID: 34270116 PMCID: PMC8519038 DOI: 10.1111/and.14182] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 06/10/2021] [Accepted: 06/19/2021] [Indexed: 11/30/2022] Open
Abstract
The sperm quality of some males is in a critical state, making it hard for clinicians to choose the suitable fertilisation methods. This study aimed to develop an intelligent nomogram for predicting fertilisation rate of infertile males with borderline semen. 160 males underwent in vitro fertilisation (IVF), 58 of whom received rescue ICSI (R‐ICSI) due to fertilisation failure (fertilisation rate of IVF ≤30%). A least absolute shrinkage and selection operator (LASSO) regression analysis identified sperm concentration, progressively motile spermatozoa (PMS), seminal plasma anti‐Müllerian hormone (spAMH), seminal plasma inhibin (spINHB), serum AMH (serAMH) and serum INHB (serINHB) as significant predictors. The nomogram was plotted by multivariable logistic regression. This nomogram‐illustrated model showed good discrimination, calibration and clinical value. The area under the receiver operating characteristic curve (AUC) of the nomogram was 0.762 (p < .001). Calibration curve and Hosmer–Lemeshow test (p = .5261) showed good consistency between the predictions of the nomogram and the actual observations, and decision curve analysis showed that the nomogram was clinically useful. This nomogram may be useful in predicting fertilisation rate, mainly focused on new biomarkers, INHB and AMH. It could assist clinicians and laboratory technicians select appropriate fertilisation methods (IVF or ICSI) for male patients with borderline semen.
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Affiliation(s)
- Jialing Li
- Ningxia Medical University, Yinchuan, China.,Key Laboratory of Fertility Preservation and Maintenance of Ministry of Education, Ningxia Medical University, Yinchuan, China
| | - Ting Hu
- Gansu Provincial Maternity and Child-care Hospital, Lanzhou, Gansu, China
| | - Yanfei Wang
- Gansu Provincial Maternity and Child-care Hospital, Lanzhou, Gansu, China
| | - Yuxing Fu
- Ningxia Medical University, Yinchuan, China.,Key Laboratory of Fertility Preservation and Maintenance of Ministry of Education, Ningxia Medical University, Yinchuan, China
| | - Feimiao Wang
- Reproductive Medicine Center, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Rong Hu
- Reproductive Medicine Center, General Hospital of Ningxia Medical University, Yinchuan, China
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8
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Qi L, Liu YP, Zhang NN, Su YC. Predictors of testicular sperm retrieval in patients with non-obstructive azoospermia: a review. J Int Med Res 2021; 49:3000605211002703. [PMID: 33794677 PMCID: PMC8020245 DOI: 10.1177/03000605211002703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Azoospermia is divided into two categories of obstructive azoospermia and
non-obstructive azoospermia. Before 1995, couples with a male partner diagnosed
with non-obstructive azoospermia had to choose sperm donation or adoption to
have a child. Currently, testicular sperm aspiration or micro-dissection
testicular sperm extraction combined with intracytoplasmic sperm injection
allows patients with non-obstructive azoospermia to have biological offspring.
The sperm retrieval rate is significantly higher in micro-dissection testicular
sperm extraction compared with testicular sperm aspiration. Additionally,
micro-dissection testicular sperm extraction has the advantages of minimal
invasion, safety, limited disruption of testicular function, a low risk of
postoperative intratesticular bleeding, and low serum testosterone
concentrations. Failed micro-dissection testicular sperm extraction has
significant emotional and financial implications on the involved couples.
Testicular sperm aspiration and micro-dissection testicular sperm extraction
have the possibility of failure. Therefore, predicting the sperm retrieval rate
before surgery is important. This narrative review summarizes the existing data
on testicular sperm aspiration and micro-dissection testicular sperm extraction
to identify the possible factor(s) that can predict the presence of sperm to
guide clinical practice. The predictors of surgical sperm retrieval in patients
with non-obstructive azoospermia have been widely studied, but there is no
consensus.
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Affiliation(s)
- Lin Qi
- Department of Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.,Department of Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Ya P Liu
- Department of Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.,Department of Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Nan N Zhang
- Department of Clinical Laboratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Ying C Su
- Department of Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.,Department of Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
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9
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Barbotin AL, Dauvergne A, Dumont A, Ramdane N, Mitchell V, Rigot JM, Boitrelle F, Robin G. Bilateral versus unilateral cryptorchidism in nonobstructive azoospermia: Testicular sperm extraction outcomes. Asian J Androl 2020; 21:445-451. [PMID: 30880688 PMCID: PMC6732891 DOI: 10.4103/aja.aja_2_19] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Cryptorchidism is one of the most frequent causes of nonobstructive azoospermia (NOA) in adulthood. Although it is well known that spermatogenesis is more impaired in bilateral than in unilateral cryptorchidism, previous studies have only described small cohorts or inhomogeneous population. Consequently, we analyzed a cohort of 225 men with only a history of cryptorchidism as sole etiopathogenetic factor for NOA, and compared testicular sperm extraction (TESE) outcomes between men with bilateral versus unilateral cryptorchidism. Our results show no difference in follicle-stimulating hormone (FSH) levels and testicular volumes between men with a history of bilateral cryptorchidism compared to unilateral cryptorchidism (median: 21.3 IU l−1vs 19.3 IU l−1, P = 0.306; and 7.2 ml vs 7.9 ml, P = 0.543, respectively). In addition, sperm retrieval rates were similar (66.2% vs 60.0%, P = 0.353). Using multivariate analysis, we have found that only a low inhibin B level (above the assay's detection limit) was positively associated with successful sperm retrieval (P < 0.05). Regarding intracytoplasmic sperm injection outcomes, we found that cumulative pregnancy rate and live birth rate per cycle were not statistically different between the two groups (17.4% vs 27.8%, P = 0.070; and 16.1% vs 26.4%, P = 0.067, respectively). Unexpectedly, there was no significant difference in hormonal profiles (FSH, luteinizing hormone [LH], testosterone, and inhibin B levels) and TESE outcomes between unilateral versus bilateral cryptorchidism. This suggests that a history of unilateral cryptorchidism could reflect a bilateral testicular impairment. Interestingly, inhibin B level might be a predictor of successful TESE.
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Affiliation(s)
- Anne-Laure Barbotin
- CHU Lille, Reproductive Biology-Spermiology- CECOS Institute, Jeanne de Flandre Hospital, F-59000 Lille, France.,EA4308: Gametogenesis and Gamete Quality, Lille University, F-59000 Lille, France
| | - Anaïs Dauvergne
- CHU Lille, Department of Andrology, Calmette Hospital, F-59000 Lille, France
| | - Agathe Dumont
- CHU Lille, Department of Endocrine Gynaecology and Reproductive Medicine, Jeanne de Flandre Hospital, F-59000 Lille, France
| | - Nassima Ramdane
- CHU Lille, Department of Biostatistics, EA2694, Lille University, F-59000 Lille, France
| | - Valérie Mitchell
- CHU Lille, Reproductive Biology-Spermiology- CECOS Institute, Jeanne de Flandre Hospital, F-59000 Lille, France.,EA4308: Gametogenesis and Gamete Quality, Lille University, F-59000 Lille, France
| | - Jean-Marc Rigot
- EA4308: Gametogenesis and Gamete Quality, Lille University, F-59000 Lille, France.,CHU Lille, Department of Andrology, Calmette Hospital, F-59000 Lille, France
| | - Florence Boitrelle
- Fertility Unit, Poissy-Saint-Germain-en-Laye General Hospital, 78303 Poissy, France
| | - Geoffroy Robin
- EA4308: Gametogenesis and Gamete Quality, Lille University, F-59000 Lille, France.,CHU Lille, Department of Andrology, Calmette Hospital, F-59000 Lille, France.,CHU Lille, Department of Endocrine Gynaecology and Reproductive Medicine, Jeanne de Flandre Hospital, F-59000 Lille, France
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10
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Zeadna A, Khateeb N, Rokach L, Lior Y, Har-Vardi I, Harlev A, Huleihel M, Lunenfeld E, Levitas E. Prediction of sperm extraction in non-obstructive azoospermia patients: a machine-learning perspective. Hum Reprod 2020; 35:1505-1514. [DOI: 10.1093/humrep/deaa109] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 04/23/2020] [Indexed: 11/15/2022] Open
Abstract
Abstract
STUDY QUESTION
Can a machine-learning-based model trained in clinical and biological variables support the prediction of the presence or absence of sperm in testicular biopsy in non-obstructive azoospermia (NOA) patients?
SUMMARY ANSWER
Our machine-learning model was able to accurately predict (AUC of 0.8) the presence or absence of spermatozoa in patients with NOA.
WHAT IS KNOWN ALREADY
Patients with NOA can conceive with their own biological gametes using ICSI in combination with successful testicular sperm extraction (TESE). Testicular sperm retrieval is successful in up to 50% of men with NOA. However, to the best of our knowledge, there is no existing model that can accurately predict the success of sperm retrieval in TESE. Moreover, machine-learning has never been used for this purpose.
STUDY DESIGN, SIZE, DURATION
A retrospective cohort study of 119 patients who underwent TESE in a single IVF unit between 1995 and 2017 was conducted. All patients with NOA who underwent TESE during their fertility treatments were included. The development of gradient-boosted trees (GBTs) aimed to predict the presence or absence of spermatozoa in patients with NOA. The accuracy of these GBTs was then compared to a similar multivariate logistic regression model (MvLRM).
PARTICIPANTS/MATERIALS, SETTING, METHODS
We employed univariate and multivariate binary logistic regression models to predict the probability of successful TESE using a dataset from a retrospective cohort. In addition, we examined various ensemble machine-learning models (GBT and random forest) and evaluated their predictive performance using the leave-one-out cross-validation procedure. A cutoff value for successful/unsuccessful TESE was calculated with receiver operating characteristic (ROC) curve analysis.
MAIN RESULTS AND THE ROLE OF CHANCE
ROC analysis resulted in an AUC of 0.807 ± 0.032 (95% CI 0.743–0.871) for the proposed GBTs and 0.75 ± 0.052 (95% CI 0.65–0.85) for the MvLRM for the prediction of presence or absence of spermatozoa in patients with NOA. The GBT approach and the MvLRM yielded a sensitivity of 91% vs. 97%, respectively, but the GBT approach has a specificity of 51% compared with 25% for the MvLRM. A total of 78 (65.3%) men with NOA experienced successful TESE. FSH, LH, testosterone, semen volume, age, BMI, ethnicity and testicular size on clinical evaluation were included in these models.
LIMITATIONS, REASONS FOR CAUTION
This study is a retrospective cohort study, with all the associated inherent biases of such studies. This model was used only for TESE, since micro-TESE is not performed at our center.
WIDER IMPLICATIONS OF THE FINDINGS
Machine-learning models may lay the foundation for a decision support system for clinicians together with their NOA patients concerning TESE. The findings of this study should be confirmed with further larger and prospective studies.
STUDY FUNDING/COMPETING INTEREST(S)
The study was funded by the Division of Obstetrics and Gynecology, Soroka University Medical Center, there are no potential conflicts of interest for all authors.
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Affiliation(s)
- A Zeadna
- IVF Unit, Division of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - N Khateeb
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - L Rokach
- Department of Software and Information Systems Engineering, Faculty of Engineering Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Y Lior
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - I Har-Vardi
- IVF Unit, Division of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - A Harlev
- IVF Unit, Division of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - M Huleihel
- The Shraga Segal Department of Microbiology, Immunology and Genetics, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva 84105, Israel
| | - E Lunenfeld
- IVF Unit, Division of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - E Levitas
- IVF Unit, Division of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer Sheva, Israel
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11
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Ghanem MA, Adawi EA, Hakami NA, Ghanem AM, Ghanem HA. The predictive value of the platelet volume parameters in evaluation of varicocelectomy outcome in infertile patients. Andrologia 2020; 52:e13574. [DOI: 10.1111/and.13574] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 02/13/2020] [Accepted: 02/20/2020] [Indexed: 12/18/2022] Open
Affiliation(s)
- Mazen A. Ghanem
- Department of Urology Jazan University, KSA Jazan Saudi Arabia
- Menoufia University Shebin El‐kom Egypt
| | - Essa A. Adawi
- Department of Urology Jazan University, KSA Jazan Saudi Arabia
| | - Nasser A. Hakami
- Department of General Surgery Jazan University, KSA Jazan Saudi Arabia
| | - Ahmed M. Ghanem
- Kasr Al‐Ainy Faculty of Medicine Cairo University Cairo Egypt
| | - Hosam A. Ghanem
- Clinical Pathology Department Mansoura University Mansoura Egypt
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12
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Wang J, Lu N, Zhang S, Tang Z, Huang Y, Li W, Liu G. Reference range and cutoff value of serum inhibin B to predict successful sperm retrieval: A cross-sectional study of 30 613 Chinese men. Clin Endocrinol (Oxf) 2020; 92:232-240. [PMID: 31793003 DOI: 10.1111/cen.14138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 11/29/2019] [Accepted: 11/30/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND The power of inhibin B to predict competent spermatogenesis is not fully understood. The aims of this study were to identify the reliable reference range of inhibin B among normozoospermic men in China and to evaluate the diagnostic accuracy of serum inhibin B level as a complementary predictor of successful sperm retrieval in patients with azoospermia. METHODS This was a cross-sectional study. The male partners of 30 613 infertile couples who visited our hospital were investigated between March 2017 and March 2019. We analysed semen parameters, serum levels of reproductive hormones (inhibin B, FSH and testosterone) and sperm retrieval results from PESA/TESE in Chinese men. RESULTS The normal reference range of inhibin B was 87.42-299.93 pg/mL among men with normozoospermia in China. Inhibin B levels were negatively correlated with age (r = -.111; P < .001) but positively correlated with total sperm counts in the overall population, reference group and case group (r = .311, r = .208 and r = .444, respectively; P < .001). Stepwise multiple regression analyses revealed that compared with the FSH and testosterone levels, the inhibin B level had the closest relationship with the total sperm count. The best cutoff value of inhibin B for predicting the retrieval outcome of testicular/epididymal sperm was >77.72 pg/mL (sensitivity = 59.14%, specificity = 92.00% and AUC = 0.801). The inhibin B:FSH ratio (cutoff value > 6.98, sensitivity = 56.99%, specificity = 96.00% and AUC = 0.814) performed better than either the inhibin B level or the FSH level alone. CONCLUSION A new reference range for serum inhibin B was established in China. However, neither serum inhibin B, FSH nor their ratio is adequate for men to decide whether to undergo PESA/TESE to determine the adequacy of spermatogenesis.
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Affiliation(s)
- Jian Wang
- The Institute of Reproduction and Stem Cell Engineering, Central South University, Changsha, China
| | - Na Lu
- Reproductive and Genetic Hospital of CITIC Xiangya, Changsha, China
| | - Shuolei Zhang
- Reproductive and Genetic Hospital of CITIC Xiangya, Changsha, China
| | - Zhangming Tang
- Reproductive and Genetic Hospital of CITIC Xiangya, Changsha, China
| | - Yifei Huang
- Reproductive and Genetic Hospital of CITIC Xiangya, Changsha, China
| | - Weina Li
- Reproductive and Genetic Hospital of CITIC Xiangya, Changsha, China
- Hunan Guangxiu Hi-tech Life Technology Co., Ltd., Changsha, China
| | - Gang Liu
- The Institute of Reproduction and Stem Cell Engineering, Central South University, Changsha, China
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13
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Comparison of Serum Inhibin B and Follicle-Stimulating Hormone (FSH) Level between Normal and Infertile Men in Yaoundé. Int J Reprod Med 2020; 2020:4765809. [PMID: 32047804 PMCID: PMC7003264 DOI: 10.1155/2020/4765809] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 08/08/2019] [Accepted: 08/24/2019] [Indexed: 11/17/2022] Open
Abstract
Objective Hormones play a vital role in initiating and maintaining male reproductive function. The present study explores the influence and predictive ability of two reproductive hormones on semen quality among men who were partners in an infertile couple. Design During our cross sectional study, men were recruited from private and public hospital and laboratories for clinical evaluation of fertility status. Methods Fresh semen samples were assessed for quality (concentration, motility and morphology) according to the 2010 World Health Organization manual and the serum levels of hormones, including follicle-stimulating hormone (FSH), Inhibin B was measured (ELISA). Results We found a significant difference in the two groups regarding sperm concentration (p < 0.0001), total sperm count (p < 0.0001), total sperm count (p < 0.0001), total sperm count (p < 0.0001), total sperm count (p < 0.0001), total sperm count ( Conclusion Consistent with other studies, our results show strong association between semen quality and FSH and Inhibin B.
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14
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Effect of Wuzi Yanzong on Reproductive Hormones and TGF-β1/Smads Signal Pathway in Rats with Oligoasthenozoospermia. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2019; 2019:7628125. [PMID: 31118967 PMCID: PMC6500641 DOI: 10.1155/2019/7628125] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 02/28/2019] [Accepted: 04/01/2019] [Indexed: 11/22/2022]
Abstract
Introduction Wuzi Yanzong (WZYZ) formula, a famous traditional Chinese medicinal prescription, has been widely used to treat kidney essence insufficiency-induced oligoasthenozoospermia in ancient and modern clinical practice. Previous studies have demonstrated that WZYZ formula exhibits significantly therapeutic activity. The aim of this study was to evaluate the effect of WZYZ formula on the reproductive hormone levels and the TGF-β1/Smads signal pathway in the testis, to explore the underlying mechanisms of WZYZ formula to improve spermatogenic function of testis in rats with oligoasthenozoospermia. Materials and Methods In order to control the quality of the drug, the main components of the WZYZ formula were analyzed by HPLC. A rat model of oligoasthenozoospermia was established, by daily administration of tripterygium glucosides for 4 weeks, and treated with 1.62g/kg of WZYZ formula. The testes were histopathologically examined and serum levels of gonadotropin release hormone (GnRH), estradiol (E2), follicle-stimulating hormone (FSH), testosterone (T), and luteinizing hormone (LH) were measured by ELISA. TGf-β1, Smad2, and Smad4 mRNA and protein levels in the testis were evaluated by immunohistochemistry (IHC), quantitative real-time RT-PCR (qRT-PCR), and Western blotting (WB). Result Oral administration of WZYZ formula restored testicular structure and significantly increased the histology score in the oligoasthenozoospermic rats. In addition, WZYZ also significantly increased the serum levels of GnRH, LH, E2, and T and decreased that of FSH. Meanwhile, TGf-β1, Smad2, and Sma4 expression levels were significantly decreased. Conclusions WZYZ alleviates oligoasthenozoospermia by restoring the reproductive hormones and targeting the TGf-β1/Smads pathway.
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15
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Zhu ZG, Zhao ZG, Pang QY, Chen T, Zhang JM, Zhang TJ, Xu C, Zhang HB, Liu W, Xuan XJ. Predictive significance of serum inhibin B on testicular haploid gamete retrieval outcomes in nonobstructive azoospermic men. Asian J Androl 2018; 21:137-142. [PMID: 30520425 PMCID: PMC6413552 DOI: 10.4103/aja.aja_94_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The purpose of this study was to determine the diagnostic accuracy of serum inhibin B (INHB) as a predictor of the retrieval outcome of testicular haploid gametes (spermatids and testicular spermatozoa) in nonobstructive azoospermic men. Serum hormone levels, testicular volume, and histological evaluation were performed in 403 Chinese nonobstructive azoospermic men. Testicular haploid gamete was successfully retrieved in 213 of 403 patients (52.85%). The haploid gamete group always had higher INHB levels than the non-haploid gamete group. According to the receiver operating characteristic (ROC) curve analysis, INHB was a good predictor of testicular haploid gamete retrieval outcome in all patients (sensitivity: 77.93% and specificity: 91.58%) and patients with normal follicle-stimulating hormone (FSH; sensitivity: 88.52% and specificity: 70.83%). The area under the ROC curve (AUC) of INHB was similar to that of FSH in all patients or patients with normal FSH. In patients with elevated FSH, INHB was superior to FSH in predicting the presence of haploid gamete (AUC: 0.73 vs 0.55, P < 0.05), with a sensitivity of 60.00% and a specificity of 80.28%. It concluded that serum INHB as an effective marker for spermatogenesis was a significant predictor of testicular haploid gamete retrieval outcomes in nonobstructive azoospermic men. Especially, INHB is superior to FSH in predicting the presence of haploid gamete in the patients with elevated FSH.
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Affiliation(s)
- Zhi-Guo Zhu
- Department of Urology and Andrology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510230, China.,Guangzhou Institute of Urology, Guangzhou 510230, China.,Guangdong Key Laboratory of Urology, Guangzhou 510230, China.,Center for Reproductive Medicine, Shandong University, Jinan 250001, China.,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan 250001, China.,The Key Laboratory for Reproductive Endocrinology of Ministry of Education, Jinan 250001, China
| | - Zhi-Gang Zhao
- Department of Urology and Andrology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510230, China.,Guangzhou Institute of Urology, Guangzhou 510230, China.,Guangdong Key Laboratory of Urology, Guangzhou 510230, China
| | - Qing-Yang Pang
- Center for Reproductive Medicine, Shandong University, Jinan 250001, China.,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan 250001, China.,The Key Laboratory for Reproductive Endocrinology of Ministry of Education, Jinan 250001, China
| | - Tong Chen
- Center for Reproductive Medicine, Shandong University, Jinan 250001, China.,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan 250001, China.,The Key Laboratory for Reproductive Endocrinology of Ministry of Education, Jinan 250001, China
| | | | - Tai-Jian Zhang
- Center for Reproductive Medicine, Shandong University, Jinan 250001, China.,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan 250001, China.,The Key Laboratory for Reproductive Endocrinology of Ministry of Education, Jinan 250001, China
| | - Chao Xu
- Center for Reproductive Medicine, Shandong University, Jinan 250001, China.,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan 250001, China.,The Key Laboratory for Reproductive Endocrinology of Ministry of Education, Jinan 250001, China
| | - Hao-Bo Zhang
- Center for Reproductive Medicine, Shandong University, Jinan 250001, China.,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan 250001, China.,The Key Laboratory for Reproductive Endocrinology of Ministry of Education, Jinan 250001, China
| | - Wen Liu
- Center for Reproductive Medicine, Shandong University, Jinan 250001, China.,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan 250001, China.,The Key Laboratory for Reproductive Endocrinology of Ministry of Education, Jinan 250001, China
| | - Xu-Jun Xuan
- Center for Reproductive Medicine, Shandong University, Jinan 250001, China.,National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Jinan 250001, China.,The Key Laboratory for Reproductive Endocrinology of Ministry of Education, Jinan 250001, China
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16
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Barbotin AL, Dossou Gbete F, Prasivoravong J, Marcelli F, Rigot JM, Robin G, Mitchell V. New insights into the morphological and hormonal characteristics of spermatogenic arrest. Andrologia 2018; 50:e13136. [PMID: 30159913 DOI: 10.1111/and.13136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 06/01/2018] [Accepted: 07/31/2018] [Indexed: 12/27/2022] Open
Abstract
The reported sperm retrieval rate (SRR) in patients with nonobstructive azoospermia (NOA) due to spermatogenic arrest (SA) is highly variable in the literature. This discrepancy could be explained by the heterogeneity of testicular tissues. Surprisingly, even though inhibin B levels reflect directly Sertoli cell function; no studies have evaluated this parameter in SA. We aimed to clarify the morphological and biological profile in 158 men with SA. From the total population, patients whose seminiferous tubules diameter was below 165 µm have higher SRR (46.9% vs. 27.4%, p < 0.05), lower inhibin levels and a higher frequency of nonuniform SA (71.9% vs. 38.7%, p < 0.001). On multivariate analysis, patients with late SA and a history of cryptorchidism were positively associated with successful sperm extraction. Patients with successful SRR and uniform SA exhibited inhibin levels twofold lower than those with failed TESE (45 pg/ml vs. 95 pg/ml, p < 0.05), whereas FSH levels were similar in the two groups. In this study, we showed for the first time that the mean diameter of the seminiferous tubules may be of value in the diagnosis of SA. Our results suggest that inhibin levels could be useful in the management of NOA with SA, along with FSH levels and testicular volume.
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Affiliation(s)
- Anne-Laure Barbotin
- CHU Lille, Reproductive Biology Institute-Spermiologie-CECOS, Jeanne de Flandre Hospital, Lille, France.,Univ. Lille, EA4308 «Gametogenesis and Gamete Quality», Lille, France
| | - Florian Dossou Gbete
- CHU Lille, Reproductive Biology Institute-Spermiologie-CECOS, Jeanne de Flandre Hospital, Lille, France
| | - Julie Prasivoravong
- Univ. Lille, EA4308 «Gametogenesis and Gamete Quality», Lille, France.,CHU Lille, Department of Andrology, Calmette Hospital, Lille, France
| | - François Marcelli
- Univ. Lille, EA4308 «Gametogenesis and Gamete Quality», Lille, France.,CHU Lille, Department of Andrology, Calmette Hospital, Lille, France
| | - Jean-Marc Rigot
- Univ. Lille, EA4308 «Gametogenesis and Gamete Quality», Lille, France.,CHU Lille, Department of Andrology, Calmette Hospital, Lille, France
| | - Geoffroy Robin
- Univ. Lille, EA4308 «Gametogenesis and Gamete Quality», Lille, France.,CHU Lille, Department of Andrology, Calmette Hospital, Lille, France.,CHU Lille, Department of Endocrine Gynaecology and Reproductive Medicine, Jeanne de Flandre Hospital, Lille, France
| | - Valerie Mitchell
- CHU Lille, Reproductive Biology Institute-Spermiologie-CECOS, Jeanne de Flandre Hospital, Lille, France.,Univ. Lille, EA4308 «Gametogenesis and Gamete Quality», Lille, France
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Uçar M, Oksay T, Özorak A, Soyupek S, Armağan A, Koşar A. Nonobstruktif Azospermik Hastalarda Yapılan Mikrocerrahi Testiküler Sperm Ekstraksiyonu Sonuçları ve Bu Sonuçları Etkileyen Faktörlerin Değerlendirilmesi. ACTA MEDICA ALANYA 2017. [DOI: 10.30565/medalanya.342563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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18
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Takeda T, Iwatsuki S, Hamakawa T, Mizuno K, Kamiya H, Umemoto Y, Kubota H, Kubota Y, Sasaki S, Yasui T. Chromosomal anomalies and sperm retrieval outcomes of patients with non-obstructive azoospermia: a case series. Andrology 2017; 5:473-476. [DOI: 10.1111/andr.12338] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 12/06/2016] [Accepted: 01/16/2017] [Indexed: 11/26/2022]
Affiliation(s)
- T. Takeda
- Department of Nephro-urology; Nagoya City University Graduate School of Medical Sciences; Nagoya Japan
| | - S. Iwatsuki
- Department of Nephro-urology; Nagoya City University Graduate School of Medical Sciences; Nagoya Japan
| | - T. Hamakawa
- Department of Nephro-urology; Nagoya City University Graduate School of Medical Sciences; Nagoya Japan
| | - K. Mizuno
- Department of Nephro-urology; Nagoya City University Graduate School of Medical Sciences; Nagoya Japan
| | - H. Kamiya
- Department of Nephro-urology; Nagoya City University Graduate School of Medical Sciences; Nagoya Japan
| | - Y. Umemoto
- Department of Nephro-urology; Nagoya City University Graduate School of Medical Sciences; Nagoya Japan
| | - H. Kubota
- Department of Nephro-urology; Nagoya City University Graduate School of Medical Sciences; Nagoya Japan
| | - Y. Kubota
- Department of Nephro-urology; Nagoya City University Graduate School of Medical Sciences; Nagoya Japan
| | - S. Sasaki
- Department of Nephro-urology; Nagoya City University Graduate School of Medical Sciences; Nagoya Japan
| | - T. Yasui
- Department of Nephro-urology; Nagoya City University Graduate School of Medical Sciences; Nagoya Japan
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19
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Altinkilic B, Pilatz A, Diemer T, Wolf J, Bergmann M, Schönbrunn S, Ligges U, Schuppe HC, Weidner W. Prospective evaluation of scrotal ultrasound and intratesticular perfusion by color-coded duplex sonography (CCDS) in TESE patients with azoospermia. World J Urol 2017; 36:125-133. [PMID: 28429094 DOI: 10.1007/s00345-017-2039-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Accepted: 04/13/2017] [Indexed: 11/28/2022] Open
Abstract
PURPOSE The objective of this study was to assess whether CCDS might improve the outcome of testicular sperm retrieval in patients with azoospermia. Furthermore, we evaluated potential sonographic alterations of the testis before and after trifocal and Micro-TESE. METHODS 78 patients were enrolled prospectively: 24 with obstructive azoospermia (OA) and 54 with non-obstructive azoospermia (NOA). 31 of 54 patients in the NOA group had negative surgical sperm retrieval. Testicular volume, hormonal parameters and sonographical findings were compared before and after TESE. The spermatogenetic score was determined for all retrieval sites. CCDS was performed at the upper, middle and lower segment of the testis. Ultrasound parameters and peak systolic velocity (PSV) were measured pre- and post-operatively. RESULTS Testicular volume and epididymal head size were significantly increased in OA patients compared to NOA patients. Ultrasound parameters were comparable between NOA patients with and without successful sperm retrieval. A higher intratesticular PSV was significantly correlated with a better spermatogenic score in the corresponding sonographic position. However, after adjustment for other clinical confounders, PSV does not show a significant influence on the spermatogenic score. Testicular volume decreased significantly in all patients post-operatively after 6 weeks (p < 0.001). Finally, the PSV significantly increased in all patients 24 h after surgery and nearly returned to baseline levels after 6 weeks (p < 0.001). CONCLUSIONS A higher intratesticular PSV may be helpful as a pre-operative diagnostic parameter in mapping for better sperm retrieval, but CCDS does not help to predict successful testicular sperm retrieval after adjustment for other clinical confounders.
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Affiliation(s)
- Bora Altinkilic
- Department of Urology, Pediatric Urology and Andrology, Justus-Liebig University Giessen, Rudolf-Buchheim-Str. 7, 35392, Giessen, Germany.
| | - Adrian Pilatz
- Department of Urology, Pediatric Urology and Andrology, Justus-Liebig University Giessen, Rudolf-Buchheim-Str. 7, 35392, Giessen, Germany
| | - Thorsten Diemer
- Department of Urology, Pediatric Urology and Andrology, Justus-Liebig University Giessen, Rudolf-Buchheim-Str. 7, 35392, Giessen, Germany
| | - Julia Wolf
- Department of Urology, Pediatric Urology and Andrology, Justus-Liebig University Giessen, Rudolf-Buchheim-Str. 7, 35392, Giessen, Germany
| | - Martin Bergmann
- Institute of Veterinary Anatomy, Histology and Embryology, Justus-Liebig University Giessen, Frankfurter Str. 98, 35392, Giessen, Germany
| | - Sarah Schönbrunn
- Department of Statistics, TU Dortmund University, Dortmund, Germany
| | - Uwe Ligges
- Department of Statistics, TU Dortmund University, Dortmund, Germany
| | - Hans-Christian Schuppe
- Department of Urology, Pediatric Urology and Andrology, Justus-Liebig University Giessen, Rudolf-Buchheim-Str. 7, 35392, Giessen, Germany
| | - Wolfgang Weidner
- Department of Urology, Pediatric Urology and Andrology, Justus-Liebig University Giessen, Rudolf-Buchheim-Str. 7, 35392, Giessen, Germany
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20
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Plouvier P, Barbotin AL, Boitrelle F, Dewailly D, Mitchell V, Rigot JM, Lefebvre-Khalil V, Robin G. Extreme spermatogenesis failure: andrological phenotype and intracytoplasmic sperm injection outcomes. Andrology 2017; 5:219-225. [PMID: 28187504 DOI: 10.1111/andr.12323] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 12/01/2016] [Accepted: 12/02/2016] [Indexed: 11/30/2022]
Abstract
Patients with very low sperm count through direct sperm examination can exhibit extreme oligozoospermia or cryptozoospermia (after centrifugation). The management of these patients is a real challenge for both clinicians and biologists. In this retrospective and comparative cohort study, we compared the andrological phenotype of patients with extreme alterations of spermatogenesis and assessed whether the origin of spermatozoa (testicular or ejaculate) had any influence on intracytoplasmic sperm injection (ICSI) outcomes. A total of 161 ICSI cycles were performed using ejaculated spermatozoa from 75 patients with extreme oligozoospermia (EOS) or cryptozoospermia (CS) and 150 ICSI cycles using extracted testicular spermatozoa from 74 patients with non-obstructive azoospermia (NOA). Physical, hormonal, ultrasound assessments, and ICSI outcomes were performed in each group. Cryptorchidism was significantly more frequent in the NOA group (60.8% vs. 22.6%, p = 0.001). FSH levels were significantly higher [18.9 IU/L (5.9-27.0) vs. 15.3 IU/L (9.0-46.5), p = 0.001] and the majority of inhibin B levels measured were found mostly undetectable in the NOA group as compared to EOS/CS group (31.1% vs. 10.7%, p = 0.0004). Moreover, we found no significant differences in the respect to the fertilization rates (48.9% and 43.3%, p = 0.43), implantation rates (17.4% and 15.9%, p = 0.77), and percentage of top quality embryo (22.4% and 20.4%, p = 0.73) between the two groups. The clinical pregnancy rates per embryo transferred were comparable in both groups (28.3% and 27.4%, p = 0.89). In this study, we showed for the first time a different andrological phenotype between EOS/CS and NOA groups. Indeed, cryptorchidism was significantly more frequent with more severe endocrine parameters found in the NOA group. These results reflect a more profound alteration in spermatogenesis in NOA patients. However, there was no difference in ICSI outcomes between NOA and EOS/CS groups.
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Affiliation(s)
- P Plouvier
- Service de Gynécologie Endocrinienne et Médecine de la Reproduction, Hôpital Jeanne de Flandre, Centre Hospitalier Régional Universitaire, Lille, France
| | - A-L Barbotin
- Service de Biologie de la Reproduction-Spermiologie-CECOS, Hôpital Jeanne de Flandre, Centre Hospitalier Régional Universitaire, Lille
| | - F Boitrelle
- Service de Biologie de la Reproduction et Cytogénétique, Hôpital de Poissy, Yvelines, France
| | - D Dewailly
- Service de Gynécologie Endocrinienne et Médecine de la Reproduction, Hôpital Jeanne de Flandre, Centre Hospitalier Régional Universitaire, Lille, France
| | - V Mitchell
- Service de Biologie de la Reproduction-Spermiologie-CECOS, Hôpital Jeanne de Flandre, Centre Hospitalier Régional Universitaire, Lille.,EA 4308 Gametogenese et qualite du gamete, Institut de Biologie de la Reproduction-Spermiologie-CECOS, Hôpital Albert Calmette, Centre Hospitalier Régional Universitaire, Lille, France
| | - J-M Rigot
- EA 4308 Gametogenese et qualite du gamete, Institut de Biologie de la Reproduction-Spermiologie-CECOS, Hôpital Albert Calmette, Centre Hospitalier Régional Universitaire, Lille, France.,Service d'Andrologie, Hôpital Albert Calmette, Centre Hospitalier Régional Universitaire, Lille, France
| | - V Lefebvre-Khalil
- Service de Biologie de la Reproduction-Spermiologie-CECOS, Hôpital Jeanne de Flandre, Centre Hospitalier Régional Universitaire, Lille
| | - G Robin
- Service de Gynécologie Endocrinienne et Médecine de la Reproduction, Hôpital Jeanne de Flandre, Centre Hospitalier Régional Universitaire, Lille, France.,EA 4308 Gametogenese et qualite du gamete, Institut de Biologie de la Reproduction-Spermiologie-CECOS, Hôpital Albert Calmette, Centre Hospitalier Régional Universitaire, Lille, France.,Service d'Andrologie, Hôpital Albert Calmette, Centre Hospitalier Régional Universitaire, Lille, France
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21
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22
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Enatsu N, Miyake H, Chiba K, Fujisawa M. Predictive factors of successful sperm retrieval on microdissection testicular sperm extraction in Japanese men. Reprod Med Biol 2015; 15:29-33. [PMID: 29259419 DOI: 10.1007/s12522-015-0212-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Accepted: 06/10/2015] [Indexed: 10/23/2022] Open
Abstract
Purpose To evaluate retrospectively the outcomes of microdissection testicular sperm extraction (micro-TESE) in men with nonobstructive azoospermia (NOA) and to identify the parameters predicting successful sperm retrieval in this cohort of patients. Methods After excluding patients with normal testicular volume and serum follicle-stimulating hormone (FSH) level who received conventional TESE, this study included 329 consecutive NOA patients undergoing micro-TESE at our institution. The significance of several factors, including age, testicular volume, etiology and serum levels of FSH, luteinizing hormone (LH) and serum testosterone (T), as predictors of successful sperm retrieval, was evaluated. Results Of the 329 men included in this series, 246 (74.8 %), 40 (12.2 %), and 43 (13.1 %) were pathologically diagnosed with Sertoli cell only, maturation arrest, and hypospermatogenesis, respectively. Spermatozoa were retrieved in 97 (29.5 %) of these 329 men by micro-TESE. Older age and non-idiopathic etiology were significantly associated with the probability of successful sperm retrieval; however, there were no significant effects of testicular volume as well as serum levels of FSH, LH, and T on sperm retrieval outcome. Furthermore, Johnsen score of the micro-TESE specimen showed a significant association with whether spermatozoa were successfully retrieved. Univariate analysis of preoperative parameters identified older age and non-idiopathic etiology as significant predictors of successful sperm retrieval, of which only etiology appeared to be independently related to successful sperm retrieval on multivariate analysis. Conclusions Spermatozoa are significantly less likely to be successfully retrieved by micro-TESE in men with idiopathic azoospermia.
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Affiliation(s)
- Noritoshi Enatsu
- Division of Urology Kobe University Graduate School of Medicine 7-5-1 Kusunoki-cho, Chuo-ku 650-0017 Kobe Japan
| | - Hideaki Miyake
- Division of Urology Kobe University Graduate School of Medicine 7-5-1 Kusunoki-cho, Chuo-ku 650-0017 Kobe Japan
| | - Koji Chiba
- Division of Urology Kobe University Graduate School of Medicine 7-5-1 Kusunoki-cho, Chuo-ku 650-0017 Kobe Japan
| | - Masato Fujisawa
- Division of Urology Kobe University Graduate School of Medicine 7-5-1 Kusunoki-cho, Chuo-ku 650-0017 Kobe Japan
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23
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The serum inhibin B concentration and reference ranges in normozoospermia. Eur J Endocrinol 2015; 172:669-76. [PMID: 25740852 DOI: 10.1530/eje-14-0932] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 03/04/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Although an inhibin B assay may be useful in the assessment of testicular function in a number of genital conditions, reliable reference ranges are still lacking. The present study sought to establish the reference range for serum inhibin B by applying the updated Gen II assay. DESIGN This prospective study included 818 men referred for semen analysis: 377 were normozoospermic (reference group) and 441 presented at least one abnormal semen parameter (case group). METHODS Semen parameters were interpreted according to the 2010 World Health Organization manual and David's modified classification for normal morphology. The inhibin B concentration was determined with the current ELISA. RESULTS In the reference group, the 2.5th percentile for inhibin B was 92 pg/ml and the 97.5th percentile for FSH was 7.8 IU/l. In the overall population, an inhibin B level <92 pg/ml was associated with increased odds ratio (OR; 95% CI) for oligozoospermia (16.93 (9.82-29.18), P<0.0001), asthenozoospermia (4.87 (2.88-8.10), P<0.0001), and teratozoospermia (2.20 (1.31-3.68), P=0.0026). The combination of a FSH >7.8 IU/l and an inhibin B <92 pg/ml was associated with greater OR for oligozoospermia (98.74 (23.99-406.35), P<0.0001) than for each hormone considered separately. CONCLUSIONS A new reference range for serum inhibin B was established by the use of updated immunoassay. The correlations between hormone levels and semen parameters highlighted the importance of establishing these values with respect to the spermogram. When combined with FSH assay, the inhibin B range may be of value in the evaluation of spermatogenesis in a number of male genital conditions.
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Aydin T, Sofikerim M, Yucel B, Karadag M, Tokat F. Effects of testicular histopathology on sperm retrieval rates and ICSI results in non-obstructive azoospermia. J OBSTET GYNAECOL 2015; 35:829-31. [DOI: 10.3109/01443615.2015.1009879] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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25
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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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26
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Roche C, Sonigo C, Benmiloud-Tandjaoui N, Boujenah J, Benzacken B, Poncelet C, Hugues JN. [48,XXYY men with azoospermia: how to manage infertility?]. ACTA ACUST UNITED AC 2014; 42:528-32. [PMID: 24934769 DOI: 10.1016/j.gyobfe.2014.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 01/31/2014] [Indexed: 10/25/2022]
Abstract
48,XXYY syndrome is a rare form of sex chromosomal aneuploidy. Usually considered as a variant of Klinefelter syndrome because of shared features (azoospermia, tall stature, hypergonadotropic hypogonadism), it is a separate entity because diagnostic is currently made in prepubertal boy with neuro-psychological disorders. We here report the case of a 48,XXYY patient consulting for adult infertility and the indication to perform testicular sperm extraction is discussed.
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Affiliation(s)
- C Roche
- Pôle femme et enfant, site Jean-Verdier, groupe hospitalier HUPSSD, AP-HP, avenue du 14-Juillet, 93143 Bondy, France; Université SMBH Leonard-de-Vinci, Paris-13, 93000 Bobigny, France.
| | - C Sonigo
- Pôle femme et enfant, site Jean-Verdier, groupe hospitalier HUPSSD, AP-HP, avenue du 14-Juillet, 93143 Bondy, France; Université SMBH Leonard-de-Vinci, Paris-13, 93000 Bobigny, France
| | - N Benmiloud-Tandjaoui
- Pôle femme et enfant, site Jean-Verdier, groupe hospitalier HUPSSD, AP-HP, avenue du 14-Juillet, 93143 Bondy, France; Université SMBH Leonard-de-Vinci, Paris-13, 93000 Bobigny, France
| | - J Boujenah
- Pôle femme et enfant, site Jean-Verdier, groupe hospitalier HUPSSD, AP-HP, avenue du 14-Juillet, 93143 Bondy, France; Université SMBH Leonard-de-Vinci, Paris-13, 93000 Bobigny, France
| | - B Benzacken
- Pôle femme et enfant, site Jean-Verdier, groupe hospitalier HUPSSD, AP-HP, avenue du 14-Juillet, 93143 Bondy, France; Université SMBH Leonard-de-Vinci, Paris-13, 93000 Bobigny, France
| | - C Poncelet
- Pôle femme et enfant, site Jean-Verdier, groupe hospitalier HUPSSD, AP-HP, avenue du 14-Juillet, 93143 Bondy, France; Université SMBH Leonard-de-Vinci, Paris-13, 93000 Bobigny, France
| | - J-N Hugues
- Pôle femme et enfant, site Jean-Verdier, groupe hospitalier HUPSSD, AP-HP, avenue du 14-Juillet, 93143 Bondy, France; Université SMBH Leonard-de-Vinci, Paris-13, 93000 Bobigny, France
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Prasivoravong J, Marcelli F, Lemaître L, Pigny P, Ramdane N, Peers MC, Mitchell V, Rigot JM. Beneficial effects of varicocele embolization on semen parameters. Basic Clin Androl 2014; 24:9. [PMID: 25780583 PMCID: PMC4349315 DOI: 10.1186/2051-4190-24-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 04/28/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The value of varicocele repair and the latter's impact on semen parameters are still subject to debate. METHODS We analyse changes over time in initially abnormal sperm parameters and serum concentrations of testosterone, FSH and inhibin B after embolization treatment of males with high-grade varicocele. From 2007 to 2012, we recruited 47 male infertile patients with clinically visible left varicocele in the resting patient and at least one abnormal semen parameter. Sperm parameters and serum levels of total testosterone, FSH and inhibin B were measured prior to retrograde embolization (M0) and then 3 (M3) and 6 (M6) months afterwards. RESULTS At M0, the median sperm concentration was 5.78 [0.84-37.70] × 10(6)/ejaculate. The mean ± SD sperm progressive motility, vitality and percentage of normal sperm were respectively, 21.83 ± 16.48%, 61.88 ± 15.98% and 12.88 ± 7.15%. The corresponding values at M3 were significantly higher (38.75 [3.96-95] × 10(6)/ejaculate, 29.32 ± 14.21%, 69.14 ± 14.86% and 19.03 ± 11.02%, respectively). The mean percentage of spermatozoa with a thin head was significantly lower at M6 (6.35 ± 5.29%) than at M0 (14.03 ± 13.09%). The mean serum testosterone, FSH and inhibin B levels did not change significantly over time. CONCLUSIONS Embolization treatment in men with clinically visible left varicocele, abnormal sperm parameters and documented infertility is associated with a significant improvement in semen parameters including sperm head morphology.
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Affiliation(s)
- Julie Prasivoravong
- />Department of Andrology, Lille University Hospital, Lille Cedex, France
- />Department of Andrology, CHRU Lille, Hôpital Calmette, Boulevard du Professeur Leclercq, 59037 Lille Cedex, France
| | - François Marcelli
- />Department of Andrology, Lille University Hospital, Lille Cedex, France
| | - Laurent Lemaître
- />Department of Radiology, Lille University Hospital, Lille Cedex, France
| | - Pascal Pigny
- />Department of Biochemistry and Molecular Biology, Lille University Hospital, Lille Cedex, France
| | - Nassima Ramdane
- />Department of Biostatistics, Lille University Hospital, Lille Cedex, France
| | - Marie-Claire Peers
- />Biology of Reproduction Unit, Lille University Hospital, Lille Cedex, France
| | - Valérie Mitchell
- />Biology of Reproduction Unit, Lille University Hospital, Lille Cedex, France
- />EA4308 Gametogenesis and Gamete Quality, University of Lille, Lille Cedex, France
| | - Jean-Marc Rigot
- />Department of Andrology, Lille University Hospital, Lille Cedex, France
- />EA4308 Gametogenesis and Gamete Quality, University of Lille, Lille Cedex, France
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Is there any role of FSH as a predictor for the microsurgical testicular sperm extraction outcome in nonobstructive azoospermia? ACTA ACUST UNITED AC 2014. [DOI: 10.1097/01.xha.0000439144.35911.d7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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29
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Bernie AM, Ramasamy R, Schlegel PN. Predictive factors of successful microdissection testicular sperm extraction. Basic Clin Androl 2013; 23:5. [PMID: 25763186 PMCID: PMC4346292 DOI: 10.1186/2051-4190-23-5] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 09/02/2013] [Indexed: 11/25/2022] Open
Abstract
Azoospermia in men requires microsurgical reconstruction or a procedure for sperm retrieval with assisted reproduction to allow fertility. While the chance of successful retrieval of sperm in men with obstructive azoospermia approaches >90%, the chances of sperm retrieval in men with non-obstructive azoospermia (NOA) are not as high. Conventional procedures such as fine needle aspiration of the testis, testicular biopsy and testicular sperm extraction are successful in 20-45% of men with NOA. With microdissection testicular sperm extraction (micro-TESE), the chance of successful retrieval can be up to 60%. Despite this increased success, the ability to counsel patients preoperatively on their probability of successful sperm retrieval has remained challenging. A combination of variables such as age, serum FSH and inhibin B levels, testicular size, genetic analysis, history of Klinefelter syndrome, history of cryptorchidism or varicocele and histopathology on diagnostic biopsy have provided some insight into the chance of successful sperm retrieval in men with NOA. The goal of this review was to evaluate the preoperative factors that are currently available to predict the outcome for success with micro-TESE.
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Affiliation(s)
- Aaron M Bernie
- Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY USA
| | - Ranjith Ramasamy
- Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY USA
| | - Peter N Schlegel
- Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY USA
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Gul U, Turunc T, Haydardedeoglu B, Yaycioglu O, Kuzgunbay B, Ozkardes H. Sperm retrieval and live birth rates in presumed Sertoli-cell-only syndrome in testis biopsy: a single centre experience. Andrology 2012; 1:47-51. [PMID: 23258629 DOI: 10.1111/j.2047-2927.2012.00003.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Revised: 06/27/2012] [Accepted: 06/29/2012] [Indexed: 11/28/2022]
Abstract
We aimed to investigate sperm retrieval rates (SRR) by testicular sperm extraction (TESE), factors affecting SRR, and fertilization rate (FR), implantation rate (IR), clinical pregnancy rate (CPR) and live birth rate (LBR) in patients with presumed Sertoli-cell-only syndrome in testis biopsy (SCOS). We retrospectively evaluated files of 134 patients with SCOS who underwent TESE. Group I were patients in whom spermatozoa were retrieved and Group II were patients in whom no spermatozoa could be retrieved. SRR, Follicle stimulating hormone (FSH), Luteinizing hormone (LH), and testosterone levels, and the volume of testicles were compared between groups. In addition, FR, IR, CPR and LBR were determined. Sperm retrieval was achieved in 37 (27.6%) patients (Group I), and the remaining 97 (72.4%) patients made Group II. There were no significant differences in age, infertility time, testicular volume, serum FSH, LH and testosterone levels between Groups I and II (p > 0.05). Intracytoplasmic sperm injection (ICSI) was performed in 36 patients. FR, IR, and CPR were 60.86 ± 23.03, 36.53 ± 41.78 and 51.3% respectively. Cycle and patient based LBRs were 37.8 and 45.1% respectively. SRR in SCOS is lower than patients with non-obstructive azoospermia (NOA) in general. No parameters to predict spermatozoa retrieval were determined. In patients with SCOS, ICSI achieves similar live birth rate to other patients with NOA.
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Affiliation(s)
- U Gul
- Faculty of Medicine, Department of Urology, Baskent University, Ankara, Turkey.
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31
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Marconi M, Keudel A, Diemer T, Bergmann M, Steger K, Schuppe HC, Weidner W. Combined Trifocal and Microsurgical Testicular Sperm Extraction Is the Best Technique for Testicular Sperm Retrieval in “Low-Chance” Nonobstructive Azoospermia. Eur Urol 2012; 62:713-9. [DOI: 10.1016/j.eururo.2012.03.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 03/05/2012] [Indexed: 10/28/2022]
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Functional testicular evaluation using PET/CT with 18F-fluorodeoxyglucose. Eur J Nucl Med Mol Imaging 2011; 39:129-37. [DOI: 10.1007/s00259-011-1929-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Accepted: 08/23/2011] [Indexed: 10/17/2022]
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