Author
Lawrence S. Ross
Other affiliations: University of Illinois at Urbana–Champaign, University of Chicago, American Urological Association ...read more
Bio: Lawrence S. Ross is an academic researcher from University of Illinois at Chicago. The author has contributed to research in topics: Sperm & Azoospermia. The author has an hindex of 20, co-authored 53 publications receiving 1396 citations. Previous affiliations of Lawrence S. Ross include University of Illinois at Urbana–Champaign & University of Chicago.
Papers published on a yearly basis
Papers
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TL;DR: The traditional role of isolated testicular biopsy as a diagnostic tool, as opposed to the value as a therapeutic procedure for azoospermic men, is evaluated, believing that the isolated diagnostic testicularBiopsy is rarely if ever indicated.
188 citations
TL;DR: This guideline was peer reviewed by 55 independent experts during the guideline development process and recommended that vasectomy be considered for permanent contraception much more frequently than is the current practice in the U.S. and many other nations.
157 citations
TL;DR: In this article, a new protocol of clomiphene citrate, hCG and human menopausal gonadotropin (hMG) was used in treatment of non-obstructive azoospermia.
Abstract: Study Type – Therapy (outcomes)
Level of Evidence 2a
What's known on the subject? and What does the study add?
Clomiphene citrate, hCG and human menopausal gonadotropin (hMG) are widely used in treatment of oligospermia, because they increase FSH and testosterone which are essential for spermatogenesis. Finding a sperm in non-obstructive azoospermia for intracytoplasmic sperm injection is a challenge and much effort is required to reach the optimum method of sperm retrieval.
The study shows that a new protocol of clomiphene citrate, hCG and hMG in the treatment of non-obstructive azoospermia achieves an increase in the levels of FSH, LH and total testosterone to the target levels that we set. Our target level of FSH was 1.5 times its initial level and for serum testosterone it was 600–800 ng/dL. Using our described medical treatment protocol in cases of non-obstructive azoospermia, sperm may be found in patients' ejaculate (∼11%) and if they remain azoospermic they will have a greater likelihood of sperms being obtained in testicular sperm extraction.
OBJECTIVE
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To evaluate the effect of optimizing serum level of follicle-stimulating hormone (FSH), luteinizing hormone (LH) and testosterone on sperm retrieval for intracytoplasmic sperm injection.
PATIENTS AND METHODS
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A total of 612 patients with non-obstructive azoospermia were evaluated with routine history, physical examination and hormonal assessment.
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Of these, 116 patients underwent microsurgical (micro)-testicular sperm extraction (TESE) without any medical treatment and formed the control group and the remaining 496 patients were administered clomiphene citrate in a titrated dose.
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Patients were classified into four groups according to their response to clomiphene citrate. Group 1: patients with an obvious increase in FSH and total testosterone (n= 372). Group 2: patients showing an increase in FSH with no or little increase in LH and total testosterone (n= 62). For these patients we continued with clomiphene citrate and added human chorionic gonadotrophin (hCG). Group 3: patients with no increase in the levels of the three hormones (n= 46). Group 4: included patients with continuously decreasing serum testosterone levels in response to the increasing dose of clomiphene citrate (n= 16). Accordingly, patients in groups 3 and 4 discontinued clomiphene citrate and started hCG and human menopausal gonadotropin (hMG).
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Semen analyses were performed periodically and, in patients who remained azoospermic, micro-TESE was performed.
RESULTS
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Sperm were noted in 54 patients (10.9%) in semen analysis after treatment in all groups (with no significant difference) at a mean (sd) concentration of 2.3 (4.1) million/mL.
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For the 442 patients who remained azoospermic after treatment, successful sperm retrieval was significantly higher (57%) compared with the control group (33.6%).
CONCLUSION
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For patients with non-obstructive azoospermia, clomiphene citrate, hCG and hMG administration, leading to an increased level of FSH and total testosterone, results in an increased rate of sperm in the ejaculate and increased likelihood of successful micro-TESE.
117 citations
TL;DR: No differences were found in IVF-ICSI outcomes in patients with obstructive and nonobstructive azoospermia with fresh or frozen-thawed testicular spermatozoa and cryopreservation provides several advantages for the patients and reproductive team.
110 citations
TL;DR: It is concluded that clomiphene citrate administration may result in sperm in the ejaculate of patients with nonobstructive azoospermia or the simplification of testis sperm retrieval.
Abstract: Clomiphene citrate is a well-established agent thathas been empirically used in cases of idiopathic oligospermia. Clo-miphene increases endogenous gonadotropin-releasing hormonesecretion from the hypothalamus and gonadotropin hormone secre-tion directly from the pituitary and, thus, increases intratesticulartes-tosterone concentration. Using intracytoplasmic sperm injection(ICSI), very few sperm may be required for fertilization.Theobjectiveof this study was to determine if the application of clomiphenecitratein males with nonobstructive azoospermia might produce sufficientsperm for ICSI, either by resulting in sperm identified in the ejaculateor by potentially improving outcomes of surgical testicular sperm ex-traction. Forty-two patients with nonobstructive azoospermia (agerange, 25–39 years) from 3 international centers were evaluatedwithroutine history, physical examination, and hormonal assessment.Ini-tial testicular biopsy demonstrated maturation arrest in 42.9% andhypospermatogenesis in 57.1% of patients. Clomiphene citrate wasadministered, with the dose titrated to achieve serum testosteronelevels between 600 ng/dL and 800 ng/dL, and semen analyses wereperformed at periodic intervals. In patients remaining azoospermicon semen analysis, surgical testicular biopsy and sperm extractionwere performed. After clomiphene citrate therapy, 64.3% of the pa-tients demonstrated sperm in their semen analyses ranging from 1to 16 million sperm/mL, with a mean sperm density of 3.8 million/mL. Sufficient sperm for ICSI was retrieved by testicular sperm ex-traction in all patients, even though 35.7% remained azoospermic.Additionally, clomiphene citrate administration resulted in a statisti-cally significant increase in testis biopsy patterns associated withgreater likelihood of sperm obtained by surgical extraction (P, .05).We conclude that clomiphene citrate administration may result insperm in the ejaculate of patients with nonobstructive azoospermiaor the simplification of testis sperm retrieval. Surgeons may considera course of clomiphene citrate administration prior to surgical spermretrieval in patients with nonobstructive azoospermia.Key words: Hypospermatogenesis, maturation arrest, ICSI,TESE.J Androl 2005;26:787–791
100 citations
Cited by
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University of California, San Francisco1, Johns Hopkins University School of Medicine2, University of Louisville3, Baylor College of Medicine4, Brown University5, Cleveland Clinic6, NewYork–Presbyterian Hospital7, University of Virginia8, Mayo Clinic9, University of Pennsylvania10, University of California, Davis11, SUNY Downstate Medical Center12
TL;DR: This research aims to provide a more complete picture of the central nervous system and the role that emotion, disease and disease play in the development of chronic disease and its treatment.
661 citations
TL;DR: In this article, a laparoscopic dismembered pyeloplasty was performed on 5 patients with ureteropelvic junction obstruction, with operating time ranging from 3 to 7 hours and hospital stay averaged 3 days and all patients returned to normal activity within 1 week.
598 citations
TL;DR: Yankaskas, Bruce C. Marshall, Beth Sufian, Richard H. Simon, and David Rodman as discussed by the authors discussed Cystic Fibrosis Adult Care in the American College of Chest Physicians.
540 citations
TL;DR: In aging male patients, psychosomatic complaints and metabolic risk relate to testosterone in a symptom-specific manner, and there is no evidence that a uniform structure of testosterone concentrations and complaints exists within the cohort of elderly male patients.
Abstract: Context: Although attention and concern about health disorders in aging men have been growing, the structure of psychological and somatic complaints of actual patients, not population-based cohorts, has not been elucidated in relation to sex hormone patterns and metabolism. Objective: The objective of the study was investigation of factors influencing complaint structures in aging male patients. Design: This was a cross-sectional cohort study. Setting: The study was conducted in an andrological outpatient department. Patients: Subjects included 434 consecutive male patients aged 50–86 yr. Main Outcome Measures: The following hypotheses were measured: 1) psychosomatic complaints and metabolic factors in aging male patients are related to sex hormone levels in a symptom-specific manner, and 2) patients form subcohorts. Results: A clear-cut threshold for late-onset hypogonadism was not found; rather, prevalence of psychosomatic symptoms and metabolic risk factors accumulated with decreasing androgen levels. ...
510 citations
TL;DR: In this paper, the authors provide detailed cardiac recommendations from the conference on "Maximizing Use of Organs Recovered From the Cadaver Donor" held March 28 to 29, 2001, in Crystal City, Va.
Abstract: The shortage of available donor hearts continues to limit cardiac transplantation. For this reason, strict criteria have limited the number of patients placed on the US waiting list to approximately 6000 to 8000 per year. Because the number of available donor hearts has not increased beyond approximately 2500 per year, the transplant waiting list mortality rate remains substantial. Suboptimal and variable utilization of donor hearts has compounded the problem in the United States. In 1999, the average donor yield from 55 US regions was 39%, ranging from 19% to 62%. This report provides the detailed cardiac recommendations from the conference on "Maximizing Use of Organs Recovered From the Cadaver Donor" held March 28 to 29, 2001, in Crystal City, Va. The specific objective of the report is to provide recommendations to improve the evaluation and successful utilization of potential cardiac donors. The report describes the accuracy of current techniques such as echocardiography in the assessment of donor heart function before recovery and the impact of these data on donor yield. The rationale for and specific details of a donor-management pathway that uses pulmonary artery catheterization and hormonal resuscitation are provided. Administrative recommendations such as enhanced communication strategies among transplant centers and organ-procurement organizations, financial incentives for organ recovery, and expansion of donor database fields for research are also described.
459 citations