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      Testicular volume in non‐obstructive azoospermia with a history of bilateral cryptorchidism may predict successful sperm retrieval by testicular sperm extraction

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          Abstract

          Purpose

          Cryptorchidism is one of the most common causes of non‐obstructive azoospermia (NOA) in adulthood. Even if early orchidopexy is performed to preserve fertility potential, some patients still suffer from azoospermia. Fertility potential is significantly lower in bilateral than unilateral cryptorchidism. The aims of this study were to identify clinical parameters that predict the likely success of sperm recovery by microscopic testicular sperm extraction (micro‐TESE) and also the likely outcome of intracytoplasmic sperm injection using sperm from NOA patients who submitted to bilateral orchidopexy.

          Methods

          Fifty‐two NOA patients with a history of bilateral cryptorchidism underwent micro‐TESE. The following clinical parameters were evaluated as predictive factors for successful sperm recovery: age at micro‐TESE; age at orchidopexy; period from orchidopexy to micro‐TESE; luteinizing hormone (LH); follicle‐stimulating hormone (FSH); testosterone; average testicular volume; and body mass index.

          Results

          In the successful sperm retrieval group, average testicular volume was significantly greater, while serum LH and FSH, and body mass index were significantly lower. In a multivariate analysis, average testicular volume was positively correlated with successful sperm recovery.

          Conclusion

          Our results indicate that testicular volume in NOA patients with bilateral cryptorchidism is a predictor for successful sperm recovery.

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          Most cited references28

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          Diagnostic evaluation of the infertile male: a committee opinion.

          (2015)
          The purpose of this ASRM Practice Committee report is to provide clinicians with principles and strategies for the evaluation of couples with male infertility problems. This revised document replaces the document of the same name, last published in 2012 (Fertil Steril 2012;98:294-301).
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            The importance of both an early orchidopexy and germ cell maturation for fertility.

            Delayed orchidopexy for undescended testes has been associated with abnormal testicular histology, but the effect on later fertility is unknown. We aimed to establish the importance of the first postnatal maturational step-ie, the transformation of gonocytes into Ad (dark) spermatogonia on fertility. We matched histological findings of the testes from 31 patients who had undergone an early orchidopexy with their total number of sperm. If Ad spermatogonia were present, 17 (94%) of 18 (95% CI 72.7-99.9) of the men had a total sperm count of 40 x 10(6)/ejaculate or greater. By contrast, despite successful early surgery, if Ad spermatogonia were absent, 12 (92%) of 13, (64.0-99.8) patients had abnormal spermiograms. Thus, the transformation of gonocytes into Ad spermatogonia is crucial for male fertility.
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              Fertility after Bilateral Cryptorchidism

              Purpose: Evaluation of the fertility of a cohort of formerly bilaterally cryptorchid men in comparison with a group of formerly unilaterally cryptorchid men, and a group of control men. Materials and Methods: Using a detailed questionnaire concerning paternity and factors related to paternity, a cohort of formerly bilateral cryptorchid men were studied and compared with men who had undergone orchiopexy for unilateral cryptorchidism, and a group of control men. All study subjects had had surgery at the Children’s Hospital of Pittsburgh, Pittsburgh, Pa., between 1955 and 1975. A subset of the full cohort underwent clinical evaluation that included a physical examination, serum hormonal determination and semen analyses. Results: Paternity rates are significantly lower among the formerly bilaterally cryptorchid men who have attempted to father a child (65.3%) as compared to the formerly unilaterally cryptorchid (89.7%; p < 0.001) and control men (93.2%; p < 0.001). Differences in the ability to father children are also apparent when semen and hormone levels are compared between the three groups. The bilateral group has significantly lower sperm density and inhibin B levels, and higher FSH and LH levels, than the unilateral and control groups. Conclusions: Men born with bilateral cryptorchidism have severely compromised fertility in adulthood. This reduction in fertility is clearly shown in comparisons of both paternity rates, and in semen and hormone analyses, between the formerly bilateral, formerly unilateral, and control groups.
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                Author and article information

                Contributors
                osaka917@dokkyomed.ac.jp
                Journal
                Reprod Med Biol
                Reprod Med Biol
                10.1111/(ISSN)1447-0578
                RMB2
                Reproductive Medicine and Biology
                John Wiley and Sons Inc. (Hoboken )
                1445-5781
                1447-0578
                12 July 2020
                October 2020
                : 19
                : 4 ( doiID: 10.1111/rmb2.v19.4 )
                : 372-377
                Affiliations
                [ 1 ] Department of Urology Dokkyo Medical University Saitama Medical Center Koshigaya Japan
                [ 2 ] Department of Reproduction Center Dokkyo Medical University Saitama Medical Center Koshigaya Japan
                Author notes
                [*] [* ] Correspondence

                Akiyoshi Osaka, MD, Department of Urology, Dokkyo Medical University Saitama Medical Center, 2‐1‐50 Minamikoshigaya, Koshigaya, Saitama 343‐8555, Japan.

                Email: osaka917@ 123456dokkyomed.ac.jp

                Author information
                https://orcid.org/0000-0002-5159-8028
                https://orcid.org/0000-0002-9950-0245
                Article
                RMB212338
                10.1002/rmb2.12338
                7542013
                33071639
                75d2f56d-e8b2-451e-84b4-1e82696b6758
                © 2020 The Authors. Reproductive Medicine and Biology published by John Wiley & Sons Australia, Ltd on behalf of Japan Society for Reproductive Medicine.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

                History
                : 31 March 2020
                : 14 June 2020
                : 27 June 2020
                Page count
                Figures: 0, Tables: 3, Pages: 6, Words: 4151
                Funding
                Funded by: Japan Agency for Medical Research and Development , open-funder-registry 10.13039/100009619;
                Award ID: 19gk0110027h0003
                Categories
                Original Article
                Original Articles
                Custom metadata
                2.0
                October 2020
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.9.2 mode:remove_FC converted:08.10.2020

                cryptorchidism,microdissection testicular sperm extraction,non‐obstructive azoospermia,orchidopexy,testicular volume

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