Clinical Andrology Research Articles

7119 Klinefelter Syndrome in a Tertiary Referral Clinic: A Case Series and Clinical Audit

Abstract Disclosure: J. Luo: None. S. Sarlos: None. R. Giri: None. I. Sim: None. R.I. McLachlan: None. C.A. Allan: None. R. Upreti: None. Background: Klinefelter syndrome, the most common chromosomal disorder in men, remains underdiagnosed in many of those affected. Klinefelter syndrome is associated with hypogonadism and infertility, as well as an increased risk for venous thromboembolism (VTE), cardiometabolic disease, osteoporosis and gynaecomastia in adults. We studied the clinical features and disease associations in a tertiary referral cohort, and audited the care provided. Methods: Following ethics approval, adult patients with Klinefelter syndrome attending a Clinical Andrology Service in a tertiary Australian institution since 1 January 2011 were recruited. A database was established and demographics, aspects of initial diagnosis, ongoing treatments and comorbidities were documented. We audited our care using the European Academy of Andrology 2021 Guidelines for Klinefelter Syndrome. Results: Of 94 patients eligible, 57 patients consented to participation. The median age of diagnosis was 28 years, with the most common karyotype being 47,XXY (74%), followed by mosaic (20%) and higher degree polysomy (6%). Infertility (44%) and hypogonadism (33%) were the most common reasons for diagnosis. Most patients (88%) were treated with testosterone. Five men (11%) had genetic children with seven (18%) having previously attempted surgical sperm extraction. VTE occurred in seven patients (12%), with five on long-term anticoagulation following VTE diagnosis. Cardiovascular risk factor prevalence assessed at a median age of 42 years included increased BMI (72%), hypertension (25%), dyslipidaemia (70%), tobacco use (26%), impaired fasting glucose (11%) and type 2 diabetes (22%), though only one patient had a previous cardiovascular event. Osteopenia and osteoporosis were present in 28% and 4% of patients respectively, though only two patients had minimal trauma fractures. The audit of longitudinal care showed that gynaecomastia status was underreported (42%) in our clinic, whilst assessment and management of other health domains were mostly in keeping with the current recommendations. Conclusions: Klinefelter syndrome diagnosis continues to be delayed until adulthood in many men, with presentations most commonly involving infertility and/or hypogonadism. Our tertiary cohort demonstrates low rates of fertility treatment and success, which is likely multifactorial. There is a high burden of VTE, cardiovascular risk factors and reduced bone density despite testosterone treatment. Low rates of cardiovascular events and fracture may be reflective of a younger cohort as well as more aggressive risk factor management in a sub-specialist service. Gynaecomastia identification, documentation and management are areas for potential improvement. Increased awareness of Klinefelter syndrome and research into its associated risks are essential for standardising care and improving long-term outcomes. Presentation: 6/1/2024

7119 Klinefelter Syndrome in a Tertiary Referral Clinic: A Case Series and Clinical Audit

Abstract Disclosure: J. Luo: None. S. Sarlos: None. R. Giri: None. I. Sim: None. R.I. McLachlan: None. C.A. Allan: None. R. Upreti: None. Background: Klinefelter syndrome, the most common chromosomal disorder in men, remains underdiagnosed in many of those affected. Klinefelter syndrome is associated with hypogonadism and infertility, as well as an increased risk for venous thromboembolism (VTE), cardiometabolic disease, osteoporosis and gynaecomastia in adults. We studied the clinical features and disease associations in a tertiary referral cohort, and audited the care provided. Methods: Following ethics approval, adult patients with Klinefelter syndrome attending a Clinical Andrology Service in a tertiary Australian institution since 1 January 2011 were recruited. A database was established and demographics, aspects of initial diagnosis, ongoing treatments and comorbidities were documented. We audited our care using the European Academy of Andrology 2021 Guidelines for Klinefelter Syndrome. Results: Of 94 patients eligible, 57 patients consented to participation. The median age of diagnosis was 28 years, with the most common karyotype being 47,XXY (74%), followed by mosaic (20%) and higher degree polysomy (6%). Infertility (44%) and hypogonadism (33%) were the most common reasons for diagnosis. Most patients (88%) were treated with testosterone. Five men (11%) had genetic children with seven (18%) having previously attempted surgical sperm extraction. VTE occurred in seven patients (12%), with five on long-term anticoagulation following VTE diagnosis. Cardiovascular risk factor prevalence assessed at a median age of 42 years included increased BMI (72%), hypertension (25%), dyslipidaemia (70%), tobacco use (26%), impaired fasting glucose (11%) and type 2 diabetes (22%), though only one patient had a previous cardiovascular event. Osteopenia and osteoporosis were present in 28% and 4% of patients respectively, though only two patients had minimal trauma fractures. The audit of longitudinal care showed that gynaecomastia status was underreported (42%) in our clinic, whilst assessment and management of other health domains were mostly in keeping with the current recommendations. Conclusions: Klinefelter syndrome diagnosis continues to be delayed until adulthood in many men, with presentations most commonly involving infertility and/or hypogonadism. Our tertiary cohort demonstrates low rates of fertility treatment and success, which is likely multifactorial. There is a high burden of VTE, cardiovascular risk factors and reduced bone density despite testosterone treatment. Low rates of cardiovascular events and fracture may be reflective of a younger cohort as well as more aggressive risk factor management in a sub-specialist service. Gynaecomastia identification, documentation and management are areas for potential improvement. Increased awareness of Klinefelter syndrome and research into its associated risks are essential for standardising care and improving long-term outcomes. Presentation: 6/1/2024

Biomarker-based human and animal sperm phenotyping: the good, the bad and the ugly†.

Conventional, brightfield-microscopic semen analysis provides important baseline information about sperm quality of an individual; however, it falls short of identifying subtle subcellular and molecular defects in cohorts of "bad," defective human and animal spermatozoa with seemingly normal phenotypes. To bridge this gap, it is desirable to increase the precision of andrological evaluation in humans and livestock animals by pursuing advanced biomarker-based imaging methods. This review, spiced up with occasional classic movie references but seriously scholastic at the same time, focuses mainly on the biomarkers of altered male germ cell proteostasis resulting in post-testicular carryovers of proteins associated with ubiquitin-proteasome system. Also addressed are sperm redox homeostasis, epididymal sperm maturation, sperm-seminal plasma interactions, and sperm surface glycosylation. Zinc ion homeostasis-associated biomarkers and sperm-borne components, including the elements of neurodegenerative pathways such as Huntington and Alzheimer disease, are discussed. Such spectrum of biomarkers, imaged by highly specific vital fluorescent molecular probes, lectins, and antibodies, reveals both obvious and subtle defects of sperm chromatin, deoxyribonucleic acid, and accessory structures of the sperm head and tail. Introduction of next-generation image-based flow cytometry into research and clinical andrology will soon enable the incorporation of machine and deep learning algorithms with the end point of developing simple, label-free methods for clinical diagnostics and high-throughput phenotyping of spermatozoa in humans and economically important livestock animals.

A bibliometric perspective with research trends and global productivity on the modernization of andrology from the founder of modern clinical andrology Edward Martin to the present.

The number of studies in the field of andrology is increasing day by day, but a bibliometric study covering the entire literature on andrology has not yet been conducted. This bibliometric study aims to shed light on the question of where we came from and where we are going in andrology from past to present. It also aimed to summarize the intellectual structure of andrology to reveal global productivity and identify and map the latest trends of scientific articles published in the field of andrology. 16,659 articles published between 1980 and 2022 were extracted from the Web of Science and analyzed using various statistical methods. Bibliometric network visualization maps revealed trending topics, global productivity, the most influential studies, and international collaborations. Spearman's correlation analysis was used for determining correlations. The top three productive countries were United States of America (3,452; 20.7%), China (2,300; 13.8%), and Germany (1,069; 6.4%). The top two most productive authors were Agarwal A. (n=130) and Nieschlag E. (n=130). The most productive institution was the Egyptian Knowledge Bank (n=422). From past to present, the most studied subjects were testis, male infertility, spermatozoa, testosterone, infertility, erectile dysfunction, spermatogenesis, sperm, prostate cancer (PCA)/neoplasms, oxidative stress, fertility/fertilization, semen, rat(s), apoptosis, azoospermia, sperm motility, human and varicocele. The trend topics that have been researched more in recent years include erectile dysfunction, oxidative stress, prostate cancer, sperm quality, sperm parameters, infertility, premature ejaculation, diabetes mellitus, obesity, prognosis, sperm DNA fragmentation/damage, antioxidant, asthenozoospermia, varicocelectomy, COVID-19, inflammation, prostatectomy, metabolic syndrome, hypogonadism, benign prostatic hyperplasia, lower urinary tract symptoms, meta-analysis, sexual dysfunction, peyronie's disease, and proliferation. We identified the research leadership of China, Japan, Turkey and India, in addition to Western countries, such as the USA and European countries.

O-285 The 6th edition of the WHO manual for the examination and processing of human semen: How should it affect our practice?

Abstract The WHO laboratory manual (World Health Organization 2021) has widened the scope of semen examination from primarily a prognostic tool for Medically Assisted Reproduction (MAR) by indicating the importance of evaluating men with possible disorders in male reproductive functions. Practical instructions for basic examination have been clarified and focused to measures of sperm production and motility as judged from sperm number, motility (vitality if poor motility) and sperm morphology. In addition to the recommendations by the WHO, an international standard based on the same laboratory science as the WHO manual has been published (International Organization for Standardization 2021) to facilitate for laboratories to provide reliable results of semen examination. Each ejaculate must be handled with great care before analysis begins. Time and temperature between sample collection and start of assessments is crucial. To reduce assessment variability, it is essential to ascertain that the examined aliquots are representative for the entire ejaculate and that the number of observations is sufficient to reduce the risk for significant influence of random factors. The former is handled both by aliquot volume (at least 50 µL for sperm concentration) and replicate assessment and comparison that the two assessments don’t differ too much. Regarding number of observations, 400 sperm counted in sperm concentration and in sperm motility assessments is required to reduce this source of errors to ± 10%. For assessment of sperm morphology and vitality a minimum number of observations is 200 spermatozoa. To achieve acceptable performance, thorough in-house training is necessary. There are protocols how to set up and run such schemes (Mortimer 1994, 1994). Basic medical laboratory standards also require that the laboratory regularly performs internal quality control to monitor that inter- and intra-personal variability is under control. Each laboratory should also participate in an external scheme for quality assessment (EQA) (International Organization for Standardization 2012). For the proper interpretation of semen examination results reference limits are important. However, the reference limits suggested by the WHO (World Health Organization 2021) come from a very mixed group of men and should therefore not be mistaken for true limits between fertility and infertility. The new WHO manual therefore argues for development of decision limits (when is it reasonable to act?) that are much more important than limits from a mixed population. It has been argued that semen examination must be better standardized (Björndahl et al. 2016), but the compliance has been almost non-existent (Vasconcelos et al. 2022) leading to even stronger appeals for stronger improvement of basic laboratory investigations of male reproductive functions (Björndahl et al. 2022) References Björndahl L, Barratt CL, Mortimer D, and Jouannet P. ‘How to count sperm properly': checklist for acceptability of studies based on human semen analysis. Hum Reprod 2016: 31; 227-232. Björndahl L, Barratt CLR, Mortimer D, Agarwal A, Aitken RJ, Alvarez JG, Aneck-Hahn N, Arver S, Baldi E, Bassas L, et al. Standards in semen examination: publishing reproducible and reliable data based on high-quality methodology. Hum Reprod 2022. International Organization for Standardization. ISO 15189:2012 Medical Laboratories – Requirements for Quality and Competence 2012. Geneva. International Organization for Standardization. ISO 23162:2021 Basic semen examination — Specification and test methods 2021. ISO, Geneva. Mortimer D. Laboratory standards in routine clinical andrology. Reproductive Medicine Review 1994: 3; 97-111. Mortimer D. Practical Laboratory Andrology 1994. Oxford University Press, Oxford. Vasconcelos AL, Campbell MJ, Barratt CLR, and Gellatly SA. Do studies published in two leading reproduction journals between 2011 and 2020 demonstrate that they followed WHO5 recommendations for basic semen analysis? Hum Reprod 2022. World Health Organization. WHO laboratory manual for the examination and processing of human semen. 6th edn, 2021. World Health Organization, Geneva.

Productivity Index in Clinical Andrology: Research Directions on High-Impact Topics and in Particular on Male Infertility.

Andrological diseases have an important social and economic impact as they cause a serious impairment of the quality of life of the affected patient. Epidemiologically, the impact of these disorders is progressively increasing, as demonstrated by the ever-growing prevalence of male infertility. This evidence justifies the rapid development of research in andrology that the scientific community has undertaken in recent decades. This study aims to evaluate the productivity index of the main andrological topics studied and reported in the literature. The total number of published articles was extracted from the Scopus database by entering the following keywords and mesh terms: "Male Infertility", "Erectile Dysfunction", "Premature Ejaculation", "Male Hypogonadism", "Testicular Tumors", "Prostate Cancer", "Prostatic hyperplasia", "Prostate hyperplasia", "Prostatitis", "Prostate inflammation", and "Male Accessory Gland Infections". Furthermore, a list of the top 50 researchers sorted by productivity was created for each topic. For male infertility, a further search was performed by combining the search term "male infertility" with the above-mentioned terms. Thus, a list of the top 30 authors in order of productivity was also extracted. The graphs were created using Excel. As could be expected, we observed that prostate cancer and male infertility were the two most investigated topics, followed by benign prostatic hyperplasia and erectile dysfunction, whose prevalence is set to increase given the progressive aging of the population. Less investigated is the inflammation of the accessory sexual glands. In conclusion, this study provides a ranking of the main andrological topics investigated in the literature, also presenting the top list of the most productive authors for each one.

European Academy of Andrology: Collaboration with other societies and organisations

European Academy of Andrology: Collaboration with other societies and organisations

P-046 Effect of different sperm chromatin dispersion type on IVF/ICSI outcome and offspring profile

Abstract Study question Whether the percentage of different sperm chromatin dispersion type are associated with the IVF/ICSI outcome and offspring profile? Summary answer Percentage of different sperm chromatin dispersion type are significantly associated with the embryo cleavage rate, embryo quality, live birth rate and offspring gender. What is known already The sperm DNA fragmentation index (DFI) is increasingly recognized as a key sperm functional parameter for assessing male fertility. Sperm chromatin dispersion (SCD) test is widely used in clinical andrology lab to measure DFI, and according to the size of sperm halo it divides sperm into three categories: big halo sperm, middle halo sperm, small or no halo sperm. Previous study reported that big halo sperm are significantly associated with embryo quality and pregnancy rate. The average halo size of Y-chromosome bearing sperm are significantly smaller than X - chromosome bearing sperm. Study design, size, duration This is a multi-center retrospective study recruited 200 couples underwent IVF/ICSI treatment in Nanfang Hospital and Guangdong Women's and Children's Hospital from May 2018 to May 2019. Participants/materials, setting, methods Patients meet the followed inclusion criteria were recruited: (1) The male partners received sperm chromatin dispersion test; (2) The female partners have normal ovarian reserve (female age < 35 years old, FSH ≤10 IU/L and AFC ≥ 5); (3) Couples received fresh single embryo transfer. The association between sperm chromatin dispersion type and IVF/ICSI outcome and the offspring profile were retrospectively analyzed. Main results and the role of chance Regression analysis showed that the embryo cleavage rate is positively associated with the percentage of sperm with big halo (Adjusted ?????(95% CI) 0.09 (0.01, 0.17), P<0.05), but negatively associated with the percentage of sperm with middle halo (Adjusted ????? (95% CI)- 0.22 (-0.35, -0.09), P<0.001). The good embryo rate is negatively associated with the percentage of sperm with middle halo (Adjusted ????? (95% CI) -0.60 (-1.04, -0.16), P<0.05). Live birth is significantly associated with the percentage of sperm with small halo (Adjusted OR (95% CI) 0.89 (0.80, 1.00), P<0.05). Offspring gender is significantly associated with the percentage of sperm with big halo (Adjusted OR (95% CI) 0.95 (0.91, 0.99), P<0.05) and the percentage of sperm with middle halo (Adjusted OR (95% CI) 1.09 (1.02, 1.17), P<0.05). The area under the receiver operator characteristic (ROC) curve (AUC) of the big halo sperm percentage to predict male offspring is 0.68 (95%CI (0.54, 0.81), P < 0.05). The AUC of middle halo sperm percentage to predict female offspring is 0.66 (95%CI (0.52, 0.80), P < 0.05). Limitations, reasons for caution This is a retrospective study which may have the bias caused by the nature of this type of study. The sample size is relatively small. Wider implications of the findings The percentage of big halo sperm are significantly associated with embryo cleavage rate and male offspring. The percentage of middle halo sperm are significantly associated with embryo cleavage rate, lower good embryo rate and female offspring. The percentage of small halo sperm is significantly associated with live birth. Trial registration number 82101683

Multiparameter Flow Cytometry Assay for Analysis of Nitrosative Stress Status in Human Spermatozoa.

Male infertility is an increasing health problem, and oxidative/nitrosative stress plays an important role in the etiology of this condition. Nitrosative stress due to excessive levels of reactive nitrogen species (RNS) is associated with impaired male fertility. Flow cytometry may be a useful tool for semen evaluation, but the availability of multiparameter assays for analysis of sperm quality is limited. The present study standardized a multiparameter flow cytometry analysis for nitrosative stress status in human spermatozoa in a single assay. A suitable multicolor fluorochrome panel was designed and consisted of fluorescein-boronate to detect peroxynitrite, a highly RNS, propidium iodide to analyze viability, tetramethylrhodamine methyl ester perchlorate to detect mitochondrial membrane potential (MMP) and monobromobimane to analyze thiol oxidation. Proper positive and negative controls for each fluorochrome were used to establish the technique, and sperm cells of different qualities and spermatozoa subjected to cryopreservation were analyzed. The results showed that the controls clearly discriminated between the high and low fluorescence intensities for each fluorochrome. The analysis of sperm cells of different quality demonstrated that the assay properly detected differences in all parameters analyzed according to sperm quality. The results may be reported as the mean fluorescence intensity of each fluorochrome and the percentage of cells exhibiting different characteristics. In conclusion, a protocol was standardized to analyze nitrosative stress status, including peroxynitrite production, viability, MMP, and thiol oxidation, in a single analysis using flow cytometry. This protocol may be applied to research approaches and clinical andrology to improve the evaluation of sperm quality and provide a promising tool to increase the use of clinical flow cytometry. © 2020 International Society for Advancement of Cytometry.

Proteomics and metabolomics - Current and future perspectives in clinical andrology.

Proteomics and metabolomics are emerging as promising tools to investigate the molecular mechanisms associated with male infertility. Proteins and metabolites play a pivotal role in regulating the molecular pathways associated with physiological functions of spermatozoa. Semen analysis, physical examination and laboratory work up cannot identify the etiology of infertility in 30%-40% of cases, which are classified as idiopathic. Therefore, the application of proteomics and metabolomics in the field of andrology will aid to overcome the limitations of the standard semen analysis. Understanding the molecular pathways associated with male infertility will help in planning ad hoc treatments, contributing to the clinical management of infertile patients. In this review, proteomics and metabolomics studies on spermatozoa and seminal plasma are discussed with a focus on molecular biomarkers associated with male infertility-related conditions.

Diagnostic value of routine semen analysis in clinical andrology.

Infertility is a major health issue affecting over 48.5 million couples around the world, with themale factor accounting for about 50% of the cases. The conventional semen analysis recommended by the World Health Organization (WHO) is the cornerstone in the evaluation of male fertility status. It includes macroscopic and microscopic evaluation of the ejaculate, which reflects the production of spermatozoa in the testes, the patency of the duct system and the glandular secretory activity. Evaluation of seminal fructose, sperm vitality and leucocytes (Endtz test) are useful adjuncts to semen analysis that provide information on specific clinical conditions. Though several computer-assisted sperm analysis (CASA) systems have been developed, conventional methods for semen analysis are still widely accepted in clinical practice. This review summarises the conventional techniques used in routine semen analysis and their diagnostic value in clinical andrology.

Low total motile sperm in transgender women seeking hormone therapy.

This study was undertaken to compare semen quality, hormonal status, and social factors in transgender women seeking fertility preservation with those of fertile cisgender men. Long-range goals are to establish standard practice measures ensuring optimum semen quality for cryopreservation and fertility preservation in transgender women. This is a case-control study carried out at an academic medical center. Cases are transgender women seeking fertility preservation prior to initiation of hormone therapy. Controls are cisgender men recently fathering a child. All participants completed the Depression Anxiety Stress Scales 21 survey and additional survey questions related to personal behaviors. Complete semen analysis was carried out in a clinical andrology laboratory according to WHO guidelines, 5th edition. Serum follicle stimulating hormone, estradiol, and testosterone were measured at the time of semen analysis. Sperm concentration, total sperm per ejaculate, total motile sperm, volume, and normal sperm morphology were significantly lower in transgender females compared with fertile cisgender men. Other measures of semen parameters and hormone concentrations were not different between groups. Survey results indicated transgender women were more likely to have symptoms of depression, anxiety, and stress and utilize tucking and tight undergarments, compared with controls; however, both groups reported similar numbers of ejaculations per week. Although semen parameters were low, cryopreservation of sperm prior to hormone therapy is a viable fertility preservation option for most transgender women. The etiology of the differences in semen parameters is not known. Enhanced education related to personal behaviors or treatment to reduce effects of stressors prior to cryopreservation may improve future fertility potential.

EDITORIAL COMMENT

The inconsistent adoption of the WHO 5th edition (2010) semen analysis reporting standard by laboratories is a huge problem in clinical andrology. Although the study by [First author last name] and colleagues has a few methodological shortcomings, its simple design is particularly effective at conveying the magnitude of this widespread problem. For those in a reproductive medicine specialty practice it will not be surprising, but for the rest of the urology community it will be staggering to see that over a third of US laboratories are performing semen analyses according to decades-old standards. 1 Place reference for present study (currently unknown): “Inconsistent Adoption of World Health Organization V (2010) Semen Analysis Reference Ranges in the United States Six Years After Publication” Google Scholar

Flow cytometry analysis of spermatozoa: Is it time for flow spermetry?

Flow cytometry is increasingly used in research and also in clinical andrology. Recent developments in instrumentation, availability of probes and bioinformatics expand the possibilities of flow cytometry well beyond the classical two parametric analyses in use. In this paper, an overview of recent developments in flow cytometry will be presented under the perspective of the authors; aspects such a multicolor assays and computational cytometry will be discussed as well.

FR-17 MEMOIR OF EDWARD MARTIN, GENITOURINARY SURGEON, PIONEER OF CLINICAL ANDROLOGY, EDUCATOR AND PHILANTROPIST

You have accessJournal of UrologyHistory Forum1 Apr 2018FR-17 MEMOIR OF EDWARD MARTIN, GENITOURINARY SURGEON, PIONEER OF CLINICAL ANDROLOGY, EDUCATOR AND PHILANTROPIST William Berg, David Schulsinger, and Yefim Sheynkin William BergWilliam Berg More articles by this author , David SchulsingerDavid Schulsinger More articles by this author , and Yefim SheynkinYefim Sheynkin More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.3037AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES At the turn of the 20th century, many surgeons were attracted by a new subspecialty of urology. Edward Martin was one of them. His larger than life personality and talents determined amazing achievements in many fields, including male sterility, where science in the lab was as important as surgical skills METHODS Literature review regarding life and work of Edward Martin RESULTS Born into a Quaker family in Philadelphia in 1859, Martin was educated at Swarthmore College and graduated from the University of Pennsylvania Medical School in 1883.He served as assistant to celebrity surgeons Dr. H. Agnew and Dr. W. White. In 1897, White and Martin published a famous textbook ″Genito-urinary surgery and venereal diseases″ where Martin suggested a new procedure of vasoepididymal anastomosis for epididymal obstruction:″ We believe on theoretical considerations alone that it is worth while to divide the vas , splitting its lumen,open the head of the epididymis, and secure the vas in this opening by catgut sutures″.It took 5 more years of research and experiments to detail and successfully perform this procedure on men. Martin was a pioneer in many ways. Prior to the Wright brothers' flight, he conducted experiments to prove air flight possible. He supervised educational films production at the Eastman Kodak to improve teaching in medical schools. He used the lantern slides for students teaching. Martin practiced deep breathing exercises to prevent postoperative pulmonary complications; the "no-touch" technic in surgery, using white cotton gloves as telltales on the offender. Martin helped many students to obtain needed scholarships from the Kirby Fund, established by his friend Fred Kirby, creator of Five and Dime stores. Martin was a Fellow and Regent of the American College of Surgeons and one time president of the Clinical Congress of Surgeons, a member of the American Association of Genito-Urinary Surgeons, the president of Swarthmore College. Martin had many allied activities in public enterprises. He was Director of Health and Charities in Philadelphia During WWI, Martin served as a Director of Professional Service and Surgical Chief at the Walter Reed Hospital. CONCLUSIONS Edward Martin had wide interests in surgery but urology remains his main passion. In the days when male infertility treatment was in its infancy, he made substantial scientific and clinical contribution to this evolving field. His public, military, research and teaching records manifest the integrity and fairness of his character. Edward Martin worked and lived up to his motto- ″The Best Is Yet to Come″. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1247 Advertisement Copyright & Permissions© 2018MetricsAuthor Information William Berg More articles by this author David Schulsinger More articles by this author Yefim Sheynkin More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

European Academy of Andrology Newsletter

European Academy of Andrology Newsletter

Association between JMJD1A Expression and Sperm Retrieval in Non-Obstructive Azoospermic Patients.

Identification of molecular markers which can predict the outcome of sperm retrieval non-invasively in patients with non-obstructive azoospermia (NOA) are valuable in clinical andrology. Jumonji domain-containing 1a (JMJD1A) is a significant epigenetic regulator during spermatogenesis, which plays an important role in the differentiation of post-meiotic germ cells into mature spermatozoa. We therefore aimed to examine the potential association between JMJD1A expression and the outcome of sperm retrieval in patients with NOA. Testicular biopsy specimens from 50 NOA patients with either successful sperm retrieval (sperm+, n=22) or failed sperm retrieval (sperm-, n=28) were collected and then examined for JMJD1A expression by reverse transcription-quantitative polymerase chain reaction (RT-qPCR). In addition, conventional clinical parameters including luteinizing hormone, follicle-stimulating hormone, testosterone, age, and testicular volume were compared between the two NOA groups. The expression of JMJD1A in the sperm+ group was significantly higher than in the sperm- group (P<0.001), however, no significant difference was observed between the two groups in clinical parameters. The receiver operating characteristic (ROC) curve of JMJD1A expression in predicting the sperm retrieval outcome showed a sensitivity of 90.91% and a specificity of 89.29% with significant discriminatory ability between the sperm+ and sperm- groups [area under the ROC curve (AUC)= 0.91]. This study demonstrates a significant association between the expression of JMJD1A and the success of sperm recovery in patients with NOA, and thus suggests that JMJD1A expression quantification in testicular biopsies may be a valuable biomarker along with conventional parameters in predicting the presence of spermatozoa.

Implications of ejaculatory sperm DNA fragmentation on male infertility management.

Latest guidelines from the World Health Organization (WHO) on the laboratory examination of human semen still focus on traditional semen analysis (SA) (1). However, the more recent recommendations from the major societies in the andrology field suggest to utilize new functional tests in certain conditions (2,3). Although the American Urological Association (AUA) best practice statement (2) and the joint guideline course of European Academy of Andrology (EAA) and the European Association of Urology (EAU) on clinical andrology (2) stated that routine use of ejaculatory sperm DNA fragmentation (SDF) in all infertile couples is not supported by current literature, there is a general consensus that some of the infertile couples may benefit from sperm DNA integrity evaluation. Abnormal SDF, is characterized by more than 15% (fair sperm DNA integrity) to more than 30% (poor sperm integrity) fragmented DNA in ejaculatory sperm (4).

Frontiers in clinical andrology

Since the introduction of intracytoplasmic sperm injection (ICSI) in 1992 (1) the research into the clinical management of infertile men slowed to a grind in the last three decades (2). Attention has been drawn to assisted reproductive technology (ART) in improving embryo quality and pregnancy outcome. The enthusiasm in sperm function tests, including post coital and sperm penetration tests, in 1990s disappeared and none of these tests have been widely studied clinically. Despite all the pitfalls, conventional semen analysis has remained as one-and-only cornerstone in the evaluation of infertile men over the years (3). The increasing use of ICSI in bypassing severe male factors renders semen analysis a screening tool merely for the presence or absence of sperm. Despite its widespread use, the live birth rate utilizing ICSI as the treatment of male factor infertility is around 30% only (4). This clearly illustrates the pivotal role of paternal contribution to fertilization and development of healthy offspring. A comprehensive evaluation of infertile men and correction of male factors represent the way to improve both natural pregnancy and ART outcomes.

Flow cytometry in Spermatology: A bright future ahead.

Techniques such as mass spectrometry have led to unprecedented knowledge of the proteins that are present in the spermatozoa of humans and other mammals. However, in spite of their high-throughput and fractioning techniques, most of the techniques in use only offer average values for the entire sperm population. Yet, ejaculate is very heterogeneous, and average values may mask relevant biological information.The application of flow cytometry may overcome this disadvantage, allowing proteomic analysis at the single-cell level. Moreover, recent advances in cytometry, allowing multiple analyses within a single cell combined with powerful statistical tools, as an expanding subfield in spermatology, are described. The increased use of advanced flow cytometers in andrology laboratories will allow the rapid development of multiparametric, multicolour flow cytometry in andrology that will expand the clinical applications and research possibilities of flow cytometry-based proteomic approaches, especially in the subfields of clinical andrology and sperm biotechnology.