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Cheung S, Ng L, Xie P, Kocur O, Elias R, Schlegel P, Rosenwaks Z, Palermo GD. Genetic profiling of azoospermic men to identify the etiology and predict reproductive potential. J Assist Reprod Genet 2024; 41:1111-1124. [PMID: 38403804 PMCID: PMC11052749 DOI: 10.1007/s10815-024-03045-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 01/24/2024] [Indexed: 02/27/2024] Open
Abstract
PURPOSE To identify germline mutations related to azoospermia etiology and reproductive potential of surgically retrieved spermatozoa, and to investigate the feasibility of predicting seminiferous tubule function of nonobstructive azoospermic men by transcriptomic profiling of ejaculates. MATERIALS AND METHODS Sperm specimens were obtained from 30 men (38.4 ± 6 years) undergoing epididymal sperm aspiration for obstructive azoospermia (OA, n = 19) acquired by vasectomy, or testicular biopsy for nonobstructive azoospermia (NOA, n = 11). To evaluate for a correlation with azoospermia etiology, DNAseq was performed on surgically retrieved spermatozoa, and cell-free RNAseq on seminal fluid (n = 23) was performed to predict spermatogenesis in the seminiferous tubule. RESULTS Overall, surgically retrieved sperm aneuploidy rates were 1.7% and 1.8% among OA and NOA cohorts, respectively. OA men carried housekeeping-related gene mutations, while NOA men displayed mutations on genes involved in crucial spermiogenic functions (AP1S2, AP1G2, APOE). We categorized couples within each cohort according to ICSI clinical outcomes to investigate genetic causes that may affect reproductive potential. All OA-fertile men (n = 9) carried mutations in ZNF749 (sperm production), whereas OA-infertile men (n = 10) harbored mutations in PRB1, which is essential for DNA replication. NOA-fertile men (n = 8) carried mutations in MPIG6B (stem cell lineage differentiation), whereas NOA-infertile individuals (n = 3) harbored mutations in genes involved in spermato/spermio-genesis (ADAM29, SPATA31E1, MAK, POLG, IFT43, ATG9B) and early embryonic development (MBD5, CCAR1, PMEPA1, POLK, REC8, REPIN1, MAPRE3, ARL4C). Transcriptomic assessment of cell-free RNAs in seminal fluid from NOA men allowed the prediction of residual spermatogenic foci. CONCLUSIONS Sperm genome profiling provides invaluable information on azoospermia etiology and identifies gene-related mechanistic links to reproductive performance. Moreover, RNAseq assessment of seminal fluid from NOA men can help predict sperm retrieval during testicular biopsies.
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Affiliation(s)
- Stephanie Cheung
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, 1305 York Avenue, Y720, New York, NY, 10021, USA
| | - Lily Ng
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, 1305 York Avenue, Y720, New York, NY, 10021, USA
| | - Philip Xie
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, 1305 York Avenue, Y720, New York, NY, 10021, USA
| | - Olena Kocur
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, 1305 York Avenue, Y720, New York, NY, 10021, USA
| | - Rony Elias
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, 1305 York Avenue, Y720, New York, NY, 10021, USA
| | - Peter Schlegel
- Department of Urology, James Buchanan Brady Foundation and Cornell Reproductive Medicine Institute, Weill Cornell Medicine, New York, NY, USA
| | - Zev Rosenwaks
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, 1305 York Avenue, Y720, New York, NY, 10021, USA
| | - Gianpiero D Palermo
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, 1305 York Avenue, Y720, New York, NY, 10021, USA.
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Romano M, Cirillo F, Spadaro D, Busnelli A, Castellano S, Albani E, Levi-Setti PE. High sperm DNA fragmentation: do we have robust evidence to support antioxidants and testicular sperm extraction to improve fertility outcomes? a narrative review. Front Endocrinol (Lausanne) 2023; 14:1150951. [PMID: 37867514 PMCID: PMC10585152 DOI: 10.3389/fendo.2023.1150951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 09/01/2023] [Indexed: 10/24/2023] Open
Abstract
To date, infertility affects 10% to 15% of couples worldwide. A male factor is estimated to account for up to 50% of cases. Oral supplementation with antioxidants could be helpful to improve sperm quality by reducing oxidative damage. At the same time, there is a growing interest in the literature on the use of testicular sperm in patients with high DNA fragmentation index (DFI). This narrative review aims to evaluate the effectiveness of supplementation of oral antioxidants in infertile men with high DFI compared to testicular sperm retrieval. The current evidence is non-conclusive because of serious risk of bias due to small sample sizes and statistical methods. Further large well-designed randomised placebo-controlled trials are still required to clarify the exact role of these to different therapeutic approaches.
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Affiliation(s)
- Massimo Romano
- Department of Gynecology, Division of Gynecology and Reproductive Medicine, Fertility Center, Humanitas Research Hospital, IRCCS, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Federico Cirillo
- Department of Gynecology, Division of Gynecology and Reproductive Medicine, Fertility Center, Humanitas Research Hospital, IRCCS, Milan, Italy
| | - Daria Spadaro
- Department of Gynecology, Division of Gynecology and Reproductive Medicine, Fertility Center, Humanitas Research Hospital, IRCCS, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Andrea Busnelli
- Department of Gynecology, Division of Gynecology and Reproductive Medicine, Fertility Center, Humanitas Research Hospital, IRCCS, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Stefano Castellano
- Department of Gynecology, Division of Gynecology and Reproductive Medicine, Fertility Center, Humanitas Research Hospital, IRCCS, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Elena Albani
- Department of Gynecology, Division of Gynecology and Reproductive Medicine, Fertility Center, Humanitas Research Hospital, IRCCS, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Paolo Emanuele Levi-Setti
- Department of Gynecology, Division of Gynecology and Reproductive Medicine, Fertility Center, Humanitas Research Hospital, IRCCS, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
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Kim SW, Lee J, Lee TH, Kim DS, Song SH, Kim DK. Azoospermic Men with a History of Cryptorchidism Treated by Orchiopexy Have Favorable Outcomes after Testicular Sperm Extraction: A Systematic Review and Meta-Analysis. World J Mens Health 2023; 41:81-93. [PMID: 35274507 PMCID: PMC9826915 DOI: 10.5534/wjmh.210198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 12/12/2021] [Accepted: 12/19/2021] [Indexed: 01/21/2023] Open
Abstract
PURPOSE This systematic review and meta-analysis investigated the sperm retrieval rate (SRR) and pregnancy rate after testicular sperm extraction in men with azoospermia and those with a history of cryptorchidism treated by orchiopexy. MATERIALS AND METHODS The SRR and clinical pregnancy rate were investigated. We performed a sub-analysis that included factors such as bilaterality, age, and idiopathic non-obstructive azoospermia (iNOA). The analysis comprised 13 studies from January 1995 to July 2021. The data sources were PubMed/MEDLINE, Embase, and the Cochrane Library included "cryptorchidism", "orchidopexy", "azoospermia", and "testicular sperm extraction". RESULTS The overall mean SRR was 63.3% (95% confidence interval [CI], 57.6%-68.6%; I²=62.4%), and the overall mean clinical pregnancy rate was 30.1% (95% CI, 22.6%-38.8%; I²=69.9%). The meta-analysis comparing the SRR, there was no significant difference between patients with a history of bilateral and unilateral orchiopexy (relative risk [RR]=1.02; 95% CI, 0.89-1.16; p=0.79). Orchiopexy performed under the age of 10 years showed significantly increased SRR compared to the age of over 10 years (RR=1.25; 95% CI, 1.06-1.47; p=0.008). Azoospermic men with a history of cryptorchidism treated by orchiopexy had significantly higher SRR than iNOA (RR=1.90; 95% CI, 1.40-2.58; p<0.0001). CONCLUSIONS Men with azoospermia and a history of cryptorchidism treated by orchiopexy had significantly higher SRR than those with iNOA after testicular sperm extraction. Furthermore, patients who underwent orchiopexy before the age of ten years had significantly higher SRR than patients operated at an older than the age of ten years.
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Affiliation(s)
- Sang Woon Kim
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jongsoo Lee
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Tae Ho Lee
- Department of Urology, Fertility Center, CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | - Dong Suk Kim
- Department of Urology, Fertility Center, CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | - Seung-Hun Song
- Department of Urology, Fertility Center, CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | - Dae Keun Kim
- Department of Urology, CHA Fertility Center Seoul Station, CHA University School of Medicine, Seoul, Korea
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Herndon CC, Godart ES, Turek PJ. Testosterone levels among non-obstructive azoospermic patients 2 years after failed bilateral microdissection testicular sperm extraction: a nested case-cohort study. J Assist Reprod Genet 2022; 39:1297-1303. [PMID: 35469372 PMCID: PMC9174376 DOI: 10.1007/s10815-022-02497-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 04/13/2022] [Indexed: 11/03/2022] Open
Abstract
PURPOSE To define the risk of hypogonadism following microdissection testicular sperm extraction in cases of non-obstructive azoospermia. While sperm retrieval by open testicular sperm extraction can be associated with an increased risk of hypogonadism, there is limited data addressing which procedures and which patients harbor the greatest risk. METHODS We report on a community-acquired, nested, case-cohort of non-obstructive azoospermic patients referred to one clinic after failed bilateral microdissection testicular sperm extraction. Patients were health-matched (1:2) to surgically naïve controls and divided into 2 cohorts based on risk factors for hypogonadism. Among microdissection patients, we compared total testosterone and gonadotropin levels before and > 6 months after surgery. Biochemical hypogonadism was defined as a total serum testosterone level ≤ 300 ng/dL. Hormone levels were compared to risk-matched controls. Comparative statistics were used to assess hormone levels within and between cohorts. RESULTS There were no significant differences in baseline testosterone levels between microdissection patients (n = 26) and risk-matched controls (n = 52). At a mean of 26 months (range 6.2-112.8) post-procedure, mean testosterone levels decreased significantly (73 ng/dL or 16%; CI - 27, - 166; p < 0.01, paired t-test). Among microdissection patients with baseline testosterone > 300 ng/dL, 8/22 (36%) experienced hypogonadism post-procedure. There was a corresponding increase in follicle stimulating hormone (p = 0.05) and a trending increase in luteinizing hormones (p = 0.10). CONCLUSION A durable decrease in testosterone levels occurs after failed microdissection testicular sperm extraction regardless of baseline risk of hypogonadism. In addition, a significant proportion of eugonadal patients will become hypogonadal after failed testicular microdissection procedures.
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Affiliation(s)
- Charles C Herndon
- The Turek Clinic, 9033 Wilshire Blvd, Suite 408, Beverly Hills, CA, 90211, USA
- College of Osteopathic Medicine, Touro University Nevada, Henderson, NV, USA
| | - Erica S Godart
- The Turek Clinic, 9033 Wilshire Blvd, Suite 408, Beverly Hills, CA, 90211, USA
| | - Paul J Turek
- The Turek Clinic, 9033 Wilshire Blvd, Suite 408, Beverly Hills, CA, 90211, USA.
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Benderradji H, Prasivoravong J, Marcelli F, Barbotin AL, Catteau-Jonard S, Marchetti C, Guittard C, Puech P, Mitchell V, Rigot JM, Villers A, Pigny P, Leroy C. Contribution of serum anti-Müllerian hormone in the management of azoospermia and the prediction of testicular sperm retrieval outcomes: a study of 155 adult men. Basic Clin Androl 2021; 31:15. [PMID: 34134632 PMCID: PMC8210365 DOI: 10.1186/s12610-021-00133-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 04/25/2021] [Indexed: 12/02/2022] Open
Abstract
Background Testicular sperm extraction (TESE) is the method of choice for recovering spermatozoa in patients with azoospermia. However, the lack of reliable biomarkers makes it impossible to predict sperm retrieval outcomes at TESE. To date, little attention has been given to anti-Müllerian hormone (AMH) serum levels in adult men with altered spermatogenesis. In this study we aimed to investigate whether serum concentrations of AMH and the AMH to total testosterone ratio (AMH/T) might be predictive factors for sperm retrieval outcomes during TESE in a cohort of 155 adult Caucasian men with azoospermia. Results AMH serum levels were significantly lower in nonobstructive azoospermia (NOA) that was unexplained, cryptorchidism-related, cytotoxic and genetic (medians [pmol/l] = 30.1; 21.8; 26.7; 7.3; and p = 0.02; 0.001; 0.04; <0.0001, respectively]) compared with obstructive azoospermia (OA) (median = 44.8 pmol/l). Lowest values were observed in cases of genetic NOA (p < 0.0001, compared with unexplained NOA) and especially in individuals with non-mosaic Klinefelter syndrome (median = 2.3 pmol/l, p <0.0001). Medians of AMH/T values were significantly lower in genetic NOA compared to unexplained, cryptorchidism-related NOA as well as OA. Only serum concentrations of AMH differed significantly between positive and negative groups in men with non-mosaic Klinefelter syndrome. The optimal cut-off of serum AMH was set at 2.5 pmol/l. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of this cut-off to predict negative outcomes of SR were 100 %, 76.9 %, 66.6 %, 100 and 84.2 %, respectively. Conclusions Serum AMH levels, but not AMH/T values, are a good marker for Sertoli and germ cell population dysfunction in adult Caucasian men with non-mosaic Klinefelter syndrome and could help us to predict negative outcomes of SR at TESE with 100 % sensitivity when serum levels of AMH are below 2.5 pmol/l. Supplementary Information The online version contains supplementary material available at 10.1186/s12610-021-00133-9.
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Affiliation(s)
- Hamza Benderradji
- Department of Andrology, Urology and Renal Transplantation, Claude Huriez Hospital, Lille University Hospital, 1 Place de Verdun, 59045, Lille Cedex, France.
| | - Julie Prasivoravong
- Department of Andrology, Urology and Renal Transplantation, Claude Huriez Hospital, Lille University Hospital, 1 Place de Verdun, 59045, Lille Cedex, France
| | - François Marcelli
- Department of Andrology, Urology and Renal Transplantation, Claude Huriez Hospital, Lille University Hospital, 1 Place de Verdun, 59045, Lille Cedex, France
| | - Anne-Laure Barbotin
- Department of Reproductive Biology-Spermiology-CECOS, Lille University Hospital, Lille, France
| | - Sophie Catteau-Jonard
- Department of Endocrine Gynecology and Reproductive Medicine, Lille University Hospital, Lille, France
| | - Carole Marchetti
- Department of Reproductive Biology, BIOLILLE Laboratory, Lille, France
| | | | - Philippe Puech
- Department of Radiology, Lille University Hospital, Lille, France
| | - Valérie Mitchell
- Department of Reproductive Biology-Spermiology-CECOS, Lille University Hospital, Lille, France
| | - Jean-Marc Rigot
- Department of Andrology, Urology and Renal Transplantation, Claude Huriez Hospital, Lille University Hospital, 1 Place de Verdun, 59045, Lille Cedex, France
| | - Arnauld Villers
- Department of Andrology, Urology and Renal Transplantation, Claude Huriez Hospital, Lille University Hospital, 1 Place de Verdun, 59045, Lille Cedex, France
| | - Pascal Pigny
- Department of Biochemistry & Hormonology, Lille University Hospital, Lille, France
| | - Clara Leroy
- Department of Andrology, Urology and Renal Transplantation, Claude Huriez Hospital, Lille University Hospital, 1 Place de Verdun, 59045, Lille Cedex, France
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6
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Lee J, Yoo JH, Lee JH, Ahn HS, Hwang KJ, Kim M. Effect of in vitro testicular spermatozoa culture on pregnancy outcomes: an experience at a single university hospital. Yeungnam Univ J Med 2020; 38:53-59. [PMID: 33290646 PMCID: PMC7787895 DOI: 10.12701/yujm.2020.00773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 11/05/2020] [Indexed: 01/07/2023] Open
Abstract
Background There are no guidelines for the optimal incubation time or temperature to improve pregnancy outcomes in testicular sperm extraction-intracytoplasmic sperm injection (TESE-ICSI) cycles. We aimed to evaluate whether a 24-hour in vitro culture of testicular spermatozoa affects pregnancy outcomes in TESE-ICSI cycles. Methods This was a retrospective study of 83 TESE-ICSI cycles using testicular spermatozoa in 46 couples with male partners suffering from nonobstructive or obstructive azoospermia. Sperm retrieval was performed either on the oocyte retrieval (OR) day (65 cycles in 33 couples; group A) or on the day before OR (18 cycles in 13 couples; group B) followed by in vitro culture for 24 hours. The clinical characteristics and pregnancy outcomes, including the number of retrieved oocytes, fertilization rates, embryo transfer rates, implantation and clinical pregnancy rates, were compared between the two groups. Results There were no differences in terms of clinical characteristics except for the levels of luteinizing hormone (LH) in males. Group B had higher LH levels than group A (4.56±1.24 IU/L vs. 3.67±1.07 IU/L, p=0.017). Group B showed higher fertilization rate (72.4%±32.1% vs. 59.2%±21.7%, p=0.045), implantation rate (35.0%±34.1% vs. 14.0%±21.5%, p=0.010), pregnancy rate per cycle (80% vs. 39%, p=0.033), and clinical pregnancy rate per cycle (80% vs. 37.5%, p=0.024) than those of group A. Conclusion Testicular sperm retrieval performed on the day before OR followed by in vitro culture can potentially improve pregnancy outcomes.
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Affiliation(s)
- Jisun Lee
- Department of Obstetrics and Gynecology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jung Hyeon Yoo
- Department of Obstetrics and Gynecology, Bundang Jaeseng Hospital, Seongnam, Korea
| | - Jae Hun Lee
- Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea
| | - Hyun Soo Ahn
- Department of Urology, Ajou University School of Medicine, Suwon, Korea
| | - Kyung Joo Hwang
- Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea
| | - Miran Kim
- Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea
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Sparidaens EM, Braat DDM, van den Berg M, D'Hauwers KWM, Fleischer K, Nelen WLDM. Informational needs of couples undergoing intracytoplasmic sperm injection with surgical sperm retrieval: A qualitative study. Eur J Obstet Gynecol Reprod Biol 2020; 255:177-182. [PMID: 33166938 DOI: 10.1016/j.ejogrb.2020.10.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 10/14/2020] [Accepted: 10/16/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Infertile couples consider patient information a very important dimension of patient-centred care. Although testicular sperm extraction (TESE) followed by intracytoplasmic sperm injection (ICSI) has long been offered to infertile couples, little is known about couples' informational needs. The aim of this study was to identify the informational needs of couples undergoing TESE and ICSI, including information content and the channels providing the information as a first step to improve patient-centred care. STUDY DESIGN We conducted a qualitative study consisting of semi-structured interviews with 11 couples. The topic guide was based on a literature review and interviews with an expert panel. The number of interviews was determined with data saturation. The data were analysed using a constant comparative method. RESULTS The couples needed information about many topics. They considered information about the success rates of the treatment, an explanation of the treatment procedure, and other patient experiences the most important. Regarding information channels, the couples preferred face-to-face information, but they also valued a leaflet, website, or an online application, especially when it is personalized or providing interactive functionalities. CONCLUSION We obtained in-depth insight into the information needs of couples undergoing TESE and ICSI. The results of this study give fertility clinics an opportunity to develop patient information that meets the needs of their patients and thus improve patient-centred fertility care.
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Affiliation(s)
- Ellen Marie Sparidaens
- Department of Obstetrics and Gynaecology (Route 791), Radboud University Medical Center, P.O. Box 9101, 6500HB Nijmegen, the Netherlands.
| | - Didi D M Braat
- Department of Obstetrics and Gynaecology (Route 791), Radboud University Medical Center, P.O. Box 9101, 6500HB Nijmegen, the Netherlands.
| | - Michelle van den Berg
- Department of Obstetrics and Gynaecology (Route 791), Radboud University Medical Center, P.O. Box 9101, 6500HB Nijmegen, the Netherlands.
| | - Kathleen W M D'Hauwers
- Department of Urology (Route 725), Radboud University Medical Center, P.O. Box 9101, 6500HB Nijmegen, the Netherlands.
| | - Kathrin Fleischer
- Department of Obstetrics and Gynaecology (Route 791), Radboud University Medical Center, P.O. Box 9101, 6500HB Nijmegen, the Netherlands.
| | - Willianne L D M Nelen
- Department of Obstetrics and Gynaecology (Route 791), Radboud University Medical Center, P.O. Box 9101, 6500HB Nijmegen, the Netherlands.
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Abstract
Sperm DNA damage reduces pregnancy rates in couples undergoing in vitro fertilization (IVF). Because it has been shown that testicular sperm have lower DNA damage than ejaculated sperm, it is an attractive idea to consider using testicular sperm for IVF for men with high sperm DNA damage. In fact, there are multiple centers throughout the world now offering sperm retrieval for IVF to manage this condition. However, there is insufficient evidence to conclude that testicular sperm improves pregnancy/live birth rates. Further studies are required before offering sperm retrieval as a standard of care to manage high sperm DNA damage.
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Kuroda S, Kondo T, Mori K, Yasuda K, Asai T, Sanjo H, Yakanaka H, Takeshima T, Kawahara T, Kato Y, Miyoshi Y, Uemura H, Iwasaki A, Yumura Y. Successful onco-testicular sperm extraction from a testicular cancer patient with a single testis and azoospermia. Clin Exp Reprod Med 2018; 45:44-47. [PMID: 29662825 PMCID: PMC5897247 DOI: 10.5653/cerm.2018.45.1.44] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 12/24/2017] [Accepted: 01/23/2018] [Indexed: 11/17/2022] Open
Abstract
Onco-testicular sperm extraction is used to preserve fertility in patients with bilateral testicular tumors and azoospermia. We report the case of a testicular tumor in the solitary testis of a patient who had previously undergone successful contralateral orchiectomy and whose sperm was preserved by onco-testicular sperm extraction. A 35-year-old patient presented with swelling of his right scrotum that had lasted for 1 month. His medical history included a contralateral orchiectomy during childhood. Ultrasonography revealed a mosaic echoic area in his scrotum, suggesting a testicular tumor. The lesion was palpated within the normal testicular tissue along its edge and semen analysis showed azoospermia. Radical inguinal orchiectomy and onco-testicular sperm extraction were performed simultaneously. Motile spermatozoa were extracted from normal seminiferous tubules under microscopy and were frozen. Eventual intracytoplasmic sperm injection using the frozen spermatozoa is planned. Onco-testicular sperm extraction is an important fertility preservation method in patients with bilateral testicular tumors or a history of a previous contralateral orchiectomy.
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Affiliation(s)
- Shinnosuke Kuroda
- Department of Urology, Reproduction Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Takuya Kondo
- Department of Urology, Reproduction Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Kohei Mori
- Department of Urology, Reproduction Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Kengo Yasuda
- Department of Urology, Reproduction Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Takuo Asai
- Department of Urology, Reproduction Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Hiroyuki Sanjo
- Department of Urology, Reproduction Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Hiroyuki Yakanaka
- Department of Urology, Reproduction Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Teppei Takeshima
- Department of Urology, Reproduction Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Takashi Kawahara
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan
| | - Yoshitake Kato
- Department of Urology, Reproduction Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Yasuhide Miyoshi
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan
| | - Hiroji Uemura
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan
| | - Akira Iwasaki
- Department of Urology, Reproduction Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Yasushi Yumura
- Department of Urology, Reproduction Center, Yokohama City University Medical Center, Yokohama, Japan
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Shin T, Kobayashi T, Shimomura Y, Iwahata T, Suzuki K, Tanaka T, Fukushima M, Kurihara M, Miyata A, Kobori Y, Okada H. Microdissection testicular sperm extraction in Japanese patients with persistent azoospermia after chemotherapy. Int J Clin Oncol 2016; 21:1167-1171. [PMID: 27306218 DOI: 10.1007/s10147-016-0998-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 05/29/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Combinations of surgery, radiation therapy, and chemotherapy can achieve high remission rates in patients with cancer, but these treatments can have damaging effects on spermatogenesis. In particular, cytotoxic chemotherapy may lead to irreversible spermatogenic dysfunction. Microdissection testicular sperm extraction (micro-TESE) is the only method that can address infertility in cancer survivors with persistent postchemotherapy azoospermia. METHODS We included 66 Japanese patients with postchemotherapy azoospermia who underwent micro-TESE for sperm retrieval in this analysis. Age, oncology data, hormone profiles, and outcomes of micro-TESE and subsequent intracytoplasmic sperm injections (ICSIs) were reviewed. RESULTS The common disease in our patients was testicular cancer (21 patients), followed by acute lymphoblastic leukemia and Hodgkin's lymphoma (nine patients). In this cohort of 66 patients, sperm was successfully retrieved in 31 patients (47 %), and clinical pregnancy occurred in 23 cases (35 %). The live birth rate was 27 %. No significant differences in sperm retrieval, clinical pregnancy, and live birth rates were seen between testicular cancer, Hodgkin's lymphoma, non-Hodgkin's lymphoma, acute lymphoblastic leukemia, acute myeloid leukemia, or sarcoma cases. Multiple logistic regression analysis showed that the chance of retrieving sperm during micro-TESE could not be predicted by any variable. CONCLUSIONS Cryopreservation of sperm should be offered before any gonadotoxic chemotherapy takes place. However, micro-TESE and subsequent ICSI could be effective treatment options for patients with persistent postchemotherapy azoospermia whose sperm were not frozen before therapy. Our results suggest that micro-TESE-ICSI could benefit 27 % of such Japanese patients.
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Affiliation(s)
- Takeshi Shin
- Department of Urology, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minamikoshigaya, Koshigaya, Saitama, 343-8555, Japan.
- Center for Reproductive Medicine, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minamikoshigaya, Koshigaya, Saitama, 343-8555, Japan.
| | - Tomohiro Kobayashi
- Department of Urology, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minamikoshigaya, Koshigaya, Saitama, 343-8555, Japan
| | - Yukihito Shimomura
- Department of Urology, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minamikoshigaya, Koshigaya, Saitama, 343-8555, Japan
| | - Toshiyuki Iwahata
- Department of Urology, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minamikoshigaya, Koshigaya, Saitama, 343-8555, Japan
| | - Keisuke Suzuki
- Department of Urology, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minamikoshigaya, Koshigaya, Saitama, 343-8555, Japan
| | - Takashi Tanaka
- Center for Reproductive Medicine, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minamikoshigaya, Koshigaya, Saitama, 343-8555, Japan
| | - Mai Fukushima
- Center for Reproductive Medicine, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minamikoshigaya, Koshigaya, Saitama, 343-8555, Japan
| | - Megumi Kurihara
- Center for Reproductive Medicine, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minamikoshigaya, Koshigaya, Saitama, 343-8555, Japan
| | - Akane Miyata
- Center for Reproductive Medicine, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minamikoshigaya, Koshigaya, Saitama, 343-8555, Japan
| | - Yoshitomo Kobori
- Department of Urology, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minamikoshigaya, Koshigaya, Saitama, 343-8555, Japan
| | - Hiroshi Okada
- Department of Urology, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minamikoshigaya, Koshigaya, Saitama, 343-8555, Japan
- Center for Reproductive Medicine, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minamikoshigaya, Koshigaya, Saitama, 343-8555, Japan
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