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Kadoch E, Benguigui J, Chow-Shi-Yée M, Tadevosyan A, Bissonnette F, Phillips S, Zini A, Kadoch IJ. The paternal clock: Uncovering the consequences of advanced paternal age on sperm DNA fragmentation. Reprod Biol 2024; 24:100931. [PMID: 39180943 DOI: 10.1016/j.repbio.2024.100931] [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: 12/03/2023] [Revised: 07/23/2024] [Accepted: 08/12/2024] [Indexed: 08/27/2024]
Abstract
The objective of the study was to investigate the relationship between advanced paternal age and sperm DNA fragmentation (SDF) levels, specifically identifying the age at which a significant increase in SDF occurs. This is a retrospective cohort study involving 4250 consecutive semen samples from patients presenting for infertility evaluation. Patients were stratified into seven age groups: < 26 (n = 36; 0.8 %), 26-30 (n = 500; 11.8 %), 31-35 (n = 1269; 29.9 %), 36-40 (n = 1268; 29.8 %), 41-45 (n = 732; 17.2 %), 46-50 (n = 304; 7.2 %), > 50 (n = 141; 3.3 %). The main outcome measures included comparing mean SDF levels throughout different age groups and assessing the prevalence of normal, intermediate, and high SDF among the age groups. A positive correlation was observed between paternal age and SDF (r = 0.17, p < 0.001). SDF remained relatively constant until the age of 35 but increased significantly beyond age 35. Mean SDF levels in the older age groups (36-40, 41-45, 46-50, and >50 years) were significantly higher than in the younger age groups (<26, 26-30, and 31-35 years) (p < 0.001). The prevalence of normal SDF was highest among the younger age groups, whereas the prevalence of high SDF was highest among the older age groups. Interestingly, the prevalence of intermediate SDF was relatively constant throughout the age groups (ranging between 29.8 % to 37.2 %). The increase in SDF after the age of 35 highlights the importance of considering male age in infertility evaluations. Assessing SDF in men over the age of 35 is crucial in couples seeking to conceive.
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Affiliation(s)
| | - Jonas Benguigui
- Clinique ovo, Montreal, Canada; Department of Obstetrics and Gynecology, University of Montreal, Montreal, Canada
| | | | - Artak Tadevosyan
- Clinique ovo, Montreal, Canada; Department of Pharmacology and Physiology, Faculty of Medicine, University of Montreal, Montreal, Canada
| | - François Bissonnette
- Clinique ovo, Montreal, Canada; Department of Obstetrics and Gynecology, University of Montreal, Montreal, Canada
| | - Simon Phillips
- Clinique ovo, Montreal, Canada; Department of Obstetrics and Gynecology, University of Montreal, Montreal, Canada
| | - Armand Zini
- Clinique ovo, Montreal, Canada; Division of Urology, Department of Surgery, McGill University, Montreal, Canada
| | - Isaac-Jacques Kadoch
- Clinique ovo, Montreal, Canada; Department of Obstetrics and Gynecology, University of Montreal, Montreal, Canada.
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Sonigo C, Robin G, Boitrelle F, Fraison E, Sermondade N, Mathieu d'Argent E, Bouet PE, Dupont C, Creux H, Peigné M, Pirrello O, Trombert S, Lecorche E, Dion L, Rocher L, Arama E, Bernard V, Monnet M, Miquel L, Birsal E, Haïm-Boukobza S, Plotton I, Ravel C, Grzegorczyk-Martin V, Huyghe É, Dupuis HGA, Lefebvre T, Leperlier F, Bardet L, Lalami I, Robin C, Simon V, Dijols L, Riss J, Koch A, Bailly C, Rio C, Lebret M, Jegaden M, Fernandez H, Pouly JL, Torre A, Belaisch-Allart J, Antoine JM, Courbiere B. [First-line management of infertile couple. Guidelines for clinical practice of the French College of Obstetricians and Gynecologists 2022]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2024; 52:305-335. [PMID: 38311310 DOI: 10.1016/j.gofs.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 01/25/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVE To update the 2010 CNGOF clinical practice guidelines for the first-line management of infertile couples. MATERIALS AND METHODS Five major themes (first-line assessment of the infertile woman, first-line assessment of the infertile man, prevention of exposure to environmental factors, initial management using ovulation induction regimens, first-line reproductive surgery) were identified, enabling 28 questions to be formulated using the Patients, Intervention, Comparison, Outcome (PICO) format. Each question was addressed by a working group that had carried out a systematic review of the literature since 2010, and followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) methodology to assess the quality of the scientific data on which the recommendations were based. These recommendations were then validated during a national review by 40 national experts. RESULTS The fertility work-up is recommended to be prescribed according to the woman's age: after one year of infertility before the age of 35 and after 6months after the age of 35. A couple's initial infertility work-up includes a single 3D ultrasound scan with antral follicle count, assessment of tubal permeability by hysterography or HyFOSy, anti-Mullerian hormone assay prior to assisted reproduction, and vaginal swabbing for vaginosis. If the 3D ultrasound is normal, hysterosonography and diagnostic hysteroscopy are not recommended as first-line procedures. Chlamydia trachomatis serology does not have the necessary performance to predict tubal patency. Post-coital testing is no longer recommended. In men, spermogram, spermocytogram and spermoculture are recommended as first-line tests. If the spermogram is normal, it is not recommended to check the spermogram. If the spermogram is abnormal, an examination by an andrologist, an ultrasound scan of the testicles and hormonal test are recommended. Based on the data in the literature, we are unable to recommend a BMI threshold for women that would contraindicate medical management of infertility. A well-balanced Mediterranean-style diet, physical activity and the cessation of smoking and cannabis are recommended for infertile couples. For fertility concern, it is recommended to limit alcohol consumption to less than 5 glasses a week. If the infertility work-up reveals no abnormalities, ovulation induction is not recommended for normo-ovulatory women. If intrauterine insemination is indicated based on an abnormal infertility work-up, gonadotropin stimulation and ovulation monitoring are recommended to avoid multiple pregnancies. If the infertility work-up reveals no abnormality, laparoscopy is probably recommended before the age of 30 to increase natural pregnancy rates. In the case of hydrosalpinx, surgical management is recommended prior to ART, with either salpingotomy or salpingectomy depending on the tubal score. It is recommended to operate on polyps>10mm, myomas 0, 1, 2 and synechiae prior to ART. The data in the literature do not allow us to systematically recommend asymptomatic uterine septa and isthmoceles as first-line surgery. CONCLUSION Based on strong agreement between experts, we have been able to formulate updated recommendations in 28 areas concerning the initial management of infertile couples.
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Affiliation(s)
- Charlotte Sonigo
- Service de médecine de la reproduction et préservation de la fertilité, hôpital Antoine-Béclère, 157, rue de la Porte-Trivaux, 92140 Clamart, France; Faculté de médecine, université Paris-Sud Saclay, 63, rue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France
| | - Geoffroy Robin
- Service d'assistance médicale à la procréation et préservation de la fertilité, CHU de Lille, Lille, France
| | - Florence Boitrelle
- Service de biologie de la reproduction, préservation de fertilité, CECOS, CHI de Poissy, Poissy, France; INRAe, ENVA, BREED, UVSQ, université Paris Saclay, Jouy-en Josas, France
| | - Eloïse Fraison
- Département médecine de la reproduction, CHU Lyon, hôpital Femme-Mère-Enfant, 59, boulevard Pinel, 69500 Bron, France
| | - Nathalie Sermondade
- Service de biologie de la reproduction CECOS, hôpital Tenon, AP-HP, Sorbonne université, 75020 Paris, France; Inserm US938, centre de recherche Saint-Antoine, Sorbonne université, 75012 Paris, France
| | - Emmanuelle Mathieu d'Argent
- Service de gynécologie-obstétrique et médecine de la reproduction, Dmu Origyne, hôpital Tenon, GHU Sorbonne université, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - Pierre-Emmanuel Bouet
- Service de gynécologie-obstétrique, centre hospitalier universitaire d'Angers, 4, rue Larrey, 49000 Angers, France
| | - Charlotte Dupont
- Service de biologie de la reproduction - CECOS, hôpital Tenon, AP-HP, Sorbonne université, 75012 Paris, France
| | - Hélène Creux
- Centre AMP, polyclinique Saint-Roch, 550, avenue du Colonel-André-Pavelet, 34070 Montpellier cedex, France
| | - Maeliss Peigné
- Service de médecine de la reproduction et préservation de la fertilité, hôpital Jean-Verdier-Béclère, avenue du 14-Juillet, Bondy, France
| | - Olivier Pirrello
- Service d'aide médicale à la procréation, centre médicochirurgical obstétrique (CMCO), CHU de Strasbourg, 19, rue Louis-Pasteur, 67303 Schiltigheim, France
| | - Sabine Trombert
- Laboratoire Cerba, 6-11, rue de l'Équerre, 95310 Saint-Ouen L'Aumône, France
| | - Emmanuel Lecorche
- Laboratoire Cerba, 6-11, rue de l'Équerre, 95310 Saint-Ouen L'Aumône, France
| | - Ludivine Dion
- Département de gynécologie-obstétrique et reproduction humaine - CECOS, hôpital Sud, CHU de Rennes, 16, boulevard de Bulgarie, 35000 Rennes, France
| | - Laurence Rocher
- Service de radiologie diagnostique et interventionnelle, site Bicêtre, hôpitaux Paris Sud, 94270 Le Kremlin-Bicêtre, France; Université Paris Sud, 63, rue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France; Service hospitalier Frédéric-Joliot, imagerie par résonance magnétique médicale et multimodalités, CNRS UMR8081, université Paris Sud, 4, place du Gal-Leclerc, 91401 Orsay cedex, France
| | - Emmanuel Arama
- Service de radiologie diagnostique et interventionnelle, site Bicêtre, hôpitaux Paris Sud, 94270 Le Kremlin-Bicêtre, France; Université Paris Sud, 63, rue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France; Service hospitalier Frédéric-Joliot, imagerie par résonance magnétique médicale et multimodalités, CNRS UMR8081, université Paris Sud, 4, place du Gal-Leclerc, 91401 Orsay cedex, France
| | - Valérie Bernard
- Service de chirurgie gynécologique, gynécologie médicale et médecine de la reproduction, centre Aliénor d'Aquitaine, CHU Pellegrin, Bordeaux, France
| | - Margaux Monnet
- Département de gynécologie médicale, maternité régionale de Nancy, hôpitaux universitaires de Nancy, Nancy, France
| | - Laura Miquel
- Service d'assistance médicale à la procréation, pôle Femmes-Parents-Enfants, hôpital de la Conception, AP-HM, 147, boulevard Baille, 13005 Marseille, France
| | - Eva Birsal
- Service d'assistance médicale à la procréation, pôle Femmes-Parents-Enfants, hôpital de la Conception, AP-HM, 147, boulevard Baille, 13005 Marseille, France
| | | | - Ingrid Plotton
- Service d'hormonologie, endocrinologie moléculaire et maladies rares, CPBE, groupement hospitalier Lyon-Est, Lyon-Bron, France; Université Claude-Bernard, Lyon 1, Lyon, France; Unité Inserm 1208, Lyon, France
| | - Célia Ravel
- Département de gynécologie-obstétrique et reproduction humaine - CECOS, hôpital Sud, CHU de Rennes, 16, boulevard de Bulgarie, 35000 Rennes, France
| | - Véronika Grzegorczyk-Martin
- Centre d'assistance médicale à la procréation et de préservation de la fertilité, clinique Mathilde, 76100 Rouen, France
| | - Éric Huyghe
- Département d'urologie, hôpital de Rangueil, CHU de Toulouse, Toulouse, France; Service de médecine de la reproduction, hôpital Paule-de-Viguier, CHU de Toulouse, Toulouse, France; Inserm 1203, UMR DEFE, université de Toulouse, université de Montpellier, Montpellier, France
| | - Hugo G A Dupuis
- Service d'urologie et d'andrologie, CHU - hôpitaux de Rouen, CHU Charles-Nicolle, 76031 Rouen, France
| | - Tiphaine Lefebvre
- Service de médecine et biologie de la reproduction - gynécologie médicale, centre hospitalier universitaire de Nantes, 38, boulevard Jean-Monnet, 44093 Nantes, France
| | - Florence Leperlier
- Service de médecine et biologie de la reproduction - gynécologie médicale, centre hospitalier universitaire de Nantes, 38, boulevard Jean-Monnet, 44093 Nantes, France
| | - Léna Bardet
- Service de gynécologie-obstétrique et médecine de la reproduction, Dmu Origyne, hôpital Tenon, GHU Sorbonne université, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - Imane Lalami
- Service de gynécologie-obstétrique et de médecine de la reproduction, grand hôpital de l'Est Francilien - site de Meaux, 6-8, rue Saint-Fiacre, 77100 Meaux, France
| | - Camille Robin
- Service d'assistance médicale à la procréation et préservation de la fertilité, CHU de Lille, Lille, France
| | - Virginie Simon
- Unité fonctionnelle de gynécologie endocrinienne, service de gynécologie médicale, orthogénie et sexologie, hôpital Jeanne-de-Flandre, CHU de Lille, avenue Eugène-Avinée, 59037 Lille cedex, France
| | - Laura Dijols
- Service de médecine de la reproduction et préservation de la fertilité, hôpital Bretonneau, CHU de Tours, Tours, France
| | - Justine Riss
- Service d'aide médicale à la procréation, centre médicochirurgical obstétrique (CMCO), CHU de Strasbourg, 19, rue Louis-Pasteur, 67303 Schiltigheim, France
| | - Antoine Koch
- Service d'aide médicale à la procréation, centre médicochirurgical obstétrique (CMCO), CHU de Strasbourg, 19, rue Louis-Pasteur, 67303 Schiltigheim, France
| | - Clément Bailly
- Service de biologie de la reproduction CECOS, hôpital Tenon, AP-HP, Sorbonne université, 75020 Paris, France; Inserm US938, centre de recherche Saint-Antoine, Sorbonne université, 75012 Paris, France
| | - Constance Rio
- Service de gynécologie-obstétrique, centre hospitalier universitaire d'Angers, 4, rue Larrey, 49000 Angers, France
| | - Marine Lebret
- Service de gynécologie-obstétrique, CHU Charles-Nicolle, 37, boulevard Gambetta, 76000 Rouen, France
| | - Margaux Jegaden
- Faculté de médecine, université Paris-Sud Saclay, 63, rue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France; Département de chirurgie gynécologique et obstétrique, hôpital Bicêtre, GHU-Sud, AP-HP, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Hervé Fernandez
- Faculté de médecine, université Paris-Sud Saclay, 63, rue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France; Département de chirurgie gynécologique et obstétrique, hôpital Bicêtre, GHU-Sud, AP-HP, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Jean-Luc Pouly
- Service de gynécologie chirurgicale, CHU Estaing, 1, place Lucie-et-Raymond-Aubrac, 63003 Clermont-Ferrand, France
| | - Antoine Torre
- Centre d'assistance médicale à la procréation clinicobiologique, centre hospitalier Sud Francilien Corbeil-Essonnes, 40, avenue Serge-Dassault, 91106 Corbeil-Essonnes, France
| | - Joëlle Belaisch-Allart
- Service de médecine de la reproduction, pôle Femme-Enfant, Centre hospitalier des 4 villes, rue Charles-Lauer, 92210 Saint-Cloud, France
| | - Jean-Marie Antoine
- Service de gynécologie-obstétrique et médecine de la reproduction, Dmu Origyne, hôpital Tenon, GHU Sorbonne université, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - Blandine Courbiere
- Service d'assistance médicale à la procréation, pôle Femmes-Parents-Enfants, hôpital de la Conception, AP-HM, 147, boulevard Baille, 13005 Marseille, France; IMBE, CNRS, IRD, Aix-Marseille université, Avignon université, Marseille, France.
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Warli SM, Nabil RA, Kadar DD, Prapiska FF, Siregar GP. A comparison between the efficacy and complication of laparoscopic and microsurgical varicocelectomy: Systematic review and meta-analysis. Urol Ann 2024; 16:113-119. [PMID: 38818427 PMCID: PMC11135350 DOI: 10.4103/ua.ua_3_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 08/30/2023] [Indexed: 06/01/2024] Open
Abstract
Varicocele is the dilatation of the scrotal veins and may affect sperm count and infertility. It is caused by congenital vein insufficiency or absence of venous valve. The main treatment is by surgery, and currently, there are two minimally invasive choices: laparoscopic and microsurgical varicocelectomy. This systematic review aimed to record randomized clinical trials from various sources using all qualified studies up to June 2022. The assessed outcomes were operation time, hydrocele, hospital stay, change in semen parameter, recurrence rate, and pregnancy rate. The essential data extracted were Jadad score, publication year, age, and sample size. This systematic review consisted of 509 and 512 patients in the laparoscopic and microsurgery group, respectively, taken from 12 out of 281 studies. The result of this systematic review was significant difference in operation time between patients from two groups (weighted mean difference [WMD] -21.40, 95% confidence interval [CI]: -28.90--13.89); length of hospitalization (WMD: 0.38, 95% CI: 0.02-0.74); laparoscopic could significantly increase the risk of hydrocele by 3.30-fold (risk ratio [RR]: 3.30, 95% CI: 1.07-10.12); laparoscopic could significantly increase the recurrence rate by 6.98-fold (RR: 6.98, 95% CI: 3.46-14.08); no significant difference in spontaneous pregnancy between patients in both groups (RR: 0.81, 95% CI: 0.57-1.16); and laparoscopic surgery decreased the occurrence of sperm parameter changes by 40% (RR = 0.40, 95% CI: 0.25-0.62).
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Affiliation(s)
- Syah Mirsya Warli
- Department of Surgery, Division of Urology, Faculty of Medicine, Universitas Sumatera Utara – Haji Adam Malik General Hospital, Medan, Indonesia
- Department of Urology, Universitas Sumatera Utara, Universitas Sumatera Utara Hospital, Medan, Indonesia
| | - Rizky An Nabil
- Department of Urology, Faculty of Medicine, Universitas Indonesia – Haji Adam Malik General Hospital, Medan, Indonesia
| | - Dhirajaya Dharma Kadar
- Department of Surgery, Division of Urology, Faculty of Medicine, Universitas Sumatera Utara – Haji Adam Malik General Hospital, Medan, Indonesia
| | - Fauriski Febrian Prapiska
- Department of Surgery, Division of Urology, Faculty of Medicine, Universitas Sumatera Utara – Haji Adam Malik General Hospital, Medan, Indonesia
| | - Ginanda Putra Siregar
- Department of Surgery, Division of Urology, Faculty of Medicine, Universitas Sumatera Utara – Haji Adam Malik General Hospital, Medan, Indonesia
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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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Shiraishi K. Role of varicocele repair in the era of assisted reproductive technologies: Lessons from 2000 cases of microsurgical varicocele repair. Reprod Med Biol 2024; 23:e12589. [PMID: 38948338 PMCID: PMC11211092 DOI: 10.1002/rmb2.12589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 05/03/2024] [Accepted: 05/27/2024] [Indexed: 07/02/2024] Open
Abstract
Backgrounds In an era of advanced maternal age, there is less conclusive evidence regarding the treatment outcomes of varicocele repair for assisted reproductive technology (ART). Progress in basic research on varicocele is notable whereas there are many clinically relevant points to discuss. Methods Based on our experience with more than 2000 cases of microsurgical varicocele repair, we focused on the effectiveness of varicocele repair, pathophysiology, surgical approaches, contributions to ART, sperm DNA fragmentation, and varicocele-associated azoospermia in this review with the aim of identifying clearer directions for basic and clinical research on varicocele. Results Microsurgical low ligation for varicocele repair is expected to remain the gold standard for surgical therapy. Based on the findings from a number of systematic reviews and meta-analyses, negative opinions regarding the efficacy of microsurgical varicocele repair in male infertility treatment have become virtually nonexistent. However, the majority of evidence regarding surgical indications and effectiveness pertains to improvements in semen parameters or non-ART pregnancy rates. Conclusions Further understandings regarding to pathophysiology of varicocele will likely be gained through comprehensive genetic, transcriptomic, and epigenetic analyses using blood and testicular samples from humans and we hope to develop new diagnostic methods and pharmacotherapy.
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Affiliation(s)
- Koji Shiraishi
- Department of UrologyYamaguchi University School of MedicineUbeYamaguchiJapan
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Nielsen JLM, Majzoub A, Esteves S, Humaidan P. Unraveling the Impact of Sperm DNA Fragmentation on Reproductive Outcomes. Semin Reprod Med 2023; 41:241-257. [PMID: 38092034 DOI: 10.1055/s-0043-1777324] [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: 03/20/2024]
Abstract
In recent years, there has been a growing interest in identifying subcellular causes of male infertility, and sperm DNA fragmentation (SDF) research has been at the forefront of this focus. DNA damage can occur during spermatogenesis due to faulty chromatin compaction or excessive abortive apoptosis. It can also happen as sperm transit through the genital tract, often induced by oxidative stress. There are several methods for SDF testing, with the sperm chromatin structure assay, terminal deoxynucleotidyl transferase d-UTI nick end labeling (TUNEL) assay, comet assay, and sperm chromatin dispersion test being the most commonly used. Numerous studies strongly support the negative impact of SDF on male fertility potential. DNA damage has been linked to various morphological and functional sperm abnormalities, ultimately affecting natural conception and assisted reproductive technology outcomes. This evidence-based review aims to explore how SDF influences male reproduction and provide insights into available therapeutic options to minimize its detrimental impact.
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Affiliation(s)
- Jeanett L M Nielsen
- The Fertility Clinic, Skive Regional Hospital, Skive, Denmark
- Department of Obstetrics and Gynecology, Viborg Regional Hospital, Viborg, Denmark
| | - Ahmad Majzoub
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
- Department of Clinical Urology, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Sandro Esteves
- ANDROFERT, Andrology and Human Reproduction Clinic, Campinas, Brazil
- Division of Urology, Department of Surgery, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
- Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Peter Humaidan
- The Fertility Clinic, Skive Regional Hospital, Skive, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Huyghe E, Methorst C, Faix A. [Varicocele and male infertility]. Prog Urol 2023; 33:624-635. [PMID: 38012908 DOI: 10.1016/j.purol.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 09/04/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Varicocele is the most common correctable cause of male infertility. It was the subject of recent Association française d'urologie (AFU) Comité d'andrologie et de médecine sexuelle (CAMS) recommendations. Since then, the literature has provided additional information. This review will comprehensively reassess current indications for the treatment of varicocele, and revisit contemporary issues in the light of current advances. METHODS Update of the literature search carried out as part of the CAMS recommendations for the period between 2020 and 2023. RESULTS Microsurgical sub-inguinal varicocelectomy remains the surgical treatment of choice for infertile men with clinical varicocele and abnormal sperm parameters. It offers recurrence rates of less than 4%. It significantly improves both natural and in vitro fertilization live birth and pregnancy rates, as well as sperm count, total and progressive motility, morphology and DNA fragmentation rates. All in all, it modifies the MPA strategy in around one in two cases. Varicocele grade and bilaterality are predictive of improved sperm parameters and pregnancy rate. Treatment of subclinical varicocele is not recommended. Complications are rare, notably hydroceles (0.5%), unilateral testicular atrophy due to arterial damage (1/1000), hematomas, delayed healing and postoperative pain. Retrograde embolization is an alternative to surgery. CONCLUSION Whenever possible, the urologist should present and discuss treatment options for varicocele with the MPA team and the patient, taking a personalized approach.
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Affiliation(s)
- E Huyghe
- Département d'urologie, hôpital de Rangueil, CHU de Toulouse, Toulouse, France; Service de médecine de la reproduction, hôpital Paule-de-Viguier, CHU de Toulouse, Toulouse, France; UMR DEFE, Inserm 1203, université de Toulouse, université de Montpellier, Toulouse, France.
| | - C Methorst
- Service de médecine de la reproduction, hôpital des Quatre Villes, Saint-Cloud, France
| | - A Faix
- Clinique Saint-Roch, 560, avenue du Colonel-Pavelet-dit-Villars, 34000 Montpellier, France
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Belardin LB, Antoniassi MP, Camargo M, Intasqui P, Bertolla RP. Separating the chaff from the wheat: antibody-based removal of DNA-fragmented sperm. Hum Reprod 2023; 38:204-215. [PMID: 36539256 DOI: 10.1093/humrep/deac260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 11/12/2022] [Indexed: 12/24/2022] Open
Abstract
STUDY QUESTION Is it possible to remove sperm with damaged DNA from a semen sample? SUMMARY ANSWER By using immunomagnetic cell sorting that targets the sperm head-bound epididymal sperm-binding protein 1 (ELSPBP1), it was possible to produce an ELSPBP1(-) sperm fraction characterized by consistently lower levels of sperm DNA fragmentation (SDF). WHAT IS KNOWN ALREADY In bovines, ELSPBP1 is bound to dead spermatozoa. Human ejaculates with high SDF have increased detected levels of sperm ELSPBP1 when compared to ejaculates with low native SDF. STUDY DESIGN, SIZE, DURATION We recruited 267 patients who were referred to the clinic for conjugal infertility. After applying exclusion criteria, such as fever within 90 days of the study, history of systemic diseases, alterations or surgical interventions to the genital tract and use of cigarette or drugs, a total of 133 patients were included. A total of 52 samples were used for the evaluation of sperm ELSPBP1 levels (Sub-study 1), 41 samples for determination of ELSPBP1 location in human sperm (Sub-study 2), and 40 samples for immunomagnetic cell sorting targeting ELSPBP1, to produce ELSPBP1(-) (without ELSPBP1) and ELSPBP1(+) (with ELSPBP1) fractions (Sub-study 3). Samples were collected between July 2016 and September 2019. PARTICIPANTS/MATERIALS, SETTING, METHODS In Sub-study 1, sperm ELSPBP1 levels were assessed by western blotting. For Sub-study 2, ELSPBP1 was localized in sperm by immunocytochemistry. Finally, for Sub-study 3, sperm were selected based on incubation of semen samples with antibody-coated magnetic microspheres targeting ELSPBP1. Two fractions were produced (with or without ELSPBP1), and these sub-populations were submitted to an alkaline Comet assay for determination of SDF. MAIN RESULTS AND THE ROLE OF CHANCE Men with high SDF presented higher sperm ELSPBP1 levels when compared to the control group (low SDF), while no difference between groups was observed in seminal plasma. ELSPBP1 was located in the head region of human sperm. The ELSPBP1(+) fractions presented high and variable levels of SDF, while their paired ELSPBP(-) fractions presented consistently low SDF. LIMITATIONS, REASONS FOR CAUTION This work did not validate the levels of ELSPBP1 in other functional alterations of sperm, such as acrosome integrity or mitochondrial activity. Moreover, this is still a pre-clinical study, intended to demonstrate proof-of-concept that ELSPBP1 selects sperm with low DNA fragmentation; further investigation is warranted to demonstrate safety for use in ART. Sperm fractions were not assessed for sperm vitality. A clinical trial is still necessary for these findings to be extrapolated to outcomes in ART. WIDER IMPLICATIONS OF THE FINDINGS Our findings demonstrate that ELSPBP1 is associated with sperm with higher levels of DNA fragmentation. The finding that the sperm membrane can reflect alterations in DNA integrity could give rise to a novel molecular method for sperm preparation prior to use of assisted reproductive procedures. Moreover, the detection of sperm-bound ELSPBP1 could serve as an indirect method for the determination of DNA fragmentation. STUDY FUNDING/COMPETING INTEREST(S) L.B.B. was a recipient of a Ph.D. scholarship from the Sao Paulo Research Foundation-FAPESP (process number 2016/05487-3). R.P.B. is a recipient of a Scientific Productivity scholarship from the Brazilian National Council for Scientific and Technological Development-CNPq (process number 306705/2017-6). The authors have no conflict of interest to disclose. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- L B Belardin
- Human Reproduction Section, Division of Urology, Department of Surgery, Universidade Federal de São Paulo, São Paulo, Brazil
| | - M P Antoniassi
- Human Reproduction Section, Division of Urology, Department of Surgery, Universidade Federal de São Paulo, São Paulo, Brazil
| | - M Camargo
- Human Reproduction Section, Division of Urology, Department of Surgery, Universidade Federal de São Paulo, São Paulo, Brazil
| | - P Intasqui
- Human Reproduction Section, Division of Urology, Department of Surgery, Universidade Federal de São Paulo, São Paulo, Brazil
| | - R P Bertolla
- Human Reproduction Section, Division of Urology, Department of Surgery, Universidade Federal de São Paulo, São Paulo, Brazil
- Hospital São Paulo, São Paulo, Brazil
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9
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Nam CS, Mehta A. Advanced sperm tests and impact on clinical male factor management. Curr Opin Urol 2023; 33:24-30. [PMID: 36444649 DOI: 10.1097/mou.0000000000001049] [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: 11/30/2022]
Abstract
PURPOSE OF REVIEW Although semen analysis remains a cornerstone of male fertility evaluation, conventional semen analysis parameters do not assess for DNA integrity or functional capacity of sperm. Sperm DNA fragmentation (SDF) and sperm aneuploidy tests have been utilized as adjunct tools to distinguish fertile and infertile men and predict pregnancy outcomes. This review serves as an update on indications and utility of advanced sperm tests, as well as associated controversies and limitations. RECENT FINDINGS Elevated SDF is associated with prolonged time to pregnancy, lower chance of spontaneous pregnancy, and lower live birth rates. Sperm aneuploidy is more frequent in infertile men, in male partners of couples experiencing recurrent pregnancy loss, and recurrent failure of assisted reproductive technology (ART). These tests can, therefore, provide important information to guide management and counseling of infertile couples to optimize reproductive outcomes. SUMMARY We evaluated data surrounding SDF and sperm aneuploidy tests, which are utilized both within and beyond the scope of AUA/ASRM guidelines. While the tests at hand require further standardization and randomized controlled studies, the current data suggest strong associations with pregnancy outcomes and can be utilized to counsel and manage infertile males.
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Affiliation(s)
- Catherine S Nam
- Department of Urology, Michigan Medicine University of Michigan, Ann Arbor, Michigan
| | - Akanksha Mehta
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA
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10
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Adler A, Roth B, Lundy SD, Takeshima T, Yumura Y, Kuroda S. Sperm DNA fragmentation testing in clinical management of reproductive medicine. Reprod Med Biol 2023; 22:e12547. [PMID: 37915974 PMCID: PMC10616814 DOI: 10.1002/rmb2.12547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/26/2023] [Accepted: 10/12/2023] [Indexed: 11/03/2023] Open
Abstract
Background Approximately 8%-12% of couples worldwide face infertility, with infertility of individuals assigned male at birth (AMAB) contributing to at least 50% of cases. Conventional semen analysis commonly used to detect sperm abnormalities is insufficient, as 30% of AMAB patients experiencing infertility show normal results in this test. From a genetic perspective, the assessment of sperm DNA fragmentation (SDF) is important as a parameter of sperm quality. Methods In this narrative study, we review and discuss pathophysiological causes, DNA repair mechanisms, and management of high SDF. We then summarize literature exploring the association between SDF and reproductive outcomes. Main Findings Recent systematic reviews and meta-analyses have revealed a significant association between high SDF in AMAB individuals and adverse reproductive outcomes including embryo development, natural conception, intrauterine insemination, and in vitro fertilization. However, the association with live birth rates and pregnancy rates following intracytoplasmic injection remains inconclusive. The disparities among quantitative assays, inconsistent reference range values, absent high-quality prospective clinical trials, and clinical heterogeneity in AMAB patients with elevated SDF represent the main limitations affecting SDF testing. Conclusion The evaluation and management of SDF plays an important role in a subset of AMAB infertility, but widespread integration into clinical guidelines will require future high-quality clinical trials and assay standardization.
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Affiliation(s)
- Ava Adler
- Glickman Urological & Kidney InstituteCleveland Clinic FoundationClevelandOhioUSA
| | - Bradley Roth
- Glickman Urological & Kidney InstituteCleveland Clinic FoundationClevelandOhioUSA
| | - Scott D. Lundy
- Glickman Urological & Kidney InstituteCleveland Clinic FoundationClevelandOhioUSA
| | - Teppei Takeshima
- Department of Urology, Reproduction CenterYokohama City University Medical CenterYokohamaJapan
| | - Yasushi Yumura
- Department of Urology, Reproduction CenterYokohama City University Medical CenterYokohamaJapan
| | - Shinnosuke Kuroda
- Glickman Urological & Kidney InstituteCleveland Clinic FoundationClevelandOhioUSA
- Department of Urology, Reproduction CenterYokohama City University Medical CenterYokohamaJapan
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11
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Alahmar A, Singh R, Palani A. Sperm DNA fragmentation in reproductive medicine: A review. J Hum Reprod Sci 2022; 15:206-218. [PMID: 36341018 PMCID: PMC9635374 DOI: 10.4103/jhrs.jhrs_82_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/08/2022] [Accepted: 08/28/2022] [Indexed: 11/17/2022] Open
Abstract
Approximately 15% of the world's couples suffer from infertility during their reproductive period of which the male factor is responsible for 50% of cases. Male factor infertility is multifactorial in origin, and sperm DNA fragmentation (SDF) has also been linked to male infertility including idiopathic male infertility. Some degree of controlled DNA nicking is essential for adequate DNA compaction, but excessive SDF is usually associated with reduced male fertility potential, reduced fertilisation, poor embryo quality, recurrent pregnancy loss and poor assisted reproductive techniques (ARTs) outcomes. Although semen analysis remains the gold standard for diagnosis of male factor infertility worldwide, its limitations motivated the search and the development of complementary tests of sperm function and integrity. SDF assay is an emerging diagnostic tool in infertile men, and several indications for SDF testing in infertile couples have also been proposed. The use of SDF in routine male infertility assessment is, however, still controversial. Furthermore, both direct and indirect SDF tests are now available. Hence, the present review was conducted to summarise the recent evidence of SDF, underlying mechanisms, clinical indications, diagnostic tests, as well as the role of SDF in male factor infertility, pregnancy and ART outcomes.
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12
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Rivera Mirabal JL, Lipshultz LI. Clinical implications of repeat sperm deoxyribonucleic acid damage testing in men with clinical infertility. Fertil Steril 2021; 117:74. [PMID: 34865851 DOI: 10.1016/j.fertnstert.2021.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 11/30/2022]
Affiliation(s)
| | - Larry I Lipshultz
- Scott Department of Urology, Baylor College of Medicine, Houston, Texas
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13
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Wood GJA, Cardoso JPG, Paluello DV, Nunes TF, Cocuzza M. Varicocele-Associated Infertility and the Role of Oxidative Stress on Sperm DNA Fragmentation. FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3:695992. [PMID: 36304050 PMCID: PMC9580684 DOI: 10.3389/frph.2021.695992] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 09/28/2021] [Indexed: 12/17/2022] Open
Abstract
Varicocele has been extensively described and studied as the most important reversible cause of male infertility. Its impact on semen parameters, pregnancy rates, and assisted reproductive outcomes have been associated with multifactorial aspects, most of them converging to increase of reactive oxygen species (ROS). More recently, sperm DNA fragmentation has gained significant attention and potential clinical use, although the body of evidence still needs further evolution. The associations between sperm DNA damage and a variety of disorders, including varicocele itself, share common pathways to ROS increase. This mini-review discusses different aspects related to the etiology of ROS and its relation to varicocele and potential mechanisms of DNA damage.
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Affiliation(s)
- Guilherme Jacom Abdulmassih Wood
- Huntington Medicina Reprodutiva, São Paulo, Brazil
- Division of Urology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- *Correspondence: Guilherme Jacom Abdulmassih Wood
| | - João Paulo Greco Cardoso
- Division of Urology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Davi Vischi Paluello
- Division of Urology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Marcello Cocuzza
- Division of Urology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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14
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Adiga PK, Vitthala S, Shivaranjeni. Correlation of sperm DNA damage with blastocyst formation: systematic review and meta-analysis. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2021. [DOI: 10.1186/s43043-021-00067-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The routine semen analysis fails to detect sperm DNA damage which contributes to the majority of male factor infertility. Sperm DNA fragmentation test (DFI) measures the sperm DNA damage. Blastocyst formation is an important step in IVF ± ICSI. At present, the literature lacks any data that correlates DFI and blastocyst formation.
Main body of the abstract
We searched MEDLINE and other databases till 2020 for the studies that reported on sperm DNA damage and blastocyst formation in assisted reproductive technology (ART). The outcomes analyzed were (1) a comparison of blastulation rates in high DFI and low DFI groups. (2) Comparison of blastulation rates in high DFI and low DFI groups based on (a) different sperm DNA fragmentation assays (COMET, SCD, SCSA, TUNEL), (b) different types of ART (IVF/IVF + ICSI/ICSI). 10 studies were included in this review. A non-significant increase in the blastocyst formation was observed in high DFI group (OR = 0.70; 95% CI = 0.4 to 1.21; P = 0.20) and with SCD and TUNEL assays.
Short conclusion
Our study emphasizes on sperm DNA fragmentation (sperm DNA damage) as an important marker of blastocyst formation. The results of this meta-analysis suggest that the high sperm DNA fragmentation may not adversely affect the blastocyst formation.
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15
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Minhas S, Bettocchi C, Boeri L, Capogrosso P, Carvalho J, Cilesiz NC, Cocci A, Corona G, Dimitropoulos K, Gül M, Hatzichristodoulou G, Jones TH, Kadioglu A, Martínez Salamanca JI, Milenkovic U, Modgil V, Russo GI, Serefoglu EC, Tharakan T, Verze P, Salonia A. European Association of Urology Guidelines on Male Sexual and Reproductive Health: 2021 Update on Male Infertility. Eur Urol 2021; 80:603-620. [PMID: 34511305 DOI: 10.1016/j.eururo.2021.08.014] [Citation(s) in RCA: 241] [Impact Index Per Article: 80.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 08/20/2021] [Indexed: 12/19/2022]
Abstract
CONTEXT The European Association of Urology (EAU) has updated its guidelines on sexual and reproductive health for 2021. OBJECTIVE To present a summary of the 2021 version of the EAU guidelines on sexual and reproductive health, including advances and areas of controversy in male infertility. EVIDENCE ACQUISITION The panel performed a comprehensive literature review of novel data up to January 2021. The guidelines were updated and a strength rating for each recommendation was included that was based either on a systematic review of the literature or consensus opinion from the expert panel, where applicable. EVIDENCE SYNTHESIS The male partner in infertile couples should undergo a comprehensive urological assessment to identify and treat any modifiable risk factors causing fertility impairment. Infertile men are at a higher risk of harbouring and developing other diseases including malignancy and cardiovascular disease and should be screened for potential modifiable risk factors, such as hypogonadism. Sperm DNA fragmentation testing has emerged as a novel biomarker that can identify infertile men and provide information on the outcomes from assisted reproductive techniques. The role of hormone stimulation therapy in hypergonadotropic hypogonadal or eugonadal patients is controversial and is not recommended outside of clinical trials. Furthermore, there is insufficient evidence to support the widespread use of other empirical treatments and surgical interventions in clinical practice (such as antioxidants and surgical sperm retrieval in men without azoospermia). There is low-quality evidence to support the routine use of testicular fine-needle mapping as an alternative diagnostic and predictive tool before testicular sperm extraction (TESE) in men with nonobstructive azoospermia (NOA), and either conventional or microdissection TESE remains the surgical modality of choice for men with NOA. CONCLUSIONS All infertile men should undergo a comprehensive urological assessment to identify and treat any modifiable risk factors. Increasing data indicate that infertile men are at higher risk of cardiovascular mortality and of developing cancers and should be screened and counselled accordingly. There is low-quality evidence supporting the use of empirical treatments and interventions currently used in clinical practice; the efficacy of these therapies needs to be validated in large-scale randomised controlled trials. PATIENT SUMMARY Approximately 50% of infertility will be due to problems with the male partner. Therefore, all infertile men should be assessed by a specialist with the expertise to not only help optimise their fertility but also because they are at higher risk of developing cardiovascular disease and cancer long term and therefore require appropriate counselling and management. There are many treatments and interventions for male infertility that have not been validated in high-quality studies and caution should be applied to their use in routine clinical practice.
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Affiliation(s)
- Suks Minhas
- Department of Urology, Imperial Healthcare NHS Trust, Charing Cross Hospital, London, UK.
| | | | - Luca Boeri
- Department of Urology, Foundation IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Paolo Capogrosso
- Department of Urology and Andrology, Ospedale di Circolo and Macchi Foundation, Varese, Italy
| | - Joana Carvalho
- CPUP: Center for Psychology of Porto University, Faculty of Psychology and Educational Sciences, Porto University, Porto, Portugal
| | - Nusret Can Cilesiz
- Department of Urology, Taksim Training & Research Hospital, Istanbul, Turkey
| | - Andrea Cocci
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, University of Florence, Florence, Italy
| | - Giovanni Corona
- Endocrinology Unit, Medical Department, Maggiore-Bellaria Hospital, Bologna, Italy
| | - Konstantinos Dimitropoulos
- Academic Urology Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK; Department of Urology, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
| | - Murat Gül
- School of Medicine, Department of Urology, Selcuk University, Konya, Turkey
| | | | - Thomas Hugh Jones
- Centre for Diabetes and Endocrinology, Barnsley Hospital NHS Trust, Barnsley, UK
| | - Ates Kadioglu
- Department of Urology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | | | - Uros Milenkovic
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Vaibhav Modgil
- Manchester Andrology Centre, Manchester Royal Infirmary, Manchester University Hospitals NHS Foundation Trust, UK
| | - Giorgio Ivan Russo
- Urology Section, Department of Surgery, University of Catania, Catania, Italy
| | - Ege Can Serefoglu
- Department of Urology, Biruni University School of Medicine, Istanbul, Turkey
| | - Tharu Tharakan
- Department of Urology, Imperial Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - Paolo Verze
- Department of Medicine and Surgery, Scuola Medica Salernitana, University of Salerno, Fisciano, Italy
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
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16
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Esteves SC, Zini A, Coward RM, Evenson DP, Gosálvez J, Lewis SEM, Sharma R, Humaidan P. Sperm DNA fragmentation testing: Summary evidence and clinical practice recommendations. Andrologia 2021; 53:e13874. [PMID: 33108829 PMCID: PMC7988559 DOI: 10.1111/and.13874] [Citation(s) in RCA: 103] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 09/06/2020] [Accepted: 09/13/2020] [Indexed: 12/12/2022] Open
Abstract
We herein summarise the evidence concerning the impact of sperm DNA fragmentation in various clinical infertility scenarios and the advances on sperm DNA fragmentation tests. The collected evidence was used to formulate 41 recommendations. Of these, 13 recommendations concern technical aspects of sperm DNA fragmentation testing, including pre-analytical information, clinical thresholds and interpretation of results. The remaining 28 recommendations relate to indications for sperm DNA fragmentation testing and clinical management. Clinical scenarios like varicocele, unexplained infertility, idiopathic infertility, recurrent pregnancy loss, intrauterine insemination, in vitro fertilisation/intracytoplasmic sperm injection, fertility counselling for men with infertility risk factors and sperm cryopreservation have been contemplated. The bulk evidence supporting the recommendations has increased in recent years, but it is still of moderate to low quality. This guideline provides clinicians with advice on best practices in sperm DNA fragmentation testing. Also, recommendations are provided on possible management strategies to overcome infertility related to sperm DNA fragmentation, based on the best available evidence. Lastly, we identified gaps in knowledge and opportunities for research and elaborated a list of recommendations to stimulate further investigation.
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Affiliation(s)
- Sandro C. Esteves
- ANDROFERT, Andrology and Human Reproduction ClinicReferral Center for Male ReproductionCampinasSPBrazil
- Department of Surgery (Division of Urology)University of Campinas (UNICAMP)CampinasSPBrazil
- Faculty of HealthAarhus UniversityAarhusDenmark
| | - Armand Zini
- Division of UrologyDepartment of SurgerySt. Mary's HospitalMcGill UniversityMontrealQuébecCanada
| | - Robert Matthew Coward
- Department of UrologyUniversity of North CarolinaChapel HillNCUSA
- UNC FertilityRaleighNCUSA
| | - Donald P. Evenson
- SCSA DiagnosticsBrookingsSDUSA
- Sanford Medical SchoolUniversity of South DakotaSioux FallsSDUSA
| | - Jaime Gosálvez
- Unit of GeneticsDepartment of BiologyUniversidad Autónoma de MadridMadridSpain
| | | | - Rakesh Sharma
- American Center for Reproductive MedicineCleveland ClinicClevelandOHUSA
| | - Peter Humaidan
- Faculty of HealthAarhus UniversityAarhusDenmark
- Fertility Clinic SkiveSkive Regional HospitalSkiveDenmark
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17
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Phan HT, Nguyen TX, Nguyen DV, Vu HA, Le DA, Pham NH. Efficacy of scroto-inguinal microsurgical varicocelectomy in treating male infertility. AFRICAN JOURNAL OF UROLOGY 2021. [DOI: 10.1186/s12301-021-00141-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AbstractBackgroundVaricocele presents as the most frequent cause of infertility in men. Most reports showed that varicocelectomy has a significant impact on male fertility and reproductive outcome. This study aims to evaluate the safety and effectiveness of scrotal–inguinal microsurgical varicocelectomy in treating male infertility.MethodsWe prospectively studied preoperatively and postoperatively (at 3 and 6 months) 86 consecutive patients diagnosed with varicocele, abnormal semen parameters, and infertility, undergoing scrotal–inguinal microsurgical varicocelectomy. Semen test was performed before surgery and at 3 months and 6 months after surgery. The reproductive events were short-term followed up.ResultsThe median age of the patient was 32.9 ± 5.1 (20–43). Two cases (2.7%) had a minor infection of the scrotum incision, who were well treated by appropriate antibiotics. After operation, total sperm count and the percentage of motile sperms at 3 months and 6 months were significantly higher than those pre-varicocelectomy, respectively. In total, 26.7% (23/86) of all couples achieved a spontaneous pregnancy. Late complications such as testicular atrophy, hydroceles, and recurrent varicocele have not occurred.ConclusionsScrotal–inguinal microsurgical varicocelectomy is an acceptable method in treating male infertility due to high rate of reproductive outcomes and very low rate of complications.
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Methorst C, Akakpo W, Graziana JP, Ferretti L, Yiou R, Morel-Journel N, Terrier JE, Beley S, Carnicelli D, Hupertan V, Madec FX, Faix A, Marcelli F, Huyghe E. [Recommendations of the Committee of Andrology and Sexual Medicine of the AFU concerning the management of Varicocele]. Prog Urol 2020; 31:119-130. [PMID: 33308982 DOI: 10.1016/j.purol.2020.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 11/04/2020] [Accepted: 11/09/2020] [Indexed: 11/19/2022]
Abstract
The diagnosis of varicocele is clinical, carried out in supine and standing position and in Valsalva maneuver. Only clinical varicoceles have to be treated. A scrotal ultrasound with Doppler is generally performed as part of the infertile man's evaluation or in case of examination difficulties. The main indication for varicocele treatment is the adult man with clinical varicocele and abnormalities of sperm parameters, in a context of infertility of couple, with a partner having a satisfactory ovarian reserve and no cause of female infertility or a curable infertility cause. The decision to treat varicocele must therefore be taken after evaluation of the two partners of the couple. Adults with symptomatic varicocele and those with spermogram abnormalities may also be offered a cure for their varicocele even in the absence of a paternity plan, as well as adolescents with reduced testicular growth, an ipsilateral decrease testicular volume, or a size gradient between the 2 testes. The cure of varicocele can be carried out by surgery or by percutaneous embolization. Microsurgery (inguinal or subinguinal) offers lower rates of recurrence and complications than high surgical approaches (laparoscopic or not) and surgeries without magnification. It is therefore the reference surgical technique. Percutaneous retrograde embolization is a minimally invasive alternative to microsurgery offering satisfactory outcomes with rare and often benign complications. The cure for varicocele results in an improvement in sperm parameters and recent data seem to confirm that it increases the natural pregnancy rate. These results appear after a delay of 3 to 9 months (at least 1 to 2 cycles of spermatogenesis). When the sperm involvement was severe (azoospermia, severe oligospermia), the improvement of the spermogram allow (1) to avoid surgery testicular sperm extraction or (2) perform intrauterine insemination rather than ICSI.
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Affiliation(s)
- C Methorst
- Service d'urologie, CH des quatre villes, Saint-Cloud, France
| | - W Akakpo
- Service d'urologie, Hôpital universitaire de la Pitié Salpêtrière, Paris, France
| | - J P Graziana
- Clinique mutualiste de la porte de l'Orient, Lorient, France
| | - L Ferretti
- Service d'urologie, Hôpital d'instruction des armées Robert Picqué, Villenave-d'Ornon, France
| | - R Yiou
- Service d'urologie, CHU Henri Mondor, Créteil, France
| | | | - J E Terrier
- Hôpital privé de La Châtaignerie, Beaumont, France
| | - S Beley
- Service d'urologie, Hôpital américain, Paris, France
| | - D Carnicelli
- Service d'urologie, CHU Henri Mondor, Créteil, France
| | - V Hupertan
- Cabinet médical Paris Batignolles, Paris, France
| | - F X Madec
- Service d'urologie, Hôpital Foch, Suresnes, France
| | - A Faix
- 265, avenue des États du Languedoc, Montpellier
| | - F Marcelli
- Service d'urologie, CHRU de Lille, France
| | - E Huyghe
- Département d'urologie, Transplantation Rénale et Andrologie, CHU de Toulouse, site de Rangueil, Toulouse, France.
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19
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Razi M, Tavalaee M, Sarrafzadeh-Rezaei F, Moazamian A, Gharagozloo P, Drevet JR, Nasr-Eshafani MH. Varicocoele and oxidative stress: New perspectives from animal and human studies. Andrology 2020; 9:546-558. [PMID: 33145958 DOI: 10.1111/andr.12940] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 10/31/2020] [Accepted: 11/01/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Varicocoele (VCL), one of the main causes of male subfertility, negatively affects testicular function. Due to limited access to human testicular tissue, animal model studies have been used to evaluate molecular and, recently, epigenetic changes attributed to pathophysiology induced by VCL. OBJECTIVES This review aims to provide an update on the latest findings regarding the link between VCL-induced biochemical stress and molecular changes in germ cells and spermatozoa. Endocrine and antioxidant status, testicular chaperone-specific hemostasis failure, altered testicular ion balance, metabolic disorders, and altered carbon cycling during spermatogenesis are among the many features that will be presented. DISCUSSION Literature review coupled with our own findings suggests that ionic imbalance, hypoxia, hyperthermia, and altered blood flow could lead to severe chronic oxidative and nitrosative stress in patients with VCL leading to defective spermatogenesis and impairment of the integrity of all sperm cell components and compartments down to the epigenetic information they carry. CONCLUSION Since oxidative stress is an important feature of the reproductive pathology of VCL, therapeutic strategies such as the administration of appropriate antioxidants could be undertaken as a complementary non-invasive treatment line.
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Affiliation(s)
- Mazdak Razi
- Department of Basic Sciences, Faculty of Veterinary Medicine, Urmia University, Urmia, Iran
| | - Marziyeh Tavalaee
- Department of Animal Biotechnology, Reproductive Biomedicine Research Center, Royan Institute for Biotechnology, ACECR, Isfahan, Iran
| | - Farshid Sarrafzadeh-Rezaei
- Department of Surgery and Diagnostic Imaging, Faculty of Veterinary Medicine, Urmia University, Urmia, Iran
| | | | | | - Joël R Drevet
- Faculty of Medicine, GReD Institute, INSERM U1103, CNRS UMR6293, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Mohammad-Hossein Nasr-Eshafani
- Department of Animal Biotechnology, Reproductive Biomedicine Research Center, Royan Institute for Biotechnology, ACECR, Isfahan, Iran
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20
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Agarwal A, Majzoub A, Baskaran S, Panner Selvam MK, Cho CL, Henkel R, Finelli R, Leisegang K, Sengupta P, Barbarosie C, Parekh N, Alves MG, Ko E, Arafa M, Tadros N, Ramasamy R, Kavoussi P, Ambar R, Kuchakulla M, Robert KA, Iovine C, Durairajanayagam D, Jindal S, Shah R. Sperm DNA Fragmentation: A New Guideline for Clinicians. World J Mens Health 2020; 38:412-471. [PMID: 32777871 PMCID: PMC7502318 DOI: 10.5534/wjmh.200128] [Citation(s) in RCA: 124] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 07/13/2020] [Accepted: 07/13/2020] [Indexed: 12/13/2022] Open
Abstract
Sperm DNA integrity is crucial for fertilization and development of healthy offspring. The spermatozoon undergoes extensive molecular remodeling of its nucleus during later phases of spermatogenesis, which imparts compaction and protects the genetic content. Testicular (defective maturation and abortive apoptosis) and post-testicular (oxidative stress) mechanisms are implicated in the etiology of sperm DNA fragmentation (SDF), which affects both natural and assisted reproduction. Several clinical and environmental factors are known to negatively impact sperm DNA integrity. An increasing number of reports emphasizes the direct relationship between sperm DNA damage and male infertility. Currently, several assays are available to assess sperm DNA damage, however, routine assessment of SDF in clinical practice is not recommended by professional organizations. This article provides an overview of SDF types, origin and comparative analysis of various SDF assays while primarily focusing on the clinical indications of SDF testing. Importantly, we report four clinical cases where SDF testing had played a significant role in improving fertility outcome. In light of these clinical case reports and recent scientific evidence, this review provides expert recommendations on SDF testing and examines the advantages and drawbacks of the clinical utility of SDF testing using Strength-Weaknesses-Opportunities-Threats (SWOT) analysis.
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Affiliation(s)
- Ashok Agarwal
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA.
| | - Ahmad Majzoub
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
- Department of Urology, Weill Cornell Medicine - Qatar, Doha, Qatar
| | - Saradha Baskaran
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | | | - Chak Lam Cho
- Department of Surgery, Union Hospital, Hong Kong
- S. H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong
| | - Ralf Henkel
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Department of Medical Bioscience, University of the Western Cape, Bellville, South Africa
| | - Renata Finelli
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Kristian Leisegang
- School of Natural Medicine, Faculty of Community and Health Sciences, University of the Western Cape, Bellville, South Africa
| | - Pallav Sengupta
- Department of Physiology, Faculty of Medicine, Bioscience and Nursing, MAHSA University, Jenjarom, Malaysia
| | - Catalina Barbarosie
- Department of Genetics, Faculty of Biology, University of Bucharest, Bucharest, Romania
| | - Neel Parekh
- Department of Urology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Marco G Alves
- Department of Microscopy, Laboratory of Cell Biology & Unit for Multidisciplinary Research in Biomedicine (UMIB), Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal
| | - Edmund Ko
- Department of Urology, Loma Linda University, Loma Linda, CA, USA
| | - Mohamed Arafa
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
- Andrology Department, Cairo University, Giza, Egypt
| | - Nicholas Tadros
- Division of Urology, Southern Illinois University School of Medicine, Springfield, IL, USA
| | | | - Parviz Kavoussi
- Austin Fertility & Reproductive Medicine/Westlake IVF, Austin, TX, USA
| | - Rafael Ambar
- Urology Department of Centro Universitario em Saude do ABC, Santo André, Brazil
| | | | - Kathy Amy Robert
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Concetta Iovine
- Department of Environmental, Biological and Pharmaceutical Sciences and Technologies, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | | | - Sunil Jindal
- Department of Andrology and Reproductive Medicine, Jindal Hospital, Meerut, India
| | - Rupin Shah
- Department of Urology, Lilavati Hospital and Research Centre, Mumbai, India
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21
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Sperm DNA status in infertile patients with clinical varicocele. Prog Urol 2020; 31:105-111. [PMID: 32826197 DOI: 10.1016/j.purol.2020.07.241] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 06/24/2020] [Accepted: 07/28/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To evaluate if a potential relationship exists between sperm nuclear DNA damage and clinical varicocele and to determine the impact of clinical varicocele on standard semen parameters. MATERIALS AND METHODS A prospective study involving 30 infertile patients with clinical varicocele and 15 controls patients referred to our laboratory for routine spermiological exploration. Spermograms were performed and analyzed according to World Health Organisation (WHO) guidelines 2010. The DNA fragmentation was detected by the terminal desoxynucleotidyl transferase-mediated deoxyuridine triphosphate biotin nick-end labeling (TUNEL) assay. RESULTS The DNA fragmentation index (DFI) was significantly higher in patients with clinical varicocele compared to controls (13.3±3.4% versus 6.1±2.5%, P=0.0001). In addition, the DFI was positively and significantly correlated with the degree of severity of varicocele thus the DFI was 15.24±1.9% in patients with grade 3 versus 12.92±3.5% in those with grade 2(P<0.0001). However, an abnormality of at least one of the spermatic parameters was found in 90% of varicocele patients, and all semen characteristics such as sperm count, vitality, mobility and typical forms were decreased compared to the controls. Furthermore, statistically significant negative correlations were noted between sperm DNA fragmentation index and sperm concentration (P=0.0001), motility (P=0.03), and normal sperm morphology (P=0.03). CONCLUSION Clinical varicocele generates a significant increase of sperm abnormalities and DNA damage, and these changes are positively correlated with varicocele grade. Sperm DNA damage independent of its cause, may affect the quality of the ejaculated sperm and may have implications on patient's fertility potential. LEVEL OF EVIDENCE 3.
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22
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Sharma R, Iovine C, Agarwal A, Henkel R. TUNEL assay-Standardized method for testing sperm DNA fragmentation. Andrologia 2020; 53:e13738. [PMID: 32706440 DOI: 10.1111/and.13738] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/29/2020] [Accepted: 05/30/2020] [Indexed: 12/31/2022] Open
Abstract
Sperm DNA integrity is important for normal functions such as fertilization, implantation, pregnancy and fetal development. Sperm DNA fragmentation (SDF) is more common in infertile men and may be responsible for poor reproductive function. Although there are a number of tests available to measure SDF, the terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate-nick end labelling TUNEL) assay using flow cytometry is becoming more popular to measure the sperm DNA fragmentation. It is a direct test that measures both single- and double- DNA strand breaks. In this review, we describe the protocol, quality control and measurement of sperm DNA fragmentation using a benchtop flow cytometer. We also briefly discuss the factors that can affect the results, challenges and clinical implications of TUNEL in assessing male infertility.
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Affiliation(s)
- Rakesh Sharma
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Concetta Iovine
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Ashok Agarwal
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Ralf Henkel
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA.,Department of Medical Bioscience, University of the Western Cape, Bellville, South Africa
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23
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Santana VP, James ER, Miranda-Furtado CL, Souza MFD, Pompeu CP, Esteves SC, Carrell DT, Aston KI, Jenkins TG, Reis RMD. Differential DNA methylation pattern and sperm quality in men with varicocele. Fertil Steril 2020; 114:770-778. [PMID: 32709382 DOI: 10.1016/j.fertnstert.2020.04.045] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 04/22/2020] [Accepted: 04/22/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To study the global DNA methylation pattern in spermatozoa of patients with varicocele as well as investigate their semen quality. DESIGN Prospective observational case-control study. SETTING University-affiliated hospital. PATIENT(S) A total of 26 men with varicocele and 26 fertile men without the disorder. INTERVENTIONS Analysis of semen quality and sperm DNA methylation patterns. MAIN OUTCOME MEASURE(S) Semen quality evaluated by semen analysis, and sperm DNA methylation patterns investigated using the Infinium MethylationEPIC BeadChip platform. RESULT(S) Men with varicocele displayed decreased semen quality. The sperm DNA methylation analysis showed that men with varicocele exhibit global hypomethylation in comparison with the control group. A total of 59 differentially methylated CpG sites were identified, most of them hypomethylated in the varicocele group. In regional analyses, 1,695 DNA regions were differentially methylated in men with varicocele. These regions show associations with gamete generation, meiotic and meiosis cell cycle, and semen quality based on gene ontology analysis. CONCLUSION(S) Gene ontology results suggest that changes in methylation may be associated with the low semen quality phenotype observed in some varicocele patients because the observed differentially methylated regions in varicocele patients are related to male reproductive pathways. Additionally, the varicocele grade may influence the magnitude of global sperm DNA methylation change. To our knowledge, this is the first report analyzing changes at a regional or CpG-specific level in men with varicocele.
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Affiliation(s)
- Viviane Paiva Santana
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - Emma Rae James
- Department of Surgery, School of Medicine, University of Utah, Salt Lake City, Utah
| | - Cristiana Libardi Miranda-Furtado
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil; Drug Research and Development Center, Postgraduate Program in Medical and Surgical Sciences, Federal University of Ceara, Fortaleza, Brazil
| | - Mateus Felipe de Souza
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | | | | | - Douglas T Carrell
- Department of Surgery, School of Medicine, University of Utah, Salt Lake City, Utah
| | - Kenneth Ivan Aston
- Department of Surgery, School of Medicine, University of Utah, Salt Lake City, Utah
| | - Timothy Gerald Jenkins
- Department of Surgery, School of Medicine, University of Utah, Salt Lake City, Utah; Department of Physiology and Developmental Biology, Brigham Young University, Provo, Utah
| | - Rosana Maria Dos Reis
- Department of Gynecology and Obstetrics, Ribeirao Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil.
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24
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Panner Selvam MK, Ambar RF, Agarwal A, Henkel R. Etiologies of sperm DNA damage and its impact on male infertility. Andrologia 2020; 53:e13706. [PMID: 32559347 DOI: 10.1111/and.13706] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 05/11/2020] [Accepted: 05/15/2020] [Indexed: 12/12/2022] Open
Abstract
Male factor is responsible for up to 50% of infertility cases in the world. Semen analysis is considered the cornerstone of laboratory evaluation of male infertility, but it has its own drawbacks and fails to predict the male fertility potential with high sensitivity and specificity. Different etiologies have been linked with male infertility, of which sperm DNA damage has gained significant attention with extensive research on sperm function tests. The associations between sperm DNA damage and a variety of disorders such as varicocele, obesity, cancer, radiation and lifestyle factors are explored in this review. Furthermore, we discuss the mechanisms of DNA damage as well as its impact in different scenarios of male infertility, associated with spontaneous and assisted reproduction. Finally, we review the clinical applicability of sperm DNA fragmentation testing in the management of male infertility.
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Affiliation(s)
| | - Rafael F Ambar
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA.,Sexual and Reproductive Medicine - Department of Urology, Faculdade de Medicina do ABC, Santo André, Brazil
| | - Ashok Agarwal
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Ralf Henkel
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA.,Department of Medical Bioscience, University of the Western Cape, Bellville, South Africa
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25
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Abstract
Sperm DNA damage reduces pregnancy rates in couples undergoing in vitro fertilization (IVF). Because it has been shown that testicular sperm have lower DNA damage than ejaculated sperm, it is an attractive idea to consider using testicular sperm for IVF for men with high sperm DNA damage. In fact, there are multiple centers throughout the world now offering sperm retrieval for IVF to manage this condition. However, there is insufficient evidence to conclude that testicular sperm improves pregnancy/live birth rates. Further studies are required before offering sperm retrieval as a standard of care to manage high sperm DNA damage.
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26
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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: 7] [Impact Index Per Article: 1.8] [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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27
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Su JS, Farber NJ, Vij SC. Pathophysiology and treatment options of varicocele: An overview. Andrologia 2020; 53:e13576. [PMID: 32271477 DOI: 10.1111/and.13576] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 03/03/2020] [Indexed: 12/12/2022] Open
Abstract
Varicocele is the most common correctable cause for male infertility, but not all men with varicocele are affected equally by this condition. The pathophysiology of varicocele-induced fertility remains ill-defined. While evidence suggests that oxidative stress remains a central factor, other mechanisms likely include scrotal hyperthermia, reflux of metabolites, hypoxia and cadmium accumulation. Microsurgical varicocelectomy remains the gold standard treatment option for infertile men with a clinically palpable varicocele and abnormal semen parameters. Newer evidence suggests a potential role for antioxidant supplementation and a meaningful role of varicocelectomy for patients destined for ART to improve pregnancy outcomes.
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Affiliation(s)
- Johnny S Su
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Nicholas J Farber
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sarah C Vij
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
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28
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Baskaran S, Agarwal A, Panner Selvam MK, Finelli R, Robert KA, Iovine C, Pushparaj PN, Samanta L, Harlev A, Henkel R. Tracking research trends and hotspots in sperm DNA fragmentation testing for the evaluation of male infertility: a scientometric analysis. Reprod Biol Endocrinol 2019; 17:110. [PMID: 31878936 PMCID: PMC6931248 DOI: 10.1186/s12958-019-0550-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 11/25/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND This article describes the research trends in sperm DNA fragmentation (SDF) over the past 20 years (1999-2018) using a scientometric approach. METHODS A stepwise approach was adopted to retrieve scientometric data (articles per year, authors, affiliations, journals, countries) from Scopus and analyze the publication pattern of SDF with reference to key areas of research in the field of Andrology. RESULTS A total of 2121 articles were retrieved related to SDF. Our data revealed an increasing research trend in SDF (n = 33 to n = 173) over the past 20 years (R2 = 0.894). Most productive country in publications was the USA (n = 450), while Agarwal A. (n = 129) being the most productive author. Most of the articles in SDF were primarily focused on lifestyle (n = 157), asthenozoospermia (n = 135) and varicocele (130). Mechanistic studies on SDF were published twice as much as prognostic/diagnostic studies, with significant emphasis on oxidative stress. Terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) was the most widely used technique to evaluate SDF. Publications on SDF related to assisted reproductive techniques also showed a linear increasing trend (R2 = 0.933). CONCLUSIONS Our analysis revealed an increasing trend in SDF publications predominantly investigating lifestyle, asthenozoospermia and varicocele conditions with TUNEL being the most widely used technique. A substantial increase in research is warranted to establish SDF as prognostic/diagnostic parameter to evaluate clinical scenarios and ART outcomes.
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Affiliation(s)
- Saradha Baskaran
- American Center for Reproductive Medicine, Cleveland Clinic, Mail Code X-11, 10681 Carnegie Avenue, Cleveland, OH, 44195, USA
| | - Ashok Agarwal
- American Center for Reproductive Medicine, Cleveland Clinic, Mail Code X-11, 10681 Carnegie Avenue, Cleveland, OH, 44195, USA.
| | - Manesh Kumar Panner Selvam
- American Center for Reproductive Medicine, Cleveland Clinic, Mail Code X-11, 10681 Carnegie Avenue, Cleveland, OH, 44195, USA
| | - Renata Finelli
- American Center for Reproductive Medicine, Cleveland Clinic, Mail Code X-11, 10681 Carnegie Avenue, Cleveland, OH, 44195, USA
| | - Kathy Amy Robert
- American Center for Reproductive Medicine, Cleveland Clinic, Mail Code X-11, 10681 Carnegie Avenue, Cleveland, OH, 44195, USA
| | - Concetta Iovine
- American Center for Reproductive Medicine, Cleveland Clinic, Mail Code X-11, 10681 Carnegie Avenue, Cleveland, OH, 44195, USA
| | - Peter Natesan Pushparaj
- Center of Excellence in Genomic Medicine Research, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, 21589, Kingdom of Saudi Arabia
| | - Luna Samanta
- American Center for Reproductive Medicine, Cleveland Clinic, Mail Code X-11, 10681 Carnegie Avenue, Cleveland, OH, 44195, USA
- Redox Biology Laboratory, Center of Excellence in Environment and Public Health, Ravenshaw University, -753003, Cuttack, India
| | - Avi Harlev
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ralf Henkel
- American Center for Reproductive Medicine, Cleveland Clinic, Mail Code X-11, 10681 Carnegie Avenue, Cleveland, OH, 44195, USA
- Department of Medical Bioscience, University of the Western Cape, Bellville, South Africa
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29
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Lipshultz LI, Ramasamy R, Sandlow JI, Hotaling J, Eisenberg M, Niederberger C, Brannigan RE. Microsurgical varicocelectomy: novel applications to optimize patient outcomes. Fertil Steril 2019; 112:632-639. [DOI: 10.1016/j.fertnstert.2019.08.057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 08/19/2019] [Indexed: 11/30/2022]
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30
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A. S. V, Dhama K, Chakraborty S, Abdul Samad H, K. Latheef S, Sharun K, Khurana SK, K. A, Tiwari R, Bhatt P, K. V, Chaicumpa W. Role of Antisperm Antibodies in Infertility, Pregnancy, and Potential forContraceptive and Antifertility Vaccine Designs: Research Progress and Pioneering Vision. Vaccines (Basel) 2019; 7:E116. [PMID: 31527552 PMCID: PMC6789593 DOI: 10.3390/vaccines7030116] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 08/22/2019] [Accepted: 09/04/2019] [Indexed: 02/07/2023] Open
Abstract
Sperm of humans, non-human primates, and other mammalian subjects is considered to be antigenic. The effect of changes in autoimmunity on reproductive cells such as spermatozoa and oocytes play a critical but indistinct role in fertility. Antisperm antibodies (ASAs) are invariably present in both females and males. However, the degree of ASA occurrence may vary according to individual and gender. Although the extent of infertility due to ASAs alone is yet to be determined, it has been found in almost 9-12% of patients who are infertile due to different causes. Postcoital presence of spermatozoa in the reproductive tract of women is not a contributory factor in ASA generation. However, ASA generation may be induced by trauma to the vaginal mucosa, or by anal or oral sex resulting in the deposition of sperm inside the digestive tract. It is strongly believed that, in humans and other species, at least some antibodies may bind to sperm antigens, causing infertility. This form of infertility is termed as immunological infertility, which may be accompanied by impairment of fertility, even in individuals with normozoospermia. Researchers target ASAs for two major reasons: (i) to elucidate the association between ASAs and infertility, the reason ASAs causes infertility, and the mechanism underlying ASA-mediated infertility; and (ii) to assess the potential of ASAs as a contraceptive in humans in case ASAs influences infertility. Therefore, this review explores the potential application of ASAs in the development of anti-spermatozoa vaccines for contraceptive purposes. The usefulness of ASAs for diagnosing obstructive azoospermia, salpingitis, and oligoasthenoteratozoospermia has been reviewed extensively. Important patents pertaining to potential candidates for spermatozoa-derived vaccines that may be utilized as contraceptives are discussed in depth. Antifertility vaccines, as well as treatments for ASA-related infertility, are also highlighted. This review will address many unresolved issues regarding mechanisms involving ASAs in the diagnosis, as well as prognoses, of male infertility. More documented scientific reports are cited to support the mechanisms underlying the potential role of ASA in infertility. The usefulness of sperm antigens or ASAs (recombinant) in human and wild or captive animal contraceptive vaccines has been revealed through research but is yet to be validated via clinical testing.
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Affiliation(s)
- Vickram A. S.
- Department of Biotechnology, Saveetha School of Engineering, Young Scientist DST-SERB, Govt. of India, Saveetha Institute of Technical and Medical Sciences, Chennai 600077, Tamil Nadu, India
| | - Kuldeep Dhama
- Division of Pathology, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly 243122, Uttar Pradesh, India;
| | - Sandip Chakraborty
- Department of Veterinary Microbiology, College of Veterinary Sciences and Animal Husbandry, R.K. Nagar, West Tripura 799008, India;
| | - Hari Abdul Samad
- Division of Physiology and Climatology, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly 243122, Uttar Pradesh, India;
| | - Shyma K. Latheef
- Division of Pathology, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly 243122, Uttar Pradesh, India;
| | - Khan Sharun
- Division of Surgery, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly 243122, Uttar Pradesh, India;
| | - Sandip Kumar Khurana
- ICAR-Central Institute for Research on Buffaloes, Sirsa Road, Hisar 125001, Haryana, India;
| | - Archana K.
- Department of Biotechnology, School of Biosciences and Technology, Vellore Institute of Technology, Vellore 632014, Tamil Nadu, India; (A.K.); (V.K.)
| | - Ruchi Tiwari
- Department of Veterinary Microbiology and Immunology, College of Veterinary Sciences, Deen Dayal Upadhayay Pashu Chikitsa Vigyan Vishwavidyalay Evum Go-Anusandhan Sansthan (DUVASU), Mathura 281001, India;
| | - Prakash Bhatt
- Teaching Veterinary Clinical Complex, College of Veterinary and Animal Sciences, Govind Ballabh Pant University of Agriculture and Technology, Pantnagar 263145 (Udham Singh Nagar), Uttarakhand, India;
| | - Vyshali K.
- Department of Biotechnology, School of Biosciences and Technology, Vellore Institute of Technology, Vellore 632014, Tamil Nadu, India; (A.K.); (V.K.)
| | - Wanpen Chaicumpa
- Center of Research Excellence on Therapeutic Proteinsand Antibody Engineering, Department of Parasitology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
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31
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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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Esteves SC, Roque M, Bedoschi G, Haahr T, Humaidan P. Intracytoplasmic sperm injection for male infertility and consequences for offspring. Nat Rev Urol 2019; 15:535-562. [PMID: 29967387 DOI: 10.1038/s41585-018-0051-8] [Citation(s) in RCA: 127] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Intracytoplasmic sperm injection (ICSI) has become the most commonly used method of fertilization in assisted reproductive technology. The primary reasons for its popularity stem from its effectiveness, the standardization of the procedure, which means that it can easily be incorporated into the routine practice of fertility centres worldwide, and the fact that it can be used to treat virtually all forms of infertility. ICSI is the clear method of choice for overcoming untreatable severe male factor infertility, but its (over)use in other male and non-male factor infertility scenarios is not evidence-based. Despite all efforts to increase ICSI efficacy and safety through the application of advanced sperm retrieval and cryopreservation techniques, as well as methods for selecting sperm with better chromatin integrity, the overall pregnancy rates from infertile men remain suboptimal. Treating the underlying male infertility factor before ICSI seems to be a promising way to improve ICSI outcomes, but data remain limited. Information regarding the health of ICSI offspring has accumulated over the past 25 years, and there are reasons for concern as risks of congenital malformations, epigenetic disorders, chromosomal abnormalities, subfertility, cancer, delayed psychological and neurological development, and impaired cardiometabolic profile have been observed to be greater in infants born as a result of ICSI than in naturally conceived children. However, as subfertility probably influences the risk estimates, it remains to be determined to what extent the observed adverse outcomes are related to parental factors or associated with ICSI.
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Affiliation(s)
- Sandro C Esteves
- ANDROFERT, Andrology and Human Reproduction Clinic, Campinas, Brazil. .,Department of Surgery (Division of Urology), Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. .,Faculty of Health, Aarhus University, Aarhus, Denmark.
| | - Matheus Roque
- ORIGEN, Center for Reproductive Medicine, Rio de Janeiro, Brazil
| | - Giuliano Bedoschi
- Division of Reproductive Medicine, Department of Gynecology and Obstetrics, University of São Paulo (USP), São Paulo, Brazil
| | - Thor Haahr
- Faculty of Health, Aarhus University, Aarhus, Denmark.,Fertility Clinic, Skive Regional Hospital, Skive, Denmark
| | - Peter Humaidan
- Faculty of Health, Aarhus University, Aarhus, Denmark.,Fertility Clinic, Skive Regional Hospital, Skive, Denmark
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Abstract
The relationship between varicoceles and subfertility is well-established, but recent evidence suggests that varicoceles may cause global testicular dysfunction. This has led to exploration into expanding the indications for varicocelectomy. This review examines the literature regarding varix ligation as a treatment for non-obstructive azoospermia, elevated DNA fragmentation, and hypogonadism.
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Affiliation(s)
- G Luke Machen
- Department of Urology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - Jay I Sandlow
- Department of Urology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
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Abstract
Varicoceles exert deleterious effect on testicular function. The condition has been associated with male infertility, testicular hypotrophy and pain. These comprises the common indications for varicocele repair currently. Significant improvement in semen parameters and pregnancy outcomes had been suggested by reports decades ago. However, selection of the best candidates remains an issue since not all patients respond positively to treatment. Consensus has been reached in recent decade after the publication of a series of meta-analyses. Significant improvement in pregnancy outcomes were reported in patients with clinical varicocele and abnormal semen parameters. Varicocelectomy in adolescents with testicular hypotrophy was supported by the positive implication on catch-up growth and semen parameters. However, little is known about the treatment effect of adolescence varicocelectomy on long term fertility and paternity rate. Recent studies on outcome of varicocele repair for pain consistently demonstrated a resolution rate of approximately 90% and support varicocele-associated pain as an indication for surgery. Alternate indications for varicocele repair have been proposed in recent decade. Despite the encouraging preliminary data, most studies were uncontrolled retrospective series. Although varicocelectomy may not obviate the need for assisted reproductive techniques in patients with non-obstructive azoospermia, it potentially increases sperm retrieval rate. The significant increase in serum testosterone after varicocelectomy in patients with androgen deficiency may open an alternative treatment for hypogonadism. The adjunctive role of varicocelectomy before assisted reproduction and the significant decrease in sperm DNA fragmentation after varicocele repair deserve further well-designed controlled studies.
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Affiliation(s)
- Chak-Lam Cho
- Department of Surgery, Union Hospital, Hong Kong, China
| | - Sandro C Esteves
- Andrology and Human Reproduction Clinic ANDROFERT, Referral Center for Male Reproduction, Campinas, Brazil
| | - Ashok Agarwal
- American Center for Reproductive Medicine, Department of Urology, Cleveland Clinic, Cleveland, OH, USA -
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Freeman S, Bertolotto M, Richenberg J, Belfield J, Dogra V, Huang DY, Lotti F, Markiet K, Nikolic O, Ramanathan S, Ramchandani P, Rocher L, Secil M, Sidhu PS, Skrobisz K, Studniarek M, Tsili A, Tuncay Turgut A, Pavlica P, Derchi LE. Ultrasound evaluation of varicoceles: guidelines and recommendations of the European Society of Urogenital Radiology Scrotal and Penile Imaging Working Group (ESUR-SPIWG) for detection, classification, and grading. Eur Radiol 2019; 30:11-25. [DOI: 10.1007/s00330-019-06280-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 04/19/2019] [Accepted: 05/20/2019] [Indexed: 02/07/2023]
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Agarwal A, Panner Selvam MK, Baskaran S, Cho CL. Sperm DNA damage and its impact on male reproductive health: a critical review for clinicians, reproductive professionals and researchers. Expert Rev Mol Diagn 2019; 19:443-457. [DOI: 10.1080/14737159.2019.1614916] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Ashok Agarwal
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | | | - Saradha Baskaran
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Chak-Lam Cho
- Department of Surgery, Union Hospital, Sha Tin, Hong Kong
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Smits RM, Mackenzie‐Proctor R, Yazdani A, Stankiewicz MT, Jordan V, Showell MG. Antioxidants for male subfertility. Cochrane Database Syst Rev 2019; 3:CD007411. [PMID: 30866036 PMCID: PMC6416049 DOI: 10.1002/14651858.cd007411.pub4] [Citation(s) in RCA: 109] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND The inability to have children affects 10% to 15% of couples worldwide. A male factor is estimated to account for up to half of the infertility cases with between 25% to 87% of male subfertility considered to be due to the effect of oxidative stress. Oral supplementation with antioxidants is thought to improve sperm quality by reducing oxidative damage. Antioxidants are widely available and inexpensive when compared to other fertility treatments, however most antioxidants are uncontrolled by regulation and the evidence for their effectiveness is uncertain. We compared the benefits and risks of different antioxidants used for male subfertility. This review did not examine the use of antioxidants in normospermic men. OBJECTIVES To evaluate the effectiveness and safety of supplementary oral antioxidants in subfertile men. SEARCH METHODS The Cochrane Gynaecology and Fertility (CGF) Group trials register, CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, and two trials registers were searched on 1 February 2018, together with reference checking and contact with study authors and experts in the field to identify additional trials. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared any type, dose or combination of oral antioxidant supplement with placebo, no treatment or treatment with another antioxidant, among subfertile men of a couple attending a reproductive clinic. We excluded studies comparing antioxidants with fertility drugs alone and studies that included fertile men attending a fertility clinic because of female partner infertility. DATA COLLECTION AND ANALYSIS We used standard methodological procedures recommended by Cochrane. The primary review outcome was live birth. Clinical pregnancy, adverse events and sperm parameters were secondary outcomes. MAIN RESULTS We included 61 studies with a total population of 6264 subfertile men, aged between 18 and 65 years, part of a couple who had been referred to a fertility clinic and some of whom were undergoing assisted reproductive techniques (ART). Investigators compared and combined 18 different oral antioxidants. The evidence was of 'low' to 'very low' quality: the main limitation was that out of the 44 included studies in the meta-analysis only 12 studies reported on live birth or clinical pregnancy. The evidence is current up to February 2018.Live birth: antioxidants may lead to increased live birth rates (OR 1.79, 95% CI 1.20 to 2.67, P = 0.005, 7 RCTs, 750 men, I2 = 40%, low-quality evidence). Results suggest that if in the studies contributing to the analysis of live birth rate, the baseline chance of live birth following placebo or no treatment is assumed to be 12%, the chance following the use of antioxidants is estimated to be between 14% and 26%. However, this result was based on only 124 live births from 750 couples in seven relatively small studies. When studies at high risk of bias were removed from the analysis, there was no evidence of increased live birth (Peto OR 1.38, 95% CI 0.89 to 2.16; participants = 540 men, 5 RCTs, P = 0.15, I2 = 0%).Clinical pregnancy rate: antioxidants may lead to increased clinical pregnancy rates (OR 2.97, 95% CI 1.91 to 4.63, P < 0.0001, 11 RCTs, 786 men, I2 = 0%, low-quality evidence) compared to placebo or no treatment. This suggests that if in the studies contributing to the analysis of clinical pregnancy, the baseline chance of clinical pregnancy following placebo or no treatment is assumed to be 7%, the chance following the use of antioxidants is estimated to be between 12% and 26%. This result was based on 105 clinical pregnancies from 786 couples in 11 small studies.Adverse eventsMiscarriage: only three studies reported on this outcome and the event rate was very low. There was no difference in miscarriage rate between the antioxidant and placebo or no treatment group (OR 1.74, 95% CI 0.40 to 7.60, P = 0.46, 3 RCTs, 247 men, I2 = 0%, very low-quality evidence). The findings suggest that in a population of subfertile men with an expected miscarriage rate of 2%, the chance following the use of an antioxidant would result in the risk of a miscarriage between 1% and 13%.Gastrointestinal: antioxidants may lead to an increase in mild gastrointestinal upsets when compared to placebo or no treatment (OR 2.51, 95% CI 1.25 to 5.03, P = 0.010, 11 RCTs, 948 men, I2 = 50%, very low-quality evidence). This suggests that if the chance of gastrointestinal upsets following placebo or no treatment is assumed to be 2%, the chance following the use of antioxidants is estimated to be between 2% and 9%. However, this result was based on a low event rate of 35 out of 948 men in 10 small or medium-sized studies, and the quality of the evidence was rated very low and was high in heterogeneity.We were unable to draw any conclusions from the antioxidant versus antioxidant comparison as insufficient studies compared the same interventions. AUTHORS' CONCLUSIONS In this review, there is low-quality evidence from seven small randomised controlled trials suggesting that antioxidant supplementation in subfertile males may improve live birth rates for couples attending fertility clinics. Low-quality evidence suggests that clinical pregnancy rates may also increase. Overall, there is no evidence of increased risk of miscarriage, however antioxidants may give more mild gastrointestinal upsets but the evidence is of very low quality. Subfertilte couples should be advised that overall, the current evidence is inconclusive based on serious risk of bias due to poor reporting of methods of randomisation, failure to report on the clinical outcomes live birth rate and clinical pregnancy, often unclear or even high attrition, and also imprecision due to often low event rates and small overall sample sizes. Further large well-designed randomised placebo-controlled trials reporting on pregnancy and live births are still required to clarify the exact role of antioxidants.
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Affiliation(s)
- Roos M Smits
- Radboud University Medical CenterDepartment of Gynaecology and ObstetricsNijmegenNetherlands
| | | | - Anusch Yazdani
- Queensland Fertility Group Research Foundation55 Little Edward St, Level 2 Boundary CourtSpring HillBrisbaneQueenslandAustralia4000
| | - Marcin T Stankiewicz
- Ashford Specialist Centre Suite 2257‐59 Anzac Highway AshfordAdelaideSAAustralia
| | - Vanessa Jordan
- University of AucklandDepartment of Obstetrics and GynaecologyPrivate Bag 92019AucklandNew Zealand1003
| | - Marian G Showell
- University of AucklandDepartment of Obstetrics and GynaecologyPrivate Bag 92019AucklandNew Zealand1003
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Jallad S, Khan MJ, Desai A, Kalsi J. Should primary microsurgical ligation of varicocele be the gold standard approach? JOURNAL OF CLINICAL UROLOGY 2019. [DOI: 10.1177/2051415818815389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction: Varicocele is a common condition affecting over one in 10 men, and in cases with abnormal semen parameters, varicocele is present in about one in four men. Several methods have been used to treat this condition, of which microsurgical treatment has the lowest failure and complication rates. We present a single-centre UK series of microsurgical repair of varicocele. Methods: All microsurgical varicocelectomy cases performed between 2013 and 2017 were retrospectively identified and reviewed. The approach used is low inguinal using a high-powered Leica microscope. Results: Microsurgical varicocele repairs were performed in 30 cases, with a median age of 34.7 years. There were 22 cases with chronic scrotal pain of which eight cases had failed previous embolisation with a success rate of 90.5%. There were eight with oligoasthenoteratozoospermia, showing an improvement of more than 75% in sperm count after repair. Conclusions: Microsurgical ligation is a very effective treatment for symptomatic varicoceles and should be considered when radiological embolisation has failed. It is also effective in improving semen parameters in all followed up oligoasthenoteratozoospermia cases. It should be considered a primary method of varicocele treatment in the UK. Level of evidence: 3.
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Affiliation(s)
- Samer Jallad
- Department of Urology, Frimley Health NHS Foundation Trust, Wexham Park Hospital, UK
- Department of Urology, Imperial College Healthcare NHS Trust, UK
| | - Muhammad Jamal Khan
- Department of Urology, Frimley Health NHS Foundation Trust, Wexham Park Hospital, UK
| | - Ankit Desai
- Department of Urology, Frimley Health NHS Foundation Trust, Wexham Park Hospital, UK
| | - Jas Kalsi
- Department of Urology, Frimley Health NHS Foundation Trust, Wexham Park Hospital, UK
- Department of Urology, Imperial College Healthcare NHS Trust, UK
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Kızılay F, Altay B. Evaluation of the effects of antioxidant treatment on sperm parameters and pregnancy rates in infertile patients after varicocelectomy: a randomized controlled trial. Int J Impot Res 2019; 31:424-431. [DOI: 10.1038/s41443-018-0109-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 09/26/2018] [Accepted: 12/17/2018] [Indexed: 01/30/2023]
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Santana VP, Miranda-Furtado CL, Pedroso DCC, Eiras MC, Vasconcelos MAC, Ramos ES, Calado RT, Ferriani RA, Esteves SC, dos Reis RM. The relationship among sperm global DNA methylation, telomere length, and DNA fragmentation in varicocele: a cross-sectional study of 20 cases. Syst Biol Reprod Med 2019; 65:95-104. [DOI: 10.1080/19396368.2018.1557762] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Viviane Paiva Santana
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | | | - Daiana Cristina Chielli Pedroso
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Matheus Credendio Eiras
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
- Department of Genetics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | | | - Ester Silveira Ramos
- Department of Genetics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Rodrigo Tocantins Calado
- Department of Internal Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Rui Alberto Ferriani
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | | | - Rosana Maria dos Reis
- Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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Zavattaro M, Ceruti C, Motta G, Allasia S, Marinelli L, Di Bisceglie C, Tagliabue MP, Sibona M, Rolle L, Lanfranco F. Treating varicocele in 2018: current knowledge and treatment options. J Endocrinol Invest 2018; 41:1365-1375. [PMID: 30284221 DOI: 10.1007/s40618-018-0952-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 09/11/2018] [Indexed: 01/20/2023]
Abstract
PURPOSE Varicocele is defined as a state of varicosity and tortuosity of the pampiniform plexus around the testis caused by retrograde blood flow through the internal spermatic vein. The prevalence of clinically relevant varicocele ranges from 5 to 20% in the male population and is often associated with infertility and reduction of sperm quality. In this review, the pathophysiology and clinical aspects of varicocele are reviewed along with therapeutic options and treatment effects on sperm parameters and fertility both in adult and in pediatric/adolescent subjects. METHODS We conducted a Medline and a PubMed search from 1965 to 2018 to identify publications related to varicocele clinical aspects, treatment procedures and treatment outcomes. Keywords used for the search were: "varicocele", "varicocelectomy", "sclerotherapy", "male infertility", "subfertility", and "semen abnormalities". RESULTS Data from a large number of studies in adolescent and adult males indicate that varicocele correction improves semen parameters in the majority of patients, reducing oxidative stress and improving sperm nuclear DNA integrity either with surgical or percutaneous approach. CONCLUSIONS Varicocele repair seems to represent a cost-effective therapeutic option for all males (both adolescent and adults) with a clinical varicocele in the presence of testicular hypotrophy, worsening sperm alterations or infertility. On the other hand, some investigators questioned the role of varicocelectomy in the era of assisted reproduction. Thus, a better understanding of the pathophysiology of varicocele-associated male subfertility is of paramount importance to elucidating the deleterious effects of varicocele on spermatogenesis and possibly formulating new treatment strategies.
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Affiliation(s)
- M Zavattaro
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - C Ceruti
- Division of Urology, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - G Motta
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - S Allasia
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - L Marinelli
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - C Di Bisceglie
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - M P Tagliabue
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
| | - M Sibona
- Division of Urology, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - L Rolle
- Division of Urology, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - F Lanfranco
- Division of Endocrinology, Diabetology and Metabolism, Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy.
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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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Ghandehari-Alavijeh R, Tavalaee M, Zohrabi D, Foroozan-Broojeni S, Abbasi H, Nasr-Esfahani MH. Hypoxia pathway has more impact than inflammation pathway on etiology of infertile men with varicocele. Andrologia 2018; 51:e13189. [DOI: 10.1111/and.13189] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 03/04/2018] [Accepted: 03/28/2018] [Indexed: 12/15/2022] Open
Affiliation(s)
- Rana Ghandehari-Alavijeh
- Department of Reproductive Biotechnology, Reproductive Biomedicine Research Center, Royan Institute for Biotechnology; ACECR; Isfahan Iran
- Department of Biology, Faculty of Science; NourDanesh Institute of Higher Education; Isfahan Iran
| | - Marziyeh Tavalaee
- Department of Reproductive Biotechnology, Reproductive Biomedicine Research Center, Royan Institute for Biotechnology; ACECR; Isfahan Iran
| | - Dina Zohrabi
- Department of Biology, Faculty of Science; NourDanesh Institute of Higher Education; Isfahan Iran
| | - Shaqayeq Foroozan-Broojeni
- Department of Reproductive Biotechnology, Reproductive Biomedicine Research Center, Royan Institute for Biotechnology; ACECR; Isfahan Iran
| | | | - Mohammad H. Nasr-Esfahani
- Department of Reproductive Biotechnology, Reproductive Biomedicine Research Center, Royan Institute for Biotechnology; ACECR; Isfahan Iran
- Isfahan Fertility and Infertility Center; Isfahan Iran
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Kim GY. What should be done for men with sperm DNA fragmentation? Clin Exp Reprod Med 2018; 45:101-109. [PMID: 30202739 PMCID: PMC6125150 DOI: 10.5653/cerm.2018.45.3.101] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 08/24/2018] [Indexed: 12/25/2022] Open
Abstract
In an age when a small quantity of sperm can lead to pregnancy through in vitro fertilization or intracytoplasmic sperm injection, selecting healthy sperm is important. Sperm DNA fragmentation (SDF) is known to be higher in infertile men. Terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end labeling (TUNEL) and the alkaline comet test are SDF tests that directly measure DNA damage and have shown closer correlations with assisted reproduction results than indirect tools such as the sperm chromatin structure assay or the sperm chromatic dispersion test. It is difficult; however, to endorse a single test as the best test overall; instead, it is best to select a testing method based on each patient's clinical condition and goals. In a couple struggling with infertility, if the male partner has a high level of SDF, he should aim to decrease SDF through lifestyle modifications, antioxidant treatment, and ensuring an appropriate duration of abstinence, and physicians need to treat the underlying diseases of such patients. If sperm DNA damage continues despite the patient's and physician's efforts, other methods, such as micromanipulation-based sperm selection or testicular sperm extraction, should be used to select healthy sperm with nuclear DNA integrity.
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Affiliation(s)
- Gi Young Kim
- Department of Urology, Mizmedi Hospital, Seoul, Korea
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Smits RM, Mackenzie-Proctor R, Fleischer K, Showell MG. Antioxidants in fertility: impact on male and female reproductive outcomes. Fertil Steril 2018; 110:578-580. [DOI: 10.1016/j.fertnstert.2018.05.028] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 05/23/2018] [Indexed: 12/15/2022]
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Lotti F, Tamburrino L, Marchiani S, Maseroli E, Vitale P, Forti G, Muratori M, Maggi M, Baldi E. DNA fragmentation in two cytometric sperm populations: relationship with clinical and ultrasound characteristics of the male genital tract. Asian J Androl 2018; 19:272-279. [PMID: 26924281 PMCID: PMC5427780 DOI: 10.4103/1008-682x.174854] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We investigated whether DNA fragmentation in two cytometric sperm populations (PIdimmer and PIbrighter) with different biological characteristics and clinical relevance is related to clinical and color-Doppler ultrasound (CDUS) parameters of the male genital tract. One hundred and sixty males of infertile couples without genetic abnormalities were evaluated for clinical, scrotal, and transrectal CDUS characteristics, presence of prostatitis-like symptoms (with the National Institutes of Health-Chronic Prostatitis Symptom Index) and sperm DNA fragmentation (sDF) in PIdimmer and PIbrighter populations (using TUNEL/PI method coupled with flow cytometry). Data were adjusted for age (Model 1) along with waistline, testosterone levels, smoking habit, and sexual abstinence (Model 2). According to the statistical Model 2, PIdimmer sDF was associated with testicular abnormalities, including lower clinical and ultrasound volume (r = -0.21 and r = -0.20, respectively; P < 0.05), higher FSH levels (r = 0.34, P < 0.0001) and occurrence of testicular inhomogeneity (P < 0.05) and hypoechogenicity (P < 0.05). PIbrighter sDF was associated with prostate-related symptoms and abnormal signs, including higher NIH-CPSI total and subdomain scores, a higher prevalence of prostatitis-like symptoms and of CDUS alterations such as macro-calcifications, severe echo-texture inhomogeneity, hyperemia (all P < 0.05), and higher arterial peak systolic velocity (r = 0.25, P < 0.05). Our results suggest that DNA fragmentation in PIdimmer sperm, which is related to poor semen quality, mainly originates in the testicles, likely due to apoptosis. Conversely, DNA fragmentation in PIbrighter sperm appears to mainly originate during or after transit through the prostate, increasing with the presence of an inflammatory status of the organ. These results could lead to new perspectives for the identification of therapeutic targets to reduce sDF.
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Affiliation(s)
- Francesco Lotti
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, Center of Excellence DeNothe, University of Florence, Viale Pieraccini 6, I-50036, Florence, Italy
| | - Lara Tamburrino
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, Center of Excellence DeNothe, University of Florence, Viale Pieraccini 6, I-50036, Florence, Italy
| | - Sara Marchiani
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, Center of Excellence DeNothe, University of Florence, Viale Pieraccini 6, I-50036, Florence, Italy
| | - Elisa Maseroli
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, Center of Excellence DeNothe, University of Florence, Viale Pieraccini 6, I-50036, Florence, Italy
| | - Pasquale Vitale
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, Center of Excellence DeNothe, University of Florence, Viale Pieraccini 6, I-50036, Florence, Italy
| | - Gianni Forti
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, Center of Excellence DeNothe, University of Florence, Viale Pieraccini 6, I-50036, Florence, Italy
| | - Monica Muratori
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, Center of Excellence DeNothe, University of Florence, Viale Pieraccini 6, I-50036, Florence, Italy
| | - Mario Maggi
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, Center of Excellence DeNothe, University of Florence, Viale Pieraccini 6, I-50036, Florence, Italy
| | - Elisabetta Baldi
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, Center of Excellence DeNothe, University of Florence, Viale Pieraccini 6, I-50036, Florence, Italy
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Cho CL, Agarwal A. Role of sperm DNA fragmentation in male factor infertility: A systematic review. Arab J Urol 2018; 16:21-34. [PMID: 29713533 PMCID: PMC5922225 DOI: 10.1016/j.aju.2017.11.002] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 11/07/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To summarise the latest evidence on the role of sperm DNA fragmentation (SDF) in male factor infertility, as SDF has been emerging as a valuable tool for male infertility evaluation. METHODS A search of PubMed was conducted using the keywords 'sperm DNA fragmentation' and 'male infertility'. Studies in languages other than English were excluded. All identified studies were screened and clinical studies in humans were included. RESULTS In all, 150 articles were included for analysis. Current evidence supports the association between high SDF and poor reproductive outcomes for natural conception and intrauterine insemination. Although the relationship between high SDF and in vitro fertilisation and intracytoplasmic sperm injection is less clear, the negative implication of high SDF on pregnancy loss is evident. Various treatment strategies have been attempted with varying success. The predictive value of SDF testing on outcomes of natural pregnancy and assisted reproduction illustrates its value in clinical practice. CONCLUSION The significant role of SDF in male factor infertility is supported by current evidence. The beneficial role of SDF testing in selection of varicocelectomy candidates, evaluation of patients with unexplained infertility and recurrent pregnancy loss, selection of the most appropriate assisted reproductive technique with highest success rate for infertile couples, and assessment of infertile men with modifiable lifestyle factors or gonadotoxin exposure has been recently proposed.
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Key Words
- ART, assisted reproductive technology
- ASRM, American Society for Reproductive Medicine
- Assisted reproductive technology (ART)
- Comet, single cell gel electrophoresis assay
- EAU, European Association of Urology
- ICSI, intracytoplasmic sperm injection
- IMSI, intracytoplasmic morphologically selected sperm injection
- IUI, intrauterine insemination
- IVF, in vitro fertilisation
- MACS, magnetic cell sorting
- Male infertility
- OR, odds ratio
- PICSI, physiological ICSI with hyaluronic acid binding assay
- ROS, reactive oxygen species
- RR, relative risk
- SCD, sperm chromatin dispersion
- SCSA, sperm chromatin structure assay
- SDF, sperm DNA fragmentation
- Sperm DNA fragmentation (SDF)
- TUNEL, terminal deoxynucleotidyl transferase dUTP nick end labelling
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Affiliation(s)
- Chak-Lam Cho
- Division of Urology, Department of Surgery, Kwong Wah Hospital, Yaumatei, Hong Kong
| | - Ashok Agarwal
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
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Zhu WJ. Transmission electron microscopy analysis of the origin and incidence of sperm intranuclear cytoplasmic retention in fertile and teratozoospermia men. Andrology 2018; 6:317-324. [PMID: 29457364 DOI: 10.1111/andr.12469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 12/31/2017] [Accepted: 01/02/2018] [Indexed: 11/27/2022]
Abstract
The human sperm nucleus contains cytoplasm. However, the origin and incidence of human sperm intranuclear cytoplasmic retention (INCR) remain unknown. The objectives of this study were to observe the morphological origin of INCR within the seminiferous epithelium and investigate the incidence of INCR in fertile and teratozoospermia men using transmission electron microscopy (TEM). By TEM, INCR initially appeared in elongating round spermatid nuclei and varied in size, number, shape, content, location and distribution within sperm nuclei. The teratozoospermia group (n = 16) demonstrated a higher incidence of INCR than did the fertile group (n = 16) (17.6 ± 5.2% vs. 9.7 ± 3.4%; p = 0.000). In the fertile group, no correlations were found between the incidence of INCR and abnormal sperm morphology, nuclear vacuole, acrosome integrity, motility or concentration (p > 0.05). However, the incidence of INCR exhibited a positive relationship with sperm abnormal morphology in the teratozoospermia group (r = 0.616, p = 0.011). These results demonstrate that INCR occurs in the early process of spermatogenesis and is an alteration found in the nucleus. Spermatozoa from teratozoospermia men contained more INCRs than those from fertile males. More attention should be paid to the possibility of spermatozoa containing INCR when using spermatozoa with abnormal head morphology for clinical or diagnostic purposes.
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Affiliation(s)
- W-J Zhu
- Department of Developmental and Regenerative Biology, College of Life Science and Technology, Jinan University, Guangzhou, China
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