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Li J, Yang F, Dong L, Chang D, Yu X. Seminal plasma biomarkers for predicting successful sperm retrieval in patients with nonobstructive azoospermia: a narrative review of human studies. Basic Clin Androl 2023; 33:9. [PMID: 37076787 PMCID: PMC10116801 DOI: 10.1186/s12610-023-00184-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 01/08/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Non-obstructive azoospermia (NOA) is considered to be the most severe form of male infertility. Before the emergence of surgical testicular sperm extraction and assisted reproductive technology, NOA patients could hardly become biological fathers of their children. However, failure of the surgery could cause physical and psychological harm to patients such as testicular damage, pain, hopeless of fertility and additional cost. Therefore, predicting the successful sperm retrieval (SSR) is so important for NOA patients to make their choice whether to do the surgery or not. Because seminal plasma is secreted by the testes and accessory gonads, it can reflect the spermatogenic environment, making it a preferential choice for SSR valuation. The purpose of this paper is to summarize the available evidence and provide the reader with a broad overview of biomarkers in seminal plasma for SSR prediction. RESULTS A total of 15,390 studies were searched from PUBMED, EMBASE, CENTRAL and Web of Science, but only 6615 studies were evaluated after duplications were removed. The abstracts of 6513 articles were excluded because they were irrelevant to the topic. The full texts of 102 articles were obtained, with 21 of them being included in this review. The included studies range in quality from medium to high. In the included articles, surgical sperm extraction methods included conventional testicular sperm extraction (TESE) and microdissection testicular sperm extraction (micro-TESE). Currently, the biomarkers in seminal plasma used to predict SSR are primarily RNAs, metabolites, AMH, inhibin B, leptin, survivin, clusterin, LGALS3BP, ESX1, TEX101, TNP1, DAZ, PRM1 and PRM2. CONCLUSION The evidence does not conclusively indicate that AMH and INHB in seminal plasma are valuable to predict the SSR. It is worth noting that RNAs, metabolites and other biomarkers in seminal plasma have shown great potential in predicting SSR. However, existing evidence is insufficient to provide clinicians with adequate decision support, and more prospective, large sample size, and multicenter trials are urgently needed.
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Affiliation(s)
- Junjun Li
- Chengdu Fifth People's Hospital, The Fifth People's Hospital of Chengdu University of Traditional Chinese Medicine, 611130, Chengdu, China
| | - Fang Yang
- TCM Regulating Metabolic Diseases Key Laboratory of Sichuan Province, Hospital of Chengdu, University of Traditional Chinese Medicine, 610072, Chengdu, China
| | - Liang Dong
- The Reproductive & Women-Children Hospital, Chengdu University of Traditional Chinese Medicine, 610041, Chengdu, China
| | - Degui Chang
- TCM Regulating Metabolic Diseases Key Laboratory of Sichuan Province, Hospital of Chengdu, University of Traditional Chinese Medicine, 610072, Chengdu, China
| | - Xujun Yu
- School of Medical and Life Sciences, Chengdu University of Traditional Chinese Medicine, 611137, Chengdu, China.
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Deng C, Liu D, Zhao L, Lin H, Mao J, Zhang Z, Yang Y, Zhang H, Xu H, Hong K, Jiang H. Inhibin B-to-Anti-Mullerian Hormone Ratio as Noninvasive Predictors of Positive Sperm Retrieval in Idiopathic Non-Obstructive Azoospermia. J Clin Med 2023; 12:jcm12020500. [PMID: 36675430 PMCID: PMC9861861 DOI: 10.3390/jcm12020500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 01/02/2023] [Accepted: 01/04/2023] [Indexed: 01/11/2023] Open
Abstract
Background: The lack of clinically useful biomarkers for predicting micro-TESE outcomes in males with idiopathic NOA. To find clinically reliable serum reproductive hormone markers to predict the outcome of sperm retrieval in men with idiopathic NOA undergoing micro-TESE. Methods: We analyzed the clinical data of 168 men with idiopathic NOA treated with micro-TESE. The clinical predictors of a successful sperm retrieval were put to the test using logistic regression analysis. The clinical net benefit was calculated using a decision-curve analysis, and the predictive power of each variable was assessed using the ROC-derived area under the curve. Result: Between positive group and negative group for sperm retrieval, there was a statistically significant difference in INHB, AMH, and INHB/AMH. AMH, INHB, and INHB/AMH were each independent predictors of successful sperm retrieval, with INHB (OR1.02, p = 0.03), AMH (OR0.85, p = 0.01), INHB/AMH (OR1.08, p < 0.01). The ROC curve determined the optimal cut-off values for serum INHB and INHB/AMH in positive sperm retrieval patients undergoing micro-TESE. 21.51 pg/mL was the cut-off value for INHB. The cut-off value for INHB/AMH was 3.19, which had a 86.3% sensitivity and a 53.8% specificity. Using INHB and INHB/AMH prior to micro-TESE sperm retrieval in idiopathic NOA patients improved the net benefit of positive sperm retrieval, and the net benefit score of INHB/AMH was better than that of INHB, according to decision analysis curves. Conclusion: Serum INHB have predictive value for sperm retrieval outcomes in idiopathic NOA patients undergoing micro-TESE. Combining INHB and AMH, INHB/AMH seems to be a better predictor.
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Affiliation(s)
- Chenyao Deng
- Department of Urology, Peking University Third Hospital, Beijing 100191, China
- Department of Andrology, Peking University Third Hospital, Beijing 100191, China
| | - Defeng Liu
- Department of Andrology, Peking University Third Hospital, Beijing 100191, China
- Department of Reproductive Medicine Center, Peking University Third Hospital, Beijing 100191, China
| | - Lianming Zhao
- Department of Urology, Peking University Third Hospital, Beijing 100191, China
- Department of Andrology, Peking University Third Hospital, Beijing 100191, China
- Department of Human Sperm Bank, Peking University Third Hospital, Beijing 100191, China
| | - Haocheng Lin
- Department of Urology, Peking University Third Hospital, Beijing 100191, China
- Department of Andrology, Peking University Third Hospital, Beijing 100191, China
- Department of Human Sperm Bank, Peking University Third Hospital, Beijing 100191, China
| | - Jiaming Mao
- Department of Andrology, Peking University Third Hospital, Beijing 100191, China
- Department of Reproductive Medicine Center, Peking University Third Hospital, Beijing 100191, China
| | - Zhe Zhang
- Department of Andrology, Peking University Third Hospital, Beijing 100191, China
- Department of Reproductive Medicine Center, Peking University Third Hospital, Beijing 100191, China
| | - Yuzhuo Yang
- Department of Andrology, Peking University Third Hospital, Beijing 100191, China
- Department of Reproductive Medicine Center, Peking University Third Hospital, Beijing 100191, China
| | - Haitao Zhang
- Department of Urology, Peking University Third Hospital, Beijing 100191, China
- Department of Andrology, Peking University Third Hospital, Beijing 100191, China
- Department of Human Sperm Bank, Peking University Third Hospital, Beijing 100191, China
| | - Huiyu Xu
- Department of Reproductive Medicine Center, Peking University Third Hospital, Beijing 100191, China
| | - Kai Hong
- Department of Urology, Peking University Third Hospital, Beijing 100191, China
- Department of Andrology, Peking University Third Hospital, Beijing 100191, China
- Department of Human Sperm Bank, Peking University Third Hospital, Beijing 100191, China
- Correspondence: (K.H.); (H.J.)
| | - Hui Jiang
- Department of Urology, Peking University Third Hospital, Beijing 100191, China
- Department of Andrology, Peking University Third Hospital, Beijing 100191, China
- Department of Human Sperm Bank, Peking University Third Hospital, Beijing 100191, China
- Correspondence: (K.H.); (H.J.)
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Llavanera M, Delgado-Bermúdez A, Ribas-Maynou J, Salas-Huetos A, Yeste M. A systematic review identifying fertility biomarkers in semen: a clinical approach through Omics to diagnose male infertility. Fertil Steril 2022; 118:291-313. [PMID: 35718545 DOI: 10.1016/j.fertnstert.2022.04.028] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 04/27/2022] [Accepted: 04/27/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To identify the most robust molecular biomarkers in sperm and seminal plasma for the diagnosis of male infertility, and to evaluate their clinical use. DESIGN Systematic review. SETTING Not applicable. PATIENT(S) Accessible studies reporting well-defined (in)fertile populations and semen molecular biomarkers were included in this review. INTERVENTION(S) A systematic search of the literature published in MEDLINE-PubMed and EMBASE databases was performed, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. MAIN OUTCOME MEASURE(S) The primary outcome was the content, expression, or activity of molecular biomarkers in human semen samples. Only studies reporting a receiver-operating characteristic (ROC) analysis values were included. RESULT(S) Eighty-nine studies were included. Direct evaluation of sperm DNA damage has high potential as a diagnostic biomarker of fertility and assisted reproductive technology outcomes (area under the curve [AUCs] median = 0.67). Regarding strand break-associated chromatin modifications, γH2AX levels show good predictive value for the diagnosis of male infertility (AUCs median = 0.93). Some noncoding ribonucleic acid (RNA) exhibit excellent predictive values; miR-34c-5p in semen is the most well-characterized and robust transcriptomic biomarker (AUCs median = 0.78). While many proteins in semen show fair diagnostic value for sperm quality and fertilizing capacity, the levels of some, such as TEX101, in seminal plasma have an excellent diagnostic potential (AUCs median = 0.69). Although individual metabolites and metabolomic profiles in seminal plasma present good predictive value, the latter seem to be better than the former when inferring sperm quality and fertilizing capacity. CONCLUSION(S) The current review supports that some Omics (e.g., DNA structure and integrity, genomics and epigenomics, transcriptomics, metabolomics, and proteomics) could be considered relevant molecular biomarkers that may help identify infertility etiologies and fertilization prognosis with cost-effective, simple, and accurate diagnosis.
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Affiliation(s)
- Marc Llavanera
- Unit of Cell Biology, Department of Biology, Faculty of Sciences, University of Girona, Girona, Spain; Biotechnology of Animal and Human Reproduction (TechnoSperm), Institute of Food and Agricultural Technology, University of Girona, Girona, Spain
| | - Ariadna Delgado-Bermúdez
- Unit of Cell Biology, Department of Biology, Faculty of Sciences, University of Girona, Girona, Spain; Biotechnology of Animal and Human Reproduction (TechnoSperm), Institute of Food and Agricultural Technology, University of Girona, Girona, Spain
| | - Jordi Ribas-Maynou
- Unit of Cell Biology, Department of Biology, Faculty of Sciences, University of Girona, Girona, Spain; Biotechnology of Animal and Human Reproduction (TechnoSperm), Institute of Food and Agricultural Technology, University of Girona, Girona, Spain
| | - Albert Salas-Huetos
- Unit of Cell Biology, Department of Biology, Faculty of Sciences, University of Girona, Girona, Spain; Biotechnology of Animal and Human Reproduction (TechnoSperm), Institute of Food and Agricultural Technology, University of Girona, Girona, Spain; Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts; Consorcio CIBER, M.P., Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
| | - Marc Yeste
- Unit of Cell Biology, Department of Biology, Faculty of Sciences, University of Girona, Girona, Spain; Biotechnology of Animal and Human Reproduction (TechnoSperm), Institute of Food and Agricultural Technology, University of Girona, Girona, Spain
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Zarezadeh R, Fattahi A, Nikanfar S, Oghbaei H, Ahmadi Y, Rastgar Rezaei Y, Nouri M, Dittrich R. Hormonal markers as noninvasive predictors of sperm retrieval in non-obstructive azoospermia. J Assist Reprod Genet 2021; 38:2049-2059. [PMID: 33791895 PMCID: PMC8417206 DOI: 10.1007/s10815-021-02176-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 03/28/2021] [Indexed: 12/12/2022] Open
Abstract
Non-obstructive azoospermia (NOA) is one of the leading causes of male factor infertility, which results from impaired spermatogenesis. Currently, the sole feasible therapeutic option for men with NOA to father their biologic children is sperm retrieval by testicular sperm extraction (TESE) approaches followed by an intracytoplasmic sperm injection program. Nevertheless, the rate of sperm retrieval from NOA men following TESE has remained as low as 50%, leading to a significant number of unsuccessful TESE operations. Given that TESE is associated with multiple side effects, the prediction of TESE outcome preoperatively can abolish unnecessary operations and thereby prevent NOA patients from sustaining adverse side effects. As the process of spermatogenesis is under the regulation of hormones, the hormonal profile of serum and/or seminal plasma may contain useful information about spermatogenesis status and can potentially predict the chance of sperm retrieval from NOA patients. A large body of literature is available on the predictive capability of different serum and seminal plasma hormones such as FSH, LH, testosterone, inhibin B, AMH, estradiol, prolactin, and leptin in a stand-alone basis or combinational fashion with respect to the TESE outcome. The present review aimed to evaluate the potential of these hormonal markers as noninvasive predictors of sperm retrieval in men with NOA.
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Affiliation(s)
- Reza Zarezadeh
- Department of Biochemistry and Clinical Laboratories, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Amir Fattahi
- Department of Reproductive Biology, Faculty of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saba Nikanfar
- Department of Biochemistry and Clinical Laboratories, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hajar Oghbaei
- Department of Physiology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Yadollah Ahmadi
- Department of Urology, Sina Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Yeganeh Rastgar Rezaei
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Medical Biotechnology, Faculty of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Nouri
- Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Medical Biotechnology, Faculty of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ralf Dittrich
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Friedrich-Alexander University of Erlangen–Nürnberg, Erlangen, Germany
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5
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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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6
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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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Abstract
Infertility affects 1 in 6 couples, and male factor infertility has been implicated as a cause in 50% of cases. Azoospermia is defined as the absence of spermatozoa in the ejaculate and is considered the most extreme form of male factor infertility. Historically, these men were considered sterile but, with the advent of testicular sperm extraction and assisted reproductive technologies, men with azoospermia are able to biologically father their own children. Non-obstructive azoospermia (NOA) occurs when there is an impairment to spermatogenesis. This review describes the contemporary management of NOA and discusses the role of hormone stimulation therapy, surgical and embryological factors, and novel technologies such as proteomics, genomics, and artificial intelligence systems in the diagnosis and treatment of men with NOA. Moreover, we highlight that men with NOA represent a vulnerable population with an increased risk of developing cancer and cardiovascular comorbodities.
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Affiliation(s)
- Tharu Tharakan
- Section of Investigative Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom
- Department of Urology, Imperial Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London, United Kingdom
| | - Rong Luo
- Section of Investigative Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Channa N Jayasena
- Section of Investigative Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Suks Minhas
- Department of Urology, Imperial Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London, United Kingdom
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8
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Liu YP, Qi L, Zhang NN, Shi H, Su YC. Follicle-stimulating hormone may predict sperm retrieval rate and guide surgical approach in patients with non-obstructive azoospermia. Reprod Biol 2020; 20:573-579. [PMID: 33203587 DOI: 10.1016/j.repbio.2020.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 09/14/2020] [Accepted: 10/17/2020] [Indexed: 02/06/2023]
Abstract
Testicular sperm aspiration- (TESA) or micro-dissection testicular sperm extraction- (MD-TESE) combined intracytoplasmic sperm injection (ICSI) was the only option for non-obstructive azoospermia (NOA) patients to have a biological offspring and they had different success rates in sperm retrieval. Our study aimed to find predictor(s) for predicting the sperm retrieval rate (SRR) in NOAs and guide clinicians in choosing different surgical approaches, TESA or MD-TESE for NOAs. 294 NOAs who had undergone TESA or MD-TESE were divided into TESA group and MD-TESE group. Depending on sperm retrieval, each group was divided into two subgroups: successful subgroups and failure subgroups. They respectively were 24 cases and 131 cases, 53 cases and 86 cases. Clinical data, including body mass index (BMI), testicular volume, and serum hormone levels, were analyzed in a retrospective manner. The results showed that follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels and SRR were lower in TESA group as compared to these in MD-TESE group, while testicular volume was higher (P < 0.05). The surgical approach of sperm retrieval significantly affected the SRR (P < 0.05). In TESA subgroups, testicular volume, FSH and LH differed significantly (P < 0.05). In MD-TESE subgroups, the level of FSH and LH differed significantly between both groups (P < 0.05). Using logistics regression, we found a negative correlation (β=-0.083) between FSH and the SRR in TESA group but a positive correlation (β = 0.064) in MD-TESE group (P < 0.05). In conclusion, serum FSH level can predict the SRR of NOAs and guide the clinicians while selecting the suitable surgery approach for NOAs.
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Affiliation(s)
- Ya-Ping Liu
- Department of Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, Henan, China; Department of Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, Henan, China
| | - Lin Qi
- Department of Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, Henan, China; Department of Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, Henan, China
| | - Nan-Nan Zhang
- Department of Clinical Laboratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, China
| | - Hao Shi
- Department of Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, Henan, China; Department of Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, Henan, China
| | - Ying-Chun Su
- Department of Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, Henan, China; Department of Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, 450052, Zhengzhou, Henan, China.
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9
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Corona G, Minhas S, Giwercman A, Bettocchi C, Dinkelman-Smit M, Dohle G, Fusco F, Kadioglou A, Kliesch S, Kopa Z, Krausz C, Pelliccione F, Pizzocaro A, Rassweiler J, Verze P, Vignozzi L, Weidner W, Maggi M, Sofikitis N. Sperm recovery and ICSI outcomes in men with non-obstructive azoospermia: a systematic review and meta-analysis. Hum Reprod Update 2020; 25:733-757. [PMID: 31665451 DOI: 10.1093/humupd/dmz028] [Citation(s) in RCA: 140] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 07/18/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Factor affecting sperm retrieval rate (SRR) or pregnancy rates (PR) after testicular sperm extraction (TESE) in patients with non-obstructive azoospermia (NOA) have not been systematically evaluated. In addition, although micro-TESE (mTESE) has been advocated as the gold standard for sperm retrieval in men with NOA, its superiority over conventional TESE (cTESE) remains conflicting. OBJECTIVE AND RATIONALE The objective was to perform a meta-analysis of the currently available studies comparing the techniques of sperm retrieval and to identify clinical and biochemical factors predicting SRR in men with NOA. In addition, PRs and live birth rates (LBRs), as derived from subjects with NOA post-ICSI, were also analysed as secondary outcomes. SEARCH METHODS An extensive Medline, Embase and Cochrane search was performed. All trials reporting SRR derived from cTESE or mTESE in patients with NOA and their specific determinants were included. Data derived from genetic causes of NOA or testicular sperm aspiration were excluded. OUTCOMES Out of 1236 studies, 117 studies met the inclusion criteria for this study, enrolling 21 404 patients with a mean age (± SD) of 35.0 ± 2.7 years. cTESE and mTESE were used in 56 and 43 studies, respectively. In addition, 10 studies used a mixed approach and 8 studies compared cTESE with mTESE approach. Overall, a SRR per TESE procedure of 47[45;49]% (mean percentage [95% CI]) was found. No differences were observed when mTESE was compared to cTESE (46[43;49]% for cTESE versus 46[42;49]% for mTESE). Meta-regression analysis demonstrated that SRR per cycle was independent of age and hormonal parameters at enrolment. However, the SRR increased as a function of testis volume. In particular, by applying ROC curve analysis, a mean testis volume higher than 12.5 ml predicted SRR >60% with an accuracy of 86.2% ± 0.01. In addition, SRR decreased as a function of the number of Klinefelter's syndrome cases included (S = -0.02[-0.04;-0.01]; P < 0.01. I = 0.12[-0.05;0.29]; P = 0.16). Information on fertility outcomes after ICSI was available in 42 studies. Overall, a total of 1096 biochemical pregnancies were reported (cumulative PR = 29[25;32]% per ICSI cycle). A similar rate was observed when LBR was analysed (569 live births with a cumulative LBR = 24[20;28]% per ICSI cycle). No influence of male and female age, mean testis volume or hormonal parameters on both PR and LBR per ICSI cycle was observed. Finally, a higher PR per ICSI cycle was observed when the use of fresh sperm was compared to cryopreserved sperm (PR = 35[30;40]%, versus 20[13;29]% respectively): however, this result was not confirmed when cumulative LBR per ICSI cycle was analysed (LBR = 30[20;41]% for fresh versus 20[12;31]% for cryopreserved sperm). WIDER IMPLICATIONS This analysis shows that cTESE/mTESE in subjects with NOA results in SRRs of up to 50%, with no differences when cTESE was compared to mTESE. Retrieved sperms resulted in a LBR of up to 28% ICSI cycle. Although no difference between techniques was found, to conclusively clarify if one technique is superior to the other, there is a need for a sufficiently powered and well-designed randomized controlled trial to compare mTESE to cTESE in men with NOA.
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Affiliation(s)
- Giovanni Corona
- Endocrinology Unit, Medical Department, Endocrinology Unit, Azienda Usl Bologna Maggiore-Bellaria Hospital, Bologna, Italy
| | - Suks Minhas
- Department of Urology, Imperial College NHS Healthcare, London, UK
| | - Aleksander Giwercman
- Molecular Reproductive Medicine, Department of Translational Medicine, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Carlo Bettocchi
- Department of Urology, Andrology and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | | | - Gert Dohle
- Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Ferdinando Fusco
- Department of Neurosciences, Human Reproduction and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Ates Kadioglou
- Department of Urology, Istanbul Faculty of Medicine, University of Istanbul, Istanbul, Turkey
| | - Sabine Kliesch
- Department of Clinical and Surgical Andrology, Centre of Reproductive Medicine and Andrology (CeRA), Münster University Hospital (UKM), Münster, Germany
| | - Zsolt Kopa
- Andrology Centre, Department of Urology Semmelweis University, Budapest, Hungary
| | - Csilla Krausz
- Andrology, Women's Endocrinology and Gender Inconguence Unit, Department of Experimental and Clinical Biomedical Sciences, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Fiore Pelliccione
- Diabetes and Metabolism Unit, Department of Internal Medicine, Azienda ASL 02 Chieti-Lanciano-Vasto, F. Renzetti Hospital, Lanciano, Italy
| | - Alessandro Pizzocaro
- Endocrinology Unit, Department of Biomedical Sciences, Humanitas University and Humanitas Research Center IRCCS, Rozzano, Milan, Italy
| | - Jens Rassweiler
- Department of Urology, SLK-Kliniken Heilbronn, University of Heidelberg, Heilbronn, Germany
| | - Paolo Verze
- Department of Neurosciences, Human Reproduction and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Linda Vignozzi
- Andrology, Women's Endocrinology and Gender Inconguence Unit, Department of Experimental and Clinical Biomedical Sciences, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Wolfgang Weidner
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University of Giessen, Giessen, Germany
| | - Mario Maggi
- Diabetes and Metabolism Unit, Department of Internal Medicine, Azienda ASL 02 Chieti-Lanciano-Vasto, F. Renzetti Hospital, Lanciano, Italy
| | - Nikolaos Sofikitis
- Department of Urology, Ioannina University School of Medicine, Ioannina, Greece
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Chen X, Ma Y, Zou S, Wang S, Qiu J, Xiao Q, Zhou L, Ping P. Comparison and outcomes of nonobstructive azoospermia patients with different etiology undergoing MicroTESE and ICSI treatments. Transl Androl Urol 2019; 8:366-373. [PMID: 31555560 DOI: 10.21037/tau.2019.04.08] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background The purpose of the study was to compare clinical, laboratory, histological features, microdissection testicular sperm extraction (MicroTESE) and intracytoplasmic sperm injection (ICSI) treatment outcomes of nonobstructive azoospermia (NOA) patients of various etiologies, and to investigate ICSI outcomes using fresh and frozen thawed sperms from MicroTESE, so to explore an optimal MicroTESE-ICSI procedure for NOA couples. Methods A retrospective analysis was made in 595 NOA patients undergoing MicroTESE from January 2013 to December 2017. The men were classified into six groups based on etiology. Patients' age, history, hormone profile, testis volume, testicular histology, sperm retrieval, fertile and pregnancy outcomes of ICSI were included for analysis. Results A total of 595 NOA patients were included in this study, with 446 (75.0%) were idiopathic NOA, 66 (11.1%) were Klinefelter syndrome (KS), 34 (5.7%) with microdeletion of the AZFc, 33 (5.5%) cases had the history of cryptorchidism, 13 (2.2%) had a history of mumps orchitis, and 3 (0.5%) cases underwent chemotherapy. The overall sperm retrieval rate (SRR) was 40.3% (240/595), SRR of the cryptorchidism (84.8%, 28/33) and mumps orchitis (84.6%, 11/13) groups were much higher than that of other groups, the SRR of idiopathic group was the lowest (31.8%, 142/446). One hundred and ninety-eight ICSI cycles utilizing MicroTESE sperm were retrospectively analyzed, including 155 fresh MicroTESE ICSI cycles and 43 frozen-thawed MicroTESE ICSI cycles. Fertilization rate, cleavage rate, and clinical pregnancy rate of fresh sperm group were slightly higher than those in frozen thawed MicroTESE sperm group, but high qualified embryo rate of fresh sperm group was lower than frozen thawed group. The differences were of no statistical meaning. Conclusions Etiology may be an effective prognostic factor for SRR in NOA patients. NOA of definite etiology, such as cryptorchidism, has high SRR, while idiopathic NOA, the most common type of NOA, has the lowest SRR. Using of frozen thawed sperm from MicroTESE had similar pregnant outcome to that of fresh sperm, so cryopreservation of testicular sperm seems to be more suitable and of great benefit in these cases and good results can also be expected when oocyte retrieval and ICSI are not performed at the same time.
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Affiliation(s)
- Xiangfeng Chen
- Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200135, China.,Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai 200135, China.,Shanghai Human Sperm Bank, Shanghai 200135, China
| | - Yi Ma
- Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200135, China.,Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai 200135, China
| | - Shasha Zou
- Shanghai Human Sperm Bank, Shanghai 200135, China
| | - Siqi Wang
- Shanghai Human Sperm Bank, Shanghai 200135, China
| | - Jin Qiu
- Shanghai Human Sperm Bank, Shanghai 200135, China
| | - Qian Xiao
- Shanghai Human Sperm Bank, Shanghai 200135, China
| | - Liang Zhou
- Northwest Women's and Children's Hospital, Xi'an 710000, China
| | - Ping Ping
- Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200135, China.,Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai 200135, China
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Cito G, Coccia ME, Picone R, Cocci A, Criscuoli L, Dabizzi S, Nesi G, Serni S, Carini M, Natali A. Are hormone measurements and ultrasounds really predictors of sperm retrieval in testicular sperm extraction? A case report and literature review. Andrologia 2018; 50:e13022. [DOI: 10.1111/and.13022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2018] [Indexed: 11/30/2022] Open
Affiliation(s)
- G. Cito
- Department of Urology; Careggi Hospital; University of Florence; Florence Italy
| | - M. E. Coccia
- Assisted Reproductive Technology Centre; Careggi Hospital; University of Florence; Florence Italy
| | - R. Picone
- Assisted Reproductive Technology Centre; Careggi Hospital; University of Florence; Florence Italy
| | - A. Cocci
- Department of Urology; Careggi Hospital; University of Florence; Florence Italy
| | - L. Criscuoli
- Assisted Reproductive Technology Centre; Careggi Hospital; University of Florence; Florence Italy
| | - S. Dabizzi
- Sexual Medicine and Andrology Unit; Department of Experimental and Clinical Biomedical Sciences; Careggi Hospital; University of Florence; Florence Italy
| | - G. Nesi
- Department of Human Pathology and Oncology; Careggi Hospital; University of Florence; Florence Italy
| | - S. Serni
- Department of Urology; Careggi Hospital; University of Florence; Florence Italy
| | - M. Carini
- Department of Urology; Careggi Hospital; University of Florence; Florence Italy
| | - A. Natali
- Department of Urology; Careggi Hospital; University of Florence; Florence Italy
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Alhalabi M. Predictive value of serum Inhibin-B levels as an indicator of the presence of testicular spermatozoa in non-obstructive azoospermia. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2016. [DOI: 10.1016/j.mefs.2016.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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13
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Güneri Ç, Alkibay T, Tunç L. Effects of clinical, laboratuary and pathological features on successful sperm retrieval in non-obstructive azoospermia. Turk J Urol 2016; 42:168-77. [PMID: 27635292 DOI: 10.5152/tud.2016.45403] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The study aims to evaluate the correlation of testicular sperm extraction (TESE) and histopathology with various features of non-obstructive azoospermia (NOA) cases who consulted to our university-based infertility clinic, and the probability of prompting couples about TESE success and to investigate the cost reduction chance through cost-beneficial aspects. MATERIAL AND METHODS One hundred and twenty-five patients were enrolled in this study. Age, unprotected intercourse period, age of puberty, and concomittant diseases were noted. Testicular volumes were measured. The correlations between genetic test results and serum levels of Follicle-Stimulating Hormone (FSH), Luteinizing Hormone (LH), free testosterone, prolactine were investigated. RESULTS The incidence of NOA among infertile men was found to be 15.1%. Median age of the cases was 33.1 years. Decrease in TESE success rate was seen in the group aged >30, and those who practiced unprotected intercourse for more than 10 years. TESE success rate was 40 percent. The required negative correlation between FSH levels, and testicular volume was not observed when the patient had additional diseases and/or genitourinary surgery. FSH and LH levels were significantly different between TESE- positive and negative groups (p=0.006, and p=0.001 respectively). Success rate in bilateral TESE group was 14.2%, and 96% of TESE- negative patients had bilateral TESE. Fifteen of 118 patients had Y chromosome microdeletions. These results were similar in both TESE- positive and negative group. CONCLUSION None of the parameters investigated herein predicted succesful TESE outcomes. However, in cases with increased FSH and AZFa/AZFb deletion before application of bilateral TESE, in cases of increased FSH and AZFa/AZFb deletion, detailed information should be given to these patients about low success rates and risk of disease inheritance which may reduce procedural costs. Knowing groups with poor prognosis, may help rearrangement of the appropriation of infertility in health policies.
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Affiliation(s)
- Çağrı Güneri
- Department of Urology, Liv Hospital, Ankara, Turkey
| | - Turgut Alkibay
- Department of Urology, Gazi University School of Medicine, Ankara, Turkey
| | - Lütfi Tunç
- Department of Urology, Gazi University School of Medicine, Ankara, Turkey
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14
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Datta AK, Nayini K, Eapen A, Barlow S, Lockwood G. Can we predict the chance of successful epididymal or testicular sperm aspiration following vasectomy? HUM FERTIL 2016; 19:120-6. [DOI: 10.1080/14647273.2016.1191681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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15
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Amir A, Oenzil F. Alteration Expression of Bax, Bcl-2 and VDAC1 Genes in Oligozoospermic and Fertile Subjects. Pak J Biol Sci 2016; 19:71-76. [PMID: 29023042 DOI: 10.3923/pjbs.2016.71.76] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
One of factors causing oligozoospermic circumstances is excessive apoptosis during spermatogenesis. Spermatogenesis known involves Bcl-2 family proteins in cytoplasm and Voltage Dependent Anion Channel 1 (VDAC1) in outer mitochondrial membrane to facilitate releasing of apoptosis factor such as cytochrome-c from inter-membrane space into cytoplasm. The study was aimed to analyze the mRNA expression of pro-apoptotic Bax, anti-apoptotic Bcl-2 and VDAC1 genes derived from 45 oligozoospermic subjects and 20 fertile subjects as control. Analysis of transcript expression was performed by two-steps real-time (PCR) and calculating by standard curve method. Stages of works were followed: Analysis of sperm basal characterization, isolation of spermatozoa to separate it from cement and resulted pellets. Pellets were saturated with PBS to obtain mRNA and reversed into cDNA. The cDNA were sequenced to investigate SNP of Bax, Bcl-2 and VDAC1 genes. Results showed that comparison of log mRNA copy number of Bax, Bcl-2 and VDAC1 genes for oligospemic and fertile subjects varied. The Bax, Bcl-2 and VDAC1 were significantly different between oligozoospermic and normozoospermic subjects (p = 0.000, p = 0.041, p = 0.000, respectively). It was suggested that oligozoospermia may be occurred by inducing the increase of Bax pro-apoptotic and VDAC1 genes expression and decreasing of Bcl-2 expression to lead the excessive of apoptosis.
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Affiliation(s)
- Arni Amir
- Department of Biology, Faculty of Medicine, Padang Andalas University, Indonesia
| | - Fadil Oenzil
- Department of Biochemistry, Faculty of Medicine, Padang Andalas University, Indonesia
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Hewedy ESS, Sweilm MA, Abd El-Naby NM, Hassan AM, Fawzy MM, Agrama MS. Serum and seminal plasma inhibin-B level in infertile men with varicocele. HUMAN ANDROLOGY 2015; 5:18-22. [DOI: 10.1097/01.xha.0000459553.60734.93] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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17
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Yang Q, Huang YP, Wang HX, Hu K, Wang YX, Huang YR, Chen B. Follicle-stimulating hormone as a predictor for sperm retrieval rate in patients with nonobstructive azoospermia: a systematic review and meta-analysis. Asian J Androl 2015; 17:281-4. [PMID: 25337843 PMCID: PMC4650470 DOI: 10.4103/1008-682x.139259] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Revised: 04/27/2014] [Accepted: 06/13/2014] [Indexed: 11/17/2022] Open
Abstract
Noninvasive parameters for predicating sperm retrieval rate (SRR) are desirables. Follicle-stimulating hormone (FSH) has been an important predictor since the first years of testicular sperm extraction. Recent studies showed continuous interests in FSH, with both pros and cons. Thus, we conducted a meta-analysis to evaluate the diagnostic value of FSH as a predictor for patients with nonobstructive azoospermia (NOA) taking testicular sperm retrieval. Eligible diagnosis tests were identified from electronic databases (Cochrane Central Register of Controlled Trials, Medline, and EMBASE) without language restrictions. The database search, quality assessment, and data extraction were performed independently by two reviewers. The reference standard was the sperm retrieval result. Diagnostic value of FSH were explored by area under receiver operation characteristics (ROC) curve using Review Manager, version 5.1.0 (Cochrane Collaboration, Oxford, UK) and Meta-DiSc, version 1.4. Meta regression will be done if there is heterogeneity. Then, we find 11 tests including a total of 1350 patients met the inclusion criteria. Our pooled analysis showed that the area under ROC curve of FSH was 0.72 ± 0.04. Meta regression analyses showed that region and average age have an influence on the diagnostic value. FSH showed more diagnostic value with patients in East Asia and with younger patients. We concluded that FSH had moderate value in independently predicating SRR in men with NOA (area under curve >0.7). More detailed diagnosis tests should be anticipated in the future to confirm the diagnostic value of other noninvasive parameters.
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Affiliation(s)
- Qi Yang
- Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Andrology, Shanghai 200127, China
| | - Yan-Ping Huang
- Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Andrology, Shanghai 200127, China
| | - Hong-Xiang Wang
- Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Andrology, Shanghai 200127, China
| | - Kai Hu
- Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Andrology, Shanghai 200127, China
| | - Yi-Xin Wang
- Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Andrology, Shanghai 200127, China
| | - Yi-Ran Huang
- Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Andrology, Shanghai 200127, China
| | - Bin Chen
- Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Andrology, Shanghai 200127, China
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Bonarriba C, Burgués J, Vidaña V, Ruiz X, Pizá P. Predictive factors of successful sperm retrieval in azoospermia. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.acuroe.2012.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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19
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Bonarriba CR, Burgués JP, Vidaña V, Ruiz X, Pizá P. Predictive factors of successful sperm retrieval in azoospermia. Actas Urol Esp 2013; 37:266-72. [PMID: 23062736 DOI: 10.1016/j.acuro.2012.06.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Accepted: 06/30/2012] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Testicular sperm extraction with intracytoplasmic sperm injection is the standard treatment for azoospermia. The objective of this study is to identify predictive factors of successful sperm retrieval. MATERIALS AND METHODS Between June 2003 and May 2011, we tried testicular sperm extraction (TESE) in 74 azoospermic patients in the Reproductive Medicine Unit of Son Espases Hospital (Palma de Mallorca). Serum follicle stimulating hormone (FSH) and inhibin B levels, testicular histology, genetic study, presence or not of cryptozoospermia and testicular volume were examined. RESULTS Spermatozoa were successfully recovered in 47.2% of the total patients, in 36% of non-obstructive azoospermic patients and in 100% of obstructive azoospermic patients. Low inhibin B and high FSH were correlated to sperm retrieval failure. The cutoff points were determined using ROC curves that were 67 pg/mL for inhibin B and 12.2 mUI/mL for FSH. Spermatozoa were not successfully retrieved in any patient with Y microdeletions in AZFa,b regions. Spermatozoa were successfully retrieved in 100% of the patients with CFTR mutations. The highest sperm retrieval rate was for hypospermatogenesis, followed by maturation arrest and Sertoli-cell-only. Spermatozoa were successfully retrieved in all cryptozoospermic patients. Although using a non-significant test, there seems to be a correlation between higher testicular volume and a higher probability of successful sperm retrieval. CONCLUSIONS Except for Y microdeletions in AZFa,b regions, there is no predictive factor of testicular sperm retrieval to rule out a patient for TESE. Lower inhibin B is more related to sperm retrieval failure than higher FSH. Sperm retrieval is possible for all cases of CFTR mutations but in any case of microdeletion Y in AZFa,b. The lack of germ cells is correlated with a high probability of sperm retrieval failure. The presence of cryptozoospermia is correlated with a high probability of sperm retrieval success. We do not find a statistically significant relation between testicular volume and successful sperm retrieval.
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Affiliation(s)
- C R Bonarriba
- Unidad de Reproducción Humana, Servicio de Urología, Hospital Universitario Son Espases, Palma de Mallorca, España.
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20
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Nya-Ngatchou JJ, Arnold SLM, Walsh TJ, Muller CH, Page ST, Isoherranen N, Amory JK. Intratesticular 13-cis retinoic acid is lower in men with abnormal semen analyses: a pilot study. Andrology 2012; 1:325-31. [PMID: 23413144 DOI: 10.1111/j.2047-2927.2012.00033.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Revised: 09/26/2012] [Accepted: 09/29/2012] [Indexed: 01/01/2023]
Abstract
Intratesticular retinoic acid is necessary for spermatogenesis, but the relationship between intratesticular retinoic acid and sperm quality in man has not been studied. We hypothesized that intratesticular concentrations of retinoic acid would be lower in men with abnormal semen analyses compared to men with normal semen analyses. We recruited men requiring scrotal or penile surgery in a pilot observational study examining the relationship between sperm quality and intratesticular and serum retinoic acid. Twenty-four men provided two pre-operative blood and semen samples, and underwent a testicular biopsy during surgery. Serum and tissue all-trans and 13-cis retinoic acid and reproductive hormones were measured by LC/MS/MS and radioimmunoassays, respectively. Seven men had abnormal semen analyses by at least one WHO criteria and 17 men were normal. In men with abnormal semen, the median (25th, 75th percentile) intratesticular 13-cis retinoic acid was 0.14 (0.08, 0.25) pmol/gram tissue compared with 0.26 (0.18, 0.38) pmol/gram tissue in men with normal semen (p = 0.04). There were no significant differences in intratesticular all-trans retinoic acid or serum reproductive hormones between men with normal and abnormal semen analyses. Intratesticular 13-cis retinoic acid is significantly lower in men with abnormal semen analyses compared to men with normal semen analyses. Lower intratesticular 13-cis retinoic acid concentrations may be due to decreased biosynthesis or increased metabolism in the testes. Further investigation of the relationship between intratesticular 13-cis retinoic acid and poor sperm quality is warranted to determine if this association is present in infertile men.
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Affiliation(s)
- J J Nya-Ngatchou
- Departments of Medicine, University of Washington, Seattle, WA 98195, USA
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Boitrelle F, Robin G, Marcelli F, Albert M, Leroy-Martin B, Dewailly D, Rigot JM, Mitchell V. A predictive score for testicular sperm extraction quality and surgical ICSI outcome in non-obstructive azoospermia: a retrospective study. Hum Reprod 2011; 26:3215-21. [DOI: 10.1093/humrep/der314] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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22
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Toulis KA, Iliadou PK, Venetis CA, Tsametis C, Tarlatzis BC, Papadimas I, Goulis DG. Inhibin B and anti-Mullerian hormone as markers of persistent spermatogenesis in men with non-obstructive azoospermia: a meta-analysis of diagnostic accuracy studies. Hum Reprod Update 2010; 16:713-724. [DOI: 10.1093/humupd/dmq024] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Ruiz Plazas X, Burgués Gasión J, Ozonas Moragues M, Pizá Reus P. Utilidad de la inhibina B en el manejo del varón infértil. Actas Urol Esp 2010. [DOI: 10.1016/j.acuro.2010.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Chen SC, Hsieh JT, Yu HJ, Chang HC. Appropriate cut-off value for follicle-stimulating hormone in azoospermia to predict spermatogenesis. Reprod Biol Endocrinol 2010; 8:108. [PMID: 20825644 PMCID: PMC2944172 DOI: 10.1186/1477-7827-8-108] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Accepted: 09/08/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study was undertaken to determine the optimal cut-off value for FSH to predict the presence of spermatogenesis in patients with non-obstructive azoospermia. METHODS A total of 206 non-obstructive azoospermic men were enrolled in this prospective study. By using receiver operating characteristic (ROC) curves, we determined the optimal cut-off value for FSH and evaluated whether the test could adequately predict successful sperm retrieval. RESULTS There were 108 non-obstructive azoospermic patients who had evidence of spermatogenesis (group A) and achieved success in sperm retrieval. Another 98 non-obstructive azoospermic patients (group B) failed in sperm retrieval. The mean value of serum FSH in group B was significantly higher than in group A (28.03 +/- 14.56 mIU/mL vs 7.94 +/- 4.95 mIU/mL, p < 0.01; respectively). The area under the receiver operating characteristic curves were 0.939 +/- 0.02 and a cut-off value of 19.4 mIU/mL discriminated between group A and B with a sensitivity of 70%. The positive predictive value for failed sperm retrieval (group B) can reach 100%. CONCLUSIONS Elevated plasma levels of FSH of more than 19.4 mIU/mL could be used as a reliable criterion for a trial of sperm retrieval from testes in artificial reproductive techniques.
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Affiliation(s)
- Shyh-Chyan Chen
- Department of Urology, National Taiwan University Hospital and National Taiwan University, College of Medicine, Taipei, Taiwan
| | - Ju-Ton Hsieh
- Department of Urology, National Taiwan University Hospital and National Taiwan University, College of Medicine, Taipei, Taiwan
| | - Hong-Jeng Yu
- Department of Urology, National Taiwan University Hospital and National Taiwan University, College of Medicine, Taipei, Taiwan
| | - Hong-Chiang Chang
- Department of Urology, National Taiwan University Hospital and National Taiwan University, College of Medicine, Taipei, Taiwan
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Yamada K, Fujita K, Quan J, Sekine M, Kashima K, Yahata T, Tanaka K. Increased apoptosis of germ cells in patients with AZFc deletions. J Assist Reprod Genet 2010; 27:293-7. [PMID: 20333463 DOI: 10.1007/s10815-010-9400-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2009] [Accepted: 02/11/2010] [Indexed: 11/28/2022] Open
Abstract
PURPOSE AZFc deletions are associated with variable testicular histology ranging from the Sertoli cell only to spermatogenic arrest and hypospermatogenesis. Such variable phenotypes may be explained by progressive germ cell regression over time. Increased apoptosis is likely responsible for progressive regression of spermatogenic potential. This study evaluated germ cell apoptosis as a cause of the progressive decrease in the number of germ cells in patients with AZFc deletions. METHODS This study evaluated germ cell apoptosis in patients with AZFc deletions. A total of 151 patients who were diagnosed with either severe oligozoospermia or non-obstructive azoospermia were screened for Y chromosome microdeletions. Germ cell apoptosis was examined using terminal deoxy-nucleotidyl transferase-mediated digoxigenin-dUTP nick-end labeling (TUNEL) on formalin-fixed 5-microm sections of testicular specimens. RESULTS Seven out of 117 (6.0%) patients with azoospermia and 4 of 34 (11.8%) patients with severe oligozoospermia had Y chromosome microdeletions. The percentage of apoptotic germ cells in the testes of patients with AZFc deletions were significantly increased compared to those of patients without AZFc deletions. CONCLUSIONS These results suggest that increased apoptosis of germ cells is responsible for the progressive decline of spermatogenic potential in patients with AZFc deletions.
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Affiliation(s)
- Kyoko Yamada
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Niigata, 951-8520, Japan
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Mitchell V, Boitrelle F, Pigny P, Robin G, Marchetti C, Marcelli F, Rigot JM. Seminal plasma levels of anti-Müllerian hormone and inhibin B are not predictive of testicular sperm retrieval in nonobstructive azoospermia: a study of 139 men. Fertil Steril 2010; 94:2147-50. [PMID: 20172518 DOI: 10.1016/j.fertnstert.2009.11.046] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2009] [Revised: 10/27/2009] [Accepted: 11/24/2009] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To evaluate the seminal levels of the Sertoli anti-Müllerian hormone (AMH) and inhibin B in the testicular sperm extraction (TESE) in nonobstructive azoospermia. DESIGN Prospective study. SETTING Reproductive biology division in a university hospital. PATIENT(S) One hundred thirty-nine men. INTERVENTION(S) Men were classified on the basis of positive and negative TESE. MAIN OUTCOME MEASURE(S) Seminal levels of AMH and inhibin B, serum levels of FSH and inhibin B, testicular volume, sperm retrieval, and spermatogenesis. RESULT(S) The mean serum FSH and inhibin B concentrations were 21.4 IU/L and 54.68 pg/mL. Spermatozoa were retrieved in 43.17% of the men. Mean seminal AMH and inhibin B concentrations were 12.06±37.30 pmol/L and 142.72±950.91 pmol/L, respectively. Seminal AMH and inhibin B levels were simultaneously undetectable in 35.97% of subjects. Seminal plasma levels of AMH and inhibin B were positively correlated, as were seminal and serum inhibin B concentrations. The successful and failed TESE groups did not differ significantly in terms of either AMH or inhibin B seminal plasma concentrations. Combining the latter parameters with the serum FSH level did not improve the predictive value for successful TESE. The presence or absence of germ cells did not have a statistically significant relationship with seminal plasma AMH and inhibin B concentrations. CONCLUSION(S) There is no value in seminal plasma levels of AMH and inhibin B as criteria for sperm extraction in men with nonobstructive azoospermia.
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Affiliation(s)
- Valérie Mitchell
- Laboratoire de Spermiologie, Hôpital A. Calmette, Groupe de recherche EA 4308 Spermatogenesis and Male Gamete Quality, CHRU, Lille cedex, France.
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Adamopoulos DA, Koukkou EG. ‘Value of FSH and inhibin-B measurements in the diagnosis of azoospermia’- A clinician’s overview. ACTA ACUST UNITED AC 2009; 33:e109-13. [DOI: 10.1111/j.1365-2605.2009.00980.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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The effect of varicocele on seminal plasma and serum inhibin-B levels in adolescent and adult men. Int Urol Nephrol 2009; 42:47-51. [DOI: 10.1007/s11255-009-9605-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2009] [Accepted: 06/14/2009] [Indexed: 10/20/2022]
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Goulis DG, Tsametis C, Iliadou PK, Polychronou P, Kantartzi PD, Tarlatzis BC, Bontis IN, Papadimas I. Serum inhibin B and anti-Müllerian hormone are not superior to follicle-stimulating hormone as predictors of the presence of sperm in testicular fine-needle aspiration in men with azoospermia. Fertil Steril 2009; 91:1279-84. [DOI: 10.1016/j.fertnstert.2008.01.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2007] [Revised: 12/27/2007] [Accepted: 01/03/2008] [Indexed: 10/22/2022]
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Goulis DG, Polychronou P, Mikos T, Grimbizis G, Gerou S, Pavlidou V, Papanikolaou A, Tarlatzis BC, Bontis IN, Papadimas I. Serum inhibin-B and follicle stimulating hormone as predictors of the presence of sperm in testicular fine needle aspirate in men with azoospermia. Hormones (Athens) 2008; 7:140-7. [PMID: 18477551 DOI: 10.1007/bf03401505] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Inhibin-B (Inh-B) is produced by Sertoli cells and controls Follicle Stimulating Hormone (FSH) secretion through a negative feedback mechanism. The primary aim of this study was to compare Iotanh-B with FSH as predictors of the recovery of sperm in testicular fine needle aspirate in men with azoospermia. DESIGN In 51 men with azoospermia basal values of Luteinizing Hormone (LH), FSH, prolactin and testosterone as well as Inh-B values before and 24 h and 48 h after the administration of 300 IU recombinant human FSH were determined. Testicular Fine Needle Aspiration (FNA) was also carried out. Thirty-one young healthy men were also enrolled in the study as controls. RESULTS There was significant difference between men with azoospermia and controls with regard to the basal Inh-B levels [median (interquartile range) 37.2 (36) vs. 103.0 (90) pg/mL, respectively, p=0.003] but not to the stimulated Inh-B levels [40.5 (41) vs. 73.0 (44) pg/mL, p=0.113 at 24 h and 34.3 (34) vs. 82.0 (50) pg/mL, p=0.098 at 48 h)]. The Area Under Curve in Receiver Operating Characteristic curves were similar for Inh-B and FSH (0.610 vs. 0.716, respectively, p=0.151) as far as prediction of sperm retrieval is concerned. CONCLUSIONS Basal serum Inh-B values are significantly lower in men with azoospermia compared to controls. However, Inh-B is not superior to FSH in predicting the presence of sperm in testicular fine needle aspirate.
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Affiliation(s)
- Dimitrios G Goulis
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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Okada H, Tajima A, Shichiri K, Tanaka A, Tanaka K, Inoue I. Genome-wide expression of azoospermia testes demonstrates a specific profile and implicates ART3 in genetic susceptibility. PLoS Genet 2008; 4:e26. [PMID: 18266473 PMCID: PMC2233677 DOI: 10.1371/journal.pgen.0040026] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2007] [Accepted: 12/13/2007] [Indexed: 11/18/2022] Open
Abstract
Infertility affects about one in six couples attempting pregnancy, with the man responsible in approximately half of the cases. Because the pathophysiology underlying azoospermia is not elucidated, most male infertility is diagnosed as idiopathic. Genome-wide gene expression analyses with microarray on testis specimens from 47 non-obstructive azoospermia (NOA) and 11 obstructive azoospermia (OA) patients were performed, and 2,611 transcripts that preferentially included genes relevant to gametogenesis and reproduction according to Gene Ontology classification were found to be differentially expressed. Using a set of 945 of the 2,611 transcripts without missing data, NOA was further categorized into three classes using the non-negative matrix factorization method. Two of the three subclasses were different from the OA group in Johnsen's score, FSH level, and/or LH level, while there were no significant differences between the other subclass and the OA group. In addition, the 52 genes showing high statistical difference between NOA subclasses (p < 0.01 with Tukey's post hoc test) were subjected to allelic association analyses to identify genetic susceptibilities. After two rounds of screening, SNPs of the ADP-ribosyltransferase 3 gene (ART3) were associated with NOA with highest significance with ART3-SNP25 (rs6836703; p = 0.0025) in 442 NOA patients and 475 fertile men. Haplotypes with five SNPs were constructed, and the most common haplotype was found to be under-represented in patients (NOA 26.6% versus control 35.3%, p = 0.000073). Individuals having the most common haplotype showed an elevated level of testosterone, suggesting a protective effect of the haplotype on spermatogenesis. Thus, genome-wide gene expression analyses were used to identify genes involved in the pathogenesis of NOA, and ART3 was subsequently identified as a susceptibility gene for NOA. These findings clarify the molecular pathophysiology of NOA and suggest a novel therapeutic target in the treatment of NOA.
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Affiliation(s)
- Hiroyuki Okada
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Atsushi Tajima
- Division of Molecular Life Science, School of Medicine, Tokai University, Isehara, Japan
| | - Kazuyoshi Shichiri
- Department of Obstetrics and Gynecology, Tachikawa Hospital, Nagaoka, Japan
| | | | - Kenichi Tanaka
- Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Ituro Inoue
- Division of Molecular Life Science, School of Medicine, Tokai University, Isehara, Japan
- Core Research for Evolutional Science and Technology, Japan Science and Technology Corporation, Kawaguchi, Japan
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Duvilla E, Lejeune H, Trombert-Paviot B, Gentil-Perret A, Tostain J, Levy R. Significance of inhibin B and anti-Müllerian hormone in seminal plasma: a preliminary study. Fertil Steril 2008; 89:444-8. [PMID: 17681330 DOI: 10.1016/j.fertnstert.2007.03.032] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2006] [Revised: 03/06/2007] [Accepted: 03/07/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate the predictive value of seminal inhibin B and anti-Müllerian hormone (AMH) on the outcome of testicular sperm extraction (TESE) in patients with nonobstructive azoospermia. DESIGN Prospective study. SETTING Reproductive biology department. PATIENT(S) Forty-seven normospermic, 28 oligozoospermic, and 68 azoospermic patients. INTERVENTION(S) Testicular sperm extraction. MAIN OUTCOME MEASURE(S) Seminal inhibin B and AMH measure. RESULT(S) The seminal values of inhibin B and AMH are widely dispersed. Both inhibin B and AMH seminal values are significantly different between the three groups. The average rates of seminal AMH (not inhibin B) differ significantly according to the etiology of the azoospermia. Both seminal markers are correlated. A significant positive correlation could be observed between the seminal inhibin B and the sperm count, but not for AMH. A significant correlation also exists between seminal and serum inhibin B. The predictive value for TESE outcome of each parameter is rather low. Conversely, a logistic regression combining serum FSH, seminal inhibin B, and AMH produced a satisfying area under the curve of 0.985. CONCLUSION(S) Seminal inhibin B and AMH values are proposed. Separately, seminal markers are poor predictors of TESE outcome. A logistic regression model led to a satisfying area under the curve of 0.985.
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Affiliation(s)
- Emma Duvilla
- Laboratoire de Biologie de la Reproduction, Hôpital Nord, CHU de Saint Etienne, Saint Etienne, France
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