Microsurgical vasoepididymostomy (MVE) is the standard treatment for epididymal obstructive azoospermia (EOA). However, existing studies report inconsistent pregnancy and patency rates. To comprehensively review the therapeutic effects of various MVE techniques on EOA, address prior research controversies, and identify factors influencing MVE efficacy. Eligible studies focused on MVE outcomes, such as patency, pregnancy, or natural pregnancy rates. Relative pregnancy rate refers to natural pregnancies occurring in partners of patients with post-operative patency. Meta-analyses were performed using the "meta" R package. Heterogeneity was assessed with Q and I2 tests. A total of 56 studies involving 3204 patients were included. End-to-end/end-to-side (EE/ES) techniques were associated with patency, pregnancy, and relative pregnancy rates of 65.0%, 23.0%, and 38.0%, respectively, whereas longitudinal intussusception vasoepididymostomy (LIVE) technique demonstrated slightly higher rates (68.0%, 27.0%, 40.0%). However these differences were not statistically significant (all p > 0.05). Compared with the 2-suture TIVE (72.0%) and LIVE (58.0%; p < 0.01) techniques, the 3-suture transverse intussusception vasoepididymostomy (TIVE) technique demonstrated significantly higher patency rates (89.0%). Pregnancy rates (33.0% vs. 26.0% vs. 28.0%) and relative pregnancy rates (38.0% vs. 33.0% vs. 42.0%) did not significantly differ among the three techniques (p > 0.05). Single-armed LIVE (SA-LIVE) demonstrated numerically higher patency (69.0% vs. 64.0%), pregnancy (31.0% vs. 26.0%), and relative pregnancy rates (46.0% vs. 39.0%) compared with double-armed LIVE (DA-LIVE). However, these differences were not statistically significant (all p > 0.05). Vessel-sparing SA-LIVE demonstrated superior patency (83.0%) compared with classical SA-LIVE (67.0%; p < 0.01), whereas pregnancy (38.0% vs. 31.0%) and relative pregnancy rates (both 47.0%) were not significantly different (p > 0.05). Bilateral MVE, genital infections, and the presence of motile spermatozoa were associated with increased patency rates. The overall late failure rate was 23.0%, with significantly higher rates for the EE/ES techniques (32.0%) than the IVE technique (15.0%; p = 0.03). This meta-analysis confirms the efficacy of MVE for EOA. IVE has supplanted ES/EE, likely owing to its technical superiority and reduced rate of late failures, with LIVE emerging as the dominant approach. SA-LIVE and DA-LIVE yield comparable outcomes, and both should be recommended. Bilateral cases, infectious etiology, and motile epididymal spermatozoa predict increased patency rate. The relative pregnancy rate may better reflect effectiveness.

The authors declare no conflicts of interest. Data sharing does not apply to this article as no datasets were generated during the current study; all data were sourced from published literature.

Numerous publications have questioned the lack of analytical reliability and clinical relevance of sperm morphology assessment for infertility workup and before use of assisted reproductive techniques (ART). There is a huge variability in the performance and interpretation of this test. It has become necessary to evaluate its true medical service rendered to the patient. To develop clinical guidelines for use of spermatozoa morphology assessment during male fertility check-up and before ART. These guidelines were produced following a pre-defined standard methodology for narrative and Patient Intervention Comparison Outcomes (PICO) questions. The French Working Group (WG) on Sperm Morphology Assessment consisted of 15 members including an expert in statistics. R1: WG does not recommend systematic detailed analysis of abnormalities (or groups of abnormalities) during sperm morphology assessment. R2: WG recommends that the laboratory should use a qualitative or quantitative method for detection of a monomorphic abnormality (globozoospermia, macrocephalic spermatozoa syndrome, pinhead spermatozoa syndrome, multiple flagellar abnormalities). The result may be given as an interpretative commentary or as a numerical report of the percentage of detailed abnormalities. R3: There is insufficient evidence to demonstrate the clinical value of indexes of multiple sperm defects (TZI, SDI, MAI) in investigation of infertility and before ART. Accordingly, the working group does not recommend the use of sperm abnormality indexes (TZI, SDI, MAI) in sperm morphology assessment. R4: WG gives a positive opinion on the use of automated systems based on cytological analysis after staining after qualification of the operators, and validation of the analytical performance within their own laboratory. R5: WG does not recommend using the percentage of spermatozoa with normal morphology as a prognostic criterion before IUI, IVF, or ICSI, or as a tool for selecting the ART procedure. This article examines the clinical interest of sperm morphology assessment during fertility check-up and before ART. The overall level of evidence from studies is low, challenging current practices regarding sperm morphology assessment. These guidelines suggest a significant simplification of sperm morphology assessment in the light of the examined publications while maintaining the detection of monomorphic sperm abnormalities.

Although a nomogram for predicting the efficacy of dapoxetine (DapE-Nomo) has already been developed, its reliability is limited due to only 4weeks of follow-up and a lack of external validation. Several patients with premature ejaculation (PE) achieve satisfactory therapeutic effects after longer periods of treatment clinically, we therefore aimed to develop and validate an 8-week DapE-Nomo. The training cohort included 243 patients with lifelong PE from Xijing Hospital and Northwest Women's and Children's Hospital (Jan 2019-Jul 2020), while the validation cohort comprised 397 patients from Xijing Hospital and Xi'an Daxing Hospital (Aug 2020-Jan 2022). Efficacy was measured using the Clinical Global Impression of Change (CGIC) scale, with a CGIC score ≥ 1 indicating an improvement (iCGI). LASSO regression was utilized to identify the most valuable predictors (MVPs) of iCGI. The DapE-Nomo was developed utilizing logistic regression coefficients of MVPs and validated across both cohorts. After 8weeks of medication, 47.7% of patients in the training cohort and 47.6% in the validation cohort achieved iCGI. MVPs of iCGI included intravaginal ejaculation latency time, difficulty delaying ejaculation, and education level. The DapE-Nomo showed discriminatory abilities of 0.722 and 0.709 in internal and external validations, respectively, with satisfactory calibration and clinical utility in both. The optimal cutoff value of the DapE-Nomo was identified as 153.4 in both cohorts. Individuals with scores ≥153.4 exhibited a 3.833-fold and 4.137-fold chance of achieving iCGI, respectively, compared with those with scores<153.4. We constructed and validated the inaugural 8-week DapE-Nomo. In outpatient settings, it will enable andrologists to more accurately evaluate the efficacy and promptly adjust treatment plans for patients with scores below 153.4. Moreover, It will help patients who've taken dapoxetine for 4weeks with poor results decide whether to stop.

We aimed to investigate the association of a low serum testosterone concentration with the risk of abnormal glucose metabolism (i.e., prediabetes and type 2 diabetes) in men at a 15-year follow-up. In a population birth cohort, men with low testosterone (testosterone<12.1nmol/L, n=136) and normal testosterone concentration (testosterone≥12.1nmol/L, n=2555) at age 31 were followed up until age 46. Blood samples were drawn at ages 31 and 46, and an oral glucose tolerance test (n=1409) was performed at age 46. Men with low testosterone had significantly greater body mass index and waist circumference than men with normal testosterone at ages 31 and 46 (p<0.001 in all comparisons). In men with low testosterone, the association with abnormal glucose metabolism was mainly driven by adiposity (p=0.4 after adjusting for waist circumference). However, the risk remained increased, independently of waist circumference, when comparing the lowest and highest quartiles of testosterone (odds ratio:1.8 [95% confidence interval 1.3-2.7]) or when using testosterone as a continuous variable (odds ratio: 0.97 [95% confidence interval 0.95-0.99]). Between ages 31 and 46, body mass index increased more in men with normal testosterone at age 31 and low testosterone at age 46 than in men with normal testosterone or low testosterone at both ages (p<0.001). Higher sex hormone binding globulin levels were associated with a lower risk for abnormal glucose metabolism independently of waist circumference (p<0.001). Low levels of testosterone and sex hormone binding globulin at age 31 associated with an increased risk of developing abnormal glucose metabolism after 15 years' follow-up. This association was partly independent of adiposity but was linked to waist circumference and weight gain.

Drug-induced hypogonadism is an underrecognized but significant adverse effect of various medications, contributing to male sexual dysfunction and infertility. Despite its clinical significance, comprehensive studies systematically identifying high-risk drugs remain limited. This study aimed to investigate the potential drugs associated with hypogonadism from FDA Adverse Event Reporting System. This study analyzed adverse drug events reported from FDA Adverse Event Reporting System covering the period from the first quarter of 2004 to the third quarter of 2024. Cases related to hypogonadism were identified using standardized Medical Dictionary for Regulatory Activities preferred terms. Disproportionality analyses were conducted using the reporting odds ratio and the Bayesian confidence propagation neural network. Drugs were classified according to Anatomical Therapeutic Chemical classification system and clinical applications. This study utilized FDA Label to determine whether adverse drug events related to male hypogonadism are mentioned on their labels. We identified 10 classes including 42 drugs that showed positive signals for both reporting odds ratio and Bayesian confidence propagation neural network: anesthetics and analgesics, psychiatric and neurological medications, antineoplastic agents, urological medications, hormonal agents, cardiovascular medications, gastrointestinal medications, bone metabolism modifiers, antiretroviral agents, and other drugs. According to the Bayesian confidence propagation neural network algorithm, 6 drugs were considered to have a high risk of causing hypogonadism, and 11 drugs had medium risk. In addition, 20 drugs did not mention adverse drug events related to male hypogonadism, of which 3 were identified as high risk using the Bayesian confidence propagation neural network algorithm. This research summarized a list of potential drugs associated with hypogonadism. A clear understanding of the risk and frequency of drug-induced hypogonadism can reduce the likelihood of patients developing the condition.

Non-obstructive azoospermia (NOA) affects approximately 10% of infertile men and represents a major challenge in assisted reproductive technology (ART). A model that includes histological variants could be helpful in predicting sperm retrieval rate (SRR) after microdissection testicular sperm extraction (mTESE) in patients affected by NOA and without genetic abnormalities OBJECTIVES: To develop and validate a predictive nomogram integrating clinical and histopathological variables to estimate SRR in NOA patients undergoing microTESE. A multi-center retrospective/prospective cohort study was conducted between 2022 and 2024, enrolling 333 men diagnosed with NOA across six academic centers. Preoperative data, including age, body mass index (BMI), hormonal profile (follicle-stimulating hormone [FSH], luteinizing hormone [LH], testosterone), genetic analysis, and ultrasound-measured testicular volume, were collected. MicroTESE was performed under microscopic guidance with histopathological evaluation. Predictive factors for successful sperm retrieval were analyzed through logistic regression, and a predictive nomogram was constructed and internally validated using bootstrapping techniques. Multi-variate logistic regression was performed to identify independent variables associated with SRR in patients with available final pathology. Therefore, a predictive nomogram was developed and validated using 1000 bootstrap samples. The overall SRR was 52.55%. Multi-variate analysis identified FSH levels (odds ratio [OR]: 0.97; p=0.049), maturation arrest (OR: 0.04; p<0.01), and Sertoli cell-only syndrome (SCOS; OR: 0.03; p<0.01) as independent predictors of SRR. The predictive nomogram demonstrated good accuracy, with a C-index of 0.75, sensitivity of 73%, specificity of 82%, and overall accuracy of 77% at a cutoff of 0.33. Using preoperative and histology data, we developed a nomogram to predict SR outcomes in patients with NOA undergoing mTESE. Our findings demonstrate that integrating hormonal and histopathological data enhances predictive accuracy of the model, thus providing a valuable tool for preoperative counseling and clinical decision-making in couples presenting with infertility. This validated nomogram effectively predicts sperm retrieval outcomes in NOA patients undergoing microTESE, facilitating improved patient counseling, informed clinical decisions, and optimized patient selection. Prospective external validation and further model refinement are recommended to enhance generalizability and clinical applicability.

Microplastic pollution increasingly affects human health. Polystyrene nanoparticles (PS-NPs) and microplastics (PS-MPs) may impair Sertoli cells (SCs), vital for male fertility. To compare PS-NPs (80nm)/PS-MPs (8µm) toxicity on rat SCs, focusing on oxidative stress, apoptosis, epithelial barrier integrity, endocytosis pathways, and miRNA-mediated ceRNA networks. SCs viability was assessed via CCK-8. Trans-epithelial electrical resistance (TER) was measured to assess the epithelial barrier function. Particle internalization was evaluated by confocal microscopy and flow cytometry.Endocytosis was detected by using specific inhibitors. Whole-transcriptome sequencing profiling identified differential expression of miRNAs, lncRNAs, circRNAs, and mRNAs, with subsequent ceRNA network construction. Pro-inflammatory factors and apoptosis were detected by RT-qPCR and flow cytometry, respectively. At 100µg/mL, PS-NPs reduced cell viability to 77% versus 94% for PS-MPs (p<0.05) and decreased TER by 81% versus 63% for PS-MPs (p<0.01). PS-NPs were internalized via clathrin- and caveolin-dependent pathways, while PS-MPs remained extracellular. RNA-seq revealed PS-MPs activated inflammation pathways (Ank3/Daxx), while PS-NPs triggered oxidative stress and apoptosis pathways (Map2k4/Grin2a). PS-NPs induced higher apoptosis (17%vs. 9.3%, p<0.01), Reactive oxygen species (3.7-fold vs. 1.87-fold), and more severe catalase activity reduction (67%vs. 17%, p<0.01) compared to PS-MPs. PS-NPs pose greater toxicity to SCs than PS-MPs due to cellular internalization, disrupting barrier integrity via oxidative stress/apoptosis. PS-MPs primarily trigger extracellular inflammation. Distinct ceRNA networks underpin their differential mechanisms. These results highlight risks of environmental microplastic fragmentation into nanoplastics, emphasizing the need for further research on microplastic impacts on male fertility.

This report is the transcript of what was discussed in a convention at the Endocrinology Unit in Modena, Italy, in the form of the aporetic dialogs of ancient Greece. It is the third episode of a series of four discussions on the differences between males and females, with a multidisciplinary approach. In this work, the role of testosterone in gender differences in the aptitude for mathematics is explored. First, the definitions of mathematical abilities were provided together with any gender difference in the distribution of females and males in science, technology, engineering, and mathematics subjects. A clear predominance of males is evident at most science, technology, engineering, and mathematics education levels, especially in advanced academic careers. Then, the discussants were divided into two groups: group 1, which illustrated the thesis that testosterone promotes the development of logical‒mathematical skills, and group 2, which, in contrast, asserted the inconsistency of a direct role of testosterone in improving cognitive abilities and that socio‐cultural factors should be considered on the basis of this gender gap. In the end, an expert referee (a female engineer) tried to resolve the aporia: are the two theories equivalent or is one superior?

End-stage renal disease (ESRD) is reported to be associated with the impairment of sex hormones, including decreased testosterone levels and increased follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin levels. Additionally, patients with ESRD often experience impaired spermatogenesis, leading to infertility. However, variations in study methodologies and reported outcomes make it challenging to draw definitive conclusions. Therefore, this study aims to evaluate the effects of kidney transplantation (KT) on these issues, which can be useful in counseling male patients with ESRD. A systematic search was conducted in Web of Science, Medline (via PubMed), and Embase (via Scopus) to identify peer-reviewed studies evaluating the impact of KT on sex hormones and reproductive parameters. A systematic review (SR) was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. This review included English-language articles published between January 1975 and December 2024. Excluded from this search were reviews, editorials, book chapters, conference abstracts, case reports, and case series with up to four patients were excluded. A total of 2939 publications were initially identified, and 23 studies met the inclusion criteria, comprising 738 patients for analysis. Most studies reported a significant increase in testosterone levels 3, 6, and 12 months post-KT. LH and prolactin levels exhibited a trend parallel to that of testosterone. A statistically significant decrease in LH levels was observed at both 1 and 12 months post-KT, while prolactin levels showed a significant reduction at all evaluated time points from 1 to 12 months. In contrast, FSH levels fluctuated over time and did not demonstrate statistical significance at any assessment point. Additionally, KT led to improvements in testis biopsy findings, and all categories of sperm parameters. This SR demonstrates that KT improves sex hormone levels, sperm parameters, and sexual function in male kidney recipients. However, to gain a more comprehensive understanding of the sexual health of male kidney recipients, the establishment of an international database with prospectively collected data is warranted.