Search

In cryptorchid boys, failures in germ cell development have been clearly established. Some studies reported some abnormalities in Sertoli cells morphology but the results regarding their endocrine secretion remain controversial. To compare testicular hormone levels in young boys with and without cryptorchidism, we performed a cross-sectional hospital-based study. From surgery appointment records, we identified a case group of boys with unilateral or bilateral cryptorchidism and a control group undergoing dental care, minor osteoarticular or dermal surgery. Blood samples were withdrawn during the surgical procedure to perform testosterone, inhibin B and anti-müllerian hormone ( AMH) immunoassays. We included 27 cryptorchid boys and 27 controls aged of 26.6 vs. 24.2 months, respectively ( p = 0.172) far from the post-natal mini-puberty and the corresponding hormonal surges. Age-adjusted AMH and inhibin B levels were significantly lower in cryptorchid than in control boys ( AMH: 87 ng/ mL vs. 135 ng/ mL; p = 0.009, inhibin B: 97 pg/ mL vs. 133 pg/ mL; p = 0.019, respectively). Moreover, AMH and inhibin B levels were significantly lower in the bilateral cryptorchid subgroup, being 50% lower than in the controls ( p = 0.011 and 0.019, respectively) and while both hormones levels were independent in controls, they became strongly correlated in bilateral cryptorchid boys ( R² = 0.75, p = 0.001). In addition, testosterone levels were still detectable in some boys, with significantly lower levels in cryptorchid group than in controls. Overall, 2-year-old cryptorchid patients presented a simultaneous and significant drop in AMH and inhibin B levels, suggesting a functional defect of Sertoli cells. This deficiency appeared more pronounced in bilateral cryptorchidism and thus, regarding the pivotal role of Sertoli cells in germ cell development, it may explain the compromised fertility found later in men born with such a malformation. [ABSTRACT FROM AUTHOR]

Study Question: In which cases is freezing of ejaculated sperm indicated before ICSI?Summary Answer: Sperm freezing should be performed only when out of two analyses at least one total sperm count in the ejaculate is lower than 10(6).What Is Known Already: Due to variations in individual sperm parameters, in cases of severe oligozoospermia there is a risk of absence of spermatozoa on the day of ICSI, leading to cancellation of the attempt. Sperm freezing can avoid this problem but little is known of the parameters governing the decision to freeze sperm or not.Study Design, Size, Duration: This retrospective study included 247 men who underwent sperm cryopreservation to prevent the risk of azoospermia on the day of ICSI, from 2000 to 2012.Participants/materials, Setting, Methods: Receiver operating characteristic curve analysis was used to define the threshold value. The lowest total sperm count per ejaculate was studied as a predictive factor for the use of frozen sperm in a total of 593 ICSI attempts. Moreover, 2003 patients who had at least 4 semen analyses for andrological diagnosis have been studied to evaluate the reproducibility of sperm count. To evaluate the psychological impact of sperm freezing, a questionnaire was administered to 84 men who attended for sperm cryopreservation between June and December 2014. The cost of sperm freezing was analysed according to the French prices.Main Results and the Role Of Chance: When at least one total sperm count was <10(5) the risk of azoospermia in at least one ICSI attempt was 52% (34/66) versus 3% (5/181) when all counts were ≥10(5) (P < 0.0001). However, the study of the reproducibility of pre-ICSI semen analyses has shown wide variations among ejaculates, and therefore sperm freezing is recommended when one analysis from at least two, showed a sperm count <10(6). Such a policy could allow a saving of about €70 000 by avoiding unnecessary sperm freezings. The psychological impact of sperm freezing was good since >70% of men had positive feelings about this technique.Limitations, Reasons For Caution: This was a fairly short-term study and preservation of future fertility was not assessed. It appeared impossible to find a threshold that would predict the risk of azoospermia with 100% accuracy. Therefore there is still a risk of absence of spermatozoa on the day of ICSI despite a good negative predictive value when no total sperm count was lower than 10(5).Wider Implications Of the Findings: These data suggest that sperm freezing should be proposed when total sperm count is lower than 10(6) to avoid cancellation of the ICSI attempt due to azoospermia. [ABSTRACT FROM AUTHOR]

Objectives:To evaluate the efficacy of anticholinergic agents in the treatment of neurogenic overactive bladder (NOAB) and neurogenic detrusor overactivity (NDO) in spinal cord injury (SCI) patients on clean intermittent catheterisation (CIC).Methods:Chronic suprasacral SCI patients on CIC presenting with at least one urinary leakage a day were included. Urodynamics and voiding diaries were performed at baseline and 1 month follow-up. In case of NDO at baseline, an anticholinergic drug was prescribed.Results:The 231 SCI patients presented with one to five urinary leakages per day (mean 2.1). Urodynamics showed NDO in all patients. A new anticholinergic treatment was started in all, either in monotherapy (134 patients) or in association with the existing anticholinergic drug (oxybutynin+trospium bitherapy, 97 patients). The mean maximum bladder capacity significantly increased from 225 to 441 ml, and the mean involuntary detrusor contractions (IDC) significantly decreased from 67 to 41 cm H2O. Only 75 SCI patients (32%) were fully continent. However, 25 out of these 75 patients showed persistent NDO, with amplitudes of IDC above 40 cm H2O in 12 patients. Incontinence was still found in 156 SCI patients (67%), with an average of 1,2 leakages a day. In 100 patients, amplitudes of IDC remained above 40 cm H2O. There was no statistical difference between patients on anticholinergic monotherapy or bitherapy at follow-up.Conclusion:Anticholinergic treatment is not always satisfactory in terms of control of NDO and rarely allows full continence. Urodynamic follow-up is mandatory in all patients, even in those showing clinical continence. [ABSTRACT FROM AUTHOR]

An international workshop titled 'Assessing Endocrine-Related Endpoints within the First Years of Life' was held 30 April-1 May 2007, in Ottawa, Ontario, Canada. Representatives from a number of pregnancy cohort studies in North America and Europe presented options for measuring various endocrine-sensitive endpoints in early life and discussed issues related to performing and using those measures. The workshop focused on measuring reproductive tract developmental endpoints [e.g., anogenital distance (AGD)], endocrine status, and infant anthropometry. To the extent possible, workshop participants strove to develop or recommend standardized measurements that would allow comparisons and pooling of data across studies. The recommended outcomes include thigh fat fold, breast size, vaginal cytology, AGD, location of the testis, testicular size, and growth of the penis, with most of the discussion focusing on the genital exam. Although a number of outcome measures recommended during the genital exam have been associated with exposure to endocrine-disrupting chemicals, little is known about how predictive these effects are of later reproductive health or other chronic health conditions. [ABSTRACT FROM AUTHOR]

Introduction/Background Ejaculation disorders are common in Spinal Cord Injury (SCI) patients and require often samples to preserve their fertility potential. The means to obtain ejaculation depend on the neurological level and the experience of the team. We reviewed the results of our cohort, the means used, particularly the benefits of adding Midodrine or penile vibratory stimulation (PVS) to obtain the sample. Material and method We collected retrospectively in our cohort of patients the epidemiological data, the type of ejaculation (anterograde or retrograde) and the means used to obtain a frozen sample of sperm. We compared the data of two groups: those who obtained an anterograde ejaculation (AE) and those only a retrograde (ER). Results Between January 2013 and July 2017, 86 patients were seen in consultation, with a mean age of 30 years, mainly after traumatic injury (90%), cervico-thoracic level (89%) and complete lesion (59%). Ejaculation was not obtained in 13 patients (15%): 7 (8%) were considered to be failing, 4 had dropped out of care, and 2 were starting treatment. AE and RE were obtained in 73 patients (85%), which could be frozen in 63 patients (73%) mainly from an EA for 47 patients. Only 9 patients were able to obtain their sperm by self-stimulation, the other 54 needed to use single or double PVS associated or not with Midodrine. In the only ER group, predominantly patients with complete deficiency below T10, the dose of Midodrine, the number of trials and the frequency of use of double PVS were more important than in the EA group (respectively 23.5 mg vs 9 mg, 3 vs 1.8, 64 vs 29%). Conclusion In SCI patients for whom it is difficult to obtain an ejaculation, it's fundamental to look for ER, repeat the tests, aided by increasing dose Midodrine and PVS. [ABSTRACT FROM AUTHOR]