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Garg T, Meeks WD, Coward RM, Merrill SB, Huang WC, Burnett AL. Reply by Authors. Urol Pract 2022; 9:490. [PMID: 37145766 DOI: 10.1097/upj.0000000000000311.02] [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] [Accepted: 04/11/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Tullika Garg
- Departments of Urology and Population Health Sciences, Geisinger, Danville, Pennsylvania
| | - William D Meeks
- Data Management and Statistical Analysis, American Urological Association, Linthicum, Maryland
| | - R Matthew Coward
- Department of Urology, University of North Carolina, Chapel Hill, North Carolina
- UNC Fertility, Raleigh, North Carolina
| | | | - William C Huang
- Departments of Urology and Radiology, NYU Grossman School of Medicine, New York, New York
| | - Arthur L Burnett
- Department of Urology, Johns Hopkins Medical Institutions, Baltimore, Maryland
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Garg T, Meeks WD, Coward RM, Merrill SB, Huang WC, Burnett AL. Demographic and Practice Trends of Rural Urologists in the U.S.: Implications for Workforce Policy. Urol Pract 2022; 9:481-490. [PMID: 37145722 DOI: 10.1097/upj.0000000000000311] [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] [Accepted: 04/11/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION There is a shortage in the number of urologists needed to satisfy the needs of an aging U.S. POPULATION The urologist shortage may have a pronounced impact on aging rural communities. Our objective was to describe the demographic trends and scope of practice of rural urologists using data from the American Urological Association Census. METHODS We conducted a retrospective analysis of American Urological Association Census survey data over a 5-year period (2016-2020), including all U.S.-based practicing urologists. Metropolitan (urban) and nonmetropolitan (rural) practice classifications were based on rural-urban commuting area codes for the primary practice location zip code. We conducted descriptive statistics of demographics, practice characteristics and specific rural-focused survey items. RESULTS In 2020, rural urologists were older (60.9 years, 95% CI 58.5-63.3 vs 54.6 years, 95% CI 54.0-55.1) and were in practice longer (25.4 years, 95% CI 23.2-27.5 vs 21.2 years, 95% CI 20.8-21.5) than urban counterparts. Since 2016, mean age and years in practice increased for rural urologists but remained stable for urban urologists, suggesting an influx of younger urologists to urban areas. Compared with urban urologists, rural urologists had significantly less fellowship training and more frequently worked in solo practice, multispecialty groups and private hospitals. CONCLUSIONS The urological workforce shortage will particularly impact rural communities and their access to urological care. We hope our findings will inform and empower policymakers to develop targeted interventions to expand the rural urologist workforce.
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Affiliation(s)
- Tullika Garg
- Departments of Urology and Population Health Sciences, Geisinger, Danville, Pennsylvania
| | - William D Meeks
- Data Management and Statistical Analysis, American Urological Association, Linthicum, Maryland
| | - R Matthew Coward
- Department of Urology, University of North Carolina, Chapel Hill, North Carolina
- UNC Fertility, Raleigh, North Carolina
| | | | - William C Huang
- Departments of Urology and Radiology, NYU Grossman School of Medicine, New York, New York
| | - Arthur L Burnett
- Department of Urology, Johns Hopkins Medical Institutions, Baltimore, Maryland
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Baker KC, Steiner AZ, Hansen KR, Barnhart KT, Cedars MI, Legro RS, Diamond MP, Krawetz SA, Usadi R, Baker VL, Coward RM, Sun F, Wild R, Masson P, Smith JF, Santoro N, Zhang H. Poor reproducibility of percentage of normally shaped sperm using the World Health Organization Fifth Edition strict grading criteria. F S Rep 2022; 3:110-115. [PMID: 35789726 PMCID: PMC9250115 DOI: 10.1016/j.xfre.2022.03.003] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/22/2022] [Accepted: 03/13/2022] [Indexed: 12/03/2022] Open
Abstract
Objective To determine the reproducibility of the World Health Organization Fifth Edition (WHO5) strict grading methodology by comparing the percentage of morphologically normal sperm (PNS) recorded by the core laboratory with results obtained at the fertility centers participating in a multisite clinical trial. Design Secondary cohort analysis of data from the Males, Antioxidants, and Infertility trial. Setting Fertility centers. Patients Semen values of 171 men participating in a multicenter, double-blind, randomized, placebo-controlled trial evaluating the effect of antioxidants on male fertility. Interventions Not applicable. Main Outcome Measures Strict morphology expressed as PNS as determined at each fertility center and the core central laboratory for the same semen sample. Results No correlation was found in the PNS values for the same semen sample between the core laboratory and fertility center laboratories either as a group or by individual site. Interobserver agreement was similarly low (κ = 0.05 and 0.15) between the core and fertility laboratories as a group for strict morphology, categorized by the WHO5 lower reference limits of 4% and 0, respectively. Moderate agreement was found between the core and 2 individual fertility laboratories for the cutoff value of 0 (κ = 0.42 and 0.57). The remainder of the comparisons demonstrated poor to fair agreement. Conclusions Strict morphology grading using the WHO5 methodology demonstrated overall poor reproducibility among a cohort of experienced fertility laboratories. This lack of correlation and agreement in the PNS values calls into question the reproducibility, and thereby the potential applicability, of sperm strict morphology testing.
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Affiliation(s)
- Karen C Baker
- Division of Urology, Duke University, Durham, North Carolina
| | - Anne Z Steiner
- Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina
| | - Karl R Hansen
- Department of Obstetrics and Gynecology, Health Sciences Center, University of Oklahoma, Oklahoma City, Oklahoma
| | - Kurt T Barnhart
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Marcelle I Cedars
- Department of Obstetrics and Gynecology, University of California-San Francisco, San Francisco, California
| | - Richard S Legro
- Department of Obstetrics and Gynecology, Pennsylvania State University, Hershey, Pennsylvania
| | - Michael P Diamond
- Department of Obstetrics and Gynecology, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Stephen A Krawetz
- Department of Obstetrics and Gynecology & Center for Molecular Medicine and Genetics, Wayne State University, Detroit, Michigan
| | - Rebecca Usadi
- Department of Reproductive Endocrinology and Infertility, Atrium Health, Charlotte, North Carolina
| | - Valerie L Baker
- Department of Gynecology and Obstetrics, Johns Hopkins University, Lutherville, Maryland
| | - R Matthew Coward
- Department of Urology, University of North Carolina, Chapel Hill, North Carolina
| | - Fangbai Sun
- Department of Biostatistics, Yale School of Public Health, New Haven Connecticut
| | - Robert Wild
- Department of Obstetrics and Gynecology, Biostatistics and Epidemiology University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Puneet Masson
- Department of Urology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - James F Smith
- Department of Urology, University of California-San Francisco, San Francisco, California
| | - Nanette Santoro
- Department of Obstetrics and Gynecology, University of Colorado, Aurora, Colorado
| | - Heping Zhang
- Collaborative Center for Statistics in Science, Yale School of Public Health, New Haven, Connecticut
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Schneider D, Loeb C, Coward RM, Jenkins L, Yafi F. Assessment of work-related musculoskeletal pain in urologic microsurgeons. J Sex Med 2022. [DOI: 10.1016/j.jsxm.2022.03.489] [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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Spitzer TL, Trussell JC, Coward RM, Hansen KR, Barnhart KT, Cedars MI, Diamond MP, Krawetz SA, Sun F, Zhang H, Santoro N, Steiner AZ. Biomarkers of Stress and Male Fertility. Reprod Sci 2022; 29:1262-1270. [PMID: 35106743 PMCID: PMC9078052 DOI: 10.1007/s43032-022-00853-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 01/08/2022] [Indexed: 11/25/2022]
Abstract
To study if stress, as measured by salivary alpha-amylase and cortisol, negatively impacts male fertility, as measured by semen parameters, pregnancy, and live birth rates. Prospective, cohort study of men enrolled in the Males, Antioxidants, and Infertility (MOXI) trial. One-hundred twelve infertile men provided first-morning salivary and semen samples at baseline. Salivary samples were analyzed for alpha-amylase and cortisol. Couples attempted to conceive naturally (months 1-3) and with clomiphene citrate/intrauterine insemination (months 4-6). The association between stress-related biomarkers and semen parameters including DNA fragmentation was assessed using linear regression models adjusting for male age. Salivary levels were dichotomized at the 80th percentile. Pregnancy/live birth rates in couples in the upper quintile were compared to remaining subjects using chi-square testing. Salivary levels of alpha-amylase were not associated with semen parameters or DNA fragmentation. Salivary cortisol levels were not correlated with DNA fragmentation or normal morphology. For every 1-unit increase in salivary cortisol, total sperm count increased by 13.9 million (95% CI: 2.5, 25.3) and total motile sperm count increased by 9.9 million (95% CI: 3.2-16.6). Couple pregnancy rates and live birth rates did not differ for males in the highest quintile of alpha-amylase (27% and 28%, p = 0.96; 23% and 21%, p = 0.87) or cortisol (40% and 26%, p = 0.22; 35% and 19%, p = 0.12), compared to males with lower values. Physiologic measures of high stress may not harm but actually improve semen parameters among men with male-factor infertility.
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Affiliation(s)
- Trimble L Spitzer
- Department of Obstetrics and Gynecology, Naval Medical Center Portsmouth, 620 John Paul Jones Cir, Portsmouth, VA, 23708, USA.
| | - J C Trussell
- Department of Urology, State University of New York Upstate Medical University, 750 E Adams St, Syracuse, NY, 13210, USA
| | - R Matthew Coward
- Department of Urology, UNC School of Medicine, 2113 Physicians Office Building CB#7235, Chapel Hill, NC, 27599-7235, USA
- UNC Fertility, 7920 ACC Blvd #300, Raleigh, NC, 27617, USA
| | - Karl R Hansen
- Department of Obstetrics and Gynecology, University of Oklahoma College of Medicine, Oklahoma City, OK, 73104, USA
| | - Kurt T Barnhart
- Division of Reproductive Endocrinology and Infertility, University of Pennsylvania Medical Center, Philadelphia, PA, USA
| | - Marcelle I Cedars
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco School of Medicine, San Francisco, CA, 94143, USA
| | - Michael P Diamond
- Department of Obstetrics and Gynecology, Augusta University, Augusta, GA, 30912, USA
| | - Stephen A Krawetz
- Department of Obstetrics and Gynecology, Center for Molecular Medicine and Genetics, Wayne State University, Detroit, MI, 48202, USA
| | - Fangbai Sun
- Department of Biostatistics, Yale University School of Public Health, New Haven, CT, USA
| | - Heping Zhang
- Department of Biostatistics, Yale University School of Public Health, New Haven, CT, USA
| | - Nanette Santoro
- Department of Obstetrics and Gynecology, University of Colorado, Denver, CO, 80204, USA
| | - Anne Z Steiner
- Department of Obstetrics and Gynecology, Duke University, Durham, NC, 27713, USA
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Schneider D, Loeb C, Nguyen J, Coward RM, Jenkins L, Yafi F. Assessment of Work-Related Musculoskeletal Pain in Urologic Microsurgeons. J Sex Med 2022. [DOI: 10.1016/j.jsxm.2022.01.367] [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: 10/18/2022]
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Brems JA, Coward RM. The forest and the trees-the importance of male dietary patterns extends beyond in vitro fertilization outcomes. Fertil Steril 2021; 117:313-314. [PMID: 34980433 DOI: 10.1016/j.fertnstert.2021.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 12/15/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Jacob A Brems
- Department of Urology, University of North Carolina School of Medicine, Chapel Hill, North Carolina; UNC Fertility, Raleigh, North Carolina
| | - R Matthew Coward
- Department of Urology, University of North Carolina School of Medicine, Chapel Hill, North Carolina; UNC Fertility, Raleigh, North Carolina
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Knudtson JF, Sun F, Coward RM, Hansen KR, Barnhart KT, Smith J, Legro RS, Diamond MP, Krawetz SA, Zhang H, Usadi R, Baker VL, Santoro N, Steiner AZ. The relationship of plasma antioxidant levels to semen parameters: the Males, Antioxidants, and Infertility (MOXI) randomized clinical trial. J Assist Reprod Genet 2021; 38:3005-3013. [PMID: 34455507 PMCID: PMC8609082 DOI: 10.1007/s10815-021-02301-2] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 08/12/2021] [Indexed: 11/24/2022] Open
Abstract
PURPOSE The understanding of the role of plasma antioxidant levels in male fertility in the USA is limited. In a secondary analysis of the Males, Antioxidants, and Infertility (MOXI) randomized clinical trial, we sought to determine whether serum levels of vitamin E (α-tocopherol), zinc, and selenium were correlated with semen parameters and couple fertility outcomes. METHODS This study is a secondary analysis of the MOXI clinical trial. The primary endpoints in this secondary analysis include semen parameters, and DNA fragmentation and clinical outcomes including pregnancy and live birth. Analyses were completed using Wilcoxon's rank-sum test and linear regression models. RESULTS At baseline, the analysis included plasma labs for vitamin E (n = 131), selenium (n = 124), and zinc (n = 128). All baseline plasma values were in the normal ranges. There was no association between selenium, zinc, or vitamin E levels and semen parameters or DNA fragmentation. Baseline antioxidant levels in the male partners did not predict pregnancy or live birth among all couples. Among those randomized to placebo, baseline male antioxidant levels did not differ between those couples with live birth and those that did not conceive or have a live birth. CONCLUSIONS Among men attending fertility centers in the USA, who have sufficient plasma antioxidant levels of zinc, selenium, or vitamin E, no association was observed between vitamins and semen parameters or clinical outcomes in couples with male infertility. Higher levels of antioxidants among men with circulating antioxidants in the normal range do not appear to confer benefit on semen parameters or male fertility.
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Affiliation(s)
- Jennifer F Knudtson
- Department of Obstetrics and Gynecology, University of Texas Health Science Center San Antonio, San Antonio, Texas; and Aspire Fertility, San Antonio, TX, USA.
| | - Fangbai Sun
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | - R Matthew Coward
- Department of Urology, University of North Carolina, Chapel Hill, NC, USA
| | - Karl R Hansen
- Department of Obstetrics and Gynecology, Health Sciences Center, University of Oklahoma, Oklahoma City, OK, USA
| | - Kurt T Barnhart
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA, USA
| | - James Smith
- Department of Urology, University of California- San Francisco, San Francisco, CA, USA
| | - Richard S Legro
- Department of Obstetrics and Gynecology, Pennsylvania State University, Hershey, PA, USA
| | - Michael P Diamond
- Department of Obstetrics and Gynecology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Stephen A Krawetz
- Department of Obstetrics and Gynecology & Molecular Medicine and Genetics, Wayne State University, Detroit, MI, USA
| | - Heping Zhang
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | - Rebecca Usadi
- Department of Reproductive Endocrinology and Infertility, Atrium Health, Charlotte, NC, USA
| | - Valerie L Baker
- Department of Gynecology and Obstetrics, Division of Reproductive Endocrinology and Infertility, Johns Hopkins University, Lutherville, MD, USA
| | - Nanette Santoro
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Anne Z Steiner
- Department of Reproductive Endocrinology and Infertility, Duke University School of Medicine, Durham, NC, USA
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Rios JS, Coward RM, Hansen KR, Barnhart KT, Cedars MI, Legro RS, Diamond MP, Krawetz SA, Usadi R, Baker VL, Sun F, Wild R, Smith JF, Santoro N, Zhang H, Steiner AZ. Sperm deoxyribonucleic acid fragmentation: predictors, fertility outcomes, and assays among infertile males. F S Rep 2021; 2:282-288. [PMID: 34553152 PMCID: PMC8441563 DOI: 10.1016/j.xfre.2021.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 06/09/2021] [Accepted: 06/11/2021] [Indexed: 11/25/2022] Open
Abstract
Objective To examine the factors associated with increased deoxyribonucleic acid fragmentation index (DFI), evaluate the pregnancy outcomes of men with increased DFI, and compare three independent DFI assays. Design Secondary analysis. Setting Nine US-based fertility centers. Patient(s) Infertile men (N = 147) with sperm concentration ≤15 × 106/mL, motility ≤40%, or normal morphology ≤4% were enrolled. The female partners were ovulatory, ≤40 years old, and had documented tubal patency. Intervention(s) At a baseline visit, the men provided a semen sample. The couples attempted conception without assistance for 3 months and with ovarian stimulation and intrauterine insemination in the subsequent 3 months. Main Outcome Measure(s) The DFI was analyzed using the sperm chromatin structure assay (SCSA) with increased DFI defined as >30%. The predictors of increased DFI were determined by a multivariable linear regression model. The pregnancy outcomes were compared using the χ2 test. The independent DFI assays (SCSA, deoxynucleotidyl transferase-mediated dUTP nick end labeling, and Comet) were compared with Pearson and Spearman correlations. Result(s) The 19% of men with increased DFI were older (36.0 vs. 33.0 years) and had lower total sperm motility (38.2% ± 20.5% vs. 45.2% ± 15.6%). Increased male age was found to be a significant predictor of DFI (0.75, 95% confidence interval [0.06, 1.45]). Increased DFI was not associated with conception or live birth. There was a modest correlation of the deoxynucleotidyl transferase-mediated dUTP nick end labeling assay with the SCSA (r = 0.34) and Comet assay (r = 0.19). Conclusion(s) Older age was associated with increased DFI among infertile men. The DFI assays were only weakly correlated, indicating a standard definition of DFI is needed to truly interrogate how sperm deoxyribonucleic acid fragmentation impacts male fertility.
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Affiliation(s)
- Julie S Rios
- University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | - Karl R Hansen
- University of Oklahoma College of Medicine, Oklahoma City, Oklahoma
| | - Kurt T Barnhart
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Marcelle I Cedars
- University of California San Francisco School of Medicine, San Francisco, California
| | - Richard S Legro
- Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | | | | | | | | | - Fangbai Sun
- Yale School of Public Health, New Haven, Connecticut
| | - Robert Wild
- University of North Carolina, Chapel Hill, North Carolina
| | - James F Smith
- University of California San Francisco School of Medicine, San Francisco, California
| | | | - Heping Zhang
- Yale School of Public Health, New Haven, Connecticut
| | - Anne Z Steiner
- Duke University School of Medicine, Durham, North Carolina
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Asanad K, Matthew Coward R, Mehta A, Smith JF, Vij SC, Nusbaum DJ, Rodman JCS, Samplaski MK. Factors Influencing the Decision for Fresh vs Cryopreserved Microdissection Testicular Sperm Extraction for Non-Obstructive Azoospermia. Urology 2021; 157:131-137. [PMID: 34331998 DOI: 10.1016/j.urology.2021.07.016] [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] [Received: 04/21/2021] [Revised: 06/14/2021] [Accepted: 07/18/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To determine reproductive urologists' (RU) practice patterns for microdissection testicular sperm extraction (microTESE) and factors associated with use of fresh vs frozen microTESE for non-obstructive azoospermia. MATERIALS AND METHODS We electronically surveyed Society for Study of Male Reproduction members with a 21-item questionnaire. Our primary outcomes were to determine RU preference for fresh or frozen microTESE and to understand barriers to performing microTESE. Pearson's chi-square and Fisher's exact tests were used to analyze categorical outcomes and candidate predictor variables. Firth logistic regression was performed to identify the predictors for preferring and performing fresh vs frozen microTESE. RESULTS A total of 208 surveys were sent with 76 responses. Most (63.0%) primarily perform frozen microTESE for non-obstructive azoospermia, while 37.0% primarily perform fresh. However, in an ideal practice, 59.3% prefer fresh microTESE, 22.2% prefer frozen microTESE, and 18.5% had no preference. MicroTESE is performed most often (61.1%) at surgical centers not affiliated with a fertility practice. The most commonly reported barriers for both fresh and frozen microTESE are cost (42.6%), scheduling (33.3%), and andrologist unavailability (16.7%). There are no statistically significant differences between these barriers and performing fresh vs frozen microTESE. On multivariable analysis, reproductive endocrinology and infertility-based surgical center (OR 22.9; 95% CI 1.1-467.2; P = 0.04) and professional fee $2,500-$4,999 (OR 20.7; 95% CI 1.27-337.9; P = 0.03) are significant predictors of performing fresh microTESE. CONCLUSION Frozen microTESE is performed more commonly than fresh, despite most RU preferring fresh microTESE in an ideal setting. Both fresh and frozen microTESE have a role in reproductive care. Barriers to performing fresh microTESE include cost, scheduling and andrologist availability.
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Affiliation(s)
- Kian Asanad
- University of Southern California Institute of Urology
| | | | - Akanksha Mehta
- Department of Urology, Emory University School of Medicine
| | - James F Smith
- Department of Urology, University of California San Francisco
| | - Sarah C Vij
- Department of Urology, Cleveland Clinic Foundation Glickman Urological and Kidney Institute
| | | | - John C S Rodman
- University of Southern California, Southern California Clinical and Translational Science Institute
| | - Mary K Samplaski
- University of Southern California Institute of Urology, Los Angeles, CA.
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Banks N, Sun F, Krawetz SA, Coward RM, Masson P, Smith JF, Trussell JC, Santoro N, Zhang H, Steiner AZ. Male vitamin D status and male factor infertility. Fertil Steril 2021; 116:973-979. [PMID: 34289935 DOI: 10.1016/j.fertnstert.2021.06.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 06/11/2021] [Accepted: 06/21/2021] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To determine the association between vitamin D levels in the male partner and fertility outcomes in couples with mild male factor infertility. DESIGN Secondary analysis of a randomized, controlled trial. SETTING Nine fertility centers in the United States. PATIENT(S) Men (n = 154) with sperm concentration between 5 and 15 million/mL, motility ≤40%, or normal morphology ≤4% were eligible. Female partners were ovulatory, ≤40 years old, and had documented tubal patency. INTERVENTION(S) Men provided semen and blood at baseline for semen analysis and 25-hydroxyvitamin D (25(OH)D) levels. They were randomly assigned to receive a vitamin formulation including vitamin D 2,000 IU daily or placebo for up to 6 months. Couples attempted to conceive naturally during the first 3 months and with clomiphene citrate with intrauterine insemination of the female partner in months 4 through 6. MAIN OUTCOME MEASURE(S) Primary: sperm concentration, motility, morphology, and DNA fragmentation at baseline. Secondary: cumulative pregnancy, miscarriage, and live birth rates. RESULT(S) Semen parameters and sperm DNA fragmentation were not statistically significantly different between men with vitamin D deficiency and men with 25(OH)D levels ≥20 ng/mL. In addition, clinical pregnancy and live birth rates were similar. Male 25(OH)D level <20 ng/mL was associated with a higher rate of pregnancy loss (adjusted odds ratio 9.0; 95% confidence interval 1.3 to 61.3). CONCLUSION(S) Vitamin D deficiency in the male partner did not significantly impact semen parameters or treatment outcomes. Further study is warranted to better characterize the rate of miscarriage in couples with male vitamin D deficiency.
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Affiliation(s)
- Nicole Banks
- Department of Obstetrics and Gynecology, Virginia Commonwealth University Health, Richmond, Virginia.
| | - Fangbai Sun
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
| | - Stephen A Krawetz
- Department of Obstetrics and Gynecology and Center for Molecular Medicine and Genetics, Wayne State University, Detroit, Michigan
| | - R Matthew Coward
- Department of Urology, University of North Carolina, Chapel Hill, North Carolina
| | - Puneet Masson
- Department of Urology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - James F Smith
- Department of Urology, University of California, San Francisco, California
| | - J C Trussell
- Department of Urology, Upstate University Hospital, Syracuse, New York
| | - Nanette Santoro
- Department of Obstetrics and Gynecology, University of Colorado, Denver, Colorado
| | - Heping Zhang
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
| | - Anne Z Steiner
- Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina
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Mohan CS, Coward RM. Ethical Dilemmas in Penile Implant Surgery. J Sex Med 2021; 18:1009-1011. [PMID: 34020924 DOI: 10.1016/j.jsxm.2021.03.076] [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: 01/03/2021] [Revised: 03/24/2021] [Accepted: 03/30/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Charan S Mohan
- Smith Institute for Urology, Northwell Health, Lake Success, NY, USA
| | - R Matthew Coward
- Department of Urology, UNC School of Medicine, Chapel Hill, NC, USA.
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Hansen KR, Peck JD, Coward RM, Wild RA, Trussell JC, Krawetz SA, Diamond MP, Legro RS, Coutifaris C, Alvero R, Robinson RD, Casson P, Christman GM, Santoro N, Zhang H. Intrauterine insemination performance characteristics and post-processing total motile sperm count in relation to live birth for couples with unexplained infertility in a randomised, multicentre clinical trial. Hum Reprod 2021; 35:1296-1305. [PMID: 32432326 DOI: 10.1093/humrep/deaa027] [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: 11/29/2019] [Revised: 01/28/2020] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION Are intrauterine insemination (IUI) performance characteristics and post-processing total motile sperm count (TMC) related to live birth rate in couples with unexplained infertility? SUMMARY ANSWER Patient discomfort with IUI and lower inseminate TMC were associated with a reduced live birth rate, while time from hCG injection to IUI, sperm preparation method and ultrasound guidance for IUI were not associated with live birth success. WHAT IS ALREADY KNOWN We previously determined that some baseline characteristics of couples with unexplained infertility, including female age, duration of infertility, history of prior loss and income, were related to live birth rate across a course of ovarian stimulation and IUI treatment. However, the relationship between treatment outcomes and per-cycle characteristics, including ultrasound guidance for IUI, timing of IUI relative to hCG injection, difficult or painful IUI and inseminate TMC, are controversial, and most prior investigations have not evaluated live birth outcome. STUDY DESIGN, SIZE, DURATION This was a secondary analyses of 2462 cycles from the Assessment of Multiple Intrauterine Gestations from Ovarian Stimulation (AMIGOS) clinical trial. This prospective, randomised, multicentre clinical trial determined live birth rates following IUI after ovarian stimulation with clomiphene citrate, letrozole or gonadotropins in 854 couples with unexplained infertility. It was conducted between 2011 and 2014, and couples could undergo up to four consecutive treatment cycles. PARTICIPANTS/MATERIALS, SETTING, METHODS AMIGOS was an NIH-sponsored Reproductive Medicine Network trial conducted at 12 clinical sites. Participants were women with unexplained infertility who were between 18 and 40 years of age. Cluster-weighted generalised estimating equations (GEE), which account for informative clustering of multiple IUI treatment cycles within the same patient, were used to determine associations between IUI performance characteristics, including inseminate TMC, and live birth rate. Efficiency curves were also generated to examine the relationship between inseminate TMC and live birth rate. MAIN RESULTS AND THE ROLE OF CHANCE After adjustment for treatment group and baseline factors previously associated with live birth across a course of OS-IUI treatment, patient discomfort during the IUI procedure was associated with a reduction in live birth rate (aRR 0.40 (0.16-0.96)). Time from hCG trigger injection to IUI was not significantly associated with outcome. Higher TMC was associated with greater live birth rate (TMC 15.1-20.0 million (14.8%) compared to ≤5 million (5.5%)) (aRR 2.09 (1.31-3.33)). However, live births did occur with TMC ≤ 1 million (5.1%). LIMITATIONS, REASONS FOR CAUTION This investigation is a secondary analysis, and AMIGOS was not designed to address the present question. Since timed intercourse was allowed as part of the AMIGOS trial, we cannot rule out the possibility that any given pregnancy resulted from intercourse rather than IUI. WIDER IMPLICATIONS OF THE FINDINGS Most factors associated with the performance of IUI were not significantly related to obtaining live birth. Our findings suggest that higher TMC inseminated leads to an increase in live birth rate up to TMC ~20 million. However, there may be no reasonable threshold below which live birth is not possible with IUI. STUDY FUNDING/COMPETING INTEREST(S) Funding was received through grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD): U10 HD077680, U10 HD39005, U10 HD38992, U10 HD27049, U10 HD38998, U10 HD055942, HD055944, U10 HD055936 and U10 HD055925. This research was made possible by funding by the American Recovery and Reinvestment Act. Dr Hansen reports grants from NIH/NICHD and Yale University during the conduct of the study, grants from Roche Diagnostics and grants from Ferring International Pharmascience Center US outside the submitted work. Dr Peck reports support from Ferring Pharmaceuticals outside the submitted work. Dr Coward has nothing to disclose. Dr Wild reports grants from NICHD during the conduct of the study. Dr Trussell has nothing to disclose. Dr Krawetz reports grants from NICHD during the conduct of the study, grants from Merck and support from Taylor and Frances and from Springer, outside the submitted work. Dr Diamond reports grants from NIH/NICHD, Yale University, during the conduct of the study and support from Advanced Reproductive Care AbbVie, Bayer and ObsEva, outside the submitted work. Dr Legro reports support from Bayer, Kindex, Odega, Millendo and AbbVie and grants and support from Ferring, outside the submitted work. Dr Coutifaris reports grants from NICHD/NIH and personal fees from American Society for Reproductive Medicine, outside the submitted work. Dr Alvero has nothing to disclose. Dr Robinson reports grants from NIH during the conduct of the study. Dr Casson has nothing to disclose. Dr Christman reports grants from NICHD during the conduct of the study. Dr Santoro reports grants from NIH during the conduct of the study. Dr Zhang reports grants from NIH during the conduct of the study and support from Shangdong University outside the submitted work. TRIAL REGISTRATION NUMBER n/a.
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Affiliation(s)
- Karl R Hansen
- Department of Obstetrics and Gynecology, University of Oklahoma College of Medicine, Oklahoma City, OK 73104, USA
| | - Jennifer D Peck
- Department of Obstetrics and Gynecology, University of Oklahoma College of Medicine, Oklahoma City, OK 73104, USA.,Department of Biostatistics and Epidemiology, University of Oklahoma College of Public Health, Oklahoma City, OK 73104, USA
| | - R Matthew Coward
- Department of Urology, UNC School of Medicine, 2113 Physicians Office Building CB#7235, Chapel Hill, NC 27599-7235, USA.,UNC Fertility, 7920 ACC Blvd #300, Raleigh, NC 27617, USA
| | - Robert A Wild
- Department of Obstetrics and Gynecology, University of Oklahoma College of Medicine, Oklahoma City, OK 73104, USA.,Department of Biostatistics and Epidemiology, University of Oklahoma College of Public Health, Oklahoma City, OK 73104, USA
| | - J C Trussell
- Department of Urology, Upstate University Hospital, 750 East Adams Street, Syracuse, NY 13210, USA
| | - Stephen A Krawetz
- Department of Obstetrics and Gynecology and Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, MI 48201, USA
| | - Michael P Diamond
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, MI 48201, USA.,Department of Obstetrics and Gynecology, Augusta University, Augusta, GA 30912, USA
| | - Richard S Legro
- Department of Obstetrics and Gynecology, Pennsylvania State University, Hershey, PA 17033, USA
| | - Christos Coutifaris
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Ruben Alvero
- Department of Obstetrics and Gynecology, University of Colorado Denver, Aurora, CO 80045, USA.,Department of Obstetrics and Gynecology, Stanford University, Sunnyvale, CA 94087, USA
| | - Randal D Robinson
- Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, TX 78229, USA
| | - Peter Casson
- Department of Obstetrics and Gynecology, University of Vermont, Burlington, VT 05446, USA.,Northeastern Reproductive Medicine, 105 W View Rd, #302, Colchester, VT 05446, USA
| | - Gregory M Christman
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI 48109, USA.,Department of Obstetrics and Gynecology, University of Florida College of Medicine, PO Box 100294, Gainesville, FL 32610, USA
| | - Nanette Santoro
- Department of Obstetrics and Gynecology, University of Colorado Denver, Aurora, CO 80045, USA
| | - Heping Zhang
- Department of Biostatistics, Yale University School of Public Health, New Haven, CT 06520, USA
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Mohan CS, Sonntag E, Ehlers M, Akerman JP, Hayon S, Figler BD, Coward RM. AUTHOR REPLY. Urology 2021; 148:171-172. [PMID: 33549213 DOI: 10.1016/j.urology.2020.10.057] [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] [Indexed: 10/22/2022]
Affiliation(s)
| | - Elizabeth Sonntag
- Division of Pulmonary Diseases and Critical Care Medicine, Department of Medicine, University of North Carolina, Chapel Hill, NC
| | - Mark Ehlers
- Department of Urology, University of North Carolina, Chapel Hill, NC
| | - Jason P Akerman
- Department of Urology, University of North Carolina, Chapel Hill, NC
| | - Solomon Hayon
- Department of Urology, University of North Carolina, Chapel Hill, NC
| | - Bradley D Figler
- Department of Urology, University of North Carolina, Chapel Hill, NC
| | - R Matthew Coward
- Department of Urology, University of North Carolina, Chapel Hill, NC; UNC Fertility, Raleigh, NC
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15
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Dupree JM, Coward RM, Hsieh TC, Tanrikut C, Shin P, Mehta A, Hotaling JM, Pastuszak AW, Williams D, Alukal J, Lipshultz LI, Schlegel P, Walsh TJ, Eisenberg ML, Shin D, Honig S, Nagler HM, Samplaski M, Nangia AK, Sandlow J, Smith JF. The Impact of Physician Productivity Models on Access to Subspecialty Care: A White Paper From the Society for the Study of Male Reproduction and the Society for Male Reproduction and Urology. Urology 2021; 153:28-34. [PMID: 33484822 DOI: 10.1016/j.urology.2021.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 12/06/2020] [Accepted: 01/07/2021] [Indexed: 01/25/2023]
Abstract
Male infertility is a common disease. Male infertility is also a core competency of urology training and clinical practice. In this white paper from the Society for the Study of Male Reproduction and the Society for Male Reproduction and Urology, we identify and define different physician productivity plans. We then describe the advantages and disadvantages of various physician productivity measurement systems for male infertility practices. We close with recommendations for measuring productivity that we hope urologists and administrators can use when creating productivity plans for male infertility practices.
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Affiliation(s)
- James M Dupree
- Department of Urology, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI.
| | - R Matthew Coward
- Department of Urology, UNC School of Medicine, Chapel Hill, NC and UNC Fertility LLC, Raleigh NC
| | | | | | - Paul Shin
- Department of Urology, Shady Grove Fertility, Washington, DC
| | - Akanksha Mehta
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | | | | | - Daniel Williams
- Department of Urology, Department of Obstetrics and Gynecology, University of Wisconsin, Madison, WI
| | - Joseph Alukal
- Department of Urology, Columbia University, New York, NY
| | | | - Peter Schlegel
- Department of Urology, Weill Cornell Medicine, New York, NY
| | - Thomas J Walsh
- Department of Urology, Men's Health Center at University of Washington Medical Center, Seattle, WA
| | - Michael L Eisenberg
- Department of Urology, Department of Obstetrics and Gynecology, Stanford University, Palo Alto, CA
| | - David Shin
- Department of Urology, Hackensack Meridan School of Medicine, Nutley, NJ
| | - Stan Honig
- Department of Urology, Yale Urology, New Haven, CT
| | - Harris M Nagler
- Department of Urology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Mary Samplaski
- University of Southern California, Institute of Urology, Los Angeles, CA
| | - Ajay K Nangia
- Department of Urology, University of Kansas Medical Center, Kansas City, KS
| | - Jay Sandlow
- Department of Urology, Medical College of Wisconsin, Milwaukee, WI
| | - James F Smith
- Department of Urology, University of California San Francisco, San Francisco, CA
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16
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McBride JA, Kohn TP, Mazur DJ, Lipshultz LI, Coward RM. Sperm retrieval and intracytoplasmic sperm injection outcomes in men with cystic fibrosis disease versus congenital bilateral absence of the vas deferens. Asian J Androl 2021; 23:140-145. [PMID: 32930103 PMCID: PMC7991824 DOI: 10.4103/aja.aja_48_20] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Recent data suggest that cystic fibrosis transmembrane conductance regulator (CFTR) gene alterations negatively impact male fertility beyond obstruction. We sought to compare gene alterations, sperm retrieval rates, and intracytoplasmic sperm injection (ICSI) outcomes among men with cystic fibrosis (CF) disease and congenital bilateral absence of the vas deferens (CBAVD) only. We retrospectively evaluated all men who underwent surgical sperm retrieval at two academic, high-volume andrology centers from 2010 to 2018. Only men with documented CFTR alterations and obstructive azoospermia from either CBAVD or CF were included. Differences between groups for CFTR abnormality, sperm retrieval, and ICSI outcomes were statistically analyzed. Overall,39 patients were included with 10 in the CF and 29 in the CBAVD groups. Surgical sperm retrieval rates were significantly lower in the CF group for sperm concentration (14.8 × 106 ml-1vs 61.4 × 106 m-1, P = 0.02) and total motile sperm count (2.9 million vs 11.4 million, P = 0.01). This difference was only predicted by homozygous delta F508 CFTR mutations (P < 0.05). The CF group also demonstrated a significantly higher rate of rescue testicular sperm extraction (70.0% vs 27.6%, P < 0.03) and lower fertilization rate with ICSI (32.5% vs 68.9%, P < 0.01). In conclusion, those with CF demonstrated lower sperm quality, greater difficulty with sperm retrieval, and worse ICSI outcomes compared with CBAVD-only patients. Homozygous delta F508 CFTR mutations appear to significantly impair spermatogenesis and sperm function.
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Affiliation(s)
- J Abram McBride
- Scott Department of Urology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Taylor P Kohn
- Scott Department of Urology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Daniel J Mazur
- Scott Department of Urology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Larry I Lipshultz
- Scott Department of Urology, Baylor College of Medicine, Houston, TX 77030, USA
| | - R Matthew Coward
- Department of Urology, UNC School of Medicine, Chapel Hill, NC 27599, USA.,UNC Fertility, Raleigh, NC 27617, USA
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17
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Stanhiser J, Mersereau JE, Dock D, Boylan C, Caprell H, Coward RM, Berger DS, Fritz M. Sperm morphology from the actual inseminated sample does not predict clinical pregnancy following intrauterine insemination. F S Rep 2020; 2:16-21. [PMID: 34223268 PMCID: PMC8244316 DOI: 10.1016/j.xfre.2020.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/29/2020] [Accepted: 11/29/2020] [Indexed: 11/17/2022] Open
Abstract
Objective To determine the effect of sperm morphology from the specific sample used for intrauterine insemination (IUI) on clinical pregnancy rates (CPR). Design Prospective cohort study. Setting Academic fertility clinic. Patients Couples undergoing IUI July 2016-January 2017. Interventions Morphology slides were prepared from the semen sample produced for IUI. Main Outcome Measures CPR was measured by detection of cardiac activity. Multiple logistic regression modeling was performed to determine the association of sperm morphology with CPR, controlling for age, antimüllerian hormone level, and post-wash total motile sperm count. Results Semen analyses, including Kruger strict criteria for morphology from the actual sample inseminated, were reviewed for 155 couples, comprising 234 total treatment cycles. The percent normal morphology significantly differed between the preliminary semen analysis and the IUI sample (-2.0% +3.7% (95% CI -2.55, -1.53). Of the total 234 treatment cycles, 8.6% resulted in clinical pregnancy. When categorized by strict morphology >4%, <4%, and <1%, the CPR was 6.6%, 9.8%, and 10.9%, respectively. In couples with otherwise normal semen parameters (isolated teratospermia), CPR by >4%, <4%, and <1% normal forms was 7.2%, 9.8%, and 11.1%, respectively. There was no significant association between the percent normal morphology and CPR in multivariate analysis. Conclusions This study evaluating the morphology of the actual inseminated sample did not find differences in CPR following IUI among couples with normal and abnormal sperm morphology, including severe teratospermia. Abnormal sperm morphology should not exclude couples from attempting IUI.
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Affiliation(s)
- Jamie Stanhiser
- Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina.,University of North Carolina Fertility, LLC., Raleigh, North Carolina
| | - Jennifer E Mersereau
- Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina.,University of North Carolina Fertility, LLC., Raleigh, North Carolina
| | - Daquan Dock
- University of North Carolina Fertility, LLC., Raleigh, North Carolina
| | - Caitlin Boylan
- University of North Carolina Fertility, LLC., Raleigh, North Carolina
| | - Hunter Caprell
- University of North Carolina Fertility, LLC., Raleigh, North Carolina
| | - R Matthew Coward
- University of North Carolina Fertility, LLC., Raleigh, North Carolina.,Department of Urology, University of North Carolina, Chapel Hill, North Carolina
| | - Dara S Berger
- University of North Carolina Fertility, LLC., Raleigh, North Carolina
| | - Marc Fritz
- Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina.,University of North Carolina Fertility, LLC., Raleigh, North Carolina
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18
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Mohan C, Sonntag E, Ehlers M, Akerman J, Hayon S, Figler B, Coward RM. Challenging Ethical Scenarios in the Surgical Treatment of Erectile Dysfunction: A Survey of High-Volume Penile Prosthesis Surgeons. Urology 2020; 148:166-172. [PMID: 33285211 DOI: 10.1016/j.urology.2020.10.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 10/11/2020] [Accepted: 10/13/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate how surgeons approach ethically challenging scenarios that arise in penile prosthesis surgery and identify patient-related factors that impact their approach. METHODS A survey was distributed to the Society for Urologic Prosthetic Surgeons membership consisting of 6 ethically challenging scenarios: an HIV+ patient, a patient with cognitive disability, a registered sex offender, a nonverbal patient, a litigious patient, and an uncontrolled diabetic patient whose insurance will lapse soon. Additional clinical information was provided to assess how the likelihood to offer surgery might change. The primary outcome was the likelihood of offering surgery in each scenario. RESULTS The response rate was 15.6% (n = 29). When compared to the baseline patient, respondents had a lower likelihood of offering surgery in all scenarios except the HIV+ patient, with the lowest likelihood of offering surgery to a sex offender (P < .01). Within each scenario, factors associated with an increased odds of offering surgery included knowledge that a patient with Down Syndrome is high functioning (odds ratio [OR] 5.0, confidence interval [CI]: 1.4-17.8), that a prior sex offender is currently married (OR 16.5, CI:3.5-99.8), that a litigious patient sued a surgeon for a retained sponge (OR 6.3, CI:1.7-24.3), and that a nonverbal patient had expressed prior interest in penile prosthesis surgery (OR 4.5, CI: 1.3-16.2). CONCLUSION Ethical principles, including respect for autonomy, nonmaleficence, beneficence, and justice, are appropriately applied by urological prosthetic surgeons when ethical challenges arise. While the likelihood of offering penile prosthesis surgery is decreased with most ethical dilemmas, specific clinical factors often augment decision-making.
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Affiliation(s)
- Charan Mohan
- The Smith Institute for Urology, New Hyde Park, NY
| | - Elizabeth Sonntag
- Division of Pulmonary Diseases and Critical Care Medicine, Department of Medicine, University of North Carolina, Chapel Hill, NC
| | - Mark Ehlers
- Department of Urology, University of North Carolina, Chapel Hill, NC
| | - Jason Akerman
- Department of Urology, University of North Carolina, Chapel Hill, NC
| | - Solomon Hayon
- Department of Urology, University of North Carolina, Chapel Hill, NC
| | - Brad Figler
- Department of Urology, University of North Carolina, Chapel Hill, NC
| | - R Matthew Coward
- Department of Urology, University of North Carolina, Chapel Hill, NC; UNC Fertility, Raleigh, NC.
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19
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Abstract
The testicular prosthesis can be an afterthought for providers when performing an orchiectomy for testicular cancer, torsion, atrophic testis, or trauma. However, data suggest that patients find the offer of a testicular prosthesis and counseling regarding placement to be extremely important from both a pragmatic and a psychosocial perspective. Only two-thirds of men undergoing orchiectomy are offered an implant at the time of orchiectomy and of those offered about one-third move forward with prosthesis placement. The relatively low acceptance rate is in stark contrast with high patient satisfaction and low complication rates for those who undergo the procedure. The most common postoperative patient concerns are minor and involve implant positioning, size, and weight. Herein, we provide an up-to-date review of modern preoperative evaluation, patient selection, expectation management, surgical technique, and expected outcomes for testicular prostheses.
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Affiliation(s)
- Solomon Hayon
- Department of Urology, University of North Carolina School of Medicine, Chapel Hill, NC 27500-7235, USA
| | - Jamie Michael
- University of North Carolina School of Medicine, Chapel Hill, NC 27500-7235, USA
| | - R Matthew Coward
- Department of Urology, University of North Carolina School of Medicine, Chapel Hill, NC 27500-7235, USA
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20
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Gessner KH, Jung J, Cook HE, Graves JL, McNaull P, Chidgey B, Mann J, Woody N, Deal AM, Coward RM, Figler B, Borawski K, Bjurlin MA, Raynor M, Tan HJ, Viprakasit D, Wallen EM, Nielsen ME, Smith AB. Implementation of Postoperative Standard Opioid Prescribing Schedules Reduces Opioid Prescriptions Without Change in Patient-reported Pain Outcomes. Urology 2020; 148:126-133. [PMID: 33217455 DOI: 10.1016/j.urology.2020.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 10/31/2020] [Accepted: 11/05/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To implement Standard Opioid Prescribing Schedules (SOPS) based on opioid use following urologic surgeries and to evaluate how evidence-based prescribing schedules affect opioid use and patient reported outcomes. METHODS Patients who underwent urologic surgeries within 6 procedure subtypes at UNC Health during the 2 study time periods ("pre-SOPS": 7/2017-1/2018, "post-SOPS": 7/2018-1/2019) were invited to complete a survey analyzing postoperative opioid usage, storage and disposal, and patient reported outcomes (including pain interference using a validated questionnaire). A pharmacy database provided medication prescribing data and patient demographics. During the pre-SOPS time period, baseline outcomes were measured. Following the pre-SOPS period, usage amounts were analyzed and Standard Opioid Prescribing Schedules were developed to guide prescriptions during the post-SOPS period. Descriptive summary statistics and appropriate t test or r2 were calculated. RESULTS A total of 438 patients within 6 procedure types completed the survey (pre-SOPS: 282 patients, post-SOPS: 156 patients). Pre-SOPS, patients were prescribed significantly more 5-mg oxycodone tablets than used (20.9 vs 7.8, P <.001). Post-SOPS, compared to pre-SOPS amounts, patients were prescribed significantly fewer tablets (12.7 vs 20.9, P <.001) and used fewer tablets (5.3 vs 7.8, P = .003). No difference was observed in pain interference (average t-score (standard deviation): 54.33 (10.9) pre-SOPS vs 55.89 (9.1) post-SOPS, P = .125) or patient satisfaction (95% pre-SOPS vs 94% post-SOPS). CONCLUSION Adherence to data-driven postoperative opioid prescribing schedules reduce opioid prescriptions and use without compromising pain interference or patient satisfaction. These results have important implications for urologists' ability to decrease opioid prescriptions and fight the opioid epidemic.
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Affiliation(s)
- Kathryn H Gessner
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | - Jaehyuk Jung
- University of North Carolina School of Pharmacy, Chapel Hill, NC
| | - Hannah E Cook
- University of North Carolina School of Pharmacy, Chapel Hill, NC
| | - J Lee Graves
- University of North Carolina School of Medicine, Chapel Hill, NC
| | - Peggy McNaull
- Department of Anesthesia, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Brooke Chidgey
- Department of Anesthesia, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jami Mann
- Department of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Nathan Woody
- Department of Anesthesia, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Allison M Deal
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - R Matthew Coward
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Bradley Figler
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Kristy Borawski
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Marc A Bjurlin
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Mathew Raynor
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Hung-Jui Tan
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Davis Viprakasit
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Eric M Wallen
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Matthew E Nielsen
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Angela B Smith
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, NC; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
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21
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Gan ZS, Coward RM. Response to The HardTruth Regarding Cycling and Erectile Dysfunction? Sex Med Rev 2020; 8:636-637. [PMID: 32917559 DOI: 10.1016/j.sxmr.2020.08.002] [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] [Indexed: 11/15/2022]
Affiliation(s)
- Zoe S Gan
- Division of Urology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - R Matthew Coward
- Department of Urology, University of North Carolina School of Medicine, Chapel Hill, NC, USA; UNC Fertility LLC, Raleigh, NC, USA.
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22
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Coward RM, Davis EL, Young SL. Cystic fibrosis carrier screening using next generation sequencing: A cautionary tale. Fertil Steril 2020; 114:495-496. [PMID: 32778331 DOI: 10.1016/j.fertnstert.2020.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 06/03/2020] [Indexed: 11/29/2022]
Affiliation(s)
- R Matthew Coward
- Department of Urology, University of North Carolina School of Medicine, Chapel Hill, North Carolina; Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina; UNC Fertility, Raleigh, North Carolina
| | - Elysia L Davis
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina; UNC Fertility, Raleigh, North Carolina
| | - Steven L Young
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina; UNC Fertility, Raleigh, North Carolina
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23
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Coward RM, Boylan C. EDITORIAL COMMENT. Urology 2020; 140:75. [DOI: 10.1016/j.urology.2019.12.056] [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] [Received: 05/17/2019] [Accepted: 12/18/2019] [Indexed: 11/28/2022]
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Legro RS, Diamond MP, Coutifaris C, Schlaff WD, Alvero R, Casson P, Christman GM, Rosen RM, Cedars MI, Hansen KR, Robinson R, Baker V, Usadi R, Dodson WC, Estes SJ, Kunselman A, Stetter C, Barnhart KT, Coward RM, Trussell JC, Krawetz SA, Santoro N, Huang H, Zhang H, Eisenberg E. Pregnancy registry: three-year follow-up of children conceived from letrozole, clomiphene, or gonadotropins. Fertil Steril 2020; 113:1005-1013. [PMID: 32386612 DOI: 10.1016/j.fertnstert.2019.12.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 06/24/2019] [Revised: 12/11/2019] [Accepted: 12/11/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To study the development of children conceived from non-IVF infertility treatments consisting of gonadotropins, clomiphene, or letrozole. DESIGN Prospective cohort study. SETTING U.S. academic health centers. PATIENT(S) Children of women with polycystic ovary syndrome who conceived with letrozole (LTZ) or clomiphene (CC) in the PPCOS II study or women with unexplained infertility (AMIGOS study) who conceived with LTZ, CC, or gonadotropin (GN). INTERVENTION(S) Longitudinal annual follow-up from birth to age 3. MAIN OUTCOME MEASURE(S) Scores from Ages and Stages Developmental Questionnaire (ASQ), MacArthur-Bates Communicative Development Inventory (MCDI), and annual growth. RESULT(S) One hundred eighty-five children from 160 families participated in at least one follow-up evaluation from the two infertility trials. Most multiple gestations in the follow-up study resulted from GN treatment (n = 14) followed by CC (n = 6) and LTZ (n = 3). There were no significant differences among the three groups at any time point with respect to abnormal scores on the ASQ. On the MCDI Words and Gestures, the LTZ group scored significantly higher than the GN group for most items (phrases, early gestures, later gestures, and total gestures). Children in the CC group scored significantly higher than the GN group for the later gestures and total gestures items. CONCLUSION(S) Differences in growth and cognitive developmental rates among children conceived with first-line infertility therapies, including LTZ, are relatively minor and likely due to differences in multiple pregnancy rates.
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Affiliation(s)
- Richard S Legro
- Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey, Pennsylvania.
| | - Michael P Diamond
- Department of Obstetrics and Gynecology, Augusta University, Augusta, Georgia
| | - Christos Coutifaris
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - William D Schlaff
- Department of Obstetrics and Gynecology, University of Colorado, Denver, Colorado
| | - Ruben Alvero
- Department of Obstetrics and Gynecology, University of Colorado, Denver, Colorado
| | - Peter Casson
- Department of Obstetrics and Gynecology, University of Vermont, Burlington, Vermont
| | - Gregory M Christman
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
| | - R Mitchell Rosen
- Department of Obstetrics and Gynecology, University of California at San Francisco, San Francisco, California
| | - Marcelle I Cedars
- Department of Obstetrics and Gynecology, University of California at San Francisco, San Francisco, California
| | - Karl R Hansen
- Department of Obstetrics and Gynecology University of Oklahoma, Oklahoma City, Oklahoma
| | - Randal Robinson
- Department of Obstetrics and Gynecology, University of Texas at San Antonio, San Antonio, Texas
| | - Valerie Baker
- Department of Obstetrics and Gynecology, Stanford University, Palo Alto, California
| | - Rebecca Usadi
- Department of Obstetrics and Gynecology, Carolinas Medical Center, Charlotte, North Carolina
| | - William C Dodson
- Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey, Pennsylvania
| | - Stephanie J Estes
- Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey, Pennsylvania
| | - Allen Kunselman
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Christina Stetter
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Kurt T Barnhart
- Department of Obstetrics and Gynecology, University of Colorado, Denver, Colorado
| | - R Matthew Coward
- Department of Urology, University of North Carolina, Raleigh, North Carolina; UNC Fertility LLC, Raleigh, North Carolina
| | - J C Trussell
- Department of Urology, SUNY Upstate University Hospital, Syracuse, New York
| | - Stephen A Krawetz
- Department of Obstetrics and Gynecology and Center for Molecular Medicine and Genetics, Wayne State University, Detroit, Michigan
| | - Nanette Santoro
- Department of Obstetrics and Gynecology, University of Colorado, Denver, Colorado
| | - Hao Huang
- Department of Biostatistics, Yale University, New Haven, Connecticut
| | - Heping Zhang
- Department of Biostatistics, Yale University, New Haven, Connecticut
| | - Esther Eisenberg
- Fertility and Infertility Branch, National Institute of Child Health and Human Development, Rockville, Maryland
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Gan ZS, Ehlers ME, Lin FC, Wright ST, Figler BD, Coward RM. Systematic Review and Meta-Analysis of Cycling and Erectile Dysfunction. Sex Med Rev 2020; 9:304-311. [PMID: 32147498 DOI: 10.1016/j.sxmr.2020.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 11/03/2019] [Revised: 01/24/2020] [Accepted: 01/27/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Conflicting evidence exists on the relationship between bicycle riding and erectile dysfunction (ED). A major limitation to several prior studies is the lack of a validated measure of ED. OBJECTIVE To assess the relationship between cycling and clinically validated ED based on existing literature. METHODS We searched several major databases from database inception through 2018 using a variety of search terms relating to "cycling" and "erectile dysfunction." Studies were included if they were written in English, reported original data, compared ED between cyclists and non-cycling controls, and used a validated measure of ED, such as the International Index of Erectile Function or the subset Sexual Health Inventory for Men (SHIM). Age, SHIM score, and comorbidities were extracted for all groups. Primary outcomes for each group were mean SHIM score and presence of ED (SHIM ≤ 21). A generalized linear mixed-effects model was used to fit the collected data for meta-analysis. Main outcome measures were unadjusted odds ratios of ED for cyclists and non-cyclists, mean SHIM score difference between cyclists and noncyclists, and both of these measures adjusted for age and comorbidities. RESULTS After a systematic evaluation of 843 studies, 6 studies met our inclusion criteria, encompassing 3,330 cyclists and 1,524 non-cycling controls. When comparing cyclists to non-cyclists in an unadjusted analysis, there were no significant differences in the odds of having ED or mean SHIM score. However, when controlling for age and comorbidities, cyclists had significantly higher odds of having ED (odds ratio: 2.00; 95% confidence interval: 1.57, 2.55). CONCLUSIONS Limited evidence supports a positive correlation between cycling and ED when adjusting for age and several comorbidities. Heterogeneity among studies suggests that further investigation into certain populations of cyclists that may be more vulnerable to ED may be beneficial. Gan ZS, Ehlers ME, Lin FC, et al. Systematic Review and Meta-Analysis of Cycling and Erectile Dysfunction. Sex Med 2021;9:304-311.
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Affiliation(s)
- Zoe S Gan
- University of North Carolina School of Medicine, Chapel Hill, NC, USA; Division of Urology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
| | - Mark E Ehlers
- Department of Urology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Feng-Chang Lin
- The North Carolina Translational and Clinical Sciences Institute, Chapel Hill, NC, USA
| | - Sarah T Wright
- Health Sciences Library, University of North Carolina, Chapel Hill, NC, USA
| | - Bradley D Figler
- Department of Urology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - R Matthew Coward
- Department of Urology, University of North Carolina School of Medicine, Chapel Hill, NC, USA; UNC Fertility LLC, Raleigh, NC, USA
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Steiner AZ, Hansen KR, Barnhart KT, Cedars MI, Legro RS, Diamond MP, Krawetz SA, Usadi R, Baker VL, Coward RM, Huang H, Wild R, Masson P, Smith JF, Santoro N, Eisenberg E, Zhang H. The effect of antioxidants on male factor infertility: the Males, Antioxidants, and Infertility (MOXI) randomized clinical trial. Fertil Steril 2020. [PMID: 32111479 DOI: 10.1016/j.fertnstert.2019.11.008.the] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
OBJECTIVE To determine whether antioxidants improve male fertility, as measured by semen parameters and DNA fragmentation at 3 months and pregnancy resulting in live birth after up to 6 months of treatment, among couples with male factor infertility. DESIGN Multicenter, double-blind, randomized, placebo-controlled trial with an internal pilot study. SETTING Nine fertility centers in the United States from December 2015 to December 2018. PATIENT(S) Men (N = 174) with sperm concentration ≤15 million/mL, motility ≤40%, normal morphology ≤4%, or DNA fragmentation >25%, and female partners who were ovulatory, ≤40 years old, and had documented tubal patency. INTERVENTION(S) Males randomly assigned to receive an antioxidant formulation (n = 85) containing 500 mg of vitamin C, 400 mg of vitamin E, 0.20 mg of selenium, 1,000 mg of l-carnitine, 20 mg of zinc, 1,000 μg of folic acid, 10 mg of lycopene daily, or placebo (n = 86). Treatment lasted for a minimum of 3 months and maximum of 6 months, and couples attempted to conceive naturally during the first 3 months and with clomiphene citrate with intrauterine insemination of the female partner in months 4 through 6. MAIN OUTCOME MEASURE(S) Primary outcome was live birth; secondary outcomes included pregnancy within 6 months of treatment. For the internal pilot, the primary outcomes were semen parameters and sperm DNA fragmentation index after 3 months of treatment. RESULT(S) In the Males, Antioxidants, and Infertility (MOXI) study, after 3 months of treatment, the change in sperm concentration differed between the antioxidant group (median -4.0 [interquartile range-12.0, 5.7] million/mL) and placebo group (+2.4 [-9.0, 15.5] million/mL). However, there were no statistically significant differences between the two groups for changes in sperm morphology, motility, or DNA fragmentation. Among the 66 oligospermic men at randomization, sperm concentration did not differ at 3 months between the antioxidant and control groups: 8.5 (4.8, 15.0) million/mL versus 15.0 (6.0, 24.0) million/mL. Of the 75 asthenospermic men, motility did not differ at 3 months: 34% ± 16.3% versus 36.4% ± 15.8%. Among the 44 men with high DNA fragmentation, DNA fragmentation did not differ at 3 months: 29.5% (21.6%, 36.5%) versus 28.0% (20.6%, 36.4%). In the entire cohort, cumulative live birth did not differ at 6 months between the antioxidant and placebo groups: 15% versus 24%. CONCLUSION(S) Antioxidants do not improve semen parameters or DNA integrity among men with male factor infertility. Although limited by sample size, this study suggests that antioxidant treatment of the male partner does not improve in vivo pregnancy or live-birth rates. CLINICAL TRIAL REGISTRATION NUMBER NCT02421887.
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Affiliation(s)
- Anne Z Steiner
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina.
| | - Karl R Hansen
- Department of Obstetrics and Gynecology, Health Sciences Center, University of Oklahoma, Oklahoma City, Oklahoma
| | - Kurt T Barnhart
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Marcelle I Cedars
- Department of Obstetrics and Gynecology, University of California-San Francisco, San Francisco, California
| | - Richard S Legro
- Department of Obstetrics and Gynecology, Pennsylvania State University, Hershey, Pennsylvania
| | - Michael P Diamond
- Department of Obstetrics and Gynecology, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Stephen A Krawetz
- Department of Obstetrics and Gynecology & Center for Molecular Medicine and Genetics, Wayne State University, Detroit, Michigan
| | - Rebecca Usadi
- Department of Reproductive Endocrinology and Infertility, Atrium Health, Charlotte, North Carolina
| | - Valerie L Baker
- Department of Obstetrics and Gynecology, Stanford University, Palo Alto, California
| | - R Matthew Coward
- Department of Urology, University of North Carolina, Chapel Hill, North Carolina
| | - Hao Huang
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
| | - Robert Wild
- Department of Obstetrics and Gynecology, Health Sciences Center, University of Oklahoma, Oklahoma City, Oklahoma
| | - Puneet Masson
- Department of Urology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - James F Smith
- Department of Urology, University of California- San Francisco, San Francisco, California
| | - Nanette Santoro
- Department of Obstetrics and Gynecology, University of Colorado, Denver, Colorado
| | - Esther Eisenberg
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Heping Zhang
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
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Kohn TP, Kohn JR, Owen RC, Matthew Coward R. Reply to Alberto Ferlin's Letter to the Editor, re: Taylor P. Kohn, Jaden R. Kohn, Ryan C. Owen, R. Matthew Coward. The Prevalence of Y-chromosome Microdeletions in Oligozoospermic Men: A Systematic Review, Meta-analysis of European, North American Studies. Eur Urol 2019, 76:626-36. Indication for Y Chromosome Microdeletion Analysis in Infertile Men Should Not be, Based Merely on Sperm Concentration: Shared Decision-Making and Reconsideration of Thresholds for Genetic Testing of Men with Severe Spermatogenic Failure. Eur Urol 2020; 77:e98-e99. [PMID: 31980315 DOI: 10.1016/j.eururo.2020.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 01/10/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Taylor P Kohn
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Jaden R Kohn
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ryan C Owen
- Department of Urology, Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX, USA
| | - R Matthew Coward
- Department of Urology, University of North Caroline School of Medicine, Chapel Hill, NC, USA; UNC Fertility LLC, Raleigh, NC, USA
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Swanson GM, Estill M, Diamond MP, Legro RS, Coutifaris C, Barnhart KT, Huang H, Hansen KR, Trussell JC, Coward RM, Zhang H, Goodrich R, Krawetz SA. Human chromatin remodeler cofactor, RNA interactor, eraser and writer sperm RNAs responding to obesity. Epigenetics 2020; 15:32-46. [PMID: 31354029 PMCID: PMC6961666 DOI: 10.1080/15592294.2019.1644880] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 07/05/2019] [Accepted: 07/09/2019] [Indexed: 12/23/2022] Open
Abstract
In the United States almost 33% of adults are considered obese (BMI > 30 kg/m2). Both animal models and to a lesser extent human studies, have associated BMI, a measure of obesity, with alterations in sperm DNA methylation and RNAs. Sperm RNAs from the Assessment of Multiple Gestations from Ovarian Stimulation trial, were isolated and sequenced. A Generalized Linear Model identified 487 BMI associated human sperm RNA elements (short exon-sized sequences). They partitioned into four patterns; a continual increase with BMI, increase once obese (BMI>30 kg/m2); a steady decrease with BMI; and decrease once overweight (BMI 25 - 30 kg/m2). Gene Ontology revealed a unique relationship between BMI and transcripts associated with chromosome organization, adipogenesis, cellular stress and obesity-related inflammation. Coregulatory networks linked by Chromatin remodeler cofactors, RNA interactors, Erasers and Writers (CREWs) were uncovered to reveal a hierarchical epigenetic response pathway.
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Affiliation(s)
- Grace M. Swanson
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, USA
| | - Molly Estill
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, USA
| | - Michael P. Diamond
- Department of Obstetrics and Gynecology, Augusta University, Augusta, USA
| | - Richard S. Legro
- Department of Obstetrics and Gynecology, Pennsylvania State University, Hershey, USA
| | - Christos Coutifaris
- Department of Obstetrics and Gynecology, University of Pennsylvania School of Medicine, Philadelphia, USA
| | - Kurt T. Barnhart
- Department of Obstetrics and Gynecology, University of Pennsylvania School of Medicine, Philadelphia, USA
| | - Hao Huang
- Department of Biostatistics, Yale University School of Public Health, New Haven, USA
| | - Karl R. Hansen
- Department of Obstetrics and Gynecology, University of Oklahoma College of Medicine, Oklahoma City, USA
| | - J. C. Trussell
- Urology Department, Upstate Medical University, Syracuse, USA
| | - R. Matthew Coward
- Department of Urology, University of North Carolina School of Medicine, Chapel Hill, USA
| | - Heping Zhang
- Department of Biostatistics, Yale University School of Public Health, New Haven, USA
| | - Robert Goodrich
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, USA
| | - Stephen A. Krawetz
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, USA
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29
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Kohn TP, Kohn JR, Owen RC, Coward RM. The Prevalence of Y-chromosome Microdeletions in Oligozoospermic Men: A Systematic Review and Meta-analysis of European and North American Studies. Eur Urol 2019; 76:626-636. [PMID: 31400948 DOI: 10.1016/j.eururo.2019.07.033] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 07/16/2019] [Indexed: 10/26/2022]
Abstract
CONTEXT European and North American guidelines recommend Y-chromosome microdeletion (YCM) screening in azoospermic and oligozoospermic men with sperm concentrations of <5 million sperm/ml; however, numerous studies have suggested that YCMs are rare when sperm concentrations are >1 million sperm/ml. OBJECTIVE We systematically reviewed and meta-analyzed European and North American studies to determine the prevalence of a complete YCM in oligozoospermic men with sperm concentrations of >0-1, >1-5, and >5-20 million sperm/ml, and to determine whether 1 or 5 million sperm/ml is the most appropriate sperm concentration threshold for YCM screening. EVIDENCE ACQUISITION A systematic review of MEDLINE, EMBASE, Cochrane Library, and ClinicalTrials.gov was performed for studies assessing the prevalence of a complete YCM in oligozoospermic men in European and North American studies. EVIDENCE SYNTHESIS Thirty-seven studies were identified during a systematic review (n = 12 492 oligozoospermic men). All complete YCMs in oligozoospermic men were AZFc microdeletions. Eighteen studies contained data conducive to meta-analysis (n = 10 866 men). Comparing the pooled estimated prevalence by sperm concentration, complete YCMs were significantly more common in men with sperm concentrations of >0-1 million sperm/ml (5.0% [95% confidence interval {CI}: 3.6-6.8%]) versus >1-5 million sperm/ml (0.8% [95% CI: 0.5-1.3%], p < 0.001). YCMs were similar in men with sperm concentrations of >1-5 and >5-20 million sperm/ml (0.8% [95% CI: 0.5-1.3%] vs 0.5% [95% CI: 0.2-0.9%], p = 0.14). CONCLUSIONS In Europe and North America, the majority of YCMs occur in men with sperm concentrations of ≤1 million sperm/ml, with <1% identified in men with >1 million sperm/ml. Male infertility guidelines for North America and Europe should reconsider the sperm concentration screening thresholds to recommend testing for YCMs only for men with sperm concentrations of <1 million sperm/ml. PATIENT SUMMARY Complete Y-chromosome microdeletions (YCMs) are rare in men with >1 million sperm/ml. Routine screening for YCMs should occur only if sperm concentration is ≤1 million sperm/ml.
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Affiliation(s)
- Taylor P Kohn
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Jaden R Kohn
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ryan C Owen
- Department of Urology, Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX, USA
| | - R Matthew Coward
- Department of Urology, University of North Caroline School of Medicine, Chapel Hill, NC, USA; UNC Fertility LLC, Raleigh, NC, USA
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Coward RM, Stetter C, Kunselman A, Trussell JC, Lindgren MC, Alvero RR, Casson P, Christman GM, Coutifaris C, Diamond MP, Hansen KR, Krawetz SA, Legro RS, Robinson RD, Smith JF, Steiner AZ, Wild RA, Zhang H, Santoro N. Fertility Related Quality of Life, Gonadal Function and Erectile Dysfunction in Male Partners of Couples with Unexplained Infertility. J Urol 2019; 202:379-384. [PMID: 30835629 PMCID: PMC6686175 DOI: 10.1097/ju.0000000000000205] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2019] [Indexed: 12/31/2022]
Abstract
PURPOSE We sought to determine whether lower fertility related quality of life or depression in men of couples with unexplained infertility is associated with low total testosterone levels, abnormal semen quality or erectile dysfunction. MATERIALS AND METHODS This study is a secondary analysis of a large, multicenter, randomized controlled trial in couples with unexplained infertility. Male partners underwent baseline semen analysis with measurement of fasting total testosterone and gonadotropin. They also completed surveys, including the FertiQOL (Fertility Quality of Life), the PHQ-9 (Patient Health Questionnaire-9) and the IIEF (International Index of Erectile Function). The primary study outcomes were total testosterone with low total testosterone defined as less than 264 ng/dl, semen parameters and the IIEF score. We performed multivariable logistic regression analyses adjusted for patient age, race, body mass index, education, smoking, alcohol use, infertility duration and comorbidity. RESULTS A total of 708 men with a mean ± SD age of 34.2 ± 5.6 were included in study. Of the men 59 (8.3%) had a PHQ-9 score of 5 or greater, which was consistent with depression, 99 (14.0%) had low total testosterone and 63 (9.0%) had mild or worse erectile dysfunction. Neither the FertiQOL score nor depression was associated with total testosterone or any semen parameter. The FertiQOL score was inversely associated with erectile dysfunction (for every 5-point score decline AOR 1.30, 95% CI 1.16-1.46). Depressed men were significantly more likely to have erectile dysfunction than nondepressed men (AOR 6.31, 95% CI 3.12-12.77). CONCLUSIONS In men in couples with unexplained infertility lower fertility related quality of life and depression are strongly associated with erectile dysfunction. However, neither is associated with spermatogenesis or testosterone levels. Erectile dysfunction in infertile men merits longitudinal investigation in future studies.
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Affiliation(s)
- R. Matthew Coward
- Department of Urology, University of North Carolina School of Medicine, Chapel Hill, NC
- UNC Fertility, Raleigh, NC
| | - Christy Stetter
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Allen Kunselman
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - JC Trussell
- Department of Urology, Upstate University Hospital, Syracuse, NY
| | - Mark C. Lindgren
- Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Ruben R. Alvero
- Department of Obstetrics and Gynecology, Warren Alpert School of Medicine at Brown University, Providence, RI
| | - Peter Casson
- Northeastern Reproductive Medicine, Colchester, VT
| | | | - Christos Coutifaris
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Michael P. Diamond
- Department of Obstetrics and Gynecology, Augusta University, Augusta, GA
| | - Karl R. Hansen
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Stephen A. Krawetz
- Department of Obstetrics and Gynecology, Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, MI
| | - Richard S. Legro
- Department of Obstetrics and Gynecology, Pennsylvania State University, Hershey, PA
| | - Randal D. Robinson
- Department of Obstetrics and Gynecology, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - James F. Smith
- Department of Urology, University of California, San Francisco, San Francisco, CA
| | - Anne Z. Steiner
- Department of Obstetrics and Gynecology, Duke University, Durham, NC
| | - Robert A. Wild
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Heping Zhang
- Department of Biostatistics, Yale University School of Public Health, New Haven, CT
| | - Nanette Santoro
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO
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Matthew Coward R. EDITORIAL COMMENT. Urology 2019; 129:33. [PMID: 31235001 DOI: 10.1016/j.urology.2019.01.065] [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: 12/14/2018] [Accepted: 01/30/2019] [Indexed: 11/26/2022]
Affiliation(s)
- R Matthew Coward
- Department of Urology, University of North Carolina School of Medicine, Chapel Hill, NC; UNC Fertility, Raleigh, NC
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Matthew Coward R. EDITORIAL COMMENT. Urology 2019; 129:34. [PMID: 31235003 DOI: 10.1016/j.urology.2019.01.066] [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: 12/14/2018] [Accepted: 01/30/2019] [Indexed: 10/26/2022]
Affiliation(s)
- R Matthew Coward
- Department of Urology, University of North Carolina School of Medicine, Chapel Hill, NC; UNC Fertility, Raleigh, NC
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Trussell JC, Coward RM, Santoro N, Stetter C, Kunselman A, Diamond MP, Hansen KR, Krawetz SA, Legro RS, Heisenleder D, Smith J, Steiner A, Wild R, Casson P, Coutifaris C, Alvero RR, Robinson RB, Christman G, Patrizio P, Zhang H, Lindgren MC. Association between testosterone, semen parameters, and live birth in men with unexplained infertility in an intrauterine insemination population. Fertil Steril 2019; 111:1129-1134. [PMID: 30982604 DOI: 10.1016/j.fertnstert.2019.01.034] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 01/14/2019] [Accepted: 01/24/2019] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To determine whether men with unexplained infertility and low total T (TT) have abnormal spermatogenesis and lower fecundity. DESIGN Secondary analysis of the prospective, randomized, multicenter clinical trial, Assessment of Multiple Intrauterine Gestations from Ovarian Stimulation (AMIGOS). SETTING Infertility clinics. PATIENT(S) Nine hundred couples with unexplained infertility enrolled in AMIGOS. Semen analysis with an ejaculate of at least 5 million total motile sperm was required for enrollment. For inclusion in this secondary analysis, a fasting TT was required. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Logistic regression, adjusted for age and body mass index, assessed the association between low TT (defined as <264 ng/dL), semen parameters, and pregnancy outcome. RESULT(S) Seven hundred eighty-one men (mean age, 34.2 ± 5.7 years) with a median (interquartile range) TT of 411 (318-520) ng/dL were included. Men with TT <264 ng/dL were less likely to have normal (≥4% strict Kruger) morphology (unadjusted odds ratio [OR], 0.56; 95% confidence interval [CI], 0.34, 0.92; adjusted OR, 0.59; 95% CI, 0.35, 0.99). There was no association between low TT and semen volume < 1.5 mL, sperm concentration < 15 × 106/mL, or motility < 40%. Among couples whose male partner had low TT, 21 (18.8%) had a live birth, compared with 184 (27.5%) live births in couples with a male partner having TT > 264 ng/dL. The odds of live birth decreased by 40% in couples whose male partner had low TT (unadjusted OR, 0.60; 95% CI, 0.36, 1.00; adjusted OR, 0.65; 95% CI, 0.38, 1.12). CONCLUSION(S) In couples with unexplained infertility, low TT in the male partner was associated with abnormal sperm morphology and lower live birth rates. CLINICAL TRIAL REGISTRATION NUMBER NCT01044862.
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Affiliation(s)
- J C Trussell
- Department of Urology, Upstate University Hospital, Syracuse, New York.
| | - R Matthew Coward
- Department of Urology, UNC School of Medicine, Chapel Hill, North Carolina; UNC Fertility, Raleigh, North Carolina
| | - Nanette Santoro
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado
| | - Christy Stetter
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Allen Kunselman
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Michael P Diamond
- Department of Obstetrics and Gynecology, Georgia Regents University, Augusta, Georgia
| | - Karl R Hansen
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Stephen A Krawetz
- Department of Obstetrics and Gynecology and Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, Michigan
| | - Richard S Legro
- Department of Obstetrics and Gynecology, Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Dan Heisenleder
- Ligand Assay and Analysis Core, University of Virginia, Charlottesville, Virginia
| | - James Smith
- Department of Urology, University of California, San Francisco, San Francisco, California
| | - Anne Steiner
- Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina
| | - Robert Wild
- Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Peter Casson
- Partner of Northeastern Reproductive Medicine, Colchester, Vermont
| | - Cristos Coutifaris
- Department of Obstetrics and Gynecology, University of Pennsylvania, Phildelphia, Pennsylvania
| | - Reuben R Alvero
- Department of Obstetrics and Gynecology, Women and Infants Hospital, Providence, Rhode Island
| | - R B Robinson
- University of Texas Health Science Center, San Antonio, San Antonio, Texas
| | - Greg Christman
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, Gainesville, Florida
| | | | - Heping Zhang
- Department of Biostatistics, Yale University School of Public Health, New Haven, Connecticut
| | - Mark C Lindgren
- Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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Matthew Coward R. EDITORIAL COMMENT. Urology 2019; 126:100-101. [DOI: 10.1016/j.urology.2018.09.042] [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] [Received: 03/10/2017] [Accepted: 09/08/2018] [Indexed: 10/27/2022]
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Affiliation(s)
- R. Matthew Coward
- Department of Urology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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Macey MR, Owen RC, Ross SS, Coward RM. Best practice in the diagnosis and treatment of varicocele in children and adolescents. Ther Adv Urol 2018; 10:273-282. [PMID: 30116303 DOI: 10.1177/1756287218783900] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 05/29/2018] [Indexed: 11/17/2022] Open
Abstract
A varicocele is an abnormal dilation of the pampiniform plexus of veins in the scrotum which begins at puberty in approximately 15% of males. Although common in the general population and often asymptomatic, varicoceles are associated with gonadal dysfunction including testicular atrophy, infertility, and hypogonadism in a subset of men diagnosed later in life. Because of the high prevalence and uncertain pathogenesis, definitive management guidelines for varicoceles diagnosed in the pediatric and adolescent population remain poorly defined. The varicocele is the most common etiology of male factor infertility, and treatment in the pediatric and adolescent population may improve semen quality and improve fecundity in adulthood. Evaluation of the pediatric and adolescent varicocele should include history, physical exam, and measurement of testicular volume with orchidometer or ultrasound. Testicular volume differentials and peak retrograde flow on Doppler ultrasonography are important factors in risk stratification of the pediatric varicocele population. Semen analysis and reproductive endocrine assessment should also be considered as part of the workup for adolescent patients. A variety of treatment approaches exist for varicocele, and while the microsurgical subinguinal approach is the gold standard for the adult population, it has yet to be confirmed as superior for the adolescent population. Referral to an andrologist for the adolescent patient with varicocele should be considered in equivocal cases. While active treatment of varicocele in the pediatric and adolescent population is controversial, it is clear that some untreated patients will suffer symptoms later in life, while overtreatment remains a concern for this large, vulnerable population. Therefore, surveillance strategies and improved accuracy in diagnosis of clinically important pediatric varicoceles prompting treatment are needed in the future.
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Affiliation(s)
- Matthew R Macey
- Department of Urology, UNC School of Medicine, Physicians Office Building, 170 Manning Drive, Campus Box #7235, Chapel Hill, NC 27599-7235, USA
| | - Ryan C Owen
- Department of Urology, UNC School of Medicine, Chapel Hill, NC, USA
| | - Sherry S Ross
- Department of Urology, UNC School of Medicine, Chapel Hill, NC, USA
| | - R Matthew Coward
- Department of Urology, UNC School of Medicine, Chapel Hill, NC, USA UNC Fertility LLC, Raleigh, NC, USA
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Affiliation(s)
- R Matthew Coward
- Department of Urology, University of North Carolina School of Medicine, Chapel Hill; and UNC Fertility, Raleigh, North Carolina
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McBride JA, Carson CC, Coward RM. Readability, credibility and quality of patient information for hypogonadism and testosterone replacement therapy on the Internet. Int J Impot Res 2017; 29:110-114. [PMID: 28228646 DOI: 10.1038/ijir.2017.4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 10/19/2016] [Accepted: 01/22/2017] [Indexed: 11/09/2022]
Abstract
The incidence of hypogonadism and use of testosterone replacement therapy (TRT) are rising, while data evaluating the complexity and quality of health-care information available to patients on the Internet for hypogonadism or TRT are lacking. This study focuses on characterizing the readability, credibility and quality of patient-centered information for hypogonadism on the Internet. A Google search was performed to identify top-ranked websites offering patient-centered information on hypogonadism and TRT. Readability was quantified by reading grade level using several validated instruments. Credibility and quality were determined by several additional criteria, including authorship, references, health-care information quality certification and breadth of topic discussion. Twenty of 75 total sites identified (27%) met the inclusion and exclusion criteria and were evaluated. The mean reading grade level was 13.1 (interquartile range 11.7-15.1), with all websites demonstrating reading levels significantly above recommended levels. Less than half (45%) of the sites were neither authored nor reviewed by a physician, 60% contained at least one reference and 40% were certified for displaying quality health-care information. Over half (55%) did not comprehensively discuss management of hypogonadism or mention treatment-associated risks. In conclusion, the majority of patient-centered information available on the Internet regarding hypogonadism or TRT is of poor quality and too complex for the average patient to comprehend. These results highlight a critical shortage in easily accessible, high-quality, comprehensible online patient health-care information on hypogonadism and TRT.
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Affiliation(s)
- J A McBride
- Department of Urology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - C C Carson
- Department of Urology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - R M Coward
- Department of Urology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
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Kovac JR, Scovell J, Ramasamy R, Rajanahally S, Coward RM, Smith RP, Lipshultz LI. Men regret anabolic steroid use due to a lack of comprehension regarding the consequences on future fertility. Andrologia 2014; 47:872-8. [PMID: 25220690 DOI: 10.1111/and.12340] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2014] [Indexed: 11/26/2022] Open
Abstract
We examined whether men with anabolic-steroid-induced hypogonadism (ASIH) seeking testosterone supplementation therapy (TST) regretted their decision to use anabolic-androgenic steroids (AAS) and what their reasons were for this regret. An anonymous, prospective survey was distributed to 382 men seeking follow-up treatment for hypogonadism. Prior AAS use was confirmed by self-report, and men were categorised based upon whether they regretted (R) or did not regret (NR) their use of AAS. The average patient age was 40 ± 0.9 years (n = 79) and 15.2% expressed regret over AAS use. No demographic differences were identified between those who regretted AAS use (n = 12) and those who did not (n = 67). Regret was not related to ASIH diagnosis or to AAS-related side effects like increased aggression, mood disorders, erectile dysfunction, acne, fluid retention or dyslipidemia. Those who regretted AAS use were significantly more likely to have not comprehended the negative impact on future fertility (P < 0.030). Actual fertility issues were comparable in men who regretted AAS use (16.7%) and those who did not (13%). A total of 15.2% of men regretted using AAS. A lack of awareness regarding the negative long-term effects on fertility was the primary factor related to regret of AAS use in men with ASIH.
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Affiliation(s)
- J R Kovac
- Urology of Indiana, Male Reproductive Endocrinology and Surgery, Carmel, IN, USA
| | - J Scovell
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - R Ramasamy
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - S Rajanahally
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - R M Coward
- Department of Urology, University of North Carolina, Chapel Hill, NC, USA
| | - R P Smith
- Department of Urology, University of Virginia, Charlottesville, VA, USA
| | - L I Lipshultz
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
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Simhan J, Coward RM, Carson CC. 957: PSA & LIPID Dynamics in Hypogonadal Men Treated with Testosterone Replacement Therapy. J Urol 2007. [DOI: 10.1016/s0022-5347(18)31185-6] [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: 10/17/2022]
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