CUA Guideline: The workup and management of azoospermic males

Jarvi, Keith; Lo, Kirk; Grober, Ethan; Mak, Victor; Fischer, Anthony; Grantmyre, John; Zini, Armand; Chan, Peter; Patry, Geneviève; Chow, Victor; Domes, Trustin

doi:10.5489/cuaj.3209

Cited by 42 publications

(36 citation statements)

References 32 publications

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“…The median dosage of gonadotropins used was 1950 IU (interquartile range, 1650-2550 IU), duration of stimulation 12 days (11-14 days), peak oestradiol level 11 341 pmol/L (7859.5-19 260.5 pmol/L), and the number of metaphase II oocytes obtained was 8 (4)(5)(6)(7)(8)(9)(10)(11)(12)(13). Pregnancy test was positive in 15/89 (16.9%) and the clinical pregnancy rate was 12/89 (13.5%).…”

Section: Resultsmentioning

confidence: 99%

“…Testing for chromosomal abnormalities and Y-microdeletion are recommended as an essential part of the workup of men with NOA or severe oligospermia by the American Society for Reproductive Medicine, 13 American Urological Association, 12 Canadian Urological Association, 11 and International Federation of Fertility Societies guidelines. 14 In particular, microdeletion of the AZFa or AZFb regions were associated with poor prognosis of sperm retrieval and no sperms have been retrieved in these patients.…”

Section: Discussionmentioning

confidence: 99%

“…10 Guidelines from the American Society for Reproductive Medicine, American Urological Association, Canadian Urological Association, and International Federation of Fertility Societies are unanimous in suggesting that all men with NOA due to testicular failure should be offered genetic testing to exclude chromosomal abnormalities and Y chromosome microdeletions, and that genetic counselling be offered if an abnormality is detected. [11][12][13][14] There are currently no local data on the sperm retrieval and pregnancy rates in IVF-TESE cycles, especially with regard to the presence of genetic abnormalities. Such information is invaluable to couples in pretreatment counselling and could affect their decision about treatment options.…”

Section: Introductionmentioning

confidence: 99%

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Sperm retrieval rate and pregnancy rate in infertile couples undergoing in-vitro fertilisation and testicular sperm extraction for non-obstructive azoospermia in Hong Kong

Chai

Lee

et al. 2016

Hong Kong Med J

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Objective: There are currently no local data on the sperm retrieval and pregnancy rates in in-vitro fertilisation and testicular sperm extraction cycles, especially with regard to the presence of genetic abnormalities. This study aimed to determine the sperm retrieval and pregnancy rates in infertile couples who underwent in-vitro fertilisation and testicular sperm extraction for non-obstructive azoospermia.Methods: This retrospective case series was conducted at a tertiary assisted reproduction unit in Hong Kong. Men with non-obstructive azoospermia who underwent in-vitro fertilisation and testicular sperm extraction between January 2001 and December 2013 were included. The main outcome measures were sperm retrieval and pregnancy rates.Results: During the study period, 89 men with non-obstructive azoospermia underwent in-vitro fertilisation and testicular sperm extraction. Sperm was successfully retrieved in 40 (44.9%) men. There was no statistically significant difference in the sperm retrieval rate of those with karyotypic abnormalities (2/5, 40.0% vs 28/61, 45.9%; P=1.000) and AZFc microdeletion (3/6, 50.0% vs 28/61, 45.9%; P=1.000) compared with those without. Sperms were successfully retrieved in patients who had mosaic Klinefelter syndrome (2/3, 66.7%) but not in the patient with non-mosaic Klinefelter syndrome. No sperms were found in men with AZFa or AZFb microdeletions. Pregnancy test was positive in 15 (16.9%) patients and the clinical pregnancy rate was 13.5% (12/89) per cycle. The clinical pregnancy rate Sperm retrieval rate and pregnancy rate in infertile couples undergoing in-vitro fertilisation and testicular sperm extraction for nonobstructive azoospermia in Hong KongNew knowledge added by this study • Our study provides important local data for counselling of men with non-obstructive azoospermia. The sperm retrieval rate and clinical pregnancy rate per cycle in men undergoing in-vitro fertilisation and testicular sperm extraction in our unit were 44.9% and 13.5%, respectively.• There was no statistically significant difference in the sperm retrieval and pregnancy rates in those with karyotypic abnormalities and AZFc microdeletion compared with those without. Sperms, however, were not found in men with AZFa or AZFb microdeletions. Implications for clinical practice or policy • Although karyotype abnormalities and AZFc microdeletion did not affect the sperm retrieval and pregnancy rates in couples undergoing in-vitro fertilisation and testicular sperm extraction, karyotype and Y-microdeletion should be checked in men with non-obstructive azoospermia. The risk of vertical transmission of genetic abnormalities should be discussed and couples should be offered appropriate genetic counselling before treatment.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Sperm retrieval rate and pregnancy rate in infertile couples undergoing in-vitro fertilisation and testicular sperm extraction for non-obstructive azoospermia in Hong Kong

Chai

Lee

et al. 2016

Hong Kong Med J

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“…5,9 Relevant historical factors in the evaluation of azoospermia are listed in Table 1 12 These findings are reflected in current guidelines on the evaluation of azoospermia and have greatly reduced the need for testicular biopsy in the evaluation of azoospermia. 5,9 The purpose of this case report is to discuss a diagnostically challenging presentation of azoospermia in the context of current recommendations and to propose a situation-specific treatment algorithm to aid in the management of azoospermia and varicocele.…”

Section: Cuaj -Residents' Room Masterson Et Al Case: Azoospermia Withmentioning

confidence: 96%

“…Current guidelines in both the US and Canada call for diagnostic testicular biopsy for patients with normal testicular size, at least one palpable vas deferens and a normal serum follicle-stimulating hormone level. 5,9 Our patient fit only one of these criteria, normal FSH, and lacked any obvious source of obstruction on history and physical exam. Varicocele is a known cause of NOA and varicocele repair has been shown to return sperm to the ejaculate or improve sperm retrieval outcomes in men with NOA and varicocele.…”

Section: Discussionmentioning

confidence: 99%

Case – Azoospermia with bilateral varicocele and normal follicle-stimulating hormone

Masterson

Ramasamy

2018

CUAJ

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Differentiation of Peritubular Myoid‐Like Cells from Human Induced Pluripotent Stem Cells

Robinson¹,

Haegert²,

Li³

et al. 2023

Advanced Biology

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treatments is hampered due to our limited understanding of the underlying function of normal human testicular cell-typespecific function, as well as cell-type-specific dysfunction contributing to spermatogenic failure. The somatic cells contributing to the spermatogenic niche include Sertoli cells, peritubular myoid cells (PTMs), Leydig cells, macrophages, and endothelial cells. PTMs, in combination with Sertoli cells, constitute a barrier surrounding the seminiferous tubules. A frequent finding in the cellular histology of infertile males is defects in the architecture of this barrier, suggesting a dysregulation in its formation or regulation, [2] and consequently the local spermatogenic microenvironment. [3] PTMs occupy the boundary separating the interstitial Leydig cell compartment from the germ cell tubular compartment, and contribute an important element to seminiferous tubule cytoarchitecture and cell regulation within the somatic niche (Figure 1). PTMs remain poorly characterized despite their importance. Our understanding of PTMs is derived predominately from rodent cell cultures and knock-out mouse models. These in vitro and in vivo studies have shown that PTMs are responsive to androgen stimulation, as evidenced by increased secretion Infertility affects 10-15% of couples, with half attributed to male factors. An improved understanding of the cell-type-specific dysfunction contributing to male infertility is needed to improve available therapies; however, human testicular tissues are difficult to obtain for research purposes. To overcome this, researchers have begun to use human induced pluripotent stem cells (hiPSCs) to generate various testis-specific cell types in vitro. Peritubular myoid cells (PTMs) are one such testicular cell type that serves a critical role in the human testis niche but, to date, have not been derived from hiPSCs. This study set forth to generate a molecular-based differentiation method for deriving PTMs from hiPSCs, mirroring in vivo patterning factors. Whole transcriptome profiling and quantitative polymerase chain reaction (qPCR) show that this differentiation method is sufficient to derive cells with PTM-like transcriptomes, including upregulation of hallmark PTM functional genes, secreted growth and matrix factors, smooth muscle, integrins, receptors, and antioxidants. Hierarchical clustering shows that they acquire transcriptomes similar to primary isolated PTMs, and immunostaining shows the acquisition of a smooth muscle phenotype. Overall, these hiPSC-PTMs will allow in vitro study of patient-specific PTM development and function in spermatogenesis and infertility.

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CUA Guideline: The workup and management of azoospermic males

Cited by 42 publications

References 32 publications

Sperm retrieval rate and pregnancy rate in infertile couples undergoing in-vitro fertilisation and testicular sperm extraction for non-obstructive azoospermia in Hong Kong

Sperm retrieval rate and pregnancy rate in infertile couples undergoing in-vitro fertilisation and testicular sperm extraction for non-obstructive azoospermia in Hong Kong

Case – Azoospermia with bilateral varicocele and normal follicle-stimulating hormone

Differentiation of Peritubular Myoid‐Like Cells from Human Induced Pluripotent Stem Cells

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