Male Infertility.

Abstract

You have accessJournal of UrologyUrological Survey1 Feb 2022Male Infertility Craig NiederbergerMD Craig NiederbergerCraig Niederberger More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002320AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Re: Semen Impairment and Occurrence of SARS-CoV-2 Virus in Semen after Recovery from COVID-19 M. Gacci, M. Coppi, E. Baldi, A. Sebastianelli, C. Zaccaro, S. Morselli, A. Pecoraro, A. Manera, R. Nicoletti, A. Liaci, C. Bisegna, L. Gemma, S. Giancane, S. Pollini, A. Antonelli, F. Lagi, S. Marchiani, S. Dabizzi, S. Degl'Innocenti, F. Annunziato, M. Maggi, L. Vignozzi, A. Bartoloni, G. M. Rossolini and S. Serni Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, Careggi University Hospital (AOUC), University of Florence, Florence, Italy, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy, Clinical Microbiology and Virology Unit, Florence Careggi University Hospital, Florence, Italy, Unit of Andrology, Female Endocrinology and Gender Incongruence, AOUC and Center of Excellence DeNothe, University of Florence, Florence, Italy, Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy, and Endocrinology Unit and Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy Hum Reprod 2021;36:1520–1529. Editorial Comment: Evidence generally supports at this point that if a man survives COVID-19 infection, the virus clears his reproductive tract. But does the illness affect the making of sperm? These investigators studied semen analyses of 43 men who recovered from COVID-19 and observed that about a quarter had poor seminal parameters that were related to viral disease severity. The relatively limited number of men studied and not knowing their semen analyses prior to illness clearly hampers the interpretation of these results, but the relationship of disease severity to poor parameters suggests a real effect of infection on sperm. At this time of continued need to vaccinate against this dread disease, for those men concerned about fertility, we can say that there's reasonable evidence that COVID hurts sperm and that a vaccine doesn't. Re: Video Visits Are Practical for the Follow-Up and Management of Established Male Infertility Patients J. Andino, A. Zhu, Z. Chopra, S. Daignault-Newton, C. Ellimoottil and J. M. Dupree Michigan Medicine Department of Urology, Ann Arbor, Michigan, and University of Michigan Medical School, Ann Arbor, Michigan Urology 2021;154:158–163. Editorial Comment: The COVID-19 pandemic vastly accelerated telehealth with about 1 billion such visits in the U.S. in 2020. These authors describe their experience with return male fertility patients seen via video during this horrific time, and what caught my eye was their description of patient time and cost savings: “video visits saved patients a median of 80 miles... and 97 minutes of round-trip travel time per visit.” That really spoke to me. I've learned that a full fifth of my patients come in from our neighboring Indiana to my practice in Chicago, Illinois. I've made that drive many times, and the terrible traffic commonly requires several hours each way. I now have nightmares of the lost productivity that I've engendered over decades with so many patients losing days of work only for me to review labs and make medication adjustments. If there's one good thing coming out of this pandemic, it's a complete change in the way we do medicine, bringing us doctors closer to where patients live, a technological reviving of the traditional house call. Suggested Reading Hsiang WR, Honig S and Leapman MS: Evaluation of online telehealth platforms for treatment of erectile dysfunction. J Urol 2021; 205: 330. Stephany HA: Trends in medicine: virtual visits, now and in the future. J Urol 2020; 204: 22. Gadzinski AJ, Gore JL, Ellimoottil C et al: Implementing telemedicine in response to the COVID-19 pandemic. J Urol 2020; 204: 14. Re: Characterizing the Epidemiology and Provider Landscape of Male Infertility Care in the United States R. J. Fantus, K. Alter, C. Chang, S. S. Ambulkar, N. E. Bennett, B. T. Helfand, R. E. Brannigan and J. A. Halpern Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, Department of Urology, Rush University Medical Center, Chicago, Illinois, and Department of Surgery, NorthShore University Health System, Chicago, Illinois Urology 2021;153:169–174. Editorial Comment: Call me biased, but I think a key doctor for a man faced with infertility is a urologist. Urology training includes male reproductive medicine, epidemiology, natural history, comorbidities, anatomy, physiology and surgery. Urologists have led the charge in identifying the relationships of diseases such as the metabolic syndrome and cancer with male reproductive dysfunction, understanding that these often young men are at higher risk for chronic illnesses and should be treated as such. These investigators queried the National Ambulatory Medical Care Survey to determine which doctors are seeing men with infertility, finding the most common provider to be a urologist at about 42% followed by primary care at about 40%. To my surprise, gynecology came in at a distant 7%. Perhaps I'm a rare bird, but few patients come my way by primary care. The authors gingerly posit the importance of a multidisciplinary approach to male fertility, but I'd go farther: if so many are seen by primary care, those providers need more urological input for the good of the patient. Suggested Reading Schlegel PN, Sigman M, Collura B et al: Diagnosis and treatment of infertility in men: AUA/ASRM guideline part I. J Urol 2021; 205: 36. Schlegel PN, Sigman M, Collura B et al: Diagnosis and treatment of infertility in men: AUA/ASRM guideline part II. J Urol 2021; 205: 44. Eisenberg ML, Li S, Brooks JD et al: Increased risk of cancer in infertile men: analysis of U.S. claims data. J Urol 2015; 193: 1596. Re: The Association between Mortality and Male Infertility: Systematic Review and Meta-Analysis F. Del Giudice, A. M. Kasman, T. Chen, E. De Berardinis, G. M. Busetto, A. Sciarra, M. Ferro, G. Lucarelli, F. Belladelli, A. Salonia and M. L. Eisenberg Department of Urology, Stanford University School of Medicine, Stanford, California, Department of Maternal-Infant and Urological Sciences, “Sapienza” University of Rome, Policlinico Umberto I Hospital, Rome, Italy, Department of Urology, European Institute of Oncology (IEO), Milan, Italy, Department of Urology, University of Bari, Bari, Italy, Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy, and Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California Urology 2021;154:148–157. Editorial Comment: Numerous studies support relationships between male infertility and diseases such as cancer and metabolic disease. These authors report results of a meta-analysis correlating death to infertility, finding a higher risk compared to infertile men. That the risk increased with the severity of semen impairment strongly reinforces the argument that mortality and male infertility are related. Interestingly, when compared to men from the general population, infertile men had a lower risk. So while infertility may predispose a man to early demise, other factors are obviously important. Suggested Reading Schlegel PN, Sigman M, Collura B et al: Diagnosis and treatment of infertility in men: AUA/ASRM guideline part I. J Urol 2021; 205: 36. Schlegel PN, Sigman M, Collura B et al: Diagnosis and treatment of infertility in men: AUA/ASRM guideline part II. J Urol 2021; 205: 44. Eisenberg ML, Li S, Brooks JD et al: Increased risk of cancer in infertile men: analysis of U.S. claims data. J Urol 2015; 193: 1596. Re: Functional and Taxonomic Dysbiosis of the Gut, Urine, and Semen Microbiomes in Male Infertility S. D. Lundy, N. Sangwan, N. V. Parekh, M. N. Panner Selvam, S. Gupta, P. McCaffrey, K. Bessoff, A. Vala, A. Agarwal, E. S. Sabanegh, S. C. Vij and C. Eng Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio Genomic Medicine Institute, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, Center for Microbiome and Human Health, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, Vastbiome, Millbrae, California, and Department of Genetics and Genome Sciences and Germline High Risk Cancer Focus Group, Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio Eur Urol 2021;79:826–836. Editorial Comment: Humans carry many microbial passengers: they in fact outnumber human cells by about 10 to 1. Investigators now have the molecular and computational tools to assess our little hitchhikers in health and disease, and these authors did just that with 25 men with primary infertility and 12 healthy men with proven paternity. They collected rectal swabs, semen, urine and controls. With these kinds of studies, like the epigenome, researchers seek patterns that are similar in subjects with disease and that are different from those who are healthy. In this study, the investigators did find a microbial fingerprint in the semen that was somewhat similar to that in the urine and that somewhat distinguished infertile from fertile men. Interestingly, vasectomy appeared to alter the microbiome, indicating that the testis or epididmyis likely contributed to it. With increasingly sophisticated tools, we're finding that our microbial tourists play an important role in disease, and that includes infertility. © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue 2February 2022Page: 449-451 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Craig Niederberger More articles by this author Expand All Advertisement Advertisement Loading ...