Publications by authors named "Edmund Ko"
Purpose: Premature ejaculation (PE) is a commonly encountered male sexual dysfunction (MSD) with various definitions, diagnostic criteria, and treatment options, leading to significant heterogeneity and controversy in its management. This study aimed to explore the global practice patterns of the diagnosis and management of PE.
Materials And Methods: A cross-sectional, global, online survey on PE was conducted using a questionnaire developed by an international cohort of experts.
Purpose: The objective of this manuscript is to assess the effect of varicocele repair (VR) in patients with clinical varicoceles on serum total testosterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH), and inhibin B serum levels.
Materials And Methods: The study was performed in compliance with the Meta-Analysis and Systematic Reviews of Observational Studies (MOOSE) guidelines and the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). All eligible studies were selected following the PICOS (Population, Intervention, Comparison/Comparator, Outcomes, Study design) model.
Article Synopsis
- Surgical sperm retrieval (SSR) is performed to extract sperm from men with azoospermia and may result in reduced testosterone levels and other hormonal changes post-operation.* -
- A systematic review analyzed 17 studies involving 1,685 azoospermic men, revealing a significant decrease in testosterone after SSR, but no major changes in follicle-stimulating hormone (FSH), luteinizing hormone (LH), or testicular volume.* -
- The study highlights the importance of considering potential sexual dysfunction and the psychosocial impacts of SSR in postoperative care and preoperative discussions.*
Article Synopsis
- * A survey created by Global Andrology Forum experts was disseminated online, collecting responses from 479 ED specialists across 62 countries, leading to insights on the most commonly used RT methods.
- * Results indicate that RT is becoming more popular, especially among middle-aged patients with mild-to-moderate ED, but the lack of robust evidence and guidelines highlights a need for further research in this area.
Global Practice Patterns and Variations in the Medical and Surgical Management of Non-Obstructive Azoospermia: Results of a World-Wide Survey, Guidelines and Expert Recommendations.
World J Mens Health
January 2025
Article Synopsis
- Non-obstructive azoospermia (NOA) is a prevalent and complex issue with varied treatment options and no definitive guidelines, leading to differing management practices internationally.
- A comprehensive survey with 336 responses from specialists in 49 countries explored current medical and surgical strategies for NOA, analyzing results against existing guidelines and offering expert recommendations.
- Key findings included diverse approaches to hormonal therapy, significant variation in sperm retrieval success rates, and differing protocols around varicocele repair and follicle-stimulating hormone cutoff levels for sperm retrieval.
Global Practice Patterns in the Evaluation of Non-Obstructive Azoospermia: Results of a World-Wide Survey and Expert Recommendations.
World J Mens Health
October 2024
Article Synopsis
- * Conducted from July to September 2022, a questionnaire gathered responses from 367 doctors in 49 countries, focusing on how they diagnose NOA through methods like hormone tests and genetic analyses.
- * The survey identified that while many practices align with guidelines, significant differences in approaches were found, underscoring the need for standardized, evidence-based international guidelines for NOA evaluation.
Effects of Varicocele Repair on Sperm DNA Fragmentation and Seminal Malondialdehyde Levels in Infertile Men with Clinical Varicocele: A Systematic Review and Meta-Analysis.
World J Mens Health
April 2024
Article Synopsis
- This systematic review and meta-analysis investigates whether varicocele repair (VR) can lower sperm DNA fragmentation (SDF) and seminal oxidative stress (measured by malondialdehyde or MDA) in infertile men.
- An analysis of 29 studies involving 1,491 men shows a significant reduction in SDF post-VR, regardless of the surgical technique used and the method of SDF testing.
- The findings also indicate a notable decrease in seminal MDA levels following VR, supporting the effectiveness of varicocele repair in improving reproductive parameters in affected men.
Technical Aspects and Clinical Limitations of Sperm DNA Fragmentation Testing in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations.
World J Mens Health
January 2024
Article Synopsis
- The study investigates global practices and challenges in using sperm DNA fragmentation (SDF) assays, which can affect male reproductive potential, as outlined in the latest WHO manual.
- A survey of 436 reproductive clinicians revealed that the most popular SDF assay is TUNEL, with a significant influence from availability on their choices.
- Clinicians see the value of SDF testing in understanding infertility but face barriers like insufficient professional guidelines and a lack of accepted reference values for interpreting SDF results.
Does Varicocele Repair Improve Conventional Semen Parameters? A Meta-Analytic Study of Before-After Data.
World J Mens Health
January 2024
Article Synopsis
- The meta-analysis investigates the effects of varicocele repair on semen parameters in infertile males, combining data from diverse studies without language restrictions.
- A total of 351 studies were analyzed, revealing significant improvements in several semen parameters post-repair, including semen volume, sperm concentration, total sperm count, motility, and morphology, while sperm vitality showed no improvement.
- This research is the largest of its kind and highlights the benefits of varicocele repair for male infertility, contributing valuable insights for clinical practice.
Article Synopsis
- AI has rapidly advanced in medicine, particularly benefiting fields like andrology and reproductive medicine through technologies like machine learning and neural networks.
- AI tools can enhance the diagnosis and treatment of male infertility, improve patient care accuracy, and increase efficiency in clinical management and research.
- Future advancements in AI integration are expected to lead to significant breakthroughs and improvements in evidence-based practices within andrology and reproductive medicine.
Controversy and Consensus on the Management of Elevated Sperm DNA Fragmentation in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations.
World J Mens Health
October 2023
Article Synopsis
- The study investigates global practices for managing sperm DNA fragmentation (SDF) in infertile men, highlighting its impact on fertility and assisted reproductive technology (ART).
- A survey collecting data from 436 reproductive experts across 55 countries revealed a common recommendation for lifestyle changes and antioxidants, with varying durations for treatment and differing management approaches for specific infertility cases.
- The findings indicate a lack of uniformity in practices, emphasizing the need for standardized guidelines and expert consensus for treating men with elevated SDF.
Controversy and Consensus on Indications for Sperm DNA Fragmentation Testing in Male Infertility: A Global Survey, Current Guidelines, and Expert Recommendations.
World J Mens Health
July 2023
Article Synopsis
- The study explores global practices for sperm DNA fragmentation (SDF) testing in infertile men, following its inclusion in the WHO laboratory manual.
- A survey conducted among 436 infertility clinicians across 55 countries reveals varied testing practices, with many testing SDF in cases of unexplained infertility, recurrent pregnancy loss, and among smokers.
- The findings highlight the need for clearer professional guidelines on SDF testing, given the diversity in current practices and the potential benefits for certain patient populations.
Article Synopsis
- Infertility is a global issue affecting about 186 million people, with male factors contributing to around half of all cases, indicating a growing prevalence of male infertility over the past 40 years.
- The field of Andrology, which focuses on male reproductive health, has faced challenges due to cultural neglect regarding male partners in infertility diagnosis and treatment, and reliance on assisted reproductive techniques (ART) may overlook the importance of male gamete quality.
- Recent advancements in Andrology, including research on genetics, oxidative stress, and innovative technologies like artificial intelligence and gene engineering, highlight a critical need for further studies to better understand male infertility and improve ART outcomes.
Purpose: Despite the significant role of varicocele in the pathogenesis of male infertility, the impact of varicocele repair (VR) on conventional semen parameters remains controversial. Only a few systematic reviews and meta-analyses (SRMAs) have evaluated the impact of VR on sperm concentration, total motility, and progressive motility, mostly using a before-after analytic approach. No SRMA to date has evaluated the change in conventional semen parameters after VR compared to untreated controls.
View Article and Find Full Text PDFImpact of Antioxidant Therapy on Natural Pregnancy Outcomes and Semen Parameters in Infertile Men: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
World J Mens Health
January 2023
Purpose: Seminal oxidative stress (OS) is a recognized factor potentially associated with male infertility, but the efficacy of antioxidant (AOX) therapy is controversial and there is no consensus on its utility. Primary outcomes of this study were to investigate the effect of AOX on spontaneous clinical pregnancy, live birth and miscarriage rates in male infertile patients. Secondary outcomes were conventional semen parameters, sperm DNA fragmentation (SDF) and seminal OS.
View Article and Find Full Text PDFConsensus and Diversity in the Management of Varicocele for Male Infertility: Results of a Global Practice Survey and Comparison with Guidelines and Recommendations.
World J Mens Health
January 2023
Purpose: Varicocele is a common problem among infertile men. Varicocele repair (VR) is frequently performed to improve semen parameters and the chances of pregnancy. However, there is a lack of consensus about the diagnosis, indications for VR and its outcomes.
View Article and Find Full Text PDFPurpose: This study provides a comprehensive analysis of research trends on the etiology, mechanisms, potential risk factors, diagnosis, prognosis, surgical and non-surgical treatment of varicocele, and clinical outcomes before and after varicocele repair.
Materials And Methods: Varicocele studies published between 1988 and 2020 were retrieved from the Scopus database on April 5, 2021. Original studies on human varicocele were included, irrespective of language.
Purpose: Azoospermia is defined as the absence of spermatozoa in the pellet of a centrifuged semen sample. In fact, when a basic semen analysis fails to detect sperm in the ejaculate, there is still the possibility of detecting rare sperm after centrifugation of the sample and examination of the pellet. In this study, we assessed the role of Cytospin centrifugation in combination with the nuclear fast picroindigocarmine (NF-PIC) staining in identifying sperm in azoospermic samples.
View Article and Find Full Text PDFPurpose: The success of vasectomy is determined by the outcome of a post-vasectomy semen analysis (PVSA). This article describes a step-by-step procedure to perform PVSA accurately, report data from patients who underwent post vasectomy semen analysis between 2015 and 2021 experience, along with results from an international online survey on clinical practice.
Materials And Methods: We present a detailed step-by-step protocol for performing and interpretating PVSA testing, along with recommendations for proficiency testing, competency assessment for performing PVSA, and clinical and laboratory scenarios.
Antisperm Antibody Testing: A Comprehensive Review of Its Role in the Management of Immunological Male Infertility and Results of a Global Survey of Clinical Practices.
World J Mens Health
July 2022
Antisperm antibodies (ASA), as a cause of male infertility, have been detected in infertile males as early as 1954. Multiple causes of ASA production have been identified, and they are due to an abnormal exposure of mature germ cells to the immune system. ASA testing (with mixed anti-globulin reaction, and immunobead binding test) was described in the WHO manual 5th edition and is most recently listed among the extended semen tests in the WHO manual 6th edition.
View Article and Find Full Text PDFSperm Proteome Analysis to Investigate DNA Repair Mechanisms in Varicocele Patients.
Front Endocrinol (Lausanne)
February 2022
Varicocele, a condition associated with increased oxidative stress, negatively affects sperm DNA integrity and reduces pregnancy rates. However, the molecular mechanisms related to DNA integrity, damage, and repair in varicocele patients remain unclear. This study aimed to determine the role of DNA repair molecular mechanisms in varicocele-related infertility by combining an proteomics approach with wet-laboratory techniques.
View Article and Find Full Text PDFArticle Synopsis
- * Differentiating between asthenozoospermia (low sperm motility) and necrozoospermia (low sperm vitality) is crucial for diagnosing and treating infertility, as their causes can be local or systemic.
- * A global survey was conducted to assess current practices regarding sperm vitality testing and necrozoospermia management, aiming to create a standard approach for diagnosis and treatment in clinical settings.
: To review the available literature and identify factors associated with successful outcomes after varicocele repair (VR) in the setting of non-obstructive azoospermia (NOA). : The PubMed and EMBASE databases were searched for relevant articles. Primary outcomes were return of spontaneous spermatogenesis, sperm retrieval rates (SRRs), and unassisted and assisted pregnancy rates.
View Article and Find Full Text PDFObjective: To compare racial differences in male fertility history and treatment.
Design: Retrospective review of prospectively collected data.
Setting: North American reproductive urology centers.