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Wyrwoll MJ, van der Heijden GW, Krausz C, Aston KI, Kliesch S, McLachlan R, Ramos L, Conrad DF, O'Bryan MK, Veltman JA, Tüttelmann F. Improved phenotypic classification of male infertility to promote discovery of genetic causes. Nat Rev Urol 2024; 21:91-101. [PMID: 37723288 DOI: 10.1038/s41585-023-00816-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 09/20/2023]
Abstract
An increasing number of genes are being described in the context of non-syndromic male infertility. Linking the underlying genetic causes of non-syndromic male infertility with clinical data from patients is important to establish new genotype-phenotype correlations. This process can be facilitated by using universal nomenclature, but no standardized vocabulary is available in the field of non-syndromic male infertility. The International Male Infertility Genomics Consortium aimed at filling this gap, providing a standardized vocabulary containing nomenclature based on the Human Phenotype Ontology (HPO). The "HPO tree" was substantially revised compared with the previous version and is based on the clinical work-up of infertile men, including physical examination and hormonal assessment. Some causes of male infertility can already be suspected based on the patient's clinical history, whereas in other instances, a testicular biopsy is needed for diagnosis. We assembled 49 HPO terms that are linked in a logical hierarchy and showed examples of morphological features of spermatozoa and testicular histology of infertile men with identified genetic diagnoses to describe the phenotypes. This work will help to record patients' phenotypes systematically and facilitate communication between geneticists and andrologists. Collaboration across institutions will improve the identification of patients with the same phenotypes, which will promote the discovery of novel genetic causes for non-syndromic male infertility.
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Affiliation(s)
- Margot J Wyrwoll
- Institute of Reproductive Genetics, University of Münster, Münster, Germany
| | | | - Csilla Krausz
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Florence, University Hospital of Careggi (AOUC), Florence, Italy
| | - Kenneth I Aston
- Andrology and IVF Laboratory, Department of Surgery (Urology), University of Utah, Salt Lake City, UT, USA
| | - Sabine Kliesch
- Centre of Reproductive Medicine and Andrology, Department of Clinical and Surgical Andrology, University of Münster, Münster, Germany
| | - Robert McLachlan
- Department of Clinical Research, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
| | - Liliana Ramos
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Donald F Conrad
- Department of Genetics, Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, OR, USA
| | - Moira K O'Bryan
- School of BioSciences and Bio21 Institute, The University of Melbourne, Parkville, Victoria, Australia
| | - Joris A Veltman
- Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Frank Tüttelmann
- Institute of Reproductive Genetics, University of Münster, Münster, Germany.
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Riccetto L, Vieira TP, Viguetti-Campos NL, Mazzola TN, Guaragna MS, Fabbri-Scallet H, de Mello MP, Marques-de-Faria AP, Maciel-Guerra AT, Guerra G. Clinical and laboratory differences between chromosomal and undefined causes of non-obstructive azoospermia: A retrospective study. SAO PAULO MED J 2022; 141:e2022281. [PMID: 36449967 PMCID: PMC10065101 DOI: 10.1590/1516-3180.2022.0281.r1.30082022] [Citation(s) in RCA: 1] [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: 05/06/2022] [Accepted: 08/30/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Knowledge of clinical and laboratory differences between chromosomal and undefined causes aids etiological research on non-obstructive azoospermia. OBJECTIVE Compare clinical and laboratory differences between men with non-obstructive azoospermia due to chromosomal anomalies versus undefined causes. DESIGN AND SETTING A cross-sectional retrospective study conducted at a public university hospital in Campinas (Brazil). METHODS All men aged 20-40 years with non-obstructive azoospermia were included in the analysis. RESULTS The 107 cases included 14 with Klinefelter syndrome (KS) (13%), 1 with mosaic KS, 4 with sex development disorders (2 testicular XX, 1 NR5A1 gene mutation, and 1 mild androgen insensitivity syndrome) (4%), 9 with other non-obstructive azoospermia etiologies (8%), and 79 with undefined causes. The 22 chromosomal anomaly cases (14 KS, 1 mosaic KS, 2 testicular XX, 4 sex chromosome anomalies, and 1 autosomal anomaly) were compared with the 79 undefined cause cases. The KS group had lower average testicular volume, shorter penile length, and lower total testosterone levels but greater height, arm span, serum luteinizing hormone (LH) and follicle stimulating hormone (FSH) levels, and gynecomastia frequency (absent in the undefined group and affecting more than half of the KS group). Patients with testicular XX DSD had LH, FSH, and penile length data intermediate between the KS and undefined cause groups, testicular volume similar to the KS group, and other data similar to the undefined group. CONCLUSION Clinical and laboratory data differentiate men with non-obstructive azoospermia and chromosomal anomalies, particularly KS and testicular XX, from those with undefined causes or other chromosomal anomalies.
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Affiliation(s)
- Luísa Riccetto
- Undergraduate Medicine Student, Pontifícia Universidade Católica de Campinas (PUCCAMP), Campinas (SP), Brazil; and Member, Grupo Interdisciplinar de Estudos da Determinação e Diferenciação do Sexo (GIEDDS), Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil
| | - Tarsis Paiva Vieira
- PhD. Professor, Department of Translational Medicine, School of Medical Sciences, Laboratory of Human Cytogenetics, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil
| | - Nilma Lucia Viguetti-Campos
- PhD. Laboratory Worker, Department of Medical Genetics Genomics, School of Medical Sciences, Laboratory of Cytogenetics, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil
| | - Tais Nitsch Mazzola
- PhD. Laboratory Worker, Laboratory of Human Molecular Genetics, Center of Molecular Biology and Genetic Engineering, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil
| | - Mara Sanches Guaragna
- PhD. Researcher, Laboratory Worker, Laboratory of Human Molecular Genetics, Center of Molecular Biology and Genetic Engineering, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil
| | - Helena Fabbri-Scallet
- PhD Researcher, Laboratory Worker, Laboratory of Human Molecular Genetics, Center of Molecular Biology and Genetic Engineering, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil
| | - Maricilda Palandi de Mello
- PhD. Professor, Laboratory of Human Molecular Genetics, Center of Molecular Biology and Genetic Engineering, Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil
| | - Antonia Paula Marques-de-Faria
- PhD. Professor, Department of Medical Genetics and Genomics Medicine, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP); and Member, Grupo Interdisciplinar de Estudos da Determinação e Diferenciação do Sexo (GIEDDS), Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil
| | - Andrea Trevas Maciel-Guerra
- PhD. Professor, Department of Medical Genetics and Genomics Medicine, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP); and Member, Grupo Interdisciplinar de Estudos da Determinação e Diferenciação do Sexo (GIEDDS) Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil
| | - Gil Guerra
- PhD. Professor, Department of Pediatrics, School of Medical Sciences Universidade Estadual de Campinas (UNICAMP); and Member, Grupo Interdisciplinar de Estudos da Determinação e Diferenciação do Sexo (GIEDDS), Universidade Estadual de Campinas (UNICAMP), Campinas (SP), Brazil
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Santos-Neto OO, Mariano MH, Marques-de-Faria AP, Andrade JGR, Vieira TAP, Viguetti-Campos NL, Dos Santos AP, Mello MP, Mazzola TN, Guaragna MS, Fabbri-Scallet H, Damiani D, Steinmetz L, Ferreira MR, Saito PA, Sievert JC, Maciel-Guerra AT, Guerra-Junior G. Association between Down Syndrome and Disorders of Sex Development: Report of Three Cases and Review of 188 Cases in the Literature. Sex Dev 2021; 14:3-11. [PMID: 33652437 DOI: 10.1159/000513415] [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: 06/20/2020] [Accepted: 09/16/2020] [Indexed: 11/19/2022] Open
Abstract
In this study, we present 3 cases of Down syndrome (DS) associated with disorders/differences of sex development (DSD) and review the literature on this topic. Case 1: 1-year-old child with male genitalia and DS phenotype, 47,XX,+21 karyotype and testicular DSD. Case 2: 11-month-old child with male genitalia and few DS dysmorphisms, 45,X/47,XY,+21 karyotype, and mixed gonadal dysgenesis. Case 3: 4-month-old child with female genitalia and DS phenotype, 47,XY,+21 karyotype and XY complete gonadal dysgenesis. In the literature, among 188 patients, 107 (57%) had Klinefelter syndrome and 61 (33%) Turner syndrome, 12 (6%) had mixed gonadal dysgenesis, 2 (1%) had partial androgen insensitivity, 2 (1%) ovotesticular DSD, and the others had congenital adrenal hyperplasia, XY partial gonadal dysgenesis, XY complete gonadal dysgenesis, and complete androgen insensitivity (1 case each). A typical DS phenotype was found in all individuals of the revision, with the exception of one case, but DSD features were not always reported. In conclusion, the association of DS with sex chromosome DSD is the most frequently observed, whereas associations with 46,XX and 46,XY DSD is extremely rare.
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Affiliation(s)
- Octavio O Santos-Neto
- Interdisciplinary Group for the Study of Gender Determination and Differentiation (GIEDDS), School of Medical Sciences (FCM), State University of Campinas (UNICAMP), Campinas, Brazil
| | - Marina H Mariano
- Interdisciplinary Group for the Study of Gender Determination and Differentiation (GIEDDS), School of Medical Sciences (FCM), State University of Campinas (UNICAMP), Campinas, Brazil
| | - Antonia P Marques-de-Faria
- Interdisciplinary Group for the Study of Gender Determination and Differentiation (GIEDDS), School of Medical Sciences (FCM), State University of Campinas (UNICAMP), Campinas, Brazil.,Department of Medical Genetics and Genomic Medicine, FCM, UNICAMP, Campinas, Brazil
| | - Juliana G R Andrade
- Interdisciplinary Group for the Study of Gender Determination and Differentiation (GIEDDS), School of Medical Sciences (FCM), State University of Campinas (UNICAMP), Campinas, Brazil
| | - Tarsis A P Vieira
- Department of Medical Genetics and Genomic Medicine, FCM, UNICAMP, Campinas, Brazil.,Cytogenetics Laboratory, FCM, UNICAMP, Campinas, Brazil
| | | | - Ana P Dos Santos
- Department of Medical Genetics and Genomic Medicine, FCM, UNICAMP, Campinas, Brazil.,Cytogenetics Laboratory, FCM, UNICAMP, Campinas, Brazil.,Human Molecular Genetics Laboratory, Molecular Biology and Genetic Engineering Center (CBMEG), UNICAMP, Campinas, Brazil
| | - Maricilda P Mello
- Interdisciplinary Group for the Study of Gender Determination and Differentiation (GIEDDS), School of Medical Sciences (FCM), State University of Campinas (UNICAMP), Campinas, Brazil.,Human Molecular Genetics Laboratory, Molecular Biology and Genetic Engineering Center (CBMEG), UNICAMP, Campinas, Brazil
| | - Tais N Mazzola
- Human Molecular Genetics Laboratory, Molecular Biology and Genetic Engineering Center (CBMEG), UNICAMP, Campinas, Brazil
| | - Mara S Guaragna
- Human Molecular Genetics Laboratory, Molecular Biology and Genetic Engineering Center (CBMEG), UNICAMP, Campinas, Brazil
| | - Helena Fabbri-Scallet
- Human Molecular Genetics Laboratory, Molecular Biology and Genetic Engineering Center (CBMEG), UNICAMP, Campinas, Brazil
| | - Durval Damiani
- Pediatric Endocrinology Unit, Child's Institute, University of Sao Paulo (USP), Sao Paulo, Brazil
| | - Leandra Steinmetz
- Pediatric Endocrinology Unit, Child's Institute, University of Sao Paulo (USP), Sao Paulo, Brazil
| | - Marianna R Ferreira
- Pediatric Endocrinology Unit, Child's Institute, University of Sao Paulo (USP), Sao Paulo, Brazil
| | - Paula A Saito
- Pediatric Endocrinology Unit, Child's Institute, University of Sao Paulo (USP), Sao Paulo, Brazil
| | | | - Andrea T Maciel-Guerra
- Interdisciplinary Group for the Study of Gender Determination and Differentiation (GIEDDS), School of Medical Sciences (FCM), State University of Campinas (UNICAMP), Campinas, Brazil.,Department of Medical Genetics and Genomic Medicine, FCM, UNICAMP, Campinas, Brazil
| | - Gil Guerra-Junior
- Interdisciplinary Group for the Study of Gender Determination and Differentiation (GIEDDS), School of Medical Sciences (FCM), State University of Campinas (UNICAMP), Campinas, Brazil, .,Pediatric Endocrinology Unit, Department of Pediatrics, FCM, UNICAMP, Campinas, Brazil,
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