Total Testicular Volume Research Articles

Body and testicular biometry of Crioulo stallions

ABSTRACT: Brazilian Association of Crioulo Horse Breeders (ABCCC) establishes minimal and maximal body biometrics evaluation; although, nothing is mentioned about testicular measurements. Body and testicular growth are associated and related to age. We described data regarding body and testicular biometry of Crioulo stallions, with a comparative study between young and adult categories. Evaluation was performed in 56 stallions, Crioulo breed, split in: youngsters (3 and 4 years-old, n=16) and adults (above 5 years-old, n=40). Body biometry included weight, height, cannon bone and chest circumference, body score condition and neck fat accumulation. Testicular biometry included height, length, width, volume, combined volume and daily sperm output (DSO). Statistical analyses included descriptive statistic, Pearson correlation, comparison between means by Kruskal Wallis, being P < 0.05 considered significant. There was no significant difference between the parameters of body and testicular biometrics between categories young and adult. In relation to height, the average was very close to the lower limit established, while chest and cannon bone circumference were above the minimum recommended by ABCCC. Cannon bone circumference presented a positive correlation with height. Most of stallions presented excessive body fat, with a body score condition above 8 (scale 1-9). Neck fat accumulation presented a positive correlation with body score condition. Testicular height, length, width and volume presented a positive correlation between the ipsi and contralateral testicle, total testicular volume and DSO. In conclusion, no difference in the body and testicular biometric evaluation was observed between young and adult Crioulo stallions. Testicular and body growth are associated and also related to age, so our finding suggested that after 3-4 years-old most of Crioulo stallions have already reached maximum growth.

Use of Infrared Thermography during Ejaculation Process and Its Link with Semen Quality and Freezability in Dogs.

Simple SummaryScientific attention to infrared technology has grown over the last decade. Remote and non-invasive monitoring techniques are of great importance in discovering ejaculation response and future trends because of their role in vascular flux regulation. However, detailed information about its use in andrology has yet to be fully explained. Therefore, we aimed to reveal information about the amount of sperm to be obtained by observing stress levels with non-invasive eye temperature measurement, and the relationship between various reproductive temperature patterns and parameters of the animal’s various physiological conditions such as age, body condition, total ejaculation time and testicular volume.This study aimed to describe the thermal variation of external reproductive tracts during ejaculation in relation to sperm quality in dogs. Forty-six adult fertile dogs were monitored using a thermal camera before, during and after the semen collection, taking into account penile and scrotal temperatures as reproductive thermal patterns while eye and perianal temperatures were recorded as complementary thermal patterns of behavioral response. The parameters were classified depending on age (≤4 years and >4 years), body weight (BW) (≤75 kg and >75 kg), sperm concentration (CON) (≤300 million and >300 million), total testicular volume (TTV) (≤600 cm3 and >600 cm3) and total ejaculation time (TET) (≤800 s and >800 s) of the animals from which semen was collected successfully. Heavier males (p < 0.05) that have more consistent testicles (p < 0.01) as well as quicker ejaculate responders (p < 0.001) and lower scrotal temperature had better semen (Δ motility) freezability. The lower eye temperature prior to the ejaculation (p < 0.01), lower scrotal temperature following ejaculation (p < 0.01), and conversely, higher penile temperature during the ejaculation (p < 0.001) had a higher sperm concentration. Furthermore, the sperm freezability was negatively correlated with total ejaculation time (r = −0.39, p < 0.05) and sperm abnormalities were lower in the ejaculate of dogs having a higher temperature of the scrotum, bulbus and penis. In conclusion, infrared monitoring throughout semen collection in dogs can provide information on behavioral reactions during human manipulation, as well as semen quality and testicular functionality.

A Preliminary Study on Semen Collection, Its Evaluation, and Testicular and Sperm Morphometries in The Wild Proboscis Monkey (Nasalis Larvatus).

IntroductionThe proboscis monkey (Nasalis larvatus) is an endangered species with a declining population. This article describes the first successful attempt at sperm collection and evaluation, and the testicular and sperm morphometries of the wild proboscis monkey in Sabah, Malaysia.Material and MethodsEight semen collection procedures using electro-ejaculation and digital manipulation were conducted in three wild adult male proboscis monkeys. A total of 21 ejaculates were collected. The testicular biometry was measured with the aid of ultrasonography. Sample evaluation included semen volume and pH and sperm concentration, viability, and abnormality. The sperm morphometry was undertaken using phase contrast microscopy.ResultsThe mean (±SD) total testicular volume of these animals was 5.77 cm3 (±1.58). Semen collection by electro-ejaculation resulted in an 84% success rate, while digital manipulation did not result in any ejaculation. Each animal showed different semen characteristics, where the volume was 5–540 μL, pH 8–9, and sperm concentration 0.041–83.00 ×106/mL. The percentage of abnormal sperm was high at 76.8% (±89.60), largely due to midpiece abnormality. Normal sperm had a spherical head and long tail with a head : midpiece : tail length ratio of 1 : 2: 8.ConclusionThe social status of these animals may contribute to the generally low quality of the semen. The techniques and data from this study are useful for future conservation and application of assisted reproductive technology in this species.

Correlation Between Ultrasonic Testicular Volume and Seminal Fluid Analysis in Men with Infertility

Background: Infertility is a major cause of marital disharmony in Nigeria because of the high premium placed on childbearing. Unfortunately, the blame is on the woman most times in Nigeria. Seminiferous tubules comprise 80-90% of testicular mass. Thus, the testicular volume is an index of spermatogenesis. Therefore, accurate testicular volume will help in assessing testicular function if there is no obstruction. This study was conducted to evaluate the correlation between testicular volume, measured by ultrasound and conventional sperm parameters (semen volume, sperm concentration, sperm motility and sperm morphology) in men with infertility presenting to Urology Division, University of Abuja Teaching Hospital, Gwagwalada Abuja.&#x0D; Methodology: This was a descriptive cross sectional study, male subjects with infertility presenting to University of Abuja Teaching Hospital were recruited into the study. The testicular volume of all the subjects was measured by ultrasonography. The semen samples were collected by the process of masturbation on day five of sexual abstinence and analyzed according to WHO criteria 2010. Collated data were analyzed using SPSS version 20.0. P-value&lt;0.05 was taken as statistically significant.&#x0D; Results: The average total testicular volume (TTV) of men with infertility was 19.83 ml while mean testicular volume (MTV) was 10.24 ml. There was a statistically significant difference between MTV and semen volume (r=0.391, p=0.000), and sperm concentration (r=0.639, p=0.000). There was a weak and insignificant correlation between MTV and sperm motility and MTV and morphology (r=0.216, p=0.055 and r=0.076, p=0.502) respectively. Linear regression analysis showed significant impact of MTV (P&lt;0.001) on sperm concentration with a critical MTV of ≤10ml.0 indicating poor testicular function (severe oligospermia)&#x0D; Conclusion: The mean ultrasonic testicular volume in men with infertility in this study was 10.24ml and there was a significant positive correlation of MTV with semen volume and sperm concentration. Although, there was correlation of MTV with sperm motility and morphology, this was not significant. The critical mean ultrasonic testicular volume indicating poor testicular function (severe oligospermia) was found to be 10ml. This study has shown that the mean ultrasonic testicular volume can be a pointer to semen volume and sperm concentration in evaluating men with infertility.

Role of total motile sperm count in the evaluation of young men with bilateral subclinical varicocele and asthenospermia.

In comparison to its clinical analogue, the subclinical varicocele represents a questionable entity and specific guidelines for the optimal management are lacking. In our previous study of patients with subclinical varicocele, we showed that bilateral condition is associated with risk of dyspermia. In the present study, we evaluated the risk of deterioration of semen quality in men with bilateral disease and impaired motility according to WHO criteria. Men with bilateral subclinical varicocele, not desiring fatherhood at the time of presentation, were included in study. During initial evaluation, the number of Total Motile Sperm Count (TMSC) was calculated and the patients' age, total testicular volume (TTV), maximum venous size and mean resistive index (RI) of the intratesticular arteries were recorded. We classified the participants in five classes according to the TMSC reading: class A-: TMSC < 5 x 106, class A: TMSC between 5-10 x 106, class B: TMSC between 10-15 x 106, class C: TMSC between 15-20 x 106, and class D: TMSC > 20 x 106 per ejaculate. The participants were seen after 6 months for a repeat spermiogram and physical examination. If clinical varicocele was diagnosed or a new abnormality in the spermiogram was noted, the participants were excluded from the study. The remaining patients were allocated to two groups according to the repeat TMSC reading: patients sub-classified into a lower class (group 1), and patients remaining at the same class (group 2). A comparative analysis was performed between two groups. Nineteen men were included. Nine patients were subclassified (group 1). Three patients moved to A- class (< 5 x 106). Ten patients remained in the same class having no deterioration (group 2). Comparing the two groups, no statistically significant difference was recognized for age, TTV, maximum venous size on both sides, and mean RI (p > 0.05). However, the initial reading for TMSC was 14.57 x 106 in group 1, and 22.84 x 106 in group 2, respectively. This difference was statistically significant (p < 0.05). Additionally, in a paired analysis there was a significant difference in TMSC after 6 months (p < 0.05), too. Summary Conclusions: Young men with bilateral varicocele and asthenospermia seem to be at risk of deterioration in their semen quality after a follow-up of 6 months. The measurement of TMSC can unmask patients at risk, whereas men with the lowest readings seem to be at highest risk for deterioration. The possibility of a worsening sperm quality should be considered in the appropriate clinical context.

Testicular Function of childhood cancer survivors: Who is worse?

This cross-sectional study evaluated morpho-volumetric development of the testis, endocrine function and sperm parameters in 102 young adult childhood cancer survivors (CCS). About 1/3 of patients showed low testicular volume (<24 ml); the Hodgkin disease group showed significantly lower total testicular volumes, compared to the rest of the group. CCS who underwent hematopoietic stem cell transplantation (SCT) showed significantly lower total testicular volume, followed by those who received chemotherapy plus radiotherapy. Eighty-seven CCS underwent hormonal evaluation; 3/87 showed low LH levels, 5/87 high LH levels, 8/87 high FSH values. Twenty-eight out of 84 patients (33.3%) had suboptimal testosterone values (<3.5 ng/ml), while 5/84 showed frankly reduced levels (<2.3 ng/ml). AMH levels were measured in 17 CCS and were normal in all of them. Thirty-four patients accepted to undergo sperm analysis; sperm count was reduced in 7/34 patients (20.6%), while azoospermia was found in 6/34 patients (17.7%). All patients with azoospermia had a primary testicular failure (FSH levels >8 UI/l and low testicular volume) and had received radiotherapy or SCT. History of Hodgkin’s disease, SCT, and non-cranial irradiation associated with chemotherapy were risk factors for reduced sperm concentration. Patients treated during puberty showed lower total testicular volume than patients treated before puberty, probably due to a more aggressive treatment in older patients. Sperm concentration was more closely related to testicular volume than to FSH levels, while AMH values were unrelated to testicular function. In this study, only one third of patients accepted to undergo sperm analysis. The same reluctance has been described by other authors. This common attitude among CCS has prompted the search for surrogate markers of spermatogenesis to be used in infertility screening. Inhibin B has proved to be a better marker for spermatogenesis than FSH. Surprisingly, inhibin B was not analysed in this study, while as expected, AMH was not useful in the evaluation of testicular function. Similarly, the cumulative dose of alkylating agents, already identified as a detrimental factor affecting gonadal function in these patients, was not evaluated.

Fertility outcomes and predictors for successful sperm retrieval and pregnancy in 327 azoospermic men with a history of cryptorchidism who underwent microdissection testicular sperm extraction.

Although few studies have reported fertility outcomes, no study has reported risk factors that might predict sperm retrieval and pregnancy in azoospermic men with a history of cryptorchidism in a large series. To investigate fertility outcomes and predictors for successful sperm retrieval and pregnancy in azoospermic men with a history of cryptorchidism who underwent microdissection testicular sperm extraction (mTESE). This retrospective observational study included 327 azoospermic men with a history of cryptorchidism who underwent mTESE. Fertility outcomes including sperm retrieval, fertilization rate, number of transferred embryos, pregnancy, miscarriage, and live birth rates were recorded. Sperm retrieval was observed in 172 (52.6%) of the patients. The mean fertilization, pregnancy, and live birth rates were 55.2%±20.5, 53.5%, and 44.8%, respectively. The sperm retrieval rate was significantly higher at the orchidopexy age of≤9.5years (70.8%) than the orchidopexy age of>9.5years (42.1%) (P=.000). Patients with total testicular volume of≥13.75mL had significantly higher sperm retrieval rate (65.2%) than the patients with total testicular volume of<13.75mL (45.5%) (P=.001). Patients with total testosterone level of≥300.5ng/dL had significantly higher sperm retrieval rate (65.6%) than the patients with total testosterone level of<300.5ng/dL (40.3%) (P=.000). Patients with follicle-stimulating hormone (FSH) level of≤17.25 mIU/ml had significantly higher sperm retrieval rate (72.3%) than the patients with FSH level of>17.25 mIU/mL (44.4%) (P=.000). Younger male and female ages, and higher fertilization rates were the parameters that might predict pregnancy. Infertile azoospermic men with a history of cryptorchidism have high sperm retrieval rate with mTESE. Patients who had orchidopexy at the age of≤9.5years, and having total testicular volumes of≥13.75mL with total testosterone level of>300.5ng/dL and FSH level of≤17.25 mIU/mL have higher success rate for sperm retrieval.

Total Motile Sperm Count in Adolescent Boys with Varicocele is Associated with Hormone Levels and Total Testicular Volume.

The risk factors for future infertility in adolescents with varicocele are controversial, and little is known about the association between hormone levels and semen parameters. Semen analysis is likely the closest marker of fertility but may be difficult to obtain in some boys secondary to personal, familial or religious reasons. Identifying other clinical surrogates for abnormal semen parameters may offer an alternative for assessing varicocele severity in these boys. We hypothesized that hormone levels and total testicular volume are predictive of abnormal total motile sperm count. We retrospectively reviewed Tanner 5 boys with palpable left varicoceles who underwent a semen analysis and had serum hormone levels tested (luteinizing hormone, follicle-stimulating hormone, inhibin B, anti-müllerian hormone and/or total testosterone) within a 6-month period. Total testicular volume was also calculated. Abnormal total motile sperm count was defined as <9 million sperm per ejaculate. A total of 78 boys (median age 17.2 years, IQR 16.5-18.0) were included. Luteinizing hormone, anti-müllerian hormone and total testosterone were not correlated with any semen analysis parameter. There was a negative correlation between follicle-stimulating hormone and total motile sperm count (ρ -0.35, p=0.004) and positive correlation between inhibin B and total motile sperm count (ρ 0.50, p <0.001). Total testicular volume was significantly positively correlated with total motile sperm count (ρ 0.35, p=0.01). ROC analyses revealed an optimal follicle-stimulating hormone cutoff of 2.9, an optimal inhibin B cutoff of 204 and an optimal total testicular volume cutoff of 34.4 cc to predict abnormal total motile sperm count. Total motile sperm count is inversely associated with follicle-stimulating hormone levels, and directly associated with inhibin B levels and total testicular volume. Optimized cutoffs for serum follicle-stimulating hormone, inhibin B and total testicular volume may prove to be reasonable surrogates for total motile sperm count in boys who defer semen analysis for personal or religious/cultural reasons.

420 - Fertility outcomes and predictors for successful sperm retrieval and pregnancy in 327 azoospermic men with a history of cryptorchidism who underwent microdissection testicular sperm extraction

Background Although few studies have reported fertility outcomes, no study has reported risk factors that might predict sperm retrieval and pregnancy in azoospermic men with a history of cryptorchidism in a large series. Objectives To investigate fertility outcomes and predictors for successful sperm retrieval and pregnancy in azoospermic men with a history of cryptorchidism who underwent microdissection testicular sperm extraction (mTESE). Materials and methods This retrospective observational study included 327 azoospermic men with a history of cryptorchidism who underwent mTESE. Fertility outcomes including sperm retrieval, fertilization rate, number of transferred embryos, pregnancy, miscarriage, and live birth rates were recorded. Results Sperm retrieval was observed in 172 (52.6%) of the patients. The mean fertilization, pregnancy, and live birth rates were 55.2%±20.5, 53.5%, and 44.8%, respectively. The sperm retrieval rate was significantly higher at the orchidopexy age of ≤ 9.5 years (70.8%) than the orchidopexy age of > 9.5 years (42.1%) (P = .000). Patients with total testicular volume of ≥ 13.75 mL had significantly higher sperm retrieval rate (65.2%) than the patients with total testicular volume of 17.25 mIU/mL (44.4%) (P = .000). Younger male and female ages, and higher fertilization rates were the parameters that might predict pregnancy. Conclusions Infertile azoospermic men with a history of cryptorchidism have high sperm retrieval rate with mTESE. Patients who had orchidopexy at the age of ≤ 9.5 years, and having total testicular volumes of ≥ 13.75 mL with total testosterone level of > 300.5 ng/dL and FSH level of ≤ 17.25 mIU/mL have higher success rate for sperm retrieval.

Slow release exogenous melatonin modulates scrotal circumference and testicular parameters, libido, endocrinological profiles and antioxidant and oxidative stress profiles in mithun

Mithun (Bos frontalis) is a unique domestic free-range bovine species available in North Eastern hilly (NEH) regions of India and is reared for its protein rich meat. Although, mithun suffers from severe non-cyclical population fluctuations, it is not yet declared as endangered. Therefore, present study was conducted to assess the effect of slow release subcutaneous exogenous melatonin (MT) implant on sexual behaviour, scrotal circumference (SC) and testicular parameters, endocrinological profiles and antioxidant and oxidative stress profiles in mithun during different seasons (winter, spring, summer and autumn) to improve its reproductive efficiency. Experimental mithun bulls (5–6 years of age) were selected and divided randomly into two groups, Gr I: Control (n = 6) and Gr II: Treatment (n = 6; melatonin implant @ 18mg/50 kg B. Wt). Scrotal circumference and testicular parameters [total testicular volume and weight], endocrinological profiles [follicle stimulating hormone (FSH), luteinizing hormone/interstitial cell stimulating hormone (LH/ICSH), testosterone, thyroxine (T4), cortisol, prolactin and melatonin (MT)], sex behaviour profiles [libido score, mating ability score and sexual behaviour score], antioxidant profiles [total antioxidant capacity (TAC), catalase (CAT), glutathione (GSH), glutathione reductase (GSHRx) and superoxide dismutase (SOD)] and oxidative stress profile [malondialdehyde (MDA)] were estimated. Statistical analysis revealed that these experimental profiles differed between treatment and control groups within the seasons and among the seasons within the experimental groups. FSH, LH, testosterone, T4 and MT were higher and cortisol and prolactin were lower in spring and winter than in summer season. Concentration of FSH, LH, testosterone and MT were higher and concentration of T4, cortisol and prolactin were lower in MT treated than in untreated control group. Similarly, sexual behavioural scores, SC, testicular parameters and antioxidant profiles were higher and oxidative stress profile was lower in MT treated than in untreated control group and in winter and spring than in summer season. The study concluded that exogenous slow-release melatonin implantation and spring and winter seasons had significant beneficial effects in improvement of the antioxidant profiles, minimization of oxidative stress with cascading beneficial effects on endocrinological profiles, SC, testicular parameters and libido, which will improve the semen production, higher sperm cryo-survivability and fertility rate in mithun species.

Testicular Function of Childhood Cancer Survivors: Who Is Worse?

Background: A multi-disciplinary approach has led to an improvement in prognosis of childhood cancers. However, in parallel with the increase in survival rate, there is a greater occurrence of long-term toxicity related to antineoplastic treatment. Hypogonadism and infertility are among the most frequent endocrinological sequelae in young adult childhood cancer survivors. The aim of this study was to identify which category of patients, grouped according to diagnosis, therapy, and age at treatment, shows the worst reproductive function in adulthood. Methods: We evaluated morpho-volumetric development of the testis, endocrine function of the hypothalamic–pituitary–gonadal axis, and sperm parameters in 102 young adult childhood cancer survivors. Results: Overall, about one-third of patients showed low total testicular volume, total testosterone (TT) <3.5 ng/mL, and altered sperm count. Hodgkin’s disease, hematopoietic stem cell transplantation, and non-cranial irradiation associated to chemotherapy were risk factors for poor gonadal function. Patients treated in pubertal age showed lower total testicular volume; however, the difference was due to more gonadotoxic treatment performed in older age. Testicular volume was more predictive of spermatogenesis than follicle-stimulating hormone (FSH), while anti-Müllerian hormone (AMH) was not useful in the evaluation of testicular function of male childhood cancer survivors. Conclusions: Pre-pubertal subjects at high risk of future infertility should be candidates for testicular tissue cryopreservation.

Phage constructs targeting gonadotropin-releasing hormone for fertility control: evaluation in cats.

Phage-gonadotropin-releasing hormone (GnRH) constructs with potential contraceptive properties were generated in our previous study via selection from a phage display library using neutralizing GnRH antibodies as selection targets. In mice, these constructs invoked the production of antibodies against GnRH and suppressed serum testosterone. The goal of this study was to evaluate this vaccine against GnRH for its potential to suppress reproductive characteristics in cats. Sexually mature male cats were injected with a phage-GnRH vaccine using the following treatment groups: (1) single phage-GnRH vaccine with adjuvant; (2) phage-GnRH vaccine without adjuvant and half-dose booster 1 month later; or (3) phage-GnRH vaccine with adjuvant and two half-dose boosters with adjuvant 3 and 6 months later. Anti-GnRH antibodies and serum testosterone, testicular volume and sperm characteristics were evaluated monthly for 7-9 months. All cats developed anti-GnRH antibodies following immunization. Serum antibody titers increased significantly after booster immunizations. In group 3, serum testosterone was suppressed 8 months after primary immunization. Total testicular volume decreased in group 1 by 24-42% and in group 3 by 15-36% at 7 months after immunization, indicating potential gonadal atrophy. Vacuolation of epididymides was observed histologically. Although all cats produced sperm at the conclusion of the study, normal morphology was decreased as much as 38%. Phage alone produced no local or systemic reactions. Immunization of phage with AdjuVac produced unacceptable injection site reactions. Our phage-based vaccine against GnRH demonstrated a potential for fertility impairment in cats. Future research is required to optimize vaccine regimens and identify animal age groups most responsive to the vaccine. If permanent contraception (highly desirable in feral and shelter cats) cannot be achieved, the vaccine has a potential use in zoo animals or pets where multiple administrations are more practical and/or reversible infertility is desirable.

Bilateral disease and intratesticular haemodynamics as markers of dyspermia in patients with subclinical varicocele: A prospective study

ABSTRACTObjective: To study scrotal ultrasonographic characteristics in patients with subclinical varicocele (SV) and investigate their relationship with semen parameters.Patients and methods: In all, 56 men with SV were recruited and divided into two groups, according to their semen characteristics. Group A, comprised 34 men with normal semen analysis; and Group B, comprised 22 men who carried at least one abnormality, regarding sperm concentration, motility and morphology. Between the two groups we compared: age; body mass index (BMI); semen pH and semen volume; total testicular volume (TTV); maximal vein diameter (MVD) and degree of reflux; mean values of peak-systolic velocity (PSV), end-diastolic velocity (EDV), and resistive index (RI) of the intratesticular arteries; whether bilateral SV; and serum testosterone and follicle-stimulating hormone (FSH) levels.Results: Asthenospermia was present in all patients in Group B; 10 patients had asthenospermia only, six patients were astheno-oligospermic and six patients had astheno-oligo-teratospermia. Age, BMI, semen pH and volume, TTV, MVD and degree of reflux did not differ significantly between the two groups (P > 0.05). However, EDV, PSV and RI were significantly different (P < 0.05). Bilateral SV was significantly more frequent in patients in Group B (P < 0.05). Finally, FSH was elevated in Group B (P < 0.05), whereas testosterone was normal in both groups, albeit significantly lower in men with abnormal semen analyses (P < 0.05).Conclusion: Classic ultrasonographic characteristics in men with SV, such as venous size or degree of reflux, were insufficient to distinguish patients with abnormal semen analysis. However, bilateral disease and intratesticular haemodynamics differed significantly in patients with SV and abnormal semen analysis.Abbreviations: BMI: body mass index; CDU: colour Doppler ultrasonography; EDV: end-diastolic velocity; MVD: maximal vein diameter; PSV: peak-systolic velocity; RI: resistive index; SV: subclinical varicocele; TTV: total testicular volume; US: ultrasonography

SUN-371 Successful Induction of Fertility with Low-Dose Dexamethasone in a Patient with Congenital Adrenal Hyperplasia and Testicular Adrenal Rest Tumor

Background Testicular adrenal rest tumors (TARTs) have been described in men with classic congenital adrenal hyperplasia (CAH) at a prevalence up to 90% and are a common cause of infertility in men with CAH. These tumors are located in the rete testis and because of their central location, can lead to mechanical obstruction, impaired blood flow and functional impairment of seminiferous tubules. TARTs have characteristics of adrenocortical cells and ACTH has been implicated in tumor growth. Previous reports have described restoration of fertility in patients with classic CAH and TARTs with administration of dexamethasone at relatively high doses of 750-1000 mcg daily (1, 2). We describe restoration of fertility in a male with classic CAH and TART with the use of lower dose dexamethasone. Case description A 28-year old male with classic CAH due to 21-hydroxylase deficiency presented to us for a follow-up visit after having been lost to follow-up for over a decade with concerns of impaired fertility. He had known bilateral TARTs, first noted at age 18. He and his wife had discontinued all forms of contraception 6 months prior to seeking care and reported a minimal coital frequency of 2-3 times/ week. His biochemical evaluation showed poor CAH control despite reported compliance with Prednisone 5 mg every morning and Fludrocortisone 50 mcg twice daily{(0800h evaluation prior to medication: 17-hydroxyprogesterone (17-OHP): 13060 ng/dL (reference: 13- 120); androstenedione (A4) 1025 ng/dl (reference: 26- 125), ACTH 866 pg/ml (reference: 5-46), plasma renin activity (PRA) 7.1 ng/ ml/h (reference: 0.6-4.3), FSH 1.7 U/L (reference: 1-11), LH 1.3 U/L (reference: 1-8 U/L) and total testosterone 473 ng/ dL (reference: 240-950). A semen analysis showed azoospermia (sperm count =0). Testicular ultrasonography (U/S) showed marked progression of total TART volume to approximately 16% of his total testicular volume (5.01 cc of 32.30 cc). Patient was switched to dexamethasone (250 mcg at bedtime) to suppress the nocturnal surge of ACTH to help decrease TART size. A follow-up U/S performed 5 months later showed a significant decrease in tumor size bilaterally. His total TART volume decreased by 90% (0.48 cc from a previous volume of 5.01 cc). Repeat semen analysis showed a sperm count of 131. In conjunction, biochemical control of CAH showed improvement with 0800h evaluation prior to medication: 17-OHP 66 ng/dL, A4 16 ng/ dL, ACTH 13.5 pg/ml, PRA 11 ng/ ml/h, FSH 5.4 U/L, LH 1 U/L and T 287 ng/dL. The patient’s wife was confirmed to be pregnant nine months after the initiation of dexamethasone and delivered a healthy full-term baby girl. Conclusion This case demonstrates that use of a long-acting glucocorticoid such as dexamethasone at doses as low as 250 mcg daily can decrease TART size and reverse male infertility. Acknowledgements This research was supported by the Intramural Research Program of the NIH.

Sperm cryopreservation prior to gonadotoxic treatment: experience of a single academic centre over 4 decades.

What is the natural history of outcomes of sperm cryostorage at an Australian tertiary academic centre? Cryostorage is feasible in virtually all men facing gonadotoxic therapy but the timing of sperm disposal varies according to the reason for it. Gonadotoxic treatment for cancer or non-cancer diseases damages spermatogenesis and impairs male fertility. Sperm cryopreservation is an established technique to preserve male fertility prior to gonadotoxic treatment. A retrospective review of clinical, anthropometric, semen analysis and hormonal data from 1978 to 2017 involving 2717 men comprising 2085 men with cancer, 234 non-cancer disease and 398 healthy controls, in a single tertiary academic centre with the same clinic and laboratory staff. Sperm output was analysed according to diseases, the feasibility of sperm cryostorage notably for adolescents, regional access to an urban cryostorage facility, the determinants of sperm output and time-dependent disposal of cryostored sperm. Semen samples were assessed by contemporaneous WHO methods. Of 2085 men with cancer, 904 (43%) had haematological malignancies, 680 (33%) testicular cancers and 136 (6.5%) were adolescents. Most men (89%) and adolescents (80%) could collect sperm. Sperm output for all cancers and non-cancer diseases was lower than controls. Sperm output correlated positively with total testicular volume (r = 0.44, P < 0.0001) and negatively with serum FSH and LH (r = -0.24, -0.12, respectively, both P < 0.0001) but not testosterone. For all stored samples, the median time in cryostorage was 8.5 years, 7% were transferred for use to induce pregnancy (median time 2.5 years) and 62.2% were discarded as no longer needed (return of fertility, 35.9% median 3.5 years; death, 26.3%, median 6.5 years), the high disposal rate reflecting regular annual follow-up to establish ongoing need for continued cryostorage. Cryostorage facilities are not available in remote and rural areas of the State and the proportion of outer regional and remote area residents cryostoring sperm was only about half that compared with urban residents. This study does not report the pregnancy outcomes of the patients who used the cryostored sperm, due to recent limitations on health data privacy. Sperm cryostorage is feasible for virtually all men, including sufficiently mature adolescents, who can collect semen to insure future paternity as well as making positive psychological preparation for the patient's survival. Disposal of cryostored material when no longer required is efficient with regular follow-up. Sperm cryopreservation should be an integral part of comprehensive treatment plan in men receiving gonadotoxic treatment but remains underutilized. There was no external funding for this study and there were no relevant conflicts of interest.

Scrotal ultrasonographic findings in obese infertile patients and their correlations to semen and hormonal profile.

The aim of this prospective study was to compare scrotal ultrasonographic findings in obese and normal weight infertile men and correlate these findings with semen parameters and hormonal profile. A total of 188 men presented for infertility evaluation were included in this study. They were divided according to body mass indices into obese (n=96) and normal weight infertile patients (n=92). Basic infertility evaluation, semen analysis and scrotal duplex ultrasound examination in addition to measurement of serum levels of follicular stimulating hormone, testosterone and estradiol were done for all cases. The ratio between testicular size measured by scrotal ultrasound and body mass index were calculated. Any significant differences were not observed in semen parameters, serum levels of follicular stimulating hormone and testosterone between obese and normal weight infertile men (p>0.05). Serum estradiol level was significantly higher in obese than normal weight infertile men (p<0.001). There is significant increase in subclinical varicocele, hydrocele and testicular microlithiasis detected by scrotal ultrasound in obese infertile men than nonobese patients (p<0.05). Despite having comparable testicular size detected on scrotal ultrasound, infertile obese men had significantly lower total testicular volume to body mass index ratio and this ratio correlated positively with semen volume, sperm concentration, total sperm count and serum testosterone but negatively with serum follicular stimulating hormone and estradiol levels. We therefore conclude that the incidence of subclinical varicocele, hydrocele and testicular microlithiasis was higher in obese infertile patients and the ratio between testicular volume assessed by scrotal ultrasound and body mass index may be a new parameter that correlates with subfertility status in these men.

Ultrasound Evaluation of Testicular Volume in Patients with Testicular Microlithiasis

Purpose Ultrasonography is a useful tool to measure testicular volume. According to the European Society of Urogenital Radiology, the combination of testicular atrophy and testicular microlithiasis (TML) is a risk factor for testicular cancer. Testicular atrophy is defined as a volume of less than 12 ml. The aim of this study was to compare testicular volume in patients with TML to patients with normal testicular tissue. Materials and Methods From 2013 to 2015 we included a total of 91 adult patients with TML, and 91 adult patients with normal testicular tissue as a control group. All patients underwent scrotal B-mode ultrasound investigation including measurement of width, length and height in both testicles. Testicular volume was calculated using the formula π/6×length×height×width. Results The median age for patients with TML was 48 years (range: 19-94 years), and 48 years (range: 20–75 years) in patients with normal tissue. No statistically significant difference was found between total testicular volume (both testes) >30 ml in patients with TML compared to patients without (OR 0.77 (95% CI 0.43-1.38, p=0.37). However, patients with TML tended to have lower testicular volume compared to patients without TML, when investigating testicular volume below 12 ml. Conclusion Overall, no association was found between testicular volume and TML, but there was a trend indicating that severe atrophy is often seen in patients with TML compared to patients without TML. However, a significant difference was only found in testicular volume ≤8 ml.

Anti-Müllerian hormone profiling in prepubertal horses and its relationship with gonadal function

Anti-Müllerian hormone (AMH) has gained increasing interest as a biomarker for assessment of gonadal activity. The ability to predict the ovarian follicular reserve of prepubertal female horses (fillies) or to identify stallions with testicular pathologies already during their prepubertal life has not been analyzed so far. Both would help to select fertile horses and reduce costs associated with keeping animals. The objectives of the present study were to (1) assess AMH, LH, FSH, progesterone (females) and testosterone (males) dynamics in prepubertal horses from birth onwards and (2) determine whether AMH concentrations detected in plasma of prepubertal female and male horses are correlated with postpubertal gonadal development. Warmblood foals (n = 30, 14 females, 10 normal males and 6 males with abnormal testicular development) born between February and May of two consecutive years (n = 28 in the first year and n = 2 the next year), were included in the study. Information on gestational length, parity of the dam and placental weight was collected for all foals. Blood samples for hormone analysis were collected from birth onwards every four weeks up to the age of one year. At two years, blood samples were collected on the day when antral follicle count (AFC) and total testicular volume (TTV) were assessed. AMH was detectable in the plasma of all animals from birth onwards and its concentration was significantly higher (P < .001) in males than in females, regardless of testicular development. In males, AMH and testosterone concentration were similar for all animals during the first year of life, regardless of testicular development. At two years, AMH concentration was higher (P < .05) in males with abnormal testicular development than in those with normal testes. In females, AMH concentration at two years was correlated with AMH concentration at birth (P < .05) and with AFC (P < .001). At birth, LH concentration was lower (P < .05) in stallions with abnormal testes (0.3 ± 0.2 ng/ml) than in controls (0.6 ± 0.2 ng/ml). A high negative correlation between AMH concentration and gestation length was observed in males during the first eight weeks of life (P < .01, r = −0.64 to −0.71). Elevated progesterone concentrations over 1 ng/ml were observed in several females starting with 20 weeks of age. This was paralleled by an increase in AMH concentration and was preceded by FSH and LH increases. In conclusion, AMH determination can be reliably used from two years onwards to identify stallions with abnormal testicular development, but it is inconclusive before puberty. In female horses, determination of AMH concentration at a prepubertal age allows for prediction of AMH and AFC after puberty. We suggest that premature luteinisation occurs before the onset of puberty in female horses and that LH secretion in the perinatal period is involved in testicular development and descent in the horse.

Artificial Neural Network for the Prediction of Chromosomal Abnormalities in Azoospermic Males.

To evaluate whether an artifical neural network helps to diagnose any chromosomal abnormalities in azoospermic males. The data of azoospermic males attending to a tertiary academic referral center were evaluated retrospectively. Height, total testicular volume, follicle stimulating hormone, luteinising hormone, total testosterone and ejaculate volume of the patients were used for the analyses. In artificial neural network, the data of 310 azoospermics were used as the education and 115 as the test set. Logistic regression analyses and discriminant analyses were performed for statistical analyses. The tests were re-analysed with a neural network. Both logistic regression analyses and artificial neural network predicted the presence or absence of chromosomal abnormalities with more than 95% accuracy. The use of artificial neural network model has yielded satisfactory results in terms of distinguishing patients whether they have any chromosomal abnormality or not.

Does total testicular volume predict testicular volume difference in adolescent males with varicocele?

ABSTRACTIntroduction:We evaluated the relationship between total testicular volume (TTV) and testicular volume differential (TVD) in adolescent males with varicocele. Both low TTV and high TVD have been independently associated with higher incidences of infertility later in life, but a predictive relationship between TTV and TVD directly has yet to be described.Materials and Methods:We retrospectively analyzed a database of Tanner 5 boys ages 16-21 who presented with varicocele at a single institution between 2009 and 2017. All patients had a scrotal sonogram prior to surgical intervention. TTV and TVD were calculated for each individual and four non-exclusive groupings of patients were created for statistical analysis. We chose 30 cc as a cut off value for low TTV based on prior studies.Results:209 patients met our inclusion criteria. Mean age was 18.3 years (16–21, SD 1.7) with a mean total testicular volume of 36 cc (13.5-78.2, SD 11.1). Cut off points of TVD of 20% and TTV of 30 cc were used to separate patients. There were 65 boys (31%) with TTV < 30 cc and 58 boys (28%) with TVD ≥ 20%. Among males with TTV < 30 cc, 23 (35%) had a TVD ≥ 20%. Among males with TTV ≥ 30 cc, 35 (24%) had a TVD ≥ 20%. The relationship between TVD and TTV was found to be non-significant (p > 0.05).Discussion:Adolescent varicoceles continue to pose a challenge to pediatric urologists. The dilemma of over-aggressive treatment has proven difficult to balance with the risk of infertility. We hoped that elucidating the relationship between TTV and TVD could be useful in identifying patients who are at greater risk for infertility while decreasing the need for more intrusive testing, such as semen analysis, in an adolescent population. We looked at the direct relationship between low TTV and high TVD. In our population, there was a non-significant relationship between TTV < 30 cc and TVD ≥ 20% (p > 0.05) indicating that in adolescents with varicocele, TTV and TVD are independent variables. Our study limitations include the inherent user dependent bias of ultrasound measurements and data collection at a single institution with high ethnic diversity, possibly not comparable to all patient populations.Conclusions:Low TTV (< 30 cc) itself is not predictive of high TVD (≥ 20%) in adolescent boys with varicocele, despite their reported independent associations with impaired fertility in other studies.