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Re: Vasectomy Reversal Outcomes in Men Previously on Testosterone Supplementation Therapy
MALE INFERTILITY
500
Re: Hepatitis B Virus Infection and the Risk of Male Infertility: A Population-Based Analysis F. H. Su, S. N. Chang, F. C. Sung, C. T. Su, Y. H. Shieh, C. C. Lin and C. C. Yeh Department of Family Medicine and School of Public Health, College of Public Health and Nutrition, Taipei Medical University School of Medicine, Department of Family Medicine, Wan Fang Hospital and Institute of Biomedical Sciences, Academia Sinica, Taipei, and PhD Program for Cancer Biology and Drug Discovery, Management Office for Health Data, Department of Public Health and Division of Family Medicine, China Medical University, Taichung, Taiwan Fertil Steril 2014; 102: 1677e1684.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.05.057 available at http://jurology.com/ Editorial Comment: Hepatitis B is a significant global health scourge. After adjusting for covariates these investigators observed a significantly higher incidence of infertility in Taiwanese men with vs without hepatitis B infection. The connection of medical illness with male infertility is a broad one, encompassing infectious disease. When we see a male patient for infertility, we must consider the vast breadth of underlying causes, and those who fund health care must stop seeing fertility as an isolated inconvenience. Craig Niederberger, MD
Re: Vasectomy Reversal Outcomes in Men Previously on Testosterone Supplementation Therapy R. M. Coward, D. A. Mata, R. P. Smith, J. R. Kovac and L. I. Lipshultz Department of Urology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, Scott Department of Urology, Baylor College of Medicine, and Department of Biochemistry and Cell Biology, Wiess School of Natural Sciences, Rice University, Houston, Texas, and Department of Urology, School of Medicine, University of Virginia, Charlottesville, Virginia Urology 2014; 84: 1335e1340.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.05.058 available at http://jurology.com/ Editorial Comment: Men who undergo vasectomy reversal are often a little older, and testosterone declines with male age, so urologists are not infrequently faced with the problem of a man who wants a vasal reconstruction but who is also prescribed spermatogenesis suppressing exogenous testosterone. These authors demonstrate that transitioning a man from exogenous testosterone to spermatogenesis preserving endocrine modulation, such as with clomiphene citrate or gonadotropin analogues, can be highly effective in returning him to fertility. Median length of exogenous testosterone administration in this series was 9 months before discontinuation and transition to spermatogenesis sparing medication, which is fairly short. As few data exist regarding return of spermatogenesis after 2 or more years of exogenous testosterone therapy, the open question remains how long a man can be prescribed it before vasectomy reversal is unlikely to be successful. Craig Niederberger, MD
500
Re: Hepatitis B Virus Infection and the Risk of Male Infertility: A Population-Based Analysis F. H. Su, S. N. Chang, F. C. Sung, C. T. Su, Y. H. Shieh, C. C. Lin and C. C. Yeh Department of Family Medicine and School of Public Health, College of Public Health and Nutrition, Taipei Medical University School of Medicine, Department of Family Medicine, Wan Fang Hospital and Institute of Biomedical Sciences, Academia Sinica, Taipei, and PhD Program for Cancer Biology and Drug Discovery, Management Office for Health Data, Department of Public Health and Division of Family Medicine, China Medical University, Taichung, Taiwan Fertil Steril 2014; 102: 1677e1684.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.05.057 available at http://jurology.com/ Editorial Comment: Hepatitis B is a significant global health scourge. After adjusting for covariates these investigators observed a significantly higher incidence of infertility in Taiwanese men with vs without hepatitis B infection. The connection of medical illness with male infertility is a broad one, encompassing infectious disease. When we see a male patient for infertility, we must consider the vast breadth of underlying causes, and those who fund health care must stop seeing fertility as an isolated inconvenience. Craig Niederberger, MD
Re: Vasectomy Reversal Outcomes in Men Previously on Testosterone Supplementation Therapy R. M. Coward, D. A. Mata, R. P. Smith, J. R. Kovac and L. I. Lipshultz Department of Urology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, Scott Department of Urology, Baylor College of Medicine, and Department of Biochemistry and Cell Biology, Wiess School of Natural Sciences, Rice University, Houston, Texas, and Department of Urology, School of Medicine, University of Virginia, Charlottesville, Virginia Urology 2014; 84: 1335e1340.
Abstract for this article http://dx.doi.org/10.1016/j.juro.2015.05.058 available at http://jurology.com/ Editorial Comment: Men who undergo vasectomy reversal are often a little older, and testosterone declines with male age, so urologists are not infrequently faced with the problem of a man who wants a vasal reconstruction but who is also prescribed spermatogenesis suppressing exogenous testosterone. These authors demonstrate that transitioning a man from exogenous testosterone to spermatogenesis preserving endocrine modulation, such as with clomiphene citrate or gonadotropin analogues, can be highly effective in returning him to fertility. Median length of exogenous testosterone administration in this series was 9 months before discontinuation and transition to spermatogenesis sparing medication, which is fairly short. As few data exist regarding return of spermatogenesis after 2 or more years of exogenous testosterone therapy, the open question remains how long a man can be prescribed it before vasectomy reversal is unlikely to be successful. Craig Niederberger, MD