A varicocele is defined as the abnormal dilation of the internal testicular vein and pampiniform venus plexus within the spermatic cord. If a semen analysis is not obtained from the adolescent male, in the absence of ...A varicocele is defined as the abnormal dilation of the internal testicular vein and pampiniform venus plexus within the spermatic cord. If a semen analysis is not obtained from the adolescent male, in the absence of other symptoms, the main clinical indication used by many urologists to recommend repair is testicular atrophy. The varicocele may result in testicular damage in some males causing testicular atrophy with impaired sperm production and decreased Leydig cell function, while in other males the varicocele may seemingly cause no ill effects. In adult men, varicoceles are frequently present and surgically correctable, yet the measurable benefits of surgical repair are slight according to a Cochrane review. While occurring more commonly in infertile men than fertile men, only 20% of men with a documented varicocele will suffer from fertility problems. Most varicoceles found in adolescents are detected during a routine medical examination, and it is difficult to predict which adolescent presenting with a varicocele will ultimately show diminished testicular function in adolescence or adulthood. As in adults, the mainstay of treatment for varicocele in adolescents is surgical correction. However, unlike an adult varicocelectomy （the microsurgical approach is the most common）, treatment for an adolescent varicocele is more often laparoscopic. Nevertheless, the goals of treatment are the same in the adolescent and adult patients. Controversy remains as to which patients to treat, when to initiate the treatment, and what type of treatment is the best. This review will present the current understanding of the etiology, diagnosis and treatment of the adolescent varicocele.展开更多
In couples with infertility, abnormal strict morphology of 0% normal forms （NF） is a criterion to proceed rapidly to in vitro fertilization （IVF）. Since no data currently exist, we investigated the outcomes for me...In couples with infertility, abnormal strict morphology of 0% normal forms （NF） is a criterion to proceed rapidly to in vitro fertilization （IVF）. Since no data currently exist, we investigated the outcomes for men with 0% NF to determine reproductive success without the use of assisted reproductive technologies （ART）. A cohort of 24 men with 0% NF were identified （2010-2013） with 27 randomly selected men with 〉4% NF as controls. Patient charts were reviewed with men contacted and administered an Institutional Review Board （IRB）-approved telephone questionnaire to ascertain outcomes. After a median follow-up time of 2.5 years, 29.2% of men with 0% NF did not require ART for their first pregnancy （controls = 55.6%, P〈 0.05）. When all pregnancies were analyzed together, men with 0% NF achieved twenty pregnancies of which 75% did not require IVF （controls - thirty pregnancies; 76.7% did not require IVF）. The average age of men and female partners was similar between men with 0% NF and 〉4% NF. All men had normal follicle-stimulating hormone （FSH）, testosterone, prolactin, sex hormone-binding globulin （SHBG）, and estradiol. Although, global semen parameters were worse in men with 0% NF, when a first pregnancy was a natural conception （NC）, 100% of men with 0% NF （n = 7/7） and 37.5% of controls in = 3/8） went on to have a subsequent pregnancy via NC. Men with 0% NF conceived without IVF in 29.2% of cases compared to 55.6% of controls. Strict morphology should not be used to predict fertilization, pregnancy, or live birth potential. In men with 0% NF, alternative modalities should be considered before immediate IVF.展开更多
Augmented reality is widely used in aeronautics and is a developing concept within surgery. In this pilot study, we developed an application for use on Google Glass optical head-mounted display to train urology reside...Augmented reality is widely used in aeronautics and is a developing concept within surgery. In this pilot study, we developed an application for use on Google Glass optical head-mounted display to train urology residents in how to place an inflatable penile prosthesis. We use the phrase Augmented Reality Assisted Surgery to describe this novel application of augmented reality in the setting of surgery. The application demonstrates the steps of the surgical procedure of inflatable penile prosthesis placement. It also contains software that allows for detection of interest points using a camera feed from the optical head-mounted display to enable faculty to interact with residents during placement of the penile prosthesis. Urology trainees and faculty who volunteered to take part in the study were given time to experience the technology in the operative or perioperative setting and asked to complete a feedback survey. From 30 total participants using a lO-point scale, educational usefulness was rated 8.6, ease of navigation was rated 7.6, likelihood to use was rated 7.4, and distraction in operating room was rated 4.9. When stratified between trainees and faculty, trainees found the technology more educationally useful, and less distracting. Overall, 81% of the participants want this technology in their residency program, and 93% see this technology in the operating room in the future. Further development of this technology is warranted before full release, and further studies are necessary to better characterize the effectiveness of Augmented Reality Assisted Surgery in urologic surgical training.展开更多
In recent years, investigators have noted a trend toward a declining proportion of male births in many industrialized nations. While men bear the sex-determining chromosome, the role of the female partner as it pertai...In recent years, investigators have noted a trend toward a declining proportion of male births in many industrialized nations. While men bear the sex-determining chromosome, the role of the female partner as it pertains to fertilization or miscarriage may also alter the gender ratio. We attempted to determine a man＇s secondary sex ratio （F1 generation） by directly examining the sex chromosomes of his sperm. We examined our male infertility clinic database for all men who had undergone a semen fluorescence in situ hybridization （FISH）. Patient demographic and semen parameters were recorded. Chi-squared analysis was used to compare gender ratios （Y chromosomes/total chromosomes）. Multivariable logistic regression was used to predict the odds of possessing a Y-bearing sperm after accounting for demographic and semen parameters. A total of 185 men underwent sperm FISH. For the entire cohort, the proportion of Y chromosome-bearing sperm was 51.5%. Men with less than five million motile sperm had a significantly lower proportion of Y chromosome-bearing sperm （50.8%） compared to men with higher sperm counts （51.6%; P= 0.02）. After multivariable adjustment, a higher sperm concentration, total motile sperm count and semen volume significantly increased the odds of having a Y chromosome-bearing sperm （P〈0.01）. As a man＇s sperm production declines, so does the proportion of Y chromosome-bearing sperm. Thus, a man＇s reproductive potential may predict his ability to sire male offspring.展开更多
Anogenital distance （AGD） is used to define degree of virilization of genital development, with shorter length being associated with feminization and male infertility. The first exon of the androgen receptor （AR） ...Anogenital distance （AGD） is used to define degree of virilization of genital development, with shorter length being associated with feminization and male infertility. The first exon of the androgen receptor （AR） consists of a polymorphic sequence of cytosine-adenineguanine （CAG） repeats, with longer CAG repeat lengths being associated with decreased receptor function. We sought to determine if there is an association between AGD and AR CAG repeat length. A cross-sectional, prospective cohort of men evaluated at a urology clinic at a single institution was recruited. AGD （the distance from the posterior scrotum to the anal verge） and penile length （PL） were measured. Sanger DNA sequence analysis was used to define CAG repeat length. AGD and CAG repeat lengths in 195 men were determined. On unadjusted analysis, there was no linear relationship between CAG repeat length and PL （P=0.17） or AGD （P=-0.31）. However, on sub-population analyses, those men with longer CAG repeat lengths （〉26） had significantly shorter AGDs compared to men with shorter CAG repeat lengths. For example, the mean AGD was 41.9 vs. 32.4 mm with a CAG repeat length ≤26 vs. 〉26 （P=0.01）. In addition, when stratifying the cohort based on AGD, those with AGD less than the median （i.e. 40 mm） had a longer CAG repeat length compared to men with an AGD 〉40 mm （P=-0.02）. In summary, no linear relationship was found between AGD and AR CAG repeat length overall.展开更多
In recent years, there has been a significant trend toward postponing childbearing, especially in developed countries. There are multiple factors influencing this change including advanced marital age, higher levels o...In recent years, there has been a significant trend toward postponing childbearing, especially in developed countries. There are multiple factors influencing this change including advanced marital age, higher levels of postgraduate education, and the changing role for women in society. This is reflected in the findings that from 1993 to 2003, the number of new fathers 〉35 years increased by 15%.展开更多
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 in...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(14.8×10^(6)ml^(-1)vs 61.4×10^(6)ml^(−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.展开更多
Recent increases in the awareness of hypogonadism as a clinical condition have led to more men being managed with testosterone supplementation therapy （TST）. While highly effective at raising serum testosterone leve...Recent increases in the awareness of hypogonadism as a clinical condition have led to more men being managed with testosterone supplementation therapy （TST）. While highly effective at raising serum testosterone levels and controlling the symptoms of hypogonadism such as fatigue and low energy,1 the resultant suppression of the hypothalamic-pituitary-gonadal axis can lead to an inhibition of gonadotropins, including follicle-stimulating hormone （FSH） and luteinizing hormone （LH） and subsequent azoospermia.展开更多
The manuscript by Drs. Patel and Smith1 presents an excellent summary on the preoperative work up for patients undergoing vasectomy reversal （VR）, and describs factors that help predict success such as surgeon skill...The manuscript by Drs. Patel and Smith1 presents an excellent summary on the preoperative work up for patients undergoing vasectomy reversal （VR）, and describs factors that help predict success such as surgeon skill/experience, shorter obstructive interval, a partner＇s positive fertility history and younger female age53 While intraoperative decision-making is discussed in the text, it is important to ask why, with all the research available, do some physicians still feel comfortable only offering a vasovasostomy （VV）, irrespective of the microscopic characteristics of the vasal effluent.展开更多
Infertility affects roughly 15% of couples; in nearly half of these cases, there is a male contributing factor.1 Along with advances in modern drugs and assisted reproductive technologies, some infertile patients choo...Infertility affects roughly 15% of couples; in nearly half of these cases, there is a male contributing factor.1 Along with advances in modern drugs and assisted reproductive technologies, some infertile patients choose to use complementary and alternative medical therapies （CAM）. These are either administered as adjuncts or, in some cases, as the sole mode of medical therapy. Reasons for using CAM vary and may include faith, beliefs, economic factors or simply fear of a surgical procedure and apprehension about using hormone-modifying medications.展开更多
The fact that most men are severely distressed by pharmaceutical and/ or surgical treatments resulting in functional castrations is inherently obvious. Unfortunately, significant male infertility, predictable after so...The fact that most men are severely distressed by pharmaceutical and/ or surgical treatments resulting in functional castrations is inherently obvious. Unfortunately, significant male infertility, predictable after some types of treatment, is often not considered or discussed with patients.展开更多
Spinal cord injuries （SCIs） are often devastating to patients and their families. In those men young enough to consider families and unfortunate enough to be unable to ejaculate, multiple options exist. The attached...Spinal cord injuries （SCIs） are often devastating to patients and their families. In those men young enough to consider families and unfortunate enough to be unable to ejaculate, multiple options exist. The attached manuscript by Dr. Ibrahim et al. contains a detailed outline of a multitude of techniques available to the Andrologist to both evoke ejaculation and harvest sperm from these patients. The authors, pioneers in the field of male fertility research for SCI patients, detail very high success rates for penile vibratory stimulation （86% success if above T10, 15% if below） and electroejaculation （91.9% success）.展开更多
The insurance environment in the United States has traditionally ignored fertility as a barometer of meals health. However, there is now growing evidence that male infertility is associated with multiple medical comor...The insurance environment in the United States has traditionally ignored fertility as a barometer of meals health. However, there is now growing evidence that male infertility is associated with multiple medical comorbidities including a variety of cardiovascular, genetic, endocrine, and malignant conditions2 Since insurance providers still fail to recognize these relationships, even when appropriately referred, couples still face barriers to care, including insurance coverage rejections and high costs.展开更多
Drs. Sikka and HellstromI provide an excellent summary focusing on the basics of the endocrine evaluation of male fertility with a detailed look at the specifics of semen analyses. Discussing details such as concentra...Drs. Sikka and HellstromI provide an excellent summary focusing on the basics of the endocrine evaluation of male fertility with a detailed look at the specifics of semen analyses. Discussing details such as concentration, motility and morphology, Sikka and Hellstrom expand on how these tests are conducted in a laboratory setting. An understanding of these particulars is valuable to the Andrologist who must subsequently synthesize these reports and relay them to patients in a simplistic manner.展开更多
The 2012 American Urological Association （AUA） vasectomy guidelines advise that of those men who undergo vasectomy, 1%-2% will develop chronic scrotal pain that negatively impacts their quality of life.1 These low n...The 2012 American Urological Association （AUA） vasectomy guidelines advise that of those men who undergo vasectomy, 1%-2% will develop chronic scrotal pain that negatively impacts their quality of life.1 These low numbers are contrasted with a study by McMahon et al.2 that characterized the incidence of chronic testicular pain postvasectomy as being about 33%.展开更多
Many controversial topics regarding Andrology in general, and male infertility more specifically have been discussed and debated for decades. Numerous manuscripts and entire journals have been dedicated to the dissemi...Many controversial topics regarding Andrology in general, and male infertility more specifically have been discussed and debated for decades. Numerous manuscripts and entire journals have been dedicated to the dissemination of standardized information with multiple reviews covering similar topics. This massive amount of data leads to difficulty identifying pertinent clinical practice guidelines.展开更多
Numerous approaches to the detection of novel biomarkers for male fertility have been proposed. As reviewed in the manuscript by Bieniek et al.analysis of seminal plasma has yielded numerous possible candidate biomark...Numerous approaches to the detection of novel biomarkers for male fertility have been proposed. As reviewed in the manuscript by Bieniek et al.analysis of seminal plasma has yielded numerous possible candidate biomarkers. Since semen analysis is a critical component in the initial workup for infertile males, seminal fluid biomarkers inherently have several distinct advantages.展开更多
Medical management of male infertility has traditionally involved therapies directed toward manipulation of the hypothalamic-pituitary-gonadal axis. The medications available currently are essentially identical to tho...Medical management of male infertility has traditionally involved therapies directed toward manipulation of the hypothalamic-pituitary-gonadal axis. The medications available currently are essentially identical to those utilized decades ago. Moreover, these agents require that the infertile patient can produce at least a small number of functional sperm.展开更多
The hypothalamic-pituitary-gonadal （HPG） axis represents a complex interplay in which male reproductive and sexual functions are regulated. The role of estrogen, once relegated to being that of a minor player, has h...The hypothalamic-pituitary-gonadal （HPG） axis represents a complex interplay in which male reproductive and sexual functions are regulated. The role of estrogen, once relegated to being that of a minor player, has had its importance resurrected by a recent research.展开更多
Approximately, 1.6% of all infants born in the United States are conceived using assisted reproductive technologies （ARTs）. With the growing rise of ART, questions have been raised about the utility of varicocele re...Approximately, 1.6% of all infants born in the United States are conceived using assisted reproductive technologies （ARTs）. With the growing rise of ART, questions have been raised about the utility of varicocele repair. While the ability ofa microsurgical varicocele repair to improve semen parameters has been established, there remains no standard definition as to what constitutes significant improvements in semen parameters following varicocele repair. The majority of trials have observed enhanced parameters （specifically concentration and motility） as well as increased fertility.展开更多
文摘A varicocele is defined as the abnormal dilation of the internal testicular vein and pampiniform venus plexus within the spermatic cord. If a semen analysis is not obtained from the adolescent male, in the absence of other symptoms, the main clinical indication used by many urologists to recommend repair is testicular atrophy. The varicocele may result in testicular damage in some males causing testicular atrophy with impaired sperm production and decreased Leydig cell function, while in other males the varicocele may seemingly cause no ill effects. In adult men, varicoceles are frequently present and surgically correctable, yet the measurable benefits of surgical repair are slight according to a Cochrane review. While occurring more commonly in infertile men than fertile men, only 20% of men with a documented varicocele will suffer from fertility problems. Most varicoceles found in adolescents are detected during a routine medical examination, and it is difficult to predict which adolescent presenting with a varicocele will ultimately show diminished testicular function in adolescence or adulthood. As in adults, the mainstay of treatment for varicocele in adolescents is surgical correction. However, unlike an adult varicocelectomy （the microsurgical approach is the most common）, treatment for an adolescent varicocele is more often laparoscopic. Nevertheless, the goals of treatment are the same in the adolescent and adult patients. Controversy remains as to which patients to treat, when to initiate the treatment, and what type of treatment is the best. This review will present the current understanding of the etiology, diagnosis and treatment of the adolescent varicocele.
文摘In couples with infertility, abnormal strict morphology of 0% normal forms （NF） is a criterion to proceed rapidly to in vitro fertilization （IVF）. Since no data currently exist, we investigated the outcomes for men with 0% NF to determine reproductive success without the use of assisted reproductive technologies （ART）. A cohort of 24 men with 0% NF were identified （2010-2013） with 27 randomly selected men with 〉4% NF as controls. Patient charts were reviewed with men contacted and administered an Institutional Review Board （IRB）-approved telephone questionnaire to ascertain outcomes. After a median follow-up time of 2.5 years, 29.2% of men with 0% NF did not require ART for their first pregnancy （controls = 55.6%, P〈 0.05）. When all pregnancies were analyzed together, men with 0% NF achieved twenty pregnancies of which 75% did not require IVF （controls - thirty pregnancies; 76.7% did not require IVF）. The average age of men and female partners was similar between men with 0% NF and 〉4% NF. All men had normal follicle-stimulating hormone （FSH）, testosterone, prolactin, sex hormone-binding globulin （SHBG）, and estradiol. Although, global semen parameters were worse in men with 0% NF, when a first pregnancy was a natural conception （NC）, 100% of men with 0% NF （n = 7/7） and 37.5% of controls in = 3/8） went on to have a subsequent pregnancy via NC. Men with 0% NF conceived without IVF in 29.2% of cases compared to 55.6% of controls. Strict morphology should not be used to predict fertilization, pregnancy, or live birth potential. In men with 0% NF, alternative modalities should be considered before immediate IVF.
文摘Augmented reality is widely used in aeronautics and is a developing concept within surgery. In this pilot study, we developed an application for use on Google Glass optical head-mounted display to train urology residents in how to place an inflatable penile prosthesis. We use the phrase Augmented Reality Assisted Surgery to describe this novel application of augmented reality in the setting of surgery. The application demonstrates the steps of the surgical procedure of inflatable penile prosthesis placement. It also contains software that allows for detection of interest points using a camera feed from the optical head-mounted display to enable faculty to interact with residents during placement of the penile prosthesis. Urology trainees and faculty who volunteered to take part in the study were given time to experience the technology in the operative or perioperative setting and asked to complete a feedback survey. From 30 total participants using a lO-point scale, educational usefulness was rated 8.6, ease of navigation was rated 7.6, likelihood to use was rated 7.4, and distraction in operating room was rated 4.9. When stratified between trainees and faculty, trainees found the technology more educationally useful, and less distracting. Overall, 81% of the participants want this technology in their residency program, and 93% see this technology in the operating room in the future. Further development of this technology is warranted before full release, and further studies are necessary to better characterize the effectiveness of Augmented Reality Assisted Surgery in urologic surgical training.
文摘In recent years, investigators have noted a trend toward a declining proportion of male births in many industrialized nations. While men bear the sex-determining chromosome, the role of the female partner as it pertains to fertilization or miscarriage may also alter the gender ratio. We attempted to determine a man＇s secondary sex ratio （F1 generation） by directly examining the sex chromosomes of his sperm. We examined our male infertility clinic database for all men who had undergone a semen fluorescence in situ hybridization （FISH）. Patient demographic and semen parameters were recorded. Chi-squared analysis was used to compare gender ratios （Y chromosomes/total chromosomes）. Multivariable logistic regression was used to predict the odds of possessing a Y-bearing sperm after accounting for demographic and semen parameters. A total of 185 men underwent sperm FISH. For the entire cohort, the proportion of Y chromosome-bearing sperm was 51.5%. Men with less than five million motile sperm had a significantly lower proportion of Y chromosome-bearing sperm （50.8%） compared to men with higher sperm counts （51.6%; P= 0.02）. After multivariable adjustment, a higher sperm concentration, total motile sperm count and semen volume significantly increased the odds of having a Y chromosome-bearing sperm （P〈0.01）. As a man＇s sperm production declines, so does the proportion of Y chromosome-bearing sperm. Thus, a man＇s reproductive potential may predict his ability to sire male offspring.
文摘Anogenital distance （AGD） is used to define degree of virilization of genital development, with shorter length being associated with feminization and male infertility. The first exon of the androgen receptor （AR） consists of a polymorphic sequence of cytosine-adenineguanine （CAG） repeats, with longer CAG repeat lengths being associated with decreased receptor function. We sought to determine if there is an association between AGD and AR CAG repeat length. A cross-sectional, prospective cohort of men evaluated at a urology clinic at a single institution was recruited. AGD （the distance from the posterior scrotum to the anal verge） and penile length （PL） were measured. Sanger DNA sequence analysis was used to define CAG repeat length. AGD and CAG repeat lengths in 195 men were determined. On unadjusted analysis, there was no linear relationship between CAG repeat length and PL （P=0.17） or AGD （P=-0.31）. However, on sub-population analyses, those men with longer CAG repeat lengths （〉26） had significantly shorter AGDs compared to men with shorter CAG repeat lengths. For example, the mean AGD was 41.9 vs. 32.4 mm with a CAG repeat length ≤26 vs. 〉26 （P=0.01）. In addition, when stratifying the cohort based on AGD, those with AGD less than the median （i.e. 40 mm） had a longer CAG repeat length compared to men with an AGD 〉40 mm （P=-0.02）. In summary, no linear relationship was found between AGD and AR CAG repeat length overall.
文摘In recent years, there has been a significant trend toward postponing childbearing, especially in developed countries. There are multiple factors influencing this change including advanced marital age, higher levels of postgraduate education, and the changing role for women in society. This is reflected in the findings that from 1993 to 2003, the number of new fathers 〉35 years increased by 15%.
文摘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(14.8×10^(6)ml^(-1)vs 61.4×10^(6)ml^(−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.
文摘Recent increases in the awareness of hypogonadism as a clinical condition have led to more men being managed with testosterone supplementation therapy （TST）. While highly effective at raising serum testosterone levels and controlling the symptoms of hypogonadism such as fatigue and low energy,1 the resultant suppression of the hypothalamic-pituitary-gonadal axis can lead to an inhibition of gonadotropins, including follicle-stimulating hormone （FSH） and luteinizing hormone （LH） and subsequent azoospermia.
文摘The manuscript by Drs. Patel and Smith1 presents an excellent summary on the preoperative work up for patients undergoing vasectomy reversal （VR）, and describs factors that help predict success such as surgeon skill/experience, shorter obstructive interval, a partner＇s positive fertility history and younger female age53 While intraoperative decision-making is discussed in the text, it is important to ask why, with all the research available, do some physicians still feel comfortable only offering a vasovasostomy （VV）, irrespective of the microscopic characteristics of the vasal effluent.
文摘Infertility affects roughly 15% of couples; in nearly half of these cases, there is a male contributing factor.1 Along with advances in modern drugs and assisted reproductive technologies, some infertile patients choose to use complementary and alternative medical therapies （CAM）. These are either administered as adjuncts or, in some cases, as the sole mode of medical therapy. Reasons for using CAM vary and may include faith, beliefs, economic factors or simply fear of a surgical procedure and apprehension about using hormone-modifying medications.
文摘The fact that most men are severely distressed by pharmaceutical and/ or surgical treatments resulting in functional castrations is inherently obvious. Unfortunately, significant male infertility, predictable after some types of treatment, is often not considered or discussed with patients.
文摘Spinal cord injuries （SCIs） are often devastating to patients and their families. In those men young enough to consider families and unfortunate enough to be unable to ejaculate, multiple options exist. The attached manuscript by Dr. Ibrahim et al. contains a detailed outline of a multitude of techniques available to the Andrologist to both evoke ejaculation and harvest sperm from these patients. The authors, pioneers in the field of male fertility research for SCI patients, detail very high success rates for penile vibratory stimulation （86% success if above T10, 15% if below） and electroejaculation （91.9% success）.
文摘The insurance environment in the United States has traditionally ignored fertility as a barometer of meals health. However, there is now growing evidence that male infertility is associated with multiple medical comorbidities including a variety of cardiovascular, genetic, endocrine, and malignant conditions2 Since insurance providers still fail to recognize these relationships, even when appropriately referred, couples still face barriers to care, including insurance coverage rejections and high costs.
文摘Drs. Sikka and HellstromI provide an excellent summary focusing on the basics of the endocrine evaluation of male fertility with a detailed look at the specifics of semen analyses. Discussing details such as concentration, motility and morphology, Sikka and Hellstrom expand on how these tests are conducted in a laboratory setting. An understanding of these particulars is valuable to the Andrologist who must subsequently synthesize these reports and relay them to patients in a simplistic manner.
文摘The 2012 American Urological Association （AUA） vasectomy guidelines advise that of those men who undergo vasectomy, 1%-2% will develop chronic scrotal pain that negatively impacts their quality of life.1 These low numbers are contrasted with a study by McMahon et al.2 that characterized the incidence of chronic testicular pain postvasectomy as being about 33%.
文摘Many controversial topics regarding Andrology in general, and male infertility more specifically have been discussed and debated for decades. Numerous manuscripts and entire journals have been dedicated to the dissemination of standardized information with multiple reviews covering similar topics. This massive amount of data leads to difficulty identifying pertinent clinical practice guidelines.
文摘Numerous approaches to the detection of novel biomarkers for male fertility have been proposed. As reviewed in the manuscript by Bieniek et al.analysis of seminal plasma has yielded numerous possible candidate biomarkers. Since semen analysis is a critical component in the initial workup for infertile males, seminal fluid biomarkers inherently have several distinct advantages.
文摘Medical management of male infertility has traditionally involved therapies directed toward manipulation of the hypothalamic-pituitary-gonadal axis. The medications available currently are essentially identical to those utilized decades ago. Moreover, these agents require that the infertile patient can produce at least a small number of functional sperm.
文摘The hypothalamic-pituitary-gonadal （HPG） axis represents a complex interplay in which male reproductive and sexual functions are regulated. The role of estrogen, once relegated to being that of a minor player, has had its importance resurrected by a recent research.
文摘Approximately, 1.6% of all infants born in the United States are conceived using assisted reproductive technologies （ARTs）. With the growing rise of ART, questions have been raised about the utility of varicocele repair. While the ability ofa microsurgical varicocele repair to improve semen parameters has been established, there remains no standard definition as to what constitutes significant improvements in semen parameters following varicocele repair. The majority of trials have observed enhanced parameters （specifically concentration and motility） as well as increased fertility.
