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3. Sperm Vitality

Author

Salvio, Gianmaria, Zenoaga-Barbăroșie, Cătălina, Agarwal, Ashok, editor, Boitrelle, Florence, editor, Saleh, Ramadan, editor, and Shah, Rupin, editor

Published
2024
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6. Global Practice Patterns and Variations in the Medical and Surgical Management of Non- Obstructive Azoospermia: Results of a World-Wide Survey, Guidelines and Expert Recommendations.

Author

Rambhatla, Amarnath, Shah, Rupin, Ziouziou, Imad, Kothari, Priyank, Salvio, Gianmaria, Gul, Murat, Hamoda, Taha, Kavoussi, Parviz, Atmoko, Widi, Toprak, Tuncay, Birowo, Ponco, Ko, Edmund, Arafa, Mohamed, Ghayda, Ramy Abou, Karthikeyan, Vilvapathy Senguttuvan, Russo, Giorgio Ivan, Pinggera, Germar-Michael, Chung, Eric, Harraz, Ahmed M., and Martinez, Marlon

Subjects
KLINEFELTER'S syndrome, PHYSICIAN practice patterns, AZOOSPERMIA, FOLLICLE-stimulating hormone, HYPOGONADISM
Abstract

Purpose: Non-obstructive azoospermia (NOA) is a common, but complex problem, with multiple therapeutic options and a lack of clear guidelines. Hence, there is considerable controversy and marked variation in the management of NOA. This survey evaluates contemporary global practices related to medical and surgical management for patients with NOA. Materials and Methods: A 56-question online survey covering various aspects of the evaluation and management of NOA was sent to specialists around the globe. This paper analyzes the results of the second half of the survey dealing with the management of NOA. Results have been compared to current guidelines, and expert recommendations have been provided using a Delphi process. Results: Participants from 49 countries submitted 336 valid responses. Hormonal therapy for 3 to 6 months was suggested before surgical sperm retrieval (SSR) by 29.6% and 23.6% of participants for normogonadotropic hypogonadism and hypergonadotropic hypogonadism respectively. The SSR rate was reported as 50.0% by 26.0% to 50.0% of participants. Interestingly, 46.0% reported successful SSR in <10% of men with Klinefelter syndrome and 41.3% routinely recommended preimplantation genetic testing. Varicocele repair prior to SSR is recommended by 57.7%. Half of the respondents (57.4%) reported using ultrasound to identify the most vascularized areas in the testis for SSR. One-third proceed directly to microdissection testicular sperm extraction (mTESE) in every case of NOA while others use a staged approach. After a failed conventional TESE, 23.8% wait for 3 months, while 33.1% wait for 6 months before proceeding to mTESE. The cut-off of follicle-stimulating hormone for positive SSR was reported to be 12–19 IU/mL by 22.5% of participants and 20–40 IU/mL by 27.8%, while 31.8% reported no upper limit. Conclusions: This is the largest survey to date on the real-world medical and surgical management of NOA by reproductive experts. It demonstrates a diverse practice pattern and highlights the need for evidence-based international consensus guidelines. [ABSTRACT FROM AUTHOR]

Published
2025
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7. Pembrolizumab-induced Thyroiditis, Hypophysitis and Adrenalitis: A Case of Triple Endocrine Dysfunction.

Author

Rossi, Silvia, Silvetti, Francesca, Bordoni, Monia, Ciarloni, Alessandro, Salvio, Gianmaria, and Balercia, Giancarlo

Subjects
IMMUNE checkpoint inhibitors, AUTOIMMUNE diseases, SYMPTOMS, STEROID drugs, LEVOTHYROXINE, ADRENAL insufficiency
Abstract

Immune checkpoint inhibitor drugs can trigger autoimmune endocrine reactions as a known side effect. Several cases of immunotherapy-induced autoimmune endocrinopathies have been described, but multiple sequential endocrine toxicities are a rare occurrence. A 39-year-old patient with metastatic melanoma started adjuvant therapy with pembrolizumab. One month later he presented with asymptomatic thyrotoxicosis and, within several weeks, overt hypothyroidism, for which he started levothyroxine therapy. Subsequently the patient developed central adrenal insufficiency due to probable hypophysitis, and steroid replacement therapy was started. Pembrolizumab therapy was then discontinued. After a few months, a full recovery of pituitary function was observed, but primary adrenal insufficiency occurred, requiring additional fludrocortisone therapy. The described clinical case is a very uncommon case of triple endocrinological toxicity from immunotherapy. The clinical and biochemical manifestations of immunotherapy-induced endocrinopathies can be variable and atypical; therefore, it is necessary to pay special attention to any clue of hormonal dysfunction. [ABSTRACT FROM AUTHOR]

Published
2024
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9. The Thyroid Function

Author

Cutini, Melissa, Balercia, Giancarlo, Salvio, Gianmaria, Pasquali, Daniela, Jannini, Emmanuele A., Series Editor, Foresta, Carlo, Series Editor, Lenzi, Andrea, Series Editor, Maggi, Mario, Series Editor, Garolla, Andrea, editor, and Corona, Giovanni, editor

Published
2020
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10. Global Practice Patterns in the Evaluation of Non-Obstructive Azoospermia: Results of a World-Wide Survey and Expert Recommendations.

Author

Shah, Rupin, Rambhatla, Amarnath, Atmoko, Widi, Martinez, Marlon, Ziouziou, Imad, Kothari, Priyank, Tadros, Nicholas, Vinh Phuoc, Nguyen Ho, Kavoussi, Parviz, Harraz, Ahmed, Salvio, Gianmaria, Gul, Murat, Hamoda, Taha, Toprak, Tuncay, Birowo, Ponco, Ko, Edmund, Arafa, Mohamed, Ghayda, Ramy Abou, Karthikeyan, Vilvapathy Senguttuvan, and Saleh, Ramadan

Subjects
AZOOSPERMIA, Y chromosome, FOLLICLE-stimulating hormone, LUTEINIZING hormone, SEMEN
Abstract

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: 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 countries were analyzed descriptively, with a Delphi process used for expert recommendations. Results: Of 336 eligible responses, most participants were experienced attending physicians (70.93%). To diagnose azoospermia 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. Differentiation 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: 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. [ABSTRACT FROM AUTHOR]

Published
2024
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13. Effects of Varicocele Repair on Sperm DNA Fragmentation and Seminal Malondialdehyde Levels in Infertile Men with Clinical Varicocele: A Systematic Review and Meta-Analysis

Author

Cannarella, Rossella, primary, Shah, Rupin, additional, Saleh, Ramadan, additional, Boitrelle, Florence, additional, Hamoda, Taha Abo-Almagd Abdel-Meguid, additional, Singh, Rajender, additional, Salvio, Gianmaria, additional, Toprak, Tuncay, additional, Falcone, Marco, additional, Gul, Murat, additional, Dimitriadis, Fotios, additional, Rambhatla, Amarnath, additional, Russo, Giorgio I., additional, Ko, Edmund, additional, Zini, Armand, additional, Kavoussi, Parviz, additional, Phuoc, Nguyen Ho Vinh, additional, Kandil, Hussein, additional, Ghayda, Ramy Abou, additional, Birowo, Ponco, additional, Gherabi, Nazim, additional, Ceyhan, Erman, additional, Dong, Jie, additional, Malhotra, Vineet, additional, Durairajanayagam, Damayanthi, additional, Kolbasi, Bircan, additional, Bahar, Fahmi, additional, Calik, Gokhan, additional, Çayan, Selahittin, additional, Pinggera, Germar-Michael, additional, Calogero, Aldo E., additional, Rajmil, Osvaldo, additional, Mostafa, Taymour, additional, Atmoko, Widi, additional, Harraz, Ahmed M., additional, Le, Tan V., additional, de la Rosette, Jean, additional, Hakim, Lukman, additional, Pescatori, Edoardo, additional, Sergeyev, Oleg, additional, Rashed, Ayman, additional, Saini, Pallavi, additional, and Agarwal, Ashok, additional

Published
2024
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14. Impact of Varicocele on Testicular Oxidative Stress and Sperm Parameters in Experimental Animals: A Systematic Review and Meta-Analysis

Author

Russo, Giorgio Ivan, primary, Saleh, Ramadan, additional, Finocchi, Federica, additional, Juma, Almas Ramadhani, additional, Durairajanayagam, Damayanthi, additional, Kahraman, Oguzhan, additional, Söğütdelen, Emrullah, additional, Sokolakis, Ioannis, additional, Vishwakarma, Ranjit B., additional, Bahar, Fahmi, additional, Harraz, Ahmed M., additional, Kavoussi, Parviz, additional, Atmoko, Widi, additional, Chung, Eric, additional, Kumar, Naveen, additional, Zohdy, Wael, additional, Rambhatla, Amarnath, additional, Arafa, Mohamed, additional, Phuoc, Nguyen Ho Vinh, additional, Salvio, Gianmaria, additional, Calogero, Aldo E., additional, Toprak, Tuncay, additional, Pinggera, Germar-Michael, additional, Cannarella, Rossella, additional, Colpi, Giovanni, additional, Abdel-Meguid Hamoda, Taha Abo-Almagd, additional, Shah, Rupin, additional, and Agarwal, Ashok, additional

Published
2024
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18. The Thyroid Function

Author

Cutini, Melissa, primary, Balercia, Giancarlo, additional, Salvio, Gianmaria, additional, and Pasquali, Daniela, additional

Published
2020
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19. Acromegaly, Herniation of Cerebellar Tonsils, and Arnold–Chiari 1 Malformation: The Importance of Right Definitions.

Author

Ciarloni, Alessandro and Salvio, Gianmaria

Subjects
*ARNOLD-Chiari deformity, *ACROMEGALY, *TONSILS, *CONGENITAL disorders, *HERNIA, *LITERATURE reviews
Abstract

We present a case of acromegaly associated with Arnold–Chiari 1 malformation and a literature review regarding this association, mainly focusing on the importance of a clear distinction between Chiari malformation and herniation of cerebellar tonsils (CTH). Indeed, in many clinical cases, this distinction has not been properly made and a better description of the radiological findings could be important for the clinical management of these patients. In fact, Arnold–Chiari 1 malformation, as a congenital disease, is not caused by acquired growth hormone (GH) excess, but the latter could worsen pre-existing CTH or even induce it ex novo. Therefore, awareness of this condition in the clinical management of acromegaly appears crucial. [ABSTRACT FROM AUTHOR]

Published
2024
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21. Controversy and consensus on the management of elevated sperm DNA fragmentation in male infertility: A global survey, current guidelines, and expert recommendations

Author

Farkouh, Ala’a, Agarwal, Ashok, Hamoda, Taha Abo-Almagd Abdel-Meguid, Kavoussi, Parviz, Saleh, Ramadan, Zini, Armand, Arafa, Mohamed, Harraz, Ahmed M., Gul, Murat, Karthikeyan, Vilvapathy Senguttuvan, Durairajanayagam, Damayanthi, Rambhatla, Amarnath, Boitrelle, Florence, Chung, Eric, Birowo, Ponco, Toprak, Tuncay, Ghayda, Ramy Abou, Cannarella, Rossella, Phuoc, Nguyen Ho Vinh, Dimitriadis, Fotios, Russo, Giorgio I., Sokolakis, Ioannis, Mostafa, Taymour, Makarounis, Konstantinos, Ziouziou, Imad, Kuroda, Shinnosuke, Bendayan, Marion, Kaiyal, Raneen Sawaid, Japari, Andrian, Simopoulou, Mara, Rocco, Lucia, Garrido, Nicolas, Gherabi, Nazim, Bocu, Kadir, Kahraman, Oguzhan, Le, Tan V., Wyns, Christine, Tremellen, Kelton, Sarikaya, Selcuk, Lewis, Sheena, Evenson, Donald P., Ko, Edmund, Calogero, Aldo E., Bahar, Fahmi, Martinez, Marlon, Crafa, Andrea, Nguyen, Quang, Ambar, Rafael F., Colpi, Giovanni, Bakircioglu, Mustafa Emre, Henkel, Ralf, Kandil, Hussein, Serefoglu, Ege Can, Alarbid, Abdullah, Tsujimura, Akira, Kheradmand, Alireza, Anagnostopoulou, Christina, Marino, Angelo, Adamyan, Aram, Zilaitiene, Birute, Ozer, Cevahir, Pescatori, Edoardo, Vogiatzi, Paraskevi, Busetto, Gian Maria, Balercia, Giancarlo, Elbardisi, Haitham, Akhavizadegan, Hamed, Sajadi, Hesamoddin, Taniguchi, Hisanori, Park, Hyun Jun, Rosas, Israel Maldonado, Al-Marhoon, Mohamed, Gilani, Mohammad Ali Sadighi, Alhathal, Naif, Pinggera, Germar-Michael, Kothari, Priyank, Mogharabian, Nasser, Micic, Sava, Homa, Sheryl T., Darbandi, Sara, Long, Tran Quang Tien, Zohdy, Wael, Atmoko, Widi, Sabbaghian, Marjan, Ibrahim, Wael, Smith, Ryan P., Ho, Christopher Chee Kong, Rosette, Jean de la, El-Sakka, Ahmed I., Preto, Mirko, Zenoaga-Barbăroșie, Cătălina, Abumelha, Saad Mohammed, Baser, Aykut, Aydos, Kaan, Ramirez-Dominguez, Liliana, Kumar, Vijay, Ong, Teng Aik, Mierzwa, Tiago Cesar, Adriansjah, Ricky, Banihani, Saleem A., Bowa, Kasonde, Fukuhara, Shinichiro, Peña, Marcelo Rodriguez, Moussa, Mohamad, Ari, Umut Çağın, Cho, Chak-Lam, Tadros, Nicholas N., Ugur, Muhammet Rasit, Amar, Edouard, Falcone, Marco, Santer, Frederic Romain, Kalkanli, Arif, Karna, Keshab Kumar, Khalafalla, Kareim, Vishwakarma, Ranjit B., Finocchi, Federica, Giulioni, Carlo, Ceyhan, Erman, Çeker, Gökhan, Yazbeck, Chadi, Rajmil, Osvaldo, Yilmaz, Mehmet, Altay, Baris, Barrett, Trenton L., Ngoo, Kay Seong, Roychoudhury, Shubhadeep, Salvio, Gianmaria, Lin, Haocheng, Kadioglu, Ates, Timpano, Massimiliano, Avidor-Reiss, Tomer, Hakim, Lukman, Sindhwani, Puneet, Franco, Giorgio, Singh, Rajender, Giacone, Filippo, Ruzaev, Mikhail, Kosgi, Raghavender, Sofikitis, Nikolaos, Palani, Ayad, Calik, Gokhan, Kulaksız, Deniz, Jezek, Davor, Al Hashmi, Manaf, Drakopoulos, Panagiotis, Omran, Huda, Leonardi, Sofia, Celik-Ozenci, Ciler, Güngör, Nur Dokuzeylül, Ramsay, Jonathan, Amano, Toshiyasu, Sogutdelen, Emrullah, Duarsa, Gede Wirya Kusuma, Chiba, Koji, Jindal, Sunil, Savira, Missy, Boeri, Luca, Borges, Edson, Gupte, Deepak, Gokalp, Fatih, Hebrard, Guadalupe Hernández, Minhas, Suks, Shah, Rupin, Farkouh, Ala’a, Agarwal, Ashok, Hamoda, Taha Abo-Almagd Abdel-Meguid, Kavoussi, Parviz, Saleh, Ramadan, Zini, Armand, Arafa, Mohamed, Harraz, Ahmed M., Gul, Murat, Karthikeyan, Vilvapathy Senguttuvan, Durairajanayagam, Damayanthi, Rambhatla, Amarnath, Boitrelle, Florence, Chung, Eric, Birowo, Ponco, Toprak, Tuncay, Ghayda, Ramy Abou, Cannarella, Rossella, Phuoc, Nguyen Ho Vinh, Dimitriadis, Fotios, Russo, Giorgio I., Sokolakis, Ioannis, Mostafa, Taymour, Makarounis, Konstantinos, Ziouziou, Imad, Kuroda, Shinnosuke, Bendayan, Marion, Kaiyal, Raneen Sawaid, Japari, Andrian, Simopoulou, Mara, Rocco, Lucia, Garrido, Nicolas, Gherabi, Nazim, Bocu, Kadir, Kahraman, Oguzhan, Le, Tan V., Wyns, Christine, Tremellen, Kelton, Sarikaya, Selcuk, Lewis, Sheena, Evenson, Donald P., Ko, Edmund, Calogero, Aldo E., Bahar, Fahmi, Martinez, Marlon, Crafa, Andrea, Nguyen, Quang, Ambar, Rafael F., Colpi, Giovanni, Bakircioglu, Mustafa Emre, Henkel, Ralf, Kandil, Hussein, Serefoglu, Ege Can, Alarbid, Abdullah, Tsujimura, Akira, Kheradmand, Alireza, Anagnostopoulou, Christina, Marino, Angelo, Adamyan, Aram, Zilaitiene, Birute, Ozer, Cevahir, Pescatori, Edoardo, Vogiatzi, Paraskevi, Busetto, Gian Maria, Balercia, Giancarlo, Elbardisi, Haitham, Akhavizadegan, Hamed, Sajadi, Hesamoddin, Taniguchi, Hisanori, Park, Hyun Jun, Rosas, Israel Maldonado, Al-Marhoon, Mohamed, Gilani, Mohammad Ali Sadighi, Alhathal, Naif, Pinggera, Germar-Michael, Kothari, Priyank, Mogharabian, Nasser, Micic, Sava, Homa, Sheryl T., Darbandi, Sara, Long, Tran Quang Tien, Zohdy, Wael, Atmoko, Widi, Sabbaghian, Marjan, Ibrahim, Wael, Smith, Ryan P., Ho, Christopher Chee Kong, Rosette, Jean de la, El-Sakka, Ahmed I., Preto, Mirko, Zenoaga-Barbăroșie, Cătălina, Abumelha, Saad Mohammed, Baser, Aykut, Aydos, Kaan, Ramirez-Dominguez, Liliana, Kumar, Vijay, Ong, Teng Aik, Mierzwa, Tiago Cesar, Adriansjah, Ricky, Banihani, Saleem A., Bowa, Kasonde, Fukuhara, Shinichiro, Peña, Marcelo Rodriguez, Moussa, Mohamad, Ari, Umut Çağın, Cho, Chak-Lam, Tadros, Nicholas N., Ugur, Muhammet Rasit, Amar, Edouard, Falcone, Marco, Santer, Frederic Romain, Kalkanli, Arif, Karna, Keshab Kumar, Khalafalla, Kareim, Vishwakarma, Ranjit B., Finocchi, Federica, Giulioni, Carlo, Ceyhan, Erman, Çeker, Gökhan, Yazbeck, Chadi, Rajmil, Osvaldo, Yilmaz, Mehmet, Altay, Baris, Barrett, Trenton L., Ngoo, Kay Seong, Roychoudhury, Shubhadeep, Salvio, Gianmaria, Lin, Haocheng, Kadioglu, Ates, Timpano, Massimiliano, Avidor-Reiss, Tomer, Hakim, Lukman, Sindhwani, Puneet, Franco, Giorgio, Singh, Rajender, Giacone, Filippo, Ruzaev, Mikhail, Kosgi, Raghavender, Sofikitis, Nikolaos, Palani, Ayad, Calik, Gokhan, Kulaksız, Deniz, Jezek, Davor, Al Hashmi, Manaf, Drakopoulos, Panagiotis, Omran, Huda, Leonardi, Sofia, Celik-Ozenci, Ciler, Güngör, Nur Dokuzeylül, Ramsay, Jonathan, Amano, Toshiyasu, Sogutdelen, Emrullah, Duarsa, Gede Wirya Kusuma, Chiba, Koji, Jindal, Sunil, Savira, Missy, Boeri, Luca, Borges, Edson, Gupte, Deepak, Gokalp, Fatih, Hebrard, Guadalupe Hernández, Minhas, Suks, and Shah, Rupin

Abstract

Purpose Sperm DNA fragmentation (SDF) has been associated with male infertility and poor outcomes of assisted reproductive technology (ART). The purpose of this study was to investigate global practices related to the management of elevated SDF in infertile men, summarize the relevant professional society recommendations, and provide expert recommendations for managing this condition. Materials and Methods An online global survey on clinical practices related to SDF was disseminated to reproductive clinicians, according to the CHERRIES checklist criteria. Management protocols for various conditions associated with SDF were captured and compared to the relevant recommendations in professional society guidelines and the appropriate available evidence. Expert recommendations and consensus on the management of infertile men with elevated SDF were then formulated and adapted using the Delphi method. Results A total of 436 experts from 55 different countries submitted responses. As an initial approach, 79.1% of reproductive experts recommend lifestyle modifications for infertile men with elevated SDF, and 76.9% prescribe empiric antioxidants. Regarding antioxidant duration, 39.3% recommend 4–6 months and 38.1% recommend 3 months. For men with unexplained or idiopathic infertility, and couples experiencing recurrent miscarriages associated with elevated SDF, most respondents refer to ART 6 months after failure of conservative and empiric medical management. Infertile men with clinical varicocele, normal conventional semen parameters, and elevated SDF are offered varicocele repair immediately after diagnosis by 31.4%, and after failure of antioxidants and conservative measures by 40.9%. Sperm selection techniques and testicular sperm extraction are also management options for couples undergoing ART. For most questions, heterogenous practices were demonstrated. Conclusions This paper presents the results of a large global survey on the management of infertile men with elevat

Published
2023

22. Controversy and Consensus on Indications for Sperm DNA Fragmentation Testing in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations

Author

Agarwal, Ashok, Farkouh, Ala’a, Saleh, Ramadan, Abdel-Meguid Hamoda, Taha Abo-Almagd, Harraz, Ahmed M., Kavoussi, Parviz, Arafa, Mohamed, Salvio, Gianmaria, Rambhatla, Amarnath, Toprak, Tuncay, Gül, Murat, Phuoc, Nguyen Ho Vinh, Boitrelle, Florence, Birowo, Ponco, Ghayda, Ramy Abou, Cannarella, Rossella, Kuroda, Shinnosuke, Durairajanayagam, Damayanthi, Zini, Armand, Wyns, Christine, Sarikaya, Selcuk, Tremellen, Kelton, Mostafa, Taymour, Sokolakis, Ioannis, Evenson, Donald P., Henkel, Ralf, Zohdy, Wael, Chung, Eric, Ziouziou, Imad, Falcone, Marco, Russo, Giorgio I., Al-Hashimi, Manaf, Calogero, Aldo E., Ko, Edmund, Colpi, Giovanni, Lewis, Sheena, Serefoglu, Ege Can, Bahar, Fahmi, Martinez, Marlon, Nguyen, Quang, Ambar, Rafael F., Bakircioglu, Mustafa Emre, Kandil, Hussein, Mogharabian, Nasser, Sabbaghian, Marjan, Taniguchi, Hisanori, Tsujimura, Akira, Sajadi, Hesamoddin, Ibrahim, Wael, Atmoko, Widi, Vogiatzi, Paraskevi, Gunes, Sezgin, Gilani, Mohammad Ali Sadighi, Roychoudhury, Shubhadeep, Güngör, Nur Dokuzeylül, Hakim, Lukman, Adriansjah, Ricky, Kothari, Priyank, Jindal, Sunil, Amar, Edouard, Park, Hyun Jun, Long, Tran Quang Tien, Homa, Sheryl T., Karthikeyan, Vilvapathy Senguttuvan, Zilaitiene, Birute, Rosas, Israel Maldonado, Marino, Angelo, Pescatori, Edoardo, Ozer, Cevahir, Akhavizadegan, Hamed, Garrido, Nicolas, Busetto, Gian Maria, Adamyan, Aram, Al-Marhoon, Mohamed, Elbardisi, Haitham, Dolati, Parisa, Darbandi, Mahsa, Darbandi, Sara, Balercia, Giancarlo, Pinggera, Germar-Michael, Micic, Sava, Ho, Christopher Chee Kong, Moussa, Mohamad, Preto, Mirko, Zenoaga-Barbăroşie, Cătălina, Smith, Ryan P., Kosgi, Raghavender, Rosette, Jean de la, El-Sakka, Ahmed I., Abumelha, Saad Mohammed, Mierzwa, Tiago Cesar, Ong, Teng Aik, Banihani, Saleem A., Bowa, Kasonde, Fukuhara, Shinichiro, Boeri, Luca, Danacıoğlu, Yavuz Onur, Gokalp, Fatih, Selim, Osama Mohamed, Cho, Chak-Lam, Tadros, Nicholas N., Ugur, Muhammet Rasit, Ozkent, Mehmet Serkan, Chiu, Peter, Kalkanli, Arif, Khalafalla, Kareim, Vishwakarma, Ranjit B., Finocchi, Federica, Andreadakis, Sotiris, Giulioni, Carlo, Çeker, Gökhan, Ceyhan, Erman, Malhotra, Vineet, Yilmaz, Mehmet, Timpano, Massimiliano, Barrett, Trenton L., Kim, Shannon Hee Kyung, Ahn, Sun-Tae, Giacone, Filippo, Palani, Ayad, Duarsa, Gede Wirya Kusuma, Kadioglu, Ates, Gadda, Franco, Zylbersztejn, Daniel Suslik, Aydos, Kaan, Kulaksız, Deniz, Gupte, Deepak, Calik, Gokhan, Karna, Keshab Kumar, Drakopoulos, Panagiotis, Baser, Aykut, Kumar, Vijay, Molina, Juan Manuel Corral, Rajmil, Osvaldo, Ferreira, Raphael H., Leonardi, Sofia, Avoyan, Armen, Sogutdelen, Emrullah, Franco, Giorgio, Ramsay, Jonathan, Ramirez, Liliana, Shah, Rupin, Agarwal, Ashok, Farkouh, Ala’a, Saleh, Ramadan, Abdel-Meguid Hamoda, Taha Abo-Almagd, Harraz, Ahmed M., Kavoussi, Parviz, Arafa, Mohamed, Salvio, Gianmaria, Rambhatla, Amarnath, Toprak, Tuncay, Gül, Murat, Phuoc, Nguyen Ho Vinh, Boitrelle, Florence, Birowo, Ponco, Ghayda, Ramy Abou, Cannarella, Rossella, Kuroda, Shinnosuke, Durairajanayagam, Damayanthi, Zini, Armand, Wyns, Christine, Sarikaya, Selcuk, Tremellen, Kelton, Mostafa, Taymour, Sokolakis, Ioannis, Evenson, Donald P., Henkel, Ralf, Zohdy, Wael, Chung, Eric, Ziouziou, Imad, Falcone, Marco, Russo, Giorgio I., Al-Hashimi, Manaf, Calogero, Aldo E., Ko, Edmund, Colpi, Giovanni, Lewis, Sheena, Serefoglu, Ege Can, Bahar, Fahmi, Martinez, Marlon, Nguyen, Quang, Ambar, Rafael F., Bakircioglu, Mustafa Emre, Kandil, Hussein, Mogharabian, Nasser, Sabbaghian, Marjan, Taniguchi, Hisanori, Tsujimura, Akira, Sajadi, Hesamoddin, Ibrahim, Wael, Atmoko, Widi, Vogiatzi, Paraskevi, Gunes, Sezgin, Gilani, Mohammad Ali Sadighi, Roychoudhury, Shubhadeep, Güngör, Nur Dokuzeylül, Hakim, Lukman, Adriansjah, Ricky, Kothari, Priyank, Jindal, Sunil, Amar, Edouard, Park, Hyun Jun, Long, Tran Quang Tien, Homa, Sheryl T., Karthikeyan, Vilvapathy Senguttuvan, Zilaitiene, Birute, Rosas, Israel Maldonado, Marino, Angelo, Pescatori, Edoardo, Ozer, Cevahir, Akhavizadegan, Hamed, Garrido, Nicolas, Busetto, Gian Maria, Adamyan, Aram, Al-Marhoon, Mohamed, Elbardisi, Haitham, Dolati, Parisa, Darbandi, Mahsa, Darbandi, Sara, Balercia, Giancarlo, Pinggera, Germar-Michael, Micic, Sava, Ho, Christopher Chee Kong, Moussa, Mohamad, Preto, Mirko, Zenoaga-Barbăroşie, Cătălina, Smith, Ryan P., Kosgi, Raghavender, Rosette, Jean de la, El-Sakka, Ahmed I., Abumelha, Saad Mohammed, Mierzwa, Tiago Cesar, Ong, Teng Aik, Banihani, Saleem A., Bowa, Kasonde, Fukuhara, Shinichiro, Boeri, Luca, Danacıoğlu, Yavuz Onur, Gokalp, Fatih, Selim, Osama Mohamed, Cho, Chak-Lam, Tadros, Nicholas N., Ugur, Muhammet Rasit, Ozkent, Mehmet Serkan, Chiu, Peter, Kalkanli, Arif, Khalafalla, Kareim, Vishwakarma, Ranjit B., Finocchi, Federica, Andreadakis, Sotiris, Giulioni, Carlo, Çeker, Gökhan, Ceyhan, Erman, Malhotra, Vineet, Yilmaz, Mehmet, Timpano, Massimiliano, Barrett, Trenton L., Kim, Shannon Hee Kyung, Ahn, Sun-Tae, Giacone, Filippo, Palani, Ayad, Duarsa, Gede Wirya Kusuma, Kadioglu, Ates, Gadda, Franco, Zylbersztejn, Daniel Suslik, Aydos, Kaan, Kulaksız, Deniz, Gupte, Deepak, Calik, Gokhan, Karna, Keshab Kumar, Drakopoulos, Panagiotis, Baser, Aykut, Kumar, Vijay, Molina, Juan Manuel Corral, Rajmil, Osvaldo, Ferreira, Raphael H., Leonardi, Sofia, Avoyan, Armen, Sogutdelen, Emrullah, Franco, Giorgio, Ramsay, Jonathan, Ramirez, Liliana, and Shah, Rupin

Abstract

Purpose: Sperm DNA fragmentation (SDF) testing was recently added to the sixth edition of the World Health Organization laboratory manual for the examination and processing of human semen. Many conditions and risk factors have been associated with elevated SDF; therefore, it is important to identify the population of infertile men who might benefit from this test. The purpose of this study was to investigate global practices related to indications for SDF testing, compare the relevant professional society guideline recommendations, and provide expert recommendations. Materials and Methods: Clinicians managing male infertility were invited to take part in a global online survey on SDF clinical practices. This was conducted following the CHERRIES checklist criteria. The responses were compared to professional society guideline recommendations related to SDF and the appropriate available evidence. Expert recommendations on indications for SDF testing were then formulated, and the Delphi method was used to reach consensus. Results: The survey was completed by 436 experts from 55 countries. Almost 75% of respondents test for SDF in all or some men with unexplained or idiopathic infertility, 39% order it routinely in the work-up of recurrent pregnancy loss (RPL), and 62.2% investigate SDF in smokers. While 47% of reproductive urologists test SDF to support the decision for varicocele repair surgery when conventional semen parameters are normal, significantly fewer general urologists (23%; p=0.008) do the same. Nearly 70% would assess SDF before assisted reproductive technologies (ART), either always or for certain conditions. Recurrent ART failure is a common indication for SDF testing. Very few society recommendations were found regarding SDF testing. Conclusions: This article presents the largest global survey on the indications for SDF testing in infertile men, and demonstrates diverse practices. Furthermore, it highlights the paucity of professional society guideline

Published
2023

23. Technical Aspects and Clinical Limitations of Sperm DNA Fragmentation Testing in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations.

Author

Agarwal, Ashok, Farkouh, Ala’a, Saleh, Ramadan, Abdel-Meguid Hamoda, Taha Abo-Almagd, Salvio, Gianmaria, Boitrelle, Florence, Harraz, Ahmed M., Ghayda, Ramy Abou, Kavoussi, Parviz, Gül, Murat, Toprak, Tuncay, Russo, Giorgio Ivan, Durairajanayagam, Damayanthi, Rambhatla, Amarnath, Birowo, Ponco, Cannarella, Rossella, Nguyen Ho Vinh Phuoc, Zini, Armand, Arafa, Mohamed, and Wyns, Christine

Subjects
MALE infertility, SEMEN analysis, DELPHI method, INTERNET surveys, SPERMATOZOA
Abstract

Purpose: Sperm DNA fragmentation (SDF) is a functional sperm abnormality that can impact reproductive potential, for which four assays have been described in the recently published sixth edition of the WHO laboratory manual for the examination and processing of human semen. The purpose of this study was to examine the global practices related to the use of SDF assays and investigate the barriers and limitations that clinicians face in incorporating these tests into their practice. Materials and Methods: Clinicians managing male infertility were invited to complete an online survey on practices related to SDF diagnostic and treatment approaches. Their responses related to the technical aspects of SDF testing, current professional society guidelines, and the literature were used to generate expert recommendations via the Delphi method. Finally, challenges related to SDF that the clinicians encounter in their daily practice were captured. Results: The survey was completed by 436 reproductive clinicians. Overall, terminal deoxynucleotidyl transferase deoxyuridine triphosphate Nick-End Labeling (TUNEL) is the most commonly used assay chosen by 28.6%, followed by the sperm chromatin structure assay (24.1%), and the sperm chromatin dispersion (19.1%). The choice of the assay was largely influenced by availability (70% of respondents). A threshold of 30% was the most selected cut-off value for elevated SDF by 33.7% of clinicians. Of respondents, 53.6% recommend SDF testing after 3 to 5 days of abstinence. Although 75.3% believe SDF testing can provide an explanation for many unknown causes of infertility, the main limiting factors selected by respondents are a lack of professional society guideline recommendations (62.7%) and an absence of globally accepted references for SDF interpretation (50.3%). Conclusions: This study represents the largest global survey on the technical aspects of SDF testing as well as the barriers encountered by clinicians. Unified global recommendations regarding clinician implementation and standard laboratory interpretation of SDF testing are crucial. [ABSTRACT FROM AUTHOR]

Published
2024
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24. Does Varicocele Repair Improve Conventional Semen Parameters? A Meta-Analytic Study of Before-After Data.

Author

Cannarella, Rossella, Shah, Rupin, Abdel-Meguid Hamoda, Taha Abo-Almagd, Boitrelle, Florence, Saleh, Ramadan, Gul, Murat, Rambhatla, Amarnath, Kavoussi, Parviz, Toprak, Tuncay, Harraz, Ahmed M., Ko, Edmund, Çeker, Gökhan, Durairajanayagam, Damayanthi, Alkahidi, Noora, Shinnosuke Kuroda, Crafa, Andrea, Henkel, Ralf, Salvio, Gianmaria, Hazir, Berk, and Darbandi, Mahsa

Subjects
VARICOCELE, SEMEN analysis, META-analysis, SPERM motility, MALE infertility
Abstract

Purpose The purpose of this meta-analysis is to study the impact of varicocele repair in the largest cohort of infertile males with clinical varicocele by including all available studies, with no language restrictions, comparing intra-person conventional semen parameters before and after the repair of varicoceles. Materials and Methods The meta-analysis was performed according to PRISMA-P and MOOSE guidelines. A systematic search was performed in Scopus, PubMed, Cochrane, and Embase databases. Eligible studies were selected according to the PICOS model (Population: infertile male patients with clinical varicocele; Intervention: varicocele repair; Comparison: intra-person before-after varicocele repair; Outcome: conventional semen parameters; Study type: randomized controlled trials [RCTs], observational and case-control studies).Out of 1,632 screened abstracts, 351 articles (23 RCTs, 292 observational, and 36 case-control studies) were included in the quantitative analysis. The before-and-after analysis showed significant improvements in all semen parameters after varicocele repair (except sperm vitality); semen volume: standardized mean difference (SMD) 0.203, 95% CI: 0.129–0.278; p<0.001; I²=83.62%, Egger’s p=0.3329; sperm concentration: SMD 1.590, 95% CI: 1.474–1.706; p<0.001; I²=97.86%, Egger’s p<0.0001; total sperm count: SMD 1.824, 95% CI: 1.526–2.121; p<0.001; I²=97.88%, Egger’s p=0.0063; total motile sperm count: SMD 1.643, 95% CI: 1.318–1.968; p<0.001; I²=98.65%, Egger’s p=0.0003; progressive sperm motility: SMD 1.845, 95% CI: 1.537%–2.153%; p<0.001; I²=98.97%, Egger’s p<0.0001; total sperm motility: SMD 1.613, 95% CI 1.467%–1.759%; p<0.001; l2=97.98%, Egger’s p<0.001; sperm morphology: SMD 1.066, 95% CI 0.992%–1.211%; p<0.001; I²=97.87%, Egger’s p=0.1864. Conclusions The current meta-analysis is the largest to date using paired analysis on varicocele patients. In the current meta-analysis, almost all conventional semen parameters improved significantly following varicocele repair in infertile patients with clinical varicocele. [ABSTRACT FROM AUTHOR]

Published
2024
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25. Artificial Intelligence in Andrology: From Semen Analysis to Image Diagnostics.

Author

Ghayda, Ramy Abou, Cannarella, Rossella, Calogero, Aldo E., Shah, Rupin, Rambhatla, Amarnath, Zohdy, Wael, Kavoussi, Parviz, Avidor-Reiss, Tomer, Boitrelle, Florence, Mostafa, Taymour, Saleh, Ramadan, Toprak, Tuncay, Birowo, Ponco, Salvio, Gianmaria, Calik, Gokhan, Shinnosuke Kuroda, Kaiyal, Raneen Sawaid, Ziouziou, Imad, Crafa, Andrea, and Nguyen Ho Vinh Phuoc

Subjects
ANDROLOGY, ARTIFICIAL intelligence in medicine, SEMEN analysis, MEDICAL informatics, REPRODUCTIVE health, DIAGNOSTIC imaging
Abstract

Artificial intelligence (AI) in medicine has gained a lot of momentum in the last decades and has been applied to various fields of medicine. Advances in computer science, medical informatics, robotics, and the need for personalized medicine have facilitated the role of AI in modern healthcare. Similarly, as in other fields, AI applications, such as machine learning, artificial neural networks, and deep learning, have shown great potential in andrology and reproductive medicine. AI-based tools are poised to become valuable assets with abilities to support and aid in diagnosing and treating male infertility, and in improving the accuracy of patient care. These automated, AI-based predictions may offer consistency and efficiency in terms of time and cost in infertility research and clinical management. In andrology and reproductive medicine, AI has been used for objective sperm, oocyte, and embryo selection, prediction of surgical outcomes, cost-effective assessment, development of robotic surgery, and clinical decision-making systems. In the future, better integration and implementation of AI into medicine will undoubtedly lead to pioneering evidence-based breakthroughs and the reshaping of andrology and reproductive medicine. [ABSTRACT FROM AUTHOR]

Published
2024
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27. Alterations in Pregnenolone and Testosterone Levels in Male Shift Workers

Author

Bracci, Massimo, primary, Zingaretti, Laura, additional, Martelli, Margherita, additional, Lazzarini, Raffaella, additional, Salvio, Gianmaria, additional, Amati, Monica, additional, Milinkovic, Marijana, additional, Ulissi, Alfio, additional, Medori, Anna Rita, additional, Vitale, Ermanno, additional, Ledda, Caterina, additional, and Santarelli, Lory, additional

Published
2023
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30. Contributors

Author

Abdel-Hamid, Ibrahim, Agarwal, Ashok, Aljifri, Hassan Mohammed, Ambar, Rafael Favero, Anagnostopoulou, Christina, Arafa, Mohamed, Balercia, Giancarlo, Bardhi, Erlisa, Bassas, Lluís, Bendayan, Marion, Bocu, Kadir, Boitrelle, Florence, Borges, Edson, Jr., Braga, Daniela Paes de Almeida Ferreira, Butaney, Mohit, Calogero, Aldo E., Cannarella, Rossella, Chung, Eric, Condorelli, Rosita A., Das, Mausumi, de Paula, Thais Serzedello, Drakopoulos, Panagiotis, Durairajanayagam, Damayanthi, Evgeni, Evangelini, Firmani, Francesca, Puchalt, Nicolas Garrido, Gül, Murat, Hamoda, Taha Abo-Almagd Abdel-Meguid, Henkel, Ralf Reinhold, Kandil, Hussein, Kavoussi, Parviz K., Khalafalla, Kareim, Kun Ko, Edmund Yuey, Kosgi, Raghavender, Vignera, Sandro La, Le, Tan V., Leisegang, Kristian, Malhotra, Vineet, Maldonado-Rosas, Israel, Martinez, Marlon Pedrozo, Mathes, Melissa A., McMurray, Megan, Minhas, Suks, Moichela, Faith Tebatso, Mostafa, Taymour, Nguyen, Hoang P.C., Navarro-Gomezlechon, Ana, Neto, Filipe Tenorio Lira, Ombelet, Willem, Oraiopoulou I, Chara, Papatheodorou, Achilleas, Pham, Phu V., Pons-Rejraji, Hanae, Qutub, Mahmoud Fareed, Rajmil, Osvaldo, Ramasamy, Ranjith, Rambhatla, Amarnath, Ramirez-Dominguez, Liliana, Saleh, Ramadan, Sallam, Hassan Nooman, Salvio, Gianmaria, Schon, Samantha B., Sengupta, Pallav, Setti, Amanda Souza, Shah, Rupin, Shete, Kanha Charudutt, Tadros, Nicholas N., Vogiatzi, Paraskevi, Zini, Armand, Zohdy, Wael, and Dutta, Sulagna

Published
2025
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32. Impact of Antioxidant Therapy on Natural Pregnancy Outcomes and Semen Parameters in Infertile Men: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Author

Agarwal, Ashok, primary, Cannarella, Rossella, additional, Saleh, Ramadan, additional, Harraz, Ahmed M., additional, Kandil, Hussein, additional, Salvio, Gianmaria, additional, Boitrelle, Florence, additional, Kuroda, Shinnosuke, additional, Farkouh, Ala’a, additional, Rambhatla, Amarnath, additional, Zini, Armand, additional, Colpi, Giovanni, additional, Gül, Murat, additional, Kavoussi, Parviz, additional, Hamoda, Taha Abo-Almagd Abdel-Meguid, additional, Ko, Edmund, additional, Calik, Gokhan, additional, Toprak, Tuncay, additional, Pinggera, Germar-Michael, additional, Park, Hyun Jun, additional, Ghayda, Ramy Abou, additional, Minhas, Suks, additional, Busetto, Gian Maria, additional, Bakırcıoğlu, Mustafa Emre, additional, Kadioglu, Ates, additional, Chung, Eric, additional, Russo, Giorgio Ivan, additional, Calogero, Aldo E., additional, Ambar, Rafael F., additional, Jayasena, Channa N., additional, and Shah, Rupin, additional

Published
2023
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33. Impact of Varicocele Repair on Semen Parameters in Infertile Men: A Systematic Review and Meta-Analysis

Author

Agarwal, Ashok, primary, Cannarella, Rossella, additional, Saleh, Ramadan, additional, Boitrelle, Florence, additional, Gül, Murat, additional, Toprak, Tuncay, additional, Salvio, Gianmaria, additional, Arafa, Mohamed, additional, Russo, Giorgio I., additional, Harraz, Ahmed M., additional, Singh, Rajender, additional, Garrido, Nicolas, additional, Hamoda, Taha Abo-Almagd Abdel-Meguid, additional, Rambhatla, Amarnath, additional, Kavoussi, Parviz, additional, Kuroda, Shinnosuke, additional, Çalik, Gökhan, additional, Saini, Pallavi, additional, Ceyhan, Erman, additional, Dimitriadis, Fotios, additional, Henkel, Ralf, additional, Crafa, Andrea, additional, Palani, Ayad, additional, Duran, Mesut Berkan, additional, Maziotis, Evangelos, additional, Saïs, Émine, additional, Bendayan, Marion, additional, Darbandi, Mahsa, additional, Le, Tan V., additional, Gunes, Sezgin, additional, Tsioulou, Petroula, additional, Sengupta, Pallav, additional, Hazir, Berk, additional, Çeker, Gökhan, additional, Darbandi, Sara, additional, Durairajanayagam, Damayanthi, additional, Aghamajidi, Azin, additional, Alkhalidi, Noora, additional, Sogutdelen, Emrullah, additional, Leisegang, Kristian, additional, Alarbid, Abdullah, additional, Ho, Christopher C. K., additional, Malhotra, Vineet, additional, Finocchi, Federica, additional, Crisóstomo, Luís, additional, Kosgi, Raghavender, additional, ElBardisi, Haitham, additional, Zini, Armand, additional, Birowo, Ponco, additional, Colpi, Giovanni, additional, Park, Hyun Jun, additional, Serefoglu, Ege Can, additional, Nguyen, Quang, additional, Ko, Edmund, additional, de la Rosette, Jean, additional, Pinggera, Germar M., additional, Nguyen, Ho Vinh Phuoc, additional, Kandil, Hussein, additional, and Shah, Rupin, additional

Published
2023
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34. The Renaissance of Male Infertility Management in the Golden Age of Andrology

Author

Calogero, Aldo E., primary, Cannarella, Rossella, additional, Agarwal, Ashok, additional, Hamoda, Taha Abo-Almagd Abdel-Meguid, additional, Rambhatla, Amarnath, additional, Saleh, Ramadan, additional, Boitrelle, Florence, additional, Ziouziou, Imad, additional, Toprak, Tuncay, additional, Gul, Murat, additional, Avidor-Reiss, Tomer, additional, Kavoussi, Parviz, additional, Chung, Eric, additional, Birowo, Ponco, additional, Abou Ghayda, Ramy, additional, Ko, Edmund, additional, Colpi, Giovanni, additional, Dimitriadis, Fotios, additional, Russo, Giorgio Ivan, additional, Martinez, Marlon, additional, Calik, Gokhan, additional, Kandil, Hussein, additional, Salvio, Gianmaria, additional, Mostafa, Taymour, additional, Lin, Haocheng, additional, Park, Hyun Jun, additional, Gherabi, Nazim, additional, Phuoc, Nguyen Ho Vinh, additional, Quang, Nguyen, additional, Adriansjah, Ricky, additional, La Vignera, Sandro, additional, Micic, Sava, additional, Durairajanayagam, Damayanthi, additional, Serefoglu, Ege Can, additional, Karthikeyan, Vilvapathy Senguttuvan, additional, Kothari, Priyank, additional, Atmoko, Widi, additional, and Shah, Rupin, additional

Published
2023
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35. Consensus and Diversity in the Management of Varicocele for Male Infertility: Results of a Global Practice Survey and Comparison with Guidelines and Recommendations

Author

Shah, Rupin, Agarwal, Ashok, Kavoussi, Parviz, Rambhatla, Amarnath, Saleh, Ramadan, Cannarella, Rossella, Harraz, Ahmed M., Boitrelle, Florence, Kuroda, Shinnosuke, Hamoda, Taha Abo-Almagd Abdel-Meguid, Zini, Armand, Ko, Edmund, Çalık, Gökhan, Toprak, Tuncay, Kandil, Hussein, Gül, Murat, Bakırcıoğlu, Mustafa Emre, Parekh, Neel, Russo, Giorgio Ivan, Tadros, Nicholas, Kadıoğlu, Ateş, Arafa, Mohamed, Chung, Eric, Rajmil, Osvaldo, Dimitriadis, Fotios, Malhotra, Vineet, Salvio, Gianmaria, Henkel, Ralf, Le, Tan V., Sogutdelen, Emrullah, Vij, Sarah, Alarbid, Abdullah, Güdeloğlu, Ahmet, Tsujimura, Akira, Calogero, Aldo E., El Meliegy, Amr, Crafa, Andrea, Kalkanlı, Arif, Baser, Aykut, Hazır, Berk, Giulioni, Carlo, Cho, Chak-Lam, Ho, Christopher C.K., Salzano, Ciro, Zylbersztejn, Daniel Suslik, Tien, Dung Mai Ba, Pescatori, Edoardo, Borges, Edson, Saïs-Hamza, Eminej, Huyghe, Eric, Ceyhan, Erman, Caroppo, Ettore, Castiglioni, Fabrizio, Bahar, Fahmi, Gökalp, Fatih, Lombardo, Francesco, Gadda, Franco, Duarsa, Gede Wirya Kusuma, Pinggera, Germar-Michael, Busetto, Gian Maria, Balercia, Giancarlo, Cito, Gianmartin, Blecher, Gideon, Franco, Giorgio, Liguori, Giovanni, Elbardisi, Haitham, Keskin, Hakan, Lin, Haocheng, Taniguchi, Hisanori, Park, Hyun Jun, Ziouziou, Imad, de la Rosette, Jean J. M. C. H., Hotaling, Jim, Ramsay, Jonathan, Molina, Juan Manuel Corral, Lo, Ka Lun, Böcü, Kadir, Khalafalla, Kareim, Bowa, Kasonde, Okada, Keisuke, Nagao, Koichi, Chiba, Koji, Hakim, Lukman, Makarounis, Konstantinos, Hehemann, Marah, Peña, Marcelo Rodriguez, Falcone, Marco, Bendayan, Marion, Martinez, Marlon, Timpano, Massimiliano, Altan, Mesut, Fode, Mikkel, Al-Marhoon, Mohamed S., Gilani, Mohammad Ali Sadighi, Soebadi, Mohammad Ayodhia, Gherabi, Nazim, Sofikitis, Nikolaos, Kahraman, Oğuzhan, Birowo, Ponco, Kothari, Priyank, Sindhwani, Puneet, Javed, Qaisar, Ambar, Rafael F., Kosgi, Raghavender, Ghayda, Ramy Abou, Adriansjah, Ricky, Condorelli, Rosita Angela, La Vignera, Sandro, Micic, Sava, Kim, Shannon Hee Kyung, Fukuhara, Shinichiro, Ahn, Sun Tae, Mostafa, Taymour, Ong, Teng Aik, Takeshima, Teppei, Amano, Toshiyasu, Barrett, Trenton, Arslan, Umut, Karthikeyan, Vilvapathy Senguttuvan, Atmoko, Widi, Yumura, Yasushi, Yuan, Yiming, Kato, Yuki, Jezek, Davor, Cheng, Bryan Kwun-Chung, Hatzichristodoulou, Georgios, Dy, Jun, Castañé, Eduard Ruiz, El-Sakka, Ahmed I., Nguyen, Quang, Sarıkaya, Selçuk, Boeri, Luca, Tan, Ronny, Moussa, Mohamad A., El-Assmy, Ahmed, Alali, Hamed, Alhathal, Naif, Osman, Yasser, Perovic, Dragoljub, Sajadi, Hesamoddin, Akhavizadegan, Hamed, Vučinić, Miroslav, Kattan, Said, Kattan, Mohamed S., Mogharabian, Nasser, Phuoc, Nguyen Ho Vinh, Ngoo, Kay Seong, Alkandari, Mohammad H., Alsuhaibani, Shaheed, Sokolakis, Ioannis, Babaei, Mehdi, King, Mak Siu, Diemer, Thorsten, Gava, Marcelo M., Henrique, Raphael, Spinola e Silva, Rodrigo, Paul, Gustavo Marquesine, Mierzwa, Tiago Cesar, Glina, Sidney, Siddiqi, Kashif, Wu, Han, Wurzacher, Jana, Farkouh, Ala'a, Son, Hwancheol, Minhas, Suks, Lee, Joe, Magsanoc, Nikko, Capogrosso, Paolo, Albano, German Jose, Lewis, Sheena E.M., Jayasena, Channa N., Alvarez, Juan G., Teo, Colin, Smith, Ryan P., Chua, Jo Ben M., Jensen, Christian Fuglesang S., Parekattil, Sijo, Finelli, Renata, Durairajanayagam, Damayanthi, Karna, Keshab Kumar, Ahmed, Abdelkareem, Evenson, Don, Umemoto, Yukihiro, Puigvert, Ana, Çeker, Gökhan, Colpi, Giovanni M., Rolitsky, Sarah, Bouzouita, Abderrazak, Shokeir, Ahmed, Aşçı, Ahmet, Bouker, Amin, Adamyan, Aram, Avoyan, Armen E., Palani, Ayad, Aghamajidi, Azin, Eze, Balantine, Noegroho, Bambang Sasongko, Purnomo, Basuki, Erkan, Bircan Kolbaşı, Zilaitiene, Birute, Kulaksız, Deniz, Kafetzis, Dimitrios, Lee, Dong Sup, Stember, Doron, Evgeni, Evangelini, Alhajeri, Faisal, Finocchi, Federica, Colombo, Fulvio, Tsangaris, George, Sallam, Hassan N., Acosta, Herik, Rosas, Israel Maldonado, Kirkman-Brown, Jackson, Shin, Jae Il, Sonksen, Jens, Dong, Jie, Marmar, Joel, Moreno-Sepulveda, Jose, Seo, Ju Tae, Aydos, Kaan, Kesari, Kavindra Kumar, Trost, Landon, Jenkins, Lawrence, Rocco, Lucia, Darbandi, Mahsa, Simopoulou, Mara, Alves, Marco, Sabbaghian, Marjan, Tavalaee, Marziyeh, Razi, Mazdak, Duran, Mesut Berkan, Nago, Mitsuru, Elkhouly, Mohamed, Khalili, Mohamed, Nasr-Esfahani, Mohammad Hossein, Kamath, Mohan S., Uğur, Muhammet Raşit, Park, Nam Cheol, Cruz, Natalio, Garrido, Nicolas, Sodeifi, Niloofar, Al Khalidi, Noora, Shoshany, Ohad, Satyagraha, Paksi, Drakopoulos, Panagiotos, Vogiatzi, Paraskevi, Dolati, Parisa, Das, Partha, Chiu, Peter Ka-Fung, Tsioulou, Petroula A., Patel, Premal, Singh, Rajender, Kaiyal, Raneen Sawaid, Santos, Ferreira, Dada, Rima, Brodjonegoro, Sakti, Banihani, Saleem Ali, Schon, Samantha, Darbandi, Sara, Güneş, Sezgin, Homa, Sheryl, Mutambirwa, Shingai, Roychoudhury, Shubhadeep, Diaz, Sofia Ines Leonardi, Gopalakrishnan, Sreelatha, Krawetz, Stephen, Jindal, Sunil, Avidor-Reiss, Tomer, Lin, Tsung Yen, Kumar, Vijay, Ibrahim, Wael, Kerkeni, Walid, Woo, Wongi, Morimoto, Yoshiharu, Cheng, Yu-Sheng, Shah, Rupin, Agarwal, Ashok, Kavoussi, Parviz, Rambhatla, Amarnath, Saleh, Ramadan, Cannarella, Rossella, Harraz, Ahmed M., Boitrelle, Florence, Kuroda, Shinnosuke, Hamoda, Taha Abo-Almagd Abdel-Meguid, Zini, Armand, Ko, Edmund, Calik, Gokhan, Toprak, Tuncay, Kandil, Hussein, Gül, Murat, Bakırcıoğlu, Mustafa Emre, Parekh, Neel, Russo, Giorgio Ivan, Tadros, Nichola, Kadioglu, Ate, Arafa, Mohamed, Chung, Eric, Rajmil, Osvaldo, Dimitriadis, Fotio, Malhotra, Vineet, Salvio, Gianmaria, Henkel, Ralf, Le, Tan V., Sogutdelen, Emrullah, Vij, Sarah, Alarbid, Abdullah, Gudeloglu, Ahmet, Tsujimura, Akira, Calogero, Aldo E., Meliegy, Amr El, Crafa, Andrea, Kalkanli, Arif, Baser, Aykut, Hazir, Berk, Giulioni, Carlo, Cho, Chak-Lam, Ho, Christopher C. K., Salzano, Ciro, Zylbersztejn, Daniel Suslik, Tien, Dung Mai Ba, Pescatori, Edoardo, Borges, Edson, Serefoglu, Ege Can, Sas-Hamza, Emine, Huyghe, Eric, Ceyhan, Erman, Caroppo, Ettore, Castiglioni, Fabrizio, Bahar, Fahmi, Gokalp, Fatih, Lombardo, Francesco, Gadda, Franco, Duarsa, Gede Wirya Kusuma, Pinggera, Germar-Michael, Busetto, Gian Maria, Balercia, Giancarlo, Cito, Gianmartin, Blecher, Gideon, Franco, Giorgio, Liguori, Giovanni, Elbardisi, Haitham, Keskin, Hakan, Lin, Haocheng, Taniguchi, Hisanori, Park, Hyun Jun, Ziouziou, Imad, Rosette, Jean de la, Hotaling, Jim, Ramsay, Jonathan, Molina, Juan Manuel Corral, Lo, Ka Lun, Bocu, Kadir, Khalafalla, Kareim, Bowa, Kasonde, Okada, Keisuke, Nagao, Koichi, Chiba, Koji, Hakim, Lukman, Makarounis, Konstantino, Hehemann, Marah, Peña, Marcelo Rodriguez, Falcone, Marco, Bendayan, Marion, Martinez, Marlon, Timpano, Massimiliano, Altan, Mesut, Fode, Mikkel, Al-Marhoon, Mohamed S., Gilani, Mohammad Ali Sadighi, Soebadi, Mohammad Ayodhia, Gherabi, Nazim, Sofikitis, Nikolao, Kahraman, Oğuzhan, Birowo, Ponco, Kothari, Priyank, Sindhwani, Puneet, Javed, Qaisar, Ambar, Rafael F., Kosgi, Raghavender, Ghayda, Ramy Abou, Adriansjah, Ricky, Condorelli, Rosita Angela, Vignera, Sandro La, Micic, Sava, Kim, Shannon Hee Kyung, Fukuhara, Shinichiro, Ahn, Sun Tae, Mostafa, Taymour, Ong, Teng Aik, Takeshima, Teppei, Amano, Toshiyasu, Barrett, Trenton, Arslan, Umut, Karthikeyan, Vilvapathy Senguttuvan, Atmoko, Widi, Yumura, Yasushi, Yuan, Yiming, Kato, Yuki, Jezek, Davor, Cheng, Bryan Kwun-Chung, Hatzichristodoulou, Georgio, Dy, Jun, Castañé, Eduard Ruiz, El-Sakka, Ahmed I., Nguyen, Quang, Sarikaya, Selcuk, Boeri, Luca, Tan, Ronny, Moussa, Mohamad A., El-Assmy, Ahmed, Alali, Hamed, Alhathal, Naif, Osman, Yasser, Perovic, Dragoljub, Sajadi, Hesamoddin, Akhavizadegan, Hamed, Vučinić, Miroslav, Kattan, Said, Kattan, Mohamed S., Mogharabian, Nasser, Phuoc, Nguyen Ho Vinh, Ngoo, Kay Seong, Alkandari, Mohammad H., Alsuhaibani, Shaheed, Sokolakis, Ioanni, Babaei, Mehdi, King, Mak Siu, Diemer, Thorsten, Gava, Marcelo M., Henrique, Raphael, Silva, Rodrigo Spinola e, Paul, Gustavo Marquesine, Mierzwa, Tiago Cesar, Glina, Sidney, Siddiqi, Kashif, Wu, Han, Wurzacher, Jana, Farkouh, Ala’A, Son, Hwancheol, Minhas, Suk, Lee, Joe, Magsanoc, Nikko, Capogrosso, Paolo, Albano, German Jose, Lewis, Sheena E. M., Jayasena, Channa N., Alvarez, Juan G., Teo, Colin, Smith, Ryan P., Chua, Jo Ben M., Jensen, Christian Fuglesang S., Parekattil, Sijo, Finelli, Renata, Durairajanayagam, Damayanthi, Karna, Keshab Kumar, Ahmed, Abdelkareem, Evenson, Don, Umemoto, Yukihiro, Puigvert, Ana, Çeker, Gökhan, Forum, Giovanni M Colpi, Shah, R., Agarwal, A., Kavoussi, P., Rambhatla, A., Saleh, R., Cannarella, R., Harraz, A. M., Boitrelle, F., Kuroda, S., Hamoda, T. A. -A. A. -M., Zini, A., Ko, E., Calik, G., Toprak, T., Kandil, H., Gul, M., Bakircioglu, M. E., Parekh, N., Russo, G. I., Tadros, N., Kadioglu, A., Arafa, M., Chung, E., Rajmil, O., Dimitriadis, F., Malhotra, V., Salvio, G., Henkel, R., Le, T. V., Sogutdelen, E., Vij, S., Alarbid, A., Gudeloglu, A., Tsujimura, A., Calogero, A. E., El Meliegy, A., Crafa, A., Kalkanli, A., Baser, A., Hazir, B., Giulioni, C., Cho, C. -L., Ho, C. C. K., Salzano, C., Zylbersztejn, D. S., Tien, D. M. B., Pescatori, E., Borges, E., Serefoglu, E. C., Sais-Hamza, E., Huyghe, E., Ceyhan, E., Caroppo, E., Castiglioni, F., Bahar, F., Gokalp, F., Lombardo, F., Gadda, F., Duarsa, G. W. K., Pinggera, G. -M., Busetto, G. M., Balercia, G., Cito, G., Blecher, G., Franco, G., Liguori, G., Elbardisi, H., Keskin, H., Lin, H., Taniguchi, H., Park, H. J., Ziouziou, I., de la Rosette, J., Hotaling, J., Ramsay, J., Molina, J. M. C., Lo, K. L., Bocu, K., Khalafalla, K., Bowa, K., Okada, K., Nagao, K., Chiba, K., Hakim, L., Makarounis, K., Hehemann, M., Pena, M. R., Falcone, M., Bendayan, M., Martinez, M., Timpano, M., Altan, M., Fode, M., Al-Marhoon, M. S., Gilani, M. A. S., Soebadi, M. A., Gherabi, N., Sofikitis, N., Kahraman, O., Birowo, P., Kothari, P., Sindhwani, P., Javed, Q., Ambar, R. F., Kosgi, R., Ghayda, R. A., Adriansjah, R., Condorelli, R. A., La Vignera, S., Micic, S., Kim, S. H. K., Fukuhara, S., Ahn, S. T., Mostafa, T., Ong, T. A., Takeshima, T., Amano, T., Barrett, T., Arslan, U., Karthikeyan, V. S., Atmoko, W., Yumura, Y., Yuan, Y., Kato, Y., Jezek, D., Cheng, B. K. -C., Hatzichristodoulou, G., Dy, J., Castane, E. R., El-Sakka, A. I., Nguyen, Q., Sarikaya, S., Boeri, L., Tan, R., Moussa, M. A., El-Assmy, A., Alali, H., Alhathal, N., Osman, Y., Perovic, D., Sajadi, H., Akhavizadegan, H., Vucinic, M., Kattan, S., Kattan, M. S., Mogharabian, N., Phuoc, N. H. V., Ngoo, K. S., Alkandari, M. H., Alsuhaibani, S., Sokolakis, I., Babaei, M., King, M. S., Diemer, T., Gava, M. M., Henrique, R., Spinola e Silva, R., Paul, G. M., Mierzwa, T. C., Glina, S., Siddiqi, K., Wu, H., Wurzacher, J., Farkouh, A., Son, H., Minhas, S., Lee, J., Magsanoc, N., Capogrosso, P., Albano, G. J., Lewis, S. E. M., Jayasena, C. N., Alvarez, J. G., Teo, C., Smith, R. P., Chua, J. B. M., Jensen, C. F. S., Parekattil, S., Finelli, R., Durairajanayagam, D., Karna, K. K., Ahmed, A., Evenson, D., Umemoto, Y., Puigvert, A., Ceker, G., Colpi, G. M., Rolitsky, S., Bouzouita, A., Shokeir, A., Asci, A., Bouker, A., Adamyan, A., Avoyan, A. E., Palani, A., Aghamajidi, A., Eze, B., Noegroho, B. S., Purnomo, B., Erkan, B. K., Zilaitiene, B., Kulaksiz, D., Kafetzis, D., Lee, D. S., Stember, D., Evgeni, E., Alhajeri, F., Finocchi, F., Colombo, F., Tsangaris, G., Sallam, H. N., Acosta, H., Rosas, I. M., Kirkman-Brown, J., Shin, J. I., Sonksen, J., Dong, J., Marmar, J., Moreno-Sepulveda, J., Seo, J. T., Aydos, K., Kesari, K. K., Trost, L., Jenkins, L., Rocco, L., Darbandi, M., Simopoulou, M., Alves, M., Sabbaghian, M., Tavalaee, M., Razi, M., Duran, M. B., Nago, M., Elkhouly, M., Khalili, M., Nasr-Esfahani, M. H., Kamath, M. S., Ugur, M. R., Park, N. C., Cruz, N., Garrido, N., Sodeifi, N., Al Khalidi, N., Shoshany, O., Satyagraha, P., Drakopoulos, P., Vogiatzi, P., Dolati, P., Das, P., Chiu, P. K. -F., Tsioulou, P. A., Patel, P., Singh, R., Kaiyal, R. S., Santos, F., Dada, R., Brodjonegoro, S., Banihani, S. A., Schon, S., Darbandi, S., Gunes, S., Homa, S., Mutambirwa, S., Roychoudhury, S., Diaz, S. I. L., Gopalakrishnan, S., Krawetz, S., Jindal, S., Avidor-Reiss, T., Lin, T. Y., Kumar, V., Ibrahim, W., Kerkeni, W., Woo, W., Morimoto, Y., Cheng, Y. -S., and Tıp Fakültesi

Subjects
Aging, Consensus, Urology, INGUINAL VARICOCELECTOMY, Disease management, Male infertility, Survey, Varicocele, Consensu, Global Andrology Forum, Endocrinology & Metabolism, NONOBSTRUCTIVE AZOOSPERMIA, ASSISTED REPRODUCTIVE TECHNOLOGY, Male Infertility, Pharmacology (medical), Andrology, IMPAIRED SEMEN QUALITY, EUROPEAN ASSOCIATION, Science & Technology, UROLOGY GUIDELINES, Health Policy, Public Health, Environmental and Occupational Health, Disease Management, Urology & Nephrology, SUBCLINICAL VARICOCELE, Psychiatry and Mental health, Health Care Sciences & Services, MICROSURGICAL SUBINGUINAL VARICOCELECTOMY, Reproductive Medicine, SPERM MORPHOLOGY, UNTREATED VARICOCELE, Life Sciences & Biomedicine
Abstract

Purpose: Varicocele is a common problem among infertile men. Varicocele repair (VR) is frequently performed to improve semen parameters and the chances of pregnancy. However, there is a lack of consensus about the diagnosis, indications for VR and its outcomes. The aim of this study was to explore global practice patterns on the management of varicocele in the context of male infertility. Materials and Methods: Sixty practicing urologists/andrologists from 23 countries contributed 382 multiple-choice-questions pertaining to varicocele management. These were condensed into an online questionnaire that was forwarded to clinicians involved in male infertility management through direct invitation. The results were analyzed for disagreement and agreement in practice patterns and, compared with the latest guidelines of international professional societies (American Urological As- sociation [AUA], American Society for Reproductive Medicine [ASRM], and European Association of Urology [EAU]), and with evidence emerging from recent systematic reviews and meta-analyses. Additionally, an expert opinion on each topic was provided based on the consensus of 16 experts in the field. Results: The questionnaire was answered by 574 clinicians from 59 countries. The majority of respondents were urologists/ uro-andrologists. A wide diversity of opinion was seen in every aspect of varicocele diagnosis, indications for repair, choice of technique, management of sub-clinical varicocele and the role of VR in azoospermia. A significant proportion of the re- sponses were at odds with the recommendations of AUA, ASRM, and EAU. A large number of clinical situations were identi- fied where no guidelines are available. Conclusions: This study is the largest global survey performed to date on the clinical management of varicocele for male in- fertility. It demonstrates: 1) a wide disagreement in the approach to varicocele management, 2) large gaps in the clinical prac- tice guidelines from professional societies, and 3) the need for further studies on several aspects of varicocele management in infertile men.

Published
2022
Full Text
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37. The European Academy of Andrology (EAA) ultrasound study on healthy, fertile men: An overview on male genital tract ultrasound reference ranges

Author

Lotti, Francesco, primary, Frizza, Francesca, additional, Balercia, Giancarlo, additional, Barbonetti, Arcangelo, additional, Behre, Hermann M., additional, Calogero, Aldo E., additional, Cremers, Jann‐Frederik, additional, Francavilla, Felice, additional, Isidori, Andrea M., additional, Kliesch, Sabine, additional, La Vignera, Sandro, additional, Lenzi, Andrea, additional, Marcou, Marios, additional, Pilatz, Adrian, additional, Poolamets, Olev, additional, Punab, Margus, additional, Godoy, Maria Fernanda Peraza, additional, Quintian, Claudia, additional, Rajmil, Osvaldo, additional, Salvio, Gianmaria, additional, Shaeer, Osama, additional, Weidner, Wolfgang, additional, Maseroli, Elisa, additional, Cipriani, Sarah, additional, Baldi, Elisabetta, additional, Degl'Innocenti, Selene, additional, Danza, Giovanna, additional, Caldini, Anna Lucia, additional, Terreni, Alessandro, additional, Boni, Luca, additional, Krausz, Csilla, additional, and Maggi, Mario, additional

Published
2022
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38. SINGLE COMPOUND ANTIOXIDANTS ARE SIMILARLY EFFECTIVE AS MULTI-COMPOUND ANTIOXIDANTS OVER A 3-MONTH PERIOD IN MEN WITH IDIOPATHIC INFERTILITY: A SYSTEMATIC REVIEW AND META-ANALYSIS

Author

Cannarella, Rossella, primary, Agarwal, Ashok, additional, Saleh, Ramadan, additional, Kandil, Hussein, additional, Salvio, Gianmaria, additional, Boitrelle, Florence, additional, Kuroda, Shinnosuke, additional, Farkouh, Ala'A., additional, Harraz, Ahmed, additional, Rambhatla, Amarnath, additional, Calogero, Aldo E., additional, and Shah, Rupin, additional

Published
2022
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40. The European Academy of Andrology (EAA) ultrasound study on healthy, fertile men: Prostate‐vesicular transrectal ultrasound reference ranges and associations with clinical, seminal and biochemical characteristics

Author

Lotti, Francesco, primary, Frizza, Francesca, additional, Balercia, Giancarlo, additional, Barbonetti, Arcangelo, additional, Behre, Hermann M., additional, Calogero, Aldo E., additional, Cremers, Jann‐Frederik, additional, Francavilla, Felice, additional, Isidori, Andrea M., additional, Kliesch, Sabine, additional, La Vignera, Sandro, additional, Lenzi, Andrea, additional, Marcou, Marios, additional, Pilatz, Adrian, additional, Poolamets, Olev, additional, Punab, Margus, additional, Godoy, Maria Fernanda Peraza, additional, Quintian, Claudia, additional, Rajmil, Osvaldo, additional, Salvio, Gianmaria, additional, Shaeer, Osama, additional, Weidner, Wolfgang, additional, Maseroli, Elisa, additional, Cipriani, Sarah, additional, Baldi, Elisabetta, additional, Degl'Innocenti, Selene, additional, Danza, Giovanna, additional, Caldini, Anna Lucia, additional, Terreni, Alessandro, additional, Boni, Luca, additional, Krausz, Csilla, additional, and Maggi, Mario, additional

Published
2022
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44. Sodium alterations impair the long-term prognosis of hospitalized patients with COVID-19 pneumonia: hospital readmissions and mortality rates after a 18-month follow-up

Author

Martino, Marianna, primary, Aboud, Nairus, additional, Perrone, Michele, additional, Falcioni, Paolo, additional, Giancola, Giulia, additional, Ciarloni, Alessandro, additional, Salvio, Gianmaria, additional, Silvetti, Francesca, additional, Taccaliti, Augusto, additional, and Arnaldi, Giorgio, additional

Published
2022
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45. Consensus and Diversity in the Management of Varicocele for Male Infertility:Results of a Global Practice Survey and Comparison with Guidelines and Recommendations

Author

Shah, Rupin, Agarwal, Ashok, Kavoussi, Parviz, Rambhatla, Amarnath, Saleh, Ramadan, Cannarella, Rossella, Harraz, Ahmed M., Boitrelle, Florence, Kuroda, Shinnosuke, Hamoda, Taha Abo Almagd Abdel Meguid, Zini, Armand, Ko, Edmund, Calik, Gokhan, Toprak, Tuncay, Kandil, Hussein, Gül, Murat, Bakırcıoğlu, Mustafa Emre, Parekh, Neel, Russo, Giorgio Ivan, Tadros, Nicholas, Kadioglu, Ates, Arafa, Mohamed, Chung, Eric, Rajmil, Osvaldo, Dimitriadis, Fotios, Malhotra, Vineet, Salvio, Gianmaria, Henkel, Ralf, Le, Tan V., Sogutdelen, Emrullah, Vij, Sarah, Alarbid, Abdullah, Gudeloglu, Ahmet, Tsujimura, Akira, Calogero, Aldo E., El Meliegy, Amr, Crafa, Andrea, Kalkanli, Arif, Baser, Aykut, Hazir, Berk, Giulioni, Carlo, Cho, Chak Lam, Ho, Christopher C.K., Salzano, Ciro, Zylbersztejn, Daniel Suslik, Tien, Dung Mai Ba, Pescatori, Edoardo, Fode, Mikkel, Jensen, Christian Fuglesang S., Sonksen, Jens, Shah, Rupin, Agarwal, Ashok, Kavoussi, Parviz, Rambhatla, Amarnath, Saleh, Ramadan, Cannarella, Rossella, Harraz, Ahmed M., Boitrelle, Florence, Kuroda, Shinnosuke, Hamoda, Taha Abo Almagd Abdel Meguid, Zini, Armand, Ko, Edmund, Calik, Gokhan, Toprak, Tuncay, Kandil, Hussein, Gül, Murat, Bakırcıoğlu, Mustafa Emre, Parekh, Neel, Russo, Giorgio Ivan, Tadros, Nicholas, Kadioglu, Ates, Arafa, Mohamed, Chung, Eric, Rajmil, Osvaldo, Dimitriadis, Fotios, Malhotra, Vineet, Salvio, Gianmaria, Henkel, Ralf, Le, Tan V., Sogutdelen, Emrullah, Vij, Sarah, Alarbid, Abdullah, Gudeloglu, Ahmet, Tsujimura, Akira, Calogero, Aldo E., El Meliegy, Amr, Crafa, Andrea, Kalkanli, Arif, Baser, Aykut, Hazir, Berk, Giulioni, Carlo, Cho, Chak Lam, Ho, Christopher C.K., Salzano, Ciro, Zylbersztejn, Daniel Suslik, Tien, Dung Mai Ba, Pescatori, Edoardo, Fode, Mikkel, Jensen, Christian Fuglesang S., and Sonksen, Jens

Abstract

Purpose: Varicocele is a common problem among infertile men. Varicocele repair (VR) is frequently performed to improve semen parameters and the chances of pregnancy. However, there is a lack of consensus about the diagnosis, indications for VR and its outcomes. The aim of this study was to explore global practice patterns on the management of varicocele in the context of male infertility. Materials and Methods: Sixty practicing urologists/andrologists from 23 countries contributed 382 multiple-choice-questions pertaining to varicocele management. These were condensed into an online questionnaire that was forwarded to clinicians involved in male infertility management through direct invitation. The results were analyzed for disagreement and agreement in practice patterns and, compared with the latest guidelines of international professional societies (American Urological Association [AUA], American Society for Reproductive Medicine [ASRM], and European Association of Urology [EAU]), and with evidence emerging from recent systematic reviews and meta-analyses. Additionally, an expert opinion on each topic was provided based on the consensus of 16 experts in the field. Results: The questionnaire was answered by 574 clinicians from 59 countries. The majority of respondents were urologists/uro-andrologists. A wide diversity of opinion was seen in every aspect of varicocele diagnosis, indications for repair, choice of technique, management of sub-clinical varicocele and the role of VR in azoospermia. A significant proportion of the responses were at odds with the recommendations of AUA, ASRM, and EAU. A large number of clinical situations were identified where no guidelines are available. Conclusions: This study is the largest global survey performed to date on the clinical management of varicocele for male infertility. It demonstrates: 1) a wide disagreement in the approach to varicocele management, 2) large gaps in the clinical practice guidelines from professional so

Published
2022

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