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Minhas S, Boeri L, Capogrosso P, Cocci A, Corona G, Dinkelman-Smit M, Falcone M, Jensen CF, Gül M, Kalkanli A, Kadioğlu A, Martinez-Salamanca JI, Morgado LA, Russo GI, Serefoğlu EC, Verze P, Salonia A. European Association of Urology Guidelines on Male Sexual and Reproductive Health: 2025 Update on Male Infertility. Eur Urol 2025; 87:601-616. [PMID: 40118737 DOI: 10.1016/j.eururo.2025.02.026] [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: 02/24/2025] [Accepted: 02/27/2025] [Indexed: 03/23/2025]
Abstract
BACKGROUND AND OBJECTIVE To present a summary of the updated 2025 European Association of Urology (EAU) Guidelines on Sexual and Reproductive Health (SRH) on male infertility, providing practical recommendations on the clinical work-up with a focus on diagnosis, treatment and follow-up. METHODS For the 2025 SRH guidelines, new and relevant evidence was identified, collated, and appraised via a structured assessment of the literature. Databases searched included Medline, EMBASE, and the Cochrane Libraries. Recommendations within the guidelines were developed by the panel to prioritise clinically important care decisions. The strength of each recommendation was determined according to a balance between desirable and undesirable consequences of alternative management strategies, the quality of the evidence (including the certainty of estimates), and the nature and variability of patient values and preferences. KEY FINDINGS AND LIMITATIONS Key recommendations emphasise the importance of a thorough urological assessment of all men seeking medical help for fertility problems to ensure appropriate treatment. The guidelines also stress the clinical relevance of a parallel investigation of the female partner during the diagnostic and management work-up of the infertile couple, to promote shared-decision making in terms of timing and therapeutic strategies. Furthermore, the guidelines recommend to counsel all infertile men and men with abnormal semen parameters on the associated health risks. Key changes in the male infertility guidelines for 2025 include: the addition of two new sections addressing exome sequencing and probiotic treatment; and significant update of the evidence base and recommendations for the diagnostic work-up of male infertility. CONCLUSIONS AND CLINICAL IMPLICATIONS This overview of the 2025 SHR guidelines offers valuable insights into the diagnosis, classification, treatment and follow-up of male factor infertility and are designed for effective integration into clinical practice.
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Affiliation(s)
- Suks Minhas
- Department of Urology, Charing Cross Hospital, Imperial Healthcare NHS Trust, London, UK
| | - Luca Boeri
- Department of Urology, IRCCS Fondazione Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Capogrosso
- Department of Medicine and Technological Innovations/Unit of Urology, Circolo & Fondazione Macchi Hospital, University of Insubria, Varese, Italy
| | - Andrea Cocci
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, University of Florence, Florence, Italy
| | - Giovanni Corona
- Endocrinology Unit, Medical Department, Maggiore-Bellaria Hospital, Bologna, Italy
| | - Marij Dinkelman-Smit
- Department of Urology, ErasmusMC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marco Falcone
- Urology Clinic, A.O.U. Città della Salute e della Scienza, Molinette Hospital, University of Turin, Turin, Italy; Neurourology Clinic, A.O.U. Città della Salute e della Scienza, Unità Spinale Unipolare, Turin, Italy
| | | | - Murat Gül
- Department of Urology, School of Medicine, Selcuk University, Konya, Turkey
| | - Arif Kalkanli
- Department of Urology, Taksim Education and Research Hospital, Istanbul, Turkey
| | - Ates Kadioğlu
- Department of Urology, İstanbul University School of Medicine, Istanbul, Turkey
| | | | - L Afonso Morgado
- Urology Service, Centro Hospitalar Universitário São João, Porto, Portugal; Department of Biomedicine, Faculty of Medicine, Porto University, Porto, Portugal
| | - Giorgio I Russo
- Urology Section, Department of Surgery, University of Catania, Catania, Italy
| | - Ege Can Serefoğlu
- Department of Urology, Biruni University School of Medicine, Istanbul, Turkey
| | - Paolo Verze
- Department of Medicine and Surgery, Scuola Medica Salernitana, University of Salerno, Fisciano, Italy
| | - Andrea Salonia
- Vita-Salute San Raffaele University, Milan, Italy; Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy.
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Santi D, Corona G, Salonia A, Ferlin A. Current drawbacks and future perspectives in the diagnosis and treatment of male factor infertility, with a focus on FSH treatment: an expert opinion. J Endocrinol Invest 2025; 48:1085-1100. [PMID: 39804439 PMCID: PMC12049307 DOI: 10.1007/s40618-024-02524-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2024] [Accepted: 12/26/2024] [Indexed: 05/04/2025]
Abstract
PURPOSE Infertility is defined as the inability to conceive after 1 year of unprotected intercourse, affecting approximately 15-20% of couples in Western countries. It is a shared problem within the couple; when the main issue lies with one of the partners, it is preferable to refer to "male factor" or "female factor" infertility rather than simply male or female infertility. Despite male factor infertility accounting for half of all couple infertility cases, the clinical approach to the male partner is not uniformly standardized across international guidelines. METHODS To provide an expert overview, we have comprehensively reviewed and critically analyzed the most up-to-date literature on this sensitive topic, leading to the development of a proposal for tailored assessment of the diagnostic-therapeutic pathway and preventive strategies. The diagnostic approach also considers that infertile men are objectively less healthy than their fertile counterparts of the same age and ethnicity. RESULTS This article discusses the diagnostic flow, the classification of male factor infertility, the definition of idiopathic infertility, the involvement of general health, and treatment recommendations, emphasizing follicle-stimulating hormone treatment in selected groups of patients. CONCLUSION We provide expert opinion on current drawbacks and future perspectives in this field, with practical advice for the clinical practice of general practitioners and expert in reproductive medicine.
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Affiliation(s)
- D Santi
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - G Corona
- Endocrinology Unit, Azienda AUSL, Bologna, Italy
| | - A Salonia
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - A Ferlin
- Department of Medicine, University of Padova, Padua, Italy.
- Unit of Andrology and Reproductive Medicine, Department of Systems Medicine, University Hospital of Padova, Via Giustiniani 2, 35121, Padua, Italy.
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Shah R, Rambhatla A, Kavoussi PK. Historical perspective of surgical sperm retrieval techniques for nonobstructive azoospermia. Asian J Androl 2025; 27:361-364. [PMID: 39254421 DOI: 10.4103/aja202465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 05/31/2024] [Indexed: 09/11/2024] Open
Affiliation(s)
- Rupin Shah
- Lilavati Hospital & Research Centre, Mumbai 400049, Maharashtra, India
- Sir HN Reliance Foundation Hospital, Mumbai 400049, Maharashtra, India
- Global Andrology Forum, Moreland Hills, OH 44022, USA
| | - Amarnath Rambhatla
- Global Andrology Forum, Moreland Hills, OH 44022, USA
- Vatikutti Urology Institute, Henry Ford Health, Detroit, MI 48202, USA
| | - Parviz K Kavoussi
- Global Andrology Forum, Moreland Hills, OH 44022, USA
- Austin Fertility & Reproductive Medicine/Westlake IVF, Austin, TX 78746, USA
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4
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Sikiru AB, Truong MN, Zohdy W. Future prospects for the advancement of treatment of men with NOA: focus on gene editing, artificial sperm, stem cells, and use of imaging. Asian J Androl 2025; 27:433-439. [PMID: 39422616 DOI: 10.4103/aja202486] [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: 01/27/2024] [Accepted: 08/20/2024] [Indexed: 10/19/2024] Open
Abstract
ABSTRACT Nonobstructive azoospermia (NOA) affects about 60% of men with azoospermia, representing a severe form of male infertility. The current approach to manage NOA primarily involves testicular sperm retrieval methods such as conventional testicular sperm extraction (c-TESE) and microdissection testicular sperm extraction (micro-TESE). While combining testicular sperm retrieval with intracytoplasmic sperm injection (ICSI) offers hope for patients, the overall sperm retrieval rate (SRR) stands at around 50%. In cases where micro-TESE fails to retrieve sperm, limited options, like donor sperm or adoption, can be problematic in certain cultural contexts. This paper delves into prospective treatments for NOA management. Gene editing technologies, particularly clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPR-associated (Cas) protein 9 (CRISPR/Cas9), hold potential for correcting genetic mutations underlying testicular dysfunction. However, these technologies face challenges due to their complexity, potential off-target effects, ethical concerns, and affordability. This calls for research to address key challenges associated with NOA management within the clinical settings. This also necessitate ongoing research essential for developing more sensitive diagnostic tests, validating novel treatments, and customizing current treatment strategies for individual patients. This review concluded that the future of NOA management may entail a combination of these treatment options, tailored to each patient's unique circumstances, providing a comprehensive approach to address NOA challenges.
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Affiliation(s)
- Akeem Babatunde Sikiru
- Department of Animal Science, Federal University of Agriculture Zuru (FUAZ), Kebbi 872101, Nigeria
| | - Manh Nguyen Truong
- Fertility Centre, Hanh Phuc International Hospital, Ho Chi Minh City 70000, Vietnam
| | - Wael Zohdy
- Andrology and STIs, Cairo University, Giza 12613, Egypt
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Salman A, Radwan AF, Shaker OG, A A, Sayed GA. A comparison of the expression patterns and diagnostic capability of the ncRNAs NEAT1 and miR-34a in non-obstructive azoospermia and severe oligospermia. Hum Genomics 2025; 19:35. [PMID: 40165339 PMCID: PMC11959825 DOI: 10.1186/s40246-025-00742-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2024] [Accepted: 03/11/2025] [Indexed: 04/02/2025] Open
Abstract
Infertility is a major global health problem, affecting 8-12% of couples worldwide, with male causes contributing to approximately 50% of cases. Notably, around 15% of infertile men are azoospermic. Consequently, there is a critical necessity to find noninvasive biomarkers to help in diagnosing and assessing the susceptibility of patients with various infertility disorders. This study is designed to determine the roles of NEAT1 and miR-34a as diagnostic and susceptibility biomarkers for non-obstructive azoospermia and severe oligospermia. The interactions between these non-coding RNA (ncRNAs) were explored, along with their correlations to hormonal profiles and clinical parameters like sperm count and motility. The potential of serum NEAT1 and miR-34a as diagnostic biomarkers for these conditions was explored. The study included 100 participants: 40 non-obstructive azoospermia patients, 40 severe oligospermia patients, and 20 healthy controls. Quantitative real-time PCR and transcriptomics-based bioinformatics tools were employed to explore the co-expression networks and molecular interactions of NEAT1, miR-34a, SIRT1, and their associated hormonal and genetic pathways. Results indicated that NEAT1 was significantly downregulated in severe oligospermia patients, while its levels in non-obstructive azoospermia patients did not differ significantly from healthy controls. Furthermore, serum miR-34a expression was considerably upregulated in both patient groups compared to controls. This study highlights the promise of serum NEAT1 and miR-34a as diagnostic markers for non-obstructive azoospermia and severe oligospermia. These findings provide valuable insights into male infertility and indicate potential avenues for personalized treatment strategies.
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Affiliation(s)
- Aya Salman
- Department of Biochemistry & Molecular Biology, Faculty of Pharmacy, Egyptian Russian University, Cairo, 11829, Egypt
| | - Abdullah F Radwan
- Department of Biochemistry & Molecular Biology, Faculty of Pharmacy, Egyptian Russian University, Cairo, 11829, Egypt
- Department of Pharmacy, Kut University College, Wasit, 52001, Iraq
| | - Olfat G Shaker
- Department of Medical Biochemistry and Molecular Biology, Kasr AlAiny Faculty of Medicine, Cairo University, Cairo, 12613, Egypt
| | - Adel A
- Department of Andrology, Sexology, and STIs, Faculty of Medicine, Cairo University, Cairo, 12613, Egypt
| | - Ghadir A Sayed
- Department of Biochemistry & Molecular Biology, Faculty of Pharmacy, Egyptian Russian University, Cairo, 11829, Egypt.
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Chang D, Li F, Kang Y, Yan Y, Kong F, Jiang W, Wang D, Cao Z, Xu L, Huang C, Kang Y, Shang X, Zhang B. The effects of L-carnitine and fructose in improved Ham's F10 on sperm culture in idiopathic severe asthenospermia within 24h. PLoS One 2025; 20:e0306235. [PMID: 39928618 PMCID: PMC11809793 DOI: 10.1371/journal.pone.0306235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Accepted: 11/26/2024] [Indexed: 02/12/2025] Open
Abstract
To study the effects of L-carnitine and fructose on semen parameters of severe asthenospermia patients by sperm culturing in vitro within 24h. We optimized the energy composition and antioxidant substances of sperm culture medium in vitro (based on Ham's F10 culture medium) by orthogonal test for preparing high quality culture medium. Sperms of 60 patients with idiopathic severe asthenospermia were collected, and cultured in vitro within 24h, by Ham's F10 culture medium added to different concentrations of L-carnitine and fructose and culture temperature, whose effects on sperm motility were observed to determine which is the most appropriate concentration and temperature. For determining the appropriate concentration of L-carnitine and fructose and the suitable culture temperature in Ham's F10 culture medium, the orthogonal experiments were carried out to optimize above three factors, which had great influence on sperm viability, survival rate, deformity rate and DNA fragmentation index (DFI). The final concentration of L-carnitine and fructose was determined in terms of initial tests to assess the effects of different concentrations (4, 8, 12, and 16 mg/ml L-carnitine and 0.125, 0.250, 0.375, and 0.50 mg/ml fructose) on sperm viability and motility in culture. During the operation of processing and culturing sperms in vitro within 24h, orthogonal test showed that sperm viability was better at the final concentration of 8 mg/ml L-carnitine and 0.375 mg/ml fructose in improved Ham's F10 culture medium at 36.5°C. Idiopathic severe asthenospermia sperm can be effectively improved by the modified Ham's F10 culture medium of the final concentration of 8 mg/ml L-carnitine and 0.375 mg/ml fructose at 36.5°C within 24h, which has shown better culture effect and is superior to Ham's F10 basic medium.
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Affiliation(s)
- Dehui Chang
- Department of Urology, The 940th Hospital of the People’s Liberation Army Joint Logistics Support Force, Lanzhou, Gansu, China
| | - Fudong Li
- Department of Urology, The 940th Hospital of the People’s Liberation Army Joint Logistics Support Force, Lanzhou, Gansu, China
| | - Yindong Kang
- Department of Urology, The 940th Hospital of the People’s Liberation Army Joint Logistics Support Force, Lanzhou, Gansu, China
| | - Yixin Yan
- Department of Urology, The 940th Hospital of the People’s Liberation Army Joint Logistics Support Force, Lanzhou, Gansu, China
| | - Feiyan Kong
- Second Department of Surgery, Beijing Fengtai Hospital of Integrated Traditional Chinese and Western Medicine, Beijing, China
| | - Wei Jiang
- Convalescent Section First of Convalescent Zone Second, Air Force Hangzhou Secret Service Rehabilitation Center, Hangzhou, Zhejiang, China
| | - Dongxing Wang
- Department of Urology, The 940th Hospital of the People’s Liberation Army Joint Logistics Support Force, Lanzhou, Gansu, China
| | - Zhigang Cao
- Department of Urology, The 940th Hospital of the People’s Liberation Army Joint Logistics Support Force, Lanzhou, Gansu, China
| | - Liuting Xu
- Department of Urology, The 940th Hospital of the People’s Liberation Army Joint Logistics Support Force, Lanzhou, Gansu, China
| | - Chuang Huang
- Department of Urology, The 940th Hospital of the People’s Liberation Army Joint Logistics Support Force, Lanzhou, Gansu, China
| | - Yafen Kang
- Department of Urology, The 940th Hospital of the People’s Liberation Army Joint Logistics Support Force, Lanzhou, Gansu, China
| | - Xuejun Shang
- Department of Urology, Nanjing Jinling Hospital: General Hospital of Eastern Theatre Command, Nanjing, Jiangsu, China
| | - Bin Zhang
- Department of Urology, The 940th Hospital of the People’s Liberation Army Joint Logistics Support Force, Lanzhou, Gansu, China
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7
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Esteves SC, Viana MC, Achermann APP, Santi D. Human chorionic gonadotropin-based clinical treatments for infertile men with non-obstructive azoospermia. Andrology 2025. [PMID: 39901824 DOI: 10.1111/andr.70003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Revised: 12/02/2024] [Accepted: 01/16/2025] [Indexed: 02/05/2025]
Abstract
Spermatogenesis is primarily controlled by follicle-stimulating hormone and luteinizing hormone-driven testosterone. Luteinizing hormone acts on the Leydig cells, stimulating steroid production, predominantly testosterone, and activating critical inter-related spermatogenesis regulatory pathways. Despite evidence that exogenous gonadotropins containing luteinizing hormone activity, particularly human chorionic gonadotropin, can effectively restore spermatogenesis in azoospermic males with hypogonadotropic hypogonadism, the use of these drugs to treat other forms of non-obstructive azoospermia is the subject of an ongoing debate. In this review, we delve into the molecular properties and functions of human chorionic gonadotropin in spermatogenesis regulation and explore available preparations for therapeutic use. We examine the evidence regarding the effectiveness of human chorionic gonadotropin in treating infertility in men with pre-testicular or testicular non-obstructive azoospermia and, additionally, identify the main areas for future research. Our review highlights the critical role of luteinizing hormone activity in spermatogenesis and emphasizes the potential of human chorionic gonadotropin in treating male infertility. The variation in the characteristics of patients with non-obstructive azoospermia underscores the importance of assessing hormonal profiles when contemplating hormonal treatment for these patients. A novel stratification of male infertility patients, the APHRODITE criteria, which considers clinical and laboratory indicators, may assist in identifying individuals who could benefit from human chorionic gonadotropin therapy. While accumulating evidence suggests promising venues for pharmacological treatment in male infertility, including non-obstructive azoospermia, further research is required to completely elucidate the mechanisms underlying the effects of exogenous gonadotropins with luteinizing hormone activity on sperm production and to establish the most effective dosages and treatment durations.
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Affiliation(s)
- Sandro C Esteves
- ANDROFERT, Andrology and Human Reproduction Clinic, Campinas, Brazil
- Department of Surgery (Division of Urology), State University of Campinas (UNICAMP), Campinas, Brazil
- Faculty of Health, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Marina C Viana
- ANDROFERT, Andrology and Human Reproduction Clinic, Campinas, Brazil
| | - Arnold P P Achermann
- Department of Surgery (Division of Urology), State University of Campinas (UNICAMP), Campinas, Brazil
| | - Daniele Santi
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero - University of Modena and Reggio Emilia, Modena, Italy
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Pozzi E, Venigalla G, Raymo A, Ila V, Achermann APP, Esteves SC, Salonia A, Ramasamy R. Eligibility for the medical therapy among men with non-obstructive azoospermia-Findings from a multi-centric cross-sectional study. Andrology 2025; 13:234-242. [PMID: 38804793 DOI: 10.1111/andr.13670] [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: 01/13/2024] [Revised: 04/08/2024] [Accepted: 05/14/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Existing literature does not provide accurate epidemiological data regarding the true prevalence of men with non-obstructive azoospermia (NOA) who would be eligible for hormonal optimization therapy, according to specific pre-treatment criteria. OBJECTIVES To investigate the characteristics of those men with NOA who would qualify for the medical therapy prior to any SR procedure in a large multi-centric cross-sectional study. MATERIALS AND METHODS Complete data from 1644 NOA patients seeking medical help for primary infertility at three tertiary referral centers from USA, Brazil, and Italy were analyzed. Baseline serum hormone levels were collected for all patients. NOA was confirmed after two consecutive semen analyses. Genetic tests, including karyotype analysis and Y microdeletions, were performed on all patients. Patients with secondary hypogonadism (total testosterone (T) levels less than 300 ng/dL and luteinizing hormone (LH) levels less than 8 mIU/mL) were earmarked as potential candidates for receiving clomiphene citrate (CC) and/or human chorionic gonadotropin (hCG). Patients with a T to 17β-estradiol (E2) ratio < 10 were classified as eligible for aromatase inhibitors (AIs) therapy (e.g., anastrazole). A third sub-cohort was created by combining the criteria of the first two sub-cohorts. Descriptive statistics was used to detail overall characteristics and differences between the different sub-cohorts. RESULTS Among the 1,644 men, 28% (n = 460) had T < 300 ng/dL and LH < 8 mIU/mL, thereby being potentially suitable for CC and/or hCG, while 37% (n = 607) had a T to E2 ratio < 10 thus potentially suitable for AIs. Lastly, 17.7% (n = 280) met the criteria for potential eligibility for both CC and/or hCG and AIs. CONCLUSIONS Findings from this multicentric cross-sectional study reveal that about 30% of men with NOA were eligible for hormonal treatment with CC and/or hCG while 37% were found to be potential candidates for AIs, and 17% for both therapies. Therefore, these findings show that a only a small subset of NOA patients can benefit from medical therapy prior to considering any SR procedures.
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Affiliation(s)
- Edoardo Pozzi
- Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, Miami, Florida, USA
- Vita-Salute San Raffaele University, Milan, Italy
- Division of Experimental Oncology, Unit of Urology, (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Greeshma Venigalla
- Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Adele Raymo
- Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Vishal Ila
- Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Arnold P P Achermann
- Department of Surgery, Division of Urology, University of Campinas, Campinas, Sao Paulo, Brazil
- Faculty of Health, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Sandro C Esteves
- Department of Surgery, Division of Urology, University of Campinas, Campinas, Sao Paulo, Brazil
- Faculty of Health, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Andrea Salonia
- Vita-Salute San Raffaele University, Milan, Italy
- Division of Experimental Oncology, Unit of Urology, (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Ranjith Ramasamy
- Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, Miami, Florida, USA
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Esteves SC, Humaidan P. The role of luteinizing hormone activity in spermatogenesis: from physiology to clinical practice. Reprod Biol Endocrinol 2025; 23:6. [PMID: 39800700 PMCID: PMC11726975 DOI: 10.1186/s12958-024-01333-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 12/11/2024] [Indexed: 01/16/2025] Open
Abstract
The production of spermatozoa, a process known as spermatogenesis, is primarily controlled by follicle-stimulating hormone (FSH) and luteinizing hormone (LH)-driven testosterone. LH acts on the Leydig cells, stimulating steroid production, predominantly testosterone, and activating critical inter-related spermatogenesis regulatory pathways. Despite evidence that exogenous gonadotropins containing LH activity can effectively restore spermatogenesis in males with hypogonadotropic hypogonadism, the use of these drugs to treat other forms of male infertility is the subject of an ongoing debate. In this review, we delve into the molecular properties and functions of LH activity in spermatogenesis regulation and explore available preparations for therapeutic use. We also examine the evidence regarding the effectiveness of LH-containing drugs in treating specific male infertility conditions and identify the main areas for future research. Our review highlights the critical role of LH in spermatogenesis and emphasizes the potential of LH-containing drugs in treating male infertility. However, further research is required to completely elucidate the mechanisms underlying the effects of LH activity on sperm production and to establish the most effective dosages and treatment durations.
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Affiliation(s)
- Sandro C Esteves
- ANDROFERT, Andrology and Human Reproduction Clinic, Av. Dr. Heitor Penteado, 1464, Campinas, 13075-460, Brazil.
- Department of Surgery (Division of Urology), University of Campinas (UNICAMP), Campinas, Brazil.
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark.
| | - Peter Humaidan
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
- Skive Regional Hospital, Fertility Unit, Skive, Denmark
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Rambhatla A, Shah R, Ziouziou I, Kothari P, Salvio G, Gul M, Hamoda T, Kavoussi P, Atmoko W, Toprak T, Birowo P, Ko E, Arafa M, Ghayda RA, Karthikeyan VS, Russo GI, Pinggera GM, Chung E, Harraz AM, Martinez M, Phuoc NHV, Tadros N, Saleh R, Savira M, Colpi GM, Zohdy W, Pescatori E, Park HJ, Fukuhara S, Tsujimura A, Rojas-Cruz C, Marino A, Mak SK, Amar E, Ibrahim W, Sindhwani P, Alhathal N, Busetto GM, Al Hashimi M, El-Sakka A, Ramazan A, Dimitriadis F, Timpano M, Jezek D, Altay B, Zylbersztejn DS, Wong MYC, Moon DG, Wyns C, Gamidov S, Akhavizadegan H, Franceschelli A, Aydos K, Quang N, Ashour S, Al Dayel A, Al-Marhoon MS, Micic S, Binsaleh S, Hussein A, Elbardisi H, Mostafa T, Ramsay J, Zachariou A, Abdelrahman IFS, Rajmil O, Kalkanli A, Molina JMC, Bocu K, Duarsa GWK, Çeker G, Serefoglu EC, Bahar F, Gherabi N, Kuroda S, Bouzouita A, Gudeloglu A, Ceyhan E, Hasan MSM, Musa MU, Motawi A, Cho CL, Taniguchi H, Ho CCK, Vazquez JFS, Mutambirwa S, Gungor ND, Bendayan M, Giulioni C, Baser A, Falcone M, Boeri L, Blecher G, Kheradmand A, Sethupathy T, Adriansjah R, Narimani N, Konstantinidis C, Nguyen TT, Japari A, et alRambhatla A, Shah R, Ziouziou I, Kothari P, Salvio G, Gul M, Hamoda T, Kavoussi P, Atmoko W, Toprak T, Birowo P, Ko E, Arafa M, Ghayda RA, Karthikeyan VS, Russo GI, Pinggera GM, Chung E, Harraz AM, Martinez M, Phuoc NHV, Tadros N, Saleh R, Savira M, Colpi GM, Zohdy W, Pescatori E, Park HJ, Fukuhara S, Tsujimura A, Rojas-Cruz C, Marino A, Mak SK, Amar E, Ibrahim W, Sindhwani P, Alhathal N, Busetto GM, Al Hashimi M, El-Sakka A, Ramazan A, Dimitriadis F, Timpano M, Jezek D, Altay B, Zylbersztejn DS, Wong MYC, Moon DG, Wyns C, Gamidov S, Akhavizadegan H, Franceschelli A, Aydos K, Quang N, Ashour S, Al Dayel A, Al-Marhoon MS, Micic S, Binsaleh S, Hussein A, Elbardisi H, Mostafa T, Ramsay J, Zachariou A, Abdelrahman IFS, Rajmil O, Kalkanli A, Molina JMC, Bocu K, Duarsa GWK, Çeker G, Serefoglu EC, Bahar F, Gherabi N, Kuroda S, Bouzouita A, Gudeloglu A, Ceyhan E, Hasan MSM, Musa MU, Motawi A, Cho CL, Taniguchi H, Ho CCK, Vazquez JFS, Mutambirwa S, Gungor ND, Bendayan M, Giulioni C, Baser A, Falcone M, Boeri L, Blecher G, Kheradmand A, Sethupathy T, Adriansjah R, Narimani N, Konstantinidis C, Nguyen TT, Japari A, Dolati P, Singh K, Ozer C, Sarikaya S, Sheibak N, Bosco NJ, Özkent MS, Le ST, Sokolakis I, Katz D, Smith R, Truong MN, Le TV, Huang Z, Deger MD, Arslan U, Calik G, Franco G, Rashed A, Kahraman O, Andreadakis S, Putra R, Balercia G, Khalafalla K, Cannarella R, Tuấn AĐ, El Meliegy A, Zilaitiene B, Ramirez MLZ, Giacone F, Calogero AE, Makarounis K, Jindal S, Hoai BN, Banthia R, Peña MR, Moorthy D, Adamyan A, Kulaksiz D, Kandil H, Sofikitis N, Salzano C, Jungwirth A, Banka SR, Mierzwa TC, Turunç T, Jain D, Avoyan A, Salacone P, Kadıoğlu A, Gupta C, Lin H, Shamohammadi I, Mogharabian N, Barrett T, Danacıoğlu YO, Crafa A, Daoud S, Malhotra V, Almardawi A, Selim OM, Moussa M, Haghdani S, Duran MB, Kunz Y, Preto M, Eugeni E, Nguyen T, Elshahid AR, Suyono SS, Parikesit D, Nada E, Orozco EG, Boitrelle F, Trang NTM, Jamali M, Nair R, Ruzaev M, Gadda F, Thomas C, Ferreira RH, Gul U, Maruccia S, Kanbur A, Kinzikeeva E, Abumelha SM, Kosgi R, Gokalp F, Soebadi MA, Paul GM, Sajadi H, Gupte D, Ambar RF, Sogutdelen E, Singla K, Basukarno A, Kim SHK, Gilani MAS, Nagao K, Brodjonegoro SR, Rezano A, Elkhouly M, Mazzilli R, Farsi HMA, Ba HN, Alali H, Kafetzis D, Long TQT, Alsaid S, Cuong HBN, Oleksandr K, Mustafa A, Acosta H, Pai H, Şahin B, Arianto E, Teo C, Jayaprakash SP, Rachman RI, Yenice MG, Sefrioui O, Priyadarshi S, Tanic M, Alfatlaw NK, Rizaldi F, Vishwakarma RB, Kanakis G, Cherian DT, Lee J, Galstyan R, Keskin H, Wurzacher J, Seno DH, Noegroho BS, Margiana R, Javed Q, Castiglioni F, Tanwar R, Puigvert A, Kaya C, Purnomo M, Yazbeck C, Amir A, Borges E, Bellavia M, Deswanto IA, KV V, Liguori G, Minh DH, Siddiqi K, Colombo F, Zini A, Patel N, Çayan S, Al-kawaz U, Ragab M, Hebrard GH, de la Rosette J, Efesoy O, Hoffmann I, Teixeira TA, Saylam B, Delgadillo D, Agarwal A, Global Andrology Forum. Global Practice Patterns and Variations in the Medical and Surgical Management of Non-Obstructive Azoospermia: Results of a World-Wide Survey, Guidelines and Expert Recommendations. World J Mens Health 2025; 43:92-122. [PMID: 38606867 PMCID: PMC11704169 DOI: 10.5534/wjmh.230339] [Show More Authors] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/05/2023] [Accepted: 12/07/2023] [Indexed: 04/13/2024] Open
Abstract
PURPOSE Non-obstructive azoospermia (NOA) is a common, but complex problem, with multiple therapeutic options and a lack of clear guidelines. Hence, there is considerable controversy and marked variation in the management of NOA. This survey evaluates contemporary global practices related to medical and surgical management for patients with NOA. MATERIALS AND METHODS A 56-question online survey covering various aspects of the evaluation and management of NOA was sent to specialists around the globe. This paper analyzes the results of the second half of the survey dealing with the management of NOA. Results have been compared to current guidelines, and expert recommendations have been provided using a Delphi process. RESULTS Participants from 49 countries submitted 336 valid responses. Hormonal therapy for 3 to 6 months was suggested before surgical sperm retrieval (SSR) by 29.6% and 23.6% of participants for normogonadotropic hypogonadism and hypergonadotropic hypogonadism respectively. The SSR rate was reported as 50.0% by 26.0% to 50.0% of participants. Interestingly, 46.0% reported successful SSR in <10% of men with Klinefelter syndrome and 41.3% routinely recommended preimplantation genetic testing. Varicocele repair prior to SSR is recommended by 57.7%. Half of the respondents (57.4%) reported using ultrasound to identify the most vascularized areas in the testis for SSR. One-third proceed directly to microdissection testicular sperm extraction (mTESE) in every case of NOA while others use a staged approach. After a failed conventional TESE, 23.8% wait for 3 months, while 33.1% wait for 6 months before proceeding to mTESE. The cut-off of follicle-stimulating hormone for positive SSR was reported to be 12-19 IU/mL by 22.5% of participants and 20-40 IU/mL by 27.8%, while 31.8% reported no upper limit. CONCLUSIONS This is the largest survey to date on the real-world medical and surgical management of NOA by reproductive experts. It demonstrates a diverse practice pattern and highlights the need for evidence-based international consensus guidelines.
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Affiliation(s)
- Amarnath Rambhatla
- Department of Urology, Henry Ford Health System, Vattikuti Urology Institute, Detroit, MI, USA
| | - Rupin Shah
- Division of Andrology, Department of Urology, Lilavati Hospital and Research Centre, Mumbai, India
| | - Imad Ziouziou
- Department of Urology, College of Medicine and Pharmacy, Ibn Zohr University, Agadir, Morocco
| | - Priyank Kothari
- Department of Urology, Topiwala National Medical College, B.Y.L Nair Charitable Hospital, Mumbai, India
| | - Gianmaria Salvio
- Department of Endocrinology, Polytechnic University of Marche, Ancona, Italy
| | - Murat Gul
- Department of Urology, Selçuk University School of Medicine, Konya, Turkey
| | - Taha Hamoda
- Department of Urology, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Urology, Faculty of Medicine, Minia University, Minia, Egypt
| | - Parviz Kavoussi
- Department of Reproductive Urology, Austin Fertility & Reproductive Medicine/Westlake IVF, Austin, TX, USA
| | - Widi Atmoko
- Department of Urology, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Tuncay Toprak
- Department of Urology, Fatih Sultan Mehmet Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ponco Birowo
- Department of Urology, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Edmund Ko
- Department of Urology, Loma Linda University Health, Loma Linda, CA, USA
| | - Mohamed Arafa
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
- Department of Andrology, Sexology and STIs, Faculty of Medicine, Cairo University, Cairo, Egypt
- Department of Urology, Weill Cornell Medical-Qatar, Doha, Qatar
| | - Ramy Abou Ghayda
- Urology Institute, University Hospitals, Case Western Reserve University, Cleveland, OH, USA
| | | | - Giorgio Ivan Russo
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | | | - Eric Chung
- Department of Urology, Princess Alexandra Hospital, University of Queensland, Brisbane, Australia
| | - Ahmed M. Harraz
- Department of Urology, Mansoura University Urology and Nephrology Center, Mansoura, Egypt
- Department of Surgery, Urology Unit, Farwaniya Hospital, Farwaniya, Kuwait
- Department of Urology, Sabah Al Ahmad Urology Center, Kuwait City, Kuwait
| | - Marlon Martinez
- Section of Urology, Department of Surgery, University of Santo Tomas Hospital, Manila, Philippines
| | | | - Nicholas Tadros
- Division of Urology, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Ramadan Saleh
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Missy Savira
- Department of Urology, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Giovanni M. Colpi
- Andrology and IVF Center, Next Fertility Procrea, Lugano, Switzerland
| | - Wael Zohdy
- Department of Andrology, Sexology and STIs, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Edoardo Pescatori
- Andrology and Reproductive Medicine Unit, Next Fertility GynePro, Bologna, Italy
| | - Hyun Jun Park
- Department of Urology, Pusan National University School of Medicine, Busan, Korea
- Medical Research Institute of Pusan National University Hospital, Busan, Korea
| | - Shinichiro Fukuhara
- Department of Urology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Akira Tsujimura
- Department of Urology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Cesar Rojas-Cruz
- Department of Urology, University Hospital of Rostock, Rostock, Germany
| | - Angelo Marino
- Reproductive Medicine Unit, ANDROS Day Surgery Clinic, Palermo, Italy
| | - Siu King Mak
- Department of Surgery, Union Hospital Reproductive Medicine Centre (Tsim Sha Tsui), Kowloon, China
| | - Edouard Amar
- Department of Urology, American Hospital of Paris, Paris, France
| | - Wael Ibrahim
- Department of Obstetrics Gynecology and Reproductive Medicine, Fertility Care Center in Cairo, Cairo, Egypt
| | - Puneet Sindhwani
- Department of Urology, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA
| | - Naif Alhathal
- Department of Urology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Gian Maria Busetto
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
| | - Manaf Al Hashimi
- Department of Urology, Burjeel Hospital, Abu Dhabi, UAE
- Department of Urology, Khalifa University College of Medicine and Health Science, Abu Dhabi, UAE
| | - Ahmed El-Sakka
- Department of Urology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Asci Ramazan
- 45Department of Urology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Fotios Dimitriadis
- 1st Urology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Massimiliano Timpano
- Department of Urology, Molinette Hospital, A.O.U. Città della Salute e della Scienza, University of Turin, Torino, Italy
| | - Davor Jezek
- Department for Transfusion Medicine and Transplantation Biology, Reproductive Tissue Bank, University Hospital Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Baris Altay
- Department of Urology, Ege University Medical School, Bornova, Turkey
| | - Daniel Suslik Zylbersztejn
- Department of Surgery, Discipline of Urology, Fleury Group and Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Michael YC Wong
- Department of Andrology, International Urology, Fertility and Gynecology Centre, Mount Elizabeth Hospital, Singapore
| | - Du Geon Moon
- Department of Urology, Korea University Guro Hospital, Seoul, Korea
| | - Christine Wyns
- Department of Gynaecology-Andrology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Safar Gamidov
- V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, Moscow, Russia
| | - Hamed Akhavizadegan
- Department of Urology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Kaan Aydos
- Department of Urology, Ankara University, Ankara, Turkey
| | - Nguyen Quang
- Center for Andrology and Sexual Medicine, Viet Duc University Hospital, Hanoi, Vietnam
- Department of Urology, Andrology and Sexual Medicine, University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
| | - Shedeed Ashour
- Department of Andrology, Sexology and STIs, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | | | - Sava Micic
- Department of Andrology, Uromedica Polyclinic, Belgrade, Serbia
| | - Saleh Binsaleh
- Division of Urology, Deparment of Surgery, Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Alayman Hussein
- Department of Urology, Faculty of Medicine, Minia University, Minia, Egypt
| | - Haitham Elbardisi
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
- Department of Urology, Weill Cornell Medical-Qatar, Doha, Qatar
| | - Taymour Mostafa
- Department of Andrology, Sexology and STIs, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | | | - Islam Fathy Soliman Abdelrahman
- Department of Andrology, Sexology and STIs, Faculty of Medicine, Cairo University, Cairo, Egypt
- Department of Andrology, Armed Forces College of Medicine, Cairo, Egypt
| | - Osvaldo Rajmil
- Department of Andrology, Fundació Puigvert, Barcelona, Spain
| | - Arif Kalkanli
- Department of Urology, Taksim Education and Research Hospital, Istanbul, Turkey
| | | | - Kadir Bocu
- Urology Department, Niğde Omer Halis Demir University, Faculty of Medicine, Sirnak, Turkey
| | | | - Gökhan Çeker
- Department of Urology, Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey
| | - Ege Can Serefoglu
- Department of Urology, Biruni University School of Medicine, Istanbul, Turkey
| | - Fahmi Bahar
- Andrology Section, Siloam Sriwijaya Hospital, Palembang, Indonesia
| | - Nazim Gherabi
- Department of Medicine, University of Algiers 1, Algiers, Algeria
| | - Shinnosuke Kuroda
- Department of Urology, Glickman Urological & Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | - Ahmet Gudeloglu
- Department of Urology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Erman Ceyhan
- Department of Urology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Mohamed Saeed Mohamed Hasan
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Muhammad Ujudud Musa
- Urology Unit, Department of Surgery, Federal Medical Center, Katsina State, Nigeria
| | - Ahmad Motawi
- Department of Andrology, Sexology and STIs, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Chak-Lam Cho
- Department of Surgery, S. H. Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong
| | - Hisanori Taniguchi
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan
| | | | | | - Shingai Mutambirwa
- Department of Urology, Dr. George Mukhari Academic Hospital, Sefako Makgatho Health Science University, Medunsa, South Africa
| | - Nur Dokuzeylul Gungor
- Department of Obstetrics and Gynecology, Reproductive Endocrinology and IVF Unit, School of Medicine, Bahcesehir University, Istanbul, Turkey
| | - Marion Bendayan
- Department of Reproductive Biology, Fertility Preservation, Andrology, CECOS, Poissy Hospital, Poissy, France
- Department of Biology, Reproduction, Epigenetics, Environment and Development, Paris Saclay University, UVSQ, INRAE, BREED, Jouy-en-Josas, France
| | - Carlo Giulioni
- Department of Urology, Polytechnic University of Marche, Ancona, Italy
| | - Aykut Baser
- Department of Urology, Faculty of Medicine, Bandırma Onyedi Eylül University, Balıkesir, Turkey
| | - Marco Falcone
- Department of Urology, Molinette Hospital, A.O.U. Città della Salute e della Scienza, University of Turin, Torino, Italy
| | - Luca Boeri
- Department of Urology, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Gideon Blecher
- Department of Surgery, School of Clinical Sciences, Monash University, Melbourne, Australia
- Department of Urology, The Alfred Hospital, Melbourne, Australia
| | - Alireza Kheradmand
- Department of Urology, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | - Ricky Adriansjah
- Department of Urology, Hasan Sadikin General Hospital, Faculty of Medicine of Padjadjaran University, Bandung, Indonesia
| | - Nima Narimani
- Department of Urology, School of Medicine, Hasheminejad Kidney Center, Iran University of Medical Science, Tehran, Iran
| | | | - Tuan Thanh Nguyen
- Department of Urology, University of California, Irvine, CA, USA
- Department of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
- Department of Urology, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Andrian Japari
- Department of Urology, Fertility Clinic, Telogorejo Hospital, Central Java, Indonesia
| | - Parisa Dolati
- Department of Animal Science, Faculty of Agriculture, University of Shiraz, Shiraz, Iran
| | - Keerti Singh
- Department of Preclinical and Health Sciences, Faculty of Medical Sciences, The University of West Indies, Bridgetown, Barbados
- Windsor Medical Centre, Bridgetown, Barbados
| | - Cevahir Ozer
- Department of Urology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Selcuk Sarikaya
- Department of Urology, Gulhane Research and Training Hospital, University of Health Sciences, Ankara, Turkey
| | - Nadia Sheibak
- Department of Anatomical Sciences, Reproductive Sciences and Technology Research Center, Iran University of Medical Sciences, Tehran, Iran
- Shahid Akbarabadi Clinical Research Development Unit (ShACRDU), Iran University of Medical Sciences, Tehran, Iran
| | - Ndagijimana Jean Bosco
- Department of Dermatology, Venereology & Andrology, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | | | - Sang Thanh Le
- Department of Urology, Faculty of Medicine, Minia University, Minia, Egypt
- Department of Urology, Fertility Clinic, Telogorejo Hospital, Central Java, Indonesia
| | - Ioannis Sokolakis
- Department of Urology, Martha-Maria Hospital Nuremberg, Nuremberg, Germany
| | - Darren Katz
- Men’s Health Melbourne, Victoria, Australia
- Department of Surgery, Western Precinct, University of Melbourne, Victoria, Australia
- Department of Urology, Western Health, Victoria, Australia
| | - Ryan Smith
- Department of Urology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Manh Nguyen Truong
- Department of Animal Science, Faculty of Agriculture, University of Shiraz, Shiraz, Iran
- Fertility Centre, Hanh Phuc International Hospital, Binh Duong, Vietnam
| | - Tan V. Le
- Department of Andrology, Binh Dan Hospital, Ho Chi Minh City, Vietnam
- Department of Urology and Andrology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Zhongwei Huang
- Department of Obstetrics and Gynaecology, National University Health Systems, Singapore
| | - Muslim Dogan Deger
- Department of Urology, Edirne Sultan 1st Murat State Hospital, Edirne, Turkey
| | - Umut Arslan
- Department of Urology, Fatih Sultan Mehmet Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Gokhan Calik
- Department of Urology, Istanbul Medipol University, Istanbul, Turkey
| | - Giorgio Franco
- Department of Urology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Ayman Rashed
- 123Department of Urology, Faculty of Medicine, 6th of October University, Giza, Egypt
| | - Oguzhan Kahraman
- Department of Urology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | | | - Rosadi Putra
- Department of Urology, RSUD Ciawi Regional General Hospital, West Java, Indonesia
| | - Giancarlo Balercia
- Department of Endocrinology, Polytechnic University of Marche, Ancona, Italy
| | - Kareim Khalafalla
- Department of Urology, Princess Alexandra Hospital, University of Queensland, Brisbane, Australia
- Department of Urology, University of Illinois, Chicago, IL, USA
| | - Rossella Cannarella
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Anh Đặng Tuấn
- Tam Anh IVF Center, Tam Anh General Hospital, Hanoi, Vietnam
| | - Amr El Meliegy
- Department of Andrology, Sexology and STIs, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Birute Zilaitiene
- Institute of Endocrinology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | - Filippo Giacone
- HERA Center, Unit of Reproductive Medicine, Sant'Agata Li Battiati, Catania, Italy
| | - Aldo E. Calogero
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | | | - Sunil Jindal
- Department of Andrology & Reproductive Medicine, Jindal Hospital & Fertility Center, Meerut, India
| | - Bac Nguyen Hoai
- Department of Andrology and Sexual Medicine, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Ravi Banthia
- Department of Urology, Western General Hospital, Edinburgh, UK
| | - Marcelo Rodriguez Peña
- Institute of Gynecology and Fertility (IFER), University of Buenos Aires, Buenos Aires, Argentina
| | - Dharani Moorthy
- IVF Department, Swarupa Fertility & IVF Centre, Vijayawada, India
| | - Aram Adamyan
- Department of Urology, Astghik Medical Center, Yerevan, Armenia
| | - Deniz Kulaksiz
- Department of Obstetrics and Gynecology, Kanuni Training and Research Hospital, University of Health Sciences, Trabzon, Turkey
| | | | - Nikolaos Sofikitis
- Department of Urology, Ioannina University School of Medicine, Ioannina, Greece
| | - Ciro Salzano
- PO San Giovanni Bosco, ASL Napoli 1 Centro, Napoli, Italy
| | | | - Surendra Reddy Banka
- Department of Andrology, Androcare Institute of Andrology and Men's Health, Hyderabad, India
| | - Tiago Cesar Mierzwa
- Department of Urology, Centro Universitario em Saude do ABC, Santo André, Brazil
| | - Tahsin Turunç
- Urology Clinic, Iskenderun Gelisim Hospital, Iskenderun, Turkey
| | - Divyanu Jain
- Department of Obstetrics and Gynecology, Jaipur Golden Hospital, New Delhi, India
| | - Armen Avoyan
- Department of Obstetrics and Gynecology, Kanuni Training and Research Hospital, University of Health Sciences, Trabzon, Turkey
| | - Pietro Salacone
- Andrology and Pathophysiology of Reproduction Unit, Santa Maria Goretti Hospital, Latina, Italy
| | - Ateş Kadıoğlu
- Section of Andrology, Department of Urology, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - Chirag Gupta
- Department of Urology, Jaipur National University, Jaipur, India
| | - Haocheng Lin
- Department of Urology, Peking University Third Hospital, Peking University, Beijing, China
| | - Iman Shamohammadi
- Department of Urology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nasser Mogharabian
- Sexual Health and Fertility Research Center, Shahroud University of Medical Sciences, Shahroud, Iran
| | | | - Yavuz Onur Danacıoğlu
- Department of Urology, University of Health Science, Istanbul Bakırköy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Andrea Crafa
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Salima Daoud
- Laboratory of Histo-Embryology and Reproductive Biology, Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Vineet Malhotra
- Department of Urology and Andrology, VNA Hospital, New Delhi, India
| | - Abdulmalik Almardawi
- Department of Urology, Prince Sultan Millitary Medical City, Riyadh, Saudi Arabia
| | - Osama Mohamed Selim
- Department of Andrology, Sexology and STIs, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamad Moussa
- Department of Urology, Lebanese University, Beirut, Lebanon
- Department of Urology, Al Zahraa Hospital, UMC, Beirut, Lebanon
| | - Saeid Haghdani
- Andrology Research Center, Yazd Reproductive Science Institute, Isfahan Fertility and Infertility Center, Isfahan, Iran
| | - Mesut Berkan Duran
- Department of Urology, Pamukkale University School of Medicine, Denizli, Turkey
| | - Yannic Kunz
- Department of Urology, University Hospital Innsbruck, Innsbruck, Austria
| | - Mirko Preto
- Department of Urology, Molinette Hospital, A.O.U. Città della Salute e della Scienza, University of Turin, Torino, Italy
| | - Elena Eugeni
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
- Department of Medicine and Medical Specialties, Division of Medical Andrology and Endocrinology of Reproduction, University of Terni, Terni, Italy
| | - Thang Nguyen
- Department of Obstetrics and Gynecology, Kanuni Training and Research Hospital, University of Health Sciences, Trabzon, Turkey
| | - Ahmed Rashad Elshahid
- 123Department of Urology, Faculty of Medicine, 6th of October University, Giza, Egypt
| | | | - Dyandra Parikesit
- Department of Urology, Faculty of Medicine, Universitas Indonesia Hospital, Depok, Indonesia
| | - Essam Nada
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt
| | | | - Florence Boitrelle
- Department of Reproductive Biology, Fertility Preservation, Andrology, CECOS, Poissy Hospital, Poissy, France
- Department of Biology, Reproduction, Epigenetics, Environment and Development, Paris Saclay University, UVSQ, INRAE, BREED, Jouy-en-Josas, France
| | | | - Mounir Jamali
- Department of Urology, Military Teaching Hospital, Rabat, Morocco
| | - Raju Nair
- Department of Reproductive Medicine, Mitera Hospital, Kottayam, India
| | | | - Franco Gadda
- Department of Urology, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Charalampos Thomas
- Urology and Neuro-Urology Unit, National Rehabilitation Center, Athens, Greece
| | | | - Umit Gul
- Private EPC Hospital, Adana, Turkey
| | - Serena Maruccia
- Department of Urology, ASST Santi Paolo e Carlo, San Paolo Hospital, Milano, Italy
| | - Ajay Kanbur
- Department of Andrology, Kanbur Clinic, Thane, India
- Department of Urosurgery, Jupiter Hospital, Thane, India
| | | | | | - Raghavender Kosgi
- Department of Andrology and Men’s Health, Apollo Hospitals, Hyderabad, India
| | - Fatih Gokalp
- Department of Urology, Faculty of Medicine, Hatay Mustafa Kemal University, Antakya, Turkey
| | | | - Gustavo Marquesine Paul
- Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Hesamoddin Sajadi
- Department of Urology, Bombay Hospital and Medical Research Center, Mumbai, India
| | - Deepak Gupte
- Department of Urology, Bolu Abant Izzet Baysal University, Bolu, Turkey
| | - Rafael F. Ambar
- Department of Urology, Centro Universitario em Saude do ABC, Santo André, Brazil
| | | | - Karun Singla
- Department of Urology, Dr. Dradjat Hospital, Serang, Indonesia
| | | | - Shannon Hee Kyung Kim
- Department of Urology, Macquarie University Faculty of Medicine and Health Sciences, Sydney, Australia
| | | | - Koichi Nagao
- Department of Urology, Toho University Faculty of Medicine, Tokyo, Japan
| | - Sakti Ronggowardhana Brodjonegoro
- Division of Urology, Department of Surgery, Prof. Dr. Sardjito Hospital, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Andri Rezano
- Andrology Study Program, Department of Biomedical Sciences, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Department of Biomedical Sciences, Faculty of Medicine, Universitas Padjadjaran, Sumedang, Indonesia
| | | | - Rossella Mazzilli
- Unit of Endocrinology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Hasan M. A. Farsi
- Department of Urology, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Hung Nguyen Ba
- Andrology Unit, ART Center, Vinmec Times City International Hospital, Hanoi, Vietnam
| | - Hamed Alali
- Department of Urology, Macquarie University Faculty of Medicine and Health Sciences, Sydney, Australia
| | | | - Tran Quang Tien Long
- Department of Obstetrics and Gynecology, Hanoi Obstetrics and Gynecology Hospital, Hanoi, Vietnam
| | - Sami Alsaid
- Department of Andrology, Sexology and STIs, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hoang Bao Ngoc Cuong
- Department of Surgery, Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Knigavko Oleksandr
- Department of Urology, Nephrology and Andrology Kharkiv National Medical University, Kharkiv, Ukraine
| | - Akhmad Mustafa
- Department of Urology, Hasan Sadikin General Hospital, Faculty of Medicine of Padjadjaran University, Bandung, Indonesia
| | - Herik Acosta
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
| | | | - Bahadır Şahin
- Department of Urology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Eko Arianto
- Department of Urology, Prof R.D. Kandou Hospital, Manado, Indonesia
| | - Colin Teo
- Department of Urology, Gleneagles Hospital, Singapore
| | | | - Rinaldo Indra Rachman
- Department of Urology, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Mustafa Gurkan Yenice
- Department of Urology, University of Health Science, Istanbul Bakırköy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | | | - Shivam Priyadarshi
- Department of Urology, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan, India
| | - Marko Tanic
- Department of Urology, General Hospital, Cuprija, Serbia
| | - Noor Kareem Alfatlaw
- Fertility Center of Al-Najaf, Al-Sadr Medical City, Babylon Health Directorate, Iraqi Ministry of Health, Baghdad, Iraq
| | - Fikri Rizaldi
- Andrology Study Program, Department of Biomedical Sciences, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Ranjit B. Vishwakarma
- Division of Andrology, Department of Urology, Lilavati Hospital and Research Centre, Mumbai, India
| | - George Kanakis
- Department of Endocrinology, Diabetes and Metabolism, Athens Naval & VA Hospital, Athens, Greece
| | | | - Joe Lee
- Department of Urology, National University Hospital, Singapore
| | - Raisa Galstyan
- Department of Urology, Yerevan State Medical University, Yerevan, Armenia
| | - Hakan Keskin
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Janan Wurzacher
- Department of Urology, University Hospital Innsbruck, Innsbruck, Austria
| | - Doddy Hami Seno
- Division of Urology, Department of Surgery, Persahabatan General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Bambang S Noegroho
- Department of Urology, Hasan Sadikin General Hospital, Faculty of Medicine of Padjadjaran University, Bandung, Indonesia
| | - Ria Margiana
- Department of Urology, Prof R.D. Kandou Hospital, Manado, Indonesia
- Department of Anatomy, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Master’s Programme Biomedical Sciences, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Urology Unit, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Qaisar Javed
- Department of Urology, Al-Ahlia Hospital, Abu Dhabi, UAE
| | | | | | - Ana Puigvert
- Department of Obstetrics and Gynecology, Reproductive Endocrinology and IVF Unit, School of Medicine, Bahcesehir University, Istanbul, Turkey
- Institute of Andrology and Sexual Medicine (IANDROMS), Barcelona, Spain
| | - Coşkun Kaya
- Department of Urology, Health Science University Eskisehir City HPRH, Eskisehir, Turkey
| | | | - Chadi Yazbeck
- Department of Obstetrics Gynecology and Reproductive Medicine, Reprogynes Medical Institute, Paris, France
| | - Azwar Amir
- Department of Urology, Dr Wahidin Sudirohusodo Hospital, Makassar, Indonesia
| | - Edson Borges
- IVF Department, Fertility Assisted Fertilization Center, São Paulo, Brazil
| | - Marina Bellavia
- Andrology and IVF Center, Next Fertility Procrea, Lugano, Switzerland
| | - Isaac Ardianson Deswanto
- Department of Urology, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Vinod KV
- Department of Urology, Cure & SK Hospital, Trivandrum, India
| | | | - Dang Hoang Minh
- Department of Urology, Andrology and Sexual Medicine, University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
| | | | - Fulvio Colombo
- Andrology and Reproductive Medicine Unit, Next Fertility GynePro, Bologna, Italy
| | - Armand Zini
- Department of Surgery, McGill University, Montreal, QC, Canada
| | - Niket Patel
- Akanksha Hospital and Research Institute, Anand, Gujarat, India
| | - Selahittin Çayan
- Department of Urology, University of Mersin School of Medicine, Mersin, Turkey
| | - Ula Al-kawaz
- High Institute for Infertility Diagnosis and Assisted Reproductive Technologies, Al-Nahrain University, Baghdad, Iraq
| | - Maged Ragab
- Department of Andrology, Tanta University, Tanta, Egypt
| | | | | | - Ozan Efesoy
- Department of Andrology, Tanta University, Tanta, Egypt
| | - Ivan Hoffmann
- Department of Reproductive Medicine and Andrology, University Clinic Halle (Saale), Halle, Germany
- Reproductive Center Dr. Hoffmann, Berlin, Germany
| | - Thiago Afonso Teixeira
- Division of Urology, University Hospital, Federal University of Amapa, Macapá, Brazil
- Men’s Health Study Group, Institute for Advanced Studies, University of São Paulo, São Paulo, Brazil
- Androscience-Science and Innovation Center and High Complexity Clinical and Research Andrology Laboratory, São Paulo, Brazil
| | - Barış Saylam
- Department of Urology, University of Mersin School of Medicine, Mersin, Turkey
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11
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Cheng NM, Huang WJ, Huang CY, Chen YJ, Ho CH. Clinical outcomes of round spermatid injection vs intracytoplasmic sperm injection: The role of hormonal pretreatment for nonobstructive azoospermia. J Chin Med Assoc 2025; 88:52-57. [PMID: 39444049 DOI: 10.1097/jcma.0000000000001184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2024] Open
Abstract
BACKGROUND Round spermatid injection (ROSI) into oocytes offers men with nonobstructive azoospermia (NOA) the opportunity to have biological offspring in cases where mature spermatozoa are not detected. However, the clinical outcomes of ROSI remain poor. This study compared the outcomes of ROSI with intracytoplasmic sperm injection (ICSI) and investigated the effect of hormonal pretreatment. METHODS This retrospective cohort study enrolled infertile couples undergoing either ROSI or ICSI at the reproductive center in Taipei Veterans General Hospital. The administration of selective estrogen receptor modulators, gonadotropins, and aromatase inhibitors in male patients were recorded. Relevant hormonal markers and biochemical parameters were determined. The outcomes of ROSI and ICSI were assessed based on fertilization rate, implantation rate, and live birth rate. RESULTS A total of 36 couples were recruited in the ROSI group, whereas 39 couples were recruited in the ICSI group for the analysis. Patients in each group demonstrated similar characteristics, except for a higher proportion of male patients in the ROSI group who were pretreated with anastrozole. The fertilization rate and implantation rate were similar between ROSI and ICSI groups after adjusting for confounding variables. The live birth rate was significantly lower in the ROSI group (8.3%) than in the ICSI group (30.8%) before and after adjusting for confounding variables. CONCLUSION ROSI demonstrated fertilization and implantation rates comparable to those of ICSI for male patient with NOA undergoing testicular sperm extraction surgery. Anastrozole may improve the outcomes of ROSI into oocytes. Further studies evaluating the effect of anastrozole administration on ROSI outcomes are warranted.
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Affiliation(s)
- Nai-Ming Cheng
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - William J Huang
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Urology, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Shu-Tien Urological Science Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Chen-Yu Huang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Obstetrics and Gynecology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Yi-Jen Chen
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Obstetrics and Gynecology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Chi-Hong Ho
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Obstetrics and Gynecology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Obstetrics and Gynecology, School of Medicine, National Defense Medical Center, Taipei, Taiwan, ROC
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12
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Rambhatla A, Shah R, Pinggera GM, Mostafa T, Atmoko W, Saleh R, Chung E, Hamoda T, Cayan S, Jun Park H, Kadioglu A, Hubbard L, Agarwal A. Pharmacological therapies for male infertility. Pharmacol Rev 2024; 77:PHARMREV-AR-2023-001085. [PMID: 39433442 DOI: 10.1124/pharmrev.124.001085] [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: 06/04/2024] [Revised: 09/25/2024] [Accepted: 10/15/2024] [Indexed: 10/23/2024] Open
Abstract
Male factor infertility is a multifaceted problem that affects approximately 50% of couples suffering from infertility. Causes of male infertility include endocrine disturbances, gonadotoxins, genetic abnormalities, varicocele, malignancies, infections, congenital or acquired urogenital abnormalities, iatrogenic factors, immunological factors, and idiopathic reasons. There are a variety of treatment options for male infertility, depending on the underlying cause(s). These can include surgical treatments, medical/hormonal therapies, and assisted reproductive techniques (ART), which can be combined with surgical sperm retrieval (SSR) if necessary. In this review article, the pharmacological therapies for male infertility are grouped by their underlying causes. Some of these therapies are targeted and specific, while others are used empirically to treat idiopathic male infertility. This will include treatments to optimize infertility in patients who have hypogonadism, ejaculatory dysfunction, infections, or idiopathic male infertility. Finally, we will provide an overview of the future directions of pharmacological therapies for male infertility. Significance Statement Male infertility is a significant worldwide problem. Detailed knowledge of the pharmacological therapies available will ensure the prescription of appropriate therapy and avoid the use of unnecessary or harmful treatments.
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Affiliation(s)
| | - Rupin Shah
- Division of Andrology, Department of Urology,, Lilavati Hospital and Research Centre,, Mexico
| | | | | | - Widi Atmoko
- Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Indonesia
| | | | - Eric Chung
- Urology, University of Queensland, Australia
| | | | | | - Hyun Jun Park
- Medical Research Institute of Pusan National University Hospital, Korea, Democratic People's Republic of
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13
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Esteves SC, Achermann APP, Miyaoka R, Verza S, Fregonesi A, Riccetto CLZ. Clinical factors impacting microdissection testicular sperm extraction success in hypogonadal men with nonobstructive azoospermia. Fertil Steril 2024; 122:636-647. [PMID: 38909671 DOI: 10.1016/j.fertnstert.2024.06.013] [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: 02/22/2024] [Revised: 06/09/2024] [Accepted: 06/17/2024] [Indexed: 06/25/2024]
Abstract
OBJECTIVE To explore factors influencing microdissection testicular sperm extraction (micro-TESE) success in hypogonadal men with nonobstructive azoospermia (NOA). DESIGN A cohort study. SETTING University-affiliated male reproductive health center. PATIENT(S) A total of 616 consecutive patients with NOA and hypogonadism (total testosterone [T] levels <350 ng/dL) underwent micro-TESE between 2014 and 2021. All patients had no prior sperm retrieval (SR) history. INTERVENTION(S) Patients aged 23-55 years underwent comprehensive clinical, laboratory, and histopathological diagnostic evaluation for NOA and were further categorized into two cohorts on the basis of pre-SR hormonal stimulation. MAIN OUTCOME MEASURE(S) A multivariable logistic regression analysis explored the associations between patient variables and micro-TESE success, defined as the presence of viable spermatozoa in extracted specimens. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were computed to assess the relationship between SR success and relevant predictors. Sperm retrieval rates were compared between patients receiving or not hormonal stimulation, and logistic regression analysis evaluated the effect of baseline follicle-stimulating hormone levels (i.e., normogonadotropic vs. hypergonadotropic classes) on SR success. RESULT(S) The overall micro-TESE success rate was 56.6%. Baseline follicle-stimulating hormone levels (aOR, 0.97; 95% CI, 0.94-0.99), pre-SR hormonal stimulation (aOR, 2.54; 95% CI, 1.64-3.93), presence of clinical varicocele (aOR, 0.05; 95% CI, 0.01-0.51), history of previous varicocelectomy (aOR, 2.55; 95% CI, 1.26-5.16), and testicular histopathology were independent predictors of SR success. Among hormone-pretreated patients, pre-micro-TESE T levels and delta T (an absolute increase in T levels from baseline) were associated with SR success. A pre-micro-TESE T level of 418.5 ng/dL (area under the curve value: 0.78) and a delta T of 258 ng/dL (area under the value: 0.76) distinguished patients with positive and negative SR outcomes. Subgroup analysis showed that pre-SR hormonal stimulation yielded a greater benefit for normogonadotropic patients than for those who were hypergonadotropic. CONCLUSION(S) This study underscores the association between clinical factors and micro-TESE success in hypogonadal men with NOA. Although causality is not established, our findings suggest that these patients may benefit from pre-SR interventions, particularly hormonal stimulation and varicocele repair. CLINICAL TRIAL REGISTRATION NUMBER NCT05110391.
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Affiliation(s)
- Sandro C Esteves
- ANDROFERT, Andrology and Human Reproduction Clinic, Campinas, São Paulo, Brazil; Division of Urology, Department of Surgery, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil.
| | - Arnold P P Achermann
- ANDROFERT, Andrology and Human Reproduction Clinic, Campinas, São Paulo, Brazil; Post-graduation Program in Surgical Sciences, University of Campinas (UNICAMP), São Paulo, Brazil
| | - Ricardo Miyaoka
- ANDROFERT, Andrology and Human Reproduction Clinic, Campinas, São Paulo, Brazil; Division of Urology, Department of Surgery, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Sidney Verza
- ANDROFERT, Andrology and Human Reproduction Clinic, Campinas, São Paulo, Brazil
| | - Adriano Fregonesi
- Division of Urology, Department of Surgery, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Cassio L Z Riccetto
- Division of Urology, Department of Surgery, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil; Post-graduation Program in Surgical Sciences, University of Campinas (UNICAMP), São Paulo, Brazil
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14
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Zohdy W, Shah R, Ho CCK, Calik G, Malhotra V, Erkan BK, Duran MB, Tsampoukas G, Radion G, Saleh R, Harraz AM, Kavoussi P, Chung E, Ko E, Boeri L, Kumar N, Çayan S, Rambhatla A, Rajmil O, Arafa M, Cannarella R, Raheem O, Mostafa T, Atmoko W, Hamoda TAAAM, Zini A, Agarwal A. Changes in Testosterone Levels Following Surgical Sperm Retrieval in Men with Non-Obstructive Azoospermia: Systematic Review and Meta-Analysis. World J Mens Health 2024; 42:42.e78. [PMID: 39344115 DOI: 10.5534/wjmh.240129] [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: 05/24/2024] [Revised: 06/01/2024] [Accepted: 06/12/2024] [Indexed: 10/01/2024] Open
Abstract
PURPOSE Surgical sperm retrieval (SSR) is used to extract spermatozoa for use with intracytoplasmic sperm injection in men with obstructive and non-obstructive azoospermia (NOA). The procedure may lead to segmental devascularization, postoperative fibrosis, and atrophy with a subsequent decrease in testosterone. The aim of the study is to investigate the impact of SSR on serum levels of total testosterone (TT), follicle-stimulating hormone (FSH), luteinizing hormone (LH) testicular volume, and sexual function in infertile azoospermic men. MATERIALS AND METHODS In this systematic review and meta-analysis (SRMA), we searched articles in "PubMed" and "Scopus" exploring the impact of SSR on TT, FSH, LH, and testicular volume. The full-text articles were screened to assess eligibility before data extraction, quality assessment, and meta-analysis. RESULTS Seventeen studies meeting the inclusion criteria were finally analyzed and included 1,685 infertile, azoospermic men. Patients underwent SSR and were followed in the postoperative period (one week to 32 months). The analysis showed a significant reduction in TT (mean difference [MD] 3.81 nmol/L, 95% confidence interval [CI] 0.55:7.06; p=0.02) compared to pre-SSR values. We also observed insignificant differences in serum FSH (MD 5.08 IU/L, 95% CI -5.6:15.8; p=0.35), LH (MD -2.96 IU/L, 95% CI -6.31:0.39; p=0.08), and no change in testicular volume (MD 0.07 mL, 95% CI -1.92:2.07; p=0.94) after SSR. Sexual dysfunction was associated with hypogonadism, depression, and anxiety, especially in men with unsuccessful SSR and Klinefelter syndrome. CONCLUSIONS The results of this SRMA indicate a significant reduction in TT after SSR. Sexual dysfunction after testicular sperm extraction and the potential negative impact of future SSR repeat should be considered during preoperative counseling.
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Affiliation(s)
- Wael Zohdy
- Department of Andrology, Sexology & STIs, Faculty of Medicine, Cairo University, Cairo, Egypt
- Global Andrology Forum, Moreland Hills, OH, USA
| | - Rupin Shah
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Lilavati Hospital and Research Centre, Mumbai, India
| | - Christopher Chee Kong Ho
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Surgery, School of Medicine, Taylor's University, Subang Jaya, Selangor, Malaysia
| | - Gokhan Calik
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Istanbul Medipol University, Istanbul, Türkiye
| | - Vineet Malhotra
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, VNA Hospital, New Delhi, India
| | - Bircan Kolbaşı Erkan
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Histology and Embryology, Istanbul Medipol University, Istanbul, Türkiye
| | - Mesut Berkan Duran
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Pamukkale University School of Medicine, Denizli, Türkiye
| | - Georgios Tsampoukas
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Princess Alexandra Hospital, Harlow, UK
- U-merge Ltd, Urology for Emerging Countries, London, UK
| | - Garaz Radion
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, University Hospital of Tübingen, Tübingen, Germany
| | - Ramadan Saleh
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt
- Ajyal IVF Center, Ajyal Hospital, Sohag, Egypt
| | - Ahmed M Harraz
- Global Andrology Forum, Moreland Hills, OH, USA
- Mansoura University Urology and Nephrology Center, Mansoura, Egypt
- Department of Surgery, Urology Unit, Farwaniya Hospital, Farwaniya, Kuwait
- Department of Urology, Sabah Al Ahmad Urology Center, Kuwait City, Kuwait
| | - Parviz Kavoussi
- Global Andrology Forum, Moreland Hills, OH, USA
- Austin Fertility & Reproductive Medicine/Westlake IVF, Austin, TX, USA
| | - Eric Chung
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Princess Alexandra Hospital, University of Queensland, Brisbane, Australia
| | - Edmund Ko
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Loma Linda University Health, Loma Linda, CA, USA
| | - Luca Boeri
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Naveen Kumar
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, All India Institute of Medical Sciences, Patna, India
| | - Selahittin Çayan
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, University of Mersin School of Medicine, Mersin, Türkiye
| | - Amarnath Rambhatla
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
| | - Osvaldo Rajmil
- Global Andrology Forum, Moreland Hills, OH, USA
- Andrology Department, Fundació Puigvert, Barcelona, Spain
- Instituto de Investigaciones Biomédicas Sant Pau, IIB-Sant Pau, Universitat Autò noma de Barcelona, Barcelona, Spain
| | - Mohamed Arafa
- Department of Andrology, Sexology & STIs, Faculty of Medicine, Cairo University, Cairo, Egypt
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
- Department of Urology, Weill Cornell Medical-Qatar, Doha, Qatar
| | - Rossella Cannarella
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
- Glickman Urological & Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Omer Raheem
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, The University of Chicago Medical Center, Pritzker School of Medicine, Chicago, IL, USA
| | - Taymour Mostafa
- Department of Andrology, Sexology & STIs, Faculty of Medicine, Cairo University, Cairo, Egypt
- Global Andrology Forum, Moreland Hills, OH, USA
| | - Widi Atmoko
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Cipto Mangunkusumo General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Taha Abo-Almagd Abdel-Meguid Hamoda
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Urology, Faculty of Medicine, Minia University, Minia, Egypt
| | - Armand Zini
- Global Andrology Forum, Moreland Hills, OH, USA
- Division of Urology, Department of Surgery, The Royal Victoria Hospital, McGill University, Montreal, QC, Canada
| | - Ashok Agarwal
- Global Andrology Forum, Moreland Hills, OH, USA
- Cleveland Clinic Foundation, Cleveland, OH, USA.
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15
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Catford SR, Katz D, McLachlan RI. Use of empirical medical therapies for idiopathic male infertility in Australia and New Zealand. Clin Endocrinol (Oxf) 2024; 100:565-574. [PMID: 38606557 DOI: 10.1111/cen.15059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 02/01/2024] [Accepted: 04/02/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVE Idiopathic male infertility is common, yet there is no approved treatment. This study aimed to understand practice patterns towards empirical medical therapy (EMT) for idiopathic male infertility in Australia and New Zealand (NZ). DESIGN Clinical members of the Endocrine Society of Australia, Fertility Society of Australia & NZ, and Urological Society of Australia & NZ were invited to complete a survey. Questions included demographics, EMT practice habits, and thoughts regarding infertility case scenarios. Unadjusted group differences between specialists, those with and without additional training in male infertility, and frequency of managing it were evaluated. RESULTS Overall, 147 of 2340 members participated (6.3%); majority were endocrinologists and gynaecologists. Participants were experienced; 35% had completed additional training in male infertility and 36.2% reported they frequently manage male infertility. Gynaecologists were more likely to manage male infertility and attend education courses than endocrinologists and urologists. Beliefs about the effect of EMT on sperm concentration and pregnancy did not differ between speciality types. Many respondents considered all patient scenarios suitable for EMT. Of medications, hCG and clomiphene were selected most. Two respondents indicated they would use testosterone to treat male infertility. CONCLUSIONS This study demonstrates common use of EMT in Australia and NZ for idiopathic male infertility. The breadth of responses reflects a lack of consensus within the current literature, highlighting the need for further research to clarify their role in the management of idiopathic male infertility.
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Affiliation(s)
- Sarah R Catford
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
- Reproductive Services, The Royal Women's Hospital, Melbourne, Victoria, Australia
- Department of Endocrinology and Diabetes, Alfred Health, Melbourne, Victoria, Australia
| | - Darren Katz
- Men's Health Melbourne, Melbourne, Victoria, Australia
- Department of Urology, Western Health, Melbourne, Victoria, Australia
- Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia
| | - Robert I McLachlan
- Centre for Endocrinology and Metabolism, Hudson Institute of Medical Research, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
- Monash IVF Group Pty Ltd, Melbourne, Victoria, Australia
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16
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Dong X, Ouyang H, Lou X, Xia F, Jin L, Wang S, Dai J. Dual-Activated H 2O 2-Responsive AIE Probes for Oocyte Quality Assessment. Anal Chem 2024; 96:5960-5967. [PMID: 38581372 DOI: 10.1021/acs.analchem.4c00160] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2024]
Abstract
Nonobstructive azoospermia (NOA) is an important cause of infertility, and intracytoplasmic sperm injection (ICSI) is the mainstay of treatment for these patients. In cases where a sufficient number of sperm (usually 1-2) is not available, the selection of oocytes for ICSI is a difficult problem that must be solved. Here, we constructed a dual-activated oxidative stress-responsive AIE probe, b-PyTPA. The strong donor-acceptor configuration of b-PyTPA leads to twisted intramolecular charge transfer (TICT) effect that quenches the fluorescence of the probe, however, H2O2 would specifically remove the boronatebenzyl unit and release a much weaker acceptor, which inhibits TICT and restores the fluorescence. In addition, the presence of a pyridine salt makes b-PyTPA more hydrophilic, whereas removal of the pyridine salt increases the hydrophobicity of PyTPA, which triggers aggregation and further enhances fluorescence. Thus, the higher the intracellular level of oxidative stress, the stronger the fluorescence. In vitro, this dual-activated fluorescent probe is capable of accurately detecting senescent cells (high oxidative stress). More importantly, b-PyTPA was able to characterize senescent oocytes, as assessed by the level of oxidative stress. It is also possible to identify high quality oocytes from those obtained for subsequent ICSI. In conclusion, this dual-activated oxidative stress-assessment probe enables the quality assessment of oocytes and has potential application in ICSI.
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Affiliation(s)
- Xiyuan Dong
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430034, China
| | - Hanzhi Ouyang
- State Key Laboratory of Biogeology and Environmental Geology, Faculty of Materials Science and Chemistry, China University of Geosciences, Wuhan 430074, China
| | - Xiaoding Lou
- State Key Laboratory of Biogeology and Environmental Geology, Faculty of Materials Science and Chemistry, China University of Geosciences, Wuhan 430074, China
| | - Fan Xia
- State Key Laboratory of Biogeology and Environmental Geology, Faculty of Materials Science and Chemistry, China University of Geosciences, Wuhan 430074, China
| | - Lei Jin
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430034, China
| | - Shixuan Wang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430034, China
| | - Jun Dai
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430034, China
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Esteves SC, Humaidan P, Ubaldi FM, Alviggi C, Antonio L, Barratt CLR, Behre HM, Jørgensen N, Pacey AA, Simoni M, Santi D. APHRODITE criteria: addressing male patients with hypogonadism and/or infertility owing to altered idiopathic testicular function. Reprod Biomed Online 2024; 48:103647. [PMID: 38367592 DOI: 10.1016/j.rbmo.2023.103647] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 10/25/2023] [Accepted: 10/26/2023] [Indexed: 02/19/2024]
Abstract
RESEARCH QUESTION Can a novel classification system of the infertile male - 'APHRODITE' (Addressing male Patients with Hypogonadism and/or infeRtility Owing to altereD, Idiopathic TEsticular function) - stratify different subgroups of male infertility to help scientists to design clinical trials on the hormonal treatment of male infertility, and clinicians to counsel and treat the endocrinological imbalances in men and, ultimately, increase the chances of natural and assisted conception? DESIGN A collaboration between andrologists, reproductive urologists and gynaecologists, with specialization in reproductive medicine and expertise in male infertility, led to the development of the APHRODITE criteria through an iterative consensus process based on clinical patient descriptions and the results of routine laboratory tests, including semen analysis and hormonal testing. RESULTS Five patient groups were delineated according to the APHRODITE criteria; (1) Hypogonadotrophic hypogonadism (acquired and congenital); (2) Idiopathic male infertility with lowered semen analysis parameters, normal serum FSH and normal serum total testosterone concentrations; (3) A hypogonadal state with lowered semen analysis parameters, normal FSH and reduced total testosterone concentrations; (4) Lowered semen analysis parameters, elevated FSH concentrations and reduced or normal total testosterone concentrations; and (5) Unexplained male infertility in the context of unexplained couple infertility. CONCLUSION The APHRODITE criteria offer a novel and standardized patient stratification system for male infertility independent of aetiology and/or altered spermatogenesis, facilitating communication among clinicians, researchers and patients to improve reproductive outcomes following hormonal therapy. APHRODITE is proposed as a basis for future trials of the hormonal treatment of male infertility.
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Affiliation(s)
- Sandro C Esteves
- ANDROFERT, Andrology and Human Reproduction Clinic, Campinas, Brazil.; Department of Surgery (Division of Urology), University of Campinas (UNICAMP), Campinas, Brazil.; Faculty of Health, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark..
| | - Peter Humaidan
- Fertility Clinic at Skive Regional Hospital, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Filippo M Ubaldi
- IVIRMA Global Research Alliance, GENERA, Clinica Valle Giulia, Rome, Italy
| | - Carlo Alviggi
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Leen Antonio
- Department of Endocrinology, Universitair Ziekenhuis Leuven, Leuven, Belgium
| | | | - Hermann M Behre
- Center for Reproductive Medicine and Andrology, University Medicine Halle, Halle, Germany
| | - Niels Jørgensen
- Department of Growth and Reproduction and International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Allan A Pacey
- Faculty of Biology, Medicine and Health, Core Technology Facility, University of Manchester, Manchester, UK
| | - Manuela Simoni
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.; Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero - Universitaria of Modena, Modena, Italy.; Unit of Andrology and Sexual Medicine of the Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero - Universitaria of Modena, Modena, Italy
| | - Daniele Santi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.; Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero - Universitaria of Modena, Modena, Italy.; Unit of Andrology and Sexual Medicine of the Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero - Universitaria of Modena, Modena, Italy
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18
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Achermann AP, Esteves SC. Prevalence and clinical implications of biochemical hypogonadism in patients with nonobstructive azoospermia undergoing infertility evaluation. F S Rep 2024; 5:14-22. [PMID: 38524219 PMCID: PMC10958705 DOI: 10.1016/j.xfre.2023.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 11/12/2023] [Indexed: 03/26/2024] Open
Abstract
Objective To investigate the prevalence and clinical implications of biochemical hypogonadism in infertile men with nonobstructive azoospermia (NOA). Design Cohort study. Setting University-affiliated tertiary center for male reproductive health. Patients 767 consecutive normogonadotropic or hypergonadotropic patients with NOA undergoing infertility evaluation from 2014 to 2021. Intervention Patients aged 23-55 years underwent comprehensive clinical, hormonal, genetic, semen analysis, and histopathology evaluations and were classified on the basis of predefined baseline follicle-stimulating hormone (12 IU/L) and total testosterone (350 ng/dL) serum levels cutpoints into four groups: hypergonadotropic hypogonadal, hypergonadotropic eugonadal, normogonadotropic hypogonadal, and normogonadotropic eugonadal. All patients were naïve regarding previous sperm retrieval (SR) or hormonal therapy use. Main Outcome Measures The period prevalence of biochemical hypogonadism, defined as testosterone levels of <350 ng/dL, and the distribution of patients per group were computed. The associations between hypogonadism, clinical factors, and SR success were evaluated using multivariable logistic regression analyses. Adjusted relative risks (aRRs) and 95% confidence intervals (CIs) were estimated to assess the association between SR and patient classification. Results The overall period prevalence of biochemical hypogonadism was 80.8% (95% CI 77.9%-83.4%). The prevalence of patients by group was hypergonadotropic hypogonadal (42.4%, 38.9%-45.9%), normogonadotropic hypogonadal (38.5%; 35.1%-41.9%), hypergonadotropic eugonadal (8.3%; 6.6%-10.5%), and normogonadotropic eugonadal (10.8%; 8.8%-13.2%). Reduced testicular volume and lower estradiol levels were associated with an increased likelihood of hypogonadism. Paternal age was also an independent predictor, with higher age linked to an increased likelihood of hypogonadism. Hypogonadism was less likely in patients with germ cell maturation arrest and more likely in those with Sertoli cell-only. Patients with hypergonadotropic hypogonadism had lower SR success than normogonadotropic eugonadal counterparts (aRR 0.611; 95% CI 0.398-0.855). In the subset of hypogonadal men, hypergonadotropic patients had lower SR success than normogonadotropic participants (aRR 0.632; 0.469-0.811). Conclusion The prevalence of biochemical hypogonadism among men with NOA is substantial. Hypogonadism is associated with testicular volume, estradiol levels, age, and histopathology patterns. This condition impacts SR success and emphasizes the need for improved care for men with NOA.
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Affiliation(s)
- Arnold P.P. Achermann
- ANDROFERT, Andrology and Human Reproduction Clinic, Campinas, São Paulo, Brazil
- Division of Urology, Department of Surgery, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Sandro C. Esteves
- ANDROFERT, Andrology and Human Reproduction Clinic, Campinas, São Paulo, Brazil
- Division of Urology, Department of Surgery, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
- Faculty of Health, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Amjad S, Munir A, Mushtaq S, Rehman R. Correlation of serum kisspeptin and leptin with non-obstructive azoospermia: A cross-sectional study in a subset of Karachi population. Pak J Med Sci 2024; 40:410-414. [PMID: 38356829 PMCID: PMC10862447 DOI: 10.12669/pjms.40.3.8125] [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: 05/06/2023] [Revised: 10/19/2023] [Accepted: 11/18/2023] [Indexed: 02/16/2024] Open
Abstract
Objective To determine the association of serum kisspeptin, leptin, and other hormonal profile with non-obstructive azoospermia (NOA) in infertile male subjects. Methods This cross-sectional study was conducted at Australian Concept Infertility Medical Center, and Ziauddin University, Karachi from March 2018 to March 2020. The duration of the study was two years. Serum samples of 106 azoospermic participants were taken. Division of the subjects was done on a histological basis into obstructive azoospermia (OA) n=36, NOA n=70 which were further divided into spermatid maturation arrest (SMA), n=41, and sertoli cell-only syndrome (SCOS) n=29. Serum kisspeptin and leptin were measured by ELISA (Cloud-Clone Corp). Results The follicle-stimulating hormone (FSH) (p<0.01), luteinizing hormone (LH) (p<0.01), thyroid-stimulating hormone (TSH) (p<0.01), and estradiol (p<0.01) was significantly high in the NOA group. However, kisspeptin was significantly decreased (p<0.01) in the NOA group. In the multivariate analysis after adjusting for other variables, the results showed that with the decrease in kisspeptin, the chances of being NOA were increased. Moreover, with the increase in Leptin, FSH, LH, and TSH the chances of being NOA were significantly enhanced. Conclusion Serum kisspeptin, leptin, FSH, LH, TSH, and estradiol can be a potential marker for NOA in terms of better diagnosis, targeted therapeutic management, and the decision to proceed with surgical intervention.
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Affiliation(s)
- Sofia Amjad
- Sofia Amjad, Ph.D. Department of Physiology, Azra Naheed Medical College, Superior University, Lahore, Pakistan
| | - Adnan Munir
- Adnan Munir, FCPS. Department of Andrology. Australian Concept Infertility, Medical Center Karachi, Karachi, Pakistan
| | - Shamim Mushtaq
- Shamim Mushtaq, Ph.D. Department of Biochemistry, Ziauddin University, Karachi, Pakistan
| | - Rehana Rehman
- Rehana Rehman, Ph.D. Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
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20
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Adriansyah RF, Margiana R, Supardi S, Narulita P. Current Progress in Stem Cell Therapy for Male Infertility. Stem Cell Rev Rep 2023; 19:2073-2093. [PMID: 37440145 DOI: 10.1007/s12015-023-10577-3] [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] [Accepted: 06/14/2023] [Indexed: 07/14/2023]
Abstract
Infertility has become one of the most common issues worldwide, which has negatively affected society and infertile couples. Meanwhile, male infertility is responsible for about 50% of infertility. Accordingly, a great number of researchers have focused on its treatment during the last few years; however, current therapies such as assisted reproductive technology (ART) are not effective enough in treating male infertility. Because of their self-renewal and differentiation capabilities and unlimited sources, stem cells have recently raised great hope in the treatment of reproductive system disorders. Stem cells are undifferentiated cells that can induce different numbers of specific cells, such as male and female gametes, demonstrating their potential application in the treatment of infertility. The present review aimed at identifying the causes and potential factors that influence male fertility. Besides, we highlighted the recent studies that investigated the efficiency of stem cells such as spermatogonial stem cells (SSCs), embryonic stem cells (ESCs), very small embryonic-like stem cells (VSELs), induced pluripotent stem cells (iPSCs), and mesenchymal stem cells (MSCs) in the treatment of various types of male infertility.
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Affiliation(s)
| | - Ria Margiana
- Andrology Program, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia.
- Dr. Soetomo General Academic Hospital, Surabaya, Indonesia.
- Department of Anatomy, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
- Master's Programme Biomedical Sciences, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
- Indonesia General Academic Hospital, Depok, Indonesia.
- Ciptomangunkusumo General Academic Hospital, Jakarta, Indonesia.
| | - Supardi Supardi
- Andrology Program, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Pety Narulita
- Andrology Program, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
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21
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Zhang B, Li F, Huang C, Xu L, Cao Z, Kang Y, Jiang W, Chang D. The correlation between clinical features and ultrastructure of testis of non-mosaic Klinefelter's syndrome patients with hypogonadism and androgen deficiency: A case report. Heliyon 2023; 9:e19940. [PMID: 37809695 PMCID: PMC10559353 DOI: 10.1016/j.heliyon.2023.e19940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 08/23/2023] [Accepted: 09/06/2023] [Indexed: 10/10/2023] Open
Abstract
Background Klinefelter Syndrome (KS) is a sex chromosomal syndrome usually with an extra X chromosome (47, XXY) in males, which has various phenotype (mosaicism 47, XXY/46, XY, or more chromosomes 48, XXXY, 49, XXXXY) and clinical features, including eunuchoid body proportions, abnormally long legs and arm span, gynecomastia, ynecomastia, absent or decreased facial and pubic hair, small hyalinized testes, small penis, below-normal verbal intelligence quotient, and learning difficulties. At present, there are no studies on the correlation between the clinical characteristics of patients with KS and the ultrastructural changes of intracellular organelles in testicular tissue in China. Case presentation Here we report the ultrastructure manifestation of the testis tissues in a KS patient with hypogonadism and androgen deficiency, to find a relationship between ultrastructural changes of organelles and spermatogenic dysfunction, clinical features, timing of surgery and metabolic abnormalities. It has been shown that the spermatocytes are absent and the ultrastructure of Sertoli cells and Leydig cells is obviously abnormal, which may lead to spermatogenic dysfunction, androgen deficiency, impaired glucose tolerance (IGT), and abdominal fat accumulation. Conclusions Based on the European Academy of Andrology (EAA) Gudilines on Klinefelter Syndrome, this study conducted a retrospective study on the diagnosis and treatment of one adult patient with KS, aiming to provide a standardized diagnosis and treatment for patients with KS. This study is also highly concerned with the correlation between the ultrastructural changes of target organs and clinical symptoms.
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Affiliation(s)
- Bin Zhang
- Department of Urology, The 940th Hospital of PLA Joint Logistic Support Force, Lanzhou, Gansu, China
| | - Fudong Li
- Department of Urology, The 940th Hospital of PLA Joint Logistic Support Force, Lanzhou, Gansu, China
| | - Chuang Huang
- Department of Urology, The 940th Hospital of PLA Joint Logistic Support Force, Lanzhou, Gansu, China
| | - Liuting Xu
- Department of Urology, The 940th Hospital of PLA Joint Logistic Support Force, Lanzhou, Gansu, China
| | - Zhigang Cao
- Department of Urology, The 940th Hospital of PLA Joint Logistic Support Force, Lanzhou, Gansu, China
| | - Yafen Kang
- Department of Urology, The 940th Hospital of PLA Joint Logistic Support Force, Lanzhou, Gansu, China
| | - Wei Jiang
- Convalescent Section First of Convalescent Zone Second, Air Force Hangzhou Secret Service Rehabilitation Center, Hangzhou, Zhejiang, China
| | - Dehui Chang
- Department of Urology, The 940th Hospital of PLA Joint Logistic Support Force, Lanzhou, Gansu, China
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22
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Flannigan R, Tadayon Najafabadi B, Violette PD, Jarvi K, Patel P, Bach PV, Domes T, Zini A, Grober E, Mak V, Fischer MA, Chan P, Lo K, Chow V, Wu C, Grantmyre J, Patry G. 2023 Canadian Urological Association guideline: Evaluation and management of azoospermia. Can Urol Assoc J 2023; 17:228-240. [PMID: 37581550 PMCID: PMC10426420 DOI: 10.5489/cuaj.8445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Affiliation(s)
- Ryan Flannigan
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
- Department of Urology, Weill Cornell Medicine, New York, NY, United States
| | | | - Philippe D. Violette
- Departments of Surgery and Health Research Methods Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Keith Jarvi
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Premal Patel
- Division of Urology, Department of Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - Phil Vu Bach
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Trustin Domes
- Division of Urology, Department of Surgery, University of Saskatchewan, Saskatoon, SK, Canada
| | - Armand Zini
- Division of Urology, Department of Surgery, McGill University, Montreal, QC, Canada
| | - Ethan Grober
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Victor Mak
- Division of Urology, Department of Surgery, Mackenzie Health, Richmond Hill, ON, Canada
| | - Marc Anthony Fischer
- Departments of Surgery and Health Research Methods Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Peter Chan
- Division of Urology, Department of Surgery, McGill University, Montreal, QC, Canada
| | - Kirk Lo
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Victor Chow
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Chris Wu
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - John Grantmyre
- Division of Urology, Department of Surgery, Dalhousie University, Halifax, NS, Canada
| | - Genevieve Patry
- Division of Urology, Department of Surgery, Hôtel-Dieu De Lévis, Lévis, QC, Canada
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23
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Corona G, Sparano C, Rastrelli G, Vignozzi L, Maggi M. Developments and challenges for new and emergent preparations for male hypogonadism treatment. Expert Opin Investig Drugs 2023; 32:1071-1084. [PMID: 37943011 DOI: 10.1080/13543784.2023.2276760] [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: 04/03/2023] [Accepted: 10/24/2023] [Indexed: 11/10/2023]
Abstract
INTRODUCTION The specific role of testosterone (T) replacement therapy in patients with late onset hypogonadism is still conflicting. Several available preparations have been developed to restore either fertility and normal testosterone (T) levels (secondary hypogonadism) or just T levels (primary hypogonadism). AREAS COVERED Advantages and limitations related to available new treatments will be discussed in detail. In addition, possible news related to preparations in the pipeline will be discussed. EXPERT OPINION The selection of a specific T preparation should be adequately discussed with each subject. Transdermal T preparations are those that can preserve, after a unique morning administration, the circadian rhythmicity of T secretion. Conversely, short-acting preparations (such as oral or intranasal) need two- or three-times daily administration, potentially reducing patient compliance. Long acting T preparations, such as injectable T undecanoate have the advantage of bimestrial or trimestral administration, reducing the required number of administrations. The use of non-steroidal selective androgen receptor modulators (SARM), a heterogeneous class of compounds selectively acting on androgen receptor targets, remains investigational due to the lack of the full spectrum of T's action and the possible risk of side effects, despite their potential use in the treatment of muscle wasting and osteoporosis.
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Affiliation(s)
- Giovanni Corona
- Endocrinology Unit, Maggiore Hospital, Azienda AUSL Bologna, Bolognas, Italy
| | - Clotilde Sparano
- Endocrinology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
| | - Giulia Rastrelli
- Andrology, Female Endocrinology and Gender Incongruence Unit Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
| | - Linda Vignozzi
- Andrology, Female Endocrinology and Gender Incongruence Unit Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
| | - Mario Maggi
- Endocrinology Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
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24
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Bole R, Lundy SD, Vij S, Lipshultz LI, Lindsey JP, Torres-Anguiano JR, Eisenberg ML. Should a negative microsurgical testicular sperm extraction be repeated routinely? Fertil Steril 2023:S0015-0282(23)00585-X. [PMID: 37395689 DOI: 10.1016/j.fertnstert.2023.05.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 05/26/2023] [Indexed: 07/04/2023]
Affiliation(s)
- Raevti Bole
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Scott D Lundy
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Sarah Vij
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Larry I Lipshultz
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - John P Lindsey
- Scott Department of Urology, Baylor College of Medicine, Houston, Texas
| | | | - Michael L Eisenberg
- Male Reproductive Medicine and Surgery, Department of Urology and Obstetrics and Gynecology, School of Medicine, Stanford University, Stanford, California.
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25
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Foran D, Chen R, Jayasena CN, Minhas S, Tharakan T. The use of hormone stimulation in male infertility. Curr Opin Pharmacol 2023; 68:102333. [PMID: 36580771 DOI: 10.1016/j.coph.2022.102333] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 11/22/2022] [Indexed: 12/28/2022]
Abstract
Infertility affects 15% of couples worldwide and in approximately 50% of cases the cause is secondary to an abnormality of the sperm. However, treatment options for male infertility are limited and empirical use of hormone stimulation has been utilised. We review the contemporary data regarding the application of hormone stimulation to treat male infertility. There is strong evidence supporting the use of hormone stimulation in hypogonadotropic hypogonadism but there is inadequate evidence for all other indications.
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Affiliation(s)
- Daniel Foran
- Department of Metabolism, Digestion, and Reproduction, Imperial College London, London, United Kingdom.
| | - Runzhi Chen
- Department of Metabolism, Digestion, and Reproduction, Imperial College London, London, United Kingdom
| | - Channa N Jayasena
- Department of Metabolism, Digestion, and Reproduction, Imperial College London, London, United Kingdom
| | - Suks Minhas
- Department of Urology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, United Kingdom
| | - Tharu Tharakan
- Department of Metabolism, Digestion, and Reproduction, Imperial College London, London, United Kingdom; Department of Urology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, United Kingdom
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26
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Rastrelli G, Vignozzi L, Corona G, Maggi M. Pharmacotherapy of male hypogonadism. Curr Opin Pharmacol 2023; 68:102323. [PMID: 36525815 DOI: 10.1016/j.coph.2022.102323] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/30/2022] [Accepted: 11/07/2022] [Indexed: 12/15/2022]
Abstract
Hypogonadism is frequent with a prevalence of 2% in the general population. Hypogonadism may derive from any condition able to disrupt the hypothalamic-pituitary-testis (HPT) axis at one or more levels. Hypogonadism may be classified according to the age of onset, its potential reversibility and level of the HPT axis damage. The latter categorization is useful to decide on the treatment. Damages to the hypothalamus-pituitary may benefit from either GnRH, gonadotropin or T therapy with the former carrying the advantage of stimulating spermatogenesis. Conversely, when the testis is damaged, T therapy is the only option and restoration of spermatogenesis is not possible. Therefore, the choice of therapy is primarily based on the diagnosis and patients' needs and both should be carefully considered.
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Affiliation(s)
- Giulia Rastrelli
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Mario Serio Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Linda Vignozzi
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Mario Serio Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Giovanni Corona
- Endocrinology Unit, Medical Department, Azienda Usl, Maggiore-Bellaria Hospital, Bologna, Italy.
| | - Mario Maggi
- Endocrinology Unit, Mario Serio Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
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Testosterone Serum Levels Are Related to Sperm DNA Fragmentation Index Reduction after FSH Administration in Males with Idiopathic Infertility. Biomedicines 2022; 10:biomedicines10102599. [PMID: 36289860 PMCID: PMC9599665 DOI: 10.3390/biomedicines10102599] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/20/2022] [Accepted: 09/21/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose: Although a robust physiological rationale supports follicle stimulating hormone (FSH) use in male idiopathic infertility, useful biomarkers to evaluate its efficacy are not available. Thus, the primary aim of the study was to evaluate if testosterone serum levels are related to sperm DNA fragmentation (sDF) index change after FSH administration. The secondary aim was to confirm sDF index validity as a biomarker of FSH administration effectiveness in male idiopathic infertility. Methods: A retrospective, post-hoc re-analysis was performed on prospectively collected raw data of clinical trials in which idiopathic infertile men were treated with FSH and both testosterone serum levels and sDF were reported. Results: Three trials were included, accounting for 251 patients. The comprehensive analysis confirmed FSH’s beneficial effect on spermatogenesis detected in each trial. Indeed, an overall significant sDF decrease (p < 0.001) of 20.2% of baseline value was detected. Although sDF resulted to be unrelated to testosterone serum levels at baseline, a significant correlation was highlighted after three months of FSH treatment (p = 0.002). Moreover, testosterone serum levels and patients’ age significantly correlated with sDF (p = 0.006). Dividing the cohort into responders/not responders to FSH treatment according to sDF change, the FSH effectiveness in terms of sDF improvement was related to testosterone and male age (p = 0.003). Conclusion: Exogenous FSH administration in male idiopathic infertility is efficient in reducing sDF basal levels by about 20%. In terms of sDF reduction, 59.2% of the patients treated were FSH-responders. After three months of FSH administration, a significant inverse correlation between sDF and testosterone was detected, suggesting an association between the FSH-administration-related sDF improvement and testosterone serum levels increase. These observations lead to the hypothesis that FSH may promote communications or interactions between Sertoli cells and Leydig cells.
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Liu H, Zheng H, Li Y, Tang Y, Peng H, Li Q, Zhuang J, Zhou Y, Zhou Y, Tu X, Zhang X. "Seminal testosterone", rising viewpoint of local spermatogenesis in nonobstructive azoospermia: One center long-term bidirectional cohort study. Front Endocrinol (Lausanne) 2022; 13:992556. [PMID: 36568123 PMCID: PMC9772016 DOI: 10.3389/fendo.2022.992556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 11/07/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Reproductive hormones are a traditional good method to evaluate spermatogenesis but might not accurately represent local spermatogenesis. To find a more accurate method, seminal reproductive hormones were studied. METHODS A bidirectional cohort study was performed. A total of 126 infertile men from 2018 to 2019 were retrospectively analyzed. They were divided into nonobstructive azoospermia (NOA), oligozoospermia (OLZ) and normal (NOR) groups. A prospective study was conducted on patients in the NOA and OLZ groups for 2 years. Microscopic testicular sperm extraction was performed for NOA patients, who were divided into a focal spermatogenesis group (FS) and an idiopathic azoospermia group (IA). Drug treatment was for OLZ patients, who were divided into a valid group (VA) and an invalid group (IN). The differences in sperm parameters and reproductive hormones were compared. ANOSIM analysis was used between and within groups. Pearson correlation analysis, CO inertia analysis and Proctor's analysis were for relationships. ROC curve for the specificity and sensitivity. Time series analysis was for the trends between hormones and time. RESULTS The b-FSH, b-LH, s-T and ΔT in the NOA group were significantly higher than those in the OLZ and NOR groups. However, the s-FSH, s-E2, s-P, ΔFSH, ΔLH, ΔP and ΔE2 were lower. Thirty-one NOA patients underwent MTSE, of whom 12 had sperm (FS) and 19 had no sperm (IA). The s-FSH and s-E2 of the FS group were higher than those of the IA group. Twenty-six OLZ patients completed 30 days of treatment, of which 11 had an improved sperm count (VA) and 15 had no (IN). The ΔT of the VA group was higher than that of the IN group. After follow-up for 2 years, 18 patients' results showed that b-FSH, b-LH and s-T were different over time, with delays of 19, 3 and -19 days. SC is closely related to pH, s-FSH, s-LH, s-E2, s-P, s-T, b-FSH, b-LH, ΔFSH, ΔLH, ΔP, ΔE2 and ΔT. There were complex common trends and relationships between different kinds of hormones. s-FSH, s-LH, s-E2, s-P, s-T, b-FSH and b-LH were useful to judge spermatogenesis, of which s-T, b-FSH and b-LH were more sensitive. If s-T, b-FSH and b-LH reached 64.4, 9.4 and 4.7, respectively, their prediction performance was the strongest. CONCLUSION Seminal testosterone is sensitive for judging local spermatogenesis in nonobstructive azoospermia patients, which may be the direction of local spermatogenesis in nonobstructive azoospermia. CLINICAL TRIAL REGISTRATION http://www.chictr.org.cn/index.aspx, identifier ChiCTR2200060463.
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Affiliation(s)
- Huang Liu
- Department of Andrology, National Health Commission (NHC) Key Laboratory of Male Reproduction and Genetics, Guangdong Provincial Reproductive Science Institute (Guangdong Provincial Fertility Hospital), Human Sperm Bank of Guangdong Province, Guangzhou, China
- *Correspondence: Xiang’an Tu, ; Xinzong Zhang, ; Huang Liu,
| | - Houbin Zheng
- Department of Andrology, National Health Commission (NHC) Key Laboratory of Male Reproduction and Genetics, Guangdong Provincial Reproductive Science Institute (Guangdong Provincial Fertility Hospital), Human Sperm Bank of Guangdong Province, Guangzhou, China
| | - Yuehua Li
- Department of Andrology, National Health Commission (NHC) Key Laboratory of Male Reproduction and Genetics, Guangdong Provincial Reproductive Science Institute (Guangdong Provincial Fertility Hospital), Human Sperm Bank of Guangdong Province, Guangzhou, China
| | - Yuqian Tang
- Department of Andrology, National Health Commission (NHC) Key Laboratory of Male Reproduction and Genetics, Guangdong Provincial Reproductive Science Institute (Guangdong Provincial Fertility Hospital), Human Sperm Bank of Guangdong Province, Guangzhou, China
| | - Hongbo Peng
- Department of Clinical Laboratory, National Health Commission (NHC) Key Laboratory of Male Reproduction and Genetics, Guangdong Provincial Reproductive Science Institute (Guangdong Provincial Fertility Hospital), Human Sperm Bank of Guangdong Province, Guangzhou, China
| | - Qianyi Li
- Department of Andrology, National Health Commission (NHC) Key Laboratory of Male Reproduction and Genetics, Guangdong Provincial Reproductive Science Institute (Guangdong Provincial Fertility Hospital), Human Sperm Bank of Guangdong Province, Guangzhou, China
| | - Jiaming Zhuang
- Department of Andrology, National Health Commission (NHC) Key Laboratory of Male Reproduction and Genetics, Guangdong Provincial Reproductive Science Institute (Guangdong Provincial Fertility Hospital), Human Sperm Bank of Guangdong Province, Guangzhou, China
| | - Yingyi Zhou
- Department of Andrology, National Health Commission (NHC) Key Laboratory of Male Reproduction and Genetics, Guangdong Provincial Reproductive Science Institute (Guangdong Provincial Fertility Hospital), Human Sperm Bank of Guangdong Province, Guangzhou, China
| | - Yu Zhou
- Department of Andrology, National Health Commission (NHC) Key Laboratory of Male Reproduction and Genetics, Guangdong Provincial Reproductive Science Institute (Guangdong Provincial Fertility Hospital), Human Sperm Bank of Guangdong Province, Guangzhou, China
| | - Xiang’an Tu
- Department of Urology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- *Correspondence: Xiang’an Tu, ; Xinzong Zhang, ; Huang Liu,
| | - Xinzong Zhang
- Department of Andrology, National Health Commission (NHC) Key Laboratory of Male Reproduction and Genetics, Guangdong Provincial Reproductive Science Institute (Guangdong Provincial Fertility Hospital), Human Sperm Bank of Guangdong Province, Guangzhou, China
- *Correspondence: Xiang’an Tu, ; Xinzong Zhang, ; Huang Liu,
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