Natural course of idiopathic oligozoospermia: Comparison of mild, moderate and severe forms
|
|
- Helena Gordon
- 6 years ago
- Views:
Transcription
1 International Journal of Urology (2010) 17, doi: /j x Original Article: Clinical Investigationiju_ Natural course of idiopathic oligozoospermia: Comparison of mild, moderate and severe forms Chong Won Bak, 1 Seung-Hun Song, 1 Tae Ki Yoon, 2 Jung Jin Lim, 3 Tai Eun Shin 3 and Suye Sung 3 Departments of 1 Urology and 2 Obstetrics and Gynecology, and 3 Andrology Lab, Fertility Center, CHA Gangnam Medical Center, CHA University, Seoul, Korea Objectives: To investigate the natural courses of mild, moderate and severe idiopathic oligozoospermia, and which factors or semen variables were of utmost importance in predicting the courses. Methods: A total of 208 men (age years) who were diagnosed with mild, moderate and severe idiopathic oligozoospermia in a 9-year-period between January 2000 and December 2008 were followed up for more than 6 months. Results: Overall, 16 (24.6%) of 65 patients with severe oligozoospermia developed azoospermia, whereas two (3.1%) patients with moderate oligozoospermia developed azoospermia and none of the patients with mild oligozoospermia developed azoospermia. Initial follicle stimulating hormone level and testicular volume between the subgroups were significantly different (P = and , respectively). The subgroup of patients who became azoospermic (n = 18) showed statistically significant differences in terms of body mass index and the level of prolactin (PRL) from the subgroup that maintained the initial lingering sperm count (n = 190; P = and , respectively). As the vitality of semen variables increased 1%, the risk of progression to azoospermia diminished by fold, according to Cox s proportional hazards model analysis. A receiver operating characteristic curve analysis showed that the area under the curve was and the sperm concentration value with the highest sensitivity and specificity was the reference value of 3 5 million/ml, with a sensitivity of and specificity of (P = 0.01). Conclusions: Patients with severe oligozoospermia should be warned of the possibility of becoming azoospermic and hence sperm freezing should be encouraged as early as possible. Key words: male infertility, moderate oligozoospermia, natural course, severe oligozoospermia, sperm cryopreservation. Introduction Infertility affects approximately 15% of couples attempting pregnancy, with male factor infertility identified in approximately 50% of the cases. 1 3 Reproductive fecundity depends on coordinated functions of various organs along the hypothalamo pituitary gonadal reproductive tract axis. Intracytoplasmic sperm injection (ICSI), since its introduction in 1992, has revolutionized the treatment of male infertility. However, complete loss of paternity casts a devastating effect on a man, and the preservation of paternity for the future is of utmost importance. To our knowledge, this is the first report on the natural fate of different degrees of oligozoospermia. Correspondence: Seung-Hun Song MD, Department of Urology, Fertility Center, CHA Gangnam Medical Center, CHA University, Seoul , Korea. shsong02@cha.ac.kr Received 31 May 2010; accepted 11 August Online publication 10 September 2010 Methods Patients A total of 208 eligible men were identified from 1201 men with fertility problems of severe, moderate and mild degrees of oligozoospermia who sought evaluation for infertility in the fertility center of our university hospital during a 9-year period between January 2000 and December The present study was approved by the local hospital ethics committee. Inclusion and exclusion criteria Other than the 208 men who represented the final study cohort, the remaining 993 patients decided to undergo assisted reproductive technology (ART) within 6 months of their initial visit, were not eligible for the study due to exclusion criteria or were lost to follow up mainly owing to visiting other centers. Men were considered to have male factor fertility problems based on a clinical presentation with abnormal semen analysis variables as defined by World 2010 The Japanese Urological Association 937
2 CW BAK ET AL. Health Organization criteria (fourth edition, 1999). Inclusion criteria were severe oligozoospermia (less than 5 million sperm/ml), moderate oligozoospermia (between 5 and 10 million sperm/ml) and mild oligozoospermia (between 10 and 20 million sperm/ml) using a centrifuged specimen at the initial visit and follow up of more than 6 months. To completely rule out transient worsening of semen parameters, strict exclusion criteria including previous history of infection, varicocele, cryptorchidism, exposure to gonadotoxin, surgery of the genitourinary tract, insufficient sexual abstinence period and more than 3 months of any medical therapy, including oriental or herbal medicine as well as genetic abnormalities, such as chromosome anomaly and Y-chromosome microdeletion, was applied. Measurements All semen samples were obtained by masturbation into a wide-mouthed plastic container in a separate room. Sexual abstinence of a minimum of 48 h was requested and the reported abstinence time was recorded. The semen characteristics evaluated were sperm concentration, percentage of total motile spermatozoa, strict morphology and percentage of living spermatozoa by the vital stain. Testicular volume was measured using a Prado orchidometer. Complete personal information, including demographics as well as previous history of infection or surgery regarding the reproductive tract, and hormonal evaluations, such as follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin (PRL) and testosterone were carried out. Evaluation of chromosome anomalies and Y-chromosome microdeletion were also carried out. Statistical analysis All statistical analyses were carried out using a commercially available software program (SAS Enterprise Guide 4.1; SAS Institute, Cary, NC, USA). The Kaplan Meier method was used to calculate unadjusted estimates of azoospermia. Odds ratios and the corresponding 95% confidence intervals were used to measure the strength of the association. The c 2 -test, Kruskal Wallis test and t-tests (or Wilcoxon rank sum test) were used to compare parameters between groups, and multiple logistic regression analysis was carried out to assess the independent contributions of variables on the development of azoospermia. Cox s proportional hazards model analysis was used to estimate hazard ratio, and logistic regression analysis was applied to discover the risk of becoming azoospermic with every 1 million decrease in sperm count. One-way analysis of variance (ANOVA) was utilized to evaluate vitality, morphology and motility of each subgroup. A receiver operating characteristic (ROC) curve analysis was carried out to determine the threshold sperm concentration. Statistical significance was defined as a P-value <0.05 and all statistical tests were two-sided. Results Table 1 presents the characteristics of the study population. Of 208 eligible participants, a total number of 18 cases of azoospermia developed. In detail, 16 (23.5%) of the severe oligozoospermic patients developed into azoospermia, whereas just two (3.0%) of the moderate degree developed into azoospermia. Not a single patient in the subgroup of mild oligozoospermia became azoospermic. Table 1 also clearly summarizes different characteristics of the three different degrees of oligozoospermia. Initial severe oligozoospermia recorded a declining tendency of sperm concentration, as time went by, from the initial concentration of *10 6 /ml (mean SD) to *10 6 /ml after the interval of days and again reduced to *10 6 /ml after days. In contrast, initial mild oligozoospermia showed a slight improvement of sperm concentration from the initial concentration of *10 6 /ml to *10 6 /ml after days then *10 6 /ml after days. A total of 13 men in the mild oligozoospermia subgroup achieved fatherhood before undergoing a third semen analysis. Not a single man with a mild degree of oligozoospermia developed azoospermia on their natural course, whereas six men in the subgroup showed transient worsening to the level of moderate oligozoospermia that eventually recovered back to the mild degree and even to the normal ranges. As shown in Figure 1, the Kaplan Meier method was used to calculate unadjusted estimates of progression to azoospermia (P = ). The median duration to developing azoospermia in the present study group was 1193 days, with a standard error of 94.6 days. The subgroup of severe oligozoospermia had statistically smaller testicles than the other two groups (11.9 vs 14.3 ml vs 14.5 ml, P = ). Severe oligozoospermic men also had a statistically higher level of FSH ( miu/ml) than the moderate oligozoospermic men ( miu/ml), and men with mild oligozoospermia ( miu/ml; P = ). Other study parameters, such as age, body mass index (BMI) and smoking, as well as other hormonal levels, were also not statistically related to progression to azoospermia in the present study groups. The study population of 208 was divided into the two subgroups in terms of progression to azoospermia, that is, the subgroup that progressed to azoospermia (n = 18) and the subgroup that maintained semen parameters (n = 190), as shown in Table 2. Student s t-test and Wilcoxon rank sum test showed that there were statistically significant differences in BMI and PRL between the two groups (P = The Japanese Urological Association
3 Different fates of oligozoospermia Table 1 Characteristics of study participants Severe oligozoospermia Moderate oligozoospermia Mild oligozoospermia P-value No. patients N/A No. patients developed azoospermia * Initial sperm count, *10 6 /ml (median;range) N/A (0.5; 0.05 to 5.0) (10; 5.2 to 10.0) (16; 11 to 19) Second sperm count, N/A (0.2; 0 to 4.8) (11; 0 to 46.0) (18; 11 to 25) Interval between 1 st and 2 nd semen analysis (days) N/A (97.5; 23 to 1033) (171; 14 to 2041) (153; 14 to 895) Third sperm count, *10 6 /ml (median; range) N/A (0.05; 0 to 3.5) (16.5; 0.5 to 46.0) (18.5; 11 to 39) Interval between 2 nd and 3 rd semen analysis (days) N/A (160; 19 to 1417) (178; 14 to 1290) (198; 14 to 1814) Fourth sperm count, *10 6 /ml (median; range) N/A (0.075; 0 to 1.8) (12; 0.5 to 58) (20; 11 to 57) Age (y) *** BMI (kg/m 2 ) ** Mean follow-up duration (days) *** Smoker 43(66.15%) 43(66.15%) 39(55.7%) * Testis volume (ml) ** FSH (miu/ml) *** LH (miu/ml) *** PRL (ng/ml) *** Testosterone (ng/ml) *** *(c 2 -test. **ANOVA test. ***Kruskal Wallis test. Values are means SD. BMI, body mass index; FSH, follicle stimulating hormone; LH, luteinizing hormone; N/A, not applicable; PRL, prolactin. Cumulative survival Follow - up (days) Fig. 1 Different fates of severe and moderate idiopathic oligozoospermia., Mild oligozoospermia;, censored group of mild oligozoospermia;, moderate oligozoospermia;, censored group of moderate oligozoospermia;, severe oligozoospermia;, censored group of severe oligozoospermia. and , respectively). Table 3 shows the characteristics of the two subgroups of severe oligozoospermia; one group that diminished to azoospermia (n = 16) and the other group that maintained already impaired semen variables (n = 49). Wilcoxon rank sum test found that the two groups showed statistically significant differences with regard to BMI and PRL (P = and , respectively). Vitality was found to be the most important factor for predicting the natural course of severe oligozoospermia, that as the vitality of semen parameter increased 1%, the risk of progression to azoospermia diminished by fold according to Cox s proportional hazards model analysis that also produced a hazard ratio (HR) of motility of 1.012, HR of morphology of 0.936, HR of BMI of and HR of testicular volume of Cox s PH model analysis of various hormones showed HR of FSH of 0.888, HR of LH of 1.307, HR of PRL of and HR of testosterone of Logistic regression analysis of the data found that FSH has no statistical significance with the progression to azoospermia. However, the analysis showed that there was an increased risk of becoming azoospermic with every decrease of 1 million in sperm count (OR = 1.411). ROC curve showed 2010 The Japanese Urological Association 939
4 CW BAK ET AL. Table 2 Characteristics of the patients classified according to progression to azoospermia Diminish to azoospermia No decline to azoospermia P-value No. patients N/A Age (years) NS Sperm count (*10 6 /ml) at initial visit * BMI (kg/m 2 ) ** Smoker 10 (55.56%) 86 (66.15%) NS Testis volume (ml) NS FSH (miu/ml) NS LH (miu/ml) NS PRL (ng/ml) * Testosterone (ng/ml) NS *Wilcoxon rank sum test. **t-test. Values are means SD. BMI, body mass index; FSH, follicle stimulating hormone; LH, luteinizing hormone; N/A, not applicable; NS, not significant; PRL, prolactin. Table 3 Characteristics of the severe oligozoospermics classified according to progression to azoospermia Diminish to azoospermia Not decline to azoospermia P-value No. patients N/A Age (years) NS Smoker 10 (55.56%) 32 (65.31%) NS BMI (kg/m 2 ) * Testis volume (ml) NS FSH (miu/ml) NS LH (miu/ml) NS PRL (ng/ml) * Testosterone (ng/ml) NS Sperm count (*10 6 /ml ) NS *Wilcoxon rank sum test. Values are means SD. BMI, body mass index; FSH, follicle stimulating hormone; LH, luteinizing hormone; N/A, not applicable; NS, not significant; PRL, prolactin. that the area under the curve was and the sperm concentration value with the highest sensitivity and specificity was the reference value of 3 to /ml, with a sensitivity of and specificity of 0.711(P = 0.01) (Fig. 2). Discussion Several studies suggest that sperm concentration has decreased over time. 4 6 Subfertility is defined as the failure to conceive after 1 year of regular, unprotected intercourse with the same partner. Approximately 10 17% of all couples experience primary or secondary subfertility at some time during their reproductive life, 7,8 with male factor infertility identified in approximately 50% of the cases. 1 Subfertile couples try to conceive with all possible techniques, such as ART, which do not actually treat the cause of the subfertility. Sensitivity Specificity Fig. 2 Receiver operating characteristic curve of sperm concentration The Japanese Urological Association
5 Different fates of oligozoospermia Advances in in vitro fertilization (IVF) techniques, namely ICSI, have allowed the use of very few sperm to achieve fertilization, which leads to the possibility of cryopreservation of semen, even from patients with very low sperm counts. 9 However, there has been no large scale study on the fate of patients with severely impaired semen status. Among several definitions of severe oligozoospermia, we consented to the idea of less than 5 million sperm/ml implying underlying impaired spermatogenesis. 10 It is well known that neuroendocrine regulation of mammalian fertility is governed by the episodic release of the hypothalamic peptide gonadotropin-releasing hormone (GnRH), which acts in a hypophysiotropic manner to drive the anterior pituitary gonadotropes to secrete FSH and LH in a pulsatile fashion. 11 One of the key findings in the present study is that FSH in the cohort of severe oligozoospermia shows a statistically higher level than the group of moderate oligozoospermia (P = ). FSH, a dimeric glycoprotein hormone of the pituitary, stimulates the Sertoli cells to produce androgen-binding protein, inhibin and a variety of growth factors. 12 FSH plays a crucial role in males as the most important tropic hormone regulating Sertoli cell function. The hormone interacts with its signaling repertoire in the gonads, stimulates spermatogenesis by activating the specific receptor, FSH receptor (FSHR), that is a member of the G protein-coupled receptor family, including the classical Gs-linked systems. 13 In males, the FSHR system is highly specific, as mrna is expressed only in testicular Sertoli cells. However, FSHR haplotype is not associated with different serum FSH levels, but it is differently distributed in normal and azoospermic men. 14 We believe that, as shown in Table 1 and Figure 1, severe, moderate and mild oligozoospermia are different disease entities. There is plenty of room for men with mild oligozoospermia to improve their semen quality by changing their lifestyle, avoiding harmful environments, treating undetected infections and hence adopting preventive measures. However, men with severe oligozoospermia, especially those with a sperm concentration of approximately 1 million/ml, are facing a great danger of developing azoospermia, as shown in the present study (23/65 patients). However, the remaining 42 men in the present study barely maintained their initial lingering sperm concentration until they opted to undergo ART. Nine subjects in the subgroup of mild oligozoospermia showed an improvement, though slow and time consuming, of semen quality. However, 61 patients maintained an initial sperm concentration of a mild degree of oligozoospermia after a period of days with a median of 153 ranging from days. A third semen analysis of the subgroup was carried out in 52 patients, showing an improvement in the sperm concentration of 21 patients to a level above 20*10 6 /ml, whereas the level of mild oligozoospermia was maintained in the remaining of 31 men. Men with moderate oligozoospermia are not in a safe zone, but in gray zone, because two out of the 65 patients in the present study eventually developed azoospermia, whereas the remaining 63 men either maintained the initial lingering sperm concentration or the semen quality improved during a longer period of observation than for men with severe oligozoospemia. The underlying genetic and epigenetic causes of male infertility are not fully understood, but have just begun to unfold and, hence, be further elucidated. One of the surprising findings in the present study is the statistically different level of PRL between the subgroup that diminished to azoospermia (n = 18) and the subgroup that maintained already impaired semen variables (n = 190; P = ), whereas a similar difference presents between patients whose sperm count decreased to azoospermia (n = 16) and those who maintained the lingering sperm count (n = 49; P = 0.015) among the men with severe oligozoospermia. The physiological role of PRL in male sexual behavior remains to be elucidated. However, a recent study of hypoprolactinemia documented that PRL in the lowest quartile levels (<113 mu/l or 5 ng/ml) is associated with metabolic syndrome and arteriogenic erectile dysfunction, as well as with premature ejaculation and anxiety symptoms. 15 The present results showed that men who developed azoospermia recorded statistically lower levels of PRL ( ng/ml) than others who did not develop azoospermia ( ng/ml). According to previous studies, low PRL levels in a group of infertile men might be one of the primary causes of their infertility. 16,17 LH binds to a G protein-coupled reception in the Leydig cells. Germ cells do not have androgen receptors, so androgens secreted by Leydig cells act through receptors on the Sertoli cells. 18 Testosterone secreted from Leydig cells, inhibin secreted from Sertoli cells and estradiol formed from aromatization of testosterone act on the hypothalamus and pituitary to regulate gonadotropin secretion by negative inhibition. There were significant associations between decreased levels of testosterone and increased severity of erectile dysfunction, longer duration and poor metabolic control of diabetes, ischemic heart disease, hyperprolactinemia and low desire. 19 Although estrogen receptor-alpha (ERa) has traditionally been considered an important regulator of female development, its crucial role in the male reproductive tract was recently shown. 20 The study shows that the BMI of the subgroup that diminished to azoospermia (n = 18) and not-declined-to-azoospermia (n = 190) presents statistically significant differences (P = ), whereas a similar difference presents between those who decreased to azoospermia (n = 16) and those who maintained the lingering semen count (n = 49; P = ) among the men with severe oligozoospermia. Male factor infertility has been considered to be associated with a higher incidence of obesity. Serum leptin is also known to mediate a link between obesity and male infertility. 21 Obesity was 2010 The Japanese Urological Association 941
6 CW BAK ET AL. also been shown to affect the GnRH LH/FSH pulse that might impair Leydig and Sertoli cell functions and interfere with the release of sex hormones with a consequent effect on sperm maturation. 22 However, the present study produced the result that not only extreme levels of obesity, but also a BMI in the normal range is involved in the development of azoospermia; as seen in men who became azoospermic an recorded a statistically lower BMI than men who did not develop azoospermia (P = ). According to a recent report, BMI was unrelated to sperm concentration, motility or morphology despite the fact that only extreme levels of obesity might negatively influence male reproductive potential. 23 It remains an enigma why patients in the severe oligozoospermia group developed azoospermia when they had such unique characteristics in terms of BMI and PRL, despite recent evidence showing a role for PRL in adipogenesis. 24,25 Fertility depends on coordinated functions of organs along the hypothalamo pituitary gonadal reproductive tract axis. In the present study, severe oligozoospermic men showed statistically smaller testicles than the moderate group (11.9 vs 14.3 ml, P = ). Testicular volumes are known to be significantly correlated with sperm density, total sperm count and total motile sperm count. 26 It is also well known that a decrease in size of one or both testes is an important symptom of spermatogenic defects. 27 We consent to the idea that a variety of environmental hazards related to testicular dysgenesis syndrome affects sperm quality of men with an already severely impaired sperm count. 28 In the present study, sperm vitality turns out to be the most important factor for predicting the natural course of severe oligozoospermia. The risk of progression to azoospermia declines fold as the vitality of semen variable increases 1%. The percentage of sperm vitality has been known to be affected by smoking as well as fever, though not significantly. 29,30 It has also been found that the percentage of non-vital spermatozoa increases with the degree of oligozoospermia. 31 Sperm vitality is also known to bear a significant relationship to pregnancy; 32 meanwhile, sperm morphology assessment is very useful for the selection of patients for ICSI. 33 The reason why patients with genetic abnormalities, such as chromosome anomaly or Y chromosome microdeletion, were excluded from the present study was that few microdeleted patients were reported to have a decline in sperm output over time A case report documented that a father of four sons was found to be azoospermic with Y chromosomal microdeletions at the age of 63 years, suggesting that spermatogenic defects with Y chromosomal microdeletions might worsen with age. 37 Despite the fact that the present study has several limitations, including the nature of the retrospective design, lack of a control group, missing data and individual variation of semen variables, the result clearly showed the diminishing tendency of sperm count over time in the cohort of severe oligozoospermia, especially in comparison with the group of moderate oligozoospermia. The present study findings show that idiopathic severe oligozoospermia poses quite a risk of progression to azoospermia, whereas moderate oligozoospermia is less associated with the risk. To our knowledge, these are the first large scale data to report such a relationship. Thus, it is important that our results are confirmed in additional studies. It should be emphasized that patients with lower BMI and lower PRL level among initial severe oligozoospermics are more likely to worsen to azoospermia and, hence, require more attention. We trust that it is of interest for subfertile men as well as clinicians to be familiar with the importance of the differential diagnosis of and outcome of mild, moderate and severe oligozoospermia. Sperm cryobanking has been mainly available to men facing gonadotoxic treatment or awaiting ART, but not available on the day of ART. The present study, however, definitely suggests that patients with severe oligozoospermia, especially those with a sperm concentration of less than 5 million/ml, should be given enough information about the possibility of loss of fatherhood on the course and the option of cryopreservation from the very beginning of evaluation. And if a trend in the decline of semen variables is shown, they should be encouraged to cryopreserve sperm without any further delay. Although men with idiopathic severe oligozoospermia hoping to conceive should be reminded of the relentless declining quality of their sperm as time passes, those with moderate oligozoospermia should also be informed of the possibility of becoming azoospermia, though the risk is less. Acknowledgments We thank Ms Yon-Wan Han for her helpful comments and excellent editing assistance. The present study was supported by a grant from the Korea Healthcare Technology R&D Project, Ministry of Health, Welfare & Family affairs, Republic of Korea (A084923). The sponsor had no role in the design and conduct of the study, in the collection, analysis or interpretation of the data, or in the preparation, review or approval of the manuscript. References 1 Bhasin S, de Krester DM, Baker HW. Clinical review 64: pathophysiology and natural history of male infertility. J. Clin. Endocrinol. Metab. 1994; 79: Brugh VM III, Matschke HM, Lipshultz LI. Male factor infertility. Med. Clin. North Am. 2004; 88: Sokol RZ. Endocrinology of male infertility: evaluation and treatment. Semin. Reprod. Med. 2009; 27: Carlsen E, Giwercman A, Keiding N, Skakkebaek NE. Evidence for decreasing quality of semen during past 50 years. BMJ 1992; 305: The Japanese Urological Association
7 Different fates of oligozoospermia 5 Auger J, Kunstmann JM, Czyglik F, Jouannet P. Decline in semen quality among fertile men in Paris during the past 20 years. N. Engl. J. Med. 1995; 332: Swan SH, Elkin EP, Fenster L. Have sperm densities declined? A reanalysis of global trend data. Environ. Health Perspect. 1997; 105: Mosher WD, Pratt WF. Use of contraception and family planning services in the United States, Am. J. Public Health 1990; 80: Buckett W, Bentick B. The epidemiology of infertility in a rural population. Acta Obstet. Gynecol. Scand. 1997; 76: Sanger WG, Olson JH, Sherman JK. Semen cryobanking for men with cancer criteria change. Fertil. Steril. 1992; 58: Hirsh A. Male subfertility. BMJ 2003; 327: Fink G. Neuroendocrine regulation of pituitary function: general principles. In: Conn PM, Freeman ME (eds). Neuroendocrinology in Physiology and Medicine. Humana Press, Totowa, NJ, 2000; Bilezikjian LM, Blount AL, Leal AM, Donaldson CJ, Fischer WH, Vale WW. Autocrine/paracrine regulation of pituitary function by activin, inhibin and follistatin. Mol. Cell. Endocrinol. 2004; 225: Simoni M, Gromoll J, Nieschlag E. The follicle-stimulating hormone receptor: biochemistry, molecular biology, physiology, and pathophysiology. Endocr. Rev. 1997; 18: Themmen APN, Huhtaniemi IT. Mutations of gonadotropins and gonadotropin receptors: elucidating the physiology and pathophysiology of pituitary-gonadal function. Endocr. Rev. 2000; 21: Corona G, Mannucci E, Jannini EA et al. Hypoprolactinemia: a new clinical syndrome in patients with sexual dysfunction. J. Sex. Med. 2009; 6: Ufearo CS, Orisakwe OE. Restoration of normal sperm characteristics in hypoprolactinemic infertile men treated with metoclopramide and exogenous human prolactin. Clin. Pharmacol. Ther. 1995; 58: Gonzales GF, Velasquez G, Garcia-Hjarles M. Hypoprolactinemia as related to seminal quality and serum testosterone. Arch. Androl. 1989; 23: Lyon MF, Glenister PH, Lamoreaux ML. Normal spermatozoa from androgen-resistant germ cells of chimaeric mice and the role of androgen in spermatogenesis. Nature 1975; 258: El-Sakka AI, Hassoba HM. Age related testosterone depletion in patients with erectile dysfunction. J. Urol. 2006; 176: Sinkevicius KW, Laine M, Lotan TL, Woloszyn K, Richburg JH, Greene GL. Estrogen-dependent and -independent estrogen receptor-alpha signaling separately regulate male fertility. Endocrinology 2009; 150: Hofny ER, Ali ME, Abdel-Hafez HZ et al. Semen parameters and hormonal profile in obese fertile and infertile males. Fertil. Steril. 2009; 94: May 5. [Epub ahead of print]. 22 Hammoud AO, Gibson M, Peterson CM, Meikle AW, Carrell DT. Impact of male obesity on infertility: a critical review of the current literature. Fertil. Steril. 2008; 90: Chavarro JE, Toth TL, Wright DL, Meeker JD, Hauser R. Body mass index in relation to semen quality, sperm DNA integrity, and serum reproductive hormone levels among men attending an infertility clinic. Fertil. Steril. 2009; 93: Mar 2. [Epub ahead of print]. 24 McFarland-Mancini M, Hugo E, Loftus J, Ben-Jonathan N. Induction of prolactin expression and release in human preadipocytes by camp activating ligands. Biochem. Biophys. Res. Commun. 2006; 344: Brandebourg TD, Bown JL, Ben-Jonathan N. Prolactin upregulates its receptors and inhibits lipolysis and leptin release in male rat adipose tissue. Biochem. Biophys. Res. Commun. 2007; 357: Sakamoto H, Yajima T, Nagata M, Okumura T, Suzuki K, Ogawa Y. Relationship between testicular size by ultrasonography and testicular function: measurement of testicular length, width, and depth in patients with infertility. Int. J. Urol. 2008; 15: Baker HWG. Management of male infertility. Baillieres Best Pract. Res. Clin. Endocrinol. Metab. 2000; 14: Skakkebaek NE. Testicular dysgenesis syndrome: new epidemiological evidence. Int. J. Androl. 2004; 27: Künzle R, Mueller MD, Hänggi W, Birkhäuser MH, Drescher H, Bersinger NA. Semen quality of male smokers and nonsmokers in infertile couples. Fertil. Steril. 2003; 79: Sergerie M, Mieusset R, Croute F, Daudin M, Bujan L. High risk of temporary alteration of semen parameters after recent acute febrile illness. Fertil. Steril. 2007; 88: 970.e Singer R, Sagiv M, Barnet M et al. Motility, vitality and percentages of morphologically abnormal forms of human spermatozoa in relation to sperm counts. Andrologia 1980; 12: Kjaergaard N, Mortensen BB, Hostrup P, Lauritsen JG. Prognostic value of semen analyses in infertility evaluation (male fertility/life-table analysis). Andrologia 1990; 22: Liu DY, Baker HW. Evaluation and assessment of semen for IVF/ICSI. Asian J. Androl. 2002; 4: Girardi SK, Mielnik A, Schlegel PN. Submicroscopic deletions in the Y chromosome of infertile men. Hum. Reprod. 1997; 12: Reijo R, Alagappan RK, Patrizio P, Page DC. Severe oligozoospermia resulting from deletions of azoospermia factor gene on Y chromosome. Lancet 1996; 347: Calogero AE, Garofalo MR, Barone N et al. Spontaneous regression over time of the germinal epithelium in a Y chromosome-microdeleted patient: case report. Hum. Reprod. 2001; 16: Chang PL, Saver MV, Brown S. Y chromosome microdeletion in a father and his four infertile sons. Hum. Reprod. 1999; 14: The Japanese Urological Association 943
What You Need to Know
UW MEDICINE PATIENT EDUCATION What You Need to Know Facts about male infertility This handout explains what causes male infertility, how it is diagnosed, and possible treatments. Infertility is defined
More informationMale Factor Infertility
Male Factor Infertility Simplified Evaluaon and Treatment* ^ * In 20 minutes or less In 20 slides ^ 5 minute office visit ALWAYS EVALUATE THE MALE & THE FEMALE Why 1. To help the coupleachieve a pregnancy
More informationTime to improvement in semen parameters after microsurgical varicocelectomy in men with severe oligospermia
Time to improvement in semen parameters after microsurgical varicocelectomy in men with severe oligospermia Thomas A. Masterson; Aubrey B. Greer; Ranjith Ramasamy University of Miami, Miami, FL, United
More informationMALE INFERTILITY & SEMEN ANALYSIS
MALE INFERTILITY & SEMEN ANALYSIS DISCLOSURE Relevant relationships with commercial entities none Potential for conflicts of interest within this presentation none Steps taken to review and mitigate potential
More informationTestosterone Therapy-Male Infertility
Testosterone Therapy-Male Infertility Testosterone Therapy-Male Infertility Many men are prescribed testosterone for a variety of reasons. Low testosterone levels (Low T) with no symptoms, general symptoms
More informationReproductive FSH. Analyte Information
Reproductive FSH Analyte Information 1 Follicle-stimulating hormone Introduction Follicle-stimulating hormone (FSH, also known as follitropin) is a glycoprotein hormone secreted by the anterior pituitary
More informationMEN S HEALTH AFTER CANCER WHAT YOU NEED TO KNOW: INFERTILITY
UW MEDICINE TITLE OR EVENT MEN S HEALTH AFTER CANCER WHAT YOU NEED TO KNOW: INFERTILITY KEVIN A. OSTROWSKI, MD OSTROWSK@UW.EDU TOM WALSH, MD WALSHT@UW.EDU LEARNING OBJECTIVES At the conclusion of this
More informationProf. Dr. Michael Zitzmann Internal Medicine Endocrinology, Diabetology, Andrology University of Muenster, Germany
Induction of fertility in hypogonadal men Prof. Dr. Michael Zitzmann Internal Medicine Endocrinology, Diabetology, Andrology University of Muenster, Germany Induction of fertility in hypogonadal men Prof.
More informationAromatase 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 informationAlternative management of hypogonadism Tamoxifen. Emmanuele A. Jannini, MD Tor Vergata University of Rome ITALY
Alternative management of hypogonadism Tamoxifen Emmanuele A. Jannini, MD Tor Vergata University of Rome ITALY eajannini@gmail.com What hypogonadism is? What hypogonadism is? It is an empty glass The two
More informationREPRODUCTIVE ENDOCRINOLOGY OF THE MALE
Reproductive Biotechnologies Andrology I REPRODUCTIVE ENDOCRINOLOGY OF THE MALE Prof. Alberto Contri REPRODUCTIVE ENDOCRINOLOGY OF THE MALE SPERMATOGENESIS AND REPRODUCTIVE BEHAVIOR RELATED TO THE ACTIVITY
More informationBIOCHEMICAL TESTS FOR THE INVESTIGATION OF COMMON ENDOCRINE PROBLEMS IN THE MALE
Authoriser: Moya O Doherty Page 1 of 7 BIOCHEMICAL TESTS FOR THE INVESTIGATION OF COMMON ENDOCRINE PROBLEMS IN THE MALE The purpose of this protocol is to describe common tests used for the investigation
More informationMale factors can be identified as the cause of infertility in 30~40% of couples and a
Focused Issue of This Month Causes and Diagnosis of Male Infertility Nam Cheol Park, MD Department of Urology, Pusan National University College of Medicine Email : pnc@pusan.ac.kr J Korean Med Assoc 2007;
More informationIndex. urologic.theclinics.com. Note: Page numbers of article titles are in boldface type.
Note: Page numbers of article titles are in boldface type. A Acquired hypogonadism, prevalence of, 165 167 primary, 165 secondary, 167 Adipose tissue, as an organ, 240 241 Adrenal hyperplasia, congenital,
More informationANDROLOGY. Introduction. Original Article. Serkan Karamazak, Fuat Kızılay, Tuncer Bahçeci, Bülent Semerci ABSTRACT
202 Turk J Urol 2018; 44(3): 202-7 DOI: 10.5152/tud.2017.80000 ANDROLOGY Original Article Do body mass index, hormone profile and testicular volume effect sperm retrieval rates of microsurgical sperm extraction
More informationClinical evaluation of infertility
Clinical evaluation of infertility DR. FARIBA KHANIPOUYANI OBSTETRICIAN & GYNECOLOGIST PRENATOLOGIST Definition: inability to achieve conception despite one year of frequent unprotected intercourse. Male
More informationEvaluation of hormonal and physical factors responsible for male infertility in Sagamu South Western Nigeria
Available online at wwwscholarsresearchlibrarycom Scholars Research Library Der Pharmacia Lettre, 2012, 4 (5):1475-1479 (http://scholarsresearchlibrarycom/archivehtml) ISSN 0975-5071 USA CODEN: DPLEB4
More informationSemen 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 informationMale History, Clinical Examination and Testing
Male History, Clinical Examination and Testing Dirk Vanderschueren, MD, PhD Case Jan is 29 years old and consults for 1 year primary subfertility partner 28 years old and normal gynaecological investigation
More informationSpontaneous Pregnancy Outcome after Surgical Repair of Clinically Palpable Varicocele in Young Men with Abnormal Semen Analysis
African Journal of Urology 1110-5704 Vol. 17, No. 4, 2011 115-121 Original article Spontaneous Pregnancy Outcome after Surgical Repair of Clinically Palpable Varicocele in Young Men with Abnormal Semen
More informationWith advances in assisted reproduction techniques,
Journal of Andrology, Vol. 26, No. 6, November/December 2005 Copyright American Society of Andrology Clomiphene Administration for Cases of Nonobstructive Azoospermia: A Multicenter Study ALAYMAN HUSSEIN,*
More informationSubfertility/Infertility Assessment in the Medical Laboratory
Article Subfertility/Infertility Assessment in the Medical Laboratory PD Dr. med. habil. Michaela Jaksch, Consultant Laboratory Medicine, Medical Director, Freiburg Medical Laboratory ME LLC, Dubai, UAE
More informationYour environment: Your fertility
Your environment: Your fertility Strong Fertility Center Education Series September 25, 2008 Shanna H. Swan, PhD Professor Obstetrics & Gynecology University of Rochester School of Medicine Has fertility
More informationRelationship of FSH, LH, DHEA and Testosterone Levels in Seminal Plasma with Sperm Function Parameters in Infertile Men
Merit Research Journal of Medicine and Medical Sciences (ISSN: 2354-323X) Vol. 5(12) pp. 627-634, December, 2017 Available online http://www.meritresearchjournals.org/mms/index.htm Copyright 2017 Merit
More informationSERUM TOTAL TESTOSTERONE AND INHIBIN B ARE THE BETTER MARKERS OF SPERMATOGENESIS THAN ANTI-MULLERIAN HORMONE IN OLIGOSPERMIC MEN
SERUM TOTAL TESTOSTERONE AND INHIBIN B ARE THE BETTER MARKERS OF SPERMATOGENESIS THAN ANTI-MULLERIAN HORMONE IN OLIGOSPERMIC MEN 1 Basil O Saleh, 2 Nawal Khairy AL-Ani and 3 Widad Hamel Khraibet 1 Department
More informationSemen parameters from 2002 to 2013 in Korea young population: A preliminary report
Original Article - Sexual Dysfunction/Infertility Korean J Urol 215;56:831-836. http://dx.doi.org/1.4111/kju.215.56.12.831 pissn 25-6737 eissn 25-6745 Semen parameters from 22 to 213 in Korea young population:
More informationEvaluation and Treatment of the Subfertile Male. Karen Baker, MD Associate Professor Duke University, Division of Urology
Evaluation and Treatment of the Subfertile Male Karen Baker, MD Associate Professor Duke University, Division of Urology Disclosures: None Off label uses: There are no oral medications approved by the
More informationInfertility in Women over 35. Alison Jacoby, MD Dept. of Ob/Gyn UCSF
Infertility in Women over 35 Alison Jacoby, MD Dept. of Ob/Gyn UCSF Learning Objectives Review the effect of age on fertility Fertility counseling for the patient >35 - timing - lifestyle - workup Fertility
More informationThe impact of cigarette smoking on semen parameters in infertile Sudanese males in Khartoum
The impact of cigarette smoking on semen parameters in infertile Sudanese males in Khartoum Salah Eldin Omar Hussein 1, Kamal Eldin Hussein Elhassan 2, Shamsoun Khamis Kafi 3 1- College of Applied Medical
More informationWhat to do about infertility?
What to do about infertility? Dr. M.A. Fischer Section Head, Division of Urology, Department of Surgery Assistant Clinical Professor, Department of Obstetrics and Gynecology Hamilton Health Sciences, Hamilton,
More informationInfertility for the Primary Care Provider
Infertility for the Primary Care Provider David A. Forstein, DO FACOOG Clinical Associate Professor Obstetrics and Gynecology University of South Carolina School of Medicine Greenville Disclosure I have
More informationThe use of assisted reproductive technology before male factor infertility evaluation
Original Article The use of assisted reproductive technology before male factor infertility evaluation Madhur Nayan 1, Nahid Punjani 2, Ethan Grober 1, Kirk Lo 1,3,4, Keith Jarvi 1,3,4 1 Division of Urology,
More informationInfertility. Rhian Allen & David Rogers.
Infertility Rhian Allen & David Rogers http://www.worldofsurrogacy.com Objectives Definition & Epidemiology Female Gonadal Axis Normal Menstrual Cycle Causes Patient History Patient Examination Investigations
More informationTest Briefing on Hormonal Disorders and Infertility
Test Briefing on Hormonal Disorders and Infertility Test Briefing on Hormonal Disorders Common Tests FSH LH Progesterone Estradiol Prolactin Testosterone AFP AMH PCOS Panel FSH (Follicle Stimulating Hormone)
More informationThe serum estradiol/oocyte ratio in patients with breast cancer undergoing ovarian stimulation with letrozole and gonadotropins
Original Article Obstet Gynecol Sci 2018;61(2):242-246 https://doi.org/10.5468/ogs.2018.61.2.242 pissn 2287-8572 eissn 2287-8580 The serum estradiol/oocyte ratio in patients with breast cancer undergoing
More informationMATERIALS AND METHODS
www.kjurology.org http://dx.doi.org/1.4111/kju.213.54.2.111 Male Infertility Detection of Y Chromosome Microdeletion is Valuable in the Treatment of Patients With Nonobstructive Azoospermia and Oligoasthenoteratozoospermia:
More informationTreatment 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 informationClinical 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 informationA Therapeutic Scheme For Oligospermia Based On Serum Levels Of FSH And Estradiol
ISPUB.COM The Internet Journal of Gynecology and Obstetrics Volume 8 Number 1 A Therapeutic Scheme For Oligospermia Based On Serum Levels Of FSH And Estradiol P Sah Citation P Sah. A Therapeutic Scheme
More informationHormones of brain-testicular axis
(Hormone Function) Hormones of brain-testicular axis anterior pituitary drives changes during puberty controlled by GnRH from hypothalamus begins to secrete FSH, LH LH targets interstitial endocrinocytes
More informationChapter 4. Managing Fertility in Childhood Cancer Patients T.K. Woodruff and K.A. Snyder (eds.) Oncofertility. Springer 2007
Chapter 4 Managing Fertility in Childhood Cancer Patients T.K. Woodruff and K.A. Snyder (eds.) Oncofertility. Springer 2007 The original publication of this article is available at www.springerlink.com
More informationHormonal Control of Male Sexual Function
Hormonal Control of Male Sexual Function A majority of the control of sexual functions in the male (and the female) begins with secretions of gonadotropin-releasing hormone (GnRH) by the hypothalamus.
More informationFirst you must understand what is needed for becoming pregnant?
What is infertility? Infertility means difficulty in becoming pregnant without using contraception. First you must understand what is needed for becoming pregnant? Ovum from the woman to combine with a
More informationThe new 5 th WHO manual semen parameter reference values do they help or hinder?
The new 5 th WHO manual semen parameter reference values do they help or hinder? Roelof Menkveld, PhD Andrology Laboratory, Department of Obstetrics and Gynaecology, Tygerberg Academic Hospital and University
More informationMale infertility too often ignored & forgotten
Male infertility too often ignored & forgotten The journey 1. of the men A review of the guidelines Joo Teoh FRANZCOG MRCP(Ire) MRCOG MBBCh MSc(Lon) MD(Glasgow) SubspecialtyRepromed(UK) Consultant Obstetrician
More informationESHRE Andrology Campus Course Reproductive Andrology Brussels 8-10 November 2007
ESHRE Andrology Campus Course Reproductive Andrology Brussels 8-10 November 2007 To treat the man or his sperm? When to treat the man? Conventional non-surgical treatment of male infertility Axel Kamischke
More informationAchieving Pregnancy: Obesity and Infertility. Jordan Vaughan, MSN, APN, WHNP-BC Women s Health Nurse Practitioner Nashville Fertility Center
Achieving Pregnancy: Obesity and Infertility Jordan Vaughan, MSN, APN, WHNP-BC Women s Health Nurse Practitioner Nashville Fertility Center Disclosures Speakers Bureau EMD Serono Board of Directors Nurse
More informationSexual dysfunction of chronic kidney disease. Razieh salehian.md psychiatrist
Sexual dysfunction of chronic kidney disease Razieh salehian.md psychiatrist Disturbances in sexual function are a common feature of chronic renal failure. Sexual dysfunction is inversely associated with
More informationHigh percentage of abnormal semen parameters in a prevasectomy population
High percentage of abnormal semen parameters in a prevasectomy population Fábio Firmbach Pasqualotto, M.D., Ph.D., a,b Bernardo Passos Sobreiro, M.D., a Jorge Hallak, M.D., Ph.D., a Kelly Silveira Athayde,
More informationMale Reproductive Physiology
Male Reproductive Physiology Overview Anatomy Function Endocrine and spermatogenesis Testis epididymus,vas deferens,seminal vesicles and prostate Hypothalamic pituitary testicular axis Hormones of the
More informationlbt lab tests t Conrolled Ovarian Hyperstimulation Dr Soheila Ansaripour
lbt lab tests t and Conrolled Ovarian Hyperstimulation Dr Soheila Ansaripour Research Instituteof Avicenna 4/23/2012 Why good prediction of poor response good prediction i of OHSS application appropriate
More informationEVALUATION OF MALE AND FEMALE INFERTILITY ANDREA BARRUECO AMERICAN CENTER FOR REPRODUCTIVE MEDICINE CLEVELAND CLINIC ART TRAINING 2018
EVALUATION OF MALE AND FEMALE INFERTILITY ANDREA BARRUECO AMERICAN CENTER FOR REPRODUCTIVE MEDICINE CLEVELAND CLINIC ART TRAINING 2018 The evaluation of an infertile couple requires an understanding of
More informationReproduction. AMH Anti-Müllerian Hormone. Analyte Information
Reproduction AMH Anti-Müllerian Hormone Analyte Information - 1-2011-01-11 AMH Anti-Müllerian Hormone Introduction Anti-Müllerian Hormone (AMH) is a glycoprotein dimer composed of two 72 kda monomers 1.
More informationMale reproduction. Cross section of Human Testis ผศ.ดร.พญ.ส ว ฒณ ค ปต ว ฒ ภาคว ชาสร รว ทยา คณะแพทยศาสตร ศ ร ราชพยาบาล 1. Aims
Aims Male reproduction Male reproductive structure Spermatogenesis ส ว ฒณ ค ปต ว ฒ ห อง 216 โทร: 7578 Hypothalamo-pituitary-testicular axis Male sex hormone action Male reproductive structure Male reproductive
More informationOlder Age Is Associated With Similar Improvements in Semen Parameters and Testosterone After Subinguinal Microsurgical Varicocelectomy
Older Age Is Associated With Similar Improvements in Semen Parameters and Testosterone After Subinguinal Microsurgical Varicocelectomy Wayland Hsiao, James S. Rosoff, Joseph R. Pale, Eleni A. Greenwood
More informationInfertility: failure to conceive within one year of unprotected regular sexual intercourse. Primary secondary
Subfertility Infertility: failure to conceive within one year of unprotected regular sexual intercourse. Primary secondary Infertility affects about 15 % of couples. age of the female. Other factors that
More informationClinical Policy Committee
Clinical Policy Committee Commissioning policy: Assisted Conception Fertility assessment and investigations are commissioned where: A woman is of reproductive age and has not conceived after one (1) year
More information15% ART accounts for ~4% of Australian births
The General Practice Education Day HealthEd / Generation Next 5 th March Melbourne Declarations Male Infertility & Assisted Reproduction Prof Robert I McLachlan FRACP, Ph.D. Consultant Andrologist, Monash
More informationResults and Discussion
The AMH and Inhibin B in serum and follicular fluid was a very good predictive marker for assessment of oocyte quantity but did not correlate with the maturity of the oocyte or fertilization or reproductive
More informationAbnormalities 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 informationDo Cigarette Smoking and Obesity Affect Semen Abnormality in Idiopathic Infertile Males?
pissn: 22874208 / eissn: 22874690 World J Mens Health 2014 August 32(2): 105109 http://dx.doi.org/10.5534/wjmh.2014.32.2.105 Original Article Do Cigarette Smoking and Obesity Affect Semen Abnormality in
More information15% ART accounts for ~4% of Australian births
The General Practice Education Day HealthEd / Generation Next 23 rd July Brisbane Declarations Male Infertility & Assisted Reproduction Equity interest in Monash IVF Group Prof Robert I McLachlan FRACP,
More informationRECENTLY, CONSIDERABLE attention has focused on
0021-972X/01/$03.00/0 Vol. 86, No. 6 The Journal of Clinical Endocrinology & Metabolism Printed in U.S.A. Copyright 2001 by The Endocrine Society Double-Blind Y Chromosome Microdeletion Analysis in Men
More information15% ART accounts for ~4% of Australian births
The General Practice Education Day HealthEd / Generation Next 20 th February Sydney Declarations Male Infertility & Assisted Reproduction Prof Robert I McLachlan FRACP, Ph.D. Consultant Andrologist, Monash
More informationBank your future: Insemination and semen cryopreservation. Disclosure. Lecture objectives
Bank your future: Insemination and semen cryopreservation Roelof Menkveld, PhD Andrology Laboratory, Department of Obstetrics and Gynaecology, Tygerberg Academic Hospital and University of Stellenbosch.
More informationTesticular fine needle aspiration as a diagnostic tool in nonobstructive
Asian J Androl 2005; 7 (3): 289 294 DOI: 10.1111/j.1745-7262.2005.00043.x. Original Article. Testicular fine needle aspiration as a diagnostic tool in nonobstructive azoospermia A. Bettella 1, A. Ferlin
More informationReversible 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 informationUnderstanding Infertility, Evaluations, and Treatment Options
Understanding Infertility, Evaluations, and Treatment Options Arlene J. Morales, M.D., F.A.C.O.G. Fertility Specialists Medical Group, Inc. What We Will Cover Introduction What is infertility? Briefly
More informationRecent Developments in Infertility Treatment
Recent Developments in Infertility Treatment John T. Queenan Jr., MD Professor, Dept. Of Ob/Gyn University of Rochester Medical Center Rochester, NY Disclosures I don t have financial interest or other
More informationMale Fertility: Your Questions Answered
Male Fertility: Your Questions Answered Michael S. Neal Scientific Director, ONE Fertility, 3210 Harvester Rd. Burlington, Ontario www.onefertility.com mneal@onefertility.com Outline Assisted Conception
More informationChris Davies & Greg Handley
Chris Davies & Greg Handley Contents Definition Epidemiology Aetiology Conditions for pregnancy Female Infertility Male Infertility Shared infertility Treatment Definition Failure of a couple to conceive
More informationExogenous testosterone: a preventable cause of male infertility
Review Article Exogenous testosterone: a preventable cause of male infertility Lindsey E. Crosnoe 1, Ethan Grober 2, Dana Ohl 3, Edward D. Kim 1 1 University of Tennessee Graduate School of Medicine, Knoxville,
More informationHarbor-UCLA Medical Center Division of Endocrinology and Metabolism
LABioMed Harbor-UCLA Medical Center Division of Endocrinology and Metabolism Reversible Contraceptive Method for Men Niloufar Ilani, M.D. Endocrine Fellow Introduction Unintended pregnancy remains a major
More informationDURING the past three decades, several reports
Copyright, 1995, by the Massachusetts Medical Society Volume 332 FEBRUARY 2, 1995 Number 5 DECLINE IN SEMEN QUALITY AMONG FERTILE MEN IN PARIS DURING THE PAST YEARS JACQUES AUGER, M.D., PH.D., JEAN MARIE
More informationInterpreting follicular Progesterone: Late follicular Progesterone to Estradiol ratio is not influenced by protocols or gonadotropins used
Interpreting follicular Progesterone: Late follicular Progesterone to Estradiol ratio is not influenced by protocols or gonadotropins used Ellenbogen A., M.D., Shalom-Paz E., M.D, Asalih N., M.D, Samara
More informationHypogonadism 4/27/2018. Male Hypogonadism -- Definition. Epidemiology. Objectives HYPOGONADISM. Men with Hypogonadism. 95% untreated.
Male Hypogonadism -- Definition - Low T, Low Testosterone Hypogonadism -...a clinical syndrome that results from failure of the testes to produce physiological concentrations of testosterone due to pathology
More informationIOF POI. hypergonadotropic hypogonadism primary ovarian insufficiency POI /premature ovarian failure POF. Van Kasteren. Coulam POI FSH E.
hypergonadotropic hypogonadism primary ovarian insufficiency POI /premature ovarian failure POF Coulam POI Turner Fragile X premutation FSHR NOBOX FOXL etc POI FSH miu/ml AMH AMH AMH FSH / Knauff POI IOF
More informationLH and FSH. Women. Men. Increased LH. Decreased LH. By Ronald Steriti, ND, PhD 2011
LH and FSH By Ronald Steriti, ND, PhD 2011 Luteinizing hormone (LH) and follicle-stimulating hormone (FSH) are gonadotropins that stimulate the gonads - the testes in males, and the ovaries in females.
More informationStudy on semen analysis in the evaluation of male infertility in coastal Karnataka, India
International Journal of Reproduction, Contraception, Obstetrics and Gynecology Ganiga P et al. Int J Reprod Contracept Obstet Gynecol. 2018 Jul;7(7):2603-2607 www.ijrcog.org DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20182412
More informationPredictive 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 informationVariability 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 informationREPRODUCCIÓN. La idea fija. Copyright 2004 Pearson Education, Inc., publishing as Benjamin Cummings
REPRODUCCIÓN La idea fija How male and female reproductive systems differentiate The reproductive organs and how they work How gametes are produced and fertilized Pregnancy, stages of development, birth
More informationComparison of the effectiveness of placebo and a-blocker therapy for the treatment of idiopathic oligozoospermia *
FERTILITY AND STERILITY Copyright c 1995 American Society for Reproductive Medicine Printed on acid-free paper in U. S. A. Comparison of the effectiveness of placebo and a-blocker therapy for the treatment
More informationMale factors determining the outcome of intracytoplasmic sperm injection with epididymal and testicular spermatozoa
andrologia 35, 220 226 (2003) Accepted: April 25, 2003 Male factors determining the outcome of intracytoplasmic sperm injection with epididymal and testicular spermatozoa J. U. Schwarzer, K. Fiedler, I.
More informationInduction of spermatogenesis in azoospermic men after varicocelectomy repair: an update
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
More informationTreatment of Oligospermia with Large Doses of Human Chorionic Gonadotropin
Treatment of Oligospermia with Large Doses of Human Chorionic Gonadotropin A Preliminary Report S. J. GLASS, M.D., and H. M. HOLLAND, M.D. BEFORE discussing gonadotropic therapy of oligospermia, it is
More informationUpdate on male reproductive endocrinology
Review Article Update on male reproductive endocrinology Raul I. Clavijo 1, Wayland Hsiao 2 1 Department of Urology, University of California, Davis, School of Medicine, Sacramento, California, USA; 2
More informationACUPUNCTURE 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 informationThe understanding about infertility in different regions of the world is different. It varies from
The Professional Medical Journal DOI: 10.29309/TPMJ/18.4478 1. MBBS, M.Phil (Chemical Pathology) Professor, Chemical Section, Continental Medical College Lahore. 2. MBBS, M.Phil (Microbiology) Assistant
More informationPDF hosted at the Radboud Repository of the Radboud University Nijmegen
PDF hosted at the Radboud Repository of the Radboud University Nijmegen The following full text is a publisher's version. For additional information about this publication click this link. http://hdl.handle.net/2066/24403
More informationOutline. Male Reproductive System Testes and Sperm Hormonal Regulation
Outline Male Reproductive System Testes and Sperm Hormonal Regulation Female Reproductive System Genital Tract Hormonal Levels Uterine Cycle Fertilization and Pregnancy Control of Reproduction Infertility
More informationThe Journal of Veterinary Medical Science
Advance Publication The Journal of Veterinary Medical Science Accepted Date: 1 Jun 01 J-STAGE Advance Published Date: Jun 01 Theriogenology (Note) Therapeutic effects of oral clomiphene citrate in dogs
More informationReproduction. Inhibin B. Analyte Information
Reproduction Inhibin B Analyte Information - 1-2011-01-11 Inhibin B Introduction Inhibins are polypeptides belonging to the transforming growth factor-β (TGF-β) superfamily which also includes TGF-β, activin
More informationThe assessment and investigation of the infertile couple
The assessment and investigation of the infertile couple BIRUTE ZILAITIENE, MD, PHD, PROF., FECSM DEPARTMENT OF ENDOCRINOLOGY AND INSTITUTE OF ENDOCRINOLOGY, LITHUANIAN UNIVERSITY OF HEALTH SCIENCES, KAUNAS,
More informationOverview of Reproductive Endocrinology
Overview of Reproductive Endocrinology I have no conflicts of interest to report. Maria Yialamas, MD Female Hypothalamic--Gonadal Axis 15 4 Hormone Secretion in the Normal Menstrual Cycle LH FSH E2, Progesterone,
More informationMale Reproduction Organs. 1. Testes 2. Epididymis 3. Vas deferens 4. Urethra 5. Penis 6. Prostate 7. Seminal vesicles 8. Bulbourethral glands
Outline Terminology Human Reproduction Biol 105 Lecture Packet 21 Chapter 17 I. Male Reproduction A. Reproductive organs B. Sperm development II. Female Reproduction A. Reproductive organs B. Egg development
More informationREPRODUCTION & GENETICS. Hormones
REPRODUCTION & GENETICS Hormones http://www.youtube.com/watch?v=np0wfu_mgzo Objectives 2 Define what hormones are; Compare and contrast the male and female hormones; Explain what each hormone in the mail
More information5/5/2010. Infertility FINANCIAL DISCLOSURE. Infertility Definition. Objectives. Normal Human Fertility. Normal Menstrual Cycle
Infertility FINANCIAL DISCLOSURE I HAVE NO FINANCIAL INTEREST IN ANY OF THE PRODUCTS MENTIONED IN MY PRESENTATION Bryan K. Rone, M.D. University of Kentucky Obstetrics and Gynecology I AM RECEIVING COMPENSATION
More informationSperm retrieval from patients with nonmosaic Klinefelter s syndrome by semen cytology examination
Sperm retrieval from patients with nonmosaic Klinefelter s syndrome by semen cytology examination Y.-T. Jiang 1, Y. Dong 1, X.-W. Yu 1, R.-C. Du 1,2, L.-L. Li 1,2, H.-G. Zhang 1 and R.-Z. Liu 1 1 Center
More information