Looking down on sperm motion： a useful addeddimension？

The assumed association of sperm motility with fertility has long beena preoccupation of clinicians. Whereas assessing fertility of a couple has relatively easy end-points （time to pregnancy, number of children）, assessing motility does not. ＂[he many methods developed to determine it include assessing a sperm population subjectively （by grading） and objectively （by measuring its motion-induced movement into a light beam by spectrophotometry or nephelometry）, and making measurements on individual sperm cells （by stroboscopic or multiple-exposure photography or digitized video-recordings）.     

＂One sperm,one embryo,one baby＂？

Dear Editor,
The introduction of intracytoplasmic sperm injection （ICSI） technology has revolutionised the treatment of patients with severe oligozoospermia and azoospermia. A patient is usually considered oligozoospermic if his sperm concentration is less than 20 million mL^-1. A patient is labelled azoospermic according to the World Health Organisation guideline , if, on two different occasions, no spermatozoa can be detected by high-power microscopy after the seminal fluid has been centrifuged for 15 min at a centrifugation force of 3 000 × g or greater.     

Assessing human sperm morphology： top models,underdogs or biometrics？

The assessment of the percentage of spermatozoa having an ＇ideal＇ morphology using so-called strict method is the method recommended in the latest edition of the World Health Organization （WHO） laboratory manual for semen analysis. This recommendation is a result of the statistical association between ＇ideal＇ sperm morphology and fertility, and of the current general belief that sperm morphology assessment should be used primarily as a fertility tool. The notion of an ＇ideal＇ sperm morphology has persisted despite the very low percentage of such spermatozoa in the semen of fertile men, a subject of intense controversy. The detailed categorization of each abnormal spermatozoon has thus, for a long time, been considered optional and partially redundant, an idea which is reflected in the earlier editions of the WHO manual. However, several recent studies have shown the importance of carefully assessing abnormal sperm morphology for use in the diagnosis ＆infertility, to determine fertility prognosis, and for basic or public health studies. One approach, which combines videomicroscopy and computer vision, and is the only approach able to assess the continuum of sperm biometrics, has been used successfully in several recent clinical, basic and toxicology studies. In summary, the visual assessment of detailed sperm morphology--including the categorization of anomalies allowing arithmetically derived indices of teratozoospermia--and the more modern computer-based approaches, although often considered to be redundant, are in fact complementary. The choice of the most appropriate method depends on the field of investigation （clinical, research, toxicology） and the problem being addressed. Each approach has advantages as well as certain limitations, which will be discussed briefly herein.     

Awareness of and attitudes towards infertility and its treatment： a cross-sectional survey of men in a United States primary care population

Previous studies have described racial and socioeconomic disparities in the treatment of infertility. Patient factors such as attitudes and awareness may be contributing factors. Since primary care is often the setting that serves as an entry into other areas of medicine, we sought to evaluate men＇s attitudes and awareness of male infertility in the primary care setting. To do this, we performed a cross-sectional survey of men＇s attitudes toward men＇s health issues in 210 men from two primary care clinic waiting rooms in Atlanta, Georgia. The survey was self-administered with closed-ended question items and was approximately 20 min in length. Of the 310 men approached, 210 agreed to participate and returned completed surveys. Overall, 52% of men said they were ＂very＂ or ＂somewhat＂ familiar with infertility and 25% were familiar with treatments for infertility. Some men had heard of surgery （21%） and medication （35%） as treatments for male infertility. Awareness and familiarity with the condition was greater in high socioeconomic status men （i.e. college graduates or those with income 〉$100 k per year） but did not differ by race on multivariate analysis. Attitudes toward infertility varied by race with non-Caucasian men being more likely to indicate that infertility is a serious condition, to be concerned about infertility, and to believe it decreases a man＇s quality-of-life. Therefore, a lack of awareness, but not negative attitudes, may contribute to previously-described disparities in the treatment of infertility.     

Human sperm pattern of movement during chemotactic ＇e-orientation towards a progesterone source

Human spermatozoa may chemotactically find out the egg by following an increasing gradient of attractant molecules. Although human spermatozoa have been observed to show several of the physiological characteristics of chemotaxis, the chemotactic pattern of movement has not been easy to describe. However, it is apparent that chemotactic cells may be identified while returning to the attractant source. This study characterizes the pattern of movement of human spermatozoa during chemotactic re-orientation towards a progesterone source, which is a physiological attractant candidate. By means of videomicroscopy and image analysis, a chemotactic pattern of movement was identified as the spermatozoon returned towards the source of a chemotactic concentration of progesterone (10 pmol l⁻¹). First, as a continuation of its original path, the spermatozoon swims away from the progesterone source with linear movement and then turns back with a transitional movement that can be characterized by an increased velocity and decreased linearity. This sperm behaviour may help the spermatozoon to re-orient itself towards a progesterone source and may be used to identify the few cells that are undergoing chemotaxis at a given time.     

Sperm chromatin structure assay （SCSA）： a tool in diagnosis and treatment of infertility

Diagnosis of male infertility has mainly been based on the World Health Organization (WHO) manual-based semen parameter's concentration, motility and morphology. It has, however, become apparent that none of these parameters are reliable markers for evaluation of the fertility potential of a couple. A search for better markers has led to an increased focus on sperm chromatin integrity testing in fertility work-up and assisted reproductive techniques. During the last couple of decades, numerous sperm DNA integrity tests have been developed. These are claimed to be characterized by a lower intraindividual variation, less intralaboratory and interlaboratory variation and thus less subjective than the conventional sperm analysis. However, not all the sperm chromatin integrity tests have yet been shown to be of clinical value. So far, the test that has been found to have the most stable clinical threshold values in relation to fertility is the sperm chromatin structure assay (SCSA), a flow cytometric test that measures the susceptibility of sperm DNA to acid-induced DNA denaturation in situ. Sperm DNA fragmentation as measured by SCSA has shown to be an independent predictor of successful pregnancy in first pregnancy planners as well as in couples undergoing intrauterine insemination, and can be used as a tool in investigation, counseling and treatment of involuntary childlessness. More conflicting data exist regarding the role of sperm DNA fragmentation in relation to fertilization, pre-embryo development and pregnancy outcome in in vitro fertilization and intracytoplasmic sperm injection (ICSI).     

Scoring of sperm chromosomal abnormalities by manual and automated approaches：qualitative and quantitative comparisons

It is now well known that levels of sperm disomy correlate to levels of infertility （as well as other factors）.The risk of perpetuating aneuploidy to the offspring of infertile males undergoing intracytoplasmic sperm injection （ICSI） has become a hotly debated issue in assisted reproduction;however,there remain barriers to the practical implementation of offering sperm disomy screening in a clinical setting. The major barrier is the operator time taken to analyze a statistically meaningful （sufficient） number of cells. The introduction of automated ＇spot counting＇software-hardware combinations presents a potential solution to this problem. In this preliminary validation study,we analyzed 10 patients,both manually and using a commercially available spot counter. Results show a statistically significant correlation between both approaches for scoring of sperm disomy,but no correlation is found when scoring for diploid sperm. The most likely explanation for the latter is an apparent overscoring of two closely associated sperm heads as a single diploid cell. These results,and similar further studies that will ensue,help to inform cost-benefit analyses that individual clinics need to carry out in order to decide whether to adopt sperm aneuploidy screening as a routine tool for the assessment of sperm from men requiring ICSI treatment.     

Lipogenic metabolism： a viable target for prostate cancer treatment？

Cancer cells often depend on altered metabolism compared with their normal counterparts.1-4 As observed in 1924 by Otto Warburg, cancer cells show preferential glucose consumption by way of aerobic glycolysis while normal cells generally assume mitochondrial oxidative phosphorylation.4 Another metabolic hallmark of carcinogenesis is altered lipid metabolism, whereby cancer cells may adopt enhanced de novo lipid production （lipogenesis）.l-3 Enhanced lipid metabolism is also observed in individuals with metabolic syndromes potentially a consequence of increasing popularity of the Standard American Diet, composed of high levels of saturated fats and carbohydrates.5 A growing body of epidemiological data indicates a positive correlation between the occurrence of metabolic syndromes, such as cardiovascular disease, obesity, type-2 diabetes and associated hyperinsulemia, with the aggressiveness of cancer.6-9 Remarkably, it is estimated that for every 1% reduction in saturated fats, replaced by polyunsaturated, there would be a 2%-3% reduction in cardiovascular disease.10 Thus, it is conceivable that an equally remarkable attenuation in cancer progression might be achieved with such a reduction in lipid accumulation.     

The effectiveness and safety of acupuncture for poor semen quality in infertile males： a systematic review and meta-analysis

The aim of this review is to evaluate the effectiveness and safety of acupuncture for poor semen quality in infertile men. We searched for relevant trials registered up to May 2013 in 14 databases. We selected randomized controlled trials （RCTs） that compared acupuncture, with or without additional treatment, against placebo, sham, no treatment, or the same additional treatment. Two reviewers independently performed the study selection, data extraction, risk of bias and reporting quality appraisal. Risk of bias and reporting quality were appraised by the Cochrane risk of bias tool, the consolidated standards of reporting trials and Standards for Reporting Interventions in Clinical Trials of Acupuncture. The outcomes were sperm motility, sperm concentration, pregnancy rate, and adverse events. Pregnancy was defined as a positive pregnancy test. Four RCTs met the eligibility criteria. Acupuncture increased the percentage of sperm with rapid progression （mean difference - 6.35, 95% confidence interval （CI）. 4.38-8.32, P〈 0.00001） and sperm concentration （mean difference - 6.42, 95% CI. 4.91-7.92, P〈 0.00001）, but these two outcomes were substantially heterogeneous among the studies （F = 72% and 58%, respectively）. No differences in pregnancy rate were found between acupuncture and control groups （odds ratio 1.60, 95% CI. 0.70-3.69, P= 0.27, F = 0%）. No participants experienced adverse events. The current evidence showing that acupuncture might improve poor semen quality is insufficient because of the small number of studies, inadequacy of procedures and/or insufficient information for semen analysis, high levels of heterogeneity, high risk of bias, and poor quality of reporting. Further large, well-designed RCTs are required.     

Penile fracture and its treatment： Is retrograde urethrograghy necessary for management of penile fracture？

[Abstract] Objective： Penile fracture, being defined as rupture of the tunica albuginea of the corpus cavernosum, is uncommon. Here, we analyze findings on our patients during a 10-year period and evaluate the role of retrograde urethrography. Methods： From February 2002 to April 2012, 116 patients were admitted with penile fracture at Ghaem Medical Center. Patient history and physical examination were taken at their admittance to detect probable urethral injury. Before surgery, retrograde urethrography was performed in all patients. The size and site of the tunical rupture were recorded. Then the rupture of tunica albuginea was sutured with nonabsorbable （3-0 nylon） sutures and the ties were placed on the internal surface （continuous method）. All patients were followed up for 12 months. Results： Patients＇ mean age was （32.78±10.61） years and ranged （16-62） years. The mechanism of trauma was sexual intercourse in 103 patients （89%） and masturbation in 13 patients （11%）. The most common site of injury found after exploration was right （55%） and lateral （74%） of the corpus cavernosum. The size of the tunical rupture was from 0.5 to 3.0 cm （mean 1.88±0.72）. Three of the patients had Marphan＇s syndrome. Urethral injury was detected by retrograde urethrography in 4 patients （3%） who had macroscopic hematuria and urethrorrhagia. During 12 months follow-up, no complication was seen. Conclusion： There is no need to perform retrograde urethrography unless the patients have gross hematuria or urethrorrhagia. The key to success in treatment of penile fracture is to achieve a rapid diagnosis based on history and a physical examination, avoid unnecessary imaging tests and perform immediate surgery to reconstruct the site of injury.     

Should cross-sex hormone treatment of transsexual subjects vary with ethnic group？

Guidelines for cross-sex hormone treatment of transsexual people have been developed, but no attention has been paid to the specifics of ethnic groups. South East （SE） Asian male-to-female （MtoF） transsexual people may be able to transition to the female sex with lower doses of estrogens/progestins than Caucasians thus reducing health risks. Female-to-male （FtoM） may virilize less profoundly with standard doses of androgens, but this is probably sufficient to pass acceptably as men in view of the less pronounced sex differences in physique in Asians compared with Caucasians. It is timely that studies in Asians are conducted to get a better insight into their specific needs and risks of cross-sex hormone treatment.     

Efficacy and safety of on demand tadalafil in the treatment of East and Southeast Asian men with erectile dysfunction： a randomized double-blind, parallel, placebo-controlled clinical study

Aim： To assess the efficacy and safety of tadalafil in comparison to a placebo, when taken on demand for 12 weeks by East/Southeast Asian men with erectile dysfunction （ED）, Methods： This multicenter, randomized, double-blind, parallel group, placebo-controlled study was conducted at 17 centers across East and Southeast Asia between August 2002 and February 2003. Men more than 18 years of age with mild to severe ED of various etiologies were randomized to receive a placebo or 20 mg of tadalafil taken as needed （maximum once daily）. Efficacy assessments included the International Index of Erectile Function, the Sexual Encounter Profile diary and Global Assessment Questions. Results： Tadalafil significantly improved erectile function as compared to the placebo （P 〈 0.001）. At the endpoint, the patients receiving 20 mg of tadalafil reported a greater mean per patient percentage of successful intercourse attempts （Sexual Encounter Profile question 3： 70.9% compared to 33.5% in the placebo） and a greater proportion of improved erections （Global Assessment Question： 86.2% compared to 30.1%）. Most （≥3%） treatment emergent adverse events were mild or moderate. The most common treatment emergent adverse events were headache, back pain, dizziness and dyspepsia. Conclusion： Tadalafil was an effective and well-tolerated treatment for ED in East and Southeast Asian men.     

Castrate-tolerant cells： what are the implications for the treatment of localized prostate cancer？

More effective treatment of prostate cancer relies on eliminating cellsthat survive androgen withdrawal therapy. The discovery that castrate-tolerant tumour cells pre-exist in localized prostate cancer, prior to androgen withdrawal or progres-sion to castrate-resistant disease, supports the notion that neo-adjuvant therapies might be considered in the management of early stage prostate cancer. Advances in our ability to xenograft human prostate cancer provides a unique model system to study individual patient responses and test the preclinical efficacy of novel compounds for men with localized disease.     

Efficacy of maximal androgen blockade versus castration alone in the treatment of advanced prostate cancer： a retrospective clinical experience from a Chinese medical centre

In this retrospective study, we evaluated and compared the efficacy and toxicities of maximal androgen blockade （MAB） versus castration alone in Chinese patients with advanced prostate cancer. From 1996 to 2004, 608 patients with advanced prostate cancer were included in the study. Patients were retrospectively divided into two groups according to different therapeutic regimens. Of the 608 patients, 300 patients were treated with MAB （castration plus nonsteroidal antiandrogens） and the remaining 308 were treated with castration alone. The 2- and 5-year overall survival rates of these patients were 73.7% and 56%, respectively. Multivariate analysis showed that, in patients with metastatic prostate cancer, MAB was associated with not only the improvement of progression-free survival （PFS） （increased by 10 months） but also a 20.6% reduction in mortality risk compared with castration alone. In contrast, the efficacy of MAB was not superior to castration alone for patients with nonmetastatic prostate cancer. Interestingly, among patients with MAB, those using bicalutamide had a longer PFS than those using flutamide; this was especially so in patients with metastatic prostate cancer. Almost all of the toxicities due to the hormone therapy were mild to moderate and manageable. To conclude, in China, hormone therapies, including MAB and castration alone, have been standard treatments for advanced prostate cancer. For patients with nonmetastatic prostate cancer, castration alone might be adequately practical and efficient. In patients with metastatic prostate cancer, however, MAB has superior efficacy over castration alone. It is clear that MAB should be considered the first-line standard treatment for patients with metastatic prostate cancer.     

Long-term results of the surgical treatment of Peyronie＇s disease with Egydio＇s technique： a European multicentre study

The long-term outcomes of 157 patients affected by Peyronie's disease (PD) who underwent penile straightening with Egydio's technique between January 2004 and December 2008 are reported. Only patients with PD who were stable for at least 6-12 months prior to surgery were enrolled in this study. Preoperative assessment included a dynamic echo colour Doppler ultrasound scan to evaluate the degree of penile deformity and the peak systolic velocity in the cavernosal arteries and an assessment of erectile function with the administration of the International Index of Erectile Function 5 (IIEF-5) questionnaire. Stretched penile length was recorded pre- and postoperatively. Surgical complications, cosmesis and sexual function, patient satisfaction and postoperative erectile function were assessed postoperatively at 3 months, 1 year and 2 years, respectively. After a median follow-up period of 20 months (range: 12-24 months), we found that mild residual curvature (12%) and glans hypoesthesia (3%) were the only causes of partial dissatisfaction. No rejection of the graft was observed. All patients recovered their ability to penetrate with no difficulty. In addition, an intraoperative average increase of 2.5 cm (range: 1.7-4.1 cm) in stretched penile length was recorded, with all patients engaging in penetrative sexual intercourse. In conclusion, this procedure represents a safe and reproducible technique for the correction of penile curvature resulting from PD and yields excellent cosmetic and functional results.     

The impact of minimally invasive surgeries for the treatment of symptomatic benign prostatic hyperplasia on male sexual function： a systematic review

A systematic review of randomized controlled trials and cohort studies was conducted to evaluate data for the effects of minimally invasive procedures for treatment of symptomatic benign prostatic hyperplasia （BPH） on male sexual function. The studies searched were trials that enrolled men with symptomatic BPH who were treated with laser surgeries, transurethral microwave therapy （TUMT）, transurethral needle ablation of the prostate （TUNA）, transurethral ethanol ablation of the prostate （TEAP） and high-intensity frequency ultrasound （HIFU）, in comparison with traditional transurethral resection of the prostate （TURP） or sham operations. A total of 72 studies were identified, of which 33 met the inclusion criteria. Of the 33 studies, 21 were concerned with laser surgeries, six with TUMT, four with TUNA and two with TEAP containing information regarding male sexual function. No study is available regarding the effect of HIFU for BPH on male sexual function. Our analysis shows that minimally invasive surgeries for BPH have comparable effects to those of TURP on male erectile function. Collectively, less than 15.4% or 15.2% of patients will have either decrease or increase, respectively, of erectile function after laser procedures, TUMT and TUNA. As observed with TURP, a high incidence of ejaculatory dysfunction （EjD） is common after treatment of BPH with holmium, potassium-titanyl-phosphate and thulium laser therapies （〉 33.6%）. TUMT, TUNA and neodymium：yttrium aluminum garnet visual laser ablation or interstitial laser coagulation for BPH has less incidence of EjD, but these procedures are considered less effective for BPH treatment when compared with TURP.