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Benchaib M, Labrune E, Giscard d'Estaing S, Jovet C, Soignon G, Jaeger P, Salle B. ICSI using testicular spermatozoa after failure of ICSI with ejaculated spermatozoa could be a good choice: A propensity score-matched cohort study. Andrology 2024; 12:1301-1311. [PMID: 38108555 DOI: 10.1111/andr.13572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/30/2023] [Accepted: 12/02/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Ejaculated spermatozoa are considered to possess a higher fertilisation potential than testicular spermatozoa. In selected cases, the use of testicular spermatozoa from non-azoospermic infertile men resulted in a higher implantation and pregnancy rate than the use of ejaculated spermatozoa. OBJECTIVE The primary objective was to compare the live birth rate and cumulative live birth rate between couples with failed intracytoplasmic sperm injection procedure using ejaculated spermatozoa who subsequently had an intracytoplasmic sperm injection cycle with testicular spermatozoa and those who subsequently had an intracytoplasmic sperm injection cycle with ejaculated spermatozoa. The secondary objective was to determine the indications for the use of testicular spermatozoa after intracytoplasmic sperm injection failure with ejaculated spermatozoa. MATERIALS AND METHODS A retrospective study of matched couples using propensity score matching analysis was performed. After an intracytoplasmic sperm injection failure (cycle_1), intracytoplasmic sperm injection with either ejaculated spermatozoa (ejaculated sperm group), or testicular spermatozoa (testicular sperm group), was performed (cycle_2). The matching was on intracytoplasmic sperm injection performed in cycle_1 according to spermatozoa used (testicular or ejaculated) in cycle_2. Logistic regression was used to evaluate the influence of sperm origin on cumulative live birth rate. Univariate analysis on parameters of cycle_1 was used to identify the prognostic factors to propose an intracytoplasmic sperm injection with testicular spermatozoa in case of cycle_1 failure. The study outcomes were live birth rate and cumulative live birth rate. RESULTS Among the 6034 couples available, 63 were selected to constitute the testicular sperm group and 63 were selected by propensity score matching to constitute the ejaculated sperm group. After matching, the DNA fragmentation index was higher in the testicular sperm group (13.43% ± 9.65% vs. 8.93% ± 4.47%, p = 0.013); no significant difference was observed for the fertilisation rate, the number of obtained embryos, blastulation rate and frozen embryo rate. In cycle_2, the live birth rate was higher in the testicular group (22.2% vs. 0.0%, p < 0.001), as was the cumulative live birth rate (25.4% vs. 6.3%, p = 0.065). The prognostic factors identified for the proposal of intracytoplasmic sperm injection procedure with testicular spermatozoa after intracytoplasmic sperm injection failure with ejaculated spermatozoa were: teratozoospermia, cryptozoospermia and high DNA fragmentation index. DISCUSSION According to the present study and current knowledge, the use of testicular spermatozoa after failed intracytoplasmic sperm injection procedure in non-azoospermic men could be proposed instead of sperm donation in case of high sperm DNA fragmentation index, cryptozoospermia and teratozoospermia. A good oocyte response to ovarian stimulation during the previous assisted reproductive technology attempt will increase the chance of success. Although the main limitation of the current study is its retrospective nature, the use of the propensity score matching to perform causal inference study increases its reliability. CONCLUSION The present study supports that the use of testicular spermatozoa outside the classical indication of azoospermia is a good option when the indication is well established. However, before proposing a testicular biopsy, an improvement in sperm characteristics should be considered by treating the causes of sperm alteration.
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Affiliation(s)
- Mehdi Benchaib
- Hospices Civils de Lyon, HFME, Biologie de la Reproduction, Cedex Bron, France
- UMR CNRS 5558, LBBE, Villeurbanne Cedex, France
- Faculté de Médecine Lyon Est, Université Claude Bernard, Lyon, France
| | - Elsa Labrune
- Hospices Civils de Lyon, HFME, Biologie de la Reproduction, Cedex Bron, France
- Faculté de Médecine Lyon Est, Université Claude Bernard, Lyon, France
- Inserm U1208, Bron Cedex, France
| | - Sandrine Giscard d'Estaing
- Hospices Civils de Lyon, HFME, Biologie de la Reproduction, Cedex Bron, France
- Inserm U1208, Bron Cedex, France
- Faculté de Médecine Lyon Sud, Université Claude Bernard, Oullins Cedex, France
| | - Cynthia Jovet
- Hospices Civils de Lyon, HFME, Biologie de la Reproduction, Cedex Bron, France
- Faculté de Médecine Lyon Est, Université Claude Bernard, Lyon, France
| | - Gaëlle Soignon
- Hospices Civils de Lyon, HFME, Biologie de la Reproduction, Cedex Bron, France
| | - Pauline Jaeger
- Hospices Civils de Lyon, HFME, Biologie de la Reproduction, Cedex Bron, France
| | - Bruno Salle
- Hospices Civils de Lyon, HFME, Biologie de la Reproduction, Cedex Bron, France
- Inserm U1208, Bron Cedex, France
- Faculté de Médecine Lyon Sud, Université Claude Bernard, Oullins Cedex, France
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2
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Mulloy E, Zhang A, Balladelli F, Del Giudice F, Glover F, Eisenberg ML. Diagnoses and medications associated with delayed ejaculation. Sex Med 2023; 11:qfad040. [PMID: 37547871 PMCID: PMC10397419 DOI: 10.1093/sexmed/qfad040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 06/27/2023] [Accepted: 06/27/2023] [Indexed: 08/08/2023] Open
Abstract
Background Delayed ejaculation (DE) is a disorder that can cause significant distress for sexually active men. The etiology of DE is largely idiopathic, with even less being known about clinical factors associated with the condition. Aim We sought to use data mining techniques to examine a broad group of health conditions and pharmaceutical treatments to identify factors associated with DE. Methods Using an insurance claims database, we evaluated all men with a diagnosis of DE and matched them to a cohort (1:1) of men with other male sexual disorders of urologic origin (ie, erectile dysfunction [ED] and Peyronie's disease [PD]). Given the low prevalence of DE, we incorporated the random forest approach for classification of DE vs controls, with a plethora of predictors and cross-validation with the least absolute shrinkage and selection operator (LASSO). We used both a high-performance generalized linear model and a multivariate logistic model. The area under the curve was reported to demonstrate classifier performance, and odds ratios were used to indicate risks of each predictor. We also evaluated for differences in the prevalence of conditions in DE by race/ethnicity. Outcomes Clinical factors (ie, diagnoses and medications) associated with DE were identified. Results In total, 11 602 men with DE were matched to a cohort of men with PD and ED. We focused on the 20 factors with the strongest association with DE across all models. The factors demonstrating positive associations with DE compared to other disorders of male sexual dysfunction (ie, ED and PD) included male infertility, testicular dysfunction, anxiety, disorders of lipid metabolism, alpha adrenergic blocker use, anemia, antidepressant use, and psychoses such as schizophrenia or schizoaffective disorder. In addition, the prevalence of several conditions varied by race/ethnicity. For example, male infertility was present in 5% of Asian men compared to <2% of men of other races. Clinical Implications Several medical conditions and pharmacologic treatments are associated with DE, findings that may provide insight into the etiology of DE and offer treatment options. Strengths and Limitations This study is to our knowledge the first to use using data mining techniques to investigate the association between medical conditions/pharmacologic agents and the development of subsequent DE. The generalizability of our findings is limited given that all men were commercially insured. Conclusion DE is associated with multiple medical conditions, a finding that may help identify the etiology for this disorder.
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Affiliation(s)
- Evan Mulloy
- Corresponding author: Department of Urology, Stanford University School of Medicine, Palo Alto, CA, United States.
| | - Amy Zhang
- Department of Urology, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Federico Balladelli
- Department of Urology, Stanford University School of Medicine, Palo Alto, CA, United States
- Division of Experimental Oncology/Unit of Urology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Del Giudice
- Department of Urology, Stanford University School of Medicine, Palo Alto, CA, United States
- Department of Maternal Infant and Urologic Sciences, “Sapienza” University of Rome, Rome, Italy
| | - Frank Glover
- Emory University School of Medicine, Atlanta, GA United States
| | - Michael L Eisenberg
- Department of Urology, Stanford University School of Medicine, Palo Alto, CA, United States
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3
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Franco A, Proietti F, Palombi V, Savarese G, Guidotti M, Leonardo C, Ferro F, Manna C, Franco G. Varicocele: To Treat or Not to Treat? J Clin Med 2023; 12:4062. [PMID: 37373755 DOI: 10.3390/jcm12124062] [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: 03/29/2023] [Revised: 06/07/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023] Open
Abstract
Varicocele treatment in infertility still remains controversial. It is clear, in fact, that in many patients, varicocele has no impact on fertility. Recent scientific evidence demonstrated that varicocele treatment is beneficial in improving semen parameters and pregnancy rate when an appropriate selection of patients is made. The purpose of treating varicocele in adults is mainly to improve current fertility status. On the other hand, the goal of treatment in adolescents is to prevent testicular injury and maintain testicular function for future fertility. Hence, the key to the success of varicocele treatment seems to be a correct indication. The aim of this study is to review and summarize current evidence in managing varicocele treatment focusing on the controversies regarding surgical indications in adolescent and adult patients, and in other specific situations such as azoospermia, bilateral or subclinical varicocele, and prior to ART.
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Affiliation(s)
- Antonio Franco
- Department of Urology, Sant'Andrea Hospital, "Sapienza" University of Rome, 00185 Rome, Italy
| | - Flavia Proietti
- Department of Maternal and Child Health and Urological Sciences, Policlinico Umberto I, "Sapienza" University of Rome, 00185 Rome, Italy
| | - Veronica Palombi
- Department of Maternal and Child Health and Urological Sciences, Policlinico Umberto I, "Sapienza" University of Rome, 00185 Rome, Italy
| | - Gabriele Savarese
- Department of Maternal and Child Health and Urological Sciences, Policlinico Umberto I, "Sapienza" University of Rome, 00185 Rome, Italy
| | - Michele Guidotti
- Department of Urology, Nuovo Ospedale dei Castelli, 00040 Rome, Italy
| | - Costantino Leonardo
- Department of Maternal and Child Health and Urological Sciences, Policlinico Umberto I, "Sapienza" University of Rome, 00185 Rome, Italy
| | | | - Claudio Manna
- Biofertility IVF and Infertility Center, 00198 Rome, Italy
| | - Giorgio Franco
- Department of Maternal and Child Health and Urological Sciences, Policlinico Umberto I, "Sapienza" University of Rome, 00185 Rome, Italy
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Peserico A, Barboni B, Russo V, Nardinocchi D, Turriani M, Cimini C, Bernabò N, Parolini O, Silini AR, Antonucci I, Stuppia L, Berardinelli P, Falanga I, Perruzza D, Valbonetti L, Mauro A. AEC and AFMSC Transplantation Preserves Fertility of Experimentally Induced Rat Varicocele by Expressing Differential Regenerative Mechanisms. Int J Mol Sci 2023; 24:ijms24108737. [PMID: 37240083 DOI: 10.3390/ijms24108737] [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: 04/15/2023] [Revised: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
Amniotic membrane and amniotic fluid derived cells are regarded as a promising stem cell source for developing regenerative medicine techniques, although they have never been tested on male infertility diseases such as varicocele (VAR). The current study aimed to examine the effects of two distinct cell sources, human Amniotic Fluid Mesenchymal Stromal Cells (hAFMSCs) and amniotic epithelial cells (hAECs), on male fertility outcomes in a rat induced VAR model. To explain cell-dependent enhancement of reproductive outcomes in rats transplanted with hAECs and hAFMSCs, insights on testis morphology, endocannabinoid system (ECS) expression and inflammatory tissue response have been carried out alongside cell homing assessment. Both cell types survived 120 days post-transplantation by modulating the ECS main components, promoting proregenerative M2 macrophages (Mφ) recruitment and a favorable anti-inflammatory IL10 expression pattern. Of note, hAECs resulted to be more effective in restoring rat fertility rate by enhancing both structural and immunoresponse mechanisms. Moreover, immunofluorescence analysis revealed that hAECs contributed to CYP11A1 expression after transplantation, whereas hAFMSCs moved towards the expression of Sertoli cell marker, SOX9, confirming a different contribution into the mechanisms leading to testis homeostasis. These findings highlight, for the first time, a distinct role of amniotic membrane and amniotic fluid derived cells in male reproduction, thus proposing innovative targeted stem-based regenerative medicine protocols for remedying high-prevalence male infertility conditions such as VAR.
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Affiliation(s)
- Alessia Peserico
- Department of Bioscience and Technology for Food, Agriculture and Environment, University of Teramo, Via R. Balzarini 1, 64100 Teramo, Italy
| | - Barbara Barboni
- Department of Bioscience and Technology for Food, Agriculture and Environment, University of Teramo, Via R. Balzarini 1, 64100 Teramo, Italy
| | - Valentina Russo
- Department of Bioscience and Technology for Food, Agriculture and Environment, University of Teramo, Via R. Balzarini 1, 64100 Teramo, Italy
| | - Delia Nardinocchi
- Department of Bioscience and Technology for Food, Agriculture and Environment, University of Teramo, Via R. Balzarini 1, 64100 Teramo, Italy
| | - Maura Turriani
- Department of Bioscience and Technology for Food, Agriculture and Environment, University of Teramo, Via R. Balzarini 1, 64100 Teramo, Italy
| | - Costanza Cimini
- Department of Bioscience and Technology for Food, Agriculture and Environment, University of Teramo, Via R. Balzarini 1, 64100 Teramo, Italy
| | - Nicola Bernabò
- Department of Bioscience and Technology for Food, Agriculture and Environment, University of Teramo, Via R. Balzarini 1, 64100 Teramo, Italy
| | - Ornella Parolini
- Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Largo Vito, 1, 00168 Rome, Italy
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, 00168 Rome, Italy
| | - Antonietta Rosa Silini
- Centro di Ricerca E. Menni, Fondazione Poliambulanza Istituto Ospedaliero, 25124 Brescia, Italy
| | - Ivana Antonucci
- Department of Oral Sciences, Nano and Biotechnologies, "G. d'Annunzio" University, Via dei Vestini 31, 66013 Chieti, Italy
| | - Liborio Stuppia
- Department of Oral Sciences, Nano and Biotechnologies, "G. d'Annunzio" University, Via dei Vestini 31, 66013 Chieti, Italy
| | - Paolo Berardinelli
- Department of Bioscience and Technology for Food, Agriculture and Environment, University of Teramo, Via R. Balzarini 1, 64100 Teramo, Italy
| | - Ilaria Falanga
- Medline Srl, Via Galileo Ferraris 1, 84018 Scafati, Italy
| | - Davide Perruzza
- Reproductive Medicine Unit, S.I.S.Me.R., Via Mazzini 12, 40138 Bologna, Italy
| | - Luca Valbonetti
- Department of Bioscience and Technology for Food, Agriculture and Environment, University of Teramo, Via R. Balzarini 1, 64100 Teramo, Italy
| | - Annunziata Mauro
- Department of Bioscience and Technology for Food, Agriculture and Environment, University of Teramo, Via R. Balzarini 1, 64100 Teramo, Italy
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Orssaud C, Barraud Lange V, Wolf JP, LeFoll N, Soufir JC. Case Report: Abnormalities of sperm motility and morphology in a patient with Leber hereditary optic neuropathy: Improvement after idebenone therapy. Front Neurol 2023; 13:946559. [PMID: 36686502 PMCID: PMC9845611 DOI: 10.3389/fneur.2022.946559] [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: 05/17/2022] [Accepted: 11/30/2022] [Indexed: 01/05/2023] Open
Abstract
Case We report the sperm characteristics of a male patient who developed, when he was 18 years old, a Leber hereditary optic neuropathy, a hereditary optic neuropathy due to mtDNA mutation as well as variants in the nuclear DNA. At the age of 30 years-old, he complained of infertility lasting for 2 years. Semen analyses showed low motility spermatozoa and a high percentage of morphological or ultrastructural abnormalities. Levels of epididymal markers were strongly atypical. Idebenone was prescribed as treatment of his Leber hereditary optic neuropathy in order to improve his visual acuity. After 5 months of this treatment, motility of spermatozoa increased, and their vitality improved. A natural conception occurred. Outcome This case is the first description of an anomaly of spermatozoas and of the epididymis epithelium in a patient with Leber hereditary optic neuropathy. It draws attention to sperm pathologies in patients with mitochondrial disorders. The role of the mtDNA mutations must be suspected since it plays an important role in the development and motility of spermatozoa. In addition, idebenone can by-pass the complex I and transfer electrons to complex III. It has been suspected to have a favorable effect on spermatogenesis. Conclusion This case confirms the possibility of sperm dysfunction in Leber hereditary optic neuropathy and the interest of idebenone as a treatment for infertility due to mtDNA mutations in human.
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Affiliation(s)
- Christophe Orssaud
- Functional Unit of Ophthalmology, Ophtara Rare disease Center, Sensgène Filière, ERN EYE, European Hospital Georges Pompidou, University Hospital Paris Centre, Assistance Publique de Hôpitaux de Paris, Paris, France,*Correspondence: Christophe Orssaud ✉
| | - Virginie Barraud Lange
- Team Genomic Epigenetic and Physiopathology of Reproduction, Department of Genetic, Development and Cancer, Cochin Institute, Inserm U1016, Paris, France,Laboratory of Histology Embryology Biology of Reproduction, Sorbonne Paris Cité, Faculty of Medicine, University Hospital Paris Centre, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jean Philippe Wolf
- Team Genomic Epigenetic and Physiopathology of Reproduction, Department of Genetic, Development and Cancer, Cochin Institute, Inserm U1016, Paris, France,Laboratory of Histology Embryology Biology of Reproduction, Sorbonne Paris Cité, Faculty of Medicine, University Hospital Paris Centre, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Nathalie LeFoll
- Laboratory of Histology Embryology Biology of Reproduction, Sorbonne Paris Cité, Faculty of Medicine, University Hospital Paris Centre, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jean Claude Soufir
- Biologie de la Reproduction, University Hospital Paris Centre, Assistance Publique Hôpitaux de Paris, Paris, France
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CIRSE Standards of Practice on Varicocele Embolisation. Cardiovasc Intervent Radiol 2023; 46:19-34. [PMID: 36380154 DOI: 10.1007/s00270-022-03293-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 09/23/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Percutaneous embolisation is an effective, minimally invasive means of treating a variety of benign and malignant lesions and has been successfully used to treat varicoceles since the late 1970s, with refined and expanded techniques and tools currently offering excellent outcomes for varicocele embolisation. PURPOSE This document will presume that the indication for treatment is clear and approved by the multidisciplinary team (MDT) and will define the standards required for the performance of each modality, as well as their advantages and limitations. CIRSE Standards of Practice documents are not intended to impose a standard of clinical patient care, but recommend a reasonable approach to, and best practices for, the performance of percutaneous varicocele embolisation. METHODS The writing group was established by the CIRSE Standards of Practice Committee and consisted of five clinicians with internationally recognised expertise in embolisation of male varicoceles. The writing group reviewed the existing literature on varicocele embolisation, performing a pragmatic evidence search using PubMed to search for publications in English and relating to human subjects published from 2006 to 2021. The final recommendations were formulated through consensus. CONCLUSION Embolisation has an established role in the successful management of male varicoceles. This Standards of Practice document provides up-to-date recommendations for the safe performance of varicocele embolisation.
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Bao B, Ke M, Guo J, Pan Z, Huang H, Ke Z, Zhou X, Liu B. Bibliometrics and visualisation analysis of literature on varicocele: From 2002 to 2021. Andrologia 2022; 54:e14537. [PMID: 35920088 DOI: 10.1111/and.14537] [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: 05/11/2022] [Revised: 06/23/2022] [Accepted: 07/11/2022] [Indexed: 11/27/2022] Open
Abstract
Varicocele is a common disease in men, with a global incidence of approximately 25%. A comprehensive and systematic analysis of the knowledge map on it will help in assessing frontier research and identify knowledge gaps. In total, 4103 articles published from 2002 to 2021 in 1066 journals were included. They represent the current research status worldwide, potential hotspots and future research directions. In the past decades, the number of publications and citations of varicocele-related studies have increased steadily. Academic institutions in the United States played a leading role in varicocele research. The country, institution, journal and author with the most publications were the United States (779), Cleveland Clinic Foundation (132), Andrologia (246) and Agarwal A (106), respectively. The most frequently used keywords were Varicocele (1620), Male Infertility (944), Varicocelectomy (288), Testis (245), Sperm (166), Oxidative Stress (144), Azoospermia (119), Semen Analysis (118), Laparoscopy (116) and Adolescent (97). Currently, the main focus of current varicocele research is its surgical treatment method and effect on sperm quality. The frontier research hotspot is the specific mechanism of varicocele-induced decrease in sperm quality.
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Affiliation(s)
- Binghao Bao
- Graduate School of Beijing University of Chinese Medicine, Beijing, China.,Department of Andrology, China-Japan Friendship Hospital, Beijing, China
| | - Minghui Ke
- Department of Andrology, China-Japan Friendship Hospital, Beijing, China
| | - Jianqiang Guo
- Graduate School of Beijing University of Chinese Medicine, Beijing, China.,Department of Andrology, China-Japan Friendship Hospital, Beijing, China
| | - Zhengkun Pan
- Graduate School of Beijing University of Chinese Medicine, Beijing, China.,Department of Andrology, China-Japan Friendship Hospital, Beijing, China
| | - Haonan Huang
- Graduate School of Beijing University of Chinese Medicine, Beijing, China.,Department of Andrology, China-Japan Friendship Hospital, Beijing, China
| | - Zhenghao Ke
- Graduate School of Beijing University of Chinese Medicine, Beijing, China.,Department of Andrology, China-Japan Friendship Hospital, Beijing, China
| | - Xiaofeng Zhou
- Department of Urology, China-Japan Friendship Hospital, Beijing, China
| | - Baoxing Liu
- Department of Andrology, China-Japan Friendship Hospital, Beijing, China
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