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Functional histology of human scrotal wall layers and their overlooked relation with infertility: a narrative review

International Journal of Impotence Research volume 35, pages 428–438 (2023)Cite this article

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Abstract

Male infertility currently contributes to nearly half of the reported infertility cases. Scrotal wall layers play a cardinal role in regulating testicular physiology. However, few studies have focused on the functional histology of these layers and their relations with infertility in humans. The objective of the present narrative review is to collate novel insights into the functional histology of the human scrotal wall layers and their relation with infertility. The data was extracted from articles published between 1946 and 2021. The study was performed between January and December 2021. 71 original studies have been included in this review. Despite the fact that few studies have presented detailed functional histology of the human scrotal wall layers, this narrative review elucidates the possible influence of scrotal histology on infertility. Scrotal wall layers-associated pathologies may induce infertility by various mechanisms. They can impose mechanical forces that may affect the testicular histology and stimulate testicular inflammation. Moreover, they may induce testicular hyperthermia. Various unanswered clinical questions have been identified in this narrative review. More clinical studies are needed to assess the effect of alterations in the components of the scrotal wall layers on fertility (e.g., due to the exposure to metabolic and/or psychological stressors). In addition, testing the effectiveness of various pharmacological/surgical interventions to treat scrotal wall layers-associated pathologies will provide more insights into infertility treatment.

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Fig. 1: Illustration of human testicular capsule.
Fig. 2: Impacts of testicular capsule physiology and tunica vaginalis-associated pathologies on fertility.
Fig. 3: Schematic representation of the normal, hypoactive, and hyperactive cremaster muscle reflexes.
Fig. 4: Dartos muscle-associated pathologies and fertility.

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Data availability

No new datasets were generated or analyzed for this narrative review.

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Acknowledgements

We would like to acknowledge Judy Tanios for the critical review of the manuscript. We would like to acknowledge Ramy Salemeh and Marwa Bazzi for their help to generate the figures.

Author information

Author notes

  1. These authors contributed equally: Georges Raad, Vinal Massaad.

  2. These authors jointly supervised this work: Chadi Fakih, Fadi Fakih.

Authors and Affiliations

  1. Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon

    Georges Raad, Rita Issa, Maria Joy Khachan & Nay Makhlouf

  2. Al Hadi Laboratory and Medical Center, Beirut, Lebanon

    Georges Raad, Vinal Massaad, Youmna Mourad, Chadi Fakih & Fadi Fakih

  3. Department of Histology and EmbryologyFaculty of Medicine, Cyprus International University, Northern Cyprus via Mersin 10, Nicosia, Turkey

    Munevver Serdarogullari

  4. Monash IVF Group, Sydney, NSW, Australia

    Hassan W. Bakos

  5. University of Newcastle, Callaghan, NSW, Australia

    Hassan W. Bakos

  6. Faculty of Medicine, Lebanese University, Beirut, Lebanon

    Chadi Fakih

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Substantial contributions to conception and design: GR, VM, M-JK, RI, and NM; Drafting the manuscript: GR, VM, MS, M-JK, RI, and NM. Revising manuscript critically for important intellectual content: All authors. Final approval of the manuscript: All authors.

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Correspondence to Munevver Serdarogullari.

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Raad, G., Massaad, V., Serdarogullari, M. et al. Functional histology of human scrotal wall layers and their overlooked relation with infertility: a narrative review. Int J Impot Res 35, 428–438 (2023). https://doi.org/10.1038/s41443-022-00573-5

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