Ethan D Grober

University of Toronto, Toronto, Ontario, Canada

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Publications (86)267.64 Total impact

  • Current Urology 05/2015; 8(1):38-42. DOI:10.1159/000365687
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    ABSTRACT: In humans, sperm DNA fragmentation rates have been correlated with sperm viability rates. Reduced sperm viability is associated with high sperm DNA fragmentation, while conversely high sperm viability is associated with low rates of sperm DNA fragmentation. Both elevated DNA fragmentation rates and poor viability are correlated with impaired male fertility, with a DNA fragmentation rate of > 30% indicating subfertility. We postulated that in some men, the sperm viability assay could predict the sperm DNA fragmentation rates. This in turn could reduce the need for sperm DNA fragmentation assay testing, simplifying the infertility investigation and saving money for infertile couples. All men having semen analyses with both viability and DNA fragmentation testing were identified via a prospectively collected database. Viability was measured by eosin-nigrosin assay. DNA fragmentation was measured using the sperm chromosome structure assay. The relationship between DNA fragmentation and viability was assessed using Pearson's correlation coefficient. From 2008-2013, 3049 semen analyses had both viability and DNA fragmentation testing. A strong inverse relationship was seen between sperm viability and DNA fragmentation rates, with r = -0.83. If viability was ≤ 50% (n = 301) then DNA fragmentation was ≥ 30% for 95% of the samples. If viability was ≥ 75% (n = 1736), then the DNA fragmentation was ≤ 30% for 95% of the patients. Sperm viability correlates strongly with DNA fragmentation rates. In men with high levels of sperm viability ≥ 75%, or low levels of sperm viability ≤ 30%, DFI testing may be not be routinely necessary. Given that DNA fragmentation testing is substantially more expensive than vitality testing, this may represent a valuable cost-saving measure for couples undergoing a fertility evaluation.
    Reproductive Biology and Endocrinology 05/2015; 13(1):42. DOI:10.1186/s12958-015-0035-y · 2.41 Impact Factor
  • The Journal of Urology 04/2015; 193(4):e1113. DOI:10.1016/j.juro.2015.02.1776 · 3.75 Impact Factor
  • Fertility and Sterility 09/2014; 102(3):e190. DOI:10.1016/j.fertnstert.2014.07.641 · 4.30 Impact Factor
  • Ethan D Grober
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    ABSTRACT: Testosterone deficiency, or hypogonadism, is common and may have deleterious effects on men, including decreased overall well-being, reduced sexual function and bone loss. Despite data demonstrating strong links between testosterone deficiency and significant comorbid conditions (including type 2 diabetes and metabolic syndrome as well as the health benefits of testosterone-replacement therapy [TRT]), some physicians are still hesitant to initiate these therapies. Their reluctance is based on a number of prevailing myths associating TRT with adverse prostate health and recent concerns highlighting the possibility of increased cardiovascular risk.
    07/2014; 8(7-8 Suppl 5):S145-7. DOI:10.5489/cuaj.2309
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    ABSTRACT: To formulate nomograms based on pre-repair characteristics to predict improvements in semen parameters after varicocele repair. Model using multivariable linear regression based on prospectively collected database, with performance was quantified by concordance correlation coefficient and Pearson correlation coefficient after internal validation with bootstrapping. A male infertility specialty clinic. Men presenting for fertility evaluation from 2003-2012 having varicocele repair. None. Semen parameters before and after varicocele repair. Men undergoing varicocele repair (surgical or embolization) were identified via a prospectively collected database. The relationship of pre-repair semen and clinical characteristics to improvements in semen parameters was modeled using multivariable linear regression, then the model performance was quantified by concordance correlation coefficient and Pearson correlation coefficient after internal validation with bootstrapping. A total of 376 men who had undergone varicocele repair had data available for analysis. After varicocelectomy, the total motile count (TMC) varied depending on the initial left varicocele grade, ejaculate volume, sperm concentration, and motility. The final sperm concentration depended on the initial left varicocele grade, sperm concentration, and motility. The postvaricocelectomy sperm motility varied depending on the patient's age, left varicocele grade, sperm motility, morphology, and TMC. The final percentage of normal forms depended on the prevaricocelectomy sperm morphology, age, right varicocele grade, normal morphology, and TMC. Nomograms using prevaricocelectomy semen parameters and clinical features were developed to predict postvaricocelectomy TMC, sperm concentration, motility, and morphology. The concordance correlation coefficients were 0.45, 0.47, 0.65, and 0.36, respectively. Clinical factors provide substantial ability to predict postvaricocele repair semen parameters. These nomograms may be used by clinicians to predict postvaricocele repair semen parameters.
    Fertility and sterility 05/2014; 102(1). DOI:10.1016/j.fertnstert.2014.03.046 · 4.30 Impact Factor
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    ABSTRACT: Objective To determine whether men with Klinefelter syndrome (KS) have the same phenotype as men with mosaic KS. Design Subject identification via prospectively collected database. Setting Male infertility specialty clinic. Patient(s) Men undergoing a fertility evaluation from 2005 to 2012 at a single male infertility specialty clinic and having a karyotype demonstrating KS (mosaic or non-mosaic). Intervention(s) None. Main Outcome Measure(s) Testicular size, and semen and hormone parameters, genetic evaluation, and signs of testosterone (T) deficiency using validated questionnaires. Result(s) Of 86 men identified with KS, 6 (6.7%) were mosaic KS, and 80 (93.3%) were non-mosaic KS. Men with mosaic KS had lower baseline luteinizing hormone (LH) levels (10.31 IU/L ± 5.52 vs. 19.89 IU/L ± 6.93), lower estradiol levels (58.71 ± 31.10 pmol/L vs. 108.57 ± 43.45 pmol/L), larger mean testicular volumes (11 ± 7.3 mL vs. 6.35 ± 3.69 mL), and a higher mean total sperm count (4.43 ± 9.86 M/mL vs. 0.18 ± 1.17 M/mL). A higher proportion of men with mosaic KS had sperm in the ejaculate: 3 (50%) of 6 versus 3 (3.75%) of 80. The Sexual Health Inventory for Men (SHIM) and Androgen Deficiency in the Aging Male (ADAM) questionnaire scores were not different between groups. Conclusion(s) Men with mosaic KS seem to be more well androgenized than their non-mosaic KS counterparts, both with respect to hormones and sperm in the ejaculate.
    Fertility and sterility 04/2014; 101(4). DOI:10.1016/j.fertnstert.2013.12.051 · 4.30 Impact Factor
  • Ethan D. Grober, Mary Samplaski, Shaun Mehta
    The Journal of Urology 04/2014; 191(4):e786. DOI:10.1016/j.juro.2014.02.2152 · 3.75 Impact Factor
  • The Journal of Urology 04/2014; 191(4):e803-e804. DOI:10.1016/j.juro.2014.02.2194 · 3.75 Impact Factor
  • The Journal of Urology 04/2014; 191(4):e731-e732. DOI:10.1016/j.juro.2014.02.1994 · 3.75 Impact Factor
  • The Journal of Urology 04/2014; 191(4):e805. DOI:10.1016/j.juro.2014.02.2199 · 3.75 Impact Factor
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    ABSTRACT: To evaluate whether hormonal markers predict erectile dysfunction (ED) and symptoms of T deficiency syndrome (TDS), which are commonly found in the population of infertile men. Retrospective study utilizing a prospectively maintained infertility database. A tertiary referral center. A total of 1,750 of 2,783 men presenting for evaluation of infertility between 1995 and 2010 completed validated questionnaires. Androgen Deficiency in the Aging Male (ADAM) and Sexual Health Inventory for Men questionnaires were administered. Baseline risk factors for ED and TDS were also measured. Subjects underwent serum hormone evaluation for total T, calculated bioavailable T, sex hormone-binding globulin, E2, LH, FSH, and PRL. Multivariable logistic regression modeling was used to determine the significance of hormonal markers in predicting ED (Sexual Health Inventory for Men score <22) and/or a positive ADAM score. The prevalence of ED and a positive response to the ADAM questionnaire were 30.5% and 45.2%, respectively, in this population (mean age, 36 years). Low serum T (total T < 10 nmol/L) was found in 29.4%. Neither T nor bioavailable T was significantly associated with the symptoms of ED or TDS on multivariable regression analysis. Erectile dysfunction and TDS in young, infertile men seem to be unrelated to hormone changes.
    Fertility and sterility 03/2014; 101(6). DOI:10.1016/j.fertnstert.2014.02.044 · 4.30 Impact Factor
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    ABSTRACT: To develop a novel clinical test using microarray technology as a high-resolution alternative to current methods for detection of known and novel microdeletions on the Y chromosome. Custom Agilent 8x15K array comparative genomic hybridization (aCGH) with 10,162 probes on an average probe spacing of 2.5 kb across the euchromatic region of the Y chromosome. Clinical diagnostic laboratory. Men with infertility (n = 104) and controls with proven fertility (n = 148). Microarray genotyping of DNA. Gene copy number variation determined by log ratio of probe signal intensity against a DNA reference. Our aCGH experiments found all known AZF microdeletions as well as additional unbalanced structural alterations. In addition to complete AZF microdeletions, we found that AZFc partial deletions represent a risk factor for male infertility. In total, aCGH-based detection achieved a diagnostic yield of ∼11% and also revealed additional potentially etiologic copy number variations requiring further characterization. The aCGH approach is a reliable high-resolution alternative to multiplex polymerase chain reaction for the discovery of pathogenic chromosome Y microdeletions in male infertility.
    Fertility and sterility 01/2014; 101(4). DOI:10.1016/j.fertnstert.2013.12.027 · 4.30 Impact Factor
  • Ethan D Grober, Edward Karpman, Majid Fanipour
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    ABSTRACT: To analyze the vasectomy reversal (VR) outcomes specifically among patients with vasal obstructive intervals (VOIs) of >10 years. The VOI has been shown to be a significant predictor of outcome after VR. Although no strict cutoff exists, couples have frequently been discouraged from considering a VR strictly according to the interval from vasectomy. From 2006 to 2011, all consecutive VRs performed by 2 fellowship-trained microsurgeons were analyzed. The patients were stratified into 4 categories according to the duration of the VOI: <10, 10-15, >15-20, and >20 years. The postoperative semen parameters, patency rates, and pregnancy outcomes were compared among the 4 groups. Of 535 consecutive VRs, 177 patients (33%) had a VOI of >10 years. The couple characteristics, type of VR required, postoperative semen quality, and patency and pregnancy rates among the 4 groups were analyzed. The men with longer VOIs were older (P <.001) and had older female partners (P = .006). Although the VOI influenced the type of reversal performed, favorable semen concentrations (average >20 million/mL in all groups) and patency (average >90%) and pregnancy rates (range 24%-39%) were achieved in men with a VOI >10 years. Although the interval since vasectomy has a significant effect on the type of VR required, provided a surgeon is proficient in both microsurgical vasovasostomy and vasoepididymostomy, favorable semen parameters and patency and pregnancy rates can be achieved in men with a VOI >10 years. Couples should not be discouraged from considering VR simply according to the VOI.
    Urology 11/2013; 83(2). DOI:10.1016/j.urology.2013.09.016 · 2.13 Impact Factor
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    ABSTRACT: To analyze how frequently and why men presenting with infertility take testosterone (T) and if negative effects of T on semen parameters are reversed following cessation. Analysis of a prospectively collected database. Male Infertility clinic. Men presenting for fertility evaluation from 2008 to 2012. None. The frequency and reason for T use in the infertile male population, and semen and hormonal parameters while on T and following discontinuation. A total of 59/4,400 men (1.3%) reported taking T. T was prescribed by a variety of physicians, including endocrinologists (24%), general practitioners (17%), urologists (15%), gynecologists (5%), and reproductive endocrinologists (3%). Only one of the men admitted that he had obtained T from an illicit source. More than 82% of men were prescribed T for the treatment of hypogonadism, but surprisingly, 12% (7/59) were prescribed T to treat their infertility. While on T, 88.4% of men were azoospermic, but by 6 months after T cessation, 65% of the men without other known causes for azoospermia recovered spermatogenesis. In Canada, T was not commonly used by men presenting for fertility investigation (1.3%). Close to 2/3 of infertile men using T recovered spermatogenesis within 6 months of T discontinuation.
    Fertility and sterility 10/2013; 101(1). DOI:10.1016/j.fertnstert.2013.09.003 · 4.30 Impact Factor
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    ABSTRACT: To determine the degree of improvement in semen parameters after finasteride discontinuation. A prospective database of men presenting for a fertility evaluation was analyzed for semen and hormone parameters before and after discontinuation of finasteride. A male infertility specialty clinic. Men presenting for fertility evaluation from 2008-2012 on finasteride. None. Semen and hormone parameters before and after discontinuation of finasteride. At presentation, 27 (0.6%) of 4,400 men on finasteride. The mean duration of treatment with finasteride was 57.4 months, and mean dose was 1.04 mg/day. There was an average 11.6-fold increase in sperm counts after finasteride discontinuation. Of the men with severe oligospermia (<5 M/mL), 57% had counts increase to >15 M/mL after finasteride cessation. No man had a decrease in sperm count. There was no change in hormone parameters, sperm motility, or sperm morphology. Finasteride, even at low doses, may cause reduced sperm counts in some men. In this population, counts improved dramatically for the majority of men after finasteride discontinuation. The hormone parameters, sperm motility, and sperm morphology were unchanged after cessation. Finasteride should be discontinued in subfertile men with oligospermia, and used with caution in men who desire fertility.
    Fertility and sterility 09/2013; 100(6). DOI:10.1016/j.fertnstert.2013.07.2000 · 4.30 Impact Factor
  • Fertility and Sterility 09/2013; 100(3):S71-S72. DOI:10.1016/j.fertnstert.2013.07.1902 · 4.30 Impact Factor
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    ABSTRACT: INTRODUCTION AND OBJECTIVES: In fertile men, exogenous testosterone (T) negatively impacts spermatogenesis and discontinuation leads to recovery. Recovery of spermatogenesis in men who are taking T and are infertile is unknown. In this study we sought to analyze the semen and hormonal parameters in men presenting for male infertility evaluation on T and after T cessation. METHODS: Men presenting for a fertility evaluation from 2008- 2012 on T were identified via a prospectively collected database. Data were analyzed for semen and hormonal parameters while on T and after discontinuation. RESULTS: 4400 men were evaluated for male infertility and 56 (1.3%) reported being on T at the time of the initial office consult. These men were a medically heterogeneous population, including men with Klinefelters syndrome (8), history of bilateral undescended testicles (7), Kallmans syndrome (5), other causes of testicular failure (6) and men without known pathology using T for athletics (3) or symptoms of T deficiency (17). Of these men, 24 (42.9%) had semen and blood hormone testing only while on T, 26 (46.4%) had testing on T and after discontinuation, and 6 (10.7%) had no testing. 34/50 (68%) tested men were azoospermic while on T at presentation. While on T, the average serum T was 14.74 nmol/L, and sperm count 4.11 M/mL. After T discontinuation, the average T was 11.79 nmol/L, and sperm count 26.84 M/mL. The mean time between measurements was 8.52 months. 10/26 (38.5%) men tested remained azoospermic despite repeated sperm testing for over 6 months. Of these 10 men, 2 had Klinefelters syndrome, 1 had Kallmans syndrome, 1 had Sertoli cell only syndrome, 1 had bilateral undescended testicles, and 1 had chemotherapy-induced azoospermia. If these men were excluded, then 4/20 (20%) without known previous causes for azoospermia were persistently azoospermic following the cessation of T. CONCLUSIONS: Infertile men on T represent a heterogeneous group with different underlying conditions, many of which could lead to infertility. T cessation resulted in a fairly rapid increase in sperm counts (4.11 M/mL. to 26.84 M/mL). A subset of men with no other cause for the azoospermia remained azoospermic despite T cessation; this may have been present before the men started T and may represent an underlying condition unrelated to the use of T. While men in reproductive years should be discouraged from using T unless medically required, this study is reassuring and indicates that at least 80% of infertile men who have no other cause for azoospermia recover spermatogenesis when T is discontinued.
    The Journal of urology 05/2013; 189(4S):e779. DOI:10.1016/j.juro.2013.02.2319 · 3.75 Impact Factor
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    ABSTRACT: OBJECTIVE: To determine the coital frequency among infertile couples and which factors are associated with less frequent coitus. DESIGN: Cross-sectional study. SETTING: Tertiary-level male infertility clinic. PATIENT(S): A total of 1,298 infertile men. INTERVENTION(S): Administration of computer-based survey, semen analysis, and serum hormone evaluation. MAIN OUTCOME MEASURE(S): Monthly coital frequency. RESULT(S): A total of 1,298 patients presented to clinic for infertility consultation and completed the computer-based survey. The median male age was 35 years (interquartile range [IQR] 32-39 years) and the median duration of infertility was 2 years (IQR 1-4 years) before consultation. Median monthly coital frequency was seven (IQR 5-10; range 0-40); 24% of couples were having intercourse ≤4 times per month. Overall, 0.6%, 2.7%, 4.8%, 5.8%, and 10.8% of the men reported having intercourse 0, 1, 2, 3, and 4 times per month, respectively. When simultaneously taking into account the influence of age, libido, erectile function, and semen volume on coital frequency, older patients had 1.05 times higher odds (per year of age) of less frequent coitus (odds ratio 1.05, 95% confidence interval 1.03-1.08). In addition, patients with better erectile function had 1.12 times higher odds (per point on Sexual Health Inventory for Men scale) of more frequent coitus (odds ratio 1.12, 95% confidence interval 1.09-1.18). CONCLUSION(S): Similar to the general population, most infertile couples report having coitus more than four times per month. Older male age and erectile dysfunction are independent risk factors for less frequent coitus among infertile men, which could have an impact on fertility. Coital frequency should be considered in infertility assessments.
    Fertility and sterility 05/2013; DOI:10.1016/j.fertnstert.2013.04.020 · 4.30 Impact Factor
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    ABSTRACT: INTRODUCTION AND OBJECTIVES: Over the last decade there has been a gradual increase in testosterone (T) prescribing. We sought to analyze patterns of T prescribing in men presenting for infertility evaluation. METHODS: Men presenting for fertility evaluation from 2008-2012 on T were identified via a prospective database. Data were analyzed for prevalence, prescriber, formulation, dosage and indication. RESULTS: 4400 men were evaluated for male infertility, and 56 (1.3%) were on T at presentation. Prescribers included: Endocrinologists (10, 17.9%), General Practitioners (5, 8.9%), Urologists (3, 5.3%), and independently obtained (4, 7.1%). Formulations and dosages included: Gel (26, 46.4%): most commonly 5mg every other day (QOD), range: 5mg QOD to 10mg daily; Intramuscular injection (25, 44.6%), most commonly 200mg every 2 weeks, range: 50-300mg every 2 weeks; Oral (1, 1.8%), 80mg QOD; Pellet (1, 1.7%), dose unknown; and unknown formulation and dose (5, 8.9%). Indications for T included: symptoms of hypogonadism (27, 48.2%), symptoms � low serum T (21, 37.5%), low serum T (4, 7.1%), athletic purposes (3, 5.4%), and subfertility (1, 1.8%). Co-existing conditions included: Klinefelters syndrome (8, 14.3%), history of bilateral undescended testicles (7, 12.5%), Kallmans syndrome (5, 8.9%), Sertoli only syndrome (2, 3.6%), chemotherapy induced testicular failure (2, 3.6%), prolactinoma (2, 3.6%), anejaculation (1, 1.8%), and opioid induced testicular failure (1, 1.8%). CONCLUSIONS: At our infertility center, T was not commonly used by men presenting for infertility investigation. Most men on T were being treated for appropriate conditions, with appropriate routes and dosages. Endocrinologists and General Practitioners were the most common prescribers, and educational efforts to emphasize the negative impacts of T on spermatogenesis should be focused on these groups. There are a group of men that obtain their T independently, and a group that uses T for athletic purposes. While this was a small fraction of the men in our population of infertile men, as the use of T increases, this fraction will undoubtedly grow.
    The Journal of urology 05/2013; 189(4S):e939. DOI:10.1016/j.juro.2013.02.2232 · 3.75 Impact Factor

Publication Stats

1k Citations
267.64 Total Impact Points


  • 2004–2015
    • University of Toronto
      • • Department of Surgery
      • • Division of Urology
      Toronto, Ontario, Canada
    • Government of Ontario, Canada
      XIA, Ontario, Canada
  • 2009–2014
    • Mount Sinai Hospital, Toronto
      • • Department of Urology
      • • Department of Pathology and Laboratory Medicine
      Toronto, Ontario, Canada
  • 2013
    • CUNY Graduate Center
      New York City, New York, United States
  • 2011
    • Sinai Hospital
      Mount Sinai, New York, United States
    • The Princess Margaret Hospital
      Toronto, Ontario, Canada
  • 2007–2008
    • Baylor College of Medicine
      • Department of Urology
      Houston, Texas, United States
  • 2006
    • SickKids
      • Department of Surgery
      Toronto, Ontario, Canada