INTRODUCTION:The need for varicocelectomy for varicoceles complicated by nonobstructive azoospermia (NOA) has long been debated in the field of male infertility. In this study, we analyzed the clinical outcomes of varicocelectomies for varicoceles in patients with NOA. METHODS:We retrospectively reviewed the following data of 11 patients with NOA and varicoceles who underwent varicocelectomies: age at admission, right and left testicular volumes, operative varicocele grades, operative site, body mass index, endocrine and genetic examination results, number of semen analyses before and after varicocelectomy, sperm appearance rate in ejaculated semen after varicocelectomy, sperm retrieval rate (SRR) with microdissection testicular sperm extraction (MD-TESE), and histopathological analysis results of testicular tissue. RESULTS:Varicocelectomies were performed bilaterally and on the left side in 1 and 10 patients, respectively. The number of pre- and postoperative semen analyses was 1-3 and 1-7, respectively. Ejaculated semen analysis after varicocelectomy did not reveal sperm in any patient. Ten patients underwent MD-TESE; however, sperm was retrieved from only two patients (20%). Pathological examination of seminiferous tubular tissue collected by MD-TESE revealed hyalinization in one patient, Sertoli cells in eight, and hypospermatogenesis in two. CONCLUSIONS:Sperm could not be retrieved from the ejaculated semen of patients with NOA and varicoceles who underwent varicocelectomies, and the SRR of MD-TESE was suboptimal. These results suggest that varicocelectomy should be performed cautiously in patients with NOA.

Multiple semen analyses are important for identifying patients with severe oligozoospermia or cryptozoospermia. Moreover, clinical predictive factors for cryptozoospermia and severe oligozoospermia are warranted. Therefore, we aimed to identify predictors of sperm retrieval in patients with a prior diagnosis of non-obstructive azoospermia based on repeat semen analysis. We retrospectively included 209 patients diagnosed with non-obstructive azoospermia. Data regarding age at diagnosis; body mass index; testicular volume; serum luteinizing hormone, follicle-stimulating hormone, and testosterone levels; smoking history; and testicular microlithiasis were analyzed. Patients were classified into the falsely reported azoospermia (FAZO) and true azoospermia (TAZO) groups. Furthermore, FAZO-related factors were evaluated using the Mann–Whitney U test, as well as univariate and multivariate analysis logistic regression models. Regarding FAZO-related factors, the cut-off level was determined using receiver operating characteristic curve analysis. Among 209 patients with non-obstructive azoospermia, 33 (15.8%) had spermatozoa identified in subsequent semen analyses. Multivariate analysis revealed that the FAZO group had significantly lower follicle-stimulating hormone levels than the TAZO group. Receiver operating characteristic curve analysis showed that the cut-off value for the follicle-stimulating hormone level was 15.3 mIU/mL, with 26 (78.8%) and 29 (16.5%) patients in the FAZO and TAZO groups, respectively, having follicle-stimulating hormone levels ≤15.3 mIU/mL. In conclusion, the follicle-stimulating hormone level was a predictive factor for FAZO. In patients diagnosed with azoospermia who have relatively low follicle-stimulating hormone levels, multiple semen analyses might facilitate identification of sperm in ejaculated semen.

Purpose: To investigate factors that obstruct and facilitate the use of the foster parent and special adoption systems (i.e., foster systems) by cancer survivors, and examine how to effectively provide information. Methods: This was a cross-sectional study that compared the results of a questionnaire survey of foster parents and adoptive parents (i.e., foster parents) who were and were not cancer survivors belonging to foster parent associations in 33 locations in Japan. This study was supported by a 2022 Ministry of Health, Labor, and Welfare Grant-in-Aid for Scientific Research (Grant No. 20EA1004). Results: "Lack of information," an obstructive factor and "Sympathetic understanding and cooperation from my partner and family," a facilitative factor were the highest score in both groups. Significant differences between the two groups were found in "Support from government agencies and others for foster parents," a facilitative factor, which was lower in the cancer survivors' group. There were no other significant differences between both the groups. Conclusion: This study found that when considering the use of the foster systems, a lack of information was the biggest obstructive factor and family understanding was the most helpful for both cancer survivors and noncancer groups. It was thought that stronger government support for cancer survivors might encourage cancer survivors to consider becoming foster parents. It would be effective for cancer treatment facilities, reproductive medical facilities, the government, and foster parent associations to work together to provide information carefully to cancer survivors.

You have accessJournal of UrologyCME1 Apr 2023MP01-04 A NEW SEMEN CONTAINER DESIGNED TO MINIMIZE DAMAGE TO SPERM DURING TRANSPORTATION AT LOW TEMPERATURE CONDITIONS Hiroshi Okada, Toshiyuki Iwahata, Hiroshi Okada, Hiroshi Okada, Kazutaka Saito, and Kouhei Sugimoto Hiroshi OkadaHiroshi Okada More articles by this author , Toshiyuki IwahataToshiyuki Iwahata More articles by this author , Hiroshi OkadaHiroshi Okada More articles by this author , Hiroshi OkadaHiroshi Okada More articles by this author , Kazutaka SaitoKazutaka Saito More articles by this author , and Kouhei SugimotoKouhei Sugimoto More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003212.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Rapid cooling is believed to be harmful to mammalian spermatozoa. Thus, special care should be taken when transporting semen in low temperature conditions. A new semen container, TPS-2 was designed to protect sperm against damage caused by cold shock. We investigated the ability of TPS-2 to protect sperm from low temperature conditions, using sperm from both fertile and infertile men. METHODS: We measured the change in temperature of semen stored in TPS-2 at 10°C compared with Sperm Cup, a conventional semen collecting cup. We also investigated change in total sperm motility, sperm DNA fragmentation index, and seminal oxidation-reduction potential when stored in TPS-2 or Sperm Cup at 10°C. We used Sperm Cup and TPS-2 to transport 25 semen samples of infertile patients from home to the clinic below 10°C, and compared the difference of sperm motion parameters. RESULTS: After storage for 3 h, the temperature in TPS-2 and Sperm Cup was 20.1°C and 12.1°C, respectively (Figure 1). The temperature dropped more gradually in TPS-2 than in Sperm Cup. Semen from fertile volunteers stored in Sperm Cup showed significantly lower total sperm motility, whereas in TPS-2, total sperm motility was the same as at 25°C (Figure 2). Semen from infertile patients stored at 10°C showed significantly lower total sperm motility in Sperm Cup. In TPS-2, total sperm motility did not change after storage at 10°C for 3 h. TPS-2 could maintain sperm motility (p=0.000), percentage of rapid moving sperm (p=0.002) and total motile sperm count (p=0.014) during transportation in low temperature conditions (Figure 3). CONCLUSIONS: TPS-2 maintains the temperature of semen stored in it during exposure to low temperatures conditions, preventing sperm damage. TPS-2 is recommended for transportation of semen in cold conditions. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e2 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hiroshi Okada More articles by this author Toshiyuki Iwahata More articles by this author Hiroshi Okada More articles by this author Hiroshi Okada More articles by this author Kazutaka Saito More articles by this author Kouhei Sugimoto More articles by this author Expand All Advertisement PDF downloadLoading ...

BackgroundA couples' psycho-educational program called Oncofertility! Psycho-Education and Couple Enrichment (O!PEACE) therapy was created and its effect when provided before cancer treatment was examined. MethodsThis multicenter randomized controlled trial with nonmasking, parallel two-group comparison enrolled women aged 20 to 39 years with early-stage breast cancer and their partners. They were randomly assigned to receive O!PEACE (37 couples) or usual care (37 couples). Primary end points were cancer-related posttraumatic stress symptoms, symptoms of depression, and anxiety. Secondary end points were stress-coping strategies, resilience, and marital relationship. ResultsWomen receiving psycho-educational therapy had significantly reduced Impact of Event Scale-revised version for Japanese scores (p = .011, eta(2)(p) = = .089). For patients with Impact of Event Scale-revised version for Japanese scores at baseline >= 18.27, O!PEACE therapy improved these scores when compared with usual care (U = 172.80, p = .027, r = 0.258). A >5-point reduction was present in 59.3% and 30% of women in the O!PEACE therapy and usual-care groups, respectively. For partners, O!PEACE therapy significantly improved stress-coping strategies (95% CI, -0.60 to -0.05; p = .018, eta(2)(p) = = .074) and escape-avoidance marital communication (95% CI, -0.33 to -0.08; p = .001, eta(2)(p) = .136). O!PEACE therapy significantly improved the partners' support (95% CI, 0.10-0.50; p = .001, eta(2)(p) = .127), the rate of receiving fertility preservation consultations, and knowledge levels. ConclusionsO!PEACE therapy before cancer treatment can improve posttraumatic stress symptoms, stress-coping behavior, and marital relationships. Larger sample sizes and longer term follow-up are required. Plain Language Summary A psycho-educational program, the Oncofertility! Psycho-Education and Couple Enrichment (O!PEACE) therapy program was developed and evaluated for women diagnosed with breast cancer and their partners.A multicenter randomized controlled trial showed that the O!PEACE psycho-educational therapy, with only two precancer treatment sessions, can reduce cancer-related posttraumatic stress symptoms and improve oncofertility knowledge and marital relationships in young adult patients with breast cancer.The therapy could also improve stress-coping strategies in marital communications with their partners. Couples may use O!PEACE psycho-educational therapy to consider fertility preservation and improve their psychosocial aspects.

This study aimed to assess outcomes of microdissection testicular sperm extraction (MD-TESE) and identify predictors for sperm retrieval (SR) in patients with non-mosaic Klinefelter syndrome (NM-KFS). We retrospectively evaluated 37 patients with NM-KFS who underwent MD-TESE. Data of age at operation, body mass index (BMI), testicular volume, serum luteinizing hormone (LH), follicle stimulating hormone (FSH), preoperative and postoperative testosterone levels with reduction ratio between the two values, and FSH/preoperative testosterone ratio were analysed. These patients were divided into two groups according to success or failure of SR: the successful and failure groups. Factors related to SR were evaluated by statistical analyses using the Mann-Whitney U test and logistic regression modelling. Regarding these factors, the cut-off level was specified using the receiver operating characteristics (ROC) curve. Moreover, the percentage of SR at that level was assessed. A simple scoring model was developed based on the multivariate analysis. Fourteen patients underwent successful SR, whereas 23 experienced failure SR. Statistical analysis found preoperative testosterone and FSH levels to be significant factors associated with SR. On the ROC curve, the cut-off levels for preoperative testosterone and FSH were 2.34 ng/ml and 33.2 mIU/ml respectively. A new scoring model was developed, consisting of preoperative testosterone (≥2.34 ng/ml) and FSH (≤33.2 mIU/ml). The sperm retrieval rates (SRRs) were clearly discriminated by stratification according to the scoring model. The SRR of the cases of scores of 2, 1 and 0 were 87.5%, 31.6% and 10% respectively. At our hospital, the SRR of MD-TESE in patients with NM-KFS was 37.8%. The patients with high testosterone and low FSH levels tended to demonstrate successful SR.

Semen analysis has long been used to evaluate male fertility. Recently, several sperm function tests have been developed. Of those, the sperm DNA fragmentation index (DFI), which describes the status of the sperm DNA, is thought to be a suitable parameter for evaluating male fertility. However, there have been no large-scale studies on the sperm DFI of Japanese men. Therefore, we investigated the feasibility of using an in-house flow cytometry-based sperm DFI analysis based on the sperm DNA fragmentation test of sperm chromatin structure assay (SCSA) to assess male fertility in Japan. This study enrolled 743 infertile and 20 fertile Japanese men. To evaluate reproducibility, inter- and intraobserver precision was analyzed. A receiver operating characteristic curve analysis was used to set a cutoff value for the sperm DFI to identify men who could father children by timed intercourse or intrauterine insemination. The variability of the sperm DFI among fertile volunteers was determined. The relationship between semen parameters and the sperm DFI was assessed by Spearman's rho test. A precision analysis revealed good reproducibility of the sperm DFI. The cutoff value of sperm DNA fragmentation in infertile men was 24.0%. Semen volume had no relationship with the sperm DFI. Sperm concentration, sperm motility, total motile sperm count, and percentage of normal-shaped sperm were significantly and negatively correlated with the sperm DFI. The median sperm DFI was smaller in fertile volunteers (7.7%) than that in infertile men (19.4%). Sperm DNA fragmentation analysis can be used to assess sperm functions that cannot be evaluated by ordinary semen analysis.

Purpose Today, male and female adult and pediatric cancer patients, individuals transitioning between gender identities, and other individuals facing health extending but fertility limiting treatments can look forward to a fertile future. This is, in part, due to the work of members associated with the Oncofertility Consortium. Methods The Oncofertility Consortium is an international, interdisciplinary initiative originally designed to explore the urgent unmet need associated with the reproductive future of cancer survivors. As the strategies for fertility management were invented, developed or applied, the individuals for who the program offered hope, similarly expanded. As a community of practice, Consortium participants share information in an open and rapid manner to addresses the complex health care and quality-of-life issues of cancer, transgender and other patients. To ensure that the organization remains contemporary to the needs of the community, the field designed a fully inclusive mechanism for strategic planning and here present the findings of this process. Results This interprofessional network of medical specialists, scientists, and scholars in the law, medical ethics, religious studies and other disciplines associated with human interventions, explore the relationships between health, disease, survivorship, treatment, gender and reproductive longevity. Conclusion The goals are to continually integrate the best science in the service of the needs of patients and build a community of care that is ready for the challenges of the field in the future.

We investigated the feasibility of agarose-gel microcapsules to cryopreserve extremely small numbers of sperm for assisted reproductive technology. Semen samples were collected from 16 patients attending the center for reproductive medicine male infertility clinic at a university hospital. We used agarose microcapsules to cryopreserve extremely small numbers of sperm from 16 patients with male infertility (10 with sperm concentration >= 1 million/mL; 6 with sperm concentration <1 million/mL). Six spermatozoa were injected into agarose-gel microcapsules and cryopreserved in a liquid nitrogen tank for 7 days. The Crytop method was used for cryopreservation as a control. After thawing, spermatozoa were recovered. Sperm recovery rates, motility and viability, and recovery time were compared. The post-thawing recovery rate, motility rate, and viability rate were higher whereas the recovery time was shorter in samples preserved using the agarose-gel microcapsule method compared to samples preserved using the Cryotop method in both the group with sperm concentrations of 1 million/mL or above and the group with sperm concentrations of less than 1 million/mL. This study demonstrated that using the agarose-gel microcapsule method increased post-thawing sperm recovery rate, sperm motility rate, and sperm viability rate, and reduced sperm recovery time compared with the conventional Cryotop method when cryopreserving samples with low sperm count. Although requiring further study, the agarose-gel microcapsule method shows much promise as a new option for freezing sperm.

To evaluate whether the long‐term usage of mirabegron, which was reported to have potential side effects on male reproductive organs in animal studies, was harmful to spermatogenesis in human testis.

Cryptorchidism is one of the most common causes of non-obstructive azoospermia (NOA) in adulthood. Even if early orchidopexy is performed to preserve fertility potential, some patients still suffer from azoospermia. Fertility potential is significantly lower in bilateral than unilateral cryptorchidism. The aims of this study were to identify clinical parameters that predict the likely success of sperm recovery by microscopic testicular sperm extraction (micro-TESE) and also the likely outcome of intracytoplasmic sperm injection using sperm from NOA patients who submitted to bilateral orchidopexy. Fifty-two NOA patients with a history of bilateral cryptorchidism underwent micro-TESE. The following clinical parameters were evaluated as predictive factors for successful sperm recovery: age at micro-TESE; age at orchidopexy; period from orchidopexy to micro-TESE; luteinizing hormone (LH); follicle-stimulating hormone (FSH); testosterone; average testicular volume; and body mass index. In the successful sperm retrieval group, average testicular volume was significantly greater, while serum LH and FSH, and body mass index were significantly lower. In a multivariate analysis, average testicular volume was positively correlated with successful sperm recovery. Our results indicate that testicular volume in NOA patients with bilateral cryptorchidism is a predictor for successful sperm recovery.

Purpose Cryptorchidism is one of the most common causes of non-obstructive azoospermia (NOA) in adulthood. Even if early orchidopexy is performed to preserve fertility potential, some patients still suffer from azoospermia. Fertility potential is significantly lower in bilateral than unilateral cryptorchidism. The aims of this study were to identify clinical parameters that predict the likely success of sperm recovery by microscopic testicular sperm extraction (micro-TESE) and also the likely outcome of intracytoplasmic sperm injection using sperm from NOA patients who submitted to bilateral orchidopexy. Methods Fifty-two NOA patients with a history of bilateral cryptorchidism underwent micro-TESE. The following clinical parameters were evaluated as predictive factors for successful sperm recovery: age at micro-TESE; age at orchidopexy; period from orchidopexy to micro-TESE; luteinizing hormone (LH); follicle-stimulating hormone (FSH); testosterone; average testicular volume; and body mass index. Results In the successful sperm retrieval group, average testicular volume was significantly greater, while serum LH and FSH, and body mass index were significantly lower. In a multivariate analysis, average testicular volume was positively correlated with successful sperm recovery. Conclusion Our results indicate that testicular volume in NOA patients with bilateral cryptorchidism is a predictor for successful sperm recovery.

Varicocele is a common cause of male infertility. It is reported that low sperm concentration, motility and morphology are indicative of increased sperm DNA fragmentation index (DFI) in men with varicocele. Although research has been conducted into the relationship between varicocele and DFI, little is known about seminal oxidation-reduction potential (ORP) in varicocele patients. We assessed the relationship between varicocele with seminal ORP and sperm DFI in both fertile and infertile men. This prospective case-control study compared the findings from infertile men with varicocele to those of men with normal spermatogenesis without varicocele. Semen samples were collected and assessed using the WHO (2010) guidelines. ORP was measured (mV) and normalized to sperm concentration (mV/10(6) sperm/mL). DFI was measured using the sperm chromatin structure assay (SCSA) method. For group comparisons, only samples with a concentration >1 x 10(6) sperm/mL were included. Infertile men with varicocele had significantly lower mean sperm concentration, motility and total sperm count. Conversely, infertile men with varicocele had a significantly higher mean serum FSH level, and higher ORP and DFI values than fertile controls. ORP was higher in patients with varicocele and positively correlated with DFI (p < 0.01). ORP and DFI showed significant negative correlations with semen parameters (sperm concentration, motility and total sperm count) in infertile men with a varicocele.

The container for storage and transport of ejaculated semen is "clean and wide-bore glass or plastic container" in the guidelines in usual, and it is generally used that a cylindrical container with a height of about 8 cm is used. Since this container has a large volume relative to the amount of semen, which is 100 to 200 ml, it is difficult to completely remove it when collecting it for examination. The new container (Transporter-S: TS) is less likely to be exposed to air and has excellent liquid stability and is suitable for storage and transport of ejaculated semen compared with conventional products. Prospective study. TS is characterized in that stored samples are less susceptible to temperature changes than conventional containers, and the effects of storage environment on samples were compared between TS and conventional containers. As a substitute for semen in TS and conventional containers, put 5 ml of distilled water at 37 ° C and leave each container in an environment at room temperature (25 ° C) and the ambient temperature in winter (estimated at 10 ° C) for 15 hours. It compared about the temperature change for every minute. Sperm tests were performed on each of the 14 healthy volunteers at the same abstinence period. At that time, with respect to sperm parameters and sperm DNA fragmentation index (DFI) in seminal fluid stored in a conventional container and transporter S, place them at room temperature 25 ° C. and change over time (0 hours 2 hours 4 hours 6 hours) Measurement survey. The volunteers who provided ejaculated semen were asked about the feeling of using TS and compared with the conventional container. The contents of the questionnaire were evaluated by comparing the conventional container and TS ・ very good 5 ・ good 4 ・ normal 3 ・ bad 2 ・ very bad 1 of 5 stages. Compared with conventional containers, TS has a slower change in sample temperature and is less susceptible to low ambient temperature and, it was more difficult to be affected when the outside temperature was low.In semen that was stored using TS, the decline in exercise rate and survival rate over time became slower than in conventional containers. (Motor rate changes are significantly different after 4 hours and 6 hours. Sperm survival rates are also significantly different after 6 hours.).The sequestration using TS became 1 very good, 4 good, 5 normal, 1 bad, 1 bad. The average value of the questionnaire results was 3.07 ± 0.92, which was comparable to conventional containers.We think that TS use is effective in infertility treatment including the use that is not stable in the climatic area and the patient who takes time after preparation. It is considered that TS is less likely to be exposed to air and has excellent liquid stability and is suitable for storage and transport of ejaculated semen, as compared with conventional containers. In the future, it is necessary to conduct further examinations by changing semen and storage temperature with relatively poor findings such as OAT cases.

Autophagy is a lysosome-mediated intracellular process for protein degradation and is induced in the situation of amino acid starvation and several biological stimulations to maintain the cytoplasmic homeostasis. And previous studies in the reproductive field have shown that autophagy after fertilization is essential in embryogenesis. Though in the male infertility field, there is the test named mouse-oocyte-activation test (MOAT) to check the human sperm function after fertilization, there are no reports about the relation between MOAT and autophagy induction and we check the relations. Experimental Research. To collect MII oocytes, 8-10 weeks old female mice (C57BL/6) were superovulated. Oocytes were fertilized by intracytoplasmic sperm injection (ICSI) using 1 (or 2) human sperm; MOAT or mouse sperm. After 5-hour incubation, embryos in paraformaldehyde and immunostained by microtubule-associated protein 1 light chain 3 alpha (LC3) which is the marker of autophagy. Then they were analyzed by fluorescence microscopy and LC3 puncta in each embryo were counted. LC3 puncta were significantly detected in a human sperm injection more than in a mouse sperm injection. The number of puncta was almost the same in 1 sperm injection as in 2 sperm injections. The size of puncta was bigger in 1 sperm injection than in 2 sperm injections. Autophagy was induced by xenogeneic sperm fertilization. The reason why autophagy was induced strongly in human sperm injection may be that the removal reaction of xenogeneic proteins occur strongly, or that the volume of autophagy inducing factor is more in the human than in mice. LC3 puncta was bigger in two-sperm injection because the proteins to remove may be much more than in one-sperm injection. Though we have to check the phenomenon quantitatively and analyze the difference autophagic induction between normal and infertile man, to detect autophagic function individually by MOAT may lead to a new evaluation of male infertility therapy.