151
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Aminzadeh Z, Jamalan M, Chupani L, Lenjannezhadian H, Ghaffari MA, Aberomand M, Zeinali M. In vitroreprotoxicity of carboxyl-functionalised single- and multi-walled carbon nanotubes on human spermatozoa. Andrologia 2016; 49. [DOI: 10.1111/and.12741] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2016] [Indexed: 12/24/2022] Open
Affiliation(s)
- Z. Aminzadeh
- Department of Clinical Biochemistry; Cellular and Molecular Research Center; Ahvaz Jundishapur University of Medical Sciences; Ahvaz Iran
| | - M. Jamalan
- Abadan School of Medical Sciences; Abadan Iran
| | - L. Chupani
- Faculty of Fisheries and Protection of Waters; South Bohemian Research Center of Aquaculture and Biodiversity of Hydrocenoses; Research Institute of Fish Culture and Hydrobiology; University of South Bohemia in Ceske Budejovice; Vodňany Czech Republic
| | - H. Lenjannezhadian
- Biotechnology Research Center; Research Institute of Petroleum Industry (RIPI); Tehran Iran
| | - M. A. Ghaffari
- Department of Clinical Biochemistry; Cellular and Molecular Research Center; Ahvaz Jundishapur University of Medical Sciences; Ahvaz Iran
| | - M. Aberomand
- Department of Clinical Biochemistry; Cellular and Molecular Research Center; Ahvaz Jundishapur University of Medical Sciences; Ahvaz Iran
| | - M. Zeinali
- Biotechnology Research Center; Research Institute of Petroleum Industry (RIPI); Tehran Iran
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152
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Agarwal A, Majzoub A, Esteves SC, Ko E, Ramasamy R, Zini A. Clinical utility of sperm DNA fragmentation testing: practice recommendations based on clinical scenarios. Transl Androl Urol 2016; 5:935-950. [PMID: 28078226 PMCID: PMC5182232 DOI: 10.21037/tau.2016.10.03] [Citation(s) in RCA: 260] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Sperm DNA fragmentation (SDF) has been generally acknowledged as a valuable tool for male fertility evaluation. While its detrimental implications on sperm function were extensively investigated, little is known about the actual indications for performing SDF analysis. This review delivers practice based recommendations on commonly encountered scenarios in the clinic. An illustrative description of the different SDF measurement techniques is presented. SDF testing is recommended in patients with clinical varicocele and borderline to normal semen parameters as it can better select varicocelectomy candidates. High SDF is also linked with recurrent spontaneous abortion (RSA) and can influence outcomes of different assisted reproductive techniques. Several studies have shown some benefit in using testicular sperm rather than ejaculated sperm in men with high SDF, oligozoospermia or recurrent in vitro fertilization (IVF) failure. Infertile men with evidence of exposure to pollutants can benefit from sperm DNA testing as it can help reinforce the importance of lifestyle modification (e.g., cessation of cigarette smoking, antioxidant therapy), predict fertility and monitor the patient’s response to intervention.
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Affiliation(s)
- Ashok Agarwal
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Ahmad Majzoub
- Department of Urology, Glickman Urological and kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sandro C Esteves
- ANDROFERT, Andrology and Human Reproduction Clinic, Referral Center for Male Reproduction, Campinas, SP, Brazil
| | - Edmund Ko
- Department of Urology, Loma Linda University, Loma Linda, California, USA
| | | | - Armand Zini
- Department of Urology, McGill University, Montreal, Canada
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153
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Gandhi J, Dagur G, Sheynkin YR, Smith NL, Khan SA. Testicular compartment syndrome: an overview of pathophysiology, etiology, evaluation, and management. Transl Androl Urol 2016; 5:927-934. [PMID: 28078225 PMCID: PMC5182235 DOI: 10.21037/tau.2016.11.05] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Testicular compartment syndrome (TCS) refers to the impairment of microcirculation in the testicle due to either increased venous resistance or extraluminal compression, which leads to hypoxia. TCS releases oxidants through hypoxia and ischemia/reperfusion injury (IRI). The pathophysiology, etiology, evaluation, and management of TCS are reviewed. Based on the properties of TCS, specific causes, e.g., varicocele, hydrocele, orchitis, cryptorchidism, and scrotal hernia, are suggested and categorized. The oxidant-induced stress from TCS may explain the correlations between these causes and infertility. A chief shortcoming of current imaging modalities is that they detect TCS late after it has progressed to impair the macrocirculation of the testicle. We propose frequent sequential periodic power Doppler ultrasonography to monitoring for earlier detection. Intraoperatively, TCS can be diagnosed by the dull purple appearance of a hypoxic testicle and by tissue pressures above 30 mmHg. When compartment pressure is low, the underlying etiology must be promptly treated. During acute presentation, an incision of the resilient tunica albuginea may be necessary. A great challenge of treating TCS is restoring microcirculation while minimizing IRI; concomitant antioxidant therapy secondary to treatment may be effective and harmless at the least. Because testicular oxidant stress is common in infertility and since TCS can cause such a stress, TCS may be a larger factor in infertility than currently suspected.
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Affiliation(s)
- Jason Gandhi
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - Gautam Dagur
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - Yefim R Sheynkin
- Department of Urology, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | | | - Sardar Ali Khan
- Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, NY, USA;; Department of Urology, Stony Brook University School of Medicine, Stony Brook, NY, USA
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154
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Mass spectrometry profiling of oxysterols in human sperm identifies 25-hydroxycholesterol as a marker of sperm function. Redox Biol 2016; 11:111-117. [PMID: 27912195 PMCID: PMC5133663 DOI: 10.1016/j.redox.2016.11.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 11/07/2016] [Accepted: 11/08/2016] [Indexed: 12/12/2022] Open
Abstract
Cholesterol is a main lipid component of sperm cell that is essential for sperm membrane fluidity, capacitation, and acrosomal reaction. Recent data obtained in bovine sperm showed that sperm capacitation is associated to the formation of oxysterols, oxidized products of cholesterol. The aim of this study was to profile oxysterol content in human semen, and to investigate their potential role in sperm pathophysiology. Among the 12 oxysterols analyzed, 25-hydroxycholesterol (25-HC) resulted the most represented in normozoospermic samples, and its concentration positively correlated with spermatozoa number. We detected Cholesterol 25-hydroxylase, the enzyme responsible for 25-HC production, in human spermatozoa at the level of the neck and the post acrosomal area. Upon incubation with spermatozoa, 25-HC induced calcium and cholesterol transients in connection with the acrosomal reaction. Our results support a role for 25-HC in sperm function.
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155
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Tiseo BC, Esteves SC, Cocuzza MS. Summary evidence on the effects of varicocele treatment to improve natural fertility in subfertile men. Asian J Androl 2016; 18:239-45. [PMID: 26806080 PMCID: PMC4770493 DOI: 10.4103/1008-682x.172639] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The objective of this review was to summarize the evidence concerning the benefit of varicocele treatment to improve natural fertility in subfertile males. We also analyzed the effect of varicocele treatment on conventional semen parameters and sperm functional tests. An electronic search to collect the data was performed using the PubMed/MEDLINE databases until July 2015. Data pooled from a variety of study designs indicate that varicocelectomy improves semen parameters in the majority of the treated men with clinical varicocele and abnormal semen parameters regardless of the chosen surgical method. Surgical varicocele repair was beneficial not only for alleviating oxidative stress-associated infertility but also to improve sperm nuclear DNA integrity. However, given the low magnitude of the effect size in sperm DNA integrity, further research is needed to elucidate its clinical significance. Conflicting results on the effect of varicocele treatment on natural fertility seem to be due to heterogeneous study designs and, more importantly, patient selection criteria. When these issues are controlled, current evidence indicates that treatment of subclinical varicocele is not warranted, as it does not seem to improve fertility. On the contrary, fair evidence indicates that varicocele treatment should be offered to infertile patients with palpable varicocele and abnormal semen parameters. This evidence supports the current guidelines issued by the American Urological Association and European Association of Urology, which state that varicocele treatment should be offered to male partners of infertile couples presenting for evaluation with clinical varicocele and semen parameters alterations.
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Affiliation(s)
| | | | - Marcello S Cocuzza
- Department of Urology, University of Sao Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, 7 andar - Sala 710F, Sao Paulo, 05403-000, Brazil
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156
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Majzoub A, Esteves SC, Gosálvez J, Agarwal A. Specialized sperm function tests in varicocele and the future of andrology laboratory. Asian J Androl 2016; 18:205-12. [PMID: 26780873 PMCID: PMC4770487 DOI: 10.4103/1008-682x.172642] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Varicocele is a common medical condition entangled with many controversies. Though it is highly prevalent in men with infertility, still it marks its presence in males who do have normal fertility. Determining which patients are negatively affected by varicocele would enable clinicians to better select those men who benefitted the most from surgery. Since conventional semen analysis has been limited in its ability to evaluate the negative effects of varicocele on fertility, a multitude of specialized laboratory tests have emerged. In this review, we examine the role and significance of specialized sperm function tests with regards to varicocele. Among the various tests, analysis of sperm DNA fragmentation and measurements of oxidative stress markers provide an independent measure of fertility in men with varicocele. These diagnostic modalities have both diagnostic and prognostic information complementary to, but distinct from conventional sperm parameters. Test results can guide management and aid in monitoring intervention outcomes. Proteomics, metabolomics, and genomics are areas; though still developing, holding promise to revolutionize our understanding of reproductive physiology, including varicocele.
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Affiliation(s)
- Ahmad Majzoub
- Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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157
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Garg H, Kumar R. An update on the role of medical treatment including antioxidant therapy in varicocele. Asian J Androl 2016; 18:222-8. [PMID: 26763549 PMCID: PMC4770490 DOI: 10.4103/1008-682x.171657] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Varicocele-associated male infertility has classically been managed using surgery or assisted reproductive techniques. With increasing evidence of oxidative stress as a pathophysiological factor in varicocele-associated infertility, medical therapy especially antioxidants might become a treatment option with lower risks. We reviewed the existing literature on the role of various medical agents in the management of male infertility attributed to varicoceles. Medical therapy is typically evaluated in three different situations such as (a) comparison of two drugs or one drug with placebo, (b) comparison of drugs versus surgery, and (c) comparison of drugs as adjuvant therapy with surgery versus drug therapy alone. Due to heterogeneity of data and lack of well-conducted studies, there is insufficient data to recommend routine use of medical therapy for men with varicocele-associated infertility and surgery remains the treatment of choice. Pregnancy and live birth rates are usually not reported in most studies and mere improvement in sperm parameters or antioxidant capacity is insufficient to support its routine use. Antioxidant therapy is a potential option due to its theoretical benefit, data from preclinical studies, and lack of major side effects. Adjuvant therapy with antioxidants after surgical repair of varicocele may improve the outcome and is a potential area for further research.
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Affiliation(s)
| | - Rajeev Kumar
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
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158
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Esteves SC. Novel concepts in male factor infertility: clinical and laboratory perspectives. J Assist Reprod Genet 2016; 33:1319-1335. [PMID: 27423664 PMCID: PMC5065546 DOI: 10.1007/s10815-016-0763-8] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 06/22/2016] [Indexed: 12/22/2022] Open
Abstract
In recent years, the management of male factor infertility has undergone important changes with the introduction of novel concepts, advanced testing, and therapeutic interventions. This review highlights some of these changes and discusses their impact to routine clinical practice. First, we discuss the recent changes in the World Health Organization (WHO) laboratory methods and reference values for the examination of human semen. Second, we examine the role of sperm chromatin integrity tests in light of increasing evidence of the detrimental effect of sperm DNA fragmentation on reproductive outcomes. Third, we summarize the main findings of varicocele-related infertility and the outcomes of microsurgical varicocele repair to different case scenarios. Lastly, we critically discuss the current management of men with nonobstructive azoospermia seeking fertility and the new opportunities that emerged to help these men achieve biological fatherhood.
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Affiliation(s)
- Sandro C Esteves
- ANDROFERT, Andrology and Human Reproduction Clinic, Referral Center for Male Reproduction, Av. Dr. Heitor Penteado, 1464, Campinas, SP, 13075-460, Brazil.
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159
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Agarwal A, Roychoudhury S, Bjugstad KB, Cho CL. Oxidation-reduction potential of semen: what is its role in the treatment of male infertility? Ther Adv Urol 2016; 8:302-318. [PMID: 27695529 PMCID: PMC5004233 DOI: 10.1177/1756287216652779] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
The diagnosis of male infertility relies largely on conventional semen analysis, and its interpretation has a profound influence on subsequent management of patients. Despite poor correlation between conventional semen parameters and male fertility potential, inclusion of advanced semen quality tests to routine male infertility workup algorithms has not been widely accepted. Oxidative stress is one of the major mediators in various etiologies of male infertility; it has deleterious effects on spermatozoa, including DNA damage. Alleviation of oxidative stress constitutes a potential treatment strategy for male infertility. Measurement of seminal oxidative stress is of crucial role in the identification and monitoring of patients who may benefit from treatments. Various tests including reactive oxygen species (ROS) assay, total antioxidant capacity (TAC) assay or malondialdehyde (MDA) assay used by different laboratories have their own drawbacks. Oxidation-reduction potential (ORP) is a measure of overall balance between oxidants and antioxidants, providing a comprehensive measure of oxidative stress. The MiOXSYS™ System is a novel technology based on a galvanostatic measure of electrons; it presents static ORP (sORP) measures with static referring to the passive or current state of activity between oxidants and antioxidants. Preliminary studies have correlated sORP to poor semen qualities. It is potentially useful in prognostication of assisted reproductive techniques outcomes, screening of antioxidants either in vivo or during IVF cycles, identification of infertile men who may benefit from treatment of oxidative stress, and monitoring of treatment success. The simplified laboratory test requiring a small amount of semen would facilitate clinical application and research in the field. In this paper, we discuss the measurement of ORP by the MiOXSYS System as a real-time assessment of seminal oxidative stress, and argue that it is a potential valuable clinical test that should be incorporated into the male infertility workup and become an important guide to the treatment of oxidative stress-induced male infertility.
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Affiliation(s)
- Ashok Agarwal
- Director, Andrology Center and American Center for Reproductive Medicine, Lerner College of Medicine, Cleveland Clinic, 10681 Carnegie Avenue, Desk X11, Cleveland, OH 44195, USA
| | - Shubhadeep Roychoudhury
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA Department of Life Science and Bioinformatics, Assam University, Silchar, India
| | | | - Chak-Lam Cho
- Department of Surgery, Kwong Wah Hospital, Hong Kong
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160
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Gholirad S, Razi M, Hassani Bafrani H. Tracing of zinc and iron in experimentally induced varicocele: correlation with oxidative, nitrosative and carbonyl stress. Andrologia 2016; 49. [PMID: 27682184 DOI: 10.1111/and.12687] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2016] [Indexed: 01/21/2023] Open
Abstract
This study was designed to evaluate how varicocele (VCL) can time dependently induce zinc (Zn) and iron (Fe) toxicity in testicular tissue and to analyse the relation between heavy metals toxicity and lipid peroxidation, sperm DNA damage, nitrosative and carbonyl stresses. Twenty-four mature male Wistar rats were divided into control-sham and test groups, which were then submitted to experimentally induced VCL. Non-VCL-induced rats were considered as control-sham. The test groups were subdivided into three groups based on the sample collecting date (2, 6 and 8 months after VCL induction). Zn and Fe distribution in testicles, DNA ladder for sperm DNA fragmentation, testicular total antioxidant capacity (TAC), malondialdehyde (MDA), nitrite oxide (NO) and carbonyl groups (CG) were analysed. A significant (p < .05) enhancement in the percentage of tubules with negative tubular repopulation, differentiation and spermiogenesis indices was revealed. The VCL increased Zn and Fe distribution in testicles. The VCL, time dependently, reduced sperm count, motility and enhanced sperm DNA damage (p < .05). The VCL downregulated the testicular TAC and enhanced the MDA, NO and CG contents. Our data showed that the VCL results in intensive Fe and Zn toxicities. Produced Zn- and Fe-mediated-oxidative stress increases sperm DNA damage associated with NO and CG-induced stresses.
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Affiliation(s)
- S Gholirad
- Department of Comparative Histology and Embryology, Faculty of Veterinary Medicine, University of Urmia, Urmia, Iran
| | - M Razi
- Department of Comparative Histology and Embryology, Faculty of Veterinary Medicine, University of Urmia, Urmia, Iran
| | - H Hassani Bafrani
- Gametogenesis Research Center, Kashan University of Medical Sciences, Kashan, Iran.,Anatomical Sciences Research Center, Kashan University of Medical Sciences, Kashan, Iran
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161
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Abstract
With expanding knowledge on the health benefits of exercise, there is an increasing demand for information on the andrological consequences of participating in sports. These consequences are especially important in the context of infertility problems worldwide. The so-called “male factor” is reported in up to 50% of couples having trouble with conception. The answer to the question, “Is physical activity good for male reproductive health?” is not straightforward. A number of studies have suggested that significant changes in semen parameters may occur due to sports training of certain types, intensities, and durations. The changes to these parameters vary in scope, direction, and magnitude. Findings in recreational athletes have also differed from those in professional athletes. This review of the current literature suggests that intense physical activity may affect the semen concentration, as well as the number of motile and morphologically normal spermatozoa. Training at higher intensities and with increased loads seems to be associated with more profound changes in semen quality. In recreational athletes, exercise has either a positive or neutral effect on semen parameters. Due to many limitations (e.g., global sperm count trends, concerns about the quality control of sperm evaluations, and new standards for semen analysis), comparisons among historical data and their interpretation are difficult.
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Affiliation(s)
- Paweł Jóźków
- 1 University School of Physical Education, Wrocław, Poland
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162
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Alterations in the proliferative/apoptotic equilibrium in semen of adolescents with varicocele. J Assist Reprod Genet 2016; 33:1657-1664. [PMID: 27629121 DOI: 10.1007/s10815-016-0808-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 08/30/2016] [Indexed: 10/21/2022] Open
Abstract
PURPOSE To verify if the presence of varicocele (grades II and III) with and without seminal alterations, using the 5th centile cutoff values in table A1.1 of the World Health Organization (WHO, 2010) manual, alters the seminal plasma levels of proteins DNASE1 (deoxyribonuclease-1) and IGFBP7 (Insulin-like growth factor-binding protein 7), which are related to apoptosis regulation and cell proliferation, respectively, demonstrating that these proteins are important for correct spermatogenesis. METHODS This cross sectional study was performed at the Sao Paulo Federal University Paulo between May 2014 and April 2016. A total of 61 male adolescents were included in this study, of which 20 controls without varicocele (C), 22 with varicocele and normal semen analysis (VNS) and 19 with varicocele and altered semen analysis (VAS). Seminal plasma from each patient was used for Western blotting analysis of individual protein levels. Values of each protein were normalized to a testicular housekeeping protein (PARK7-protein deglycase DJ-1). RESULTS Levels of IGFBP7 protein are increased in varicocele. Levels of DNASE1 are progressively decreased in varicocele (lower in varicocele and normal semen analysis, lowest in varicocele and altered semen analysis) when compared to adolescents without varicocele. DNASE1 levels are positively correlated with sperm concentration and morphology (correlation values of 0.400 and 0.404, respectively; p values of 0.001 and 0.001, respectively). CONCLUSION In conclusion, in adolescents, seminal plasma levels of IGFBP7, responsible for proliferative activity, are increased in varicocele grades II and III, and DNASE1, responsible for apoptosis regulation, are lower in varicocele, lowest in varicocele and low semen quality. These proteins demonstrate molecular alterations brought upon by varicocele. Moreover, DNASE1 is capable of discriminating a varicocele that causes alterations to semen quality from one that does not. We propose that the initial response of varicocele is to increase proliferative activity which, if followed by regulation of apoptosis, may lead to the ejaculation of a population of sperm that are in accordance with WHO cutoff values but, in the presence of dysregulated apoptosis, leads to lower sperm concentration and morphology.
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163
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Mendes TB, Paccola CC, de Oliveira Neves FM, Simas JN, da Costa Vaz A, Cabral REL, Vendramini V, Miraglia SM. Resveratrol improves reproductive parameters of adult rats varicocelized in peripuberty. Reproduction 2016; 152:23-35. [DOI: 10.1530/rep-16-0025] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 04/05/2016] [Indexed: 11/08/2022]
Abstract
The aim of this study was to investigate the protective action of resveratrol against the reproductive damage caused by left-sided experimental varicocele. There was a reduction of testicular major axis in the varicocele group when compared with the other groups; the testicular volume was reduced in varicocele group in comparison to the sham–control and resveratrol groups. The frequency of morphologically abnormal sperm was higher in varicocele and varicocele treated with resveratrol groups than in sham–control and resveratrol groups. The frequency of sperm with 100% of mitochondrial activity and normal acrosome integrity were lower in varicocele group than in varicocele treated with resveratrol, sham–control and resveratrol groups. Sperm motility was also reduced in varicocele group than in other groups. The sperm DNA fragmentation was higher in varicocele group than in other groups. Testicular levels of malondialdehyde were higher in varicocele and varicocele treated with resveratrol groups. The varicocele and varicocele treated with resveratrol groups had a significantly higher frequency of TUNEL-positive cells than sham–control and resveratrol groups; however, immunolabeling of the testes from varicocele treated with resveratrol group showed a lower number of apoptotic germ cells in comparison with the left testis of rats of the varicocele group. Reproductive alterations produced by varicocele from peripuberty were reduced by resveratrol in adulthood. Resveratrol should be better investigated as an adjuvant in the treatment of varicocele. Daily administration of resveratrol to rats with varicocele from peripuberty improves sperm quality in the adulthood.
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164
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Samanta L, Swain N, Ayaz A, Venugopal V, Agarwal A. Post-Translational Modifications in sperm Proteome: The Chemistry of Proteome diversifications in the Pathophysiology of male factor infertility. Biochim Biophys Acta Gen Subj 2016; 1860:1450-65. [DOI: 10.1016/j.bbagen.2016.04.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 03/26/2016] [Accepted: 04/04/2016] [Indexed: 12/18/2022]
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165
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Ni K, Steger K, Yang H, Wang H, Hu K, Zhang T, Chen B. A comprehensive investigation of sperm DNA damage and oxidative stress injury in infertile patients with subclinical, normozoospermic, and astheno/oligozoospermic clinical varicocoele. Andrology 2016; 4:816-24. [PMID: 27218783 DOI: 10.1111/andr.12210] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Revised: 04/03/2016] [Accepted: 04/05/2016] [Indexed: 11/30/2022]
Affiliation(s)
- K. Ni
- Department of Urology; Shanghai Institute of Andrology; Renji Hospital; Shanghai Jiaotong University School of Medicine; Shanghai China
- Department of Urology; Pediatric Urology and Andrology; Section Molecular Andrology; Justus Liebig University Giessen; Giessen Germany
| | - K. Steger
- Department of Urology; Pediatric Urology and Andrology; Section Molecular Andrology; Justus Liebig University Giessen; Giessen Germany
| | - H. Yang
- Department of Assisted Reproductive medicine; Shanghai First Maternity and Infant Hospital; Tongji University School of Medicine; Shanghai China
| | - H. Wang
- Department of Urology; Shanghai Institute of Andrology; Renji Hospital; Shanghai Jiaotong University School of Medicine; Shanghai China
| | - K. Hu
- Department of Urology; Shanghai Institute of Andrology; Renji Hospital; Shanghai Jiaotong University School of Medicine; Shanghai China
| | - T. Zhang
- Department of Urology; Shanghai Institute of Andrology; Renji Hospital; Shanghai Jiaotong University School of Medicine; Shanghai China
| | - B. Chen
- Department of Urology; Shanghai Institute of Andrology; Renji Hospital; Shanghai Jiaotong University School of Medicine; Shanghai China
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166
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Del Giudice PT, Belardin LB, Camargo M, Zylbersztejn DS, Carvalho VM, Cardozo KHM, Bertolla RP, Cedenho AP. Determination of testicular function in adolescents with varicocoele - a proteomics approach. Andrology 2016; 4:447-55. [DOI: 10.1111/andr.12174] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 12/03/2015] [Accepted: 01/25/2016] [Indexed: 12/19/2022]
Affiliation(s)
- P. T. Del Giudice
- Division of Urology; Human Reproduction Section; Department of Surgery; Universidade Federal de São Paulo; São Paulo Brazil
| | - L. B. Belardin
- Division of Urology; Human Reproduction Section; Department of Surgery; Universidade Federal de São Paulo; São Paulo Brazil
| | - M. Camargo
- Division of Urology; Human Reproduction Section; Department of Surgery; Universidade Federal de São Paulo; São Paulo Brazil
| | - D. S. Zylbersztejn
- Division of Urology; Human Reproduction Section; Department of Surgery; Universidade Federal de São Paulo; São Paulo Brazil
- Hospital São Paulo; São Paulo Brazil
| | | | | | - R. P. Bertolla
- Division of Urology; Human Reproduction Section; Department of Surgery; Universidade Federal de São Paulo; São Paulo Brazil
- Hospital São Paulo; São Paulo Brazil
| | - A. P. Cedenho
- Division of Urology; Human Reproduction Section; Department of Surgery; Universidade Federal de São Paulo; São Paulo Brazil
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167
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Barekat F, Tavalaee M, Deemeh MR, Bahreinian M, Azadi L, Abbasi H, Rozbahani S, Nasr-Esfahani MH. A Preliminary Study: N-acetyl-L-cysteine Improves Semen Quality following Varicocelectomy. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2016; 10:120-6. [PMID: 27123209 PMCID: PMC4845522 DOI: 10.22074/ijfs.2016.4777] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 04/20/2014] [Indexed: 11/21/2022]
Abstract
Background Surgery is considered the primary treatment for male infertility from clinical varicocele. One of the main events associated with varicocele is excessive production
of reactive oxygen species (ROS). N-acetyl-L-cysteine (NAC), an antioxidant that scavenges free radicals, is considered a supplement to alleviate glutathione (GSH) depletion
during oxidative stress. Despite beneficial effects of NAC in other pathological events,
there is no report on the effect of NAC in individuals with varicocele. Therefore, the aim
of this study is to evaluate the outcome of NAC on semen quality, protamine content,
DNA damage, oxidative stress and fertility following varicocelectomy. Materials and Methods This prospective clinical trial included 35 infertile men with
varicocele randomly divided into control (n=20) and NAC (n=15) groups. We assessed
semen parameters, protamine content [chromomycin A3 (CMA3)], DNA integrity [terminal deoxynucleotidyltransferase-mediated dUTP nick-end labeling (TUNEL)] and oxidative stress [2', 7'-dichlorodihydrofluorescein-diacetate (DCFH-DA)] before and three
months after varicocelectomy. Results Percentage of abnormal semen parameters, protamine deficiency, DNA fragmentation and oxidative stress were significantly decreased in both groups compared to
before surgery. We calculated the percentage of improvement in these parameters compared to before surgery for each group, then compared the results between the groups.
Only percentage of protamine deficiency and DNA fragmentation significantly differed
between the NAC and control groups. Conclusion The results of this study, for the first time, revealed that NAC improved
chromatin integrity and pregnancy rate when administered as adjunct therapy post-varico-
celectomy (Registeration Number: IRCT201508177223N5).
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Affiliation(s)
- Foroogh Barekat
- Department of Reproductive Biotechnology, Reproductive Biomedicine Research Center, Royan Institute for Biotechnology, ACECR, Isfahan, Iran; Department of Biology, Flavarjan Branch, Islamic Azad University, Flavarjan, Isfahan, Iran
| | - Marziyeh Tavalaee
- Department of Reproductive Biotechnology, Reproductive Biomedicine Research Center, Royan Institute for Biotechnology, ACECR, Isfahan, Iran
| | - Mohammad Reza Deemeh
- Department of Reproductive Biotechnology, Reproductive Biomedicine Research Center, Royan Institute for Biotechnology, ACECR, Isfahan, Iran
| | - Mahsa Bahreinian
- Department of Reproductive Biotechnology, Reproductive Biomedicine Research Center, Royan Institute for Biotechnology, ACECR, Isfahan, Iran
| | - Leila Azadi
- Department of Reproductive Biotechnology, Reproductive Biomedicine Research Center, Royan Institute for Biotechnology, ACECR, Isfahan, Iran
| | | | - Shahla Rozbahani
- Department of Biology, Flavarjan Branch, Islamic Azad University, Flavarjan, Isfahan, Iran
| | - Mohammad Hossein Nasr-Esfahani
- Department of Reproductive Biotechnology, Reproductive Biomedicine Research Center, Royan Institute for Biotechnology, ACECR, Isfahan, Iran; Isfahan Fertility and Infertility Center, Isfahan, Iran
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168
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Marmar JL. The evolution and refinements of varicocele surgery. Asian J Androl 2016; 18:171-8. [PMID: 26732111 PMCID: PMC4770481 DOI: 10.4103/1008-682x.170866] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 11/04/2015] [Accepted: 11/13/2015] [Indexed: 12/20/2022] Open
Abstract
Varicoceles had been recognized in clinical practice for over a century. Originally, these procedures were utilized for the management of pain but, since 1952, the repairs had been mostly for the treatment of male infertility. However, the diagnosis and treatment of varicoceles were controversial, because the pathophysiology was not clear, the entry criteria of the studies varied among centers, and there were few randomized clinical trials. Nevertheless, clinicians continued developing techniques for the correction of varicoceles, basic scientists continued investigations on the pathophysiology of varicoceles, and new outcome data from prospective randomized trials have appeared in the world's literature. Therefore, this special edition of the Asian Journal of Andrology was proposed to report much of the new information related to varicoceles and, as a specific part of this project, the present article was developed as a comprehensive review of the evolution and refinements of the corrective procedures.
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Affiliation(s)
- Joel L Marmar
- Director of Men's Health Services, Planned Parenthood of Southern New Jersey, 317 S. Broadway, Camden, NJ 08103, USA
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169
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Cho CL, Esteves SC, Agarwal A. Novel insights into the pathophysiology of varicocele and its association with reactive oxygen species and sperm DNA fragmentation. Asian J Androl 2016; 18:186-93. [PMID: 26732105 PMCID: PMC4770484 DOI: 10.4103/1008-682x.170441] [Citation(s) in RCA: 141] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Varicocele has been associated with reduced male reproductive potential. With the advances in biomolecular techniques, it has been possible to better understand the mechanisms involved in testicular damage provoked by varicocele. Current evidence suggests the central role of reactive oxygen species (ROS) and the resultant oxidative stress (OS) in the pathogenesis of varicocele-associated male subfertility although the mechanisms have not yet been fully described and it is likely to be multifactorial. Excessive ROS is associated with sperm DNA fragmentation, which may mediate the clinical manifestation of poor sperm function and fertilization outcome related to varicocele. Testing of ROS/OS and DNA fragmentation has the potential to provide additional diagnostic and prognostic information compared to conventional semen analysis and may guide therapeutic management strategies in individual patient.
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Affiliation(s)
- Chak-Lam Cho
- Division of Urology, Department of Surgery, Kwong Wah Hospital, 25 Waterloo Road, Yau Ma Tei, Hong Kong
| | - Sandro C Esteves
- ANDROFERT, Center for Male Reproduction, Av. Dr. Heitor Penteado 1464, Campinas, SP 13075-460, Brazil
| | - Ashok Agarwal
- American Center for Reproductive Medicine, 10681 Carnegie Avenue, X-11, Cleveland, OH 44195, USA
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170
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Esteves SC, Roque M, Agarwal A. Outcome of assisted reproductive technology in men with treated and untreated varicocele: systematic review and meta-analysis. Asian J Androl 2016; 18:254-8. [PMID: 26510504 PMCID: PMC4770495 DOI: 10.4103/1008-682x.163269] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 08/11/2015] [Accepted: 08/18/2015] [Indexed: 12/11/2022] Open
Abstract
Varicocele affects approximately 35%-40% of men presenting for an infertility evaluation. There is fair evidence indicating that surgical repair of clinical varicocele improves semen parameters, decreases seminal oxidative stress and sperm DNA fragmentation, and increases the chances of natural conception. However, it is unclear whether performing varicocelectomy in men with clinical varicocele prior to assisted reproductive technology (ART) improve treatment outcomes. The objective of this study was to evaluate the role of varicocelectomy on ART pregnancy outcomes in nonazoospermic infertile men with clinical varicocele. An electronic search was performed to collect all evidence that fitted our eligibility criteria using the MEDLINE and EMBASE databases until April 2015. Four retrospective studies were included, all of which involved intracytoplasmic sperm injection (ICSI), and accounted for 870 cycles (438 subjected to ICSI with prior varicocelectomy, and 432 without prior varicocelectomy). There was a significant increase in the clinical pregnancy rates (OR = 1.59, 95% CI: 1.19-2.12, I 2 = 25%) and live birth rates (OR = 2.17, 95% CI: 1.55-3.06, I 2 = 0%) in the varicocelectomy group compared to the group subjected to ICSI without previous varicocelectomy. Our results indicate that performing varicocelectomy in patients with clinical varicocele prior to ICSI is associated with improved pregnancy outcomes.
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Affiliation(s)
- Sandro C Esteves
- ANDROFERT, Center for Male Reproduction, Av. Dr. Heitor Penteado 1464, Campinas, SP 13075-460, Brazil
| | - Matheus Roque
- ORIGEN, Center for Reproductive Medicine, Rio de Janeiro, Av. Rodolfo de Amoedo 140, Rio de Janeiro, RJ 22620-330, Brazil
| | - Ashok Agarwal
- American Center for Reproductive Medicine, 10681 Carnegie Avenue, X-11, Cleveland, OH 44195, USA
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171
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Ferramosca A, Albani D, Coppola L, Zara V. Varicocele Negatively Affects Sperm Mitochondrial Respiration. Urology 2015. [DOI: 10.1016/j.urology.2015.07.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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172
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Cortés-Gutiérrez EI, Dávila-Rodríguez MI, Fernández JL, López-Fernández C, Aragón-Tovar AR, Urbina-Bernal LC, Gosálvez J. DNA damage in spermatozoa from infertile men with varicocele evaluated by sperm chromatin dispersion and DBD-FISH. Arch Gynecol Obstet 2015. [DOI: 10.1007/s00404-015-3822-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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173
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Park HJ, Choe S, Park NC. Effects of Korean red ginseng on semen parameters in male infertility patients: A randomized, placebo-controlled, double-blind clinical study. Chin J Integr Med 2015; 22:490-5. [PMID: 25967606 DOI: 10.1007/s11655-015-2139-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To investigate the effects of Korean red ginseng (KRG) on semen parameters in male infertility patients in a randomized, double-blind, placebo-controlled study. METHODS A total of 80 male infertility patients with varicocele were recruited from April 2011 to February 2012. The subjects were then divided into the following four groups: non-varicocelectomy (V)+placebo (P) group, V+P group, non-V+KRG group (1.5-g KRG daily), and V+KGR group (1.5-g KRG daily). Semen analysis was performed and hormonal levels were measured in each treatment arm after 12 weeks. RESULTS All groups but not the non-V+P group, showed significant improvements in sperm concentrations, motility, morphology, and viability at the end of the study. However, there were no significant differences in serum follicle-stimulating hormone, luteinizing hormone, and testosterone among groups. The incidence of adverse events was low, and all events were assumed to be unrelated to the treatments administered. CONCLUSIONS Although the exact mechanism by which KRG improves spermatogenesis remains unclear, KRG may be a useful agent for the treatment of male infertility. Nevertheless, additional studies to evaluate the optimal dose and duration of treatment are needed.
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Affiliation(s)
- Hyun Jun Park
- Department of Urology, Pusan National University School of Medicine, Busan, 602-739, Republic of Korea.,Medical Research Institute of Pusan National University Hospital, Busan, 602-739, Republic of Korea
| | - Sangmin Choe
- Medical Research Institute of Pusan National University Hospital, Busan, 602-739, Republic of Korea.,Division of Clinical Pharmacology, Clinical Trial Center, Pusan National University Hospital, Busan, 602-739, Republic of Korea
| | - Nam Cheol Park
- Department of Urology, Pusan National University School of Medicine, Busan, 602-739, Republic of Korea. .,Medical Research Institute of Pusan National University Hospital, Busan, 602-739, Republic of Korea.
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174
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Agarwal A, Hamada A, Esteves SC. Engaging practicing gynecologists in the management of infertile men. J Obstet Gynaecol India 2015; 65:75-87. [PMID: 25883438 PMCID: PMC4395576 DOI: 10.1007/s13224-014-0623-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 09/16/2014] [Indexed: 12/01/2022] Open
Abstract
In the modern era, contemporary management of male infertility has undergone groundbreaking changes with the introduction of new concepts, advanced testing, and therapeutic interventions. As practicing gynecologists are often the first physicians who encounter an infertile couple, it is essential that these clinicians are continuously updated about the new pearls and pitfalls of male infertility management. Semen analysis is commonly ordered by gynecologists. In 2010, the WHO released new cutoff reference values for the semen parameters adopting novel methodology, which has incited much debate. Reference values have been lowered in comparison with previous standards, with a direct clinical implication in decision-making strategies. Specialized sperm-function tests, such as sperm oxidative stress and sperm chromatin integrity assessments, became clinically available, thus offering an opportunity to better understand sperm dysfunctions concealed during routine semen analysis. Furthermore, the initial counseling of azoospermic men by an andrologically well educated gynecologist may alleviate the misconception and distress surrounding the false belief of sterility, and will clarify the available options of percutaneous and microsurgical sperm-retrieval techniques and assisted conception outcome. Regarding varicocele, which is commonly seen in infertile males, it is now clear that the best treatment option for infertile men with clinical varicocele is the microsurgical vein ligation. Natural conception is significantly improved after varicocelectomy, and recent data suggest that such treatment optimizes reproductive outcome of couples undergoing ICSI or micro-TESE sperm retrieval. Lastly, new therapeutic interventions, including oral antioxidant therapy and lifestyle modifications, have gained increasing attention, as they aid in alleviating male infertility.
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Affiliation(s)
- Ashok Agarwal
- />Lerner College of Medicine, Andrology Center and Center for Reproductive Medicine, Cleveland Clinic, Mail Code X-11, 10681 Carnegie Avenue, Cleveland, OH 44195 USA
| | - Alaa Hamada
- />Department of Urology, Columbia University, New York, USA
| | - Sandro C. Esteves
- />Andrology and Human Reproduction Clinic, ANDROFERT, Av. Dr. Heitor Penteado, 1464, Campinas, SP 13075-460 Brazil
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175
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Agarwal A, Sharma R, Durairajanayagam D, Ayaz A, Cui Z, Willard B, Gopalan B, Sabanegh E. Major protein alterations in spermatozoa from infertile men with unilateral varicocele. Reprod Biol Endocrinol 2015; 13:8. [PMID: 25890347 PMCID: PMC4383193 DOI: 10.1186/s12958-015-0007-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 02/11/2015] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The etiology of varicocele, a common cause of male factor infertility, remains unclear. Proteomic changes responsible for the underlying pathology of unilateral varicocele have not been evaluated. The objective of this prospective study was to employ proteomic techniques and bioinformatic tools to identify and analyze proteins of interest in infertile men with unilateral varicocele. METHODS Spermatozoa from infertile men with unilateral varicocele (n=5) and from fertile men (control; n=5) were pooled in two groups respectively. Proteins were extracted and separated by 1-D SDS-PAGE. Bands were digested and identified on a LTQ-Orbitrap Elite hybrid mass spectrometer system. Bioinformatic analysis identified the pathways and functions of the differentially expressed proteins (DEP). RESULTS Sperm concentration, motility and morphology were lower, and reactive oxygen species levels were higher in unilateral varicocele patients compared to healthy controls. The total number of proteins identified were 1055, 1010 and 1042 in the fertile group, and 795, 713 and 763 proteins in the unilateral varicocele group. Of the 369 DEP between both groups, 120 proteins were unique to the fertile group and 38 proteins were unique to the unilateral varicocele group. Compared to the control group, 114 proteins were overexpressed while 97 proteins were underexpressed in the unilateral varicocele group. We have identified 29 proteins of interest that are involved in spermatogenesis and other fundamental reproductive events such as sperm maturation, acquisition of sperm motility, hyperactivation, capacitation, acrosome reaction and fertilization. The major functional pathways of the 359 DEP related to the unilateral varicocele group involve metabolism, disease, immune system, gene expression, signal transduction and apoptosis. Functional annotations showed that unilateral varicocele mostly affected small molecule biochemistry and post-translational modification proteins. Proteins expressed uniquely in the unilateral varicocele group were cysteine-rich secretory protein 2 precursor (CRISP2) and arginase-2 (ARG2). CONCLUSIONS The expression of these proteins of interest are altered and possibly functionally compromised in infertile men with unilateral varicocele. If validated, these proteins may lead to potential biomarker(s) and help better understand the mechanism involved in the pathophysiology of unilateral varicocele in infertile men.
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Affiliation(s)
- Ashok Agarwal
- Center for Reproductive Medicine, Glickman Urological & Kidney Institute, Cleveland Clinic, Mail Code X-11, 10681 Carnegie Avenue, Cleveland, OH, 44195, USA.
| | - Rakesh Sharma
- Center for Reproductive Medicine, Glickman Urological & Kidney Institute, Cleveland Clinic, Mail Code X-11, 10681 Carnegie Avenue, Cleveland, OH, 44195, USA.
| | - Damayanthi Durairajanayagam
- Center for Reproductive Medicine, Glickman Urological & Kidney Institute, Cleveland Clinic, Mail Code X-11, 10681 Carnegie Avenue, Cleveland, OH, 44195, USA.
| | - Ahmet Ayaz
- Center for Reproductive Medicine, Glickman Urological & Kidney Institute, Cleveland Clinic, Mail Code X-11, 10681 Carnegie Avenue, Cleveland, OH, 44195, USA.
| | - Zhihong Cui
- Center for Reproductive Medicine, Glickman Urological & Kidney Institute, Cleveland Clinic, Mail Code X-11, 10681 Carnegie Avenue, Cleveland, OH, 44195, USA.
| | - Belinda Willard
- Proteomics Research Core Services, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, 44195, USA.
| | - Banu Gopalan
- Proteomics Research Core Services, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, 44195, USA.
| | - Edmund Sabanegh
- Center for Reproductive Medicine, Glickman Urological & Kidney Institute, Cleveland Clinic, Mail Code X-11, 10681 Carnegie Avenue, Cleveland, OH, 44195, USA.
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177
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Abstract
Excessive amounts of reactive oxygen species (ROS) cause a state of oxidative stress, which result in sperm membrane lipid peroxidation, DNA damage and apoptosis, leading to decreased sperm viability and motility. Elevated levels of ROS are a major cause of idiopathic male factor infertility, which is an increasingly common problem today. Lycopene, the most potent singlet oxygen quencher of all carotenoids, is a possible treatment option for male infertility because of its antioxidant properties. By reacting with and neutralizing free radicals, lycopene could reduce the incidence of oxidative stress and thus, lessen the damage that would otherwise be inflicted on spermatozoa. It is postulated that lycopene may have other beneficial effects via nonoxidative mechanisms in the testis, such as gap junction communication, modulation of gene expression, regulation of the cell cycle and immunoenhancement. Various lycopene supplementation studies conducted on both humans and animals have shown promising results in alleviating male infertility—lipid peroxidation and DNA damage were decreased, while sperm count and viability, and general immunity were increased. Improvement of these parameters indicates a reduction in oxidative stress, and thus the spermatozoa is less vulnerable to oxidative damage, which increases the chances of a normal sperm fertilizing the egg. Human trials have reported improvement in sperm parameters and pregnancy rates with supplementation of 4–8 mg of lycopene daily for 3–12 months. However, further detailed and extensive research is still required to determine the dosage and the usefulness of lycopene as a treatment for male infertility.
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Affiliation(s)
| | - Ashok Agarwal
- Center for Reproductive Medicine, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA,
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178
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Free radicals in adolescent varicocele testis. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2014; 2014:912878. [PMID: 25580183 PMCID: PMC4279722 DOI: 10.1155/2014/912878] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 12/01/2014] [Indexed: 11/17/2022]
Abstract
We examine the relationship between the structure and function of the testis and the oxidative and nitrosative stress, determined by an excessive production of free radicals and/or decreased availability of antioxidant defenses, which occur in the testis of adolescents affected by varicocele. Moreover, the effects of surgical treatment on oxidative stress were provided. We conducted a PubMed and Medline search between 1980 and 2014 using “adolescent,” “varicocele,” “free radicals,” “oxidative and nitrosative stress,” “testis,” and “seminiferous tubules” as keywords. Cross-references were checked in each of the studies, and relevant articles were retrieved. We conclude that increased concentration of free radicals, generated by conditions of hypoxia, hyperthermia, and hormonal dysfunction observed in adolescent affected by varicocele, can harm germ cells directly or indirectly by influencing nonspermatogenic cells and basal lamina. With regard to few available data in current literature, further clinical trials on the pre- and postoperative ROS and RNS levels together with morphological studies of the cellular component of the testis are fundamental for complete comprehension of the role played by free radicals in the pathogenesis of adolescent varicocele and could justify its pharmacological treatment with antioxidants.
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179
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Hu W, Zhou PH, Zhang XB, Xu CG, Wang W. Roles of adrenomedullin and hypoxia-inducible factor 1 alpha in patients with varicocele. Andrologia 2014; 47:951-7. [PMID: 25335788 DOI: 10.1111/and.12363] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2014] [Indexed: 11/27/2022] Open
Affiliation(s)
- W. Hu
- Department of Urology; Renmin Hospital of Wuhan University; Wuhan Hubei Province China
| | - P.-H. Zhou
- Department of Orthopedics; Renmin Hospital of Wuhan University; Wuhan Hubei Province China
| | - X.-B. Zhang
- Department of Urology; Renmin Hospital of Wuhan University; Wuhan Hubei Province China
| | - C.-G. Xu
- Department of Urology; Renmin Hospital of Wuhan University; Wuhan Hubei Province China
| | - W. Wang
- Department of Urology; Renmin Hospital of Wuhan University; Wuhan Hubei Province China
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180
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Durairajanayagam D, Agarwal A, Ong C. Causes, effects and molecular mechanisms of testicular heat stress. Reprod Biomed Online 2014; 30:14-27. [PMID: 25456164 DOI: 10.1016/j.rbmo.2014.09.018] [Citation(s) in RCA: 216] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 09/14/2014] [Accepted: 09/25/2014] [Indexed: 12/31/2022]
Abstract
The process of spermatogenesis is temperature-dependent and occurs optimally at temperatures slightly lower than that of the body. Adequate thermoregulation is imperative to maintain testicular temperatures at levels lower than that of the body core. Raised testicular temperature has a detrimental effect on mammalian spermatogenesis and the resultant spermatozoa. Therefore, thermoregulatory failure leading to heat stress can compromise sperm quality and increase the risk of infertility. In this paper, several different types of external and internal factors that may contribute towards testicular heat stress are reviewed. The effects of heat stress on the process of spermatogenesis, the resultant epididymal spermatozoa and on germ cells, and the consequent changes in the testis are elaborated upon. We also discuss the molecular response of germ cells to heat exposure and the possible mechanisms involved in heat-induced germ cell damage, including apoptosis, DNA damage and autophagy. Further, the intrinsic and extrinsic pathways that are involved in the intricate mechanism of germ cell apoptosis are explained. Ultimately, these complex mechanisms of apoptosis lead to germ cell death.
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Affiliation(s)
- Damayanthi Durairajanayagam
- Center for Reproductive Medicine, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ashok Agarwal
- Center for Reproductive Medicine, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA.
| | - Chloe Ong
- Center for Reproductive Medicine, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
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181
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Wright C, Milne S, Leeson H. Sperm DNA damage caused by oxidative stress: modifiable clinical, lifestyle and nutritional factors in male infertility. Reprod Biomed Online 2014; 28:684-703. [DOI: 10.1016/j.rbmo.2014.02.004] [Citation(s) in RCA: 247] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 02/01/2014] [Accepted: 02/04/2014] [Indexed: 12/23/2022]
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182
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Kimura M, Nagao K. Role of varicocele repair for male infertility in the era of assisted reproductive technologies. Reprod Med Biol 2014; 13:185-192. [PMID: 29699160 DOI: 10.1007/s12522-014-0181-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 04/30/2014] [Indexed: 01/10/2023] Open
Abstract
Varicocele is an abnormal condition characterized by dilatation of the pampiniform plexus veins draining the testis and is present in 15 % of men. Varicoceles have an adverse effect on spermatogenesis and are the most common cause of male infertility. Approximately 35 % of infertile men and more than 70 % of men with secondary infertility were reported to have varicoceles. Although data on methods of varicocele repair are accumulating, there remains controversy regarding the indications and techniques for varicocele repair. In addition, the role of varicocele repair in this era of assisted reproductive technologies continues to be debated. In this study, we performed a comprehensive PubMed search in order to review the current status of varicocele repair for male infertility. We reviewed English-language studies published from 1992 through 2013. After reviewing the articles, we identified a recent meta-analysis of four randomized controlled trials, which found that varicocele repair for oligozoospermic men was associated with better pregnancy rates as compared with observation. Our review of prospective studies showed that all semen parameters, including sperm concentration, motility, and progressive motility, were significantly improved after varicocele repair. We also summarize the findings of recent studies reporting beneficial effects of varicocele repair, i.e., decreased oxidative stress and sperm DNA fragmentation after varicocele repair and superior cost effectiveness versus in vitro fertilization/intracytoplasmic sperm injection alone, which may be important in the era of assisted reproductive technologies. Varicocele repair is a widespread, well-established procedure that can improve semen parameters in men with infertility. The effect of such treatment on the pregnancy rate is unclear because evidence is limited due to difficulties in recruiting patients for studies. Among the repair techniques, microsurgical repair using a subinguinal approach is potentially the best practice, although this procedure requires training in microsurgery. All these topics require further research in studies with sufficient patient enrollment and follow-up.
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Affiliation(s)
- Masaki Kimura
- Department of Urology Teikyo University School of Medicine Tokyo Japan
| | - Koichi Nagao
- Department of Urology Toho University School of Medicine Tokyo Japan
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183
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Zhang J, Mu X, Xia Y, Martin FL, Hang W, Liu L, Tian M, Huang Q, Shen H. Metabolomic Analysis Reveals a Unique Urinary Pattern in Normozoospermic Infertile Men. J Proteome Res 2014; 13:3088-99. [PMID: 24796210 DOI: 10.1021/pr5003142] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Jie Zhang
- Key Lab of Urban
Environment and Health, Institute of Urban Environment, Chinese Academy of Sciences, 1799 Jimei Road, Xiamen 361021, China
| | - Xiaoli Mu
- Key Lab of Urban
Environment and Health, Institute of Urban Environment, Chinese Academy of Sciences, 1799 Jimei Road, Xiamen 361021, China
| | - Yankai Xia
- Key Laboratory
of Reproductive Medicine, Institute of Toxicology, Nanjing Medical University, Nanjing, China
| | - Francis L Martin
- Centre for Biophotonics,
Lancaster Environment Centre, Lancaster University, Lancaster LA1 4YQ, U.K
| | - Wei Hang
- Department
of Chemistry, Key Laboratory of Analytical Sciences,
College of Chemistry and Chemical Engineering, Xiamen University, Xiamen 361005, China
| | - Liangpo Liu
- Key Lab of Urban
Environment and Health, Institute of Urban Environment, Chinese Academy of Sciences, 1799 Jimei Road, Xiamen 361021, China
| | - Meiping Tian
- Key Lab of Urban
Environment and Health, Institute of Urban Environment, Chinese Academy of Sciences, 1799 Jimei Road, Xiamen 361021, China
| | - Qingyu Huang
- Key Lab of Urban
Environment and Health, Institute of Urban Environment, Chinese Academy of Sciences, 1799 Jimei Road, Xiamen 361021, China
| | - Heqing Shen
- Key Lab of Urban
Environment and Health, Institute of Urban Environment, Chinese Academy of Sciences, 1799 Jimei Road, Xiamen 361021, China
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184
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Vivas-Acevedo G, Lozano-Hernández R, Camejo MI. Varicocele decreases epididymal neutral α-glucosidase and is associated with alteration of nuclear DNA and plasma membrane in spermatozoa. BJU Int 2014; 113:642-9. [PMID: 24148354 DOI: 10.1111/bju.12523] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To assess the relationship between a marker of epididymal function and both the fragmentation of the sperm nucleus and the integrity and maturity of the sperm membrane in patients with or without varicocele. PATIENTS AND METHODS Semen samples were obtained from men with varicocele grades II and III (n = 60) and from a control group with zoospermia defined as normal (n = 30). Samples were evaluated by a spermiogram, a hypoosmotic swelling test (HOST), neutral α-glucosidase (NAG) enzyme activity, sperm hyaluronan-binding assay (HBA) and DNA fragmentation using a sperm chromatin dispersion (SCD) test. RESULTS Seminal plasma NAG levels, percentage of sperm bound to hyaluronic acid, HOST-positive cells and sperm quality were significantly lower in the varicocele compared with the control group. Higher levels of sperm DNA fragmentation, as measured by SCD, were also observed in the varicocele group compared with the control group. Seminal NAG activity levels showed a strong negative correlation with DNA fragmentation and a significant positive correlation with the HBA test and the HOST. CONCLUSIONS Varicocele causes a reduction in NAG activity by the epididymis that is associated with damage to both the membrane and sperm nucleus and a reduction in the seminal parameters. NAG levels were correlated with the quality of the sperm membrane and nucleus. Data suggest that a reduction of fertilization capacity in men during varicocele can result from damage to both the testis and the epididymis.
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Affiliation(s)
- Giovanny Vivas-Acevedo
- Department of Clinical Bioanalysis, Centro Diagnóstico de Infertilidad y Enfermedades Genéticas (CEDIEG), University of Los Andes, Mérida
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185
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Esteves SC, Sharma RK, Gosálvez J, Agarwal A. A translational medicine appraisal of specialized andrology testing in unexplained male infertility. Int Urol Nephrol 2014; 46:1037-52. [PMID: 24771472 DOI: 10.1007/s11255-014-0715-0] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 04/05/2014] [Indexed: 02/06/2023]
Abstract
The diagnostic and prognostic validity of sperm function biomarkers is particularly relevant for males with unexplained infertility in which routine semen analysis fails to detect subcellular sperm dysfunctions. In this general review, we examine the role and significance of specialized andrology laboratory tests from past to present and provide a glance toward the future. We concluded that the assessment of sperm DNA damage and oxidative stress provide a relatively independent measure of fertility that yields diagnostic and prognostic information complementary to, but distinct and more significant than, standard sperm parameters. Since none of the available methods for such testing have been fully translated, further research is necessary to evaluate their cost-effectiveness when applied in large scale to daily medical practice. Application of translational medicine concepts would also be useful to accelerate the clinical application of recent discoveries in the fields of genomics, proteomics and metabolomics.
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Affiliation(s)
- Sandro C Esteves
- Androfert, Andrology and Human Reproduction Clinic, Av. Dr. Heitor Penteado, 1464, Campinas, São Paulo, 13075-460, Brazil,
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186
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Agarwal A, Virk G, Ong C, du Plessis SS. Effect of oxidative stress on male reproduction. World J Mens Health 2014; 32:1-17. [PMID: 24872947 PMCID: PMC4026229 DOI: 10.5534/wjmh.2014.32.1.1] [Citation(s) in RCA: 714] [Impact Index Per Article: 71.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 10/24/2013] [Indexed: 12/22/2022] Open
Abstract
Infertility affects approximately 15% of couples trying to conceive, and a male factor contributes to roughly half of these cases. Oxidative stress (OS) has been identified as one of the many mediators of male infertility by causing sperm dysfunction. OS is a state related to increased cellular damage triggered by oxygen and oxygen-derived free radicals known as reactive oxygen species (ROS). During this process, augmented production of ROS overwhelms the body's antioxidant defenses. While small amounts of ROS are required for normal sperm functioning, disproportionate levels can negatively impact the quality of spermatozoa and impair their overall fertilizing capacity. OS has been identified as an area of great attention because ROS and their metabolites can attack DNA, lipids, and proteins; alter enzymatic systems; produce irreparable alterations; cause cell death; and ultimately, lead to a decline in the semen parameters associated with male infertility. This review highlights the mechanisms of ROS production, the physiological and pathophysiological roles of ROS in relation to the male reproductive system, and recent advances in diagnostic methods; it also explores the benefits of using antioxidants in a clinical setting.
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Affiliation(s)
- Ashok Agarwal
- Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Gurpriya Virk
- Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Chloe Ong
- Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Stefan S du Plessis
- Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
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187
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Sheehan MM, Ramasamy R, Lamb DJ. Molecular mechanisms involved in varicocele-associated infertility. J Assist Reprod Genet 2014; 31:521-6. [PMID: 24643631 DOI: 10.1007/s10815-014-0200-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 02/24/2014] [Indexed: 12/01/2022] Open
Abstract
Varicocele is a pathologic enlargement of the pampiniform venous plexus within the spermatic cord, a condition that is a common cause of impaired sperm production and decreased quality of sperm. While varicocele is the most common surgically correctable risk factor for male infertility, not all males with varicocele experience infertility. In fact, most men with varicocele have normal spermatogenesis. Despite its prevalence, the molecular mechanisms of varicocele and its effect on testicular function are yet to be completely understood. We postulate that men with varicocele-associated infertility could have preexisting genetic lesions or defects in molecular mechanisms that make them more susceptible to varicocele-mediated testicular injury affecting spermatogenesis.
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Affiliation(s)
- Matthew M Sheehan
- Department of Urology, Weill Cornell Medical College, New York, NY, USA
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188
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Kadioglu TC, Aliyev E, Celtik M. Microscopic varicocelectomy significantly decreases the sperm DNA fragmentation index in patients with infertility. BIOMED RESEARCH INTERNATIONAL 2014; 2014:695713. [PMID: 24712000 PMCID: PMC3966333 DOI: 10.1155/2014/695713] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Revised: 01/27/2014] [Accepted: 01/27/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Varicocele is associated with high levels of DNA damage in spermatozoa due to oxidative stress and elevated levels of sperm DNA fragmentation, which has been currently proposed to be an essential additional diagnostic test to be recommended for patients with clinical varicocele. The aim of this study was to evaluate the parameters of semen and the DNA fragmentation index (DFI) in patients with varicocele before and after varicocelectomy. METHODS The details of 92 consecutive patients were retrospectively analyzed from January 2010 to December 2012. The sperm samples were evaluated according to the World Health Organization Guidelines. Sperm DNA damage, characterized as DFI, was evaluated by sperm chromatin structure assay using flow cytometry. RESULTS There was a statistically significant improvement in the semen concentration, the total motile count, the total normal sperm count, and the sperm DNA fragmentation index (DFI; the percentage of sperm with denatured DNA) after varicocelectomy. There was a large decrease in DFI from a preoperative mean of 42.6% to a postoperative mean of 20.5% (P < 0.001). A higher preoperative DFI was associated with a larger decrease in postoperative DFI, and significant negative correlations were observed between the DFI and sperm motility (r = -0.42, P < 0.01). CONCLUSION Our data suggest that varicocelectomy can improve multiple semen parameters and sperm DNA damage in infertile men with varicocele. The patients with preoperative defects in those parameters showed greater improvement postoperatively. Further research in this area is needed to understand the exact mechanisms of DNA damage in infertile men with varicocele.
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Affiliation(s)
- Teoman Cem Kadioglu
- Department of Urology, Istanbul School of Medicine, University of Istanbul, 34365 Istanbul, Turkey
| | - Emin Aliyev
- Department of Urology, Istanbul School of Medicine, University of Istanbul, 34365 Istanbul, Turkey
| | - Murad Celtik
- Department of Urology, Istanbul School of Medicine, University of Istanbul, 34365 Istanbul, Turkey
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189
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Liang Y, Dong Y, Zhao J, Li W. YES1 activation elicited by heat stress is anti-apoptotic in mouse pachytene spermatocytes. Biol Reprod 2013; 89:131. [PMID: 24132961 DOI: 10.1095/biolreprod.113.112235] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Deregulated expression of protein tyrosine phosphorylation has been implicated in testicular response to different stimuli. Herein, YES1, a nonreceptor protein tyrosine kinase, was found to be significantly up-regulated in pachytene spermatocytes (PS) during early recovery from a transient testicular heat stress. Coculture of PS with Sertoli cells (SCs) could enhance the hyperthermia-induced YES1 activation, indicative of a positive regulation of the paracrine signaling. Moreover, SU6656, a selective YES1 inhibitor, was shown to effectively block YES1 activity, thereafter resulting in a dramatic increase of heat stress-induced apoptosis in primary cultured PS. Mechanistically, the antiapoptotic effect of YES1 activation in response to testicular heat insult may mediate via the regulation of extracellular signal-regulated kinase (ERK)/metastasis-associated 1 (MTA1) cascade. From a clinical standpoint, a notably higher level of YES1 expression was observed in the pathological testis from varicocele patients as compared to a negligible staining in the control group. Taken together, our present results provide the first evidence that the YES1/ERK/MTA1/p53 cascade may serve as a naturally occurring, indispensable self-defensive mechanism maintaining apoptotic balance during meiotic heat stress. Our study may have also partially answered the question of how activation of signal pathways at the cell membrane surface interacts with the key regulatory events occurring in the nucleus during testicular heat shock.
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Affiliation(s)
- Yuan Liang
- Department of Pathology and Pathophysiology, Fourth Military Medical University, Xi'an, People's Republic of China
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190
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Gosálvez J, Rodríguez-Predreira M, Mosquera A, López-Fernández C, Esteves SC, Agarwal A, Fernández JL. Characterisation of a subpopulation of sperm with massive nuclear damage, as recognised with the sperm chromatin dispersion test. Andrologia 2013; 46:602-9. [PMID: 23710631 DOI: 10.1111/and.12118] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2013] [Indexed: 11/27/2022] Open
Abstract
Assessment of human sperm DNA fragmentation by the sperm chromatin dispersion (SCD) test is based on the detection of haloes of spreading DNA loops after sequential DNA denaturing and protamine removal. After the SCD test, sperm without DNA fragmentation show chromatin haloes emerging from the central nuclear core, while sperm containing fragmented DNA present small or no haloes. The nuclear degraded sperm are recognised as a differentiated category within the sperm with fragmented DNA, whose cores appear irregularly and/or faintly stained. This subpopulation is more prevalent in patients with varicocele. Protein staining with 2.7-dibrom-4-hydroxy-mercury-fluorescein demonstrated that degraded sperm intensely lose nuclear core proteins after the SCD processing. Moreover, degraded sperm are 65% more faintly labelled for DNA breaks after in situ nick translation (ISNT) on average, due to extensive DNA loss. A two-dimensional comet assay under sequential neutral and alkaline conditions demonstrated that degraded sperm contain both massive double- and single-strand DNA breaks. The degraded sperm appear as a subpopulation with stronger nuclear damage, affecting both DNA and protein fractions, possibly due to intense intratesticular oxidative stress, what could explain its higher proportion in patients with varicocele.
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Affiliation(s)
- J Gosálvez
- Department of Biology, Genetics Unit, Universidad Autónoma de Madrid, Madrid, Spain
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191
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De Zordo T, Stronegger D, Pallwein-Prettner L, Harvey CJ, Pinggera G, Jaschke W, Aigner F, Frauscher F. Multiparametric ultrasonography of the testicles. Nat Rev Urol 2013; 10:135-48. [DOI: 10.1038/nrurol.2012.255] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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192
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Hamada A, Esteves SC, Agarwal A. Insight into oxidative stress in varicocele-associated male infertility: part 2. Nat Rev Urol 2012; 10:26-37. [PMID: 23165400 DOI: 10.1038/nrurol.2012.198] [Citation(s) in RCA: 114] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Varicocele, the leading cause of male infertility, can impair spermatogenesis through several pathophysiological mechanisms. Of these, current evidence suggests that oxidative stress is the central element contributing to infertility in men with varicocele, to which the testis responds by way of heat stress, ischaemia or production of vasodilators, such as nitric oxide. Surgical varicocele repair (varicocelectomy) is beneficial not only for alleviating oxidative stress-associated infertility, but also for preventing and protecting against the progressive character of varicocele and its consequent upregulations of systemic oxidative stress. However, antioxidant therapy in infertile men with surgically treated and those with untreated varicocele is poorly studied, and well-designed trials are needed.
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Affiliation(s)
- Alaa Hamada
- Center for Reproductive Medicine, Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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