The treatment of men with infertility from azoospermia is challenging.As some men with severe oligozoospermia improve sperm output during treatment with isotretinoin,we treated nine men with azoospermia with isotretin...The treatment of men with infertility from azoospermia is challenging.As some men with severe oligozoospermia improve sperm output during treatment with isotretinoin,we treated nine men with azoospermia with isotretinoin to determine if azoospermic men would also respond to isotretinoin treatment.One of these men who had a previous negative testicular sperm extraction(TESE)was found to have an area of sperm production on a postisotretinoin testicular extraction.This man achieved a pregnancy and a live birth of a healthy,term daughter after in vitro fertilization coupled with intracytoplasmic sperm injection(IVF/ICSI).A second subject had a positive TESE after treatment as well.Additional study of isotretinoin therapy in men with azoospermia undergoing testicular sperm harvesting procedures is warranted.展开更多
Measurement of intratesticular sex steroid concentrations in men informs both the development of male hormonal contraceptives and the understanding of male infertility. Given the challenges of using invasive technique...Measurement of intratesticular sex steroid concentrations in men informs both the development of male hormonal contraceptives and the understanding of male infertility. Given the challenges of using invasive techniques to measure testicular hormone physiology, our group has used a minimally-invasive fine-needle aspiration technique to measure intratesticular hormones in normal healthy men. Herein, we present a post-hoc analysis of the safety and efficacy of testicular fine-needle aspiration （FNA） completed as part of six clinical trials. From 2001 through 2011, a total of 404 procedures were conducted among 163 research volunteers, 85.9% of which were successful in obtaining sufficient fluid for the measurement of intratesticular steroid concentrations. Pain was the most common side effect, with 36.8% of procedures associated with moderate procedural pain and 4.7% with severe procedural pain. Postprocedural pain was uncommon and abated within a few days. Mild local bruising occurred with 14.9% of procedures. Two serious adverse events （0.5%） required surgical intervention. The risk of an adverse event was not associated with age, body mass index, testicular size, or the volume of fluid aspirated. Testicular FNA to obtain fluid for measurement of intratesticular steroid concentrations frequently causes mild to moderate procedural pain, but serious adverse events occur rarely. Testicular FNA has been instrumental for defining human intratesticular hormone physiology and is a minimally-invasive, safe, effective method for obtaining fluid for research on testicular physiology and pathology.展开更多
Our objective was to identify predictors of improved postthaw semen quality in men with testicular cancer banking sperm for fertility preservation. We reviewed 173 individual semen samples provided by 67 men with test...Our objective was to identify predictors of improved postthaw semen quality in men with testicular cancer banking sperm for fertility preservation. We reviewed 173 individual semen samples provided by 67 men with testicular germ cell tumor （TGCT） who cryopreserved sperm before gonadotoxic treatment between 1994 and 2010 at our tertiary university medical center. Our main outcomes measures were independent predictors for the greater postthaw total motile count （TMC） in men with TGCT. Men with NSGCT were more likely to be younger （P 〈 0.01） and had high cancer stage （Ⅱ or Ⅲ, P 〈 0.01） compared with men with seminoma. In our multiple regression model, NSGCT histology, use of density gradient purification, and fresh TMC 〉 median fresh TMC each had increased odds of a postthaw TMC greater than median postthaw TMC. Interestingly, age, advanced cancer stage （11 or III）, rapid freezing protocol, and motility enhancer did not show increased odds of improved postthaw TMC in our models. In conclusion, men with TGCT or poor fresh TMC should consider preserving additional vials （at least 15 vials） before oncologic treatment. Density gradient purification should be routinely used to optimize postthaw TMC in men with TGCT. Larger, randomized studies evaluating cancer stage and various cryopreservation techniques are needed to assist in counseling men with TGCT regarding fertility preservation and optimizing cryosurvival.展开更多
基金The Eunice Kennedy Shriver National Institute of Child Health and Human Development supported this work through grant K24HD082231 to John K Amory.
文摘The treatment of men with infertility from azoospermia is challenging.As some men with severe oligozoospermia improve sperm output during treatment with isotretinoin,we treated nine men with azoospermia with isotretinoin to determine if azoospermic men would also respond to isotretinoin treatment.One of these men who had a previous negative testicular sperm extraction(TESE)was found to have an area of sperm production on a postisotretinoin testicular extraction.This man achieved a pregnancy and a live birth of a healthy,term daughter after in vitro fertilization coupled with intracytoplasmic sperm injection(IVF/ICSI).A second subject had a positive TESE after treatment as well.Additional study of isotretinoin therapy in men with azoospermia undergoing testicular sperm harvesting procedures is warranted.
文摘Measurement of intratesticular sex steroid concentrations in men informs both the development of male hormonal contraceptives and the understanding of male infertility. Given the challenges of using invasive techniques to measure testicular hormone physiology, our group has used a minimally-invasive fine-needle aspiration technique to measure intratesticular hormones in normal healthy men. Herein, we present a post-hoc analysis of the safety and efficacy of testicular fine-needle aspiration （FNA） completed as part of six clinical trials. From 2001 through 2011, a total of 404 procedures were conducted among 163 research volunteers, 85.9% of which were successful in obtaining sufficient fluid for the measurement of intratesticular steroid concentrations. Pain was the most common side effect, with 36.8% of procedures associated with moderate procedural pain and 4.7% with severe procedural pain. Postprocedural pain was uncommon and abated within a few days. Mild local bruising occurred with 14.9% of procedures. Two serious adverse events （0.5%） required surgical intervention. The risk of an adverse event was not associated with age, body mass index, testicular size, or the volume of fluid aspirated. Testicular FNA to obtain fluid for measurement of intratesticular steroid concentrations frequently causes mild to moderate procedural pain, but serious adverse events occur rarely. Testicular FNA has been instrumental for defining human intratesticular hormone physiology and is a minimally-invasive, safe, effective method for obtaining fluid for research on testicular physiology and pathology.
文摘Our objective was to identify predictors of improved postthaw semen quality in men with testicular cancer banking sperm for fertility preservation. We reviewed 173 individual semen samples provided by 67 men with testicular germ cell tumor （TGCT） who cryopreserved sperm before gonadotoxic treatment between 1994 and 2010 at our tertiary university medical center. Our main outcomes measures were independent predictors for the greater postthaw total motile count （TMC） in men with TGCT. Men with NSGCT were more likely to be younger （P 〈 0.01） and had high cancer stage （Ⅱ or Ⅲ, P 〈 0.01） compared with men with seminoma. In our multiple regression model, NSGCT histology, use of density gradient purification, and fresh TMC 〉 median fresh TMC each had increased odds of a postthaw TMC greater than median postthaw TMC. Interestingly, age, advanced cancer stage （11 or III）, rapid freezing protocol, and motility enhancer did not show increased odds of improved postthaw TMC in our models. In conclusion, men with TGCT or poor fresh TMC should consider preserving additional vials （at least 15 vials） before oncologic treatment. Density gradient purification should be routinely used to optimize postthaw TMC in men with TGCT. Larger, randomized studies evaluating cancer stage and various cryopreservation techniques are needed to assist in counseling men with TGCT regarding fertility preservation and optimizing cryosurvival.
