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Mei Y, Xie P, Liu D, Zhang B, Feng X. Mean platelet volume might be an effective indicator of poor semen quality in varicocele patients. Int Urol Nephrol 2024:10.1007/s11255-024-04089-3. [PMID: 38789870 DOI: 10.1007/s11255-024-04089-3] [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: 04/04/2024] [Accepted: 05/18/2024] [Indexed: 05/26/2024]
Abstract
OBJECTIVE To delve into the relationship between mean platelet volume (MPV) and semen quality in patients with varicocele. MATERIALS AND METHODS A total of 246 varicocele patients and 120 healthy adult males were enrolled. Physical examinations and the color Doppler ultrasonography were conducted on patients with varicocele to confirm the diagnosis. Venous blood samples and semen samples were collected from all participants for subsequent analysis. A series of statistical analyses were conducted to assess the relationship between their MPV levels and semen quality. A series of statistical analyses were performed to assess the relationship between MPV and semen quality. RESULTS No statistically significant differences were found between body mass index (BMI), sexual hormones, semen volume, platelet count, and right testicular volume in all three groups (health subjects, varicocele without symptoms, and varicocele with infertility). When conducting regression analysis on two groups with varicocele, the results indicated that a lower MPV is associated with a reduced risk of varicocele accompanied by infertility (OR = 0.557 95% CI: 0.432-0.719, P < 0.001). Further correlation analysis in varicocele patients revealed that high MPV had a statistically negative impact on the occurrence of poor semen quality, affecting sperm concentration, progressive motility, and morphology (all P < 0.001). More importantly, when predicting varicocele associated with infertility, MPV demonstrated high diagnostic sensitivity (AUC = 0.745, P < 0.001). CONCLUSION Our results indicate that MPV is higher in varicocele with infertility and is closely related to semen quality, which may suggest an accompanying decline in semen quality associated with varicocele. However, these conclusions require further experimental validation.
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Affiliation(s)
- Yangyang Mei
- Department of Urology, Jiangyin People's Hospital of Jiangsu Province, Jiangyin, China
| | - Pinpeng Xie
- Department of Clinical Medicine, The Second School of Clinical Medicine, Anhui Medical University, Anhui, China
- Department of Urology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China
| | - Dalu Liu
- Department of General Surgery, The Affiliated Chuzhou Hospital of Anhui Medical University, Chuzhou, Anhui, China.
| | - Bo Zhang
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Xingliang Feng
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China.
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2
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Hekim N, Gunes S, Ergun S, Barhan EN, Asci R. Investigation of sperm hsa-mir-145-5p and MLH1 expressions, seminal oxidative stress and sperm DNA fragmentation in varicocele. Mol Biol Rep 2024; 51:588. [PMID: 38683237 DOI: 10.1007/s11033-024-09534-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 04/08/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Mechanisms by which varicocele causes infertility are not clear and few studies have reported that some miRNAs show expression alterations in men with varicocele. Recently, sperm promoter methylation of MLH1 has been shown to be higher in men diagnosed with varicocele. This study aimed to assess the potential effects of miR-145, which was determined to target MLH1 mRNA in silico on sperm quality and function in varicocele. METHODS Sperm miR-145 and MLH1 expressions of six infertile men with varicocele (Group 1), nine idiopathic infertile men (Group 2), and nine fertile men (control group) were analyzed by quantitative PCR. Sperm DNA fragmentation was evaluated by TUNEL and the levels of seminal oxidative damage and total antioxidant capacity were analyzed by ELISA. RESULTS Our results have shown that sperm expression of miR-145 was decreased in Group 1 compared to Group 2 (P = 0.029). MLH1 expression was significantly higher in Group 2 than the controls (P = 0.048). Total antioxidant level and sperm DNA fragmentations of Group 1 and Group 2 were decreased (P = 0.001 and P = 0.011, respectively). Total antioxidant capacity was positively correlated with sperm concentration (ρ = 0.475, P = 0.019), total sperm count (ρ = 0.427, P = 0.037), motility (ρ = 0.716, P < 0.0001) and normal morphological forms (ρ = 0.613, P = 0.001) and negatively correlated with the seminal oxidative damage (ρ=-0.829, P = 0.042) in varicocele patients. CONCLUSION This is the first study investigating the expressions of sperm miR-145 and MLH1 in varicocele patients. Further studies are needed to clarify the potential effect of miR-145 on male fertility.
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Affiliation(s)
- Neslihan Hekim
- Faculty of Medicine, Department of Medical Biology, Ondokuz Mayis University, Samsun, 55139, Turkey.
- Graduate Institute, Department of Molecular Medicine, Ondokuz Mayis University, Samsun, Turkey.
| | - Sezgin Gunes
- Faculty of Medicine, Department of Medical Biology, Ondokuz Mayis University, Samsun, 55139, Turkey
- Graduate Institute, Department of Molecular Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Sercan Ergun
- Faculty of Medicine, Department of Medical Biology, Ondokuz Mayis University, Samsun, 55139, Turkey
- Graduate Institute, Department of Molecular Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Elzem Nisa Barhan
- Faculty of Medicine, Department of Medical Biology, Ondokuz Mayis University, Samsun, 55139, Turkey
| | - Ramazan Asci
- Graduate Institute, Department of Molecular Medicine, Ondokuz Mayis University, Samsun, Turkey
- Faculty of Medicine, Department of Urology, Ondokuz Mayis University, Samsun, Turkey
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3
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Lira Neto FT, Roque M, Esteves SC. Effect of varicocele and varicocelectomy on sperm deoxyribonucleic acid fragmentation rates in infertile men with clinical varicocele. Minerva Obstet Gynecol 2024; 76:49-69. [PMID: 36222786 DOI: 10.23736/s2724-606x.22.05169-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Varicocele is the leading cause of male infertility. It can affect sperm quantity and quality through various non-mutually exclusive pathophysiological mechanisms, mainly oxidative stress. Excessive production of reactive oxygen species may overwhelm the sperm's defenses against oxidative stress and harm the sperm's DNA. Excessive sperm DNA breaks, so-called sperm DNA fragmentation, result from the oxidative stress cascade and are commonly found in the ejaculates of men with varicocele and fertility-related issues. Measuring sperm DNA fragmentation can provide valuable information on the extent of harm and might help select candidates for surgical treatment. Varicocelectomy is beneficial for alleviating oxidative stress-associated infertility and improving sperm DNA integrity. However, reproductive outcomes of infertile men with elevated sperm DNA fragmentation rates and surgically treated varicoceles remain poorly studied, and there is a need for well-designed trials to determine the impact of sperm DNA fragmentation reduction on natural and medically assisted reproduction.
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Affiliation(s)
- Filipe T Lira Neto
- AndrosRecife, Andrology Clinic, Recife, Brazil
- Department of Urology, Prof. Fernando Figueira Institute of Integrative Medicine, Recife, Brazil
| | - Matheus Roque
- Department of Reproductive Medicine, Mater Prime, São Paulo, Brazil
| | - Sandro C Esteves
- ANDROFERT, Andrology and Human Reproduction Clinic, Referral Center for Male Reproduction, Campinas, Brazil -
- Division of Urology, Department of Surgery, University of Campinas (UNICAMP), Campinas, Brazil
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
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4
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Sperm DNA Damage and Its Relevance in Fertility Treatment: A Review of Recent Literature and Current Practice Guidelines. Int J Mol Sci 2023; 24:ijms24021446. [PMID: 36674957 PMCID: PMC9860847 DOI: 10.3390/ijms24021446] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/02/2023] [Accepted: 01/04/2023] [Indexed: 01/14/2023] Open
Abstract
Sperm deoxyribonucleic acid (DNA) damage has recently emerged as one of the most controversial topics in male reproductive medicine. While level I evidence indicates that abnormal sperm DNA damage has substantial adverse effects on reproductive outcomes (including chance of pregnancy and risk of miscarriage), there is limited consensus on how sperm DNA fragmentation (SDF) testing should be performed and/or interpreted in clinical practice. In this article, we review: (1) how SDF is assessed, (2) cumulative evidence regarding its impact on reproductive outcomes, (3) methods for mitigating high SDF, and (4) the most recent practice guidelines available for clinicians regarding the use and interpretation of SDF testing.
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5
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Bao B, Ke M, Guo J, Pan Z, Huang H, Ke Z, Zhou X, Liu B. Bibliometrics and visualisation analysis of literature on varicocele: From 2002 to 2021. Andrologia 2022; 54:e14537. [PMID: 35920088 DOI: 10.1111/and.14537] [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: 05/11/2022] [Revised: 06/23/2022] [Accepted: 07/11/2022] [Indexed: 11/27/2022] Open
Abstract
Varicocele is a common disease in men, with a global incidence of approximately 25%. A comprehensive and systematic analysis of the knowledge map on it will help in assessing frontier research and identify knowledge gaps. In total, 4103 articles published from 2002 to 2021 in 1066 journals were included. They represent the current research status worldwide, potential hotspots and future research directions. In the past decades, the number of publications and citations of varicocele-related studies have increased steadily. Academic institutions in the United States played a leading role in varicocele research. The country, institution, journal and author with the most publications were the United States (779), Cleveland Clinic Foundation (132), Andrologia (246) and Agarwal A (106), respectively. The most frequently used keywords were Varicocele (1620), Male Infertility (944), Varicocelectomy (288), Testis (245), Sperm (166), Oxidative Stress (144), Azoospermia (119), Semen Analysis (118), Laparoscopy (116) and Adolescent (97). Currently, the main focus of current varicocele research is its surgical treatment method and effect on sperm quality. The frontier research hotspot is the specific mechanism of varicocele-induced decrease in sperm quality.
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Affiliation(s)
- Binghao Bao
- Graduate School of Beijing University of Chinese Medicine, Beijing, China.,Department of Andrology, China-Japan Friendship Hospital, Beijing, China
| | - Minghui Ke
- Department of Andrology, China-Japan Friendship Hospital, Beijing, China
| | - Jianqiang Guo
- Graduate School of Beijing University of Chinese Medicine, Beijing, China.,Department of Andrology, China-Japan Friendship Hospital, Beijing, China
| | - Zhengkun Pan
- Graduate School of Beijing University of Chinese Medicine, Beijing, China.,Department of Andrology, China-Japan Friendship Hospital, Beijing, China
| | - Haonan Huang
- Graduate School of Beijing University of Chinese Medicine, Beijing, China.,Department of Andrology, China-Japan Friendship Hospital, Beijing, China
| | - Zhenghao Ke
- Graduate School of Beijing University of Chinese Medicine, Beijing, China.,Department of Andrology, China-Japan Friendship Hospital, Beijing, China
| | - Xiaofeng Zhou
- Department of Urology, China-Japan Friendship Hospital, Beijing, China
| | - Baoxing Liu
- Department of Andrology, China-Japan Friendship Hospital, Beijing, China
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Lai TCT, Roychoudhury S, Cho CL. Oxidative Stress and Varicocele-Associated Male Infertility. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1358:205-235. [PMID: 35641872 DOI: 10.1007/978-3-030-89340-8_10] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Despite being regarded as one of the most common causes of male subfertility, the pathophysiology of varicocele remains largely unknown. Recently, oxidative stress (OS) is proposed to be the mediator in how varicocele may negatively impact fertility. The imbalance of reactive oxygen species (ROS) and seminal antioxidants results in damage to sperm DNA and lipid membrane. There is evidence demonstrating higher OS level in men with varicocele which is also positively correlated with clinical grading of varicocele. Moreover, a number of studies have revealed the negative correlation between OS and conventional semen parameters. Furthermore, various interventions have shown their potential in alleviating OS in men with varicocele-associated infertility. Although direct evidence on improving pregnancy rate is not available at the moment, varicocelectomy has demonstrated promising results in relieving OS. Oral antioxidants represent another option with a favourable safety profile. The supplement can be used alone or as adjunct to varicocelectomy. However, most of the studies are hampered by heterogenous dose regime and high-level evidence is lacking.
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Affiliation(s)
- Terence Chun-Ting Lai
- Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | | | - Chak-Lam Cho
- S. H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, Hong Kong.
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7
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Chakraborty S, Roychoudhury S. Pathological Roles of Reactive Oxygen Species in Male Reproduction. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1358:41-62. [PMID: 35641865 DOI: 10.1007/978-3-030-89340-8_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Reactive oxygen species (ROS) are free radicals that have at least one unpaired electron and play specific roles in the human body. An imbalance of ROS and antioxidant levels gives rise to a condition called oxidative stress. High levels of ROS in the male reproductive tract can interfere with its normal functioning and can even pose as toxic to the sperm, inhibiting sperm functioning (including motility) and metabolism. Oxidative stress resulting from ROS and lipid peroxidation is one of the major causes of male infertility including infertility in varicocele patients. These may cause DNA and peroxidative damage and apoptosis. Production of ROS in excess also leads to erectile dysfunction (ED). In recent years, studies have also linked oxidative stress with the development, progress, and therapy response of prostate cancer patients. The present study summarizes the pathological roles of ROS in male reproductive problems such as infertility, ED, and prostate cancer and also provide an insight into the probable mechanism through which ROS exert their pathological impact.
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Inflammation and Oxidative Stress in Seminal Plasma: Search for Biomarkers in Diagnostic Approach to Male Infertility. J Pers Med 2022; 12:jpm12060857. [PMID: 35743642 PMCID: PMC9224911 DOI: 10.3390/jpm12060857] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 05/20/2022] [Accepted: 05/23/2022] [Indexed: 02/04/2023] Open
Abstract
Oxidative and inflammatory damage underlie several conditions related to male infertility, including varicocele. Free light chains of immunoglobulins (FLCs) are considered markers of low-grade inflammation in numerous diseases. Coenzyme Q10 (CoQ10), a lipidic antioxidant and anti-inflammatory compound, is involved in spermatozoa energy metabolism and motility. We aimed to evaluate FLCs’ seminal levels in patients with varicocele in comparison to control subjects and to correlate them with CoQ10 and Total Antioxidant Capacity (TAC) in human semen. Sixty-five patients were enrolled. Semen analysis was performed; patients were divided into three groups: controls, 12 normozoospermic patients, aged 34 (33–41) years; varicocele (VAR), 29 patients, aged 33 (26–37) years; and idiopathic, 24 oligo-, astheno- and oligoasthenozoospermic patients aged 37 (33.5–40.5) years. FLCs (κ and λ) were assayed by turbidimetric method; CoQ10 by HPLC; TAC by spectrophotometric method. λ FLCs showed a trend toward higher levels in VAR vs. controls and the idiopathic group. VAR showed a trend toward lower κ FLCs levels vs. the other two groups. When comparing κ/λ ratio, VAR showed significantly lower levels vs. controls and idiopathic. Moreover, CoQ10 seminal levels showed higher levels in VAR and idiopathic compared to controls. Data reported here confirm lower levels of κ/λ ratio in VAR and suggest a possible application in personalized medicine as clinical biomarkers for male infertility.
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9
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Karam ZM, Baba Salari M, Anjom Shoaa A, Dehghan Kouhestani S, Bahram Nejad A, Ashourzadeh S, Zangouyee MR, Bazrafshani MR. Impact of oxidative stress SNPs on sperm DNA damage and male infertility in a south-east Iranian population. Reprod Fertil Dev 2022; 34:633-643. [PMID: 35361312 DOI: 10.1071/rd21305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 02/04/2022] [Indexed: 12/20/2022] Open
Abstract
AIM We examined four single nucleotide polymorphisms in four antioxidant genes (PON1 , CAT , GPx1 and SOD2 ) in 100 infertility cases and 100 controls from an Iranian population-based case-control study to confirm the assumption that polymorphisms in oxidative stress genes increase the risk of sperm DNA damage and idiopathic male infertility. METHODS Restriction fragment length polymorphism and tetra-primer amplification refractory mutation system PCR were used to identify genotypes. Sperm DNA damage was assessed using the Sperm Chromatin Dispersion test (Halo Sperm), and the total antioxidant capacity of seminal fluid was determined using the FRAP assay. KEY RESULTS Our findings demonstrated that alleles Arg-PON1 (rs662) and Ala-MnSOD (rs4880) variant genotypes were considerably linked with a higher risk of male infertility. CONCLUSIONS Linear regression analysis revealed that those with the PON1 Gln192Arg or SOD2 Val16Ala variants have significantly higher levels of sperm DNA fragmentation and lower levels of the total antioxidant capacity in seminal fluid. IMPLICATIONS These findings suggest that genetic differences in antioxidant genes may be linked to oxidative stress, sperm DNA damage, and idiopathic male infertility.
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Affiliation(s)
- Zahra Miri Karam
- Department of Medical Genetics, Afzalipour School of Medicine, Kerman University of Medical Sciences, Kerman, Iran; and Physiology Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Milad Baba Salari
- Department of Medical Genetics, Afzalipour School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Ahmad Anjom Shoaa
- Department of Medical Genetics, Afzalipour School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Somaye Dehghan Kouhestani
- Department of Medical Biotechnology, Faculty of Medical Sciences, Tarbiat Moddares University, Tehran, Iran; and Dr. Bazrafshani's Medical Genetic Laboratory, Kerman, Iran
| | | | - Sareh Ashourzadeh
- Afzalipour Clinical Center for Infertility, Kerman University of Medical Sciences, Kerman, Iran
| | - Moahammad Reza Zangouyee
- Department of Medical Genetics, Afzalipour School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Reza Bazrafshani
- Department of Medical Genetics, Afzalipour School of Medicine, Kerman University of Medical Sciences, Kerman, Iran; and Centre for Integrated Genomic Medical Research (CIGMR), University of Manchester, Stopford Building, Oxford Road, Manchester M13 9PT, UK
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Napolitano L, Pandolfo SD, Aveta A, Cirigliano L, Martino R, Mattiello G, Celentano G, Barone B, Rosati C, La Rocca R, Spena G, Spirito L. The Management of Clinical Varicocele: Robotic Surgery Approach. FRONTIERS IN REPRODUCTIVE HEALTH 2022; 4:791330. [PMID: 36303643 PMCID: PMC9580646 DOI: 10.3389/frph.2022.791330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 02/07/2022] [Indexed: 12/04/2022] Open
Abstract
Varicocele is a pathologic dilation of the testicular veins within the spermatic cord. Varicocele is considered the most common problem in reproductive medicine practice. It is identified in 15% of healthy men and up to 35% of men with primary infertility. The exact pathophysiology of varicoceles is not very well understood, and several theories have been proposed to explain it. Varicocele can impair sperm quality and fertility via various mechanisms: reflux of adrenal metabolites, increased testicular hypoxia, oxidative stress, and increased testicular temperature have been proposed. Several studies have reported the significant benefits on semen parameters with the surgical treatment of varicocele: reducing oxidatively induced sperm DNA damage and potentially improving fertility. Varicocele repair should be offered as a part of treatment option for male partners of infertile couples presenting with palpable varicoceles. Nowadays, there are several surgical approaches available for the treatment of varicocele, such as the retroperitoneal approach, inguinal approach, and the subinguinal approach. The subinguinal microscopic approach offers the best outcomes, such as shorter hospital stays, preservation of the testicular arteries and lymphatics, least number of postoperative complications, recurrence, and a higher number of pregnancies. Currently robotic-assisted laparoscopic surgery is widely adopted in urology and surgeons began to explore the potential applications of the robotic platform to male infertility microsurgical operations. Robotic approach offers many advantages: elimination of tremor, retraction with third arm, high quality, 3-dimensional visualization and surgeon ergonomics, all contributing to the precision of surgery.
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Affiliation(s)
- Luigi Napolitano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Savio Domenico Pandolfo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Achille Aveta
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Lorenzo Cirigliano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Raffaele Martino
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Gennaro Mattiello
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Giuseppe Celentano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Biagio Barone
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Claudia Rosati
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Roberto La Rocca
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Gianluca Spena
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Lorenzo Spirito
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
- *Correspondence: Lorenzo Spirito
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Ayad B, Omolaoye TS, Louw N, Ramsunder Y, Skosana BT, Oyeipo PI, Du Plessis SS. Oxidative Stress and Male Infertility: Evidence From a Research Perspective. FRONTIERS IN REPRODUCTIVE HEALTH 2022; 4:822257. [PMID: 36303652 PMCID: PMC9580735 DOI: 10.3389/frph.2022.822257] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 01/17/2022] [Indexed: 11/30/2022] Open
Abstract
Male fertility potential can be influenced by a variety of conditions that frequently coincide. Spermatozoa are particularly susceptible to oxidative damage due to their limited antioxidant capacity and cell membrane rich in polyunsaturated fatty acids (PUFAs). The role of oxidative stress (OS) in the etiology of male infertility has been the primary focus of our Stellenbosch University Reproductive Research Group (SURRG) over the last 10 years. This review aims to provide a novel insight into the impact of OS on spermatozoa and male reproductive function by reviewing the OS-related findings from a wide variety of studies conducted in our laboratory, along with those emerging from other investigators. We will provide a concise overview of the production of reactive oxygen species (ROS) and the development of OS in the male reproductive tract along with the physiological and pathological effects thereof on male reproductive functions. Recent advances in methods and techniques used for the assessment of OS will also be highlighted. We will furthermore consider the current evidence regarding the association between OS and ejaculatory abstinence period, as well as the potential mechanisms involved in the pathophysiology of various systemic diseases such as obesity, insulin resistance, hypertension, and certain mental health disorders which have been shown to cause OS induced male infertility. Finally, special emphasis will be placed on the potential for transferring and incorporating research findings emanating from different experimental studies into clinical practice.
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Affiliation(s)
- Bashir Ayad
- Department of Physiology, Faculty of Medicine, Misurata University, Misrata, Libya
- Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Temidayo S. Omolaoye
- Department of Basic Medical Sciences, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Nicola Louw
- Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Yashthi Ramsunder
- Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Bongekile T. Skosana
- Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Peter I. Oyeipo
- Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
- Department of Physiology, College of Health Sciences, Osun State University, Osogbo, Nigeria
| | - Stefan S. Du Plessis
- Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
- Department of Basic Medical Sciences, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
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Imran Afridi H, Gul Kazi T, Naz Talpur F, Ahmed Baig J, Qadir Chanihoon G. Essential trace and Toxic elemental concentrations in biological samples of male adult referent and Eunuch subjects. Clin Chim Acta 2022; 529:96-103. [DOI: 10.1016/j.cca.2022.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 02/14/2022] [Accepted: 02/14/2022] [Indexed: 11/25/2022]
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13
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Agarwal A, Finelli R, Durairajanayagam D, Leisegang K, Henkel R, Salvio G, Aghamajidi A, Sengupta P, Crisóstomo L, Tsioulou PA, Roychoudhury S, Finocchi F, Darbandi M, Mottola F, Darbandi S, Iovine C, Santonastaso M, Zaker H, Kesari KK, Nomanzadeh A, Gugnani N, Rambhatla A, Duran MB, Ceyhan E, Kandil H, Arafa M, Saleh R, Shah R, Boitrelle F. Comprehensive Analysis of Global Research on Human Varicocele: A Scientometric Approach. World J Mens Health 2022; 40:636-652. [PMID: 35118839 PMCID: PMC9482861 DOI: 10.5534/wjmh.210202] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/13/2021] [Accepted: 10/25/2021] [Indexed: 12/05/2022] Open
Abstract
Purpose This study provides a comprehensive analysis of research trends on the etiology, mechanisms, potential risk factors, diagnosis, prognosis, surgical and non-surgical treatment of varicocele, and clinical outcomes before and after varicocele repair. Materials and Methods Varicocele studies published between 1988 and 2020 were retrieved from the Scopus database on April 5, 2021. Original studies on human varicocele were included, irrespective of language. Retrieved articles were manually screened for inclusion in various sub-categories. Bibliometric data was subjected to scientometric analysis using descriptive statistics. Network, heat and geographic mapping were generated using relevant software. Results In total, 1,943 original human studies on varicocele were published. These were predominantly from the northern hemisphere and developed countries, and published in journals from the United States and Germany. Network map analysis for countries showed several interconnected nodal points, with the USA being the largest, and Agarwal A. from Cleveland Clinic, USA, being a center point of worldwide varicocele research collaborations. Studies of adolescents were underrepresented compared with studies of adults. Studies on diagnostic and prognostic aspects of varicocele were more numerous than studies on varicocele prevalence, mechanistic studies and studies focusing on etiological and risk factors. Varicocele surgery was more investigated than non-surgical approaches. To evaluate the impact of varicocele and its treatment, researchers mainly analyzed basic semen parameters, although markers of seminal oxidative stress are being increasingly investigated in the last decade, while reproductive outcomes such as live birth rate were under-reported in the literature. Conclusions This study analyzes the publication trends in original research on human varicocele spanning over the last three decades. Our analysis emphasizes areas for further exploration to better understand varicocele’s impact on men’s health and male fertility.
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Affiliation(s)
- Ashok Agarwal
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA.
| | - Renata Finelli
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Damayanthi Durairajanayagam
- Department of Physiology, Faculty of Medicine, Universiti Teknologi Mara, Sungai Buloh Campus, Selangor, Malaysia
| | - Kristian Leisegang
- Department of Physiology, School of Natural Medicine, Faculty of Community and Health Sciences, University of the Western Cape, Bellville, South Africa
| | - Ralf Henkel
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA.,LogixX Pharma Ltd., Theale, Berkshire, UK.,Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.,Department of Medical Bioscience, University of the Western Cape, Bellville, South Africa
| | - Gianmaria Salvio
- Department of Endocrinology and Metabolic Diseases, Polytechnic University of Marche, Ancona, Italy
| | - Azin Aghamajidi
- Department of Immunology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Pallav Sengupta
- Department of Physiology, Faculty of Medicine, Bioscience and Nursing, MAHSA University, Jenjarom, Selangor, Malaysia
| | - Luís Crisóstomo
- Unidade Multidisciplinar de Investigação Biomédica (UMIB), Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal.,Laboratory for Integrative and Translational Research in Population Health (ITR), Universidade do Porto, Porto, Portugal
| | - Petroula A Tsioulou
- Department of Physiology, Group of Physiology of Reproduction and Clinical Embryology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Federica Finocchi
- Department of Endocrinology and Metabolic Diseases, Polytechnic University of Marche, Ancona, Italy
| | - Mahsa Darbandi
- Fetal Health Research Center, Hope Generation Foundation, Tehran, Iran
| | - Filomena Mottola
- Department of Environmental, Biological and Pharmaceutical Sciences and Technologies, University of Campania Luigi Vanvitelli, Caserta, Italy
| | - Sara Darbandi
- Fetal Health Research Center, Hope Generation Foundation, Tehran, Iran
| | - Concetta Iovine
- Department of Environmental, Biological and Pharmaceutical Sciences and Technologies, University of Campania Luigi Vanvitelli, Caserta, Italy.,Gamma Analisi Cliniche S.r.l, Caserta, Italy
| | - Marianna Santonastaso
- Department of Women, Children and General and Specialized Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Himasadat Zaker
- Histology and Mcroscopic Analysis Division, RASTA Specialized Research Institute (RSRI), West Azerbaijan Science and Technology Park (WASTP), Urmia, Iran
| | | | - Amir Nomanzadeh
- Histology and Mcroscopic Analysis Division, RASTA Specialized Research Institute (RSRI), West Azerbaijan Science and Technology Park (WASTP), Urmia, Iran
| | | | - Amarnath Rambhatla
- Department of Urology, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
| | - Mesut Berkan Duran
- Department of Urology, Samsun Training and Research Hospital, Samsun, Turkey
| | - Erman Ceyhan
- Deparment of Urology, Baskent University Faculty of Medicine, Ankara, Turkey
| | | | - Mohamed Arafa
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA.,Department of Urology, Hamad Medical Corporation, Doha, Qatar.,Department of Andrology, Cairo University, Cairo, Egypt
| | - Ramadan Saleh
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt.,Ajyal IVF Center, Ajyal Hopsital, Sohag, Egypt
| | - Rupin Shah
- Division of Andrology, Department of Urology, Lilavati Hospital and Research Centre, Mumbai, India
| | - Florence Boitrelle
- Reproductive Biology, Fertility Preservation, Andrology, CECOS, Poissy Hospital, Poissy, France.,Paris Saclay University, UVSQ, INRAE, BREED, Jouy-en-Josas, France
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14
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Dolatkhah MA, Shokoohi M, Charvandeh S, Tvrda E, Shoorei H, Moghimian M, Alihemmati A. Fumaria parviflora regulates oxidative stress and apoptosis gene expression in the rat model of varicocele induction. Andrologia 2020; 52:e13826. [PMID: 32991040 DOI: 10.1111/and.13826] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 08/02/2020] [Accepted: 08/12/2020] [Indexed: 12/14/2022] Open
Abstract
Varicocele is one of the leading causes of male infertility in which oxidative stress induces DNA damages in spermatozoa of patients with varicocele. Recent studies indicated that the treatment with antioxidant agents has protective effects against the formation of reactive oxygen species (ROS). Our research aimed to evaluate the impact of Fumaria Parviflora (FP) on the varicocele-induced testicular injury. For this purpose, 32 adult male Wistar rats (n = 8 per group) were randomly assigned to four groups as follows: sham group, varicocele group, varicocele treatment group and the control treatment group. The experimental groups daily received FP (250 mg/kg) for 8 weeks. The induction of varicocele was conducted by partial occlusion on the left renal vein. The diameter of seminiferous tubules, Johnsen's score and the epithelium thickness improved in the treated-varicocele group as compared to the varicocele group. FP extract could increase the biochemical parameters including superoxide dismutase and glutathione peroxidase, and also decrease malondialdehyde level in the varicocele group. Furthermore, varicocele markedly increased both mRNA and intensity of Bax, while treatment with FP could alleviate them. We concluded that FP could alleviate varicocele, possibly by lowering oxidative stress and testicular damage.
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Affiliation(s)
- Mohammad Amin Dolatkhah
- Molecular Medicine Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Anatomical Sciences, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Majid Shokoohi
- Department of Anatomical Sciences, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sheida Charvandeh
- Department of Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Eva Tvrda
- Department of Animal Physiology, Faculty of Biotechnology and Food Sciences, Slovak University of Agriculture, Nitra, Slovakia
| | - Hamed Shoorei
- Department of Anatomical Sciences, Faculty of Medicine, Birjand University of Medical Sciences, Birjand, Iran
| | - Maryam Moghimian
- Department of Basic Sciences, Faculty of Medicine, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Alireza Alihemmati
- Molecular Medicine Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Anatomical Sciences, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Histology and Embryology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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15
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Xu D, Wu L, Yang L, Liu D, Chen H, Geng G, Li Q. Rutin protects boar sperm from cryodamage via enhancing the antioxidative defense. Anim Sci J 2020; 91:e13328. [PMID: 32219925 DOI: 10.1111/asj.13328] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 11/11/2019] [Accepted: 11/29/2019] [Indexed: 12/31/2022]
Abstract
This study was aimed to investigate whether and how Rutin protects boar sperm against cryoinjury during cryopreservation. Five concentrations of Rutin with 0.2, 0.4, 0.6, 1.0, and 2.0 mM were added to the freezing extender of boar sperm, respectively, and the effects on quality and function of boar sperm after freezing-thawing were assessed. The results showed that the sperm motility, mitochondrial activity, plasma membrane integrity, and acrosomal integrity were significantly improved in 0.4 mM and 0.6 mM Rutin groups (p < .05). Compared with ganoderma lucidum polysaccharide (GLP) or Tanshinone IIA, Rutin exhibited higher rates of mitochondrial activity and acrosome integrity (p < .05). Mechanistically, the addition of Rutin at the concentration of 0.6, 0.8, and 1.0 mM significantly attenuated ROS accumulation and MDA production by improving antioxidant enzymatic activity, including SOD, CAT, and GSH-Px (p < .05). Functionally, a higher penetration rate and the increased total efficiency of fertilization were observed in the 0.4, 0.6, and 1.0 mM Rutin groups than in the control group (p < .05). Moreover, the addition of Rutin (0.6 mM) significantly induced an increase in both the cleavage and blastocyst rates (p < .05). In summary, supplementation with Rutin in cryopreservation medium protects boar sperm against ROS attack by enhancing the antioxidative defense.
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Affiliation(s)
- Dejun Xu
- College of Animal Science and Technology, Northwest Agriculture and Forestry University, Yangling, China
| | - Lin Wu
- College of Animal Science and Technology, Northwest Agriculture and Forestry University, Yangling, China
| | - Li Yang
- College of Animal Science and Technology, Northwest Agriculture and Forestry University, Yangling, China
| | - Dingbang Liu
- College of Animal Science and Technology, Northwest Agriculture and Forestry University, Yangling, China
| | - Huali Chen
- College of Animal Science and Technology, Northwest Agriculture and Forestry University, Yangling, China
| | - Guoxia Geng
- College of Veterinary Medicine, Northwest Agriculture and Forestry University, Yangling, China
| | - Qingwang Li
- College of Animal Science and Technology, Northwest Agriculture and Forestry University, Yangling, China
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16
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Yang H, Kuhn C, Kolben T, Ma Z, Lin P, Mahner S, Jeschke U, von Schönfeldt V. Early Life Oxidative Stress and Long-Lasting Cardiovascular Effects on Offspring Conceived by Assisted Reproductive Technologies: A Review. Int J Mol Sci 2020; 21:ijms21155175. [PMID: 32707756 PMCID: PMC7432066 DOI: 10.3390/ijms21155175] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/18/2020] [Accepted: 07/20/2020] [Indexed: 02/06/2023] Open
Abstract
Assisted reproductive technology (ART) has rapidly developed and is now widely practised worldwide. Both the characteristics of ART (handling gametes/embryos in vitro) and the infertility backgrounds of ART parents (such as infertility diseases and unfavourable lifestyles or diets) could cause increased oxidative stress (OS) that may exert adverse influences on gametogenesis, fertilisation, and foetation, even causing a long-lasting influence on the offspring. For these reasons, the safety of ART needs to be closely examined. In this review, from an ART safety standpoint, the origins of OS are reviewed, and the long-lasting cardiovascular effects and potential mechanisms of OS on the offspring are discussed.
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Affiliation(s)
- Huixia Yang
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, 81377 Munich, Germany; (H.Y.); (C.K.); (T.K.); (Z.M.); (P.L.); (S.M.); (V.v.S.)
| | - Christina Kuhn
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, 81377 Munich, Germany; (H.Y.); (C.K.); (T.K.); (Z.M.); (P.L.); (S.M.); (V.v.S.)
- Department of Obstetrics and Gynecology, University Hospital Augsburg, 86156 Augsburg, Germany
| | - Thomas Kolben
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, 81377 Munich, Germany; (H.Y.); (C.K.); (T.K.); (Z.M.); (P.L.); (S.M.); (V.v.S.)
| | - Zhi Ma
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, 81377 Munich, Germany; (H.Y.); (C.K.); (T.K.); (Z.M.); (P.L.); (S.M.); (V.v.S.)
| | - Peng Lin
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, 81377 Munich, Germany; (H.Y.); (C.K.); (T.K.); (Z.M.); (P.L.); (S.M.); (V.v.S.)
| | - Sven Mahner
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, 81377 Munich, Germany; (H.Y.); (C.K.); (T.K.); (Z.M.); (P.L.); (S.M.); (V.v.S.)
| | - Udo Jeschke
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, 81377 Munich, Germany; (H.Y.); (C.K.); (T.K.); (Z.M.); (P.L.); (S.M.); (V.v.S.)
- Department of Obstetrics and Gynecology, University Hospital Augsburg, 86156 Augsburg, Germany
- Correspondence: ; Tel.: +49-(0)821-400-165505
| | - Viktoria von Schönfeldt
- Department of Obstetrics and Gynecology, University Hospital, LMU Munich, 81377 Munich, Germany; (H.Y.); (C.K.); (T.K.); (Z.M.); (P.L.); (S.M.); (V.v.S.)
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17
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Dave P, Farber N, Vij S. Conventional semen analysis and advanced sperm function tests in diagnosis and management of varicocele. Andrologia 2020; 53:e13629. [PMID: 32369238 DOI: 10.1111/and.13629] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 04/06/2020] [Accepted: 04/10/2020] [Indexed: 12/17/2022] Open
Abstract
Clinical varicoceles are a common cause of male infertility and affect sperm parameters as measured in a conventional semen analysis. Varicocelectomy has been shown in prospective studies to improve semen parameters in men with a clinical varicocele. Clinical varicoceles are also a well-known source of oxidative stress which may affect the quality of spermatozoa. Spermatozoa are particularly susceptible to oxidative stress due to a limited capacity for DNA repair. The susceptibility of spermatozoa to oxidative stress is modulated by a balance between ROS and antioxidants, which can be quantified by various laboratory assays. Varicocelectomy has been consistently shown to reduce both ROS and sperm DNA fragmentation, and various assays should be utilised in the diagnosis and treatment of infertile men with a clinical varicocele.
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Affiliation(s)
- Priya Dave
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Nicholas Farber
- Department of Urology, Cleveland Clinic Foundation, Glickman Urological & Kidney Institute, Cleveland, OH, USA
| | - Sarah Vij
- Department of Urology, Cleveland Clinic Foundation, Glickman Urological & Kidney Institute, Cleveland, OH, USA
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18
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Esteves SC. Interventions to Prevent Sperm DNA Damage Effects on Reproduction. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1166:119-148. [PMID: 31301050 DOI: 10.1007/978-3-030-21664-1_8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Excessive oxidation and antioxidant imbalance resulting from several conditions may cause sperm DNA damage, which, in turn, affect male fertility, both natural and assisted. Sperm DNA damage transferred to the embryo might also affect the health of offspring. Several conditions associated with excessive oxidative stress are modifiable by the use of specific treatments, lifestyle changes, and averting exposure to environmental/occupational toxicants. Here, we discuss the strategies to reduce sperm DNA damage with a focus on clinical and surgical interventions.
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Affiliation(s)
- Sandro C Esteves
- ANDROFERT, Andrology and Human Reproduction Clinic, Referral Center for Male Reproduction, Campinas, SP, Brazil. .,Department of Surgery (Division of Urology), University of Campinas (UNICAMP), Campinas, SP, Brazil. .,Faculty of Health, Aarhus University, Aarhus, Denmark.
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19
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Besiroglu H, Otunctemur A, Dursun M, Ozbek E. The prevalence and severity of varicocele in adult population over the age of forty years old: a cross-sectional study. Aging Male 2019; 22:207-213. [PMID: 29683379 DOI: 10.1080/13685538.2018.1465913] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Objectives: To investigate the prevalence and severity of varicocele in adult population over the age of 40. We also measured testicular size, consistency, and total testosterone levels with an aim to observe the effect of varicocele on testis as men age. Methods: Two hundred twenty-four patients with varicocele, 241 patients without varicocele who admitted to our clinic were enrolled in the study. We stratified participants by four age groups (40-49, 50-59, 60-69, >70 yr). Patients were grouped according to varicocele grade and laterality. The morning testosterone level was drawn. The subgroups were compared with each other. Results: Overall, varicocele prevalence was 48%. Of the patients, 104 had unilateral, 120 had bilateral varicocele. Of the patients with varicocele, 62 (13.30%) were found as grade 3, 99 (21.10%) were grade 2, and 63 (13.60%) were grade 1. The percentages of smaller testes in grade 1, grade 2, and grade 3 varicocele group were 20.60, 79.80, and 88.70 and a significant association was detected. Age stratification of the data revealed the smaller and soft testis prevalence as well as higher grade varicocele prevalance increased in older age groups. Conclusions: Varicocele presence is associated with lower testicular size, softer testicular consistency, and lower testosterone levels, especially in older patients with bilateral and high-grade varicocele.
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Affiliation(s)
- Huseyin Besiroglu
- a Department of Urology , Catalca Ilyas Cokay State Hospital , Istanbul , Turkey
| | - Alper Otunctemur
- b Department of Urology , Okmeydani Training and Research Hospital , Istanbul , Turkey
| | - Murat Dursun
- c Department of Urology , Malatya Training and Research Hospital , Istanbul , Turkey
| | - Emin Ozbek
- d Department of Urology, Cerrahpasa Medicine Faculty , Istanbul , Turkey
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20
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Biochemical and Histological Evaluation of Protective Effect of Betaine in Experimental Varicocele Using Animal Model. Int J Pept Res Ther 2019. [DOI: 10.1007/s10989-018-9718-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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21
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Salama N, Samir M, Blgozah S. Evaluation of Normal and Varicocele-Bearing Testes Using Real-time Strain Elastography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:621-627. [PMID: 30171622 DOI: 10.1002/jum.14730] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 05/25/2018] [Accepted: 06/02/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To evaluate testes in patients with varicocele using real-time strain elastography and to correlate the results with the patients' clinical, seminal, and hormonal profiles. METHODS Fifty patients with left varicocele and 20 age-matched control participants were included in the study. All participants were evaluated via a historical interview, clinical examination, including testicular volume and varicocele grade, hormonal assay (total and free testosterone, luteinizing hormone, and follicle-stimulating hormone), computer-assisted semen analysis, and testicular assessment using real-time strain elastography to define the strain ratio and elasticity score. RESULTS Testicular volume and sperm parameters were significantly lower (P < .001), whereas the follicle-stimulating hormone level, strain ratio, and elasticity score were significantly higher (P < .01; P < .001; P < .001, respectively), in the varicocele group. Other hormone levels in the endocrine profile were not significantly different between the groups. Significant negative correlations were found between the elasticity score and testicular volume and the percentage of normal forms (P = .029; P = .005). The varicocele grade showed significant positive correlations with both the strain ratio and elasticity score (P < .001). CONCLUSIONS Strong correlations were found between real-time strain elastography and the testicular volume, varicocele grade, and sperm morphologic characteristics. Real-time strain elastography is a simple, noninvasive investigative modality that can potentially be used to study the structure and function of the testicular tissue in varicocele.
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Affiliation(s)
- Nader Salama
- Department of Urology, Taiba University, Madina, Saudi Arabia
- Department of Urology, Alexandria Faculty of Medicine, Alexandria, Egypt
| | - Mohamed Samir
- Department of Diagnostic Radiology, Alexandria Faculty of Medicine, Alexandria, Egypt
| | - Saeed Blgozah
- Department of Urology, Hadramout Faculty of Medicine, Mukalla, Yemen
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22
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Soni KK, Zhang LT, Choi BR, Karna KK, You JH, Shin YS, Lee SW, Kim CY, Zhao C, Chae HJ, Kim HK, Park JK. Protective effect of MOTILIPERM in varicocele-induced oxidative injury in rat testis by activating phosphorylated inositol requiring kinase 1α (p-IRE1α) and phosphorylated c-Jun N-terminal kinase (p-JNK) pathways. PHARMACEUTICAL BIOLOGY 2018; 56:94-103. [PMID: 29316840 PMCID: PMC6130442 DOI: 10.1080/13880209.2017.1421672] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
CONTEXT MOTILIPERM was prepared as a mixture of extracts of three medicinal herbs [roots of Morinda officinalis How (Rubiaceae), outer scales of Allium cepa L. (Liliaceae) and seeds of Cuscuta chinensis Lamark (Convolvulaceae)]. OBJECTIVE To investigate the role of reactive oxygen species (ROS)-based endoplasmic reticulum (ER) stress in a rat model of varicocele and the therapeutic efficacy of MOTILIPERM in this model. MATERIALS AND METHODS Sixty male rats were divided into five experimental groups: a normal control group (CTR + vehicle), a control group administered MOTILIPERM 200 mg/kg (CTR + M 200), a varicocele-induced control group (VC + vehicle) and two varicocele-induced groups administered MOTILIPERM 100 (VC + M 100) or 200 (VC + M 200) mg/kg for 4 weeks. Testis weights were recorded and serums were assayed for hormone concentrations. Tissues were subjected to semen analysis, histopathology, analyses of ER response protein expression levels and oxidative stress were assessed by measuring ROS, reactive nitrogen species (RNS), malondialdehyde (MDA) level and ratios of total glutathione (GSH)/oxidized GSH (GSSG). RESULTS MOTILIPERM treatment of varicocele-induced groups significantly increased left testis weight, testosterone level, sperm motility, count and spermatogenic cell density. ER-response protein expression levels were dose-dependently decreased in VC + M 200 group compared with VC + vehicle group. MOTILIPERM treatment also decreased MDA and ROS/RNS level but increased GSH/GSSG ratio. DISCUSSION AND CONCLUSIONS This study suggests that ROS-related ER stress may play a major role in varicocele-induced infertility and MOTILIPERM, a novel compound targeting ROS-based ER stress, may be therapeutically useful in treatment of varicocele, or as a supplement for the treatment of infertility.
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Affiliation(s)
- Kiran Kumar Soni
- Department of Urology, Chonbuk National University and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute and Clinical Trial Center of Medical Device of Chonbuk National University, Jeonju, Republic of Korea
| | - Li Tao Zhang
- Department of Urology, Chonbuk National University and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute and Clinical Trial Center of Medical Device of Chonbuk National University, Jeonju, Republic of Korea
| | - Bo Ram Choi
- Department of Urology, Chonbuk National University and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute and Clinical Trial Center of Medical Device of Chonbuk National University, Jeonju, Republic of Korea
| | - Keshab Kumar Karna
- Department of Urology, Chonbuk National University and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute and Clinical Trial Center of Medical Device of Chonbuk National University, Jeonju, Republic of Korea
| | - Jae Hyung You
- Department of Urology, Chonbuk National University and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute and Clinical Trial Center of Medical Device of Chonbuk National University, Jeonju, Republic of Korea
| | - Yu Seob Shin
- Department of Urology, Chonbuk National University and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute and Clinical Trial Center of Medical Device of Chonbuk National University, Jeonju, Republic of Korea
| | - Sung Won Lee
- Department of Urology, Samsung Medical Center, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chul Young Kim
- College of Pharmacy, Hanyang University, Ansan, Republic of Korea
| | - Chen Zhao
- Department of Urology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, and Shanghai Institute of Andrology, Shanghai, China
| | - Han-Jung Chae
- Department of Pharmacology, Chonbuk University of Medical School, Jeonju, Republic of Korea
| | - Hye Kyung Kim
- College of Pharmacy, Kyungsung University, Busan, Republic of Korea
| | - Jong Kwan Park
- Department of Urology, Chonbuk National University and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute and Clinical Trial Center of Medical Device of Chonbuk National University, Jeonju, Republic of Korea
- CONTACT Jong Kwan ParkDepartment of Urology, Chonbuk National University and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute and Clinical Trial Center of Medical Device of Chonbuk National University, Jeonju54909, Republic of Korea
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23
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Laleethambika N, Anila V, Manojkumar C, Muruganandam I, Giridharan B, Ravimanickam T, Balachandar V. Diabetes and Sperm DNA Damage: Efficacy of Antioxidants. ACTA ACUST UNITED AC 2018. [DOI: 10.1007/s42399-018-0012-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Nguyen TT, Trieu TS, Tran TO, Luong TLA. Evaluation of sperm DNA fragmentation index, Zinc concentration and seminal parameters from infertile men with varicocele. Andrologia 2018; 51:e13184. [DOI: 10.1111/and.13184] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 09/07/2018] [Accepted: 09/28/2018] [Indexed: 12/27/2022] Open
Affiliation(s)
- Thi Trang Nguyen
- Department of Biology and Medical Genetic; Hanoi Medical University; Hanoi Vietnam
- Genetic Counseling Center; Hanoi Medical University Hospital; Hanoi Vietnam
| | - Tien Sang Trieu
- Biomedical and Genetics Department; Vietnam Military Medical University; Hanoi Vietnam
| | | | - Thi Lan Anh Luong
- Department of Biology and Medical Genetic; Hanoi Medical University; Hanoi Vietnam
- Genetic Counseling Center; Hanoi Medical University Hospital; Hanoi Vietnam
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García Rodríguez A, de la Casa M, Johnston S, Gosálvez J, Roy R. Association of polymorphisms in genes coding for antioxidant enzymes and human male infertility. Ann Hum Genet 2018; 83:63-72. [PMID: 30191955 DOI: 10.1111/ahg.12286] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 02/08/2018] [Accepted: 08/03/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE Although oxidative stress is thought to be an important cause of male infertility, primarily due to DNA and cell membrane damage, little is known about the genetic causes underlying suboptimal function of the seminal enzymatic antioxidant system. The aim of this study was to investigate the relationship of four potentially functional polymorphisms associated with oxidative stress pathway genes (superoxide dismutase-SOD2 lle58Thr and SOD2 rs4880, catalase-CAT C-262T, glutathione peroxidase 1-GPX1 Pro200Leu) and two null variants of the glutathione S transferase (GSTT and GSTM) genes and infertility risk. METHODS A case control study was conducted on 313 infertile patients and 80 fertile donors. Each ejaculate was subjected to a seminal analysis that included the classical parameters seminal volume, sperm concentration, sperm motility, and sperm morphology, as well as sperm DNA fragmentation (patients only). Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and PCR multiplex methods were carried out for genotyping. RESULTS Statistically significant differences were found between fertile donors and infertile patients for SNP CAT C-262T; the CC genotype was related with a twofold increased risk of infertility (odds ratio [OR] = 2.262; 95% confidence interval [CI] = 1.369-3.733; P = 0.001), whereas the CT genotype was associated with a protective effect (OR = 0.401; 95% CI = 0.241-0.667; P = 0.001). Surprisingly, the SOD2 Ile58ssThr SNP was not represented in the sample population, so its frequency in the current population frequenting fertility clinics in Madrid may be very low. CONCLUSIONS Our results suggest that the CAT SNP C-262T is potentially associated with an increased risk of male infertility.
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Affiliation(s)
| | | | - Stephen Johnston
- School of Agriculture and Food Science, University of Queensland, Queensland, Australia
| | - Jaime Gosálvez
- Biology Department, University Autónoma of Madrid, Madrid, Spain
| | - Rosa Roy
- Biology Department, University Autónoma of Madrid, Madrid, Spain
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Asadi N, Kheradmand A, Gholami M, Moradi FH. Effect of ghrelin on the biochemical and histopathology parameters and spermatogenesis cycle following experimental varicocele in rat. Andrologia 2018; 50:e13106. [DOI: 10.1111/and.13106] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 05/21/2018] [Accepted: 06/11/2018] [Indexed: 12/20/2022] Open
Affiliation(s)
- Nematollah Asadi
- Razi Herbal Medicines Research Center; Lorestan University of Medical Sciences; Khorramabad Iran
- Animal Science Research Institute (ASRI); Jihad-e-Agriculture Ministry; Karaj Iran
| | - Arash Kheradmand
- Department of Clinical Sciences, School of Veterinary Medicine; Lorestan University; Khorramabad Iran
| | | | - Forouzan Hadipour Moradi
- Razi Herbal Medicines Research Center; Lorestan University of Medical Sciences; Khorramabad Iran
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Lundy SD, Sabanegh ES. Varicocele management for infertility and pain: A systematic review. Arab J Urol 2018; 16:157-170. [PMID: 29713547 PMCID: PMC5922006 DOI: 10.1016/j.aju.2017.11.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 11/01/2017] [Accepted: 11/01/2017] [Indexed: 12/18/2022] Open
Abstract
Despite being first described two thousand years ago, the varicocele remains a controversial multifaceted disease process with numerous biological consequences including infertility, hypogonadism, and chronic orchidalgia. The underlying mechanisms remain poorly understood and likely include hypoxia, oxidative stress, hyperthermia, anatomical aberrations, and genetics as primary components. Despite a high prevalence amongst asymptomatic fertile men, varicoceles paradoxically also represent the most common correctable cause for male infertility. In this systematic review we discuss the rich historical aspects of the varicocele and the contemporary data regarding its clinical manifestations. We performed a systematic literature review with the goal of comparing outcomes and complication rates of each of the major surgical approaches as they relate to infertility and pain. We performed a Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA)-compliant systematic literature review for manuscripts focused on varicocele and its biological consequences. We identified 112 studies suitable for qualitative analysis and included 56 of these for quantitative analysis, with an emphasis on infertility and chronic pain outcomes. Taken together, the clinical work to date suggests that the highest fertility rates and the lowest complication rates are associated with the microsurgical subinguinal surgical approach to varicocelectomy. In all, 26-40% of patients undergoing varicocelectomy will successfully achieve short-term spontaneous pregnancy, and up to 90% of all patients undergoing varicocelectomy for pain will have improvement and/or resolution of their symptoms. Taken together, the data support an ongoing role for varicocelectomy in both of these clinical arenas.
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Affiliation(s)
- Scott D. Lundy
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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29
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Alkan İ, Yüksel M, Canat HL, Atalay HA, Can O, Özveri H, Başar MM. Superoxide Anion Production by the Spermatozoa of Men with Varicocele: Relationship with Varicocele Grade and Semen Parameters. World J Mens Health 2018; 36:255-262. [PMID: 30168299 PMCID: PMC6119845 DOI: 10.5534/wjmh.180028] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 06/11/2018] [Accepted: 06/25/2018] [Indexed: 11/16/2022] Open
Abstract
Purpose To investigate the pathophysiological role of superoxide anion and total reactive oxygen species (ROS) production by the spermatozoa of men with varicocele and its relationship with varicocele grade and semen parameters. Materials and Methods This prospective study included 34 men with grade II–III varicocele, regardless of their fertility status. The control group consisted of 13 healthy men. Semen characteristics were examined according to the 2010 World Health Organization criteria. The swim-up method was used for sperm preparation. Total ROS and superoxide anion production was assayed by luminol- and lucigenin-dependent chemiluminescence (CL), respectively. Results The men with varicocele had significantly higher total ROS and superoxide anion levels than the healthy control subjects (2.9±0.4 relative light unit (RLU) vs. 2.4±0.1 RLU, p=0.001 for luminol-dependent CL and 2.8±0.4 RLU vs. 2.3±0.2 RLU, p=0.002 for lucigenin-dependent CL). Cases of grade III varicocele had significantly higher superoxide anion and total ROS levels than grade II cases and control subjects (p<0.001). Superoxide anion and total ROS levels were negatively correlated with all semen parameters. Conclusions The superoxide anion levels produced by spermatozoa were significantly higher in varicocele patients than in control subjects. ROS production was related to increased varicocele grade, impaired semen concentration, and abnormal morphology in men with varicocele. Our findings suggest that superoxide anion overproduction may be an important step in the cascade of ROS-related damage to spermatozoa, resulting in impaired semen parameters in patients with varicocele.
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Affiliation(s)
- İlter Alkan
- Department of Urology, Okmeydanı Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.
| | - Meral Yüksel
- Department of Medical Laboratory, Vocational School of Health-Related Services, Marmara University, Istanbul, Turkey
| | - Halil Lütfi Canat
- Department of Urology, Okmeydanı Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Hasan Anıl Atalay
- Department of Urology, Okmeydanı Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Osman Can
- Department of Urology, Okmeydanı Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Hakan Özveri
- Department of Urology & Andrology, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Mehmet Murad Başar
- Department of Urology & Andrology, Memorial Şişli Hospital, Istanbul, Turkey
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Zheng Y, Zhang N, Liu S, Li Q, Jiang Z. Effects of water-soluble Laminaria japonica polysaccharide 3 (LJP-P3) on bull cryopreservation sperm. Cryobiology 2017; 79:50-55. [PMID: 28941986 DOI: 10.1016/j.cryobiol.2017.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 09/17/2017] [Accepted: 09/18/2017] [Indexed: 11/19/2022]
Abstract
In this study, water-soluble Laminaria japonica polysaccharide3 (LJP-P3) was investigated for the cryoprotective effects on bull sperm. Five concentrations of LJP-P3 with 0.1, 1, 10, 50 and 100 mmol/L were added into the extenders of bull semen, respectively, and the effects on quality of sperm after freezing-thawing were assessed. The results showed that the kinematic parameters of bull sperm including linear motile sperm (LM), curvilinear line velocity (VCL) value, straight line velocity (VSL) and velocity of the average path (VAP) were greater in the extenders containing LJP-P3 (P<0.05). In comparison to those of other treatments and control group the extenders containing 1.0, 10.0 and 50.0 mmol/L of LJP-P3 led to higher percentage of mitochondrial activity and sperm membrane integrity(P<0.05), and the acrosome integrity of bull cryopreservation sperm were significantly improved in all treatment groups. Moreover, the higher GSH-Px, SOD and CAT levels in bull cryopreservation sperm were favored from the extenders of 10.0, 50.0 and 100.0 mmol/L LJP-P3 added (P<0.05) compared with other treatments and control group. In addition, the results of artificial insemination showed that both the pregnancy rate and the number of calving were higher in the group of semen containing 10 mmol/L of LJP-P3 than that of control group (P <0.05). In summary, LJP-P3 exhibited a greater cryoprotective effect to bull sperm and the most suitable concentration of LJP-P3 is 10.0 mmol/L.
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Affiliation(s)
- Yuxin Zheng
- College of Animal Science and Technology, Northwest A & F University, Yangling, Shaanxi 712100, China
| | - Nina Zhang
- College of Animal Science and Technology, Northwest A & F University, Yangling, Shaanxi 712100, China
| | - Shujie Liu
- State Key Laboratory of Plateau Ecology and Agriculture, Key Laboratory of Plateau Grazing Animal Nutrition and Feed Science of Qinghai Province, Qinhai University, Xining, Qinghai 810016, China
| | - Qingwang Li
- College of Animal Science and Technology, Northwest A & F University, Yangling, Shaanxi 712100, China
| | - Zhongliang Jiang
- College of Animal Science and Technology, Northwest A & F University, Yangling, Shaanxi 712100, China.
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Combined effects of varicocele and cell phones on semen and hormonal parameters. Wien Klin Wochenschr 2017; 130:335-340. [DOI: 10.1007/s00508-017-1277-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 09/18/2017] [Indexed: 12/11/2022]
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Vakalopoulos I, Kampantais S, Lymperi S, Grivas N, Ioannidis A, Mykoniatis I, Nikolaou V, Dimitriadis G. Should we expand the indications for varicocele treatment? Transl Androl Urol 2017; 6:931-942. [PMID: 29184794 PMCID: PMC5673807 DOI: 10.21037/tau.2017.08.01] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Current guidelines suggest that treatment of varicocele should be considered in patients with clinically palpable disease and abnormal semen parameters. However, the clinicians are often challenged with the decision whether to treat varicocele in patients with testicular pain or low testosterone levels. Moreover, varicocele is highly associated with DNA fragmentation due to the oxidative stress and it has been demonstrated that surgical repair of varicocele ameliorates oxidative stress markers and consequently the sperm DNA integrity. These new markers could have an adjunctive role to standard semen parameters especially when normal semen analysis is found in adult men with conventional methods. This review presents a contemporary overview of the rationale for varicocele treatment, as well as of the relationship between varicocele and other novel parameters such as DNA fragmentation index and reactive oxygen species. We will also discuss data from several recent series demonstrating that surgical treatment and especially microsurgical approach could resolve testicular pain, increase testosterone levels and fertility rate both in patients with non-obstructive azoospermia as well as in normozoospermia men. The correlation with progressive testicular failure will be also examined. We hope that this overview will provide clinicians with an evidence-based approach to managing these unanswered and conflicting topics.
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Affiliation(s)
- Ioannis Vakalopoulos
- 1 Urologic Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | | | - Nikolaos Grivas
- Department of Urology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Anastasios Ioannidis
- 1 Urologic Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Mykoniatis
- 1 Urologic Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vassilios Nikolaou
- 1 Urologic Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Dimitriadis
- 1 Urologic Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
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33
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The Effect of Saffron on Semen Analysis in Infertile Men with Clinical Varicocele After Varicocelectomy. Nephrourol Mon 2017. [DOI: 10.5812/numonthly.59939] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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35
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Agarwal A, Majzoub A. Laboratory tests for oxidative stress. Indian J Urol 2017; 33:199-206. [PMID: 28717269 PMCID: PMC5508430 DOI: 10.4103/iju.iju_9_17] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 04/29/2017] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Oxidative stress (OS) is considered a significant contributor to male infertility. A number of laboratory techniques have been developed to evaluate oxidative stress in the semen. We review these tests and their current use. METHODS A literature review was performed utilizing the PubMed search engine for articles studying OS etiology and impact on male fertility, and the laboratory tests used in its assessment. RESULTS The state of OS results from exaggerated production of oxygen-derived free radicals, also known as reactive oxygen species, to an extent overwhelming the body's antioxidant defense mechanisms. Several laboratory tests have been utilized in OS measurement during male fertility evaluation. These tests are classified into direct assays which measure the degree of oxidation within a sperm cell and indirect assays which estimate the detrimental effects of OS. The chemiluminescence assay, flow cytometry, nitroblue tetrazolium assay, and cytochrome c reduction are examples of direct assays while the myeloperoxidase test and measurements of lipid peroxidation, oxidation-reduction potential, and total antioxidant capacity are examples of the indirect assays. CONCLUSION OS measurement is an important tool that may help in understanding the pathophysiology of male infertility and provide valuable information that would guide treatment decisions and patient follow-up.
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Affiliation(s)
- Ashok Agarwal
- Center for Reproductive Medicine, Cleveland Clinic, Cleveland, USA
| | - Ahmad Majzoub
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
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36
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Santana VP, Miranda-Furtado CL, de Oliveira-Gennaro FG, Dos Reis RM. Genetics and epigenetics of varicocele pathophysiology: an overview. J Assist Reprod Genet 2017; 34:839-847. [PMID: 28523408 DOI: 10.1007/s10815-017-0931-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 04/19/2017] [Indexed: 11/26/2022] Open
Abstract
Varicocele is found in approximately 20% of adults and adolescents and in 19-41% of men seeking treatment for infertility. It is associated with a decrease in sperm count as well as sperm motility and morphology. The currently accepted description of the pathophysiology of varicocele does not explain all its clinical manifestations; therefore, other factors such as genetic and epigenetic changes, associated with the environment, might be involved in causing infertility and decrease in sperm quality. It has been reported that the varicocele-induced deterioration of testicular function is progressive and interferes with fertility; hence, early and efficient assessment of the genetic manifestations in patients would be important for developing future medical interventions. Chromosomal disorders, mutations, polymorphisms, changes in gene expression, and epigenetic changes have all been reported to be associated with varicocele. Several studies are underway to unravel the genetic basis of this disease, as it is important to understand the origin and the aggravating factors to ensure appropriate guidance and intervention. Here, we review the available literature regarding the genetic and epigenetic changes associated with varicocele, and how these alterations are related to the different clinical manifestations of the disease.
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Affiliation(s)
- Viviane Paiva Santana
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of São Paulo (USP), 3900 Bandeirantes Ave, São Paulo, Ribeirão Preto, 14049-900, Brazil
| | - Cristiana Libardi Miranda-Furtado
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of São Paulo (USP), 3900 Bandeirantes Ave, São Paulo, Ribeirão Preto, 14049-900, Brazil
- Oswaldo Cruz Foundation (FIOCRUZ), Ceará, Fortaleza, Brazil
| | - Flavia Gaona de Oliveira-Gennaro
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of São Paulo (USP), 3900 Bandeirantes Ave, São Paulo, Ribeirão Preto, 14049-900, Brazil
| | - Rosana Maria Dos Reis
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of São Paulo (USP), 3900 Bandeirantes Ave, São Paulo, Ribeirão Preto, 14049-900, Brazil.
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Abstract
Varicocele is present in approximately 15% of men, and, although it is the most commonly diagnosed cause of male infertility, nearly two-thirds of men with varicoceles remain fertile. It was decided to make use of the current evidence obtained from the previous meta-analyses between 2004 and 2015 as well as available articles covering this field, preferably randomized controlled articles dealing with the topic of semen analysis before and after repair. Two important meta-analyses were discussed as well as other articles dealing with the topic of semen analysis before and after varicocelectomy. The evidence suggests that all semen parameters improve after varicocele repair. Based on the available evidence, it is clear that there is a benefit in treating men with a palpable varicocele. One can expect that all semen parameters will improve within 3 months after repair.
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Affiliation(s)
- Thinus Kruger
- Aevitas Clinic, Pinelands and Reproductive Biology Unit, Stellenbosch University/Tygerberg Hospital, South Africa
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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: 67] [Impact Index Per Article: 8.4] [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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Association of semen cytokines with reactive oxygen species and histone transition abnormalities. J Assist Reprod Genet 2016; 33:1239-46. [PMID: 27364628 PMCID: PMC5010814 DOI: 10.1007/s10815-016-0756-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 06/06/2016] [Indexed: 11/10/2022] Open
Abstract
Purpose The aim of this study is to investigate the relationships among reactive oxygen species (ROS) elevation, histone transition, and seminal cytokine concentrations. Methods Total levels of ROS in semen samples from 6560 men were measured. From this sample, 118 cases with high ROS and 106 controls were recruited. Basic semen parameters and histone-to-protamine ratios were analyzed, 400 semen cytokine and receptor alterations were assayed by protein chip, and finally 18 cytokines were validated in each sample using a Bio-Plex Cytokine assay. Results The results showed that the seminal ROS concentration was associated with abnormalities in the sperm histone transition. Compared with controls, 93 cytokines had significant alterations in the high ROS cases, with 14 of them further verified in individual samples. The concentrations of CXCL5, CXCL16, CXCL8, IL-1b, IL-10, CSF3, CCL3, and TNF-α were significantly correlated with the histone transition ratio. In addition, IL-16 showed significantly different concentrations in controls, normal semen with high ROS levels, and abnormal semen with high ROS levels. Conclusions Semen ROS are associated with abnormalities in sperm histone transition. CXCL5, CXCL8, IL-16, CCL8, CCL22, CCL20, CXCL16, IL-1B, IL-6, IL-7, IL-10, CSF3, CCL3, CCL4, and TNF-α all have elevated concentrations in semen with high ROS levels. These data might help to explain the mechanisms behind the increase in the levels of ROS and seminal cytokines and their relationship with defective spermatogenesis.
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Majzoub A, Elbardisi H, Arafa M, Agarwal A, Al Said S, Al Rumaihi K. Does the number of veins ligated during varicococele surgery influence post-operative semen and hormone results? Andrology 2016; 4:939-43. [PMID: 27317389 DOI: 10.1111/andr.12226] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 04/21/2016] [Accepted: 04/26/2016] [Indexed: 12/01/2022]
Abstract
Varicocele is a well-established cause of male subfertility, which is directly proportional to its clinical grade. Although newer ultrasonic grading systems have taken into account the existence of pampiniform venous plexi, little is known about the clinical significance of the number of veins ligated during surgery. Very few undersized studies reported an influence which triggered the need to evaluate such association. This is a retrospective study of 378 patients who underwent left microsurgical subinguinal varicocoelectomy. Semen analyses and blood hormone studies performed pre-operatively were compared to those executed 6 months after surgery. Patients were divided into abnormal semen and normal semen groups based on their initial semen results. They were also subdivided according to the number of veins ligated intraoperatively into three groups: <5, 5-10, and >10 veins. Sperm count, total motility, and progressive motility were significantly increased in 62, 60.3, and 53.3% of patients post-operatively (p = 0.001), respectively. No significant differences in hormone levels were detected overall. Of the 378 patients, 332 had an abnormal semen analysis, while the remaining 46 patients had a normal result. Sperm count, total motility, and progressive motility significantly increased after varicocoelectomy in patients with an abnormal initial semen analysis (p = 0.001). In 48.7% of patients, 5-10 veins were ligated during surgery, whereas 28.3% had >10 and 23% had <5 ligated veins. No statistically significant differences were noted in the initial or the follow-up results among the number of vein subgroups. Varicocele ligation improves patients' fertility potential. This improvement, however, is not influenced by the number of veins ligated intraoperatively. Clinical grading maintains its superiority in the evaluation of varicocele patients.
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Affiliation(s)
- A Majzoub
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.,Department of Urology, Hamad Medical Corporation, Doha, Qatar
| | - H Elbardisi
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
| | - M Arafa
- Department of Andrology, Cairo University, Cairo, Egypt
| | - A Agarwal
- American Center for Reproductive Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - S Al Said
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
| | - K Al Rumaihi
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
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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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Abstract
Testicular varicocele, a dilation of the veins of the pampiniform plexus thought to increase testicular temperature via venous congestion, is commonly associated with male infertility. Significant study has clarified the negative impact of varicocele on semen parameters and more recent work has shed light on its detrimental effects on the molecular and ultrastructural features of sperm and the testicular microenvironment, as well as more clearly defined the positive impacts of treatment on couples’ fertility. The relationship between varicocele and testicular endocrine function, while known for some time based on histologic evaluation, has become more apparent in the clinical setting with a growing link between varicocele and hypogonadism. Finally, in the pediatric setting, while future study will clarify the impact of varicocele on fertility and testicular function, recent work supports a parallel effect of varicocele in adolescents and adults, suggesting a re-evaluation of current treatment approaches in light of the progressive nature of the condition and potential increased risk of future disease.
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Affiliation(s)
- Alexander W Pastuszak
- Center for Reproductive Medicine; Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
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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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Kucuk EV, Bindayi A, Boylu U, Onol FF, Gumus E. Randomised clinical trial of comparing effects of acupuncture and varicocelectomy on sperm parameters in infertile varicocele patients. Andrologia 2016; 48:1080-1085. [PMID: 26791438 DOI: 10.1111/and.12541] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2015] [Indexed: 01/20/2023] Open
Abstract
The aim of the study was to evaluate the effect of the acupuncture treatment on sperm parameters and pregnancy rates in patients with primary infertility. Between January 2008 and May 2010, 30 men with the primary infertility (one year of unprotected intercourse, healthy wife) and varicocele with normal hormone levels and abnormal semen analysis were randomised into two groups. Group 1 underwent subinguinal microscopic varicocelectomy, and Group 2 underwent acupuncture treatment twice a week for 2 months. Both groups were evaluated with semen analysis at 6 months after the treatment. Patients in both groups evaluated with telephone calls and e-mail in terms of pregnancy. The mean age of the patients was 27.2, and groups were comparable regarding the age (P = 0.542). The pre-treatment sperm concentration, motility and morphological characteristics were similar in both groups. Sperm concentration and motility improved significantly in both groups after the treatment. Increase in sperm concentration was higher in the acupuncture group compared to the varicocelectomy group (P = 0.039). The average follow-up was 42 months, and pregnancy rates were emphasised 33% in both groups. Acupuncture treatment in primary infertile varicocele patients with semen abnormalities seems to be effective and has comparable results with the varicocelectomy treatment.
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Affiliation(s)
- E V Kucuk
- Umraniye Education & Research Hospital, Istanbul, Turkey
| | - A Bindayi
- Umraniye Education & Research Hospital, Istanbul, Turkey
| | - U Boylu
- Umraniye Education & Research Hospital, Istanbul, Turkey
| | - F F Onol
- Umraniye Education & Research Hospital, Istanbul, Turkey
| | - E Gumus
- Umraniye Education & Research Hospital, Istanbul, Turkey
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SOREN S, SINGH SV, SINGH P. Influence of season on seminal antioxidant enzymes in Karan Friesbulls under tropical climatic conditions. TURKISH JOURNAL OF VETERINARY & ANIMAL SCIENCES 2016. [DOI: 10.3906/vet-1603-76] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
Varicoceles are associated with testicular atrophy and abnormal spermatogenesis. Varicocele-related testicular damage is thought to be progressive in nature. Adult varicoceles are common in men with infertility, and varicocele repair in this population has demonstrated improved semen parameters and paternity outcomes. However, without solid objective endpoints (reproducible semen analyses, paternity), the indications for adolescent varicocele repair remain controversial. Given the controversy surrounding adolescent varicocele management, it is not surprising that surveys of pediatric urologists have revealed a lack of consensus on diagnostic approaches, treatment decisions, and operative approaches.
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Affiliation(s)
- Jessica T Casey
- Department of Pediatric Urology, Riley Hospital for Children, 705 Riley Hospital Drive, Suite 4230, Indianapolis, IN 46202, USA.
| | - Rosalia Misseri
- Department of Pediatric Urology, Riley Hospital for Children, 705 Riley Hospital Drive, Suite 4230, Indianapolis, IN 46202, USA
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Cao XN, Yan C, Liu DY, Peng JP, Chen JJ, Zhou Y, Long CL, He DW, Lin T, Shen LJ, Wei GH. Fine particulate matter leads to reproductive impairment in male rats by overexpressing phosphatidylinositol 3-kinase (PI3K)/protein kinase B (Akt) signaling pathway. Toxicol Lett 2015; 237:181-90. [DOI: 10.1016/j.toxlet.2015.06.015] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Revised: 06/08/2015] [Accepted: 06/13/2015] [Indexed: 01/05/2023]
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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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Fraczek M, Kurpisz M. Cytokines in the male reproductive tract and their role in infertility disorders. J Reprod Immunol 2015; 108:98-104. [DOI: 10.1016/j.jri.2015.02.001] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 01/27/2015] [Accepted: 02/17/2015] [Indexed: 10/23/2022]
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Moazzam A, Sharma R, Agarwal A. Relationship of spermatozoal DNA fragmentation with semen quality in varicocele-positive men. Andrologia 2014; 47:935-44. [PMID: 25346327 DOI: 10.1111/and.12360] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2014] [Indexed: 01/08/2023] Open
Abstract
The aim of the study was to assess the semen quality and levels of spermatozoal nuclear DNA fragmentation in subfertile subjects clinically diagnosed with varicocele, subfertile subjects without varicocele and healthy fertile controls. Semen samples were obtained from 302 subjects. Of them, 115 were healthy fertile controls having normal semen characteristics, 121 subfertile men diagnosed with varicocele, both, clinically and on ultrasonography, while 66 subjects were subfertile with no varicocele. Spermatozoal concentration, percentage motility, morphology and DNA fragmentation were measured. In the study population, deterioration in semen quality-decreased spermatozoal concentration, percentage motility and normal morphology was seen in subfertile subjects, especially with varicocele. Highest spermatozoal DNA fragmentation was observed in varicocele-positive subjects as compared with varicocele-negative subjects and healthy fertile controls. Significant negative correlation was seen between spermatozoal DNA fragmentation and concentration (r = -0.310), motility (r = -0.328) normal morphology, WHO method (r = -0.221) and Tygerberg strict criteria (r = -0.180) in the varicocele-positive subfertile subjects. In conclusion, this study suggests existence of a negative relationship between spermatozoal DNA fragmentation and semen quality in varicocele-positive subfertile subjects.
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Affiliation(s)
- A Moazzam
- Center for Research in Molecular Medicine, University of Lahore, Lahore, Pakistan
| | - R Sharma
- Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - A Agarwal
- Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
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