Can serum 17-hydroxy progesterone predict an improvement in semen parameters following micro-varicocelectomy? A prospective study.

BACKGROUND & OBJECTIVES: Notably, 17-hydroxy progesterone (17-OHP) (17-OHP) is a precursor for testosterone (T) synthesis, and intratesticular testosterone (ITT) is essential for spermatogenesis. Varicocele (Vx) has an estimated prevalence of 15% in the general population and 35% in those with primary infertility. We aimed to evaluate the correlation between changes of serum 17-OHP after sub-inguinal micro-varicocelectomy and improvement of semen parameters. PATIENTS AND METHODS: The current prospective study included 45 infertile men attending the andrology clinic form February 2021 to August 2021. Two semen analyses and hormonal profile were evaluated. Colored duplex ultasonography (CDUS) was done in standing and supine position for accurate measurements of testicular volumes and confirmation of Vx. Patients underwent sub-inguinal micro-varicocelectomy using a surgical microscope HB surgitech. We followed them prospectively up for three months following micro-varicocelectomy with serum TT and 17-OHP. RESULTS: Sperm concentration improved significantly from 8.36 ± 5.04 million/ml to 12.52 ± 8.42 million/ml after 3 months following sub-inguinal micro-varicocelectomy (p= 0.001), with normalization of concentration in 15/45 (33%) patients. Total motility did not improve significantly but progressive motility improved significantly from 8.62 ± 8.74% to 16.24 ± 14.45% (p=0.001). Abnormal forms significantly declined from 96.67 ± 2.03% to 95.75 ± 2.47% (p=0.009).  Serum 17 OHP and 17 OHP/total testosterone (TT) improved significantly from 1.21 ± 0.45 ng/ml and 0.26 ± 0.09 to 1.42 ± 0.76 ng/ml and 0.3 ± 0.16 (p= 0.013, p= 0.004), respectively, while serum TT did not improve significantly. A significant correlation was found between improvement in sperm concentration and both serum 17 OHP and 17 OHP/TT ratio (p=0.001, p=004). Furthermore, change in abnormal sperm forms showed significant correlations with changes in both 17-OHP and 17-OHP/TT. CONCLUSION: 17 OHP and 17OHP/ TT ratio can be used as biomarkers to detect improvement in semen parameters following sub-inguinal micro-varicocelectomy.

Evaluation of daily supplementation of fertitonex on different semen parameters in idiopathic male infertility: a randomized double blind placebo controlled cross over study.

PURPOSE: The study aimed to evaluate the effect of fertitonex containing L-carnitine L-tartrate together with other micronutrients on different semen parameters in idiopathic male infertility as well as male reproductive hormones. METHODS: 100 randomized infertile patients were recruited from July 2023 to February 2024. They were randomized into two groups. Group (A) received fertitonex twice daily for the first 3 months. Group (B) received placebo twice daily for the first 3 months. Crossover was done after 1 month wash-out period for additional 3 months. RESULTS: Group (A) who started fertitonex first showed significant improvement in sperms concentration and motility and progressive motility as well as significant reduction in abnormal forms after 3 months from beginning the study (p < 0.001, p < 0.001, p < 0.001, p < 0.001, respectively). Interestingly, these improvements continued for additional 3 months after placebo intake (p < 0.001, p 0.005, p < 0.001, p < 0.001, respectively). Group (B) who started placebo first showed significant improvement in sperms concentration and motility and progressive motility as well as significant reduction in abnormal forms after 6 months from beginning the study (p < 0.001, p < 0.001, p < 0.001, p < 0.001, respectively). LH level was significantly higher among group (A) compared to group (B) at baseline and 3 months and 6 months (p value 0.02, 0.032. 0.024, respectively). CONCLUSION: We finally concluded that fertitonex is an effective, tolerable and safe drug that can be used for treating idiopathic male infertility.

Role of penile rehabilitation through daily intake of 5 mg tadalafil on erectile dysfunction after different presentations of penile fracture: a prospective case-control study.

PURPOSE: We aimed in the current study to identify the predictive factors of ED occurrence in healthy individuals following penile fracture surgical repair as well as the effect of penile rehabilitation in the form of daily tadalafil 5 mg intake for 1 month for patients who suffered from ED after penile fracture incident. METHOD: The current study was a prospective case-control study. Twenty-five patients were enrolled into the study starting from January (2022) to February (2023). Furthermore, time of presentation was determined, and length of tear intra-operative was measured, and then, a follow-up 1 week postoperatively in the outpatient clinic was conducted. All patients were instructed to start intercourse at least 2 weeks after the first visit provided that the wound epithelialized. Potent patients returned back home. A rehabilitation course of daily tadalafil 5 mg for 1 month was prescribed for patients who started complaining of ED that was confirmed by evaluation with the Arabic validated version of the international index of erectile function (ArIIEF-5). The rehabilitation therapy was terminated by resumption of normal erectile function. Thus, re-evaluation with the ArIIEF-5 was determined according to their response to therapy. Also, the patients were evaluated by hospital anxiety and depression scale (HADS) before and after penile fracture repair. RESULTS: The current study had demonstrated that a 1% increase in age determines an increase in odds ratio for post-penile fracture ED with 73.6% and 1 cm increase in the length of tear determines an increase in odds ratio for post-penile fracture ED with 20.04 times. CONCLUSION: The current study enhances the proper counseling of these patients prior to repairing the defect about the probability of ED occurrence as well as initiating early penile rehabilitation to help these patients resuming their normal sexual activity as soon as possible.