Recent Contributions from Dr. Schlegel

Dr. Schlegel routinely continues to identify new ways to help men with a variety of urologic conditions, especially severe male infertility. Several of his most recent medical publications are overviewed below.

Can sperm quality affect reproductive outcomes?

Published: August 10, 2023 | View Article

As an editor for the medical journal, Fertility & Sterility, Dr. Schlegel routinely asks experts to provide input into topics of interest to other reproductive experts. One set of these contributions was published in October, 2023 with articles on a variety of studies that analyze sperm quality, using structural analysis of the sperm structures called centrosomes, sperm DNA damage, and forms of Artificial Intelligence evaluation of sperm. Of note, sperm centrosomes provide the tubules that drive early embryo development. Sperm DNA fragmentation has been shown to affect the chance of achieving a pregnancy naturally, with IVF or with ICSI, as well as the risk of miscarriage – indicating that sperm can affect embryo development even after the embryo has implanted in the uterus and is a developing fetus.

Dr. Schlegel delivers The Patrick Steptoe Lecture at the British Fertility Society

Medical meetings are an opportunity for doctors and scientists to gather and present the latest information on treatments that are available for care of patients, including new breakthrough interventions and the most effective treatments available for specific medical conditions. One of the most important contributions at these meetings are “named” or “endowed” presentations, usually recognized by a historical contributor to the field of medicine/science. For the 2024 annual meeting of the British Fertility Society, the programme committee asked Dr. Schlegel to give a talk on the evolution of treatment of severe male infertility. On January 11 at this meeting at the Edinburgh International Convention Center in Scotland, Dr. Schlegel gave a 45 minute talk overviewing the work that he has done in identifying genetic, hormonal and surgical treatments that can be used for men with few or no sperm in the ejaculate. The invitation by the British Fertility Society to give this talk is a unique recognition of Dr. Schlegel’s contributions to the field of male infertility by his international colleagues.

Births after intracytoplasmic injection of sperm obtained by testicular extraction from men with nonmosaic Klinefelter's syndrome

Published: February 26, 1998 | View Article

Published January 11, 2024 | View Article

Men with Klinefelter syndrome (KS) routinely have severe male infertility. These men were previously thought to be sterile, incapable of having children. Dr. Schlegel was an integral part of the first team to be able to allow men with KS to have children (https://pubmed.ncbi.nlm.nih.gov) published in the New England Journal of Medicine. Some men with KS are identified in childhood or early adolescence, so there has been a debate as to whether early efforts should be taken to preserve fertility for these young men, possibly before they lose that fertility potential. In one of the most extensive experiences with surgical sperm retrieval in KS, Dr. Schlegel and co-authors reported in The Journal of Urology that early sperm retrieval (during adolescence) is not necessary – men can wait until they are married and have treatment with their future wife or female partner (published 2024 in the Journal of Urology ).

Sperm Production is Stable Over Time for Men with Azoospermia Factor C (AZFc) Y-Chromosome Microdeletions

Published: September 15, 2023 | View Article

For men with severe male infertility, including those with rare sperm in the ejaculate (cryptozoospermia), there has been controversy about whether these men are at risk of losing the rare sperm in the ejaculate. If they were at risk of losing their ejaculated sperm, then this would be reasons to aggressively freeze sperm or do an operation to surgically retrieve and freeze sperm for future use. Cryptozoospermia is the condition form men where sperm in the ejaculate are so rare that no sperm are initially seen on semen analysis, but only detected after centrifugation and concentration of the semen specimen. A well-defined group of men who routinely have cryptozoospermia are men with deletions of a region of the Y chromosome called AZFc deletions of the Y chromosome. We have a large number of men with AZFc deletions that we have treated over time, allowing us to examine whether these men are at risk of losing sperm production and the few rare sperm seen in the ejaculate. In our recent study in Fertility & Sterility has shown that even men with very low sperm production tend to maintain sperm production over time. (see above link for access to the complete article published in January of 2024)

Does hormone treatment or varicocele repair improve sperm retrieval rates in men with non-obstructive azoospermia? Probably not!!!

Published: August 20, 2024 | View Article

High quality evidence, summarized in the American Urological Association & American Society for Reproductive Medicine Guidelines (chaired by Dr. Schlegel) did not find evidence in dozens of manuscripts to recommend hormone treatment or varicocele repair routinely before microTESE in men with NOA (non-obstructive azoospermia.). A recent article from Brazil suggested that men did better with medical treatment and/or those who had varicocele repair before microTESE. What conclusion is correct? In the commentary (article referenced above), Dr. Schlegel points out the many methodological flaws in this Brazilian study, that make their conclusions inaccurate to apply for most men with NOA. Although Esteves et al. suggested 2.5-fold improvements in sperm retrieval rates, these data are not “high quality” evidence and may not be accurate representations of the benefit, if any, of such treatments. Of course, men with low testosterone should be treated with medications to normalize their production of testosterone before microTESE, but routine treatment is not necesarily beneficial if testosterone is borderline or normal (many of the men in the Esteves study had what would be considered normal testosterone levels without treatment.). Don’t be confused by the term, “Real World Evidence”; it is not usually high quality data that we get from randomized, controlled, carefully done scientific studies because of biases in how patients are treated.

Published: June 5, 2024 | View Webinar

Dr. Schlegel in an EAU (European Association of Urology) panel of experts on male infertility

On June 4, 2024, a panel of experts from the European Association of Urology participated in a webinar on the treatment of male infertility. This discussion included experts from across Europe, and Dr. Schlegel was invited to discuss the role of his development, the novel treatment of microTESE for non-obstructive azoospermia. This webinar is available on YouTube (see link above.)

Further information on treatment options for severe male infertility and the opportunity for a virtual or in-person consultation are available by contacting us at nymenshealth@gmail.com.

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