Induction of spermatogenesis in azoospermic men after varicocelectomy repair: an update

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Induction of spermatogenesis in azoospermic men after varicocelectomy repair: an update"

Transcription

1 Induction of spermatogenesis in azoospermic men after varicocelectomy repair: an update Fábio Firmbach Pasqualotto, M.D., Ph.D., Bernardo Passos Sobreiro, M.D., Jorge Hallak, M.D., Ph.D., Eleonora Bedin Pasqualotto, M.D., Ph.D., and Antônio Marmo Lucon, M.D., Ph.D. Divisão de Clínica Urológica, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, and Universidade de Caxias do Sul, Caxias do Sul, Brazil Objective: To assess the treatment outcome after varicocele repair in azoospermic men and to correlate this outcome with the testicular histology patterns. Design: Prospective study. Setting: Academic medical centers. Patient(s): Medical records of 27 azoospermic men, who underwent testis biopsy and microsurgical repair of clinical varicocele between July 1999 and May 2004, were reviewed. Intervention(s): Twenty-seven azoospermic men underwent testis biopsy and microsurgical repair of clinical varicocele. All patients had at least two semen analyses showing azoospermia taken before the surgery and two semen analyses postoperatively. Main Outcome Measure(s): Semen analysis after varicocelectomy. Result(s): Hypospermatogenesis was identified in 9, maturation arrest in 8, and germ cell aplasia in 10 men. Induction of spermatogenesis was achieved in nine men (33.3%). Of these, four had germ cell aplasia, three had maturation arrest, and two had hypospermatogenesis. The improvement in sperm concentration and motility ranged from /ml to /ml, and from 24% to 75.7%, respectively. Of these nine patients with improvement in semen quality, five relapsed into azoospermia 6 months after the recovery of spermatogenesis (four germ cell aplasia and one maturation arrest). One patient with maturation arrest established pregnancy. Conclusion(s): Azoospermic patients may have an improvement in semen quality after varicocelectomy. Semen samples may be cryopreserved after an initial improvement after varicocelectomy. (Fertil Steril 2006;85: by American Society for Reproductive Medicine.) Key Words: Varicocele, azoospermia, semen, testis, cryopreservation Although the incidence of clinical varicocele in men in the general population is roughly 15%, it has been implicated as a factor responsible for infertility in as many as one-third of the infertile population (1 3). With recent advances in diagnostic techniques and widespread application of scrotal ultrasonography and color Doppler imaging, varicoceles are being reported in up to 91% of subfertile cases, most of whom were previously regarded as having idiopathic etiology (4, 5). A number of theories have been proposed to explain the observed pathophysiology of varicoceles. Semen quality uniformly declines in animals with induced varicoceles, even when only a left varicocele is produced (6). The reduction in scrotal temperature after varicocele ligation supports a causative role of increased temperature on the infertility produced by the varicocele (7). It has been hypothesized that varicoceles cause hypoxia, which may play a role in altering spermatogenesis in the varicocele patient. Infertile men with Received April 19, 2005; revised and accepted August 23, Reprint requests: Fabio Firmbach Pasqualotto, M.D, Ph.D., Pinheiro Machado, 2569, sl 23/24, Bairro São Pelegrino, Caxias do Sul, RS, Brazil, CEP (FAX: ; conception-rs.combr). varicocele have elevated levels of spermatozoal reactive oxygen species (8, 9). The effects of the varicocele vary but may often result in a generalized impairment of sperm production, characterized by abnormal semen quality and the fertilizing capacity of the haploid male gamete (10). Although the true pathogenesis of the varicocele remains enigmatic, gross testicular alterations associated with varicocele are well documented and the fact that both oligoasthenoazoospermia and azoospermia indicate bilateral testicular dysfunction is in agreement with recent reports that varicocele is mainly a bilateral disease (11, 12). Induction of spermatogenesis in 7 of 15 azoospermic men (46.6%) after varicocelectomy (13) was in agreement with other investigators who found that varicocele repair in men with azoospermia and severe oligoasthenozoospermia may result in induction or enhancement of spermatogenesis in 40% 60% of the patients (14 16). On the other hand, the initial benefit of varicocele repair in azoospermic patients may be limited, with only 9.6% of men after varicocele repair having enough viable sperm in the ejaculate to avoid a testicular sperm extraction (TESE) procedure (17). Because of this discrepancy, the purpose of our study was to reassess the improvement in semen quality and pregnancy /06/$32.00 Fertility and Sterility Vol. 85, No. 3, March 2006 doi: /j.fertnstert Copyright 2006 American Society for Reproductive Medicine, Published by Elsevier Inc. 635

2 outcome after varicocelectomy in men with azoospermia. Increasing the numbers from 15 to 27 men, we also sought to correlate the testicular histology patterns of a group of azoospermic men with varicocele with the treatment outcome after varicocele repair. MATERIALS AND METHODS This study was approved by the University of São Paulo and University of Caxias do Sul review board and the patients involved granted their informed consent. In a prospective study, 27 azoospermic men with clinical varicocele underwent microsurgical varicocele repair between July 1999 and May All of them had primary infertility. The minimum duration of infertility required was defined as a failure to establish a pregnancy within 1 year with unprotected intercourse. A basic infertility evaluation including a detailed history and a complete physical examination was undertaken. Only patients with varicocele grade II III identified on physical examination were included. Patients who were taking antioxidants like vitamin C and E were excluded from the study. The mean age of the wife at presentation was years (range years). All women were normal based on history, hormonal levels, and hysterosalpingogram. Testicular size was evaluated in all patients with a caliper or by scrotal ultrasound. Testicular atrophy/hypotrophy ( 10 ml) was bilateral in six patients (22.2%) and unilateral in five (18.51%). The mean ( SD) right testes was ml and left testes was ml. Mean preoperative hormone levels were FSH, miu/ml (range miu/ml); LH, miu/ml (range 6 43 miu/ml); and T ng/dl (range ng/dl). Karyotype and Y microdelection were available only in the last 12 patients operated, showing no evidence of abnormalities. All patients had at least two semen analyses showing azoospermia obtained by masturbation after 2 5 days of abstinence before the surgery. Samples were centrifuged at 600 g for 10 minutes and no sperm were detected in the pellet, confirming the diagnosis of azoospermia. Patients with pyospermia were treated before varicocele repair. Repair was bilateral in 15 and unilateral in 12 patients using a subinguinal approach and a microsurgical technique. Using the microsurgical approach, we ligate the pampiniform plexus, leaving intact the cremasterium plexus as well as the gubernaculum veins. Each patient underwent open diagnostic testis biopsy at the same time as the varicocele repair under general anesthesia. Biopsies were performed on both testes, irrespective of which appeared healthier whether by size or shape. Two new semen analyses were performed on each patient at 6 and 12 months postoperatively. Sperm concentration and motility were evaluated according to the World Health Organization criteria and sperm morphology according to Tygerberg s strict criteria. Samples were centrifuged at 600 g for 10 minutes and if no sperm were detected in the pellet, a diagnosis of azoospermia was confirmed. The biopsy results, postoperative semen analysis, and the correlation between the induction of spermatogenesis and the testis biopsy were studied. We also evaluated the pregnancy outcome after varicocele repair. RESULTS Germ cell aplasia was identified in 10, hypospermatogenesis in 9, and early maturation arrest (arrest at the primary spermatocyte stage) in 8 of the men (Table 1). Induction of spermatogenesis was achieved in nine of them (33.3%), six with bilateral (40%, 6/15) and three with unilateral varicoceles (25%, 3/12). Of these nine men, four had germ cell aplasia, three maturation arrest, and two hypospermatogenesis. After the varicocelectomy in men with germ cell aplasia, the mean SD sperm concentration was /ml, the sperm motility (grades A B) was 18.8% 26.9%, and normal sperm morphology was 1.7% 2.3%. In men with maturation arrest, sperm concentration was /ml, the sperm motility was 11.3% 16%, and the normal sperm morphology was 1.5% 2.3% postoperatively. Furthermore, in patients with hypospermatogenesis, the mean SD sperm concentration was 0.87% 1.74%, sperm motility was 6.7% 13.3%, and normal sperm morphology was 0.78% 1.7% after the surgery. The highest sperm concentration, motility, and morphology between the two semen analyses obtained after the surgical procedure are depicted in Table 1. Thirty-three percent (2/6) of the patients with bilateral testicular atrophy and high FSH levels, 20% (1/5) of the patients with unilateral atrophy with high FSH levels, and 37.5% (6/16) of the patients with normal testicular size and FSH levels had sperm in the semen. Of the nine patients with improved semen quality, five relapsed into azoospermia 6 months after the recovery of spermatogenesis (four germ cell aplasia and one maturation arrest). Of these 5 patients who relapsed, 3 underwent a bilateral varicocelectomy and 2, a unilateral procedure. The only patient who established a pregnancy had a testicular biopsy showing maturation arrest (Table 1). DISCUSSION The first study on the importance of varicocelectomy to male infertility was published in 1952 by Tulloch (18), who reported spontaneous pregnancy after varicocele repair in an azoospermic man. Since that time, varicocelectomy has become the most commonly performed surgery for male factor infertility. However, only in the past 10 years, some studies have shown that nonobstructive azoospermic patients with 636 Pasqualotto et al. Azoospermic men after varicocelectomy Vol. 85, No. 3, March 2006

3 Fertility and Sterility TABLE 1 Histology pattern of the testis in azoospermic man with varicocele and semen analysis (ejaculate specimen) after varicocelectomy. Patient Testis biopsy Varicocelectomy Concentration ( 10 6 /ml) Motility (%) Morphology Tygerberg (%) Pregnancy Azoospermia 1 Hypospermatogenesis Bilateral Zero Zero Zero No Yes 2 Hypospermatogenesis Unilateral Zero Zero Zero No Yes 3 Hypospermatogenesis Bilateral Zero Zero Zero No Yes 4 Hypospermatogenesis Bilateral Zero Zero Zero No Yes 5 Hypospermatogenesis Unilateral Zero Zero Zero No Yes 6 Hypospermatogenesis Unilateral Zero Zero Zero No Yes 7 Hypospermatogenesis Bilateral Zero Zero Zero No Yes 8 Hypospermatogenesis Bilateral No No 9 Hypospermatogenesis Unilateral No No 10 Maturation arrest Bilateral Zero Zero Zero No Yes 11 Maturation arrest Unilateral Zero Zero Zero No Yes 12 Maturation arrest Unilateral Zero Zero Zero No Yes 13 Maturation arrest Bilateral Zero Zero Zero No Yes 14 Maturation arrest Bilateral Yes No 15 Maturation arrest Unilateral No Yes 16 Maturation arrest Bilateral No No 17 Maturation arrest Unilateral Zero Zero Zero No Yes 18 Germ cell aplasia Unilateral Zero Zero Zero No Yes 19 Germ cell aplasia Unilateral Zero Zero Zero No Yes 20 Germ cell aplasia Bilateral Zero Zero Zero No Yes 21 Germ cell aplasia Bilateral Zero Zero Zero No Yes 22 Germ cell aplasia Bilateral Zero Zero Zero No Yes 23 Germ cell aplasia Bilateral Zero Zero Zero No Yes 24 Germ cell aplasia Unilateral No Yes 25 Germ cell aplasia Bilateral No Yes 26 Germ cell aplasia Unilateral No Yes 27 Germ cell aplasia Bilateral No Yes Pasqualotto. Azoospermic men after varicocelectomy. Fertil Steril

4 varicocele identified on physical examination may benefit from varicocele repair (13 16, 18 21). Gat et al. (21) observed a significant improvement in sperm concentration, motility, and morphology in 82% of the azoospermic and oligoteratoasthenospermic men after internal spermatic vein embolization. They concluded that if azoospermia is not too long-standing, the treatment of varicocele may significantly improve spermatogenesis or renew sperm production. In addition, adequate treatment may spare in 50% of azoospermic patients the need for TESE as preparation for intracytoplasmic sperm injection (ICSI). On the other hand, Schlegel and Kaufmann (17), evaluating whether a previous history of varicocele repair, although not sufficient to avoid TESE, increases the rate of sperm retrieval, came to conclusion that retrieval rates are 60% per TESE attempt, regardless of whether previous varicocelectomy had been done. The initial benefit of varicocele repair in azoospermic patients treated may be limited, with only 9.6% of men after varicocele repair having enough viable sperm in the ejaculate to avoid a TESE procedure (17). These results for the success rate after varicocelectomy in men with nonobstructive azoospermia is lower than that previously reported (13 16). However, previous reports have considered success to be the presence of sperm on any semen analysis after varicocelectomy (13 16). Schlegel and Kaufmann chose a clinically relevant end point of whether varicocele repair has affected the need for TESE (17). There is another point that might explain why Schlegel and Kaufmann reported less than 10% of men with enough viable sperm in the ejaculate: the presence of subclinical varicocele in their analysis. There are many unresolved clinical questions related to varicoceles. For instance, as to whether subclinical varicoceles should be diagnosed and treated. Therefore, although recent progress in diagnostic methods has revealed a higher incidence of subclinical varicoceles, the clinical significance of this is controversial with regard to male factor infertility (22, 23). Therefore, selecting a population with clinical varicocele might be more suitable to evaluate whether an azoospermic man with varicocele should be operated or not. Another point of discussion is the presence of Y microdeletion or abnormalities in the karyotype, which may be observed in 15% of completely azoospermic men, which may render assisted reproductive technology (ART) necessary (24). According to Cayan et al. (25), azoospermic men undergoing varicocelectomy may achieve improvement in spermatogenesis only when genetic abnormality is not detected. The site of Y chromosome deletion is a more important predictive factor for sperm retrieval than is a coincident varicocele (25, 26). Similarly, for men with Klinefelter syndrome, a history of varicocele repair does not appear to change the outcome of TESE. In the study by Schlegel and Kaufmann 7 patients included in the study had partial deletions of the Y chromosome and 14 patients had Klinefelter syndrome (17). There might be another possible reason for the small percentage of men with enough sperm present in the ejaculate to avoid sperm extraction procedure. In our study, karyotype and Y microdelection were available only in the last 12 patients operated, showing no evidence of abnormalities. The fact that 15 of the 27 patients with left varicocele had right varicocele is of clinical importance. Studying animal models, it was observed that the surgical repair of the secondary right varicocele improved all semen parameters, indicating the harmful consequences of the primary induced left varicocele on the right testis (7). It is important to notice here that in patients with improvement in semen quality, sperm morphology according to the Tygerberg strict criteria varied from 2% to 6%, demonstrating that the varicocele repair may cause an improvement in sperm function. However, despite postoperative improvement in semen parameters in our updated series, ART may still be required to enable the majority of couples to initiate pregnancy (27). The clinical importance of varicocele repair is that a substantial number of completely azoospermic men destined to undergo invasive testicular sperm retrieval in combination with ICSI now have the potential of providing sperm by ejaculation (28, 29). When a choice is possible, using motile spermatozoa from a fresh ejaculate is preferable to using TESE in preparation for ICSI and IVF (27). In addition, couples have to be counseled that they will have to wait for at least 12 months after varicocelectomy before proceeding to any type of ART. Longer follow-up will determine whether these azoospermic patients after the varicocele repair will improve even more their sperm concentration, motility, and morphology. Even without more cases with relapse of azoospermia after an initial appearance of sperm in the semen in our updated series, five of nine patients (55.55%) who had an improvement in the quality of the semen taken 6 months after a varicocele repair returned to their previous azoospermia in a semen analysis performed 12 months after the surgery. We believe that the varicocele repair in those patients who relapsed to azoospermia might have had a temporary effect resulting in the induction of spermatogenesis that, over a small period of time, returned to their original status of azoospermia. On the other hand, there is a possibility that these men have intermittent sperm production and the results are unrelated to the surgery. Nevertheless, these men were not able to sustain spermatogenesis for a long time, suggesting that semen cryopreservation should be performed once the patient has sperm in the semen (13). One may argue that testicular spermatozoa retrieved from azoospermic patients with varicocele might have intrinsic defects, thus reinforcing the idea that these azoospermic patients should undergo a varicocelectomy before initiating any type of ART procedure (25). Again, the importance of these findings is that a significant number of azoospermic 638 Pasqualotto et al. Azoospermic men after varicocelectomy Vol. 85, No. 3, March 2006

5 men destined to undergo invasive testicular sperm retrieval procedures involving repeated open or needle biopsies in combination with ICSI now have the potential of providing spermatozoa by ejaculation or even of establishing a pregnancy without technical assistance. Although in our updated series the percentage of men with spermatozoa present in the ejaculate after the varicocelectomy had decreased compared to our previous report, we suggest that a varicocele repair must be considered for all men with azoospermia who have a palpable varicocele. A single testis biopsy showing germ cell aplasia may not reflect the overall testis histology, only a focal area. Therefore, azoospermic patients with germ cell aplasia in a single large testis biopsy may have improvement in semen quality after varicocelectomy. Due to the possibility of their relapsing into azoospermia after an initial improvement in semen quality after varicocelectomy, patients should be informed of the possibility of sperm cryopreservation. REFERENCES 1. Schlesinger MH, Wilets IF, Nagler HM. Treatment outcome after varicocelectomy. Urol Clin North Am 1994;21: Kamal KM, Javeri K, Zini A. Microsurgical varicocelectomy in the era of assisted reproductive technology: influence of initial semen quality on pregnancy rates. Fertil Steril 2001;75: Witt MA, Lipshultz LI. Varicocele: a progressive or static lesion? Urology 1993;42: Resim S, Cek M, Fazlioglu A, Caskurlu T, Gurbuz G, Sevin G. Echocolour Doppler ultrasonography in the diagnosis of varicocele. Internat Urol and Nephrol 1999;31: Gonzales R, Reddy P, Kaye KW, Narayan P. Comparison of Doppler examination retrograde spermatic venography in the diagnosis of varicocele. Fertil Steril 1983;40: Sofikitis N, Miyagawa I. Bilateral effect of varicocele on testicular metabolism in the rat. Int J Fertil 1994;39: Sofikitis NV, Takahashi C, Nakamura I, Hirakawa S, Miyagawa I. Surgical repair of secondary right varicocele in rats with primary left varicocele: effects on fertility, testicular temperature, spermatogenesis, and sperm maturation. Arch Androl 1992;28: Hendin BN, Kolettis PN, Sharma RK, Thomas AJ Jr, Agarwal A. Varicocele is associated with elevated spermatozoal reactive oxygen species production and diminished seminal plasma antioxidant capacity. J Urol 1999;161: Pasqualotto FF, Sharma RK, Nelson DR, Thomas AJ Jr, Agarwal A. Relationship between oxidative stress, semen characteristics and clinical diagnosis in men undergoing infertility investigation. Fertil Steril 2000;73: Sofikitis NV, Miyagawa I, Incze P, Andrighetti S. Detrimental effect of left varicocele on the reproductive capacity of the early haploid male gamete. J Urol 1996;156: Gat Y, Zukerman Z, Bachar GN, Feldberg DO, Gornish M. Adolescent varicocele: Is it a unilateral disease? Urology 2003;62: Gat Y, Bachar GN, Zukerman Z, Belenky A, Gornish M. Varicocele: a bilateral disease. Fertil Steril 2004;81: Pasqualotto FF, Lucon AM, Hallak J, Saldanha LB, Góes PM, Arap S. Induction of spermatognesis in azoospermic men after varicocele repair. Hum Reprod 2003;18: Matthews GJ, Matthews ED, Goldstein M. Induction of spermatogenesis and achievement of pregnancy after microsurgical varicocelectomy in men with azoospermia and severe oligoasthenospermia. Fertil Steril 1998;70: Kadioglu A, Tefkeli A, Cayan S, Kendirali E, Erdemir F, Tellaloglu S. Microsurgical inguinal varicocele repair in azoospermic men. Urology 2001;57: Kim ED, Leibman BB, Grinblat DM, Lipshultz LI. Varicocele repair improves semen parameters in azoospermic men with spermatogenic failure. J Urol 1999;162: Schlegel PN, Kaufmann J. Role of varicocelectomy in men with nonobstructive azoospermia. Fertil Steril 2004;81: Tulloch WS. Consideration of sterility; subfertility in the male. Edinburg Med J 1952;59: Czaplicki M, Bablock L, Janczewski Z. Varicocelectomy in patients with azoospermia. Arch Androl 1979;3: Mehan DJ. Results of ligation of internal spermatic vein in the treatment of infertility in azoospermic patients. Fertil Steril 1976;27: Gat Y, Bachar GN, Everaert K, Levinger U, Gornish M. Induction of spermatogenesis in azoospermic men after internal spermatic vein embolization for the treatment of varicocele. Hum Reprod 2005;20: Evers J, Collins A. Assessment of efficacy of varicocele repair for male subfertility: a systematic review. Lancet 2003;361: Jarow JP, Ogle SR, Eskew A. Seminal improvement following repair of ultrasound detected subclinical varicoceles. J Urol 1996;155: Pryor JL, Kent-First M, Muallen A. Microdeletions in the Y chromosome of infertile men. N Engl J Med 1997;336: Cayan S, Lee D, Black LD, Reijo Pera RA, Turek PJ. Response to varicocelectomy in oligospermic men with and without defined genetic infertility. Urology 2001;57: Foresta C, Moro E, Ferlin A. Y chromosome microdeletions and alterations of spermatogenesis. Endocr Rev 2001;22: Aboulghar MA, Mansour RT, Serour GI, et al: Fertilization and pregnancy rates after intracytoplasmic sperm injection using ejaculate semen and surgically retrieved sperm. Fertil Steril 1997;68: Silber SJ. Microsurgical TESE and the distribution of spermatogenesis in non-obstructive azoospermia. Hum Reprod 2000;15: Turek PJ, Cha I, Ljung B-M. Systematic fine-needle aspiration of the testis: correlation to biopsy and results of organ mapping for mature sperm in azoospermic men. Urology 1997;49: Fertility and Sterility 639

Induction of spermatogenesis in azoospermic men after varicocele repair

Induction of spermatogenesis in azoospermic men after varicocele repair Human Reproduction Vol.18, No.1 pp. 108±112, 2003 DOI: 10.1093/humrep/deg032 Induction of spermatogenesis in azoospermic men after varicocele repair FaÂbio F.Pasqualotto 1, AntoÃnio M.Lucon, Jorge Hallak,

More information

Fertility problems occur in approximately 10% to

Fertility problems occur in approximately 10% to Journal of Andrology, Vol. 33, No. 2, March/April 2012 Copyright E American Society of Andrology Varicocelectomy Does Not Impact Pregnancy Outcomes Following Intracytoplasmic Sperm Injection Procedures

More information

MALE FACTOR. Gerald J. Matthews, M.D.,* Ellen Dakin Matthews, R.N., and Marc Goldstein, M.D.*

MALE FACTOR. Gerald J. Matthews, M.D.,* Ellen Dakin Matthews, R.N., and Marc Goldstein, M.D.* FERTILITY AND STERILITY VOL. 70, NO. 1, JULY 1998 Copyright 1998 American Society for Reproductive Medicine Published by Elsevier Science Inc. Printed on acid-free paper in U.S.A. MALE FACTOR Induction

More information

Variability in testis biopsy interpretation: implications for male infertility care in the era of intracytoplasmic sperm injection

Variability in testis biopsy interpretation: implications for male infertility care in the era of intracytoplasmic sperm injection Variability in testis biopsy interpretation: implications for male infertility care in the era of intracytoplasmic sperm injection Matthew R. Cooperberg, M.D., a Thomas Chi, B.A., a Amir Jad, M.D., a Imok

More information

Alternate indications for varicocele repair: non-obstructive azoospermia, pain, androgen deficiency and progressive testicular dysfunction

Alternate indications for varicocele repair: non-obstructive azoospermia, pain, androgen deficiency and progressive testicular dysfunction Alternate indications for varicocele repair: non-obstructive azoospermia, pain, androgen deficiency and progressive testicular dysfunction Peter N. Schlegel, M.D., and Marc Goldstein, M.D. Department of

More information

Outcome of varicocele repair in men with nonobstructive azoospermia: systematic review and meta analysis

Outcome of varicocele repair in men with nonobstructive azoospermia: systematic review and meta analysis (2016) 18, 246 253 2016 AJA, SIMM & SJTU. All rights reserved 1008-682X www.asiaandro.com; www.ajandrology.com Male Fertility Open Access INVITED REVIEW Outcome of varicocele repair in men with nonobstructive

More information

Effect of female partner age on pregnancy rates after vasectomy reversal

Effect of female partner age on pregnancy rates after vasectomy reversal MALE FACTOR Effect of female partner age on pregnancy rates after vasectomy reversal Edward R. Gerrard, Jr., M.D., a Jay I. Sandlow, b Robert A. Oster, Ph.D., c John R. Burns, M.D., a Lyndon C. Box, M.D.,

More information

Varicocele: surgical techniques in 2005

Varicocele: surgical techniques in 2005 Daniel H. Williams, MD, Edward Karpman, MD, Larry I. Lipshultz, MD Department of Urology, Baylor College of Medicine, Houston, Texas, USA WILLIAMS DH, KARPMAN E, LIPSHULTZ LI. Varicocele: surgical techniques

More information

REVIEW INTRODUCTION. Keywords: Varicocele. Varicocelectomy. Male infertility. Seminal parameters. Assisted reproductive techniques.

REVIEW INTRODUCTION. Keywords: Varicocele. Varicocelectomy. Male infertility. Seminal parameters. Assisted reproductive techniques. CLINICS 2008;63:395-404 REVIEW The role of varicocele repair in the new era of assisted reproductive technology Marcello Cocuzza, I Mariana Amora Cocuzza, II Frances Monette Papa Bragais, III Ashok Agarwal

More information

MALE FACTOR. Preoperative semen analysis as a predictor of seminal improvement following varicocelectomy

MALE FACTOR. Preoperative semen analysis as a predictor of seminal improvement following varicocelectomy FERTILITY AND STERILITY VOL. 75, NO. 1, JANUARY 2001 Copyright 2001 American Society for Reproductive Medicine Published by Elsevier Science Inc. Printed on acid-free paper in U.S.A. MALE FACTOR Preoperative

More information

Varicocele repair for infertility: what is the evidence?

Varicocele repair for infertility: what is the evidence? REVIEW C URRENT OPINION Varicocele repair for infertility: what is the evidence? Vincenzo Ficarra a, Alessandro Crestani a, Giacomo Novara a, and Vincenzo Mirone b Purpose of review Considering the persistent

More information

Prediction of Successful Sperm Retrieval in Patients with Nonobstructive Azoospermia

Prediction of Successful Sperm Retrieval in Patients with Nonobstructive Azoospermia Urology Journal UNRC/IUA Vol. 3, No. 2, 92-96 Spring 2006 Printed in IRAN Prediction of Successful Sperm Retrieval in Patients with Nonobstructive Azoospermia Seyed Amirmohsen Ziaee, 1 * Mohammadreza Ezzatnegad,

More information

The Role of Testicular Volume in Adolescents With Varicocele: The Better Way and Time of Surgical Treatment

The Role of Testicular Volume in Adolescents With Varicocele: The Better Way and Time of Surgical Treatment The Role of Testicular Volume in Adolescents With Varicocele: The Better Way and Time of Surgical Treatment Claudio Spinelli, Martina Di Giacomo, Roberto Lo Piccolo, Alessandra Martin and Antonio Messineo

More information

Sperm recovery and IVF outcome after surgical sperm retrieval in azoospermia: our experience

Sperm recovery and IVF outcome after surgical sperm retrieval in azoospermia: our experience International Journal of Reproduction, Contraception, Obstetrics and Gynecology Rai S et al. Int J Reprod Contracept Obstet Gynecol. 2018 Feb;7(2):xxx-xxx www.ijrcog.org DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20180019

More information

Testicular Biopsy in Males With Infertility: A Longitudinal Study

Testicular Biopsy in Males With Infertility: A Longitudinal Study Short Communication Iran J Pathol. 2017; 12(2): 177-182 Iranian Journal of Pathology ISSN: 2345-3656 Testicular Biopsy in Males With Infertility: A Longitudinal Study Sepideh Siadati 1*, Hamid Shafi 2,

More information

Comparing three different surgical techniques used in adult bilateral varicocele

Comparing three different surgical techniques used in adult bilateral varicocele Asian J Endosc Surg ISSN 1758-5902 ORIGINAL ARTICLE Comparing three different surgical techniques used in adult bilateral varicocele HB Sun, Y Liu, MB Yan, ZD Li & XG Gui Department of Urology, Fifth Affiliated

More information

Clinical Study Treatment of Bilateral Varicocele and Other Scrotal Comorbidities Using a Single Scrotal Access: Our Experience on 34 Patients

Clinical Study Treatment of Bilateral Varicocele and Other Scrotal Comorbidities Using a Single Scrotal Access: Our Experience on 34 Patients , Article ID 403603, 4 pages http://dx.doi.org/10.1155/2014/403603 Clinical Study Treatment of Bilateral Varicocele and Other Scrotal Comorbidities Using a Single Scrotal Access: Our Experience on 34 Patients

More information

Multiple testicular sampling in non-obstructive azoospermia is it necessary?

Multiple testicular sampling in non-obstructive azoospermia is it necessary? Human Reproduction vol.13 no.11 pp.3081 3085, 1998 Multiple testicular sampling in non-obstructive azoospermia is it necessary? R.Hauser 1,3, A.Botchan 1, A.Amit 2, D.Ben Yosef 2, R.Gamzu 1, G.Paz 1, J.B.Lessing

More information

Fine-Needle Aspiration Cytology of the Testis: Can It Be a Single Diagnostic Modality in Azoospermia?

Fine-Needle Aspiration Cytology of the Testis: Can It Be a Single Diagnostic Modality in Azoospermia? Urologia Internationalis Original Paper Urol Int 2004;73:23 27 DOI: 10.1159/000078799 Received: July 16, 2003 Accepted after revision: October 29, 2003 Fine-Needle Aspiration Cytology of the Testis: Can

More information

Predictive Factors of Successful Microdissection Testicular Sperm Extraction in Patients with Presumed Sertoli Cell-Only Syndrome

Predictive Factors of Successful Microdissection Testicular Sperm Extraction in Patients with Presumed Sertoli Cell-Only Syndrome Original Article Predictive Factors of Successful Microdissection Testicular Sperm Extraction in Patients with Presumed Sertoli Cell-Only Syndrome Tahereh Modarresi, M.Sc. 1, Hani Hosseinifar, M.Sc. 1,

More information

Cryptorchidism and its impact on male fertility: a state of art review of current literature. Case 1

Cryptorchidism and its impact on male fertility: a state of art review of current literature. Case 1 CASE REPORT Cryptorchidism and its impact on male fertility: a state of art review of current literature Eric Chung, MBBS, FRACS; Gerald B. Brock, MD, FRCSC Division of Urology, University of Western Ontario,

More information

Azoospermia, which is the complete absence of

Azoospermia, which is the complete absence of SEXUAL DYSFUNCTION AND INFERTILITY Evaluation of Microdissection Testicular Sperm Extraction Results in Patients with Non-Obstructive Azoospermia: Independent Predictive Factors and Best Cutoff Values

More information

The significance of clinical practice guidelines on adult varicocele detection and management

The significance of clinical practice guidelines on adult varicocele detection and management (2016) 18, 269 275 2016 AJA, SIMM & SJTU. All rights reserved 1008-682X www.asiaandro.com; www.ajandrology.com Male Fertility Open Access INVITED REVIEW The significance of clinical practice guidelines

More information

Clinical Study Influence of Preoperative Pain Duration on Microsurgical Varicocelectomy Outcomes

Clinical Study Influence of Preoperative Pain Duration on Microsurgical Varicocelectomy Outcomes Advances in Urology Volume 2013, Article ID 370969, 4 pages http://dx.doi.org/10.1155/2013/370969 Clinical Study Influence of Preoperative Pain Duration on Microsurgical Varicocelectomy Outcomes Mustafa

More information

Treatment of male idiopathic infertility with recombinant human follicle-stimulating hormone: a prospective, controlled, randomized clinical study

Treatment of male idiopathic infertility with recombinant human follicle-stimulating hormone: a prospective, controlled, randomized clinical study Treatment of male idiopathic infertility with recombinant human follicle-stimulating hormone: a prospective, controlled, randomized clinical study Carlo Foresta, M.D., Ph.D., a Andrea Bettella, M.D., Ph.D.,

More information

MICROSCOPIC TESTICULAR SPERM EXTRACTION; IN PATIENTS OF NON-OBSTRUCTIVE AZOOSPERMIA WITH HISTPATHOLOGIC, CYTOGENETIC AND HORMONAL VARIATIONS.

MICROSCOPIC TESTICULAR SPERM EXTRACTION; IN PATIENTS OF NON-OBSTRUCTIVE AZOOSPERMIA WITH HISTPATHOLOGIC, CYTOGENETIC AND HORMONAL VARIATIONS. The Professional Medical Journal DOI: 10.29309/TPMJ/18.4055 ORIGINAL PROF-4055 1. MD, FRCSC, FEBU,. 2. FACS, FCPS, FRCSEd Ex. Assistant Assistant Prof. Urology, University Medical & Dental College, Madina

More information

Clinical Study Predictive Factors for Natural Pregnancy after Microsurgical Reconstruction in Patients with Primary Epididymal Obstructive Azoospermia

Clinical Study Predictive Factors for Natural Pregnancy after Microsurgical Reconstruction in Patients with Primary Epididymal Obstructive Azoospermia International Endocrinology, Article ID 873527, 6 pages http://dx.doi.org/10.1155/2014/873527 Clinical Study Predictive Factors for Natural Pregnancy after Microsurgical Reconstruction in Patients with

More information

Yang Yu, Qun Wang, Hongguo Zhang, Linlin Li, Dongliang Zhu, Ruizhi Liu

Yang Yu, Qun Wang, Hongguo Zhang, Linlin Li, Dongliang Zhu, Ruizhi Liu Int J Clin Exp Med 2017;10(3):5338-5343 www.ijcem.com /ISSN:1940-5901/IJCEM0041408 Original Article Relationship of paternal age with outcome of percutaneous epididymal sperm aspiration and testicular

More information

THE PATIENT S GUIDE TO VARICOCELE

THE PATIENT S GUIDE TO VARICOCELE The Varicocele Decision Varicoceles are a relatively common problem that can hurt a man's fertility. The good news is that this is a fairly simple problem to fix. Dr. Fisch has treated hundreds of men

More information

THE ROLE OF VARICOCELE TREATMENT IN THE ERA OF ASSISTED REPRODUCTIVE TECHNOLOGY

THE ROLE OF VARICOCELE TREATMENT IN THE ERA OF ASSISTED REPRODUCTIVE TECHNOLOGY Clinical Urology Brazilian Journal of Urology Official Journal of the Brazilian Society of Urology Vol. 27 (1): 19-25, January - February, 2001 THE ROLE OF VARICOCELE TREATMENT IN THE ERA OF ASSISTED REPRODUCTIVE

More information

Aromatase Inhibitors in Male Infertility:

Aromatase Inhibitors in Male Infertility: Aromatase Inhibitors in Male Infertility: The hype of hypogonadism? BEATRIZ UGALDE, PHARM.D. H-E-B/UNIVERSITY OF TEXAS COMMUNITY PHARMACY PGY1 03 NOVEMBER 2017 PHARMACOTHERAPY ROUNDS Disclosures No conflicts

More information

PERCUTANEOUS EMBOLIZATION OF VARICOCELES: OUTCOMES AND CORRELATION OF SEMEN IMPROVEMENT WITH PREGNANCY

PERCUTANEOUS EMBOLIZATION OF VARICOCELES: OUTCOMES AND CORRELATION OF SEMEN IMPROVEMENT WITH PREGNANCY ADULT UROLOGY PERCUTANEOUS EMBOLIZATION OF VARICOCELES: OUTCOMES AND CORRELATION OF SEMEN IMPROVEMENT WITH PREGNANCY G. NABI, S. ASTERLINGS, D. R. GREENE, AND R. L. MARSH ABSTRACT Objectives. To assess

More information

Article Right varicocele and hypoxia, crucial factors in male infertility: fluid mechanics analysis of the impaired testicular drainage system

Article Right varicocele and hypoxia, crucial factors in male infertility: fluid mechanics analysis of the impaired testicular drainage system RBMOnline - Vol 13. No 4. 2006 510-515 Reproductive BioMedicine Online; www.rbmonline.com/article/2380 on web 12 July 2006 Article Right varicocele and hypoxia, crucial factors in male infertility: fluid

More information

GUIDELINES FOR THE INVESTIGATION AND TREATMENT OF MALE INFERTILITY

GUIDELINES FOR THE INVESTIGATION AND TREATMENT OF MALE INFERTILITY GUIDELINES FOR THE INVESTIGATION AND TREATMENT OF MALE INFERTILITY G.R. Dohle, Z. Kopa, A. Jungwirth, T.B. Hargreave. Eur Urol 2002;42(4):313-322 Eur Urol 2004;46(5):555-558 Definition Infertility is the

More information

GUIDELINES ON THE INVESTIGATION AND TREATMENT OF MALE INFERTILITY

GUIDELINES ON THE INVESTIGATION AND TREATMENT OF MALE INFERTILITY GUIDELINES ON THE INVESTIGATION AND TREATMENT OF MALE INFERTILITY G. Dohle (chairman), A. Jungwirth and W. Weidner. Eur Urol 2002;42(4):313-322 Eur Urol 2004;46(5):555-558 1. Introduction Infertility is

More information

REAPPRAISAL OF THE VALUE OF TESTICULAR BIOPSY IN THE INVESTIGATION OF INFERTILITY

REAPPRAISAL OF THE VALUE OF TESTICULAR BIOPSY IN THE INVESTIGATION OF INFERTILITY FERTWTY AND STEIuLlTY Copyright 1980 The American Fertility Society Vol., No.1 January 1980 Prinwl in U.S.A. REAPPRAISAL OF THE VALUE OF TESTICULAR BIOPSY IN THE INVESTIGATION OF INFERTILITY TERENCE

More information

Getting Help for Obstructive Azoospermia A BASIC GUIDE TO MALE. A doctor s guide for patients developed by the American Urological Association, Inc.

Getting Help for Obstructive Azoospermia A BASIC GUIDE TO MALE. A doctor s guide for patients developed by the American Urological Association, Inc. A BASIC GUIDE TO MALE Getting Help for Obstructive Azoospermia A doctor s guide for patients developed by the American Urological Association, Inc. Based on the AUA Best Practice Policy and ASRM Practice

More information

The role of animal models in the study of varicocele

The role of animal models in the study of varicocele Review Article The role of animal models in the study of varicocele Matthew J. Katz, Bobby B. Najari, Philip S. Li, Marc Goldstein Department of Urology, Weill Cornell Medical College, New York, NY, USA

More information

UroToday International Journal. Volume 2 - February 2009

UroToday International Journal.  Volume 2 - February 2009 UroToday International Journal www.urotodayinternationaljournal.com Volume 2 - February 2009 Azoospermic Patients: Mosaic Pattern in Testicular Sperm Extraction Mai Ahmed Banakhar, Hassan A. Farsi, Suha

More information

Information Sheet. Male Infertility

Information Sheet. Male Infertility Infertility National Public Awareness Campaign Information Sheet Male Infertility In approximately half of couples complaining of infertility part of the problem lies with the male. Male infertility has

More information

Assisted reproduction for the treatment of azoospermia

Assisted reproduction for the treatment of azoospermia Assisted reproduction for the treatment of azoospermia Anat Safran 1, Benjamin E.Reubinoff, Anat Porat-Katz, Joseph G.Schenker and Aby Lewin IVF Unit, Department of Obstetrics and Gynecology, Hadassah

More information

Clinical Policy Committee

Clinical Policy Committee Northern, Eastern and Western Devon Clinical Commissioning Group South Devon and Torbay Clinical Commissioning Group Clinical Policy Committee Commissioning policy: Assisted Conception Fertility treatments

More information

Reversible Conditions Organising More Information semen analysis Male Infertility at Melbourne IVF Fertility Preservation

Reversible Conditions Organising More Information semen analysis Male Infertility at Melbourne IVF Fertility Preservation Male Infertility Understanding fertility in men Conceiving a baby depends on a number of factors, including healthy sperm. After a woman s age, this can be the biggest issue. Reproduction, although simple

More information

Tomomoto ISHIKAWA and Masato FUJISAWA

Tomomoto ISHIKAWA and Masato FUJISAWA Microdissection testicular sperm extraction micro- TESE has become a recognized procedure for men with nonobstructive azoospermia NOA. Micro-TESE and intracytoplasmic sperm injection ICSI cycles expose

More information

Semen Quality in Infertile Men with a History of Unilateral Cryptorchidism

Semen Quality in Infertile Men with a History of Unilateral Cryptorchidism Journal of Reproduction & Contraception (2004) 15 (3):139-143 Semen Quality in Infertile Men with a History of Unilateral Cryptorchidism P. Tzvetkova 1, Wei-Jie ZHU 2, D. Tzvetkov 3 1. Department of Immunoneuroendocrinology,

More information

Shunt-type and stop-type varicocele in adolescents: prognostic value of these two different hemodynamic patterns

Shunt-type and stop-type varicocele in adolescents: prognostic value of these two different hemodynamic patterns Shunt-type and stop-type varicocele in adolescents: prognostic value of these two different hemodynamic patterns Mohammad Javad Mohseni, M.D., Hamid Nazari, M.D., Erfan Amini, M.D., Niloufar Javan-Farazmand,

More information

AZOOSPERMIA CYTOLOGICAL MANIFESTATIONS

AZOOSPERMIA CYTOLOGICAL MANIFESTATIONS ý Comptes rendus de l Académie bulgare des Sciences ÌÓÑ ÆÓ ¾¼½½ BIOLOGIE Morphologie AZOOSPERMIA CYTOLOGICAL MANIFESTATIONS Stefka Ivanova, Petia Tzvetkova (Submitted by Corresponding Member J. Jordanov

More information

A comparison between open and percutaneous needle biopsies in men with azoospermia

A comparison between open and percutaneous needle biopsies in men with azoospermia Human Reproduction vol.13 no.5 pp.1266 1271, 1998 A comparison between open and percutaneous needle biopsies in men with azoospermia B.Rosenlund 1,6, U.Kvist 3, L.Plöen 4, B.Lundh Rozell 2, P.Sjöblom 1

More information

Outcome of first and repeated testicular sperm extraction and ICSI in patients with non-obstructive azoospermia

Outcome of first and repeated testicular sperm extraction and ICSI in patients with non-obstructive azoospermia Human Reproduction Vol.17, No.9 pp. 2356 2361, 2002 Outcome of first and repeated testicular sperm extraction and ICSI in patients with non-obstructive azoospermia S.Friedler 1, A.Raziel, M.Schachter,

More information

Article Genetic association between AZF region polymorphism and Klinefelter syndrome

Article Genetic association between AZF region polymorphism and Klinefelter syndrome RBMOnline - Vol 19. No 4. 2009 547 551 Reproductive BioMedicine Online; www.rbmonline.com/article/3741 on web 21 August 2009 Article Genetic association between AZF region polymorphism and Klinefelter

More information

PERCUTANEOUS EPIDIDYMAL SPERM ASPIRATION (PESA) IN MEN WITH OBSTRUCTIVE AZOOSPERMIA

PERCUTANEOUS EPIDIDYMAL SPERM ASPIRATION (PESA) IN MEN WITH OBSTRUCTIVE AZOOSPERMIA Clinical Urology PESA IN OBSTRUCTIVE AZOOSPERMIA International Braz J Urol Vol. 29 (2): 4-46, March - April, 2003 Official Journal of the Brazilian Society of Urology PERCUTANEOUS EPIDIDYMAL SPERM ASPIRATION

More information

Comparison of Intracytoplasmic Sperm Injection Outcomes between Oligozoospermic, Obstructive Azoospermic and Non-Obstructive Azoospermic Patients

Comparison of Intracytoplasmic Sperm Injection Outcomes between Oligozoospermic, Obstructive Azoospermic and Non-Obstructive Azoospermic Patients Original Article Comparison of Intracytoplasmic Sperm Injection Outcomes between Oligozoospermic, Obstructive Azoospermic and Non-Obstructive Azoospermic Patients Ensieh Shahrokh Tehraninejad, M.D. 1,

More information

Microdissection testicular sperm extraction: an update

Microdissection testicular sperm extraction: an update (2013) 15, 35 39 ß 2013 AJA, SIMM & SJTU. All rights reserved 1008-682X/13 $32.00 www.nature.com/aja REVIEW Microdissection testicular sperm extraction: an update Ali A Dabaja and Peter N Schlegel Patients

More information

Applied Anatomic Study of Testicular Veins in Adult Cadavers and in Human Fetuses

Applied Anatomic Study of Testicular Veins in Adult Cadavers and in Human Fetuses Clinical Urology Anatomy of Testicular Veins in Adults and Human Fetuses International Braz J Urol Vol. 33 (2): 176-180, March - April, 2007 Applied Anatomic Study of Testicular Veins in Adult Cadavers

More information

CONTROVERSIAL PROBLEMS INVOLVING MALE INFERTILITY

CONTROVERSIAL PROBLEMS INVOLVING MALE INFERTILITY CONTROVERSIAL PROBLEMS INVOLVING MALE INFERTILITY Sherman J. Silber, M.D. Infertility Center of St. Louis St. Luke s Hospital 224 South Woods Mill Road, Suite 730 St. Louis, MO 63017 Telephone: 314-576-1400

More information

CURRICULUM VITAE Robert Brannigan, M.D. Revised : 04/01

CURRICULUM VITAE Robert Brannigan, M.D. Revised : 04/01 CURRICULUM VITAE Robert Brannigan, M.D. Revised : 04/01 CURRICULUM VITAE Robert Brannigan, M.D. Address The Center for Human Reproduction 60 East Delaware Place The Annex to the 900 North Michigan Building

More information

TECHNIQUES AND INSTRUMENTATION

TECHNIQUES AND INSTRUMENTATION TECHNIQUES AND INSTRUMENTATION FERTILITY AND STERILITY VOL. 81, NO. 2, FEBRUARY 2004 Copyright 2004 American Society for Reproductive Medicine Published by Elsevier Inc. Printed on acid-free paper in U.S.A.

More information

Influence of Oxidative Stress on Functional Integrity of Human Spermatozoal Membrane.

Influence of Oxidative Stress on Functional Integrity of Human Spermatozoal Membrane. The Journal of Obstetrics and Gynecology of India, March / April 2011 pg 195-199 Original Article Influence of Oxidative Stress on Functional Integrity of Human Spermatozoal Membrane. Chaudhari Ajay 1,

More information

Computer-assisted semen analysis parameters in men with varicocele: is surgery helpful?

Computer-assisted semen analysis parameters in men with varicocele: is surgery helpful? FERTILITY AND STERILITY Copyright 1996 American Society for Reproductive Medicine Vol. 66, No, 3, September 1996 Printed on acid-free paper in U. S. A. Computer-assisted semen analysis parameters in men

More information

CUA Guideline: The workup and management of azoospermic males

CUA Guideline: The workup and management of azoospermic males Original cua guideline research CUA Guideline: The workup and management of azoospermic males Keith Jarvi, MD, FRCSC; * Kirk Lo, MD, FRCSC; * Ethan Grober, MD; * Victor Mak, MD, FRCSC; * Anthony Fischer,

More information

Abstract. Introduction. RBMOnline - Vol 18. No Reproductive BioMedicine Online; on web 8 January 2009

Abstract. Introduction. RBMOnline - Vol 18. No Reproductive BioMedicine Online;  on web 8 January 2009 RBMOnline - Vol 18. No 3. 2009 315-319 Reproductive BioMedicine Online; www.rbmonline.com/article/3549 on web 8 January 2009 Article Microsurgical TESE versus conventional TESE for ICSI in non-obstructive

More information

Information for Patients. Male infertility. English

Information for Patients. Male infertility. English Information for Patients Male infertility English Table of contents What is male infertility?... 3 Diagnosis... 3 Medical history... 3 Physical examination... 3 Hormone blood tests... 3 Semen analysis...

More information

Infertility is not an uncommon problem in Western

Infertility is not an uncommon problem in Western Review Article A Practical Approach to Testicular Biopsy Interpretation for Male Infertility Lisa A. Cerilli, MD; Wayne Kuang, MD; David Rogers, MD Infertility is not an uncommon problem in Western societies

More information

Infertility Age-Related Increase of Reactive Oxygen Species in Neat Semen in Healthy Fertile Men

Infertility Age-Related Increase of Reactive Oxygen Species in Neat Semen in Healthy Fertile Men Infertility Age-Related Increase of Reactive Oxygen Species in Neat Semen in Healthy Fertile Men Marcello Cocuzza, Kelly S. Athayde, Ashok Agarwal, Rakesh Sharma, Rodrigo Pagani, Antonio M. Lucon, Miguel

More information

Varicocele treatment in the light of evidence-based andrology

Varicocele treatment in the light of evidence-based andrology Human Reproduction Update, Vol.7, No.1 pp. 65±69, 2001 Varicocele treatment in the light of evidence-based andrology A.Kamischke and E.Nieschlag 1 Institute of Reproductive Medicine of the University,

More information

TESE: Testis Sperm Extraction

TESE: Testis Sperm Extraction TESE: Testis Sperm Extraction Robert D. Oates, M.D., F.A.C.S. Department of Urology Boston University School of Medicine When is Microsurgical TESE indicated? Cases of Non-obstructive Azoospermia (NOA)

More information

Study of Theophylline Role in Sperm Selection for Intracytoplasmic Sperm Injection (ICSI) in Men with Non-Obstructive Azoospermia

Study of Theophylline Role in Sperm Selection for Intracytoplasmic Sperm Injection (ICSI) in Men with Non-Obstructive Azoospermia Study of Theophylline Role in Sperm Selection for Intracytoplasmic Sperm Injection (ICSI) in Men with Non-Obstructive Azoospermia Huda H. Oraibi 1, Hayder A. L. Mossa 1 *, Ula M. Al-Kawaz 1 and Nuofel

More information

Report on optimal evaluation of the infertile male

Report on optimal evaluation of the infertile male Report on optimal evaluation of the infertile male The Male Infertility Best Practice Policy Committee of the American Urological Association a and the Practice Committee of the American Society for Reproductive

More information

Inhibin B plasma concentrations in oligozoospermic subjects before and after therapy with follicle stimulating hormone

Inhibin B plasma concentrations in oligozoospermic subjects before and after therapy with follicle stimulating hormone Human Reproduction vol.14 no.4 pp.906 912, 1999 Inhibin B plasma concentrations in oligozoospermic subjects before and after therapy with follicle stimulating hormone Carlo Foresta 1,4, Andrea Bettella

More information

Infertility treatment

Infertility treatment In the name of God Infertility treatment Treatment options The optimal treatment is one that provide an acceptable success rate, has minimal risk and is costeffective. The treatment options are: 1- Ovulation

More information

Article Gonadotrophin therapy in combination with ICSI in men with hypogonadotrophic hypogonadism

Article Gonadotrophin therapy in combination with ICSI in men with hypogonadotrophic hypogonadism RBMOnline - Vol 15. No 2. 2007 156-160 Reproductive BioMedicine Online; www.rbmonline.com/article/2798 on web 14 June 2007 Article Gonadotrophin therapy in combination with ICSI in men with hypogonadotrophic

More information

Effects of Cryopreservation on the Ultrastructure of Human Testicular Sperm

Effects of Cryopreservation on the Ultrastructure of Human Testicular Sperm Journal of Reproduction & Contraception (2005) 16 (4):195-200 ORIGINAL PAPER Effects of Cryopreservation on the Ultrastructure of Human Testicular Sperm Xin-qiang LAI 1, Wei-jie ZHU 2, Jing LI 3, Fu-xing

More information

Is defined as the altruistic gift of the male gametes from an anonymous man to help single women and couples to procreate.

Is defined as the altruistic gift of the male gametes from an anonymous man to help single women and couples to procreate. Dr. Marcos Meseguer (marcos.meseguer@ivi.es) Dr. Nicolás Garrido (nicolas.garrido@ivi.es) Help Wanted; Sperm donation in the era of ICSI Sperm Donation Is defined as the altruistic gift of the male gametes

More information

Abnormalities of Spermatogenesis

Abnormalities of Spermatogenesis Abnormalities of Spermatogenesis Male Factor 40% of the cause for infertility Sperm is constantly produced by the germinal epithelium of the testicle Sperm generation time 73 days Sperm production is thermoregulated

More information

The role of microsurgical varicocelectomy in treating male infertility

The role of microsurgical varicocelectomy in treating male infertility Review Article The role of microsurgical varicocelectomy in treating male infertility Alexander J. Tatem 1, Robert E. Brannigan 2 1 Department of Urology, Indiana University, Indiana University School

More information

ORIGINAL ARTICLE TESTICULAR VERSUS EPIDIDYMAL SPERMATOZOA IN INTRACYTOPLASMIC SPERM INJECTION TREATMENT CYCLES

ORIGINAL ARTICLE TESTICULAR VERSUS EPIDIDYMAL SPERMATOZOA IN INTRACYTOPLASMIC SPERM INJECTION TREATMENT CYCLES ORIGINAL ARTICLE TESTICULAR VERSUS EPIDIDYMAL SPERMATOZOA IN INTRACYTOPLASMIC SPERM INJECTION TREATMENT CYCLES Hameed N, Ozturk O* PAF Hospital, Munir Road, Lahore, Pakistan, *University College Hospital,

More information

Cytogenetic and Y Chromosome Microdeletions Screening in Tunisian Infertile Men

Cytogenetic and Y Chromosome Microdeletions Screening in Tunisian Infertile Men Donnish Journal of Genetics and Molecular Biology Vol 1(1) pp. 001-005 October, 2015. http:///djgmb Copyright 2015 Donnish Journals Original Research Article Cytogenetic and Y Chromosome Microdeletions

More information

RESULTS OF MICROSURGICAL ANASTOMOSIS IN MEN WITH SEMINAL TRACT OBSTRUCTION DUE TO INGUINAL HERNIORRHAPHY

RESULTS OF MICROSURGICAL ANASTOMOSIS IN MEN WITH SEMINAL TRACT OBSTRUCTION DUE TO INGUINAL HERNIORRHAPHY RESULTS OF MICROSURGICAL ANASTOMOSIS IN MEN WITH SEMINAL TRACT OBSTRUCTION DUE TO INGUINAL HERNIORRHAPHY Fabio Firmbach Pasqualotto, Eleonora Bedin Pasqualotto, Ashok Agarwal and Anthony Joseph Thomas

More information

COMPARATIVE STUDY OF LAPAROSCOPIC VARICOCELE LIGATION VERSUS INGUINAL VARICOCELECTOMY

COMPARATIVE STUDY OF LAPAROSCOPIC VARICOCELE LIGATION VERSUS INGUINAL VARICOCELECTOMY International Journal of Medical Science and Education An official Publication of Association for Scientific and Medical Education (ASME) Original research Article COMPARATIVE STUDY OF LAPAROSCOPIC VARICOCELE

More information

ACUPUNCTURE AND MALE INFERTILITY

ACUPUNCTURE AND MALE INFERTILITY ACUPUNCTURE AND MALE INFERTILITY About male infertility The clinical definition of male infertility is the presence of abnormal semen parameters in the male partner of a couple who have been unable to

More information

INFERTILITY. Services - Part 2

INFERTILITY. Services - Part 2 INFERTILITY Services - Part 2 1 Imprint Published in January, 2013 By Victory A.R.T. Laboratory Phils, Inc. These articles were compiled by in hopes of helping bring into light infertility questions and

More information

Results of ICSI in severe oligozoospermic and azoospermic patients with AZF microdeletions

Results of ICSI in severe oligozoospermic and azoospermic patients with AZF microdeletions Iranian Journal of Reproductive Medicine Vol.7. No.2. pp: 79-84, Spring 2009 Results of ICSI in severe oligozoospermic and azoospermic patients with AZF microdeletions Sevtap Kilic 1 M.D., Ph.D., Beril

More information

COMMISSIONING POLICY. Tertiary treatment for assisted conception services

COMMISSIONING POLICY. Tertiary treatment for assisted conception services Final Version COMMISSIONING POLICY Tertiary treatment for assisted conception services Designated providers for patients registered with a Worcestershire GP BMI The Priory Hospital, Birmingham - 1 - Commissioning

More information

How successful is TESE-ICSI in couples with non-obstructive azoospermia?

How successful is TESE-ICSI in couples with non-obstructive azoospermia? Human Reproduction, Vol.30, No.8 pp. 1790 1796, 2015 Advanced Access publication on June 16, 2015 doi:10.1093/humrep/dev139 ORIGINAL ARTICLE Andrology How successful is TESE-ICSI in couples with non-obstructive

More information

Does Varicocele Repair Improve Male Infertility? An Evidence-Based Perspective From a Randomized, Controlled Trial

Does Varicocele Repair Improve Male Infertility? An Evidence-Based Perspective From a Randomized, Controlled Trial EUROPEAN UROLOGY 59 (2011) 455 461 available at www.sciencedirect.com journal homepage: www.europeanurology.com Andrology Does Varicocele Repair Improve Male Infertility? An Evidence-Based Perspective

More information

GUIDELINES ON MALE INFERTILITY

GUIDELINES ON MALE INFERTILITY European Association of Urology GUIDELINES ON MALE INFERTILITY G.R. Dohle, W. Weidner, A. Jungwirth, G. Colpi, G. Papp, J. Pomerol, T.B. Hargreave UPDATE MARCH 2004 TABLE OF CONTENTS PAGE 1 INTRODUCTION

More information

CLINICAL ASSISTED REPRODUCTION

CLINICAL ASSISTED REPRODUCTION Journal of Assisted Reproduction and Genetics, Vol. 17, No. 4. 2000 CLINICAL ASSISTED REPRODUCTION CLINICAL ASSISTED REPRODUCTION Effect of Clinical and Semen Characteristics on Efficacy of Ovulatory Stimulation

More information

Sherman J.Silber 1,3, Zsolt Nagy 2, Paul Devroey 2, Michel Camus 2 and André C.Van Steirteghem 2

Sherman J.Silber 1,3, Zsolt Nagy 2, Paul Devroey 2, Michel Camus 2 and André C.Van Steirteghem 2 Human Reproduction vol.12 no.12 pp.2693 2700, 1997 The effect of female age and ovarian reserve on pregnancy rate in male infertility: treatment of azoospermia with sperm retrieval and intracytoplasmic

More information

CRYOPRESERVATION OF SEMEN FROM TESTICULAR TISSUE

CRYOPRESERVATION OF SEMEN FROM TESTICULAR TISSUE INFERTILITY & IVF MEDICAL ASSOCIATES OF WESTERN NEW YORK CRYOPRESERVATION OF SEMEN FROM TESTICULAR TISSUE BUFFALOIVF.COM When you have scheduled your appointment with Dr Crickard or Dr Sullivan to sign

More information

Somatic cytogenetic and azoospermia factor gene microdeletion studies in infertile men

Somatic cytogenetic and azoospermia factor gene microdeletion studies in infertile men Brazilian Journal of Medical and Biological Research (2006) 39: 555-561 Cytogenetic and Y microdeletion studies of infertile men ISSN 0100-879X 555 Somatic cytogenetic and azoospermia factor gene microdeletion

More information

UNTIL a decade ago, most surgeons would have agreed with Hotchkiss that

UNTIL a decade ago, most surgeons would have agreed with Hotchkiss that Varicocele: A Study of its Effects on Human Spermatogenesis, and of the Results Produced by Spermatic Vein Ligation L. STUART SCOTT, M.D., CH.M., F.R.C.S.ED., F.R.F.P.S., and DONALD YOUNG, O.B.E., M.D.,

More information

Intratubular Germ Cell Neoplasia of the Testis

Intratubular Germ Cell Neoplasia of the Testis Intratubular Germ Cell Neoplasia of the Testis KS Ngoo Department of Urology Hospital Selayang Advanced Urology Course 15 Aug 2014 MUA Office Clinical scenario A 33 years old man has bilateral testicular

More information

Testicular histology and gonadotropin levels in infertile men with non-obstructive oligo-/azoospermia

Testicular histology and gonadotropin levels in infertile men with non-obstructive oligo-/azoospermia 1 THE NATIONAL MEDICAL JOURNAL OF INDIA VOL., NO.5 Testicular histology and gonadotropin levels in infertile men with non-obstructive oligo-/azoospermia ARUN KUMAR, B. JAYAKUMAR, M. L. KHURANA, VED PRAKASH,

More information

Surgical complications were highest in the laparoscopic technique Varicocelectomy by itself or in conjunction with IVF is cost effective

Surgical complications were highest in the laparoscopic technique Varicocelectomy by itself or in conjunction with IVF is cost effective 2010 THE AUTHORS. 2010 Sexual Medicine REVIEW OF VARICOCELECTOMY TECHNIQUES DIEGIDIO ET AL. BJUI Review of current varicocelectomy techniques and their outcomes Paul Diegidio 1, Jay K. Jhaveri 1, Suzanne

More information