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Medicina
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Male Infertility: A Contemporary Review on Present Status and Future...
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Male Infertility: A Contemporary Review on Present Status and Future Perspective

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Urology & Nephrology".

Deadline for manuscript submissions: 31 May 2025 | Viewed by 1410

Special Issue Editor

Prof. Dr. Nikolaos Sofikitis

E-Mail Website
Guest Editor
Department of Urology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
Interests: male infertility; diagnosis of male infertility; varicocele; sperm function and quality; human spermatogenesis
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Male infertility is a significant global issue, accounting for nearly 50% of infertility cases among couples. The causes of male infertility are multifactorial, ranging from genetic mutations to environmental and lifestyle factors such as obesity and exposure to toxins. Recent research has explored the role of sperm DNA fragmentation, oxidative stress, and genetic abnormalities in male infertility, alongside the impact of aging on male reproductive health. While there have been advances in diagnostic techniques such as sperm DNA fragmentation tests and genetic screening, effective medical treatments remain limited. Assisted reproductive technologies (ARTs) like IVF and ICSI continue to be the primary interventions for many infertile couples. The future of male infertility treatment looks to leverage breakthroughs in molecular biology, including gene therapy, hormonal therapies, and novel biomarkers to improve outcomes. Additionally, male infertility is increasingly being recognized as a marker of overall health, with correlations to cardiovascular disease, diabetes, and certain cancers. This Special Issue will review the current diagnostic and treatment practices for male infertility, with an emphasis on emerging technologies and future perspectives for improving male reproductive health.

Prof. Dr. Nikolaos Sofikitis
Guest Editor

Manuscript Submission Information

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • male infertility
  • assisted reproductive technologies
  • sperm DNA fragmentation
  • genetic screening
  • oxidative stress
  • hormonal therapy
  • IVF/ICSI
  • biomarkers
  • gene therapy
  • reproductive health

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Published Papers (2 papers)

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Research

9 pages, 253 KiB  
Article
Comparison of Effects of Chorionic Gonadotropin Alfa and Anastrozole on Sperm Retrieval Rate in Patients with Non-Mosaic Klinefelter Syndrome Following Microdissection Testicular Sperm Extraction
by Eyyup Sabri Pelit, Yavuz Onur Danacıoğlu and Bülent Katı
Medicina 2025, 61(3), 467; https://doi.org/10.3390/medicina61030467 - 7 Mar 2025
Viewed by 58
Abstract
Background and Objectives: This study aimed to compare the effects of choriogonadotropin alfa and anastrozole treatments on the success of sperm retrieval in patients with Klinefelter syndrome (KS) undergoing micro-TESE at our clinic. Materials and Methods: We conducted a retrospective review [...] Read more.
Background and Objectives: This study aimed to compare the effects of choriogonadotropin alfa and anastrozole treatments on the success of sperm retrieval in patients with Klinefelter syndrome (KS) undergoing micro-TESE at our clinic. Materials and Methods: We conducted a retrospective review of a cohort including patients with non-mosaic KS who underwent micro-TESE for fertility treatment at the Reproductive Medicine Center of our university hospital. This study included 43 patients who had not received exogenous testosterone therapy prior to or during the procedure. Before surgical sperm retrieval, all patients received either choriogonadotropin alfa or anastrozole treatment based on their preference. Micro-TESE was performed on all patients after three months of treatment. Results: The overall SRR in the cohort post-micro-TESE was found to be 32.6%. There was a significant increase in post-treatment testosterone levels compared to pre-treatment levels. Upon dividing patients into two groups based on whether sperm was successfully retrieved, we observed significant improvements in testosterone levels in both groups following treatment. In the group presenting with successful sperm retrieval, 28.6% of patients had received choriogonadotropin alfa, while 71.4% had received anastrozole. No statistically significant difference was found between treatment groups in terms of micro-TESE success. Both choriogonadotropin alfa and anastrozole treatments resulted in significant improvements in testosterone levels following treatment compared to pre-operative levels. Furthermore, in the choriogonadotropin alfa group, there were significant decreases in follicle-stimulating hormone and luteinizing hormone levels, as well as a significant increase in estradiol levels after treatment. Post-treatment E2 levels were significantly lower in the anastrozole group than in the choriogonadotropin alfa group (p = 0.032), while the mean testicular volume was statistically significantly lower in the choriogonadotropin alfa group. Conclusions: This study suggests that anastrozole treatment before micro-TESE in patients with KS yields more successful results in terms of the SRR compared to choriogonadotropin alfa treatment. Full article
(This article belongs to the Special Issue Male Infertility: A Contemporary Review on Present Status and Future Perspective)
16 pages, 1604 KiB  
Article
Predictive Value of Varicocele Grade and Histopathology in Simultaneous Varicocelectomy and Sperm Retrieval in Non-Obstructive Azoospermia: A Retrospective Cohort Study
by Aris Kaltsas, Fotios Dimitriadis, Michael Chrisofos, Nikolaos Sofikitis and Athanasios Zachariou
Medicina 2024, 60(12), 2056; https://doi.org/10.3390/medicina60122056 - 13 Dec 2024
Viewed by 999
Abstract
Background and Objectives: Varicocele repair in men with non-obstructive azoospermia (NOA) remains a subject of debate due to inconsistent outcomes. This study aimed to evaluate the impact of microsurgical varicocelectomy on sperm recovery rates in men with NOA and to assess the role [...] Read more.
Background and Objectives: Varicocele repair in men with non-obstructive azoospermia (NOA) remains a subject of debate due to inconsistent outcomes. This study aimed to evaluate the impact of microsurgical varicocelectomy on sperm recovery rates in men with NOA and to assess the role of varicocele grade and testicular histopathology in predicting postoperative outcomes. Materials and Methods: A retrospective cohort study was conducted of 78 men diagnosed with NOA and clinical varicocele who underwent microsurgical subinguinal varicocelectomy with simultaneous diagnostic and therapeutic testicular biopsy at the Department of Urology of the University of Ioannina between September 2013 and December 2021. Varicoceles were graded I to III based on physical examination and Doppler ultrasound. Histopathological patterns were classified as hypospermatogenesis (HYPO), early maturation arrest (EMA), late maturation arrest (LMA), or Sertoli cell-only syndrome (SCOS). Patients were followed postoperatively at 3, 6, 9, and 12 months, with semen analyses performed according to World Health Organization guidelines to assess sperm presence. Results: At the 12-month follow-up, spermatozoa were detected in the ejaculate of 26 out of 78 patients, resulting in an overall sperm return to ejaculate rate of 33.3%. Varicocele grade significantly influenced outcomes: patients with Grade II varicoceles had the highest sperm return to ejaculate rate (45.2%, 14/31), followed by Grade III (39.1%, 9/23) and Grade I (12.5%, 3/24) (p-value < 0.05). The sperm retrieval rate (SRR) from testicular biopsies also varied with varicocele grade: Grade II had the highest SRR (54.8%, 17/31), followed by Grade III (47.8%, 11/23) and Grade I (33.3%, 8/24). Histopathological findings were significant predictors of sperm retrieval: patients with HYPO had an SRR of 84.8% (28/33) and a sperm return to ejaculate rate of 66.7% (22/33); those with LMA had an SRR of 47.1% (8/17) and a sperm return rate of 23.5% (4/17). No sperm retrieval was observed in patients with EMA (0%, 0/4) or SCOS (0%, 0/24) (p-value < 0.01). Multivariate logistic regression identified varicocele grade and histopathology as independent predictors of sperm retrieval, with higher grades and favorable histopathology associated with increased likelihood of success. Conclusions: Microsurgical varicocelectomy can induce spermatogenesis in a significant proportion of men with NOA, particularly those with higher-grade varicoceles and favorable histopathological patterns such as HYPO or LMA. Varicocele grade and histopathological findings are important predictors of postoperative outcomes and should inform patient selection and counseling. These findings provide valuable insights for optimizing fertility treatments in men with NOA undergoing varicocele repair. Full article
(This article belongs to the Special Issue Male Infertility: A Contemporary Review on Present Status and Future Perspective)
►▼ Show Figures

Figure 1

Figure 1
<p>Histopathological patterns of testicular biopsies.</p> Full article ">Figure 2
<p>Sperm return to ejaculate and testicular sperm retrieval rates by varicocele grade.</p> Full article ">Figure 3
<p>Kaplan–Meier curves illustrating the time to sperm recovery after microsurgical varicocelectomy in patients with non-obstructive azoospermia, stratified by varicocele grade.</p> Full article ">
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