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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 MY, 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, Tuân AÐ, 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 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 2024; 42:42.e42. [PMID: 38606867 DOI: 10.5534/wjmh.230339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [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 Ðăng Tuân
- 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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Shah R, Rambhatla A, Atmoko W, Martinez M, Ziouziou I, Kothari P, Tadros N, Phuoc NHV, Kavoussi P, Harraz A, Salvio G, Gul M, Hamoda T, Toprak T, Birowo P, Ko E, Arafa M, Ghayda RA, Karthikeyan VS, Saleh R, Russo GI, Pinggera GM, Chung E, 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 MY, Moon DG, Wyns C, Gamidov S, Akhavizadegan H, Franceschelli A, Aydos K, Quang VN, Ashour S, Al Dayel A, Al-Marhoon MS, Micic S, Binsaleh S, Hussein A, Elbardisi H, Mostafa T, Taha E, Ramsay J, Zachariou A, Abdelrahman IFS, Rajmil O, Kalkanli A, Molina JMC, Bocu K, Duarsa GWK, Ceker G, Serefoglu EC, Bahar F, Gherabi N, Kuroda S, Bouzouita A, Gudeloglu A, Ceyhan E, Hasan MSM, Musa MU, Motawi A, Chak-Lam C, 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, Tuân AÐ, 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 S, Quang N, Kosgi R, Gokalp F, Soebadi MA, Paul GM, Sajadi H, Gupte D, Ambar RF, Sogutdelen E, Singla K, Basurkano 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, Paghdar S, Priyadarshi S, Tanic M, Alfatlawy 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, V VK, Liguori G, Minh DH, Siddiqi K, Colombo F, Zini A, Patel N, Çayan S, Al-Kawaz U, Ragab M, Hebrard GH, Hoffmann I, Efesoy O, Saylam B, Agarwal A. Global Practice Patterns in the Evaluation of Non-Obstructive Azoospermia: Results of a World-Wide Survey and Expert Recommendations. World J Mens Health 2024; 42:42.e40. [PMID: 38606865 DOI: 10.5534/wjmh.230333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 11/27/2023] [Indexed: 04/13/2024] Open
Abstract
PURPOSE Non-obstructive azoospermia (NOA) represents the persistent absence of sperm in ejaculate without obstruction, stemming from diverse disease processes. This survey explores global practices in NOA diagnosis, comparing them with guidelines and offering expert recommendations. MATERIALS AND METHODS A 56-item questionnaire survey on NOA diagnosis and management was conducted globally from July to September 2022. This paper focuses on part 1, evaluating NOA diagnosis. Data from 367 participants across 49 countries were analyzed descriptively, with a Delphi process used for expert recommendations. RESULTS Of 336 eligible responses, most participants were experienced attending physicians (70.93%). To diagnose azoospermia definitively, 81.7% requested two semen samples. Commonly ordered hormone tests included serum follicle-stimulating hormone (FSH) (97.0%), total testosterone (92.9%), and luteinizing hormone (86.9%). Genetic testing was requested by 66.6%, with karyotype analysis (86.2%) and Y chromosome microdeletions (88.3%) prevalent. Diagnostic testicular biopsy, distinguishing obstructive azoospermia (OA) from NOA, was not performed by 45.1%, while 34.6% did it selectively. Differentiation relied on physical examination (76.1%), serum hormone profiles (69.6%), and semen tests (68.1%). Expectations of finding sperm surgically were higher in men with normal FSH, larger testes, and a history of sperm in ejaculate. CONCLUSIONS This expert survey, encompassing 367 participants from 49 countries, unveils congruence with recommended guidelines in NOA diagnosis. However, noteworthy disparities in practices suggest a need for evidence-based, international consensus guidelines to standardize NOA evaluation, addressing existing gaps in professional recommendations.
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Affiliation(s)
- Rupin Shah
- Division of Andrology, Department of Urology, Lilavati Hospital and Research Centre, Mumbai, India
- Global Andrology Forum, Moreland Hills, OH, USA
| | - Amarnath Rambhatla
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Henry Ford Health System, Vattikuti Urology Institute, Detroit, MI, USA
| | - Widi Atmoko
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Marlon Martinez
- Global Andrology Forum, Moreland Hills, OH, USA
- Section of Urology, Department of Surgery, University of Santo Tomas Hospital, Manila, Philippines
| | - Imad Ziouziou
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, College of Medicine and Pharmacy, Ibn Zohr University, Agadir, Morocco
| | - Priyank Kothari
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, B.Y.L Nair Ch Hospital, Topiwala National Medical College, Mumbai, India
| | - Nicholas Tadros
- Global Andrology Forum, Moreland Hills, OH, USA
- Division of Urology, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Nguyen Ho Vinh Phuoc
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Andrology, Binh Dan Hospital, Ho Chi Minh City, Vietnam
| | - Parviz Kavoussi
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Reproductive Urology, Austin Fertility & Reproductive Medicine/Westlake IVF, Austin, TX, USA
| | - Ahmed Harraz
- Global Andrology Forum, Moreland Hills, OH, USA
- 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
| | - Gianmaria Salvio
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Endocrinology, Polytechnic University of Marche, Ancona, Italy
| | - Murat Gul
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Selçuk University School of Medicine, Konya, Turkey
| | - Taha Hamoda
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Andrology, Faculty of Medicine, Assiut University, Asyut, Egypt
| | - Tuncay Toprak
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Fatih Sultan Mehmet Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ponco Birowo
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Edmund Ko
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Loma Linda University Health, Loma Linda, CA, USA
| | - Mohamed Arafa
- Global Andrology Forum, Moreland Hills, OH, USA
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
- Department of Urology, Weill Cornell Medical-Qatar, Doha, Qatar
| | - Ramy Abou Ghayda
- Global Andrology Forum, Moreland Hills, OH, USA
- Urology Institute, University Hospitals, Case Western Reserve University, Cleveland, OH, USA
| | | | - Ramadan Saleh
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Giorgio Ivan Russo
- Global Andrology Forum, Moreland Hills, OH, USA
- Urology Section, University of Catania, Catania, Italy
| | - Germar-Michael Pinggera
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, University Hospital Innsbruck, Innsbruck, Austria
| | - Eric Chung
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Princess Alexandra Hospital, University of Queensland, Brisbane, Australia
| | - Missy Savira
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, College of Medicine and Pharmacy, Ibn Zohr University, Agadir, Morocco
| | - Giovanni M Colpi
- Global Andrology Forum, Moreland Hills, OH, USA
- Andrology and IVF Center, Next Fertility Procrea, Lugano, Switzerland
| | - Wael Zohdy
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Andrology, Sexology & STIs, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Edoardo Pescatori
- Global Andrology Forum, Moreland Hills, OH, USA
- Andrology and Reproductive Medicine Unit, Gynepro Medical, Bologna, Italy
| | - Hyun Jun Park
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Pusan National University School of Medicine, Busan, Korea
- Medical Research Institute of Pusan National University Hospital, Busan, Korea
| | - Shinichiro Fukuhara
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Akira Tsujimura
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Cesar Rojas-Cruz
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, University Hospital of Rostock, Rostock, Germany
| | - Angelo Marino
- Global Andrology Forum, Moreland Hills, OH, USA
- Reproductive Medicine Unit, ANDROS Day Surgery Clinic, Palermo, Italy
| | - Siu King Mak
- Global Andrology Forum, Moreland Hills, OH, USA
- Union Hospital, Hong Kong SAR, China
| | - Edouard Amar
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, American Hospital of Paris, Paris, France
| | - Wael Ibrahim
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Obstetrics Gynaecology and Reproductive Medicine, Fertility Care Center in Cairo, Cairo, Egypt
| | - Puneet Sindhwani
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA
| | - Naif Alhathal
- Global Andrology Forum, Moreland Hills, OH, USA
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Gian Maria Busetto
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology and Organ Transplantation, University of Foggia, Foggia, Italy
| | - Manaf Al Hashimi
- Global Andrology Forum, Moreland Hills, OH, USA
- 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
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Asci Ramazan
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Fotios Dimitriadis
- Global Andrology Forum, Moreland Hills, OH, USA
- 1st Urology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Massimiliano Timpano
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Molinette Hospital, A.O.U. Città della Salute e della Scienza, University of Turin, Torino, Italy
| | - Davor Jezek
- Global Andrology Forum, Moreland Hills, OH, USA
- Department for Transfusion Medicine and Transplantation Biology, Reproductive Tissue Bank, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Baris Altay
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Ege University Medical School, Bornova, Izmir, Turkey
| | - Daniel Suslik Zylbersztejn
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Fleury Group and Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Michael Yc Wong
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Andrology, International Urology, Fertility and Gynecology Centre, Mount Elizabeth Hospital, Singapore
| | - Du Geon Moon
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Korea University Guro Hospital, Seoul, Korea
| | - Christine Wyns
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Gynaecology-Andrology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Safar Gamidov
- Global Andrology Forum, Moreland Hills, OH, USA
- V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, Moscow, Russia
| | - Hamed Akhavizadegan
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, School of Medicine, Hasheminejad Kidney Center, Iran University of Medical Science, Tehran, Iran
| | - Alessandro Franceschelli
- Global Andrology Forum, Moreland Hills, OH, USA
- Andrology Unit, University Hospital S. Orsola, Bologna, Italy
| | - Kaan Aydos
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Ankara University, Ankara, Turkey
| | - Vinh Nguyen Quang
- Global Andrology Forum, Moreland Hills, OH, USA
- Center for Andrology and Sexual Medicine, Viet Duc University Hospital, Hanoi, Vietnam
- Department of Urology, Can Tho University of Medicine and Pharmacy Hospital, Can Tho, Vietnam
| | - Shedeed Ashour
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Andrology, Sexology & STIs, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Adel Al Dayel
- Global Andrology Forum, Moreland Hills, OH, USA
- Men's Health Clinic Dammam, Dammam, Saudi Arabia
| | - Mohamed S Al-Marhoon
- Global Andrology Forum, Moreland Hills, OH, USA
- Division of Urology, Department of Surgery, Sultan Qaboos University, Muscat, Oman
| | - Sava Micic
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Andrology, Uromedica Polyclinic, Belgrade, Serbia
| | - Saleh Binsaleh
- Global Andrology Forum, Moreland Hills, OH, USA
- Division of Urology, Department of Surgery, Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Alayman Hussein
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Andrology, Faculty of Medicine, Assiut University, Asyut, Egypt
| | - Haitham Elbardisi
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
- Department of Urology, Weill Cornell Medical-Qatar, Doha, Qatar
| | - Taymour Mostafa
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Andrology, Sexology & STIs, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Emad Taha
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Andrology, Faculty of Medicine, Assiut University, Asyut, Egypt
| | - Jonathan Ramsay
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Andrology, Hammersmith Hospital, London, UK
| | - Athanasios Zachariou
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Ioannina University School of Medicine, Ioannina, Greece
| | - Islam Fathy Soliman Abdelrahman
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Andrology, Sexology & STIs, Faculty of Medicine, Cairo University, Cairo, Egypt
- Department of Andrology, Armed Forces College of Medicine, Cairo, Egypt
| | - Osvaldo Rajmil
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Andrology, Fundacio Puigvert, Barcelona, Spain
| | - Arif Kalkanli
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Taksim Education and Research Hospital, Istanbul, Turkey
| | - Juan Manuel Corral Molina
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Hospital Clínico de Barcelona, Barcelona, Spain
| | - Kadir Bocu
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Niğde Omer Halis Demir University Faculty of Medicine, Nigde, Turkey
| | - Gede Wirya Kusuma Duarsa
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Udayana University, Denpasar, Indonesia
| | - Gokhan Ceker
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey
| | - Ege Can Serefoglu
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Biruni University School of Medicine, Istanbul, Turkey
| | - Fahmi Bahar
- Global Andrology Forum, Moreland Hills, OH, USA
- Andrology Section, Siloam Sriwijaya Hospital, Palembang, Indonesia
| | - Nazim Gherabi
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Medicine, University of Algiers 1, Algiers, Algeria
| | - Shinnosuke Kuroda
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Glickman Urological & Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Abderrazak Bouzouita
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Anatomy, Faculty of Medicine, Faculty Tunis Manar, Tunis, Tunisia
| | - Ahmet Gudeloglu
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Erman Ceyhan
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Mohamed Saeed Mohamed Hasan
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Muhammad Ujudud Musa
- Global Andrology Forum, Moreland Hills, OH, USA
- Urology Unit, Department of Surgery, Federal Medical Center, Katsina State, Nigeria
| | - Ahmad Motawi
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Andrology, Sexology & STIs, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Cho Chak-Lam
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Surgery, S. H. Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong
| | - Hisanori Taniguchi
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan
| | - Christopher Chee Kong Ho
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Surgery, School of Medicine, Taylor's University, Selangor, Malaysia
| | | | - Shingai Mutambirwa
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Dr. George Mukhari Academic Hospital, Sefako Makgatho Health Science University, Medunsa, South Africa
| | - Nur Dokuzeylul Gungor
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Obstetrics and Gynecology, Reproductive Endocrinology and IVF Unit, School of Medicine, Bahcesehir University, Istanbul, Turkey
| | - Marion Bendayan
- Global Andrology Forum, Moreland Hills, OH, USA
- 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
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Polytechnic University of Marche, Ancona, Italy
| | - Aykut Baser
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Faculty of Medicine, Bandırma Onyedi Eylül University, Balıkesir, Turkey
| | - Marco Falcone
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Molinette Hospital, A.O.U. Città della Salute e della Scienza, University of Turin, Torino, Italy
| | - Luca Boeri
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Gideon Blecher
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Surgery, School of Clinical Sciences, Monash University, Melbourne, Australia
- Department of Urology, The Alfred Hospital, Melbourne, Australia
| | - Alireza Kheradmand
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Tamilselvi Sethupathy
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Obstetrics and Gynaecology, CK Medical Centre Hospital, Erode, India
| | - Ricky Adriansjah
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Hasan Sadikin General Hospital, Faculty of Medicine of Padjadjaran University, Bandung, Indonesia
| | - Nima Narimani
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, School of Medicine, Hasheminejad Kidney Center, Iran University of Medical Science, Tehran, Iran
| | - Charalampos Konstantinidis
- Global Andrology Forum, Moreland Hills, OH, USA
- Urology Department, General Hospital of Corinth, Corinth, Greece
| | - Tuan Thanh Nguyen
- Global Andrology Forum, Moreland Hills, OH, USA
- 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
- Global Andrology Forum, Moreland Hills, OH, USA
- Deparment of IVF, Fertility Clinic, Telogorejo Hospital, Semarang, Indonesia
| | - Parisa Dolati
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Animal Science, Faculty of Agriculture, University of Shiraz, Shiraz, Iran
| | - Keerti Singh
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Preclinical and Health Sciences, Faculty of Medical Sciences, The University of West Indies, Cave Hill Campus, Bridgetown, Barbados
- Windsor Medical Centre, Bridgetown, Barbados
| | - Cevahir Ozer
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Selcuk Sarikaya
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Gulhane Research and Training Hospital, University of Health Sciences, Ankara, Turkey
| | - Nadia Sheibak
- Global Andrology Forum, Moreland Hills, OH, USA
- 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
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Dermatology, Venereology & Andrology, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Mehmet Serkan Özkent
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Konya City Hospital, Konya, Turkey
| | - Sang Thanh Le
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Andrology, Binh Dan Hospital, Ho Chi Minh City, Vietnam
- Deparment of IVF, Fertility Clinic, Telogorejo Hospital, Semarang, Indonesia
| | - Ioannis Sokolakis
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Martha-Maria Hospital Nuremberg, Nuremberg, Germany
| | - Darren Katz
- Global Andrology Forum, Moreland Hills, OH, USA
- 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
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Manh Nguyen Truong
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Tan V Le
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
- Department of Urology and Andrology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Zhongwei Huang
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Obstetrics and Gynaecology, National University Health Systems, Singapore
| | - Muslim Dogan Deger
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Edirne Sultan 1st Murat State Hospital, Edirne, Turkey
| | - Umut Arslan
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Fatih Sultan Mehmet Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Gokhan Calik
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Istanbul Medipol University, Istanbul, Turkey
| | - Giorgio Franco
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Ayman Rashed
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Faculty of Medicine, 6th of October University, Giza, Egypt
| | - Oguzhan Kahraman
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Ankara University, Ankara, Turkey
| | - Sotiris Andreadakis
- Global Andrology Forum, Moreland Hills, OH, USA
- Private Practice, Thessaloniki, Greece
| | - Rosadi Putra
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, RSUD Ciawi Regional General Hospital, West Java, Indonesia
| | - Giancarlo Balercia
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Endocrinology, Polytechnic University of Marche, Ancona, Italy
| | - Kareim Khalafalla
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
- Department of Urology, University of Illinois, Chicago, IL, USA
| | - Rossella Cannarella
- Global Andrology Forum, Moreland Hills, OH, USA
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Anh Ðăng Tuân
- Global Andrology Forum, Moreland Hills, OH, USA
- Tam Anh IVF Center, Tam Anh General Hospital, Hanoi, Vietnam
| | - Amr El Meliegy
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Andrology, Sexology & STIs, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Birute Zilaitiene
- Global Andrology Forum, Moreland Hills, OH, USA
- Institute of Endocrinology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | - Filippo Giacone
- Global Andrology Forum, Moreland Hills, OH, USA
- HERA Center, Unit of Reproductive Medicine, Sant'Agata Li Battiati, Catania, Italy
| | - Aldo E Calogero
- Global Andrology Forum, Moreland Hills, OH, USA
- Urology Section, University of Catania, Catania, Italy
| | - Konstantinos Makarounis
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology and Andrology, Locus Medicus, Athens, Greece
| | - Sunil Jindal
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Andrology & Reproductive Medicine, Jindal Hospital & Fertility Center, Meerut, India
| | - Bac Nguyen Hoai
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Andrology and Sexual Medicine, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Ravi Banthia
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Western General Hospital, Edinburgh, UK
| | - Marcelo Rodriguez Peña
- Global Andrology Forum, Moreland Hills, OH, USA
- Instituto de Ginecología y Fertilidad (IFER), Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Dharani Moorthy
- Global Andrology Forum, Moreland Hills, OH, USA
- IVF Department, Swarupa fertility & IVF Centre, Vijayawada, India
| | - Aram Adamyan
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Astghik Medical Center, Yerevan, Armenia
| | - Deniz Kulaksiz
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Obstetrics and Gynecology, Kanuni Training and Research Hospital, University of Health Sciences, Trabzon, Turkey
| | - Hussein Kandil
- Global Andrology Forum, Moreland Hills, OH, USA
- Fakih IVF Fertility Center, Abu Dhabi, UAE
| | - Nikolaos Sofikitis
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Ioannina University School of Medicine, Ioannina, Greece
| | - Ciro Salzano
- Global Andrology Forum, Moreland Hills, OH, USA
- PO San Giovanni Bosco, ASL Napoli 1 Centro, Napoli, Italy
| | - Andreas Jungwirth
- Global Andrology Forum, Moreland Hills, OH, USA
- St. Barabara Private Clinic, Bad Vigaun, Austria
| | - Surendra Reddy Banka
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Andrology, Androcare Institute of Andrology and Men's Health, Hyderabad, India
| | - Tiago Cesar Mierzwa
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Centro Universitario em Saude do ABC, Santo André, Brazil
| | - Tahsin Turunç
- Global Andrology Forum, Moreland Hills, OH, USA
- Urology Clinic, Iskenderun Gelisim Hospital, Iskenderun, Turkey
| | - Divyanu Jain
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Obstetrics and Gynecology, Jaipur Golden Hospital, New Delhi, India
| | - Armen Avoyan
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Astghik Medical Center, Yerevan, Armenia
| | - Pietro Salacone
- Global Andrology Forum, Moreland Hills, OH, USA
- Andrology and Pathophysiology of Reproduction Unit, Santa Maria Goretti Hospital, Latina, Italy
| | - Ateş Kadıoğlu
- Global Andrology Forum, Moreland Hills, OH, USA
- Section of Andrology, Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Chirag Gupta
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Jaipur National University, Jaipur, India
| | - Haocheng Lin
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Peking University Third Hospital, Peking University, Beijing, China
| | - Iman Shamohammadi
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nasser Mogharabian
- Global Andrology Forum, Moreland Hills, OH, USA
- Sexual Health and Fertility Research Center, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Trenton Barrett
- Global Andrology Forum, Moreland Hills, OH, USA
- Perth Urology Clinic, Perth, WA, Australia
| | - Yavuz Onur Danacıoğlu
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Bakırköy Dr. Sadi Konuk Training and Research Hospital, University of Health Science Istanbul, Istanbul, Turkey
| | - Andrea Crafa
- Global Andrology Forum, Moreland Hills, OH, USA
- Urology Section, University of Catania, Catania, Italy
| | - Salima Daoud
- Global Andrology Forum, Moreland Hills, OH, USA
- Laboratory of Histo-Embryology and Reproductive Biology, Faculty of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Vineet Malhotra
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology and Andrology, VNA Hospital, New Delhi, India
| | - Abdulmalik Almardawi
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Osama Mohamed Selim
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Andrology, Sexology & STIs, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamad Moussa
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Lebanese University, Beirut, Lebanon
- Department of Urology, Al Zahraa Hospital, UMC, Beirut, Lebanon
| | - Saeid Haghdani
- Global Andrology Forum, Moreland Hills, OH, USA
- Andrology Research Center, Yazd Reproductive Science Institute, Isfahan Fertility and Isfahan, Yazd, Iran
| | - Mesut Berkan Duran
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Pamukkale University School of Medicine, Denizli, Turkey
| | - Yannic Kunz
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, University Hospital Innsbruck, Innsbruck, Austria
| | - Mirko Preto
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Molinette Hospital, A.O.U. Città della Salute e della Scienza, University of Turin, Torino, Italy
| | - Elena Eugeni
- Global Andrology Forum, Moreland Hills, OH, USA
- 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
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Andrology and Sexual Medicine, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Ahmed Rashad Elshahid
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Seso Sulijaya Suyono
- Global Andrology Forum, Moreland Hills, OH, USA
- Gladiool IVF, Magelang, Indonesia
| | - Dyandra Parikesit
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Universitas Indonesia Hospital, Faculty of Medicine, Universitas Indonesia, Depok, Indonesia
| | - Essam Nada
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Eduardo Gutiérrez Orozco
- Global Andrology Forum, Moreland Hills, OH, USA
- IVF Department, CITMER Reproductive Medicine, Nuevo Leon, Mexico
| | - Florence Boitrelle
- Global Andrology Forum, Moreland Hills, OH, USA
- 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
| | - Nguyen Thi Minh Trang
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Mounir Jamali
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Military Teaching Hospital, Rabat, Morocco
| | - Raju Nair
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Reproductive Medicine, Mitera Hospital, Kottayam, India
| | - Mikhail Ruzaev
- Global Andrology Forum, Moreland Hills, OH, USA
- Urology Clinic, Moscow, Russia
| | - Franco Gadda
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Charalampos Thomas
- Global Andrology Forum, Moreland Hills, OH, USA
- Urology Department, General Hospital of Corinth, Corinth, Greece
| | - Raphael Henrique Ferreira
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Santa Casa de Ribeirão Preto, São Paulo, Brazil
| | - Umit Gul
- Global Andrology Forum, Moreland Hills, OH, USA
- Private EPC Hospital, Adana, Turkey
| | - Serena Maruccia
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, ASST Santi Paolo e Carlo, San Paolo Hospital, Milano, Italy
| | - Ajay Kanbur
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Andrology, Kanbur Clinic, Thane, India
- Department of Urosurgery, Jupiter Hospital, Thane, India
| | - Ella Kinzikeeva
- Global Andrology Forum, Moreland Hills, OH, USA
- Zucchi Clinical Institutes, Monza, Italy
| | - Saad Abumelha
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Nguyen Quang
- Global Andrology Forum, Moreland Hills, OH, USA
- Center for Andrology and Sexual Medicine, Viet Duc University Hospital, Hanoi, Vietnam
- Department of Urology, Can Tho University of Medicine and Pharmacy Hospital, Can Tho, Vietnam
| | - Raghavender Kosgi
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology and Andrology, AIG Hospitals, Hyderabad, India
| | - Fatih Gokalp
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Faculty of Medicine, Hatay Mu Stafa Kemal University, Antakya, Turkey
| | - Mohammad Ayodhia Soebadi
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Faculty of Medicine, Universitas Airlangga, Soetomo Hospital, Surabaya, Indonesia
| | - Gustavo Marquesine Paul
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Hospital de Clínicas of the Federal University of Paraná, Curitiba, Brazil
| | - Hesamoddin Sajadi
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Deepak Gupte
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Bombay Hospital and Medical Research Center, Mumbai, India
| | - Rafael F Ambar
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Fleury Group and Hospital Israelita Albert Einstein, São Paulo, Brazil
- Department of Urology, Centro Universitario em Saude do ABC, Santo André, Brazil
| | - Emrullah Sogutdelen
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Clarity Health, Chandigarh, India
| | - Karun Singla
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Dr. Dradjat Hospital, Serang, Indonesia
| | - Ari Basurkano
- Global Andrology Forum, Moreland Hills, OH, USA
- IVF Australia, Sydney, Australia
| | - Shannon Hee Kyung Kim
- Global Andrology Forum, Moreland Hills, OH, USA
- Macquarie School of Medicine, Macquaire University, Sydney, Australia
- Department of Urology, Imperial Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - Mohammad Ali Sadighi Gilani
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Koichi Nagao
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Toho University Faculty of Medicine, Tokyo, Japan
| | - Sakti Ronggowardhana Brodjonegoro
- Global Andrology Forum, Moreland Hills, OH, USA
- Division of Urology, Department of Surgery, Prof. Dr. Sardjito Hospital, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Andri Rezano
- Global Andrology Forum, Moreland Hills, OH, USA
- 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
| | - Mohamed Elkhouly
- Global Andrology Forum, Moreland Hills, OH, USA
- IVF Department, Bourn Hall Fertility Center, Dubai, UAE
| | - Rossella Mazzilli
- Global Andrology Forum, Moreland Hills, OH, USA
- Unit of Endocrinology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Hasan M A Farsi
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Hung Nguyen Ba
- Global Andrology Forum, Moreland Hills, OH, USA
- Andrology Unit, ART Center, Vinmec Times City International Hospital, Hanoi, Vietnam
| | - Hamed Alali
- Global Andrology Forum, Moreland Hills, OH, USA
- King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Dimitrios Kafetzis
- Global Andrology Forum, Moreland Hills, OH, USA
- Orchid IVF Clinic, Dubai, UAE
| | - Tran Quang Tien Long
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Obstetrics and Gynecology, Hanoi Obstetric and Gynecology Hospital, Hanoi, Vietnam
| | - Sami Alsaid
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
| | - Hoang Bao Ngoc Cuong
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Surgery, Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Knigavko Oleksandr
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Nephrology and Andrology, Kharkiv National Medical University, Kharkiv, Ukraine
| | - Akhmad Mustafa
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Hasan Sadikin General Hospital, Faculty of Medicine of Padjadjaran University, Bandung, Indonesia
| | - Herik Acosta
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Hrishikesh Pai
- Global Andrology Forum, Moreland Hills, OH, USA
- IVF Department, Bloom IVF Group, Mombai, India
| | - Bahadır Şahin
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, School of Medicine, Marmara University, İstanbul, Turkey
| | - Eko Arianto
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Prof R.D. Kandou Hospital, Manado, Indonesia
| | - Colin Teo
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Gleneagles Hospital, Singapore
| | - Sanjay Prakash Jayaprakash
- Global Andrology Forum, Moreland Hills, OH, USA
- Andrology Unit, Department of Urology, Apollo Hospitals, Greams Road, Chennai, India
| | - Rinaldo Indra Rachman
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Mustafa Gurkan Yenice
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Bakırköy Dr. Sadi Konuk Training and Research Hospital, University of Health Science Istanbul, Istanbul, Turkey
| | - Omar Sefrioui
- Global Andrology Forum, Moreland Hills, OH, USA
- African Fertility Center, Casablanca, Morocco
| | - Smit Paghdar
- Global Andrology Forum, Moreland Hills, OH, USA
- UVA Urology Clinic in Charlottesville, UVA Specialty Care Clinic in Culpeper, Culpeper, VA, USA
| | - Shivam Priyadarshi
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan, India
| | - Marko Tanic
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, General Hospital, Cuprija, Serbia
| | - Noor Kareem Alfatlawy
- Global Andrology Forum, Moreland Hills, OH, USA
- Fertility Center of Al-Najaf/Al-Sadr Medical City, Babylon Health Directorate, Iraqi Ministry of Health, Baghdad, Iraq
| | - Fikri Rizaldi
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Faculty of Medicine, Universitas Airlangga, Soetomo Hospital, Surabaya, Indonesia
| | - Ranjit B Vishwakarma
- Division of Andrology, Department of Urology, Lilavati Hospital and Research Centre, Mumbai, India
- Global Andrology Forum, Moreland Hills, OH, USA
| | - George Kanakis
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Endocrinology, Diabetes and Metabolism, Athens Naval & VA Hospital, Athens, Greece
| | - Dinesh Thomas Cherian
- Global Andrology Forum, Moreland Hills, OH, USA
- Urology Deparment, Aster Medcity, Kochi, India
| | - Joe Lee
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, National University Hospital, Singapore
| | - Raisa Galstyan
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Yerevan State Medical University, Yerevan, Armenia
| | - Hakan Keskin
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Jana Wurzacher
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, University Hospital Innsbruck, Innsbruck, Austria
| | - Doddy Hami Seno
- Global Andrology Forum, Moreland Hills, OH, USA
- Division of Urology, Department of Surgery, Persahabatan General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Bambang S Noegroho
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Hasan Sadikin General Hospital, Faculty of Medicine of Padjadjaran University, Bandung, Indonesia
| | - Ria Margiana
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Anatomy, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Master's Programme Biomedical Sciences, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Qaisar Javed
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Al-Ahlia Hospital, Abu Dhabi, UAE
| | - Fabrizio Castiglioni
- Global Andrology Forum, Moreland Hills, OH, USA
- Andrology Unit, ART Center - San Carlo Clinic, Milan, Italy
| | - Raman Tanwar
- Global Andrology Forum, Moreland Hills, OH, USA
- Urology Center, Jyoti Hospital, Gurugram, India
| | - Ana Puigvert
- Global Andrology Forum, Moreland Hills, OH, USA
- Institute of Andrology and Sexual Medicine (IANDROMS), Barcelona, Spain
| | - Coşkun Kaya
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Health Science University Eskisehir City HPRH, Eskisehir, Turkey
| | - Medianto Purnomo
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Brawijaya University, Malang, Indonesia
| | - Chadi Yazbeck
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Obstetrics Gynecology and Reproductive Medicine, Reprogynes Medical Institute, Paris, France
| | - Azwar Amir
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Dr Wahidin Sudirohusodo Hospital, Makassar, Indonesia
| | - Edson Borges
- Global Andrology Forum, Moreland Hills, OH, USA
- Fertility Assisted Fertilization Center, São Paulo, Brazil
| | - Marina Bellavia
- Global Andrology Forum, Moreland Hills, OH, USA
- Andrology and IVF Center, Next Fertility Procrea, Lugano, Switzerland
| | - Isaac Ardianson Deswanto
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, College of Medicine and Pharmacy, Ibn Zohr University, Agadir, Morocco
| | - Vinod K V
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Cure & SK Hospital, Trivandrum, India
| | - Giovanni Liguori
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, University of Trieste, Trieste, Italy
| | - Dang Hoang Minh
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Can Tho University of Medicine and Pharmacy Hospital, Can Tho, Vietnam
| | - Kashif Siddiqi
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Cleveland Clinic, Abu Dhabi, UAE
| | - Fulvio Colombo
- Global Andrology Forum, Moreland Hills, OH, USA
- Andrology and Reproductive Medicine Unit, Gynepro Medical, Bologna, Italy
| | - Armand Zini
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Surgery, McGill University, Montreal, QC, Canada
| | - Niket Patel
- Global Andrology Forum, Moreland Hills, OH, USA
- Akanksha Hospital and Research Institute, Anand, Gujarat, India
| | - Selahittin Çayan
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, University of Mersin School of Medicine, Mersin, Turkey
| | - Ula Al-Kawaz
- Global Andrology Forum, Moreland Hills, OH, USA
- High Institute for Infertility Diagnosis and Assisted Reproductive Technologies, Al-Nahrain University, Baghdad, Iraq
| | - Maged Ragab
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Tanta University, Tanta, Egypt
| | | | - Ivan Hoffmann
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Reproductive Medicine and Andrology, University Clinic Halle (Saale), Halle, Germany
- Reproductive Center Dr. Hoffmann, Berlin, Germany
| | - Ozan Efesoy
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Mersin City Training and Research Hospital, University of Health Sciences, Mersin, Turkey
| | - Barış Saylam
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Mersin City Training and Research Hospital, University of Health Sciences, Mersin, Turkey
| | - Ashok Agarwal
- Global Andrology Forum, Moreland Hills, OH, USA
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA.
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Agarwal A, Farkouh A, Saleh R, Hamoda TAAAM, Salvio G, Boitrelle F, Harraz AM, Ghayda RA, Kavoussi P, Gül M, Toprak T, Russo GI, Durairajanayagam D, Rambhatla A, Birowo P, Cannarella R, Phuoc NHV, Zini A, Arafa M, Wyns C, Tremellen K, Sarıkaya S, Lewis S, Evenson DP, Ko E, Calogero AE, Bahar F, Martínez M, Ambar RF, Colpi GM, Bakircioglu ME, Henkel R, Kandil H, Serefoglu EC, Alfakhri A, Tsujimura A, Kheradmand A, Marino A, Adamyan A, Zilaitiene B, Ozer C, Pescatori E, Vogiatzi P, Busetto GM, Balercia G, Elbardisi H, Akhavizadegan H, Sajadi H, Taniguchi H, Park HJ, Maldonado Rosas I, Al-Marhoon M, Sadighi Gilani MA, Alhathal N, Quang N, Pinggera GM, Kothari P, Micic S, Homa S, Long TQT, Zohdy W, Atmoko W, Ibrahim W, Sabbaghian M, Abumelha SM, Chung E, Ugur MR, Ozkent MS, Selim O, Darbandi M, Fukuhara S, Jamali M, de la Rosette J, Kuroda S, Smith RP, Baser A, Kalkanli A, Tadros NN, Aydos K, Mierzwa TC, Khalafalla K, Malhotra V, Moussa M, Finocchi F, Rachman RI, Giulioni C, Avidor-Reiss T, Kahraman O, Çeker G, Zenoaga-Barbăroșie C, Barrett TL, Yilmaz M, Kadioglu A, Jindal S, Omran H, Bocu K, Karthikeyan VS, Franco G, Solorzano JF, Vishwakarma RB, Arianto E, Garrido N, Jain D, Gherabi N, Sokolakis I, Palani A, Calik G, Kulaksiz D, Simanaviciene V, Simopoulou M, Güngör ND, Blecher G, Falcone M, Jezek D, Preto M, Amar E, Le TV, Ahn ST, Rezano A, Singh K, Rocco L, Savira M, Rajmil O, Darbandi S, Sogutdelen E, Boeri L, Hernández G, Hakim L, Morimoto Y, Japari A, Sofikitis N, Altay B, Metin Mahmutoglu A, Al Hashimi M, Ziouziou I, Anagnostopoulou C, Lin H, Shah R. Technical Aspects and Clinical Limitations of Sperm DNA Fragmentation Testing in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations. World J Mens Health 2024; 42:202-215. [PMID: 37635341 PMCID: PMC10782128 DOI: 10.5534/wjmh.230076] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 04/10/2023] [Indexed: 08/29/2023] Open
Abstract
PURPOSE Sperm DNA fragmentation (SDF) is a functional sperm abnormality that can impact reproductive potential, for which four assays have been described in the recently published sixth edition of the WHO laboratory manual for the examination and processing of human semen. The purpose of this study was to examine the global practices related to the use of SDF assays and investigate the barriers and limitations that clinicians face in incorporating these tests into their practice. MATERIALS AND METHODS Clinicians managing male infertility were invited to complete an online survey on practices related to SDF diagnostic and treatment approaches. Their responses related to the technical aspects of SDF testing, current professional society guidelines, and the literature were used to generate expert recommendations via the Delphi method. Finally, challenges related to SDF that the clinicians encounter in their daily practice were captured. RESULTS The survey was completed by 436 reproductive clinicians. Overall, terminal deoxynucleotidyl transferase deoxyuridine triphosphate Nick-End Labeling (TUNEL) is the most commonly used assay chosen by 28.6%, followed by the sperm chromatin structure assay (24.1%), and the sperm chromatin dispersion (19.1%). The choice of the assay was largely influenced by availability (70% of respondents). A threshold of 30% was the most selected cut-off value for elevated SDF by 33.7% of clinicians. Of respondents, 53.6% recommend SDF testing after 3 to 5 days of abstinence. Although 75.3% believe SDF testing can provide an explanation for many unknown causes of infertility, the main limiting factors selected by respondents are a lack of professional society guideline recommendations (62.7%) and an absence of globally accepted references for SDF interpretation (50.3%). CONCLUSIONS This study represents the largest global survey on the technical aspects of SDF testing as well as the barriers encountered by clinicians. Unified global recommendations regarding clinician implementation and standard laboratory interpretation of SDF testing are crucial.
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Affiliation(s)
- Ashok Agarwal
- Global Andrology Forum, Moreland Hills, OH, USA
- Cleveland Clinic, Cleveland, OH, USA.
| | | | - Ramadan Saleh
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - 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
| | - Gianmaria Salvio
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Endocrinology, Polytechnic University of Marche, Ancona, Italy
| | - Florence Boitrelle
- Global Andrology Forum, Moreland Hills, OH, USA
- 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
| | - Ahmed M Harraz
- Global Andrology Forum, Moreland Hills, OH, USA
- 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
| | - Ramy Abou Ghayda
- Global Andrology Forum, Moreland Hills, OH, USA
- Urology Institute, University Hospitals, Case Western Reserve University, Cleveland, OH, USA
| | - Parviz Kavoussi
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Reproductive Urology, Austin Fertility & Reproductive Medicine/Westlake IVF, Austin, TX, USA
| | - Murat Gül
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Selçuk University School of Medicine, Konya, Turkey
| | - Tuncay Toprak
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Fatih Sultan Mehmet Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Giorgio Ivan Russo
- Global Andrology Forum, Moreland Hills, OH, USA
- Urology Section, University of Catania, Catania, Italy
| | - Damayanthi Durairajanayagam
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Physiology, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Selangor, Malaysia
| | - Amarnath Rambhatla
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Henry Ford Health System, Vattikuti Urology Institute, Detroit, MI, USA
| | - Ponco Birowo
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Rossella Cannarella
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
- Department of Urology, Glickman Urological & Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Nguyen Ho Vinh Phuoc
- Global Andrology Forum, Moreland Hills, OH, USA
- 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
| | - Armand Zini
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Surgery, McGill University, Montreal, QC, Canada
| | - Mohamed Arafa
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
- Department of Urology, Weill Cornell Medical-Qatar, Doha, Qatar
- Department of Andrology and STDs, Cairo University, Cairo, Egypt
| | - Christine Wyns
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Gynaecology-Andrology, Cliniques Universitaires Saint-Luc, Universitat Catholique de Louvain, Brussels, Belgium
| | - Kelton Tremellen
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Obstetrics Gynaecology and Reproductive Medicine, Flinders University, Bedford Park, Australia
| | - Selçuk Sarıkaya
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Galhane Research and Training Hospital, University of Health Sciences, Ankara, Turkey
| | - Sheena Lewis
- Global Andrology Forum, Moreland Hills, OH, USA
- Examen Lab Ltd., Northern Ireland, UK
| | - Donald P Evenson
- Global Andrology Forum, Moreland Hills, OH, USA
- SCSA Diagnostics, Brookings, SD, USA
| | - Edmund Ko
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Loma Linda University Health, Loma Linda, CA, USA
| | - Aldo E Calogero
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Surgery, Urology Unit, Farwaniya Hospital, Farwaniya, Kuwait
| | - Fahmi Bahar
- Global Andrology Forum, Moreland Hills, OH, USA
- Andrology Section, Siloam Sriwijaya Hospital, Palembang, Indonesia
| | - Marlon Martínez
- Global Andrology Forum, Moreland Hills, OH, USA
- Section of Urology, Department of Surgery, University of Santo Tomas Hospital, Manila, Philippines
| | - Rafael F Ambar
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Centro Universitario em Saude do ABC, Santo Andre, Brazil
- Andrology Group at Ideia Fertil Institute of Human Reproduction, Santo Andre, Brazil
| | - Giovanni M Colpi
- Global Andrology Forum, Moreland Hills, OH, USA
- Andrology and IVF Center, Next Fertility Procrea, Lugano, Switzerland
| | | | - Ralf Henkel
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Department of Medical Bioscience, University of the Western Cape, Bellville, South Africa
| | - Hussein Kandil
- Global Andrology Forum, Moreland Hills, OH, USA
- Fakih IVF Fertility Center, Abu Dhabi, UAE
| | - Ege Can Serefoglu
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Biruni University School of Medicine, Istanbul, Turkey
| | - Abdullah Alfakhri
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Akira Tsujimura
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Alireza Kheradmand
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Angelo Marino
- Global Andrology Forum, Moreland Hills, OH, USA
- Reproductive Medicine Unit, ANDROS Day Surgery Clinic, Reproductive Medicine Unit, Palermo, Italy
| | - Aram Adamyan
- Global Andrology Forum, Moreland Hills, OH, USA
- IVF Department, Astghik Medical Center, Yerevan, Armenia
| | - Birute Zilaitiene
- Global Andrology Forum, Moreland Hills, OH, USA
- Institute of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Cevahir Ozer
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Edoardo Pescatori
- Global Andrology Forum, Moreland Hills, OH, USA
- Andrology and Reproductive Medicine Unit, Gynepro Medical, Bologna, Italy
| | - Paraskevi Vogiatzi
- Global Andrology Forum, Moreland Hills, OH, USA
- Andromed Health & Reproduction, Fertility & Reproductive Health Diagnostic Center, Athens, Greece
| | - Gian Maria Busetto
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology and Renal Transplantation, University of Foggia, Policlinico Riuniti, Foggia, Italy
| | - Giancarlo Balercia
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Endocrinology, Polytechnic University of Marche, Ancona, Italy
| | - Haitham Elbardisi
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
- Department of Urology, Weill Cornell Medical-Qatar, Doha, Qatar
- Department of Urology, College of Medicine, Qatar University, Doha, Qatar
| | - Hamed Akhavizadegan
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hesamoddin Sajadi
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Hisanori Taniguchi
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology and Andrology, Kansai Medical University, Hirakata, Osaka, Japan
| | - Hyun Jun Park
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Pusan National University School of Medicine, Busan, Korea
- Medical Research Institute of Pusan National University Hospital, Busan, Korea
| | - Israel Maldonado Rosas
- Global Andrology Forum, Moreland Hills, OH, USA
- IVF Laboratory, CITMER Reproductive Medicine, Mexico City, Mexico
| | - Mohamed Al-Marhoon
- Global Andrology Forum, Moreland Hills, OH, USA
- Division of Urology, Department of Surgery, Sultan Qaboos University, Muscat, Sultanate of Oman
| | - Mohammad Ali Sadighi Gilani
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Naif Alhathal
- Global Andrology Forum, Moreland Hills, OH, USA
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Nguyen Quang
- Global Andrology Forum, Moreland Hills, OH, USA
- 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
| | - Germar-Michael Pinggera
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Innsbruck Medical University, Innsbruck, Austria
| | - Priyank Kothari
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Topiwala National Medical College, B.Y.L Nair Ch Hospital, Mumbai, India
| | - Sava Micic
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Andrology, Uromedica Polyclinic, Belgrade, Serbia
| | - Sheryl Homa
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Biosciences, University of Kent, Canterbury, UK
| | - Tran Quang Tien Long
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Obstetrics and Gynecology, Hanoi Obstetric and Gynecology Hospital, Hanoi, Vietnam
| | - Wael Zohdy
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Andrology and STDs, Cairo University, Cairo, Egypt
| | - Widi Atmoko
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Wael Ibrahim
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Surgery, School of Medicine, Taylor's University, Subang Jaya, Selangor, Malaysia
| | - Marjan Sabbaghian
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Saad Mohammed Abumelha
- Global Andrology Forum, Moreland Hills, OH, USA
- Division of Urology, Department of Surgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Eric Chung
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, University of Queensland, Princess Alexandra Hospital, Brisbane QLD, Australia
| | - Muhammet Rasit Ugur
- Global Andrology Forum, Moreland Hills, OH, USA
- IVF Michigan, Bloomfield Hills, MI, USA
| | - Mehmet Serkan Ozkent
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Konya City Hospital, Konya, Turkey
| | - Osama Selim
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Andrology and STDs, Cairo University, Cairo, Egypt
| | - Mahsa Darbandi
- Global Andrology Forum, Moreland Hills, OH, USA
- Fetal Health Research Center, Hope Generation Foundation, Tehran, Iran
- Gene Therapy and Regenerative Medicine Research Center, Hope Generation Foundation, Tehran, Iran
| | - Shinichiro Fukuhara
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Mounir Jamali
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Mohammed V Military Hospital, Rabat, Morocco
| | - Jean de la Rosette
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Istanbul Medipol University, Istanbul, Turkey
| | - Shinnosuke Kuroda
- Department of Urology, Glickman Urological & Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Ryan P Smith
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Aykut Baser
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Bandirma Onyedi Eylül University, Balikesir, Turkey
| | - Arif Kalkanli
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Taksim Education and Research Hospital, Istanbul, Turkey
| | - Nicholas N Tadros
- Global Andrology Forum, Moreland Hills, OH, USA
- Division of Urology, Southern Illinois University, Springfield, IL, USA
| | - Kaan Aydos
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Ankara University, Ankara, Turkey
| | - Tiago Cesar Mierzwa
- Global Andrology Forum, Moreland Hills, OH, USA
- Androlab, Fertility Clinic, Curitiba, PR, Brazil
| | - Kareim Khalafalla
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
- Department of Urology, University of Texas McGovern Medical School, Houston, TX, USA
- Department of Urology, MD Anderson Cancer Center, Houston, TX, USA
| | - Vineet Malhotra
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, SCM Clinic and Hospital, New Delhi, India
| | - Mohamad Moussa
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Lebanese University, Beirut, Lebanon
- Department of Urology, Al Zahraa Hospital, UMC, Lebanon
| | - Federica Finocchi
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Endocrinology, Polytechnic University of Marche, Ancona, Italy
| | - Rinaldo Indra Rachman
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Carlo Giulioni
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Endocrinology, Polytechnic University of Marche, Ancona, Italy
| | - Tomer Avidor-Reiss
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Biological Sciences, University of Toledo, Toledo, OH, USA
- Department of Urology, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA
| | - Oguzhan Kahraman
- Global Andrology Forum, Moreland Hills, OH, USA
- Andrology and Reproductive Medicine Unit, Gynepro Medical, Bologna, Italy
| | - Gökhan Çeker
- Department of Urology, Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey
| | - Cătălina Zenoaga-Barbăroșie
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Genetics, Faculty of Biology, University of Bucharest, Bucharest, Romania
| | - Trenton L Barrett
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Perth Urology Clinic, Murdoch, WA, Australia
| | - Mehmet Yilmaz
- Global Andrology Forum, Moreland Hills, OH, USA
- Asklepios Klinik Triberg, Urology, Triberg, Germany
| | - Ates Kadioglu
- Global Andrology Forum, Moreland Hills, OH, USA
- Section of Andrology, Department of Urology, Istanbul University, Istanbul, Turkey
| | - Sunil Jindal
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Andrology and Reproductive Medicine, Jindal Hospital, Meerut, India
| | - Huda Omran
- Global Andrology Forum, Moreland Hills, OH, USA
- Molecular Genetics Department, Pulse Health Training Center, Manama, Bahrain
| | - Kadir Bocu
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Silopi State Hospital, Sirnak, Turkey
| | | | - Giorgio Franco
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Jesús Fernando Solorzano
- Global Andrology Forum, Moreland Hills, OH, USA
- IVF Laboratory, CITMER Reproductive Medicine, Mexico City, Mexico
| | - Ranjit B Vishwakarma
- Global Andrology Forum, Moreland Hills, OH, USA
- Division of Andrology, Department of Urology, Lilavati Hospital and Research Centre, Mumbai, India
| | - Eko Arianto
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Surgery, Prof. Dr. R.D. Kandou Central General Hospital, Manado, Indonesia
| | - Nicolas Garrido
- Global Andrology Forum, Moreland Hills, OH, USA
- IVIRMA Global Research Alliance, IVI Foundation, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain
| | - Divyanu Jain
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Obstetrics and Gynecology, Jaipur Golden Hospital, New Delhi, India
| | - Nazim Gherabi
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Medicine, University of Algiers 1, Algiers, Algeria
| | - Ioannis Sokolakis
- Global Andrology Forum, Moreland Hills, OH, USA
- 2nd Department of Urology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ayad Palani
- Global Andrology Forum, Moreland Hills, OH, USA
- Research Centre, University of Garmian, Kalar, Iraq
| | - Gokhan Calik
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Istanbul Medipol University, Istanbul, Turkey
| | - Deniz Kulaksiz
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Obstetrics and Gynecology, University of Health Sciences Kanuni Training and Research Hospital, Trabzon, Turkey
| | - Vaida Simanaviciene
- Global Andrology Forum, Moreland Hills, OH, USA
- Fertility Centre, Northway Medical Centre, Vilnius, Lithuania
| | - Mara Simopoulou
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Physiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Nur Dokuzeylül Güngör
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Obstetrics and Gynecology, Reproductive Endocrinology and IVF Unit, School of Medicine, Bahcesehir University, Istanbul, Turkey
| | - Gideon Blecher
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Surgery, School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Marco Falcone
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Molinette Hospital, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, University of Turin, Torino, Italy
| | - Davor Jezek
- Global Andrology Forum, Moreland Hills, OH, USA
- Reproductive Tissue Bank, Department for Transfusion Medicine and Transplantation Biology, University Hospital Zagreb, Zagreb, Croatia
| | - Mirko Preto
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Molinette Hospital, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, University of Turin, Torino, Italy
| | - Edouard Amar
- Global Andrology Forum, Moreland Hills, OH, USA
- American Hospital of Paris, Paris, France
| | - Tan V Le
- Global Andrology Forum, Moreland Hills, OH, USA
- 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
| | - Sun Tae Ahn
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Korea University College of Medicine, Seoul, Korea
| | - Andri Rezano
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Biomedical Sciences, Division of Cell Biology, Faculty of Medicine, Universitas Padjadjaran, Sumedang, West Java, Indonesia
| | - Keerti Singh
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Preclinical and Health Sciences, Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, St Michael, Barbados, Italy
| | - Lucia Rocco
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Environmental, Biological and Pharmaceutical Sciences and Technologies, University of Campania Luigi Vanvitelli, Caserta, Italy
| | - Missy Savira
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Osvaldo Rajmil
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Andrology, Fundacio Puigvert, Barcelona, Spain
| | - Sara Darbandi
- Global Andrology Forum, Moreland Hills, OH, USA
- Fetal Health Research Center, Hope Generation Foundation, Tehran, Iran
- Gene Therapy and Regenerative Medicine Research Center, Hope Generation Foundation, Tehran, Iran
| | - Emrullah Sogutdelen
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Bolu Abant Izzet Baysal University, Bolu, Turkey
| | - Luca Boeri
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Guadalupe Hernández
- Global Andrology Forum, Moreland Hills, OH, USA
- IVF Department, CITMER Reproductive Medicine, Puebla, Mexico
| | - Lukman Hakim
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Faculty of Medicine, Universitas Airlangga Teaching Hospital, Surabaya, Indonesia
| | - Yoshiharu Morimoto
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, HORAC Grand Front Osaka Clinic, Osaka, Japan
| | - Andrian Japari
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Fertility Clinic, Telogorejo Hospital, Central Java, Indonesia
| | - Nikolaos Sofikitis
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Ioannina University School of Medicine, Ioannina, Greece
| | - Baris Altay
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Ege University, Izmir, Turkey
| | - Asli Metin Mahmutoglu
- Global Andrology Forum, Moreland Hills, OH, USA
- Departmant of Medical Biology, Faculty of Medical, Yozgat Bozok University, Yozgat, Turkey
| | - Manaf Al Hashimi
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Burjeel Hospital, Abu Dhabi, UAE
| | - Imad Ziouziou
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, University Hospital of Souss Massa, Massa, Morocco
| | - Christina Anagnostopoulou
- Global Andrology Forum, Moreland Hills, OH, USA
- Unit of Reproductive Medicine, EmbryoART, Leto Maternity Hospital, Athens, Greece
| | - Haocheng Lin
- Global Andrology Forum, Moreland Hills, OH, USA
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Rupin Shah
- Global Andrology Forum, Moreland Hills, OH, USA
- Division of Andrology, Department of Urology, Lilavati Hospital and Research Centre, Mumbai, India
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Farkouh A, Agarwal A, Hamoda TAAAM, Kavoussi P, Saleh R, Zini A, Arafa M, Harraz AM, Gul M, Karthikeyan VS, Durairajanayagam D, Rambhatla A, Boitrelle F, Chung E, Birowo P, Toprak T, Ghayda RA, Cannarella R, Phuoc NHV, Dimitriadis F, Russo GI, Sokolakis I, Mostafa T, Makarounis K, Ziouziou I, Kuroda S, Bendayan M, Kaiyal RS, Japari A, Simopoulou M, Rocco L, Garrido N, Gherabi N, Bocu K, Kahraman O, Le TV, Wyns C, Tremellen K, Sarikaya S, Lewis S, Evenson DP, Ko E, Calogero AE, Bahar F, Martinez M, Crafa A, Nguyen Q, Ambar RF, Colpi G, Bakircioglu ME, Henkel R, Kandil H, Serefoglu EC, Alarbid A, Tsujimura A, Kheradmand A, Anagnostopoulou C, Marino A, Adamyan A, Zilaitiene B, Ozer C, Pescatori E, Vogiatzi P, Busetto GM, Balercia G, Elbardisi H, Akhavizadegan H, Sajadi H, Taniguchi H, Park HJ, Maldonado Rosas I, Al-Marhoon M, Sadighi Gilani MA, Alhathal N, Pinggera GM, Kothari P, Mogharabian N, Micic S, Homa S, Darbandi S, Long TQT, Zohdy W, Atmoko W, Sabbaghian M, Ibrahim W, Smith RP, Ho CCK, de la Rosette J, El-Sakka AI, Preto M, Zenoaga-Barbăroșie C, Abumelha SM, Baser A, Aydos K, Ramirez-Dominguez L, Kumar V, Ong TA, Mierzwa TC, Adriansjah R, Banihani SA, Bowa K, Fukuhara S, Rodriguez Peña M, Moussa M, Ari UÇ, Cho CL, Tadros NN, Ugur MR, Amar E, Falcone M, Santer FR, Kalkanli A, Karna KK, Khalafalla K, Vishwakarma RB, Finocchi F, Giulioni C, Ceyhan E, Çeker G, Yazbeck C, Rajmil O, Yilmaz M, Altay B, Barrett TL, Ngoo KS, Roychoudhury S, Salvio G, Lin H, Kadioglu A, Timpano M, Avidor-Reiss T, Hakim L, Sindhwani P, Franco G, Singh R, Giacone F, Ruzaev M, Kosgi R, Sofikitis N, Palani A, Calik G, Kulaksız D, Jezek D, Al Hashmi M, Drakopoulos P, Omran H, Leonardi S, Celik-Ozenci C, Güngör ND, Ramsay J, Amano T, Sogutdelen E, Duarsa GWK, Chiba K, Jindal S, Savira M, Boeri L, Borges E, Gupte D, Gokalp F, Hebrard GH, Minhas S, Shah R. Controversy and Consensus on the Management of Elevated Sperm DNA Fragmentation in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations. World J Mens Health 2023; 41:809-847. [PMID: 37118965 PMCID: PMC10523126 DOI: 10.5534/wjmh.230008] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 01/18/2023] [Accepted: 01/27/2023] [Indexed: 04/30/2023] Open
Abstract
PURPOSE Sperm DNA fragmentation (SDF) has been associated with male infertility and poor outcomes of assisted reproductive technology (ART). The purpose of this study was to investigate global practices related to the management of elevated SDF in infertile men, summarize the relevant professional society recommendations, and provide expert recommendations for managing this condition. MATERIALS AND METHODS An online global survey on clinical practices related to SDF was disseminated to reproductive clinicians, according to the CHERRIES checklist criteria. Management protocols for various conditions associated with SDF were captured and compared to the relevant recommendations in professional society guidelines and the appropriate available evidence. Expert recommendations and consensus on the management of infertile men with elevated SDF were then formulated and adapted using the Delphi method. RESULTS A total of 436 experts from 55 different countries submitted responses. As an initial approach, 79.1% of reproductive experts recommend lifestyle modifications for infertile men with elevated SDF, and 76.9% prescribe empiric antioxidants. Regarding antioxidant duration, 39.3% recommend 4-6 months and 38.1% recommend 3 months. For men with unexplained or idiopathic infertility, and couples experiencing recurrent miscarriages associated with elevated SDF, most respondents refer to ART 6 months after failure of conservative and empiric medical management. Infertile men with clinical varicocele, normal conventional semen parameters, and elevated SDF are offered varicocele repair immediately after diagnosis by 31.4%, and after failure of antioxidants and conservative measures by 40.9%. Sperm selection techniques and testicular sperm extraction are also management options for couples undergoing ART. For most questions, heterogenous practices were demonstrated. CONCLUSIONS This paper presents the results of a large global survey on the management of infertile men with elevated SDF and reveals a lack of consensus among clinicians. Furthermore, it demonstrates the scarcity of professional society guidelines in this regard and attempts to highlight the relevant evidence. Expert recommendations are proposed to help guide clinicians.
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Affiliation(s)
- Ala’a Farkouh
- Global Andrology Forum, American Center for Reproductive Medicine, Moreland Hills, OH, USA
| | - Ashok Agarwal
- Global Andrology Forum, American Center for Reproductive Medicine, Moreland Hills, OH, USA
- Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Taha Abo-Almagd Abdel-Meguid 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
| | - Ramadan Saleh
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt
- Ajyal IVF Center, Ajyal Hospital, Sohag, Egypt
| | - Armand Zini
- Department of Surgery, McGill University, Montreal, QC, Canada
| | - Mohamed Arafa
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
- Department of Andrology, Sexology & STIs, Cairo University, Cairo, Egypt
- Department of Urology, Weill Cornell Medical-Qatar, Doha, Qatar
| | - Ahmed M. Harraz
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansura, Egypt
- Department of Surgery, Urology Unit, Farwaniya Hospital, Farwaniya, Kuwait
- Department of Urology, Sabah Al Ahmad Urology Center, Kuwait City, Kuwait
| | - Murat Gul
- Department of Urology, Selçuk University School of Medicine, Konya, Turkey
| | | | - Damayanthi Durairajanayagam
- Department of Physiology, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Selangor, Malaysia
| | - Amarnath Rambhatla
- Department of Urology, Henry Ford Health System, Vattikuti Urology Institute, Detroit, MI, USA
| | - Florence Boitrelle
- 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
| | - Eric Chung
- Department of Urology, Princess Alexandra Hospital, University of Queensland, Brisbane, QLD, Australia
| | - Ponco Birowo
- 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
| | - Ramy Abou Ghayda
- Urology Institute, University Hospitals, Case Western Reserve University, Cleveland, OH, USA
| | - Rossella Cannarella
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
- Department of Urology, Glickman Urological & Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Nguyen Ho Vinh Phuoc
- 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
| | - Fotios Dimitriadis
- Department of Urology, Aristotle University, School of Medicine, Thessaloniki,
| | | | - Ioannis Sokolakis
- Department of Urology, Aristotle University, School of Medicine, Thessaloniki,
| | - Taymour Mostafa
- Department of Andrology, Sexology & STIs, Cairo University, Cairo, Egypt
| | | | - Imad Ziouziou
- Department of Urology, College of Medicine and Pharmacy, Ibn Zohr University, Agadir, Morocco
| | - Shinnosuke Kuroda
- Department of Urology, Glickman Urological & Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Marion Bendayan
- Reproductive Biology, Fertility Preservation, Andrology, CECOS, Poissy Hospital, Poissy, France
| | - Raneen Sawaid Kaiyal
- Department of Urology, Glickman Urological & Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Andrian Japari
- Fertility Clinic, Telogorejo Hospital, Semarang, Indonesia
| | - Mara Simopoulou
- Department of Physiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Lucia Rocco
- Department of Environmental, Biological and Pharmaceutical Sciences and Technologies, University of Campania Luigi Vanvitelli, Caserta, Italy
| | - Nicolas Garrido
- IVI Foundation, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain
| | - Nazim Gherabi
- Department of Urology, University of Algiers, Algiers, Algeria
| | - Kadir Bocu
- Department of Urology, Silopi State Hospital, Sirnak, Turkey
| | - Oguzhan Kahraman
- Department of Urology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - 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
| | - Christine Wyns
- Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Kelton Tremellen
- Department of Obstetrics Gynaecology and Reproductive Medicine, Flinders University, South Australia, Australia
| | - Selcuk Sarikaya
- Department of Urology, Gülhane Research and Training Hospital, University of Health Sciences, Ankara, Turkey
| | | | | | - Edmund Ko
- Department of Urology, Loma Linda University Health, Loma Linda, CA, USA
| | - Aldo E. Calogero
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Fahmi Bahar
- Andrology Section, Siloam Sriwijaya Hospital, Palembang, Indonesia
| | - Marlon Martinez
- Section of Urology, Department of Surgery, University of Santo Tomas Hospital, Manila, Philippines
| | - Andrea Crafa
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Quang Nguyen
- 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
| | - Rafael F. Ambar
- Department of Urology, Centro Universitario em Saude do ABC, Santo André, Brazil
- Andrology Group at Ideia Fertil Institute of Human Reproduction, Santo André, Brazil
| | - Giovanni Colpi
- Andrology and IVF Center, Next Fertility Procrea, Lugano, Switzerland
| | | | - Ralf Henkel
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Department of Medical Bioscience, University of the Western Cape, Bellville, South Africa
| | | | - Ege Can Serefoglu
- Department of Urology, Biruni University School of Medicine, Istanbul, Turkey
| | - Abdullah Alarbid
- Department of Surgery, Urology Unit, Farwaniya Hospital, Farwaniya, Kuwait
| | - Akira Tsujimura
- Department of Urology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Alireza Kheradmand
- Urology Department, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | - Angelo Marino
- ANDROS Day Surgery Clinic, Reproductive Medicine Unit, Palermo, Italy
| | - Aram Adamyan
- IVF Department, Astghik Medical Center, Yerevan, Armenia
| | - Birute Zilaitiene
- Institute of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Cevahir Ozer
- Department of Urology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Edoardo Pescatori
- Andrology and Reproductive Medicine Unit, Gynepro Medical, Bologna, Italy
| | - Paraskevi Vogiatzi
- Andromed Health & Reproduction, Fertility & Reproductive Health Diagnostic Center, Athens, Greece
| | - Gian Maria Busetto
- Department of Urology and Renal Transplantation, University of Foggia, Policlinico Riuniti, Foggia, Italy
| | - Giancarlo Balercia
- Department of Endocrinology, Polytechnic University of Marche, Ancona, Italy
| | - Haitham Elbardisi
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
- Department of Andrology, Sexology & STIs, Cairo University, Cairo, Egypt
| | - Hamed Akhavizadegan
- Department of Urology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hesamoddin Sajadi
- Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Teheran, Iran
| | - Hisanori Taniguchi
- Department of Urology and Andrology, Kansai Medical University, Hirakata, Osaka, Japan
| | - Hyun Jun Park
- Department of Urology, Pusan National University School of Medicine, Busan, Korea
- Medical Research Institute of Pusan National University Hospital, Busan, Korea
| | | | - Mohamed Al-Marhoon
- Division of Urology, Department of Surgery, Sultan Qaboos University, Muscat, Sultanate of Oman
| | - Mohammad Ali Sadighi Gilani
- Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Teheran, Iran
| | - Naif Alhathal
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | | | - Priyank Kothari
- Department of Urology, Topiwala National Medical College, B.Y.L Nair Ch Hospital, Mumbai, India
| | - Nasser Mogharabian
- Sexual Health and Fertility Research Center, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Sava Micic
- Department of Andrology, Uromedica Polyclinic, Belgrade, Serbia
| | - Sheryl Homa
- Department of Biosciences, University of Kent, Canterbury, UK
| | - Sara Darbandi
- Fetal Health Research Center, Hope Generation Foundation, Tehran, Iran
- Gene Therapy and Regenerative Medicine Research Center, Hope Generation Foundation, Tehran, Iran
| | - Tran Quang Tien Long
- Department of Obstetrics and Gynecology, Hanoi Obstetrics and Gynecology Hospital, Hanoi, Vietnam
| | - Wael Zohdy
- Department of Andrology, Sexology & STIs, Cairo University, Cairo, Egypt
| | - Widi Atmoko
- Department of Urology, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Marjan Sabbaghian
- Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Teheran, Iran
| | - Wael Ibrahim
- Department of Obstetrics Gynaecology and Reproductive Medicine, Fertility Care Center in Cairo, Cairo, Egypt
| | - Ryan P. Smith
- Department of Urology, University of Virginia School of Medicine, Virginia, USA
| | | | | | | | - Mirko Preto
- Department of Urology, University of Turin, Turin, Italy
| | | | - Saad Mohammed Abumelha
- Division of Urology, Department of Surgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Aykut Baser
- Department of Urology, Bandirma Onyedi Eylül University, Balikesir, Turkey
| | - Kaan Aydos
- Department of Urology, Ankara University, Ankara, Turkey
| | | | - Vijay Kumar
- Department of Microbiology, Kurukshetra University, Kurukshetra, India
| | - Teng Aik Ong
- Department of Surgery, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Ricky Adriansjah
- Department of Urology, Faculty of Medicine of Padjadjaran University, Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Saleem A. Banihani
- Department of Medical Laboratory Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Kasonde Bowa
- Department of Urology, University of Lusaka, Lusaka, Zambia
| | - Shinichiro Fukuhara
- Department of Urology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | | | - Mohamad Moussa
- Department of Urology, Lebanese University, Beirut, Lebanon
- Department of Urology, Al Zahraa Hospital, UMC, Lebanon
| | - Umut Çağın Ari
- Department of Reproduction, Kafkas University, Kars, Turkey
| | - Chak-Lam Cho
- S. H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong
| | | | | | | | - Marco Falcone
- Department of Urology, Molinette Hospital, A.O.U. Città della Salute e della Scienza, University of Turin, Torino, Italy
| | | | - Arif Kalkanli
- Department of Urology, Taksim Education and Research Hospital, Istanbul, Turkey
| | - Keshab Kumar Karna
- Department of Molecular Cell and Cancer Biology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Kareim Khalafalla
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
- Urology Department, University of Texas McGovern Medical School, Houston, TX, USA
- Urology Department, MD Anderson Cancer Center, Houston, TX, USA
| | - Ranjit B. Vishwakarma
- Division of Andrology, Department of Urology, Lilavati Hospital and Research Centre, Mumbai, India
| | - Federica Finocchi
- Department of Endocrinology, Polytechnic University of Marche, Ancona, Italy
| | - Carlo Giulioni
- Department of Urology, Polytechnic University of Marche Region, Ancona, Italy
| | - Erman Ceyhan
- Department of Urology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Gökhan Çeker
- Department of Urology, Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey
| | - Chadi Yazbeck
- Obstetrics Gynecology and Reproductive Medicine, Reprogynes Medical Institute, Paris, France
| | - Osvaldo Rajmil
- Department of Andrology, Fundacio Puigvert, Barcelona, Spain
| | - Mehmet Yilmaz
- Asklepios Clinic Triberg, Urology, Freiburg, Germany
| | - Baris Altay
- Department of Urology, Ege University, Izmir, Turkey
| | | | - Kay Seong Ngoo
- Hospital Angkatan Tentera Tuanku Mizan, Kuala Lumpur, Malaysia
| | | | - Gianmaria Salvio
- Department of Endocrinology, Polytechnic University of Marche, Ancona, Italy
| | - Haocheng Lin
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Ates Kadioglu
- Section of Andrology, Department of Urology, Istanbul University, Istanbul, Turkey
| | - Massimiliano Timpano
- Department of Urology, Molinette Hospital, A.O.U. Città della Salute e della Scienza, University of Turin, Torino, Italy
| | - Tomer Avidor-Reiss
- Department of Biological Sciences, University of Toledo, Toledo, OH, USA
- Department of Urology and Transplantation, University of Toledo, Toledo, OH, USA
| | - Lukman Hakim
- Department of Urology, Universitas Airlangga, Rumah Sakit Universitas Airlangga Teaching Hospital, Surabaya, Indonesia
| | - Puneet Sindhwani
- Department of Urology, Universitas Airlangga, Rumah Sakit Universitas Airlangga Teaching Hospital, Surabaya, Indonesia
| | - Giorgio Franco
- Department of Urology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Rajender Singh
- Division of Endocrinology, Central Drug Research Institute, Lucknow, India
| | - Filippo Giacone
- Centro HERA, Unità di Medicina della Riproduzione, Sant’Agata Li Battiati, Catania, Italy
| | | | - Raghavender Kosgi
- Department of Urology, Andrology and Renal Transplant, AIG Hospitals, Hyderabad, India
| | - Nikolaos Sofikitis
- Department of Urology, Ioannina University School of Medicine, Ioannina, Greece
| | - Ayad Palani
- Research Centre, University of Garmian, Kalar, Iraq
| | - Gokhan Calik
- Department of Urology, Istanbul Medipol University, Istanbul, Turkey
| | - Deniz Kulaksız
- Department of Obstetrics and Gynecology, University of Health Sciences Kanuni Training and Research Hospital, Trabzon, Turkey
| | - Davor Jezek
- Department for Transfusion Medicine and Transplantation Biology, Reproductive Tissue Bank, University Hospital Zagreb, Zagreb, Croatia
| | - Manaf Al Hashmi
- Department of Urology, Burjeel Hospital, Abu Dhabi, UAE
- Department of Urology, College of Medicine and Health Science, Khalifa University, Abu Dhabi, UAE
| | - Panagiotis Drakopoulos
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
- IVF Athens, Athens, Greece
| | - Huda Omran
- Al Aljenan Medical Center, Pulse Health Training Center, Manama, Kingdom of Bahrain
| | - Sofia Leonardi
- Central Laboratory, Hospital Público Materno Infantil de Salta, Salta, Argentina
| | - Ciler Celik-Ozenci
- Department of Histology and Embryology, Faculty of Medicine, Koç University, Istanbul, Turkey
| | - Nur Dokuzeylül Güngör
- Department of Obstetrics and Gynecology, Reproductive Endocrinology and IVF Unit, School of Medicine, Bahcesehir University, Istanbul, Turkey
| | | | - Toshiyasu Amano
- Department of Urology, Nagano Red Cross Hospital, Nagano, Japan
| | | | | | - Koji Chiba
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Sunil Jindal
- Department of Andrology and Reproductive Medicine, Jindal Hospital, Meerut, India
| | - Missy Savira
- Department of Urology, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Luca Boeri
- Department of Urology, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Edson Borges
- Fertility Assisted Fertilization Center, São Paulo, Brazil
| | - Deepak Gupte
- Department of Urology, Bombay Hospital and Medical Research Center, Mumbai, India
| | - Fatih Gokalp
- Department of Urology, Hatay Mustafa Kemal University, Antakya, Turkey
| | | | - Suks Minhas
- Division of Surgery, Department of Surgery and Cancer, Imperial College, London, UK
| | - Rupin Shah
- Division of Andrology, Department of Urology, Lilavati Hospital and Research Centre, Mumbai, India
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Khalafalla K, El Ansari W, Sengupta P, Majzoub A, Elbardisi H, Canguven O, El-Ansari K, Arafa M. Are sexually transmitted infections associated with male infertility? A systematic review and in-depth evaluation of the evidence and mechanisms of action of 11 pathogens. Arab J Urol 2023; 21:216-232. [PMID: 38178949 PMCID: PMC10763591 DOI: 10.1080/2090598x.2023.2218566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 05/22/2023] [Indexed: 01/06/2024] Open
Abstract
Purpose To systematically review the evidence on the association between sexually transmitted infections (STIs) and male infertility. We sought to answer two questions: Are STIs significantly associated with detrimental changes in semen parameters?; and, is the prevalence of STIs significantly higher in infertile than fertile men? Materials and methods PubMed, Scopus and Google Scholar databases were searched (inceptionMarch 2023) following the PRISMA guidelines. Identified original studies in English on the association between STIs and male infertility were included. Data was tabulated/described by pathogen, mechanisms of action, number of studies and their level of evidence. Results Seventy out of 903 originally retrieved articles were included in this review. For the detrimental changes in semen parameters (first question), the evidence seems equivocal based on the nearly equal number of studies and similar levels of evidence. The only exception was for Ureaplasma, where the number of studies and levels of evidence supported an association with male infertility. Pertaining to a significantly higher prevalence of STI among infertile compared to fertile men (second question), evidence was insufficient to support/deny a significant association. The two exceptions were Ureaplasma and Mycoplasma, where the number of studies and evidence levels were in favour of an association with male infertility. Conclusions Generally, the relationship between STIs and male infertility remains to be uncovered. Our appraisal of the overall state of this relationship shows that the evidence base leaves much to be desired. The exceptions are Ureaplasma and Mycoplasma, where the evidence convincingly suggests their associations with infertility in men.
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Affiliation(s)
- Kareim Khalafalla
- Department of Urology, Hamad General Hospital, Doha, Qatar
- Department of Urology, University of Texas Health Science Center, Houston, Texas, USA
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Walid El Ansari
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
- College of Medicine, Qatar University, Doha, Qatar
- Department of Population Health, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Pallav Sengupta
- Physiology Unit, Department of Biomedical Sciences, School of Medicine, Gulf Medical University, Ajman, UAE
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ahmad Majzoub
- Department of Urology, Hamad General Hospital, Doha, Qatar
- Department of Urology, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Haitham Elbardisi
- Department of Urology, Hamad General Hospital, Doha, Qatar
- College of Medicine, Qatar University, Doha, Qatar
- Department of Urology, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Onder Canguven
- Department of Urology, Hamad General Hospital, Doha, Qatar
- Department of Urology, Weill Cornell Medicine-Qatar, Doha, Qatar
| | | | - Mohamed Arafa
- Department of Urology, Hamad General Hospital, Doha, Qatar
- Department of Urology, Weill Cornell Medicine-Qatar, Doha, Qatar
- Department of Andrology, Cairo University, Cairo, Egypt
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Agarwal A, Farkouh A, Saleh R, Abdel-Meguid Hamoda TAA, Harraz AM, Kavoussi P, Arafa M, Salvio G, Rambhatla A, Toprak T, Gül M, Phuoc NHV, Boitrelle F, Birowo P, Ghayda RA, Cannarella R, Kuroda S, Durairajanayagam D, Zini A, Wyns C, Sarikaya S, Tremellen K, Mostafa T, Sokolakis I, Evenson DP, Henkel R, Zohdy W, Chung E, Ziouziou I, Falcone M, Russo GI, Al-Hashimi M, Calogero AE, Ko E, Colpi G, Lewis S, Serefoglu EC, Bahar F, Martinez M, Nguyen Q, Ambar RF, Bakircioglu ME, Kandil H, Mogharabian N, Sabbaghian M, Taniguchi H, Tsujimura A, Sajadi H, Ibrahim W, Atmoko W, Vogiatzi P, Gunes S, Gilani MAS, Roychoudhury S, Güngör ND, Hakim L, Adriansjah R, Kothari P, Jindal S, Amar E, Park HJ, Long TQT, Homa S, Karthikeyan VS, Zilaitiene B, Rosas IM, Marino A, Pescatori E, Ozer C, Akhavizadegan H, Garrido N, Busetto GM, Adamyan A, Al-Marhoon M, Elbardisi H, Dolati P, Darbandi M, Darbandi S, Balercia G, Pinggera GM, Micic S, Ho CCK, Moussa M, Preto M, Zenoaga-Barbăroşie C, Smith RP, Kosgi R, de la Rosette J, El-Sakka AI, Abumelha SM, Mierzwa TC, Ong TA, Banihani SA, Bowa K, Fukuhara S, Boeri L, Danacıoğlu YO, Gokalp F, Selim OM, Cho CL, Tadros NN, Ugur MR, Ozkent MS, Chiu P, Kalkanli A, Khalafalla K, Vishwakarma RB, Finocchi F, Andreadakis S, Giulioni C, Çeker G, Ceyhan E, Malhotra V, Yilmaz M, Timpano M, Barrett TL, Kim SHK, Ahn ST, Giacone F, Palani A, Duarsa GWK, Kadioglu A, Gadda F, Zylbersztejn DS, Aydos K, Kulaksız D, Gupte D, Calik G, Karna KK, Drakopoulos P, Baser A, Kumar V, Molina JMC, Rajmil O, Ferreira RH, Leonardi S, Avoyan A, Sogutdelen E, Franco G, Ramsay J, Ramirez L, Shah R. Controversy and Consensus on Indications for Sperm DNA Fragmentation Testing in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations. World J Mens Health 2023; 41:575-602. [PMID: 37118960 PMCID: PMC10307662 DOI: 10.5534/wjmh.220282] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 01/02/2023] [Indexed: 04/30/2023] Open
Abstract
PURPOSE Sperm DNA fragmentation (SDF) testing was recently added to the sixth edition of the World Health Organization laboratory manual for the examination and processing of human semen. Many conditions and risk factors have been associated with elevated SDF; therefore, it is important to identify the population of infertile men who might benefit from this test. The purpose of this study was to investigate global practices related to indications for SDF testing, compare the relevant professional society guideline recommendations, and provide expert recommendations. MATERIALS AND METHODS Clinicians managing male infertility were invited to take part in a global online survey on SDF clinical practices. This was conducted following the CHERRIES checklist criteria. The responses were compared to professional society guideline recommendations related to SDF and the appropriate available evidence. Expert recommendations on indications for SDF testing were then formulated, and the Delphi method was used to reach consensus. RESULTS The survey was completed by 436 experts from 55 countries. Almost 75% of respondents test for SDF in all or some men with unexplained or idiopathic infertility, 39% order it routinely in the work-up of recurrent pregnancy loss (RPL), and 62.2% investigate SDF in smokers. While 47% of reproductive urologists test SDF to support the decision for varicocele repair surgery when conventional semen parameters are normal, significantly fewer general urologists (23%; p=0.008) do the same. Nearly 70% would assess SDF before assisted reproductive technologies (ART), either always or for certain conditions. Recurrent ART failure is a common indication for SDF testing. Very few society recommendations were found regarding SDF testing. CONCLUSIONS This article presents the largest global survey on the indications for SDF testing in infertile men, and demonstrates diverse practices. Furthermore, it highlights the paucity of professional society guideline recommendations. Expert recommendations are proposed to help guide clinicians.
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Affiliation(s)
- Ashok Agarwal
- Global Andrology Forum, American Center for Reproductive Medicine, Moreland Hills, OH, USA
- Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Ala’a Farkouh
- Global Andrology Forum, American Center for Reproductive Medicine, Moreland Hills, OH, USA
| | - Ramadan Saleh
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Taha Abo-Almagd Abdel-Meguid Hamoda
- Department of Urology, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Urology, Faculty of Medicine, Minia University, Minia, Egypt
| | - Ahmed M. Harraz
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
- Department of Surgery, Urology Unit, Farwaniya Hospital, Farwaniya, Kuwait
- Department of Urology, Sabah Al Ahmad Urology Center, Kuwait City, Kuwait
| | - Parviz Kavoussi
- Department of Reproductive Urology, Austin Fertility & Reproductive Medicine/Westlake IVF, Austin, TX, USA
| | - Mohamed Arafa
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
- Department of Urology, Weill Cornell Medical-Qatar, Doha, Qatar
- Department of Andrology, Sexology and STIs, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Gianmaria Salvio
- Department of Endocrinology, Polytechnic University of Marche, Ancona, Italy
| | - Amarnath Rambhatla
- Department of Urology, Henry Ford Health System, Vattikuti Urology Institute, Detroit, MI, USA
| | - Tuncay Toprak
- Department of Urology, Fatih Sultan Mehmet Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Murat Gül
- Department of Urology, Selçuk University School of Medicine, Konya, Turkey
| | - Nguyen Ho Vinh Phuoc
- 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
| | - Florence Boitrelle
- 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
| | - Ponco Birowo
- Department of Urology, Cipto Mangunkusumo General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Ramy Abou Ghayda
- Urology Institute, University Hospitals, Case Western Reserve University, Cleveland, OH, USA
| | - Rossella Cannarella
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | | | - Damayanthi Durairajanayagam
- Department of Physiology, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Selangor, Malaysia
| | - Armand Zini
- Department of Surgery, McGill University, Montreal, QC, Canada
| | - Christine Wyns
- Department of Gynaecology-Andrology, Cliniques universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Selcuk Sarikaya
- Department of Urology, Gülhane Research and Training Hospital, University of Health Sciences, Ankara, Turkey
| | - Kelton Tremellen
- Department of Obstetrics Gynaecology and Reproductive Medicine, Flinders University, Bedford Park, Australia
| | - Taymour Mostafa
- Department of Andrology, Sexology and STIs, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ioannis Sokolakis
- Department of Urology, Martha-Maria Hospital Nuremberg, Nuremberg, Germany
| | | | - Ralf Henkel
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Department of Medical Bioscience, University of the Western Cape, Bellville, South Africa
- LogixX Pharma, Theale, Berkshire, UK
| | - Wael Zohdy
- Department of Andrology, Sexology and STIs, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Eric Chung
- Department of Urology, Princess Alexandra Hospital, University of Queensland, Brisbane, QLD, Australia
| | - Imad Ziouziou
- Department of Urology, College of Medicine and Pharmacy, Ibn Zohr University, Agadir, Morocco
| | - Marco Falcone
- Department of Urology, Molinette Hospital, A.O.U. Città della Salute e della Scienza, University of Turin, Torino, Italy
| | | | - Manaf Al-Hashimi
- Department of Urology, Burjeel Hospital, Abu Dhabi, UAE
- Department of Urology, Clinical Urology, Khalifa University, College of Medicine and Health Sciences, Abu Dhabi, UAE
| | - Aldo E. Calogero
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Edmund Ko
- Department of Urology, Loma Linda University Health, Loma Linda, CA, USA
| | - Giovanni Colpi
- Andrology and IVF Center, Next Fertility Procrea, Lugano, Switzerland
| | | | - Ege Can Serefoglu
- Department of Urology, Biruni University School of Medicine, Istanbul, Turkey
| | - Fahmi Bahar
- Andrology Section, Siloam Sriwijaya Hospital, Palembang, Indonesia
| | - Marlon Martinez
- Section of Urology, Department of Surgery, University of Santo Tomas Hospital, Manila, Philippines
| | - Quang Nguyen
- 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
| | - Rafael F. Ambar
- Department of Urology, Centro Universitario em Saude do ABC, Santo André, Brazil
- Andrology Group at Ideia Fertil Institute of Human Reproduction, Santo André, Brazil
| | | | | | - Nasser Mogharabian
- Sexual Health and Fertility Research Center, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Marjan Sabbaghian
- Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Hisanori Taniguchi
- Department of Urology and Andrology, Kansai Medical University, Hirakata, Osaka, Japan
| | - Akira Tsujimura
- Department of Urology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Hesamoddin Sajadi
- Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Wael Ibrahim
- Department of Obstetrics Gynaecology and Reproductive Medicine, Fertility Care Center in Cairo, Cairo, Egypt
| | - Widi Atmoko
- Department of Urology, Cipto Mangunkusumo General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Paraskevi Vogiatzi
- Andromed Health & Reproduction, Fertility & Reproductive Health Diagnostic Center, Athens, Greece
| | - Sezgin Gunes
- Department of Medical Biology, Medical Faculty, Ondokuz Mayis University, Samsun, Turkey
| | - Mohammad Ali Sadighi Gilani
- Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | | | - Nur Dokuzeylül Güngör
- Department of Obstetrics and Gynecology, Reproductive Endocrinology and IVF Unit, School of Medicine, Bahcesehir University, Istanbul, Turkey
| | - Lukman Hakim
- Department of Urology, Faculty of Medicine Universitas Airlangga, Universitas Airlangga Teaching Hospital, Surabaya, Indonesia
| | - Ricky Adriansjah
- Department of Urology, Faculty of Medicine Universitas Padjajaran, Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Priyank Kothari
- Department of Urology, Topiwala National Medical College, B.Y.L Nair Ch Hospital, Mumbai, India
| | - Sunil Jindal
- Department of Andrology and Reproductive Medicine, Jindal Hospital, Meerut, India
| | - Edouard Amar
- Department of Urology, American Hospital of Paris, Paris, France
| | - Hyun Jun Park
- Department of Urology, Pusan National University School of Medicine, Busan, Korea
- Medical Research Institute of Pusan National University Hospital, Busan, Korea
| | - Tran Quang Tien Long
- Department of Obstetrics and Gynecology, Hanoi Obstetric and Gynecology Hospital, Hanoi, Vietnam
| | - Sheryl Homa
- Department of Biosciences, University of Kent, Canterbury, UK
| | | | - Birute Zilaitiene
- Institute of Endocrinology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | - Angelo Marino
- Reproductive Medicine Unit, ANDROS Day Surgery Clinic, Palermo, Italy
| | - Edoardo Pescatori
- Andrology and Reproductive Medicine Unit, Gynepro Medical, Bologna, Italy
| | - Cevahir Ozer
- Department of Urology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Hamed Akhavizadegan
- Department of Urology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Nicolas Garrido
- IVI Foundation, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain
| | - Gian Maria Busetto
- Department of Urology and Renal Transplantation, University of Foggia, Policlinico Riuniti, Foggia, Italy
| | - Aram Adamyan
- IVF Department, Astghik Medical Center, Yerevan, Armenia
| | - Mohamed Al-Marhoon
- Division of Urology, Department of Surgery, Sultan Qaboos University, Muscat, Sultanate of Oman
| | - Haitham Elbardisi
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
- Department of Urology, Weill Cornell Medical-Qatar, Doha, Qatar
| | - Parisa Dolati
- Department of Animal Science, Faculty of Agriculture, University of Shiraz, Iran
| | - Mahsa Darbandi
- Fetal Health Research Center, Hope Generation Foundation, Tehran, Iran
- Gene Therapy and Regenerative Medicine Research Center, Hope Generation Foundation, Tehran, Iran
| | - Sara Darbandi
- Fetal Health Research Center, Hope Generation Foundation, Tehran, Iran
- Gene Therapy and Regenerative Medicine Research Center, Hope Generation Foundation, Tehran, Iran
| | - Giancarlo Balercia
- Department of Endocrinology, Polytechnic University of Marche, Ancona, Italy
| | | | - Sava Micic
- Department of Andrology, Uromedica Polyclinic, Belgrade, Serbia
| | | | - Mohamad Moussa
- Department of Urology, Lebanese University, Beirut, Lebanon
- Department of Urology, Al Zahraa Hospital, UMC, Lebanon
| | - Mirko Preto
- Department of Urology, Molinette Hospital, A.O.U. Città della Salute e della Scienza, University of Turin, Torino, Italy
| | | | - Ryan P. Smith
- Department of Urology, University of Virginia School of Medicine, Virginia, USA
| | - Raghavender Kosgi
- Department of Urology, Andrology and Renal Transplant, AIG Hospitals, Hyderabad, India
| | - Jean de la Rosette
- Department of Urology, Istanbul Medipol Mega University Hospital, Istanbul, Turkey
| | | | - Saad Mohammed Abumelha
- Division of Urology, Department of Surgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | | | - Teng Aik Ong
- Department of Surgery, University of Malaya, Kuala Lumpur, Malaysia
| | - Saleem A. Banihani
- Department of Medical Laboratory Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Kasonde Bowa
- Department of Urology, University of Lusaka, Lusaka, Zambia
| | - Shinichiro Fukuhara
- Department of Urology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Luca Boeri
- Department of Urology, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Yavuz Onur Danacıoğlu
- Department of Urology, University of Health Science Istanbul Bakırköy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Fatih Gokalp
- Department of Urology, Hatay Mustafa Kemal University, Antakya, Turkey
| | - Osama Mohamed Selim
- Department of Andrology, Sexology and STIs, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Chak-Lam Cho
- S. H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong
| | | | | | | | - Peter Chiu
- S. H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong
| | - Arif Kalkanli
- Department of Urology, Taksim Education and Research Hospital, Istanbul, Turkey
| | - Kareim Khalafalla
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
- Department of Urology, University of Illinois, Chicago, IL, USA
| | | | - Federica Finocchi
- Department of Endocrinology, Polytechnic University of Marche, Ancona, Italy
- Unit of Andrology and Reproductive Medicine, University of Padua, Padua, Italy
| | | | - Carlo Giulioni
- Department of Urology, Polytechnic University of Marche Region, Ancona, Italy
| | - Gökhan Çeker
- Department of Urology, Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey
- Department of Embryology and Histology, Zonguldak Bülent Ecevit University Institute of Health Sciences, Zonguldak, Turkey
| | - Erman Ceyhan
- Department of Urology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Vineet Malhotra
- Department of Urology, SCM Clinic and Hospital, New Delhi, India
| | - Mehmet Yilmaz
- Department of Urology, Faculty of Medicine, University of Freiburg-Medical Centre, Freiburg, Germany
| | - Massimiliano Timpano
- Department of Urology, Molinette Hospital, A.O.U. Città della Salute e della Scienza, University of Turin, Torino, Italy
| | | | - Shannon Hee Kyung Kim
- IVF Australia, Sydney, Australia
- Macquarie School of Medicine, Macquaire University, Sydney, Australia
| | - Sun-Tae Ahn
- Department of Urology, Korea University College of Medicine, Seoul, Korea
| | - Filippo Giacone
- Centro HERA, Unità di Medicina della Riproduzione, Sant'Agata Li Battiati, Catania, Italy
| | - Ayad Palani
- Research Centre, University of Garmian, Kalar, Iraq
| | | | - Ates Kadioglu
- Section of Andrology, Department of Urology, Istanbul University, Istanbul, Turkey
| | - Franco Gadda
- Department of Urology, IRCCS Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Kaan Aydos
- Department of Urology, Ankara University, Ankara, Turkey
| | - Deniz Kulaksız
- Department of Obstetrics and Gynecology, University of Health Sciences Kanuni Training and Research Hospital, Trabzon, Turkey
| | - Deepak Gupte
- Department of Urology, Bombay Hospital and Medical Research Center, Mumbai, India
| | - Gokhan Calik
- Department of Urology, Istanbul Medipol University, Istanbul, Turkey
| | - Keshab Kumar Karna
- Department of Molecular Cell and Cancer Biology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Panagiotis Drakopoulos
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
- IVF Athens, Athens, Greece
| | - Aykut Baser
- Department of Urology, Bandirma Onyedi Eylül University, Balikesir, Turkey
| | - Vijay Kumar
- Department of Microbiology, Kurukshetra University, Kurukshetra, India
| | | | - Osvaldo Rajmil
- Department of Andrology, Fundacio Puigvert, Barcelona, Spain
| | | | - Sofia Leonardi
- Central Laboratory, Hospital Publico Materno Infantil de Salta, Salta, Argentina
| | - Armen Avoyan
- Urology Department, Astghik Medical Center, Yerevan, Armenia
| | | | - Giorgio Franco
- Department of Urology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | | | - Liliana Ramirez
- IVF Laboratory, CITMER Reproductive Medicine, Mexico City, Mexico
| | - Rupin Shah
- Department of Urology, Lilavati Hospital and Research Centre, Mumbai, India
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Khalafalla K, Albakr A, El Ansari W, Majzoub A, Elbardisi H, AlRumaihi K, Arafa M. Short and long-term effectiveness of external shock wave therapy for chronic pelvic pain syndrome in men. Arab J Urol 2023; 21:162-169. [PMID: 37521448 PMCID: PMC10373607 DOI: 10.1080/2090598x.2023.2207415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/21/2023] [Indexed: 08/01/2023] Open
Abstract
Introduction Chronic pelvic pain syndrome (CPPS) is a frequent urological diagnosis that affects men's quality of life. Extracorporeal shockwave therapy (ESWT) is a recent treatment option for patients with CPPS. We evaluated ESWT's short and long - term efficacy in managing CPPS. Methods This prospective self-controlled study included 75 patients diagnosed with CPPS at our tertiary pelvic pain clinic between January 2017-June 2019. Patients were referred for ESWT and received four sessions one week apart. The National Institute for Health - Chronic Prostatitis Symptom Index (NIH - CPSI) questionnaire was used to assess patients' symptom severity before starting therapy and at 0, 12 and 26 weeks after completing ESWT. Demographics, clinical data and complications were also recorded. Results Patients' mean age was 37.9 ± 8.6 years, and mean duration of symptoms was 5 ± 4.5 years. Compared to pre-treatment scores, all patients exhibited improvements across all NIH - CPSI domains directly after completing ESWT (week 0 post-treatment), with a mean difference improvement of 9.26 ± 5.7, 5.2 ± 3.4, 1.19 ± 2.18 and 2.88 ± 2.46 points in the total, pain, urinary symptoms, and quality-of-life scores respectively. At 12 weeks after completing ESWT, 80.9% of patients reported improvements, with mean difference improvement of 8.07 ± 7.56, 4.55 ± 4.6, 0.76 ± 2.48, 2.85 ± 2.78 in the total, pain, urinary symptoms, and quality-of-life scores respectively. Again, none of the patients developed any treatment-related complications. At 26 weeks after completing ESWT, 82.4% of patients reported improvements, with mean difference improvement of 8.29 ± 7.7%, 4.92 ± 4.69, 0.75 ± 2.96, 2.5 ± 3.0 in total, pain, urinary symptoms, and quality-of-life scores respectively. None of the patients developed treatment-related complications. Conclusions ESWT is a safe and effective treatment modality for patients with CPPS, with short-term improvement in total, pain, urinary symptom, and quality-of-life scores; and long-term improvement in total, pain, and quality-of-life scores.
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Affiliation(s)
- Kareim Khalafalla
- Department of Urology, Hamad General Hospital, Doha, Qatar
- Division of Urology, Department of Surgery, University of Texas McGovern Medical School, Houston, TX, USA
- Department of Urology, MD Anderson Cancer Center, Houston, TX, USA
| | - Ahmed Albakr
- Department of Urology, Hamad General Hospital, Doha, Qatar
| | - Walid El Ansari
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
- Department of Population Health, College of Medicine, Qatar University, Doha, Qatar
- Institute for Population Health, Weill Cornell Medicine – Qatar, Doha, Qatar
| | - Ahmad Majzoub
- Department of Urology, Hamad General Hospital, Doha, Qatar
- Department of Urology, Weill Cornell Medicine – Qatar, Doha, Qatar
| | - Haitham Elbardisi
- Department of Urology, Hamad General Hospital, Doha, Qatar
- Department of Urology, Weill Cornell Medicine – Qatar, Doha, Qatar
- Department of Urology, Qatar University, Doha, Qatar
| | - Khalid AlRumaihi
- Department of Urology, Hamad General Hospital, Doha, Qatar
- Department of Urology, Weill Cornell Medicine – Qatar, Doha, Qatar
- Department of Urology, Qatar University, Doha, Qatar
| | - Mohamed Arafa
- Department of Urology, Hamad General Hospital, Doha, Qatar
- Department of Urology, Weill Cornell Medicine – Qatar, Doha, Qatar
- Department of Andrology, Cairo University, Cairo, Egypt
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Mahdi M, Majzoub A, Elbardisi H, Arafa M, Khalafalla K, Al Said S, El Ansari W. Impact of body mass index on semen parameters and reproductive hormones among men undergoing microsurgical subinguinal varicocelectomy. Arab J Urol 2023; 21:190-197. [PMID: 37521450 PMCID: PMC10373608 DOI: 10.1080/2090598x.2023.2206336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 04/19/2023] [Indexed: 08/01/2023] Open
Abstract
Background Few studies assessed the relationships between BMI and post varicocelectomy semen quality and fertility potential and they reported inconsistent findings. Objective To assess the association of BMI with semen parameters and reproductive hormones before and after microsurgical varicocelectomy. Materials and Methods Retrospective chart review in a tertiary infertility center. Of 1170 patients with clinical varicocele during the study period (8 years), 813 patients were eligible and included. Patients were grouped into: Group A (kg/m2, n = 251 patients), B (BMI 25-29.9 kg/m2, n = 289), C (BMI 30-34.9 kg/m2, n = 183) and D (kg/m2, n = 90). Clinical data, semen parameters, sperm DNA fragmentation and hormonal profile were collected before and 3 months after microsurgical varicocelectomy. Results Patients' mean age was 35.87 ± 8.17 years. Higher-grade varicocele was significantly more prevalent in the lower BMI groups. BMI was significantly negatively correlated with preoperative sperm concentration, total motility progressive motility and total motile sperm count. Pre-operatively, sperm concentration, total motility, progressive motility and total motile sperm count showed significant differences between BMI groups, where higher BMI (Groups C and D) exhibited the poorest semen parameters. Postoperatively, all groups showed significant improvement in sperm concentration compared with pre-operative values. However, total and progressive motility were significantly improved in Groups A, B and C, while in Group D (highest BMI), total motility improved clinically but not statistically, progressive motility did not display improvement, and total motile sperm count was significantly improved only in Groups B and C. Postoperatively, mean improvements in semen parameters across the BMI groups were not significantly different, except for morphology, which improved significantly more in the less obese patients. Conclusion For infertile patients with clinical varicocele undergoing micro-surgical varicocelectomy, BMI appears not to impact the improvements across most of the semen parameters and hormones. The procedure might improve the fertility potential.
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Affiliation(s)
- Mohammed Mahdi
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
| | - Ahmad Majzoub
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
- Department of Urology, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Haitham Elbardisi
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
- Department of Urology, Weill Cornell Medicine-Qatar, Doha, Qatar
- Department of Urology, Qatar University, Doha, Qatar
| | - Mohamed Arafa
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
- Department of Urology, Weill Cornell Medicine-Qatar, Doha, Qatar
- Department of Andrology, Cairo University, Cairo, Egypt
| | - Kareim Khalafalla
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
- Urology Department, University of Texas McGovern Medical School Houston, Texas, USA
- Urology Department, MD Anderson Cancer Center, Houston, TX, USA
| | - Sami Al Said
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
| | - Walid El Ansari
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
- College of Medicine, Qatar University, Doha, Qatar
- Department of Population Health, Weill Cornell Medicine-Qatar, Doha, Qatar
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9
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El Ansari W, Arafa M, Elbardisi H, Majzoub A, Mahdi M, Albakr A, AlRumaihi K, Al Ansari A. Scoping review of sexual and reproductive healthcare for men in the MENA (Middle East and North Africa) region: a handful of paradoxes? BMC Public Health 2023; 23:564. [PMID: 36973770 PMCID: PMC10040932 DOI: 10.1186/s12889-022-14716-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 11/24/2022] [Indexed: 03/28/2023] Open
Abstract
Background No study appraised the knowledge gaps and factors impacting men’s sexual and reproductive health (SRH) in MENA (Middle East and North Africa). The current scoping review undertook this task. Methods We searched PubMed and Web of Science (WoS) electronic databases for original articles on men’s SRH published from MENA. Data was extracted from the selected articles and mapped out employing the WHO framework for operationalising SRH. Analyses and data synthesis identified the factors impacting on men’s experiences of and access to SRH. Results A total of 98 articles met the inclusion criteria and were included in the analysis. The majority of studies focused on HIV and other sexually transmissible infections (67%); followed by comprehensive education and information (10%); contraception counselling/provision (9%); sexual function and psychosexual counselling (5%); fertility care (8%); and gender-based violence prevention, support/care (1%). There were no studies on antenatal/intrapartum/postnatal care and on safe abortion care (0% for both). Conceptually, there was lack of knowledge of the different domains of men’s SRH, with negative attitudes, and many misconceptions; as well as a deficiency of health system policies, strategies and interventions for SRH. Conclusion Men’s SRH is not sufficiently prioritized. We observed five ‘paradoxes’: strong focus on HIV/AIDS, when MENA has low prevalence of HIV; weak focus on both fertility and sexual dysfunctions, despite their high prevalence in MENA; no publications on men’s involvement in sexual gender-based violence, despite its frequency across MENA; no studies of men’s involvement in antenatal/intrapartum/postnatal care, despite the international literature valuing such involvement; and, many studies identifying lack of SRH knowledge, but no publications on policies and strategies addressing such shortcoming. These ‘mismatches’ suggest the necessity for efforts to enhance the education of the general population and healthcare workers, as well as improvements across MENA health systems, with future research examining their effects on men’s SRH. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-14716-2.
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Affiliation(s)
- Walid El Ansari
- grid.413548.f0000 0004 0571 546XDepartment of Surgery, Hamad Medical Corporation, Doha, Qatar
- grid.412603.20000 0004 0634 1084College of Medicine, Qatar University, Doha, Qatar
- grid.416973.e0000 0004 0582 4340Weill Cornell Medicine – Qatar, Doha, Qatar
| | - Mohamed Arafa
- grid.416973.e0000 0004 0582 4340Weill Cornell Medicine – Qatar, Doha, Qatar
- grid.413548.f0000 0004 0571 546XUrology Department, Hamad Medical Corporation, Doha, Qatar
- grid.7776.10000 0004 0639 9286Andrology Department, Cairo University, Cairo, Egypt
| | - Haitham Elbardisi
- grid.412603.20000 0004 0634 1084College of Medicine, Qatar University, Doha, Qatar
- grid.416973.e0000 0004 0582 4340Weill Cornell Medicine – Qatar, Doha, Qatar
- grid.413548.f0000 0004 0571 546XUrology Department, Hamad Medical Corporation, Doha, Qatar
| | - Ahmad Majzoub
- grid.416973.e0000 0004 0582 4340Weill Cornell Medicine – Qatar, Doha, Qatar
- grid.413548.f0000 0004 0571 546XUrology Department, Hamad Medical Corporation, Doha, Qatar
| | - Mohammed Mahdi
- grid.413548.f0000 0004 0571 546XUrology Department, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Albakr
- grid.413548.f0000 0004 0571 546XUrology Department, Hamad Medical Corporation, Doha, Qatar
| | - Khalid AlRumaihi
- grid.412603.20000 0004 0634 1084College of Medicine, Qatar University, Doha, Qatar
- grid.416973.e0000 0004 0582 4340Weill Cornell Medicine – Qatar, Doha, Qatar
- grid.413548.f0000 0004 0571 546XUrology Department, Hamad Medical Corporation, Doha, Qatar
| | - Abdulla Al Ansari
- grid.413548.f0000 0004 0571 546XDepartment of Surgery, Hamad Medical Corporation, Doha, Qatar
- grid.416973.e0000 0004 0582 4340Weill Cornell Medicine – Qatar, Doha, Qatar
- grid.413548.f0000 0004 0571 546XUrology Department, Hamad Medical Corporation, Doha, Qatar
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10
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El Ansari W, AlRumaihi K, El-Ansari K, Arafa M, Elbardisi H, Majzoub A, Shamsodini A, Al Ansari A. Reporting quality of abstracts of systematic reviews/meta-analyses: An appraisal of Arab Journal of Urology across 12 years: the PRISMA-Abstracts checklist. Arab J Urol 2023; 21:52-65. [PMID: 36818377 PMCID: PMC9930775 DOI: 10.1080/2090598x.2022.2113127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Objective We appraised the reporting quality of abstracts of systematic reviews/meta-analyses (SR/MAs) published in one urology journal and explored associations between abstract characteristics and completeness of reporting. Methods The Arab Journal of Urology (AJU) was searched for SR/MAs published between January 2011 and 31 May 2022. SR/MAs with structured abstract and quantitative synthesis were eligible. Two reviewers simultaneously together selected the SR/MAs by title, screened the abstracts, and included those based on inclusion/exclusion criteria. Data of a range of characteristics were extracted from each SR/MAs into a spreadsheet. To gauge completeness of reporting, the PRISMA-Abstract checklist (12 items) was used to appraise the extent to which abstracts adhered to the checklist. For each abstract, we computed item, section, and overall adherence. Chi-square and t-tests compared the adherence scores. Univariate and multivariate analyses identified the abstract characteristics associated with overall adherence. Results In total, 66 SR/MAs published during the examined period; 62 were included. Partial reporting was not uncommon. In terms of adherence to the 12 PRISMA-A items were: two items exhibited 100% adherence (title, objectives); five items had 80% to <100% adherence (interpretation, included studies, synthesis of results, eligibility criteria, and information sources); two items displayed 40% to <80% adherence (description of the effect, strengths/limitations of evidence); and three items had adherence that fell between 0% and 1.6% (risk of bias, funding/conflict of interest, registration). Multivariable regression revealed two independent predictors of overall adherence: single-country authorship (i.e. no collaboration) was associated with higher overall adherence (P = 0.046); and abstracts from South America were associated with lower overall adherence (P = 0.04). Conclusion This study is the first to appraise abstracts of SR/MAs in urology. For high-quality abstracts, improvements are needed in the quality of reporting. Adoption/better adherence to PRISMA-A checklist by editors/authors could improve the reporting quality and completeness of SR/MAs abstracts.
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Affiliation(s)
- Walid El Ansari
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar,College of Medicine, Qatar University, Doha, Qatar,Weill Cornell Medicine – Qatar, Doha, Qatar,CONTACT Walid El Ansari Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Khalid AlRumaihi
- College of Medicine, Qatar University, Doha, Qatar,Weill Cornell Medicine – Qatar, Doha, Qatar,Urology Department, Hamad Medical Corporation, Doha, Qatar
| | | | - Mohamed Arafa
- Weill Cornell Medicine – Qatar, Doha, Qatar,Urology Department, Hamad Medical Corporation, Doha, Qatar,Andrology Department, Cairo University, Cairo, Egypt
| | - Haitham Elbardisi
- College of Medicine, Qatar University, Doha, Qatar,Weill Cornell Medicine – Qatar, Doha, Qatar,Urology Department, Hamad Medical Corporation, Doha, Qatar
| | - Ahmad Majzoub
- Weill Cornell Medicine – Qatar, Doha, Qatar,Urology Department, Hamad Medical Corporation, Doha, Qatar
| | - Ahmad Shamsodini
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar,Weill Cornell Medicine – Qatar, Doha, Qatar,Urology Department, Hamad Medical Corporation, Doha, Qatar
| | - Abdulla Al Ansari
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar,Weill Cornell Medicine – Qatar, Doha, Qatar,Urology Department, Hamad Medical Corporation, Doha, Qatar
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11
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Majzoub A, Elbardisi H, Madani S, Leisegang K, Mahdi M, Agarwal A, Henkel R, Khalafalla K, ElSaid S, Arafa M. Impact of body composition analysis on male sexual function: A metabolic age study. Front Endocrinol (Lausanne) 2023; 13:1050441. [PMID: 36686453 PMCID: PMC9846759 DOI: 10.3389/fendo.2022.1050441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 12/05/2022] [Indexed: 01/05/2023] Open
Abstract
Introduction Metabolic Age (MetAge) and body composition analysis may reflect an individual's metabolic status, which is believed to influence male sexual and gonadal functions. Although erectile dysfunction (ED) and hypogonadism are increasingly prevalent with age, they are also detected among younger men. This study aims to assess the impact of MetAge and body composition on male sexual and gonadal status overall, and particularly in men younger than 40 years of age. Methods This was a cross-sectional study of 90 male healthcare workers, between the ages of 18-55, randomly selected based on their corporation numbers. In addition to Bioelectric Impedance Analysis, subjects were requested to fill the International Index of Erectile Function questionnaire (IIEF-5) and to provide an early morning serum testosterone (T) sample. Results The mean participants' age was 39.4 ± 9.4 years, MetAge was 45.54 ± 10.35 years, serum T level was 13.68 ± 4.49 nmol/L and BMI was 28.8 ± 4.7 kg/m2. Significant negative correlations were obtained between serum T, MetAge, body weight and fat composition. Significant negative correlations between the IIEF-5 score, MetAge, and fat composition, were only reported in subjects <40 years of age. Significantly lower T levels (p=0.002), significantly older MetAge (p=0.034), and higher BMI (p=0.044) and degree of obesity (p=0.042) were observed in participants <40 years with erectile dysfunction (ED) compared to their counterparts without ED. Discussion MetAge and body composition parameters significantly impact the androgenic state. ED in men <40 years is associated with lower T levels, older MetAge and higher BMI and degree of obesity.
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Affiliation(s)
- Ahmad Majzoub
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
- Clinical Urology, Weill Cornell Medicine -Qatar, Doha, Qatar
| | - Haitham Elbardisi
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
- Clinical Urology, Weill Cornell Medicine -Qatar, Doha, Qatar
| | - Sarah Madani
- Department of Biology and Physiology or Organisms, University of Science and Technology Houari Boumediene, Algiers, Algeria
| | - Kristian Leisegang
- School of Natural Medicine, Faculty of Community and Health Sciences, University of the Western Cape, Bellville, South Africa
| | - Mohamed Mahdi
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
| | - Ashok Agarwal
- Case Western Reserve University, Moreland Hills, OH, United States
| | - Ralf Henkel
- Department of Medical Bioscience, University of the Western Cape, Bellville, South Africa
- Department of Metabolism, Digestion and Reproduction at Imperial College London, London, United Kingdom
- LogixX Pharma, Theale, United Kingdom
| | | | - Sami ElSaid
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
- Clinical Urology, Weill Cornell Medicine -Qatar, Doha, Qatar
| | - Mohamed Arafa
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
- Clinical Urology, Weill Cornell Medicine -Qatar, Doha, Qatar
- Andrology Department, Cairo University, Cairo, Egypt
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12
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Shah R, Agarwal A, Kavoussi P, Rambhatla A, Saleh R, Cannarella R, Harraz AM, Boitrelle F, Kuroda S, Hamoda TAAAM, Zini A, Ko E, Calik G, Toprak T, Kandil H, Gül M, Bakırcıoğlu ME, Parekh N, Russo GI, Tadros N, Kadioglu A, Arafa M, Chung E, Rajmil O, Dimitriadis F, Malhotra V, Salvio G, Henkel R, Le TV, Sogutdelen E, Vij S, Alarbid A, Gudeloglu A, Tsujimura A, Calogero AE, El Meliegy A, Crafa A, Kalkanli A, Baser A, Hazir B, Giulioni C, Cho CL, Ho CCK, Salzano C, Zylbersztejn DS, Tien DMB, Pescatori E, Borges E, Serefoglu EC, Saïs-Hamza E, Huyghe E, Ceyhan E, Caroppo E, Castiglioni F, Bahar F, Gokalp F, Lombardo F, Gadda F, Duarsa GWK, Pinggera GM, Busetto GM, Balercia G, Cito G, Blecher G, Franco G, Liguori G, Elbardisi H, Keskin H, Lin H, Taniguchi H, Park HJ, Ziouziou I, de la Rosette J, Hotaling J, Ramsay J, Molina JMC, Lo KL, Bocu K, Khalafalla K, Bowa K, Okada K, Nagao K, Chiba K, Hakim L, Makarounis K, Hehemann M, Rodriguez Peña M, Falcone M, Bendayan M, Martinez M, Timpano M, Altan M, Fode M, Al-Marhoon MS, Sadighi Gilani MA, Soebadi MA, Gherabi N, Sofikitis N, Kahraman O, Birowo P, Kothari P, Sindhwani P, Javed Q, Ambar RF, Kosgi R, Ghayda RA, Adriansjah R, Condorelli RA, La Vignera S, Micic S, Kim SHK, Fukuhara S, Ahn ST, Mostafa T, Ong TA, Takeshima T, Amano T, Barrett T, Arslan U, Karthikeyan VS, Atmoko W, Yumura Y, Yuan Y, Kato Y, Jezek D, Cheng BKC, Hatzichristodoulou G, Dy J, Castañé ER, El-Sakka AI, Nguyen Q, Sarikaya S, Boeri L, Tan R, Moussa MA, El-Assmy A, Alali H, Alhathal N, Osman Y, Perovic D, Sajadi H, Akhavizadegan H, Vučinić M, Kattan S, Kattan MS, Mogharabian N, Phuoc NHV, Ngoo KS, Alkandari MH, Alsuhaibani S, Sokolakis I, Babaei M, King MS, Diemer T, Gava MM, Henrique R, Silva RSE, Paul GM, Mierzwa TC, Glina S, Siddiqi K, Wu H, Wurzacher J, Farkouh A, Son H, Minhas S, Lee J, Magsanoc N, Capogrosso P, Albano GJ, Lewis SEM, Jayasena CN, Alvarez JG, Teo C, Smith RP, Chua JBM, Jensen CFS, Parekattil S, Finelli R, Durairajanayagam D, Karna KK, Ahmed A, Evenson D, Umemoto Y, Puigvert A, Çeker G, Colpi GM. Consensus and Diversity in the Management of Varicocele for Male Infertility: Results of a Global Practice Survey and Comparison with Guidelines and Recommendations. World J Mens Health 2023; 41:164-197. [PMID: 35791302 PMCID: PMC9826919 DOI: 10.5534/wjmh.220048] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 03/15/2022] [Accepted: 03/20/2022] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Varicocele is a common problem among infertile men. Varicocele repair (VR) is frequently performed to improve semen parameters and the chances of pregnancy. However, there is a lack of consensus about the diagnosis, indications for VR and its outcomes. The aim of this study was to explore global practice patterns on the management of varicocele in the context of male infertility. MATERIALS AND METHODS Sixty practicing urologists/andrologists from 23 countries contributed 382 multiple-choice-questions pertaining to varicocele management. These were condensed into an online questionnaire that was forwarded to clinicians involved in male infertility management through direct invitation. The results were analyzed for disagreement and agreement in practice patterns and, compared with the latest guidelines of international professional societies (American Urological Association [AUA], American Society for Reproductive Medicine [ASRM], and European Association of Urology [EAU]), and with evidence emerging from recent systematic reviews and meta-analyses. Additionally, an expert opinion on each topic was provided based on the consensus of 16 experts in the field. RESULTS The questionnaire was answered by 574 clinicians from 59 countries. The majority of respondents were urologists/uro-andrologists. A wide diversity of opinion was seen in every aspect of varicocele diagnosis, indications for repair, choice of technique, management of sub-clinical varicocele and the role of VR in azoospermia. A significant proportion of the responses were at odds with the recommendations of AUA, ASRM, and EAU. A large number of clinical situations were identified where no guidelines are available. CONCLUSIONS This study is the largest global survey performed to date on the clinical management of varicocele for male infertility. It demonstrates: 1) a wide disagreement in the approach to varicocele management, 2) large gaps in the clinical practice guidelines from professional societies, and 3) the need for further studies on several aspects of varicocele management in infertile men.
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Affiliation(s)
- Rupin Shah
- Division of Andrology, Department of Urology, Lilavati Hospital and Research Centre, Mumbai, India
| | - Ashok Agarwal
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA.
| | - Parviz Kavoussi
- Austin Fertility & Reproductive Medicine/Westlake IVF, TX, USA
| | - Amarnath Rambhatla
- Department of Urology, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
| | - Ramadan Saleh
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Rossella Cannarella
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Ahmed M Harraz
- 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
| | - 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
| | - Shinnosuke Kuroda
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Taha Abo-Almagd Abdel-Meguid Hamoda
- Department of Urology, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Urology, Faculty of Medicine, Minia University, Minia, Egypt
| | - Armand Zini
- Division of Urology, Department of Surgery, McGill University, Montreal, QC, Canada
| | - Edmund Ko
- Department of Urology, Loma Linda University Health, Loma Linda, CA, USA
| | - Gokhan Calik
- Department of Urology, Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Tuncay Toprak
- Department of Urology, Fatih Sultan Mehmet Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | | | - Murat Gül
- Department of Urology, Selcuk University School of Medicine, Konya, Turkey
| | | | - Neel Parekh
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Nicholas Tadros
- Division of Urology, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Ates Kadioglu
- Section of Andrology, Department of Urology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Mohamed Arafa
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
- Department of Urology, Weill Cornell Medical-Qatar, Doha, Qatar
| | - Eric Chung
- Department of Urology, Princess Alexandra Hospital, University of Queensland, Brisbane, Australia
| | - Osvaldo Rajmil
- Department of Andrology, Fundacio Puigvert, Barcelona, Spain
| | - Fotios Dimitriadis
- Department of Urology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Gianmaria Salvio
- Department of Endocrinology, Polytechnic University of Marche, Ancona, Italy
| | - Ralf Henkel
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Department of Medical Bioscience, University of the Western Cape, Bellville, South Africa
| | - 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
| | | | - Sarah Vij
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Abdullah Alarbid
- Department of Surgery, Urology Unit, Farwaniya Hospital, Farwaniya, Kuwait
| | - Ahmet Gudeloglu
- Department of Urology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Akira Tsujimura
- Department of Urology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Aldo E Calogero
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Amr El Meliegy
- Department of Andrology, Sexology and STIs, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Andrea Crafa
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Arif Kalkanli
- Department of Urology, Taksim Education and Research Hospital, Istanbul, Turkey
| | - Aykut Baser
- Department of Urology, Faculty of Medicine, Bandırma Onyedi Eylül University, Balıkesir, Turkey
| | - Berk Hazir
- Reproductive medicine, Clinical Research Centre, Lund University, Malmö, Sweden
| | - Carlo Giulioni
- Department of Urology, Polytechnic University of Marche Region, Ancona, Italy
| | - Chak-Lam Cho
- S. H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Christopher C K Ho
- Department of Urology, Universiti Teknologi Mara (UiTM) Specialist Centre, Selangor, Malaysia
| | - Ciro Salzano
- PO San Giovanni Bosco, ASL Napoli 1 Centro, Napoli, Italy
| | | | - Dung Mai Ba Tien
- Department of Andrology, Binh Dan Hospital, Ho Chi Minh City, Vietnam
| | - Edoardo Pescatori
- Andrology and Reproductive Medicine Unit, Gynepro Medical, Bologna, Italy
| | | | - Ege Can Serefoglu
- Department of Urology, Biruni University School of Medicine, Istanbul, Turkey
| | - Emine Saïs-Hamza
- 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
| | - Eric Huyghe
- Department of Urology and Andrology, University Hospital of Toulouse, France
| | - Erman Ceyhan
- Department of Urology, School of Medicine, Baskent University, Konya, Turkey
| | - Ettore Caroppo
- Asl Bari, PTA "F Jaia", Reproductive and IVF unit, Andrology Outpatients Clinic, Asl Bari, Conversano (Ba), Italy
| | | | - Fahmi Bahar
- Andrology Section, Siloam Sriwijaya Hospital, Palembang, Indonesia
| | - Fatih Gokalp
- Department of Urology, Hatay Mustafa Kemal University, Antakya, Turkey
| | - Francesco Lombardo
- Laboratory of Seminology-Sperm Bank "Loredana Gandini", Department of Experimental Medicine, University of Rome "Sapienza", Rome, Italy
| | - Franco Gadda
- Department of Urology, IRCCS Fondazione Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | | | - Gian Maria Busetto
- Department of Urology and Organ Transplantation, University of Foggia, Ospedali Riuniti of Foggia, Foggia, Italy
| | - Giancarlo Balercia
- Department of Endocrinology, Polytechnic University of Marche, Ancona, Italy
| | - Gianmartin Cito
- Department of Urology, University of Florence, Florence, Italy
| | - Gideon Blecher
- Department of Surgery, School of Clinical Sciences, Monash University, Melbourne, Australia
- Department of Urology, The Alfred Hospital, Melbourne, Australia
| | - Giorgio Franco
- Department of Urology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | | | - Haitham Elbardisi
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
- Department of Urology, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Hakan Keskin
- Department of Urology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Haocheng Lin
- Department of Urology, Peking University Third Hospital, Peking University, Beijing, China
| | - Hisanori Taniguchi
- Department of Urology and Andrology, Kansai Medical University, Hirakata, Osaka, Japan
| | - Hyun Jun Park
- Department of Urology, Pusan National University School of Medicine, Busan, Korea
- Medical Research Institute of Pusan National University Hospital, Busan, Korea
| | - Imad Ziouziou
- Department of Urology, College of medicine and pharmacy, Ibn Zohr University, Agadir, Morocco
| | - Jean de la Rosette
- Department of urology, Faculty of Medicine, Istanbul Medipol Mega University Hospital, Istanbul, Turkey
| | - Jim Hotaling
- Department of Surgery (Urology), University of Utah, Salt Lake City, UT, USA
| | - Jonathan Ramsay
- Department of Andrology, Hammersmith Hospital, Imperial, London, UK
| | | | - Ka Lun Lo
- Division of Urology, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Kadir Bocu
- Department of Urology, Silopi State Hospital, Sirnak, Turkey
| | - Kareim Khalafalla
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
- Department of Urology, University of Illinois, Chicago, IL, USA
| | - Kasonde Bowa
- Department of Urology, School of Medicine and Health Sciences, University of Lusaka, Lusaka, Zambia
| | - Keisuke Okada
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Koichi Nagao
- Department of Urology, Toho University Faculty of Medicine, Tokyo, Japan
| | - Koji Chiba
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Lukman Hakim
- Department of Urology, Universitas Airlangga/Rumah Sakit Universitas Airlangga Teaching Hospital, Surabaya, Indonesia
| | | | - Marah Hehemann
- Department of Urology, University of Washington, Seattle, WA, USA
| | - Marcelo Rodriguez Peña
- Instituto de Ginecología y Fertilidad (IFER), Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Marco Falcone
- Department of Urology, Molinette Hospital, A.O.U. Città della Salute e della Scienza, University of Turin, Torino, Italy
| | - 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
| | - Marlon Martinez
- Section of Urology, Department of Surgery, University of Santo Tomas Hospital, Manila, Philippines
| | - Massimiliano Timpano
- Department of Urology, Molinette Hospital, A.O.U. Città della Salute e della Scienza, University of Turin, Torino, Italy
| | - Mesut Altan
- Department of Urology, Haceppete University, Ankara, Turkey
| | - Mikkel Fode
- Department of Urology, Herlev and Gentofte University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Mohammad Ali Sadighi Gilani
- Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | | | - Nazim Gherabi
- Andrology Committee of the Algerian Association of Urology, Algiers, Algeria
| | - Nikolaos Sofikitis
- Department of Urology, Ioannina University School of Medicine, Ioannina, Greece
| | - Oğuzhan Kahraman
- Department of Urology, School of Medicine, Baskent University, Konya, Turkey
| | - Ponco Birowo
- Department of Urology, Cipto Mangunkusumo General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | | | - Puneet Sindhwani
- Department of Urology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Qaisar Javed
- Department of Urology, Al - Ahlia Hospital Abu Dhabi UAE, Abu Dhabi, UAE
| | - Rafael F Ambar
- Department of Urology, Centro Universitario em Saude do ABC, Santo André, Brazil
- Andrology Group at Ideia Fertil Institute of Human Reproduction, Santo André, Brazil
| | - Raghavender Kosgi
- Department of Urology and Andrology, AIG Hospitals, Hyderabad, Telangana, India
| | - Ramy Abou Ghayda
- Urology Institute, University Hospitals, Case Western Reserve University, Cleveland, OH, USA
| | - Ricky Adriansjah
- Department of Urology, Faculty of Medicine Universitas Padjadjaran, Hasan Sadikin General Hospital, Banding, Indonesia
| | | | - Sandro La Vignera
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Sava Micic
- Department of Andrology, Uromedica Polyclinic, Belgrade, Serbia
| | - Shannon Hee Kyung Kim
- IVF Australia, Sydney, New South Wales, Australia
- Macquarie School of Medicine, Macquaire University, Sydney, New South Wales, Australia
| | - Shinichiro Fukuhara
- Department of Urology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Sun Tae Ahn
- Department of Urology, Korea University College of Medicine, Seoul, Korea
| | - Taymour Mostafa
- Department of Andrology, Sexology and STIs, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Teng Aik Ong
- Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Teppei Takeshima
- Department of Urology, Reproduction Center, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Toshiyasu Amano
- Department of Urology, Nagano Red Cross Hospital, Nagano, Japan
| | | | - Umut Arslan
- Department of Urology, Fatih Sultan Mehmet Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | | | - Widi Atmoko
- Department of Urology and Andrology, AIG Hospitals, Hyderabad, Telangana, India
| | - Yasushi Yumura
- Department of Urology, Reproduction Center, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan
| | - Yiming Yuan
- Andrology Center & Urology Department, Peking University First Hospital, Peking University, Beijing, China
| | - Yuki Kato
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Davor Jezek
- Department for Transfusion Medicine and Transplantation Biology, Reproductive Tissue Bank, University of Zagreb, School of Medicine, University Hospital Zagreb, Zagreb, Croatia
| | | | | | - Jun Dy
- Stone and Prostate Treatment Services/Pelvic Floor Center and Anorectal Diseases, St. Luke's Medical Center, Quezon City, Metro Manila, Philippines
| | - Eduard Ruiz Castañé
- Department of Andrology, Fundació Puigvert, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ahmed I El-Sakka
- Department of Urology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Quang Nguyen
- 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
| | - Selcuk Sarikaya
- Department of Urology, Gülhane Research and Training Hospital, University of Health Sciences, Ankara, Turkey
| | - Luca Boeri
- Department of Urology, IRCCS Fondazione Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ronny Tan
- Advanced Urology Associates, Singapore
- Mount Elizabeth Hospital, Singapore
| | - Mohamad A Moussa
- Department of Urology, Lebanese University, Beirut, Lebanon
- Department of Urology, Al Zahraa Hospital, UMC, Lebanon
| | - Ahmed El-Assmy
- Mansoura University Urology and Nephrology Center, Mansoura, Egypt
| | - Hamed Alali
- King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Naif Alhathal
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Yasser Osman
- Mansoura University Urology and Nephrology Center, Mansoura, Egypt
| | - Dragoljub Perovic
- Urology and Andrology Center, CODRA Hospital, University of Montenegro, Podgorica, Montenegro
| | | | - Hamed Akhavizadegan
- Department of Urology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Said Kattan
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mohamed S Kattan
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Nasser Mogharabian
- Sexual Health and Fertility Research Center, Shahroud University of Medical Sciences, Shahroud, Iran
| | | | - Kay Seong Ngoo
- Urology Unit, Department of Surgery, Hospital Angkatan Tentera Tuanku Mizan, Kuala Lumpur, Malaysia
| | - Mohammad H Alkandari
- Department of Urology, Mubarak Al-Kabeer Teaching Hospital, Kuwait University, Jabriya, Kuwait
| | - Shaheed Alsuhaibani
- Department of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ioannis Sokolakis
- Department of Urology, Martha-Maria Hospital Nuremberg, Nuremberg, Germany
| | - Mehdi Babaei
- Department of Andrology, Shariati Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mak Siu King
- Division of Urology, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Thorsten Diemer
- Department of Urology, Pediatric Urology and Andrology, Justus-Liebig-University Giessen (GER), University Hospital Giessen and Marburg GmbH, Campus Giessen, Giessen, Germany
| | - Marcelo M Gava
- Department of Urology, Centro Universitario em Saude do ABC, Santo André, Brazil
- Andrology Group at Ideia Fertil Institute of Human Reproduction, Santo André, Brazil
| | | | - Rodrigo Spinola E Silva
- Department of Urology, Centro Universitario em Saude do ABC, Santo André, Brazil
- Andrology Group at Ideia Fertil Institute of Human Reproduction, Santo André, Brazil
| | - Gustavo Marquesine Paul
- Department of Urology, Hospital de Clínicas of the Federal University of Paraná, Curitiba, Brazil
| | | | - Sidney Glina
- Department of Urology, Centro Universitario em Saude do ABC, Santo André, Brazil
| | | | - Han Wu
- Department of Andrology, PKU 3rd Hospital Reproductive Medicine Center, Beijing, China
| | - Jana Wurzacher
- Department of Urology, University Hospital Innsbruck, Innsbruck, Austria
| | - Ala'a Farkouh
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Hwancheol Son
- Department of Urology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Suks Minhas
- Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Joe Lee
- Department of Urology, National University Hospital, Singapore
| | - Nikko Magsanoc
- Department of Surgery, University of the Philippines College of Medicine, Manila, Philippines
| | | | - German Jose Albano
- Section of Urology, Department of Surgery, University of Santo Tomas Hospital, Manila, Philippines
| | | | - Channa N Jayasena
- Department of Reproductive Endocrinology and Andrology, Imperial College London, London, UK
- Department of Andrology, Hammersmith & St. Mary's Hospitals, London, UK
| | - Juan G Alvarez
- Department of Andrology, Centro ANDROGEN, La Coruña, Spain
| | - Colin Teo
- Department of Urology, Gleneagles Hospital, Singapore
| | - Ryan P Smith
- Department of Urology, University of Virginia School of Medicine, Virginia, USA
| | - Jo Ben M Chua
- Department of Urology, East Avenue Medical Center, Quezon City, Philippines
| | | | - Sijo Parekattil
- Avant Concierge Urology & University of Central Florida, Winter Garden, FL, USA
| | - Renata Finelli
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Damayanthi Durairajanayagam
- Department of Physiology, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Selangor, Malaysia
| | - Keshab Kumar Karna
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Abdelkareem Ahmed
- Department of Urology, Sabah Al Ahmad Urology Center, Kuwait City, Kuwait
| | | | - Yukihiro Umemoto
- Department of Nephro-Urology, Nagoya City West Medical Center, Nagoya, Japan
| | - Ana Puigvert
- Urological and Human Reproduction Unit, Quiron Hospital, Barcelona, Spain
| | - Gökhan Çeker
- Department of Urology, Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey
- Department of Embryology and Histology, Zonguldak Bülent Ecevit University Institute of Health Sciences, Zonguldak, Turkey
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Albakr A, Arafa M, Majzoub A, El Ansari W, Qasem M, Al Said S, Elbardisi H. A rare abnormality of ejaculatory duct opening in the bladder trigone in a 33‐year‐old male associated with primary infertility: Case report and literature review. Andrologia 2022; 54:e14627. [DOI: 10.1111/and.14627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 10/11/2022] [Accepted: 10/13/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Ahmed Albakr
- Urology Department Hamad Medical Corporation Doha Qatar
| | - Mohamed Arafa
- Urology Department Hamad Medical Corporation Doha Qatar
- Andrology Department Cairo University Cairo Egypt
- Urology department Weill Cornell Medicine‐Qatar Doha Qatar
- American Center for Reproductive Medicine Cleveland Clinic Cleveland Ohio USA
| | - Ahmad Majzoub
- Urology Department Hamad Medical Corporation Doha Qatar
- Urology department Weill Cornell Medicine‐Qatar Doha Qatar
- American Center for Reproductive Medicine Cleveland Clinic Cleveland Ohio USA
| | - Walid El Ansari
- Urology department Weill Cornell Medicine‐Qatar Doha Qatar
- Department of Surgery Hamad Medical Corporation Doha Qatar
- College of Medicine Qatar University Doha Qatar
| | - Mamon Qasem
- Department of Radiology Hamad Medical Corporation Doha Qatar
| | - Sami Al Said
- Urology Department Hamad Medical Corporation Doha Qatar
| | - Haitham Elbardisi
- Urology Department Hamad Medical Corporation Doha Qatar
- Urology department Weill Cornell Medicine‐Qatar Doha Qatar
- American Center for Reproductive Medicine Cleveland Clinic Cleveland Ohio USA
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14
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El Ansari W, Arafa M, Majzoub A, Elbardisi H, Albakr A, Mahdi M, El-Ansari K, Al Ansari A, AlRumaihi K. Bibliometric and Visualization Analysis of the Ecology of Men's Sexual and Reproductive Healthcare Research in MENA (1985-2022): Outputs, Trends, Shortcomings and Hotspots. Arab J Urol 2022; 21:82-93. [PMID: 37234677 PMCID: PMC10208131 DOI: 10.1080/2090598x.2022.2141864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 10/17/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022] Open
Abstract
Background To date, no previous research assessed the bibliometrics of men's sexual and reproductive healthcare (SRHC) across Arab countries. This study appraised the current standing of men's SRHC research in the MENA (Middle East and North Africa) region. Methods We performed a bibliometric analysis to assess qualitatively and quantitatively the peer-reviewed articles published from Arab countries from inception to 2022. In addition, we conducted a visualization analysis, and assessed outputs, trends, shortcomings and hotspots over the given time period. Results There was a generally low numbers of publications, 98 studies were identified, all with cross-sectional design, and two thirds explored prevention and control of HIV/other STDs. Studies were published in 71 journals, of which the Eastern Mediterranean Health Journal, Journal of Egyptian Public Health Association, AIDS Care and BMC public health were most common. The Journal of Adolescent Health, Fertility Sterility and Journal of Cancer Survivorship were among the highest IF ranking. Publishers were commonly USA or UK-based, median journal IF was 2.09, and five articles were in journals of IF > 4. Saudi Arabia had the highest published output followed by Egypt, Jordan and Lebanon, while 10 Arab countries had no publications on the topic. Corresponding authors expertise fields were most commonly public health, infectious diseases and family medicine). Collaborations in-between MENA countries were notably low. Conclusions There is general paucity of published outputs on SRHC. More research across MENA is needed, with more inter-MENA collaborations, and with inclusion of countries that currently have no outputs on SRHC. In order to accomplish such goals, R&D funding and capacity building are required. Research and published outputs should address SRHC burdens.
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Affiliation(s)
- Walid El Ansari
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
- College of Medicine, Qatar University, Doha, Qatar
- Weill Cornell Medicine – Qatar, Doha, Qatar
| | - Mohamed Arafa
- Weill Cornell Medicine – Qatar, Doha, Qatar
- Urology Department, Hamad Medical Corporation, Doha, Qatar
- Andrology Department, Cairo University, Cairo, Egypt
| | - Ahmad Majzoub
- Weill Cornell Medicine – Qatar, Doha, Qatar
- Urology Department, Hamad Medical Corporation, Doha, Qatar
| | - Haitham Elbardisi
- College of Medicine, Qatar University, Doha, Qatar
- Weill Cornell Medicine – Qatar, Doha, Qatar
- Urology Department, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Albakr
- Urology Department, Hamad Medical Corporation, Doha, Qatar
| | - Mohammed Mahdi
- Urology Department, Hamad Medical Corporation, Doha, Qatar
| | | | - Abdulla Al Ansari
- Department of Surgery, Hamad Medical Corporation, Doha, Qatar
- Weill Cornell Medicine – Qatar, Doha, Qatar
- Urology Department, Hamad Medical Corporation, Doha, Qatar
| | - Khalid AlRumaihi
- College of Medicine, Qatar University, Doha, Qatar
- Weill Cornell Medicine – Qatar, Doha, Qatar
- Urology Department, Hamad Medical Corporation, Doha, Qatar
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15
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Elbardisi H, Arafa M, Khalafalla K, Mahdi M, Albadr M, embryologist, Burjaq H, Almarzooqi T, Albasha S, Majzoub A. ICSI OUTCOME IN PATIENTS WITH SEVERE SPERMATOGENIC FAILURE USING EJACULATE SPERMS VS TESTICULAR SPERMS. Fertil Steril 2022. [DOI: 10.1016/j.fertnstert.2022.08.810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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16
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Mahdi M, Majzoub A, Khalafalla K, To J, Aviles‐Sandoval M, Elbardisi H, AlSaid S, Agarwal A, Henkel R, Arafa M. Effect of redo varicocelectomy on semen parameters and pregnancy outcome: An original report and meta‐analysis. Andrologia 2022; 54:e14525. [DOI: 10.1111/and.14525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/23/2022] [Accepted: 06/21/2022] [Indexed: 11/28/2022] Open
Affiliation(s)
- Mohamed Mahdi
- Department of Urology Hamad Medical Corporation Doha Qatar
| | - Ahmad Majzoub
- Department of Urology Hamad Medical Corporation Doha Qatar
- Clinical Urology Weill Cornell Medicine –Qatar Doha Qatar
| | - Kareim Khalafalla
- Department of Urology Hamad Medical Corporation Doha Qatar
- Department of Urology University of Illinois at Chicago Chicago Illinois USA
| | - Jason To
- College of Alameda Alameda California USA
| | | | - Haitham Elbardisi
- Department of Urology Hamad Medical Corporation Doha Qatar
- Clinical Urology Weill Cornell Medicine –Qatar Doha Qatar
- College of Medicine Qatar University Doha Qatar
| | - Sami AlSaid
- Department of Urology Hamad Medical Corporation Doha Qatar
- Clinical Urology Weill Cornell Medicine –Qatar Doha Qatar
| | - Ashok Agarwal
- American Center for Reproductive Medicine Cleveland Clinic Cleveland Ohio USA
| | - Ralf Henkel
- Department of Metabolism Digestion and Reproduction at Imperial College London London UK
| | - Mohamed Arafa
- Department of Urology Hamad Medical Corporation Doha Qatar
- Clinical Urology Weill Cornell Medicine –Qatar Doha Qatar
- Andrology Department Cairo University Cairo Egypt
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17
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Agarwal A, Gupta S, Sharma RK, Finelli R, Kuroda S, Vij SC, Boitrelle F, Kavoussi P, Rambhatla A, Saleh R, Chung E, Mostafa T, Zini A, Ko E, Parekh N, Martinez M, Arafa M, Tadros N, de la Rosette J, Le TV, Rajmil O, Kandil H, Blecher G, Liguori G, Caroppo E, Ho CCK, Altman A, Bajic P, Goldfarb D, Gill B, Zylbersztejn DS, Molina JMC, Gava MM, Cardoso JPG, Kosgi R, Çeker G, Zilaitiene B, Pescatori E, Borges E, Duarsa GWK, Pinggera GM, Busetto GM, Balercia G, Franco G, Çalik G, Sallam HN, Park HJ, Ramsay J, Alvarez J, Khalafalla K, Bowa K, Hakim L, Simopoulou M, Rodriguez MG, Sabbaghian M, Elbardisi H, Timpano M, Altan M, Elkhouly M, Al-Marhoon MS, Sadighi Gilani MA, Soebadi MA, Nasr-Esfahani MH, Garrido N, Vogiatzi P, Birowo P, Patel P, Javed Q, Ambar RF, Adriansjah R, AlSaid S, Micic S, Lewis SE, Mutambirwa S, Fukuhara S, Parekattil S, Ahn ST, Jindal S, Takeshima T, Puigvert A, Amano T, Barrett T, Toprak T, Malhotra V, Atmoko W, Yumura Y, Morimoto Y, Lima TFN, Kunz Y, Kato Y, Umemoto Y, Colpi GM, Durairajanayagam D, Shah R. Post-Vasectomy Semen Analysis: Optimizing Laboratory Procedures and Test Interpretation through a Clinical Audit and Global Survey of Practices. World J Mens Health 2022; 40:425-441. [PMID: 35021311 PMCID: PMC9253792 DOI: 10.5534/wjmh.210191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/16/2021] [Accepted: 09/23/2021] [Indexed: 02/05/2023] Open
Abstract
PURPOSE The success of vasectomy is determined by the outcome of a post-vasectomy semen analysis (PVSA). This article describes a step-by-step procedure to perform PVSA accurately, report data from patients who underwent post vasectomy semen analysis between 2015 and 2021 experience, along with results from an international online survey on clinical practice. MATERIALS AND METHODS We present a detailed step-by-step protocol for performing and interpretating PVSA testing, along with recommendations for proficiency testing, competency assessment for performing PVSA, and clinical and laboratory scenarios. Moreover, we conducted an analysis of 1,114 PVSA performed at the Cleveland Clinic's Andrology Laboratory and an online survey to understand clinician responses to the PVSA results in various countries. RESULTS Results from our clinical experience showed that 92.1% of patients passed PVSA, with 7.9% being further tested. A total of 78 experts from 19 countries participated in the survey, and the majority reported to use time from vasectomy rather than the number of ejaculations as criterion to request PVSA. A high percentage of responders reported permitting unprotected intercourse only if PVSA samples show azoospermia while, in the presence of few non-motile sperm, the majority of responders suggested using alternative contraception, followed by another PVSA. In the presence of motile sperm, the majority of participants asked for further PVSA testing. Repeat vasectomy was mainly recommended if motile sperm were observed after multiple PVSA's. A large percentage reported to recommend a second PVSA due to the possibility of legal actions. CONCLUSIONS Our results highlighted varying clinical practices around the globe, with controversy over the significance of non-motile sperm in the PVSA sample. Our data suggest that less stringent AUA guidelines would help improve test compliance. A large longitudinal multi-center study would clarify various doubts related to timing and interpretation of PVSA and would also help us to understand, and perhaps predict, recanalization and the potential for future failure of a vasectomy.
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Affiliation(s)
- Ashok Agarwal
- American Center for Reproductive Medicine, Cleveland, OH, USA.
| | - Sajal Gupta
- American Center for Reproductive Medicine, Cleveland, OH, USA
| | - Rakesh K Sharma
- American Center for Reproductive Medicine, Cleveland, OH, USA
| | - Renata Finelli
- American Center for Reproductive Medicine, Cleveland, OH, USA
| | | | - Sarah C Vij
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Florence Boitrelle
- Reproductive Biology, Fertility Preservation, Andrology, CECOS, Poissy Hospital, Poissy, France
- Paris Saclay University, UVSQ, INRAE, BREED, Jouy-en-Josas, France
| | - Parviz Kavoussi
- Austin Fertility and Reproductive Medicine/Westlake IVF, Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | | | - Ramadan Saleh
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Eric Chung
- Department of Urology, Princess Alexandra Hospital, University of Queensland, Brisbane, Australia
| | - Taymour Mostafa
- Department of Andrology, Sexology & STIs, Faculty of Medicina, Cairo University, Cairo, Egypt
| | - Armand Zini
- Department of Surgery, McGill University, Montreal, QC, Canada
| | - Edmund Ko
- Department of Urology, Loma Linda University Health, Loma Linda, CA, USA
| | - Neel Parekh
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Marlon Martinez
- Section of Urology, University of Santo Tomas Hospital, Manila, Philippines
| | - Mohamed Arafa
- American Center for Reproductive Medicine, Cleveland, OH, USA
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
- Department of Urology, Weill Cornell Medical-Qatar, Doha, Qatar
| | - Nicholas Tadros
- Division of Urology, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Jean de la Rosette
- Department of Urology, Medipol Mega University Hospital, Istanbul, Turkey
| | - 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
| | - Osvaldo Rajmil
- Department of Andrology, Fundacio Puigvert, Barcelona, Spain
| | | | - Gideon Blecher
- Department of Surgery, School of Clinical Sciences, Monash University, Melbourne, Australia
| | | | | | - Christopher C K Ho
- Department of Surgery, School of Medicine, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Malaysia
| | - Andrew Altman
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Petar Bajic
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - David Goldfarb
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Bradley Gill
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | | | - Marcello M Gava
- Sexual and Reproductive Medicine, Department of Urology, Faculdade de Medicina do ABC, Santo André, Brazil
- Andrology Group at Ideia Fertil Institute of Human Reproduction, Santo André, Brazil
| | - Joao Paulo Greco Cardoso
- Divisao de Urologia, Hospital das Clínicas HCFMUSP, Universidade de Sao Paulo, São Paulo, Brazil
| | - Raghavender Kosgi
- Department of Urology and Andrology, AIG Hospitals, Gachibowli, Hyderabad, India
| | - Gökhan Çeker
- Department of Urology, Samsun Vezirköprü State Hospital, Samsun, Turkey
| | - Birute Zilaitiene
- Institute of Endocrinology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Edoardo Pescatori
- Andrology and Reproductive Medicine Unit, Gynepro Medical, Bologna, Italy
| | | | - Gede Wirya Kusuma Duarsa
- Department of Urology, Faculty of Medicine, Sanglah General Academic Hospital, Udayana University, Denpasar, Indonesia
| | | | - Gian Maria Busetto
- Department of Urology and Organ Transplantation, University of Foggia, Ospedali Riuniti of Foggia, Foggia, Italy
| | - Giancarlo Balercia
- Department of Endocrinology and Metabolic Diseases, Polytechnic University of Marche, Ancona, Italy
| | - Giorgio Franco
- UOC Urologia, Department Materno-Infantile e Scienze Urologiche, AOU Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Gökhan Çalik
- Department of Urology, Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Hassan N Sallam
- Department of Obstetrics and Gynaecology, Alexandria University Faculty of Medicine, Alexandria, Egypt
| | - Hyun Jun Park
- Department of Urology, Pusan National University School of Medicine, Busan, Korea
- Medical Research Institute of Pusan National University Hospital, Busan, Korea
| | | | | | | | - Kasonde Bowa
- Department of Urology, School of Medicine and Health Sciences, University of Lusaka, Lusaka, Zambia
| | - Lukman Hakim
- Department of Urology, Universitas Airlangga/Rumah Sakit Universitas Airlangga Teaching Hospital, Surabaya, Indonesia
| | - Mara Simopoulou
- Department of Experimental Physiology, School of Health Sciences, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Marcelo Gabriel Rodriguez
- Departamento Docencia e Investigación, Hospital Militar Campo de Mayo, Universidad Barcelo, Buenos Aires, Argentina
| | - Marjan Sabbaghian
- Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Haitham Elbardisi
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
- Department of Urology, Weill Cornell Medical-Qatar, Doha, Qatar
| | | | - Mesut Altan
- Department of Urology, Hacettepe University, Ankara, Turkey
| | | | | | - Mohammad Ali Sadighi Gilani
- Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Mohammad Ayodhia Soebadi
- Department of Urology, Universitas Airlangga/Rumah Sakit Universitas Airlangga Teaching Hospital, Surabaya, Indonesia
| | - Mohammad Hossein Nasr-Esfahani
- Department of Animal Biotechnology, Reproductive Biomedicine Research Center, Royan Institute for Biotechnology, ACECR, Isfahan, Iran
| | - Nicolas Garrido
- IVI Foundation, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain
| | - Paraskevi Vogiatzi
- Andromed Health & Reproduction, Fertility Diagnostics Laboratory, Maroussi, Greece
| | - Ponco Birowo
- Department of Urology, Cipto Mangunkusumo General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Premal Patel
- Section of Urology, University of Manitoba, Winnipeg, MB, Canada
| | - Qaisar Javed
- Department of Urology, Ahalia Hospital, Hamdan Street Branch, Abu Dhabi, UAE
| | - Rafael F Ambar
- Andrology Group at Ideia Fertil Institute of Human Reproduction, Santo André, Brazil
- Department of Urology, Centro Universitario em Saude do ABC, Santo André, Brazil
| | - Ricky Adriansjah
- Department of Urology, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Sami AlSaid
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
| | - Sava Micic
- Department of Andrology, Uromedica Polyclinic, Belgrade, Serbia
| | - Sheena E Lewis
- Examenlab Ltd., Weavers Court Business Park, Linfield Road, Belfast, Northern Ireland, UK
| | - Shingai Mutambirwa
- Division of Urology, Safeko Makgatho Health Scienses University and Dr George Mukhari Academic Hospital, Pretoria, South Africa
| | - Shinichiro Fukuhara
- Department of Urology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Sijo Parekattil
- Avant Concierge Urology & University of Central Florida, Winter Garden, FL, USA
| | - Sun Tae Ahn
- Department of Urology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sunil Jindal
- Department of Andrology and Reproductive Medicine, Jindal Hospital, Meerut, India
| | - Teppei Takeshima
- Department of Urology, Reproduction Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Ana Puigvert
- Fundació Puigvert, Hospital de la Santa Cruz y San Pablo, Universidad Autonoma de Barcelona, Barcelona, Spain
| | - Toshiyasu Amano
- Department of Urology, Nagano Red Cross Hospital, Nagano, Japan
| | | | - Tuncay Toprak
- Department of Urology, University of Health Sciences, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Vineet Malhotra
- Department of Andrology and Urology, Diyos Hospital, New Delhi, India
| | - Widi Atmoko
- Department of Urology, Cipto Mangunkusumo General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Yasushi Yumura
- Department of Urology, Reproduction Center, Yokohama City University Medical Center, Yokohama, Japan
| | | | | | - Yannic Kunz
- Department of Urology, Innsbruck Medical University, Innsbruck, Austria
| | - Yuki Kato
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Yukihiro Umemoto
- Department of Nephro-Urology, Nagoya City West Medical Center, Nagoya, Japan
| | | | - Damayanthi Durairajanayagam
- Department of Physiology, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Selangor, Malaysia
| | - Rupin Shah
- Division of Andrology, Department of Urology, Lilavati Hospital and Research Centre, Mumbai, India
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18
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Elbardisi H, Arafa M, Mahdi M, Khalafallah K, Alsaid S, Majzoub A. P-054 Impact of age and correction timing on the progression of testicular dysfunction in patients with grade 3 varicocele. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
Does varicocele lead to progressive testicular dysfunction If not corrected and Can patients with long history of varicocele benefit from varicocelectomy?
Summary answer
Varicocele in older patients have more pronounced effect. Correction at a younger age leads to more significant improvement in testicular function and semen parameters.
What is known already
Varicocele is present in up to 20% of the general adult male population and is more prevalent in men with primary (40%) or secondary infertility (80%). This clinical condition is mostly asymptomatic but can present with persistent scrotal pain in about 10% of cases. More importantly, varicocele has detrimental effect on testicular function due to several pathophysiologic mechanisms including hyperthermia, tissue ischemia, oxidative stress, and reflux of adrenal metabolites.
Microsurgical varicocelectomy is considered the gold standard technique with least side effects compared to other modalities. Varicocelectomy is directly associated with improvements in pain and semen parameters and fertility potential.
Study design, size, duration
This retrospective study was approved by the ethics committee at Hamad Medical Corporation, Doha, Qatar, and has obtained a waiver of informed consent. Records of 1500 patients undergoing microsurgical subinguinal varicocelectomy between January 2017 and July 2020 were collected.
Participants/materials, setting, methods
The inclusion criteria were infertile patients who presented with a clinical grade 3 varicocele. Patients who were azoospermic or severe oligozoospermic, had genetic abnormalities or received prior infertility medical treatment were excluded. Also, patients with prior history of varicocelectomy, orchidopexy or exposure to gonadotoxins were also excluded. Patients were divided in 2 groups according to age, <40years and > =40years. The preoperative semen analysis and hormonal profile pre-surgery and 6 months post-surgery were collected.
Main results and the role of chance
265 patients met the inclusion criteria and were therefore enrolled for data analysis. 210 patients were <40 years and 55 patients >/=40 years at the time of varicocelectomy. The patients' mean age was 33.8±8 years.
Older age was found to be significantly correlated with count (-1.42), total motility (-0.166), progressive motility (-0.193), normal morphology (-0.035), FSH (-0.255) and testosterone (-0.204).
Comparing the preoperative results between the groups, older patients (>/=40years) showed significantly lower values of total motility (39% vs 48.5% P = 0.04), progressive motility (7%vs 20% P = 0.0004), FSH (4 vs 3 P = 0.005) and testosterone (14.1 vs 17.1 P = 0.002) compared with younger patients.
Compared with pre operative parameters, the post operative results in patients <40years showed significant improvement in sperm concentration (33 vs 26.9 p = 0.009), total motility (55% vs 48.5% p < 0.001) and progressive motility (23.5% vs 20% p = 0.022). However, in patients >/=40years, only progressive motility improved significantly (17% vs 7% p = 0.044).
By comparing the post-operative results between the groups, the improvement was significantly better in patients <40years regarding total motility (p = 0.01), progressive motility (p = 0.02) and FSH (p = 0.002).
Limitations, reasons for caution
Retrospective nature
Limited number if cases
Wider implications of the findings
Varicocele will lead to progressive testicular dysfunction if not corrected at younger age
Trial registration number
not applicable
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Affiliation(s)
- H Elbardisi
- Hamad Medical corporation, Urology- Andrology and male infertility , Doha, Qatar
| | - M Arafa
- Hamad Medical corporation, Urology- Andrology and male infertility , Doha, Qatar
| | - M Mahdi
- Hamad Medical corporation, Urology- Andrology and male infertility , Doha, Qatar
| | - K Khalafallah
- Hamad Medical corporation, Urology- Andrology and male infertility , Doha, Qatar
| | - S Alsaid
- Hamad Medical corporation, Urology- Andrology and male infertility , Doha, Qatar
| | - A Majzoub
- Hamad Medical corporation, Urology- Andrology and male infertility , Doha, Qatar
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19
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Majzoub A, Arafa M, Khalafalla K, Alsaid S, Elbardisi H. P-040 Impact of varicocele on male fertility potential: comparison of unilateral vs bilateral disease on clinical presentation and outcome of varicocelectomy. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Study question
Is there a difference between unilateral and bilateral varicocele on clinical presentation and postsurgical outcome of infertile men undergoing microsurgical subinguinal varicocelectomy?
Summary answer
Patients with bilateral varicocele have significantly worse clinical presentation than unilateral disease. Significantly greater improvement in total motility was detected with bilateral varicocele ligation.
What is known already
Varicocele is a common clinical condition with significant implications on male fertility potential. In the majority of cases, varicocele is unilateral affecting the left spermatic veins. Nonetheless a minority of patients may present with bilateral clinical disease. It is not entirely clear whether patients with bilateral clinical varicocele can have a more significant deterioration in testicular function than unilateral varicocele patients. Furthermore, a clear comparison of the outcome of varicocele ligation between patients with bilateral and unilateral clinical disease has not been clearly elucidated.
Study design, size, duration
This retrospective chart review was conducted at a tertiary medical center and included the charts of 1170 age matched patients who underwent microsurgical subinguinal varicocelectomy over an 8 year-period. Patients were classified into 2 groups; group 1 (n = 977; those who underwent unilateral varicocelectomy) and group 2 (n = 193; those who underwent bilateral varicocelectomy). Patients with genetic abnormalities, history of orchitis or chemoradiation were excluded.
Participants/materials, setting, methods
Patients’ demographics, varicocele grade and laterality, semen results, sperm DNA fragmentation and hormones levels initially and 3 months following varicocele ligation were collected. Frequency, median(IQR) or mean±SD were used to report categorical and numerical values, respectively. Mann-Whitney test and Repeated measures analysis of variance were used for statistical analysis of data. A p value < 0.05 was considered significant.
Main results and the role of chance
The patients’ mean age and body mass index were 34.5 ± 8.2 years and 28.13 ± 5.8 Kg/m2, respectively. Left varicocele was of grade 1 in 3.5% of cases, grade 2 in 52.8% and grade 3 in 43.7% with a mean diameter of 3.9 ±0.9mm. Right varicocele was of grade 1 in 59.6% of cases, grade 2 in 31.6% and grade 3 in 8.8% with a mean diameter of 2.5 ± 0.9mm. Preoperatively, patients with bilateral varicocele had significantly lower total motility (38 [17, 53.5] % vs 45 [20, 59] %, p = 0.027) and progressive motility (6 [0, 19.7] % vs 10 [0, 25] %, p = 0.039) and significantly higher serum FSH levels (4 [2, 6.1] IU/L vs 3.2 [2, 5.4] IU/L, p = 0.042) than patients with unilateral varicocele. Following varicocele ligation, significant improvements were noted in sperm concentration, total motility and progressive motility in both groups (group 1: p < 0.001 for all; group 2: p = 0.007, 0.003 and 0.003 respectively). Between group comparisons reveal a significantly greater increase in only total motility following surgery in the bilateral varicocele group compared with the unilateral group (median difference +9 [-5, +18] % vs + 5 [-5, +17] %, p = 0.045).
Limitations, reasons for caution
The retrospective nature of the study is one limitation. Discrepancies in the sample size between the two groups is another limitation though this is affected by the low prevalence of right varicocele.
Wider implications of the findings
Bilateral clinical varicocele is more detrimental on testicular function than unilateral disease. Proper identification and concomitant treatment of right varicocele may result in a better improvement in male fertility potential.
Trial registration number
Not applicable
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Affiliation(s)
- A Majzoub
- Hamad Medical Corporation, Department of Urology , Doha, Qatar
| | - M Arafa
- Hamad Medical Corporation, Department of Urology , Doha, Qatar
| | - K Khalafalla
- Hamad Medical Corporation, Department of Urology , Doha, Qatar
| | - S Alsaid
- Hamad Medical Corporation, Department of Urology , Doha, Qatar
| | - H Elbardisi
- Hamad Medical Corporation, Department of Urology , Doha, Qatar
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20
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Arafa M, Majzoub A, Khalafalla K, AlSaid S, Elbardisi H. P-043 Does BMI affect the outcome of microsurgical varicocelectomy in Infertile men? Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Study question
Does Body Mass Index (BMI) affect the semen parameter outcome after microsurgical varicocelectomy in infertile men?
Summary answer
BMI significantly affects the quality of semen parameters of infertile men with varicocele. However, it does not influence the outcome of varicocele repair.
What is known already
Varicocele is the most common correctable cause for male infertility. It has been proven that varicocele affects different semen parameters which can be corrected by varicocelectomy, thus restoring male fertility potential. Obesity is another well-known risk factor for male infertility. Both varicocele and obesity can affect semen parameters through similar pathophysiological mechanisms including hyperthermia and increased seminal oxidative stress. Although, varicocele was found to be negatively correlated with BMI, the effect of BMI on varicocele management was not investigated.
Study design, size, duration
This retrospective study of 1170 patients presenting with male factor infertility to a tertiary medical center over a period of 8 years. The inclusion criteria were patients who underwent microsurgical varicocelectomy for infertility. Patients with a genetic abnormality, history of chemotherapy or radiotherapy or leukocytospermia were excluded.
Participants/materials, setting, methods
813 patients were recruited and grouped according to BMI international score into Group A (n = 251patients, BMI < 25kg/m2), Group B (n = 289patients, BMI 25-29.9kg/m2), Group C (n = 183patients, BMI 30-34.9kg/m2 ) and Group D (n = 90patients, BMI>34.9kg/m2) Semen analysis, sperm DNA fragmentation(SDF), hormonal profile were collected pre-and 3 months post-operatively. Chi-squared test, Spearman correlations and Mann-Whitney test were used for statistical analysis of the study data. p-value <0.05 was considered significant.
Main results and the role of chance
The patients’ mean age was 35.87±8.17 years. High-grade varicocele (II and III) was significantly more prevalent in the lower BMI groups (group A and B, p < 0.001). BMI showed significant negative correlation with sperm concentration (r=-196, p < 0.0001), total motility (r=-117, p = 0.001) and progressive motility (r=-107, p = 0.002). The basal pre-operative investigations showed significant difference between the obesity groups as regards sperm concentration (p < 0.001), total motility (p = 0.003) and progressive motility (p = 0.037). The more obese groups (Groups C and D) showed the poorest semen parameters. Postoperatively, all groups showed significant improvement in sperm concentration (A:p=0.03, B:0.01, C:<0.001, D:0.01). Total and progressive motility were only significant in Groups A (p = 0.06, <0.0001 respectively), B (p < 0.0001, 0.03 respectively) and C (p < 0.0001, <0.0001 repectively) while in Group D, total motility was improved clinically but did reach statistical significance (p = 0.07) and progressive motility didn’t show improvement. Morphology was significantly improved in only Group B (p = 0.02). There was no significant difference between the 4 groups as regards the median improvement of semen parameters postoperatively except for morphology which improved significantly more in the less obese patients (p = 0.002).
Limitations, reasons for caution
The main limitation is the retrospective design of the study.
Wider implications of the findings
In infertile patients with varicocele, obesity is an additional factor that leads to worse semen parameters, thus weight reduction may help in these cases.
Clinicians should not be discouraged to go for varicocelectomy in obese patients based on the improvement in semen parameters post-varicocelectomy in all obesity groups.
Trial registration number
Not applicable
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Affiliation(s)
- M Arafa
- Hamad Medical Corporation, Urology/Surgery , Doha, Qatar
| | - A Majzoub
- Hamad Medical Corporation, Urology/Surgery , Doha, Qatar
| | - K Khalafalla
- Hamad Medical Corporation, Urology/Surgery , Doha, Qatar
| | - S AlSaid
- Hamad Medical Corporation, Urology/Surgery , Doha, Qatar
| | - H Elbardisi
- Hamad Medical Corporation, Urology/Surgery , Doha, Qatar
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21
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Sharma R, Gupta S, Agarwal A, Henkel R, Finelli R, Parekh N, Saleh R, Arafa M, Ko E, Zini A, Tadros N, Shah R, Ambar RF, Elbardisi H, Sengupta P, Martinez M, Boitrelle F, Simopoulou M, Vogiatzi P, Gosalvez J, Kavoussi P, Kandil H, Palani A, Rodriguez Peña M, Rajmil O, Busetto GM, Anagnostopoulou C, Micic S, Alves MG, Rocco L, Mostafa T, Alvarez JG, Jindal S, Sallam HN, Maldonado Rosas I, Lewis SEM, AlSaid S, Altan M, Park HJ, Ramsay J, Parekattil S, Sabbaghian M, Tremellen K, Khalafalla K, Durairajanayagam D, Colpi GM. Relevance of Leukocytospermia and Semen Culture and Its True Place in Diagnosing and Treating Male Infertility. World J Mens Health 2022; 40:191-207. [PMID: 34169683 PMCID: PMC8987138 DOI: 10.5534/wjmh.210063] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/17/2021] [Accepted: 04/21/2021] [Indexed: 02/05/2023] Open
Abstract
The current WHO 2010 manual for human semen analysis defines leukocytospermia as the presence of peroxidase-positive leukocytes at a concentration >1×106/mL of semen. Granular leukocytes when activated are capable of generating high levels of reactive oxygen species in semen resulting in oxidative stress. Oxidative stress has been correlated with poor sperm quality, increased level of sperm DNA fragmentation and low fertility potential. The presence of leukocytes and pathogens in the semen may be a sign of infection and/or localized inflammatory response in the male genital tract and the accessory glands. Common uro-pathogens including Chlamydia trachomatis, Ureaplasma urealyticum, Neisseria gonorrhoeae, Mycoplasma hominis, and Escherichia coli can cause epididymitis, epididymo-orchitis, or prostatitis. The relationship between leukocytospermia and infection is unclear. Therefore, we describe the pathogens responsible for male genital tract infections and their association with leukocytospermia. The review also examines the diagnostic tests available to identify seminal leukocytes. The role of leukocytospermia in male infertility and its management is also discussed.
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Affiliation(s)
- Rakesh Sharma
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Sajal Gupta
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Ashok Agarwal
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA.
| | - Ralf Henkel
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Department of Medical Bioscience, University of the Western Cape, Bellville, South Africa
| | - Renata Finelli
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Neel Parekh
- Department of Urology, Cleveland Clinic, Cleveland, OH, USA
| | - Ramadan Saleh
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Mohamed Arafa
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
- Department of Urology, Weill Cornell Medical-Qatar, Doha, Qatar
| | - Edmund Ko
- Department of Urology, Loma Linda University Health, Loma Linda, CA, USA
| | - Armand Zini
- Department of Surgery, McGill University, Montreal, Canada
| | - Nicholas Tadros
- Division of Urology, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Rupin Shah
- Department of Urology, Lilavati Hospital and Research Centre, Mumbai, India
| | - Rafael F Ambar
- Department of Urology, Centro Universitario em Saude do ABC/Andrology Group at Ideia Fertil Institute of Human Reproduction, Santo André, Brazil
| | - Haitham Elbardisi
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
- Department of Urology, Weill Cornell Medical-Qatar, Doha, Qatar
| | - Pallav Sengupta
- Department of Physiology, Faculty of Medicine, Bioscience and Nursing, MAHSA University, Jenjarom, Selangor, Malaysia
| | - Marlon Martinez
- Section of Urology, University of Santo Tomas Hospital, Manila, Philippines
| | - Florence Boitrelle
- Reproductive Biology, Fertility Preservation, Andrology, CECOS, Poissy Hospital, Poissy, France
- Paris Saclay University, UVSQ, INRAE, BREED, Jouy-en-Josas, France
| | - Mara Simopoulou
- Department of Physiology, School of Medicine, National & Kapodistrian University of Athens, Maroussi, Athens, Greece
| | - Paraskevi Vogiatzi
- Andromed Health & Reproduction, Fertility Diagnostics Laboratory, Maroussi, Greece
| | - Jaime Gosalvez
- Departamento de Biología, Universidad Autónoma de Madrid, Madrid, Spain
| | - Parviz Kavoussi
- Austin Fertility and Reproductive Medicine/Westlake IVF, Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | | | - Ayad Palani
- Department of Biochemistry, College of Medicine, University of Garmian, Kalar, Iraq
| | - Marcelo Rodriguez Peña
- Departamento Docencia e Investigación, Hospital Militar Campo de Mayo, Universidad Barcelo, Buenos Aires, Argentina
| | - Osvaldo Rajmil
- Clinical and training Centre of the European Academy of Andrology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Gian Maria Busetto
- Department of Urology and Renal Transplantation, University of Foggia Policlinico Riuniti of Foggia, Foggia, Italy
| | | | - Sava Micic
- Department of Andrology, Uromedica Polyclinic, Belgrade, Serbia
| | - Marco G Alves
- Department of Anatomy & Unit for Multidisciplinary Research in Biomedicine (UMIB), Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal
| | - Lucia Rocco
- Department of Environmental, Biological and Pharmaceutical Sciences and Technologies (DiSTABiF), University of Campania Luigi Vanvitelli, Caserta, Italy
| | - Taymour Mostafa
- Department of Andrology, Sexology & STIs, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Juan G Alvarez
- Centro ANDROGEN, La Coruña, Spain
- Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, MA, USA
| | - Sunil Jindal
- Department of Andrology and Reproductive Medicine, Jindal Hospital, Meerut, India
| | - Hassan N Sallam
- Department of Obstetrics and Gynaecology, Alexandria University Faculty of Medicine, Alexandria, Egypt
| | - Israel Maldonado Rosas
- Centerf Technological Innovation, and Reproductive Medicine (CITMER), Mexico City, Mexico
| | - Sheena E M Lewis
- Examenlab Ltd., Weavers Court Business Park, Linfield Road, Belfast, Northern Ireland, UK
| | - Sami AlSaid
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
| | - Mesut Altan
- Department of Urology, Haceppete University, Ankara, Turkey
| | - Hyun Jun Park
- Department of Urology, Pusan National University School of Medicine, Busan, Korea
- Medical Research Institute of Pusan National University Hospital, Busan, Korea
| | | | - Sijo Parekattil
- Avant Concierge Urology & University of Central Florida, Winter Garden, FL, USA
| | - Marjan Sabbaghian
- Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Kelton Tremellen
- Department of Obstetrics Gynaecology and Reproductive Medicine, Flinders University, Adelaide, South Australia
| | | | - Damayanthi Durairajanayagam
- Department of Physiology, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Selangor, Malaysia
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22
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Gupta S, Sharma R, Agarwal A, Parekh N, Finelli R, Shah R, Kandil H, Saleh R, Arafa M, Ko E, Simopoulou M, Zini A, Rajmil O, Kavoussi P, Singh K, Ambar RF, Elbardisi H, Sengupta P, Martinez M, Boitrelle F, Alves MG, Khalafalla K, Roychoudhury S, Busetto GM, Gosalvez J, Tadros N, Palani A, Rodriguez MG, Anagnostopoulou C, Micic S, Rocco L, Mostafa T, Alvarez JG, Jindal S, Sallam H, Maldonado Rosas I, Lewis SEM, AlSaid S, Altan M, Park HJ, Ramsay J, Parekattil S, Sabbaghian M, Tremellen K, Vogiatzi P, Sadighi Gilani MA, Evenson DP, Colpi GM. A Comprehensive Guide to Sperm Recovery in Infertile Men with Retrograde Ejaculation. World J Mens Health 2022; 40:208-216. [PMID: 34169680 PMCID: PMC8987146 DOI: 10.5534/wjmh.210069] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/23/2021] [Accepted: 04/30/2021] [Indexed: 02/05/2023] Open
Abstract
Retrograde ejaculation (RE) is a condition defined as the backward flow of the semen during ejaculation, and when present can result in male infertility. RE may be partial or complete, resulting in either low seminal volume or complete absence of the ejaculate (dry ejaculate). RE can result from anatomic, neurological or pharmacological conditions. The treatment approaches outlined are determined by the cause. Alkalinizing urinary pH with oral medications or by adding sperm wash media into the bladder prior to ejaculation may preserve the viability of the sperm. This article provides a step-by-step guide to diagnose RE and the optimal techniques to retrieve sperm.
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Affiliation(s)
- Sajal Gupta
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Rakesh Sharma
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Ashok Agarwal
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA.
| | - Neel Parekh
- Department of Urology, Cleveland Clinic, Cleveland, OH, USA
| | - Renata Finelli
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Rupin Shah
- Department of Urology, Lilavati Hospital and Research Centre, Mumbai, India
| | | | - Ramadan Saleh
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Mohamed Arafa
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
- Department of Urology, Weill Cornell Medical-Qatar, Doha, Qatar
| | - Edmund Ko
- Department of Urology, Loma Linda University Health, Loma Linda, CA, USA
| | - Mara Simopoulou
- Department of Experimental Physiology, School of Health Sciences, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Armand Zini
- Department of Surgery, McGill University, Montreal, QC, Canada
| | - Osvaldo Rajmil
- Department of Andrology, Fundacio Puigvert, Barcelona, Spain
| | - Parviz Kavoussi
- Austin Fertility and Reproductive Medicine/Westlake IVF, Department of Urology, University of Texas Health Science Center, San Antonio, TX, USA
| | - Keerti Singh
- Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Bridgetown, Barbados
| | - Rafael F Ambar
- Department of Urology, Centro Universitario em Saude do ABC/Andrology Group at Ideia Fertil Institute of Human Reproduction, Santo André, Brazil
| | - Haitham Elbardisi
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
- Department of Urology, Weill Cornell Medical-Qatar, Doha, Qatar
| | - Pallav Sengupta
- Department of Physiology, Faculty of Medicine, Bioscience and Nursing, MAHSA University, Jenjarom, Selangor, Malaysia
| | - Marlon Martinez
- Section of Urology, University of Santo Tomas Hospital, Manila, Philippines
| | - Florence Boitrelle
- Reproductive Biology, Fertility Preservation, Andrology, CECOS, Poissy Hospital, Poissy, France
- Paris Saclay University, UVSQ, INRAE, BREED, Jouyen-Josas, France
| | - Marco G Alves
- Department of Anatomy & Unit for Multidisciplinary Research in Biomedicine (UMIB), Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal
| | | | | | - Gian Maria Busetto
- Department of Urology and Renal Transplantation, University of Foggia Policlinico Riuniti of Foggia, Foggia, Italy
| | - Jaime Gosalvez
- Departamento de Biología, Universidad Autónoma de Madrid, Madrid, Spain
| | - Nicholas Tadros
- Division of Urology, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Ayad Palani
- Department of Biochemistry, College of Medicine, University of Garmian, Kalar, Iraq
| | - Marcelo Gabriel Rodriguez
- Departamento Docencia e Investigación, Hospital Militar Campo de Mayo, Universidad Barcelo, Buenos Aires, Argentina
| | | | - Sava Micic
- Department of Andrology, Uromedica Polyclinic, Belgrade, Serbia
| | - Lucia Rocco
- Department of Environmental, Biological and Pharmaceutical Sciences and Technologies (DiSTABiF), University of Campania Luigi Vanvitelli, Caserta, Italy
| | - Taymour Mostafa
- Department of Andrology, Sexology & STIs, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Sunil Jindal
- Department of Andrology and Reproductive Medicine, Jindal Hospital, Meerut, India
| | - Hassan Sallam
- Department of Obstetrics and Gynaecology, Alexandria University Faculty of Medicine, Alexandria, Egypt
| | - Israel Maldonado Rosas
- Center of Technological Innovation, and Reproductive Medicine (CITMER), Mexico City, Mexico
| | | | - Sami AlSaid
- Department of Urology, Weill Cornell Medical-Qatar, Doha, Qatar
| | - Mesut Altan
- Department of Urology, Haceppete University, Ankara, Turkey
| | - Hyun Jun Park
- Department of Urology, Pusan National University School of Medicine, Busan, Korea
- Medical Research Institute of Pusan National University Hospital, Busan, Korea
| | | | - Sijo Parekattil
- Avant Concierge Urology & University of Central Florida, Winter Garden, FL, USA
| | - Marjan Sabbaghian
- Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Kelton Tremellen
- Department of Obstetrics Gynaecology and Reproductive Medicine, Flinders University, Adelaide, South Australia
| | - Paraskevi Vogiatzi
- Andromed Health & Reproduction, Fertility Diagnostics Laboratory, Maroussi, Athens, Greece
| | - Mohammad Ali Sadighi Gilani
- Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
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23
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Majzoub A, Arafa M, Clemens H, Imperial J, Leisegang K, Khalafalla K, Agarwal A, Henkel R, Elbardisi H. A systemic review and meta-analysis exploring the predictors of sperm retrieval in patients with non-obstructive azoospermia and chromosomal abnormalities. Andrologia 2021; 54:e14303. [PMID: 34729809 DOI: 10.1111/and.14303] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 10/20/2021] [Accepted: 10/25/2021] [Indexed: 01/10/2023] Open
Abstract
To identify the most prevalent chromosomal abnormalities in patients with non-obstructive azoospermia (NOA), consolidate their surgical sperm retrieval (SSR) rates and determine the significant predictors of positive SSR in this patient population. A systematic review and meta-analysis were performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Fifty-three studies including 2965 patients were identified through searching the PubMed database. Klinefelter Syndrome (KS) was the most prevalent chromosomal abnormality reported in 2239 cases (75.5%). Azoospermia factor c (AZFc) microdeletions were the second most common (18.6%), but men with these deletions had higher SSR rates than patients with KS (41.95% with AZFc vs. 38.63% with KS). When examining predictors of SSR in KS patients, younger age was a significant predictor of positive SSR in patients undergoing microsurgical testicular sperm extraction (micro-TESE). Higher testosterone was a favourable predictor in those undergoing micro-TESE and conventional TESE. Lower luteinizing hormone (LH) and follicular stimulating hormone (FSH) values were significantly associated with positive SSR with testicular sperm aspiration (TESA). No parameter predicted SSR rates in patients with AZFc microdeletions. Overall, genetic abnormalities have significant implications on SSR success in patients with NOA.
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Affiliation(s)
- Ahmad Majzoub
- Department of Urology, Hamad Medical Corporation, Doha, Qatar.,Clinical Urology, Weill Cornell Medicine -Qatar, Doha, Qatar
| | - Mohamed Arafa
- Department of Urology, Hamad Medical Corporation, Doha, Qatar.,Clinical Urology, Weill Cornell Medicine -Qatar, Doha, Qatar.,American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, Ohio, USA.,Andrology Department, Cairo University, Cairo, Egypt
| | - Hailey Clemens
- Department of Molecular and Developmental Biology, University of California Santa Barbara, Santa Barbara, California, USA
| | - Jacqueline Imperial
- Department of Biology, University of California San Francisco, San Francisco, California, USA
| | - Kris Leisegang
- School of Natural Medicine, Faculty of Community and Health Sciences, University of the Western Cape, Bellville, South Africa
| | | | - Ashok Agarwal
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ralf Henkel
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Metabolism, Digestion and Reproduction at, Imperial College London, London, UK.,Department of Medical Bioscience, University of the Western Cape, Bellville, South Africa.,LogixX Pharma, Theale, Berkshire, UK
| | - Haitham Elbardisi
- Department of Urology, Hamad Medical Corporation, Doha, Qatar.,Clinical Urology, Weill Cornell Medicine -Qatar, Doha, Qatar.,American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, Ohio, USA
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24
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Agarwal A, Sharma RK, Gupta S, Boitrelle F, Finelli R, Parekh N, Durairajanayagam D, Saleh R, Arafa M, Cho CL, Farkouh A, Rambhatla A, Henkel R, Vogiatzi P, Tadros N, Kavoussi P, Ko E, Leisegang K, Kandil H, Palani A, Salvio G, Mostafa T, Rajmil O, Banihani SA, Schon S, Le TV, Birowo P, Çeker G, Alvarez J, Molina JMC, Ho CCK, Calogero AE, Khalafalla K, Duran MB, Kuroda S, Colpi GM, Zini A, Anagnostopoulou C, Pescatori E, Chung E, Caroppo E, Dimitriadis F, Pinggera GM, Busetto GM, Balercia G, Elbardisi H, Taniguchi H, Park HJ, Maldonado Rosas I, de la Rosette J, Ramsay J, Bowa K, Simopoulou M, Rodriguez MG, Sabbaghian M, Martinez M, Gilani MAS, Al-Marhoon MS, Kosgi R, Cannarella R, Micic S, Fukuhara S, Parekattil S, Jindal S, Abdel-Meguid TAA, Morimoto Y, Shah R. Sperm Vitality and Necrozoospermia: Diagnosis, Management, and Results of a Global Survey of Clinical Practice. World J Mens Health 2021; 40:228-242. [PMID: 34666422 PMCID: PMC8987132 DOI: 10.5534/wjmh.210149] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/02/2021] [Accepted: 08/05/2021] [Indexed: 02/05/2023] Open
Abstract
Sperm vitality testing is a basic semen examination that has been described in the World Health Organization (WHO) Laboratory Manual for the Examination and Processing of Human Semen from its primary edition, 40 years ago. Several methods can be used to test sperm vitality, such as the eosin-nigrosin (E-N) stain or the hypoosmotic swelling (HOS) test. In the 6th (2021) edition of the WHO Laboratory Manual, sperm vitality assessment is mainly recommended if the total motility is less than 40%. Hence, a motile spermatozoon is considered alive, however, in certain conditions an immotile spermatozoon can also be alive. Therefore, the differentiation between asthenozoospermia (pathological decrease in sperm motility) and necrozoospermia (pathological decrease in sperm vitality) is important in directing further investigation and management of infertile patients. The causes leading to necrozoospermia are diverse and can either be local or general, testicular or extra-testicular. The andrological management of necrozoospermia depends on its etiology. However, there is no standardized treatment available presently and practice varies among clinicians. In this study, we report the results of a global survey to understand current practices regarding the physician order of sperm vitality tests as well as the management practices for necrozoospermia. Laboratory and clinical scenarios are presented to guide the reader in the management of necrozoospermia with the overall objective of establishing a benchmark ranging from the diagnosis of necrozoospermia by sperm vitality testing to its clinical management.
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Affiliation(s)
- Ashok Agarwal
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA.
| | - Rakesh K Sharma
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Sajal Gupta
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Florence Boitrelle
- Reproductive Biology, Fertility Preservation, Andrology, CECOS, Poissy Hospital, Poissy, France.,Paris Saclay University, UVSQ, INRAE, BREED, Jouy-en-Josas, France
| | - Renata Finelli
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Neel Parekh
- Department of Urology, Cleveland Clinic, Cleveland, OH, USA
| | - Damayanthi Durairajanayagam
- Department of Physiology, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Selangor, Malaysia
| | - Ramadan Saleh
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Mohamed Arafa
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA.,Department of Urology, Hamad Medical Corporation, Doha, Qatar.,Department of Urology, Weill Cornell Medical-Qatar Doha, Qatar
| | - Chak Lam Cho
- SH Ho Urology Center, Department of Surgery, Chinese University of Hong Kong, Hong Kong
| | - Ala'a Farkouh
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Amarnath Rambhatla
- Department of Urology, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
| | - Ralf Henkel
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA.,Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.,Department of Medical Bioscience, University of the Western Cape, Bellville, South Africa.,LogixX Pharma, Theale, Berkshire, UK
| | - Paraskevi Vogiatzi
- Andromed Health & Reproduction, Fertility Diagnostics Laboratory, Maroussi, Greece
| | - Nicholas Tadros
- Division of Urology, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Parviz Kavoussi
- Austin Fertility and Reproductive Medicine/Westlake IVF, Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Edmund Ko
- Department of Urology, Loma Linda University Health, Loma Linda, CA, USA
| | - Kristian Leisegang
- Department of Physiology, School of Natural Medicine, Faculty of Community and Health Sciences, University of the Western Cape, Bellville, South Africa
| | | | - Ayad Palani
- Department of Biochemistry, College of Medicine, University of Garmian, Kalar, Iraq
| | - Gianmaria Salvio
- Department of Endocrinology and Metabolic Diseases, Polytechnic University of Marche, Ancona, Italy
| | - Taymour Mostafa
- Department of Andrology, Sexology and STIs, Faculty of Medicina, Cairo University, Cairo, Egypt
| | - Osvaldo Rajmil
- Department of Andrology, Fundacio Puigvert, Barcelona, Spain
| | - Saleem Ali Banihani
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Samantha Schon
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Tan V Le
- Department of Andrology and Urology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Viet Nam.,Department of Andrology, Binh Dan Hospital, Ho Chi Minh City, Viet Nam
| | - Ponco Birowo
- Department of Urology, Cipto Mangunkusumo General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Gökhan Çeker
- Department of Urology, Samsun Vezirköprü State Hospital, Samsun, Turkey
| | | | | | - Christopher C K Ho
- Department of Surgery, School of Medicine, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Malaysia
| | - Aldo E Calogero
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | | | - Mesut Berkan Duran
- Department of Urology, Samsun Training and Research Hospital, Samsun, Turkey
| | - Shinnosuke Kuroda
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | | | - Armand Zini
- Department of Surgery, McGill University, Montreal, QC, Canada
| | | | - Edoardo Pescatori
- Andrology and Reproductive Medicine Unit, Gynepro Medical, Bologna, Italy
| | - Eric Chung
- Department of Urology, Princess Alexandra Hospital, University of Queensland, Brisbane, QLD, Australia.,AndroUrology Centre, Brisbane, QLD, Australia
| | - Ettore Caroppo
- Reproductive and IVF Unit, Andrology Outpatients Clinic, ASL Bari, Conversano (Ba), Italy
| | - Fotios Dimitriadis
- 1st Urology Department, School of Medicine, Aristotle University, Thessaloniki, Greece
| | | | - Gian Maria Busetto
- Department of Urology and Renal Transplantation, University of Foggia, Ospedali Riuniti of Foggia, Foggia, Italy
| | - Giancarlo Balercia
- Department of Endocrinology and Metabolic Diseases, Polytechnic University of Marche, Ancona, Italy
| | - Haitham Elbardisi
- Department of Urology, Hamad Medical Corporation, Doha, Qatar.,Department of Urology, Weill Cornell Medical-Qatar Doha, Qatar
| | - Hisanori Taniguchi
- Department of Urology and Andrology, Kansai Medical University, Hirakata, Osaka, Japan
| | - Hyun Jun Park
- Department of Urology, Pusan National University School of Medicine, Busan, Korea.,Medical Research Institute of Pusan National University Hospital, Busan, Korea
| | | | - Jean de la Rosette
- Department of Urology, Medipol Mega University Hospital, Istanbul, Turkey
| | | | - Kasonde Bowa
- Department of Urology, Michael Chilufya Sata Copperbelt University School of Medicine, Ndola, Zambia
| | - Mara Simopoulou
- Department of Experimental Physiology, School of Health Sciences, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Marcelo Gabriel Rodriguez
- Departamento Docencia e Investigación, Hospital Militar Campo de Mayo, Universidad Barcelo, Buenos Aires, Argentina
| | - Marjan Sabbaghian
- Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Marlon Martinez
- Section of Urology, University of Santo Tomas Hospital, Manila, Philippines
| | - Mohamed Ali Sadighi Gilani
- Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | | | - Raghavender Kosgi
- Department of Urology and Andrology, AIG Hospitals, Gachibowli, Hyderabad, India
| | - Rossella Cannarella
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Sava Micic
- Department of Andrology, Uromedica Polyclinic, Belgrade, Serbia
| | - Shinichiro Fukuhara
- Department of Urology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Sijo Parekattil
- Avant Concierge Urology & University of Central Florida, Winter Garden, FL, USA
| | - Sunil Jindal
- Department of Andrology and Reproductive Medicine, Jindal Hospital, Meerut, India
| | - Taha Abo-Almagd Abdel-Meguid
- Department of Urology, Faculty of Medicine, Minia University, Minia, Egypt.,Department of Urology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Rupin Shah
- Division of Andrology, Department of Urology, Lilavati Hospital and Research Centre, Mumbai, India
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25
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Khalafalla K, Arafa M, Elbardisi H, Majzoub A. Non-pharmacological treatments for chronic orchialgia: A systemic review. Arab J Urol 2021; 19:401-410. [PMID: 34552792 PMCID: PMC8451689 DOI: 10.1080/2090598x.2021.1958469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Objective : To review the outcomes of various therapeutic modalities that can be offered to patients with chronic orchialgia (CO) after failed conservative treatment. Methods : A literature search was conducted using the PubMed and MEDLINE databases searching for articles exploring different CO treatment modalities. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses approach was used to report the results of the literature search. Results : A total of 34 studies were included for qualitative analysis. Most of the studies explored microsurgical spermatic cord denervation (MSCD; n = 19). Eight studies involved devices and interventions directed at blocking nerve sensations (pulsed radiofrequency stimulation, n = 5; transcutaneous electrical nerve stimulation, n = 1; cryoablation, n = 1; and mechanical vibratory stimulation, n = 1). Five studies reported on vasectomy reversal as a modality to relieve post-vasectomy pain syndrome (PVPS), while two studies explored the outcomes of orchidectomy on pain relief in patients with CO. Conclusion : Several treatment methods are available in the urologist’s armamentarium for the treatment of CO. MSCD appears to be an appealing treatment modality with encouraging outcomes. Neuropathic pain can be managed with a number of relatively non-invasive modalities. Vasectomy reversal is a sound treatment approach for patients with PVPS and ultimately orchidectomy is a terminal approach that can be discussed with patients suffering from intractable pain.
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Affiliation(s)
| | - Mohamed Arafa
- Department of Urology, Hamad Medical Corporation, Doha, Qatar.,Department of Urology, Weill Cornell Medicine-Qatar, Doha, Qatar.,American Center for Reproductive Medicine, Cleveland Clinic, CL, OH, USA.,Andrology Department, Cario University, Cairo, Egypt
| | - Haitham Elbardisi
- Department of Urology, Hamad Medical Corporation, Doha, Qatar.,Department of Urology, Weill Cornell Medicine-Qatar, Doha, Qatar.,American Center for Reproductive Medicine, Cleveland Clinic, CL, OH, USA
| | - Ahmad Majzoub
- Department of Urology, Hamad Medical Corporation, Doha, Qatar.,Department of Urology, Weill Cornell Medicine-Qatar, Doha, Qatar
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26
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Albakr A, Arafa M, Elbardisi H, ElSaid S, Majzoub A. Premature ejaculation: An investigative study into assumptions, facts and perceptions of patients from the Middle East (PEAP STUDY). Arab J Urol 2021; 19:303-309. [PMID: 34552781 PMCID: PMC8451653 DOI: 10.1080/2090598x.2021.1948159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To determine the prevalence of premature ejaculation (PE) in Qatar as a representative of the Middle East region and the population perception of normal ejaculation. Subjects and methods: This study was a cross-sectional, observational, non-interventional, epidemiological study, conducted from February 2012 to February 2013. Randomly selected married males were asked to answer two questionnaires in a direct interview. The first questionnaire assessed the PE complaint, the time between ejaculation and intromission (actual intravaginal ejaculatory latency time [IELT-a]), and the perceived normal average time between intromission and ejaculation (IELT-p). The second questionnaire used was the Arabic Index of Premature Ejaculation (AIPE). Results: A total of 3042 subjects were included. The mean (SD) age was 37.09 (9.1) years. The prevalence of PE in Qatar using the self-report and AIPE score was 38.5% and 36.2%, respectively. The median (interquartile range) IELT-a and IELT-p were 5 (3–13.5) and 15 (5–15) min. In the AIPE-confirmed PE group, and according to the AIPE severity classification, the differences in IELT-a and IELT-p between the severity groups were highly significant, with the duration of both IELT-a and ILET-p being higher in AIPE-No-PE and mild-PE groups (P < 0.001 for both). A negative correlation was found between AIPE score and age in the PE group. Conclusion: The prevalence of PE in Qatar is high. PE prevalence was found to increase with age. The IELT and perception of normal IELT were both correlated with the severity of PE.
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Affiliation(s)
- Ahmad Albakr
- Urology Department, Hamad Medical Corporation, Doha, Qatar
| | - Mohamed Arafa
- Urology Department, Hamad Medical Corporation, Doha, Qatar.,Andrology Department, Cairo University, Cairo, Egypt.,Urology Department, Weill Cornell Medicine-Qatar, Doha, Qatar.,American Center for Reproductive Medicine, Cleveland, OH, USA
| | - Haitham Elbardisi
- Urology Department, Hamad Medical Corporation, Doha, Qatar.,Urology Department, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Sami ElSaid
- Urology Department, Hamad Medical Corporation, Doha, Qatar.,Urology Department, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Ahmad Majzoub
- Urology Department, Hamad Medical Corporation, Doha, Qatar.,Urology Department, Weill Cornell Medicine-Qatar, Doha, Qatar.,American Center for Reproductive Medicine, Cleveland, OH, USA
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27
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Elbardisi H, Arafa M, Singh N, Betts B, Agrawal A, Henkel R, Al-Hadi AA, Burjaq H, Alattar A, Khalafalla K, Majzoub A. The effect of paternal age on intracytoplasmic sperm injection outcome in unexplained infertility. Arab J Urol 2021; 19:274-280. [PMID: 34552779 PMCID: PMC8451663 DOI: 10.1080/2090598x.2021.1955553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Objective : To examine the effect of paternal age on intracytoplasmic sperm injection (ICSI) outcomes in unexplained infertility. Subjects and Methods : This retrospective study, done at the Hamad Medical Corporation, Doha, Qatar screened infertile couples who underwent ICSI between 2014 and 2019 for the inclusion and exclusion criteria defining 'unexplained infertility'. Couples recruited were allocated into two groups: Group A (paternal age <35 years) and Group B (paternal age ≥35 years). Baseline characteristics, investigations including semen and advanced sperm function tests and ICSI records were compared for primary outcomes such as fertilisation, cleavage, clinical pregnancy, miscarriage and live birth; and secondary outcomes such as semen parameters and advanced sperm functions (DNA fragmentation index and oxidation reduction potential). Results : We found that final pregnancy outcomes including clinical pregnancy rate (P = 0.231), live-birth rate (P = 0.143), and miscarriage rates (P = 0.466) were not significantly different between the two age groups. Normal fertilisation (P = 0.01) and cleavage rate after ICSI (P = 0.001) were statistically significant when the age groups were compared. Also, normal sperm morphology was found to be significantly different (P = 0.041). Conclusions : Advanced paternal age affects sperm morphology, fertilisation and embryo cleavage in ICSI but does not appear to affect clinical pregnancy, miscarriage or live-birth rates. ICSI appears to be a valid fertility treatment option in advancing paternal age.
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Affiliation(s)
- Haitham Elbardisi
- Urology Department, Hamad Medical Corporation, Doha, Qatar.,Weill Cornell Medicine-Qatar, Education City, Qatar
| | - Mohamed Arafa
- Urology Department, Hamad Medical Corporation, Doha, Qatar.,Weill Cornell Medicine-Qatar, Education City, Qatar.,Andrology Department, Cairo University, Cairo, Egypt.,American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Neha Singh
- Obstetric & Genecology department King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Bridget Betts
- School of Pharmacy, University of Mississippi, Mississippi, USA
| | - Ashok Agrawal
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Ralf Henkel
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA.,Department of Metabolism, Digestion and Reproduction, Imperial College London, LondonUK.,Department of Medical Bioscience, University of Western Cape, Bellville, South Africa
| | - Alia A Al-Hadi
- Department of Reproductive Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Hasan Burjaq
- Department of Reproductive Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Alia Alattar
- Urology Department, Hamad Medical Corporation, Doha, Qatar
| | | | - Ahmad Majzoub
- Urology Department, Hamad Medical Corporation, Doha, Qatar.,Weill Cornell Medicine-Qatar, Education City, Qatar
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28
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Arafa M, Elbardisi H, AlSaid S, Burjaq H, AlMazooqi T, Majzoub A. P–058 The effect of sperm DNA fragmentation on intracytoplasmic sperm injection (ICSI) outcome. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Study question
Does the sperm DNA fragmentation (SDF) level impact the clinical outcome of couples undergoing intracytoplasmic sperm injection (ICSI)?
Summary answer
No significant effect was observed for SDF on the reproductive outcome of couples undergoing ICSI.
What is known already
Sperm DNA Fragmentation (SDF) has emerged as an important biomarker in the assessment of male fertility potential. It is currently being used as one of the advanced sperm function tests along with other conventional methods in male fertility evaluation. The impact of SDF on the reproductive outcomes of ICSI remains to be controversial. Evidence extracted from three meta-analyses have indicated that higher SDF is not associated with a negative impact on ICSI outcomes. On the contrary, another meta-analysis revealed that SDF can have a significant impact on the pregnancy rate of ICSI with an OR of 1.31.
Study design, size, duration
This is a retrospective cohort study carried out in the assisted conception unit of a tertiary medical center. The study duration was over a 5-year period from August 1st, 2014 to August 1st, 2019. The charts of 1922 patients who underwent ICSI were screened for inclusion in the study. Inclusion criteria were patients who underwent ICSI using ejaculate spermatozoa and had a recorded SDF test done within a week before ICSI (n = 390).
Participants/materials, setting, methods
Sperm chromatin dispersion was used to evaluate SDF utilizing the Halosperm G2 test kit (Halotech, Madrid, Spain). All patients performed the ICSI trial using ejaculated spermatozoa. Patients were divided according to the SDF level into 3 groups; SDF <20% (n = 148), SDF 20–30% (n = 133), and SDF >30% (n = 109). Female partner fertility status was recorded and couples were grouped into 2 groups based on age and AMH levels; (1) favorable female and (2) unfavorable female status.
Main results and the role of chance
Overall, clinical pregnancy occurred in 45% of cases, live birth rate was 33.60%, and 1.30% of patients had miscarriage. A significant negative correlation between SDF and sperm count (r–0.232), motility (r–0.469), progressive motility (r–0.312) and normal morphology (r–0.297) was detected (p < 0.001 for all). Fertilization rate, clinical pregnancy and live birth rate were greater in patients with lower SDF than those with higher SDF in both favorable and unfavorable groups, however the difference was not statistically significant (Table 1).
Limitations, reasons for caution
The main limitation of our study was the retrospective nature of the study where some data may be missing or incomplete. The data was also retrieved from one ART center, therefore our data lacked diversity within methodologies for IVF and SDF testing.
Wider implications of the findings: SDF was found to be significantly correlated with conventional semen parameters highlighting its significance as a robust diagnostic test during male fertility evaluation. In this study, while patients with higher SDF values had worse reproductive outcomes with ICSI, the results did not reach statistical significance.
Trial registration number
NA
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Affiliation(s)
- M Arafa
- Hamad Medical Corporation, Urology/Surgery, Doha, Qatar
| | - H Elbardisi
- Hamad Medical Corporation, Urology/Surgery, Doha, Qatar
| | - S AlSaid
- Hamad Medical Corporation, Urology/Surgery, Doha, Qatar
| | - H Burjaq
- Hamad Medical Corporation, Assisted conception unit, Doha, Qatar
| | - T AlMazooqi
- Hamad Medical Corporation, Obstetrics and Gynecology, Doha, Qatar
| | - A Majzoub
- Hamad Medical Corporation, Urology/Surgery, Doha, Qatar
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29
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Majzoub A, Elbardisi H, Almalki A, Alsaid S, Arafa M. P–014 Effect of microsurgical varicocelectomy on fertility outcome and treatment plans of patients with severe oligozoospermia: An original report and meta-analysis. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
Does microsurgical subinguinal varicocelectomy (MSV) improve semen parameters and fertility outcomes of patients with severe oligozoospermia (SO) and clinical varicocele?
Summary answer
MSV significantly improves semen parameters of patients with SO and can broaden their fertility treatment options. What is known already: Varicocele ligation has been proven to restore semen parameters and improve pregnancy rates in men with clinically palpable disease. However, its effect in men with SO is less clearly elucidated. Patients with SO are candidates for in vitro fertilization and intracytoplasmic sperm injection. Improvements in semen quality following varicocele ligation in this patient population may broaden their fertility options. While few studies indicate an improvement in semen parameters, reports revealing a negative outcome following surgery in this patient group were also published.
Study design, size, duration
This original report and meta-analysis examined the impact of MSV on semen parameters and fertility outcomes of men with SO. A retrospective chart review of 85 patients was conducted on patients with SO who underwent MSV. A literature search was carried out according to the PRISMA guidelines using the key words “severe oligozoospermia” and “varicocele”. 8 scientific articles (including the current study) reporting the impact of MSV on men with SO were included.
Participants/materials, setting, methods
Changes in semen parameters postoperatively were compared with pre-operative results. The reported natural pregnancy rates were also calculated. The Wilcoxon signed-rank test was used to compare semen and hormone values before and after varicocelectomy. The Chi-squared test was used to assess the changes in TMSC groups after surgery. The meta-analysis was performed using comprehensive meta-analysis software (Biostat, Englewood, NJ, USA). Statistical significance was set at α = 0.05. The random-effects model was used to adjust for heterogeneity.
Main results and the role of chance
The original study reported significant improvements in sperm concentration (p < 0.001), total motility (p = 0.003), progressive motility (p = 0.002) and TMSC (p < 0.001) was following the surgery. in semen parameters following surgery. 78 patients had a pre-operative TMSC < 5 million. Following surgery, 9 (11.5%) patients had a TMSC between 5–9 million, while 14 (17.9%) patients had a TMSC > 9 million. The meta-analysis shows a statistically significant increase in sperm count following surgery (MD 5.64, 95% CI, 4.195–7.090, p = 0.00) with an acceptable degree of heterogeneity (Q value= 8.75, p = 0.188, I²= 31.5%). Similarly, the total motility significantly increased by 7.77% (p = 0.001) following surgery (95% CI, 3.248–12.297), however, with considerable heterogeneity among the reported results (Q value= 34.4, p < 0.001). TMSC was assessed by three studies, including ours. The meta-analysis shows a significant increase in TMSC following surgery (MD 8.44 million sperm, 95% CI, 4.648–12.228, p < 0.001) (Q Value= 2.53, p = 283, I²=20.7%).
A total of 6 studies reported the natural pregnancy rate of patients with SO who underwent surgery. Out of 530 patients with preoperative SO, 146 patients achieved natural pregnancy following surgery indicating that the reported pregnancy rate was 27.5%.
Limitations, reasons for caution
One limitation to the original study is its relatively small sample size. However, this was compensated by conducting a meta-analysis and reporting the outcome of 601 patients with SO who underwent varicocele ligation. Another limitation is the retrospective nature of the study design.
Wider implications of the findings: 29.5% of SO patients in the original study became eligible for IUI following varicocelectomy. Meta-analysis showed that 27.5% of patients achieved natural conception following surgery. Such information is beneficial during patient counselling and needs to be measured against the financial and clinical implications in order to make sound treatment decisions.
Trial registration number
NA
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Affiliation(s)
- A Majzoub
- Hamad Medical Corporation and Weill Cornell Medicine -Qatar, Department of Urology, Doha, Qatar
| | - H Elbardisi
- Hamad Medical Corporation and Weill Cornell Medicine -Qatar, Department of Urology, Doha, Qatar
| | - A Almalki
- Hamad Medical Corporation and Qatar University, Department of Urology, Doha, Qatar
| | - S Alsaid
- Hamad Medical Corporation and Weill Cornell Medicine -Qatar, Department of Urology, Doha, Qatar
| | - M Arafa
- Hamad Medical Corporation and Weill Cornell Medicine -Qatar, Department of Urology, Doha, Qatar
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30
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Khalafalla K, Majzoub A, Elbardisi H, Bhathella A, Chaudhari A, Agarwal A, Henkel R, AlMarzooki T, Burjaq H, Arafa M. The effect of sperm DNA fragmentation on intracytoplasmic sperm injection outcome. Andrologia 2021; 53:e14180. [PMID: 34247427 DOI: 10.1111/and.14180] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 05/29/2021] [Accepted: 06/12/2021] [Indexed: 11/29/2022] Open
Abstract
Our study objective was to assess the effect of various sperm DNA fragmentation levels on clinical intracytoplasmic sperm injection outcome. This retrospective study included 392 patients who underwent ICSI and performed sperm DNA fragmentation testing before the procedure. Based on sperm DNA fragmentation cut-off values, the patients were differentiated into 3 groups as <20%, 20%-30% and >30%. According to the female status, patients were differentiated into favourable group (n = 259) with female age <35 years and anti-Mullerian hormone level ≥7.1 pmol/L; and unfavourable group (n = 133) with female age ≥35 years and anti-Mullerian hormone level ≤7.1 pmol/L. The patient's medical records were reviewed, and patient's demographic, laboratory data including semen analysis, sperm DNA fragmentation determined by means of sperm chromatin dispersion, hormonal profile and data regarding intracytoplasmic sperm injection cycle were collected. This cohort reported that the clinical reproductive outcomes of intracytoplasmic sperm injection showed no statistical significance with increase sperm DNA fragmentation levels. In sperm DNA fragmentation above 30%, favourable females had significantly higher clinical pregnancy rate and live birth rate than unfavourable females, while fertilisation rate and miscarriage rate showed no significance between the subgroups. High sperm DNA fragmentation is linked to poor semen parameters.
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Affiliation(s)
| | - Ahmad Majzoub
- Urology Department, Hamad Medical Corporation, Doha, Qatar.,American Center for Reproductive Medicine, Cleveland, OH, USA.,Urology Department, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Haitham Elbardisi
- Urology Department, Hamad Medical Corporation, Doha, Qatar.,Urology Department, Weill Cornell Medicine-Qatar, Doha, Qatar
| | | | - Arth Chaudhari
- Department of Animal Genetics and Breeding, College of Veterinary Science and Animal Husbandry, Kamdhenu University, Sardarkrushinagar, India
| | - Ashok Agarwal
- American Center for Reproductive Medicine, Cleveland, OH, USA
| | - Ralf Henkel
- American Center for Reproductive Medicine, Cleveland, OH, USA.,Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.,Department of Medical Bioscience, University of the Western Cape, Bellville, South Africa
| | - Thoraya AlMarzooki
- Obstetrics and Gynecology Department, Hamad Medical Corporation, Doha, Qatar
| | - Hasan Burjaq
- Assisted Reproduction Center, Hamad Medical Corporation, Doha, Qatar
| | - Mohamed Arafa
- Urology Department, Hamad Medical Corporation, Doha, Qatar.,American Center for Reproductive Medicine, Cleveland, OH, USA.,Urology Department, Weill Cornell Medicine-Qatar, Doha, Qatar.,Andrology Department, Cairo University, Cairo, Egypt
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31
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Majzoub A, Arafa M, El Ansari W, Mahdi M, Agarwal A, Al-Said S, Elbardisi H. Correlation of oxidation reduction potential and total motile sperm count: its utility in the evaluation of male fertility potential. Asian J Androl 2021; 22:317-322. [PMID: 31339113 PMCID: PMC7275803 DOI: 10.4103/aja.aja_75_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Oxidative stress (OS) is detrimental to sperm functions, and the oxidation reduction potential (ORP) is a good measure of OS as it considers the balance between oxidants and reductants. Total motile sperm count (TMSC) is viewed as the single most important semen analysis parameter that can predict male infertility severity, and its correlation with ORP has never been undertaken. The objectives of this study were to assess the correlation between ORP and TMSC, to identify the ORP cutoff value based on the TMSC result, and to compare this cutoff value with previously reported ORP cutoff values in literature. One thousand one hundred and sixty-eight infertile patients and 100 fertile controls were enrolled. Demographic and semen data of the participants were retrieved and analyzed. Wilcoxon's rank-sum test compared variables between infertile men and fertile controls; Spearman's correlation assessed the static ORP (sORP)-TMSC relationship for the whole sample and among each group individually. Using a 20×106 TMSC threshold, receiver operator characteristic (ROC) analysis determined the sORP cutoff associated with the highest predictive values. TMSC was significantly negatively correlated with sORP across all participants (r = 0.86, P < 0.001), among infertile patients (r = 0.729, P < 0.001), and among fertile controls (r = 0.53, P < 0.001). A 20-million TMSC threshold determined an sORP cutoff value of 2.34 mV/106 sperm/ml to be associated with 82.9% sensitivity, 82.8% specificity, 91.5% positive predictive value (PPV), 68.5% negative predictive value (NPV), and 82.9% overall accuracy. Compared with previously reported cutoff values in searched literature, the 2.34 mV/106 sperm/ml cutoff value identified in our study yielded the highest overall diagnostic accuracy in the evaluation of infertile men.
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Affiliation(s)
- Ahmad Majzoub
- Department of Urology, Hamad Medical Corporation, Doha 00974, Qatar.,Department of Urology, Weill Cornell Medicine-Qatar, Doha 00974, Qatar
| | - Mohamed Arafa
- Department of Urology, Hamad Medical Corporation, Doha 00974, Qatar.,Department of Urology, Weill Cornell Medicine-Qatar, Doha 00974, Qatar.,Department of Andrology, Cairo University, Cairo 12613, Egypt
| | - Walid El Ansari
- Department of Surgery, Hamad Medical Corporation, Doha 00974, Qatar.,College of Medicine, Qatar University, Doha 00974, Qatar.,School of Health and Education, University of Skövde, Skövde 54128, Sweden
| | - Mohammed Mahdi
- Department of Urology, Hamad Medical Corporation, Doha 00974, Qatar
| | - Ashok Agarwal
- Department of Urology, Glickman Urology and Kidney Institute, Cleveland Clinic Foundation, OH 44195, USA
| | - Sami Al-Said
- Department of Urology, Hamad Medical Corporation, Doha 00974, Qatar.,Department of Urology, Weill Cornell Medicine-Qatar, Doha 00974, Qatar
| | - Haitham Elbardisi
- Department of Urology, Hamad Medical Corporation, Doha 00974, Qatar.,Department of Urology, Weill Cornell Medicine-Qatar, Doha 00974, Qatar
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32
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Elbardisi H, Majzoub A, Daniel C, Al Ali F, Elesnawi M, Khalafalla K, Agarwal A, Henkel R, Alattar A, Al-Emadi I, Arafa M. Endocrine contribution to the sexual dysfunction in patients with advanced chronic kidney disease and the role of hyperprolactinemia. Andrologia 2021; 53:e14135. [PMID: 34089536 DOI: 10.1111/and.14135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/07/2021] [Accepted: 05/17/2021] [Indexed: 11/30/2022] Open
Abstract
In this study, we investigated the prevalence of sexual dysfunction among males with advanced chronic kidney disease and the effect of treating hyperprolactinemia among these patients. In this prospective study, patients were assessed with history, physical examination, hormonal assessment, and two questionnaires, IIEF and AIPE. Patients with hyperprolactinemia received treatment with cabergoline 0.5 mg once per week for 6 months and were re-evaluated. A total of 102 patients were included in this study, 75 (73.53%) were on hemodialysis, 13 (12.75%) on peritoneal dialysis and 14 (13.73%) on medical treatment alone. Ninety (88.24%) patients had premature ejaculation, 85 (83.33%) had anything from mild-to-moderate-to-severe erectile dysfunction. The incidence of hypogonadism and hyperprolactinemia was 34.4%. Patients treated with cabergoline (n = 26) showed a significant increase in LH levels (p = .003) and a significant decrease in prolactin levels (p = .003). Testosterone levels and the incidence of erectile dysfunction or premature ejaculation did not improve significantly. There is a high incidence of sexual dysfunction among patients. Treatment of hyperprolactinemia is effective in correcting prolactin levels, but does not improve erectile dysfunction or premature ejaculation. Therefore, treating hyperprolactinemia is not an overall effective treatment for erectile dysfunction in these patients.
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Affiliation(s)
- Haitham Elbardisi
- Department of Urology, Hamad General Hospital, Doha, Qatar.,Department of Urology, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Ahmad Majzoub
- Department of Urology, Hamad General Hospital, Doha, Qatar.,Department of Urology, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Christiana Daniel
- Political Science and Biological Science, North Carolina State University, Raleigh, NC, USA
| | - Fadwa Al Ali
- Department of Nephrology, Hamad General Hospital, Doha, Qatar
| | | | | | - Ashok Agarwal
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Ralf Henkel
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA.,Department of Medical Biosciences, University of the Western Cape, Bellville, South Africa.,Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Alia Alattar
- Women Wellness and Research Center, Hamad General Hospital, Doha, Qatar
| | | | - Mohamed Arafa
- Department of Urology, Hamad General Hospital, Doha, Qatar.,Department of Urology, Weill Cornell Medicine-Qatar, Doha, Qatar.,Department of Andrology, Cairo University, Cairo, Egypt
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33
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Agarwal A, Farkouh A, Parekh N, Zini A, Arafa M, Kandil H, Tadros N, Busetto GM, Ambar R, Parekattil S, Boitrelle F, Sallam H, Jindal S, Ko E, Simopoulou M, Park HJ, Sadighi MA, Saleh R, Ramsay J, Martinez M, Elbardisi H, Alvarez J, Colpi G, Gosalvez J, Evenson D, Shah R. Sperm DNA Fragmentation: A Critical Assessment of Clinical Practice Guidelines. World J Mens Health 2021; 40:30-37. [PMID: 33988000 PMCID: PMC8761233 DOI: 10.5534/wjmh.210056] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 04/05/2021] [Accepted: 04/07/2021] [Indexed: 11/15/2022] Open
Abstract
Sperm DNA fragmentation (SDF) is implicated in male infertility and adverse reproductive outcomes. With the publication of many studies regarding the etiologies and contributors to SDF, as well as the effects of SDF, guidelines are necessary to aid clinicians in the application of SDF for male fertility evaluation. Two recent clinical practice guidelines were published by Agarwal et al and Esteves et al. In this article, we have evaluated and compared both guidelines. We have found fairly similar recommendations between the two guidelines and have also highlighted the differences between them. Finally, we have summarized and combined the best practice recommendations from both guidelines.
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Affiliation(s)
- Ashok Agarwal
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA.
| | - Ala'a Farkouh
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Neel Parekh
- Department of Urology, Cleveland Clinic, Cleveland, OH, USA
| | - Armand Zini
- Department of Surgery, McGill University, Montreal, QC, Canada
| | - Mohamed Arafa
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA.,Department of Urology, Hamad Medical Corporation, Doha, Qatar.,Department of Andrology, Cairo University, Giza, Egypt
| | | | - Nick Tadros
- Division of Urology, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Gian Maria Busetto
- Department of Urology and Renal Transplantation, University of Foggia, Policlinico Riuniti, Foggia, Italy
| | - Rafael Ambar
- Department of Urology, Centro Universitario em Saude do ABC, Santo André, Brazil
| | - Sijo Parekattil
- Avant Concierge Urology & University of Central Florida, Winter Garden, FL, USA
| | - Florence Boitrelle
- Biologie de la Reproduction - Preservation de la fertilite' - Andrologie - CECOS CHI de Poissy Saint Germain en Laye Universite' Paris, Saclay, France
| | - Hassan Sallam
- Department of Obstetrics and Gynaecology, Alexandria University Faculty of Medicine, Alexandria, Egypt
| | - Sunil Jindal
- Department of Andrology and Reproductive Medicine, Jindal Hospital, Meerut, India
| | - Edmund Ko
- Department of Urology, Loma Linda University Health, Loma Linda, CA, USA
| | - Mara Simopoulou
- Department of Experimental Physiology, School of Health Sciences, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Hyun Jun Park
- Department of Urology, Pusan National University School of Medicine, Busan, Korea.,Medical Research Institute of Pusan National University Hospital, Busan, Korea
| | - Mohammad Ali Sadighi
- Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Ramadan Saleh
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt
| | | | - Marlon Martinez
- Section of Urology, University of Santo Tomas Hospital, Manila, Philippines
| | - Haitham Elbardisi
- Department of Urology, Hamad Medical Corporation, Doha, Qatar.,Department of Urology, Weill Cornell Medical-Qatar, Doha, Qatar
| | - Juan Alvarez
- Centro Androgen, La Coruña, Spain and Harvard Medical School, Boston, MA, USA
| | - Giovanni Colpi
- Andrology and IVF Unit, Procrea Institute, Lugano, Switzerland
| | - Jaime Gosalvez
- Departamento de Biología, Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Rupin Shah
- Department of Urology, Lilavati Hospital and Research Centre, Mumbai, India
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34
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Agarwal A, Finelli R, Selvam MKP, Leisegang K, Majzoub A, Tadros N, Ko E, Parekh N, Henkel R, Durairajanayagam D, Colpi GM, Cho CL, Sallam HN, Park HJ, Saleh R, Micic S, Ambar RF, Zini A, Tremellen K, Alvarez JG, Palani A, Arafa M, Gava MM, Jindal S, Amar E, Kopa Z, Moein MR, Busetto GM, Sengupta P, Kavoussi P, Maldonado I, Fikri J, Borges E, Martinez M, Bojovic D, Rajmil O, Aydos K, Parekattil S, Marmar JL, Sefrioui O, Jungwirth A, Peña MGR, Cordts EB, Elbardisi H, Mostafa T, Sabbaghian M, Sadighi Gilani MA, Morimoto Y, Alves MG, Spasic A, Kenic U, Ramsay J, Akande EO, Oumeziane A, Dozortsev D, Chung E, Bell EG, Allegra A, Tanos V, Fiadjoe M, Gurgan T, Abou-Abdallah M, Al-Rumaih H, Oborna I, Arab H, Esteves S, Amer M, Kadioglu A, Yuzko O, Korsak V, Shah R. A Global Survey of Reproductive Specialists to Determine the Clinical Utility of Oxidative Stress Testing and Antioxidant Use in Male Infertility. World J Mens Health 2021; 39:470-488. [PMID: 33831977 PMCID: PMC8255391 DOI: 10.5534/wjmh.210025] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 03/10/2021] [Accepted: 03/17/2021] [Indexed: 02/05/2023] Open
Abstract
Purpose The use of antioxidants is common practice in the management of infertile patients. However, there are no established guidelines by professional societies on antioxidant use for male infertility. Materials and Methods Using an online survey, this study aimed to evaluate the practice pattern of reproductive specialists to determine the clinical utility of oxidative stress (OS) testing and antioxidant prescriptions to treat male infertility. Results Responses from 1,327 participants representing 6 continents, showed the largest participant representation being from Asia (46.8%). The majority of participants were attending physicians (59.6%), with 61.3% having more than 10 years of experience in the field of male infertility. Approximately two-thirds of clinicians (65.7%) participated in this survey did not order any diagnostic tests for OS. Sperm DNA fragmentation was the most common infertility test beyond a semen analysis that was prescribed to study oxidative stress-related dysfunctions (53.4%). OS was mainly tested in the presence of lifestyle risk factors (24.6%) or sperm abnormalities (16.3%). Interestingly, antioxidants were prescribed by 85.6% of clinicians, for a duration of 3 (43.7%) or 3–6 months (38.6%). A large variety of antioxidants and dietary supplements were prescribed, and scientific evidence were mostly considered to be modest to support their clinical use. Results were not influenced by the physician's age, geographic origin, experience or training in male infertility. Conclusions This study is the largest online survey performed to date on this topic and demonstrates 1) a worldwide understanding of the importance of this therapeutic option, and 2) a widely prevalent use of antioxidants to treat male infertility. Finally, the necessity of evidence-based clinical practice guidelines from professional societies is highlighted.
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Affiliation(s)
- Ashok Agarwal
- American Center for Reproductive Medicine, Cleveland Clinic, Ohio, USA.
| | - Renata Finelli
- American Center for Reproductive Medicine, Cleveland Clinic, Ohio, USA
| | - Manesh Kumar Panner Selvam
- American Center for Reproductive Medicine, Cleveland Clinic, Ohio, USA.,Department of Urology, Tulane University Health Sciences Center, New Orleans, LA, USA
| | - Kristian Leisegang
- School of Natural Medicine, University of the Western Cape, South Africa
| | - Ahmad Majzoub
- Department of Urology, Hamad Medical Corporation, Doha, Qatar.,Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Nicholas Tadros
- Division of Urology, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Edmund Ko
- Department of Urology, Loma Linda University Health, Loma Linda, CA, USA
| | - Neel Parekh
- Department of Urology, Cleveland Clinic, Cleveland, OH, USA
| | - Ralf Henkel
- American Center for Reproductive Medicine, Cleveland Clinic, Ohio, USA.,Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.,Department of Medical Bioscience, University of the Western Cape, Bellville, South Africa
| | | | | | - Chak Lam Cho
- S. H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong
| | - Hassan N Sallam
- Alexandria University Faculty of Medicine, Alexandria, Egypt
| | - Hyun Jun Park
- Department of Urology, Pusan National University School of Medicine, Busan, Korea.,Medical Research Institute of Pusan National University Hospital, Busan, Korea
| | - Ramadan Saleh
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Sava Micic
- Uromedica Polyclinic, Andrology Department, Belgrade, Serbia
| | - Rafael F Ambar
- Sexual and Reproductive Medicine, Department of Urology, Faculdade de Medicina do ABC, Santo André, Brazil.,Andrology Group at Ideia Fertil Institute of Human Reproduction, Santo Andre, Brazil
| | - Armand Zini
- Department of Surgery, McGill University, St. Mary's Hospital, Montreal, QC, Canada
| | - Kelton Tremellen
- Department of Obstetrics Gynaecology and Reproductive Medicine, Flinders University, Bedford Park, South Australia
| | | | - Ayad Palani
- Department of Biochemistry, College of Medicine, University of Garmian, Kalar, Iraq
| | - Mohamed Arafa
- American Center for Reproductive Medicine, Cleveland Clinic, Ohio, USA.,Hamad Medical Corporation, Doha, Qatar.,Department of Andrology, Sexology & STIs, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Marcello M Gava
- Sexual and Reproductive Medicine, Department of Urology, Faculdade de Medicina do ABC, Santo André, Brazil.,Andrology Group at Ideia Fertil Institute of Human Reproduction, Santo Andre, Brazil
| | - Sunil Jindal
- Department of Andrology and Reproductive Medicine, Jindal Hospital, Meerut, India
| | - Edouard Amar
- Cabinet D'Andrologie Victor Hugo, American Hospital of Paris Reproductive Center, Paris, France
| | - Zsolt Kopa
- Andrology Centre, Department of Urology, Semmelweis University, Budapest, Hungary
| | | | - Gian Maria Busetto
- Department of Urology and Renal Transplantation, University of Foggia Policlinico Riuniti of Foggia, Foggia, Italy
| | - Pallav Sengupta
- Department of Physiology, Faculty of Medicine, Bioscience and Nursing, MAHSA University, Kuala Lumpur, Malaysia
| | - Parviz Kavoussi
- Austin Fertility & Reproductive Medicine/Westlake IVF, Austin, TX, USA
| | | | - Jamal Fikri
- IVF Unit, Al Boustane Clinic, Rabat, Morocco
| | - Edson Borges
- Fertility Medical Group, Sapientiae Institute, São Paulo, Brazil
| | - Marlon Martinez
- Department of Urology, University of Santo Tomas Hospital, Manila, Philippines
| | | | - Osvaldo Rajmil
- Deparment of Andrology, Fundacio Puigvert, Barcelona, Spain
| | - Kaan Aydos
- Department of Urology, University of Ankara, Ankara, Turkey
| | - Sijo Parekattil
- Avant Concierge Urology & University of Central Florida, Winter Garden, FL, USA
| | - Joel L Marmar
- Honorary Staff of Cooper University Hospital, Camden, NJ, USA
| | | | | | | | - Emerson B Cordts
- Instituto Ideia Fertil-Human Reproduction Centre-Faculdade de Medicina do ABC, Sao Paulo, Brazil
| | | | - Taymour Mostafa
- Department of Andrology, Sexology & STIs, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Marjan Sabbaghian
- Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Mohammad Ali Sadighi Gilani
- Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | | | - Marco G Alves
- Department of Anatomy and Unit for Multidisciplinary Research in Biomedicine (UMIB), Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal
| | | | | | | | | | | | | | - Eric Chung
- Department of Urology, University of Queensland, Brisbane, Australia
| | | | - Adolfo Allegra
- ANDROS Day Surgery Clinic, Reproductive Medicine Unit, Palermo, Italy
| | - Vasilios Tanos
- Department of Obstetrics and Gynecology, University of Nicosia Medical School, Nicosia, Cyprus
| | | | - Timur Gurgan
- Department of Obstetrics and Gynecology, Bahcesehir University, Istanbul, Turkey
| | - Michel Abou-Abdallah
- Middle East Fertility Society, Canadian Foundation for Reproductive Medicine, Lebanon
| | - Hazem Al-Rumaih
- Reproductive Medicine Unit, New Jahra Hospital, Ministry of Health, Al Jahra, Kuwait
| | | | - Hesham Arab
- RMU Dr. Arab Medical Center, Jeddah, Saudi Arabia
| | - Sandro Esteves
- ANDROFERT, Andrology & Human Reproduction Clinic, Campinas, Brazil.,Division of Urology, Department of Surgery, University of Campinas (UNICAMP), Campinas, Brazil
| | - Medhat Amer
- Department of Andrology, Sexology & STIs, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ates Kadioglu
- Section of Andrology, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Oleksandr Yuzko
- Department of Obstetrics and Gynecology, Bukovinian State Medical University, Chernivtsi, Ukraine
| | - Vladislav Korsak
- International Centre for Reproductive Medicine, Saint-Petersburg, Russia
| | - Rupin Shah
- Department of Urology, Lilavati Hospital and Research Centre, Mumbai, India
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Agarwal A, Leisegang K, Panner Selvam MK, Durairajanayagam D, Barbarosie C, Finelli R, Sengupta P, Dutta S, Majzoub A, Pushparaj PN, Elbardisi H, Sharma R, Gupta S, Arafa M, Roychoudhury S, Alves MG, Oliveira PF, Henkel R. An online educational model in andrology for student training in the art of scientific writing in the COVID-19 pandemic. Andrologia 2021; 53:e13961. [PMID: 33491204 PMCID: PMC7995002 DOI: 10.1111/and.13961] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 12/18/2020] [Accepted: 12/22/2020] [Indexed: 01/21/2023] Open
Abstract
In 2020, the COVID‐19 pandemic led to the suspension of the annual Summer Internship at the American Center for Reproductive Medicine (ACRM). To transit it into an online format, an inaugural 6‐week 2020 ACRM Online Mentorship Program was developed focusing on five core pillars of andrology research: scientific writing, scientific methodology, plagiarism understanding, soft skills development and mentee basic andrology knowledge. This study aims to determine mentee developmental outcomes based on student surveys and discuss these within the context of the relevant teaching and learning methodology. The mentorship was structured around scientific writing projects established by the team using a student‐centred approach, with one‐on‐one expert mentorship through weekly formative assessments. Furthermore, weekly online meetings were conducted, including expert lectures, formative assessments and social engagement. Data were collected through final assessments and mentee surveys on mentorship outcomes. Results show that mentees (n = 28) reported a significant (p < .0001) improvement in all criteria related to the five core pillars. These results illustrate that the aims of the online mentorship program were achieved through a unique and adaptive online educational model and that our model has demonstrated its effectiveness as an innovative structured educational experience through the COVID‐19 crisis.
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Affiliation(s)
- Ashok Agarwal
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Kristian Leisegang
- School of Natural Medicine, Faculty of Community and Health Sciences, University of the Western Cape, Bellville, South Africa
| | | | | | - Catalina Barbarosie
- Department of Genetics, Faculty of Biology, University of Bucharest, Bucharest, Romania
| | - Renata Finelli
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Pallav Sengupta
- Department of Physiology, Faculty of Medicine, Bioscience and Nursing, MAHSA University, Malaysia
| | - Sulagna Dutta
- Department of Oral Biology and Biomedical Sciences, Faculty of Dentistry, MAHSA University, Malaysia
| | - Ahmad Majzoub
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA.,Male Infertility Unit, Urology Department, Hamad General Hospital, Doha, Qatar.,Urology Department, Weill Cornell Medical-Qatar, Doha, Qatar
| | - Peter Natesan Pushparaj
- Center of Excellence in Genomic Medicine Research, King Abdulaziz University, Jeddah, Saudi Arabia.,Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Haitham Elbardisi
- Male Infertility Unit, Urology Department, Hamad General Hospital, Doha, Qatar.,Urology Department, Weill Cornell Medical-Qatar, Doha, Qatar
| | - Rakesh Sharma
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Sajal Gupta
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Mohamed Arafa
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA.,Male Infertility Unit, Urology Department, Hamad General Hospital, Doha, Qatar.,Urology Department, Weill Cornell Medical-Qatar, Doha, Qatar.,Andrology Department, Cairo University, Cairo, Egypt
| | | | - Marco G Alves
- Department of Anatomy & Unit for Multidisciplinary Research in Biomedicine (UMIB), Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal
| | | | - Ralf Henkel
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA.,Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.,Department of Medical Bioscience, University of the Western Cape, Bellville, South Africa
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Majzoub A, Arafa M, Khalafalla K, AlSaid S, Burjaq H, Albader M, Al-Marzooqi T, Esteves SC, Elbardisi H. Predictive model to estimate the chances of successful sperm retrieval by testicular sperm aspiration in patients with nonobstructive azoospermia. Fertil Steril 2020; 115:373-381. [PMID: 33059887 DOI: 10.1016/j.fertnstert.2020.08.1397] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/09/2020] [Accepted: 08/17/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To explore predictors of successful sperm retrieval (SR) and to identify potentially suitable candidates for testicular sperm aspiration (TESA), a more straightforward, less traumatic, and less costly procedure than open surgical SR methods. DESIGN Retrospective chart review. SETTING Academic tertiary medical center. PATIENTS A total of 297 patients with nonobstructive azoospermia. INTERVENTIONS All patients underwent full clinical evaluation before undergoing a staged SR procedure, starting with TESA and proceeding to microsurgical testicular sperm extraction (microTESE). Predictors of positive SR with TESA were selected using the least absolute shrinkage and selection operator (LASSO) regression analysis using k-fold cross-validation. The obtained regression coefficients were used to create a predictive model, and a receiver operating characteristic (ROC) curve was obtained to express its predictive ability. Cut-off values for each significant predictor were also identified using ROC analysis. MAIN OUTCOME MEASURE(S) Development of a prediction model for positive SR with TESA. RESULTS Overall, a positive SR was observed in 23.6% of patients undergoing TESA. Average testis size (P = .017) and serum follicle-stimulating hormone (FSH) level (P < .001) were the significant predictors of positive SR identified by LASSO regression analysis. The predictive model had an AUC of 0.742 with a sensitivity of 73.9% and specificity of 69.9%. Patients presenting with an average testis size >7.75 mL and serum FSH level <8.5 IU/L had a TESA-positive SR of 43%. CONCLUSIONS TESA may be a suitable alternative to microTESE in selected nonobstructive azoospermia patients presenting with an average testis size >7.75 mL and serum FSH level <8.5 IU/L.
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Affiliation(s)
- Ahmad Majzoub
- Urology Department, Hamad Medical Corporation, Doha, Qatar; Weill Cornell Medicine-Qatar, Doha, Qatar.
| | - Mohamed Arafa
- Urology Department, Hamad Medical Corporation, Doha, Qatar; Weill Cornell Medicine-Qatar, Doha, Qatar; Andrology Department, Cairo University, Cairo, Egypt
| | | | - Sami AlSaid
- Urology Department, Hamad Medical Corporation, Doha, Qatar; Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Hasan Burjaq
- Assisted Conception Unit, Hamad Medical Corporation, Doha, Qatar
| | - Moza Albader
- Assisted Conception Unit, Hamad Medical Corporation, Doha, Qatar
| | | | - Sandro C Esteves
- ANDROFERT, Andrology & Human Reproduction Clinic, Campinas, Brazil; Division of Urology, Department of Surgery, University of Campinas (UNICAMP), Campinas, Brazil; Faculty of Health, Department of Clinical Sciences, Aarhus University, Aarhus, Denmark
| | - Haitham Elbardisi
- Urology Department, Hamad Medical Corporation, Doha, Qatar; Weill Cornell Medicine-Qatar, Doha, Qatar
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Arafa M, Khalafalla K, Majzoub A, Burjaq H, Al Badr M, Alsaid S, Elbardisi H. THE EFFECT OF PATERNAL AGE ON ICSI OUTCOME IN UNEXPLAINED INFERTILITY. Fertil Steril 2020. [DOI: 10.1016/j.fertnstert.2020.08.1162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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38
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Elbardisi H, Khalafalla K, Arafa M, Alsaid S, Majzoub A. TREATING HYPERPROLACTINEMIA DOESN’T IMPROVE SEXUAL FUNCTION IN END STAGE RENAL DISEASE PATIENTS. Fertil Steril 2020. [DOI: 10.1016/j.fertnstert.2020.08.1149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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39
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Majzoub A, Elbardisi H, Khalafalla K, Alsaid S, Arafa M. IMPACT OF METABOLIC AGE ON SEXUAL AND ANDROGENIC FUNCTION IN YOUNG PATIENTS. Fertil Steril 2020. [DOI: 10.1016/j.fertnstert.2020.08.1084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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40
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Khalafalla K, Arafa M, Elbardisi H, Burjaq H, Al Badr M, Alsaid S, Majzoub A. IMPACT OF SPERM DNA FRAGMENTATION ON PRE- AND POST-WASH SEMEN SAMPLES AND PREGNANCY OUTCOME WITH INTRACYTOPLASMIC SPERM INJECTION. Fertil Steril 2020. [DOI: 10.1016/j.fertnstert.2020.08.1136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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41
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Elbardisi H, Majzoub A, Al-Ali F, Elesnawi M, Hamad A, Al Emadi I, Arafa M. P0955IS THERE AN ENDOCRINE CONTRIBUTION TO THE SEXUAL DYSFUNCTION SEEN IN END STAGE RENAL DISEASE PATIENTS? Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p0955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and Aims
Male sexual dysfunction is commonly prevalent in patients with end stage renal disease (ESRD) and has been partly attributed to the concurrent state of hyperprolactinemia and hypogonadism, often observed in this patient population. The aim of this study was to evaluate the hormone profile and sexual function of ESRD patient, using validated questionnaires, in attempt to explore this association.
Method
This was a prospective study which included 98 patients with ESRD who followed in the outpatient department of a tertiary medical centre over a period of 1 year. Patients receiving treatment for hyperprolactinemia or those known to have an endocrine disorder were excluded in addition to patients receiving medical or surgical treatment for erectile dysfunction (ED) or premature ejaculation (PE). After filling the international index for erectile function-5 and the Arabic index for PE questionnaire, morning serum samples were taken from patients to measure testosterone and prolactin levels. Descriptive statistics was used to report frequency or means of variables. Chi-square test was used to examine associations between categorical variables. P<0.05 was considered statistically significant.
Results
Out of the 98 ESRD patients, 72 (73.6%) were treated with hemodialysis, 13 (13.2%) with peritoneal dialysis and 13 (13.2%) with medical treatment only. Diabetes mellitus was observed in all patients (type 1, 52%; and type 2, 48%), while hypertension, coronary heart disease and dyslipidemia were detected in 97.1%, 34.3% and 25.5%, respectively. The mean age, serum testosterone and prolactin levels were 52.4 ± 12.1 years, 12.95 ± 6.5 nmol/L and 514.2 ± 592.8mIU/L. Results of the PE index questionnaire revealed that 86 (87.7) patients had PE, 9 (9.1%) probable PE and 3 (3.1%) no PE. With IIEF-5, ED was detected in 96 patients; it was severe in 23 (23.5%), moderate- severe ED in 29 (29.4%), mild-moderate ED in 30 (30.4%) and mild in 14 (14.7%). 55 patients had high prolactin while 33 had low testosterone levels. Table 1 presents the IIEF-5 and PE questionnaire results in patients with low/normal testosterone and normal/high prolactin. No significant differences were observed in IIEF or PE levels between patients with low/normal testosterone and normal/high prolactin.
Conclusion
ESRD is commonly associated with sexual dysfunction that is more likely to be attributed to organic causes rather than solely to endocrine disturbances.
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Affiliation(s)
| | | | - Fadwa Al-Ali
- Hamad Medical Corporation, Nephrology, Doha, Qatar
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Arafa M, Agarwal A, Majzoub A, Panner Selvam MK, Baskaran S, Henkel R, Elbardisi H. Efficacy of Antioxidant Supplementation on Conventional and Advanced Sperm Function Tests in Patients with Idiopathic Male Infertility. Antioxidants (Basel) 2020; 9:E219. [PMID: 32155908 PMCID: PMC7139646 DOI: 10.3390/antiox9030219] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 02/23/2020] [Accepted: 03/02/2020] [Indexed: 12/20/2022] Open
Abstract
Antioxidants are used in the empirical treatment of infertile men. The aim of this study was to evaluate the effects of antioxidant therapy on conventional semen parameters and advanced sperm function tests in men seeking fertility treatment. A total of 148 infertile men of unknown etiology were divided into idiopathic (n = 119) and unexplained male infertility (UMI; n = 29). All participants were treated with the antioxidant supplement 'FH PRO for Men' for a period of three months. Compared with pretreatment results, there was a significant improvement in conventional semen parameters including sperm concentration, total and progressive motility and normal morphology, and seminal oxidation reduction potential (ORP), and sperm DNA fragmentation (SDF) in idiopathic infertile men. The changes were more prominent in idiopathic infertile men positive for ORP and SDF. UMI patients showed an improvement in progressive motility, ORP, and SDF after antioxidant treatment. Statistical analysis revealed that the efficacy of FH PRO for Men was significant in idiopathic male infertility compared with UMI. Treatment of idiopathic male infertility patients with the FH PRO for Men antioxidant regimen for three months resulted in a significant improvement in conventional semen parameters and sperm function. Therefore, FH PRO for Men offers promise for the medical treatment of idiopathic male infertility.
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Affiliation(s)
- Mohamed Arafa
- Male Infertility Unit, Urology Department, Hamad General Hospital, 00974 Doha, Qatar; (A.M.); (H.E.)
- Urology Department, Weill Cornell Medical-Qatar, 00974 Doha, Qatar
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH 44195, USA; (A.A.); (M.K.P.S.); (S.B.); (R.H.)
- Andrology Department, Cairo University, 11562 Cairo, Egypt
| | - Ashok Agarwal
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH 44195, USA; (A.A.); (M.K.P.S.); (S.B.); (R.H.)
| | - Ahmad Majzoub
- Male Infertility Unit, Urology Department, Hamad General Hospital, 00974 Doha, Qatar; (A.M.); (H.E.)
- Urology Department, Weill Cornell Medical-Qatar, 00974 Doha, Qatar
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH 44195, USA; (A.A.); (M.K.P.S.); (S.B.); (R.H.)
| | - Manesh Kumar Panner Selvam
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH 44195, USA; (A.A.); (M.K.P.S.); (S.B.); (R.H.)
| | - Saradha Baskaran
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH 44195, USA; (A.A.); (M.K.P.S.); (S.B.); (R.H.)
| | - Ralf Henkel
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH 44195, USA; (A.A.); (M.K.P.S.); (S.B.); (R.H.)
- Department of Medical Bioscience, University of the Western Cape, 7535 Bellville, South Africa
| | - Haitham Elbardisi
- Male Infertility Unit, Urology Department, Hamad General Hospital, 00974 Doha, Qatar; (A.M.); (H.E.)
- Urology Department, Weill Cornell Medical-Qatar, 00974 Doha, Qatar
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Elbardisi H, Finelli R, Agarwal A, Majzoub A, Henkel R, Arafa M. Predictive value of oxidative stress testing in semen for sperm DNA fragmentation assessed by sperm chromatin dispersion test. Andrology 2020; 8:610-617. [DOI: 10.1111/andr.12743] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 12/02/2019] [Accepted: 12/09/2019] [Indexed: 01/12/2023]
Affiliation(s)
- Haitham Elbardisi
- Male Infertility Unit Urology Department Hamad General Hospital Doha Qatar
- Urology Department Weill Cornell Medical‐Qatar Doha Qatar
| | - Renata Finelli
- American Center for Reproductive Medicine Cleveland Clinic Cleveland OH USA
| | - Ashok Agarwal
- American Center for Reproductive Medicine Cleveland Clinic Cleveland OH USA
| | - Ahmad Majzoub
- Male Infertility Unit Urology Department Hamad General Hospital Doha Qatar
- Urology Department Weill Cornell Medical‐Qatar Doha Qatar
- American Center for Reproductive Medicine Cleveland Clinic Cleveland OH USA
| | - Ralf Henkel
- American Center for Reproductive Medicine Cleveland Clinic Cleveland OH USA
- Department of Medical Bioscience University of the Western Cape Bellville South Africa
| | - Mohamed Arafa
- Male Infertility Unit Urology Department Hamad General Hospital Doha Qatar
- Urology Department Weill Cornell Medical‐Qatar Doha Qatar
- American Center for Reproductive Medicine Cleveland Clinic Cleveland OH USA
- Andrology Department Cairo University Cairo Egypt
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Elbardisi H, El Ansari W, Majzoub A, Arafa M. Does varicocelectomy improve semen in men with azoospermia and clinically palpable varicocele? Andrologia 2019; 52:e13486. [PMID: 31825116 DOI: 10.1111/and.13486] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 10/26/2019] [Accepted: 10/31/2019] [Indexed: 01/12/2023] Open
Abstract
The effectiveness of varicocelectomy in nonobstructive azoospermia is controversial. The current study assessed the efficacy of microsurgical subinguinal varicocelectomy in nonobstructive azoospermic men with palpable varicocele and to evaluate predictive parameters of outcome. We reviewed the records of 723 patients who had microsurgical varicocelectomy and diagnostic testicular biopsy between 2012 and 2016 at a tertiary medical centre. Data pertaining to the physical, laboratory (semen analysis and hormonal profile) and histopathology features were examined, exploring the predictors of improvement in semen analysis post-varicocelectomy. In total, 42 patients with mean age 35.71 ± 6.35 years were included. After a mean varicocelectomy follow-up of 6.7 months, motile spermatozoa in the ejaculate could be observed in 11 patients (26.2). Out of all the factors examined, only testicular histopathology significantly predicted post-varicocelectomy outcome, where 8/11 patients exhibited hypospermatogenesis, and 3/11 Sertoli cell-only regained spermatozoa in semen. Microsurgical varicocelectomy in nonobstructive azoospermic men with clinically palpable varicocele can result in sperm appearance in the ejaculate with the highest success expected in hypospermatogenesis.
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Affiliation(s)
- Haitham Elbardisi
- Department of Urology, Hamad Medical Corporation, Doha, Qatar.,Department of Urology, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Walid El Ansari
- Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.,College of Medicine, Qatar University, Doha, Qatar.,School of Health and Education, University of Skövde, Skövde, Sweden
| | - Ahmad Majzoub
- Department of Urology, Hamad Medical Corporation, Doha, Qatar.,Department of Urology, Weill Cornell Medicine-Qatar, Doha, Qatar.,American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Mohamad Arafa
- Department of Urology, Hamad Medical Corporation, Doha, Qatar.,Department of Urology, Weill Cornell Medicine-Qatar, Doha, Qatar.,American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA.,Department of Andrology, Cairo University, Cairo, Egypt
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45
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Arafa M, Agarwal A, Majzoub A, Khalafalla K, Alsaid S, Elbardisi H. Efficacy of antioxidant supplementation on conventional and advanced sperm function tests in patients with idiopathic male infertility. Fertil Steril 2019. [DOI: 10.1016/j.fertnstert.2019.07.1037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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46
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Alsaid S, Khalafalla K, Majzoub A, Arafa M, Elbardisi H. Impact of body weight on semen parameters and reproductive hormones of men with idiopathic infertility. Fertil Steril 2019. [DOI: 10.1016/j.fertnstert.2019.07.1057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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47
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Khalafalla K, Arafa M, Majzoub A, Elbardisi H, Alsaid S, Agarwal A. Antioxidant combination therapy: a new hope for oligoathenoteratospermic patients. Fertil Steril 2019. [DOI: 10.1016/j.fertnstert.2019.07.1045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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48
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Agarwal A, Parekh N, Panner Selvam MK, Henkel R, Shah R, Homa ST, Ramasamy R, Ko E, Tremellen K, Esteves S, Majzoub A, Alvarez JG, Gardner DK, Jayasena CN, Ramsay JW, Cho CL, Saleh R, Sakkas D, Hotaling JM, Lundy SD, Vij S, Marmar J, Gosalvez J, Sabanegh E, Park HJ, Zini A, Kavoussi P, Micic S, Smith R, Busetto GM, Bakırcıoğlu ME, Haidl G, Balercia G, Puchalt NG, Ben-Khalifa M, Tadros N, Kirkman-Browne J, Moskovtsev S, Huang X, Borges E, Franken D, Bar-Chama N, Morimoto Y, Tomita K, Srini VS, Ombelet W, Baldi E, Muratori M, Yumura Y, La Vignera S, Kosgi R, Martinez MP, Evenson DP, Zylbersztejn DS, Roque M, Cocuzza M, Vieira M, Ben-Meir A, Orvieto R, Levitas E, Wiser A, Arafa M, Malhotra V, Parekattil SJ, Elbardisi H, Carvalho L, Dada R, Sifer C, Talwar P, Gudeloglu A, Mahmoud AMA, Terras K, Yazbeck C, Nebojsa B, Durairajanayagam D, Mounir A, Kahn LG, Baskaran S, Pai RD, Paoli D, Leisegang K, Moein MR, Malik S, Yaman O, Samanta L, Bayane F, Jindal SK, Kendirci M, Altay B, Perovic D, Harlev A. Male Oxidative Stress Infertility (MOSI): Proposed Terminology and Clinical Practice Guidelines for Management of Idiopathic Male Infertility. World J Mens Health 2019; 37:296-312. [PMID: 31081299 PMCID: PMC6704307 DOI: 10.5534/wjmh.190055] [Citation(s) in RCA: 214] [Impact Index Per Article: 42.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 04/02/2019] [Indexed: 12/29/2022] Open
Abstract
Despite advances in the field of male reproductive health, idiopathic male infertility, in which a man has altered semen characteristics without an identifiable cause and there is no female factor infertility, remains a challenging condition to diagnose and manage. Increasing evidence suggests that oxidative stress (OS) plays an independent role in the etiology of male infertility, with 30% to 80% of infertile men having elevated seminal reactive oxygen species levels. OS can negatively affect fertility via a number of pathways, including interference with capacitation and possible damage to sperm membrane and DNA, which may impair the sperm's potential to fertilize an egg and develop into a healthy embryo. Adequate evaluation of male reproductive potential should therefore include an assessment of sperm OS. We propose the term Male Oxidative Stress Infertility, or MOSI, as a novel descriptor for infertile men with abnormal semen characteristics and OS, including many patients who were previously classified as having idiopathic male infertility. Oxidation-reduction potential (ORP) can be a useful clinical biomarker for the classification of MOSI, as it takes into account the levels of both oxidants and reductants (antioxidants). Current treatment protocols for OS, including the use of antioxidants, are not evidence-based and have the potential for complications and increased healthcare-related expenditures. Utilizing an easy, reproducible, and cost-effective test to measure ORP may provide a more targeted, reliable approach for administering antioxidant therapy while minimizing the risk of antioxidant overdose. With the increasing awareness and understanding of MOSI as a distinct male infertility diagnosis, future research endeavors can facilitate the development of evidence-based treatments that target its underlying cause.
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Affiliation(s)
- Ashok Agarwal
- American Center for Reproductive Medicine, Cleveland Clinic, OH, USA
- Department of Urology, Cleveland Clinic, Cleveland, OH, USA.
| | - Neel Parekh
- Department of Urology, Cleveland Clinic, Cleveland, OH, USA
| | - Manesh Kumar Panner Selvam
- American Center for Reproductive Medicine, Cleveland Clinic, OH, USA
- Department of Urology, Cleveland Clinic, Cleveland, OH, USA
| | - Ralf Henkel
- American Center for Reproductive Medicine, Cleveland Clinic, OH, USA
- Department of Medical Bioscience, University of the Western Cape, Cape Town, South Africa
| | - Rupin Shah
- Department of Urology, Lilavati Hospital and Research Centre, Mumbai, India
| | - Sheryl T Homa
- School of Biosciences, University of Kent, Canterbury, UK
| | | | - Edmund Ko
- Department of Urology, Loma Linda University Health, Loma Linda, CA, USA
| | - Kelton Tremellen
- Department of Obstetrics Gynaecology and Reproductive Medicine, Flinders University, Bedford Park, Australia
| | - Sandro Esteves
- Division of Urology, Department of Surgery, University of Campinas (UNICAMP), Campinas, Brazil
- Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Ahmad Majzoub
- American Center for Reproductive Medicine, Cleveland Clinic, OH, USA
- Department of Urology, Hamad Medical Corporation and Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Juan G Alvarez
- Centro Androgen, La Coruña, Spain and Harvard Medical School, Boston, MA, USA
| | - David K Gardner
- School of BioSciences, University of Melbourne, Parkville, Australia
| | - Channa N Jayasena
- Section of Investigative Medicine, Imperial College London, UK
- Department of Andrology, Hammersmith Hospital, London, UK
| | | | - Chak Lam Cho
- Department of Surgery, Union Hospital, Shatin, Hong Kong
| | - Ramadan Saleh
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt
| | | | - James M Hotaling
- Department of Urology, University of Utah, Salt Lake City, UT, USA
| | - Scott D Lundy
- Department of Urology, Cleveland Clinic, Cleveland, OH, USA
| | - Sarah Vij
- Department of Urology, Cleveland Clinic, Cleveland, OH, USA
| | | | - Jaime Gosalvez
- Departamento de Biología, Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Hyun Jun Park
- Department of Urology, Pusan National University School of Medicine, Busan, Korea
- Medical Research Institute of Pusan National University Hospital, Busan, Korea
| | - Armand Zini
- Department of Surgery, McGill University, Montreal, QC, Canada
| | - Parviz Kavoussi
- Austin Fertility & Reproductive Medicine/Westlake IVF, Austin, TX, USA
| | - Sava Micic
- Uromedica Polyclinic, Kneza Milosa, Belgrade, Serbia
| | - Ryan Smith
- Department of Urology, University of Virginia, Charlottesville, VA, USA
| | | | | | - Gerhard Haidl
- Department of Dermatology, University Hospital Bonn, Bonn, Germany
| | - Giancarlo Balercia
- Division of Endocrinology, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Umberto I Hospital, Ancona, Italy
| | - Nicolás Garrido Puchalt
- IVI Foundation Edificio Biopolo - Instituto de Investigación Sanitaria la Fe, Valencia, Spain
| | - Moncef Ben-Khalifa
- University Hospital, School of Médicine and PERITOX Laboratory, Amiens, France
| | - Nicholas Tadros
- Division of Urology, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Jackson Kirkman-Browne
- Centre for Human Reproductive Science, IMSR, College of Medical & Dental Sciences, The University of Birmingham Edgbaston, UK
- The Birmingham Women's Fertility Centre, Birmingham Women's and Children's NHS Foundation Trust, Mindelsohn Drive, Edgbaston, UK
| | - Sergey Moskovtsev
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON, Canada
| | - Xuefeng Huang
- Reproductive Medicine Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | | | - Daniel Franken
- Department of Obstetrics & Gynecology, Andrology Unit Faculties of Health Sciences, Tygerberg Hospital, Tygerberg, South Africa
| | - Natan Bar-Chama
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Kazuhisa Tomita
- IVF Japan Group, Horac Grand Front Osaka Clinic, Osaka, Japan
| | | | - Willem Ombelet
- Genk Institute for Fertility Technology, Genk, Belgium
- Hasselt University, Biomedical Research Institute, Diepenbeek, Belgium
| | - Elisabetta Baldi
- Department of Experimental and Clinical Medicine, Center of Excellence DeNothe, University of Florence, Italy
| | - Monica Muratori
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", Unit of Sexual Medicine and Andrology, Center of Excellence DeNothe, University of Florence, Florence, Italy
| | - Yasushi Yumura
- Department of Urology, Reproduction Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Sandro La Vignera
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | | | - Marlon P Martinez
- Section of Urology, University of Santo Tomas Hospital, Manila, Philippines
| | | | | | - Matheus Roque
- Origen, Center for Reproductive Medicine, Rio de Janeiro, Brazil
| | | | - Marcelo Vieira
- Division of Urology, Infertility Center ALFA, São Paulo, Brazil
- Head of Male Infertility Division, Andrology Department, Brazilian Society of Urology, Rio de Janeiro, Brazil
| | - Assaf Ben-Meir
- Fertility and IVF Unit, Department of Obstetrics and Gynecology, Hebrew-University Hadassah Medical Center, Jerusalem, Israel
| | - Raoul Orvieto
- Infertility and IVF Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan, Israel
- Tarnesby-Tarnowski Chair for Family Planning and Fertility Regulation, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Eliahu Levitas
- Soroka University Medical Center, Ben-Gurion University of the Negev Beer-Sheva, Beersheba, Israel
| | - Amir Wiser
- IVF Unit, Meir Medical Center, Kfar Sava, Israel
- Sackler Medicine School, Tel Aviv University, Tel Aviv, Israel
| | - Mohamed Arafa
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
| | - Vineet Malhotra
- Department of Andrology and Urology, Diyos Hospital, New Delhi, India
| | - Sijo Joseph Parekattil
- PUR Clinic, South Lake Hospital, Clermont, FL, USA
- University of Central Florida, Orlando, FL, USA
| | | | - Luiz Carvalho
- Baby Center, Institute for Reproductive Medicine, São Paulo, Brazil
- College Institute of Clinical Research and Teaching Development, São Paulo, Brazil
| | - Rima Dada
- Lab for Molecular Reproduction and Genetics, Anatomy, All India Institute of Medical Sciences, New Delhi, India
| | - Christophe Sifer
- Department of Reproductive Biology, Hôpitaux Universitaires Paris Seine Saint-Denis, Bondy, France
| | - Pankaj Talwar
- Department of Reproductive Medicine and Embryology, Manipal Hospital, New Delhi, India
| | - Ahmet Gudeloglu
- Department of Urology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ahmed M A Mahmoud
- Department of Endocrinology/ Andrology, University Hospital Ghent, Ghent, Belgium
| | - Khaled Terras
- Department of Reproductive Medicine, Hannibal International Clinic, Tunis, Tunisia
| | - Chadi Yazbeck
- Department of Obstetrics, Gynecology and Reproductive Medicine, Pierre Cherest and Hartman Clinics, Paris, France
| | - Bojanic Nebojsa
- Clinic of Urology, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Damayanthi Durairajanayagam
- Department of Physiology, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Jalan Hospital, Selangor, Malaysia
| | - Ajina Mounir
- Department of Embryology, Faculty of Medicine, University of Sousse, Sousse, Tunisia
| | - Linda G Kahn
- Department of Pediatrics, New York University School of Medicine, New York, NY, USA
| | - Saradha Baskaran
- American Center for Reproductive Medicine, Cleveland Clinic, OH, USA
| | - Rishma Dhillon Pai
- Department of Obstetrics and Gynaecology, Lilavati Hospital and Research Centre, Mumbai, India
| | - Donatella Paoli
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Kristian Leisegang
- School of Natural Medicine, University of the Western Cape, Cape Town, South Africa
| | | | | | - Onder Yaman
- Department of Urology, School of Medicine, University of Ankara, Ankara, Turkey
| | - Luna Samanta
- Redox Biology Laboratory, Department of Zoology and Center of Excellence in Environment and Public Health, Ravenshaw University, Cutrack, India
| | - Fouad Bayane
- Marrakech Fertility Institute, Marrakech, Morocco
| | | | - Muammer Kendirci
- Department of Urology, Istinye University Faculty of Medicine, Liv Hospital Ulus, Istanbul, Turkey
| | - Baris Altay
- Department of Urology, Ege University School of Medicine, İzmir, Turkey
| | | | - Avi Harlev
- Fertility and IVF Unit, Soroka University Medical Center, Ben Gurion University of the Negev, Beer Sheva, Israel
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Khalafalla K, Arafa M, Elbardisi H, Alsaid S, Majzoub A, Mahdi M. Varicocele and testicular hyperthermia: infrared digital thermographic measurement of scrotal and inguinal temperatures among varicocele patients and normal controls. Fertil Steril 2019. [DOI: 10.1016/j.fertnstert.2019.07.1039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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50
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Arafa M, Henkel R, Agarwal A, Majzoub A, Elbardisi H. Correlation of oxidation–reduction potential with hormones, semen parameters and testicular volume. Andrologia 2019; 51:e13258. [DOI: 10.1111/and.13258] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 12/19/2018] [Accepted: 01/24/2019] [Indexed: 12/21/2022] Open
Affiliation(s)
- Mohamed Arafa
- Urology Department Hamad Medical Corporation Doha Qatar
- Andrology Department Cairo University Cairo Egypt
- Urology Department Weill Cornell Medicine-Qatar Doha Qatar
- Department of Urology, American Center for Reproductive Medicine Cleveland Clinic Cleveland Ohio
| | - Ralf Henkel
- Department of Urology, American Center for Reproductive Medicine Cleveland Clinic Cleveland Ohio
- Department of Medical Bioscience University of the Western Cape Bellville South Africa
| | - Ashok Agarwal
- Department of Urology, American Center for Reproductive Medicine Cleveland Clinic Cleveland Ohio
| | - Ahmad Majzoub
- Urology Department Hamad Medical Corporation Doha Qatar
- Urology Department Weill Cornell Medicine-Qatar Doha Qatar
- Department of Urology, American Center for Reproductive Medicine Cleveland Clinic Cleveland Ohio
| | - Haitham Elbardisi
- Urology Department Hamad Medical Corporation Doha Qatar
- Urology Department Weill Cornell Medicine-Qatar Doha Qatar
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