Anogenital distance （AGD） is used to define degree of virilization of genital development, with shorter length being associated with feminization and male infertility. The first exon of the androgen receptor （AR） ...Anogenital distance （AGD） is used to define degree of virilization of genital development, with shorter length being associated with feminization and male infertility. The first exon of the androgen receptor （AR） consists of a polymorphic sequence of cytosine-adenineguanine （CAG） repeats, with longer CAG repeat lengths being associated with decreased receptor function. We sought to determine if there is an association between AGD and AR CAG repeat length. A cross-sectional, prospective cohort of men evaluated at a urology clinic at a single institution was recruited. AGD （the distance from the posterior scrotum to the anal verge） and penile length （PL） were measured. Sanger DNA sequence analysis was used to define CAG repeat length. AGD and CAG repeat lengths in 195 men were determined. On unadjusted analysis, there was no linear relationship between CAG repeat length and PL （P=0.17） or AGD （P=-0.31）. However, on sub-population analyses, those men with longer CAG repeat lengths （〉26） had significantly shorter AGDs compared to men with shorter CAG repeat lengths. For example, the mean AGD was 41.9 vs. 32.4 mm with a CAG repeat length ≤26 vs. 〉26 （P=0.01）. In addition, when stratifying the cohort based on AGD, those with AGD less than the median （i.e. 40 mm） had a longer CAG repeat length compared to men with an AGD 〉40 mm （P=-0.02）. In summary, no linear relationship was found between AGD and AR CAG repeat length overall.展开更多
Apurported global decline in sperm counts has been a source of controversy since the early 1990s. Numerous studies performed since then, as well as reanalysis of the original data, show either no changes, or even incr...Apurported global decline in sperm counts has been a source of controversy since the early 1990s. Numerous studies performed since then, as well as reanalysis of the original data, show either no changes, or even increases, in sperm concentrations over time. In this review, we discuss the 1992 meta-analysis that initiated the continuing debate on whether sperm concentrations are declining, and the com- munity discussion surrounding it over the past two decades. We also highlight studies evaluating sperm concentrations performed since the initial study that produced different results, and conclude that no definitive cause for a decrease in sperm counts has been established, and the effects of geography and environment on sperm counts are unclear.展开更多
Many azoospermic men do not possess mature spermatozoa at the time of surgical sperm extraction.This study is a systematic review and meta-analysis evaluating outcomes following round spermatid injection(ROSI),a techn...Many azoospermic men do not possess mature spermatozoa at the time of surgical sperm extraction.This study is a systematic review and meta-analysis evaluating outcomes following round spermatid injection(ROSI),a technique which utilizes immature precursors of spermatozoa for fertilization.An electronic search was performed to identify relevant articles published through October 2018.Human cohort studies in English involving male patients who had round spermatids identified and used for fertilization with human oocytes were included.Fertilization rate,pregnancy rate,and resultant delivery rate were assessed following ROSI.Meta-analysis outcomes were analyzed using a random-effects model.Data were extracted from 22 studies involving 1099 couples and 4218 embryo transfers.The fertilization rate after ROSI was 38.7%(95%confidence interval[CI]:31.5%–46.3%),while the pregnancy rate was 3.7%(95%CI:3.2%–4.4%).The resultant delivery rate was low,with 4.3%of embryo transfers resulting in a delivery(95%CI:2.3%–7.7%).The pregnancy rate per couple was 13.4%(95%CI:6.8%–19.1%)and the resultant delivery rate per couple was 8.1%(95%CI:6.1%–14.4%).ROSI has resulted in clinical pregnancies and live births,but success rates are considerably lower than those achieved with mature spermatozoa.While this technique may be a feasible alternative for men with azoospermia who decline other options,couples should be aware that the odds of a successful delivery are greatly diminished and the prognosis is relatively poor.展开更多
Dear Editor, The patient is a 45-year-old male who presented to an outside clinic in 2014 for evaluation of painful ejaculation, infertility, and difficulty with urination for as long as he could remember. He reporte...Dear Editor, The patient is a 45-year-old male who presented to an outside clinic in 2014 for evaluation of painful ejaculation, infertility, and difficulty with urination for as long as he could remember. He reported no past significant medical or surgical history and no family history of infertility. He was given a trial of tamsulosin without improvement in his symptoms. Initial semen analysis demonstrated azoospermia.展开更多
Varicocele is the most common surgically treatable cause of male infertility, and often results in alterations in semen parameters, sperm DNA damage, and changes to the seminal milieu. Varicocele repair can result in ...Varicocele is the most common surgically treatable cause of male infertility, and often results in alterations in semen parameters, sperm DNA damage, and changes to the seminal milieu. Varicocele repair can result in improvement in these parameters in the majority of men with clinical varicocele; data supporting repair in men with subclinical varicocele are less definitive. In couples seeking fertility using assisted reproductive technologies （ARTs）, varicocele repair may offer improvement in semen parameters and sperm health that can increase the likelihood of successful fertilization using techniques such as in vitro fertilization （IVF） or intracytoplasmic sperm injection （ICSI）, or may decrease the level of ART needed to achieve successful pregnancy. Male infertility is an indicator of general male health, and evaluation of the infertile male with an eye toward future health can facilitate optimal screening and treatment of these men. Furthermore, varicocele may represent a progressive lesion, offering an argument for its repair, although this is currently unclear.展开更多
文摘Anogenital distance （AGD） is used to define degree of virilization of genital development, with shorter length being associated with feminization and male infertility. The first exon of the androgen receptor （AR） consists of a polymorphic sequence of cytosine-adenineguanine （CAG） repeats, with longer CAG repeat lengths being associated with decreased receptor function. We sought to determine if there is an association between AGD and AR CAG repeat length. A cross-sectional, prospective cohort of men evaluated at a urology clinic at a single institution was recruited. AGD （the distance from the posterior scrotum to the anal verge） and penile length （PL） were measured. Sanger DNA sequence analysis was used to define CAG repeat length. AGD and CAG repeat lengths in 195 men were determined. On unadjusted analysis, there was no linear relationship between CAG repeat length and PL （P=0.17） or AGD （P=-0.31）. However, on sub-population analyses, those men with longer CAG repeat lengths （〉26） had significantly shorter AGDs compared to men with shorter CAG repeat lengths. For example, the mean AGD was 41.9 vs. 32.4 mm with a CAG repeat length ≤26 vs. 〉26 （P=0.01）. In addition, when stratifying the cohort based on AGD, those with AGD less than the median （i.e. 40 mm） had a longer CAG repeat length compared to men with an AGD 〉40 mm （P=-0.02）. In summary, no linear relationship was found between AGD and AR CAG repeat length overall.
文摘Apurported global decline in sperm counts has been a source of controversy since the early 1990s. Numerous studies performed since then, as well as reanalysis of the original data, show either no changes, or even increases, in sperm concentrations over time. In this review, we discuss the 1992 meta-analysis that initiated the continuing debate on whether sperm concentrations are declining, and the com- munity discussion surrounding it over the past two decades. We also highlight studies evaluating sperm concentrations performed since the initial study that produced different results, and conclude that no definitive cause for a decrease in sperm counts has been established, and the effects of geography and environment on sperm counts are unclear.
文摘Many azoospermic men do not possess mature spermatozoa at the time of surgical sperm extraction.This study is a systematic review and meta-analysis evaluating outcomes following round spermatid injection(ROSI),a technique which utilizes immature precursors of spermatozoa for fertilization.An electronic search was performed to identify relevant articles published through October 2018.Human cohort studies in English involving male patients who had round spermatids identified and used for fertilization with human oocytes were included.Fertilization rate,pregnancy rate,and resultant delivery rate were assessed following ROSI.Meta-analysis outcomes were analyzed using a random-effects model.Data were extracted from 22 studies involving 1099 couples and 4218 embryo transfers.The fertilization rate after ROSI was 38.7%(95%confidence interval[CI]:31.5%–46.3%),while the pregnancy rate was 3.7%(95%CI:3.2%–4.4%).The resultant delivery rate was low,with 4.3%of embryo transfers resulting in a delivery(95%CI:2.3%–7.7%).The pregnancy rate per couple was 13.4%(95%CI:6.8%–19.1%)and the resultant delivery rate per couple was 8.1%(95%CI:6.1%–14.4%).ROSI has resulted in clinical pregnancies and live births,but success rates are considerably lower than those achieved with mature spermatozoa.While this technique may be a feasible alternative for men with azoospermia who decline other options,couples should be aware that the odds of a successful delivery are greatly diminished and the prognosis is relatively poor.
文摘Dear Editor, The patient is a 45-year-old male who presented to an outside clinic in 2014 for evaluation of painful ejaculation, infertility, and difficulty with urination for as long as he could remember. He reported no past significant medical or surgical history and no family history of infertility. He was given a trial of tamsulosin without improvement in his symptoms. Initial semen analysis demonstrated azoospermia.
文摘Varicocele is the most common surgically treatable cause of male infertility, and often results in alterations in semen parameters, sperm DNA damage, and changes to the seminal milieu. Varicocele repair can result in improvement in these parameters in the majority of men with clinical varicocele; data supporting repair in men with subclinical varicocele are less definitive. In couples seeking fertility using assisted reproductive technologies （ARTs）, varicocele repair may offer improvement in semen parameters and sperm health that can increase the likelihood of successful fertilization using techniques such as in vitro fertilization （IVF） or intracytoplasmic sperm injection （ICSI）, or may decrease the level of ART needed to achieve successful pregnancy. Male infertility is an indicator of general male health, and evaluation of the infertile male with an eye toward future health can facilitate optimal screening and treatment of these men. Furthermore, varicocele may represent a progressive lesion, offering an argument for its repair, although this is currently unclear.
