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1.
Lakartidningen ; 1162019 Jul 19.
Artigo em Sueco | MEDLINE | ID: mdl-31334817

RESUMO

The most severe form of male infertility is non obstructive azoospermia (NOA), where spermatogenesis is impaired or absent. If testicular sperm can be retrieved, men with NOA can become biological fathers with IVF/ ICSI. In Sweden, testicular sperm aspiration (TESA) is the most common method used to retrieve sperm but is only successful in up to 34% of procedures. In 2013, our fertility center introduced MD-TESE, where an operating microscope is used to target the biopsies. We have performed more than 134 MD-TESE procedures, mainly in cases where TESA sperm recovery failed previously. Sperm sufficient for ICSI were recovered in 52 % and in these cases 75 % resulted in embryo transfer, resulting in a 34 % ongoing pregnancy rate/deliveries per transfer. Results are encouraging and hopefully more Swedish IVF centers will introduce this technique.


Assuntos
Azoospermia/cirurgia , Microdissecção/métodos , Recuperação Espermática , Testículo/cirurgia , Azoospermia/etiologia , Feminino , Humanos , Infertilidade Masculina/etiologia , Infertilidade Masculina/cirurgia , Masculino , Gravidez , Injeções de Esperma Intracitoplásmicas , Resultado do Tratamento
2.
Indian J Med Res ; 149(1): 51-56, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31115375

RESUMO

Background & objectives: : Microsurgical reconstruction for idiopathic obstructive azoospermia is a challenging procedure, and selection of appropriate patients is important for successful outcomes. This prospective study was done to evaluate the ability of scrotal ultrasound measurements to predict the surgical feasibility and determine factors that could predict a patent anastomosis following vaso-epididymal anastomosis (VE) in men with idiopathic obstructive azoospermia. Methods: : In this prospective study, men diagnosed with idiopathic obstructive azoospermia, scheduled for a longitudinal intussusception VE, underwent a scrotal ultrasound measurement of testicular and epididymal dimensions. During surgery, site and type of anastomosis, presence of sperms in the epididymal fluid and technical satisfaction with the anastomosis were recorded. All men where VE could be performed were followed up for appearance of sperms in the ejaculate. Ultrasound parameters were compared between men who had a VE versus those with negative exploration. Predictive factors were compared between men with or without a patent anastomosis. Results: : Thirty four patients were included in the study conducted between September 2014 and August 2016 and a VE was possible in only 19 (55%) patients. Of these 19 patients, six had a patent anastomosis with one pregnancy. Preoperative ultrasound measurements could not identify patients where a VE could not be performed. Motile sperm in the epididymal fluid was the only significant predictor of a successful anastomosis. Interpretation & conclusion: : Forty five per cent of men planned for a VE for idiopathic obstructive azoospermia could not undergo a reconstruction. Ultrasound assessment of testicular and epididymal dimensions could not predict the feasibility of performing a VE. The presence of motile sperms in the epididymal fluid was the only significant predictor of a patent VE in our study.


Assuntos
Azoospermia/cirurgia , Epididimo/cirurgia , Infertilidade Masculina/cirurgia , Testículo/cirurgia , Adulto , Anastomose Cirúrgica/métodos , Azoospermia/fisiopatologia , Epididimo/fisiopatologia , Estudos de Viabilidade , Feminino , Humanos , Infertilidade Masculina/fisiopatologia , Masculino , Gravidez , Motilidade Espermática/fisiologia , Testículo/patologia
3.
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
4.
Biomed Res Int ; 2019: 7934328, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30984784

RESUMO

Varicocele, a vascular event, is associated with infertility due to testicular damage that causes abnormal spermatogenesis in males. The goal of this study is to ascertain the diagnostic significance of scrotal color Doppler ultrasonography (CDUS) by measuring peak systolic value (PSV) and resistive index (RI) of the arteries supplying blood to the testis and their association with semen quality attributes. Sixty prospective patients (age: 20-50 years) undergoing microsurgical varicocelectomy at a teaching hospital were included in the study. Semen parameters and CDUS were recorded and testicular blood flow was determined as PSV and RI of subcapsular artery and intraparenchymal artery of the testes. Nonparametric statistics was applied to test the correlation/association of the semen quality with the PSV, RI, and other variables. Results revealed a significant negative correlation (r = -0.28; p < 0.05) between progressive motility of spermatozoa and resistive index of the intraparenchymal arterial blood flow. Furthermore, it was noticed that the progressive motility of spermatozoa was tended to be negatively correlated (r = -0.236) with resistive index of subcapsular arterial blood flow. In conclusion, this study has revealed that progressive motility of sperms has correlation with the intraparenchymal blood flow of testes. The progressive motility of sperms could be correlated with RI of testicular blood flow. The apparent lack of association between diameter of varicocele vein and semen quality signifies the need of investigating some other factors that may be involved in pathogenicity of varicocele. The diagnostic value of CDUS may be carefully interpreted and clinically correlated in assessment of severity of varicocele.


Assuntos
Velocidade do Fluxo Sanguíneo/fisiologia , Infertilidade Masculina/sangue , Testículo/irrigação sanguínea , Varicocele/sangue , Adulto , Hemodinâmica , Humanos , Infertilidade Masculina/patologia , Infertilidade Masculina/cirurgia , Masculino , Microcirurgia , Pessoa de Meia-Idade , Paquistão , Sêmen/metabolismo , Análise do Sêmen , Motilidade Espermática/fisiologia , Espermatogênese/fisiologia , Testículo/patologia , Testículo/cirurgia , Varicocele/patologia , Varicocele/cirurgia , Veias/patologia , Veias/cirurgia , Adulto Jovem
5.
Fertil Steril ; 111(3): 415-419, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30827515

RESUMO

The impact of clinical varicoceles on semen parameters and male infertility has long been established. In the era of assisted reproduction, clinical discussion has questioned the role of varicocelectomy, offering the potential to bypass, rather than treat, varicocele-associated male infertility. However, current literature supports improved semen parameters and reproductive outcomes following repair. This article presents the stepwise operative approaches to microsurgical varicocelectomy and discusses the recent publications on outcomes.


Assuntos
Infertilidade Masculina/cirurgia , Microcirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Varicocele/cirurgia , Fertilidade , Humanos , Infertilidade Masculina/diagnóstico , Infertilidade Masculina/etiologia , Infertilidade Masculina/fisiopatologia , Ligadura , Masculino , Microcirurgia/efeitos adversos , Fatores de Risco , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos , Varicocele/complicações , Varicocele/diagnóstico , Varicocele/fisiopatologia
6.
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
7.
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
8.
Fertil Steril ; 111(3): 413-414, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30722940

RESUMO

Surgical treatments offer effective solutions for many couples experiencing male factor infertility. This Views and Reviews collection of articles offers a state-of-the-art overview of the surgical procedures commonly used to treat impaired male reproductive health.


Assuntos
Infertilidade Masculina/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Fertilidade , Humanos , Infertilidade Masculina/diagnóstico , Infertilidade Masculina/etiologia , Infertilidade Masculina/fisiopatologia , Masculino , Saúde do Homem , Saúde Reprodutiva , Fatores de Risco , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos
9.
Andrologia ; 51(2): e13188, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30397905

RESUMO

Various studies have been reported to predict the success of varicocelectomy. Neutrophil-lymphocyte ratio (NLR) is a frequently used indicator of systemic inflammation. We aimed to evaluate the effect of inflammation on the success of varicocelectomy using the NLR. The data of 86 patients who underwent varicocelectomy for infertility were evaluated retrospectively. Pre-operative demographic characteristics of patients, laboratory results such as haemogram, and semen analysis and clinical data were recorded. The semen analysis with the highest total motile sperm count was accepted as pre-operative value. Control was performed with semen analysis at post-operative 6th month. As described in previous studies, in our study, more than 50% increase in total motile sperm count in post-operative semen analysis was defined as a significant improvement. However, at least a 100% increase was required for patients with a total motile sperm count <5 million in the definition of recovery. Patients were divided into two groups as those with improvement in the semen parameters (Group 1) and those without (Group 2). NLR was statistically significantly higher in Group 2 compared with Group 1. The area under the curve (AUC) in the ROC curve for NLR was 0.89. According to the Youden index, the best cut-off value of NLR for varicocelectomy success was 1.98 (sensitivity: 94.7%, specificity: 75.9%, p < 0.001). Logistic regression analysis showed that NLR (odds ratio: 3.6, 95% confidence interval: 1.69-8.38, p < 0.001) is independent predictor factors in predicting the success of varicocelectomy. The results of this study show that systemic inflammation adversely affects the likelihood of improvement in sperm parameters by varicocelectomy. Additionally, NLR has been shown to be an independent factor in the prediction of varicocelectomy success.


Assuntos
Infertilidade Masculina/cirurgia , Canal Inguinal/cirurgia , Linfócitos , Microcirurgia/métodos , Neutrófilos , Varicocele/cirurgia , Adulto , Humanos , Infertilidade Masculina/sangue , Contagem de Leucócitos , Masculino , Prognóstico , Varicocele/sangue , Adulto Jovem
10.
Urology ; 124: 131-135, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30359710

RESUMO

OBJECTIVE: To characterize the pathways to care that infertile couples requiring varicocele repair (VR) pursue prior to presenting to a male fertility clinic. METHODS: An IRB-approved single center retrospective review of patients undergoing VR after presentation to an academic male fertility clinic was performed. Patients whose charts included partner histories were assessed for duration of attempting conception, prior workup, and assisted reproductive technology (ART) use. RESULTS: A total of 405 couples were included. At presentation, mean age was 34.4 (SD ± 6.5) years for men and 31.1 (SD ± 4.3) years for women (P < .0001). A couple's first visit to a physician was a gynecologist in 59% (198/334) of couples, a reproductive endocrinologist (REI) in 25% (83/334) of cases, with 14% (47/334) presenting without a previous female workup and were self-referred, and 2% (6/334) seeing both a gynecologist and REI prior to presentation. On average, couples attempted pregnancy for 22.3 (SD ± 21.1, range 0-120) months prior to presentation. Eighteen percent of couples underwent ART prior to presentation. Couples who had undergone ART had lower pre-VR total motile sperm counts compared to couples not pursuing ART prior to presentation (P = 0.031). The majority (70.4%) of females had no abnormality in their workup, making varicocele the only correctable factor for infertility in the couple. CONCLUSIONS: Our findings show a significant delay in referral of infertile men requiring VR. Eighteen percent of couples underwent costly ART prior to an inexpensive male workup. In an era of medical cost containment, early referral to a male infertility specialist is imperative.


Assuntos
Procedimentos Clínicos/economia , Infertilidade Masculina/cirurgia , Encaminhamento e Consulta/estatística & dados numéricos , Tempo para o Tratamento/economia , Tempo para o Tratamento/estatística & dados numéricos , Varicocele/cirurgia , Adolescente , Adulto , Feminino , Humanos , Infertilidade Masculina/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Procedimentos Cirúrgicos Urológicos Masculinos/economia , Varicocele/complicações , Adulto Jovem
11.
Andrologia ; 51(2): e13185, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30375021

RESUMO

PURPOSE: This study sought to evaluate the impact of varicocele repair on intracytoplasmic sperm injection outcomes. PATIENTS AND METHODS: A prospective comparative study was conducted at the Assisted Reproduction Unit, International Islamic Center for Population Studies and Researches, Al-Azhar University. This study included 100 non-azoospermic infertile men with a history of varicocele who were scheduled for intracytoplasmic sperm injection, half of them had already undergone prior subinguinal varicocelectomy at least 12 months prior to ICSI without clinically evident recurrence (treated group 1), and the other half has any grade of an unrepaired clinical varicocele (untreated group 2) at sperm injection. All cases were clinically evaluated and eligible for analysis by using inclusion and exclusion criteria. ICSI outcomes compared between the two groups, including fertilisation rate, embryo development rate and pregnancy outcome. RESULTS: Our study did not show any significant difference between treated and untreated groups regarding the mean values of fertilisation (0.7759 ± 0.2708 vs. 0.7119 ± 0.3057, p = 0.2708), embryo development (0.7759 ± 0.2708 vs. 0.6991 ± 0.3211, p = 0.1990) or different embryo grades. There was no statistically significant difference between groups regarding pregnancy occurrence rates (p = 0.0928). CONCLUSION: Infertile men scheduled for ICSI do not seem to benefit from varicocele repair as regard to the outcomes of ICSI.


Assuntos
Infertilidade Masculina/cirurgia , Varicocele/cirurgia , Adulto , Feminino , Humanos , Infertilidade Masculina/etiologia , Masculino , Gravidez , Resultado da Gravidez , Taxa de Gravidez , Estudos Prospectivos , Contagem de Espermatozoides , Injeções de Esperma Intracitoplásmicas , Resultado do Tratamento , Varicocele/complicações , Adulto Jovem
12.
Fertil Steril ; 110(7): 1410-1411, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30503140

RESUMO

OBJECTIVE: To demonstrate a safe and effective approach to the treatment of obstructing midline prostate utricle cyst with the use of a holmium laser. DESIGN: Video presentation. SETTING: University hospital. PATIENT(S): A 33-year-old man presented with chronic pelvic pain, pain with ejaculation, and infertility. Semen analysis demonstrated oligoasthenospermia with poor viability and computerized tomographic scan identified the presence of a midline 2-3-cm prostatic cyst with dilated seminal vesicles bilaterally. Transrectal ultrasound in the office confirmed the diagnosis of midline obstructing prostatic utricle cyst and estimated the distance from the urethra. INTERVENTION(S): Transurethral ablation of a midline prostate utricle cyst with the use of a holmium laser. MAIN OUTCOME MEASURE(S): Intraoperative technique highlighting the main steps for a transurethral ablation of a midline prostate utricle cyst with the use of a holmium laser. RESULT(S): This video highlights the technique for transurethral ablation of a midline prostate utricle cyst with the use of a holmium laser to unroof the cyst. Retrograde vesiculography was performed to confirm patency of the ejaculatory ducts. Outpatient surgery was tolerated well and the patient was discharged. After surgery at 4 weeks, his symptoms had abated and semen analysis revealed normozoospermia. CONCLUSION(S): We demonstrate safe and effective transurethral ablation of a midline prostate utricle cyst with the use of a holmium laser. Preoperative transrectal ultrasound or cross-sectional imaging can be useful for operative planning. When the orifices of the ejaculatory ducts can be identified, vesiculography can be performed to confirm patency of the ducts and seminal vesicles after relief of the obstructing cyst.


Assuntos
Cistos/cirurgia , Lasers de Estado Sólido/uso terapêutico , Doenças Prostáticas/cirurgia , Ressecção Transuretral da Próstata/métodos , Adulto , Cistos/complicações , Cistos/patologia , Ductos Ejaculatórios/patologia , Ductos Ejaculatórios/cirurgia , Hólmio , Humanos , Infertilidade Masculina/etiologia , Infertilidade Masculina/cirurgia , Masculino , Lesões Pré-Cancerosas/complicações , Lesões Pré-Cancerosas/cirurgia , Doenças Prostáticas/complicações , Doenças Prostáticas/patologia , Glândulas Seminais/patologia , Glândulas Seminais/cirurgia
14.
Zhonghua Nan Ke Xue ; 24(7): 579-288, 2018 Jul.
Artigo em Chinês | MEDLINE | ID: mdl-30173439

RESUMO

In the past two decades, with the rapid development of assisted reproductive technology and particularly the technological advances in male infertility microsurgery, many obstructive azoospermia-related infertile couples can now acquire the chances of natural pregnancy via reconstruction of the seminal tract. This article highlights the latest advances in surgical reconstruction of the seminal tract for the treatment of obstructive azoospermia, such as the application of laparoscopic and robotic techniques, with a discussion on microsurgical epididymal sperm aspiration and preservation, potential use of absorbable sutures or the bio-suture tape for microsurgical anastomosis in the management of obstructive azoospermia.


Assuntos
Azoospermia/cirurgia , Microcirurgia/métodos , Glândulas Seminais/cirurgia , Feminino , Humanos , Infertilidade Masculina/cirurgia , Laparoscopia , Masculino , Gravidez , Técnicas de Reprodução Assistida , Procedimentos Cirúrgicos Robóticos , Recuperação Espermática , Suturas
15.
Andrologia ; 50(9): e13078, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30024042

RESUMO

Varicocele is the most common cause of male infertility. Varicoceles are classified into two types: clinical and subclinical varicoceles. Some researchers reported right subclinical varicoceles are often accompanied with left clinical varicoceles. However, the treatment is controversial. Our aim was to compare the clinical outcome of unilateral varicocelectomy (UV) and bilateral varicocelectomy (BV) in infertile males with left clinical and right subclinical varicocele. A total of four randomised controlled trials (RCT) were enrolled in this study, including 637 cases with left clinical and right subclinical varicocele (318 cases in the BV group and 319 cases in the UV group). The fixed effects model combined difference in progressive sperm motility between the two groups was 6.42% (95% CI: 5.09, 7.75). The random effects model combined difference in normal sperm morphology between the two groups was 2.04% (95% CI: 0.60, 3.48). The odds ratio shown by the fixed effects model in spontaneous pregnancy rate was 1.73 (95% CI: 1.24, 2.43). No statistically significant difference between the two groups was found in sperm concentration and sperm motility. Thus, BV may be superior to UV for infertile male patients with left clinical and right subclinical varicocele. However, more properly conducted RCTs are still needed.


Assuntos
Infertilidade Masculina/cirurgia , Varicocele/cirurgia , Feminino , Humanos , Infertilidade Masculina/etiologia , Masculino , Gravidez , Taxa de Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto , Motilidade Espermática , Varicocele/complicações
16.
Urology ; 120: 109-113, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29981299

RESUMO

OBJECTIVE: To determine if subclinical varicocele repair produces similar results to palpable varicocele repair. METHODS: Retrospective review was performed on 190 infertile men who underwent a microsurgical varicocele repair by two surgeons from 2009 to 2017. Improvement in total motile sperm count (TMC) that enables men limited to in vitro fertilization (IVF) or intrauterine insemination (IUI) to undergo IUI or natural conception (upgrade) is clinically meaningful. Using TMC, men were grouped into three pre- and postoperative categories: IVF, (TMC < 5 million), IUI (TMC 5-9 million), or natural pregnancy (TMC > 9 million). Changes in category after varicocele repair were assessed. We compared the proportion of men in each category with clinical varicoceles to those with subclinical varicoceles. RESULTS: Men with clinical and subclinical varicoceles had improvements in TMC after surgery (change in TMC of 9.3 ± 19.5, 7.7 ± 22.6 million, P < 0.001 for both, respectively). There was no difference in TMC improvement between men with clinical and subclinical varicoceles (P = 0.66). Of men initially limited to IVF, 11% improved to IUI, and 38% to natural pregnancy. Of patients starting in IUI category, 22% transitioned to natural pregnancy category. No difference exists in the proportion of men who "upgraded" between palpable or subclinical varicoceles. CONCLUSION: Men with subclinical varicoceles have similar, clinically meaningful improvement in TMC after varicocele repair compared with men with palpable varicoceles.


Assuntos
Infertilidade Masculina/cirurgia , Microcirurgia/métodos , Varicocele/cirurgia , Adulto , Humanos , Infertilidade Masculina/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Contagem de Espermatozoides/estatística & dados numéricos , Motilidade Espermática , Resultado do Tratamento , Adulto Jovem
17.
BMC Urol ; 18(1): 63, 2018 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-29973189

RESUMO

BACKGROUND: To provide indicators for the likelihood of sperm retrieval in patients undergoing testicular sperm extraction is a major issue in the management of male infertility by TESE. The aim of our study was to determine the impact of different parameters, including testicular histopathology, on sperm retrieval in case of reoperation in patients undergoing testicular sperm extraction. METHODS: We retrospectively analyzed 486 patients who underwent sperm extraction for intracytoplasmic sperm injection and testicular biopsy. Histology was classified into: normal spermatogenesis; hypospermatogenesis (reduction in the number of normal spermatogenetic cells); maturation arrest (absence of the later stages of spermatogenesis); and Sertoli cell only (absence of germ cells). Semen analysis and serum FSH, LH and testosterone were measured. RESULTS: Four hundred thirty patients had non obstructive azoospermia, 53 severe oligozoospermia and 3 necrozoospermia. There were 307 (63%) successful sperm retrieval. Higher testicular volume, lower levels of FSH, and better histological features were predictive for sperm retrieval. The same parameters and younger age were predictive factors for shorter time for sperm recovery. After multivariable analysis, younger age, better semen parameters, better histological features and lower values of FSH remained predictive for shorter time for sperm retrieval while better semen and histology remained predictive factors for successful sperm retrieval. The predictive capacity of a score obtained by summing the points assigned for selected predictors (1 point for Sertoli cell only, 0.33 points for azoospermia, 0.004 points for each FSH mIU/ml) gave an area under the ROC curve of 0.843. CONCLUSIONS: This model can help the practitioner with counseling infertile men by reliably predicting the chance of obtaining spermatozoa with testicular sperm extraction when a repeat attempt is planned.


Assuntos
Aconselhamento , Infertilidade Masculina/patologia , Espermatozoides/patologia , Testículo/patologia , Procedimentos Cirúrgicos Urológicos Masculinos , Biópsia , Humanos , Infertilidade Masculina/cirurgia , Masculino , Reoperação , Análise do Sêmen
18.
Arch Ital Urol Androl ; 90(2): 130-135, 2018 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-29974723

RESUMO

OBJECTIVES: The superiority of microdissection testicular sperm extraction (mTESE) over conventional TESE (cTESE) for men with non-obstructive azoospermia (NOA) is debated. We aimed to compare the sperm retrieval rate (SRR) of mTESE to cTESE and to identify candidates who would most benefit from mTESE in a cohort of Caucasian-European men with primary couple's infertility. MATERIAL AND METHODS: Data from 49 mTESE and 96 cTESE patients were analysed. We collected demographic and clinical data, serum levels of LH, FSH and total testosterone. Patients with abnormal karyotyping were excluded from analysis. Age was categorized according to the median value of 35 years. FSH values were dichotomized according to multiples of the normal range (N) (N and 1.5 N: 1-18 mIU/mL, and > 18 mIU/mL). Testicular histology was recorded for each patient. Descriptive statistics and logistic regression analyses tested the impact of potential predictors on positive SRR in both groups. RESULTS: No differences were found between groups in terms of clinical and hormonal parameters with the exception of FSH values that were higher in mTESE patients (p = 0.004). SRR were comparable between mTESE and cTESE (49.0% vs. 41.7%, p = 0.40). SRRs were significantly higher after mTESE in patients with Sertoli cell-only syndrome (SCOS) (p = 0.038), in those older than 35 years (p = 0.03) and with FSH >1.5N (p < 0.001), as compared to men submitted to cTESE. Multivariable logistic regression analysis showed that mTESE was independent predictor of positive SR in patients older than 35 years (p = 0.002) and with FSH > 1.5N (p = 0.018). Moreover, increased FSH levels (p = 0.03) and both SCOS (p = 0.01) and MA histology (p = 0.04) were independent predictors of SRR failure. CONCLUSIONS: Microdissection and cTESE showed comparable success rates in our cohort of patients with NOA. mTESE seems beneficial for patients older than 35 years, with high FSH values, or when SCOS can be predicted. Given the high costs associated with the mTESE approach, the identification of candidates most likely to benefit from this procedure is a major clinical need.


Assuntos
Azoospermia/cirurgia , Infertilidade Masculina/cirurgia , Microdissecção/métodos , Recuperação Espermática , Espermatozoides , Testículo/cirurgia , Adulto , Estudos de Coortes , Estudos Transversais , Hormônio Foliculoestimulante/sangue , Humanos , Hormônio Luteinizante/sangue , Masculino , Pessoa de Meia-Idade , Síndrome de Células de Sertoli/cirurgia , Testosterona/sangue , Adulto Jovem
19.
Curr Urol Rep ; 19(7): 53, 2018 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-29774482

RESUMO

PURPOSE OF REVIEW: Current guidelines recommend against surgical repair of subclinical varicoceles (SCVs) for infertility; several studies demonstrate mixed fertility results after SCV correction. To determine whether surgical correction of SCV improves semen parameters and/or reproductive outcomes, we performed a systematic review and meta-analysis. Seven biomedical literature databases were searched through January 2018 for studies that assessed reproductive outcomes and/or change in semen parameters in men with corrected SCV compared to either (1) uncorrected SCV or (2) corrected clinical varicocele. Estimates were pooled using random-effects meta-analysis. RECENT FINDINGS: Data were extracted from 13 studies involving 1357 men. Overall, the risk of bias for included studies was high and without a consistent SCV definition across studies. Surgical correction of SCV was associated with a minor increase in sperm density and total motile sperm count (TMSC) compared to uncorrected SCV. This increase in semen parameters is not clinically significant, as men prior to varicocelectomy were on average normospermic nor was correction of a SCV associated with an increase in pregnancy rates when compared to men with uncorrected SCV. Comparing corrected SCV to corrected clinical varicocele, SCV correction resulted in a smaller increase in TMSC but no difference in average annual pregnancy rate. The risk of bias within and heterogeneity between studies assessing SCV correction are high, yet overall very little clinical benefit is derived from SCV correction.


Assuntos
Infertilidade Masculina/etiologia , Varicocele/complicações , Humanos , Infertilidade Masculina/cirurgia , Masculino , Sêmen , Contagem de Espermatozoides
20.
Urology ; 117: 70-77, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29630953

RESUMO

OBJECTIVE: To assess the effect of varicocele and subsequent varicocelectomy on testosterone-estradiol ratio in patients presented with infertility or testicular pain. MATERIALS AND METHODS: In this prospective, controlled, clinical study, 135 men were assigned to 3 equal groups (n = 45 per group). The varicocele-treated "varicocelectomy" group included patients with varicocele who underwent loupe-assisted subinguinal varicocelectomy for infertility or testicular pain; the varicocele-not-treated "positive control" group included patients with varicocele who refused or who wished to postpone varicocelectomy; and the no-varicocele "negative control" group included fertile men without varicocele. The varicocele-treated patients underwent loupe-assisted subinguinal varicocelectomy for infertility or testicular pain. Semen analysis, serum testosterone, estradiol, follicle stimulating hormone, luteinizing hormone, prolactin, calculation of testosterone to estradiol ratio (T:E ratio), and scrotal Doppler ultrasound were assessed at baseline and 6 months later. RESULTS: Total testosterone levels and T:E ratio were in the normal range in all groups. Men with varicocele had significantly lower levels of total testosterone and T:E ratio than men without varicocele (P <.001 for each). Testosterone levels were 4.9, 4.6, and 7.3 ng/mL, and T:E ratios were 19, 17.4, and 28.1 in the treated, positive, and negative control groups, respectively. Testosterone level and T:E ratio were significantly higher in the negative control group than the other 2 groups at baseline assessment (P <.001 for each). These parameters improved significantly 6 months after varicocelectomy in the treated group; whereas, they remained unchanged in the 2 control groups. CONCLUSION: Varicocele is associated with the diminishing of total testosterone and T:E ratio, which were significantly improved after subsequent subinguinal varicocelectomy.


Assuntos
Estradiol/sangue , Infertilidade Masculina/sangue , Testosterona/sangue , Varicocele/sangue , Varicocele/cirurgia , Adulto , Hormônio Foliculoestimulante/sangue , Humanos , Infertilidade Masculina/etiologia , Infertilidade Masculina/cirurgia , Canal Inguinal , Hormônio Luteinizante/sangue , Masculino , Dor/etiologia , Dor/cirurgia , Estudos Prospectivos , Doenças Testiculares/etiologia , Doenças Testiculares/cirurgia , Varicocele/complicações , Adulto Jovem
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