FSH Values Research Articles

Analysis of Prediagnostic Circulating Levels of Gonadotropins and Androgens with Risk of Epithelial Ovarian Cancer.

Background Prevailing experimental and epidemiological evidence supports the role of circulating endogenous sex steroid hormones in the pathogenesis of ovarian carcinogenesis by dysregulation of cell differentiation, proliferation, and apoptosis but is scarce and inconclusive. Objectives This article evaluates the role of circulating levels of gonadotropins (follicle-stimulating hormone [FSH], luteinizing hormone [LH]) and androgens (testosterone, dehydroepiandrosterone-sulfate [DHEA-S]) for the risk of epithelial ovarian cancer in a case–control approach using samples collected in advance of clinical diagnosis. Materials and Methods A total of 100 epithelial ovarian cancer (EOC) patients and 100 healthy female controls were consequently enrolled in this hospital-based case–control study. Serum FSH, LH, testosterone, and DHEA-S were measured based on the principle of electrochemiluminescence immunoassay. Suitable descriptive statistics were used for different variables. Results Median values of FSH (58.9 vs. 45.5 IU/L, p = 0.02) and DHEA-S (163.43 vs. 142.2 ug/dL, p = 0.03) were significantly high in EOC patients compared with controls. Conditional logistic regression was used to estimate the odds ratio (OR) across increasing thirds of FSH and DHEA-S concentrations, and the results revealed that the highest third tertile of FSH (> 72.6 IU/L; OR = 3.0, confidence interval [CI] = 1.24–7.29, p trend = 0.04) and DHEA-S (> 194.2 ug/dL; OR = 3.8, CI = 1.26–11.61, p trend = 0.03) were significantly associated with increased risk of ovarian cancer in postmenopausal and premenopausal women, respectively. The statistically significant trend observed for FSH in postmenopausal women, remained only for the subgroup with menopause duration greater than 10 years (OR = 5.9, CI = 1.33–26.66, p trend = 0.04). FSH and DHEA-S concentrations and ovarian cancer risk were internally consistent with groups defined by oral contraceptive pill use, hormone replacement therapy, and smoking. However, no evidence was found for the association between serum LH and testosterone level with the occurrence of ovarian tumorigenesis. Conclusion Prediagnostic circulating concentration of FSH and DHEA-S unveiled a significant positive association with augmented risk of EOC, thus might serve as a predictive marker for the susceptibility to ovarian carcinogenesis and should be added in the screening profile of EOC for early recognition and scheduling necessary interventions/management strategies.

Association Between AMH Levels and Fertility/Reproductive Outcomes Among Women Undergoing IVF: A Retrospective Study

Background:Anti-mullerian hormone (AMH) is a marker for predicting ovarian response to gonadotropin stimulation. It plays an important role in ovarian primordial follicle recruitment and dominant follicle selection. Therefore, the present study evaluated the AMH levels and their association with fertility/reproductive outcomes among women undergoing IVF.Methods:A retrospective study was conducted on 665 women in GarbhaGudi Institute of Reproductive Health and Research in India from October 2018 to 2019. Subjects were divided into ≥1.1 and ≤1.1 AMH level groups. Data on age, luteinizing hormone; LH (mIU/L), follicle-stimulating hormone values; FSH (mIU/ml), LH value, oocytes retrieved, and oocytes fertilization were collected. AMH category was considered as the primary explanatory variable. Independent sample t-test and chi-square tests were performed. The p<0.05 was considered statistically significant.Results:Couple’s age, FSH values (mIU/ml), number of large follicles, matured oocytes, fertilized oocytes, and cleaved embryos were statistically significant (p<0.001) among subjects with ≥1.1 AMH values. Percentage of women with successful embryo transfer was slightly higher among AMH category 1.1 (p=0.09). Fertilization rate (86.67±20.08 vs. 83.64±21.39, p=0.18) and clinical pregnancy rate (43.38% vs. 36.36%, p=0.19) were slightly higher among women with AMH level of ≥1.1 as compared to AMH of <1.1. Live birth rate was slightly higher among women with AMH level of 1.1 (25.85% vs. 22.22%, p=0.45). Also, the number of fertilized oocytes was associated with clinical pregnancy rate (aOR=1.20, 95%CI 1.09–1.33).Conclusion:Women with ≥1.10 serum AMH levels had more number of retrieved oocytes, good oocyte quality, increased embryo transfer, and fertilization rates.

Ten-year outcomes of patients who developed persistent azoospermia following chemotherapy associated with different oncological diagnoses: A retrospective cohort study from a different perspective.

This study evaluated the treatment procedures for chemotherapy (CT)-induced persistent azoospermia and their outcomes from a different perspective. In 63 patients (mean age: 30.16 ± 4.91 years) who had undergone CT 11 ± 5 years earlier, the semen volume, gonadotropins level, FSH level, genetics, micro-testicular sperm extraction (m-TESE) result, sperm DNA fragmentation index (SDFI), semen reactive oxidative stress (ROS) rate, duration of embryonic development, and pregnancy and baby take-home rates were examined. The correlations between the ROS rates and the SDFIs, m-TESE results, sperm motility, pathology scores, time-lapses, and baby take-home rates were evaluated. The semen volumes were 3.5 ± 1.1/ml. The FSH level following CT was 17.87 ± 5.80 mIU/ml. A sperm rate of 34.9% was found from the m-TESE result. The mean SDFI and ROS rate were 4 (<15-30>) and 1.29 ± 0.51, respectively. The time-lapse was calculated as 5h. Pregnancy and live birth were achieved at 20.63% and 12.7%, respectively. In the patients with a low ROS (≤1.42) and SDFI (≤15), the m-TESE success rate was high, the FSH value was low, the pathological score and fertilization rate were elevated, the embryonic cleavage period was normal, and the pregnancy and baby take-home rates were high. The sperms may be detected using m-TESE in patients who develop persistent azoospermia associated with CT due to different oncological diagnoses. Our study revealed that a low FSH value and normal ejaculatory ROS rates are positive predictive factors of sperm detection before m-TESE. The motility of the sperms detected after m-TESE and normal SDFI rates were found to be positive predictive criteria of high fertilization, good embryonic cleavage, pregnancy, and live birth.

Hormonal Changes in Clomiphene Citrate Cycles in Unexplained Infertility Can Predict Follicle Development?

To examine the intra-cycle and inter-cycle hormonal changes in the clomiphene citrate (CC) cycle in women with unexplained infertility; and to determine the factors that may predict follicle development or CC failure. Descriptive study. This study was conducted at the Bagcilar Training and Research Hospital, Istanbul, Turkey from August 2019 to March 2020. Fifty-two women with unexplained infertility were included. Fifty-two cycles given 50 mg of CC but without follicle development were accepted as Group I. In the next cycle, 48 cycles given 100 mg of CC were accepted as Group II. During every cycle, serum hormone (FSH, LH, E2, P4, A4, DHEA‑S, T, 17‑OHP) levels were measured on days 2, 3, 4 or 5 of the cycle (basal day), and on the days when the leading follicle was triggered (trigger day). Endogenous hormone changes were compared in both the groups with and without follicle development as well as in those who could conceive and those who could not conceive. Basal day FSH and DHEA‑S values were found to be statistically significantly higher in women with follicle development than those without follicle development (p = 0.02 and p = 0.039, respectively). The trigger day FSH value was found to be significantly lower in women who conceived compared to the basal day value (p = 0.004). The relatively high P4 value (p = 0.008) on the basal day (contingent upon it was not exceeding the 0.5 ng/mL threshold) and the low FSH value (p = 0.015) on the trigger day were found to be statistically significantly different in women who had conceived compared to those who had not. Basal serum FSH, P4 and DHEA‑S levels can be used as predictors of ovulation in CC cycles in women with unexplained infertility by determining a threshold value with more comprehensive studies to be conducted in the future. Key Words: Androgens, Ovarian stimulation, Clomiphene citrate, Unexplained infertility, Induction of ovulation, Prediction.

Serum prolactin, Preptin, CCL 18 and genetic polymorphisms in Iraqi women with polycystic ovary syndrome.

The polycystic ovary syndrome is an endocrine condition. One of the leading causes of female infertility and the most common disorder among women. The work was being carried out on 100 Iraqi women (50 cases confirmed with PCOS and 50 controls). Between October 2019 and March 2020, blood samples were collected from the Advanced Institute of Infertility Diagnosis and Assisted Reproductive Technology at AL-Nahrain University and a private laboratory. ELISA was used to evaluate the biochemical parameters of preptin, FSH, insulin, LH, and CCL 18 in serum samples from the AFIAS-6 (AFIAS Automated Immunoassay System). The findings of the analysis indicate that, as opposed to the control group, values of prolactin (ng/ml), LH (mIU/ml), Preptin (pg/ml) and CCL 18 (ng/ml) Quite higher in PCOS sickness (p &lt; 0.001) Compared with the patient group, the values of testosterone (ng/ml) and FSH (mIU/ml) was noticeably higher (p &lt;0.05), and PRLR gene expression levels in PCOS patients were significantly increased by 3.6 times. I n summary, the levels of Preptin and CCL18 can be regarded as PCOS markers.

CORRELATION BETWEEN SERUM LEVELS OF FOLLICLE STIMULATING HORMONE AND GRAAFIAN FOLLICLE VASCULARITY ON DOPPLER IN INFERTILE FEMALES OF LAHORE

Objective: To determine correlation between serum levels of Follicle Stimulating Hormone and Graafian Follicle vascularity on Doppler ultrasound in infertile females of Lahore, Pakistan.&#x0D; Study Design: Cross sectional study.&#x0D; Place and Duration of Study: Prime Ultrasound center, 2-Shalamrar Link Road, Mughalpura, Lahore, Pakistan From Mar 2018 to Sep 2019.&#x0D; Methodology: A total of 100 infertile females using simple random sampling were taken. All the married women of reproductive age and married for &gt;12 months who have not conceived despite regular unprotected intercourse, having no other uterine and endometrial or ovarian pathology were taken. The patients who fail to provide serum hormone laboratory reports were excluded. Transvaginal ultrasonography was done for all females and graafian follicle vascularity on Doppler was measured on day 12 of the cycle.&#x0D; Results: The Median age of females was 28 (30-25) years range from 19 and 46 years. The median Follicle Stimulating Hormone levels at day 12 was 6 (8.25-5.22) mlU/ml with minimum and maximum FSH values as 3.20 and 40 mlU/ml. The median follicle size was 13.65 (16.04-10.84) (mm) with minimum and maximum size as 10 mm and 26 mm. There were 61% females who had Grade–1 perifollicular vascularity, 24% females had grade-2 and 15% females had grade-3 of perifollicular vascularity. There was significant positive correlation between perifollicular vascularity grades and Follicle-stimulating hormone levels day 12 (mm) i.e., r=0.309, p-value &lt;0.001.&#x0D; Conclusion: It is concluded that perifollicular vascularity was found to correlate with serum Follicle-stimulating hormone levels, so graafian follicle vascularity on.......

PD29-05 WHICH INFERTILE MEN WITH NORMAL SEMEN ANALYSIS DESERVE A SECOND SEMEN ANALYSIS IN THE REAL-LIFE SETTING?

You have accessJournal of UrologyInfertility: Epidemiology & Evaluation II (PD29)1 Sep 2021PD29-05 WHICH INFERTILE MEN WITH NORMAL SEMEN ANALYSIS DESERVE A SECOND SEMEN ANALYSIS IN THE REAL-LIFE SETTING? Luca Boeri, Paolo Capogrosso, Edoardo Pozzi, Luigi Candela, Federico Belladelli, Walter Cazzaniga, Giuseppe Fallara, Daniele Cignoli, Nicolò Schifano, Eugenio Ventimiglia, Gianmarco Colandrea, Massimo Alfano, Costantino Abbate, Francesco Montorsi, and Andrea Salonia Luca BoeriLuca Boeri More articles by this author , Paolo CapogrossoPaolo Capogrosso More articles by this author , Edoardo PozziEdoardo Pozzi More articles by this author , Luigi CandelaLuigi Candela More articles by this author , Federico BelladelliFederico Belladelli More articles by this author , Walter CazzanigaWalter Cazzaniga More articles by this author , Giuseppe FallaraGiuseppe Fallara More articles by this author , Daniele CignoliDaniele Cignoli More articles by this author , Nicolò SchifanoNicolò Schifano More articles by this author , Eugenio VentimigliaEugenio Ventimiglia More articles by this author , Gianmarco ColandreaGianmarco Colandrea More articles by this author , Massimo AlfanoMassimo Alfano More articles by this author , Costantino AbbateCostantino Abbate More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and Andrea SaloniaAndrea Salonia More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002030.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Current EAU Guidelines suggest that during the diagnostic work-up of an infertile man one semen analysis is sufficient in the case of normality as for WHO criteria. Conversely, a second test is recommended when the first one is abnormal. We aimed to investigate the rate and the clinical characteristics of infertile men with abnormal sperm parameters at a second test, after a normal first semen analysis. METHODS: Complete demographic, clinical and laboratory data from 1358 consecutive primary infertile men (defined according to the WHO definition) were considered. Comorbidities were scored with the Charlson Comorbidity Index (CCI). Serum hormones were measured in every patient. Patients underwent two consecutive semen analyses at the same laboratory (following 2010 WHO reference criteria). Descriptive statistics and logistic regression models tested the association between clinical variables and semen parameters. ROC curves were used to create a composite risk score for pathological sperm parameters at a second test. RESULTS: At first analysis, 212 (15.6%) infertile men had normal semen parameters. Of 212, 87 (41.0%) had a second normal semen analysis, while 80 (37.7%), 35 (16.5%) and 10 (4.7%) men showed 1, 2 and 3 pathological parameters at a second test. Men with a pathological second semen analysis had higher CCI, smaller testicular volume and higher FSH values (all p<0.01) than those with normal second test. Sperm concentration was also lower, 34 (23-57) vs. 62 (35-94) (p<0.01). At multivariable logistic regression analysis, smaller testicular volume (OR 0.9, p=0.03), FSH (OR 1.2, p<0.01), and lower sperm concentration (OR 0.9, p<0.01) were associated with pathological second semen analyses, after accounting for age and CCI. ROC curves showed that testicular volume <15 ml, FSH values >6 mUI/ml and sperm concentration <40 mil/ml had good predictive ability for pathologic second sperm anlysis (all AUC >0.8). Considering 1-point for each of the previous variables, the chances of a pathological second analysis increased from 38.8% to 74.6%, 77.3% and 100% among patients with risk scores of 0, 1, 2 and 3, respectively. CONCLUSIONS: Approximately 60% of infertile men with a first normal semen analysis had a pathological second test. Predictors for pathological second test were small testicular volumes, high FSH, and low sperm concentration at first analysis. A risk score based on these parameters could be useful to identify infertile men with a first normal semen analysis that deserve a second test. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e528-e528 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Luca Boeri More articles by this author Paolo Capogrosso More articles by this author Edoardo Pozzi More articles by this author Luigi Candela More articles by this author Federico Belladelli More articles by this author Walter Cazzaniga More articles by this author Giuseppe Fallara More articles by this author Daniele Cignoli More articles by this author Nicolò Schifano More articles by this author Eugenio Ventimiglia More articles by this author Gianmarco Colandrea More articles by this author Massimo Alfano More articles by this author Costantino Abbate More articles by this author Francesco Montorsi More articles by this author Andrea Salonia More articles by this author Expand All Advertisement Loading ...

PD29-09 TRIGLYCERIDE-GLUCOSE INDEX (TYG) IS ASSOCIATED WITH SPERM PARAMETERS AND SPERM DNA FRAGMENTATION IN PRIMARY INFERTILE MEN: A CROSS-SECTIONAL STUDY

You have accessJournal of UrologyInfertility: Epidemiology & Evaluation II (PD29)1 Sep 2021PD29-09 TRIGLYCERIDE-GLUCOSE INDEX (TYG) IS ASSOCIATED WITH SPERM PARAMETERS AND SPERM DNA FRAGMENTATION IN PRIMARY INFERTILE MEN: A CROSS-SECTIONAL STUDY Luca Boeri, Paolo Capogrosso, Edoardo Pozzi, Luigi Candela, Federico Belladelli, Walter Cazzaniga, Giuseppe Fallara, Nicolò Schifano, Eugenio Ventimiglia, Daniele Cignoli, Gianmarco Colandrea, Massimo Alfano, Costantino Abbate, Francesco Montorsi, and Andrea Salonia Luca BoeriLuca Boeri More articles by this author , Paolo CapogrossoPaolo Capogrosso More articles by this author , Edoardo PozziEdoardo Pozzi More articles by this author , Luigi CandelaLuigi Candela More articles by this author , Federico BelladelliFederico Belladelli More articles by this author , Walter CazzanigaWalter Cazzaniga More articles by this author , Giuseppe FallaraGiuseppe Fallara More articles by this author , Nicolò SchifanoNicolò Schifano More articles by this author , Eugenio VentimigliaEugenio Ventimiglia More articles by this author , Daniele CignoliDaniele Cignoli More articles by this author , Gianmarco ColandreaGianmarco Colandrea More articles by this author , Massimo AlfanoMassimo Alfano More articles by this author , Costantino AbbateCostantino Abbate More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and Andrea SaloniaAndrea Salonia More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002030.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Male factor infertility (MFI) is often associated with metabolic disorders such as diabetes mellitus and metabolic syndrome, where insulin resistance (IR) plays a relevant pathological role. The Homeostatic Model Assessment (HOMA) and triglycerides/glucose index (TyG) are a good marker of IR. We aimed to investigate the relationship between the TyG and both semen and hormonal characteristics in a cohort of primary infertile men. METHODS: Complete demographic, clinical and laboratory data from 726 consecutive primary infertile men (infertility defined according to the WHO definition) were considered. Health-significant comorbidities were scored with the Charlson Comorbidity Index (CCI). Serum hormone, semen analyses (based on 2010 WHO reference criteria) and sperm DNA fragmentation index (DFI) were measured in every patient. Glucose, insulin and triglycerides levels were measured after a 12-h overnight fast, and HOMA-IR and TyG indices were calculated and classified using a 2.6 threshold (as from Ascaso et al. 2003) and a 8.1 threshold (as from Kang et al. 2017), respectively. Descriptive statistics and logistic regression models tested the association between TyG with hormonal milieu and semen parameters. RESULTS: Median (IQR) age was 39 (35-43) years. A TyG and HOMA suggestive for IR was found in 339 (46.6%) and 154 (21.2%) patients, respectively and 121 (16.7%) had both. At Spearman’s test, TyG was correlated with HOMA-IR score (rho = 0.46, p<0.001). Compared to men with normal TyG, men with TyG>8.1 were older [37 (34-41) vs. 39 (35-43) years], had greater BMI [24.5 (23-27) vs. 26 (24-28) kg/m2] and CCI scores (0 vs 1), lower total testosterone [4.5 (3.4-5.6) vs. 4.2 (3.1-5.5)] and sperm concentration [8.0 (1.5-25.0) vs. 12 (2.8-30)], but higher DFI [38.2 (23-54) vs. 28.0 (18-48)] and presented a greater proportion of NOA (24.8% vs. 16.3%) (all p<0.01). At multivariable logistic regression analysis, men with TyG>8.1 were at higher risk of NOA [OR 1.78 (CI: 1.1-2.8)] and DFI>30 [OR 1.92 (CI: 1.2-2.9)], after accounting for patient age, CCI, FSH values, and testicular volume. CONCLUSIONS: Patients with TyG suggestive for IR showed worse clinical, hormonal and semen parameters compared to those with lower TyG values. TyG index represents a reliable marker of IR for primary infertile men in the real-life setting, thus supporting an easier long-term follow-up of patients at higher risk of chronic dysmetabolic comorbidities. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e530-e530 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Luca Boeri More articles by this author Paolo Capogrosso More articles by this author Edoardo Pozzi More articles by this author Luigi Candela More articles by this author Federico Belladelli More articles by this author Walter Cazzaniga More articles by this author Giuseppe Fallara More articles by this author Nicolò Schifano More articles by this author Eugenio Ventimiglia More articles by this author Daniele Cignoli More articles by this author Gianmarco Colandrea More articles by this author Massimo Alfano More articles by this author Costantino Abbate More articles by this author Francesco Montorsi More articles by this author Andrea Salonia More articles by this author Expand All Advertisement Loading ...

MP31-16 GONADOTROPIN CONCENTRATION THRESHOLDS TO PREDICT IMPROVEMENTS IN TESTOSTERONE AND SEMEN PARAMETERS WITH CLOMIPHENE CITRATE

You have accessJournal of UrologyInfertility: Therapy (MP31)1 Sep 2021MP31-16 GONADOTROPIN CONCENTRATION THRESHOLDS TO PREDICT IMPROVEMENTS IN TESTOSTERONE AND SEMEN PARAMETERS WITH CLOMIPHENE CITRATE Tommy Jiang, Alvaro Santamaria, Neilufar Modiri, Michael Zheng, Vadim Osadchiy, John Sigalos, Jesse Mills, and Sriram Eleswarapu Tommy JiangTommy Jiang More articles by this author , Alvaro SantamariaAlvaro Santamaria More articles by this author , Neilufar ModiriNeilufar Modiri More articles by this author , Michael ZhengMichael Zheng More articles by this author , Vadim OsadchiyVadim Osadchiy More articles by this author , John SigalosJohn Sigalos More articles by this author , Jesse MillsJesse Mills More articles by this author , and Sriram EleswarapuSriram Eleswarapu More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002035.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Due to its indirect ability to increase pituitary gonadotropins, clomiphene citrate is prescribed off-label to men with hypogonadism or impaired sperm counts. However, threshold values for pre-treatment LH and FSH that predict response remain unknown. We sought to identify pre-treatment thresholds to guide clomiphene use in men with hypogonadism or subfertility. METHODS: Using an IRB approved database, we retrospectively extracted LH, FSH, testosterone (T), and semen analysis (SA) data in men pre- and 3 months post-treatment with clomiphene (25 mg daily). Patients with prior hormone therapy or genitourinary surgery were excluded. We determined efficacy thresholds by identifying the highest LH or FSH level at which a significant difference in initial and final values for each outcome (T and each SA parameter) could be observed, based on Student t-tests with α=0.05. A representative FSH threshold curve measuring fluctuation in P-value for effect on sperm concentration is provided in Figure 1. Men whose partners achieved pregnancy while taking clomiphene were used to contextualize the computed LH and FSH thresholds. RESULTS: Threshold determinations were made from data on 137 men; 28 had partners achieve pregnancy; 25 of these had pre-treatment LH and FSH levels. Table 1 reports thresholds for either LH or FSH for each outcome. For each given threshold, pregnancy rates are listed. For example, the highest FSH at which to achieve a significant improvement in sperm concentration with clomiphene is a level of 9.9 miU/mL, and this translated to a pregnancy rate of 80% in our cohort. Similar data are presented in Table 1 for each outcome. CONCLUSIONS: Threshold values of gonadotropins were identified, below which statistically significant improvements in testosterone, sperm concentration, total sperm count, and total motile sperm count occurred. These thresholds may be useful in guiding clomiphene use in men contending with hypogonadism or subfertility. Further prospective evaluation is needed to validate these thresholds. Source of Funding: N/A © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e561-e561 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tommy Jiang More articles by this author Alvaro Santamaria More articles by this author Neilufar Modiri More articles by this author Michael Zheng More articles by this author Vadim Osadchiy More articles by this author John Sigalos More articles by this author Jesse Mills More articles by this author Sriram Eleswarapu More articles by this author Expand All Advertisement Loading ...

P–108 Which infertile men with normal semen analysis deserve a second semen analysis in the real-life setting?

Abstract Study question Guidelines suggest that one semen analysis is sufficient during the diagnostic work-up of an infertile man in the case of normality as for WHO criteria. Summary answer We investigated the rate and the clinical features of men with abnormal sperm parameters at a second test, after a normal first semen analysis. What is known already A second test is recommended when the first semen analysis depicted abnormal sperm parameters. Study design, size, duration Complete demographic, clinical and laboratory data from 1358 consecutive primary infertile men (infertility as for WHO definition) were analysed. Health-significant comorbidities were scored with the Charlson Comorbidity Index (CCI). Serum hormones were measured in every patient. Patients underwent two consecutive semen analyses at the same laboratory, which followed 2010 WHO reference criteria. Participants/materials, setting, methods Descriptive statistics and logistic regression models tested the association between clinical variables and semen parameters. Receiver operative characteristic (ROC) curves were used to assess the relationship between clinical variables and to create a composite risk score for pathological sperm parameters at a second test. Main results and the role of chance At first analysis, 212 (15.6%) infertile men had normal semen parameters. Of 212, 87 (41.0%) had a second normal semen analysis, while 80 (37.7%), 35 (16.5%) and 10 (4.7%) men showed 1, 2 and 3 pathological sperm parameters at second test. Men with a pathological second semen analysis had higher CCI scores (p &amp;lt; 0.001), smaller testicular volume (p &amp;lt; 0.001) and higher FSH values (p &amp;lt; 0.01) than those with normal second samples. Overall, despite being within normal ranges, sperm concentration was lower [34 (23–57) vs. 62 (35–94); p &amp;lt; 0.01] in men with an abnormal second sample compared to those with confirmed normality. At multivariable logistic regression analysis, smaller testicular volume (OR 0.9, p = 0.03), FSH (OR 1.2, p &amp;lt; 0.01), and lower sperm concentration (OR 0.9, p &amp;lt; 0.01) were associated with pathological second semen analyses, after accounting for age and CCI. ROC curves showed that testicular volume &amp;lt;15 ml, FSH values &amp;gt;6 mUI/ml and sperm concentration &amp;lt;40 mil/ml had good predictive ability for pathologic second sperm parameters (all AUC &amp;gt;0.8). Considering 1-point for each of the previous variables, the chances of a pathological second analysis increased from 38.8% to 74.6%, 77.3% and 100% among patients with risk scores of 0, 1, 2 and 3, respectively (p &amp;lt; 0.001). Limitations, reasons for caution It is a retrospective analysis at a single, tertiary-referral academic centre, thus raising the possibility of selection biases. In spite of this, all patients have been consistently analysed over time with a rigorous follow-up, thus limiting potential heterogeneity in terms of data reporting. Wider implications of the findings: Approximately 60% of infertile men with a normal semen analysis depicted a pathological second test. Smaller testicles, higher FSH, lower sperm concentrations were independently associated with a pathologic second test. These features could be useful to identify those infertile men with a normal semen analysis who deserve a second test. Trial registration number Not applicable

P–095 Outcomes and predictive factors of successful salvage microdissection testicular sperm extraction (mTESE) after failed TESE in men with non-obstructive azoospermia: results from a multicenter study

Abstract Study question We assessed the outcome and predictors of successful salvage microdissection testicular sperm extraction (mTESE) in non-obstructive azoospermia (NOA) men previously submitted to unfruitful classic (cTESE). Summary answer The sperm retrieval rate at salvage mTESE was almost 50%. Hypospermatogenesis and low FSH values were associated with positive outcomes at salvage mTESE What is known already In men with NOA testicular sperm can be retrieved using cTESE in approximately 50% of cases. mTESE has been proposed as a salvage treatment option for men with a previously failed TESE, but data are scarce. Study design, size, duration Multicenter, cross-sectional study. Complete data from 61 NOA men who underwent mTESE after a failed cTESE between 01/2014 and 10/2020, at 6 tertiary referral centers in Italy were analysed. Participants/materials, setting, methods All men underwent testicular ultrasound, hormonal and genetic blood testing. Histopathological diagnosis from TESE was collected in every man. Semen analyses were based on the 2010 WHO reference criteria. mTESE was performed according to the technique of Schlegel et al. (1999). Descriptive statistics and logistic regression models were used to investigate potential predictors of positive sperm retrieval (SR+) after salvage mTESE. Main results and the role of chance Overall, median (IQR) age and testicular volume were 35 (31–38) years and 10 (6–15) ml, respectively. Baseline serum FSH and total testosterone levels were 17.1 (8.6–30.4) mUI/mL and 4.7 (3.5–6.4) ng/mL, respectively. Sertoli-cell-only (SCO) syndrome, maturation arrest (MA) and hypospermatogenesis were found in 24 (39.3%), 21 (34.4%) and 16 (26.2%) men after cTESE, respectively. Spermatozoa were retrieved in 30 (49.2%) men at salvage mTESE. Patients with a diagnosis of hypospermatogenesis had a higher rate of SR + [12/16 (75%)] than those with MA [12/21 (57.1%)] and SCOS [6/24 (25%)] after salvage mTESE (p &amp;lt; 0.01), which was bilateral in 36 (59%) cases. FSH was higher [16.5 (8–22) vs. 8.9 (5–13) mUI/mL, p &amp;lt; 0.01] in SR- patients compared to SR+. No difference in clinical characteristics was found between patients with SR+ and SR- at salvage mTESE. There were no significant complications after mTESE. Multivariable logistic regression analysis showed that hypospermatogenesis (OR 9.7; p &amp;lt; 0.01) and low FSH levels (OR 0.9, p &amp;lt; 0.001) were independent predictors of SR+ after salvage mTESE, after accounting for age. Limitations, reasons for caution Despite we analysed one of the largest series of salvage mTESE, the samples size is too small to draw general conclusions. Because of the multicenter nature of the study we cannot rely on standardization of surgical techniques for TESE. Wider implications of the findings: This is one of the larger studies on salvage mTESE. The selection of patients for salvage mTESE is of critical importance. Trial registration number na

Clinical and laboratory evaluation of treatment efficiency in patients with prolactinoma

Introduction. Prolactinomas are rarely detected in children and are very often characterized by aggressive growth.&#x0D; Objective. The aim of the study was to increase the effectiveness of drug treatment with prolactin based on the results of clinical and laboratory studies.&#x0D; Material and methods. In order to determine clinical, laboratory, hormonal, functional and instrumental markers, 63 patients with microprolactinomas and 53 patients with macroprolactinomas were examined. Some biochemical parameters of blood samples, such as TSH, T4, T3, FSH, LH, GH, IGF, ACTH, cortisol and prolactin were studied in healthy individuals, in patients with microprolactinoma and macroprolactinoma 4 times: 3, 6 and 12 months after the start of treatment with cabergoline.&#x0D; Results. During the study, it was determined that a mean value of FSH in blood samples obtained during hormonal studies conducted before treatment with cabergoline was 4.94 0.41 IU/L, that is slightly lower than that of healthy women (n = 24) who participated in the study (5.49 0.52 IU/L) (p = 0.4037). Statistical analysis within the 6th month of treatment with the appropriate drug showed a reliable decrease in a mean value of LH hormone to 1.93 0.25 IU / L (p = 0.0002, p1 = 0.0232). In biopsies obtained during this study period, the minimum hormone level was 0.1 IU/L, and the maximum 4.18 IU L.&#x0D; Conclusions. Thus, the treatment of patients with macro- and microprolactinoma using cabergoline can play an important role in correcting their physical, hormonal and other parameters, and will expand the use of its analogs in practical medicine.

Protective and therapeutic effect of hydrogen sulfide on hemorrhagic cystitis and testis dysfunction induced with cyclophosphamide

Backround/aimCyclophosphamide (CP) is a drug used for treatment of many malignant diseases. However, it can cause serious side effects such as hemorrhagic cystitis and male infertility. Hydrogen sulfide (H2S) is a gaseous mediator and is suggested to have antioxidant, antiinflammatory, and antiapoptotic effects. In this study, dose-dependent effects of H2S donor sodium hydrosulfide (NaHS) on cyclophosphamide-induced hemorrhagic cystitis and testicular dysfunction were investigated in rats.Material and methodsRats were divided into 5 groups (n = 8): control, CP, NaHS25 μmol/kg, NaHS50 μmol/kg, and NaHS100 μmol/ kg. After treatment for 7 days intraperitoneally (ip), a single ip dose of CP 200 mg/kg was given on the 8th day. Then, treatment was continued for 7 days. In bladder and testicular tissues, IL 6, IL 10, cGMP, NO, H2S, FSH, LH, and testosterone levels were measured by ELISA. Histopathological examination with H&E staining, as well as immunohistochemical staining for acrolein in bladder and caspase-3 and APAF-1 in testis were performed.ResultsNaHS prevented the increased IL 6 and IL 10 values induced by CP as well as prevented the decrease in cGMP values associated with CP. There was no significant change in FSH values, but the LH value, which increased with CP, decreased with 25, 50, and 100 μmol/kg NaHS. In contrast, testosterone decreased in the CP group and increased in the treatment groups. NaHS was effective in many biochemical and histopathological parameters at 25 and 50 μmol/kg doses, and this effect decreased at 100 μmol/kg dose.ConclusionH2S has a protective and therapeutic effect on hemorrhagic cystitis and testicular dysfunction induced by cyclophosphamide. It can be suggested that H2S is a promising molecule in facilitating cancer treatment.

Prevalence of Y chromosome microdeletion in north Indian infertile males with spermatogenesis defect

Deletion of specific genes present in the long arm of Y chromosome has been identified as the most common genetic cause of defective spermatogenesis. Studies have shown that frequency of Y chromosome microdeletion varies in different geographical location and is related to genetic and environmental influence preponderance. Therefore, the present study was carried out to identify the frequency of Y chromosome microdeletion in the northern region of India and to define subgroup of infertile patients who are critically under more risk of having microdeletion. A total of 292 north Indian infertile males with nonobstructive azoospermia and oligozoospermia were selected for screening the Y chromosome microdeletion. Healthy fertile males (n=100) were also enrolled as control subjects. Frequency of Y chromosome microdeletion in north Indian infertile males was found to be about 8.5%, with azoospermia factor (AZFc) region as the most susceptible region for microdeletion. Comparatively microdeletion is more common in patients with nonobstructive azoospermia than oligozoospermia (9.2% versus 7.1%). Statistical analysis also revealed that patients with hormonal FSH level between 20 and 40 mIU/mL have more chances of harbouring microdeletion. Hence, the present study highlights the importance of screening AZFc region among infertile patients with very high serum FSH value.

Anti-Mullerian Hormone Levels in Regularly Menstruating Nigerian Women

Background: Studies have shown that serum levels of Anti-Mullerian Hormones (AMH) decrease with age as it is also an early and sensitive marker of ovarian reserve in women in the North American, European and Asian regions. Various research works have also generated data about AMH in the Caucasian, Americans and Asians There was a need to compare these known data with African data.&#x0D; Objectives: To assess the serum levels of AMH in healthy women of reproductive age and determine the relationship between AMH, age, Body Mass Index, parity and menstrual cycle in healthy regularly menstruating women.&#x0D; Methods: A cross-sectional study of 200 apparently healthy women aged 21-45 years was carried out between January and May 2014. Serum AMH and FSH levels were measured in the participants using Enzyme-Linked Immunosorbent Assay.&#x0D; Results: The median AMH value was 4.07ng/mL, while the median FSH value was 9.65mIU/mL. The reference 90% CI of AMH was 0.60 -9.71 ng/ml. There was a significant negative correlation between serum level of AMH and age (r = - 0.718, p&lt;0.001).&#x0D; Conclusion: The serum AMH levels gradually declined throughout the reproductive lifespan of a woman.

Comparison of prolactin, follicle-stimulating hormone, luteinizing hormone, estradiol, thyroid-stimulating hormone, free thyroxine and body mass index between infertile and fertile Saudi women

The objective of this study was to compare the levels of prolactin, FSH, LH, E2, TSH, FT4 and BMI between infertile Saudi women with high prolactin and fertile Saudi women with normal prolactin. The study individuals were divided into two groups; infertile Saudi women with high prolactin (Group 1) and fertile Saudi women with normal prolactin (Group 2). This study used the ARCHITECT i1000SR immunoassay analyzer for the assessment of all serum hormones. The prolactin in Group 1 was higher than in the Group 2. The FSH and LH values were similar in both groups. The TSH in Group 1 was higher than in the Group 2. The FT4 values were similar in both groups. The BMI in both groups was greater than 25 (all patients were in over weight category). In Group 1, 40% women were over weight and in Group 2, 39 % women were over weight. The rate of failed cycles in group 1 was higher than in Group 2, also cases of PCOS in Group 1 were more than in the Group 2. The rate of positive pregnancy in Group 1 is lower than in the Group 2. The results of this study demonstrated that increased levels of prolactin and TSH are among the causes of infertility in Saudi women.

HYPOPITUITARISM: A CASE REPORT OF OVERLOOKED DIAGNOSIS.

Hypopituitarism, which has a number of causes, is a severe endocrine condition that needs early diagnosis and treatment to prevent serious consequences. We report a 17-year old male seen in outpatient department for lack of development of secondary sexual characters and short stature. Laboratory investigation showed low total tri-iodothyronine (T3) , low total thyroxine (T4) and slightly elevated thyroid stimulating hormone (TSH) , low basal cortisol, and normal prolactin level. The patient also had low total testosterone, low LH, and FSH values. Magnetic resonance imaging (MRI) of the pituitary revealed a hypoplastic anterior pituitary with ectopic posterior pituitary. This case highlights the notable absence of recognizing the clinical presentation of hypopituitarism which at times is nonspecic and often progress insidiously before a diagnosis is made. The case calls attention to importance of thorough history taking, attention, and observation in making a new diagnosis that has the potential to alter a patient's health care and quality of life.

PHYSIOLOGICAL AND HISTOLOGICAL RESPONSES OF GIMMIZAH COCKERELS TO GNRH INJECTION

This study was conducted to study the neuroendocrine control of spermatogenesis of Gimmizah Cocks. A total of 300 Gimmizah cockerels aged 5 weeks were selected according to their configuration. Birds were individually weighted and then randomly distributed into 4 experimental groups with 75 males of each. The first group of cockerels (T1) was injected with saline solution for the whole period (6 – 14 wk.) and was considered as a control group. The other 3 groups were injected with a synthetic (Receptal) gonadotropic releasing hormone (GnRH) during the periods from 6 -10 (T2), 8-12 (T3) and 10-14 (T4) weeks of age for the second, third, and fourth groups, respectively.The cockerels of the treated groups were divided into two subgroups the first one (R1) injected with 0.1 ml Receptal / kg of body weight, while the second (R2) injected with 0.2 ml Receptal / kg of body weight. Data obtained illustrated that at 12 weeks of age, the plasma level of LH, FSH and testosterone were insignificant. LH and FSH values of T2 group at 14 weeks of age were lower than that recorded for the other treated or control groups. At 16 weeks of age, the plasma concentrations of all hormones were comparable to those obtained at 14 weeks of age. Semen quality traits were significantly improved by injecting GnRH regardless the injected dose. These results suggested that the precocious puberty in Gimmizah males could be achieved by GnRH injection starting from 8 or 10 weeks of age as a result of increasing the spermatogenic activity.

PREDICTION OF OOCYTE OUTPUT: How can we maximize the oocyte retrieving from follicles in Controlled Ovarian Hyperstimulation cycles?

PREDICTION OF OOCYTE OUTPUT: How can we maximize the oocyte retrieving from follicles in Controlled Ovarian Hyperstimulation cycles?&#x0D; Abstract&#x0D; Aim: We designed our study with the purpose of determining which variables should be used to predict oocyte output, to increase the number of collected oocytes and the success rate of IVF.&#x0D; Materials and Method: A total of 412 infertile patients admitted to the IVF center of a tertiary university hospital between the years 2016 and 2018 were evaluated retrospectively. The number of oocytes obtained by OPU from the follicles as the result of COH was grouped in percentiles. The variables effective on oocyte output were analyzed in the groups, and tests to predict acquisition of the maximal number of oocytes were tried to be determined. &#x0D; Results: When we investigated according to the oocyte/≥ 14 mm follicle ratios, we determined that 10.2% of the patients were in the ≤ 30% group, whereas 4.1% of them were in the group of 31-40 %. 6.6% of the patients were in the group of 41-50 %, 2.9% in the group of 51-60%, 5.6% in the group of 61-70 %, 8% in the group of 71-80%, 4.9% in the group of 81-90 %, and 57.8% in the group of 91-100 %. According to the results of our study, the variables effective on the oocyte/≥14 mm follicle ratio were the patient’s age, basal FSH value (cutoff 9.5mIU/mL, sensitivity 0.706, specificity 0.621, p=0.001), basal LH (cutoff 5.5mIU/mL, sensitivity 0.640 specificity 0.690, p

Evaluation of Microdissection Testicular Sperm Extraction (mTESE), Outcomes and Predictive Factors in Ireland: The Gold Standard for Men with Non-Obstructive Azoospermia.

Background:Microdissection testicular sperm extraction (mTESE) is the gold standard approach in sperm retrieval in men with non-obstructive azoospermia (NOA). The purpose of the study was to assess the outcomes for Irish men who have undergone mTESE with a single surgeon.Methods:This is a retrospective, single cohort study. Thirty-four patients underwent mTESE between September 2015 and June 2019. A p<0.05 was considered statistically significant.Results:In this study, sperm retrieval rate (SRR) was 47.06%. (16/34). The mean age in those who had retrieved sperm at mTESE was 37.9±2.6 years. Johnson Score (JS) and FSH were statistically different between successful and unsuccessful mTESE groups (p=0.017*10−5 and p=0.004, respectively). Optimal cutoff values for FSH, T and JS were 15 IU/L, 13 nmol/L and 5, respectively. The pregnancy rate was 63.64% (7/11) among men who went on to use mTESE sperm in an ICSI cycle.Conclusion:The combination of mTESE/Intracytoplasmic sperm injection (ICSI) is the best option available for men with NOA who prefer to achieve paternity using their own DNA. Given the overall SRRs in mTESE, it is imperative to continue research for a predictive model to better counsel azoospermic men regarding the use of mTESE. For this purpose, large, multicenter, randomized controlled trials are needed.