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1.
Panminerva Med ; 61(2): 152-163, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30990285

RESUMO

Varicoceles exert deleterious effect on testicular function. The condition has been associated with male infertility, testicular hypotrophy and pain. These comprises the common indications for varicocele repair currently. Significant improvement in semen parameters and pregnancy outcomes had been suggested by reports decades ago. However, selection of the best candidates remains an issue since not all patients respond positively to treatment. Consensus has been reached in recent decade after the publication of a series of meta-analyses. Significant improvement in pregnancy outcomes were reported in patients with clinical varicocele and abnormal semen parameters. Varicocelectomy in adolescents with testicular hypotrophy was supported by the positive implication on catch-up growth and semen parameters. However, little is known about the treatment effect of adolescence varicocelectomy on long term fertility and paternity rate. Recent studies on outcome of varicocele repair for pain consistently demonstrated a resolution rate of approximately 90% and support varicocele-associated pain as an indication for surgery. Alternate indications for varicocele repair have been proposed in recent decade. Despite the encouraging preliminary data, most studies were uncontrolled retrospective series. Although varicocelectomy may not obviate the need for assisted reproductive techniques in patients with non-obstructive azoospermia, it potentially increases sperm retrieval rate. The significant increase in serum testosterone after varicocelectomy in patients with androgen deficiency may open an alternative treatment for hypogonadism. The adjunctive role of varicocelectomy before assisted reproduction and the significant decrease in sperm DNA fragmentation after varicocele repair deserve further well-designed controlled studies.


Assuntos
Varicocele/cirurgia , Adolescente , Androgênios/deficiência , Azoospermia/complicações , Fragmentação do DNA , Humanos , Infertilidade Masculina/etiologia , Infertilidade Masculina/cirurgia , Masculino , Estresse Oxidativo , Técnicas de Reprodução Assistida , Testículo/patologia , Procedimentos Cirúrgicos Urogenitais , Varicocele/fisiopatologia
2.
Fertil Steril ; 111(3): 420-426, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30827516

RESUMO

Infertility due to nonobstructive azoospermia is treatable with the use of testicular sperm extraction and IVF. The optimal approach for sperm retrieval is microdissection testicular sperm extraction (mTESE). This systematic review summarizes and evaluates the literature pertaining to patient optimization before mTESE, mTESE technique, and post-mTESE testicular tissue processing. Preoperative patient optimization has been assessed in terms of adjuvant hormone therapy and varicocele repair. Limited data are available for adjuvant medical therapy, and although also limited, data for varicocele repair support increased sperm retrieval, pregnancy, and return of sperm to the ejaculate. Post-mTESE tissue processing has few comparative studies; however, most studies support the combination of mechanical mincing and use of type 4 collagenase for tissue disintegration along with pentoxifylline to assist in identifying motile and viable spermatozoa for intracytoplasmic sperm injection.


Assuntos
Azoospermia/cirurgia , Infertilidade Masculina/cirurgia , Microdissecção , Recuperação Espermática , Espermatogênese , Testículo/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Azoospermia/complicações , Azoospermia/diagnóstico , Azoospermia/fisiopatologia , Fertilidade , Humanos , Infertilidade Masculina/diagnóstico , Infertilidade Masculina/etiologia , Infertilidade Masculina/fisiopatologia , Masculino , Microdissecção/efeitos adversos , Fatores de Risco , Injeções de Esperma Intracitoplásmicas , Recuperação Espermática/efeitos adversos , Testículo/fisiopatologia , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos
3.
Fertil Steril ; 111(3): 427-443, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30827517

RESUMO

Ejaculatory duct obstruction is an uncommon but surgically correctable cause of male infertility. With the advent and increased use of high-resolution transrectal ultrasonography, anomalies of the ejaculatory ducts related to infertility have been well documented. Although there are no pathognomonic findings associated with ejaculatory duct obstruction, the diagnosis should be suspected in an infertile male with oligospermia or azoospermia with low ejaculate volume, normal secondary sex characteristics, testes, and hormonal profile, and dilated seminal vesicles, midline cyst, or calcifications on transrectal ultrasound (TRUS). Although additional larger prospective and comparative studies are needed, it appears that TRUS with aspiration is the most effective method for diagnosis. While intrusive, it is less invasive than vasography. The most robust and published evidence for treatment involves transurethral resection of ejaculatory duct (TURED). More recent experience with antegrade endoscopic approaches are promising and may also be considered. An alternative to surgeries for reversal of obstruction is sperm retrieval for in vitro fertilization/intracytoplasmic sperm injection. A thorough discussion of all alternatives, including risks and benefits, should be held with couples facing this uncommon condition to allow them to make informed decisions regarding management.


Assuntos
Azoospermia/cirurgia , Ductos Ejaculatórios/cirurgia , Endoscopia , Infertilidade Masculina/cirurgia , Recuperação Espermática , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Azoospermia/complicações , Azoospermia/diagnóstico por imagem , Azoospermia/fisiopatologia , Ductos Ejaculatórios/diagnóstico por imagem , Ductos Ejaculatórios/fisiopatologia , Endoscopia/efeitos adversos , Fertilidade , Humanos , Infertilidade Masculina/diagnóstico , Infertilidade Masculina/etiologia , Infertilidade Masculina/fisiopatologia , Masculino , Fatores de Risco , Injeções de Esperma Intracitoplásmicas , Recuperação Espermática/efeitos adversos , Resultado do Tratamento , Ultrassonografia de Intervenção , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos
4.
Int Urol Nephrol ; 51(3): 401-408, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30701399

RESUMO

PURPOSE: We studied prospectively the role of FSH, testis volume, age, duration of infertility, hormonal therapy, varicocelectomy and testicular histopathology in determining the sperm retrieval rate (SRR) in fresh versus salvage micro-TESE. METHODS: Our study analysed retrospectively the prospectively maintained database of 330 NOA patients who underwent micro-TESE either 1st or 2nd or 3rd timers from January 2017 to August 2018 from the Andrology Clinic of a specialized IVF centre. They were divided equally into 3 groups, group (1) were 1st timers, group (2) were 2nd timers and group (3) were 3rd timers, respectively. RESULTS: Interestingly, our study demonstrated a positive correlation between high FSH level and favourable micro-TESE outcome in 1st timers who underwent micro-TESE (p 0.015). Additionally, our study revealed a positive correlation between age and favourable micro-TESE outcome in 2nd timers who underwent micro-TESE (p 0.031). Further, our study revealed a positive correlation between right testicular volume and favourable micro-TESE outcome in 1st timers who underwent micro-TESE (p 0.023). Eventually, there was a significant positive correlation between histopathology which was mainly sertoli cell only syndrome and favourable micro-TESE outcome in 1st timers micro-TESE (p 0.001). CONCLUSION: Our study demonstrates that sperms can be retrieved despite high FSH level, and preoperative histopathology is not essential in predicting SRR in NOA patients. Further, age can be considered a good prognostic factor in patients who undergo salvage micro-TESE for the 2nd time.


Assuntos
Hormônio Foliculoestimulante/sangue , Infertilidade Masculina/terapia , Recuperação Espermática , Testículo/patologia , Adulto , Fatores Etários , Azoospermia/sangue , Azoospermia/complicações , Hormônios/uso terapêutico , Humanos , Infertilidade Masculina/sangue , Infertilidade Masculina/etiologia , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Estudos Retrospectivos , Terapia de Salvação , Varicocele/cirurgia
6.
Genet Med ; 21(1): 189-194, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-29904161

RESUMO

PURPOSE: In about 10% of patients affected by Fanconi anemia (FA) the diagnosis is delayed until adulthood, and the presenting symptom in these "occult" FA cases is often a solid cancer and cancer treatment-related toxicity. Highly predictive clinical parameter(s) for diagnosing such an adult-onset cases are missing. METHODS: (1) Exome sequencing (ES), (2) Sanger sequencing of FANCA, (3) diepoxybutane (DEB)-induced chromosome breakage test. RESULTS: ES identified a pathogenic homozygous FANCA variant in a patient affected by Sertoli cell-only syndrome (SCOS) and in his azoospermic brother. Although they had no overt anemia, chromosomal breakage test revealed a reverse somatic mosaicism in the former and a typical FA picture in the latter. In 27 selected SCOS cases, 1 additional patient showing compound heterozygous pathogenic FANCA variants was identified with positive chromosomal breakage test. CONCLUSION: We report an extraordinarily high frequency of FA in a specific subgroup of azoospermic patients (7.1%). The screening for FANCA pathogenic variants in such patients has the potential to identify undiagnosed FA before the appearance of other severe clinical manifestations of the disease. The definition of this high-risk group for "occult" FA, based on specific testis phenotype with mild/borderline hematological alterations, is of unforeseen clinical relevance.


Assuntos
Azoospermia/genética , Proteína do Grupo de Complementação A da Anemia de Fanconi/genética , Anemia de Fanconi/genética , Síndrome de Células de Sertoli/genética , Adulto , Idade de Início , Azoospermia/sangue , Azoospermia/complicações , Azoospermia/patologia , Quebra Cromossômica , Exoma/genética , Anemia de Fanconi/sangue , Anemia de Fanconi/diagnóstico , Anemia de Fanconi/patologia , Feminino , Regulação da Expressão Gênica/genética , Humanos , Masculino , Mutação , Linhagem , Fenótipo , Síndrome de Células de Sertoli/sangue , Síndrome de Células de Sertoli/complicações , Síndrome de Células de Sertoli/patologia , Testículo/metabolismo , Testículo/patologia , Sequenciamento Completo do Exoma
8.
Andrologia ; 50(10): e13136, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30159913

RESUMO

The reported sperm retrieval rate (SRR) in patients with nonobstructive azoospermia (NOA) due to spermatogenic arrest (SA) is highly variable in the literature. This discrepancy could be explained by the heterogeneity of testicular tissues. Surprisingly, even though inhibin B levels reflect directly Sertoli cell function; no studies have evaluated this parameter in SA. We aimed to clarify the morphological and biological profile in 158 men with SA. From the total population, patients whose seminiferous tubules diameter was below 165 µm have higher SRR (46.9% vs. 27.4%, p < 0.05), lower inhibin levels and a higher frequency of nonuniform SA (71.9% vs. 38.7%, p < 0.001). On multivariate analysis, patients with late SA and a history of cryptorchidism were positively associated with successful sperm extraction. Patients with successful SRR and uniform SA exhibited inhibin levels twofold lower than those with failed TESE (45 pg/ml vs. 95 pg/ml, p < 0.05), whereas FSH levels were similar in the two groups. In this study, we showed for the first time that the mean diameter of the seminiferous tubules may be of value in the diagnosis of SA. Our results suggest that inhibin levels could be useful in the management of NOA with SA, along with FSH levels and testicular volume.


Assuntos
Azoospermia/congênito , Recuperação Espermática , Testículo/patologia , Adulto , Azoospermia/sangue , Azoospermia/complicações , Azoospermia/etiologia , Azoospermia/patologia , Azoospermia/terapia , Biópsia , Hormônio Foliculoestimulante/sangue , Humanos , Inibinas/sangue , Masculino , Estudos Retrospectivos
9.
Hum Reprod ; 33(7): 1212-1217, 2018 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-29850857

RESUMO

STUDY QUESTION: Given the relevant role of the extracellular microenvironment in regulating tissue homeostasis, is testicular bacterial microbiome (BM) associated with germ cell aplasia in idiopathic non-obstructive azoospermia (iNOA)? SUMMARY ANSWER: A steady increase of dysbiosis was observed among testis with normal spermatogenesis vs. iNOA with positive sperm retrieval and iNOA with complete germ cell aplasia. WHAT IS KNOWN ALREADY: Tissue-associated BM has been reported to be a biologically important extracellular microenvironment component for numerous body habitats, but not yet for the human testis. STUDY DESIGN, SIZE, DURATION: Cross-sectional study, investigating tissue-associated BM in the testis of (i) five men with iNOA and negative sperm retrieval at microdissection testicular sperm extraction (microTESE); (ii) five men with iNOA and positive sperm retrieval at microTESE; and (iii) five normozoospermic men upon orchiectomy. Every testicular specimen was histologically classified and analyzed in terms of bacterial community. PARTICIPANTS/MATERIALS, SETTING, METHODS: Massive ultra-deep pyrosequencing was applied to investigate testis microbiome. Metagenome was analyzed using Quantitative Insights Into Microbial Ecology (QIIME). Tissue-associated bacterial load was quantified by digital droplet PCR. MAIN RESULTS AND THE ROLE OF CHANCE: Normozoospermic men showed small amounts of bacteria in the testis, with Actinobacteria, Bacteroidetes, Firmicutes Proteobacteria as the dominating phyla; iNOA individuals had increased amounts of bacterial DNA (P = 0.02), associated with decreased taxa richness due to the lack of Bacteroidetes and Proteobacteria (P = 2 × 10-5). Specimens with negative sperm retrieval at microTESE depicted complete germ cell aplasia and a further decrease in terms of Firmicutes and Clostridia (P < 0.05), a complete lack of Peptoniphilus asaccharolyticus, but increased amount of Actinobacteria. LIMITATIONS, REASONS FOR CAUTION: The limited number of specimens analyzed in this preliminary study deserves external validation. The paraneoplastic microenvironment could have an impact on the residential bacterial flora. WIDER IMPLICATION OF THE FINDINGS: Human testicular microenvironment is not microbiologically sterile, containing low amounts of Actinobacteria, Bacteroidetes, Firmicutes and Proteobacteria. A dysbiotic bacterial community was associated with iNOA and complete germ cell aplasia. Novel findings on testicular BM could support future translational therapies of male-factor infertility. STUDY FUNDING/COMPETING INTEREST(S): This work was supported by URI-Urological Research Institute free funds. Authors declared no conflict of interest. TRIAL REGISTRATION NUMBER: N/A.


Assuntos
Azoospermia/complicações , Disbiose/complicações , Microbiota , Testículo/microbiologia , Azoospermia/microbiologia , Azoospermia/patologia , Estudos Transversais , Disbiose/microbiologia , Disbiose/patologia , Humanos , Masculino , Espermatogênese/fisiologia , Testículo/patologia
10.
Hum Reprod Update ; 24(4): 442-454, 2018 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-29726895

RESUMO

BACKGROUND: Testicular sperm extraction (TESE) is a surgical procedure to retrieve spermatozoa from the testes of men with azoospermia to help them achieve biological parenthood. Although effective, the surgical procedure is not without complications and haematoma, devascularization, inflammation and a decrease in testosterone levels have been described as such. The prevalence and duration of hypogonadism and associated symptoms after TESE have not been studied systematically. OBJECTIVE AND RATIONALE: In this systematic review we addressed the following research questions: Are serum testosterone levels decreased after TESE and, if so, do these levels recover over time? What is the prevalence of symptoms and signs related to hypogonadism after TESE and are they related to testosterone levels? SEARCH METHODS: We searched the databases Pubmed and Embase from 1 January 1993 to 26 June 2017. We combined subject headings with terms in title and/or abstract for participants, intervention and outcomes. We included all studies that reported on TESE, regardless of the specific technique used, that measured testosterone and/or LH, and/or had information on signs or symptoms related to hypogonadism as defined by hypogonadism guidelines. An additional inclusion criterion was that studies described these measurements both before and after TESE. The quality of the included studies was assessed using the Risk Of Bias In Non-randomized Studies-of Interventions tool. OUTCOMES: We identified 15 studies reporting on total testosterone levels of which five studies also reported on testicular volume and one study on erectile dysfunction. Men with Klinefelter syndrome and men with non-obstructive azoospermia had the strongest decrease in total testosterone levels 6 months after TESE, with a mean decrease of 4.1 and 2.7 nmol/l, respectively, which recovered again to baseline levels 26 and 18 months after TESE, respectively. At 6 months after TESE, some studies reported serum total testosterone concentrations below a cut-off value of 12 nmol/l, where symptoms and signs related to hypogonadism may appear. Furthermore, an increased prevalence of erectile dysfunction related to decreased total testosterone levels 6 months after TESE was reported. Also, in some men a decrease in testicular volume was reported. However, it is not clear if this is related to low testosterone levels. WIDER IMPLICATIONS: The transient, but statistically significant, decrease in total testosterone levels indicates that men are at risk of developing a temporary hypogonadism after TESE, but there is insufficient evidence for whether patients actually experience clinical symptoms in case of decreased serum testosterone levels. To be able to properly counsel TESE patients, more large-scale monitoring on signs and symptoms of hypogonadism, in combination with testosterone measurements, needs to be performed in men undergoing TESE.


Assuntos
Hipogonadismo/etiologia , Recuperação Espermática/efeitos adversos , Adulto , Azoospermia/sangue , Azoospermia/complicações , Humanos , Hipogonadismo/diagnóstico , Hipogonadismo/epidemiologia , Síndrome de Klinefelter/sangue , Síndrome de Klinefelter/complicações , Masculino , Fatores de Risco , Recuperação Espermática/estatística & dados numéricos , Espermatozoides/patologia , Testosterona/sangue
11.
Zhonghua Nan Ke Xue ; 24(10): 878-882, 2018 Oct.
Artigo em Chinês | MEDLINE | ID: mdl-32212441

RESUMO

Objective: To investigate the relationship between hand dermatoglyphic traits and azoospermia in the Chinese Han males in Ningxia area. METHODS: Using the inkpad prints, we obtained dermatoglyphics of both hands from 212 Han males in Ningxia area, including 106 azoospermia patients and 106 fathers as normal controls. We analyzed the photographs of the prints with the Image-Pro Plus 6.0 software and compared the finger print patterns, finger ridge counts, atd angles (the angle between the index finger triradius ï¼»aï¼½ and the little finger triradius ï¼»dï¼½ to the axial triradius ï¼»tï¼½) and a-b ridge counts between the two groups of subjects. RESULTS: The prevalence rate of radial loops in both hands was markedly higher in the azoospermia patients than in the normal controls (3.77% vs 1.70%, P < 0.01) while that of arches showed no statistically significant difference between the two groups (1.89% vs 1.51%, P > 0.05). The prevalence rates of whorls and ulnar loops, the finger ridge counts, and the a-b ridge counts were all lower in the azoospermia patients than in the fertile controls though none with statistically significant difference between the two groups (P > 0.05). The atd angles in both hands were significantly lower in the former than in the latter group (right hand: ï¼»40.52 ± 4.61ï¼½° vs ï¼»42.99 ± 4.65ï¼½°, P < 0.05; left hand: ï¼»40.04 ± 4.21ï¼½° vs ï¼»42.18 ± 4.87ï¼½°, P < 0.05). CONCLUSIONS: There are some abnormal variations in the hand dermatoglyphic traits, especially the prevalence of radial loops and the atd angle in the Chinese Han male patients with azoospermia in Ningxia area.


Assuntos
Azoospermia , Dermatoglifia , Azoospermia/complicações , Azoospermia/diagnóstico , Estudos de Casos e Controles , China , Dedos , Mãos , Humanos , Masculino , Fenótipo
12.
Rev. int. androl. (Internet) ; 15(4): 165-168, oct.-dic. 2017. ilus
Artigo em Espanhol | IBECS | ID: ibc-166863

RESUMO

La neoplasia testicular intratubular es una lesión premaligna testicular asociada a tumores germinales primarios gonadales y extragonadales. La prevalencia de neoplasia testicular intratubular en pacientes infértiles llega al 2% en diferentes estudios. Presentamos el caso de un paciente azoospérmico con diagnóstico incidental de neoplasia testicular intratubular bilateral en la biopsia testicular realizada durante la recuperación quirúrgica de espermatozoides. En pacientes infértiles, las técnicas de recuperación espermática deben incluir el estudio anatomopatológico de parénquima testicular para descartar enfermedad maligna asociada. Los pacientes con alteración de la espermatogénesis tienen mayor riesgo de presentar otras alteraciones del desarrollo gonadal (neoplasias, hipogonadismo, entre otros) en el contexto de un síndrome de disgenesia testicular (AU)


Testicular intraepithelial neoplasia is a premalignant lesion associated to gonadal and extragonadal germ cell tumors. Testicular intraepithelial neoplasia prevalence in infertile men has reached 2% in some studies. This report presents the case of an azoospermic man with an incidental diagnosis of bilateral testicular intraepithelial neoplasia after testicular sperm extraction. In infertile men, sperm retrieving techniques have to include histological analysis of testicular tissue, to discard any chance of malignant component. Patients with spermatogenesis alterations have an increased risk to present other disruptions in gonadal development (neoplasms, hypogonadism, among others) in the context of testicular dysgenesis syndrome (AU)


Assuntos
Humanos , Masculino , Adulto , Neoplasias Testiculares/complicações , Neoplasias Testiculares/diagnóstico , Neoplasias Testiculares/cirurgia , Infertilidade Masculina/complicações , Espermatogênese , Biópsia , Azoospermia/complicações , Azoospermia/diagnóstico , Imuno-Histoquímica/métodos , Fotomicrografia/métodos , Testículo/patologia
13.
Reprod Biol Endocrinol ; 15(1): 17, 2017 Mar 07.
Artigo em Inglês | MEDLINE | ID: mdl-28270212

RESUMO

BACKGROUND: Hypogonadotropic hypogonadism (HH) in men results in insufficient testicular function and deficiencies in testosterone and spermatogenesis. Combinations of human chorionic gonadotropin (hCG) and recombinant follicle-stimulating hormone (recFSH) have been successful in the treatment of HH. Corifollitropin alfa is a long-acting FSH-analog with demonstrated action in women seeking infertility care. The aim of this study was to investigate the efficacy and safety of corifollitropin alfa combined with hCG to increase testicular volume and induce spermatogenesis in men with HH. METHODS: This was a Phase III, multi-center, open-label, single-arm trial of corifollitropin alfa in azoospermic men aged 18 to 50 years with HH. After 16 weeks of pretreatment of 23 subjects with hCG alone, 18 subjects with normalized testosterone (T) levels who remained azoospermic entered the 52-week combined treatment phase with hCG twice-weekly and 150 µg corifollitropin alfa every other week. The increase in testicular volume (primary efficacy endpoint) and induction of spermatogenesis resulting in a sperm count ≥1 × 106/mL (key secondary efficacy endpoint) during 52 weeks of combined treatment were assessed. Safety was evaluated by the presence of anti-corifollitropin alfa antibodies and the occurrence of adverse events (AEs). RESULTS: Mean (±SD) testicular volume increased from 8.6 (±6.09) mL to 17.8 (±8.93) mL (geometric mean fold increase, 2.30 [95% CI: 2.03, 2.62]); 14 (77.8%) subjects reached a sperm count ≥1 × 106/mL. No subject developed confirmed anti-corifollitropin alfa antibodies during the trial. Treatment was generally well tolerated. CONCLUSIONS: Corifollitropin alfa 150 µg administrated every other week combined with twice-weekly hCG for 52 weeks increased testicular volume significantly, and induced spermatogenesis in >75% of men with HH who had remained azoospermic after hCG treatment alone. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01709331 .


Assuntos
Azoospermia/tratamento farmacológico , Gonadotropina Coriônica/uso terapêutico , Hormônio Foliculoestimulante Humano/uso terapêutico , Hipogonadismo/tratamento farmacológico , Adulto , Azoospermia/complicações , Esquema de Medicação , Humanos , Hipogonadismo/complicações , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão/efeitos dos fármacos , Espermatogênese/efeitos dos fármacos , Testículo/efeitos dos fármacos , Testículo/patologia , Resultado do Tratamento , Adulto Jovem
14.
Andrology ; 5(1): 82-86, 2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-27654638

RESUMO

Obesity is reported to have adverse effects on semen quality and the endocrine system. In this study, we evaluated the effect of obesity on sperm retrieval outcome and reproductive hormone levels in Japanese men with non-obstructive azoospermia (NOA). This study is based on the clinical records of 217 men [172 with a 46,XY karyotype, 45 with Klinefelter syndrome (KS)] with NOA who underwent microdissection testicular sperm extraction at Nagoya City University Hospital between January 2004 and December 2014. Body mass index (BMI) and serum levels of luteinizing hormone (LH), follicle-stimulating hormone (FSH), and total testosterone (TT) were measured in all patients. In a subset of patients, bioavailable testosterone (cBAT) also was calculated. Values were evaluated separately in patients with and without KS. Sperm retrieval rates (SRRs) in 46,XY men with a BMI <25 kg/m2 and ≥25 kg/m2 were 29.3% and 18.4%, respectively (p = 0.142), while SRRs in KS men with a BMI <25 kg/m2 and ≥25 kg/m2 were 25.0% and 35.3%, respectively (p = 0.460). TT level in men with a BMI ≥25 kg/m2 was lower than that in men with a BMI <25 kg/m2 , regardless of KS status. According to Pearson product-moment correlation coefficients, TT and cBAT levels tended to have negative correlations with BMI; however, statistical significance was observed only for TT level in 46,XY men (r = 0.340, p < 0.001). LH and FSH levels were negatively correlated with BMI in KS men (r = -0.466, p = 0.001 and r = -0.647, p < 0.001, respectively), but not in 46,XY men. These results suggest that obesity may be irrelevant to sperm retrieval outcome in patients with NOA. The negative correlations between gonadotropins and BMI in patients with KS suggest an underlying suppressive effect on gonadotropin excretion, which is distinctive in obese patients with KS.


Assuntos
Azoospermia/complicações , Hormônio Foliculoestimulante/sangue , Síndrome de Klinefelter/complicações , Hormônio Luteinizante/sangue , Obesidade/complicações , Testosterona/sangue , Adulto , Azoospermia/sangue , Índice de Massa Corporal , Humanos , Japão , Síndrome de Klinefelter/sangue , Masculino , Obesidade/sangue , Análise do Sêmen , Recuperação Espermática
15.
Andrologia ; 49(4)2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-27444399

RESUMO

The purpose of this study was to observe the clinical utility and the possible determinants in predicting sperm retrieval of salvage microdissection testicular sperm extraction (mTESE) for nonobstructive azoospermia (NOA) patients with failed conventional TESE at their first attempts. A total of 52 NOA males underwent salvage mTESE were recruited in this study. Related data, including age, BMI, the presence of Klinefelter's syndrome and varicocele, cryptorchidism, mean testicular volume, hormonal profile (total testosterone (TT), follicle-stimulating hormone (FSH), luteinising hormone (LH), inhibin B (INHB)), testicular histology and surgical duration, were collected and analysed. A multivariate logistic regression with likelihood ratio test revealed the following predictors of sperm retrieval: TT and testicular histology (chi-square of likelihood ratio = 26.42, df = 4, p < .005). A formula was also established using multivariate regression analysis in predicting sperm retrieval probability. A predicted probability of more than 71% was determined of the formula as the cut-off value in predicting sperm retrieval using receiver operating characteristics (ROC) analysis with a sensitivity and specificity 78.0% and 72.4% respectively. In conclusion, salvage mTESE is of clinical value in NOA males with failed TESE attempts, whereas the established formula could be useful in determining the proper salvage mTESE candidates.


Assuntos
Azoospermia/terapia , Terapia de Salvação/métodos , Recuperação Espermática , Testículo/patologia , Testosterona/sangue , Adulto , Azoospermia/sangue , Azoospermia/complicações , Criptorquidismo/complicações , Hormônio Foliculoestimulante/sangue , Humanos , Inibinas/sangue , Síndrome de Klinefelter/complicações , Hormônio Luteinizante/sangue , Masculino , Microdissecção , Estudos Retrospectivos , Espermatozoides , Testículo/cirurgia , Falha de Tratamento , Varicocele/complicações
16.
Zhonghua Nan Ke Xue ; 23(5): 473-476, 2017 May.
Artigo em Chinês | MEDLINE | ID: mdl-29717843

RESUMO

Oligoasthenozoospermia, teratozoospermia or low sperm motility is the main cause of male infertility. Low sperm motility can be induced by abnormalities of the sperm tail structure and sperm function. The outer dense fiber protein 2 (ODF2) is a protein fiber maintaining cytoskeleton, as a major component of the mammalian sperm tail and centrosome, and its abnormality is closely related to asthenospermia. Recent studies indicate that ODF2 includes many proteins of the same name and homologous splices located in the sperm centrosomes and spindles of cleaved-embryos, necessary for animal ciliogenesis and associated with sperm capacitation. The features of ODF2 indicate that it is not a single-structural protein. This paper reviews the known functions of ODF2, paving a ground for further studies of the relationship between the ODF2 protein and fertilization.


Assuntos
Proteínas de Choque Térmico/fisiologia , Espermatozoides/fisiologia , Animais , Astenozoospermia/complicações , Azoospermia/complicações , Centrossomo/química , Citoesqueleto/química , Humanos , Infertilidade Masculina/etiologia , Masculino , Motilidade Espermática/fisiologia , Cauda do Espermatozoide
17.
J Obstet Gynaecol Res ; 42(11): 1558-1566, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27785898

RESUMO

AIM: To report the outcome of intracytoplasmic sperm injection (ICSI) cycles using fresh or cryopreserved-thawed testicular spermatozoa of men with Klinefelter syndrome (KS). METHODS: Medical records of 83 azoospermic men with KS who underwent testicular sperm extraction (TESE) were reviewed. The clinical parameters for predicting sperm retrieval and fertilization, implantation, pregnancy and live birth rates of ICSI cycles in these patients were evaluated. RESULTS: A total of 88 TESE procedures were performed with sperm retrieval rates of 39.8% per cycle (35/88) and 42.1% per patient (35/83). None of the studied clinical parameters were found to be informative in predicting successful sperm recovery. A total of 41 embryo transfer cycles were carried out using fresh testicular spermatozoa in 30, cryopreserved-thawed spermatozoa in 10 and cryopreserved-thawed embryo replacement in one. The fertilization and clinical pregnancy rates were comparable at 52.7% and 51.6% with fresh and 48.3% and 60% with cryopreserved-thawed testicular spermatozoa groups, respectively. Twenty-two clinical pregnancies were obtained, including 14 singletons, five twins, two triplets and one quadruplet and ended with the delivery of 13 singletons and six twins. In total, out of 25 delivered fetuses, four died (3 female, 1 male) following delivery and 21 newborns (14 female, 7 male) were healthy with a female to male ratio of 2:1. Conclusions We concluded that no clinical or laboratory parameter predicts the presence of spermatozoa in patients with KS, except the TESE procedure itself. The use of fresh or cryopreserved-thawed spermatozoa on ICSI cycle outcomes are equally successful in patients with KS.


Assuntos
Azoospermia/terapia , Síndrome de Klinefelter/complicações , Injeções de Esperma Intracitoplásmicas , Recuperação Espermática , Espermatozoides/fisiologia , Adulto , Azoospermia/complicações , Azoospermia/fisiopatologia , Criopreservação , Feminino , Humanos , Síndrome de Klinefelter/fisiopatologia , Masculino , Gravidez , Taxa de Gravidez , Estudos Retrospectivos , Razão de Masculinidade , Resultado do Tratamento
18.
Rev. int. androl. (Internet) ; 14(3): 73-79, jul.-sept. 2016. tab, graf
Artigo em Português | IBECS | ID: ibc-154276

RESUMO

Objetivo. Reportar a nossa experiência nos últimos 17 anos na preservação da fertilidade masculina por doença oncológica, genética, imunológica e endocrinológica, assim como por alterações graves da espermatogénese. Material e métodos. avaliação de parâmetros demográficos, características do esperma e resultados obtidos com amostras descongeladas em ciclos de procriação medicamente assistida (PMA). Resultados. Duzentos e setenta e um homens com uma idade média de 31,5±6,3 anos (16‐52 anos) foram referenciados para PF. A doença oncológica foi a causa mais comum (34,3%), seguida de azoospermia secretora ou não obstrutiva, oligoastenoteratozoospermia (TAO) grave, doença genética, hipogonadismo/atrofia testicular, doença auto‐imune, doença endócrino‐metabólica e pré‐cirurgia potencialmente comprometedora da fertilidade. Dentro da doença oncológica, o tumor do testículo foi a neoplasia mais comum (64,5%), seguido do cancro hematológico e de etiologias variadas. Na doença genética, a síndrome de Klinefelter foi a condição mais frequente (50%). No total 194 homens ficaram com amostras criopreservadas (1.099 amostras no total; 5,7±3,4 por paciente). Os homens com doença oncológica tiveram, em média, um número significativo superior de amostras congeladas (p<0,001). Os casos de tumor do testículo apresentaram uma concentração média de espermatozoides/ml significativamente inferior face aos outros tumores (p<0,005). Durante estes 17 anos, 58 homens (29,9%) procuraram o centro para realização de técnicas de PMA com amostras descongeladas. Foram realizados 87 ciclos, com 19 gestações (21,8%). Nasceram 15 recém‐nascidos (RN) saudáveis. Conclusões. Ainda que o número de homens que tenham procurado o uso das amostras armazenadas, não se pode desvalorizar o impacto psicológico positivo da PF, tendo em conta que pode ser a única possibilidade de paternidade biológica (AU)


Objective. A report is presented of 17 years of experience in male fertility preservation due to oncological, genetic, immunological and endocrinological disease, as well as severe spermatogenesis alterations. Material and methods. An evaluation is made of demographic parameters, sperm characteristics and results of assisted reproduction techniques cycles with thawed samples. Results. A total of 271 men with a mean age 31.5±6.3 years (16 to 52 years) were referred to sperm banking. The most common cause was oncological disease (34.3%), followed by secretory azoospermia, oligoasthenoteratozoospermia, genetic disease, testicular atrophy/hypogonadism, auto‐immune disease, endocrine‐metabolic disease, and prior to potentially fertility damage surgery. Among oncological disease, testicular tumour was the most common cancer (64.5%), followed by haematological cancer, and other aetiologies. Klinefelter syndrome was the most common (50%) among the genetic diseases. A total of 194 men had samples cryopreserved (1099 total samples; 5.7±3.4 per patient). Men with oncological disease had a significantly higher number of cryopreserved samples (p<.001). Testicular tumour cases had a mean lower sperm concentration relative to other tumours (p<.005). During these 17 years, 58 men (29.9%) asked to have assisted reproduction techniques performed with their thawed samples. The 87 cycles performed resulted in 19 pregnancies (21.8%) and 15 healthy newborns. Conclusions. Although the number of men asking to use their cryopreserved samples is low, we cannot undervalue the positive psychological impact of fertility preservation, taking in consideration that it can be the only possibility to biological fatherhood (AU)


Assuntos
Humanos , Masculino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Preservação da Fertilidade/instrumentação , Preservação da Fertilidade/métodos , Preservação da Fertilidade , Espermatogênese/genética , Azoospermia/complicações , Criopreservação/métodos , Criopreservação/normas , Criopreservação , Tratamentos com Preservação do Órgão/tendências , Contagem de Espermatozoides/métodos , Técnicas Reprodutivas , Técnicas de Reprodução Assistida
19.
Andrology ; 4(5): 944-51, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-27368157

RESUMO

Despite complex interactions between obesity, dyslipidemia, hyperinsulinaemia, and the reproductive axis, the impact of metabolic syndrome on human male reproductive function has not been analysed comprehensively. Complete demographic, clinical, and laboratory data from 1337 consecutive primary infertile men were analysed. Health-significant comorbidities were scored with the Charlson Comorbidity Index (categorised 0 vs. 1 vs. 2 or higher). NCEP-ATPIII criteria were used to define metabolic syndrome. Semen analysis values were assessed based on the 2010 World Health Organisation (WHO) reference criteria. Descriptive statistics and logistic regression models tested the association between semen parameters and clinical characteristics and metabolic syndrome. Metabolic syndrome was found in 128 (9.6%) of 1337 men. Patients with metabolic syndrome were older (p < 0.001) and had a greater Charlson Comorbidity Index of 1 or higher (chi-square: 15.6; p < 0.001) compared with those without metabolic syndrome. Metabolic syndrome patients had lower levels of total testosterone (p < 0.001), sex hormone-binding globulin (p = 0.004), inhibin B (p = 0.03), and anti-Müllerian hormone (p = 0.009), and they were hypogonadal at a higher rate (chi-square: 32.0; p < 0.001) than patients without metabolic syndrome. Conversely, the two groups did not differ significantly in further hormonal levels, semen parameters, and rate of either obstructive or non-obstructive azoospermia. At multivariate logistic regression analysis, testicular volume (OR: 0.90; p = 0.002) achieved independent predictor status for WHO pathological semen concentration; conversely, age, Charlson Comorbidity Index scores, metabolic syndrome, and inhibin B values did not. No parameters predicted normal sperm morphology and total progressive motility. Metabolic syndrome accounts for roughly 9% of men presenting for primary couple's infertility. Although metabolic syndrome patients have a lower general male health status, semen analysis values seem independent of the presence of metabolic syndrome.


Assuntos
Hipogonadismo/complicações , Infertilidade Masculina/complicações , Síndrome Metabólica/complicações , Testosterona/sangue , Adulto , Fatores Etários , Hormônio Antimülleriano/sangue , Azoospermia/sangue , Azoospermia/complicações , Grupo com Ancestrais do Continente Europeu , Humanos , Hipogonadismo/sangue , Infertilidade Masculina/sangue , Inibinas/sangue , Masculino , Síndrome Metabólica/sangue , Análise do Sêmen , Globulina de Ligação a Hormônio Sexual/metabolismo , Motilidade Espermática
20.
Int J Clin Oncol ; 21(6): 1167-1171, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27306218

RESUMO

BACKGROUND: Combinations of surgery, radiation therapy, and chemotherapy can achieve high remission rates in patients with cancer, but these treatments can have damaging effects on spermatogenesis. In particular, cytotoxic chemotherapy may lead to irreversible spermatogenic dysfunction. Microdissection testicular sperm extraction (micro-TESE) is the only method that can address infertility in cancer survivors with persistent postchemotherapy azoospermia. METHODS: We included 66 Japanese patients with postchemotherapy azoospermia who underwent micro-TESE for sperm retrieval in this analysis. Age, oncology data, hormone profiles, and outcomes of micro-TESE and subsequent intracytoplasmic sperm injections (ICSIs) were reviewed. RESULTS: The common disease in our patients was testicular cancer (21 patients), followed by acute lymphoblastic leukemia and Hodgkin's lymphoma (nine patients). In this cohort of 66 patients, sperm was successfully retrieved in 31 patients (47 %), and clinical pregnancy occurred in 23 cases (35 %). The live birth rate was 27 %. No significant differences in sperm retrieval, clinical pregnancy, and live birth rates were seen between testicular cancer, Hodgkin's lymphoma, non-Hodgkin's lymphoma, acute lymphoblastic leukemia, acute myeloid leukemia, or sarcoma cases. Multiple logistic regression analysis showed that the chance of retrieving sperm during micro-TESE could not be predicted by any variable. CONCLUSIONS: Cryopreservation of sperm should be offered before any gonadotoxic chemotherapy takes place. However, micro-TESE and subsequent ICSI could be effective treatment options for patients with persistent postchemotherapy azoospermia whose sperm were not frozen before therapy. Our results suggest that micro-TESE-ICSI could benefit 27 % of such Japanese patients.


Assuntos
Antineoplásicos , Azoospermia , Criopreservação , Infertilidade Masculina , Neoplasias/tratamento farmacológico , Injeções de Esperma Intracitoplásmicas/métodos , Recuperação Espermática , Adulto , Antineoplásicos/efeitos adversos , Antineoplásicos/uso terapêutico , Azoospermia/induzido quimicamente , Azoospermia/complicações , Azoospermia/diagnóstico , Azoospermia/epidemiologia , Criopreservação/métodos , Criopreservação/estatística & dados numéricos , Humanos , Infertilidade Masculina/diagnóstico , Infertilidade Masculina/etiologia , Infertilidade Masculina/terapia , Japão/epidemiologia , Masculino , Microdissecção/métodos , Pessoa de Meia-Idade , Neoplasias/classificação , Neoplasias/epidemiologia , Estudos Retrospectivos , Resultado do Tratamento
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