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Purpose: Non-obstructive azoospermia (NOA) represents the persistent absence of sperm in ejaculate without obstruction, stemming from diverse disease processes. This survey explores global practices in NOA diagnosis, comparing them with guidelines and offering expert recommendations. Materials and Methods:Materials and Methods: A 56-item questionnaire survey on NOA diagnosis and management was conducted globally from July to September 2022. This paper focuses on part 1, evaluating NOA diagnosis. Data from 367 participants across 49 coun-tries were analyzed descriptively, with a Delphi process used for expert recommendations. Results:Results: Of 336 eligible responses, most participants were experienced attending physicians (70.93%). To diagnose azoosper-mia definitively, 81.7% requested two semen samples. Commonly ordered hormone tests included serum follicle-stimulating hormone (FSH) (97.0%), total testosterone (92.9%), and luteinizing hormone (86.9%). Genetic testing was requested by 66.6%, with karyotype analysis (86.2%) and Y chromosome microdeletions (88.3%) prevalent. Diagnostic testicular biopsy, distinguishing obstructive azoospermia (OA) from NOA, was not performed by 45.1%, while 34.6% did it selectively. Differ-entiation relied on physical examination (76.1%), serum hormone profiles (69.6%), and semen tests (68.1%). Expectations of finding sperm surgically were higher in men with normal FSH, larger testes, and a history of sperm in ejaculate. Conclusions:Conclusions: This expert survey, encompassing 367 participants from 49 countries, unveils congruence with recommended guidelines in NOA diagnosis. However, noteworthy disparities in practices suggest a need for evidence-based, international consensus guidelines to standardize NOA evaluation, addressing existing gaps in professional recommendations.

Two distinct teleological perspectives emerge from the ancient Greek tradition. (1) Platonic teleology, which represents teleology as the result of intentional agency and is the origin of the idea of design; and (2) Aristotelian teleology, which introduces teleology as the result of natural and intrinsic causes. The preceding framework for understanding nature was superseded by the advent of the modern era and the establishment of the scientific method. Nevertheless, despite the prevailing skepticism regarding the possibility and utility of teleology in the modern era, it is asserted that several prominent scientists of the modern era are staunch defenders of teleology (design). However, with Darwin's proposal of the theory of evolution, the path to the destruction of teleology was initiated. This article examines the interconnection between Darwin's theory of evolution (then neo-Darwinism) and teleology, focusing on how this theory effectively undermines the teleological perspective. However, it seems that recent findings in the field of biology challenge this dominant view and open the way for the revival of teleology.

Objective: To describe the outcome of female anterior wall (pubic side) onlay urethroplasty with buccal mucosal graft using laterally extended surgical dissection in patients with previously failed minimally invasive techniques. Methods: From January 2016 to April 2018, 17 symptomatic patients with previously failed minimally invasive procedures were enrolled in the study. The diagnosis of urethral stricture was confirmed based on a combination of patients’ symptoms, post-void residual urine, video-urodynamics, and cystoscopy. Urethroplasty with lower lip mucosal graft was performed using the modified laterally extended dissection. Patients were evaluated pre-operatively and 12-month post-operatively with the American Urological Association symptom score, post-void residual urine, and maximum flow rate. Results: Despite the previously failed minimally invasive procedures, urethroplasty with lower lip buccal graft and laterally extended dissection resulted in favorable outcomes (success rate=94%). The mean±standard deviation of American urological association symptom score improved from pre-operative levels at the 12-month post-operative follow-up (25.82±3.97 to 10.88±5.57); so did postvoid residual urine (71.12±74.98 mL to 15.00±28.30 mL), and maximum flow rate (7.88±1.72 mL/s to 25.82±5.59 mL/s) with all statistically significant (p

Abstract Background: The sperm DNA fragmentation index (DFI) is one of the men's reproductive health criteria that affects assisted reproductive technique outcomes. Efforts in obtaining high-quality mature sperms seem to be necessary. Advanced sperm selection techniques (including physiological intracytoplasmic sperm injection [PICSI], zeta potential, microfluidic, etc.) have gained popularity in this regard. Objective: The study aimed to compare the efficacy of zeta potential and PICSI sperm selection in obtaining sperms with better DNA integrity. Materials and Methods: In this cross-sectional study, 48 couples were enrolled where the male partner had increased sperm DFI in his ejaculated sample and the female was in normal reproductive health. For each male partner, the semen sample was processed with zeta potential and PICSI techniques, then the sperm DFI of neat semen was compared to zeta and PICSI samples by the sperm chromatin dispersion test. Results: Data showed that both the zeta potential and PICSI technique decreased sperm DFI in comparison with the neat semen sample (p < 0.001 for both). In addition, there was a statistically significant difference in sperm DFI between the PICSI and zeta potential samples (p < 0.01). Conclusion: The current study showed that both zeta potential and PICSI could result in sperm with a lower DFI. However, PICSI seems to be superior to zeta potential in this regard.

Great naturalist philosophers like David Armstrong, David Papineau, Jeagwon Kim, and others have argued that the best arguments for naturalism are based on Physical Causal Closure (in brief P.C). P.C that is a premise in these arguments implies that only natural/physical causes are responsible for natural events and supernatural/non-physical causes cannot have any effective role in the natural universe. By adding some reasonable rules such as Ockham's Razor or Eleatic Principle to P.C, they have concluded that there is no non-natural cause such as God.Many theists, in the face of the physical causal closure, may accept it and see the relationship between God and the natural world not as causal but as something entirely different; as existential or necessary relation. But this view seems to have problems. First, it is passive because it simply accepts the basic premise of the naturalistic view, and secondly, it seems unacceptable from a theistic point of view to reduce the relationship between God and the world to existential or necessary relation and to eliminate the possibility of causal influence on natural things.In this paper, I will claim that P.C is not only against supernatural causation but is also against human agency and mental causation. To show this, first, I will present an argument against human mental causation based on P.C, and Then I will consider four different physicalist (which are committed to P.C) approaches that try to save mental causation. These approaches consist of 1) anomalous monism, 2) non-reductive physicalism, 3) over-determination, and 4) reductive physicalism.The first solution is the idea that Davidson came up with to solve the problem of mental causation. By criticizing type identity and reductionism, he first re-examines the issue of mental causation in a new form. Examining the first (anomalous monism), I will show that this approach cannot save mental causation, and, in fact, mental causation will be rejected in this view. The second approach, although it hopes to maintain both mental causation and commitment to the physical closure, this article will show that it wouldn't succeed in doing either. Although at first glance, acceptance of over-determination may seem like a better solution, I show that this solution has fundamental problems, including the fact that in this approach mental causality becomes redundant, without which physical causes will produce the same result. But without a doubt, the main and popular solution of naturalists will be the last, that is, reductionism. Reductionism in this approach distances itself from early reductionism and seeks to establish a token identity between mental and physical states. But this moderate reductionism also faces fundamental problems such as the hard problem of consciousness, intention, and human agency, which will reject the possibility of its success. I will show, therefore, that none of these approaches can solve the problem of P.C and mental causation.By criticizing all of them, I will show that P.C has an absurd consequence and cannot be a plausible premise in the argument for naturalism. Therefore, the best argument for naturalism will fail and cannot work against God.

In this article, after describing the content of the theory of Evolution from Darwin to the formation of modern synthesis or Neo-Darwinism, its theological implications are discussed. In particular, the Neo-Darwinian reading of Evolution is a ground for many Neo-Darwinists to advance the idea of naturalism. A critical aspect in the Neo-Darwinists defense of naturalism is their emphasis on following empirical evidence to shape their worldview. The second approach to Evolution is Intelligent Design. Although they are generally be presented as opposed to Evolution in the sense of a common ancestor, the central idea of this movement is the need for design in the process of Evolution, and they don't necessarily deny the Evolution from a common ancestor. Nevertheless, Neo-Darwinists often accuse the Intelligent Design movement of being unscientific and having religious motives. As a result, despite the scientific efforts of the Intelligent Design movement, there is no positive view of it in academia. But another interesting approach to Evolution is the third-way or post-Darwinian Evolution. It is opposed to intelligent design, but it has crucial criticisms of the Neo-Darwinian Evolution reading based on new biological evidence. But Neo-Darwinists confrontation with this evidence does not seem to be consistent with their claim to follow empirical evidence.

Abstract Background: Outcomes of intracytoplasmic sperm injection (ICSI) may be different in azoospermic men who undergo testicular sperm extraction (TESE) vs. microdissection-TESE (micro-TESE). Objective: This study was conducted to compare the ICSI outcomes in men who underwent TESE vs. micro-TESE due to obstructive azoospermia and nonobstructive azoospermia, respectively. Materials and Methods: A total of310azoospermic men who underwent ICSI from September 2016 to September 2020 were enrolled in this cross-sectional study and divided into two groups (172 cases in the TESE and 138 cases in the micro-TESE group). The paternal and maternal age, and the fertilization, biochemical pregnancy, abortion and live birth rates were compared between the two groups. Results: Maternal mean age was significantly higher in the TESE group (34.9 ± 4.2 yr vs. 32.3 ± 5.7 yr). The fertilization and biochemical pregnancy rates were significantly higher in the TESE group, but the abortion rate was similar in the two groups. The live birth rate was higher in the TESE group, but this difference was not significant (p = 0.06). Also, the maternal and paternal age did not affect ICSI outcomes. Conclusion: Individuals who underwent TESE had higher fertilization and biochemical pregnancy rates than those who underwent micro-TESE, but the live birth rate was not significantly different.

Background: Despite numerous reports about temporal changes in semen quality from all over the world, the debates continue. The latest systemic review has shown an overtime decrease in semen quality worldwide. Objective: To assess the temporal changes in the semen quality among Iranian population referred to an infertility center. Materials and Methods: In this retrospective cross-sectional study, semen parameters including concentration, motility, and morphology were compared between Iranian men reffered to Research and Clinical Center for Infertility, Yazd between 1990 to 1992 (group 1, n = 707) and 2010 to 2012 (group 2, n = 1108). Demographic characteristics and semen analysis were collected from the records. The effect of age on semen parameters was also investigated. Results: Despite the increase in sperm concentration l in group 2, sperm with normal morphology decreased significantly (p < 0.001). Grade-A motility decreased (p < 0.001), grade B motility increased (p < 0.001), and grade C and D motile sperm remained constant (p = 0.303 and p = 0.315, respectively). Also, no significant correlation between the age and semen parameters were observed. Conclusion: This study showed inconsistent temporal changes in the participant semen quality. Significant temporal decline were obtained between various semen parameters, sperm morphology and grade A motility. These results should be further evaluated by larger studies in the future.

The necessity of consideration and usage of the modern sciences is the core of John Polkinginghorn's approach to theological problems. Although he is generally committed to a personal, sublime, and distinct conception of God, which can be ascertained in Thomistic well-known conception of God, he criticizes this Thomistic conception. The main focus of his critiques is God's active relationship with the world and creatures, especially human beings. In this article, after citing Pokinghorn's critique of the Thomistic model, his new model has been introduced. Being stemmed from the capacities of modern physics, especially information causality, this model stays far from the problems of the Thomistic model. His model, in addition to allowing the role of God's eternal creation, leaves room for the Lordship and the influence of God's Will in the universe. In the end, we will evaluate Palkinghorne's view, which has three aspects: scientific, religious, and philosophical.

Objective: 45, X is a very rare condition that usually results from Y/autosomal translocations or insertions. Here we present an infertile azoospermic man who had 45, X t(Yp;15) karyotype and deletion of AZF (azoospermia factor) gene region. Case report: A 35-year-old infertile azoospermic man with a typical male appearance came for infertility genetic counseling. He was infertile for more than ten years and had short height. High-resolution of metaphase chromosomes of 50 peripheral white blood cells were analyzed for karyotyping. Fluorescence in situ hybridization (FISH) analysis and Polymerase chain reaction (PCR) were done for SRY and AZF gene localization. Karyotyping and FISH analysis revealed 45, X t(Yp;15) karyotype and no mosaicism. More investigation on the Y chromosome revealed no deletion in the SRY region, but AZF a/b/c were deleted. It was revealed that Yp's subtelomeric region but not Yq was translocated to chromosome 15. Conclusion: This study shows that despite the lack of a complete Y chromosome in this person, the occurrence of secondary male traits is a result of the short arm translocation of the Y chromosome, which contains the (ex-determining region Y) SRY gene. Infertility is also due to the Y chromosomes long arm's deletion containing the AZF gene region.

Abstract Background Circumcision is considered to be a procedure with minimal morbidity but may be associated with catastrophic complications in inexpert hands. Case presentation We presented a 9-year-old boy with a past medical history of circumcision at the age of one year with Plastibell clamp who was referred with severe chronic penile injury due to neglected plastibell string. After string removal under a loupe magnification (4×), we saw a deep circular injury at distal penile shaft which led to painless glandular autoamputation 45 days later. The patient was managed conservatively with daily urethral self-dilation until future reconstructive surgery. Conclusion This complication emphasized the importance of the follow-up visit by a physician for any probable string remnant.