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available at http://www.ncbi.nlm.nih.gov/pubmed/28450403 Editorial Comment: We are making great progress in giving men who have no sperm the cells to produce them, and synthetic sperm cells have even been synthesized. But this process raises some interesting ethical questions, especially in same sex couples. A great deal of what we do in helping couples have biological children is in the interest of offspring sharing the genes of their parents. But with same sex couples and synthetic gametes what should the expectation and the results be in that genetic sharing? This article probes that question. As with everything we do when pushing the envelope in medicine, it is helpful to ask the big ethical questions before we get to our technological destination. Craig Niederberger, MD Re: The Impact of Using Donor Sperm in Assisted Reproductive Technology Cycles on Perinatal Outcomes B. Yu, R. Fritz, X. Xie, A. Xie, S. Jindal, M. Vega and E. Buyuk Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington, and Department of Obstetrics and Gynecology and Women’s Health, and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, and Montefiore Institute for Reproductive Medicine and Health, Hartsdale, New York Fertil Steril 2018; 110: 1285e1289. doi: 10.1016/j.fertnstert.2018.08.012 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/30503127available at http://www.ncbi.nlm.nih.gov/pubmed/30503127 Editorial Comment: One would not expect donor sperm to result in worse perinatal outcomes than partner sperm. But when it comes to bringing children into the world, no stone should be left unturned in the quest for safety. These investigators compared donor sperm to partner sperm in medically assisted reproduction outcomes in a large database of more than 100,000 cycles. They found no clinically significant differences in miscarriage, preterm birth or low birthweight rates. When patients ask if we use donor sperm whether there will be increased risk in these areas, we can confidently say no. Craig Niederberger, MD Re: An Analysis of the Frequency of Y-Chromosome Microdeletions and the Determination of a Threshold Sperm Concentration for Genetic Testing in Infertile Men M. Johnson, A. Raheem, F. De Luca, M. De Luca, Y. Zainal, S. Poselay, B. Mohammadi, A. Moubasher, T. F. Johnson, A. Muneer, P. Sangster and D. J. Ralph Andrology Department, University College London Hospital, and Centre for Reproductive and Genetic Health, London, United Kingdom, and Andrology Department, Cairo University, Giza, Egypt BJU Int 2019; 123: 367e372. doi: 10.1111/bju.14521 196 MALE INFERTILITY Copyright © 2019 American Urological Association Education and Research, Inc. Unauthorized reproduction of this article is prohibited. Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/30113756available at http://www.ncbi.nlm.nih.gov/pubmed/30113756 Editorial Comment: Current American Urological Association guidelines recommend that “karyotyping and genetic counseling should be offered to all patients with nonobstructive azoospermia and severe oligospermia (less than 5 million sperm per ml).” As the principal genetic assay in this context is for Y chromosome microdeletions, that counseling primarily addresses whether patients should be screened for defects in the AZF (azoospermic factor) region of the Y chromosome. I know from more than 30 years of practice in the Chicago area that AZF deletions even in the presence of azoospermia are infrequent in the patients I see, and when I talk to my colleagues, their observed rates of AZF deletions vary greatly by their practice locations. These investigators in the London area determined a sperm concentration threshold of 0.5 million per ml or less for higher specificity and lower cost without decreasing sensitivity. Ideally this kind of analysis would be repeated in various geographic areas to find the optimal threshold for sperm density to suggest genomic assessment rather than a “one size fits all” approach. Craig Niederberger, MD Reference 1. Jarow J, Sigman M, Kolettis PN et al: The Evaluation of the Azoospermic Male. Available at https://www.auanet.org/guidelines/male-infertility-azoospermic-male-(reviewed-and-amended-2011). Accessed April 11, 2019.