Global Practice Patterns in the Evaluation of Non-Obstructive Azoospermia: Results of a World-Wide Survey and Expert Recommendations

PURPOSE

Non-obstructive azoospermia (NOA) represents the persistent absence of sperm in ejaculate without obstruction, stemming from diverse disease processes. This survey explores global practices in NOA diagnosis, comparing them with guidelines and offering expert recommendations.

MATERIALS AND METHODS

A 56-item questionnaire survey on NOA diagnosis and management was conducted globally from July to September 2022. This paper focuses on part 1, evaluating NOA diagnosis. Data from 367 participants across 49 countries were analyzed descriptively, with a Delphi process used for expert recommendations.

RESULTS

Of 336 eligible responses, most participants were experienced attending physicians (70.93%). To diagnose azoospermia definitively, 81.7% requested two semen samples. Commonly ordered hormone tests included serum follicle-stimulating hormone (FSH) (97.0%), total testosterone (92.9%), and luteinizing hormone (86.9%). Genetic testing was requested by 66.6%, with karyotype analysis (86.2%) and Y chromosome microdeletions (88.3%) prevalent. Diagnostic testicular biopsy, distinguishing obstructive azoospermia (OA) from NOA, was not performed by 45.1%, while 34.6% did it selectively. Differentiation relied on physical examination (76.1%), serum hormone profiles (69.6%), and semen tests (68.1%). Expectations of finding sperm surgically were higher in men with normal FSH, larger testes, and a history of sperm in ejaculate.

CONCLUSIONS

This expert survey, encompassing 367 participants from 49 countries, unveils congruence with recommended guidelines in NOA diagnosis. However, noteworthy disparities in practices suggest a need for evidence-based, international consensus guidelines to standardize NOA evaluation, addressing existing gaps in professional recommendations.

Evaluating skin quality of some rabbit breeds under Egyptian conditions

Histological skin parameters in addition to mechanical and chemical properties of chrome tanned rabbits’ furs were determined in this study to evaluate and compare the quality of some rabbit breeds. Seventy-nine male rabbits aged 3 mo of New Zealand White (NZW, n=27), Rex (RX, n=24) and Gabaly (GB, n=28) were used. Results showed that GB skins had the highest values in skin weight (P<0.01) and area (P<0.05) followed by NZW and RX skins, respectively. Moreover, NZW skins differed in histological structure from the other 2 breeds, as total thickness and thickness of papillary and hypodermis layers in NZW were more than twice those of RX and GB (P<0.05). This structure is caused by an increase in fine collagen fibre bundles in papillary layer and a limited increase in larger collagen fibre bundles in the reticular layer. Furthermore, finished tanned furs properties clarify the superiority of GB furs in values of tensile and tearing strengths followed by NZW and RX, respectively. These results point to the possibility of using the chrome tanned furs of the 3 breeds in leather garment manufacturing.

Effects of pine bark supplementation on performance, rumen fermentation, and carcass characteristics of Kiko crossbred male goats

Twenty-two Kiko crossbred male goats (Capra hircus; initial BW = 27.5 ± 1.04 kg) were used in a randomized complete block design to determine the effects of feeding pine bark (PB; Pinus taeda L.) on animal performance, rumen fermentation, blood parameters, fecal egg counts (FEC), and carcass characteristics in goats. Experimental treatments included the control diet [0% PB plus 30% wheat straw (WS)], 15% PB plus 15% WS, and 30% PB plus 0% WS (on as-fed basis), where PB replaced WS. Freshly air-dried PB and WS were finely (1.5 to 3.0 mm) ground and incorporated in the grain mixes. Experimental diets provided a total of 1.9, 16.3, and 32 g of condense tannins (CT)/kg DM in 0%, 15%, and 30% PB diets, respectively. The grain mixes were fed daily at 85% of the feed offered, with remaining 15% consisting of Bermuda grass hay (Cynodon dactylon). Animals were fed once a day at 0800 h, and feed offered and refused was monitored for an 83-d performance period. Rumen and blood samples were collected at d 0, 50, and 80 of the study. Carcass traits were assessed after slaughter at the end of performance period. There was no difference in initial BW, hay, and total NDF intake among treatments; however, final BW (P = 0.06), ADG (P < 0.01), grain mix intake (P < 0.001), total DMI (P < 0.001), and G:F (P < 0.04) increased linearly as the PB increased in the diets. Rumen ammonia N, acetate, isovalerate and acetate-to-propionate ratio were reduced linearly (P < 0.05). There was no difference in carcass traits except cold carcass weight (P = 0.06), which tended to increase linearly in goats fed 15% and 30% PB. Breast, sirloin, trim trait, liver, and hide weight increased (linear; P < 0.01) with addition of PB. Blood basophils, alanine transaminase, aspartate aminotransferase, albumin, Na, and Cl concentrations decreased (linear; P < 0.02 to 0.01) as PB supplementation increased. Supplementation of PB reduced (linear; P < 0.01) average FEC. Addition of PB in the diets improved performance, reduced FEC, and favorably modified rumen fermentation.

Ex vivo mucoadhesion and in vivo bioavailability assessment and correlation of ketoprofen tablet dosage forms containing bioadhesives

The purposes of this study were to assess the mucoadhesion and bioavailability and their correlation for ketoprofen tablet dosage forms (F1-F6) containing polycarbophil (PC), sodium carboxymethylcellulose (Na CMC) as bioadhesives, Avicel pH 101 as direct compressible tablet vehicle or mixtures of these, and non compressible vehicles such as lactose and starch. For mucoadhesion assessment, we used sheep gastric mucosa and for bioavailability we used six human volunteers in an open randomized seven-way crossover study. Young's modulus (YM) and relative bioavailability (RB) parameters were used for evaluation of mucoadhesion and bioavailability, respectively. The results indicated that F2 containing Na CMC (72.5%) showed the highest value of YM (7.6 +/- 0.76 pascals) and 119.4 +/- 3.2% for RB. Decreasing the amount of Na CMC to 10% in F3 and F6 decreased the values of YM and RB to 1.4 +/- 0.08 and 84 +/- 2.05 in F3, 4.6 +/- 0.43 and 114.7 +/- 2.46 in F6, respectively. The highest RB (152.3 +/- 2.56) was observed in F5 containing starch and Avicel pH 101. This formulation showed 6 +/- 0.87 for YM. F4 containing PC (10%) showed 5.1 +/- 0.43 and 74.15 +/- 1.98 for YM and RB respectively. The lowest value of YM was observed in F1 containing Avicel pH 101 (0.27 +/- 0.01) which also showed low RB (93.3 +/- 2.3). In conclusion, formulations containing bioadhesives and/or starch in high concentration showed high values of YM and RB which indicate good correlation between mucoadhesion and bioavailability. Bioadhesives may show a high potential to improve bioavailability and therapeutic efficacy of ketoprofen in tablet dosage forms.