Dr Ibrahim Fahmy is a professor of Andrology , and the former Vice-dean for postgraute affairs, Faculty of Medicine, Cairo University. He is the senior andrology consultant, The Egyptian IVF-ET center. Dr Fahmy has published several studies in different areas of clinical andrology. His main areas of interest include endocrine and genetic aspects of male infertility, and surgical retrieval of spermatozoa
This prospective case-control study aimed to test the presence of insulin resistance (IR) in men ... more This prospective case-control study aimed to test the presence of insulin resistance (IR) in men with unexplained infertility. We included two groups: the study group including 160 infertile men with unexplained oligozoospermia (sperm count <10 × 10(6)/ml) and normal hormonal profile, and the control group of 79 men with proven fertility within the preceding year. A fasting blood test measured IR, FSH, LH, total cholesterol, low-density lipoprotein, high-density lipoprotein and triglycerides. Insulin level was significantly higher in the study group (13.67 ± 10.44) compared with the control group (5.46 ± 3.15), P < 0.0001, and IR was significantly higher in the study group, P < 0.0001. FSH was significantly (P < 0.0001) higher in the study group (4.71 ± 2.57) than the control group (3.15 ± 1.92). LH was significantly higher in the study group (4.98 ± 2.41) compared with the control group (3.15 ± 1.12), P < 0.0001. Total cholesterol was significantly higher in the stud...
Achieving fertility in obstructive azoospermic patients depends on multiple factors, including; e... more Achieving fertility in obstructive azoospermic patients depends on multiple factors, including; etiology, level of obstruction, duration and the pathology of obstruction. Taking the previous factors into consideration, the most appropriate therapeutic line could be either corrective surgery (vasoepididymostomy, vasovasosotomy, transurethral resection of the ejaculatory ducts) or Testicular Sperm Extraction (TESE) and Intracytoplasmic Sperm Injection (ICSI) [4] . The main advantage of surgical intervention, is giving the couple the chance for future spontaneous normal conception with less cost and reduced risks [5] .
The present study describes a new modification for testicular sperm extraction (TESE) with an int... more The present study describes a new modification for testicular sperm extraction (TESE) with an intraoperative surgical loop, coupled with stereomicroscopic dissection in the laboratory, to identify sperm-containing tubules. The study included 116 consecutive patients with nonobstructive azoospermia (NOA) undergoing TESE and intracytoplasmic sperm injection. After dissection of tes-ticular tissue under the stereomicroscope, patients were separated into 2 groups according to tubular diameter. In the first group (n 72), all tubules were of the same diameter. In the second group (n 44), tubules with variable diameters could be identified. In such cases, 1–2 of the most distended and opaque seminiferous tubules were selected and minced alone, then examined for the presence of spermatozoa. The rest of the testicular tissue suspension was minced and examined separately. In 11 (25%) cases, retrieved sper-matozoa were found in the isolated distended tubules only. In 21 (47.7%) cases, spermatozoa were found in both the isolated distended tubules and the rest of the specimen. In 2 cases, sperma-tozoa were found only in the whole sample, not in the isolated tu-bules. In the remaining 10 cases, spermatozoa were not found in either the whole sample or the isolated tubules. The sperm recovery rate in the isolated tubules was significantly higher than that of the rest of the specimen (72.7% vs 52%, 2 3.93, P .05), and larger numbers of spermatozoa could be easily retrieved in a shorter period of time. In conclusion, the selection and isolation of the most dilated and opaque seminiferous tubules by using the surgical loop, coupled with laboratory stereoscopic dissection, improves sperm retrieval for men with NOA. It is possible that surgical-loops TESE coupled with stereomicroscope may offer superior sperm retrieval when compared with conventional TESE and may also offer reduced operative time when compared with microdissection TESE.
ABSTRACT Review purpose: The purpose of this review is to highlight the importance of aromatase i... more ABSTRACT Review purpose: The purpose of this review is to highlight the importance of aromatase inhibitors as a possible therapeutic option in some selected cases of male infertility. Recent findings: Aromatase inhibitors in high doses produced conflicting results regarding semen parameters&#39; improvement. Low doses of aromatase inhibitors may be more beneficial as it seems that there is a minimal threshold of estrogen needed for normal spermatogenesis. Obese male patients suffering from infertility seem to be good candidates for aromatase inhibitor therapy. Aromatase inhibitors may help to induce spermatogenesis in nonobstructive azoospermia. Patients with nonobstructive azoospemia with low testosterone level that increased after the therapy seem to yield the best results. Summary: Aromatase inhibitors are one of the least studied therapeutic options for male infertility. However, some cases with obesity, low testosterone, high estradiol, or reduced testosterone-to-estradiol ratio may benefit from this form of therapy.
The present study describes a new modification for testicular sperm extraction (TESE) with an int... more The present study describes a new modification for testicular sperm extraction (TESE) with an intraoperative surgical loop, coupled with stereomicroscopic dissection in the laboratory, to identify sperm-containing tubules. The study included 116 consecutive patients with nonobstructive azoospermia (NOA) undergoing TESE and intracytoplasmic sperm injection. After dissection of testicular tissue under the stereomicroscope, patients were separated into 2 groups according to tubular diameter. In the first group (n = 72), all tubules were of the same diameter. In the second group (n = 44), tubules with variable diameters could be identified. In such cases, 1-2 of the most distended and opaque seminiferous tubules were selected and minced alone, then examined for the presence of spermatozoa. The rest of the testicular tissue suspension was minced and examined separately. In 11 (25%) cases, retrieved spermatozoa were found in the isolated distended tubules only. In 21 (47.7%) cases, sperma...
Testicular needle aspiration has been proposed as a simple alternative to open biopsy for the dia... more Testicular needle aspiration has been proposed as a simple alternative to open biopsy for the diagnosis and treatment of azoospermia. This study describes a new modification of needle aspiration biopsy using an ordinary intravenous catheter to retrieve testicular spermatozoa from patients with obstructive azoospermia, and compares it to the classical fine-needle aspiration (FNA) method. The study included 86 consecutive patients with obstructive azoospermia. Thirty-one patients underwent FNA using butterfly needles (G21 or G23) and a 20 ml syringe. For the remaining 55 patients, an i.v. catheter (G14 or G16) was used instead of the butterfly needle. When testicular tissue was seen in the aspirate, the catheter was clamped and removed from the testis. If, after a maximum of three punctures, insufficient spermatozoa were retrieved, an open biopsy was carried out. Successful sperm retrieval was achieved in 54 out of 55 patients (98.1%) using an i.v. catheter, compared with 16 out of 31 patients (51.6%) using FNA (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). Enough aspirated tissue was obtained for cryopreservation of spermatozoa in all 54 patients using the i.v. catheter, compared with 6/16 (37.5%) of the patients undergoing classical FNA. No significant complications were reported. In conclusion, the use of an i.v. catheter for testicular aspiration biopsy significantly improved sperm retrieval compared with FNA in obstructive azoospermia, and allowed for cryopreservation of excess tissue. The procedure is simple and inexpensive, however regular follow up and testing of possible adverse consequences of this method is indicated to establish its safety.
This prospective case-control study aimed to test the presence of insulin resistance (IR) in men ... more This prospective case-control study aimed to test the presence of insulin resistance (IR) in men with unexplained infertility. We included two groups: the study group including 160 infertile men with unexplained oligozoospermia (sperm count <10 × 10(6)/ml) and normal hormonal profile, and the control group of 79 men with proven fertility within the preceding year. A fasting blood test measured IR, FSH, LH, total cholesterol, low-density lipoprotein, high-density lipoprotein and triglycerides. Insulin level was significantly higher in the study group (13.67 ± 10.44) compared with the control group (5.46 ± 3.15), P < 0.0001, and IR was significantly higher in the study group, P < 0.0001. FSH was significantly (P < 0.0001) higher in the study group (4.71 ± 2.57) than the control group (3.15 ± 1.92). LH was significantly higher in the study group (4.98 ± 2.41) compared with the control group (3.15 ± 1.12), P < 0.0001. Total cholesterol was significantly higher in the stud...
Achieving fertility in obstructive azoospermic patients depends on multiple factors, including; e... more Achieving fertility in obstructive azoospermic patients depends on multiple factors, including; etiology, level of obstruction, duration and the pathology of obstruction. Taking the previous factors into consideration, the most appropriate therapeutic line could be either corrective surgery (vasoepididymostomy, vasovasosotomy, transurethral resection of the ejaculatory ducts) or Testicular Sperm Extraction (TESE) and Intracytoplasmic Sperm Injection (ICSI) [4] . The main advantage of surgical intervention, is giving the couple the chance for future spontaneous normal conception with less cost and reduced risks [5] .
The present study describes a new modification for testicular sperm extraction (TESE) with an int... more The present study describes a new modification for testicular sperm extraction (TESE) with an intraoperative surgical loop, coupled with stereomicroscopic dissection in the laboratory, to identify sperm-containing tubules. The study included 116 consecutive patients with nonobstructive azoospermia (NOA) undergoing TESE and intracytoplasmic sperm injection. After dissection of tes-ticular tissue under the stereomicroscope, patients were separated into 2 groups according to tubular diameter. In the first group (n 72), all tubules were of the same diameter. In the second group (n 44), tubules with variable diameters could be identified. In such cases, 1–2 of the most distended and opaque seminiferous tubules were selected and minced alone, then examined for the presence of spermatozoa. The rest of the testicular tissue suspension was minced and examined separately. In 11 (25%) cases, retrieved sper-matozoa were found in the isolated distended tubules only. In 21 (47.7%) cases, spermatozoa were found in both the isolated distended tubules and the rest of the specimen. In 2 cases, sperma-tozoa were found only in the whole sample, not in the isolated tu-bules. In the remaining 10 cases, spermatozoa were not found in either the whole sample or the isolated tubules. The sperm recovery rate in the isolated tubules was significantly higher than that of the rest of the specimen (72.7% vs 52%, 2 3.93, P .05), and larger numbers of spermatozoa could be easily retrieved in a shorter period of time. In conclusion, the selection and isolation of the most dilated and opaque seminiferous tubules by using the surgical loop, coupled with laboratory stereoscopic dissection, improves sperm retrieval for men with NOA. It is possible that surgical-loops TESE coupled with stereomicroscope may offer superior sperm retrieval when compared with conventional TESE and may also offer reduced operative time when compared with microdissection TESE.
ABSTRACT Review purpose: The purpose of this review is to highlight the importance of aromatase i... more ABSTRACT Review purpose: The purpose of this review is to highlight the importance of aromatase inhibitors as a possible therapeutic option in some selected cases of male infertility. Recent findings: Aromatase inhibitors in high doses produced conflicting results regarding semen parameters&#39; improvement. Low doses of aromatase inhibitors may be more beneficial as it seems that there is a minimal threshold of estrogen needed for normal spermatogenesis. Obese male patients suffering from infertility seem to be good candidates for aromatase inhibitor therapy. Aromatase inhibitors may help to induce spermatogenesis in nonobstructive azoospermia. Patients with nonobstructive azoospemia with low testosterone level that increased after the therapy seem to yield the best results. Summary: Aromatase inhibitors are one of the least studied therapeutic options for male infertility. However, some cases with obesity, low testosterone, high estradiol, or reduced testosterone-to-estradiol ratio may benefit from this form of therapy.
The present study describes a new modification for testicular sperm extraction (TESE) with an int... more The present study describes a new modification for testicular sperm extraction (TESE) with an intraoperative surgical loop, coupled with stereomicroscopic dissection in the laboratory, to identify sperm-containing tubules. The study included 116 consecutive patients with nonobstructive azoospermia (NOA) undergoing TESE and intracytoplasmic sperm injection. After dissection of testicular tissue under the stereomicroscope, patients were separated into 2 groups according to tubular diameter. In the first group (n = 72), all tubules were of the same diameter. In the second group (n = 44), tubules with variable diameters could be identified. In such cases, 1-2 of the most distended and opaque seminiferous tubules were selected and minced alone, then examined for the presence of spermatozoa. The rest of the testicular tissue suspension was minced and examined separately. In 11 (25%) cases, retrieved spermatozoa were found in the isolated distended tubules only. In 21 (47.7%) cases, sperma...
Testicular needle aspiration has been proposed as a simple alternative to open biopsy for the dia... more Testicular needle aspiration has been proposed as a simple alternative to open biopsy for the diagnosis and treatment of azoospermia. This study describes a new modification of needle aspiration biopsy using an ordinary intravenous catheter to retrieve testicular spermatozoa from patients with obstructive azoospermia, and compares it to the classical fine-needle aspiration (FNA) method. The study included 86 consecutive patients with obstructive azoospermia. Thirty-one patients underwent FNA using butterfly needles (G21 or G23) and a 20 ml syringe. For the remaining 55 patients, an i.v. catheter (G14 or G16) was used instead of the butterfly needle. When testicular tissue was seen in the aspirate, the catheter was clamped and removed from the testis. If, after a maximum of three punctures, insufficient spermatozoa were retrieved, an open biopsy was carried out. Successful sperm retrieval was achieved in 54 out of 55 patients (98.1%) using an i.v. catheter, compared with 16 out of 31 patients (51.6%) using FNA (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). Enough aspirated tissue was obtained for cryopreservation of spermatozoa in all 54 patients using the i.v. catheter, compared with 6/16 (37.5%) of the patients undergoing classical FNA. No significant complications were reported. In conclusion, the use of an i.v. catheter for testicular aspiration biopsy significantly improved sperm retrieval compared with FNA in obstructive azoospermia, and allowed for cryopreservation of excess tissue. The procedure is simple and inexpensive, however regular follow up and testing of possible adverse consequences of this method is indicated to establish its safety.
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