Predictors For TESE Outcomes and Fertility Potentials Among Infertile Adult Men

Background: Spermatogenesis is an essential process for human reproduction.   Gonadotropin-releasing hormone (GnRH), luteinizing hormone (LH), follicle-stimulating hormone (FSH), and testosterone play vital roles in the development and maturation of sperm. Growth hormone (GH) is thought to play a role in the reproductive system of both males and females. Growth Hormone deficiency can lead to reproductive problems. Aim: to assess predictors of fertility potentials and TESE outcomes among adult males. Methods: we enrolled 162 males and assessed FSH, LH, basal GH, clonidine (GH) stimulation test one time and insulin stimulation test in another time. We designed a predictive model to identify the fertility potentials, Fertility Score= 4.442 + (Basal GH*0.074) + (GH_CLON*0.035) - (FSH*0.021) (BMI*0.062)- (Smoker*0.429). The net result of this equation should be approximated to the nearest integer to predict the fertility status where, 1=TESE Negative, 2= TESE Positive, 3=Oligozoospermia, and 4= Fertile control. Results: multivariate analysis showed smoking status, testicular volume, BMI, Serum FSH, basal GH are not predictors for fertility potentials. GH after clonidine and after insulin stimulation GH after clonidine stimulation correlates positively with total motile count. Other semen parameters do not correlate with basal GH or GH after insulin or clonidine stimulation. Receiver Operator Characteristic (ROC) curve analysis is used to detect the cut off levels at which sperm recovery yield change. For the GH assessment only, the basal GH could be applied to predict the SRR in men with azoospermia, AUC=0.672 (95% CI: 0.499 to 0.844). Growth hormone after clonidine (AUC= 0.510) or Insulin stimulation (AUC=0.556) and therefore, cannot differentiate between TESE positive and TESE negative cases. Conclusion: Basal, post clonidine GH levels, has BMI and smoking are predictive factors for fertility potentials, our model have high sensitivity in predicting fertility potentials among positive TESE males. Basal GH can significantly predict TESE negative males

Technical Aspects and Clinical Limitations of Sperm DNA Fragmentation Testing in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations

PURPOSE: Sperm DNA fragmentation (SDF) is a functional sperm abnormality that can impact reproductive potential, for which four assays have been described in the recently published sixth edition of the WHO laboratory manual for the examination and processing of human semen. The purpose of this study was to examine the global practices related to the use of SDF assays and investigate the barriers and limitations that clinicians face in incorporating these tests into their practice. MATERIALS AND METHODS: Clinicians managing male infertility were invited to complete an online survey on practices related to SDF diagnostic and treatment approaches. Their responses related to the technical aspects of SDF testing, current professional society guidelines, and the literature were used to generate expert recommendations via the Delphi method. Finally, challenges related to SDF that the clinicians encounter in their daily practice were captured. RESULTS: The survey was completed by 436 reproductive clinicians. Overall, terminal deoxynucleotidyl transferase deoxyuridine triphosphate Nick-End Labeling (TUNEL) is the most commonly used assay chosen by 28.6%, followed by the sperm chromatin structure assay (24.1%), and the sperm chromatin dispersion (19.1%). The choice of the assay was largely influenced by availability (70% of respondents). A threshold of 30% was the most selected cut-off value for elevated SDF by 33.7% of clinicians. Of respondents, 53.6% recommend SDF testing after 3 to 5 days of abstinence. Although 75.3% believe SDF testing can provide an explanation for many unknown causes of infertility, the main limiting factors selected by respondents are a lack of professional society guideline recommendations (62.7%) and an absence of globally accepted references for SDF interpretation (50.3%). CONCLUSIONS: This study represents the largest global survey on the technical aspects of SDF testing as well as the barriers encountered by clinicians. Unified global recommendations regarding clinician implementation and standard laboratory interpretation of SDF testing are crucial

Controversy and Consensus on Indications for Sperm DNA Fragmentation Testing in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations

Purpose: Sperm DNA fragmentation (SDF) testing was recently added to the sixth edition of the World Health Organization laboratory manual for the examination and processing of human semen. Many conditions and risk factors have been associated with elevated SDF; therefore, it is important to identify the population of infertile men who might benefit from this test. The purpose of this study was to investigate global practices related to indications for SDF testing, compare the relevant professional society guideline recommendations, and provide expert recommendations. Materials and Methods: Clinicians managing male infertility were invited to take part in a global online survey on SDF clinical practices. This was conducted following the CHERRIES checklist criteria. The responses were compared to professional society guideline recommendations related to SDF and the appropriate available evidence. Expert recommendations on indications for SDF testing were then formulated, and the Delphi method was used to reach consensus. Results: The survey was completed by 436 experts from 55 countries. Almost 75% of respondents test for SDF in all or some men with unexplained or idiopathic infertility, 39% order it routinely in the work-up of recurrent pregnancy loss (RPL), and 62.2% investigate SDF in smokers. While 47% of reproductive urologists test SDF to support the decision for varicocele repair surgery when conventional semen parameters are normal, significantly fewer general urologists (23%; p=0.008) do the same. Nearly 70% would assess SDF before assisted reproductive technologies (ART), either always or for certain conditions. Recurrent ART failure is a common indication for SDF testing. Very few society recommendations were found regarding SDF testing. Conclusions: This article presents the largest global survey on the indications for SDF testing in infertile men, and demonstrates diverse practices. Furthermore, it highlights the paucity of professional society guideline recommendations. Expert recommendations are proposed to help guide clinicians

Technical aspects and clinical limitations of sperm DNA fragmentation testing in male infertility: A global survey, current guidelines, and expert recommendations

Purpose Sperm DNA fragmentation (SDF) is a functional sperm abnormality that can impact reproductive potential, for which four assays have been described in the recently published sixth edition of the WHO laboratory manual for the examination and processing of human semen. The purpose of this study was to examine the global practices related to the use of SDF assays and investigate the barriers and limitations that clinicians face in incorporating these tests into their practice. Materials and Methods Clinicians managing male infertility were invited to complete an online survey on practices related to SDF diagnostic and treatment approaches. Their responses related to the technical aspects of SDF testing, current professional society guidelines, and the literature were used to generate expert recommendations via the Delphi method. Finally, challenges related to SDF that the clinicians encounter in their daily practice were captured. Results The survey was completed by 436 reproductive clinicians. Overall, terminal deoxynucleotidyl transferase deoxyuridine triphosphate Nick-End Labeling (TUNEL) is the most commonly used assay chosen by 28.6%, followed by the sperm chromatin structure assay (24.1%), and the sperm chromatin dispersion (19.1%). The choice of the assay was largely influenced by availability (70% of respondents). A threshold of 30% was the most selected cut-off value for elevated SDF by 33.7% of clinicians. Of respondents, 53.6% recommend SDF testing after 3 to 5 days of abstinence. Although 75.3% believe SDF testing can provide an explanation for many unknown causes of infertility, the main limiting factors selected by respondents are a lack of professional society guideline recommendations (62.7%) and an absence of globally accepted references for SDF interpretation (50.3%). Conclusions This study represents the largest global survey on the technical aspects of SDF testing as well as the barriers encountered by clinicians. Unified global recommendations regarding clinician implementation and standard laboratory interpretation of SDF testing are crucial

Controversy and consensus on the management of elevated sperm DNA fragmentation in male infertility: A global survey, current guidelines, and expert recommendations

Purpose Sperm DNA fragmentation (SDF) has been associated with male infertility and poor outcomes of assisted reproductive technology (ART). The purpose of this study was to investigate global practices related to the management of elevated SDF in infertile men, summarize the relevant professional society recommendations, and provide expert recommendations for managing this condition. Materials and Methods An online global survey on clinical practices related to SDF was disseminated to reproductive clinicians, according to the CHERRIES checklist criteria. Management protocols for various conditions associated with SDF were captured and compared to the relevant recommendations in professional society guidelines and the appropriate available evidence. Expert recommendations and consensus on the management of infertile men with elevated SDF were then formulated and adapted using the Delphi method. Results A total of 436 experts from 55 different countries submitted responses. As an initial approach, 79.1% of reproductive experts recommend lifestyle modifications for infertile men with elevated SDF, and 76.9% prescribe empiric antioxidants. Regarding antioxidant duration, 39.3% recommend 4–6 months and 38.1% recommend 3 months. For men with unexplained or idiopathic infertility, and couples experiencing recurrent miscarriages associated with elevated SDF, most respondents refer to ART 6 months after failure of conservative and empiric medical management. Infertile men with clinical varicocele, normal conventional semen parameters, and elevated SDF are offered varicocele repair immediately after diagnosis by 31.4%, and after failure of antioxidants and conservative measures by 40.9%. Sperm selection techniques and testicular sperm extraction are also management options for couples undergoing ART. For most questions, heterogenous practices were demonstrated. Conclusions This paper presents the results of a large global survey on the management of infertile men with elevated SDF and reveals a lack of consensus among clinicians. Furthermore, it demonstrates the scarcity of professional society guidelines in this regard and attempts to highlight the relevant evidence. Expert recommendations are proposed to help guide clinicians

The urban incubator: (De)constructive (re)presentation of heterotopian spatiality and virtual image(ries)

This paper provides an imaginary navigation with the camera’s eye to grasp the psychogeography of post-modern urban spatial fragments, whilst considering the proliferation and fragmentation in production and consumption of phantasmagoric other (‘unconscious’ and ‘hidden’) urban spaces. Through an 'imaginary' Urban Incubator, the paper proposes a (de)(re)constructive reading of a conflation of real cities under space-time compression, mapped into fictional terrain of heterotopian imagery and virtuality. Such urban experimentation within cit(y)(ies) involves a sequence of digital images and video stills, constructing spatio-temporal narratives as means of navigation between imaginary (sense of) place identity, and cognitive imaging. In an attempt to capture the spirit of the 'nocturnal city' as an 'urban navigator' or as a 'flâneur', other (unconscious and hidden) urban spaces in various metropolises are represented as digital collages, experimental diagrams, virtual installations, visual semiotics, and spatial narratives. Digital fragments and diagrams will bring urban images into sharp juxtaposition, 'de-solidifying' the physical and dissolving spatial distinctions between reality and mythical spaces, between the screen and the imagination, between the virtual urbanity of the information machine and the actual urbanity of the city. Such representation will call into play the possibility of a coterminous and dialectic merging of very real city of bricks and a conceptual 'city of pixels'

Cairo’s Contested Garbage: Sustainable Solid Waste Management and the Zabaleen’s Right to the City

Over the decades, the Zabaleen, the traditional waste (garbage) collectors of Cairo, have created what is arguably one of the world’s most efficient and sustainable resource-recovery and waste-recycling systems. Yet the continuation of this intricate relationship between community, environment and livelihood is jeopardized by the official privatization of municipal solid waste (MSW) services through contracts with technology-intensive multinational corporations which threatens the sustainability of the garbage collectors’ communities by removing access to their chief economic asset, waste or garbage. The situation is exacerbated by an official policy of moving the Zabaleen and their MSW sorting, recovery, trading and recycling activities further out of the city, on the grounds that this will turn their neighbourhoods into cleaner and healthier living environments. The consumption of Cairo’s sites of MSW collection and sorting open new socio-political spaces for conflict between multi-national companies and the Zabaleen’s traditional system. This is further indicated in the way Cairo’s waste materials have been subjected to new claims and conflict, as they are seen as a ‘commodity’ by global capital entrepreneurs and multi-national corporations, and as a source of ‘livelihood’ by the disadvantaged and marginalised Zabaleen population

Cairo’s Contested Garbage: Sustainable Solid Waste Management and the Zabaleen’s Right to the City

Over the decades, the Zabaleen , the traditional waste (garbage) collectors of Cairo, have created what is arguably one of the world’s most efficient and sustainable resource-recovery and waste-recycling systems. Yet the continuation of this intricate relationship between community, environment and livelihood is jeopardized by the official privatization of municipal solid waste (MSW) services through contracts with technology-intensive multinational corporations which threatens the sustainability of the garbage collectors’ communities by removing access to their chief economic asset, waste or garbage. The situation is exacerbated by an official policy of moving the Zabaleen and their MSW sorting, recovery, trading and recycling activities further out of the city, on the grounds that this will turn their neighbourhoods into cleaner and healthier living environments. The consumption of Cairo’s sites of MSW collection and sorting open new socio-political spaces for conflict between multi-national companies and the Zabaleen ’s traditional system. This is further indicated in the way Cairo’s waste materials have been subjected to new claims and conflict, as they are seen as a ‘commodity’ by global capital entrepreneurs and multi-national corporations, and as a source of ‘livelihood’ by the disadvantaged and marginalised Zabaleen population.Cairo-Garbage; City-Zabaleen garbage; collectors-municipal solid waste management

Développement durable au Caire : une provocation ?

Related to the activities of the Urban Studies department at CEDEJ since 2008, this issue is dedicated to environmental issues, but also sustainable development also apprehended in its economic, cultural and, of course, social dimensions. If sustainable development sounds a priori as a provocative question in the case of Cairo, the authors attempt to see how the Egyptian stakeholders would deal with sustainability issues in a non-Western context. This multilingual publication consists of academic papers and interviews with Egyptian professionals that address, through three chapters, waste management issues, first experiences of urban revitalizaton and the question of social cohesion through planning and culture. Reflet des activités du pôle "Villes" du CEDEJ depuis 2008, le numéri présent est dédié aux questions d'environement urbain au Caire, mais également de développement urbain durable pris également dans ses composantes économique, culturelle et bien sûr, sociale. Si le développement durable sonne a priori comme une provocation dans le cas cairote, les auteurs tentent de voir comment les acteurs égyptiens fabriquent le développement durable dans un contexte non-occidental. Composé d'articles de chercheurs, d'interviews d'acteurs égyptiens et d'un lexique, ce numéro multilingue est constitué de trois séquences abordant tour à tour la question de la gestion des déchets, les premières expériences de revitalisation des quartiers centraux et, enfin, la problématique du lien social à travers la culture et la planification