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Purpose To investigate the incidence, etiology, treatment indications, and outcomes regarding infertile male patients in Japan. Methods Between April, 2014 and March, 2015, the authors contacted 47 clinical specialists in male infertility who had been certified by the Japan Society for Reproductive Medicine. The participating clinicians were sent a questionnaire regarding information on their infertile patients, according to etiology and the number and success rates of male infertility operations that had been performed in their practice. Results Thirty-nine specialists returned the questionnaire and provided information regarding 7268 patients. The etiology of infertility included testicular factors, sexual disorders, and seminal tract obstruction. During the study year, the clinicians performed varicocelectomies, testicular sperm extractions (TESEs), and re-anastomoses of the seminal tract. The rate of successful varicocelectomies was >70%. The sperm retrieval rates with conventional TESE and microdissection TESE were 98.3% and 34.0%, respectively, while the patency rates with vasovasostomy and epididymovasostomy were 81.8% and 61.0%, respectively. Conclusion Surgical outcomes for infertile male patients are favorable and can be of great clinical benefit for infertile couples. To achieve this, urologists should work in collaboration with gynecological specialists in order to optimize the treatment of both partners.

Purpose Oncofertility is a subspecialty that is concerned with helping patients with cancer preserve their ability to have children in the future. For men, sperm banking is an established way to preserve fertility. The aim was to determine the prefreeze semen characteristics and reproductive outcomes according to cancer type for men who chose semen cryopreservation. Methods The records of 122 men with cancer who requested semen cryopreservation at the authors' hospital from 2006 to 2015 were reviewed. The mean patient age when the semen was cryopreserved was 33.6 years. Results The 122 men who banked sperm during the study period had the following types of cancer: testicular (44.3%), hematological (31.1%), digestive (8.2%), and other types (16.4%). The mean sperm concentration by cancer type was 30.5 × 106/mL for testicular, 45.0 × 106/mL for hematological, 40.5 × 106/mL for digestive, and 68.4 × 106/mL for the other types. The mean sperm motility by cancer type was 59.6% for testicular, 50.1% for hematological, 43.0% for digestive, and 44.8% for the other types. For 12 (9.8%) men who used the banked semen, there were five (41.7%) clinical pregnancies. Conclusion Semen cryopreservation is a simple procedure that can be accomplished quickly and can preserve fertility.

Background: Testicular microlithiasis is said to be characterized by calcific concretions within the seminiferous tubules. There have been reports suggesting a link between testicular microlithiasis and testicular dysfunction and tumors.

Purpose Klinefelter syndrome (KS) (47, XXY) is the most common sex chromosome abnormality in humans. KS is characterized by gynecomastia, tall stature, small testes, low testosterone levels, learning disabilities, and behavioral problems. KS is also associated with infertility due to non‐obstructive azoospermia (NOA). The mechanism underlying NOA is still poorly understood, and although there is no current treatment, the use of microdissection testicular sperm extraction (micro‐TESE) followed by in vitro fertilization can result in successful conception. The generation of induced pluripotent stem (iPS) cells derived from KS patients may be useful for studying the disease mechanism and identifying novel therapies. Methods Cells from a KS patient were transduced with Sendai viral vectors encoding four transcription factors, OCT4, SOX2, KLF4, and C‐MYC, and the transduced cells were analyzed for in vitro and in vivo pluripotency. Results KS patient‐derived iPS cells were successfully generated and shown to produce teratomas in the testes of SCID mice. In vitro differentiation of the iPS cells into cardiomyocyte‐like cells was confirmed by the presence of clusters of beating cells. Conclusions KS patient‐derived iPS cells that could differentiate into cardiomyocyte‐like cells were established.

Stem cells have the ability both to differentiate into numerous tissues and to self‐renew. Because of these unique properties, stem cells are promising candidates for use in regenerative medicine. Among stem cell types, embryonic stem (ES) cells have been the most studied; however, alternatives such as induced pluripotent stem cells or other adult stem cells are now being established. In this review, we focus on stem cell research that may have applications in treating male infertility. Stem cells with ES‐like properties have been generated from adult human testis tissue. We expect that breakthroughs in stem cell research will increase our understanding of male infertility and lead to treatments in the near future.

Purpose Induced pluripotent stem (iPS) cells have been generated from mouse and human fibroblasts by several groups; however, transplanted mouse iPS cells can cause teratomas, depending on their tissue of origin. Therefore, human iPS cells are preferable, and various tissues are being evaluated for their potential to generate human iPS cells. Methods We examined whether adult human testicular tissue had undergone reprogramming by introducing four transcription factors, OCT4, SOX2, KLF4, and C-MYC, using lentiviral vectors. Results We obtained embryonic stem (ES)-like cells derived from human testicular tissue by introducing four cDNAs, encoding the transcription factors OCT4, SOX2, KLF4, and C-MYC, using lentiviral vectors. We showed that DAZL and VASA were expressed in testicular cells but down-regulated in ES-like cells, indicating that the cells had undergone reprogramming. ES-like cells could develop tumors, which is a hallmark of pluripotency, when SCID mice were injected with these cells. Conclusions We induced iPS cells from adult human testicular tissue by introducing four transcription factors, OCT4, SOX2, KLF4, and C-MYC, using lentiviral vectors. Future studies on these cells may elucidate the causes of male infertility, and eventually lead to treatments with autologous testicular tissue-derived iPS cells.

Purpose Inappropriate intromission time causes sexual problems for couples, and therefore it is important for the couple to set treatment targets. Methods We investigated appropriate intromission times by conducting a questionnaire survey of the interval from initiation of insertion to just before ejaculation in Japanese married couples. A questionnaire survey of 300 married couples was conducted by mail. Results The estimated mean intromission times were 14.5 min (median: 10 min) for male subjects and 13.6 min (median: 10 min) for female subjects. The mean desired intromission time for female subjects was 15.7 min (median: 15 min). Regarding the difference between the actual and desired intromission times, the desired time was longer, the same, and shorter for 43.0%, 38.7%, and 18.3% of all the female subjects. Conclusions It seems that female subjects may consider a wide variety of intravaginal insertion times to be desirable. Accordingly, married couples need to improve communication regarding the desired duration of intromission and other related issues.

Spermatogonial stem cells (SSCs) are self-renewing cells whose progeny are committed to differentiate into spermatozoa; this is a life-long process in male mammals. There are several methods for obtaining enriched populations of mouse SSCs, and immunological separation using surface antigens is a commonly used technique. The study of human SSCs is much less advanced. We used biopsied human testicular tissues [obstructive azoospermia patients (n = 5) and patients who underwent a testis biopsy as part of an evaluation for infertility (n = 7)] to obtain Thy-1+ cells. Thy-1—a glycosyl phosphatidylinositol-anchored surface antigen—is a marker uniquely expressed on SSCs that is used to isolate SSC-enriched cell populations in mice. The Thy-1+ cells from human testicular tissues were cultured in a basic system consisting of serum-free medium and mitotically inactivated STO (SIM mouse embryo-derived thioguanine- and ouabain-resistant) cell feeders with added growth factors: glial cell line-derived neurotrophic factor (GDNF), basic fibroblast growth factor (bFGF), and GDNF-family receptor α1 (GFRα-1). The Thy-1+ cells were maintained in vitro using this system for 1 week. The Thy-1+ cells expressed OCT3/4 and alkaline phosphatase, like mouse SSCs. They also expressed NANOG. Thy-1+ cells injected into nude mice did not cause tumor formation over a period of at least 6 months. These results support the possibility that the Thy-1+ cell population included human SSCs, and that Thy-1 may be a marker for human SSCs.

Aim The aim of the present study was to investigate the assessment of currently prescribed drugs and approaches to overall erectile dysfunction (ED) therapy.

Background Testicular microlithiasis is said to be characterized by calcific concretions within the seminiferous tubules. There have been reports suggesting a link between testicular microlithiasis and testicular dysfunction and tumors.

Spermatogonial stem cells (SSCs) are self-renewing cells whose progeny are committed to differentiate into spermatozoa; this is a life-long process in male mammals. There are several methods for obtaining enriched populations of mouse SSCs, and immunological separation using surface antigens is a commonly used technique. The study of human SSCs is much less advanced.We used biopsied human testicular tissues [obstructive azoospermia patients (The Thy-1These results support the possibility that the Thy-1