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
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 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
Non-obstructive azoospermia （NOA） is a severe defect in male reproductive health that occurs in 1% of adult men. In a previous study, we identified that rs7099208 is located within the last intron of FAM160B1 at 10q...Non-obstructive azoospermia （NOA） is a severe defect in male reproductive health that occurs in 1% of adult men. In a previous study, we identified that rs7099208 is located within the last intron of FAM160B1 at 10q25.3. In this study, we analysed expression Quantitative Trait Loci （eQTL） of FAM16OB1, ABLIM1 and TRUB1, the three genes surrounding rs7099208. Only the expression level of FAM16OB1 was reduced for the homozygous alternate genotype （GG） of rs7099208, but not for the homozygous reference or heterozygous geno- types. FAM160B1 is predominantly expressed in human testes, where it is found in spermatocytes and round sper- matids. From 17 patients with NOA and five with obstructive azoospermia （OA）, immunohistochemistry revealed that expression of FAM160B1 is reduced, or undetectable in NOA patients, but not in OA cases or normal men. We conclude that rs7099208 is associated with NOA via a reduction in the expression of FAM160B1.展开更多
We assessed the rates of sperm retrieval and intracytoplasmic sperm injection outcomes, including the neonatal profile of infants conceived, in men with testicular failure. Three-hundred and sixty-five men with testic...We assessed the rates of sperm retrieval and intracytoplasmic sperm injection outcomes, including the neonatal profile of infants conceived, in men with testicular failure. Three-hundred and sixty-five men with testicular failure who underwent micro-dissection testicular sperm extraction were included in this study. We compared their outcomes with 40 men with testicular failure who used donor sperm for injections due to failed retrieval, and 146 men with obstructive azoospermia who underwent percutaneous sperm retrieval. The retrieval rate in testicular failure was 41.4%, and the results were lower than the obstructed azoospermia （100%; adjusted odds ratio： 0.033; 95% Ch 0.007-0.164; P 〈 0.001）. Live birth rates after sperm injections were lower in men with testicular failure （19.9%） compared with donor sperm （37.5%; adjusted OR： 0.377 （95% Ch 0.233-0.609, P 〈 0.001）） and obstructive azoospermia （34.2%; adjusted OR： 0.403 （95% CI： 0.241-0.676, P= 0.001）. Newborn parameters of infants conceived were not significantly different among the groups. We concluded that the chances of obtaining sperm on retrieval and achieving a live birth after intracytoplasmic sperm injection （ICSI） are reduced in men with testicular failure. The profile of infants conceived after sperm injection does not seem to be negatively affected by testicular failure.展开更多
Aim： To evaluate whether inhibin-B can predict the outcome of a microsurgical epidymal sperm aspiration （MESA） procedure in patients with suspected primary obstructive azoospermia （OA） and if inhibin-B can replac...Aim： To evaluate whether inhibin-B can predict the outcome of a microsurgical epidymal sperm aspiration （MESA） procedure in patients with suspected primary obstructive azoospermia （OA） and if inhibin-B can replace testicular biopsy in the diagnostic work-up of these patients. Methods： Inhibin-B levels and testicular biopsy scores were related to the outcome of MESA in 43 patients with suspected primary OA. MESA was considered to be successful when epididymal sperm could be identified during the procedure. Results： Spermatozoa were present in the epididymal aspirate in 28 out of the 43 patients （65%）. lnhibin-B values were not significantly different in patients with successful or unsuccessful MESA. The modified Johnsen score, however, was significantly lower in patients with unsuccessful MESA （P = 0.003）. A rete testis obstruction or epididymal malfunctioning was found in 15% of patients with suspected primary OA, reflected by unsuccessful MESA despite normal inhibin-B levels and normal testicular histology. Conclusion： Inhibin-B cannot replace testicular biopsy as a diagnostic tool in the work-up of patients with suspected primary OA. Testicular biopsy is useful in identifying patients with spermatogenic arrest, who might have normal inhibin-B values.展开更多
Azoospermia is of great importance to male infertility. Obstructive azoospermia （OA） due to infection is the most prevalent form of OA in China and has been less studied. We aim to observe the treatment outcome of m...Azoospermia is of great importance to male infertility. Obstructive azoospermia （OA） due to infection is the most prevalent form of OA in China and has been less studied. We aim to observe the treatment outcome of microsurgical vasoepididymostomy （VE） and also to identify the factors relative to the result after reconstructive surgery. Two hundred and eight men presenting with OA due to infection during the study period from July 2010 to July 2013 were prospectively evaluated. Clinical examination, semen analysis, serum follicle stimulating hormone （FSH）, and scrotal ultrasound were done before surgical exploration. Among the 198 men who were selected for surgical procedures, 159 candidates underwent microsurgical VE with sperm detected in the epididymal fluid. As for the other 39 cases, reconstruction was not feasible. The average age was 28.5 ＋ 3.9 years （range 22-38）, with average follow-up being 16.5 ~ 5.9 months （range 4-28）. According to the 150 cases being followed after VE procedures, the total patency rate was 72% （108/150）. During follow-up, 38.7% （58/150） natural pregnancies occurred, with overall live birth rate being 32.7% （49/150）. Our data suggested that microsurgical VE is an effective therapy for postinfectious epididymal OA. Individualized counseling with prognosis based on etiology should be offered to patients to select optical therapy.展开更多
To evaluate the clinical outcomes of loupe-assisted intussusception vasoepididymostomy(VE)in the treatment of epididymal obstructive azoospermia(EOA),we retrospectively analyzed data from 49 patients with EOA who unde...To evaluate the clinical outcomes of loupe-assisted intussusception vasoepididymostomy(VE)in the treatment of epididymal obstructive azoospermia(EOA),we retrospectively analyzed data from 49 patients with EOA who underwent two-suture longitudinal intussusception vasoepididymostomy(LIVE)between 2000 and 2007.The data included the surgical method,postoperative motile sperm count per ejaculation,percentage of progressive motile sperm and patency and pregnancy outcomes.There were a total of 49 men undergoing scrotal exploration,and epididymal obstruction was found in all cases.Bilateral or unilateral anastomoses were performed in 40 and 6 men,respectively.The postoperative courses of 42 patients were followed up for more than 6 months,and the courses of 38 patients were followed up for more than 1 year.The overall patency and pregnancy rates were 71.4%and 26.3%,respectively.Moreover,progressive motile sperm was more frequently present in those patients who had undergone anastomosis at cauda than at corpus or caput.Pregnancy was achieved only in those patients who had undergone anastomosis at least on one side of the cauda epididymis.We think that the loupe-assisted method,with a lower overall cost and a simplified surgical procedure,can achieve satisfactory patency outcomes and pregnancy results.Data from this paper also suggest that paternity outcomes occur more frequently after anastomoses at cauda than at corpus or caput.展开更多
Nonobstructive azoospermia(NOA)is characterized by the complete absence of sperm in the ejaculate due to testicular failure.The evaluation and management of patients with NOA offer a challenge to the reproductive urol...Nonobstructive azoospermia(NOA)is characterized by the complete absence of sperm in the ejaculate due to testicular failure.The evaluation and management of patients with NOA offer a challenge to the reproductive urologist.In the era of in vitro fertilization with intracytoplasmic sperm injection,surgical sperm extraction techniques can afford men with NOA biologic paternity.To provide a comprehensive review of surgical sperm retrieval approaches in the patient with NOA emphasizing complications,success rates and outcome optimization,a Medline search was conducted querying surgical approaches used to manage NOA.Four sperm extraction techniques are described including:testicular sperm aspiration,testicular sperm extraction,fine needle aspiration mapping and microdissection testicular sperm extraction.In addition,the roles for pre-extraction varicocelectomy and sperm cryopreservation are discussed.The management of NOA continues to evolve as newer tools become available.Several modalities of sperm acquisition exist.An understanding of their complications and success rates is fundamental to the treatment of NOA.展开更多
Patients with congenital unilateral absence of the vas deferens(CUAVD)manifest diverse symptoms from normospermia to azoospermia.Treatment for CUAVD patients with obstructive azoospermia(OA)is complicated,and there is...Patients with congenital unilateral absence of the vas deferens(CUAVD)manifest diverse symptoms from normospermia to azoospermia.Treatment for CUAVD patients with obstructive azoospermia(OA)is complicated,and there is a lack of relevant reports.In this study,we describe the clinical features and evaluate the treatments and outcomes of CUAVD patients with OA.From December 2015 to December 2020,33 patients were diagnosed as CUAVD with OA in Shanghai General Hospital(Shanghai,China).Patient information,ultrasound findings,semen analysis,hormone profiles,and treatment information were collected,and the clinical outcomes were evaluated.Of 33 patients,29 patients were retrospectively analyzed.Vasoepididymostomy(VE)or cross VE was performed in 12 patients,the patency rate was 41.7%(5/12),and natural pregnancy was achieved in one of the patients.The other 17 patients underwent testicular sperm extraction as the distal vas deferens(contralateral side)was obstructed.These findings showed that VE or cross VE remains an alternative treatment for CUAVD patients with OA,even with a relatively low rate of patency and natural pregnancy.展开更多
Objective: to investigate the effect of epididymal technique in the treatment of obstructive azoospermia. Methods: a total of 9 patients with epididymal obstructive azoospermia were received in our hospital from 2019 ...Objective: to investigate the effect of epididymal technique in the treatment of obstructive azoospermia. Methods: a total of 9 patients with epididymal obstructive azoospermia were received in our hospital from 2019 to 2021, and all patients received microscopic epididymal anastomosis for obstructive azoospermia. After the treatment, the actual treatment effect of these 9 patients was discussed. Results: in the nine cases of patients, seven patients after the treatment by semen analysis can be observed that sperm. At the same time, seven patients with sperm recovery is normal, and the remaining two patients have restored fertility function, microscopy epididymal tubular anastomosis for obstructive azoospermia treatment success rate of 77.8%. Conclusion: for the treatment of obstructive azoospermia, epididymal vasoanastomosis can have good results and effectively solve the condition.展开更多
Saad et al.'s review~([1]),“Emerging trends in the management of non-obstructive azoospermia,”offers a compelling synthesis of cutting-edge diagnostic and therapeutic strategies for non-obstructive azoospermia(N...Saad et al.'s review~([1]),“Emerging trends in the management of non-obstructive azoospermia,”offers a compelling synthesis of cutting-edge diagnostic and therapeutic strategies for non-obstructive azoospermia(NOA),a challenging condition affecting 10%–15%o infertile men.By highlighting advances in whole exome sequencing(WES),biomarkers like Anti-Müllerian hormone(AMH)and microRNAs(miRNAs),and microdissection testicular sperm extraction(micro-TESE),the authors chart a path toward precision medicine in male infertility.Their exploration of AI and gene-editing technologies like CRISPR/Cas9 underscores the transformative potential of these innovations.展开更多
Objective To report the experience in sperm extraction from testicular biopsies (TESE) performed from March 1996 to July 1998 in men with non obstructive azoospermia (NOA) Methods Comparisons of age, volume of ...Objective To report the experience in sperm extraction from testicular biopsies (TESE) performed from March 1996 to July 1998 in men with non obstructive azoospermia (NOA) Methods Comparisons of age, volume of both testes, serum FSH and testosterone in men, and histology of testicular samples in the first cycles between cycles with spermatozoa found and those without spermatozoa found were performed Comparisons of fertilization, cleavage and pregnancy rates between cycles with spermatozoa injected and those with spermatids injected were performed Results Spermatozoa were found in only 12 out of 26 first TESE cycles (46 2%) and other cycles had spermatids (round cells) only Age of men, history of mumps orchitis/oligozoospermia, volume of both testes and serum FSH/testosterone levels in men were not significantly different between cycles with and without spermatozoa The fertilization rate was significantly higher in cycles with spermatozoa injected than those with round cell injections (63 3% vs 23 2%, P <0 0001, Chi squared test) The pregnancy rate was 14 3% per cycle when spermatozoa were injected Conclusions TESE followed by Intracytoplasmic sperm injection (ICSI) is an effective treatment in patients with NOA Less than half of the patients undergoing TESE had spermatozoa recovered Age of men, volume of both testes and serum FSH/ testosterone levels in men were not useful in predicting successful recovery Compared to using ejaculated and epididymal spermatozoa, fertilization and pregnancy rates were achieved when testicular spermatozoa were used for ICSI展开更多
The extent of spermatogenic impairment on intracytoplasmic sperm injection(ICSI)outcomes and the risk of major birth defects have been little assessed.In this study,we evaluated the relationship between various sperma...The extent of spermatogenic impairment on intracytoplasmic sperm injection(ICSI)outcomes and the risk of major birth defects have been little assessed.In this study,we evaluated the relationship between various spermatogenic conditions,sperm origin on ICSI outcomes,and major birth defects.A total of 934 infertile men attending the Center for Reproductive Medicine of Ren Ji Hospital(Shanghai,China)were classified into six groups:nonobstructive azoospermia(NOA;n=84),extremely severe oligozoospermia(esOZ;n=163),severe oligozoospermia(sOZ,n=174),mild oligozoospermia(mOZ;n=148),obstructive azoospermia(OAZ;n=155),and normozoospermia(NZ;n=210).Rates of fertilization,embryo cleavage,high-quality embryos,implantation,biochemical and clinical pregnancies,abortion,delivery,newborns,as well as major birth malformations,and other newborn outcomes were analyzed and compared among groups.The NOA group showed a statistically lower fertilization rate(68.2%vs esOZ 77.3%,sOZ 78.0%,mOZ 73.8%,OAZ 76.6%,and NZ 79.3%,all P<0.05),but a significantly higher implantation rate(37.8%)than the groups esOZ(30.1%),sOZ(30.4%),mOZ(32.6%),and OAZ(31.0%)(all P<0.05),which was similar to that of Group NZ(38.4%).However,there were no statistically significant differences in rates of embryo cleavage,high-quality embryos,biochemical and clinical pregnancies,abortions,deliveries,major birth malformations,and other newborn outcomes in the six groups.The results showed that NOA only negatively affects some embryological outcomes such as fertilization rate.There was no evidence of differences in other embryological and clinical outcomes with respect to sperm source or spermatogenic status.Spermatogenic failure and sperm origins do not impinge on the clinical outcomes in ICSI treatment.展开更多
Objective:To demonstrate that serum follicle-stimulating hormone(FSH)in men rises with age,and to explore FSH reference intervals of age-related partitioning.Methods:Men aged 20-50 years(n=1190)underwent semen analysi...Objective:To demonstrate that serum follicle-stimulating hormone(FSH)in men rises with age,and to explore FSH reference intervals of age-related partitioning.Methods:Men aged 20-50 years(n=1190)underwent semen analysis according to World Health Organization(2010)methods.Serum was frozen prior to measurement of FSH by using the Siemens ADVIA Centaur®XP immunoassay system.FSH central 95%intervals after logarithmic transformation based on age were derived from 1037 normozoospermic men.These were then applied to oligozoospermic and azoospermic men.Men producing azoospermic semen samples were further classified as having non-obstructive azoospermia by clinical diagnostic criteria,including genetic analysis and surgical exploration.Results:Serum FSH in normozoospermic men increased with age(P<0.05),and reference intervals were determined with 10-year brackets:21-30 years[(1.0-8.2)IU/L],31-40 years[(1.4-9.5)IU/L],41-50 years[(1.9-12.0)IU/L].The proportion of oligozoospermic men with normal FSH concentrations was less than the normozoospermic men,which in turn was lower among azoospermic men(both P<0.01).The azoospermic men were further broken down according to the nature of the azoospermia as either obstructive or non-obstructive azoospermia,and 86.4%(38/44)men with non-obstructive azoospermia had elevated serum FSH concentrations whereas only 6.7%(1/15)men with obstructive azoospermia had high FSH levels,and this was significantly different(P<0.01).Conclusions:FSH concentrations increase in men between 20-50 years,and clinical interpretation of serum FSH results in men must be made by using age-based reference intervals.展开更多
Obstructive azoospermia secondary to epididymal obstruction can be corrected by microsurgical reconstruction with vasoepididymostomy （VE）. Although alternative management such as epididymal or testicular sperm aspir...Obstructive azoospermia secondary to epididymal obstruction can be corrected by microsurgical reconstruction with vasoepididymostomy （VE）. Although alternative management such as epididymal or testicular sperm aspiration in conjunction with intracytoplasmic sperm injection is feasible, various studies have established the superior cost-effectiveness of VE as a treatment of choice. Microsurgical VE is considered one of the most technically challenging microsurgeries. Its success rate is highly dependent on the skills and experience of the surgeons. Various techniques have been described in the literature for VE. We have pioneered a technique known as longitudinal intussusception VE （LIVE） in which the epididymal tubule is opened longitudinally to obtain a larger opening to allow its tubular content to pass through the anastomosis. Our preliminary data demonstrated a patency rate of over 90%. This technique has been widely referenced in the recent literature including robotic-assisted microsurgery. The history of the development of different VE approaches, the oreoDerative evaluation along with the techniaues of various VE will be described in this article.展开更多
This study is to evaluate the effectiveness of a modified single-armed suture technique for microsurgical vasoepididymostomy （VE） in patients with epididymal obstructive azoospermia. From September 2011 to December ...This study is to evaluate the effectiveness of a modified single-armed suture technique for microsurgical vasoepididymostomy （VE） in patients with epididymal obstructive azoospermia. From September 2011 to December 2011, microsurgical two-suture longitudinal intussusception VEs were performed using our modified single-armed suture technique in 17 men with epididymal obstructive azoospermia at our hospital. Two of these patients underwent repeated VEs after previous failed VEs, and one patient underwent unilateral VE because of an occlusion of the left abdominal vas deferens. The presence of sperm in the semen sample at 3 months postoperation was used as the preliminary endpoint of this study. Each patient provided at least one semen sample at the 3-month time point, and the patency was assessed by the reappearance of sperm （〉 104 m I- 1） in the semen. The mean operative time for the modified technique was 219 min. Patency was noted in 10 men （58.8%）, including one patient who underwent repeated VE. The patient who underwent unilateral anastomosis manifested no sperm postoperatively in his semen. Sperm granulomas were not detected in this cohort. The results of this study demonstrate that our modified technique for microsurgical longitudinal intussusception VE is effective. We believe that it is a practical alternative that may reduce operation time and obviate the suture crossing.展开更多
Vasoepididymostomy （VE）, as the most challenging procedure in microsurgeries, is often carried out with a double-armed two-suture technique. In this study, we evaluated the efficacy and safety of the single-armed tw...Vasoepididymostomy （VE）, as the most challenging procedure in microsurgeries, is often carried out with a double-armed two-suture technique. In this study, we evaluated the efficacy and safety of the single-armed two-suture VEs on humans and studied the factors that could possibly affect the patency rates. From July 2012 to July 2013, we reviewed 81 patients with consecutive primary epididymal obstruction who underwent single-armed two-suture longitudinal intussusception microsurgical VEs by a single surgeon, Kai Hong （KH）. At the same time, we analyzed seven factors that possibly related to the patency rates. With the single-armed technique, a total of 81 men underwent the microsurgical VEs. Data on 62 patients were completely recorded. 19 patients were lost to follow-up. Mean age was 31 years old. Mean follow-up time was 8.8 （2-17） months. The patency rate was 66.1% （41/62）. Natural pregnancy rate was 34.1% （14/41）. Overall pregnancy rate was 22.6% （14/62）. No severe surgical complications were noted. With logistic regression test analysis, there were two factors related to a higher patency rate： anastomosis sites （P = 0.035） and motile sperm found in the epididymal fluid （P = 0.006）. Motile sperm found in the epididymal fluid were associated with a higher patency rate （OR = 11.80, 95% CI = 1.79, 77.65）. The single-armed two-suture longitudinal VE technique is feasible for microsurgical practice. The patency and pregnancy rates are comparable to the doubled-armed technique. Anastomosis sites and motile sperm found in the epididymal fluid were the most two important factors related to higher patency.展开更多
<abstract>Aim: To manage male infertility with obstructive azoospermia by means of percutaneous epididymal sperm aspiration (PESA) and intrauterine insemination (IUI). Methods: Ninety azoospermic patients with c...<abstract>Aim: To manage male infertility with obstructive azoospermia by means of percutaneous epididymal sperm aspiration (PESA) and intrauterine insemination (IUI). Methods: Ninety azoospermic patients with congenital bilateral absence of the vas deferens (BAVD, n=58) or bilateral caudal epididymal obstruction (BCEO, n=32) requesting for fine needle aspiration (FNA), PESA and IUI were recruited. The obstruction was diagnosed by vasography and determination of the fructose, carnitine and alpha-glucosidase levels in the seminal fluid. Results: The mean sperm motility, density, abnormal sperm and total sperm count of the caput epdidymis were 16 %±22 %, (12±31) ×106/mL, 55 %±36 % and (16±14)×106, respectively. In the 90 couples, a total of 74 PESA procedures and 66 cycles of IUI were performed. Three pregnancies resulted, including one twin pregnancy giving birth to two healthy boys, one single pregnancy with a healthy girl and another single pregnancy aborted at week 6 of conception. The pregnancy rate per IUI cycle was 4.5 %. Conclusion: The birth of normal, healthy infants by IUI using PESA indicates that the caput epididymal sperm possess fertilization capacity. The PESA-IUI programme is a practical and economical procedure for the management of patients with obstructive azoospermia.展开更多
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 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supported by the grants from the 973 program(2011CB944304 and 2015CB943003)
文摘Non-obstructive azoospermia （NOA） is a severe defect in male reproductive health that occurs in 1% of adult men. In a previous study, we identified that rs7099208 is located within the last intron of FAM160B1 at 10q25.3. In this study, we analysed expression Quantitative Trait Loci （eQTL） of FAM16OB1, ABLIM1 and TRUB1, the three genes surrounding rs7099208. Only the expression level of FAM16OB1 was reduced for the homozygous alternate genotype （GG） of rs7099208, but not for the homozygous reference or heterozygous geno- types. FAM160B1 is predominantly expressed in human testes, where it is found in spermatocytes and round sper- matids. From 17 patients with NOA and five with obstructive azoospermia （OA）, immunohistochemistry revealed that expression of FAM160B1 is reduced, or undetectable in NOA patients, but not in OA cases or normal men. We conclude that rs7099208 is associated with NOA via a reduction in the expression of FAM160B1.
文摘We assessed the rates of sperm retrieval and intracytoplasmic sperm injection outcomes, including the neonatal profile of infants conceived, in men with testicular failure. Three-hundred and sixty-five men with testicular failure who underwent micro-dissection testicular sperm extraction were included in this study. We compared their outcomes with 40 men with testicular failure who used donor sperm for injections due to failed retrieval, and 146 men with obstructive azoospermia who underwent percutaneous sperm retrieval. The retrieval rate in testicular failure was 41.4%, and the results were lower than the obstructed azoospermia （100%; adjusted odds ratio： 0.033; 95% Ch 0.007-0.164; P 〈 0.001）. Live birth rates after sperm injections were lower in men with testicular failure （19.9%） compared with donor sperm （37.5%; adjusted OR： 0.377 （95% Ch 0.233-0.609, P 〈 0.001）） and obstructive azoospermia （34.2%; adjusted OR： 0.403 （95% CI： 0.241-0.676, P= 0.001）. Newborn parameters of infants conceived were not significantly different among the groups. We concluded that the chances of obtaining sperm on retrieval and achieving a live birth after intracytoplasmic sperm injection （ICSI） are reduced in men with testicular failure. The profile of infants conceived after sperm injection does not seem to be negatively affected by testicular failure.
文摘Aim： To evaluate whether inhibin-B can predict the outcome of a microsurgical epidymal sperm aspiration （MESA） procedure in patients with suspected primary obstructive azoospermia （OA） and if inhibin-B can replace testicular biopsy in the diagnostic work-up of these patients. Methods： Inhibin-B levels and testicular biopsy scores were related to the outcome of MESA in 43 patients with suspected primary OA. MESA was considered to be successful when epididymal sperm could be identified during the procedure. Results： Spermatozoa were present in the epididymal aspirate in 28 out of the 43 patients （65%）. lnhibin-B values were not significantly different in patients with successful or unsuccessful MESA. The modified Johnsen score, however, was significantly lower in patients with unsuccessful MESA （P = 0.003）. A rete testis obstruction or epididymal malfunctioning was found in 15% of patients with suspected primary OA, reflected by unsuccessful MESA despite normal inhibin-B levels and normal testicular histology. Conclusion： Inhibin-B cannot replace testicular biopsy as a diagnostic tool in the work-up of patients with suspected primary OA. Testicular biopsy is useful in identifying patients with spermatogenic arrest, who might have normal inhibin-B values.
文摘Azoospermia is of great importance to male infertility. Obstructive azoospermia （OA） due to infection is the most prevalent form of OA in China and has been less studied. We aim to observe the treatment outcome of microsurgical vasoepididymostomy （VE） and also to identify the factors relative to the result after reconstructive surgery. Two hundred and eight men presenting with OA due to infection during the study period from July 2010 to July 2013 were prospectively evaluated. Clinical examination, semen analysis, serum follicle stimulating hormone （FSH）, and scrotal ultrasound were done before surgical exploration. Among the 198 men who were selected for surgical procedures, 159 candidates underwent microsurgical VE with sperm detected in the epididymal fluid. As for the other 39 cases, reconstruction was not feasible. The average age was 28.5 ＋ 3.9 years （range 22-38）, with average follow-up being 16.5 ~ 5.9 months （range 4-28）. According to the 150 cases being followed after VE procedures, the total patency rate was 72% （108/150）. During follow-up, 38.7% （58/150） natural pregnancies occurred, with overall live birth rate being 32.7% （49/150）. Our data suggested that microsurgical VE is an effective therapy for postinfectious epididymal OA. Individualized counseling with prognosis based on etiology should be offered to patients to select optical therapy.
文摘To evaluate the clinical outcomes of loupe-assisted intussusception vasoepididymostomy(VE)in the treatment of epididymal obstructive azoospermia(EOA),we retrospectively analyzed data from 49 patients with EOA who underwent two-suture longitudinal intussusception vasoepididymostomy(LIVE)between 2000 and 2007.The data included the surgical method,postoperative motile sperm count per ejaculation,percentage of progressive motile sperm and patency and pregnancy outcomes.There were a total of 49 men undergoing scrotal exploration,and epididymal obstruction was found in all cases.Bilateral or unilateral anastomoses were performed in 40 and 6 men,respectively.The postoperative courses of 42 patients were followed up for more than 6 months,and the courses of 38 patients were followed up for more than 1 year.The overall patency and pregnancy rates were 71.4%and 26.3%,respectively.Moreover,progressive motile sperm was more frequently present in those patients who had undergone anastomosis at cauda than at corpus or caput.Pregnancy was achieved only in those patients who had undergone anastomosis at least on one side of the cauda epididymis.We think that the loupe-assisted method,with a lower overall cost and a simplified surgical procedure,can achieve satisfactory patency outcomes and pregnancy results.Data from this paper also suggest that paternity outcomes occur more frequently after anastomoses at cauda than at corpus or caput.
文摘Nonobstructive azoospermia(NOA)is characterized by the complete absence of sperm in the ejaculate due to testicular failure.The evaluation and management of patients with NOA offer a challenge to the reproductive urologist.In the era of in vitro fertilization with intracytoplasmic sperm injection,surgical sperm extraction techniques can afford men with NOA biologic paternity.To provide a comprehensive review of surgical sperm retrieval approaches in the patient with NOA emphasizing complications,success rates and outcome optimization,a Medline search was conducted querying surgical approaches used to manage NOA.Four sperm extraction techniques are described including:testicular sperm aspiration,testicular sperm extraction,fine needle aspiration mapping and microdissection testicular sperm extraction.In addition,the roles for pre-extraction varicocelectomy and sperm cryopreservation are discussed.The management of NOA continues to evolve as newer tools become available.Several modalities of sperm acquisition exist.An understanding of their complications and success rates is fundamental to the treatment of NOA.
基金supported by grants from the Shanghai Science and Technology Innovation Action Plan Project (20Y11907600)National Natural Science Foundation of China (82001530)+1 种基金Shanghai Key Laboratory of Molecular Andrology (SLMA-014)Strategic Priority Research Program of the Chinese Academy of Sciences (XDA16020701).
文摘Patients with congenital unilateral absence of the vas deferens(CUAVD)manifest diverse symptoms from normospermia to azoospermia.Treatment for CUAVD patients with obstructive azoospermia(OA)is complicated,and there is a lack of relevant reports.In this study,we describe the clinical features and evaluate the treatments and outcomes of CUAVD patients with OA.From December 2015 to December 2020,33 patients were diagnosed as CUAVD with OA in Shanghai General Hospital(Shanghai,China).Patient information,ultrasound findings,semen analysis,hormone profiles,and treatment information were collected,and the clinical outcomes were evaluated.Of 33 patients,29 patients were retrospectively analyzed.Vasoepididymostomy(VE)or cross VE was performed in 12 patients,the patency rate was 41.7%(5/12),and natural pregnancy was achieved in one of the patients.The other 17 patients underwent testicular sperm extraction as the distal vas deferens(contralateral side)was obstructed.These findings showed that VE or cross VE remains an alternative treatment for CUAVD patients with OA,even with a relatively low rate of patency and natural pregnancy.
文摘Objective: to investigate the effect of epididymal technique in the treatment of obstructive azoospermia. Methods: a total of 9 patients with epididymal obstructive azoospermia were received in our hospital from 2019 to 2021, and all patients received microscopic epididymal anastomosis for obstructive azoospermia. After the treatment, the actual treatment effect of these 9 patients was discussed. Results: in the nine cases of patients, seven patients after the treatment by semen analysis can be observed that sperm. At the same time, seven patients with sperm recovery is normal, and the remaining two patients have restored fertility function, microscopy epididymal tubular anastomosis for obstructive azoospermia treatment success rate of 77.8%. Conclusion: for the treatment of obstructive azoospermia, epididymal vasoanastomosis can have good results and effectively solve the condition.
文摘Saad et al.'s review~([1]),“Emerging trends in the management of non-obstructive azoospermia,”offers a compelling synthesis of cutting-edge diagnostic and therapeutic strategies for non-obstructive azoospermia(NOA),a challenging condition affecting 10%–15%o infertile men.By highlighting advances in whole exome sequencing(WES),biomarkers like Anti-Müllerian hormone(AMH)and microRNAs(miRNAs),and microdissection testicular sperm extraction(micro-TESE),the authors chart a path toward precision medicine in male infertility.Their exploration of AI and gene-editing technologies like CRISPR/Cas9 underscores the transformative potential of these innovations.
文摘Objective To report the experience in sperm extraction from testicular biopsies (TESE) performed from March 1996 to July 1998 in men with non obstructive azoospermia (NOA) Methods Comparisons of age, volume of both testes, serum FSH and testosterone in men, and histology of testicular samples in the first cycles between cycles with spermatozoa found and those without spermatozoa found were performed Comparisons of fertilization, cleavage and pregnancy rates between cycles with spermatozoa injected and those with spermatids injected were performed Results Spermatozoa were found in only 12 out of 26 first TESE cycles (46 2%) and other cycles had spermatids (round cells) only Age of men, history of mumps orchitis/oligozoospermia, volume of both testes and serum FSH/testosterone levels in men were not significantly different between cycles with and without spermatozoa The fertilization rate was significantly higher in cycles with spermatozoa injected than those with round cell injections (63 3% vs 23 2%, P <0 0001, Chi squared test) The pregnancy rate was 14 3% per cycle when spermatozoa were injected Conclusions TESE followed by Intracytoplasmic sperm injection (ICSI) is an effective treatment in patients with NOA Less than half of the patients undergoing TESE had spermatozoa recovered Age of men, volume of both testes and serum FSH/ testosterone levels in men were not useful in predicting successful recovery Compared to using ejaculated and epididymal spermatozoa, fertilization and pregnancy rates were achieved when testicular spermatozoa were used for ICSI
基金supported by the National Natural Science Foundation of China(Grant No.81671511 to PP,No.81871199,No.81501310 to YM).
文摘The extent of spermatogenic impairment on intracytoplasmic sperm injection(ICSI)outcomes and the risk of major birth defects have been little assessed.In this study,we evaluated the relationship between various spermatogenic conditions,sperm origin on ICSI outcomes,and major birth defects.A total of 934 infertile men attending the Center for Reproductive Medicine of Ren Ji Hospital(Shanghai,China)were classified into six groups:nonobstructive azoospermia(NOA;n=84),extremely severe oligozoospermia(esOZ;n=163),severe oligozoospermia(sOZ,n=174),mild oligozoospermia(mOZ;n=148),obstructive azoospermia(OAZ;n=155),and normozoospermia(NZ;n=210).Rates of fertilization,embryo cleavage,high-quality embryos,implantation,biochemical and clinical pregnancies,abortion,delivery,newborns,as well as major birth malformations,and other newborn outcomes were analyzed and compared among groups.The NOA group showed a statistically lower fertilization rate(68.2%vs esOZ 77.3%,sOZ 78.0%,mOZ 73.8%,OAZ 76.6%,and NZ 79.3%,all P<0.05),but a significantly higher implantation rate(37.8%)than the groups esOZ(30.1%),sOZ(30.4%),mOZ(32.6%),and OAZ(31.0%)(all P<0.05),which was similar to that of Group NZ(38.4%).However,there were no statistically significant differences in rates of embryo cleavage,high-quality embryos,biochemical and clinical pregnancies,abortions,deliveries,major birth malformations,and other newborn outcomes in the six groups.The results showed that NOA only negatively affects some embryological outcomes such as fertilization rate.There was no evidence of differences in other embryological and clinical outcomes with respect to sperm source or spermatogenic status.Spermatogenic failure and sperm origins do not impinge on the clinical outcomes in ICSI treatment.
文摘Objective:To demonstrate that serum follicle-stimulating hormone(FSH)in men rises with age,and to explore FSH reference intervals of age-related partitioning.Methods:Men aged 20-50 years(n=1190)underwent semen analysis according to World Health Organization(2010)methods.Serum was frozen prior to measurement of FSH by using the Siemens ADVIA Centaur®XP immunoassay system.FSH central 95%intervals after logarithmic transformation based on age were derived from 1037 normozoospermic men.These were then applied to oligozoospermic and azoospermic men.Men producing azoospermic semen samples were further classified as having non-obstructive azoospermia by clinical diagnostic criteria,including genetic analysis and surgical exploration.Results:Serum FSH in normozoospermic men increased with age(P<0.05),and reference intervals were determined with 10-year brackets:21-30 years[(1.0-8.2)IU/L],31-40 years[(1.4-9.5)IU/L],41-50 years[(1.9-12.0)IU/L].The proportion of oligozoospermic men with normal FSH concentrations was less than the normozoospermic men,which in turn was lower among azoospermic men(both P<0.01).The azoospermic men were further broken down according to the nature of the azoospermia as either obstructive or non-obstructive azoospermia,and 86.4%(38/44)men with non-obstructive azoospermia had elevated serum FSH concentrations whereas only 6.7%(1/15)men with obstructive azoospermia had high FSH levels,and this was significantly different(P<0.01).Conclusions:FSH concentrations increase in men between 20-50 years,and clinical interpretation of serum FSH results in men must be made by using age-based reference intervals.
文摘Obstructive azoospermia secondary to epididymal obstruction can be corrected by microsurgical reconstruction with vasoepididymostomy （VE）. Although alternative management such as epididymal or testicular sperm aspiration in conjunction with intracytoplasmic sperm injection is feasible, various studies have established the superior cost-effectiveness of VE as a treatment of choice. Microsurgical VE is considered one of the most technically challenging microsurgeries. Its success rate is highly dependent on the skills and experience of the surgeons. Various techniques have been described in the literature for VE. We have pioneered a technique known as longitudinal intussusception VE （LIVE） in which the epididymal tubule is opened longitudinally to obtain a larger opening to allow its tubular content to pass through the anastomosis. Our preliminary data demonstrated a patency rate of over 90%. This technique has been widely referenced in the recent literature including robotic-assisted microsurgery. The history of the development of different VE approaches, the oreoDerative evaluation along with the techniaues of various VE will be described in this article.
文摘This study is to evaluate the effectiveness of a modified single-armed suture technique for microsurgical vasoepididymostomy （VE） in patients with epididymal obstructive azoospermia. From September 2011 to December 2011, microsurgical two-suture longitudinal intussusception VEs were performed using our modified single-armed suture technique in 17 men with epididymal obstructive azoospermia at our hospital. Two of these patients underwent repeated VEs after previous failed VEs, and one patient underwent unilateral VE because of an occlusion of the left abdominal vas deferens. The presence of sperm in the semen sample at 3 months postoperation was used as the preliminary endpoint of this study. Each patient provided at least one semen sample at the 3-month time point, and the patency was assessed by the reappearance of sperm （〉 104 m I- 1） in the semen. The mean operative time for the modified technique was 219 min. Patency was noted in 10 men （58.8%）, including one patient who underwent repeated VE. The patient who underwent unilateral anastomosis manifested no sperm postoperatively in his semen. Sperm granulomas were not detected in this cohort. The results of this study demonstrate that our modified technique for microsurgical longitudinal intussusception VE is effective. We believe that it is a practical alternative that may reduce operation time and obviate the suture crossing.
文摘Vasoepididymostomy （VE）, as the most challenging procedure in microsurgeries, is often carried out with a double-armed two-suture technique. In this study, we evaluated the efficacy and safety of the single-armed two-suture VEs on humans and studied the factors that could possibly affect the patency rates. From July 2012 to July 2013, we reviewed 81 patients with consecutive primary epididymal obstruction who underwent single-armed two-suture longitudinal intussusception microsurgical VEs by a single surgeon, Kai Hong （KH）. At the same time, we analyzed seven factors that possibly related to the patency rates. With the single-armed technique, a total of 81 men underwent the microsurgical VEs. Data on 62 patients were completely recorded. 19 patients were lost to follow-up. Mean age was 31 years old. Mean follow-up time was 8.8 （2-17） months. The patency rate was 66.1% （41/62）. Natural pregnancy rate was 34.1% （14/41）. Overall pregnancy rate was 22.6% （14/62）. No severe surgical complications were noted. With logistic regression test analysis, there were two factors related to a higher patency rate： anastomosis sites （P = 0.035） and motile sperm found in the epididymal fluid （P = 0.006）. Motile sperm found in the epididymal fluid were associated with a higher patency rate （OR = 11.80, 95% CI = 1.79, 77.65）. The single-armed two-suture longitudinal VE technique is feasible for microsurgical practice. The patency and pregnancy rates are comparable to the doubled-armed technique. Anastomosis sites and motile sperm found in the epididymal fluid were the most two important factors related to higher patency.
文摘<abstract>Aim: To manage male infertility with obstructive azoospermia by means of percutaneous epididymal sperm aspiration (PESA) and intrauterine insemination (IUI). Methods: Ninety azoospermic patients with congenital bilateral absence of the vas deferens (BAVD, n=58) or bilateral caudal epididymal obstruction (BCEO, n=32) requesting for fine needle aspiration (FNA), PESA and IUI were recruited. The obstruction was diagnosed by vasography and determination of the fructose, carnitine and alpha-glucosidase levels in the seminal fluid. Results: The mean sperm motility, density, abnormal sperm and total sperm count of the caput epdidymis were 16 %±22 %, (12±31) ×106/mL, 55 %±36 % and (16±14)×106, respectively. In the 90 couples, a total of 74 PESA procedures and 66 cycles of IUI were performed. Three pregnancies resulted, including one twin pregnancy giving birth to two healthy boys, one single pregnancy with a healthy girl and another single pregnancy aborted at week 6 of conception. The pregnancy rate per IUI cycle was 4.5 %. Conclusion: The birth of normal, healthy infants by IUI using PESA indicates that the caput epididymal sperm possess fertilization capacity. The PESA-IUI programme is a practical and economical procedure for the management of patients with obstructive azoospermia.
