Effects of age on fertility and sexual function

Solitary Sexual Desire: Its Relation to Subjective Orgasm Experience and Sexual Arousal in the Masturbation Context within a Spanish Population

The tridimensional sexual desire proposal (i.e., dyadic to partner, dyadic to attractive other and solitary) has been empirically supported. However, solitary sexual desire and its relationship to other dimensions of sexual functioning has received less attention. Hence, we examined the capacity of solitary sexual desire to explain the subjective orgasm experience (Study 1) and sexual arousal (Study 2) in the context of solitary masturbation. Study 1, composed of 2406 heterosexual adults (M age = 39.72, SD = 11.81), assessed for solitary sexual desire, dyadic sexual desire, and the intensity of the subjective orgasm experience obtained through solitary masturbation, along with other associated parameters. Study 2, consisting of 41 heterosexual young people (M age = 22.49, SD = 3.17), evaluated the genital response (penile circumference/vaginal pulse amplitude) and subjective arousal to sexually explicit films related to solitary masturbation. In both men and women, solitary sexual desire accounted for a significant percentage of the subjective orgasm experience obtained through solitary masturbation. In addition, in women, the propensity for sexual arousal was explained by solitary sexual desire. It is concluded that solitary sexual desire -as opposed to dyadic- is important to explain sexual arousal and orgasm in the solitary masturbation context. These results highlight the importance of addressing sexual desire in the solitary context, given its implications with other dimensions of sexual functioning.

The antioxidant effects of coenzyme Q10 on albino rat testicular toxicity and apoptosis triggered by bisphenol A

Polycarbonate plastics for packaging and epoxy resins are both made with the industrial chemical bisphenol A (BPA). This investigation looked at the histological structure, antioxidant enzymes, and albino rats' testis to determine how coenzyme Q10 (CoQ10) impacts BPA toxicity. For the experiments, three sets of 18 male adult rats were created: group 1 received no therapy, group 2 acquired BPA, and group 3 got the daily BPA treatment accompanied by coenzyme Q10, 1 h apart. The experimental period ran for 14 days. The biochemical biomarkers catalase (CAT), superoxide dismutase (SOD), and malondialdehyde (MDA) were altered as a result of BPA exposure. The testicular histological architecture, which is made up of apoptosis, was also exaggerated. Furthermore, rats given BPA and CoQ10 treatment may experience a diminution in these negative BPA effects. These protective properties of CoQ10 may be correlated with the ability to eliminate oxidizing substances that can harm living species. The outcomes might support the hypothesis that CoQ10 prevented oxidative damage and boosted rats' stress responses when BPA was introduced. Thus, by shielding mammals from oxidative stress, CoQ10 aids in the growth and development of the animals. BPA is extremely hazardous to humans and can persist in tissues. Human reproductive functions are a worry due to human exposure to BPA, especially for occupational workers who are typically exposed to higher doses of BPA. As a result, in order to reduce the health risks, BPA usage must be minimized across a diverse range of industries, and improper plastic container handling must be prohibited. By giving CoQ10 to patients, BPA's harmful effects on reproductive structures and functions may be avoided.

Exploring fertility knowledge amongst healthcare professional and lay population groups in the UK: a mixed methods study

As the average age of first-time parents continues to rise, there has been a concerted effort by educators, policy makers and several reproductive health groups to improve fertility awareness. This study explored fertility knowledge of lay men and women and healthcare professionals (HCPs) using the same test instrument, providing a new and unique perspective compared with previous studies. Results were obtained from 1082 survey respondents: 347 HCPs, 319 men and 413 women, 105 of whom were trying to conceive (TTC). A total of 35 interviewees were purposively sampled to include 9 HCPs, 13 men and 13 women from the reproductive age range and of varying ethnic and educational backgrounds. Interview data were transcribed and analysed using the framework method. The proportion of HCPs correctly answering the survey knowledge questions was 47.1 (95% CI = 41.7%, 52.5%) compared to 44.4% for women (95% CI = 38.9%, 50.1%); 49.9% (95% CI = 39.0, 59.9%) for women TTC; and 32.5% (95% CI = 27.1%, 37.9%) for men. HCPs were ranked as the most trusted source for seeking fertility information. Overall HCPs did not demonstrate better fertility knowledge than lay participants, with inconsistencies regarding where responsibility lies for providing the right information to patients. HCPs need to improve their knowledge about fertility to help improve patient's fertility awareness.

Fertility in the aging male: a systematic review

The negative effect of advanced female age on fertility and offspring health is well understood. In comparison, much less is known about the implications of male age on fertility, with many studies showing conflicting results. Nevertheless, increasing evidence suggests that advanced paternal age has negative effects on sperm parameters, reproductive success, and offspring health. Herein, we summarize the current body of knowledge on this controversial topic, with the belief that this review will serve as a resource for the clinicians providing fertility counseling to couples with older male partners.

The Anti-Oxidant Effects of Coenzyme Q10 on Albino Rat Testicular Toxicity and Apoptosis Triggered by Bisphenol A.. [DOI: 10.21203/rs.3.rs-2073923/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Polycarbonate plastics for packaging and epoxy resins are both made with the industrial chemical bisphenol A (BPA). This investigation looked at the histological structure, antioxidant enzymes, and albino rats' testis to determine how Coenzyme Q10 (CoQ10) impacts BPA toxicity. For the experiments, 18 adult male rats were broken into three groups: group 1 received no therapy, group 2 acquired BPA, and group 3 got daily BPA treatment accompanied by coenzyme Q10, one hour apart. All experiment done for 14 days. The biochemical biomarkers catalase (CAT), superoxide dismutase (SOD), and malondialdehyde (MDA) were altered as a result of BPA exposure. The testicular histological architecture, which is made up of apoptosis, was also exaggerated. Furthermore, rats given BPA and CoQ10 treatment may experience a diminution in these negative BPA effects. These protective properties of CoQ10 may be correlated with the ability to eliminate oxidizing substances that can harm living species.The outcomes might support the hypothesis that CoQ10 prevented oxidative damage and boosted rats' stress responses when BPA was introduced. Thus, by shielding mammals from oxidative stress, CoQ10 aids in the growth and development of the animals.BPA is extremely hazardous to humans and can persist in tissues. Human reproductive functions are a worry due to human exposure to BPA, especially for occupational workers who are typically exposed to higher doses of BPA. As a result, in order to reduce the health risks, BPA usage must be minimized across a diverse range of industries, and improper plastic container handling must be prohibited. By giving CoQ10 to patients, BPA's harmful effects on reproductive structures and functions may be avoided.

Late fertility intentions increase over time in Austria, but chances to have a child at later ages remain low

Childbearing takes place at increasingly older ages, and fertility is continuing to decrease across female birth cohorts. This study investigated whether the proportion of women who unintentionally forwent childbearing increased over time, and linked this to the age profile of fertility intentions and realization among men and women. This study was based on the Austrian Micro-Censuses (1986-2016) and on the Austrian Generations and Gender Surveys (panel data 2008/09 and 2012/13). Across the birth cohorts 1950-1979, an increasing proportion of women wanted to have children after 40 years of age, but more women failed to meet their fertility intentions expressed at 34-36 years of age. At the individual level, from 30 years of age, more than one-third of women and men with a strong fertility intention were found to persist with this intention within four years even at less fertile ages. In addition, women and men with a strong fertility intention became less likely to have a child with age: <10% of women and approximately 20% of men who had expressed a certain and short-term intention to have a child at 39-41 years of age in 2008/09 had a child by 2012/13. In particular, childless women and men, and those with only one child, persisted in certain and short-term positive intentions from 30 years of age, but parity was not a significant factor in their realization. The sharp increase in 'unrealized fertility' over time draws attention to the importance that personal circumstances and context encountered at older ages may have for fertility, and augurs a continued increase in the use of assisted reproduction.

Risky Business: Increasing Fertility Knowledge of Men in the General Public Using the Mobile Health Application Infotility XY

Male infertility presents a public health concern. As most men wish to become fathers, it is important to increase men’s awareness of infertility risk factors. We developed a mobile health application (mHealth app), Infotility XY, to promote men’s reproductive health. This study evaluates whether use of the app led to increased knowledge of infertility risk factors, and whether knowledge change was associated with participants’ sociodemographic characteristics and/or app usage. Participants were recruited between August and October 2020. Eligibility criteria included: identified as male; 18–45 years old; childless; no infertility history; able to read and write in English/French; had internet access. We assessed participants’ fertility knowledge before and after app use. App usage data were captured during the 2-week intervention period. Our sample included 49 men aged 18–45. Seventy-eight percent of participants had not previously sought fertility information. Participants viewed on average 75% of the app’s articles, and 96% of participants said the app increased their fertility knowledge. Before app use, 55% of men said they were aware of infertility risk factors, compared to 96% after app use. Men correctly identified more risk factors after app use compared to before, t(48) = 8.28, p < .001. Participants’ sociodemographic characteristics and amount of app usage were not associated with knowledge change. This study provides evidence of the feasibility of an mHealth app to improve men’s awareness of infertility risk factors. Given the positive relationship between male reproductive health and overall health, increased awareness of infertility risk factors may lead to men’s improved overall health.

Study of Semen Quality, Reproductive Hormone Levels, and Lipid Levels in Men From Arkhangelsk, a City in North of European Russia

Male populations in the European North of Russia have not previously been investigated for semen quality. The aim of this study was to evaluate semen parameters, reproductive hormone levels, and lipid levels in volunteers from the general urban population of the European North of Russia, to compare the data published for men from the neighboring Northern or Eastern European countries, and to evaluate associations between sperm quality and serum hormonal and lipid levels. Ninety-nine volunteers aged 23-63 years residing in the city of Archangelsk were enrolled in the study. All men had blood samples drawn and completed a questionnaire concerning their health status and lifestyle; 90 men delivered semen samples. The medians for semen volume, sperm concentration, progressive motility, and normal morphology were 3.0 ml, 42.12 million/ml, 43.8%, and 6.5%, respectively. Sperm parameters below normal threshold values were found in 38.9% of participants. It seems that the sperm quality in our study group was slightly worse than in men from Finland, Norway, Sweden, or Estonia, but very similar to that in men from Denmark or Poland. The significant negative correlations of luteinizing hormone levels and positive correlations of inhibin B levels with sperm concentration and progressive motility were revealed. Higher levels of luteinizing hormone and lower levels of inhibin B were found in participants with impaired compared to normal sperm quality. No reliable links were found between serum total cholesterol, triglyceride, high and low-density lipoprotein cholesterol, and semen parameters.

A systematic review of Indian studies on sexual dysfunction in patients with substance use disorders

BACKGROUND AND AIMS

Sexual dysfunction is often associated with substance use disorders. This study aimed to synthesize Indian literature on sexual dysfunction among patients with substance use disorders.

MATERIALS AND METHODS

Electronic search engines were used to identify studies of the last 20 years that reported sexual dysfunction with different substance use disorders. Information was extracted using a predefined template. Quality appraisal of the included studies was carried out using Joanna Briggs Institute checklist.

RESULTS

Twenty-seven relevant papers were identified that pertained to 24 distinct studies. Most of them were in patients with alcohol dependence, and fewer were in patients with opioid dependence. The study designs were primarily single-group cross-sectional, though many case-control, cross-sectional studies were also identified. The proportion of participants with sexual dysfunction ranged from 22.2% to 76% for studies related to alcohol dependence and 40% to 90% for studies pertaining to opioid dependence. Varied types of sexual dysfunctions were identified, including poor satisfaction, lack of desire, premature ejaculation, and erectile dysfunction. Efforts to address bias and confounders were not reported in most studies.

CONCLUSION

Sexual dysfunction affects a substantial proportion of patients with substance use disorders. Clinicians can make an effort to ascertain and address sexual dysfunction in their routine clinical practice while dealing with patients with substance use disorders.

A new original nutraceutical formulation ameliorates the effect of Tadalafil on clinical score and cGMP accumulation

OBJECTIVE

To assess the efficacy of the combination of Tadalafil 5 mg and nutritional supplements composed by Panax ginseng, Moringa Oleifera and Rutin on erectile function in men with mild and moderate vasculogenic ED.

METHODS

we prospectively enrolled 86 patients divided into two groups A (45), B (33) in this multicenter randomized, doubleblind, placebo-controlled trial . Drop out was 8 patients (3 patients in group A and 5 in Group B). At screening visit patients underwent clinical examination, blood test (hormonal and metabolic profile) and filled out the IIEF-5 questionnaire and the SEP-2, SEP-3. Patients were randomized by a computergenerated list to receive either Tadalafil 5 mg once daily plus nutritional supplement once daily (group A) or Tadalafil 5 mg plus placebo with the same administration schedule (group B) for 3 months. Blood samples, IIEF-5, SEP-2 and SEP-3 have been collected again after 3 months. cGMP was measured in platelets of 38 patients at baseline and after one months.

RESULTS

Mean age was 59.98 ± 6.90 (range 38-69), mean IIEF-5 score at baseline was 13.59 ± 3.90. After three months of treatment, IIEF-5 score significantly improved in both groups compared to baseline (13.18 ± 3.75 vs 20.48 ± 2.24, p < 0.0001; 14.15 ± 4.09 vs 19.06 ± 4.36, p < 0.0001, in group A and group B respectively). Patients treated with Tadalafil plus nutritional supplement showed a significantly higher increase in IIEF-5 score compared to those who received placebo (7.27 ± 2.20 and 4.9 ± 2.79, respectively; p < 0.0001;). No hormonal differences and metabolic effects were found. According cGMP result, nutritional supplements ameliorates and extends the activity of the chronic treatment.

CONCLUSIONS

IIEF-5 significant increase in group B, can be ascribed to the nutritional supplement properties and antioxidant effects of moringa oleifera, ginseng and rutin and this can enhance the endothelial NO and cGMP production.

A qualitative study of factors influencing male participation in fertility research

BACKGROUND

Although fertility is a couple-based outcome, fertility studies typically include far fewer males than females. We know little about which factors facilitate or inhibit male participation in fertility research. In this study we aimed to explore factors that influence male participation in fertility research among North American couples trying to conceive.

METHODS

We conducted a qualitative research study of male participation in Pregnancy Study Online (PRESTO), a prospective preconception cohort of couples actively trying to conceive in Canada and the United States. Between January-August 2019, we carried out 14 online one-on-one in-depth interviews and one online focus group of males and females with varying levels of participation. The in-depth interviews included females who enrolled in PRESTO but declined to invite their male partners to participate (n = 4), males who enrolled in PRESTO (n = 6), and males who declined to participate in PRESTO (n = 4). The focus group included 10 males who enrolled in PRESTO. We analyzed the transcriptions using inductive content analysis.

RESULTS

Male and female participants perceived that fertility is a women's health issue and is a difficult topic for men to discuss. Men expressed fears of infertility tied to masculinity. However, men were motivated to participate in fertility research to support their partners, provide data that could help others, and to learn more about their own reproductive health.

CONCLUSIONS

Male participation in fertility studies will improve our understanding of male factors contributing to fertility and reproductive health issues. Results indicate a need for more education and health communication on male fertility to normalize male participation in fertility and reproductive health research. Men are much less likely than women to participate in research on fertility and pregnancy. However, it is important for men to participate in fertility research so that we gain a better understanding of male factors that impact fertility and pregnancy outcomes. In this qualitative study, we interviewed men and women from Canada and the United States who were trying to become pregnant to understand why men choose to participate in fertility research, why men choose not to participate in fertility research, and why women choose not to invite their male partners to participate in fertility research. We found that both men and women believe fertility is a woman's health issue. Men find it difficult to talk about pregnancy and fertility and have fears of infertility tied to masculinity. However, men are motivated to participate in fertility research to support their partners, to help others, and to learn more about their own reproductive health.

Sexual function in hook-up culture: The role of body image

Hook-up mobile apps are increasing in popularity and research suggests sexual function may be lower among those who hook-up compared to those who have sex in a longer-term relationship. Sexual function is an important predictor of well-being; however, we know little about the psychosocial antecedents of sexual function, such as body image, among those who use hook-up apps. The current study aims to examine two measures of positive body image and one measure of body image self-consciousness during intimate activity among a sample of adult women and men who have hooked up in the previous month using a hook-up mobile app (N = 243). Our results suggest that higher body image self-consciousness during intimate activity was related to lower sexual function composite score and several specific domains (i.e., pain, arousal, orgasm, and lubrication) among women. Higher body appreciation was related to higher sexual satisfaction among women. Higher body image self-consciousness during intimate activity was related to higher erection difficulty, but not ejaculation difficulty, among men. These findings highlight the nuanced nature of body image and sexual function and provide further evidence that interventions for women and men aiming to improve some body image constructs may improve sexual function as well.

Association between Frailty and Erectile Dysfunction among Chinese Elderly Men

Objective

This study is aimed at assessing association between frailty and erectile dysfunction among Chinese elderly men.

Methods

This community-based study was conducted with a sample of 341 Chinese elderly men (aged 60 to 83 years old) in Fuyang City (Anhui Province, China). Each of the participants completed a standard questionnaire, including demographics (age, height, weight, yearly income, educational status, comorbidity, lifestyle factors, etc.), medical and sexual history, and the Chinese version of Tilburg Frailty Indicator (TFI) and International Index of Erectile Function-5 (IIEF-5) for assessing frailty and erectile dysfunction (ED).

Results

The prevalence of ED and frailty in Chinese elderly men was 77.13% and 68.04%, respectively. Compared with the non-ED group, the ED group had increased age, spouse's age, BMI, prevalence of diabetes, and scores of TFI and lower yearly income, educational levels, and ratio of irregular intercourse (less than once per week) (all P < 0.05). Multivariate analysis indicated that age (OR: 0.860, 95% CI: 0.763-0.969), diabetes (OR: 0.330, 95% CI: 0.165-0.661), irregular intercourse (OR: 3.416, 95% CI: 1.874-6.229), and scores of TFI (OR: 0.906, 95% CI: 0.846-0.970) were regarded as independent risk factors for ED (all P < 0.05). And after adjusting for age, the TFI score had a negative significant association with the IIEF score (r = −0.134, P = 0.013).

Conclusion

This study confirmed the strong associations between ED and frailty among elderly men. Sexual health care for elderly men with ED should be assessed and taken addressed on the multidimensional assessments of frailty.

An evaluation of the federal adverse events reporting system data on adverse effects of 5-alpha reductase inhibitors

OBJECTIVE

To investigate the sexual, physical, and mental adverse effects associated with exposure to 5-alpha reductase inhibitors (5ARIs).

METHODS

FAERS data containing finasteride and dutasteride reports were analyzed from January 2000 to April 2019. Reports identified one or more adverse effects, along with all concurrent medications. Cases of monotherapy of finasteride or dutasteride were identified. We conducted a chi-square test of independence to assess the relationship between the three drug groups and adverse event (AE) occurrence across 19 sexual, physical, and mental AE categories. The frequency procedure in SAS was utilized to summarize rates of AEs between various dosages of each drug.

RESULTS

A total of 16,014 case reports were obtained. After excluding females, 7436 case reports of 5ARI monotherapy were identified: 2628 of dutasteride 0.5 mg, 3266 of finasteride 1 mg, and 744 of finasteride 5 mg. Differences in rates of AEs occurrence were statistically significant across all 19 variables (p < 0.001) with a significantly higher proportion of AEs attributed to finasteride 1 mg, with gynecomastia being the only exception. Case report submissions rose dramatically following FDA-mandated finasteride label change.

CONCLUSIONS

Analysis of FAERS data suggests AEs of 5ARIs are dose-independent with greater likelihood of occurrence in younger patients, particularly in sexual and mental domains. The causality and the rate of AEs are not certain based on the FAERS data and future prospective studies are necessary to determine the true rates.

Latest-Late Fertility? Decline and Resurgence of Late Parenthood Across the Low-Fertility Countries

After decades of fertility postponement, we investigate recent changes in late parenthood across low-fertility countries in the light of observations from the past. We use long series of age-specific fertility rates from the Human Fertility Database (1950-2016) for women, and new data covering the period 1990-2016 for men. In 1950, the contribution of births at age 40 and over to female fertility rates ranged from 2.5 to 9 percent, but then fell sharply until the 1980s. From the 1990s, however, the prevalence of late first births increased rapidly, especially so in countries where it was initially lowest. This has produced a late fertility rebound in the last two decades, occurring much faster for women than for men. Comparisons between recent and past extremely late (age 48+) fertility levels confirm that people are now challenging the natural fertility barriers, particularly for a first child.

DNA Fragmentation in Viable and Non-Viable Spermatozoa Discriminates Fertile and Subfertile Subjects with Similar Accuracy

Sperm DNA fragmentation (sDF) negatively affects reproduction and is traditionally detected in total sperm population including viable and non-viable spermatozoa. Here, we aimed at exploring the ability of DNA fragmentation to discriminate fertile and subfertile men when detected in viable (viable sDF), non-viable (non-viable sDF), and total spermatozoa (total sDF). We revealed sDF in 91 male partners of infertile couples and 71 fertile men (max 1 year from natural conception) with LiveTUNEL coupled to flow cytometry, able to reveal simultaneously DNA fragmentation and cell viability. We found that the three sDF parameters discriminated fertile and subfertile men with similar accuracy and independently from age and basal semen parameters: AUCs (area under the curves) (95% CI) were: 0.696 (0.615–0.776), p < 0.001 for total sDF; 0.718 (0.640–0.797), p < 0.001 for viable sDF; 0.760 (0.685–0.835), p < 0.001 for non-viable sDF. We also found that total and non-viable but not viable sDF significantly correlated to age and semen quality. In conclusion, the three sDF parameters similarly discriminated fertile and subfertile men. Viable spermatozoa with DNA fragmentation are likely cells able to fertilize the oocyte but failing to properly support subsequent embryo development. Non-viable sDF could be a sign of a subtler damage extended beyond the non-viable cells.

A Prospective Clinical Study of a Prosexual Nutrient: Nano Leo for Evaluation of Libido, Erection, and Orgasm in Indian Men with Erectile Dysfunction

Aim

The present study aimed to assess the effects of Nano Leo, a prosexual nutrient formulation, on libido, erection, and orgasm in patients with erectile dysfunction (ED).

Methods

This was a prospective, single-center, phase IV efficacy study. Patients received two capsules for 7 days and thereafter one capsule through 90 days. Main outcome measures: primary endpoint was change in erectile function assessed using the International Index of Erectile Function (IIEF) questionnaire. Secondary endpoints included improvement in testosterone levels, FSH, LH, and prolactin levels; seminal parameters; and overall quality of life (QoL).

Results

Our study included 99 men (mean age 32.2 ± 4.71 years). Mean erectile function domain score increased from 18.9 ± 5.67 at baseline to 23.7 ± 4.01 on day 90 (P < 0.001). Similar improvements were observed in orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction domains of IIEF score which was seen as early as day 30. Improved IIEF corroborated with improvement in all QoL domains. From baseline to day 90, treatment with Nano Leo increased testosterone levels (5.04 ± 2.22 vs. 5.57 ± 1.53 ng/mL, P < 0.001). Similar improvements were observed in orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction domains of IIEF score which was seen as early as day 30. Improved IIEF corroborated with improvement in all QoL domains. From baseline to day 90, treatment with Nano Leo increased testosterone levels (5.04 ± 2.22 vs. 5.57 ± 1.53 ng/mL.

Conclusion

Nano Leo showed improved libido, erection, and orgasm as evaluated by IIEF and QoL and was well tolerated. Therefore, Nano Leo could be an effective and safe pronutrient supplement in managing ED.

Declining realisation of reproductive intentions with age

STUDY QUESTION

What is the likelihood of having a child within 4 years for men and women with strong short-term reproductive intentions, and how is it affected by age?

SUMMARY ANSWER

For women, the likelihood of realising reproductive intentions decreased steeply from age 35: the effect of age was weak and not significant for men.

WHAT IS KNOWN ALREADY

Men and women are postponing childbearing until later ages. For women, this trend is associated with a higher risk that childbearing plans will not be realised due to increased levels of infertility and pregnancy complications.

STUDY DESIGN, SIZE, DURATION

This study analyses two waves of the nationally representative Household, Income and Labour Dynamics in Australia (HILDA) survey. The analytical sample interviewed in 2011 included 447 men aged 18–45 and 528 women aged 18–41. These respondents expressed a strong intention to have a child in the next 3 years. We followed them up in 2015 to track whether their reproductive intention was achieved or revised.

PARTICIPANTS/MATERIALS, SETTINGS, METHODS

Multinomial logistic regression is used to account for the three possible outcomes: (i) having a child, (ii) not having a child but still intending to have one in the future and (iii) not having a child and no longer intending to have one. We analyse how age, parity, partnership status, education, perceived ability to conceive, self-rated health, BMI and smoking status are related to realising or changing reproductive intentions.

MAIN RESULTS AND THE ROLE OF CHANCE

Almost two-thirds of men and women realised their strong short-term fertility plans within 4 years. There was a steep age-related decline in realising reproductive intentions for women in their mid- and late-30s, whereas men maintained a relatively high probability of having the child they intended until age 45. Women aged 38–41 who planned to have a child were the most likely to change their plan within 4 years. The probability of realising reproductive intention was highest for married and highly educated men and women and for those with one child.

LIMITATIONS, REASONS FOR CAUTION

Our study cannot separate biological, social and cultural reasons for not realising reproductive intentions. Men and women adjust their intentions in response to their actual circumstances, but also in line with their perceived ability to have a child or under the influence of broader social norms on reproductive age.

WIDER IMPLICATIONS OF THE FINDINGS

Our results give a new perspective on the ability of men and women to realise their reproductive plans in the context of childbearing postponement. They confirm the inequality in the individual consequences of delayed reproduction between men and women. They inform medical practitioners and counsellors about the complex biological, social and normative barriers to reproduction among women at higher childbearing ages.

STUDY FUNDING/COMPETING INTEREST(S)

This research was partly supported by a Research School of Social Sciences Visiting Fellowship at the Australian National University and an Australian Research Council Discovery Project (DP150104248). Éva Beaujouan’s work was partly funded by the Austrian Science Fund (FWF) project ‘Later Fertility in Europe’ (Grant agreement no. P31171-G29). This paper uses unit record data from the HILDA Survey. The HILDA Project was initiated and is funded by the Australian Government Department of Social Services (DSS) and is managed by the Melbourne Institute of Applied Economic and Social Research (Melbourne Institute). The findings and views reported in this paper, however, are those of the authors and should not be attributed to either DSS or the Melbourne Institute. The authors have no conflicts of interest.

The use of fluorescence in situ hybridization analysis on sperm: indications to perform and assisted reproduction technology outcomes

PURPOSE

To determine the consequences of an altered sperm fluorescence in situ hybridization (FISH) result for ART outcomes and the indications for a sperm FISH analysis.

METHODS

Data from 439 infertile men were collected. Bivariate analyses were performed to determine the association of men's age, seminal alterations, and sperm FISH indication, with the incidence of X, Y, 13, 18, and 21 sperm chromosomal abnormalities. A multivariate logistic regression analysis was performed to establish the most predictive variables for altered sperm FISH. Results from the IVF/ICSI cycles were collected for 248 out of 439 patients. Two distinct groups were established: 151 couples that used their own oocytes and 97 couples involved in egg donation programs. In both groups, ART outcomes were compared between normal and altered sperm FISH.

RESULTS

Teratozoospermia and oligozoospermia were associated with sperm chromosome anomalies (p < 0.05). Indications for sperm FISH analysis with the highest predictability were teratozoospermia, male age, oligozoospermia, and implantation failure (AUC = 0.702). Embryo quality (p = 0.096), pregnancy rate (p = 0.054), and implantation rate (p = 0.089) were higher in own-oocytes couples with normal sperm FISH than in altered sperm FISH couples, although differences were not statistically significant. In donor-oocytes couples, in which high-quality embryos were transferred later than in own-oocytes couples (3.8 vs. 3.0 days), we did not identify differences in the ART outcome between normal and altered sperm FISH couples. In both groups, the possible interference of woman age was negligible.

CONCLUSIONS

Sperm FISH is indicated in middle-aged oligoteratozoospermic patients with implantation failures in previous IVF/ICSI cycles. Sperm chromosome anomalies have a moderate detrimental impact on embryo quality, implantation, and pregnancy rates.

Aging and the Male Reproductive System

This narrative review presents an overview of current knowledge on fertility and reproductive hormone changes in aging men, the factors driving and modulating these changes, their clinical consequences, and the benefits and risks of testosterone (T) therapy. Aging is accompanied by moderate decline of gamete quality and fertility. Population mean levels show a mild total T decline, an SHBG increase, a steeper free T decline, and a moderate LH increase with important contribution of comorbidities (e.g., obesity) to these changes. Sexual symptoms and lower hematocrit are associated with low T and are partly responsive to T therapy. The relationship of serum T with body composition and metabolic health is bidirectional; limited beneficial effects of T therapy on body composition have only marginal effects on metabolic health and physical function. Skeletal changes are associated primarily with estradiol and SHBG. Cognitive decline is not consistently linked to low T and is not improved by T therapy. Although limited evidence links moderate androgen decline with depressive symptoms, T therapy has small beneficial effects on mood, depressive symptoms, and vitality in elderly patients with low T. Suboptimal T (and/or DHT) has been associated with increased risk of stroke, but not of ischemic heart disease, whereas an association with mortality probably reflects that low T is a marker of poor health. Globally, neither severity of clinical consequences attributable to low T nor the nature and magnitude of beneficial treatment effects justify the concept of some broadly applied "T replacement therapy" in older men with low T. Moreover, long-term safety of T therapy is not established.

Sexual dysfunction and hyperprolactinemia in schizophrenia before and after six weeks of D2/3 receptor blockade - An exploratory study

Sexual side-effects along with antipsychotic treatment may be linked to hyperprolactinemia and dopamine D₂ receptor blockade. High prevalence of sexual dysfunction in un-medicated patients challenges the notion of sexual dysfunction as merely a side-effect of antipsychotic medication. Sexual dysfunction was assessed in fifty-six initially antipsychotic-naïve patients with schizophrenia using the UKU (Udvalget for Kliniske Undersøgelser) questionnaire. Serum-prolactin was obtained before and after six weeks of D_2/3 receptor blockade with amisulpride. At baseline 68% of patients reported one or more items of sexual dysfunction (males > females,), but the cumulative load of sexual dysfunction was similar in males and females. After 6 weeks treatment with amisulpride (mean dose 279 mg/day), 65% of patients reported one or more items of sexual dysfunctions (females > males). There was a significant sex*time interaction on mean sexual dysfunction load. All patients developed hyperprolactinaemia, and a significant effect of time and sex was found on s-prolactin (females > males). The results support that patients with schizophrenia report high levels of sexual dysfunction before antipsychotic exposure. After treatment, sexual side-effects were more frequent in females, coinciding with pronounced serum-prolactin increases. These findings suggest sex differences in sexual dysfunction before and after antipsychotic treatment.

Herbal Dietary Supplements for Erectile Dysfunction: A Systematic Review and Meta-Analysis

PURPOSE

Erectile dysfunction (ED) is a common condition that significantly affects quality of life and interpersonal relationships.

OBJECTIVE

Our objective was to perform a systematic review and meta-analysis to evaluate the efficacy of herbal dietary supplements in the treatment of ED.

MATERIALS AND METHODS

We searched five databases to identify randomized controlled trials (RCTs) that evaluated the clinical efficacy of herbal medicines in ED. Quality was assessed and risk of bias was estimated using the Jadad score and the Cochrane risk-of-bias tool.

RESULTS

In total, 24 RCTs, including 2080 patients with ED, were identified. Among these, 12 evaluated monopreparations (five ginseng [n = 399], three saffron [n = 397], two Tribulus terrestris [n = 202], and one each Pinus pinaster [n = 21] and Lepidium meyenii [n = 50]), seven evaluated formulations (n = 544), and five investigated dietary supplements in combination with pure compounds (n = 410). Ginseng significantly improved erectile function (International Index of Erectile Function [IIEF]-5 score: 140 ginseng, 96 placebo; standardized mean difference [SMD] 0.43; 95% confidence interval [CI] 0.15-0.70; P < 0.01; I² = 0), P. pinaster and L. meyenii showed very preliminary positive results, and saffron and T. terrestris treatment produced mixed results. Several herbal formulations were associated with a decrease of IIEF-5 or IIEF-15, although the results were preliminary. The quality of the included studies varied, with only seven having a prevalent low risk of bias. The median methodological quality Jadad score was three out of a maximum of five. Adverse events were recorded in 19 of 24 trials, with no significant differences between placebo and verum in placebo-controlled studies.

CONCLUSIONS

Encouraging evidence suggests that ginseng may be an effective herbal treatment for ED. However, further, larger, and high-quality studies are required before firm conclusions can be drawn. Promising (although very preliminary) results have also been generated for some herbal formulations. Overall, more research in the field, adhering to the CONSORT statement extension for reporting trials, is justified before the use of herbal products in ED can be recommended.

Epigenetic Transgenerational Inheritance

Epigenetic information refers to heritable changes in gene expression that occur without modifications at the DNA sequence level. These changes are orchestrated by different epigenetic mechanisms such as DNA methylation, posttranslational modifications of histones, and the presence of noncoding RNAs. Epigenetic information regulates chromatin structure to confer cell-specific gene expression.The sperm epigenome is the result of three periods of global resetting during men's life. Germ cell epigenome reprogramming is designed to allow cell totipotency and to prevent the transmission of epimutations via spermatozoa. At the end of these reprogramming events, the sperm epigenome has a very specific epigenetic pattern that is a footprint of past reprogramming events and has an influence on embryo development.Several data demonstrate that not all regions of the epigenome are erased during the reprogramming periods, suggesting the transmission of epigenetic information from fathers to offspring via spermatozoa. Moreover, it is becoming increasingly clear that the sperm epigenome is sensitive to environmental factors during the process of gamete differentiation, suggesting the plasticity of the sperm epigenetic signature according to the circumstances of the individual's life.In this chapter, we provided strong evidences about the association between variations of the sperm epigenome and the exposure to environmental factors. Moreover, we will present data about how epigenetic mechanisms are candidates for transferring paternal environmental information to offspring.

Aging deteriorates quality of sperm produced by male mice with partial Yq deletion

The aim of the study was to assess the cumulative effects of aging and Y-chromosome long arm deletion on sperm quality parameters. Motility, mitochondrial activity, and head morphology were evaluated for sperm of 3- and 12-month-old males from B10.BR-Y^del and B10.BR congenic mouse strains. The study revealed that quality and fertilizing potential of sperm produced by younger and older B10.BR males persist on similar levels, but worsen significantly with age of B10.BR-Y^del males. The findings imply that partial Yq deletions might be more harmful for spermiogenesis in advancing age and may be applicable to other species including humans.

ABBREVIATIONS

AZF: azoospermia factor; MSYq: male-specific region of the Y-chromosome long arm.

The diagnosis of male infertility: an analysis of the evidence to support the development of global WHO guidance-challenges and future research opportunities

BACKGROUND

Herein, we describe the consensus guideline methodology, summarize the evidence-based recommendations we provided to the World Health Organization (WHO) for their consideration in the development of global guidance and present a narrative review of the diagnosis of male infertility as related to the eight prioritized (problem or population (P), intervention (I), comparison (C) and outcome(s) (O) (PICO)) questions. Additionally, we discuss the challenges and research gaps identified during the synthesis of this evidence.

OBJECTIVE AND RATIONALE

The aim of this paper is to present an evidence-based approach for the diagnosis of male infertility as related to the eight prioritized PICO questions.

SEARCH METHODS

Collating the evidence to support providing recommendations involved a collaborative process as developed by WHO, namely: identification of priority questions and critical outcomes; retrieval of up-to-date evidence and existing guidelines; assessment and synthesis of the evidence; and the formulation of draft recommendations to be used for reaching consensus with a wide range of global stakeholders. For each draft recommendation the quality of the supporting evidence was then graded and assessed for consideration during a WHO consensus.

OUTCOMES

Evidence was synthesized and recommendations were drafted to address the diagnosis of male infertility specifically encompassing the following: What is the prevalence of male infertility and what proportion of infertility is attributable to the male? Is it necessary for all infertile men to undergo a thorough evaluation? What is the clinical (ART/non ART) value of traditional semen parameters? What key male lifestyle factors impact on fertility (focusing on obesity, heat and tobacco smoking)? Do supplementary oral antioxidants or herbal therapies significantly influence fertility outcomes for infertile men? What are the evidence-based criteria for genetic screening of infertile men? How does a history of neoplasia and related treatments in the male impact on (his and his partner's) reproductive health and fertility options? And lastly, what is the impact of varicocele on male fertility and does correction of varicocele improve semen parameters and/or fertility?

WIDER IMPLICATIONS

This evidence synthesis analysis has been conducted in a manner to be considered for global applicability for the diagnosis of male infertility.