Objective This study aimed to conduct a real‐world retrospective cohort study using routine diagnosis and treatment data to comprehensively evaluate the effects of Chinese herbal formulas containing the Cuscutae semen – Lycii fructus herb pair on sperm concentration, motility, and safety in patients with idiopathic oligoasthenozoospermia (iOAT). Methods This retrospective cohort study enrolled 440 iOAT patients aged 22–45 years. According to treatment, patients were divided into the herb‐pair group (exposure group; CHM prescriptions containing both C . semen and L . fructus ; n = 220) and the control group (patients who received CHM without this specific herb pair, with or without concomitant Western medication; n = 220). The primary outcome was the change in sperm concentration from baseline to 12 ± 4 weeks after treatment. Secondary outcomes included improvements in progressive motility and total motility, as well as safety. Multivariable analysis of covariance (ANCOVA) and propensity score matching (PSM) were employed to control for confounding bias. Results After multivariable adjustment, the posttreatment sperm concentration in the herb‐pair group was significantly higher than that in the control group, with an adjusted mean difference of 2.34 × 10 6 /mL (95% CI: 0.54–4.13; p = 0.011). The results after PSM were consistent with the primary analysis, yielding an adjusted difference of 2.88 × 10 6 /mL ( p = 0.005) in the matched cohort. Furthermore, exposure to the herb pair significantly improved progressive motility (adjusted difference, 5.73%; p < 0.001) and total motility (adjusted difference, 6.45%; p < 0.001). Subgroup analysis demonstrated that the herb pair produced beneficial effects across patients with different baseline sperm concentration severities, with no significant differences among subgroups. Regarding safety, no serious adverse events were reported in either group, and the overall incidence of adverse events was low, with no statistically significant difference between groups (herb‐pair group, 5.5% vs. control group, 6.4%; p = 0.840). Conclusion Based on real‐world data, exposure to Chinese herbal formulas containing the C. semen – L. fructus herb pair in routine clinical practice can safely and effectively improve semen parameters in patients with iOAT. Clinicians may consider adding this herb pair to conventional therapy to enhance treatment efficacy.
Objective To compare the short-term effects of microsurgical inguinal varicocelectomy (MIV) and testosterone replacement therapy (TRT) on symptoms, serum testosterone, and semen quality in men with late-onset hypogonadism (LOH) according to varicocele status. Methods A 3-month prospective, non-randomized, interventional cohort study was conducted in symptomatic men with testosterone deficiency and/or abnormal semen parameters. 120 patients underwent clinical, laboratory, and scrotal Doppler ultrasonographic assessment. Accordingly, 39 patients with varicocele chose MIV, 35 with varicocele chose TRT with Androgel (5 g/day), and 46 without varicocele were treated with Androgel (5 g/day). Questionnaires (ANDROTEST, ADAM, AMS, and IIEF), serum total testosterone levels, and semen analysis according to WHO 2021 criteria were assessed before and after treatment. Results Ejaculatory abstinence duration demonstrated the strongest correlations with semen quality (rho up to 0.52), whereas serum reproductive hormones showed only weak associations. TRT in patients without varicocele achieved the greatest improvement in the ANDROTEST and ADAM symptom domains. All treatment strategies significantly increased serum testosterone levels (all adjusted p < 0.001). ANCOVA models showed that MIV was not associated with a higher adjusted IIEF erectile function domain score and resulted in lower adjusted serum testosterone than TRT, although the adjusted total IIEF score was higher. In contrast, MIV consistently improved semen volume, sperm concentration, total sperm count, progressive motility, total motility, vitality, and normal morphology, whereas TRT led to deterioration in several semen parameters (adjusted p < 0.05). Conclusion Short-term treatment strategies for LOH produced distinct clinical benefits. TRT provided more rapid symptom relief and effectively increased serum testosterone, whereas MIV was associated with more favorable recovery of spermatogenic parameters among patients with varicocele. Hence, MIV may be considered a fertility-preserving first-line option in patients with clinical varicocele who wish to preserve fertility.
Background Among various lifestyle factors, effects of cigarette smoking (Cs) and alcohol intake (Ai) on male reproductive function have been well studied. The effects of medical treatments for androgenetic alopecia (AGA) have been recognised, but they remain unclear, which prompted this comparative study. Methods Reproductive parameters, including semen quality, were compared between patients with and without AGA medication exposure, Cs and Ai. Mann–Whitney U test was mainly used for statistical analysis. Results The study included 166 patients (aged 21–63 years, mean ± SD 35.5 ± 6.7 years). AGA medication users ( n = 14) had significantly lower semen volume, (1.9 ± 1.2 vs 2.7 ± 1.3 mL; 95% CI: 0.5, 0.8; p = 0.031) and monthly frequency of marital intercourse (MFI) (2.2 ± 2.5 vs 3.7 ± 3.0; 0.5, 0.9; p = 0.012) than those not receiving AGA medication ( n = 150). In contrast, no significant differences for those parameters were noted between patients with and without Cs or Ai. Furthermore, patients receiving AGA medication alone showed significantly lower semen volume, total motile sperm count (TMSC) and MFI as compared to those with both Cs and Ai (1.1 ± 0.7 vs 2.3 ± 1.0 mL, 95% CI:0.5, 0.8; p = 0.006, 17.7 ± 16.4 vs 54.9 ± 45.5 million, 0.5, 1.0; p = 0.022, 1.0 ± 1.0 vs 4.5 ± 4.3, 0.7, 1.0; p = 0.001, respectively). Conclusion AGA medication might have a greater association with impairment of male reproductive parameters than Cs or Ai. Further large scale studies are needed to validate these results.
Objective To evaluate the effects of Tribulus terrestris extract administered as pretreatment (TPr), posttreatment (TPo), or combined pre‐ and TPo (TPrPo) in a rat model of testicular ischemia–reperfusion (I/R) injury. Methods Sixty adult male Wistar rats were randomly divided into four experimental groups: TPr, TPo, combined TPrPo, and I/R control (IR). Left testicular torsion was induced for 2 h followed by detorsion. Animals were euthanized at 24 h, 14 days, or 56 days after reperfusion. Sperm parameters, histological findings, fibrosis, gonadosomatic index (GSI), and superoxide dismutase (SOD) activity were evaluated in ipsilateral and contralateral testes. Results TPo with T. terrestris significantly increased SOD activity in the ipsilateral testis during the early reperfusion phase (24 h) compared with all other experimental groups ( p < 0.001). Combined treatment demonstrated a transient improvement in ipsilateral sperm motility exclusively at the 24‐h time point, although no sustained differences were observed at 14 or 56 days after reperfusion. No statistically significant differences were identified in sperm concentration, Johnsen score, Cosentino score, fibrosis grading, or GSI among the treatment groups. Histological evaluation demonstrated persistent seminiferous tubule disorganization and germ cell loss despite the early enhancement of antioxidant activity. Conclusion Although T. terrestris enhanced antioxidant activity during early reperfusion, this biochemical effect did not translate into sustained histological preservation or improvement in sperm function. These findings indicate that T. terrestris provides a transient antioxidant response during early reperfusion but is insufficient as a standalone therapy for testicular I/R injury. Future studies should investigate combination therapies targeting multiple pathogenic mechanisms involved in I/R injury.
Objective This study aimed to evaluate the predictive value of preoperative magnetic resonance imaging (MRI)‐measured suspensory ligament length for postoperative penile length gain in patients undergoing penile lengthening surgery. Materials and Methods This retrospective study included 20 patients who underwent suspensory ligamentolysis between 2020 and 2025 and had available preoperative penile MRI records. Corpus cavernosum length and suspensory ligament length were measured on sagittal MRI sections. Intraoperative flaccid/stretched lengths and postoperative follow‐up data at months 1 and 3 were recorded. Data analysis was performed using Pearson correlation, linear regression, and Monte Carlo simulation. Results The mean age of the patients was 28.15 ± 6.11 years. A statistically significant difference was observed between pre‐ and postoperative penile lengths ( p < 0.001). MRI‐measured suspensory ligament length showed a significant positive correlation with postoperative penile length gain (Pearson’s r = 0.519, p < 0.05). Regression analysis resulted in the development of the predictive formula y = 0.643 + 0.708 × x for estimating postoperative gain. The Monte Carlo simulation indicated that 90% of simulated outcomes fell between 2.22 and 2.94 cm of postoperative penile length gain. Conclusion Preoperative MRI‐based anatomical assessment may provide clinically useful predictive information regarding postoperative penile length gain. However, the proposed regression model should be considered exploratory until validated in larger prospective studies. The developed mathematical model may help provide patients with realistic expectations and support surgical planning based on objective anatomical criteria.
