One major challenge in male factor infertility is nonobstructive azoospermia(NOA),which is characterized by spermatozoa-deficient semen without physical duct blockage.This review offers a thorough overview of the hist...One major challenge in male factor infertility is nonobstructive azoospermia(NOA),which is characterized by spermatozoa-deficient semen without physical duct blockage.This review offers a thorough overview of the histopathology of the testes in NOA cases,clarifying its complex etiology and emphasizing the possible value of histopathology inspection for both diagnosis and treatment.Variable histopathological findings have been linked to NOA,such as tubular hyalinization,Sertoli cell-only syndrome,hypospermatogenesis,and germ cell arrest.Understanding the pathophysiology and forecasting the effectiveness of treatment are further enhanced by both morphometric and ultrastructural analyses.The potential significance of testicular biopsy in forecasting reproductive outcomes is assessed,especially concerning assisted reproductive technologies like intracytoplasmic sperm injection(ICSI).Besides,testicular microlithiasis,serum hormone profiles,and testicular size are investigated concerning NOA histopathology.It is concluded that understanding the histopathological patterns in NOA is crucial for its accurate diagnosis and appropriate management.Further research is still warranted to improve understanding of the complex pathophysiology underlying NOA.展开更多
Dear Editor,Inguinal hernia repair(IHR)performed during childhood is a prevalent etiological factor for obstructive azoospermia(OA)attributed to vasal injury.OA couples can achieve pregnancy through intracytoplasmic s...Dear Editor,Inguinal hernia repair(IHR)performed during childhood is a prevalent etiological factor for obstructive azoospermia(OA)attributed to vasal injury.OA couples can achieve pregnancy through intracytoplasmic sperm injection or natural pregnancy after microsurgical anastomosis.Recent advancements have highlighted the potential utility of laparoscopy-assisted vasovasostomy for treating OA caused by childhood herniorrhaphy.展开更多
Infertility,defined as the inability to conceive after 1 year of regular unprotected intercourse,impacts 10%–20%of couples globally.Both male and female factors contribute equally to this condition.Azoospermia,partic...Infertility,defined as the inability to conceive after 1 year of regular unprotected intercourse,impacts 10%–20%of couples globally.Both male and female factors contribute equally to this condition.Azoospermia,particularly nonobstructive azoospermia(NOA),which affects 10%–15%of infertile men,represents a significant challenge in male infertility.The advent of assisted reproductive technology(ART),specifically microdissection testicular sperm extraction(micro-TESE)followed by intracytoplasmic sperm injection(ICSI),offers a possibility for men with NOA to father biological children.Recent studies have focused on the predictors of sperm retrieval in NOA patients,such as age,testicular volume,and follicle-stimulating hormone(FSH)level.This review aims to explore the limited data on the anatomical characteristics of NOA patients and provide surgical considerations for micro-TESE,thereby enhancing understanding and improving outcomes for this challenging condition.展开更多
Male infertility has seen an increase in prevalence with cases of azoospermia estimated to affect 10%–15%of infertile men.Confirmation of azoospermia subsequently necessitates an early causal differentiation between ...Male infertility has seen an increase in prevalence with cases of azoospermia estimated to affect 10%–15%of infertile men.Confirmation of azoospermia subsequently necessitates an early causal differentiation between obstructive azoospermia(OA)and nonobstructive azoospermia(NOA).Although less common when compared to NOA,OA can represent upward 20%–40%of cases of azoospermia.While there are a multitude of etiologies responsible for causing NOA and OA,correctly distinguishing between the two types of azoospermia has profound implications in managing the infertile male.This review represents an amalgamation of the current guidelines and literature which will supply the reproductive physician with a diagnostic armamentarium to properly distinguish between NOA and OA,therefore providing the best possible care to the infertile couple.展开更多
This review focuses on the diagnostic algorithm for nonobstructive azoospermia(NOA),a significant male factor contributing to infertility.NOA,characterized by the absence of sperm in the ejaculate,requires a systemati...This review focuses on the diagnostic algorithm for nonobstructive azoospermia(NOA),a significant male factor contributing to infertility.NOA,characterized by the absence of sperm in the ejaculate,requires a systematic diagnostic approach to identify reversible conditions,genetic factors,and prognosis for achieving pregnancy.The diagnostic pathway involves semen analysis and a comprehensive evaluation for hormonal deficiencies,anatomical abnormalities,and genetic factors.The importance of medical history,physical examination,endocrine evaluation,imaging,and genetic testing is emphasized.This review highlights the significance of differentiating NOA from obstructive azoospermia(OA)and outlines key considerations for effective management,including surgical sperm retrieval and assisted reproductive techniques.Testicular biopsy is discussed as a definitive method to distinguish obstructive cases from nonobstructive cases,providing valuable prognostic information.Overall,a thorough and systematic diagnostic approach is essential for the effective management of men suspected with NOA,offering insights into potential treatment options and reproductive outcomes.展开更多
Azoospermia, defined as a complete absence of spermatozoa in the ejaculate, is a relatively common condition among infertile men. Establishing the etiological diagnosis can be challenging and often requires various in...Azoospermia, defined as a complete absence of spermatozoa in the ejaculate, is a relatively common condition among infertile men. Establishing the etiological diagnosis can be challenging and often requires various investigations. This cross-sectional study, conducted in Cotonou among 35 azoospermic men, aimed to assess the role of biochemical analysis of seminal fluid in determining the etiological diagnosis. The results revealed significant heterogeneity in biochemical profiles. Most of the patients had normal levels of alpha-glucosidase, fructose, and zinc, indicating normal accessory gland function and suggesting non-obstructive azoospermia. However, a significant subgroup exhibited abnormalities in these markers, suggesting a possible obstructive azoospermia. The heterogeneity in biochemical profiles observed in this study highlights the need for further studies to better characterize azoospermia in Benin.展开更多
Azoospermia,defined as the absence of sperm in the ejaculate,is a well-documented consequence of exogenous testosterone(ET)and anabolic–androgenic steroid(AAS)use.These agents suppress the hypothalamic–pituitary–go...Azoospermia,defined as the absence of sperm in the ejaculate,is a well-documented consequence of exogenous testosterone(ET)and anabolic–androgenic steroid(AAS)use.These agents suppress the hypothalamic–pituitary–gonadal(HPG)axis,leading to reduced intratesticular testosterone levels and impaired spermatogenesis.This review examines the pathophysiological mechanisms underlying azoospermia and outlines therapeutic strategies for recovery.Azoospermia is categorized into pretesticular,testicular,and post-testicular types,with a focus on personalized treatment approaches based on the degree of HPG axis suppression and baseline testicular function.Key strategies include discontinuing ET and monitoring for spontaneous recovery,particularly in patients with shorter durations of ET use.For cases of persistent azoospermia,gonadotropins(human chorionic gonadotropin[hCG]and follicle-stimulating hormone[FSH])and selective estrogen receptor modulators(SERMs),such as clomiphene citrate,are recommended,either alone or in combination.The global increase in exogenous testosterone use,including testosterone replacement therapy and AAS,underscores the need for improved management of associated azoospermia,which can be temporary or permanent depending on individual factors and the type of testosterone used.Additionally,the manuscript discusses preventive strategies,such as transitioning to short-acting testosterone formulations or incorporating low-dose hCG to preserve fertility during ET therapy.While guidelines for managing testosterone-related azoospermia remain limited,emerging research indicates the potential efficacy of hormonal stimulation therapies.However,there is a notable lack of well-structured,controlled,and long-term studies addressing the management of azoospermia related to exogenous testosterone use,highlighting the need for such studies to inform evidence-based recommendations.展开更多
Background:Testicular sperm aspiration(TESA)is a minimally invasive testicular sperm retrieval technique that has been utilized in the treatment of male factor infertility.We sought to evaluate sperm retrieval outcome...Background:Testicular sperm aspiration(TESA)is a minimally invasive testicular sperm retrieval technique that has been utilized in the treatment of male factor infertility.We sought to evaluate sperm retrieval outcomes of primary and redo TESA in men with severe oligoasthenoteratozoospermia(OAT)and obstructive azoospermia(OA).Methods:This is a retrospective analysis of consecutive TESAs(primary and redo)for men with severe OAT and OA performed between January 2011 and August 2022 at a high-volume infertility center.We compared TESA outcomes in men with severe OAT to those with OA and compared outcomes of men who underwent primary and redo TESA on the same testicular unit.Results:439 TESAs(366 primary and 73 redo)in men with severe OAT(n=133)and OA(n=306)were included.Men with OA had significantly higher sperm retrieval rate(SRR)and motile SRR compared to men with severe OAT(99%vs.95%and 98%vs.83%,respectively,p<0.05).The requirement for multiple biopsies and the total number of aspirates were significantly lower in men with OA compared to those with severe OAT(15%vs.32%and 1.2±0.5 vs.1.4±0.7,respectively,p<0.05).In both groups,SRR,motile SRR,the requirement for multiple biopsies,and the total number of aspirates were not significantly different in primary compared to redo cases.Conclusion:Our data demonstrate that TESA retrieval rates are significantly higher in men with OA compared to those with severe OAT.The data also demonstrate that a redo TESA in these men is as effective as a primary TESA,suggesting that areas of active spermatogenesis are preserved 6 months after TESA.展开更多
Testicular histology based on testicular biopsy is an important factor for determining appropriate testicular sperm extraction surgery and predicting sperm retrieval outcomes in patients with azoospermia.Therefore,we ...Testicular histology based on testicular biopsy is an important factor for determining appropriate testicular sperm extraction surgery and predicting sperm retrieval outcomes in patients with azoospermia.Therefore,we developed a deep learning(DL)model to establish the associations between testicular grayscale ultrasound images and testicular histology.We retrospectively included two-dimensional testicular grayscale ultrasound from patients with azoospermia(353 men with 4357 images between July 2017 and December 2021 in The First Affiliated Hospital of Sun Yat-sen University,Guangzhou,China)to develop a DL model.We obtained testicular histology during conventional testicular sperm extraction.Our DL model was trained based on ultrasound images or fusion data(ultrasound images fused with the corresponding testicular volume)to distinguish spermatozoa presence in pathology(SPP)and spermatozoa absence in pathology(SAP)and to classify maturation arrest(MA)and Sertoli cell-only syndrome(SCOS)in patients with SAP.Areas under the receiver operating characteristic curve(AUCs),accuracy,sensitivity,and specificity were used to analyze model performance.DL based on images achieved an AUC of 0.922(95%confidence interval[CI]:0.908-0.935),a sensitivity of 80.9%,a specificity of 84.6%,and an accuracy of 83.5%in predicting SPP(including normal spermatogenesis and hypospermatogenesis)and SAP(including MA and SCOS).In the identification of SCOS and MA,DL on fusion data yielded better diagnostic performance with an AUC of 0.979(95%CI:0.969-0.989),a sensitivity of 89.7%,a specificity of 97.1%,and an accuracy of 92.1%.Our study provides a noninvasive method to predict testicular histology for patients with azoospermia,which would avoid unnecessary testicular biopsy.展开更多
This special issue of the Asian Journal of Andrology is fully dedicated to the thematic area of non-obstructive azoospermia(NOA),one of the most complex and challenging conditions in the realm of andrology,urology,and...This special issue of the Asian Journal of Andrology is fully dedicated to the thematic area of non-obstructive azoospermia(NOA),one of the most complex and challenging conditions in the realm of andrology,urology,and reproductive medicine.展开更多
Male infertility affects 10-15%of couples globally,with azoospermia-complete absence of sperm-accounting for 15%of cases.Traditional diagnostic methods for azoospermia are subjective and variable.This study presents a...Male infertility affects 10-15%of couples globally,with azoospermia-complete absence of sperm-accounting for 15%of cases.Traditional diagnostic methods for azoospermia are subjective and variable.This study presents a novel,noninvasive,and accurate diagnostic method using surface-enhanced Raman spectroscopy(SERS)combined with machine learning to analyze seminal plasma exosomes.Semen samples from healthy controls(n=32)and azoospermic patients(n=22)were collected,and their exosomal SERS spectra were obtained.Machine learning algorithms were employed to distinguish between the SERS pro files of healthy and azoospermic samples,achieving an impressive sensitivity of 99.61%and a speci ficity of 99.58%,thereby highlighting signi ficant spectral differences.This integrated SERS and machine learning approach offers a sensitive,label-free,and objective diagnostic tool for early detection and monitoring of azoospermia,potentially enhancing clinical outcomes and patient management.展开更多
Nonobstructive azoospermia(NOA)is a severe and heterogeneous form of male factor infertility caused by dysfunction of spermatogenesis.Although various factors are well defined in the disruption of spermatogenesis,not ...Nonobstructive azoospermia(NOA)is a severe and heterogeneous form of male factor infertility caused by dysfunction of spermatogenesis.Although various factors are well defined in the disruption of spermatogenesis,not all aspects due to the heterogeneity of the disorder have been determined yet.In this review,we focus on the recent findings and summarize the current data on epigenetic mechanisms such as DNA methylation and different metabolites produced during methylation and demethylation and various types of small noncoding RNAs involved in the pathogenesis of different groups of NOA.展开更多
Approximately 15%of men in the general population have varicoceles,and varicoceles are diagnosed in 40%of men presenting for fertility evaluations.One percent of men in the general population are azoospermic,and 15%of...Approximately 15%of men in the general population have varicoceles,and varicoceles are diagnosed in 40%of men presenting for fertility evaluations.One percent of men in the general population are azoospermic,and 15%of men presenting for fertility evaluations are diagnosed with azoospermia.This article aims to review the impact of varicoceles on testicular function in men with azoospermia,the impact of varicocele repair on the semen parameters of azoospermic men,and the impact of varicocele repair on sperm retrieval and pregnancy outcomes when the male partner remains azoospermic after varicocele repair.展开更多
Discovery of spermatozoa during the 17^(th) century led to developing technologies for semen analysis in the early 1900s,and then,standard techniques were implemented during the 20^(th) century.Semen analysis has a pi...Discovery of spermatozoa during the 17^(th) century led to developing technologies for semen analysis in the early 1900s,and then,standard techniques were implemented during the 20^(th) century.Semen analysis has a pivotal role in the male infertility evaluation,and azoospermia is an important finding.Azoospermia is identified in 15%of infertile men.However,the accurate laboratory assessment of azoospermia poses certain technical challenges.Laboratories currently perform semen assessment with great variability;thus,a standard method should be used.Planning suitable management and determining the cause of infertility require a precise evaluation of azoospermia.This review aims to address the definition of azoospermia and highlight laboratory methods in the assessments of azoospermia.Basic methods such as centrifugation,repeat pellet analysis,and staining and advanced methods such as genetic testing and biomarkers have been discussed.These methods have helped in standardizing the protocol for accurate azoospermia assessments with less variability.展开更多
Increasing evidence implicates disruptions in testicular fatty acid metabolism as a contributing factor in nonobstructive azoospermia(NOA),a severe form of male infertility.However,the precise mechanisms linking fatty...Increasing evidence implicates disruptions in testicular fatty acid metabolism as a contributing factor in nonobstructive azoospermia(NOA),a severe form of male infertility.However,the precise mechanisms linking fatty acid metabolism to NOA pathogenesis have not yet been fully elucidated.Multi-omics analyses,including microarray analysis,single-cell RNA sequencing(scRNA-seq),and metabolomics,were utilized to investigate disruptions in fatty acid metabolism associated with NOA using data from public databases.Results identified ACSL6,ACSBG2,and OLAH as key genes linked to fatty acid metabolism dysregulation,suggesting their potential causative roles in NOA.A marked reduction in omega-3 polyunsaturated fatty acids,especially docosahexaenoic acid(DHA),was observed,potentially contributing to the pathological process of NOA.Sertoli cells in NOA patients exhibited apparent fatty acid metabolic dysfunction,with PPARG identified as a key transcription factor(TF)regulating this process.Functional analyses demonstrated that PPARG is crucial for maintaining blood-testis barrier(BTB)integrity and promoting spermatogenesis via regulation of fatty acid metabolism.These findings reveal the pivotal role of fatty acid metabolism in NOA and identify PPARG as a potential therapeutic target.展开更多
Non-obstructive azoospermia is a common condition associated with significant health risks,including increased mortality,cancer,and chronic diseases such as metabolic and cardiovascular disorders.This review aims to h...Non-obstructive azoospermia is a common condition associated with significant health risks,including increased mortality,cancer,and chronic diseases such as metabolic and cardiovascular disorders.This review aims to highlight the potential health challenges faced by men with this condition compared to fertile counterparts.Through a comprehensive bibliographic search on PubMed,using the following algorithm:(“infertility,male”[MeSH Terms]OR“azoospermia”[MeSH Terms])AND(“mortality”[MeSH Terms]OR“neoplasms”[MeSH Terms]OR“chronic disease”[MeSH Terms]OR“diabetes mellitus”[MeSH Terms]OR“heart diseases”[MeSH Terms]),we analyzed existing literature to explore the associations between infertility,specifically azoospermia,and adverse health outcomes.Findings indicate that infertile men are at a higher risk of death,various cancers(particularly testicular cancer),metabolic syndrome,diabetes,hypogonadism,and cardiovascular disease.Although research specifically addressing azoospermia is limited,available studies support the notion that men with this condition may experience heightened health vulnerabilities.Given these risks,it is imperative for healthcare professionals,especially urologists,to conduct thorough health assessments for men diagnosed with azoospermia.Informing patients of these potential health issues and integrating comprehensive evaluations into their care can facilitate early detection and intervention for life-threatening conditions.Ultimately,men with azoospermia should receive ongoing monitoring to address their specific health concerns,thus improving their long-term health outcomes.展开更多
Azoospermia is the complete absence of spermatozoa in the ejaculate in two or more semen analyses after centrifugation.Nonobstructive azoospermia(NOA)represents the most severe form of male factor infertility accounti...Azoospermia is the complete absence of spermatozoa in the ejaculate in two or more semen analyses after centrifugation.Nonobstructive azoospermia(NOA)represents the most severe form of male factor infertility accounting for 10%–15%of cases and stems from an impairment to spermatogenesis.Understanding of the hypothalamic–pituitary–testicular axis has allowed NOA to be subcategorized by anatomic and/or pathophysiologic level.The etiologies of NOA,and therefore,the differential diagnoses when considering NOA as a cause of male factor infertility,can be subcategorized and condensed into several distinct classifications.Etiologies of NOA include primary hypogonadism,secondary hypogonadism,defects in androgen synthesis and/or response,defective spermatogenesis and sperm maturation,or a mixed picture thereof.This review includes up-to-date clinical,diagnostic,cellular,and histologic features pertaining to the multitude of NOA etiologies.This in turn will provide a framework by which physicians practicing infertility can augment their clinical decision-making,patient counseling,thereby improving upon the management of men with NOA.展开更多
Nonobstructive azoospermia(NOA),one of the most severe types of male infertility,etiology often remains unclear in most cases.Therefore,this study aimed to detect four biallelic detrimental variants(0.5%)in the minich...Nonobstructive azoospermia(NOA),one of the most severe types of male infertility,etiology often remains unclear in most cases.Therefore,this study aimed to detect four biallelic detrimental variants(0.5%)in the minichromosome maintenance domain containing 2(MCMDC2)genes in 768 NOA patients by whole-exome sequencing(WES).Hematoxylin and eosin(H&E)demonstrated that MCMDC2 deleterious variants caused meiotic arrest in three patients(c.1360G>T,c.1956G>T,and c.685C>T)and hypospermatogenesis in one patient(c.94G>T),as further confirmed through immunofluorescence(IF)staining.The single-cell RNA sequencing data indicated that MCMDC2 was substantially expressed during spermatogenesis.The variants were confirmed as deleterious and responsible for patient infertility through bioinformatics and in vitro experimental analyses.The results revealed four MCMDC2 variants related to NOA,which contributes to the current perception of the function of MCMDC2 in male fertility and presents new perspectives on the genetic etiology of NOA.展开更多
Oncological microdissection testicular sperm extraction(onco-micro-TESE)represents a significant breakthrough for patients with nonobstructive azoospermia(NOA)and a concomitant in situ testicular tumor,to be managed a...Oncological microdissection testicular sperm extraction(onco-micro-TESE)represents a significant breakthrough for patients with nonobstructive azoospermia(NOA)and a concomitant in situ testicular tumor,to be managed at the time of sperm retrieval.Onco-micro-TESE addresses the dual objectives of treating both infertility and the testicular tumor simultaneously.The technique is intricate,necessitating a comprehensive understanding of testicular anatomy,physiology,tumor biology,and advanced microsurgical methods.It aims to carefully extract viable spermatozoa while minimizing the risk of tumor dissemination.This review encapsulates the procedural intricacies,evaluates success determinants,including tumor pathology and spermatogenic tissue health,and discusses the implementation of imaging techniques for enhanced surgical precision.Ethical considerations are paramount,as the procedure implicates complex decision-making that weighs the potential oncological risks against the profound desire for fatherhood using the male gametes.The review aims to provide a holistic overview of onco-micro-TESE,detailing methodological advances,clinical outcomes,and the ethical landscape,thus offering an indispensable resource for clinicians navigating this multifaceted clinical scenario.展开更多
The advent of intracytoplasmic sperm injection,along with the realization that many men with azoospermia due to primary testicular failure may have a few spermatozoa in their testes,has resulted in the revolutionary p...The advent of intracytoplasmic sperm injection,along with the realization that many men with azoospermia due to primary testicular failure may have a few spermatozoa in their testes,has resulted in the revolutionary possibility of azoospermic men fathering their own genetic offspring.展开更多
文摘One major challenge in male factor infertility is nonobstructive azoospermia(NOA),which is characterized by spermatozoa-deficient semen without physical duct blockage.This review offers a thorough overview of the histopathology of the testes in NOA cases,clarifying its complex etiology and emphasizing the possible value of histopathology inspection for both diagnosis and treatment.Variable histopathological findings have been linked to NOA,such as tubular hyalinization,Sertoli cell-only syndrome,hypospermatogenesis,and germ cell arrest.Understanding the pathophysiology and forecasting the effectiveness of treatment are further enhanced by both morphometric and ultrastructural analyses.The potential significance of testicular biopsy in forecasting reproductive outcomes is assessed,especially concerning assisted reproductive technologies like intracytoplasmic sperm injection(ICSI).Besides,testicular microlithiasis,serum hormone profiles,and testicular size are investigated concerning NOA histopathology.It is concluded that understanding the histopathological patterns in NOA is crucial for its accurate diagnosis and appropriate management.Further research is still warranted to improve understanding of the complex pathophysiology underlying NOA.
基金supported by the National Key R&D Program of China(No.2022YFC2702701)Shanghai Scientific and Technological Project(No.20Y11907600)Clinical Research Innovation Plan of Shanghai General Hospital(No.CTCCR-2021C17).
文摘Dear Editor,Inguinal hernia repair(IHR)performed during childhood is a prevalent etiological factor for obstructive azoospermia(OA)attributed to vasal injury.OA couples can achieve pregnancy through intracytoplasmic sperm injection or natural pregnancy after microsurgical anastomosis.Recent advancements have highlighted the potential utility of laparoscopy-assisted vasovasostomy for treating OA caused by childhood herniorrhaphy.
文摘Infertility,defined as the inability to conceive after 1 year of regular unprotected intercourse,impacts 10%–20%of couples globally.Both male and female factors contribute equally to this condition.Azoospermia,particularly nonobstructive azoospermia(NOA),which affects 10%–15%of infertile men,represents a significant challenge in male infertility.The advent of assisted reproductive technology(ART),specifically microdissection testicular sperm extraction(micro-TESE)followed by intracytoplasmic sperm injection(ICSI),offers a possibility for men with NOA to father biological children.Recent studies have focused on the predictors of sperm retrieval in NOA patients,such as age,testicular volume,and follicle-stimulating hormone(FSH)level.This review aims to explore the limited data on the anatomical characteristics of NOA patients and provide surgical considerations for micro-TESE,thereby enhancing understanding and improving outcomes for this challenging condition.
文摘Male infertility has seen an increase in prevalence with cases of azoospermia estimated to affect 10%–15%of infertile men.Confirmation of azoospermia subsequently necessitates an early causal differentiation between obstructive azoospermia(OA)and nonobstructive azoospermia(NOA).Although less common when compared to NOA,OA can represent upward 20%–40%of cases of azoospermia.While there are a multitude of etiologies responsible for causing NOA and OA,correctly distinguishing between the two types of azoospermia has profound implications in managing the infertile male.This review represents an amalgamation of the current guidelines and literature which will supply the reproductive physician with a diagnostic armamentarium to properly distinguish between NOA and OA,therefore providing the best possible care to the infertile couple.
文摘This review focuses on the diagnostic algorithm for nonobstructive azoospermia(NOA),a significant male factor contributing to infertility.NOA,characterized by the absence of sperm in the ejaculate,requires a systematic diagnostic approach to identify reversible conditions,genetic factors,and prognosis for achieving pregnancy.The diagnostic pathway involves semen analysis and a comprehensive evaluation for hormonal deficiencies,anatomical abnormalities,and genetic factors.The importance of medical history,physical examination,endocrine evaluation,imaging,and genetic testing is emphasized.This review highlights the significance of differentiating NOA from obstructive azoospermia(OA)and outlines key considerations for effective management,including surgical sperm retrieval and assisted reproductive techniques.Testicular biopsy is discussed as a definitive method to distinguish obstructive cases from nonobstructive cases,providing valuable prognostic information.Overall,a thorough and systematic diagnostic approach is essential for the effective management of men suspected with NOA,offering insights into potential treatment options and reproductive outcomes.
文摘Azoospermia, defined as a complete absence of spermatozoa in the ejaculate, is a relatively common condition among infertile men. Establishing the etiological diagnosis can be challenging and often requires various investigations. This cross-sectional study, conducted in Cotonou among 35 azoospermic men, aimed to assess the role of biochemical analysis of seminal fluid in determining the etiological diagnosis. The results revealed significant heterogeneity in biochemical profiles. Most of the patients had normal levels of alpha-glucosidase, fructose, and zinc, indicating normal accessory gland function and suggesting non-obstructive azoospermia. However, a significant subgroup exhibited abnormalities in these markers, suggesting a possible obstructive azoospermia. The heterogeneity in biochemical profiles observed in this study highlights the need for further studies to better characterize azoospermia in Benin.
文摘Azoospermia,defined as the absence of sperm in the ejaculate,is a well-documented consequence of exogenous testosterone(ET)and anabolic–androgenic steroid(AAS)use.These agents suppress the hypothalamic–pituitary–gonadal(HPG)axis,leading to reduced intratesticular testosterone levels and impaired spermatogenesis.This review examines the pathophysiological mechanisms underlying azoospermia and outlines therapeutic strategies for recovery.Azoospermia is categorized into pretesticular,testicular,and post-testicular types,with a focus on personalized treatment approaches based on the degree of HPG axis suppression and baseline testicular function.Key strategies include discontinuing ET and monitoring for spontaneous recovery,particularly in patients with shorter durations of ET use.For cases of persistent azoospermia,gonadotropins(human chorionic gonadotropin[hCG]and follicle-stimulating hormone[FSH])and selective estrogen receptor modulators(SERMs),such as clomiphene citrate,are recommended,either alone or in combination.The global increase in exogenous testosterone use,including testosterone replacement therapy and AAS,underscores the need for improved management of associated azoospermia,which can be temporary or permanent depending on individual factors and the type of testosterone used.Additionally,the manuscript discusses preventive strategies,such as transitioning to short-acting testosterone formulations or incorporating low-dose hCG to preserve fertility during ET therapy.While guidelines for managing testosterone-related azoospermia remain limited,emerging research indicates the potential efficacy of hormonal stimulation therapies.However,there is a notable lack of well-structured,controlled,and long-term studies addressing the management of azoospermia related to exogenous testosterone use,highlighting the need for such studies to inform evidence-based recommendations.
文摘Background:Testicular sperm aspiration(TESA)is a minimally invasive testicular sperm retrieval technique that has been utilized in the treatment of male factor infertility.We sought to evaluate sperm retrieval outcomes of primary and redo TESA in men with severe oligoasthenoteratozoospermia(OAT)and obstructive azoospermia(OA).Methods:This is a retrospective analysis of consecutive TESAs(primary and redo)for men with severe OAT and OA performed between January 2011 and August 2022 at a high-volume infertility center.We compared TESA outcomes in men with severe OAT to those with OA and compared outcomes of men who underwent primary and redo TESA on the same testicular unit.Results:439 TESAs(366 primary and 73 redo)in men with severe OAT(n=133)and OA(n=306)were included.Men with OA had significantly higher sperm retrieval rate(SRR)and motile SRR compared to men with severe OAT(99%vs.95%and 98%vs.83%,respectively,p<0.05).The requirement for multiple biopsies and the total number of aspirates were significantly lower in men with OA compared to those with severe OAT(15%vs.32%and 1.2±0.5 vs.1.4±0.7,respectively,p<0.05).In both groups,SRR,motile SRR,the requirement for multiple biopsies,and the total number of aspirates were not significantly different in primary compared to redo cases.Conclusion:Our data demonstrate that TESA retrieval rates are significantly higher in men with OA compared to those with severe OAT.The data also demonstrate that a redo TESA in these men is as effective as a primary TESA,suggesting that areas of active spermatogenesis are preserved 6 months after TESA.
基金supported by the Key Research and Development Program of Guangzhou Science and Technology Projects(No.2023B03J1260).
文摘Testicular histology based on testicular biopsy is an important factor for determining appropriate testicular sperm extraction surgery and predicting sperm retrieval outcomes in patients with azoospermia.Therefore,we developed a deep learning(DL)model to establish the associations between testicular grayscale ultrasound images and testicular histology.We retrospectively included two-dimensional testicular grayscale ultrasound from patients with azoospermia(353 men with 4357 images between July 2017 and December 2021 in The First Affiliated Hospital of Sun Yat-sen University,Guangzhou,China)to develop a DL model.We obtained testicular histology during conventional testicular sperm extraction.Our DL model was trained based on ultrasound images or fusion data(ultrasound images fused with the corresponding testicular volume)to distinguish spermatozoa presence in pathology(SPP)and spermatozoa absence in pathology(SAP)and to classify maturation arrest(MA)and Sertoli cell-only syndrome(SCOS)in patients with SAP.Areas under the receiver operating characteristic curve(AUCs),accuracy,sensitivity,and specificity were used to analyze model performance.DL based on images achieved an AUC of 0.922(95%confidence interval[CI]:0.908-0.935),a sensitivity of 80.9%,a specificity of 84.6%,and an accuracy of 83.5%in predicting SPP(including normal spermatogenesis and hypospermatogenesis)and SAP(including MA and SCOS).In the identification of SCOS and MA,DL on fusion data yielded better diagnostic performance with an AUC of 0.979(95%CI:0.969-0.989),a sensitivity of 89.7%,a specificity of 97.1%,and an accuracy of 92.1%.Our study provides a noninvasive method to predict testicular histology for patients with azoospermia,which would avoid unnecessary testicular biopsy.
文摘This special issue of the Asian Journal of Andrology is fully dedicated to the thematic area of non-obstructive azoospermia(NOA),one of the most complex and challenging conditions in the realm of andrology,urology,and reproductive medicine.
基金support from the National Natural Science Foundation of China(No.62275049)the Natural Science Foundation of Fujian Province,China(No.2022J02024)the Fujian Province Joint Fund Project for Scientific and Technological Innovation(2023Y9383).
文摘Male infertility affects 10-15%of couples globally,with azoospermia-complete absence of sperm-accounting for 15%of cases.Traditional diagnostic methods for azoospermia are subjective and variable.This study presents a novel,noninvasive,and accurate diagnostic method using surface-enhanced Raman spectroscopy(SERS)combined with machine learning to analyze seminal plasma exosomes.Semen samples from healthy controls(n=32)and azoospermic patients(n=22)were collected,and their exosomal SERS spectra were obtained.Machine learning algorithms were employed to distinguish between the SERS pro files of healthy and azoospermic samples,achieving an impressive sensitivity of 99.61%and a speci ficity of 99.58%,thereby highlighting signi ficant spectral differences.This integrated SERS and machine learning approach offers a sensitive,label-free,and objective diagnostic tool for early detection and monitoring of azoospermia,potentially enhancing clinical outcomes and patient management.
文摘Nonobstructive azoospermia(NOA)is a severe and heterogeneous form of male factor infertility caused by dysfunction of spermatogenesis.Although various factors are well defined in the disruption of spermatogenesis,not all aspects due to the heterogeneity of the disorder have been determined yet.In this review,we focus on the recent findings and summarize the current data on epigenetic mechanisms such as DNA methylation and different metabolites produced during methylation and demethylation and various types of small noncoding RNAs involved in the pathogenesis of different groups of NOA.
文摘Approximately 15%of men in the general population have varicoceles,and varicoceles are diagnosed in 40%of men presenting for fertility evaluations.One percent of men in the general population are azoospermic,and 15%of men presenting for fertility evaluations are diagnosed with azoospermia.This article aims to review the impact of varicoceles on testicular function in men with azoospermia,the impact of varicocele repair on the semen parameters of azoospermic men,and the impact of varicocele repair on sperm retrieval and pregnancy outcomes when the male partner remains azoospermic after varicocele repair.
文摘Discovery of spermatozoa during the 17^(th) century led to developing technologies for semen analysis in the early 1900s,and then,standard techniques were implemented during the 20^(th) century.Semen analysis has a pivotal role in the male infertility evaluation,and azoospermia is an important finding.Azoospermia is identified in 15%of infertile men.However,the accurate laboratory assessment of azoospermia poses certain technical challenges.Laboratories currently perform semen assessment with great variability;thus,a standard method should be used.Planning suitable management and determining the cause of infertility require a precise evaluation of azoospermia.This review aims to address the definition of azoospermia and highlight laboratory methods in the assessments of azoospermia.Basic methods such as centrifugation,repeat pellet analysis,and staining and advanced methods such as genetic testing and biomarkers have been discussed.These methods have helped in standardizing the protocol for accurate azoospermia assessments with less variability.
基金supported by the National Natural Science Foundation of China (U22A20277,81971373)Jiangsu Provincial Medical Key Discipline Cultivation Unit (JSDW202215)+1 种基金333 High-level Personnel Training Project of Jiangsu Province (BRA2019109)Postgraduate Research&Practice Innovation Program of Jiangsu Province (KYCX22_1826)。
文摘Increasing evidence implicates disruptions in testicular fatty acid metabolism as a contributing factor in nonobstructive azoospermia(NOA),a severe form of male infertility.However,the precise mechanisms linking fatty acid metabolism to NOA pathogenesis have not yet been fully elucidated.Multi-omics analyses,including microarray analysis,single-cell RNA sequencing(scRNA-seq),and metabolomics,were utilized to investigate disruptions in fatty acid metabolism associated with NOA using data from public databases.Results identified ACSL6,ACSBG2,and OLAH as key genes linked to fatty acid metabolism dysregulation,suggesting their potential causative roles in NOA.A marked reduction in omega-3 polyunsaturated fatty acids,especially docosahexaenoic acid(DHA),was observed,potentially contributing to the pathological process of NOA.Sertoli cells in NOA patients exhibited apparent fatty acid metabolic dysfunction,with PPARG identified as a key transcription factor(TF)regulating this process.Functional analyses demonstrated that PPARG is crucial for maintaining blood-testis barrier(BTB)integrity and promoting spermatogenesis via regulation of fatty acid metabolism.These findings reveal the pivotal role of fatty acid metabolism in NOA and identify PPARG as a potential therapeutic target.
文摘Non-obstructive azoospermia is a common condition associated with significant health risks,including increased mortality,cancer,and chronic diseases such as metabolic and cardiovascular disorders.This review aims to highlight the potential health challenges faced by men with this condition compared to fertile counterparts.Through a comprehensive bibliographic search on PubMed,using the following algorithm:(“infertility,male”[MeSH Terms]OR“azoospermia”[MeSH Terms])AND(“mortality”[MeSH Terms]OR“neoplasms”[MeSH Terms]OR“chronic disease”[MeSH Terms]OR“diabetes mellitus”[MeSH Terms]OR“heart diseases”[MeSH Terms]),we analyzed existing literature to explore the associations between infertility,specifically azoospermia,and adverse health outcomes.Findings indicate that infertile men are at a higher risk of death,various cancers(particularly testicular cancer),metabolic syndrome,diabetes,hypogonadism,and cardiovascular disease.Although research specifically addressing azoospermia is limited,available studies support the notion that men with this condition may experience heightened health vulnerabilities.Given these risks,it is imperative for healthcare professionals,especially urologists,to conduct thorough health assessments for men diagnosed with azoospermia.Informing patients of these potential health issues and integrating comprehensive evaluations into their care can facilitate early detection and intervention for life-threatening conditions.Ultimately,men with azoospermia should receive ongoing monitoring to address their specific health concerns,thus improving their long-term health outcomes.
文摘Azoospermia is the complete absence of spermatozoa in the ejaculate in two or more semen analyses after centrifugation.Nonobstructive azoospermia(NOA)represents the most severe form of male factor infertility accounting for 10%–15%of cases and stems from an impairment to spermatogenesis.Understanding of the hypothalamic–pituitary–testicular axis has allowed NOA to be subcategorized by anatomic and/or pathophysiologic level.The etiologies of NOA,and therefore,the differential diagnoses when considering NOA as a cause of male factor infertility,can be subcategorized and condensed into several distinct classifications.Etiologies of NOA include primary hypogonadism,secondary hypogonadism,defects in androgen synthesis and/or response,defective spermatogenesis and sperm maturation,or a mixed picture thereof.This review includes up-to-date clinical,diagnostic,cellular,and histologic features pertaining to the multitude of NOA etiologies.This in turn will provide a framework by which physicians practicing infertility can augment their clinical decision-making,patient counseling,thereby improving upon the management of men with NOA.
基金supported by the National Key Research and Development Program of China(2022YFC2702700)the National Natural Science Foundation of China(No.82171586)+1 种基金Inner Mongolia Academy of Medical Sciences Public Hospital Joint Science and Technology Project(2023GLLH0045)Specific Project of Shanghai Jiao Tong University for“Invigorating Inner Mongolia through Science and Technology”(2022XYJG001-01-19).
文摘Nonobstructive azoospermia(NOA),one of the most severe types of male infertility,etiology often remains unclear in most cases.Therefore,this study aimed to detect four biallelic detrimental variants(0.5%)in the minichromosome maintenance domain containing 2(MCMDC2)genes in 768 NOA patients by whole-exome sequencing(WES).Hematoxylin and eosin(H&E)demonstrated that MCMDC2 deleterious variants caused meiotic arrest in three patients(c.1360G>T,c.1956G>T,and c.685C>T)and hypospermatogenesis in one patient(c.94G>T),as further confirmed through immunofluorescence(IF)staining.The single-cell RNA sequencing data indicated that MCMDC2 was substantially expressed during spermatogenesis.The variants were confirmed as deleterious and responsible for patient infertility through bioinformatics and in vitro experimental analyses.The results revealed four MCMDC2 variants related to NOA,which contributes to the current perception of the function of MCMDC2 in male fertility and presents new perspectives on the genetic etiology of NOA.
基金supported by the National Natural Science Foundation of China(No.82371633)Peking University Clinical Scientist Training Program and the Fundamental Research Funds for the Central University(BMU2023PYJ H012).
文摘Oncological microdissection testicular sperm extraction(onco-micro-TESE)represents a significant breakthrough for patients with nonobstructive azoospermia(NOA)and a concomitant in situ testicular tumor,to be managed at the time of sperm retrieval.Onco-micro-TESE addresses the dual objectives of treating both infertility and the testicular tumor simultaneously.The technique is intricate,necessitating a comprehensive understanding of testicular anatomy,physiology,tumor biology,and advanced microsurgical methods.It aims to carefully extract viable spermatozoa while minimizing the risk of tumor dissemination.This review encapsulates the procedural intricacies,evaluates success determinants,including tumor pathology and spermatogenic tissue health,and discusses the implementation of imaging techniques for enhanced surgical precision.Ethical considerations are paramount,as the procedure implicates complex decision-making that weighs the potential oncological risks against the profound desire for fatherhood using the male gametes.The review aims to provide a holistic overview of onco-micro-TESE,detailing methodological advances,clinical outcomes,and the ethical landscape,thus offering an indispensable resource for clinicians navigating this multifaceted clinical scenario.
文摘The advent of intracytoplasmic sperm injection,along with the realization that many men with azoospermia due to primary testicular failure may have a few spermatozoa in their testes,has resulted in the revolutionary possibility of azoospermic men fathering their own genetic offspring.
