Comparison of intracytoplasmic sperm injection (ICSI) outcomes in infertile men with spermatogenic impairment of differing severity / 亚洲男科学杂志(英文版)

The extent of spermatogenic impairment on intracytoplasmic sperm injection (ICSI) outcomes and the risk of major birth defects have been little assessed. In this study, we evaluated the relationship between various spermatogenic conditions, sperm origin on ICSI outcomes, and major birth defects. A total of 934 infertile men attending the Center for Reproductive Medicine of Ren Ji Hospital (Shanghai, China) were classified into six groups: nonobstructive azoospermia (NOA; n = 84), extremely severe oligozoospermia (esOZ; n = 163), severe oligozoospermia (sOZ, n = 174), mild oligozoospermia (mOZ; n = 148), obstructive azoospermia (OAZ; n = 155), and normozoospermia (NZ; n = 210). Rates of fertilization, embryo cleavage, high-quality embryos, implantation, biochemical and clinical pregnancies, abortion, delivery, newborns, as well as major birth malformations, and other newborn outcomes were analyzed and compared among groups. The NOA group showed a statistically lower fertilization rate (68.2% vs esOZ 77.3%, sOZ 78.0%, mOZ 73.8%, OAZ 76.6%, and NZ 79.3%, all P < 0.05), but a significantly higher implantation rate (37.8%) than the groups esOZ (30.1%), sOZ (30.4%), mOZ (32.6%), and OAZ (31.0%) (all P < 0.05), which was similar to that of Group NZ (38.4%). However, there were no statistically significant differences in rates of embryo cleavage, high-quality embryos, biochemical and clinical pregnancies, abortions, deliveries, major birth malformations, and other newborn outcomes in the six groups. The results showed that NOA only negatively affects some embryological outcomes such as fertilization rate. There was no evidence of differences in other embryological and clinical outcomes with respect to sperm source or spermatogenic status. Spermatogenic failure and sperm origins do not impinge on the clinical outcomes in ICSI treatment.

Microsurgical vasoepididymostomy for patients with infectious obstructive azoospermia: Cause, outcome, and associated factors / 亚洲男科学杂志(英文版)

Azoospermia is of great importance to male infertility. Obstructive azoospermia (OA) due to infection is the most prevalent form of OA in China and has been less studied. We aim to observe the treatment outcome of microsurgical vasoepididymostomy (VE) and also to identify the factors relative to the result after reconstructive surgery. Two hundred and eight men presenting with OA due to infection during the study period from July 2010 to July 2013 were prospectively evaluated. Clinical examination, semen analysis, serum follicle stimulating hormone (FSH), and scrotal ultrasound were done before surgical exploration. Among the 198 men who were selected for surgical procedures, 159 candidates underwent microsurgical VE with sperm detected in the epididymal fluid. As for the other 39 cases, reconstruction was not feasible. The average age was 28.5 ± 3.9 years (range 22-38), with average follow-up being 16.5 ± 5.9 months (range 4-28). According to the 150 cases being followed after VE procedures, the total patency rate was 72% (108/150). During follow-up, 38.7% (58/150) natural pregnancies occurred, with overall live birth rate being 32.7% (49/150). Our data suggested that microsurgical VE is an effective therapy for postinfectious epididymal OA. Individualized counseling with prognosis based on etiology should be offered to patients to select optical therapy.

Microsurgical management of male infertility in china: 15-year development and prospects / 中华男科学杂志

Male infertility is a common and complex disease in urology and andrology, and for many years there has been no effective surgical treatment. With the emergence of microsurgery and assisted reproductive medicine (IVF/ICSI), rapid development has been achieved in the treatment of male infertility. The Center for Male Reproductive Medicine and Microsurgery at Weill Cornell Medical College of Cornell University has been playing an important leading role in developing microsurgical techniques for the management of male infertility. The development of microsurgical treatment of male infertility in China has experienced the 3 periods of emerging, making, and boosting ever since its systematic introduction from Weill Cornell Medical College 15 years ago. At present, many Chinese hospitals have adopted microsurgery in the management of male infertility, which has contributed to the initial establishment of a microsurgical treatment system for male infertility in China. However, some deficiencies do exist concerning microsurgical treatment of male infertility, as in normalized technical training programs for competent surgeons, unified criteria for evaluation of surgical outcomes, and detailed postoperative follow-up data. This article presents an overview on the 15-year development of microsurgical management of male infertility in China, points out the existing deficiencies, and offers some propositions for the promotion of its development.

Vacuum therapy for erectile dysfunction that fails to respond to PDE-5i: report of 70 cases / 中华男科学杂志

<p><b>OBJECTIVE</b>To assess the efficacy and safety of the Osbon ErecAid Vacuum Therapy System in the treatment of erectile dysfunction (ED) that fails to respond to PDE-5i.</p><p><b>METHODS</b>This study included 70 cases of ED not responding to the medication of PDE-5i. The patients were aged 25 -66 (38.9 +/- 9.1) years. Under our direction, the patients used the Osbon ErecAid Vacuum Therapy System for a month to increase blood oxygenation to the corpora cavernosa, and then employed the vacuum constriction device (VCD) to maintain penile erection for sexual intercourse. We compared their IIEF-5 scores and their and their partners' sexual satisfaction before and 3 months after treatment, and evaluated the safety and effect of the vacuum therapy.</p><p><b>RESULTS</b>The mean IIEF-5 scores of the patients were significantly increased from 10.2 +/- 4.0 before treatment to 13.3 +/- 4.7 at 3 months after the vacuum therapy (P < 0.05). The rate of therapeutic effectiveness was 77.1% (54/70), and the rates of sexual satisfaction of the patients and their partners were 64.3% (45/70) and 65.7% (46/70),</p><p><b>CONCLUSION</b>Vacuum therapy for ED that does not respond to PDE-5i can significantly improve the patients' erectile function as well as their and their partners'sexual satisfaction, and therefore deserves clinical application.</p>

Efficacy of natural vitamin E on oligospermia and asthenospermia: a prospective multi-centered randomized controlled study of 106 cases / 中华男科学杂志

<p><b>OBJECTIVE</b>To explore the therapeutic effect of natural vitamin E (VitE) on oligospermia and asthenospermia in in- fertile men.</p><p><b>METHODS</b>We conducted a prospective multi-centered randomized controlled study on 64 infertile men with oligospermia (31 as controls treated with Tamoxifen 10 mg bid and 33 as experimental cases treated with Tamoxifen 10 mg bid + VitE 100 mg tid) and 42 cases of asthenospermia (20 as controls treated with Levocarnitine oral solution 1 bottle bid and 22 as experimental cases treated with Levocarnitine oral solution 1 bottle bid + VitE 100 mg tid). We compared the control and experimental groups in sperm concentration and percentage of progressively motile sperm before and 3 months after medication, as well as the rate of clinical pregnancy and adverse events.</p><p><b>RESULTS</b>Among the oligospermia patients, the average sperm concentrations in the control and experimental groups were 8.00 x 10(6)/ml and 10.66 x 10(6)/ml before medication (P > 0.05). After medication, the numbers of cases evaluated as with no, slight, moderate and marked improvement in sperm concentration were 10 and 9 (P > 0.05), 16 and 14 (P > 0.05), 5 and 4 (P > 0.05) and 0 and 0 (P >0.05); and the numbers of natural pregnancies were 0 and 6 in the control and experimental groups (P < 0.01). Among the asthenospermia patients, the average rates of progressively motile sperm were 17.00% and 18.10% in the control and experimental groups before medication (P > 0.05). After medication, the numbers of cases evaluated as with no, slight, moderate and marked improvement in the percentage of progressively motile sperm were 7 and 2 (P < 0.01), 4 and 8 (P < 0.01), 3 and 2 (P > 0.05) and 1 and 1 (P > 0.05), and the numbers of natural pregnancies were 5 and 9 in the two groups (P < 0.01), but no adverse events were observed.</p><p><b>CONCLUSION</b>As a safe and effective adjuvant agent for the treatment of oligospermia and asthenospermia, vitamin E can improve sperm concentration, the percentage of progressively motile sperm, and finally the rate of natural pregnancy.</p>

Evolution and mutation of human Y chromosome and their relationship with male infertility / 中华男科学杂志

The Y chromosome evolves from euchromosome and accumulates a variety of male-specific genes, including SRY and many others that are related with spermatogenesis. The Y chromosome is distinguished from euchromosome by its characteristics of multiple copies of gene, multiple DNA sequences and high polymorphism. A lot of gene rearrangements occur during its evolution due to the specific gene structure in the Y chromosome. It has been discovered that one subset of such gene rearrangements induces Y-chromosome microdeletions that are involved in male infertility. Spermatogenesis is actually controlled by a network of genes, which may be located on the Y chromosome, euchromosomes or even the X chromosome. Further studies on the genomics and genes in the Y chromosome between sex chromosomes and/or between sex chromosome and euchromosomes will helps us to gain deeper insights into the molecular mechanism of male infertility.

Updated dedifferentiation and pluripotency of spermatogonial stem cells / 中华男科学杂志

Spermatogonial stem cells (SSCs) are the postnatal mitotic male germ cells that undergo self-renewing and differentiate into haploid sperm through spermatogenesis throughout life time. However, some recent interesting studies indicate that pluripotent cells can be derived from SSCs in culture. Thus, it seems that SSCs are a great resource of pluripotent cells for regenerative medicine, especially to meet the demand of immuno-rejection free pluripotent cells derived from patients themselves. This article aims to introduce the current understanding and advantages of the pluripotent SSCs in regenerative medicine.

Comparative analysis of three different surgical approaches to varicocelectomy / 中华男科学杂志

<p><b>OBJECTIVE</b>To compare three different surgical approaches to varicocelectomy.</p><p><b>METHODS</b>Eighty-eight cases of varicocelectomy performed in our hospital between January 2006 and January 2008 were divided into an retroperitoneal high ligation group (n = 44), a laparoscopy group (n = 12) and a microsurgery group (n = 32), and retrospectively analyzed for postoperative semen quality, recurrence, early complications, hospital stay, and medical cost.</p><p><b>RESULTS</b>The rates of semen quality improvement were 56.52% (13/23), 66.67% (4/6) and 78.26% (18/23) , the rates of recurrence were 25% (8/32), 22.22% (2/9) and 7.41% (2/27), and the medical costs were RMB yen (1984 +/- 126), (8576 +/- 547) and (2159 +/- 298), respectively, in the retroperitoneal high ligation, laparoscopy and microsurgery groups (P < 0.05). None experienced serious early complications.</p><p><b>CONCLUSION</b>Microsurgery is obviously superior to retroperitoneal high ligation and laparoscopic approaches in improving semen quality and preventing postoperative recurrence, and, with its advantages of minor invasiveness and quick recovery, is preferred by most patients. Laparoscopy, however, ranks highest in medical cost.</p>

Survey on reproductive health status of Shanghai college students / 中华男科学杂志

<p><b>OBJECTIVE</b>To explore reproductive health condition of college students in Shanghai and provide scientific basis for reproductive health education.</p><p><b>METHODS</b>From July 2004 to March 2005, 1192 college students (majors including medicine, science and engineering, arts and culture; 618 medical students and 549 non-medical; 555 male and 612 female) from seven time-day colleges in Shanghai were investigated with a reproductive health questionnaire involving sex. The questionnaire was constituted by 72 topics, involving the need of education, sex attitude, sex videos, sex hygiene knowledge and sexually transmitted diseases (STDs), etc.</p><p><b>RESULTS</b>39.33% (459/1167) students thought they had accepted formal sex education; 49.19% (574/1167) students chose lecture as the favorite way; 41.90% (489/1167) students thought the reproductive health education would not increase the incidence of premarital sexual behavior; 64.10% (748/1167) students thought it was necessary to give college students reproductive health instructions and knowledge. On the other hand, we found 45.05% (250/555) boys and 27.45% (168/612) girls could accept the premarital sexual behaviors; 35.32% (196/555) boys and 39.38% (241/612) girls could accept premarital pregnancy; 44.39% (518/1167) students could calculate the safe period accurately; 71.38% (833/1167) students knew emergency contraception measures; 57.67% (673/1167) students knew how to and when to use condoms; To our surprise, only 2.19% (12/549) non-medical students and 12.14% (75/618) medical students knew exactly the whole 4 sexually transmitted diseases that needed to be essentially prevented in China.</p><p><b>CONCLUSION</b>At present, the reproductive health condition of college students in Shanghai is sophisticated. Much more education on sex safety, self-protection skills and acquired immunodeficiency syndrome (AIDS) knowledge, etc should be reinforced.</p>