Asymptomatic male with grade 3 left varicocele and two children desiring vasectomy with low testosterone

Univ Fed Sao Paulo, Sao Paulo Hosp, Dept Surg, Div Urol,Human Reprod Sect, Rua Napoleao Barros,715-2 Andar, BR-04024002 Sao Paulo, BrazilUniv Fed Sao Paulo, Sao Paulo Hosp, Dept Surg, Div Urol,Human Reprod Sect, Rua Napoleao Barros,715-2 Andar, BR-04024002 Sao Paulo, BrazilWeb of Scienc

A PTHi pode prever as variações do cálcio após tiroidectomia total?

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Polycystic ovary syndrome (PCOS) is an endocrine-metabolic disorder that leads to lower natural reproductive potential and presents a challenge for assisted reproductive medicine because patients may exhibit immature oocyte retrieval and a higher risk of ovarian hyper stimulation syndrome during in vitro fertilization (IVF) treatment. This study aimed to identify potential lipid biomarkers for women with PCOS and a hyper response to controlled ovarian stimulation. Follicular fluid samples were collected from patients who underwent IVF, including normal responder women who became pregnant (control group, n = 11), women with PCOS and a hyper response to gonadotropins (PCOS group, n = 7) and women with only hyper response to gonadotropins (HR group, n = 7). A lipidomic analysis was performed by electrospray ionization mass spectrometry, and candidate biomarkers were analyzed by tandem mass spectrometry experiment. The lipid profiles indicated particularities related to differences in phosphatidylcholine (PCOS and HR), phosphatidylserine, phosphatydilinositol and phosphatidylglycerol (control), sphingolipids (PCOS) and phosphatidylethanolamine (control and HR). These findings contribute to the understanding of the molecular mechanisms associated with lipid metabolism in the PCOS-related hyper response, and strongly suggest that these lipids may be useful as biomarkers, leading to the development of more individualized treatment for pregnancy outcome.Polycystic ovary syndrome (PCOS) is an endocrine-metabolic disorder that leads to lower natural reproductive potential and presents a challenge for assisted reproductive medicine because patients may exhibit immature oocyte retrieval and a higher risk of324554CNPQ - CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICOFAPESP - FUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULOConselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)FAPESP [2012/06389-4]sem informação2012/06389-4This work was supported by CNPq (National Council for Scientific and Technological Development), Brazil and by grant 2012/06389-4, São Paulo Research Foundation (FAPESP

Male Oxidative Stress Infertility (MOSI): Proposed Terminology and Clinical Practice Guidelines for Management of Idiopathic Male Infertility

Despite advances in the field of male reproductive health, idiopathic male infertility, in which a man has altered semen characteristics without an identifiable cause and there is no female factor infertility, remains a challenging condition to diagnose and manage. Increasing evidence suggests that oxidative stress (OS) plays an independent role in the etiology of male infertility, with 30% to 80% of infertile men having elevated seminal reactive oxygen species levels. OS can negatively affect fertility via a number of pathways, including interference with capacitation and possible damage to sperm membrane and DNA, which may impair the sperm’s potential to fertilize an egg and develop into a healthy embryo. Adequate evaluation of male reproductive potential should therefore include an assessment of sperm OS. We propose the term Male Oxidative Stress Infertility, or MOSI, as a novel descriptor for infertile men with abnormal semen characteristics and OS, including many patients who were previously classified as having idiopathic male infertility. Oxidation-reduction potential (ORP) can be a useful clinical biomarker for the classification of MOSI, as it takes into account the levels of both oxidants and reductants (antioxidants). Current treatment protocols for OS, including the use of antioxidants, are not evidence-based and have the potential for complications and increased healthcare-related expenditures. Utilizing an easy, reproducible, and cost-effective test to measure ORP may provide a more targeted, reliable approach for administering antioxidant therapy while minimizing the risk of antioxidant overdose. With the increasing awareness and understanding of MOSI as a distinct male infertility diagnosis, future research endeavors can facilitate the development of evidence-based treatments that target its underlying cause

Male Oxidative Stress Infertility (MOSI):proposed terminology and clinical practice guidelines for management of idiopathic male infertility

Despite advances in the field of male reproductive health, idiopathic male infertility, in which a man has altered semen characteristics without an identifiable cause and there is no female factor infertility, remains a challenging condition to diagnose and manage. Increasing evidence suggests that oxidative stress (OS) plays an independent role in the etiology of male infertility, with 30% to 80% of infertile men having elevated seminal reactive oxygen species levels. OS can negatively affect fertility via a number of pathways, including interference with capacitation and possible damage to sperm membrane and DNA, which may impair the sperm's potential to fertilize an egg and develop into a healthy embryo. Adequate evaluation of male reproductive potential should therefore include an assessment of sperm OS. We propose the term Male Oxidative Stress Infertility, or MOSI, as a novel descriptor for infertile men with abnormal semen characteristics and OS, including many patients who were previously classified as having idiopathic male infertility. Oxidation-reduction potential (ORP) can be a useful clinical biomarker for the classification of MOSI, as it takes into account the levels of both oxidants and reductants (antioxidants). Current treatment protocols for OS, including the use of antioxidants, are not evidence-based and have the potential for complications and increased healthcare-related expenditures. Utilizing an easy, reproducible, and cost-effective test to measure ORP may provide a more targeted, reliable approach for administering antioxidant therapy while minimizing the risk of antioxidant overdose. With the increasing awareness and understanding of MOSI as a distinct male infertility diagnosis, future research endeavors can facilitate the development of evidence-based treatments that target its underlying cause

Post-vasectomy semen analysis: Optimizing laboratory procedures and test interpretation through a clinical audit and global survey of practices

Purpose: 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.American Center for Reproductive Medicin

Consensus and Diversity in the Management of Varicocele for Male Infertility: Results of a Global Practice Survey and Comparison with Guidelines and Recommendations

PURPOSE: 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

The Global State of Contemporary Andrology Practice:A Comprehensive Analysis of Clinical Practice, Training Pathways, and Emerging Challenges

PURPOSE: This study evaluates the current state of andrology practice worldwide, identifies challenges faced by clinicians, and explores training, certification, and research opportunities. It also seeks to redefine the qualifications necessary to be recognized as an andrologist and to propose areas for standardization and improvement.MATERIALS AND METHODS: A global, cross-sectional survey was conducted using a 48-question online questionnaire designed by international experts. The survey, distributed in English, covered various domains of modern andrology practice. Responses from 405 participants across 59 countries were analyzed using R version 4.1.2, with categorical variables reported as frequencies and percentages.RESULTS: Among respondents, 47.3% held medical doctor (MD) degrees, with urologists (31.1%) and clinical andrologists (25.3%) being the most represented specialties. Formal, board-certified andrological training was reported as available in only 48.1% of countries. While half of the respondents identified as andrologists based on experience, only one-third did so through certification, obtained from diverse, nationally recognized organizations. The primary areas of practice included male infertility (36.7%), male sexual dysfunction (27.2%), and sexually transmitted infections (14.5%). Many participants were actively engaged in assisted reproductive technologies, imaging, and andrological surgical emergencies. Despite strong interest in clinical, basic, and translational research, respondents highlighted significant challenges, including inconsistent training pathways, insufficient certification standards, and the complexity of managing diverse andrological conditions.CONCLUSIONS: Andrology is an evolving multidisciplinary specialty where board-certified urologists, clinical andrologists, and reproductive medicine specialists collaborate to address male reproductive and sexual health challenges. Despite their advanced competencies in medical, surgical, and laboratory interventions, specialists face significant global disparities in training and certification. This survey highlights the urgent need for standardized training, evidence-based guidelines, and unified certification to ensure consistency, enhance patient care, and advance andrology's academic and clinical excellence worldwide.</p

Proteomic analysis of seminal plasma in adolescents with and without varicocele

Introdução: A varicocele, definida como uma dilatacao anormal das veias testiculares e de aparecimento peripuberal, acomete cerca de 25% dos adolescentes. Essa doenca e a principal causa tratavel de infertilidade masculina. A principal indicacao de correcao cirurgica da varicocele em adolescentes baseia-se na evidencia de retardo do crescimento testicular ipsilateral a varicocele ou, na sua ausencia, em seguimentos anuais com espermograma para deteccao de alteracoes seminais. Com o advento da proteomica, uma das formas de estudar o funcionamento dos sistemas biologicos, tornou-se possivel identificar e caracterizar proteinas envolvidas na regulacao da funcao espermatica existentes no plasma seminal. Objetivos: Comparar o perfil proteomico do plasma seminal de pacientes com varicocele e alteracao na qualidade seminal com pacientes com varicocele sem alteracao seminal e com controles sem varicocele. Metodo: Os adolescentes foram recrutados na Escola SENAI - São Paulo no periodo compreendido entre 2009 e 2010, sendo todos examinados por um unico urologista e recrutados para o estudo 67 meninos. Os adolescentes foram distribuidos em tres grupos distintos: grupo controle (em varicocele ou varicocele grau I) com 21 individuos, grupo varicocele com semen normal (VSN) com 28 individuos e grupo varicocele semen alterado (VSA) com 18 individuos. Duas amostras seminais de cada adolescente foram obtidas e analisadas de acordo com os parametros da OMS de 1999 e morfologia segundo Kruger (1986) com um periodo entre coletas de uma semana. O perfil proteomico do plasma seminal foi avaliado inicialmente atraves de eletroforese bidimensional de proteinas em gel de poliacrilamida. As proteinas foram quantificadas e amostradas em pools de amostras de cada grupo. Em seguida as amostras foram avaliadas em quadruplicatas. As proteinas foram separadas por eletroforese bidimensional de proteinas em uma fita de 18cm, pI 3-10 em gel de gradiente 10-17,5%. Os geis foram corados, digitalizados e comparados atraves do ImageMaster 2D platinum 7.0. Os spots de interesse (estatisticamente diferentes entre os grupos) foram retirados dos geis e as proteinas foram identificadas atraves de ESI-Quad-ToF MS/MS (espectrometria de massas) utilizando o software Mascot para a busca em banco de dados. O site do UniProt (SWISSPROT) foi consultado para identificacao final das proteinas. Resultados: Como resultado da eletroforese bidimensional, 322 spots foram identificados e 47 spots de interesse foram removidos para posterior analise com espectrometria de massas. Deste total, 4 spots mostraram-se comuns aos 3 grupos, 4 exclusivos aos grupos Controle e VSA, 1 exclusivo ao grupo VSN e VSA, 27 exclusivos ao grupo controle, 5 exclusivos ao grupo VSN e 6 exclusivos ao grupo VSA. Conclusao: A varicocele clinica com ou sem alteracao seminal promove alteracoes no perfil proteico do plasma seminal. As diferencas das expressoes proteicas entre adolescentes com e sem varicocele devem ser estudadas para o melhor entendimento de suas funcoes junto ao espermatozoide, promovendo a aquisicao de biomarcadores precoces de dano a funcao espermaticaBV UNIFESP: Teses e dissertaçõe

O papel da crioanestesia em um modelo de hipóxia e isquemia neonatal em ratos

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