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Li Z, Li J, Li Y, Guo L, Xu P, Du H, Lin N, Xu Y. The role of Cistanches Herba and its ingredients in improving reproductive outcomes: A comprehensive review. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2024; 129:155681. [PMID: 38718638 DOI: 10.1016/j.phymed.2024.155681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 04/11/2024] [Accepted: 04/23/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND Infertility patients account for an astonishing proportion of individuals worldwide. Due to its complex etiology and challenging treatment, infertility has imposed significant psychological and economic burdens on many patients. C. Herba (Cistanche tubulosa (Schenk) Wight and Cistanche deserticola Ma), renowned as one of the most prominent Chinese herbal medicines (CHMs), is abundant in diverse bioactive compounds that exhibit therapeutic effects on many diseases related to oxidative stress (OS) and disorders of sex hormone levels. OBJECTIVE Due to the limited drugs currently used in clinical practice to improve reproductive outcomes and their inevitable side effects, developing safe and effective new medications for infertility is of significance. This article comprehensively reviewed the phytochemicals of C. Herba, focusing on their efficacy and mechanisms on infertility and their safety for the first time, aiming to offer valuable insights for the development and application of C. Herba, and for developing novel strategies for treating infertility. METHODS We used "Cistanche" and its known bioactive components in combination with "sperm", "testicles", "epididymis", "ovaries", "uterus", and "infertility" as keywords to search in PubMed, Web of Science, Scopus and CNKI up to November 2023. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guideline was followed. RESULTS The therapeutic effects of C. Herba on infertility are mainly attributed to echinacoside (ECH), verbascoside (VB), salidroside (SAL), polysaccharides, and betaine. They can effectively improve spermatogenic dysfunction, gonadal dysfunction and erectile dysfunction (ED) by exerting anti-oxidation, sex hormones regulation and anti-hypoxia. Moreover, they can also improve premature ovarian failure (POF), ovarian and uterine cancer, oocyte maturation by exerting anti-oxidation, anti-apoptosis, and anti-cancer. C. Herba and its active ingredients also exhibit pleasing safety. CONCLUSION C. Herba is a promising source of natural medicine for infertility. Additionally, compared to current therapeutic drugs, its favorable safety also supports its development as a nutritional supplement. However, high-quality clinical studies are required to validate its effectiveness for the development of novel therapeutic strategies.
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Affiliation(s)
- Zehui Li
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Jiashan Li
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Yuan Li
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Li Guo
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Panyu Xu
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Hanqian Du
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Na Lin
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Ying Xu
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China.
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Gonzalez-Daza SJ, Díaz-Hung AM, García-Perdomo HA. Association between varicocele and hypogonadism, or erectile dysfunction: A systematic review and meta-analysis. Actas Urol Esp 2024:S2173-5786(24)00084-2. [PMID: 38960064 DOI: 10.1016/j.acuroe.2024.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 05/09/2024] [Indexed: 07/05/2024]
Abstract
OBJECTIVE To assess the association between varicocele and hypogonadism, or erectile dysfunction. METHODS We searched MEDLINE, EMBASE, LILACS, CENTRAL, and other sources. We included cohort, case-control, and cross-sectional studies. The primary outcome was the association between varicocele and hypogonadism, or erectile dysfunction, and the secondary outcome included semen analysis. We assessed the risk of bias with the Newcastle-Ottawa Scale. We performed statistical analysis in Review Manager 5.3 and reported information about the Odds Ratio (OR) with a 95% confidence interval. We produced a forest plot for the primary outcome. RESULTS We included ten studies in qualitative analysis and six studies in quantitative analysis. Most of the cross-sectional studies showed a low risk of bias, not so for the two case-control studies, which represented a high risk of bias. Most of the reports described a correlation between having varicocele and presenting low testosterone levels: the meta-analysis showed that there is a significant association between varicocele and hypogonadism (OR 3.27 95%CI 1.23 to 8.68). Regarding varicocele and erectile, only one study showed a significant difference in erectile function in comparison to varicocele patients and men without varicocele. CONCLUSION There is an association between varicocele presence and hypogonadism, although more studies are needed. Besides, not much is reported about an association between varicocele and erectile dysfunction, but impairment can occur through hormone disturbances.
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Affiliation(s)
- S J Gonzalez-Daza
- Grupo de Investigación UROGIV, Escuela de Medicina, Universidad del Valle, Cali, Colombia
| | - A M Díaz-Hung
- Grupo de Investigación UROGIV, Escuela de Medicina, Universidad del Valle, Cali, Colombia; Unidad de Urología, Departamento de Cirugía, Escuela de Medicina, Universidad del Valle, Cali, Colombia
| | - H A García-Perdomo
- Grupo de Investigación UROGIV, Escuela de Medicina, Universidad del Valle, Cali, Colombia; Unidad de Urología, Departamento de Cirugía, Escuela de Medicina, Universidad del Valle, Cali, Colombia.
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Marquardt N, Ros CTD. Can we recommend varicocele surgery for men with hypogonadism? Int Braz J Urol 2023; 49:637-643. [PMID: 37506035 PMCID: PMC10482463 DOI: 10.1590/s1677-5538.ibju.2023.0190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 05/23/2023] [Indexed: 07/30/2023] Open
Affiliation(s)
- Nilson Marquardt
- Pontifícia Universidade Católica do Rio Grande do SulDepartamento de UrologiaPorto AlegreRSBrasilDepartamento de Urologia, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - Carlos Teodósio Da Ros
- Pontifícia Universidade Católica do Rio Grande do SulDepartamento de UrologiaPorto AlegreRSBrasilDepartamento de Urologia, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brasil
- Universidade Luterana do BrasilDisciplina de UrologiaCanoasRSBrasilDisciplina de Urologia, Universidade Luterana do Brasil – ULBRA, Canoas, RS, Brasil
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Park YW, Lee JH. Long-term efficacy of varicocele repair in middle-aged men with erectile dysfunction (ED) and low testosterone: Five cases with follow-up from 16 to 60 months. JOURNAL OF CLINICAL UROLOGY 2022. [DOI: 10.1177/20514158221078724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We report five cases of middle-aged men with low testosterone levels and erectile dysfunction (ED) who were successfully treated with varicocelectomy with long-term follow-up. All five patients presented to our clinic with ED. Upon initial physical examination, each patient had varicoceles on his scrotum, and two consecutive morning samplings showed testosterone levels below 400 ng/mL. Age at varicocelectomy was from 40 to 53 years. Four patients underwent microscopic subinguinal varicocelectomy, whereas one patient underwent inguinal varicocelectomy. After surgery, testosterone increased in all cases, and the normal testosterone level was maintained during follow-up (16–60 months). In addition, all cases reported improvement of ED after surgery. In our clinical cases, microscopic varicocelectomy increased serum testosterone levels and improved erectile function, and this increase and improvement continued up to a follow-up of 60 months. Varicocelectomy would be a good option to treat testosterone deficiency in men with varicocele.
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Affiliation(s)
- Yeon Won Park
- Department of Urology, National Police Hospital, South Korea
| | - Jun Ho Lee
- Department of Urology, Nowon Eulji Medical Center, Eulji University, South Korea
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Kaltsas A, Markou E, Zachariou A, Dimitriadis F, Mamoulakis C, Andreadakis S, Giannakis I, Tsounapi P, Takenaka A, Sofikitis N. Varicoceles in Men With Non-obstructive Azoospermia: The Dilemma to Operate or Not. FRONTIERS IN REPRODUCTIVE HEALTH 2022; 4:811487. [PMID: 36303681 PMCID: PMC9580802 DOI: 10.3389/frph.2022.811487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 03/10/2022] [Indexed: 12/04/2022] Open
Abstract
The knowledge on male reproduction is constantly expanding, especially in treating infertility due to non-obstructive azoospermia (NOA). Varicocele is occasionally diagnosed in a subpopulation of males with NOA. Varicocele repair in NOA-men may contribute to the reappearance of spermatozoa in semen. However, spontaneous pregnancies are observed in only a small percentage of NOA-men post-varicocelectomy. Additionally, it has been reported that the repair of varicocele in NOA-men (before the performance of sperm retrieval techniques) may increase the testicular sperm recovery rate. In addition, it increases the pregnancy rate in intracytoplasmic sperm injection (ICSI) programs in NOA-men without spermatozoa in the semen post-varicocelectomy. In addition, to the improvement in Sertoli cellular secretory function, varicocelectomy may increase the secretory function of Leydig cells, which subsequently results in improved androgen production, raising the probability to negate the need for testosterone replacement therapy in cases of late-onset hypogonadism. On the other hand, the benefit of varicocelectomy in patients with NOA is still debatable. The current review study aims to provide a critical and extensive review of varicocele repair in males with NOA. This study additionally focuses on the impact of varicocele repair on sperm retrieval rates and its influence on the ICSI outcomes for those couples who remain negative for spermatozoa in their semen samples post-varicocelectomy.
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Affiliation(s)
- Aris Kaltsas
- Laboratory of Spermatology, Department of Urology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
- *Correspondence: Aris Kaltsas
| | - Eleftheria Markou
- Laboratory of Spermatology, Department of Urology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Athanasios Zachariou
- Laboratory of Spermatology, Department of Urology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Fotios Dimitriadis
- Department of Urology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Sotirios Andreadakis
- Laboratory of Spermatology, Department of Urology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Ioannis Giannakis
- Laboratory of Spermatology, Department of Urology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Panagiota Tsounapi
- Department of Urology, School of Medicine, Tottori University, Yonago, Japan
| | - Atsushi Takenaka
- Department of Urology, School of Medicine, Tottori University, Yonago, Japan
| | - Nikolaos Sofikitis
- Laboratory of Spermatology, Department of Urology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
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Oztekin U, Atac F, Caniklioglu M, Sari S, Tokpinar A, Sonmez G. Effects of varicocelectomy on sleep quality: Varicocele may affect sleep quality. UROLOGICAL SCIENCE 2021. [DOI: 10.4103/uros.uros_164_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Jang WS, Kim KH, Lim KT, Lee J, Heo JE, Kwon H, Kang H, Lee JH, Choe SA, Kim DK. External validation of the post-varicocele repair semen analysis nomogram to predict total motile sperm count: A multicenter study. Andrologia 2020; 52:e13809. [PMID: 32882055 DOI: 10.1111/and.13809] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/17/2020] [Accepted: 07/27/2020] [Indexed: 11/29/2022] Open
Abstract
Total motile sperm count is an important parameter for predicting the probability of natural pregnancy. We have externally validated the Samplaski's post-varicocele repair semen analysis nomogram to confirm the predictive accuracy of total motile sperm count. A total of 300 patients who had undergone varicocelectomy between July 2016 and July 2019 from 4 treatment centres were included in this validation cohort study. The predictive performance of the externally validated nomogram was revealed by applying the Pearson correlation coefficient (R = 0.328; 95% confidence interval (CI) 0.220-0.435; p < .001). Compared to Samplaski's nomogram result (R = 0.581; 95% CI 0.186-0.729), our study also revealed a statistically significant rate. However, it had a relatively lower correlation coefficient rate. Notably, the predicted total motile sperm count was lower than the observed post-varicocelectomy total motile sperm count. The calibration plot revealed that the discrepancy between the predicted and observed total motile sperm count was plausible. However, it had low explanatory power in this nomogram model. This validation study demonstrates that the post-varicocele repair Samplaski's nomogram predicts a relatively lower total motile sperm count than the observed count.
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Affiliation(s)
- Won Sik Jang
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Ki Hong Kim
- Department of Urology, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Kyoung Taek Lim
- Department of Urology, Maria Fertility Hospital, Seoul, Korea
| | - Jongsoo Lee
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Eun Heo
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hyojeong Kwon
- Andrology Laboratory, CHA Fertility Center Seoul Station, Seoul, Korea
| | - Hyoeun Kang
- Andrology Laboratory, CHA Fertility Center Seoul Station, Seoul, Korea
| | - Jae Ho Lee
- Department of Biomedical Science, College of Life Science, CHA Fertility Center Seoul Station, CHA University, Seoul, Korea
| | - Seung-Ah Choe
- Department of Obstetrics and Gynecology, CHA Fertility Center Seoul Station, CHA University School of Medicine, Seoul, Korea
| | - Dae Keun Kim
- Department of Urology, CHA Fertility Center Seoul Station, CHA University School of Medicine, Seoul, Korea
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Nutraceutical Effects of Lycopene in Experimental Varicocele: An "In Vivo" Model to Study Male Infertility. Nutrients 2020; 12:nu12051536. [PMID: 32466161 PMCID: PMC7284888 DOI: 10.3390/nu12051536] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/09/2020] [Accepted: 05/22/2020] [Indexed: 12/14/2022] Open
Abstract
Varicocele is one of the main causes of infertility in men. Oxidative stress and consequently apoptosis activation contribute to varicocele pathogenesis, worsening its prognosis. Natural products, such as lycopene, showed antioxidant and anti-inflammatory effects in several experimental models, also in testes. In this study we investigated lycopene effects in an experimental model of varicocele. Male rats (n = 14) underwent sham operations and were administered with vehicle (n = 7) or with lycopene (n = 7; 1 mg/kg i.p., daily). Another group of animals (n = 14) underwent surgical varicocele. After 28 days, the sham and 7 varicocele animals were euthanized, and both operated and contralateral testes were weighted and processed. The remaining rats were treated with lycopene (1 mg/kg i.p., daily) for 30 days. Varicocele rats showed reduced testosterone levels, testes weight, Bcl-2 mRNA expression, changes in testes structure and increased malondialdehyde levels and BAX gene expression. TUNEL (Terminal Deoxynucleotidyl Transferase dUTP Nick End Labeling) assay showed an increased number of apoptotic cells. Treatment with lycopene significantly increased testosterone levels, testes weight, and Bcl-2 mRNA expression, improved tubular structure and decreased malondialdehyde levels, BAX mRNA expression and TUNEL-positive cells. The present results show that lycopene exerts beneficial effects in testes, and suggest that supplementation with the tomato-derived carotenoid might be considered a novel nutraceutical strategy for the treatment of varicocele and male infertility.
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Krzastek SC, Smith RP. Non-testosterone management of male hypogonadism: an examination of the existing literature. Transl Androl Urol 2020; 9:S160-S170. [PMID: 32257856 PMCID: PMC7108991 DOI: 10.21037/tau.2019.11.16] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Testosterone deficiency is defined as a total testosterone level <300 ng/dL confirmed on two early morning lab draws. Testosterone therapy has historically been offered to men with symptomatic testosterone deficiency in the form of injections, gels, or pellets. However, these treatments are invasive or have undesirable effects including the risk of drug transference. Additionally, testosterone therapy has been associated with increases in hematocrit and controversy remains regarding the risk of cardiovascular and thromboembolic events while on testosterone therapy. As such, much interest has recently been focused on alternative treatment options for testosterone deficiency in the form of orally-administered medications with more favorable side effect profiles. Lifestyle modifications and varicocelectomy have been shown to raise endogenous testosterone production. Similarly, SERMs and aromatase inhibitors (AIs) have been shown to raise testosterone levels safely and effectively. Human chorionic gonadotropin (hCG) remains the only FDA-approved non-testosterone treatment option for testosterone deficiency in men. However, this medication is expensive and requires patient-administered injections. Over the counter herbal supplements and designer steroids remain available though they are poorly studied and are associated with the potential for abuse as well as increased hepatic and cardiovascular risks. This review aims to discuss the existing treatment alternatives to traditional testosterone therapy, including efficacy, safety, and side effects of these options. The authors suggest that the SERM clomiphene citrate (CC) holds the greatest promise as a non-testosterone treatment option for testosterone deficiency.
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Affiliation(s)
- Sarah C Krzastek
- Department of Urology, University of Virginia, Charlottesville, VA, USA
| | - Ryan P Smith
- Department of Urology, University of Virginia, Charlottesville, VA, USA
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Lipshultz LI, Ramasamy R, Sandlow JI, Hotaling J, Eisenberg M, Niederberger C, Brannigan RE. Microsurgical varicocelectomy: novel applications to optimize patient outcomes. Fertil Steril 2019; 112:632-639. [DOI: 10.1016/j.fertnstert.2019.08.057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 08/19/2019] [Indexed: 11/30/2022]
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