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Objective: To determine the distribution of semen parameters among adolescent and adult males presenting for fertility preservation., Methods: A retrospective, cross-sectional cohort study of adolescent males age 11-19 who underwent semen analysis for fertility preservation at 3 centers in 2 countries with a comparison cohort of adult men presenting for fertility preservation. Prevalence of azoospermia and distribution of semen parameters was compared across groups., Results: A total of 197 adolescents and 95 adults underwent semen analysis for fertility preservation. Azoospermia was present in 17 (8.6%) adolescents and 3 (3.2%) adults. There was decline in the prevalence of azoospermia with increasing age. After exclusion of patients with azoospermia, the adolescent and adult cohorts were comprised of 180 and 92 patients, respectively. Median age at presentation among adolescents vs adults was 16.5years (interquartile range [IQR] 15.2-17.6) and 30.8years (IQR 22.7-43.8), respectively. Median semen volume was 1.0mL (IQR 0.5-2.0) vs 2.5mL (IQR 1.5-3.5), P <.001. Median sperm concentration was 30million/mL (IQR 10-57) vs 39million/mL (IQR 14-57), P = .2. Median sperm motility was 39% (IQR 20-55) vs 45% (IQR 35-55), P = .01. Median total motile sperm count was 11million (IQR 1.4-33) for adolescents vs 29million (IQR 13-69) for adults, P <.001., Conclusion: Young adolescent males had higher prevalence of azoospermia and lower semen parameters compared to adults. In conjunction with physical examination, Tanner stage, and specific clinical context, these data can help to inform patients and their families about potential for fertility preservation, even in very young adolescent patients., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objective: To study the mechanism leading to elevated semen cytokines in men with spinal cord injury (SCI) and to understand if inflammasome pathways are involved in this process. To investigate inflammasome components and end-product cytokines in semen of SCI and control subjects., Design: Prospective study., Setting: Major university medical center., Patient(s): Men with and without SCI (n = 28 per group)., Intervention(s): None., Main Outcome Measure(s): Seminal plasma concentrations of caspase-1, interleukin (IL) 1β, and IL-18 were quantified by ELISA. Caspase-1 in sperm fractions and apoptosis-associated speck-like protein containing a caspase activation and recruitment domain (ASC) in seminal plasma and sperm fractions were identified by Western blot. Localization of proteins in sperm was accomplished by immunocytochemistry., Result(s): ASC, caspase-1, IL-1β, and IL-18 concentrations were elevated in the seminal plasma of SCI subjects compared with control subjects. ASC and caspase-1 were elevated in sperm cells of SCI subjects. Immunocytochemistry revealed that ASC was located in the acrosome, equatorial segment, and midpiece, and caspase-1 in the midpiece., Conclusion(s): This study provides the first evidence of ASC in human semen and demonstrates the involvement of inflammasome proteins in semen of men with SCI. These findings suggest an immunologic basis for abnormal semen quality in men with SCI., (Copyright © 2013 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Purpose: There are limited reports regarding the semen quality of men who sustained a spinal cord injury during the prepubertal period. We performed a retrospective chart review of 533 subjects with spinal cord injury to identify those injured during the prepubertal period and to characterize the semen quality of this population. To our knowledge this study is the first to formally evaluate semen parameters in this small but important subgroup of spinal cord injured subjects., Materials and Methods: A retrospective chart review was performed of all spinal cord injured subjects enrolled in the MFRP (Male Fertility Research Program) from 1991 through 2011. Prepubertal subjects were defined as those who sustained a traumatic spinal cord injury at or before the age of 11.9 years. Data collection included neurological level and completeness of injury, sexual responses, hormone profiles and semen quality., Results: Of 533 subjects 7 met the criteria for this study. Age at injury ranged from 4.4 to 11.9 years. Three subjects, injured before age 9 years, were azoospermic. One subject injured at age 10 years had a subnormal total sperm count, while those injured at age 11.9 years had normal total sperm counts, comparable to those of our subjects who sustained spinal cord injuries as adults. In most ejaculates with sperm, sperm motility was subnormal and comparable to that of subjects injured as adults., Conclusions: Spinal cord injury before the age of 9 years appears to interfere with spermatogenesis. In subjects injured near the age of 12 years semen quality in adulthood appears to be similar to that of subjects injured as adults., (Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)

Purpose: In a longitudinal study we examined changes in semen quality with time during the chronic phase of spinal cord injury., Materials and Methods: Included in this study were 87 men with spinal cord injury who underwent 2 or more semen retrieval procedures with a minimum of 3 years between the first and last procedures. Patients were selected from our database of 500 with spinal cord injury who were volunteers enrolled in the Male Fertility Research Program of the Miami Project to Cure Paralysis from January 1, 1991 through April 31, 2009. Semen was collected by masturbation, penile vibratory stimulation or electroejaculation. Semen analysis was done according to WHO criteria. We used a statistical generalized linear mixed model to analyze changes in sperm concentration, total sperm count, total motile sperm count and sperm motility with time., Results: Mean patient age was 30.1 years (range 16 to 48) and mean time after injury at the initial sperm retrieval procedure was 7.1 years (range 1 to 26). Sperm concentration decreased slightly with time but all other parameters were unchanged, including total sperm count, indicating a stable, null pattern in measures with time., Conclusions: Semen quality does not show clinically significant progressive changes during years after injury in men with spinal cord injury. This information is relevant for urologists who counsel these patients on family planning. Also, routine sperm freezing for fertility preservation is not indicated in this patient population., (Copyright © 2010 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)

Objectives: To determine factors that may help predict normal semen quality in this unique population of male patients, we examined our large database of men with spinal cord injury (SCI). Most men with SCI have abnormal semen quality; however, a small minority retain normal semen parameters., Methods: A retrospective analysis was performed on semen retrieval procedures administered between 1991 and 2009 in 500 men with SCI. From those men, we selected subjects who underwent at least 1 penile vibratory stimulation, electroejaculation, or masturbation procedure resulting in antegrade ejaculation (n = 400). Cases were defined as men who, according to World Health Organization criteria, had normal semen volume, sperm concentration, sperm motility. Control subjects (CR) were defined as all remaining subjects. Risk factors for normal semen parameters were evaluated by conditional logistic regression analysis., Results: Of the 400 subjects evaluated, only 30 had normal semen parameters. These 30 CS subjects were matched to 120 CR subjects. Analysis of risk factors revealed that incomplete lesion of the spinal cord (ASIA B to D) was significantly associated with the presence of normal sperm parameters (odds ratio 2.6 [95% confidence interval 1.1-6.1], P = .028). CS subjects were also more likely to be able to collect their samples via masturbation (odds ratio 2.7 [95% confidence interval 1.1-7.1], P = .037). Other risk factors evaluated were not predictive of normal semen parameters., Conclusions: This retrospective, case-control study, performed on a large group of subjects, showed that completeness of SCI is an important risk factor influencing semen quality., (Copyright 2010 Elsevier Inc. All rights reserved.)

Purpose: To predict the probability of azoospermia without a semen analysis in men presenting with infertility by developing an azoospermia prediction model. Materials and Methods: Two predictive algorithms were generated, one with follicle stimulating hormone (FSH) as the only input and another logistic regression (LR) model with additional clinical inputs of age, luteinizing hormone, total testosterone, and bilateral testis volume. Men presenting between 01/2016 and 03/2020 with semen analyses, testicular ochiodemetry, and serum gonadotropin measurements collected within 120 days were included. An azoospermia prediction model was developed with multi-institutional two-fold external validation from tertiary urologic infertility clinics in Chicago, Miami, and Milan. Results: Total 3,497 participants were included (n=Miami 946, Milan 1,955, Chicago 596). Incidence of azoospermia in Miami, Milan, and Chicago was 13.8%, 23.8%, and 32.0%, respectively. Predictive algorithms were generated with Miami data. On Milan external validation, the LR and quadratic FSH models both demonstrated good discrimination with areas under the receiver-operating-characteristic (ROC) curve (AUC) of 0.79 and 0.78, respectively. Data from Chicago performed with AUCs of 0.71 for the FSH only model and 0.72 for LR. Correlation between the quadratic FSH model and LR model was 0.95 with Milan and 0.92 with Chicago data. Conclusions: We present and validate algorithms to predict the probability of azoospermia. The ability to predict the probability of azoospermia without a semen analysis is useful when there are logistical hurdles in obtaining a semen analysis or for reevaluation prior to surgical sperm extraction. [ABSTRACT FROM AUTHOR]

Varicocele has been hypothesized to lead to seminal inflammation, which in turn interferes with sperm function. Thus, the aim of this study was to investigate the role of inflammatory cytokines in the pathogenesis of decreased semen quality observed in adult men with varicocele, and to determine if varicocelectomy corrects these potential alterations. A prospective study was carried out including fifteen control men without varicocele and with normal semen quality and 15 men with varicocele with surgical indication. Men with varicocele grades II or III underwent microsurgical subinguinal varicocelectomy. Controls collected one semen sample and men with varicocele collected one before and one 6 months after the surgery. Semen analysis, sperm function, and seminal lipid peroxidation levels were assessed. Seminal plasma inflammasome activity was evaluated by ELISA assays for IL-1β, IL-18 and caspase-1 and by Western blotting for ASC (apoptosis-associated speck-like protein). Groups were compared by an unpaired Student's T test. Varicocelectomy samples were compared using a paired Student's T test (α = 5%). Men with varicocele had decreased semen quality, and increased seminal IL-1β levels, when compared to control men. Varicocelectomy decreased levels of caspase-1, IL-18, and IL1β. Thus, varicocelectomy improves sperm morphology and decreases seminal plasma inflammatory activity, after a six-month post-operative period. [ABSTRACT FROM AUTHOR]

Spinal cord injury (SCI) is a catastrophic event with sequelae that are not often apparent. For the spinal cord injured man, the inability to become a biologic father because of reproductive dysfunction becomes a major negative factor in his self-esteem and a hindrance to his social rehabilitation. Approximately, 90% of men with SCI develop ejaculatory dysfunction and only 10% can ejaculate by masturbation or during sexual activity. It is only over the last 40 years that it has been possible to properly study and understand the various factors contributing to the problem. Advances have been made in governmental and societal attitudes that have led to improvements in the treatment and rehabilitation of persons with SCI and other disabilities. It is now possible to retrieve sperm reliably and safely from men with SCI. Although their semen quality is often impaired, there is a very reasonable chance for achieving biologic fatherhood using assisted reproductive techniques. Penile vibratory stimulation (PVS) is a safe, reliable, efficient, and cost-effective, method of sperm retrieval that will produce an ejaculate in up to 86% of the patients with a level of injury T10 or rostral, which accounts for approximately 80% of the SCI population. Some motile sperm will be present in 90% of these ejaculates. In approximately 75% of the ejaculates, there will be greater than 5 million motile sperm, allowing a couple to explore all the options available to a couple seeking help in conceiving a child. The Male Fertility Program of the Miami Project to Cure Paralysis is at the leading edge of basic and clinical research contributing to the management of infertility in men with SCI. This review will outline "how we got there" enabling us to recommend PVS as the first choice in assisting men with SCI to become biologic parents. [ABSTRACT FROM AUTHOR]

Purpose: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has created a surge of research to help better understand the breadth of possible sequelae. However, little is known regarding the impact on semen parameters and fertility potential. We sought to investigate for presence of viral RNA in semen of men with SARS-CoV-2 infection and to evaluate its effect on semen parameters in ejaculate. Materials and Methods: We prospectively recruited thirty men diagnosed with acute SARS-CoV-2 infection using real-time reverse transcriptase polymerase chain reaction (RT-PCR) of pharyngeal swab specimens. Semen samples were collected from each individual using mailed kits. Follow-up semen samples were done with mailed kits or in-person in office setting. Semen analysis and PCR was performed after samples were received. Results: Thirty semen samples from recovered men were obtained 11–64 days after testing positive for SAR-CoV-2 infection. The median duration between positive SAR-CoV-2 test and semen collection was 37 days (interquartile range [IQR]=23). The median total sperm number (TSN) in ejaculate was 12.5 million (IQR=52.1). When compared with age-matched SARSCoV-2(-) men, TSN was lower among SARS-CoV-2(+) men (p=0.0024). Five men completed a follow-up sperm analysis (median 3 months) and had a median TSN of 18 million (IQR=21.6). No RNA was detected by means of RT-PCR in the semen in 16 samples tested. Conclusions: SARS-CoV-2 infection, though not detected in semen of recovered men, can affect TSN in ejaculate in the acute setting. Whether SARS-CoV-2 can affect spermatogenic function long-term remains to be evaluated. [ABSTRACT FROM AUTHOR]