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Comparison of sperm retrieval and reproductive outcome in azoospermic men with testicular failure and obstructive azoospermia treated for infertility 认领 引用 被引量：13
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作者 Sandro C Esteves Christina Prudencio +3 位作者 Bill Seol Sidney Verza jr Christopher Knoedler Ashok Agarwal 《Asian Journal of Andrology》 SCIE CAS CSCD 2014年第4期602-606,共5页
We assessed the rates of sperm retrieval and intracytoplasmic sperm injection outcomes, including the neonatal profile of infants conceived, in men with testicular failure. Three-hundred and sixty-five men with testic... We assessed the rates of sperm retrieval and intracytoplasmic sperm injection outcomes, including the neonatal profile of infants conceived, in men with testicular failure. Three-hundred and sixty-five men with testicular failure who underwent micro-dissection testicular sperm extraction were included in this study. We compared their outcomes with 40 men with testicular failure who used donor sperm for injections due to failed retrieval, and 146 men with obstructive azoospermia who underwent percutaneous sperm retrieval. The retrieval rate in testicular failure was 41.4%, and the results were lower than the obstructed azoospermia （100%; adjusted odds ratio： 0.033; 95% Ch 0.007-0.164; P 〈 0.001）. Live birth rates after sperm injections were lower in men with testicular failure （19.9%） compared with donor sperm （37.5%; adjusted OR： 0.377 （95% Ch 0.233-0.609, P 〈 0.001）） and obstructive azoospermia （34.2%; adjusted OR： 0.403 （95% CI： 0.241-0.676, P= 0.001）. Newborn parameters of infants conceived were not significantly different among the groups. We concluded that the chances of obtaining sperm on retrieval and achieving a live birth after intracytoplasmic sperm injection （ICSI） are reduced in men with testicular failure. The profile of infants conceived after sperm injection does not seem to be negatively affected by testicular failure. 展开更多
关键词 infant intracytoplasmic sperm injection obstructive azoospermia pregnancy outcome sperm retrieval testicular failure
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A systematic review of clinical practice guidelines and best practice statements for the diagnosis and management of varicocele in children and adolescents 认领 引用 被引量：10
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作者 Matheus Roque Sandro C Esteves 《Asian Journal of Andrology》 SCIE CAS CSCD 2016年第2期262-268,J0006,共7页
A systematic review was conducted to identify and qualitatively analyze the methods as well as recommendations of Clinical Practice Guidelines （CPG） and Best Practice Statements （BPS） concerning varicocele in the ... A systematic review was conducted to identify and qualitatively analyze the methods as well as recommendations of Clinical Practice Guidelines （CPG） and Best Practice Statements （BPS） concerning varicocele in the pediatric and adolescent population. An electronic search was performed with the MEDLINE, EMBASE, Science Direct, and Scielo databases, as well as guidelines＇ Web sites until September 2015. Four guidelines were included in the qualitative synthesis. In general, the recommendations provided by the CPG/BPS were consistent despite the existence of some gaps across the studies. The guidelines issued by the American Urological Association （AUA） and American Society for Reproductive Medicine （ASRM） did not provide evidence-based levels for the recommendations given. Most of the recommendations given by the European Association of Urology （EAU） and European Society of Pediatric Urology （ESPU） were derived from nonrandomized clinical trials, retrospective studies, and expert opinion. Among all CPG/BPS, only one was specifically designed for the pediatric population. The studied guidelines did not undertake independent cost-effectiveness and risk-benefit analysis. The main objectives of these guidelines were to translate the best evidence into practice and provide a framework of standardized care while maintaining clinical autonomy and physician judgment. However, the limitations identified in the CPG/BPS for the diagnosis and management of varicocele in children and adolescents indicate ample opportunities for research and future incorporation of higher quality standards in patient care. 展开更多
关键词 adolescent best practice statements child clinical practice guidelines varicocele systematic review
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Afterword to varicocele and male infertility: curreni concepts and future perspectives 认领 引用 被引量：9
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作者 Sandro C Esteves Ashok Agarwal 《Asian Journal of Andrology》 SCIE CAS CSCD 2016年第2期319-322,共4页
We summarize and comment on the topics discussed by the contributors to this Special Issue of Asian Journal of Andrology. The scope of varicocele covers a wide spectrum, including proteomics and metabolomics, hormonal... We summarize and comment on the topics discussed by the contributors to this Special Issue of Asian Journal of Andrology. The scope of varicocele covers a wide spectrum, including proteomics and metabolomics, hormonal control, interventional therapy, and assisted reproductive technology （ART）. The selection of topics demonstrates the exciting breadth of this thematic area and the opportunity research holds for both increasing the understanding and improving the reproductive health of males with varicocele. 展开更多
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Re: Sperm retrieval rates and intracytoplasmic sperm injection outcomes for men with non-obstructive azoospermia and the health of resulting offspring 认领 引用 被引量：2
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作者 Sandro C Esteve Ashok Agarwal 《Asian Journal of Andrology》 SCIE CAS CSCD 2014年第4期642-642,共1页
We are thankful to Dr. Drobnis for her insights and balanced comments with regard to our article titled ＇comparison of sperm retrieval and reproductive outcome in azoospermic men with testicular failure and obstructi... We are thankful to Dr. Drobnis for her insights and balanced comments with regard to our article titled ＇comparison of sperm retrieval and reproductive outcome in azoospermic men with testicular failure and obstructive azoospermia treated for infertility＂ 展开更多
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Outcome of varicocele repair in men with nonobstructive azoospermia: systematic review and meta-analysis 认领 引用 被引量：35
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作者 Sandro C Esteves Ricardo Miyaoka +1 位作者 Matheus Roque Ashok Agarwal 《Asian Journal of Andrology》 SCIE CAS CSCD 2016年第2期246-253,J0005,J0006,共8页
The objective of this systemic review was to evaluate the benefit of repairing clinical varicocele in infertile men with nonobstructive azoospermia （NOA）. The surgically obtained sperm retrieval rate （SRR） and pre... The objective of this systemic review was to evaluate the benefit of repairing clinical varicocele in infertile men with nonobstructive azoospermia （NOA）. The surgically obtained sperm retrieval rate （SRR） and pregnancy rates following assisted reproductive technology （ART） with the use of retrieved testicular sperm were the primary outcomes. The secondary outcomes included the presence of viable sperm in postoperative ejaculate to avoid the testicular sperm retrieval and pregnancy rates （both assisted and unassisted） using postoperative ejaculated sperm. An electronic search to collect the data was performed using the MEDLINE and EMBASE databases until April 2015. Eighteen studies were included in this systematic review and accounted for 468 patients who were diagnosed with NOA and varicocele. These patients were subjected to either surgical varicocele repair or percutaneous embolization. Three controlled studies evaluating sperm retrieval outcomes indicated that in patients who underwent varicocelectomy, SRR increased compared to those without varicocele repair （OR： 2,65; 95% Cl. 1.69-4.14; P 〈 0.001）. Although pregnancy rates with the use of testicular sperm favored the varicocelectomy group, results were not statistically significant （clinical pregnancy rate OR： 2.07; 95% CI： 0.92-4.65; P = 0.08; live birth rate OR： 2.19; 95% CI： 0.99-4.83; P = 0.05）. The remaining fifteen studies reported postoperative semen analysis results. In 43.9% of the patients （range： 20.8%-55.0%）, sperm were found in postoperative ejaculates. Pregnancy rates for unassisted and assisted （after IVF/ICSI） were 13.6% and 18.9% in the group of men with sperm in postoperative ejaculates, respectively. Our findings indicate that varicocelectomy in patients with NOA and clinical varicocele is associated with improved SRR. In addition, approximately 44% of the treated men will have enough sperm in the ejaculate to avoid sperm retrieval. Limited data on pregnancy outcomes with both postoperative ejaculated sperm and harvested testicular sperm preclude any firm conclusion with regard to the possible increased fertility potential in treated individuals. In conclusion, the results of our study indicate that infertile men with NOA and clinical varicocele benefit from varicocelectomy. Given the low/moderate quality of evidence available, it is advisable that doctors discuss with their patients with NOA the risks and benefits of varicocele repair. 展开更多
关键词 azoospermia male infertility meta-analysis sperm retrieval systematic review varicocele varicocelectomy
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Novel insights into the pathophysiology of varicocele and its association with reactive oxygen species and sperm DNA fragmentation 认领 引用 被引量：43
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作者 Chak-Lam Cho Sandro C Esteves Ashok Agarwal 《Asian Journal of Andrology》 SCIE CAS CSCD 2016年第2期186-193,J0003,共8页
Varicocele has been associated with reduced male reproductive potential. With the advances in biomolecular techniques, it has been possible to better understand the mechanisms involved in testicular damage provoked by... Varicocele has been associated with reduced male reproductive potential. With the advances in biomolecular techniques, it has been possible to better understand the mechanisms involved in testicular damage provoked by varicocele. Current evidence suggests the central role of reactive oxygen species （ROS） and the resultant oxidative stress （OS） in the pathogenesis of varicocele-associated male subfertility although the mechanisms have not yet been fully described and it is likely to be multifactorial. Excessive ROS is associated with sperm DNA fragmentation, which may mediate the clinical manifestation of poor sperm function and fertilization outcome related to varicocele. Testing of ROS/OS and DNA fragmentation has the potential to provide additional diagnostic and prognostic information compared to conventional semen analysis and may guide therapeutic management strategies in individual patient. 展开更多
关键词 antioxidants infertility male reproduction oxidative stress sperm DNA damage sperm DNA fragmentation varicocele varicocelectomy
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Outcome of assisted reproductive technology in met with treated and untreated varicocele, systematic review and meta-analysis 认领 引用 被引量：25
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作者 Sandro C Esteves Matheus Roque Ashok Agarwal 《Asian Journal of Andrology》 SCIE CAS CSCD 2016年第2期254-258,J0006,共5页
Varicocele affects approximately 35%-40% of men presenting for an infertility evaluation. There is fair evidence indicating that surgical repair of clinical varicocele improves semen parameters, decreases seminal oxid... Varicocele affects approximately 35%-40% of men presenting for an infertility evaluation. There is fair evidence indicating that surgical repair of clinical varicocele improves semen parameters, decreases seminal oxidative stress and sperm DNA fragmentation, and increases the chances of natural conception. However, it is unclear whether performing varicocelectomy in men with clinical varicocele prior to assisted reproductive technology （ART） improve treatment outcomes. The objective of this study was to evaluate the role of varicocelectomy on ART pregnancy outcomes in nonazoospermic infertile men with clinical varicocele. An electronic search was performed to collect all evidence that fitted our eligibility criteria using the MEDLINE and EMBASE databases until April 2015. Four retrospective studies were included, all of which involved intracytoplasmic sperm injection （ICSI）, and accounted for 870 cycles （438 subjected to ICSI with prior varicocelectomy, and 432 without prior varicocelectomy）. There was a significant increase in the clinical pregnancy rates （OR = 1.59, 95% CI. 1.19-2.12, 12 = 25%） and live birth rates （OR = 2.17, 95% CI： 1,55-3.06, I^2 = 0%） in the varicocelectomy group compared to the group subjected to ICSI without previous varicocelectomy. Our results indicate that performing varicocelectomy in patients with clinical varicocele prior to ICSI is associated with improved pregnancy outcomes. 展开更多
关键词 assisted reproductive techniques meta-analysis pregnancy outcome systematic review varicocele varicocelectomy
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Air quality control in the ART laboratory is a major determinant of IVF success 认领 引用 被引量：4
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作者 Sandro C Esteves Fabiola C Bento 《Asian Journal of Andrology》 SCIE CAS CSCD 2016年第4期596-599,共4页
Arecently published article described how a fertility center in the UnitedStates implemented air quality control to newly designed in vitro fertilization （IVF） laboratory.1 A highly-efficient air filtration was achi... Arecently published article described how a fertility center in the UnitedStates implemented air quality control to newly designed in vitro fertilization （IVF） laboratory.1 A highly-efficient air filtration was achieved by installing a centered system supplying filtered air to the IVF laboratory and related critical areas, combining air particulate and volatile organic compound （VOC） filtration. As a consequence, live birth rates were increased by improvements in air quality. This article highlights the key aspects of air contamination in the IVF context. The topic is important not only to IVF specialists but also to Andrologists due to the great number of male infertility patients referred to assisted reproductive technology （ART） treatments. The evidence is growing that laboratory air quality is paramount importance for improved IVF outcome. 展开更多
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Summary evidence on the effects of varicocele treatment to improve natural fertility in subfertile men 认领 引用 被引量：18
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作者 Bruno C Tiseo Sandro C Esteves Marcello S Cocuzza 《Asian Journal of Andrology》 SCIE CAS CSCD 2016年第2期239-245,J0005,共7页
The objective of this review was to summarize the evidence concerning the benefit of varicocele treatment to improve natural fertility in subfertile males. We also analyzed the effect of varicocele treatment on conven... The objective of this review was to summarize the evidence concerning the benefit of varicocele treatment to improve natural fertility in subfertile males. We also analyzed the effect of varicocele treatment on conventional semen parameters and sperm functional tests. An electronic search to collect the data was performed using the PubMed/MEDLINE databases until July 2015. Data pooled from a variety of study designs indicate that varicocelectomy improves semen parameters in the majority of the treated men with clinical varicocele and abnormal semen parameters regardless of the chosen surgical method. Surgical varicocele repair was beneficial not only for alleviating oxidative stress-associated infertility but also to improve sperm nuclear DNA integrity. However, given the low magnitude of the effect size in sperm DNA integrity, further research is needed to elucidate its clinical significance. Conflicting results on the effect of varicocele treatment on natural fertility seem to be due to heterogeneous study designs and, more importantly, patient selection criteria. When these issues are controlled, current evidence indicates that treatment of subclinical varicocele is not warranted, as it does not seem to improve fertility. On the contrary, fair evidence indicates that varicocele treatment should be offered to infertile patients with palpable varicocele and abnormal semen parameters. This evidence supports the current guidelines issued by the American Urological Association and European Association of Urology, which state that varicocele treatment should be offered to male partners of infertile couples presenting for evaluation with clinical varicocele and semen parameters alterations. 展开更多
关键词 male infertility review treatment outcome varicocele varicocelectomy
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