1
|
Garolla A, Mereu S, Pizzol D, Yon DK, Rahmati M, Soysal P, Ilie PC, Bertoldo A, Trott M, Smith L. Papillomavirus infection and male infertility: A systematic review and meta-analysis. Health Sci Rep 2024; 7:e70048. [PMID: 39221052 PMCID: PMC11362025 DOI: 10.1002/hsr2.70048] [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: 04/10/2024] [Revised: 08/14/2024] [Accepted: 08/20/2024] [Indexed: 09/04/2024] Open
Abstract
Background and Aims Increasing attention is being paid to the role of human papillomavirus (HPV) in men and specifically reproduction. Growing evidence suggests an association between HPV infection with many adverse effects including the impairment of semen parameters, the increase of blastocyst apoptosis, the reduction of endometrial implantation of trophoblastic cells, as well as the increase rate of miscarriages and spontaneous preterm birth. Methods We systematically searched PubMed/MEDLINE, Scopus, Embase, Web of Science, CINHAL, PsycINFO, and ERIC from inception to 2nd of July 2024, for studies that investigated the association between HPV infection with sperm parameters and fertility outcomes. The meta-analysis was conducted on mean data and standard deviations. Results We included 25 studies with a total of 6942 patients. Sperm morphology was lower in HPV positive groups versus HPV negative control groups (SMD = -0.52 95% CI -0.84; -0.21; p = 0.001). Sperm motility was also significantly lower in HPV positive groups when compared to HPV negative controls (SMD = -0.82 95% CI -1.07; -0.57; p = <0.001). Sperm volume, concentration, and pH were not significantly different between the two groups. The other 15 studies included in the systematic review for which it was not possible to conduct a meta-analysis showed strong associations between HPV infection and impairment of sperm parameters, reduced couple fertility and increased risk of pregnancy loss. Conclusions The current evidence highlights the link between HPV infection and sperm parameters, male fertility and reproductive outcomes, which has the potential to lead to a decreased couple fertility, increased risk of pregnancy loss, re-infection and increased treatment costs.
Collapse
Affiliation(s)
- Andrea Garolla
- Unit of Andrology and Reproductive Medicine, Department of MedicineUniversity of PadovaPadovaItaly
| | - Silvia Mereu
- Unit of Andrology and Reproductive Medicine, Department of MedicineUniversity of PadovaPadovaItaly
| | | | - Dong Keon Yon
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical CenterKyung Hee University College of MedicineSeoulSouth Korea
| | - Masoud Rahmati
- Department of Physical Education and Sport Sciences, Faculty of Literature and Human SciencesLorestan UniversityKhoramabadIran
- Department of Physical Education and Sport Sciences, Faculty of Literature and HumanitiesVali‐E‐Asr University of RafsanjanRafsanjanIran
| | - Pinar Soysal
- Department of Geriatric Medicine, Faculty of MedicineBezmialem Vakif UniversityIstanbulTurkey
| | | | - Alessandro Bertoldo
- Unit of ART “G.Beltrame”, Department of Obtetrics and Ginecology, Ospedale di OderzoTrevisoULSS2Italy
| | - Mike Trott
- Princess Alexandra HospitalUniversity of QueenslandBuilding 33BrisbaneQueenslandAustralia
- Metro South Addiction and Mental Health ServicesBrisbaneQueenslandAustralia
| | - Lee Smith
- Centre for Health, Performance and WellbeingAnglia Ruskin UniversityCambridgeUK
| |
Collapse
|
2
|
Guo Y, Dong Y, Zheng R, Yan J, Li W, Xu Y, Yan X, Ke Y, Li Y, Xiang L. Correlation between viral infections in male semen and infertility: a literature review. Virol J 2024; 21:167. [PMID: 39080728 PMCID: PMC11290048 DOI: 10.1186/s12985-024-02431-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 07/06/2024] [Indexed: 08/02/2024] Open
Abstract
Infertility affects approximately one-sixth of couples globally, with the incidence of male infertility steadily increasing. However, our understanding of the impact of viral infections on fertility remains limited. This review consolidates findings from previous studies, outlining 40 viruses identified in human semen and summarizing their key characteristics, modes of transmission, and their effects on both the reproductive and endocrine systems. Furthermore, it elucidates potential pathogenic mechanisms and treatment prospects of viruses strongly associated with male infertility. This synthesis will enhance our comprehension of how viral infections influence male reproductive health, offering valuable insights for future research as well as the diagnosis and treatment of infectious infertility.
Collapse
Affiliation(s)
- Yan Guo
- Department of Reproductive Gynecology, NHC Key Laboratory of Healthy Birth and Birth Defect Prevention in Western China, the First People's Hospital of Yunnan Province, Kunming, Yunnan, China
- The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Yunhua Dong
- Department of Reproductive Medicine, NHC Key Laboratory of Healthy Birth and Birth Defect Prevention in Western China, the First People's Hospital of Yunnan Province, Kunming, Yunnan, China
- KUST-YPFPH Reproductive Medicine Joint Research Center, Medical school of Kunming University of Science and Technology, Kunming, Yunnan, China
- The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Runzi Zheng
- Department of Reproductive Medicine, NHC Key Laboratory of Healthy Birth and Birth Defect Prevention in Western China, the First People's Hospital of Yunnan Province, Kunming, Yunnan, China
- KUST-YPFPH Reproductive Medicine Joint Research Center, Medical school of Kunming University of Science and Technology, Kunming, Yunnan, China
- The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Jiacong Yan
- Department of Reproductive Medicine, NHC Key Laboratory of Healthy Birth and Birth Defect Prevention in Western China, the First People's Hospital of Yunnan Province, Kunming, Yunnan, China
- KUST-YPFPH Reproductive Medicine Joint Research Center, Medical school of Kunming University of Science and Technology, Kunming, Yunnan, China
- The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Weiyuan Li
- Department of Reproductive Medicine, NHC Key Laboratory of Healthy Birth and Birth Defect Prevention in Western China, the First People's Hospital of Yunnan Province, Kunming, Yunnan, China
- KUST-YPFPH Reproductive Medicine Joint Research Center, Medical school of Kunming University of Science and Technology, Kunming, Yunnan, China
- The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Ya Xu
- Department of Clinical Laboratory, the First People's Hospital of Yunnan Province, Kunming, Yunnan, China
| | - Xuelan Yan
- Department of Reproductive Gynecology, NHC Key Laboratory of Healthy Birth and Birth Defect Prevention in Western China, the First People's Hospital of Yunnan Province, Kunming, Yunnan, China
- The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Yunmei Ke
- Department of Reproductive Gynecology, NHC Key Laboratory of Healthy Birth and Birth Defect Prevention in Western China, the First People's Hospital of Yunnan Province, Kunming, Yunnan, China
- The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Yantao Li
- Department of Reproductive Gynecology, NHC Key Laboratory of Healthy Birth and Birth Defect Prevention in Western China, the First People's Hospital of Yunnan Province, Kunming, Yunnan, China
- The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Lifeng Xiang
- Department of Reproductive Medicine, NHC Key Laboratory of Healthy Birth and Birth Defect Prevention in Western China, the First People's Hospital of Yunnan Province, Kunming, Yunnan, China.
- KUST-YPFPH Reproductive Medicine Joint Research Center, Medical school of Kunming University of Science and Technology, Kunming, Yunnan, China.
- The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China.
| |
Collapse
|
3
|
Cutarelli A, De Falco F, Brunetti R, Napoletano M, Fusco G, Roperto S. Molecular detection of transcriptionally active ovine papillomaviruses in commercial equine semen. Front Vet Sci 2024; 11:1427370. [PMID: 39021410 PMCID: PMC11253197 DOI: 10.3389/fvets.2024.1427370] [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: 05/03/2024] [Accepted: 06/21/2024] [Indexed: 07/20/2024] Open
Abstract
Virological evaluation was performed on equine semen to detect the presence of papillomaviruses (PVs) using droplet digital polymerase chain reaction (ddPCR) as the aim of this study was to investigate whether the sperm from asymptomatic stallions harbors ovine papillomaviruses (OaPVs). Twenty-seven semen samples were analyzed, 18 of which were commercially acquired. The remaining nine samples comprising semen and peripheral blood, were collected from nine stallions with no apparent signs of PV-related diseases during clinical examination at the Didactic Veterinary University Hospital (DVUH) of Naples. OaPV was detected in 26 semen samples. OaPV1 was the most prevalent virus infecting equine semen. OaPV1 infected 21 semen samples (~80.8%) and showed a high number of DNA and RNA copies per microliter. qPCR was used to detect OaPV1 DNA in the 18 semen samples. ddPCR was used to detect and quantify the expression of OaPV2, OaPV3, and OaPV4. qPCR failed to detect DNA for these genotypes. Additionally, ddPCR was used to detect the transcriptionally active OaPV1 in six blood and semen samples from the same stallion. ddPCR failed to detect any nucleic acids in OaPVs in peripheral blood samples from the three stallions. In one semen sample, ddPCR detected OaPV1 DNA but failed to detect any nucleic acid in the remaining two semen samples, and peripheral blood from the same animals of the remaining 18 semen samples was not available, OaPV1 and OaPV4 were responsible for nine and five single infections, respectively. No single infections with either OaPV3 or OaPV4 were seen.
Collapse
Affiliation(s)
- Anna Cutarelli
- Istituto Zooprofilattico Sperimentale del Mezzogiorno, Naples, Italy
| | - Francesca De Falco
- Dipartimento di Medicina Veterinaria e delle Produzioni Animali, Università degli Studi di Napoli Federico II, Naples, Italy
- Area Science Park, Campus di Baronissi, Università degli Studi di Salerno, Salerno, Italy
| | - Roberta Brunetti
- Istituto Zooprofilattico Sperimentale del Mezzogiorno, Naples, Italy
| | | | - Giovanna Fusco
- Istituto Zooprofilattico Sperimentale del Mezzogiorno, Naples, Italy
| | - Sante Roperto
- Dipartimento di Medicina Veterinaria e delle Produzioni Animali, Università degli Studi di Napoli Federico II, Naples, Italy
| |
Collapse
|
4
|
Asero V, Scornajenghi CM, Iaconis S, Sicignano E, Falcone A, Dinacci F, Pagano G, Carino D, Corvino R, Tresh A. Interplay between male gonadal function and overall male health. J Basic Clin Physiol Pharmacol 2024; 35:105-110. [PMID: 38830206 DOI: 10.1515/jbcpp-2024-0054] [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: 04/01/2024] [Accepted: 04/23/2024] [Indexed: 06/05/2024]
Abstract
The process-of-male reproduction is intricate, and various medical conditions-have the potential to disrupt spermatogenesis. Moreover, infertility in males can serve as an indicator of-potential future health issue. Numerous conditions with systemic implications have been identified, encompassing genetic factors (such as Klinefelter Syndrome), obesity, psychological stress, environmental factors, and others. Consequently, infertility assessment-presents an opportunity for comprehensive health counseling, extending-beyond discussions about reproductive goals. Furthermore, male infertility has been suggested as a harbinger of future health problems, as poor semen quality and a diagnosis of-male infertility are associated with an increased risk of hypogonadism, cardiometabolic disorders, cancer, and even mortality. This review explores the existing-literature on the relationship between systemic illnesses and male fertility, impacting both clinical-outcomes and semen parameters. The majority of the literature analyzed, which compared gonadal function with genetic, chronic, infectious or tumoral diseases, confirm the association between overall male health and infertility.
Collapse
Affiliation(s)
- Vincenzo Asero
- Department of Maternal Infant and Urologic Sciences, 9311 University of Rome La Sapienza , Rome, Lazio, Italy
| | - Carlo Maria Scornajenghi
- Department of Maternal Infant and Urologic Sciences, 9311 University of Rome La Sapienza , Rome, Lazio, Italy
| | - Salvatore Iaconis
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, 165474 Federico II University Hospital , Napoli, Italy
| | - Enrico Sicignano
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, 165474 Federico II University Hospital , Napoli, Italy
| | - Alfonso Falcone
- Department of Neurosciences, Science of Reproduction and Odontostomatology, 9307 University of Naples Federico II , Napoli, Campania, Italy
| | - Fabrizio Dinacci
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, 165474 Federico II University Hospital , Napoli, Campania, Italy
| | - Giovanni Pagano
- Department of Neurosciences, Science of Reproduction and Odontostomatology, 9307 University of Naples Federico II , Napoli, Italy
| | - Dalila Carino
- Department of Maternal Infant and Urologic Sciences, 9311 University of Rome La Sapienza , Rome, Italy
| | - Roberta Corvino
- Department of Maternal Infant and Urologic Sciences, 9311 University of Rome La Sapienza , Rome, Italy
| | - Anas Tresh
- Department of Urology, 10624 Stanford University School of Medicine , Stanford, CA, USA
| |
Collapse
|
5
|
Hallak J, Caldini EG, Teixeira TA, Correa MCM, Duarte-Neto AN, Zambrano F, Taubert A, Hermosilla C, Drevet JR, Dolhnikoff M, Sanchez R, Saldiva PHN. Transmission electron microscopy reveals the presence of SARS-CoV-2 in human spermatozoa associated with an ETosis-like response. Andrology 2024. [PMID: 38469742 DOI: 10.1111/andr.13612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 01/05/2024] [Accepted: 01/23/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Severe acute syndrome coronavirus 2 can invade a variety of tissues, including the testis. Even though this virus is scarcely found in human semen polymerase chain reaction tests, autopsy studies confirm the viral presence in all testicular cell types, including spermatozoa and spermatids. OBJECTIVE To investigate whether the severe acute syndrome coronavirus 2 is present inside the spermatozoa of negative polymerase chain reaction-infected men up to 3 months after hospital discharge. MATERIALS AND METHODS This cross-sectional study included 13 confirmed moderate-to-severe COVID-19 patients enrolled 30-90 days after the diagnosis. Semen samples were obtained and examined with real-time polymerase chain reaction for RNA detection and by transmission electron microscopy. RESULTS In moderate-to-severe clinical scenarios, we identified the severe acute syndrome coronavirus 2 inside spermatozoa in nine of 13 patients up to 90 days after discharge from the hospital. Moreover, some DNA-based extracellular traps were reported in all studied specimens. DISCUSSION AND CONCLUSION Although severe acute syndrome coronavirus 2 was not present in the infected men's semen, it was intracellularly present in the spermatozoa till 3 months after hospital discharge. The Electron microscopy (EM) findings also suggest that spermatozoa produce nuclear DNA-based extracellular traps, probably in a cell-free DNA-dependent manner, similar to those previously described in the systemic inflammatory response to COVID-19. In moderate-to-severe cases, the blood-testes barrier grants little defence against different pathogenic viruses, including the severe acute syndrome coronavirus 2. The virus could also use the epididymis as a post-testicular route to bind and fuse to the mature spermatozoon and possibly accomplish the reverse transcription of the single-stranded viral RNA into proviral DNA. These mechanisms can elicit extracellular cell-free DNA formation. The potential implications of our findings for assisted conception must be addressed, and the evolutionary history of DNA-based extracellular traps as preserved ammunition in animals' innate defence might improve our understanding of the severe acute syndrome coronavirus 2 pathophysiology in the testis and spermatozoa.
Collapse
Affiliation(s)
- Jorge Hallak
- Departamento de Cirurgia, Disciplina de Urologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Androscience, Science & Innovation Center in Andrology and High-Complex Clinical and Research Andrology Laboratory., Androscience Institute, Sao Paulo, Brasil
| | - Elia G Caldini
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Thiago A Teixeira
- Androscience, Science & Innovation Center in Andrology and High-Complex Clinical and Research Andrology Laboratory., Androscience Institute, Sao Paulo, Brasil
- Departamento de Cirurgia, Divisão de Urologia, Hospital Universitário da Universidade Federal do Amapá, Amapá, Brazil
| | | | - Amaro N Duarte-Neto
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Fabiola Zambrano
- Department of Preclinical Sciences, Faculty of Medicine, Universidad de La Frontera, Temuco, Chile
- Center of Translational Medicine-Scientific and Technological Bioresource Nucleus (CEMT-BIOREN), Faculty of Medicine, Universidad de La Frontera, Temuco, Chile
| | - Anja Taubert
- Institute of Parasitology, Justus Liebig University Giessen, Giessen, Germany
| | - Carlos Hermosilla
- Institute of Parasitology, Justus Liebig University Giessen, Giessen, Germany
| | - Joël R Drevet
- GReD Institute, CNRS-INSERM-Université Clermont Auvergne, Faculty of Medicine, Clermont-Ferrand, France
| | - Marisa Dolhnikoff
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Raul Sanchez
- Center of Translational Medicine-Scientific and Technological Bioresource Nucleus (CEMT-BIOREN), Faculty of Medicine, Universidad de La Frontera, Temuco, Chile
- Institute of Parasitology, Justus Liebig University Giessen, Giessen, Germany
| | - Paulo H N Saldiva
- Departamento de Patologia, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| |
Collapse
|
6
|
Santos FP, Figueiredo AJ, Figueiredo-Dias M. Seminal human papillomavirus infection: a narrative review. Infect Dis (Lond) 2023; 55:809-820. [PMID: 37584178 DOI: 10.1080/23744235.2023.2246561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 08/04/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Human papillomavirus (HPV) infection is one of the most prevalent sexually transmitted infections that can lead to malignant pathologies as well as fertility problems. The aim of this study was to evaluate the prevalence of HPV infection in males, its impact on semen parameters, and reproductive consequences. We also evaluated potential measures that could prevent negative outcomes of HPV infection in males. METHODS A systematic literature search using PubMed/Medline and Embase databases was performed to search for English articles published until July 2023. We explored three different aspects: (1) prevalence of HPV semen infection and its impact on seminal parameters; (2) the relationship between HPV semen infection and infertility risk and reproductive outcomes; and (3) potential measures that could prevent the negative outcomes related to HPV seminal infection. The identified studies were first screened and assessed independently by one author, and then validated by two additional authors. Data were extracted from 19 studies. RESULTS The prevalence of seminal HPV infection was higher among infertile males. In addition to controversies about the real interference of seminal HPV infection on sperm parameters, a growing number of studies have demonstrated a correlation between unexplained infertility and seminal HPV infection. Semen HPV infection is also associated with lower rates of pregnancy and higher rates of miscarriage. Prevention measures such as HPV vaccination seem promising. CONCLUSION Further studies are required to confirm not only the association between HPV infection and reproductive outcomes but also the benefit of preventive measures.
Collapse
Affiliation(s)
- Fernanda P Santos
- Faculty of Medicine, Gynecology Department, University of Coimbra, Coimbra, Portugal
- Coimbra Academic and Clinical Centre, Coimbra, Portugal
- Gynecology Department, Hospital and University Centre of Coimbra, Coimbra, Portugal
| | - Arnaldo J Figueiredo
- Coimbra Academic and Clinical Centre, Coimbra, Portugal
- Faculty of Medicine, Urology Department, University of Coimbra, Coimbra, Portugal
- Urology and Renal Transplant Department, Hospital and University Centre of Coimbra, Coimbra, Portugal
| | - Margarida Figueiredo-Dias
- Faculty of Medicine, Gynecology Department, University of Coimbra, Coimbra, Portugal
- Coimbra Academic and Clinical Centre, Coimbra, Portugal
- Gynecology Department, Hospital and University Centre of Coimbra, Coimbra, Portugal
| |
Collapse
|
7
|
Kaltsas A, Dimitriadis F, Zachariou D, Zikopoulos A, Symeonidis EN, Markou E, Tien DMB, Takenaka A, Sofikitis N, Zachariou A. From Diagnosis to Treatment: Comprehensive Care by Reproductive Urologists in Assisted Reproductive Technology. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1835. [PMID: 37893553 PMCID: PMC10608107 DOI: 10.3390/medicina59101835] [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: 07/31/2023] [Revised: 09/28/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023]
Abstract
Infertility is a global health concern, with male factors playing an especially large role. Unfortunately, however, the contributions made by reproductive urologists in managing male infertility under assisted reproductive technology (ART) often go undervalued. This narrative review highlights the important role played by reproductive urologists in diagnosing and treating male infertility as well as any barriers they face when providing services. This manuscript presents a comprehensive review of reproductive urologists' role in managing male infertility, outlining their expertise in diagnosing and managing male infertility as well as reversible causes and performing surgical techniques such as sperm retrieval. This manuscript investigates the barriers limiting urologist involvement such as limited availability, awareness among healthcare professionals, and financial constraints. This study highlights a decrease in male fertility due to lifestyle factors like sedentary behavior, obesity, and substance abuse. It stresses the significance of conducting an evaluation process involving both male and female partners to identify any underlying factors contributing to infertility and to identify patients who do not require any interventions beyond ART. We conclude that engaging urologists more effectively in infertility management is key to optimizing fertility outcomes among couples undergoing assisted reproductive technology treatments and requires greater education among healthcare providers regarding the role urologists and lifestyle factors that could have an effect on male fertility.
Collapse
Affiliation(s)
- Aris Kaltsas
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece; (A.K.); (A.Z.); (N.S.)
| | - Fotios Dimitriadis
- Department of Urology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (F.D.); (E.N.S.)
| | - Dimitrios Zachariou
- Third Orthopaedic Department, National and Kapodestrian University of Athens, KAT General Hospital, 14561 Athens, Greece;
| | - Athanasios Zikopoulos
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece; (A.K.); (A.Z.); (N.S.)
| | - Evangelos N. Symeonidis
- Department of Urology, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (F.D.); (E.N.S.)
| | - Eleftheria Markou
- Department of Microbiology, University Hospital of Ioannina, 45500 Ioannina, Greece;
| | - Dung Mai Ba Tien
- Department of Andrology, Binh Dan Hospital, Ho Chi Minh City 70000, Vietnam;
| | - Atsushi Takenaka
- Division of Urology, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan;
| | - Nikolaos Sofikitis
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece; (A.K.); (A.Z.); (N.S.)
| | - Athanasios Zachariou
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece; (A.K.); (A.Z.); (N.S.)
| |
Collapse
|
8
|
Zhaffal M, Salame A. Semen human papillomavirus (HPV) shedding in males: frequency, clinical significance, and reproductive outcomes—literature review. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2023. [DOI: 10.1186/s43043-023-00131-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
Abstract
Background
The interest in the HPV status of the male has risen after the discovery of HPV shedding in the semen. To date, there is no consensus on the true prevalence of male HPV infection, yet there is a rising body of evidence suggesting that male HPV infection might negatively affect the sperm parameters.
Main body
The concern that HPV can lead to a couple’s infertility and affect reproductive outcomes had increased after the multiple publications of semen criteria perturbations specifically the asthenospermia associated with HPV infection. An extensive literature review was performed to define the actual frequency of male HPV infection as well as the true extent of sperm analysis perturbations related to the HPV illness. We also intended to define the impact of these infections on reproductive outcomes and to highlight any treatment plans for affected couples.
Conclusion
HPV is a prevalent disease with a rising concern among the male populations given the suggested impact on sperm motility as well as the pregnancy and miscarriage rates post-ART treatment. Vaccines are being studied now as a possible infertility adjunct treatment for males who are already infected.
Collapse
|
9
|
Busnelli A, Garolla A, Tersigni C, Parodi V, Inversetti A, Levi-Setti PE, Scambia G, Di Simone N. Sperm human papillomavirus infection and risk of idiopathic recurrent pregnancy loss: insights from a multicenter case-control study. Fertil Steril 2023; 119:410-418. [PMID: 36493870 DOI: 10.1016/j.fertnstert.2022.12.002] [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: 07/15/2022] [Revised: 11/30/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To test the hypothesis claiming an association between human papilloma virus (HPV) sperm infection and idiopathic recurrent pregnancy loss (RPL). DESIGN Multicenter retrospective case-control study. SETTING Three university hospitals. PATIENT(S) Cases included men belonging to couples affected by first trimester idiopathic RPL. Controls included men belonging to couples with proven fertility and no history of pregnancy loss; RPL was defined as the previous loss of 2 or more pregnancies. Couples were defined as "fertile" if they achieved a full-term pregnancy within the year before enrollment in the study. All participants conceived without assistance. MAIN OUTCOME MEASURE(S) The association between HPV DNA sperm infection, as identified using polymerase chain reaction, and RPL. RESULTS The HPV DNA sperm infection was detected in 23 of 117 cases (20%; 95% confidence interval [CI]: 13%, 28%) and in 3 of 84 controls (4%; 95% CI; 1%, 10%) (P<.001). A comparison across baseline characteristics and multiple regression analysis did not identify any potentially confounding factors. Multivariate regression models showed a significant association between HPV DNA sperm infection and RPL (adjusted odds ratio, 7.44; 95% CI: 2.08, 26.58; P=.002 [Model 1]; adjusted odds ratio, 8.96; 95% CI: 2.41, 33.44; P=.001 [Model 2]). CONCLUSIONS The prevalence of HPV sperm infection was significantly higher in couples affected by RPL than in their fertile counterparts. Notably, the semen sample was infected by HPV in approximately 1 out of 5 patients.
Collapse
Affiliation(s)
- Andrea Busnelli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy.
| | - Andrea Garolla
- Unit of Andrology and Reproductive Medicine and Centre for Male Gamete Cryopreservation, Department of Medicine, University of Padova, Padova, Italy
| | - Chiara Tersigni
- Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Vittorio Parodi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy
| | - Annalisa Inversetti
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Paolo Emanuele Levi-Setti
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Giovanni Scambia
- Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy; Dipartimento di Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Nicoletta Di Simone
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| |
Collapse
|
10
|
Capra G, Notari T, Buttà M, Serra N, Rizzo G, Bosco L. Human Papillomavirus (HPV) Infection and Its Impact on Male Infertility. Life (Basel) 2022; 12:1919. [PMID: 36431054 PMCID: PMC9697777 DOI: 10.3390/life12111919] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 11/12/2022] [Accepted: 11/15/2022] [Indexed: 11/19/2022] Open
Abstract
Nowadays, the striking numbers of infertile couples that turn to assisted reproductive technologies (ART) drive the research toward a more comprehensive understanding of the underlying causes. Male factors contribute to the inability to conceive in half of the cases, and it has been suggested that sexually transmitted infections could have a role in the onset of spermatozoa impairments. Since the impact of HPV infection on sperm quality and sperm DNA integrity is debated, we wanted to analyze its impact on conventional seminal parameters and the sperm DNA fragmentation index (DFI). Therefore, 117 semen samples of patients undergoing IVF were evaluated for the following characteristics: HPV DNA detection and sperm DNA fragmentation, concentration, motility, and morphology. The results showed a higher rate of HPV-negative patients (59.8% vs. 40.2%) and no HPV-related effect on DFI, sperm concentration, total sperm number, and total motility. Only progressive motility and morphology were found as significantly influenced by HPV positivity. Moreover, we observed a statistically significant difference in DFI when comparing high-risk HPV (HR-HPV) and low-risk HPV (LR-HPV) genotypes. Our data suggest that the presence of any HPV type, whatever the exact localization of the virions, can impair some sperm parameters, while HR-HPVs specifically affect the integrity of spermatozoa DNA.
Collapse
Affiliation(s)
- Giuseppina Capra
- UOC of Microbiology and Virology, Polyclinic Hospital, Via del Vespro, 133, 90127 Palermo, Italy
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE) “G. D’Alessandro”, University of Palermo, Piazza delle Cliniche, 2, 90127 Palermo, Italy
| | - Tiziana Notari
- “Check Up” Polydiagnostic and Research Laboratory, Andrology Unit, Viale Andrea De Luca 5, 84131 Salerno, Italy
- “D’Arena”—Clinical Analysis and Diagnostics Laboratory—Vallo della Lucania, Str. Giuseppe Garibaldi, 25/C-F, 84078 Salerno, Italy
| | - Michela Buttà
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE) “G. D’Alessandro”, University of Palermo, Piazza delle Cliniche, 2, 90127 Palermo, Italy
| | - Nicola Serra
- Department of Public Health, University Federico II of Naples, Via S. Pansini 5, 80131 Naples, Italy
| | - Giovanni Rizzo
- “D’Arena”—Clinical Analysis and Diagnostics Laboratory—Vallo della Lucania, Str. Giuseppe Garibaldi, 25/C-F, 84078 Salerno, Italy
| | - Liana Bosco
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D), Section of Biology and Genetics, University of Palermo, 90133 Palermo, Italy
| |
Collapse
|
11
|
de Albuquerque BHDR, de Oliveira MTFC, Aderaldo JF, de Medeiros Garcia Torres M, Lanza DCF. Human seminal virome: a panel based on recent literature. Basic Clin Androl 2022; 32:16. [PMID: 36064315 PMCID: PMC9444275 DOI: 10.1186/s12610-022-00165-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 06/16/2022] [Indexed: 02/06/2023] Open
Abstract
Background The seminal virome and its implications for fertility remain poorly understood. To date, there are no defined panels for the detection of viruses of clinical interest in seminal samples. Results In this study, we characterized the human seminal virome based on more than 1,000 studies published over the last five years. Conclusions The number of studies investigating viruses that occur in human semen has increased, and to date, these studies have been mostly prospective or related to specific clinical findings. Through the joint analysis of all these studies, we have listed the viruses related to the worsening of seminal parameters and propose a new panel with the main viruses already described that possibly affect male fertility and health. This panel can assist in evaluating semen quality and serve as a tool for investigation in cases of infertility.
Collapse
|
12
|
Ombelet W, Van der Auwera I, Bijnens H, Kremer C, Bruckers L, Mestdagh G, Dhont N, Campo R. Factors influencing pregnancy outcome with special attention to modified slow-release insemination and a patient-centred approach in a donor insemination programme: a prospective cohort study. Facts Views Vis Obgyn 2022; 14:163-170. [DOI: 10.52054/fvvo.14.2.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction: A higher pregnancy rate after slow-release insemination instead of bolus injection was described in previous studies. Besides an effective medical treatment most patients wish to receive a patient-centred approach with sufficient emotional support.
Study question: Does a patient-friendly approach with slow-release insemination (SRI) increase the clinical pregnancy rate (CPR) after intrauterine insemination (IUI) with donor semen?
Study design, size, duration: The data of an ongoing prospective cohort study were analysed investigating the results of 1995 donor inseminations in 606 women from July 2011 until December 2018. As from January 2016 the insemination procedure was performed by midwives instead of medical doctors. Instead of bolus injection of sperm a slow-release IUI was done together with a more patient-centred approach.
Materials and Methods: The data of 1995 donor inseminations were analysed to study the importance of different covariates influencing IUI success. Generalized estimating equations (GEEs) were used for statistical analysis. Results of two periods (2011-2015 and 2016-2018) were examined and compared.
Results: Clinical pregnancy rates (with foetal heartbeat) following donor inseminations increased from 16.6 % to 20.8 % per cycle, a non-significant increase (p=0.061).
Conclusion: A more patient-friendly approach with slow-release of processed semen resulted in a non-significant higher clinical pregnancy rate of 4.2 % per cycle after donor insemination.
Collapse
|
13
|
Vieira-Baptista P, Silva-Soares S, Lyra J, Falcão V, Póvoa AM, Calejo L, Sousa S. Wet Mount Microscopy of the Vaginal Milieu Does Not Predict the Outcome of Fertility Treatments: A Cross-sectional Study. J Low Genit Tract Dis 2022; 26:176-180. [PMID: 35067583 DOI: 10.1097/lgt.0000000000000655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate whether vaginal dysbiosis (bacterial vaginosis [BV] or moderate/severe aerobic vaginitis [AV]/desquamative inflammatory vaginitis) in women subjected to intrauterine insemination (IUI) or in vitro fertilization/intracytoplasmic sperm injection influences the rates of pregnancy. MATERIALS AND METHODS This is a cross-sectional study involving 392 women who underwent IUI or in vitro fertilization/intracytoplasmic sperm injection at a fertility clinic. All had a slide collected for phase contrast wet mount microscopy (WMM), which was classified according to the International Society for the Study of Vulvovaginal Disease recommendations. Correlation between flora patterns and the rate of pregnancy were evaluated. RESULTS There were no differences in any of the groups in terms of pregnancy rate (biochemical, clinical, at first trimester ultrasound, or live birth) after stratifying for the presence of BV, moderate or severe (ms) AV, BV and/or moderate or severe AV, cytolysis, or abnormal vaginal flora (lactobacillary grade ≥ IIb). The presence of Candida species, cocci, or bacilli morphotypes other than lactobacilli also showed no differences. CONCLUSIONS The vaginal flora assessment by WMM at the time of IUI or oocyte retrieval was not predictive of the success of fertility treatments.The absence of differences may be due to intrinsic limitations of WMM (i.e., identifying only bacterial morphotypes), a positive impact of the treatments in the vaginal flora or because the sperm and embryo transfer is made directly into the uterine cavity, thus overcoming any cervical or vaginal dysbiosis disadvantage. Future studies should focus on the endometrial milieu, rather than in the vaginal and/or cervical one.
Collapse
Affiliation(s)
| | - Sandra Silva-Soares
- Unit of Reproductive Medicine, Department of Gynecology, Centro Hospitalar de São João, Porto, Portugal
| | - Joana Lyra
- Lower Genital Tract Unit, Gynecology Department, Centro Hospitalar de São João, Porto, Portugal
| | - Vera Falcão
- Lower Genital Tract Unit, Gynecology Department, Centro Hospitalar de São João, Porto, Portugal
| | | | - Lucinda Calejo
- Unit of Reproductive Medicine, Department of Gynecology, Centro Hospitalar de São João, Porto, Portugal
| | - Sónia Sousa
- Unit of Reproductive Medicine, Department of Gynecology, Centro Hospitalar de São João, Porto, Portugal
| |
Collapse
|
14
|
MUSCIANISI F, FORESTA C, GAROLLA A. Role of HPV vaccination for prevention of male infertility. Minerva Endocrinol (Torino) 2022; 47:70-76. [DOI: 10.23736/s2724-6507.22.03667-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
15
|
Carbone L, Conforti A, La Marca A, Cariati F, Vallone R, Raffone A, Buonfantino C, Palese M, Mascia M, DI Girolamo R, Capuzzo M, Esteves SC, Alviggi C. The negative impact of most relevant infections on fertility and assisted reproduction technology. Minerva Obstet Gynecol 2022; 74:83-106. [PMID: 34137567 DOI: 10.23736/s2724-606x.21.04870-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Infections may act with variable impact on the physiopathology of the reproductive organs, determining infertility or reducing the outcomes of assisted reproduction technology. The aim of this narrative review is to describe the existing evidence regarding the pathogens with a supposed or recognized role in reproductive medicine. Viral hepatitis, as well as HIV, can reduce sperm quality. Syphilis carries a risk of erectile dysfunction and increased endometrial thickness. Chlamydia is the main cause of pelvic inflammatory disease. In relation to Mycoplasma and Ureaplasma spp., only few species seem to show a correlation with infertility and poor in-vitro fertilization outcomes. There is evidence of a role for bacterial vaginosis in early pregnancy loss. HPV infection in males seems to determine infertility. Herpesviruses are more a risk for fetuses than for fertility itself. Zika virus is responsible for altered early embryo development and waiting to conceive is recommended in suspected or confirmed cases. The impact of SARS-CoV-2 is yet to be elucidated. Rubella and toxoplasmosis can provoke important congenital defects and therefore screening is mandatory before conception; a vaccine for Rubella is recommended. Further and well-designed studies are still needed to better elucidate the role of some infectious agents, to improve fertility and its treatments.
Collapse
Affiliation(s)
- Luigi Carbone
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy -
| | - Alessandro Conforti
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Antonio La Marca
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Roberta Vallone
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Antonio Raffone
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Cira Buonfantino
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Michela Palese
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Marika Mascia
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Raffaella DI Girolamo
- Center for High-Risk Pregnancy and Fetal Care, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - Martina Capuzzo
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Sandro C Esteves
- Division of Urology, Department of Surgery, University of Campinas (UNICAMP), Campinas, Brazil
- Faculty of Health, Aarhus University, Aarhus, Denmark
- ANDROFERT - Andrology and Human Reproduction Clinic, Campinas, Brazil
| | - Carlo Alviggi
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| |
Collapse
|
16
|
Sperm quality and absence of SARS-CoV-2 RNA in semen after COVID-19 infection: a prospective, observational study and validation of the SpermCOVID test. Fertil Steril 2021; 117:287-296. [PMID: 34937665 PMCID: PMC8685303 DOI: 10.1016/j.fertnstert.2021.10.022] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 10/24/2021] [Accepted: 10/26/2021] [Indexed: 12/31/2022]
Abstract
Objective To study the contagiousness of sperm and its influence on fertility after recovery from COVID-19 infection. Design Prospective cohort study. Setting University medical center. Patient(s) One hundred twenty Belgian men who had recovered from proven COVID-19 infection. Intervention(s) No intervention was performed. Main outcome measure(s) Semen quality was assessed using the World Health Organisation criteria. DNA damage to sperm cells was assessed by quantifying the DNA fragmentation index and the high density stainability. Finally antibodies against SARS-CoV2 spike-1 antigen, nuclear and S1-receptor binding domain were measured by Elisa and chemilumenscent microparticle immunoassays, respectively. Result(s) SARS-CoV-2 RNA was not detected in semen during the period shortly after infection nor at a later time. Mean progressive motility was reduced in 60% of men tested shortly (<1 month) after COVID-19 infection, 37% of men tested 1 to 2 months after COVID-19 infection, and 28% of men tested >2 months after COVID-19 infection. Mean sperm count was reduced in 37% of men tested shortly (<1 month) after COVID-19 infection, 29% of men tested 1 to 2 months after COVID-19 infection, and 6% of men tested >2 months after COVID-19 infection. The severity of COVID-19 infection and the presence of fever were not correlated with sperm characteristics, but there were strong correlations between sperm abnormalities and the titers of SARS-CoV-2 IgG antibody against spike 1 and the receptor- binding domain of spike 1, but not against nucleotide, in serum. High levels of antisperm antibodies developed in three men (2.5%). Conclusion(s) Semen is not infectious with SARS-CoV-2 at 1 week or more after COVID-19 infection (mean, 53 days). However, couples with a desire for pregnancy should be warned that sperm quality after COVID-19 infection can be suboptimal. The estimated recovery time is 3 months, but further follow-up studies are under way to confirm this and to determine if permanent damage occurred in a minority of men.
Collapse
|
17
|
Ombelet W, Van der Auwera I, Bijnens H, Onofre J, Kremer C, Bruckers L, Mestdagh G, Campo R, Dhont N. Improving IUI success by performing modified slow-release insemination and a patient-centred approach in an insemination programme with partner semen: a prospective cohort study. Facts Views Vis Obgyn 2021; 13:359-367. [PMID: 35026097 PMCID: PMC9148711 DOI: 10.52054/fvvo.13.4.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Pregnancy rates after in vitro fertilisation (IVF) treatment continue to improve, while intrauterine insemination (IUI) programmes show no such trend. There is a need to improve success rates with IUI to retain it as a viable option for couples who prefer avoiding IVF as a first line treatment. Objective To investigate if a modified slow-release insemination (SRI) increases the clinical pregnancy rate (CPR) after intrauterine insemination (IUI) with partner semen. Materials and Methods This was a prospective cohort study in a Belgian tertiary fertility centre. Between July 2011 and December 2018, we studied data from an ongoing prospective cohort study including 989 women undergoing 2565 IUI procedures for unexplained or mild/moderate male infertility. These data were analysed in order to study the importance of different covariates influencing IUI success. Generalised estimating equations (GEEs) were used for statistical analysis. Results of two periods (2011-2015, period 1 and 2016-2018, period 2) were examined and compared. From January 2016 (period 2) onwards, a standardised SRI procedure instead of bolus injection of sperm was applied. The primary outcome parameter was the difference in clinical pregnancy rate (CPR) per cycle between period 1 (bolus IUI) and period 2 (modified SRI). Secondary outcome results included all other parameters significantly influencing CPR after IUI. Results Following the application of modified SRI the CPR increased significantly, from 9.03% (period 1) to 13.52% (period 2) (p = 0.0016). Other covariates significantly influencing CPR were partner’s age, smoking/ non-smoking partner, BMI patient, ovarian stimulation protocol and Inseminating Motile Count (after semen processing). Conclusion The intentional application of modified slow-release of processed semen appears to significantly increase CPRs after IUI with homologous semen. Future studies should investigate whether SRI, patient-centred measures, or a combination of both, are responsible for this improvement.
Collapse
|
18
|
Diagnostic and therapeutic workup of male infertility: results from a Delphi consensus panel. Int J Impot Res 2021:10.1038/s41443-021-00511-x. [PMID: 34853436 DOI: 10.1038/s41443-021-00511-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/16/2021] [Accepted: 11/22/2021] [Indexed: 12/11/2022]
Abstract
Male factor infertility (MFI) is a rising issue worldwide with significant socioeconomic costs and negative psychological consequences for the couple. Current guidelines provide recommendations for its diagnosis and treatment but several gaps in the management of MFI are encountered in clinical practice due to the lack of available evidence in published literature. Uncertainty in the management of MFI cases leads to a high degree of variability in therapeutic approaches. We planned a Delphi consensus method to provide insights and help bridge the gaps that separate clinical guidelines from real-world practice. The Advisory Board collected 41 statements on debated topics in the management of MFI, each including multiple items designed as a 5-point Likert scale. The questionnaire was sent by e-mail to a panel of Italian experts for a first round of voting; members of the panel were later invited to a second round of voting, preceded by discussion of the "hot topics" identified in the first round. At both rounds of the Delphi consensus 68 experts participated to the voting process. After the first round 25 statements were identified as hot topics, and these underwent the second round of voting. Consensus was reached on many, but not all cases, leaving vagueness on few debated topics where decisions are unsupported by clinical studies or driven by controversial results. In conclusion, indications emerging from this large panel of experts may help guide the management of male factor infertility in clinical practice. Studies are needed to address unanswered questions left by cases for whom no consensus was reached.
Collapse
|
19
|
Who cares about oligozoospermia when we have ICSI. Reprod Biomed Online 2021; 44:769-775. [DOI: 10.1016/j.rbmo.2021.11.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 11/19/2021] [Indexed: 12/26/2022]
|
20
|
Jaworek H, Koudelakova V, Oborna I, Zborilova B, Brezinova J, Ruzickova D, Vrbkova J, Kourilova P, Hajduch M. Impact of human papillomavirus infection on semen parameters and reproductive outcomes. Reprod Biol Endocrinol 2021; 19:156. [PMID: 34627284 PMCID: PMC8501609 DOI: 10.1186/s12958-021-00840-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 09/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV) has been shown to adversely affect human reproduction. We aimed to evaluate the prevalence of human papillomavirus (HPV) infection in men and its correlation with semen parameters and reproductive outcomes. METHODS Semen samples and penile swabs were collected from potential sperm donors (SD, n = 97) and male partners of infertile couples (IM, n = 328). The presence of HPV DNA in semen samples and penile swabs was analyzed. Associations between hrHPV positive status and fertility outcomes as well as socio-behavioral and health characteristics were evaluated using the R software package. RESULTS High-risk HPV (hrHPV) genotypes were detected in 28.9% of SD and 35.1% of IM (P = 0.312). Penile swabs were more frequently positive for hrHPV genotypes than semen samples in both IM (32.3% vs. 11.9%, P < 0.001) and SD (26.8% vs. 6.2%, P = 0.006). Men with hrHPV positive semen samples had lower semen volume (median volume 2.5 ml vs. 3 ml, P = 0.009), sperm concentration (median concentration 16 × 106/ml vs. 31 × 106/ml, P = 0.009) and total sperm count (median count 46 × 106 vs. 82 × 106, P = 0.009) than men with hrHPV negative samples. No association was identified between penile hrHPV status and semen parameters. CONCLUSIONS Our findings indicate that penile HPV infection is common in both potential sperm donors and men from infertile couples. Although HPV positivity is higher in penile swabs, only HPV infection in semen samples affects sperm parameters. However, there was no association between hrHPV positivity in semen and fertility outcomes including abortion rate.
Collapse
Affiliation(s)
- Hana Jaworek
- Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 1333/5, 779 00, Olomouc, Czech Republic
| | - Vladimira Koudelakova
- Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 1333/5, 779 00, Olomouc, Czech Republic.
| | - Ivana Oborna
- Fertimed Ltd., Boleslavova 2, 776 00, Olomouc, Czech Republic.
- SpermBank International, Katerinska 13, 779 00, Olomouc, Czech Republic.
| | | | - Jana Brezinova
- SpermBank International, Katerinska 13, 779 00, Olomouc, Czech Republic
| | - Dagmar Ruzickova
- Arleta IVF Ltd., Komenskeho 702, 517 41, Kostelec nad Orlici, Czech Republic
| | - Jana Vrbkova
- Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 1333/5, 779 00, Olomouc, Czech Republic
| | - Pavla Kourilova
- Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 1333/5, 779 00, Olomouc, Czech Republic
| | - Marian Hajduch
- Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 1333/5, 779 00, Olomouc, Czech Republic
| |
Collapse
|
21
|
Olivera C, Mosmann JP, Paira DA, Molina RI, Tissera AD, Motrich RD, Cuffini CG, Rivero VE. Association between Human Papillomavirus and Chlamydia trachomatis genital infections in male partners of infertile couples. Sci Rep 2021; 11:19924. [PMID: 34620929 PMCID: PMC8497555 DOI: 10.1038/s41598-021-99279-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 09/14/2021] [Indexed: 02/08/2023] Open
Abstract
The prevalence of HPV infection and its relationship with other sexually transmitted infections was analyzed in a cohort of 117 male partners of infertile couples from Cordoba, Argentina. Semen samples and urethral swabs were obtained and the infection with HPV, Chlamydia trachomatis, HSV1, HSV2, Mycoplasma hominis and Ureaplasma urealyticum was analyzed. A prevalence of HPV infection of 27.4% was found. Interestingly, infections by exclusively low risk HPV genotypes or high/intermediate risk HPV genotypes were present in 64.5% and 22.6% of cases, respectively. Low risk-HPV6 was the most frequently detected genotype. Remarkably, HPV and C. trachomatis infections were significantly associated to each other (OR: 11.55, 95% CI 1.14-117.06). No significant differences in sperm quality were found between HPV-positive and HPV-negative patients indicating that HPV male urogenital infection does not impair sperm quality. Our results show a high prevalence of HPV urogenital infection among male partners of infertile couples, and that HPV and C. trachomatis infections are reciprocal risk factors of their co-infection. Moreover, our results suggest that men constitute a reservoir for continued transmission of C. trachomatis and HPV to women highlighting the need for routine screening for these two pathogens in male partners of infertile couples.
Collapse
Affiliation(s)
- Carolina Olivera
- grid.10692.3c0000 0001 0115 2557Centro de Investigaciones en Bioquímica Clínica E Inmunología, CIBICI-CONICET, Facultad de Ciencias Químicas. Universidad Nacional de Córdoba. Haya de La Torre Y Medina Allende, Ciudad Universitaria, X5016HUA Córdoba, Argentina ,grid.10692.3c0000 0001 0115 2557Departamento de Bioquímica Clínica, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Jessica P. Mosmann
- grid.10692.3c0000 0001 0115 2557Instituto de Virología “Dr. José M. Vanella”, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina ,grid.423606.50000 0001 1945 2152Consejo Nacional de Investigaciones Científicas Y Técnicas (CONICET), Buenos Aires, Argentina
| | - Daniela A. Paira
- grid.10692.3c0000 0001 0115 2557Centro de Investigaciones en Bioquímica Clínica E Inmunología, CIBICI-CONICET, Facultad de Ciencias Químicas. Universidad Nacional de Córdoba. Haya de La Torre Y Medina Allende, Ciudad Universitaria, X5016HUA Córdoba, Argentina ,grid.10692.3c0000 0001 0115 2557Departamento de Bioquímica Clínica, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Rosa I. Molina
- Laboratorio de Andrología Y Reproducción, Córdoba, Argentina
| | | | - Rubén D. Motrich
- grid.10692.3c0000 0001 0115 2557Centro de Investigaciones en Bioquímica Clínica E Inmunología, CIBICI-CONICET, Facultad de Ciencias Químicas. Universidad Nacional de Córdoba. Haya de La Torre Y Medina Allende, Ciudad Universitaria, X5016HUA Córdoba, Argentina ,grid.10692.3c0000 0001 0115 2557Departamento de Bioquímica Clínica, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Cecilia G. Cuffini
- grid.10692.3c0000 0001 0115 2557Instituto de Virología “Dr. José M. Vanella”, Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Córdoba, Argentina ,grid.423606.50000 0001 1945 2152Consejo Nacional de Investigaciones Científicas Y Técnicas (CONICET), Buenos Aires, Argentina
| | - Virginia E. Rivero
- grid.10692.3c0000 0001 0115 2557Centro de Investigaciones en Bioquímica Clínica E Inmunología, CIBICI-CONICET, Facultad de Ciencias Químicas. Universidad Nacional de Córdoba. Haya de La Torre Y Medina Allende, Ciudad Universitaria, X5016HUA Córdoba, Argentina ,grid.10692.3c0000 0001 0115 2557Departamento de Bioquímica Clínica, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| |
Collapse
|
22
|
Chen T, Belladelli F, Del Giudice F, Eisenberg ML. Male fertility as a marker for health. Reprod Biomed Online 2021; 44:131-144. [PMID: 34848151 DOI: 10.1016/j.rbmo.2021.09.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/21/2021] [Accepted: 09/23/2021] [Indexed: 01/05/2023]
Abstract
Male reproduction is a complex biological process, and male factor infertility is increasingly recognized as a biomarker for overall male health. Emerging data suggest associations between male reproduction and medical disease (genetic, infectious, chronic comorbid conditions), psychological disease, environmental exposures, dietary habits, medications and substances of abuse, and even socioeconomic factors. There is also evidence that a diagnosis of male fertility is associated with future disease risk including cancer, metabolic disease and mortality. As such, there is a growing view that the male fertility evaluation is an opportunity to improve a man's health beyond his immediate reproductive goals, and also highlights the necessity of a multidisciplinary approach.
Collapse
Affiliation(s)
- Tony Chen
- Center for Academic Medicine, Stanford University School of Medicine, Palo Alto CA, USA.
| | | | | | - Michael L Eisenberg
- Center for Academic Medicine, Stanford University School of Medicine, Palo Alto CA, USA
| |
Collapse
|
23
|
Ombelet W, van Eekelen R, McNally A, Ledger W, Doody K, Farquhar C. Should couples with unexplained infertility have three to six cycles of intrauterine insemination with ovarian stimulation or in vitro fertilization as first-line treatment? Fertil Steril 2021; 114:1141-1148. [PMID: 33280720 DOI: 10.1016/j.fertnstert.2020.10.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 01/03/2023]
Affiliation(s)
- Willem Ombelet
- Genk Institute for Fertility Technology, Department of Obstetrics and Gynaecology, Genk, Belgium; Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Rik van Eekelen
- Centre for Reproductive Medicine, Amsterdam UMC, Academic Medical Center, Amsterdam, the Netherlands
| | - Aine McNally
- Department of Clinical Reproductive Endocrinology and Infertility, St. George Hospital, Kogarah, Sydney, Australia
| | - William Ledger
- Department of Obstetrics and Gynecology and Reproductive Medicine, University of New South Wales, Royal Hospital for Women, Randwick, Sydney, Australia
| | - Kevin Doody
- Center for Assisted Reproduction, Bedford, Texas
| | - Cynthia Farquhar
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand; Fertility Plus, Auckland District Health Board, Auckland, New Zealand.
| |
Collapse
|
24
|
Tuominen H, Rautava J, Kero K, Syrjänen S, Collado MC, Rautava S. HPV infection and bacterial microbiota in the semen from healthy men. BMC Infect Dis 2021; 21:373. [PMID: 33882835 PMCID: PMC8059035 DOI: 10.1186/s12879-021-06029-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 03/31/2021] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Aberrant microbiota composition has been linked to disease development at numerous anatomical sites. Microbiota changes in reaction to viral infections, such as human papillomavirus (HPV), have been investigated almost exclusively in the female reproductive tract. However, HPV infection may also affect male health by reducing semen quality and fertility. The aim of this study was to investigate whether present HPV DNA is associated with detectable changes in semen bacterial microbiota composition and diversity. METHODS This study relied on stored semen samples from 31 fertile healthy men who participated in the Finnish family HPV Study during the years 1998-2001. DNA was extracted from semen with PCR template preparation kit. HPV was genotyped using Luminex-based Multimetrix® assay. Microbiota was analyzed from the V3-V4 region of 16S rDNA gene following sequencing on an Illumina MiSeq platform. All statistical analyses were performed with Calypso software version 8.84. RESULTS HPV DNA was detected in 19.4% (6/31) of the semen samples. HPV status in the semen did not impact the α-diversity estimations, as measured by Chao1 and Shannon indices, nor ß-diversity. Nevertheless, HPV-positive semen samples exhibited differences in the taxonomic composition of the bacterial microbiota including higher abundances of Moraxellaceae (p = 0.028), Streptococcus (p = 0.0058) and Peptostreptococcus (p = 0.012) compared to HPV-negative semen samples. CONCLUSION HPV infection is associated with altered bacterial microbiota composition in semen, and this might have in impact to male health in general. As of present, it is unclear whether these changes result from HPV infection or whether altered bacterial microbiota increases susceptibility to HPV infection. More research is needed on viral-bacterial interactions in the male reproductive system.
Collapse
Affiliation(s)
- Heidi Tuominen
- Department of Oral Pathology and Oral Radiology, Institute of Dentistry, Faculty of Medicine, University of Turku, Lemminkäisenkatu 2, FIN-20520, Turku, Finland.
| | - Jaana Rautava
- Department of Oral Pathology and Oral Radiology, Institute of Dentistry, Faculty of Medicine, University of Turku, Lemminkäisenkatu 2, FIN-20520, Turku, Finland
- Department of Oral and Maxillofacial Diseases, Clinicum, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Pathology, Medicum, Faculty of Medicine, University of Helsinki and HUS Diagnostic Center, HUSLAB, Helsinki University Hospital, Helsinki, Finland
| | - Katja Kero
- Department of Obstetrics and Gynaecology, University of Turku & Turku University Hospital, Turku, Finland
| | - Stina Syrjänen
- Department of Oral Pathology and Oral Radiology, Institute of Dentistry, Faculty of Medicine, University of Turku, Lemminkäisenkatu 2, FIN-20520, Turku, Finland
- Department of Pathology, Turku University Hospital, Turku, Finland
| | - Maria Carmen Collado
- Department of Biotechnology, Institute of Agrochemistry and Food Science, Spanish National Research Council (IATA-CSIC), Valencia, Spain
| | - Samuli Rautava
- Department of Paediatrics, University of Turku & Turku University Hospital, Turku, Finland
- Department of Pediatrics, University of Helsinki & Helsinki University Hospital, Helsinki, Finland
| |
Collapse
|
25
|
Muscianisi F, De Toni L, Giorato G, Carosso A, Foresta C, Garolla A. Is HPV the Novel Target in Male Idiopathic Infertility? A Systematic Review of the Literature. Front Endocrinol (Lausanne) 2021; 12:643539. [PMID: 33763033 PMCID: PMC7982954 DOI: 10.3389/fendo.2021.643539] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 01/28/2021] [Indexed: 12/14/2022] Open
Abstract
Infertility is an important health problem that affects up to 16% of couples worldwide. Male infertility is responsible for about 50% of the cases, and the various causes of male infertility may be classified in pre-testicular (for example hypothalamic diseases), testicular, and post-testicular (for example obstructive pathologies of seminal ducts) causes. Sexually transmitted infections (STI) are increasingly widely accepted by researchers and clinicians as etiological factors of male infertility. In particular, several recent reports have documented the presence of HPV in seminal fluid and observed that sperm infection can also be present in sexually active asymptomatic male and infertile patients. In this review, we aimed to perform a systematic review of the whole body of literature exploring the impact of HPV infection in natural and assisted fertility outcomes, from both an experimental and a clinical point of view. Starting from in-vitro studies in animals up to in-vivo studies in humans, we aimed to study and evaluate the weight of this infection as a possible cause of idiopathic infertility in males with any known cause of conception failure.
Collapse
Affiliation(s)
- Francesco Muscianisi
- Unit of Andrology and Reproductive Medicine, Section of Endocrinology, Department of Medicine, Centre for Male Gamete Cryopreservation, University of Padova, Padova, Italy
| | - Luca De Toni
- Unit of Andrology and Reproductive Medicine, Section of Endocrinology, Department of Medicine, Centre for Male Gamete Cryopreservation, University of Padova, Padova, Italy
| | - Gloria Giorato
- Unit of Andrology and Reproductive Medicine, Section of Endocrinology, Department of Medicine, Centre for Male Gamete Cryopreservation, University of Padova, Padova, Italy
| | - Andrea Carosso
- Unit of Gynecology and Obstetrics, Section of Physiopathology of Reproduction and IVF, Department of Surgical Sciences, S. Anna Hospital, University of Torino, Torino, Italy
| | - Carlo Foresta
- Unit of Andrology and Reproductive Medicine, Section of Endocrinology, Department of Medicine, Centre for Male Gamete Cryopreservation, University of Padova, Padova, Italy
| | - Andrea Garolla
- Unit of Andrology and Reproductive Medicine, Section of Endocrinology, Department of Medicine, Centre for Male Gamete Cryopreservation, University of Padova, Padova, Italy
| |
Collapse
|
26
|
Weinberg M, Sar-Shalom Nahshon C, Feferkorn I, Bornstein J. Evaluation of human papilloma virus in semen as a risk factor for low sperm quality and poor in vitro fertilization outcomes: a systematic review and meta-analysis. Fertil Steril 2021; 113:955-969.e4. [PMID: 32386620 DOI: 10.1016/j.fertnstert.2020.01.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 12/19/2019] [Accepted: 01/02/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To analyze the effect of human papilloma virus (HPV) sperm infection on sperm parameters and in vitro fertilization (IVF) outcomes. DESIGN Systematic review and meta-analysis. SETTING Not applicable. PATIENTS Men with HPV sperm infection and couples undergoing IVF. INTERVENTIONS Searches were conducted in the following databases: Medline(R), PubMed, Embase, Web of Science, Scopos, and the Cochrane Library. We included studies examining sperm parameters and IVF results in patients with and without HPV sperm infection. MAIN OUTCOME MEASURES Sperm analysis (concertation, count, volume, motility, morphology), according to the World Health Organization manual, pregnancy rate (PR), and miscarriage rate (MR). RESULTS Sixteen studies were included in this meta-analysis. The presence of HPV had a significant association with impaired sperm parameters in terms of concentration (mean difference [MD] -4.48, 95% confidence interval [CI] - 6.12 to -2.83), motility (MD -11.71, 95% CI - 16.15 to -7.26), and morphology (MD -2.44, 95% CI - 4.08 to -0.79. A review of the literature regarding ART outcomes showed an association between HPV infection and decreased PR, and an even stronger association between HPV infection and increased MR. CONCLUSION Our meta-analysis shows a negative effect of HPV on sperm concentration, motility, and morphology. Further subgroup and categorical analysis confirmed the clinical significance of impaired sperm motility in HPV-infected sperm, although the sperm count and morphology must be carefully analyzed. The studies reviewed reported lower PR and increased MR in couples with HPV-infected sperm. As most studies had a moderate risk of bias, these observations warrant further large, well-designed studies before introducing clinical management recommendations. PROSPERO REGISTRATION NUMBER CRD42019127419.
Collapse
Affiliation(s)
- May Weinberg
- Department of Obstetrics and Gynecology, Galilee Medical Center, Faculty of Medicine, Bar Ilan University, Nahariya, Israel
| | - Chen Sar-Shalom Nahshon
- Division of Reproductive Endocrinology - IVF, Department of Obstetrics and Gynecology, Carmel Medical Center, Bruce & Ruth Rappaport Faculty of Medicine, Haifa, Israel.
| | - Ido Feferkorn
- Division of Reproductive Endocrinology - IVF, Department of Obstetrics and Gynecology, Carmel Medical Center, Bruce & Ruth Rappaport Faculty of Medicine, Haifa, Israel
| | - Jacob Bornstein
- Department of Obstetrics and Gynecology, Galilee Medical Center, Faculty of Medicine, Bar Ilan University, Nahariya, Israel
| |
Collapse
|
27
|
Depuydt C, Donders G, Verstraete L, Beert J, Salembier G, Bosmans E, Dhont N, Kerkhofs C, Ombelet W. Negative Impact of Elevated DNA Fragmentation and Human Papillomavirus (HPV) Presence in Sperm on the Outcome of Intra-Uterine Insemination (IUI). J Clin Med 2021; 10:jcm10040717. [PMID: 33670283 PMCID: PMC7917808 DOI: 10.3390/jcm10040717] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/02/2021] [Accepted: 02/08/2021] [Indexed: 01/04/2023] Open
Abstract
We wanted to determine the sperm DNA fragmentation index (DFI) cutoff for clinical pregnancies in women receiving intra-uterine insemination (IUI) with this sperm and to assess the contribution of Human Papillomavirus (HPV) infection on sperm DNA damage and its impact on clinical pregnancies. Prospective non-interventional multi-center study with 161 infertile couples going through 209 cycles of IUI in hospital fertility centers in Flanders, Belgium. Measurement of DFI and HPV DNA with type specific quantitative PCRs (HPV 6, 11, 16, 18, 31, 33, 35, 39, 45, 51, 52, 53, 56, 58, 59, 66 and 68) in sperm before its use in IUI. Clinical pregnancy (CP) rate was used as the outcome to analyze the impact on fertility outcome and to calculated the clinical cutoff value for DFI. A DFI criterion value of 26% was obtained by receiver operating characteristic (ROC) curve analysis. Couples with a male DFI > 26% had significantly less CPs than couples with DFI below 26% (OR 0.0326; 95% CI 0.0019 to 0.5400; p = 0.017). In sperm, HPV prevalence was 14.8%/IUI cycle. Sperm samples containing HPV had a significantly higher DFI compared to HPV negative sperm samples (29.8% vs. 20.9%; p = 0.011). When HPV-virions were present in sperm, no clinical pregnancies were observed. More than 1 in 5 of samples with normal semen parameters (17/78; 21.8%) had an elevated DFI or was HPV positive. Sperm DFI is a robust predictor of clinical pregnancies in women receiving IUI with this sperm. When DFI exceeds 26%, clinical pregnancies are less likely and in vitro fertilization techniques should be considered.
Collapse
Affiliation(s)
- Christophe Depuydt
- Department of Hormonology and Reproductive Health, AML, Sonic Healthcare, 2020 Antwerp, Belgium; (C.D.); (L.V.); (J.B.); (E.B.)
- Intermediate Structure for Human Body Material, AML, Sonic Healthcare, 2020 Antwerp, Belgium
| | - Gilbert Donders
- Femicare, Clinical Research for Women, 3300 Tienen, Belgium
- University Hospital Antwerpen, 2650 Antwerp, Belgium
- Department of Obstetrics and Gynecology, Regional Hospital Heilig Hart, 3300 Tienen, Belgium
- Correspondence: or ; Tel.: +32-16-808102
| | - Ludo Verstraete
- Department of Hormonology and Reproductive Health, AML, Sonic Healthcare, 2020 Antwerp, Belgium; (C.D.); (L.V.); (J.B.); (E.B.)
- Intermediate Structure for Human Body Material, AML, Sonic Healthcare, 2020 Antwerp, Belgium
| | - Johan Beert
- Department of Hormonology and Reproductive Health, AML, Sonic Healthcare, 2020 Antwerp, Belgium; (C.D.); (L.V.); (J.B.); (E.B.)
- Intermediate Structure for Human Body Material, AML, Sonic Healthcare, 2020 Antwerp, Belgium
- Department of Clinical and Molecular Pathology, AML, Sonic Healthcare, 2020 Antwerp, Belgium;
| | - Geert Salembier
- Department of Clinical and Molecular Pathology, AML, Sonic Healthcare, 2020 Antwerp, Belgium;
| | - Eugene Bosmans
- Department of Hormonology and Reproductive Health, AML, Sonic Healthcare, 2020 Antwerp, Belgium; (C.D.); (L.V.); (J.B.); (E.B.)
- Intermediate Structure for Human Body Material, AML, Sonic Healthcare, 2020 Antwerp, Belgium
| | - Nathalie Dhont
- Genk Institute for Fertility Technology, ZOL Hospitals, 3600 Genk, Belgium; (N.D.); (C.K.); (W.O.)
| | - Carmen Kerkhofs
- Genk Institute for Fertility Technology, ZOL Hospitals, 3600 Genk, Belgium; (N.D.); (C.K.); (W.O.)
| | - Willem Ombelet
- Genk Institute for Fertility Technology, ZOL Hospitals, 3600 Genk, Belgium; (N.D.); (C.K.); (W.O.)
- Faculty of Medicine and Life Sciences, Hasselt University, 3500 Hasselt, Belgium
| |
Collapse
|
28
|
Sharma A, Minhas S, Dhillo WS, Jayasena CN. Male infertility due to testicular disorders. J Clin Endocrinol Metab 2021; 106:e442-e459. [PMID: 33295608 PMCID: PMC7823320 DOI: 10.1210/clinem/dgaa781] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Indexed: 12/13/2022]
Abstract
CONTEXT Male infertility is defined as the inability to conceive following 1 year of regular unprotected intercourse. It is the causative factor in 50% of couples and a leading indication for assisted reproductive techniques (ART). Testicular failure is the most common cause of male infertility, yet the least studied to date. EVIDENCE ACQUISITION The review is an evidence-based summary of male infertility due to testicular failure with a focus on etiology, clinical assessment, and current management approaches. PubMed-searched articles and relevant clinical guidelines were reviewed in detail. EVIDENCE SYNTHESIS/RESULTS Spermatogenesis is under multiple levels of regulation and novel molecular diagnostic tests of sperm function (reactive oxidative species and DNA fragmentation) have since been developed, and albeit currently remain as research tools. Several genetic, environmental, and lifestyle factors provoking testicular failure have been elucidated during the last decade; nevertheless, 40% of cases are idiopathic, with novel monogenic genes linked in the etiopathogenesis. Microsurgical testicular sperm extraction (micro-TESE) and hormonal stimulation with gonadotropins, selective estrogen receptor modulators, and aromatase inhibitors are recently developed therapeutic approaches for men with the most severe form of testicular failure, nonobstructive azoospermia. However, high-quality clinical trials data is currently lacking. CONCLUSIONS Male infertility due to testicular failure has traditionally been viewed as unmodifiable. In the absence of effective pharmacological therapies, delivery of lifestyle advice is a potentially important treatment option. Future research efforts are needed to determine unidentified factors causative in "idiopathic" male infertility and long-term follow-up studies of babies conceived through ART.
Collapse
Affiliation(s)
- Aditi Sharma
- Section of Endocrinology and Investigative Medicine, Imperial College London, UK
| | - Suks Minhas
- Department of Urology, Charing Cross Hospital, London, UK
| | - Waljit S Dhillo
- Section of Endocrinology and Investigative Medicine, Imperial College London, UK
| | - Channa N Jayasena
- Section of Endocrinology and Investigative Medicine, Imperial College London, UK
| |
Collapse
|
29
|
Garolla A, Pizzol D, Carosso AR, Borini A, Ubaldi FM, Calogero AE, Ferlin A, Lanzone A, Tomei F, Engl B, Rienzi L, De Santis L, Coticchio G, Smith L, Cannarella R, Anastasi A, Menegazzo M, Stuppia L, Corsini C, Foresta C. Practical Clinical and Diagnostic Pathway for the Investigation of the Infertile Couple. Front Endocrinol (Lausanne) 2021; 11:591837. [PMID: 33542705 PMCID: PMC7851076 DOI: 10.3389/fendo.2020.591837] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 11/25/2020] [Indexed: 01/23/2023] Open
Abstract
Capsule This expert opinion summarizes current knowledge on risk factors for infertility and identifies a practical clinical and diagnostic approach for the male and female partners of an infertile couple aimed to improve the investigation and management of fertility problems. Background Infertility represents an important and growing health problem affecting up to 16% of couples worldwide. In most cases, male, female, or combined factor can be identified, and different causes or risk factors have been related to this condition. However, there are no standardized guidelines on the clinical-diagnostic approach of infertile couples and the recommendations concerning infertility are sometimes lacking, incomplete, or problematic to apply. Objective The aim of this work is to provide an appropriate clinical and diagnostic pathway for infertile couples designed by a multidisciplinary-team of experts. The rationale is based on the history and physical examination and then oriented on the basis of initial investigations. This approach could be applied in order to reduce variation in practice and to improve the investigation and management of fertility problems. Methods Prominent Italian experts of the main specialties committed in the ART procedures, including gynecologists, andrologists, embryologists, biologists, geneticists, oncologists, and microbiologists, called "InfertilItaly group", used available evidence to develop this expert position. Outcomes Starting from the individuation of the principal risk factors that may influence the fertility of females and males and both genders, the work group identified most appropriate procedures using a gradual approach to both partners aimed to obtain a precise diagnosis and the most effective therapeutic option, reducing invasive and occasionally redundant procedures. Conclusions This expert position provides current knowledge on risk factors and suggests a diagnostic workflow of infertile couples. By using this step-by-step approach, health care workers involved in ART, may individuate a practical clinical management of infertile couples shared by experts.
Collapse
Affiliation(s)
- Andrea Garolla
- Section of Andrology and Reproductive Medicine & Centre for Male Gamete Cryopreservation, Department of Medicine, University of Padova, Padova, Italy
| | - Damiano Pizzol
- Section of Andrology and Reproductive Medicine & Centre for Male Gamete Cryopreservation, Department of Medicine, University of Padova, Padova, Italy
- Italian Agency for Development Cooperation, Public Health, Jerusalem, Israel
| | - Andrea Roberto Carosso
- Department of Surgical Sciences, Gynecology and Obstetrics 1, Physiopathology of Reproduction and IVF Unit, S. Anna Hospital, University of Torino, Torino, Italy
| | - Andrea Borini
- 9.baby, Family and Fertility Center, Tecnobios Procreazione, Bologna, Italy
| | | | - Aldo Eugenio Calogero
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Alberto Ferlin
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Antonio Lanzone
- Department of Woman’s Health Sciences of the Child and Public Health, Unit of Obstetrics Pathology, University Clinic Foundation “A Gemelli” IRCCS, Rome, Italy
- Clinic of Obstetrics and Gynecology, Catholic University Sacro Cuore, Rome, Italy
| | - Francesco Tomei
- Assisted Reproductive Unit, Santa Maria degli Angeli Hospital, Pordenone, Italy
| | - Bruno Engl
- Donna Salus, Center for Women’s Health and Fertility, Bolzano, Italy
| | - Laura Rienzi
- GENERA Centre for Reproductive Medicine, Clinica Valle Giulia, Rome, Italy
| | - Lucia De Santis
- IVF Unit, Gynaecological-Obstetric Department, IRCCS San Raffaele Hospital, Vita-Salute University, Milan, Italy
- Italian Society of Embryology, Reproduction and Research (SIERR), Giarre, Italy
| | - Giovanni Coticchio
- 9.baby, Family and Fertility Center, Tecnobios Procreazione, Bologna, Italy
| | - Lee Smith
- The Cambridge Centre for Sport & Exercise Sciences, Anglia Ruskin University, Cambridge, United Kingdom
| | - Rossella Cannarella
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Attilio Anastasi
- Center for Physiopathology of Human Reproduction, Delta Hospital, Lagosanto, Italy
| | - Massimo Menegazzo
- Section of Andrology and Reproductive Medicine & Centre for Male Gamete Cryopreservation, Department of Medicine, University of Padova, Padova, Italy
| | - Liborio Stuppia
- Department of Psychological, Health and Territorial Sciences, School of Medicine and Health Sciences, “G. d’Annunzio” University, Chieti, Italy
- Center for Advanced Studies and Technology (CAST), “G. d’Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - Christian Corsini
- Section of Andrology and Reproductive Medicine & Centre for Male Gamete Cryopreservation, Department of Medicine, University of Padova, Padova, Italy
| | - Carlo Foresta
- Section of Andrology and Reproductive Medicine & Centre for Male Gamete Cryopreservation, Department of Medicine, University of Padova, Padova, Italy
| |
Collapse
|
30
|
Moreno-Sepulveda J, Rajmil O. Seminal human papillomavirus infection and reproduction: a systematic review and meta-analysis. Andrology 2020; 9:478-502. [PMID: 33220146 DOI: 10.1111/andr.12948] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 11/17/2020] [Accepted: 11/18/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND The impact of human papillomavirus (HPV) on male fertility and associated reproductive outcomes has not been clarified. OBJECTIVES To elucidate the prevalence of seminal HPV infection and assess the associated effects on seminal parameters, male infertility, and reproductive outcomes. MATERIALS AND METHODS A systematic review and meta-analysis was performed in accordance with PRISMA guidelines. A search was performed using PubMed, MEDLINE, SCOPUS, and Cochrane databases. Studies published until November 2019 were included. HPV prevalence, risk of infertility, seminal parameters, and reproductive outcomes were evaluated among the general population and infertile men. RESULTS Fifty studies met the inclusion criteria. The prevalence of seminal HPV infection is significantly higher in infertile compared to the general population (20.9% versus 8.2%). A significant association between seminal HPV infection and male infertility (OR 3.30, 95% CI 1.87-5.84), even when adjusting for female infertility (OR 3.02, 95% CI = 2.11-4.33) was founded. In addition, HPV infection is related to a significant decrease in progressive motility (DM -10.35, IC -13.75, -6.96), a low sperm morphology score (DM -2.46, 95% CI -3.83, -1.08), and a significant increase in the sperm DNA fragmentation index (7.24, 95% CI 4.44.10.03) compared with HPV-negative patients. It was also observed an increased risk of miscarriage (OR 5.13, 95% CI 2.40,10.94), and a reduced chance of ongoing pregnancy (OR 0.33, IC 95% 0.13,0,82) in patients undergoing ART with seminal HPV infection. DISCUSSION Infertile men have a higher prevalence of seminal HPV infection compared to the general population, regardless of the HPV genotype detected. CONCLUSIONS HPV in semen may have an impact in sperm quality and reproductive outcomes. Additional well-designed studies are warranted to improve the quality of evidence.
Collapse
Affiliation(s)
- Jose Moreno-Sepulveda
- Obstetrics and Gynecology Department, Universitat Autònoma de Barcelona, Barcelona, Spain.,Clínica de la Mujer Medicina Reproductiva, Viña del Mar, Chile
| | - Osvaldo Rajmil
- ndrology Department, Fundació Puigvert, Barcelona, Spain.,Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona, Barcelona, Spain
| |
Collapse
|
31
|
De Toni L, Cosci I, Carosso A, Barzon L, Engl B, Foresta C, Garolla A. Hyaluronidase-based swim-up for semen selection in patients with human papillomavirus semen infection. Biol Reprod 2020; 104:211-222. [PMID: 33164043 DOI: 10.1093/biolre/ioaa173] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/14/2020] [Accepted: 09/18/2020] [Indexed: 12/16/2022] Open
Abstract
Infection by human papillomavirus (HPV) represents one of the most common sexually transmitted diseases in both men and women worldwide. Recently, the detection of HPV virions in the semen of a large percentage of sexually active men has been associated with detrimental effects on both sperm parameters and on assisted reproductive technologies (ART) treatment outcomes. Conventional semen washing procedure used in ART have proved to be ineffective in removing HPV bound to sperm, requiring the identification of more effective and specific methods. In the present study, we assessed the possible use of hyaluronidase for the detachment of HPV from sperm cell surface. Semen samples from five normozoospermic control subjects (CTRL) were incubated with HPV virus-like particles (HPV-VLP) and treated with hyaluronidase by both a modified swim-up procedure (M-SU) and single-cell approach (SCA). The treatment with hyaluronidase was associated with the complete loss of HPV-VLP signal on sperms by both M-SU and SCA. In addition, semen samples from 12 HPV-positive infertile patients were treated with hyaluronidase 80 IU/mL by M-SU, resulting in the complete loss of HPV-DNA signal from sperm surface. Finally, the possible impact of hyaluronidase treatment on sperm parameters was assessed on both sperms from the five CTRL subjects and on further five oligo-astheno-terato-zoospermic (OAT) patients, both HPV negative. The treatment with hyaluronidase was equally associated with a slight reduction of sperm viability and progressive motility in both CTRL and OAT. In conclusion, the treatment with hyaluronidase removed efficiently and safely HPV virions bound to spermatozoa.
Collapse
Affiliation(s)
- Luca De Toni
- Department of Medicine, Unit of Andrology and Reproductive Medicine, University of Padova, Padova, Italy
| | - Ilaria Cosci
- Department of Medicine, Unit of Andrology and Reproductive Medicine, University of Padova, Padova, Italy
| | - Andrea Carosso
- Department of Surgical Sciences, Unit of Gynecology and Obstetrics, Section of Physiopathology of Reproduction and IVF, S. Anna Hospital, University of Torino, Torino, Italy
| | - Luisa Barzon
- Department of Molecular Medicine, University of Padova, Padova, Italy
| | - Bruno Engl
- Physiopathology of Reproduction Unit, Section of Women's Health and Fertility, Donna Salus Center, Bolzano, Italy
| | - Carlo Foresta
- Department of Medicine, Unit of Andrology and Reproductive Medicine, University of Padova, Padova, Italy
| | - Andrea Garolla
- Department of Medicine, Unit of Andrology and Reproductive Medicine, University of Padova, Padova, Italy
| |
Collapse
|
32
|
Hsu LC, Tsui KH, Wei JCC, Yip HT, Hung YM, Chang R. Female Human Papillomavirus Infection Associated with Increased Risk of Infertility: A Nationwide Population-Based Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186505. [PMID: 32906724 PMCID: PMC7558487 DOI: 10.3390/ijerph17186505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/28/2020] [Accepted: 09/02/2020] [Indexed: 01/23/2023]
Abstract
Objective. This study investigated whether women with a history of human papillomavirus (HPV) infection have an increased risk of infertility. Material and Methods. All patients with an HPV infection (n = 11,198) in Taiwan’s National Health Insurance Research Database (2000–2012) were propensity score matched with control subjects (n = 11,198) without an HPV infection by age, sex, index year, and relevant co-morbidities. Both groups were tracked until a diagnosis of infertility was recorded. The Chi-square test was used to analyze the distribution of demographic characteristics in the HPV group and non-HPV group. A Cox proportional hazards regression was used to estimate the hazard ratios (HRs) for the development of infertility, adjusting for age, sex, and co-morbidities. The Kaplan–Meier method was used to plot the cumulative incidence curves. We also performed negative controls to test for possible unmeasured confounding. Results. The HPV cohort had a higher risk of infertility. The adjusted HR (aHR) was found to be 1.39 (95% CI = 1.19–1.63) after adjusting for demographic characteristics and relevant co-morbidities. In the age subgroup analysis, patients with an HPV infection had an increased risk of infertility compared to the non-HPV cohort in the group aged 26 to 35 years (aHR, 1.53; 95% CI = 1.24–1.88). As we used propensity score matching to treat measurable confounders and negative controls to access unmeasured confounders, the findings of the study are robust. Conclusions. Among females of reproductive age, HPV infection is a potential risk factor that predisposes individuals to subsequent infertility.
Collapse
Affiliation(s)
- Li-Chuan Hsu
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital Pingtung Branch, Pingtung 91245, Taiwan;
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan;
| | - Kuan-Hao Tsui
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan;
- Department of Pharmacy and Master Program, College of Pharmacy and Health Care, Tajen University, Pingtung 90741, Taiwan
| | - James Cheng-Chung Wei
- Division of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Taichung 40201, Taiwan;
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
- Graduate Institute of Integrated Medicine, China Medical University, Taichung 40402, Taiwan
| | - Hei-Tung Yip
- Management Office for Health Data, China Medical University Hospital, Taichung 404332, Taiwan;
| | - Yao-Min Hung
- Department of Internal Medicine, Kaohsiung Municipal United Hospital, Kaohsiung 80457, Taiwan
- Department of Medicine, School of Medicine, National Yang Ming University, Taipei 11221, Taiwan
- Department of Senior Citizen Service Management, Yuh-Ing Junior College of Health Care and Management, Kaohsiung 80776, Taiwan
- Correspondence: (Y.-M.H.); (R.C.)
| | - Renin Chang
- Department of Emergency Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan
- Department of Recreation Sports Management, Tajen University, Pingtung 90741, Taiwan
- Correspondence: (Y.-M.H.); (R.C.)
| |
Collapse
|
33
|
Danhof NA, Wang R, van Wely M, van der Veen F, Mol BWJ, Mochtar MH. IUI for unexplained infertility-a network meta-analysis. Hum Reprod Update 2020; 26:1-15. [PMID: 31803930 DOI: 10.1093/humupd/dmz035] [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: 04/01/2018] [Revised: 08/29/2019] [Accepted: 09/06/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND IUI for unexplained infertility can be performed in a natural cycle or in combination with ovarian stimulation. A disadvantage of ovarian stimulation is an increased risk of multiple pregnancies with its inherent maternal and neonatal complication risks. Stimulation agents for ovarian stimulation are clomiphene citrate (CC), Letrozole or gonadotrophins. Although studies have compared two or three of these drugs to each other in IUI, they have never been compared to one another in one analysis. OBJECTIVE AND RATIONALE The objective of this network meta-analysis was to compare the effectiveness and safety of IUI with CC, Letrozole or gonadotrophins with each other and with natural cycle IUI. SEARCH METHODS We searched PubMed, MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, CENTRAL and the Clinical Trial Registration Database indexed up to 16 August 2018. We included randomized controlled trials that compared a stimulation regimen with CC, Letrozole or gonadotrophins to each other or to natural cycle IUI among couples with unexplained infertility. We performed the network meta-analysis within a multivariate random effects model. OUTCOMES We identified 26 studies reporting on 5316 women. The relative risk (RR) for live birth/ongoing pregnancy rates comparing IUI with CC to natural cycle IUI was 1.05 (95% CI 0.63-1.77, low quality of evidence), while comparing IUI with Letrozole to natural cycle IUI was 1.15 (95% CI 0.63-2.08, low quality of evidence) and comparing IUI with gonadotrophins to natural cycle IUI was 1.46 (95% CI 0.92-2.30, low quality of evidence). The RR for live birth/ongoing pregnancy rates comparing gonadotrophins to CC was 1.39 (95% CI 1.09-1.76, moderate quality of evidence), comparing Letrozole to CC was 1.09 (95% CI 0.76-1.57, moderate quality of evidence) and comparing Letrozole to gonadotrophins was 0.79 (95% CI 0.54-1.15, moderate quality of evidence). We did not perform network meta-analysis on multiple pregnancy due to high inconsistency. Pairwise meta-analyses showed an RR for multiple pregnancy rates of 9.11(95% CI 1.18-70.32) comparing IUI with gonadotrophins to natural cycle IUI. There was no data available on multiple pregnancy rates following IUI with CC or Letrozole compared to natural cycle IUI. The RR for multiple pregnancy rates comparing gonadotrophins to CC was 1.42 (95% CI 0.68-2.97), comparing Letrozole to CC was 0.97 (95% CI 0.47-2.01) and comparing Letrozole to gonadotrophins was 0.29 (95% CI 0.14-0.58).In a meta-analysis among studies with adherence to strict cancellation criteria, the RR for live births/ongoing pregnancy rates comparing gonadotrophins to CC was 1.20 (95% CI 0.95-1.51) and the RR for multiple pregnancy rates comparing gonadotropins to CC was 0.80 (95% CI 0.38-1.68). WIDER IMPLICATIONS Based on low to moderate quality of evidence in this network meta-analysis, IUI with gonadotrophins ranked highest on live birth/ongoing pregnancy rates, but women undergoing this treatment protocol were also at risk for multiple pregnancies with high complication rates. IUI regimens with adherence to strict cancellation criteria led to an acceptable multiple pregnancy rate without compromising the effectiveness. Within a protocol with adherence to strict cancellation criteria, gonadotrophins seem to improve live birth/ongoing pregnancy rates compared to CC. We, therefore, suggest performing IUI with ovarian stimulation using gonadotrophins within a protocol that includes strict cancellation criteria. Obviously, this ignores the impact of costs and patients preference.
Collapse
Affiliation(s)
- N A Danhof
- Center for Reproductive Medicine, AMC, Amsterdam, The Netherlands
| | - R Wang
- Department of Obstetrics and Gynaecology, Monash University
| | - M van Wely
- Obstetrics and Gynaecology, AMC, Amsterdam, The Netherlands
| | | | | | - M H Mochtar
- Obstetrics and Gynaecology, AMC, Amsterdam, The Netherlands
| |
Collapse
|
34
|
Caution in the use of standard sperm-washing procedures for assisted reproduction in HPV-infected patients. Reprod Biomed Online 2020; 41:967-968. [PMID: 32888825 DOI: 10.1016/j.rbmo.2020.08.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 07/16/2020] [Accepted: 08/13/2020] [Indexed: 12/26/2022]
|
35
|
Fenizia C, Savasi V. Sperm washing - yes or no? An open issue still to be debated. Reprod Biomed Online 2020; 41:969. [PMID: 32891519 PMCID: PMC7441950 DOI: 10.1016/j.rbmo.2020.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/06/2020] [Accepted: 08/13/2020] [Indexed: 11/16/2022]
|
36
|
Kim DJ, Park JC. Influence of Human PapillomaVirus Infection Detected by Cervical Swap on In-vitro Fertilization Outcomes. ACTA ACUST UNITED AC 2020. [DOI: 10.46308/kmj.2020.00066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
37
|
Human papillomavirus in spermatozoa is efficiently removed by washing: a suitable approach for assisted reproduction. Reprod Biomed Online 2020; 40:693-699. [DOI: 10.1016/j.rbmo.2020.01.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 01/15/2020] [Accepted: 01/29/2020] [Indexed: 12/23/2022]
|
38
|
Kasman AM, Del Giudice F, Eisenberg ML. New insights to guide patient care: the bidirectional relationship between male infertility and male health. Fertil Steril 2020; 113:469-477. [PMID: 32089256 DOI: 10.1016/j.fertnstert.2020.01.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 01/02/2020] [Indexed: 12/21/2022]
Abstract
Male reproduction is a complex process, and numerous medical conditions have the potential to alter spermatogenesis. In addition, male factor infertility may be a biomarker for future health. In the present review, we discuss the current literature regarding the association between systemic diseases and fertility, which may impact clinical outcomes or semen parameters. A number of conditions that have systemic consequences were identified, including genetic (e.g., cystic fibrosis, DNA mismatch repair alterations), obesity, psychological stress, exogenous testosterone, and a variety of common medications. As such, the infertility evaluation may offer an opportunity for health counseling beyond the discussion of reproductive goals. Moreover, male infertility has been suggested as a marker of future health, given that poor semen parameters and a diagnosis of male infertility are associated with an increased risk of hypogonadism, cardiometabolic disease, cancer, and even mortality. Therefore, male fertility requires multidisciplinary expertise for evaluation, treatment, and counseling.
Collapse
Affiliation(s)
- Alex M Kasman
- Department of Urology, School of Medicine, Stanford University, Stanford, California
| | - Francesco Del Giudice
- Department of Maternal-Infant and Urological Sciences, "Sapienza" Rome University, Policlinico Umberto I Hospital, Rome, Italy
| | - Michael L Eisenberg
- Department of Urology, School of Medicine, Stanford University, Stanford, California; Department of Obstetrics and Gynecology, School of Medicine, Stanford University, Stanford, California.
| |
Collapse
|