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Öğe Antisperm antibody testing: A comprehensive review of its role in the management of immunological male infertility and results of a global survey of clinical practices(Korean Society for Sexual Medicine and Andrology, 2022) Gupta, Sajal; Sharma, Rakesh; Agarwal, Ashok; Boitrelle, Florence; Finelli, Renata; Farkouh, Ala’a; Saleh, Ramadan; Abdel Meguid, Taha Abo Almagd; Gül, Murat; Zilaitiene, Birute; Ko, Edmund; Rambhatla, Amarnath; Zini, Armand; Leisegang, Kristian; Kuroda, Shinnosuke; Henkel, Ralf; Cannarella, Rossella; Palani, Ayad; Cho, Chak Lam; Ho, Christopher C.K.; Zylbersztejn, Daniel Suslik; Pescatori, Edoardo; Chung, Eric; Dimitriadis, Fotios; Pinggera, Germar Michael; Busetto, Gian Maria; Balercia, Giancarlo; Salvio, Gianmaria; Colpi, Giovanni M.; Çeker, Gökhan; Taniguchi, Hisanori; Kandil, Hussein; Park, Hyun Jun; Rosas, Israel Maldonado; Rosette, Jean de la; Greco Cardoso, Joao Paulo; Ramsay, Jonathan; Alvarez, Juan; Corral Molina, Juan Manuel; Khalafalla, Kareim; Bowa, Kasonde; Tremellen, Kelton; Evgeni, Evangelini; Rocco, Lucia; Rodriguez Peña, Marcelo Gabriel; Sabbaghian, Marjan; Martinez, Marlon; Arafa, Mohamed; Al-Marhoon, Mohamed S.; Tadros, Nicholas; Garrido, Nicolas; Rajmil, Osvaldo; Sengupta, Pallav; Vogiatzi, Paraskevi; Kavoussi, Parviz; Birowo, Ponco; Kosgi, Raghavender; Bani Hani, Saleem; Micic, Sava; Parekattil, Sijo; Jindal, Sunil; Le, Tan V.; Mostafa, Taymour; Toprak, Tuncay; Morimoto, Yoshiharu; Malhotra, Vineet; Aghamajidi, Azin; Durairajanayagam, Damayanthi; Shah, RupinAntisperm antibodies (ASA), as a cause of male infertility, have been detected in infertile males as early as 1954. Multiple causes of ASA production have been identified, and they are due to an abnormal exposure of mature germ cells to the immune system. ASA testing (with mixed anti-globulin reaction, and immunobead binding test) was described in the WHO manual 5th edition and is most recently listed among the extended semen tests in the WHO manual 6th edition. The relationship between ASA and infertility is somewhat complex. The presence of sperm agglutination, while insufficient to diagnose immunological infertility, may indicate the presence of ASA. However, ASA can also be present in the absence of any sperm agglutination. The andrological management of ASA depends on the etiology and individual practices of clinicians. In this article, we provide a comprehensive review of the causes of ASA production, its role in immunological male infertility, clinical indications of ASA testing, and the available therapeutic options. We also provide the details of laboratory procedures for assessment of ASA together with important measures for quality control. Additionally, laboratory and clinical scenarios are presented to guide the reader in the management of ASA and immunological male infertility. Furthermore, we report the results of a recent worldwide survey, conducted to gather information about clinical practices in the management of immunological male infertility.Öğe Changes in testosterone levels following surgical sperm retrieval in men with non-obstructive azoospermia: systematic review and meta-analysis(2025) Zohdy, Wael; Shah, Rupin; Ho, Christopher Chee Kong; Çalık, Gökhan; Malhotra, Vineet; Kolbaşı Erkan, Bircan; Agarwal, AshokPurpose: Surgical sperm retrieval (SSR) is used to extract spermatozoa for use with intracytoplasmic sperm injection in men with obstructive and non-obstructive azoospermia (NOA). The procedure may lead to segmental devascularization, postoperative fibrosis, and atrophy with a subsequent decrease in testosterone. The aim of the study is to investigate the impact of SSR on serum levels of total testosterone (TT), follicle-stimulating hormone (FSH), luteinizing hormone (LH) testicular volume, and sexual function in infertile azoospermic men. Materials and Methods: In this systematic review and meta-analysis (SRMA), we searched articles in “PubMed” and “Scopus” exploring the impact of SSR on TT, FSH, LH, and testicular volume. The full-text articles were screened to assess eligibility before data extraction, quality assessment, and meta-analysis. Results: Seventeen studies meeting the inclusion criteria were finally analyzed and included 1,685 infertile, azoospermic men. Patients underwent SSR and were followed in the postoperative period (one week to 32 months). The analysis showed a significant reduction in TT (mean difference [MD] 3.81 nmol/L, 95% confidence interval [CI] 0.55:7.06; p=0.02) compared to pre-SSR values. We also observed insignificant differences in serum FSH (MD 5.08 IU/L, 95% CI -5.6:15.8; p=0.35), LH (MD -2.96 IU/L, 95% CI -6.31:0.39; p=0.08), and no change in testicular volume (MD 0.07 mL, 95% CI -1.92:2.07; p=0.94) after SSR. Sexual dysfunction was associated with hypogonadism, depression, and anxiety, especially in men with unsuccessful SSR and Klinefelter syndrome. Conclusions: The results of this SRMA indicate a significant reduction in TT after SSR. Sexual dysfunction after testicular sperm extraction and the potential negative impact of future SSR repeat should be considered during preoperative counseling.Öğe Consensus and diversity in the management of varicocele for male infertility: Results of a global practice survey and comparison with guidelines and recommendations(Korean Society for Sexual Medicine and Andrology, 2022) Shah, Rupin; Agarwal, Ashok; Kavoussi, Parviz; Rambhatla, Amarnath; Saleh, Ramadan; Cannarella, Rossella; Harraz, Ahmed M.; Boitrelle, Florence; Kuroda, Shinnosuke; Hamoda, Taha Abo-Almagd Abdel-Meguid; Zini, Armand; Ko, Edmund; Çalık, Gökhan; Toprak, Tuncay; Kandil, Hussein; Gül, Murat; Bakırcıoğlu, Mustafa Emre; Parekh, Neel; Russo, Giorgio Ivan; Tadros, Nicholas; Kadıoğlu, Ateş; Arafa, Mohamed; Chung, Eric; Rajmil, Osvaldo; Dimitriadis, Fotios; Malhotra, Vineet; Salvio, Gianmaria; Henkel, Ralf; Le, Tan V.; Sogutdelen, Emrullah; Vij, Sarah; Alarbid, Abdullah; Güdeloğlu, Ahmet; Tsujimura, Akira; Calogero, Aldo E.; El Meliegy, Amr; Crafa, Andrea; Kalkanlı, Arif; Baser, Aykut; Hazır, Berk; Giulioni, Carlo; Cho, Chak-Lam; Ho, Christopher C.K.; Salzano, Ciro; Zylbersztejn, Daniel Suslik; Tien, Dung Mai Ba; Pescatori, Edoardo; Borges, Edson; Saïs-Hamza, Eminej; Huyghe, Eric; Ceyhan, Erman; Caroppo, Ettore; Castiglioni, Fabrizio; Bahar, Fahmi; Gökalp, Fatih; Lombardo, Francesco; Gadda, Franco; Duarsa, Gede Wirya Kusuma; Pinggera, Germar-Michael; Busetto, Gian Maria; Balercia, Giancarlo; Cito, Gianmartin; Blecher, Gideon; Franco, Giorgio; Liguori, Giovanni; Elbardisi, Haitham; Keskin, Hakan; Lin, Haocheng; Taniguchi, Hisanori; Park, Hyun Jun; Ziouziou, Imad; de la Rosette, Jean J. M. C. H.; Hotaling, Jim; Ramsay, Jonathan; Molina, Juan Manuel Corral; Lo, Ka Lun; Böcü, Kadir; Khalafalla, Kareim; Bowa, Kasonde; Okada, Keisuke; Nagao, Koichi; Chiba, Koji; Hakim, Lukman; Makarounis, Konstantinos; Hehemann, Marah; Peña, Marcelo Rodriguez; Falcone, Marco; Bendayan, Marion; Martinez, Marlon; Timpano, Massimiliano; Altan, Mesut; Fode, Mikkel; Al-Marhoon, Mohamed S.; Gilani, Mohammad Ali Sadighi; Soebadi, Mohammad Ayodhia; Gherabi, Nazim; Sofikitis, Nikolaos; Kahraman, Oğuzhan; Birowo, Ponco; Kothari, Priyank; Sindhwani, Puneet; Javed, Qaisar; Ambar, Rafael F.; Kosgi, Raghavender; Ghayda, Ramy Abou; Adriansjah, Ricky; Condorelli, Rosita Angela; La Vignera, Sandro; Micic, Sava; Kim, Shannon Hee Kyung; Fukuhara, Shinichiro; Ahn, Sun Tae; Mostafa, Taymour; Ong, Teng Aik; Takeshima, Teppei; Amano, Toshiyasu; Barrett, Trenton; Arslan, Umut; Karthikeyan, Vilvapathy Senguttuvan; Atmoko, Widi; Yumura, Yasushi; Yuan, Yiming; Kato, Yuki; Jezek, Davor; Cheng, Bryan Kwun-Chung; Hatzichristodoulou, Georgios; Dy, Jun; Castañé, Eduard Ruiz; El-Sakka, Ahmed I.; Nguyen, Quang; Sarıkaya, Selçuk; Boeri, Luca; Tan, Ronny; Moussa, Mohamad A.; El-Assmy, Ahmed; Alali, Hamed; Alhathal, Naif; Osman, Yasser; Perovic, Dragoljub; Sajadi, Hesamoddin; Akhavizadegan, Hamed; Vu?ini?, Miroslav; Kattan, Said; Kattan, Mohamed S.; Mogharabian, Nasser; Phuoc, Nguyen Ho Vinh; Ngoo, Kay Seong; Alkandari, Mohammad H.; Alsuhaibani, Shaheed; Sokolakis, Ioannis; Babaei, Mehdi; King, Mak Siu; Diemer, Thorsten; Gava, Marcelo M.; Henrique, Raphael; Spinola e Silva, Rodrigo; Paul, Gustavo Marquesine; Mierzwa, Tiago Cesar; Glina, Sidney; Siddiqi, Kashif; Wu, Han; Wurzacher, Jana; Farkouh, Ala'a; Son, Hwancheol; Minhas, Suks; Lee, Joe; Magsanoc, Nikko; Capogrosso, Paolo; Capogrosso, Paolo; Albano, German Jose; Lewis, Sheena E.M.; Jayasena, Channa N.; Alvarez, Juan G.; Teo, Colin; Smith, Ryan P.; Chua, Jo Ben M.; Jensen, Christian Fuglesang S.; Parekattil, Sijo; Finelli, Renata; Durairajanayagam, Damayanthi; Karna, Keshab Kumar; Ahmed, Abdelkareem; Evenson, Don; Umemoto, Yukihiro; Puigvert, Ana; Çeker, Gökhan; Colpi, Giovanni M.; Rolitsky, Sarah; Bouzouita, Abderrazak; Shokeir, Ahmed; Aşçı, Ahmet; Bouker, Amin; Adamyan, Aram; Avoyan, Armen E.; Palani, Ayad; Aghamajidi, Azin; Eze, Balantine; Noegroho, Bambang Sasongko; Purnomo, Basuki; Erkan, Bircan Kolbaşı; Zilaitiene, Birute; Kulaksız, Deniz; Kafetzis, Dimitrios; Lee, Dong Sup; Stember, Doron; Evgeni, Evangelini; Alhajeri, Faisal; Finocchi, Federica; Colombo, Fulvio; Tsangaris, George; Sallam, Hassan N.; Acosta, Herik; Rosas, Israel Maldonado; Kirkman-Brown, Jackson; Shin, Jae Il; Sonksen, Jens; Dong, Jie; Marmar, Joel; Moreno-Sepulveda, Jose; Seo, Ju Tae; Aydos, Kaan; Kesari, Kavindra Kumar; Trost, Landon; Jenkins, Lawrence; Rocco, Lucia; Darbandi, Mahsa; Simopoulou, Mara; Alves, Marco; Sabbaghian, Marjan; Tavalaee, Marziyeh; Razi, Mazdak; Duran, Mesut Berkan; Nago, Mitsuru; Elkhouly, Mohamed; Khalili, Mohamed; Nasr-Esfahani, Mohammad Hossein; Kamath, Mohan S.; Uğur, Muhammet Raşit; Park, Nam Cheol; Cruz, Natalio; Garrido, Nicolas; Sodeifi, Niloofar; Al Khalidi, Noora; Shoshany, Ohad; Satyagraha, Paksi; Drakopoulos, Panagiotos; Vogiatzi, Paraskevi; Dolati, Parisa; Das, Partha; Chiu, Peter Ka-Fung; Tsioulou, Petroula A.; Patel, Premal; Singh, Rajender; Kaiyal, Raneen Sawaid; Santos, Ferreira; Dada, Rima; Brodjonegoro, Sakti; Banihani, Saleem Ali; Schon, Samantha; Darbandi, Sara; Güneş, Sezgin; Homa, Sheryl; Mutambirwa, Shingai; Roychoudhury, Shubhadeep; Diaz, Sofia Ines Leonardi; Gopalakrishnan, Sreelatha; Krawetz, Stephen; Jindal, Sunil; Avidor-Reiss, Tomer; Lin, Tsung Yen; Kumar, Vijay; Ibrahim, Wael; Kerkeni, Walid; Woo, Wongi; Morimoto, Yoshiharu; Cheng, Yu-ShengPurpose: Varicocele is a common problem among infertile men. Varicocele repair (VR) is frequently performed to improve semen parameters and the chances of pregnancy. However, there is a lack of consensus about the diagnosis, indications for VR and its outcomes. The aim of this study was to explore global practice patterns on the management of varicocele in the context of male infertility. Materials and Methods: Sixty practicing urologists/andrologists from 23 countries contributed 382 multiple-choice-questions pertaining to varicocele management. These were condensed into an online questionnaire that was forwarded to clinicians involved in male infertility management through direct invitation. The results were analyzed for disagreement and agreement in practice patterns and, compared with the latest guidelines of international professional societies (American Urological Association [AUA], American Society for Reproductive Medicine [ASRM], and European Association of Urology [EAU]), and with evidence emerging from recent systematic reviews and meta-analyses. Additionally, an expert opinion on each topic was provided based on the consensus of 16 experts in the field. Results: The questionnaire was answered by 574 clinicians from 59 countries. The majority of respondents were urologists/uro-andrologists. A wide diversity of opinion was seen in every aspect of varicocele diagnosis, indications for repair, choice of technique, management of sub-clinical varicocele and the role of VR in azoospermia. A significant proportion of the responses were at odds with the recommendations of AUA, ASRM, and EAU. A large number of clinical situations were identified where no guidelines are available. Conclusions: This study is the largest global survey performed to date on the clinical management of varicocele for male infertility. It demonstrates: 1) a wide disagreement in the approach to varicocele management, 2) large gaps in the clinical practice guidelines from professional societies, and 3) the need for further studies on several aspects of varicocele management in infertile men.Öğe Effects of varicocele repair on sperm dna fragmentation and seminal malondialdehyde levels in infertile men with clinical varicocele a systematic review and meta-analysis(2024) Cannarella, Rossella; Shah, Rupin; Saleh, Ramadan; Boitrelle, Florence; Hamoda, Taha Abo-Almagd Abdel-Meguid; Singh, Rajender; Salvio, Gianmaria; Toprak, Tuncay; Falcone, Marco; Gül, Murat; Dimitriadis, Fotios; Rambhatla, Amarnath; Russo, Giorgio I.; Ko, Edmund; Zini, Armand; Kavoussi, Parviz; Phuoc, Nguyen Ho Vinh; Kandil, Hussein; Ghayda, Ramy Abou; Birowo, Ponco; Gherabi, Nazim; Ceyhan, Erman; Dong, Jie; Malhotra, Vineet; Durairajanayagam, Damayanthi; Kolbaşı, Bircan; Bahar, Fahmi; Çalık, Gökhan; Çayan, Selahittin; Pinggera, Germar Michael; Calogero, Aldo E.; Rajmil, Osvaldo; Mostafa, Taymour; Atmoko, Widi; Harraz, Ahmed M.; Le, Tan V.; de la Rosette, Jean J. M. C. H.; Hakim, Lukman; Pescatori, Edoardo; Sergeyev, Oleg; Rashed, Ayman; Saini, Pallavi; Agarwal, AshokPurpose: Varicoceles can be a source of elevated seminal oxidative stress (OS) and sperm DNA fragmentation (SDF). However, it remains unclear whether varicocele repair (VR) could reduce these parameters. This systematic review and meta-analysis (SRMA) aims to investigate the impact of VR on SDF and seminal malondialdehyde (MDA). Materials and Methods: A literature search was performed in Scopus, PubMed, Ovid, Embase, and Cochrane databases. This SRMA included randomized controlled trials and observational studies reporting the pre- and postoperative levels of SDF and seminal OS in infertile men with clinical varicocele that underwent VR. Subgroup analyses included techniques of VR and SDF testing. The effect size was expressed as standardized mean difference (SMD). Results: Out of 1,632 abstracts assessed for eligibility, 29 studies with 1,491 infertile men were included. The analysis showed a significant reduction in SDF after VR, compared to preoperative values (SMD -1.125, 95% confidence interval [CI] -1.410, -0.840; p<0.0001) with high inter-study heterogeneity (I2=90.965%). Reduction in SDF was evident with microsurgical technique and non-microsurgical inguinal approaches (SMD -1.014, 95% CI -1.263, -0.765; p<0.0001, and SMD -1.495, 95% CI -2.116, -0.873; p<0.0001), respectively. Reduction in SDF was significant irrespective of testing was done by sperm chromatin dispersion (SMD -2.197, 95% CI -3.187, -1.207; p<0.0001), sperm chromatin structure assay (SMD -0.857, 95% CI -1.156, -0.559; p<0.0001) or TUNEL (SMD -1.599, 95% CI -2.478, -0.719; p<0.0001). A significant decrease in seminal MDA levels was observed following VR (SMD -2.450, 95% CI -3.903 to -0.997, p=0.001) with high inter-study heterogeneity (I2=93.7%). Conclusions: Using pre- and post-intervention data, this SRMA indicates a significant reduction in SDF and seminal MDA levels in infertile men with clinical varicocele treated with VR. These findings may have important implications for the future management of this selected group of infertile patients.Öğe Global practice patterns and variations in the medical and surgical management of non-obstructive azoospermia: results of a world-wide survey, guidelines and expert recommendations(2025) Rambhatla, Amarnath; Shah, Rupin; Ziouziou, Imad; Kothari, Priyank; Salvio, Gianmaria; Gül, Murat; Hamoda, Taha; Kavoussi, Parviz; Atmoko, Widi; Toprak, Tuncay; Birowo, Ponco; Ko, Edmund; Arafa, Mohamed; Ghayda, Ramy Abou; Karthikeyan, Vilvapathy Senguttuvan; Russo, Giorgio Ivan; Pinggera, Germar Michael; Chung, Eric; Harraz, Ahmed M.; Martinez, Marlon; Phuoc, Nguyen Ho Vinh; Tadros, Nicholas; Saleh, Ramadan; Savira, Missy; Colpi, Giovanni M.; Zohdy, Wael; Pescatori, Edoardo; Park, Hyun Jun; Fukuhara, Shinichiro; Tsujimura, Akira; Rojas Cruz, Cesar; Marino, Angelo; Mak, Siu King; Amar, Edouard; Ibrahim, Wael; Sindhwani, Puneet; Alhathal, Naif; Busetto, Gian Maria; Al Hashimi, Manaf; El-Sakka, Ahmed; Ramazan, Asci; Dimitriadis, Fotios; Timpano, Massimiliano; Jezek, Davor; Altay, Barış; Zylbersztejn, Daniel Suslik; Wong, Michael Y.C.; Moon, Du Geon; Wyns, Christine; Gamidov, Safar; Akhavizadegan, Hamed; Franceschelli, Alessandro; Aydos, Kaan; Quang, Nguyen; Ashour, Shedeed; Al Dayel, Adel; Al Marhoon, Mohammed S.; Micic, Sava; Binsaleh, Saleh; Hussein, Alayman; Elbardisi, Haitham; Mostafa, Taymour; Ramsay, Jonathan; Zachariou, Athanasios; Abdelrahman, Islam Fathy Soliman; Rajmil, Osvaldo; Kalkanlı, Arif; Molina, Juan Manuel Corral; Böcü, Kadir; Duarsa, Gede Wirya Kusuma; Çeker, Gökhan; Şerefoğlu, Ege Can; Bahar, Fahmi; Gherabi, Nazım; Kuroda, Shinnosuke; Bouzouita, Abderrazak; Güdeloğlu, Ahmet; Ceyhan, Erman; Hasan, Mohamed Saeed Mohamed; Musa, Muhammad Ujudud; Motawi, Ahmad; Cho, Chak-Lam; Taniguchi, Hisanori; Ho, Christopher Chee Kong; Vazquez, Jesus Fernando Solorzano; Mutambirwa, Shingai; Dokuzeylül Güngör, Nur; Bendayan, Marion; Giulioni, Carlo; Baser, Aykut; Falcone, Marco; Boeri, Luca; Blecher, Gideon; Kheradmand, Alireza; Sethupathy, Tamilselvi; Adriansjah, Ricky; Narimani, Nima; Konstantinidis, Charalampos; Nguyen, Tuan Thanh; Japari, Andrian; Dolati, Parisa; Singh, Keerti; Özer, Cevahir; Sarıkaya, Selçuk; Sheibak, Nadia; Bosco, Ndagijimana Jean; Özkent, Mehmet Serkan; Le, Sang Thanh; Sokolakis, Ioannis; Katz, Darren; Smith, Ryan; Truong, Manh Nguyen; Le, Tan V.; Huang, Zhongwei; Değer, Müslim Doğan; Arslan, Umut; Çalık, Gökhan; Franco, Giorgio; Rashed, Ayman; Kahraman, Oğuzhan; Andreadakis, Sotiris; Putra, Rosadi; Balercia, Giancarlo; Khalafalla, Kareim; Cannarella, Rossella; Tuân, Anh ??ng; Meliegy, Amr El; Zilaitiene, Birute; Ramirez, Marlene Lizbeth Zamora; Giacone, Filippo; Calogero, Aldo E.; Makarounis, Konstantinos; Jindal, Sunil; Hoai, Bac Nguyen; Banthia, Ravi; Peña, Marcelo Rodriguez; Moorthy, Dharani; Adamyan, Aram; Kulaksız, Deniz; Kandil, Hussein; Sofikitis, Nikolaos; Salzano, Ciro; Jungwirth, Andreas; Banka, Surendra Reddy; Mierzwa, Tiago Cesar; Turunç, Tahsin; Jain, Divyanu; Avoyan, Armen; Salacone, Pietro; Kadıoğlu, Ateş; Gupta, Chirag; Lin, Haocheng; Shamohammadi, Iman; Mogharabian, Nasser; Barrett, Trenton; Danacıoğlu, Yavuz Onur; Crafa, Andrea; Daoud, Salima; Malhotra, Vineet; Almardawi, Abdulmalik; Selim, Osama Mohamed; Moussa, Mohamad; Haghdani, Saeid; Duran, Mesut Berkan; Kunz, Yannic; Preto, Mirko; Eugeni, Elena; Nguyen, Thang; Elshahid, Ahmed Rashad; Suyono, Seso Sulijaya; Parikesit, Dyandra; Nada, Essam; Orozco, Eduardo Gutiérrez; Boitrelle, Florence; Trang, Nguyen Thi Minh; Jamali, Mounir; Nair, Raju; Ruzaev, Mikhail; Gadda, Franco; Thomas, Charalampos; Ferreira, Raphael Henrique; Gül, Ümit; Maruccia, Serena; Kanbur, Ajay; Kinzikeeva, Ella; Abumelha, Saad Mohammed; Kosgi, Raghavender; Gökalp, Fatih; Soebadi, Mohammad Ayodhia; Paul, Gustavo Marquesine; Sajadi, Hesamoddin; Gupte, Deepak; Ambar, Rafael F.; Söğütdelen, Emrullah; Singla, Karun; Basukarno, Ari; Kim, Shannon Hee Kyung; Gilani, Mohammad Ali Sadighi; Nagao, Koichi; Brodjonegoro, Sakti Ronggowardhana; Rezano, Andri; Elkhouly, Mohamed; Mazzilli, Rossella; Farsi, Hasan M.A.; Nguyen Alali, Hamed; Ba, Hung Nguyen; Alali, Hamed; Kafetzis, Dimitrios; Long, Tran Quang Tien; Alsaid, Sami; Cuong, Hoang Bao Ngoc; Oleksandr, Knigavko; Mustafa, Akhmad; Acosta, Herik; Pai, Hrishikesh; Şahin, Bahadır; Arianto, Eko; Teo, Colin; Jayaprakash, Sanjay Prakash; Rachman, Rinaldo Indra; Yenice, Mustafa Gürkan; Sefrioui, Omar; Priyadarshi, Shivam; Tanic, Marko; Alfatlaw, Noor Kareem; Rizaldi, Fikri; Vishwakarma, Ranjit B.; Kanakis, George; Cherian, Dinesh Thomas; Lee, Joe; Galstyan, Raisa; Keskin, Hakan; Wurzacher, Janan; Seno, Doddy Hami; Noegroho, Bambang S.; Margiana, Ria; Javed, Qaisar; Castiglioni, Fabrizio; Tanwar, Raman; Puigvert, Ana; Kaya, Coşkun; Purnomo, Medianto; Yazbeck, Chadi; Amir, Azwar; Borges, Edson; Bellavia, Marina; Deswanto, Isaac Ardianson; Vinod K.V.; Liguori, Giovanni; Minh, Dang Hoang; Siddiqi, Kashif; Colombo, Fulvio; Zini, Armand; Patel, Niket; Çayan, Selahittin; Al Kawaz, Ula; Ragab, Maged; Hebrard, Guadalupe Hernández; de la Rosette, Jean J. M. C. H.; Efesoy, Ozan; Hoffmann, Ivan; Teixeira, Thiago Afonso; Saylam, Barış; Delgadillo, Daniela; Agarwal, AshokPurpose: Non-obstructive azoospermia (NOA) is a common, but complex problem, with multiple therapeutic options and a lack of clear guidelines. Hence, there is considerable controversy and marked variation in the management of NOA. This survey evaluates contemporary global practices related to medical and surgical management for patients with NOA. Materials and Methods: A 56-question online survey covering various aspects of the evaluation and management of NOA was sent to specialists around the globe. This paper analyzes the results of the second half of the survey dealing with the management of NOA. Results have been compared to current guidelines, and expert recommendations have been provided using a Delphi process. Results: Participants from 49 countries submitted 336 valid responses. Hormonal therapy for 3 to 6 months was suggested before surgical sperm retrieval (SSR) by 29.6% and 23.6% of participants for normogonadotropic hypogonadism and hypergonadotropic hypogonadism respectively. The SSR rate was reported as 50.0% by 26.0% to 50.0% of participants. Interestingly, 46.0% reported successful SSR in <10% of men with Klinefelter syndrome and 41.3% routinely recommended preimplantation genetic testing. Varicocele repair prior to SSR is recommended by 57.7%. Half of the respondents (57.4%) reported using ultrasound to identify the most vascularized areas in the testis for SSR. One-third proceed directly to microdissection testicular sperm extraction (mTESE) in every case of NOA while others use a staged approach. After a failed conventional TESE, 23.8% wait for 3 months, while 33.1% wait for 6 months before proceeding to mTESE. The cut-off of follicle-stimulating hormone for positive SSR was reported to be 12-19 IU/mL by 22.5% of participants and 20-40 IU/mL by 27.8%, while 31.8% reported no upper limit. Conclusions: This is the largest survey to date on the real-world medical and surgical management of NOA by reproductive experts. It demonstrates a diverse practice pattern and highlights the need for evidence-based international consensus guidelines.Öğe Global practice patterns in the evaluation of non-obstructive azoospermia: results of a world-wide survey and expert recommendations(2024) Shah, Rupin; Rambhatla, Amarnath; Atmoko, Widi; Martinez, Marlon; Ziouziou, Imad; Kothari, Priyank; Tadros, Nicholas; Phuoc, Nguyen Ho Vinh; Kavoussi, Parviz; Harraz, Ahmed; Salvio, Gianmaria; Gül, Murat; Hamoda, Taha; Toprak, Tuncay; Birowo, Ponco; Ko, Edmund; Arafa, Mohamed; Ghayda, Ramy Abou; Karthikeyan, Vilvapathy Senguttuvan; Saleh, Ramadan; Russo, Giorgio Ivan; Pinggera, Germar Michael; Chung, Eric; Savira, Missy; Colpi, Giovanni M.; Zohdy, Wael; Pescatori, Edoardo; Park, Hyun Jun; Fukuhara, Shinichiro; Tsujimura, Akira; Rojas Cruz, Cesar; Marino, Angelo; Mak, Siu King; Amar, Edouard; Ibrahim, Wael; Sindhwani, Puneet; Alhathal, Naif; Busetto, Gian Maria; Al Hashimi, Manaf; El Sakka, Ahmed; Aşcı, Ramazan; Dimitriadis, Fotios; Timpano, Massimiliano; Jezek, Davor; Altay, Barış; Zylbersztejn, Daniel Suslik; Wong, Michael Y.C.; Moon, Du Geon; Wyns, Christine; Gamidov, Safar; Akhavizadegan, Hamed; Franceschelli, Alessandro; Aydos, Kaan; Quang, Vinh Nguyen; Ashour, Shedeed; Al Dayel, Adel; Al Marhoon, Mohamed S.; Micic, Sava; Binsaleh, Saleh; Hussein, Alayman; Elbardisi, Haitham; Mostafa, Taymour; Taha, Emad; Ramsay, Jonathan; Zachariou, Athanasios; Abdelrahman, Islam Fathy Soliman; Rajmil, Osvaldo; Kalkanlı, Arif; Molina, Juan Manuel Corral; Böcü, Kadir; Duarsa, Gede Wirya Kusuma; Çeker, Gökhan; Şerefoğlu, Ege Can; Bahar, Fahmi; Gherabi, Nazim; Kuroda, Shinnosuke; Bouzouita, Abderrazak; Güdeloğlu, Ahmet; Ceyhan, Erman; Hasan, Mohamed Saeed Mohamed; Musa, Muhammad Ujudud; Motawi, Ahmad; Chak Lam, Cho; Taniguchi, Hisanori; Ho, Christopher Chee Kong; Vazquez, Jesus Fernando Solorzano; Mutambirwa, Shingai; Dokuzeylül Güngör, Nur; Bendayan, Marion; Giulioni, Carlo; Baser, Aykut; Falcone, Marco; Boeri, Luca; Blecher, Gideon; Kheradmand, Alireza; Sethupathy, Tamilselvi; Adriansjah, Ricky; Narimani, Nima; Konstantinidis, Charalampos; Nguyen, Tuan Thanh; Japari, Andrian; Dolati, Parisa; Singh, Keerti; Özer, Cevahir; Sarıkaya, Selçuk; Sheibak, Nadia; Bosco, Ndagijimana Jean; Özkent, Mehmet Serkan; Le, Sang Thanh; Sokolakis, Ioannis; Katz, Darren; Smith, Ryan; Truong, Manh Nguyen; Le, Tan V.; Huang, Zhongwei; Değer, Müslim Doğan; Arslan, Umut; Çalık, Gökhan; Franco, Giorgio; Rashed, Ayman; Kahraman, Oğuzhan; Andreadakis, Sotiris; Putra, Rosadi; Balercia, Giancarlo; Khalafalla, Kareim; Cannarella, Rossella; Tuan, Anh ?ang; Meliegy, Amr El; Zilaitiene, Birute; Ramirez, Marlene Lizbeth Zamora; Giacone, Filippo; Calogero, Aldo E.; Makarounis, Konstantinos; Jindal, Sunil; Hoai, Bac Nguyen; Banthia, Ravi; Peña, Marcelo Rodriguez; Moorthy, Dharani; Adamyan, Aram; Kulaksız, Deniz; Kandil, Hussein; Sofikitis, Nikolaos; Salzano, Ciro; Jungwirth, Andreas; Banka, Surendra Reddy; Mierzwa, Tiago Cesar; Turunç, Tahsin; Jain, Divyanu; Avoyan, Armen; Salacone, Pietro; Kadıoğlu, Ateş; Gupta, Chirag; Lin, Haocheng; Shamohammadi, Iman; Mogharabian, Nasser; Barrett, Trenton; Danacıoğlu, Yavuz Onur; Crafa, Andrea; Daoud, Salima; Malhotra, Vineet; Almardawi, Abdulmalik; Selim, Osama Mohamed; Moussa, Mohamad; Haghdani, Saeid; Duran, Mesut Berkan; Kunz, Yannic; Preto, Mirko; Eugeni, Elena; Nguyen, Thang; Elshahid, Ahmed Rashad; Suyono, Seso Sulijaya; Parikesit, Dyandra; Nada, Essam; Orozco, Eduardo Gutiérrez; Boitrelle, Florence; Trang, Nguyen Thi Minh; Jamali, Mounir; Nair, Raju; Ruzaev, Mikhail; Gadda, Franco; Thomas, Charalampos; Ferreira, Raphael Henrique; Gül, Ümit; Maruccia, Serena; Kanbur, Ajay; Kinzikeeva, Ella; Abumelha, Saad; Quang, Nguyen; Kosgi, Raghavender; Gökalp, Fatih; Soebadi, Mohammad Ayodhia; Paul, Gustavo Marquesine; Sajadi, Hesamoddin; Gupte, Deepak; Ambar, Rafael F.; Söğütdelen, Emrullah; Singla, Karun; Basurkano, Ari; Kim, Shannon Hee Kyung; Gilani, Mohammad Ali Sadigh; Nagao, Koichi; Brodjonegoro, Sakti Ronggowardhana; Rezano, Andri; Elkhouly, Mohamed; Mazzilli, Rossella; Farsi, Hasan M.A.; Ba, Hung Nguyen; Alali, Hamed; Kafetzis, Dimitrios; Long, Tran Quang Tien; Alsaid, Sami; Cuong, Hoang Bao Ngoc; Oleksandr, Knigavko; Mustafa, Akhmad; Acosta, Herik; Pai, Hrishikesh; Şahin, Bahadır; Arianto, Eko; Teo, Colin; Jayaprakash, Sanjay Prakash; Rachman, Rinaldo Indra; Yenice, Mustafa Gürkan; Sefrioui, Omar; Paghdar, Smit; Priyadarshi, Shivam; Tanic, Marko; Alfatlawy, Noor Kareem; Rizaldi, Fikri; Vishwakarma, Ranjit B.; Kanakis, George; Cherian, Dinesh Thomas; Lee, Joe; Galstyan, Raisa; Keskin, Hakan; Wurzacher, Jana; Seno, Doddy Hami; Noegroho, Bambang S.; Margiana, Ria; Javed, Qaisar; Castiglioni, Fabrizio; Tanwar, Raman; Puigvert, Ana; Kaya, Coşkun; Purnomo, Medianto; Yazbeck, Chadi; Amir, Azwar; Borges, Edson; Bellavia, Marina; Deswanto, Isaac Ardianson; Vinod K.V.; Liguori, Giovanni; Minh, Dang Hoang; Siddiqi, Kashif; Colombo, Fulvio; Zini, Armand; Patel, Niket; Çayan, Selahittin; Al Kawaz, Ula; Ragab, Maged; Hebrard, Guadalupe Hernández; Hoffmann, Ivan; Efesoy, Ozan; Saylam, Barış; Agarwal, AshokPurpose: Non-obstructive azoospermia (NOA) represents the persistent absence of sperm in ejaculate without obstruction, stemming from diverse disease processes. This survey explores global practices in NOA diagnosis, comparing them with guidelines and offering expert recommendations. Materials and Methods: A 56-item questionnaire survey on NOA diagnosis and management was conducted globally from July to September 2022. This paper focuses on part 1, evaluating NOA diagnosis. Data from 367 participants across 49 countries were analyzed descriptively, with a Delphi process used for expert recommendations. Results: Of 336 eligible responses, most participants were experienced attending physicians (70.93%). To diagnose azoospermia definitively, 81.7% requested two semen samples. Commonly ordered hormone tests included serum follicle-stimulating hormone (FSH) (97.0%), total testosterone (92.9%), and luteinizing hormone (86.9%). Genetic testing was requested by 66.6%, with karyotype analysis (86.2%) and Y chromosome microdeletions (88.3%) prevalent. Diagnostic testicular biopsy, distinguishing obstructive azoospermia (OA) from NOA, was not performed by 45.1%, while 34.6% did it selectively. Differentiation relied on physical examination (76.1%), serum hormone profiles (69.6%), and semen tests (68.1%). Expectations of finding sperm surgically were higher in men with normal FSH, larger testes, and a history of sperm in ejaculate. Conclusions: This expert survey, encompassing 367 participants from 49 countries, unveils congruence with recommended guidelines in NOA diagnosis. However, noteworthy disparities in practices suggest a need for evidence-based, international consensus guidelines to standardize NOA evaluation, addressing existing gaps in professional recommendations.Öğe Impact of varicocele repair on semen parameters in infertile men: A systematic review and meta-analysis(Korean Society for Sexual Medicine and Andrology, 2023) Agarwal, Ashok; Cannarella, Rossella; Saleh, Ramadan; Boitrelle, Florence; Gül, Murat; Toprak, Tuncay; Salvio, Gianmaria; Arafa, Mohamed; Russo, Giorgio I.; Harraz, Ahmed M.; Singh, Rajender; Garrido, Nicolas; Abdel-Meguid Hamoda, Taha Abo-Almagd; Rambhatla, Amarnath; Kavoussi, Parviz; Kuroda, Shinnosuke; Çalik, Gökhan; Saini, Pallavi; Ceyhan, Erman; Dimitriadis, Fotios; Henkel, Ralf; Crafa, Andrea; Palani, Ayad; Duran, Mesut Berkan; Maziotis, Evangelos; Maziotis, Evangelos; Bendayan, Marion; Darbandi, Mahsa; Le, Tan V.; Gunes, Sezgin; Tsioulou, Petroula; Sengupta, Pallav; Hazir, Berk; Çeker, Gökhan; Darbandi, Sara; Durairajanayagam, Damayanthi; Aghamajidi, Azin; Alkhalidi, Noora; Sogutdelen, Emrullah; Leisegang, Kristian; Alarbid, Abdullah; Ho, Christopher C.K.; Malhotra, Vineet; Finocchi, Federica; Crisóstomo, Luís; Kosgi, Raghavender; ElBardisi, Haitham; Zini, Armand; Birowo, Ponco; Colpi, Giovanni; Park, Hyun Jun; Serefoglu, Ege Can; Nguyen, Quang; Ko, Edmund; de la Rosette, Jean J. M. C. H.; Pinggera, Germar M.; Nguyen, Ho Vinh Phuoc; Kandil, Hussein; Shah, RupinPurpose: Despite the significant role of varicocele in the pathogenesis of male infertility, the impact of varicocele repair (VR) on conventional semen parameters remains controversial. Only a few systematic reviews and meta-analyses (SRMAs) have evaluated the impact of VR on sperm concentration, total motility, and progressive motility, mostly using a before-after analytic approach. No SRMA to date has evaluated the change in conventional semen parameters after VR compared to untreated controls. This study aimed to evaluate the effect of VR on conventional semen parameters in infertile patients with clinical varicocele compared to untreated controls. Materials and Methods: A literature search was performed using Scopus, PubMed, Embase, and Cochrane databases following the Population Intervention Comparison Outcome (PICOS) model (Population: infertile patients with clinical varicocele; Intervention: VR [any technique]; Comparison: infertile patients with clinical varicocele that were untreated; Outcome: sperm concentration, sperm total count, progressive sperm motility, total sperm motility, sperm morphology, and semen volume; Study type: randomized controlled trials and observational studies). Results: A total of 1,632 abstracts were initially assessed for eligibility. Sixteen studies were finally included with a total of 2,420 infertile men with clinical varicocele (1,424 patients treated with VR vs. 996 untreated controls). The analysis showed significantly improved post-operative semen parameters in patients compared to controls with regards to sperm concentration (standardized mean difference [SMD] 1.739; 95% CI 1.129 to 2.349; p<0.001; I2=97.6%), total sperm count (SMD 1.894; 95% CI 0.566 to 3.222; p<0.05; I2=97.8%), progressive sperm motility (SMD 3.301; 95% CI 2.164 to 4.437; p<0.01; I2=98.5%), total sperm motility (SMD 0.887; 95% CI 0.036 to 1.738; p=0.04; I2=97.3%) and normal sperm morphology (SMD 1.673; 95% CI 0.876 to 2.470; p<0.05; I2=98.5%). All the outcomes showed a high inter-study heterogeneity, but the sensitivity analysis showed that no study was sensitive enough to change these results. Publication bias was present only in the analysis of the sperm concentration and progressive motility. No significant difference was found for the semen volume (SMD 0.313; 95% CI -0.242 to 0.868; I2=89.7%). Conclusions: This study provides a high level of evidence in favor of a positive effect of VR to improve conventional semen parameters in infertile men with clinical varicocele. To the best of our knowledge, this is the first SRMA to compare changes in conventional semen parameters after VR with changes in parameters of a control group over the same period. This is in contrast to other SRMAs which have compared semen parameters before and after VR, without reference to a control group. Our findings strengthen the available evidence and have a potential to upgrade professional societies’ practice recommendations favoring VR to improve conventional semen parameters in infertile men.Öğe Post-vasectomy semen analysis: Optimizing laboratory procedures and test interpretation through a clinical audit and global survey of practices(Pusan National University's Medical School, 2022) Agarwal, Ashok; Gupta, Sajal; Sharma, Rakesh K.; Finelli, Renata; Kuroda, Shinnosuke; Vij, Sarah C.; Boitrelle, Florence; Kavoussi, Parviz; Rambhatla, Amarnath; Saleh, Ramadan; Chung, Eric; Mostafa, Taymour; Zini, Armand; Ko, Edmund; Parekh, Neel; Martinez, Marlon; Arafa, Mohamed; Tadros, Nicholas; Rosette, Jean de la; Le, Tan V.; Rajmil, Osvaldo; Kandil, Hussein; Blecher, Gideon; Liguor, Giovanni; Caroppo, Ettore; Ho, Christopher C.K.; Altman, Andrew; Bajic, Petar; Goldfarb, David; Gill, Bradley; Zylbersztejn, Daniel Suslik; Molina, Juan Manuel Corral; Gava, Marcello M.; Cardoso, Joao Paulo Greco; Kosgi, Raghavender; Çeker, Gökhan; Zilaitiene, Birute; Pescatori, Edoardo; Borges Jr, Edson; Duarsa, Gede Wirya Kusuma; Pinggera, Germar-Michael; Busetto, Gian Maria; Balercia, Giancarlo; Franco, Giorgio; Çalik, Gökhan; Sallam, Hassan N.; Park, Hyun Jun; Ramsay, Jonathan; Alvarez, Juan; Khalafalla, Kareim; Bowa, Kasonde; Hakim, Lukman; Simopoulou, Mara; Rodriguez, Marcelo Gabriel; Sabbaghian, Marjan; Elbardisi, Haitham; Timpano, Massimiliano; Altan, Mesut; Elkhouly, Mohamed; Al-Marhoon, Mohamed S.; Gilani, Mohammad Ali Sadighi; Soebadi, Mohammad Ayodhia; Nasr-Esfahani, Mohammad Hossein; Garrido, Nicolas; Vogiatzi, Paraskevi; Birowo, Ponco; Patel, Premal; Javed, Qaisar; Ambar, Rafael F.; Adriansjah, Ricky; AlSaid, Sami; Micic, Sava; Lewis, Sheena E.; Mutambirwa, Shingai; Fukuhara, Shinichiro; Parekattil, Sijo; Ahn, Sun Tae; Jinda, Sunil; Takeshima, Teppei; Puigvert, Ana; Amano, Toshiyasu; Barrett, Trenton; Toprak, Tuncay; Malhotra, Vineet; Atmoko, Widi; Yumura, Yasushi; Morimoto, Yoshiharu; Lima, Thiago Fernandes Negris; Kunz, Yannic; Kato, Yuki; Umemoto, Yukihiro; Colpi, Giovanni M.; Durairajanayagam, Damayanthi; Shah, RupinPurpose: The success of vasectomy is determined by the outcome of a post-vasectomy semen analysis (PVSA). This article describes a step-by-step procedure to perform PVSA accurately, report data from patients who underwent post vasectomy semen analysis between 2015 and 2021 experience, along with results from an international online survey on clinical practice. Materials and Methods: We present a detailed step-by-step protocol for performing and interpretating PVSA testing, along with recommendations for proficiency testing, competency assessment for performing PVSA, and clinical and laboratory scenarios. Moreover, we conducted an analysis of 1,114 PVSA performed at the Cleveland Clinic’s Andrology Laboratory and an online survey to understand clinician responses to the PVSA results in various countries. Results: Results from our clinical experience showed that 92.1% of patients passed PVSA, with 7.9% being further tested. A total of 78 experts from 19 countries participated in the survey, and the majority reported to use time from vasectomy rather than the number of ejaculations as criterion to request PVSA. A high percentage of responders reported permitting unprotected intercourse only if PVSA samples show azoospermia while, in the presence of few non-motile sperm, the majority of responders suggested using alternative contraception, followed by another PVSA. In the presence of motile sperm, the majority of participants asked for further PVSA testing. Repeat vasectomy was mainly recommended if motile sperm were observed after multiple PVSA’s. A large percentage reported to recommend a second PVSA due to the possibility of legal actions. Conclusions: Our results highlighted varying clinical practices around the globe, with controversy over the significance of non-motile sperm in the PVSA sample. Our data suggest that less stringent AUA guidelines would help improve test compliance. A large longitudinal multi-center study would clarify various doubts related to timing and interpretation of PVSA and would also help us to understand, and perhaps predict, recanalization and the potential for future failure of a vasectomy.
