MALE INFERTILITY
2053
Re: Sexual Dysfunction among Reproductive-Aged Chinese Married Women in Hong Kong: Prevalence, Risk Factors, and Associated Consequences H. Zhang, S. Fan and P. S. Yip Department of Social Work, Renmin University of China, Beijing, China J Sex Med 2015; 12: 738e745.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.03.065 available at http://jurology.com/ Editorial Comment: This study aimed to estimate the prevalence, risk factors and associated consequences of female sexual dysfunction (FSD) among reproductive age Chinese married women in Hong Kong. Data were obtained from a community based survey across Hong Kong conducted by the Family Planning Association of Hong Kong in 2012, and included 1,518 married women 21 to 49 years old. The authors found that 25.6% of the married women surveyed reported at least 1 form of sexual dysfunction and that the prevalence of 6 domains of sexual dysfunction was as follows. Of the respondents 10.6% had lack of interest in sex, 10.5% did not find sex pleasurable, 9.3% had lubrication difficulties, 8.8% were unable to achieve orgasm, 8.8% had orgasm delay and 8.4% experienced physical pain during sex. Multivariate analyses showed that low education and income, average or poor health, lower frequency of sex, abortion history, traditional attitudes toward sex and marital dissatisfaction are all significant risk factors for different components of FSD. It was also found that 4 domains of FSD (the exceptions being orgasm delay and physical pain during sex) have severe consequences for life satisfaction and sexual satisfaction in married women. The prevalence of FSD in reproductive age Chinese married women in Hong Kong is about 26%, which is less than in similar women in the United States and some Asian countries. This is an interesting finding and deserves further exploration. Allen D. Seftel, MD
Male Infertility Re: Enclomiphene Citrate Stimulates Testosterone Production while Preventing Oligospermia: A Randomized Phase II Clinical Trial Comparing Topical Testosterone R. D. Wiehle, G. K. Fontenot, J. Wike, K. Hsu, J. Nydell and L. Lipshultz; ZA-203 Clinical Study Group Department of Urology, Repros Therapeutics, Inc. and Baylor College of Medicine, Houston, Texas Fertil Steril 2014; 102: 720e727.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.03.052 available at http://jurology.com/ Editorial Comment: Practitioners have used the selective estrogen receptor modulator (SERM) clomiphene citrate for decades to increase testosterone for hypoandrogenic males with infertility, since this SERM increases intratesticular testosterone rather than decreasing it, as exogenous androgen does. Unfortunately use of clomiphene citrate is off label for this indication in the United States, as it was not pursued as a Food and Drug Administration approved indication. The authors report results of a phase II clinical trial comparing the trans isomer of clomiphene, enclomiphene, to exogenous testosterone in men with hypoandrogenism and inappropriately low luteinizing hormone, so-called secondary hypogonadism. With enclomiphene administration testosterone increased to a level similar to exogenous testosterone levels, and luteinizing hormone increased with enclomiphene, as opposed to decreasing with exogenous testosterone. With a SERM under study for Food and Drug Administration approval for the treatment of hypoandrogenism
2054
MALE INFERTILITY
urologists may finally get the data we have sought for decades characterizing the use of this modality for the treatment of secondary hypogonadism.1 Craig Niederberger, MD 1. Ross LS: Selective estrogen receptor modulators, male hypogonadism, and infertility. Fertil Steril 2014; 102: 687.
Suggested Reading Ramasamy R, Scovell JM, Kovac JR et al: Testosterone supplementation versus clomiphene citrate for hypogonadism: an age matched comparison of satisfaction and efficacy. J Urol 2014; 192: 875.
Re: Effects of Varicocele on Serum Testosterone and Changes of Testosterone after Varicocelectomy: A Prospective Controlled Study T. A. Abdel-Meguid, H. M. Farsi, A. Al-Sayyad, A. Tayib, H. A. Mosli and A. H. Halawani Departments of Urology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia, and El-Minia University, El-Minia, Egypt Urology 2014; 84: 1081e1087.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.03.053 available at http://jurology.com/ Editorial Comment: We are sensibly entering an era where urologists treat men with specific problems related to reproduction with accordingly specific therapies. For example selective endocrine modulatory therapy appears to have its best benefit when applied to men with demonstrable hypoandrogenism. These investigators consider varicocelectomy to be a specific therapy for hypoandrogenism in men with varicocele and low testosterone, and they performed a controlled study to demonstrate the use of the procedure in that context. Urologists may consider varicocele to be a treatable form of hypoandrogenism in selected infertile men. Craig Niederberger, MD
Suggested Reading Hsiao W, Rosoff JS, Pale JR et al: Older age is associated with similar improvements in semen parameters and testosterone after subinguinal microsurgical varicocelectomy. J Urol 2011; 185: 620.
Re: Livebirth after Uterus Transplantation €nnstro € m, L. Johannesson, H. Bokstro € m, N. Kvarnstro € m, J. Mo € lne, M. Bra €hler, A. Enskog, M. Milenkovic, J. Ekberg, C. Diaz-Garcia, M. Ga €bel, P. Dahm-Ka A. Hanafy, H. Hagberg, M. Olausson and L. Nilsson Departments of Obstetrics and Gynecology, Clinical Pathology and Genetics, Anesthesiology and Intensive Care, and Transplantation, Sahlgrenska Academy, University of Gothenburg, Gothenburg and Stockholm IVF, Stockholm, Sweden, Department of Obstetrics and Gynecology, La Fe University Hospital, University of Valencia, Valencia, Spain, Department of Obstetrics and Gynecology, Griffith University, Gold Coast, Queensland, Australia, and Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King’s College London and King’s Health Partners, St. Thomas’ Hospital, London, United Kingdom Lancet 2015; 385: 607e616.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.03.054 available at http://jurology.com/ Editorial Comment: Women born without a uterus (Rokitansky syndrome) were previously destined never to carry children. This group has been leading the world in investigating uterine transplantation, which is not an easy feat. To begin with, uterine vascularity is variable and complex, making transplant surgery lengthy and arduous. Here in a landmark publication Br€ annstr€om et al
MALE INFERTILITY
2055
report the first live birth from a uterus transplanted from a living 61-year-old woman into a 35-year-old woman born without a uterus. As expected, the surgery was only the beginning, with 1 of 3 episodes of mild rejection occurring during pregnancy. As with the transplantation of other organs, we can expect outcomes to improve with time and experience, opening the door to a new era of reproductive medicine. Craig Niederberger, MD
Re: Generation of Haploid Spermatids with Fertilization and Development Capacity from Human Spermatogonial Stem Cells of Cryptorchid Patients S. Yang, P. Ping, M. Ma, P. Li, R. Tian, H. Yang, Y. Liu, Y. Gong, Z. Zhang, Z. Li and Z. He Department of Urology, Shanghai Human Sperm Bank, Shanghai Institute of Andrology, and State Key Laboratory of Oncogenes and Related Genes, Renji-Med X Clinical Stem Cell Research Center, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University and Shanghai Key Laboratories of Reproductive Medicine, and Assisted Reproduction and Reproductive Genetics, Shanghai, China Stem Cell Reports 2014; 3: 663e675.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.03.055 available at http://jurology.com/ Editorial Comment: Pre-meiotic maturation arrest is a form of severe spermatogenic dysfunction that currently conveys little hope for fatherhood in those suffering with this pathological condition. These investigators demonstrate technology coaxing human spermatogonial stem cells to differentiate into haploid round cells. While we have not yet had much success in using immediate post-meiotic round cells in human assisted reproduction, this is a significant step toward making fatherhood possible for those men with the most severe form of maturation arrest. Craig Niederberger, MD
Re: Seminal BAX and BCL2 Gene and Protein Expressions in Infertile Men with Varicocele T. Mostafa, L. Rashed, N. Nabil and R. Amin Andrology and Sexology Department, and Medical Biochemistry Department, Faculty of Medicine, Cairo University, Cairo, and Dermatology and Andrology Department, Faculty of Medicine, Beni Suef University, Beni Suef, Egypt Urology 2014; 84: 590e595.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.03.056 available at http://jurology.com/ Editorial Comment: The making of sperm involves a tremendously delicate balance between cell proliferation and death, and it is not surprising that apoptosis appears to have a central role. While too little programmed cell death may lead to cancer, too much may beget spermatogenic dysfunction and infertility. These authors investigated whether 2 key regulators of apoptosis, Bax, which promotes it, and Bcl-2, which puts on the brakes, mediate the deleterious effect of varicocele on spermatogenesis. They observed that seminal Bax was increased and Bcl-2 was decreased in men with varicocele. As an even more compelling argument, Bax appeared to be increased in a dose dependent way with bilateral expression greater than that of unilateral varicoceles, with higher grades of varicocele expressing more. These observations may explain a key mechanism by which varicoceles cause male reproductive impairment. Craig Niederberger, MD
Suggested Reading Lin WW, Lamb DJ, Wheeler TM et al: Apoptotic frequency is increased in spermatogenic maturation arrest and hypospermatogenic states. J Urol 1997; 158: 1791.
2053
Re: Sexual Dysfunction among Reproductive-Aged Chinese Married Women in Hong Kong: Prevalence, Risk Factors, and Associated Consequences H. Zhang, S. Fan and P. S. Yip Department of Social Work, Renmin University of China, Beijing, China J Sex Med 2015; 12: 738e745.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.03.065 available at http://jurology.com/ Editorial Comment: This study aimed to estimate the prevalence, risk factors and associated consequences of female sexual dysfunction (FSD) among reproductive age Chinese married women in Hong Kong. Data were obtained from a community based survey across Hong Kong conducted by the Family Planning Association of Hong Kong in 2012, and included 1,518 married women 21 to 49 years old. The authors found that 25.6% of the married women surveyed reported at least 1 form of sexual dysfunction and that the prevalence of 6 domains of sexual dysfunction was as follows. Of the respondents 10.6% had lack of interest in sex, 10.5% did not find sex pleasurable, 9.3% had lubrication difficulties, 8.8% were unable to achieve orgasm, 8.8% had orgasm delay and 8.4% experienced physical pain during sex. Multivariate analyses showed that low education and income, average or poor health, lower frequency of sex, abortion history, traditional attitudes toward sex and marital dissatisfaction are all significant risk factors for different components of FSD. It was also found that 4 domains of FSD (the exceptions being orgasm delay and physical pain during sex) have severe consequences for life satisfaction and sexual satisfaction in married women. The prevalence of FSD in reproductive age Chinese married women in Hong Kong is about 26%, which is less than in similar women in the United States and some Asian countries. This is an interesting finding and deserves further exploration. Allen D. Seftel, MD
Male Infertility Re: Enclomiphene Citrate Stimulates Testosterone Production while Preventing Oligospermia: A Randomized Phase II Clinical Trial Comparing Topical Testosterone R. D. Wiehle, G. K. Fontenot, J. Wike, K. Hsu, J. Nydell and L. Lipshultz; ZA-203 Clinical Study Group Department of Urology, Repros Therapeutics, Inc. and Baylor College of Medicine, Houston, Texas Fertil Steril 2014; 102: 720e727.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.03.052 available at http://jurology.com/ Editorial Comment: Practitioners have used the selective estrogen receptor modulator (SERM) clomiphene citrate for decades to increase testosterone for hypoandrogenic males with infertility, since this SERM increases intratesticular testosterone rather than decreasing it, as exogenous androgen does. Unfortunately use of clomiphene citrate is off label for this indication in the United States, as it was not pursued as a Food and Drug Administration approved indication. The authors report results of a phase II clinical trial comparing the trans isomer of clomiphene, enclomiphene, to exogenous testosterone in men with hypoandrogenism and inappropriately low luteinizing hormone, so-called secondary hypogonadism. With enclomiphene administration testosterone increased to a level similar to exogenous testosterone levels, and luteinizing hormone increased with enclomiphene, as opposed to decreasing with exogenous testosterone. With a SERM under study for Food and Drug Administration approval for the treatment of hypoandrogenism
2054
MALE INFERTILITY
urologists may finally get the data we have sought for decades characterizing the use of this modality for the treatment of secondary hypogonadism.1 Craig Niederberger, MD 1. Ross LS: Selective estrogen receptor modulators, male hypogonadism, and infertility. Fertil Steril 2014; 102: 687.
Suggested Reading Ramasamy R, Scovell JM, Kovac JR et al: Testosterone supplementation versus clomiphene citrate for hypogonadism: an age matched comparison of satisfaction and efficacy. J Urol 2014; 192: 875.
Re: Effects of Varicocele on Serum Testosterone and Changes of Testosterone after Varicocelectomy: A Prospective Controlled Study T. A. Abdel-Meguid, H. M. Farsi, A. Al-Sayyad, A. Tayib, H. A. Mosli and A. H. Halawani Departments of Urology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia, and El-Minia University, El-Minia, Egypt Urology 2014; 84: 1081e1087.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.03.053 available at http://jurology.com/ Editorial Comment: We are sensibly entering an era where urologists treat men with specific problems related to reproduction with accordingly specific therapies. For example selective endocrine modulatory therapy appears to have its best benefit when applied to men with demonstrable hypoandrogenism. These investigators consider varicocelectomy to be a specific therapy for hypoandrogenism in men with varicocele and low testosterone, and they performed a controlled study to demonstrate the use of the procedure in that context. Urologists may consider varicocele to be a treatable form of hypoandrogenism in selected infertile men. Craig Niederberger, MD
Suggested Reading Hsiao W, Rosoff JS, Pale JR et al: Older age is associated with similar improvements in semen parameters and testosterone after subinguinal microsurgical varicocelectomy. J Urol 2011; 185: 620.
Re: Livebirth after Uterus Transplantation €nnstro € m, L. Johannesson, H. Bokstro € m, N. Kvarnstro € m, J. Mo € lne, M. Bra €hler, A. Enskog, M. Milenkovic, J. Ekberg, C. Diaz-Garcia, M. Ga €bel, P. Dahm-Ka A. Hanafy, H. Hagberg, M. Olausson and L. Nilsson Departments of Obstetrics and Gynecology, Clinical Pathology and Genetics, Anesthesiology and Intensive Care, and Transplantation, Sahlgrenska Academy, University of Gothenburg, Gothenburg and Stockholm IVF, Stockholm, Sweden, Department of Obstetrics and Gynecology, La Fe University Hospital, University of Valencia, Valencia, Spain, Department of Obstetrics and Gynecology, Griffith University, Gold Coast, Queensland, Australia, and Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King’s College London and King’s Health Partners, St. Thomas’ Hospital, London, United Kingdom Lancet 2015; 385: 607e616.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.03.054 available at http://jurology.com/ Editorial Comment: Women born without a uterus (Rokitansky syndrome) were previously destined never to carry children. This group has been leading the world in investigating uterine transplantation, which is not an easy feat. To begin with, uterine vascularity is variable and complex, making transplant surgery lengthy and arduous. Here in a landmark publication Br€ annstr€om et al
MALE INFERTILITY
2055
report the first live birth from a uterus transplanted from a living 61-year-old woman into a 35-year-old woman born without a uterus. As expected, the surgery was only the beginning, with 1 of 3 episodes of mild rejection occurring during pregnancy. As with the transplantation of other organs, we can expect outcomes to improve with time and experience, opening the door to a new era of reproductive medicine. Craig Niederberger, MD
Re: Generation of Haploid Spermatids with Fertilization and Development Capacity from Human Spermatogonial Stem Cells of Cryptorchid Patients S. Yang, P. Ping, M. Ma, P. Li, R. Tian, H. Yang, Y. Liu, Y. Gong, Z. Zhang, Z. Li and Z. He Department of Urology, Shanghai Human Sperm Bank, Shanghai Institute of Andrology, and State Key Laboratory of Oncogenes and Related Genes, Renji-Med X Clinical Stem Cell Research Center, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University and Shanghai Key Laboratories of Reproductive Medicine, and Assisted Reproduction and Reproductive Genetics, Shanghai, China Stem Cell Reports 2014; 3: 663e675.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.03.055 available at http://jurology.com/ Editorial Comment: Pre-meiotic maturation arrest is a form of severe spermatogenic dysfunction that currently conveys little hope for fatherhood in those suffering with this pathological condition. These investigators demonstrate technology coaxing human spermatogonial stem cells to differentiate into haploid round cells. While we have not yet had much success in using immediate post-meiotic round cells in human assisted reproduction, this is a significant step toward making fatherhood possible for those men with the most severe form of maturation arrest. Craig Niederberger, MD
Re: Seminal BAX and BCL2 Gene and Protein Expressions in Infertile Men with Varicocele T. Mostafa, L. Rashed, N. Nabil and R. Amin Andrology and Sexology Department, and Medical Biochemistry Department, Faculty of Medicine, Cairo University, Cairo, and Dermatology and Andrology Department, Faculty of Medicine, Beni Suef University, Beni Suef, Egypt Urology 2014; 84: 590e595.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.03.056 available at http://jurology.com/ Editorial Comment: The making of sperm involves a tremendously delicate balance between cell proliferation and death, and it is not surprising that apoptosis appears to have a central role. While too little programmed cell death may lead to cancer, too much may beget spermatogenic dysfunction and infertility. These authors investigated whether 2 key regulators of apoptosis, Bax, which promotes it, and Bcl-2, which puts on the brakes, mediate the deleterious effect of varicocele on spermatogenesis. They observed that seminal Bax was increased and Bcl-2 was decreased in men with varicocele. As an even more compelling argument, Bax appeared to be increased in a dose dependent way with bilateral expression greater than that of unilateral varicoceles, with higher grades of varicocele expressing more. These observations may explain a key mechanism by which varicoceles cause male reproductive impairment. Craig Niederberger, MD
Suggested Reading Lin WW, Lamb DJ, Wheeler TM et al: Apoptotic frequency is increased in spermatogenic maturation arrest and hypospermatogenic states. J Urol 1997; 158: 1791.
