To describe a case of reversible azoospermia temporally associated with abrocitinib treatment in a man with severe atopic dermatitis (AD) and discuss its potential implications for male reproductive safety. Case report. A 38-year-old normal-weight man with highly refractory AD, a history of neonatal orchidopexy, and primary infertility. Clinical, hormonal, and semen evaluation before and after discontinuation of abrocitinib therapy (200mg/day). Semen parameters and reproductive hormone profile. Two consecutive semen analyses performed during abrocitinib treatment demonstrated azoospermia. Baseline endocrine evaluation showed elevated follicle-stimulating hormone (FSH; 12.3 mIU/mL), suggestive of seminiferous tubule dysfunction. Abrocitinib was discontinued, and reassessment after 3 months revealed complete recovery of spermatogenesis, with a sperm concentration of 50 million/mL. Although isolated teratozoospermia persisted, FSH levels normalized (8.6 mIU/mL) and inhibin B increased markedly (from 58 to 135 pg/mL), consistent with improved Sertoli cell function. The temporal association between drug withdrawal and recovery supports a potential reversible effect on spermatogenesis. This is, to our knowledge, the first report describing reversible azoospermia temporally associated with abrocitinib therapy. Although causality cannot be established from a single observation, this case raises a potential safety signal regarding the effects of selective JAK1 inhibition on male reproductive function. Further preclinical studies, pharmacovigilance analyses, and prospective clinical investigations are warranted to determine whether prolonged or high-dose abrocitinib exposure may adversely affect spermatogenesis in susceptible individuals.

Background:Solid organ transplantation (SOT) is frequently complicated by dysglycemia and metabolic dysfunction-associated steatotic liver disease (MASLD), conditions that accelerate the development of liver fibrosis. Given the recognized thyroid-liver crosstalk, we investigated the association between thyroid function and the enhanced liver fibrosis (ELF) score in SOT recipients with diabetes or prediabetes. Methods:Seventy-one adult SOT recipients with diabetes or prediabetes, with ultrasound evidence of liver steatosis and/or a FIB-4 > 1.3, underwent standardized clinical phenotyping, biochemical profiling, thyroid hormone measurements, ELF testing, and liver stiffness measurement (LSM). Associations with ELF were assessed using correlation analyses and multivariable linear regression adjusted for age, sex, body mass index (BMI), transaminases, glycated haemoglobin, creatinine, haemoglobin, albumin, immunosuppressive drugs, glucagon-like peptide-1 receptor agonist (GLP-1RA) therapy, and transplanted organ type. Results:Participants had a mean age of 63.1 ± 9.5 years and BMI of 27.8 ± 4.8 kg/m². Mean ELF was 9.21 ± 1.00 (low risk <9.8: 70%; intermediate 9.8-11.3: 27%; high ≥11.3: 3%). ELF correlated positively with age (r=0.43, p=0.0002), aspartate aminotransferase (AST; r=0.50, p<0.0001), alanine aminotransferase (ALT; r=0.33, p=0.0059) and creatinine (r=0.39, p=0.0009), and inversely with haemoglobin (r=-0.39, p=0.0009), albumin (r=-0.38, p=0.0024), controlled attenuation parameter (CAP) (r=-0.29, p=0.0171). Among thyroid variables, free triiodothyronine (FT3) correlated inversely with ELF score (r=-0.45, p=0.0003), while TSH and FT4 showed no significant association with ELF score (r=0.00, p=0.9859; r=-0.5, p=0.6891). In multivariable analysis (R²=0.67; p=0.0002), lower FT3 (β=-0.611 ± 0.288; p=0.0404) and age (β=0.029 ± 0.012; p=0.0304) remained independently associated with higher ELF. No association was found between ELF and LSM. Conclusions:In SOT recipients with dysglycemia lower FT3 levels were independently associated with increased ELF scores. This finding suggests a potential link between subtle variations in thyroid function and markers of fibrogenic activity in metabolically vulnerable transplant recipients. Prospective studies are warranted to elucidate the causal directionality of this association and its clinical relevance.

The 47,XYY syndrome, or Jacobs syndrome, is a chromosomal disorder affecting approximately one in 1000 male births. While often asymptomatic or mildly expressed, it is associated with various physical, cognitive and behavioral features. Early studies erroneously linked the condition to aggressive behavior and elevated testosterone levels, largely based on incarcerated populations. Recent evidence contradicts this, showing testosterone levels in 47,XYY individuals are typically normal or lower than in 46,XY males. This systematic review and meta-analysis of 362 patients examine hormonal, testicular and fertility outcomes in 47,XYY syndrome. Findings reveal significantly lower testosterone levels and elevated luteinizing hormone and follicle-stimulating hormone, indicating impaired gonadal function. While testicular volumes are often normal, many patients exhibit reduced size and a notable proportion experience oligozoospermia or azoospermia. These outcomes highlight the need for counseling regarding infertility and hormonal imbalances. This review dispels the myth of 47,XYY as a 'super-male syndrome', emphasizing the complexity of hormonal, testicular and psychological factors. It underscores the importance of early diagnosis and a multidisciplinary approach to address endocrine and reproductive health. Regular monitoring for hypogonadism and consideration of assisted reproductive technologies are recommended to support affected individuals.

PURPOSE:Premature ejaculation (PE) is a commonly encountered male sexual dysfunction (MSD) with various definitions, diagnostic criteria, and treatment options, leading to significant heterogeneity and controversy in its management. This study aimed to explore the global practice patterns of the diagnosis and management of PE. MATERIALS AND METHODS:A cross-sectional, global, online survey on PE was conducted using a questionnaire developed by an international cohort of experts. Results were analyzed using R version 4.1.2. Additionally, expert recommendations were formulated using a modified Delphi method. RESULTS:The survey was completed by 264 participants from 41 countries. The majority of respondents were below the age of 45 years and were urologists focusing on andrology and sexual health. PE diagnosis was primarily based (by 61.5%) on an intravaginal ejaculatory latency time of less than one minute. Lifelong PE was the most common category reported (47.7%), and most respondents (84.2%) observed ante-portas PE in less than 25% of cases. Distinguishing PE from erectile dysfunction was challenging for many respondents (60.7%). Diabetes mellitus was the most common comorbidity (17.1%). Pharmacological therapy was the most common treatment method (34.3%), with dapoxetine being the most preferred medication (37.9%). Surgical methods were infrequently used. Emerging treatments like hyaluronic acid gel glans augmentation were favored by only 11.7%. Patient satisfaction was the primary criterion for successful PE treatment (55.9%), and cost was a significant concern for many (35.5%). CONCLUSIONS:This global survey highlights significant diversity in the diagnostic and treatment strategies for PE. Standard diagnostic criteria are generally accepted, off-label medication is widely used in therapy, and the role of surgery is still controversial. A multi-modal therapy approach, tailored to the patient's specific needs, is favored. Further research into the neurobiology of PE and the development of effective and safe options is crucial for improving the management of PE.

Type 2 diabetes mellitus (T2DM) is a multifactorial disease associated with complications that significantly affect both survival and quality of life, including cardiovascular, renal, cognitive, sexual, and reproductive dysfunctions. Sodium-glucose cotransporter 2 (SGLT2) inhibitors (SGLT2is) have emerged as a transformative class of drugs, demonstrating benefits that extend beyond glycemic control. Large clinical trials have shown that SGLT2is reduce hospitalization for heart failure by 25-35% and slow progression of chronic kidney disease by 30-45%, with variation based on the specific agent, dose, and patient population. This narrative review examines not only these well-established benefits but also emerging evidence regarding their effects in less-explored domains. SGLT2is have been associated with improved cognitive performance, potentially through reductions in neuroinflammation and oxidative stress. In the sexual and reproductive domains, studies in men with diabetes mellitus suggest potential benefits of SGLT2is in improving erectile function, sperm motility, and testosterone levels, likely mediated by antioxidant and anti-inflammatory mechanisms. By integrating current evidence across multiple systems, this review emphasizes the role of SGLT2is in a holistic, multidisciplinary approach to the management of patients with T2DM.

Sommario Il capitolo sui tumori testicolari comprende diversi tipi di neoplasie, tra cui quelle derivanti dalle cellule germinali. Questi tumori possono manifestarsi a qualsiasi età ma oltre il 90% dei casi si verifica in uomini giovani, in cui possono causare ginecomastia. Quest’ultima insorge frequentemente durante l’età adolescenziale e, nella maggior parte dei casi, ha un’eziologia benigna. Attraverso una descrizione dettagliata dei tumori testicolari e della loro capacità di produrre e secernere ormoni, questo articolo si propone di chiarire in quali circostanze la ginecomastia possa rappresentare un “campanello d’allarme”, indicando la necessità di intraprendere un iter diagnostico più approfondito.

PURPOSE:Non-obstructive azoospermia (NOA), defined as the absence of sperm in the ejaculate due to testicular failure, is observed in 5% to 15% of infertile men and accounts for two-thirds of azoospermia cases. The management of NOA is marked by significant controversy and global variation in diagnostic and therapeutic approaches, highlighting the crucial need for well-designed and standardized clinical practice guidelines. We present comprehensive graded clinical practice recommendations and statements for diagnosing and treating NOA, aiming to establish standardized strategies that can globally help guide practitioners in their practice. MATERIALS AND METHODS:A comprehensive literature review was conducted to gather evidence on the epidemiological, diagnostic, and therapeutic aspects of NOA. The Global Andrology Forum (GAF) recommendations were developed through the collaboration of a global panel of experts using the Delphi method and surveys to achieve consensus. Statements were graded according to the Oxford Centre for Evidence-Based Medicine "GRADE" classification as either "Strong" or "Weak." Statements receiving at least 80% expert consensus were graded as "Strong," while others were categorized as "Weak." RESULTS:The GAF has formulated a total of 49 recommendations and statements on the diagnosis and treatment of NOA, including 21 for diagnosis and 28 for treatment. The recommendations and statements were evaluated and graded by a panel of 48 GAF experts from 25 countries worldwide. The majority of experts (60.5%) had more than 10 years of clinical experience in managing NOA. CONCLUSIONS:The GAF guidelines address discrepancies in NOA management across diverse clinical settings and provide comprehensive graded recommendations to guide clinicians in its diagnosis and treatment. Developed and graded by a large worldwide panel of experts, the current guidelines present simplified, high-standard strategies that can be seamlessly integrated into the daily global practice, offering practitioners a clear framework for managing NOA.

Congenital hypogonadotropic hypogonadism (CHH) is a rare and heterogeneous genetic disorder with variable penetrance caused by GnRH deficiency, leading to delayed puberty and infertility. In 50–60% of cases, CHH is associated with non-reproductive abnormalities, most commonly anosmia/hyposmia (Kallmann syndrome, KS). Over 60 genes have been implicated in CHH pathogenesis. We aimed to perform genetic screening in a cohort of 14 patients (10 males, 4 females; mean age 22 ± 7.72 years) with suspected or diagnosed HH/KS. Genetic analysis was conducted using next-generation sequencing (NGS) with a custom panel of 46 candidate genes. Variant interpretation followed ACMG standards and guidelines. Multiple tools were used to predict the structural effects of variants on tertiary protein structure, assessing their pathogenicity. Novel variants were functionally characterized by qRT-PCR on mRNA extracted from peripheral leukocytes. NGS identified nine rare variants and four novel variants in genes previously associated with normosmic isolated HH (nHH) and/or KS (FGFR1, PROK2, TAC3R, DCC, WDR11, IL17RD, DUSP6, KAL1, FGF8, IL17RD and DCC). The variant in TAC3R (p.Trp275Ter) was pathogenic; variants in ANOS1 (c.541+1G>A), IL17RD (c.1303_1304dup, p.Lys436ThrfsTer58), and TAC3R (p.Lys361Ter) were likely pathogenic. Nine variants were classified as variants of uncertain significance (VUS). Our study identified a possible genetic cause in 71% of the CHH/KS cohort, emphasizing the importance of genetic screening and functional characterization of genetic variants in patients with a phenotypically and genetically heterogeneous disorder like CHH.

OBJECTIVE:To assess whether polycystic ovary syndrome (PCOS) increases the risk of persistent hypertension in women with a history of pregnancy-related hypertensive disorder (PHD). DESIGN:A single-center, prospective cohort study. SUBJECTS:A total of 124 patients with PHD were enrolled. Pregnancy-related hypertensive disorder was diagnosed on the basis of the presence of pregnancy-induced hypertension or preeclampsia. All patients with PHD were screened for PCOS diagnosis, which was confirmed or excluded on the basis of patient history and clinical reports. Sixty-two patients diagnosed with PCOS (n = 62 cases) were included as the study group. After 1-to-1 matching process on the basis of age, body mass index, and infertility treatment, 62 control patients without PCOS were also included. EXPOSURE:Polycystic ovary syndrome diagnosis according to the national and international criteria. MAIN OUTCOME MEASURES:The primary outcome was the persistence of hypertension 12 months after delivery. The secondary outcomes included persistence of hypertension at 3 and 6 months from delivery, pregnancy complications, and data on antihypertensive treatment. RESULTS:After 12 months from delivery, the risk of persistent hypertension was significantly higher in patients with PHD with PCOS than in controls [adjusted odds ratio, 5.01; 95% confidence interval (CI), 1.63-15.94]. At 6 months, that risk was also significantly higher (adjusted odds ratio, 5.01; 95% CI, 1.63-15.94). Additionally, pregnant patients with PCOS had an earlier onset of PHD (30.0 vs. 31.1 weeks), required a higher dose of nifedipine (37.5 mg vs. 30 mg), and were more likely to receive antihypertensive therapy with multiple drugs (24.2% vs. 9.7%) than controls. The incidence of fetal growth restriction (19.4% vs. 6.5%), abnormal Doppler velocimetry (16.1% vs. 4.8%), and cesarean delivery (35.5% vs. 19.4%) was also significantly higher in the PCOS group than in controls. CONCLUSION:Polycystic ovary syndrome is associated with an increased risk of persistent hypertension in patients with a history of PHD. Preventive interventions before pregnancy, specific pregnancy surveillance, and long-term follow-up should be recommended for women with PCOS.

PURPOSE:To evaluate the evidence on sperm DNA fragmentation (SDF) and its clinical applications in reproductive medicine, highlighting benefits, limitations, and guidelines for its use to assist clinicians in objective decision-making. MATERIALS AND METHODS:A multidisciplinary team of clinicians and reproductive experts from the Global Andrology Forum (GAF) reviewed the latest evidence on SDF, covering indications, testing methods, recurrent pregnancy loss, varicocele and its repair, assisted reproductive technologies (ART), treatment of associated conditions, antioxidant therapy, and sperm selection for ART. Expert statements and recommendations were developed and graded with the GRADE system using a modified Delphi process. RESULTS:Based on the GAF surveys, systematic reviews, and meta-analyses related to SDF, 52 experts introduced and scored 24 statements and recommendations using the GRADE system. Of these, 87.5% (21/24) achieved strong ratings, reflecting broad consensus, while 12.5% (3/24) were rated weak. The guidelines provide evidence-based recommendations for clinical scenarios, including the role of SDF in infertility, recurrent pregnancy loss, and ART outcomes. CONCLUSIONS:While there is growing interest and evidence regarding the clinical benefit of SDF testing and its utility in managing male infertility, significant gaps in the literature limit its routine use in clinical practice. The guidelines offer a structured framework for integrating SDF testing into male infertility management, emphasizing a tailored approach based on individual clinical scenarios. Clinicians must balance the benefits and limitations of SDF testing and antioxidant treatment to optimize care in reproductive medicine. These guidelines are critical for advancing evidence-based practices in male infertility management.

BACKGROUND & AIMS:There is still uncertainty regarding the optimal serum levels 25-Hydroxy-vitamin D [25(OH)D] and the most effective supplementation strategies, including the choice of molecule and its dosing frequency. The aim of the study is to compare the effects of calcifediol versus two different frequencies of cholecalciferol administration on vitamin D supplementation, and to identity the key parameters that predict response to treatment. METHODS:This retrospective, real-world cohort study included 105 patients, who were divided into three groups. Group 1 (n = 21) received cholecalciferol 50,000 international units (UI) once a month, Group 2 (n = 27) received cholecalciferol 25,000 UI every two weeks, and Group 3 (n = 57) received calcifediol 0.266 mg (mg) once a month. The primary outcome measured was the delta increase in 25(OH)D levels after 6 months of treatment, compared to pre-treatment levels. RESULTS:The study revealed a significant greater delta increase in 25(OH)D levels in Group 1, which received cholecalciferol 50,000 IU once a month, compared to the other two groups. However, multiple regression analysis indicated that neither the type of molecule nor the frequency of administration independently influenced the treatment outcome. Only pre-treatment serum 25(OH)D levels were found to significantly affect the outcome. Based on the receiver operating characteristic curve, serum 25(OH)D levels below 19.5 ng/dL were predictive of a doubling of pre-treatment values, with high sensitivity and specificity. CONCLUSION:Pre-treatment serum 25(OH)D levels are valuable for selecting patients who should undergo supplementation. This finding suggests the importance of tailoring therapy according to the degree of vitamin D deficiency.

After menopause, women have a higher risk of developing metabolic disorders. The discovery of follicle-stimulating hormone (FSH) receptors in extra-ovarian tissues such as the adipose tissue suggests that FSH might influence metabolic processes in postmenopausal women. However, its role remains unclear. To examine the association between serum FSH levels and glucose and lipid metabolism in postmenopausal women. A retrospective analysis was conducted on 82 postmenopausal women (mean age 65.2 ± 8.1 years). Serum levels of FSH, 17β-estradiol (E2), glucose, insulin, HbA1c, total cholesterol, LDL, HDL, and triglycerides were measured. Insulin resistance was calculated using the HOMA-IR index. FSH levels did not significantly differ between women with and without dyslipidemia. However, FSH levels were significantly lower in women with type 2 diabetes (44.3 ± 13.8 IU/mL) compared to those with insulin resistance (60.6 ± 29.4 IU/mL) or normal glucose metabolism (69.4 ± 27.2 IU/mL; p = 0.045). Women in the lowest FSH quartile had higher glucose, insulin, and HOMA-IR values. A significant inverse correlation between FSH and insulin (r = -0.30, p = 0.03) was found, stronger in women more than six years postmenopausal. Serum FSH levels inversely correlate with glucose metabolism disorders in postmenopausal women. These findings suggest a possible role of FSH in glucose metabolism, deserving further study starting from the menopausal transition.

La menopausa rappresenta una fase cruciale di transizione cardiometabolica durante la quale molte donne sperimentano un incremento ponderale e una significativa redistribuzione del grasso corporeo. Parallelamente, si osserva spesso un declino della funzione sessuale. Le donne affette da obesità sono esposte a una molteplicità di fattori di rischio, sia organici che psicosociali, che le predispongono maggiormente allo sviluppo di disfunzioni sessuali. La presente rassegna si propone di analizzare le evidenze scientifiche disponibili sulla correlazione tra obesità e disfunzioni sessuali nelle donne in menopausa e di fornire strumenti utili per agevolare il dialogo medico-paziente, diagnosticare le disfunzioni sessuali e offrire opzioni terapeutiche seguendo un modello bio-psico-sociale.

PURPOSE:This study investigated 1) the frequency of quotation errors in multi-authored medical manuscripts in andrology, 2) analyzed common types of quotation errors and the methods used to rectify them, and 3) evaluated their impact on manuscript accuracy, credibility, and research conclusions. MATERIALS AND METHODS:Twelve manuscripts written by the Global Andrology Forum (GAF) members between 2023 and 2024 were randomly selected for this study. The manuscripts and "Quotation Verification Sheets" were analyzed by senior GAF researchers to detect the number and types of quotation errors. The error rate was calculated by the total number of quotation errors and total number of all cited references in each manuscript. The impact on manuscript sections was assessed using a 0-4 grading scale. The Spearman correlation test was used to assess the correlation between scalar variables, and the Mann-Whitney U test was utilized to compare scalar variables between two groups. RESULTS:The median value of quotation errors was 10.3%. Factual inaccuracy was the most common type of error, and was observed in all twelve manuscripts at various rates. The number of errors was significantly associated with the number of references (ρ=0.706; p=0.010) and in-text citations (ρ=0.636; p=0.026). Factual inaccuracy (ρ=0.588; p=0.044) and factual interpretation (ρ=0.861; p=0.013) were also correlated with the total number of quotation errors. However, no significant associations were found between quotation errors and author numbers or their qualifications. The quotation errors adversely impacted the manuscript discussion, followed by the overall message. CONCLUSIONS:Quotation errors are common in multi-authored medical manuscripts in andrology-related scientific articles. Journal editorial offices should incorporate quotation verification into the review process. Limiting references and in-text citations to only strictly necessary ones may help improve quotation accuracy. The quotation verification model proposed by GAF offers a practical and structured approach for detecting and correcting quotation errors.

Time-lapse technology enables recording embryo morphokinetic parameters, which are associated with embryonic competence and assisted reproductive technology (ART) outcomes. While female factors such as age and BMI are known to influence these parameters, the role of male factors remains understudied. This study aimed to evaluate the influence of male factors on preimplantation embryo morphokinetics. In this prospective observational study, 1,210 embryos from infertile couples undergoing Intracytoplasmic sperm injection (ICSI) or intracytoplasmic morphologically-selected sperm injection (IMSI) were monitored using time-lapse imaging. Male data, including age, BMI, sperm concentration, and sperm DNA fragmentation (SDF) were collected. Multiple regression analysis assessed the association between paternal factors and morphokinetic parameters, adjusting for female confounders. After adjustment, male age and BMI were found to significantly influence embryo developmental stages (from time to pronuclei appearance to t4 and t6 for age, from time to pronuclei appearance to t2 and t8 for BMI). The impact of sperm concentration was less consistent, and no significant relationship was observed with SDF. These findings highlight the role of male factors, particularly age and BMI, in influencing embryo morphokinetics, even after accounting for female confounders. This underscores the potential for clinical interventions targeting paternal health to optimize ART outcomes. Additionally, the study reinforces the importance of considering both parental contributions in ART success, particularly the increasingly recognized influence of male age.

Background: We have previously shown that treatment with recombinant human growth hormone (GH) influences testicular growth in children with GH deficiency (GHD) and have suggested that GH plays a role in testicular growth in childhood. Little evidence is available on testicular function in post-pubertal GHD patients. Objective: This prospective controlled study was undertaken to evaluate testicular function in patients with GHD. Patients and Methods: Post-pubertal patients with non-syndromic GHD over the age of 16 years were enrolled. Each patient underwent to the assessment of serum levels of gonadotropins and total testosterone (TT), conventional sperm parameters, and testicular volume (TV) measured by ultrasound examination. Age-matched healthy subjects served as controls. Patients with disorders capable of interfering with testicular function were excluded. Results: 26 patients with GHD and 25 age-matched post-pubertal controls were enrolled. They did not differ in serum luteinizing hormone, follicle-stimulating hormone, and TT levels. However, GHD patients had lower semen volume, total sperm count, progressive motility, and total motility values, and a higher prevalence of oligozoospermia compared to controls. No difference was found in sperm concentration and normal morphology. Importantly, GHD patients had lower TV, and a higher prevalence of testicular hypotrophy. Conclusion: This is the first evidence of mildly impaired sperm parameters and TV in GHD patients compared to healthy controls. The integrity of the GH-IGF1 axis in prepuberty is important for achieving normal testicular function in adulthood. Evaluating testicular growth over time in GHD children and measuring TV and sperm parameters in postpubertal GHD boys is advisable.

PURPOSE:The role of varicocele repair (VR) in infertile men with non-obstructive azoospermia (NOA) and varicocele is controversial in the current guidelines, despite available studies. This study aims to assess the impact of VR on testicular sperm retrieval, sperm recovery from the ejaculate, and clinical pregnancy rates in infertile men with NOA and clinical varicocele through a systematic review and meta-analysis (SRMA) of controlled studies. MATERIALS AND METHODS:A systematic literature search was conducted using the Scopus and PubMed databases up to November 2023. Among the 1,847 articles retrieved, five observational controlled studies comparing reproductive outcomes between infertile men with NOA and clinical varicocele who underwent VR, and a control group that received no treatment, met the inclusion criteria for this SRMA. RESULTS:The selected studies included 269 men with NOA who underwent VR before the testicular sperm extraction (TESE) procedure and 364 men who did not undergo VR. The pooled estimate demonstrated a significantly higher odds ratio (OR) of 2.17 (95% confidence interval [95% CI]: 1.17-4.01, p=0.01) for surgical sperm retrieval in the VR group. VR significantly increased the likelihood of sperm appearance in the ejaculate, with an OR of 7.8 (95% CI: 3.59-16.94, p<0.001). Besides, VR provided a significantly greater clinical pregnancy rate with intracytoplasmic sperm injection (ICSI) compared to non-operated men (OR: 2.18, 95% CI: 1.03-4.60; p=0.04). CONCLUSIONS:This is the first SRMA, consisting of only controlled studies, to demonstrate that VR performed prior to TESE in men with NOA significantly improves sperm production as reflected in the spontaneous appearance of sperm in the semen and higher odds of surgical sperm retrieval and clinical pregnancy compared with non-operated men. Thus, these findings highlight the potentially beneficial impact of VR in men with NOA and clinical varicocele.

Objective: To prospectively evaluate the effects of the administration of liraglutide plus calorie deprivation, metformin plus calorie deprivation, or calorie deprivation alone on hirsutism, metabolic profile, and ovarian reserve in infertile patients with polycystic ovary syndrome (PCOS). Patients and methods: This is a prospective observational study conducted on 80 insulin-resistant and infertile PCOS women. Enrolled patients received liraglutide (Saxenda (R)) + calorie deprivation (Group 1, n = 50), metformin + calorie deprivation (Group 2, n = 15), or calorie deprivation only (Group 3, n = 15). Endpoints were assessed in all patients before and after 120 days. Results: At the end of treatment, BMI was significantly reduced in all groups, while the HOMA index decreased statistically significantly only in groups 1 and 2. Hormonal evaluation showed that serum SHBG and progesterone levels increased significantly in all three groups, while AMH levels significantly decreased in groups 1 and 3. Finally, the Ferriman-Gallwey score improved significantly in all groups. Percentage of decrease vs. baseline in BMI, HOMA index, AMH, Ferriman-Gallway score, and of increase in SHBG were higher in Group 1 than in Group 2 and Group 3. The percentage of increase in progesterone in Group 1 and Group 2 was higher than in Group 3. Conclusion: The results support the use of liraglutide in insulin-resistant and infertile women with PCOS. The improvement in AMH and progesterone following liraglutide administration could be clinically useful in preparation for controlled ovarian hyperstimulation if patients with PCOS need to resort to an assisted reproductive technique.

Background Thyroid autoimmune disorders (ADs) are common in midlife women and can impact various aspects of health, including sexual function. The effect of thyroid autoimmunity on the clinical manifestations of vulvovaginal atrophy (VVA) remains unclear.Objective To explore the relationship between thyroid ADs and VVA signs and symptoms in a sample of postmenopausal women.Methods Cross-sectional study including postmenopausal women not using systemic hormone therapy. VVA signs were assessed using the vaginal health index (VHI) and vulvar health index (VuHI); VVA symptoms were rated on a four-point severity scale.Results Among 112 women enrolled, 28 had thyroid ADs. A significantly higher percentage of women with thyroid ADs showed vaginal atrophy (75 vs. 45.2%, p < .05). A greater proportion of women with thyroid ADs exhibited vulvar atrophy or both vaginal and vulvar atrophy, though these differences were not statistically significant. Women with thyroid ADs reported significantly higher scores for dryness, burning/itching, irritation/inflammation, and dyspareunia compared to those without it. A higher percentage of women with thyroid ADs experienced severe dyspareunia (45 vs. 20.6%, p < .05), severe burning/itching (33.3 vs. 9.1%, p < .05), and severe stress urinary incontinence (17.9 vs. 3.6%, p < 0.05).Conclusions This study suggests that thyroid ADs may contribute to genital aging, with an apparent greater involvement in vaginal signs of atrophy. Women with thyroid ADs reported more severe VVA symptoms, but specific symptomatological clusters should be investigated in larger samples. Our data support the need to explore further the role of thyroid disorders in VVA.