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Guo H, Liu T, Li J, Li E, Wen X, Chen F, Li S, Li Y, Yin Q, Zhu Q. Compound probiotics regulate the NRF2 antioxidant pathway to inhibit aflatoxin B 1-induced autophagy in mouse Sertoli TM4 cells. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2024; 281:116619. [PMID: 38925031 DOI: 10.1016/j.ecoenv.2024.116619] [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: 03/20/2024] [Revised: 06/09/2024] [Accepted: 06/17/2024] [Indexed: 06/28/2024]
Abstract
This study investigated the effects of compound probiotics (CP) on AFB1-induced cytotoxicity in Sertoli TM4 cells. The L9 (3 × 3) orthogonal test was conducted to determine the optimal CP required for high AFB1 degradation in the artificial gastrointestinal fluid in vitro. The maximal AFB1 degradation rate was 40.55 % (P < 0.05) when the final viable count was 1.0 × 105 CFU/mL for Bacillus subtilis, Lactobacillus casein, and Saccharomyces cerevisiae. The effects of CP and the CP supernatant (CPS) on TM4 cell viability were evaluated to achieve the optimal protective conditions. When CPS4 (corresponding to CP viable counts of 1.0 × 104 CFU/mL) was added to the TM4 cells for 24 h, the cell viability reached 108.86 % (P < 0.05). AFB1 reduced TM4 cell viability in a concentration- and time-dependent manner at an AFB1 concentration ranging from 0 to 1.5 μM after 48-h AFB1 exposure. The optimal AFB1 concentration/times for low- and high damage models were 0.5 and 1.25 μM both for 24 h, which decreased viability to 76.04 % and 65.35 %, respectively. however, CPS4 added to low- and high-damage models increased the cell viability to 97.43 % and 75.12 %, respectively (P < 0.05). Transcriptome sequencing was performed based on the following designed groups: the control, 0.5 μM AFB1, 1.25 μM AFB1, CPS4, and CPS4+0.5 μM AFB1. The Kyoto encyclopedia of genes and genomes (KEGG) pathway enrichment analysis was further performed to identify significantly enriched signaling pathways, which were subsequently verified. It was shown that AFB1 induced apoptosis by blocking the PI3K-AKT-mTOR pathway and upregulating autophagy proteins such as LC3B, Beclin1, and ATG5 while inhibiting autophagic flux. CPS4 promoted AFB1 degradation, activated the p62-NRF2 antioxidant, and inhibited ROS/TRPML1 pathways, thereby reducing ROS production and inflammation and ultimately alleviating AFB1-induced autophagy and apoptosis. These findings supports the potential of probiotics to protect the male reproductive system from toxin damage.
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Affiliation(s)
- Hongwei Guo
- Second Department of Urology, Affiliated Central Hospital of Huanghuai University, Zhumadian 463000, China; College of Biology and Food Engineering, Huanghuai University, Zhumadian 463000, China
| | - Taiyang Liu
- Second Department of Urology, Zhumadian Center Hospital, Zhumadian 463000, China
| | - Jie Li
- Second Department of Urology, Zhumadian Center Hospital, Zhumadian 463000, China
| | - Enzhong Li
- College of Biology and Food Engineering, Huanghuai University, Zhumadian 463000, China
| | - Xiuhua Wen
- Second Department of Urology, Zhumadian Center Hospital, Zhumadian 463000, China.
| | - Fujia Chen
- College of Biology and Food Engineering, Huanghuai University, Zhumadian 463000, China
| | - Siqaing Li
- College of Biology and Food Engineering, Huanghuai University, Zhumadian 463000, China
| | - Yun Li
- College of Biology and Food Engineering, Huanghuai University, Zhumadian 463000, China
| | - Qingqiang Yin
- College of Animal Science and Technology, Henan Agricultural University, Zhengzhou 450046, China
| | - Qun Zhu
- Henan Delin Biological Product Co. Ltd., Xinxiang 453000, China
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Boeri L, Pozzi E, Belladelli F, Corsini C, Cilio S, Bertini A, Lanzaro F, Candela L, Raffo M, Negri F, Cella L, Fantin M, Fallara G, Capogrosso P, d'Arma A, Montorsi F, Salonia A. One out of two idiopathic infertile men has pathologic sperm DNA fragmentation values: Potential implications for clinical practice. Clin Endocrinol (Oxf) 2024; 101:153-161. [PMID: 38979907 DOI: 10.1111/cen.15093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 05/16/2024] [Accepted: 05/20/2024] [Indexed: 07/10/2024]
Abstract
OBJECTIVES To investigate the distribution of sperm DNA fragmentation (SDF) values and their association with clinical and seminal parameters in idiopathic infertile men. DESIGN, PATIENTS, MEASUREMENTS Data from 3224 primary infertile men (belonging to couples having failed to conceive a pregnancy within 12 months) who underwent a thorough diagnostic work-up were analysed. A SDF value ≥ 30% (according to Sperm Chromatin Structure Assay) was considered pathologic. We excluded: (1) men with genetic abnormalities; (2) men with history of cryptorchidism; (3) men with biochemical hypogonadism; (4) men with clinical varicocele; and (5) men with other possible known aetiological factors. Descriptive statistics and logistic regression analyses were used to describe the whole cohort. RESULTS Of all, 792 (23%) men with at least one abnormal WHO semen parameter but without any identified aetiologic factor for infertility, were considered as idiopathic infertile men. Of 792, 418 (52.7%) men had SDF ≥30%. Men with pathologic SDF were older (p = .02), had higher Follicle-stimulating hormone (FSH) (p = .04) but lower total testosterone (p = .03) values than those with SDF <30%. The homoeostatic model assessment index for insulin resistance (HOMA-IR) was higher in men with SDF ≥30% (p = .01). Idiopathic infertile men with SDF ≥30% presented with lower sperm concentration (p < .001) and lower progressive sperm motility (p < .01) than those with SDF < 30%. Logistic regression analysis revealed that older age (OR: 1.1, p = .02) and higher HOMA-IR score (OR: 1.8, p = .03) were associated with SDF ≥ 30%, after accounting for FSH and sperm concentration values. CONCLUSIONS Approximately half of infertile men categorized as idiopathic had pathologic SDF values. Idiopathic infertile men with pathologic SDF showed worse clinical, hormonal and semen parameters than those with normal SDF values. These results suggest that including SDF testing could be clinically relevant over the real-life management work-up of infertile men.
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Affiliation(s)
- Luca Boeri
- Department of Urology, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Edoardo Pozzi
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Federico Belladelli
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Christian Corsini
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Simone Cilio
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, Urology Unit, University of Naples 'Federico II', Naples, Italy
| | - Alessandro Bertini
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Francesco Lanzaro
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Luigi Candela
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Massimiliano Raffo
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Fausto Negri
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Ludovica Cella
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Margherita Fantin
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Giuseppe Fallara
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Paolo Capogrosso
- Department of Urology and Andrology, Ospedale di Circolo and Macchi Foundation, Varese, Italy
| | - Alessia d'Arma
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Montorsi
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
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Gill K, Machałowski T, Harasny P, Grabowska M, Duchnik E, Piasecka M. Low human sperm motility coexists with sperm nuclear DNA damage and oxidative stress in semen. Andrology 2024; 12:1154-1169. [PMID: 38018344 DOI: 10.1111/andr.13556] [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: 06/13/2023] [Revised: 10/03/2023] [Accepted: 11/06/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND Low sperm motility, one of the common causes of male infertility, is associated with abnormal sperm quality. Currently, important sperm/semen biomarkers are sperm chromatin status and oxidation‒reduction potential (ORP) in semen. Because the association between sperm motility and these biomarkers is still not fully clarified, our study was designed to verify the distribution and risk of sperm DNA fragmentation (SDF) and oxidative stress in semen in asthenozoospermic men. MATERIALS AND METHODS This study was carried out on discharged sperm cells of asthenozoospermic men (isolated asthenozoospermia or coexisted with reduced sperm number and/or morphology), nonasthenozoospermic men (reduced total sperm count and/or sperm morphology) (experimental groups) and normozoospermic men (proven and presumed fertility) (control group). Basic semen analysis was evaluated according to the 6th edition of the World Health Organization manual guidelines. SDF was assessed using the sperm chromatin dispersion test, while static(s) ORP in semen was measured by means of a MiOXSYS analyser. RESULTS The men from the asthenozoospermic group had lower basic semen parameters than those from the control and nonasthenozoospermic groups. In men with poor sperm motility SDF and sORP, prevalence and risk for > 20% SDF (high level of DNA damage) and for > 1.37 sORP (oxidative stress) were significantly higher than those of control and nonasthenozoospermic subjects. The risk for sperm DNA damage and oxidative stress in asthenozoospermic men was over 10-fold higher and almost 6-fold higher than those in control subjects and almost or over 3-fold higher than those in nonasthenozoospermic men. CONCLUSIONS AND DISCUSSION Poor human sperm motility coexisted with low basic sperm quality. Sperm DNA damage and oxidative stress in semen were much more frequent in asthenozoospermia. These abnormalities can decrease the sperm fertilizing capability under both natural and medically assisted reproduction conditions. Thus, in asthenozoospermia, the evaluation of sperm chromatin status and oxidation-reduction potential in semen is justified and inevitable, and the appropriate antioxidant therapy can be suggested.
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Affiliation(s)
- Kamil Gill
- Department of Histology and Developmental Biology, Faculty of Health Sciences, Pomeranian Medical University, Szczecin, Poland
| | - Tomasz Machałowski
- Department of Histology and Developmental Biology, Faculty of Health Sciences, Pomeranian Medical University, Szczecin, Poland
- Department of Perinatology, Obstetrics and Gynecology, Faculty of Medicine and Dentistry, Pomeranian Medical University, Police, Poland
| | - Patryk Harasny
- Department of Histology and Developmental Biology, Faculty of Health Sciences, Pomeranian Medical University, Szczecin, Poland
- Department of Urology and Urological Oncology, Faculty of Medicine and Dentistry, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Marta Grabowska
- Department of Histology and Developmental Biology, Faculty of Health Sciences, Pomeranian Medical University, Szczecin, Poland
| | - Ewa Duchnik
- Department of Aesthetic Dermatology, Faculty of Health Sciences, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Małgorzata Piasecka
- Department of Histology and Developmental Biology, Faculty of Health Sciences, Pomeranian Medical University, Szczecin, Poland
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Aerts A, Temmerman A, Vanhie A, Vanderschueren D, Antonio L. The Effect of Endurance Exercise on Semen Quality in Male Athletes: A Systematic Review. SPORTS MEDICINE - OPEN 2024; 10:72. [PMID: 38861008 PMCID: PMC11166609 DOI: 10.1186/s40798-024-00739-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 05/29/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND Endurance exercise has the potential to affect reproductive function, with amenorrhea in female athletes. However, most studies focus on women. Evidence on the association between endurance exercise and male fertility is limited. OBJECTIVE To synthesise existing literature on exercise-induced alterations in semen parameters and to assess the clinical impact on male fertility. METHODS Studies reporting on the association between semen parameters and endurance exercise in healthy men were eligible. Men attending fertility clinics were excluded. We searched MEDLINE (PubMed), Embase, SPORTDiscus, Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov and International Clinical Trials Registry Platform (ICTRP) from their inception to May 28th 2022. JBI Critical Appraisal Tool was used to assess the potential risk of bias. RESULTS Thirteen studies met inclusion criteria, reporting on 280 subjects. Eight articles reported on endurance runners, three on cyclists and four on triathletes. Four studies did not find any statistically significant sperm alterations. Five reported significant changes in semen parameters, but these were not clinically relevant, as semen parameters remained well above World Health Organisation (WHO) thresholds. Four articles reported a decrease in semen quality with potential clinical consequences as they found a reduced number of sperm cells exhibiting normal morphology in cyclists and triathletes and a greater amount of DNA fragmentation in triathletes. CONCLUSION Endurance exercise can have a negative effect on semen quality, although rarely with a clinically relevant impact on male fertility. Evidence is however limited, with poor quality of the included studies. REGISTRATION PROSPERO International prospective register of systematic reviews (CRD42022336753).
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Affiliation(s)
- Alex Aerts
- Faculty of Medicine, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Annelien Temmerman
- Faculty of Medicine, Katholieke Universiteit Leuven, Leuven, Belgium
- Department of Internal Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Arne Vanhie
- Leuven University Fertility Centre, University Hospitals Leuven, Leuven, Belgium
| | - Dirk Vanderschueren
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
- Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium
| | - Leen Antonio
- Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium.
- Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium.
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Cheng LG, Miller D, Pelzman D, Wecht A, Hwang K. High rate of isolated teratospermia in a population of fertile men and the questionable clinical utility of sperm morphology. F S Rep 2024; 5:140-144. [PMID: 38983740 PMCID: PMC11228780 DOI: 10.1016/j.xfre.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 07/11/2024] Open
Abstract
Objective To better understand the impact of sperm morphology on fertility by assessing sperm morphology in a population of known fertile men. Design A prospective cohort study. Setting Fertility center associated with the university. Patients Healthy men >18 years of age were recruited to provide one semen sample before a vasectomy appointment scheduled between March 2020 and November 2022. Patients were included in the study when they had at least one biologic child and no history of difficulty achieving pregnancy or fertility procedures. Interventions None. Main Outcome Measures Sperm morphology. Results A total of 68 patients (mean age 36.7 years) were included. Thirty-eight (55.9%) patients had 3% or lower normal sperm morphology, including two patients who had 0 normal morphology. The most common morphologic abnormalities were head-shaped defects (n = 59, 84.3%), followed by coiled tails (n = 14, 20.3%). Count, concentration, motility, and progressive motility were normal in >90% of patients. Conclusions More than half (55.9%) of fertile male patients had lower than normal sperm morphology in our study. The results of our study further question the clinical relevance of sperm morphology on fertility outcomes and when the current approach in assessing morphology is too strict.
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Affiliation(s)
- Lucille G Cheng
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - David Miller
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Daniel Pelzman
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Anna Wecht
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Kathleen Hwang
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Bar-Chama N, Rabinovitch L, Honig S. Amateur vs Professional Users of the YO Home Sperm Test: An Assessment of Usability. Urology 2024:S0090-4295(24)00257-7. [PMID: 38705243 DOI: 10.1016/j.urology.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 04/11/2024] [Accepted: 04/16/2024] [Indexed: 05/07/2024]
Abstract
OBJECTIVE To assess the accuracy of the YO home sperm test by real-world/amateur users. METHODS This multisite study investigated whether amateur users could use the FDA-cleared YO Home Sperm Test to obtain accurate motile sperm concentration (MSC) results when compared to trained laboratory technicians. The qualitative MSC results of amateur and professional YO users were compared to each other as well as to the results of an established automated sperm quality analyzer (SQA-V) above and below a 6 m/mL MSC cut-off. RESULTS This was a blinded, prospective study of 316 amateur users and 3 professional laboratory technicians across 3 study sites. Amateur vs Professional YO users demonstrated an accuracy of >97%. Qualitative results of amateurs and professionals vs SQA-V results showed a >95.7% accuracy. CONCLUSION Amateur users with no prior training were able to follow the YO test directions to receive highly accurate qualitative motile sperm concentration (MSC) results. The YO test is user-friendly and can be used as an effective initial home screening tool to gain preliminary insight into the fertility status of the male in a real-world setting. Furthermore, the YO test results correlated with those obtained by the FDA-cleared SQA-V laboratory analyzer, confirming that the YO test delivers accurate MSC results in the hands of amateur users.
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Affiliation(s)
- Natan Bar-Chama
- Reproductive Medicine Associates of New York, New York, NY; Department of Urology, The Mount Sinai Hospital, New York, NY.
| | | | - Stanton Honig
- Yale School of Medicine, Department of Urology, Yale University, New Haven, CT
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Margiana R, Gupta R, Al-Jewari WM, Hjazi A, Alsaab HO, Mustafa YF, Singh R, Thaibt R, Alkhayyat S, Ibrahim AJ. Evaluation of telomere length, reactive oxygen species, and apoptosis in spermatozoa of patients with oligospermia. Cell Biochem Funct 2024; 42:e3935. [PMID: 38379260 DOI: 10.1002/cbf.3935] [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: 07/16/2023] [Revised: 01/04/2024] [Accepted: 01/09/2024] [Indexed: 02/22/2024]
Abstract
50% of cases of infertility are caused by male factor, which acquired or congenital problems may bring on. Male infertility can be caused by oligospermia and asthenozoospermia, which are common. Since the same mutations that cause azoospermia in some people also cause oligozoospermia in others, oligozoospermia may be thought of as a less severe form of azoospermia. Studies have demonstrated telomere length, catalase activity, super oxide dismutase (SOD), and DNA fragmentation can be influential factors for male infertility. The amount of apoptosis, oxidative stress factors, telomere length, and DNA fragmentation were some aspects of healthy sperm that we chose to look into in this study and compare to oligospermia individuals. Oligospermia patients (n = 24) and fertile men (n = 27) semen samples were collected, and the apoptosis rate of sperms in both groups was analyzed (Flow cytometry). Also, gene expression of apoptotic and antiapoptotic markers and telomere length were examined (real-time polymerase chain reaction). The sperm DNA fragmentation kit was used to determine DNA fragmentation and to evaluate catalase and SOD activity; the specific kits and methods were utilized. Higher expression levels of caspase3 (p = .0042), caspase8 (p = .0145), caspase9 (p = .0275), and BAX (p = .0202) mRNA were observed in patients who had oligospermia. In contrast, lower mRNA expression of BCL-2 (p = .0009) was detected in this group. In addition, telomere length was decreased in the oligospermia group (p < .0001) compared to the health group. Moreover, the frequency of apoptosis is induced in patients (p = .0026). The catalase activity is low (p = .0008), but the SOD activity is high (p = .0015) in the patient group. As a result of our findings, we may list the sperm cell apoptosis rate, telomere length, the degree of sperm DNA fragmentation, and lastly, the measurement of significant and efficient oxidative stress markers like SOD and catalase in semen plasma among the principal diagnostic characteristics for oligospermia. Future studies will be better able to treat oligospermia by showing whether these indicators are rising or falling.
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Affiliation(s)
- Ria Margiana
- Department of Anatomy, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Master's Programme Biomedical Sciences, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Andrology Program, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
- Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Reena Gupta
- Institute of Pharmaceutical Research, GLA University, Bharthia, India
| | | | - Ahmed Hjazi
- Department of Medical Laboratory Sciences, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Hashem O Alsaab
- Pharmaceutics and Pharmaceutical Technology, Taif University, Taif, Saudi Arabia
| | | | - Rajesh Singh
- Uttaranchal Institute of Technology, Uttaranchal University, Dehradun, India
| | - Ruiscul Thaibt
- Medical Technical College, Al-Farahidi University, Baghdad, Iraq
| | - Safa Alkhayyat
- College of Pharmacy, The Islamic University, Najaf, Iraq
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Santana-Plata A, Rivera-Egea R, Garrido N. Semen cryopreservation for an oncological reason: a retrospective study. Reprod Biomed Online 2024:103898. [PMID: 38744584 DOI: 10.1016/j.rbmo.2024.103898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 02/06/2024] [Accepted: 02/09/2024] [Indexed: 05/16/2024]
Abstract
RESEARCH QUESTION How do cancer type and treatment affect semen quality before and after treatment, and what effect does it have in their clinical management of infertility? Also, what is the rate of patients using cryopreserved semen samples after treatment? DESIGN Patients who cryopreserved spermatozoa for oncological reasons between 2000 and 2022 in IVI clinics in Spain were retrospectively reviewed. Semen parameters were analysed before and after treatment, and utilization and destruction rates were calculated. Total motile sperm count (TMSC) was used for assisted reproductive technology (ART) counselling. RESULTS A total of 724 patients cryopreserved their semen during the study period. The semen parameters of the cancer patients' semen before and after treatment were heterogeneous, with significant differences between cancer type and semen parameters. The utilization rate was relatively low (0.4%), whereas the destruction rate was 23.1%. CONCLUSION Cancer and antineoplastic treatment affect everyone differently. Therefore, sperm cryopreservation should be offered to all patients before starting treatment to ensure their reproductive future. Furthermore, in addition to considering the semen parameters defined by the World Health Organization, it is important to use TMSC in the diagnosis of men to choose appropriate ART according to type of cancer.
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Affiliation(s)
- Ana Santana-Plata
- IVIRMA Global Research Alliance, IVI Foundation, Health Research Institute La Fe, Av. Fernando Abril Martorell, n°106, Torre A, Planta 1ª, 46026, Valencia, Spain..
| | - Rocio Rivera-Egea
- IVIRMA Global Research Alliance, Andrology Unit, IVIRMA Valencia, Plaza Policía Local, 3, 46015 Valencia, Spain
| | - Nicolás Garrido
- IVIRMA Global Research Alliance, IVI Foundation, Health Research Institute La Fe, Av. Fernando Abril Martorell, n°106, Torre A, Planta 1ª, 46026, Valencia, Spain
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Du C, Li Y, Yin C, Luo X, Pan X. Association of abstinence time with semen quality and fertility outcomes: a systematic review and dose-response meta-analysis. Andrology 2024. [PMID: 38197853 DOI: 10.1111/andr.13583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/11/2023] [Accepted: 12/14/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND Infertility affects 186 million people worldwide, with male factors contributing to 50% of infertility cases. Semen analysis is a key for diagnosing male factor infertility, but sperm parameters can be influenced by ejaculatory abstinence (EA) duration. Shortening or prolonging EA can impact on semen quality and assisted reproductive technology (ART) outcomes, but the optimal EA duration remains unclear, particularly for infertility patients. OBJECTIVES This study conducts a comprehensive meta-analysis to explore the impact of varying abstinence durations on semen quality and fertility outcomes. METHODS Three English database (PubMed, Embase, and Cochrane Central Register of Controlled Trials) as well as four Chinese database (China National Knowledge Infrastructure, Chinese Scientific Journals database, WanFang database, and Chinese Biomedical Literature database) were searched from 2000 to August 2023. The classical meta-analysis and "one-stage" dose-response meta-analysis were conducted to compare the associations of different abstinence durations (short-term abstinence vs. long-term abstinence) on semen quality in healthy adult and different type of infertile patients. RESULTS There were 85 eligible studies were finally included. The meta-analysis of volume (mean difference [MD] = -0.95 mL, 95% confidence interval [CI]: -1.16 to -0.74 mL), total sperm count (TSC) (MD = -102.45×106 , 95% CI: -117.98×106 to -86.91×106 ), sperm concentration (SC) (MD = -11.88×106 /mL, 95% CI: -18.96×106 /mL to -4.80×106 /mL), DNA fragmentation index (DFI) (MD = -2.37%, 95% CI: -4.73% to -0.01%) in healthy men showed a significant decrease with different abstinence durations (short-term abstinence vs. long-term abstinence). The meta-analysis of infertile men showed significant decrease in volume in various subgroups (MD range: -0.73 to -1.17 mL) with P < 0.01; TSC (MD = -61.93×106 , 95% CI: -88.84×106 to -35.01×106 ), SC (MD = -5.39×106 /mL, 95% CI: -9.97×106 to -0.81×106 /mL), DFI (MD = -5.63%, 95% CI: -10.19% to -1.06%) in unexplained infertility subgroup; significant increase in viability (MD = 6.14%, 95% CI: 3.61% to 8.68%) in the unexplained infertility subgroup. The dose-response meta-analysis showed that TSC in oligozoospermia showed a nonlinear increase (coefficient from 3.38 to -5.76, P from 0.02 to 0.22) and the truncation point was around the 4th to 5th abstinence day. The percentage of progressive motile sperm (PR) in asthenozoospermia showed a significant decrease (coefficient = -2.39, 95% CI: -4.28 to -0.50). For fertility outcomes of different ARTs, only the clinical pregnancy rate (CPR) in the intrauterine insemination (IUI) subgroup showed a significant decrease around the 3rd day (coefficient = 0.85, 95% CI: 0.75 to 0.97). CONCLUSIONS Short-term abstinence may be associated with limited improvements in semen quality in healthy men but could be more beneficial for infertile men, especially within the first 4 days of abstinence. Caution is urged in making definitive conclusions about the causal relationship between abstinence time and semen quality changes due to potential confounding and interactions.
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Affiliation(s)
- Chengchao Du
- Department of Reproductive Andrology & Sichuan Human Sperm Bank, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Yi Li
- Department of Pain Management, West China Hospital, Sichuan University, Chengdu, China
| | - Chongyang Yin
- School of Integrated Education, YiBin Vocational and Technical College, Yibin, China
| | - Xuefeng Luo
- Department of Reproductive Andrology & Sichuan Human Sperm Bank, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Xiangcheng Pan
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
- Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu, China
- Evidence-Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu, China
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10
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Tanaka T, Kojo K, Nagumo Y, Ikeda A, Shimizu T, Fujimoto S, Kakinuma T, Uchida M, Kimura T, Kandori S, Negoro H, Nishiyama H. A new clustering model based on the seminal plasma/serum ratios of multiple trace element concentrations in male patients with subfertility. Reprod Med Biol 2024; 23:e12584. [PMID: 38807752 PMCID: PMC11131575 DOI: 10.1002/rmb2.12584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/29/2024] [Accepted: 05/09/2024] [Indexed: 05/30/2024] Open
Abstract
Purpose To investigate whether seminal plasma (SP)/serum ratios of multiple trace elements (TEs) can classify patients with male subfertility. Methods SP/serum ratios of 20 TEs (lithium, sodium, magnesium, phosphorus, sulfur, potassium, calcium, manganese, iron, cobalt, copper, zinc, arsenic, selenium, rubidium, strontium, molybdenum, cesium, barium, and thallium) were calculated for healthy volunteers (n = 4) and those consulting for male subfertility (n = 245). Volunteer semen samples were collected by split ejaculation into early and subsequent fractions, and SP/serum ratio data were compared between fractions. The patients' SP/serum ratio data were used in an unsupervised clustering analysis and qualitatively compared with the data from the fractions of ejaculation from the volunteers. Semen quality parameters and pregnancy outcomes were compared between patient clusters. Results The early fraction of volunteers was characterized by lower phosphorus and arsenic and 18 other higher TEs than the subsequent fraction. Cluster analysis classified patients into four distinct clusters, one sharing characteristics with the early fraction and another with the subsequent fraction. One cluster with the early fraction characteristics had significantly lower semen volume and higher pregnancy rates from spontaneous pregnancies or intrauterine insemination. Conclusions Classification of patients based on SP/serum ratios of multiple TEs represents the dominance of fractions of ejaculation samples.
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Affiliation(s)
- Takazo Tanaka
- Department of Urology, Faculty of MedicineUniversity of TsukubaTsukubaIbarakiJapan
| | - Kosuke Kojo
- Department of Urology, Faculty of MedicineUniversity of TsukubaTsukubaIbarakiJapan
- Center for Human ReproductionInternational University of Health and Welfare HospitalNasushiobaraTochigiJapan
| | - Yoshiyuki Nagumo
- Department of Urology, Faculty of MedicineUniversity of TsukubaTsukubaIbarakiJapan
| | - Atsushi Ikeda
- Department of Urology, Faculty of MedicineUniversity of TsukubaTsukubaIbarakiJapan
| | - Takuya Shimizu
- Health Care Analysis CenterRenatech Co., Ltd.IseharaKanagawaJapan
| | | | - Toshiyuki Kakinuma
- Center for Human ReproductionInternational University of Health and Welfare HospitalNasushiobaraTochigiJapan
| | - Masahiro Uchida
- Department of UrologyTsukuba Gakuen HospitalTsukubaIbarakiJapan
| | - Tomokazu Kimura
- Department of Urology, Faculty of MedicineUniversity of TsukubaTsukubaIbarakiJapan
| | - Shuya Kandori
- Department of Urology, Faculty of MedicineUniversity of TsukubaTsukubaIbarakiJapan
| | - Hiromitsu Negoro
- Department of Urology, Faculty of MedicineUniversity of TsukubaTsukubaIbarakiJapan
| | - Hiroyuki Nishiyama
- Department of Urology, Faculty of MedicineUniversity of TsukubaTsukubaIbarakiJapan
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11
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Pelzman DL, Sandlow JI. Sperm morphology: Evaluating its clinical relevance in contemporary fertility practice. Reprod Med Biol 2024; 23:e12594. [PMID: 38915912 PMCID: PMC11194684 DOI: 10.1002/rmb2.12594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 06/06/2024] [Accepted: 06/11/2024] [Indexed: 06/26/2024] Open
Abstract
Background The World Health Organization (WHO) recommends reporting sperm morphology in a standard semen analysis. However, the clinical utility and prognostic value of morphology is often debated. Methods We reviewed and summarized studies that assessed both the benefits and limitations of sperm morphology in the context of natural fertility, assisted reproductive technologies, and recurrent pregnancy loss. We additionally describe possible environmental and anatomical etiologies of teratozoospermia. Results Sperm morphology evaluation has continuously evolved since the release of the first WHO manual in 1980. Initially, several large studies reported significant inverse associations between fertility outcomes and teratozoospermia. Most recent studies, however, fail to show an association between sperm morphology and natural or assisted fertility outcomes. Conclusion Sperm morphology analysis may have limited diagnostic and prognostic value. Providers should be aware of these limitations when counseling or managing infertile patients.
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Affiliation(s)
- Daniel L. Pelzman
- Department of UrologyMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Jay I. Sandlow
- Department of UrologyMedical College of WisconsinMilwaukeeWisconsinUSA
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12
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Lamb DJ, Marinaro JA. Can semen parameters predict pregnancy outcomes? Fertil Steril 2023; 120:709-714. [PMID: 37414207 DOI: 10.1016/j.fertnstert.2023.06.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 06/28/2023] [Accepted: 06/28/2023] [Indexed: 07/08/2023]
Abstract
Semen analysis is an integral component of the evaluation and management of men with infertility. Although it is important for patient counseling and clinical decision making, a conventional semen analysis cannot reliably predict the chance of pregnancy or differentiate fertile vs. infertile men (except in the most extreme cases). Advanced, nonstandard sperm functional tests may provide additional discriminatory and prognostic power; however, further research is needed to determine how to best incorporate these tests into modern clinical practice. Therefore, the primary applications of a conventional semen analysis should be to judge the severity of infertility, estimate the effects of future therapy, and measure the response to current therapy.
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Affiliation(s)
- Dolores J Lamb
- Department of Urology, Weill Cornell Medicine, New York, New York
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13
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Eisenberg ML, Esteves SC, Lamb DJ, Hotaling JM, Giwercman A, Hwang K, Cheng YS. Male infertility. Nat Rev Dis Primers 2023; 9:49. [PMID: 37709866 DOI: 10.1038/s41572-023-00459-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/09/2023] [Indexed: 09/16/2023]
Abstract
Clinical infertility is the inability of a couple to conceive after 12 months of trying. Male factors are estimated to contribute to 30-50% of cases of infertility. Infertility or reduced fertility can result from testicular dysfunction, endocrinopathies, lifestyle factors (such as tobacco and obesity), congenital anatomical factors, gonadotoxic exposures and ageing, among others. The evaluation of male infertility includes detailed history taking, focused physical examination and selective laboratory testing, including semen analysis. Treatments include lifestyle optimization, empirical or targeted medical therapy as well as surgical therapies that lead to measurable improvement in fertility. Although male infertility is recognized as a disease with effects on quality of life for both members of the infertile couple, fewer data exist on specific quantification and impact compared with other health-related conditions.
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Affiliation(s)
- Michael L Eisenberg
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA.
- Department of Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, CA, USA.
| | - Sandro C Esteves
- ANDROFERT Andrology and Human Reproduction Clinic, Campinas, Brazil
- Division of Urology, Department of Surgery, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Dolores J Lamb
- Center for Reproductive Genomics, Weill Cornell Medical College, New York, NY, USA
- Englander Institute for Precision Medicine, Weill Cornell Medical College, New York, NY, USA
- Department of Urology, Weill Cornell Medical College, New York, NY, USA
| | - James M Hotaling
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | | | - Kathleen Hwang
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Yu-Sheng Cheng
- Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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14
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Joseph MD, Hatch EE, Koenig MR, Eisenberg ML, Wang TR, Sommer GJ, Stuver SO, Rothman KJ, Wise LA. A North American study of anthropometric factors and semen quality. Fertil Steril 2023; 120:586-596. [PMID: 37164117 PMCID: PMC10524695 DOI: 10.1016/j.fertnstert.2023.04.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 04/27/2023] [Accepted: 04/28/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVE To evaluate the association between anthropometric measures and semen parameters. DESIGN Cross-sectional study. SUBJECTS Male participants aged ≥21 years. We analyzed data from 659 males (1185 samples) participating in a semen testing substudy of the Pregnancy Online Study (PRESTO), a North American preconception cohort study. After enrollment, we invited males aged ≥21 years to perform at-home semen testing using the Trak system. EXPOSURE(S) Participants reported selected anthropometric variables (current weight, height, waist circumference, and weight at age 17 years) and covariate data via an online baseline questionnaire. MAIN OUTCOME MEASURE(S) We used generalized estimating equations models to estimate the percent difference in mean log-transformed semen parameter values and 95% confidence intervals (CI) for associations between selected anthropometric variables and semen volume (mL), sperm concentration (million/mL), and total sperm count (million), adjusting for sociodemographics, lifestyle factors, and medical history. We also evaluated World Health Organization-defined thresholds for low semen quality. RESULT(S) Percentage differences in mean log-transformed semen volume, sperm concentration, and total sperm count (95% CI) comparing current body mass index ≥35 vs. <25 kg/m2 were -6.3 (-15.8, 4.3), -6.4 (-24.6, 16.2), and -12.2 (-31.1, 11.8), respectively. Percentage differences (95% CIs) comparing waist circumferences of ≥42 vs. <31 inches were -4.2 (-15.0, 8.0), -6.4 (-27.6, 21.0), and -10.4 (-31.9, 17.9) for semen volume, sperm concentration, and total sperm count, respectively. Greater adult weight gain since age 17 years was associated with reduced semen volume (≥25 vs. <5 kg; percent difference, -9.7; 95% CI, -18.4, 0.1), but not sperm concentration or total sperm count. The highest categories of each anthropometric variable generally were associated with World Health Organization-defined low total sperm count (≤39 million). CONCLUSION(S) Selected anthropometric factors were associated modestly with poorer semen quality.
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Affiliation(s)
- Marlon D Joseph
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Elizabeth E Hatch
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Martha R Koenig
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Michael L Eisenberg
- Department of Obstetrics and Gynecology, Stanford University, Stanford, California; Department of Urology, Stanford University, Stanford, California
| | - Tanran R Wang
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | | | - Sherri O Stuver
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Kenneth J Rothman
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts.
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15
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Barratt CL. The joys of sharing: andrology trailblazes in data transparency - an example using the World Health Organization 2021 reference ranges. Reprod Biomed Online 2023; 47:103230. [PMID: 37198008 DOI: 10.1016/j.rbmo.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
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16
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Rochdi C, Bellajdel I, El Moudane A, El Assri S, Mamri S, Taheri H, Saadi H, Barki A, Mimouni A, Choukri M. Hormonal, clinical, and genetic profile of infertile patients with azoospermia in Morocco. Pan Afr Med J 2023; 45:119. [PMID: 37745921 PMCID: PMC10516754 DOI: 10.11604/pamj.2023.45.119.38249] [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: 11/15/2022] [Accepted: 06/29/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction azoospermia affects more than 10%-15% of infertile male subjects attending the infertility center. In Morocco, there have been no studies on male infertility with azoospermia. Thereby, our objective was to evaluate the clinical, hormonal, and genetic characteristics of infertile men with azoospermia in Morocco. Methods we conducted a retrospective descriptive study performed with a convenience sample of 80 infertile men from 2021 to 2022, in the Assisted Reproductive Technology Unit of the Mohammed VI University Hospital Center in Oujda-Morocco. All patients with azoospermia were subjected to a quantitative hormone assay to evaluate the functionality of the sertolic and leydigial compartments. Human karyotyping and AZF microdeletion analysis are routinely performed in azoospermic patients. Results the results show that the mean age of patients in the study was 45.7 ± 3.5 years. Primary infertility accounts for the majority, with a rate of 96% (n=77). There were 12 cases of azoospermia of secretory origin, 22 cases of excretory origin, and 3 of undetermined origin. Azoospermia was associated with hydrocele in 29% (n=27) of cases. The average levels of FSH, LH, testosterone, and inhibin B were 15.54 ± 5.5 mIU/mL, 7.71 ± 2.7 mIU/mL, 405.09 ± 6.13 ng/dl and 38.44 ± 5.13 pg/ml, respectively. The prevalence of chromosomal abnormalities was 30.7%. Of these, the sex chromosome aneuploidy with 47, XXY karyotype (Klinefelter syndrome) accounted for 11% (n=9). The incidence of microdeletions of azoospermia factors (AZF) was 9%, and AZFc deletion was the most common at the rate of 3%. Conclusion our research shows that hydrocele, varicocele, and chromosomal abnormalities are the leading causes of azoospermia. In the Moroccan population, azoospermia is essentially of excretory origin.
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Affiliation(s)
- Chaymae Rochdi
- Maternal-Child and Mental Health Research Laboratory, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
- Medically Assisted Procreation Unit, Central Laboratory, Mohammed VI University Hospital Center, Oujda, Morocco
| | - Ibtissam Bellajdel
- Medically Assisted Procreation Unit, Central Laboratory, Mohammed VI University Hospital Center, Oujda, Morocco
- Obstetrics Gynecology Service, Mohammed VI University Hospital Center, Oujda, Morocco
| | - Anouar El Moudane
- Urology Service, Mohammed VI University Hospital Center, Oujda, Morocco
| | - Soufiane El Assri
- Maternal-Child and Mental Health Research Laboratory, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
| | - Samira Mamri
- Medically Assisted Procreation Unit, Central Laboratory, Mohammed VI University Hospital Center, Oujda, Morocco
| | - Hafsa Taheri
- Maternal-Child and Mental Health Research Laboratory, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
- Medically Assisted Procreation Unit, Central Laboratory, Mohammed VI University Hospital Center, Oujda, Morocco
- Obstetrics Gynecology Service, Mohammed VI University Hospital Center, Oujda, Morocco
| | - Hanane Saadi
- Maternal-Child and Mental Health Research Laboratory, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
- Medically Assisted Procreation Unit, Central Laboratory, Mohammed VI University Hospital Center, Oujda, Morocco
- Obstetrics Gynecology Service, Mohammed VI University Hospital Center, Oujda, Morocco
| | - Ali Barki
- Urology Service, Mohammed VI University Hospital Center, Oujda, Morocco
| | - Ahmed Mimouni
- Maternal-Child and Mental Health Research Laboratory, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
- Medically Assisted Procreation Unit, Central Laboratory, Mohammed VI University Hospital Center, Oujda, Morocco
- Obstetrics Gynecology Service, Mohammed VI University Hospital Center, Oujda, Morocco
| | - Mohammed Choukri
- Maternal-Child and Mental Health Research Laboratory, Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco
- Medically Assisted Procreation Unit, Central Laboratory, Mohammed VI University Hospital Center, Oujda, Morocco
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17
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Zuvela E, Matson P. Analytical variability and interpretation of results of a 3-category sperm motility assessment: 5 years' of an Australian external quality assurance programme. Reprod Biomed Online 2023; 47:111-119. [PMID: 37068979 DOI: 10.1016/j.rbmo.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/30/2023] [Accepted: 03/09/2023] [Indexed: 04/19/2023]
Abstract
RESEARCH QUESTION How do laboratories perform when assessing sperm motility with a 3-category system and interpreting results as per the fifth edition of the World Health Organization manual (WHO5), and will the use of a 4-category system as per the sixth edition of the WHO manual improve their performance? DESIGN Eighty video recordings of sperm samples were sent to over 200 laboratories spanning a 5-year period for the assessment of progressive motility. The results were reviewed relative to the all-laboratory trimmed mean (ALTM) in terms of the minimum and maximum values reported, the coefficient of variation and the proportion of laboratories indicating an abnormal result. A further 20 video recordings were sent over 1 year, with 6-11 laboratories per distribution adjusting to reporting rapid progressive motility using the 4-category system. RESULTS For the 3-category system, the videos covered a mean assessed progressive motility range of 12.0-81.1%. The mean difference between the minimum and maximum values per sample was 50.3% and the coefficients of variation were negatively correlated with the ALTM (r = -0.87, P < 0.00001). Progressive motility abnormality reporting formed a sigmoid curve, and the inflection point (50% of laboratories identifying an abnormality) gave an ALTM value of 32.01%. Preliminary results for laboratories using the 4-category system showed no performance improvement but the number of laboratories was small. CONCLUSIONS Analytical variation can result in laboratories crossing the clinical cut-off of the lower reference limit for samples whose motility is close to the WHO5 lower reference limit, but is less important for samples with extreme values. The benefits of a 4-category motility system are yet to be shown.
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Affiliation(s)
- Emily Zuvela
- External Quality Assurance Schemes for Reproductive Medicine, Northlands, Western Australia, Australia; City Fertility Perth (formerly Fertility Specialists of WA), Claremont and Applecross, Perth, Western Australia.
| | - Phillip Matson
- External Quality Assurance Schemes for Reproductive Medicine, Northlands, Western Australia, Australia
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18
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Levine H, Jørgensen N, Martino-Andrade A, Mendiola J, Weksler-Derri D, Jolles M, Pinotti R, Swan SH. Temporal trends in sperm count: a systematic review and meta-regression analysis of samples collected globally in the 20th and 21st centuries. Hum Reprod Update 2023; 29:157-176. [PMID: 36377604 DOI: 10.1093/humupd/dmac035] [Citation(s) in RCA: 151] [Impact Index Per Article: 151.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 09/29/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Numerous studies have reported declines in semen quality and other markers of male reproductive health. Our previous meta-analysis reported a significant decrease in sperm concentration (SC) and total sperm count (TSC) among men from North America-Europe-Australia (NEA) based on studies published during 1981-2013. At that time, there were too few studies with data from South/Central America-Asia-Africa (SAA) to reliably estimate trends among men from these continents. OBJECTIVE AND RATIONALE The aim of this study was to examine trends in sperm count among men from all continents. The broader implications of a global decline in sperm count, the knowledge gaps left unfilled by our prior analysis and the controversies surrounding this issue warranted an up-to-date meta-analysis. SEARCH METHODS We searched PubMed/MEDLINE and EMBASE to identify studies of human SC and TSC published during 2014-2019. After review of 2936 abstracts and 868 full articles, 44 estimates of SC and TSC from 38 studies met the protocol criteria. Data were extracted on semen parameters (SC, TSC, semen volume), collection year and covariates. Combining these new data with data from our previous meta-analysis, the current meta-analysis includes results from 223 studies, yielding 288 estimates based on semen samples collected 1973-2018. Slopes of SC and TSC were estimated as functions of sample collection year using simple linear regression as well as weighted meta-regression. The latter models were adjusted for predetermined covariates and examined for modification by fertility status (unselected by fertility versus fertile), and by two groups of continents: NEA and SAA. These analyses were repeated for data collected post-2000. Multiple sensitivity analyses were conducted to examine assumptions, including linearity. OUTCOMES Overall, SC declined appreciably between 1973 and 2018 (slope in the simple linear model: -0.87 million/ml/year, 95% CI: -0.89 to -0.86; P < 0.001). In an adjusted meta-regression model, which included two interaction terms [time × fertility group (P = 0.012) and time × continents (P = 0.058)], declines were seen among unselected men from NEA (-1.27; -1.78 to -0.77; P < 0.001) and unselected men from SAA (-0.65; -1.29 to -0.01; P = 0.045) and fertile men from NEA (-0.50; -1.00 to -0.01; P = 0.046). Among unselected men from all continents, the mean SC declined by 51.6% between 1973 and 2018 (-1.17: -1.66 to -0.68; P < 0.001). The slope for SC among unselected men was steeper in a model restricted to post-2000 data (-1.73: -3.23 to -0.24; P = 0.024) and the percent decline per year doubled, increasing from 1.16% post-1972 to 2.64% post-2000. Results were similar for TSC, with a 62.3% overall decline among unselected men (-4.70 million/year; -6.56 to -2.83; P < 0.001) in the adjusted meta-regression model. All results changed only minimally in multiple sensitivity analyses. WIDER IMPLICATIONS This analysis is the first to report a decline in sperm count among unselected men from South/Central America-Asia-Africa, in contrast to our previous meta-analysis that was underpowered to examine those continents. Furthermore, data suggest that this world-wide decline is continuing in the 21st century at an accelerated pace. Research on the causes of this continuing decline and actions to prevent further disruption of male reproductive health are urgently needed.
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Affiliation(s)
- Hagai Levine
- Braun School of Public Health and Community Medicine, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Niels Jørgensen
- Department of Growth and Reproduction, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Jaime Mendiola
- Division of Preventive Medicine and Public Health, University of Murcia School of Medicine and Biomedical Research Institute of Murcia (IMIB-Arrixaca-UMU), Murcia, Spain
| | - Dan Weksler-Derri
- Clalit Health Services, Kiryat Ono, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Maya Jolles
- Braun School of Public Health and Community Medicine, Hadassah Medical Center, The Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Rachel Pinotti
- Gustave L. and Janet W. Levy Library, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Shanna H Swan
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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19
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Souza MDCBD, Silva LABD, Sequeira FF, Azevedo Antunes RD, Souza MMD. The management of infertility for primary care physicians. Women Health 2023; 63:194-203. [PMID: 36696953 DOI: 10.1080/03630242.2023.2165599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
To conduct this review of primary care, we looked for related papers in PubMed from the last 15 years. WHO's initial concept of Health defined a condition of physical, mental, and social well-being, nowadays extended to quality of life. Infertility or not being able to form a family fits perfectly into the definition. Primary care is responsible for mandatory discussions about fertility as part of a broader aspect regarding reproductive health issues. Having children is a decision taken by heterosexual couples, same sex couples, or single individuals. Understanding factors associated with infertility help guiding propedeutic. Although woman's age is one of the main factors to influence treatment success rates, multifactorial male factor may contribute to 50 percent. Infertility consultations should include partners, alleviating the accompanying stress and anxiety. Anamnesis must focus on duration of infertility, primary or secondary, sexual activity, and lifestyle habits such as smoking, alcohol consumption, diet, physical activity, use of licit and/or illicit drugs, and occupational risks. Previous treatments should be accessed. Management of infertility by primary care is mandatory, and patients requiring specialized treatments must not have their journey protracted. Strategies and couple-based interventions are essential to continuity of care and close follow-up should follow these patients.
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Affiliation(s)
- Maria do Carmo Borges de Souza
- Centro de Reproducao Humana, Fertipraxis, Rio de Janeiro, Brazil.,UFRJ - Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Roberto de Azevedo Antunes
- Centro de Reproducao Humana, Fertipraxis, Rio de Janeiro, Brazil.,UFRJ - Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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20
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Becatti M, Cito G, Argento FR, Fini E, Bettiol A, Borghi S, Mannucci A, Fucci R, Giachini C, Picone R, Emmi G, Taddei N, Coccia ME, Fiorillo C. Blood Leukocyte ROS Production Reflects Seminal Fluid Oxidative Stress and Spermatozoa Dysfunction in Idiopathic Infertile Men. Antioxidants (Basel) 2023; 12:antiox12020479. [PMID: 36830037 PMCID: PMC9952358 DOI: 10.3390/antiox12020479] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/10/2023] [Accepted: 02/11/2023] [Indexed: 02/16/2023] Open
Abstract
A large proportion of infertile men do not receive a clear diagnosis, being considered as idiopathic or unexplained cases due to infertility diagnosis based on standard semen parameters. Particularly in unexplained cases, the search for new indicators seems mandatory to provide specific information. In the etiopathogenesis of male infertility oxidative stress displays important roles by negatively affecting sperm quality and function. In this study, performed in a population of 34 idiopathic infertile men and in 52 age-matched controls, redox parameters were assessed in blood, leukocytes, spermatozoa, and seminal fluid and related to semen parameters. The main findings indicate that blood oxidative stress markers reflect seminal oxidative stress. Interestingly, blood leukocyte ROS production was significantly correlated to sperm ROS production and to semen parameters. Overall, these results suggest the potential employ of blood redox markers as a relevant and adjunctive tool for sperm quality evaluation aimed to preconception care.
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Affiliation(s)
- Matteo Becatti
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Firenze, 50134 Firenze, Italy
- Correspondence: ; Tel.: +39-055-2751261
| | - Gianmartin Cito
- Department of Experimental and Clinical Medicine, University of Firenze, 50134 Firenze, Italy
| | - Flavia Rita Argento
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Firenze, 50134 Firenze, Italy
| | - Eleonora Fini
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Firenze, 50134 Firenze, Italy
| | - Alessandra Bettiol
- Department of Experimental and Clinical Medicine, University of Firenze, 50134 Firenze, Italy
| | - Serena Borghi
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Firenze, 50134 Firenze, Italy
| | - Amanda Mannucci
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Firenze, 50134 Firenze, Italy
| | - Rossella Fucci
- Assisted Reproductive Technology Centre, Careggi University Hospital, 50134 Firenze, Italy
| | - Claudia Giachini
- Assisted Reproductive Technology Centre, Careggi University Hospital, 50134 Firenze, Italy
| | - Rita Picone
- Assisted Reproductive Technology Centre, Careggi University Hospital, 50134 Firenze, Italy
| | - Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Firenze, 50134 Firenze, Italy
| | - Niccolò Taddei
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Firenze, 50134 Firenze, Italy
| | | | - Claudia Fiorillo
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Firenze, 50134 Firenze, Italy
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21
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Tavalaee M, Naderi N, Esfandiari N, Nasr-Esfahani MH. Assisted Oocyte Activation following Intracytoplasmic Sperm Injection: A Sensible Option for Infertile Couples with Severe Teratozoospermia. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2023; 17:92-98. [PMID: 36906825 PMCID: PMC10009512 DOI: 10.22074/ijfs.2023.1973580.1395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Indexed: 03/13/2023]
Abstract
The intracytoplasmic sperm injection (ICSI) has significantly improved male factor infertility treatment; however, complete fertilization failure still occurs in 1-5% of ICSI treatment cycles mainly due to oocyte activation failure. It is estimated that around 40-70% of oocyte activation failure is associated with sperm factors after ICSI. Assisted oocyte activation (AOA) as an effective approach to avoid total fertilization failure (TFF) has been proposed following ICSI. In the literature, several procedures have been described to overcome failed oocyte activation. These include mechanical, electrical, or chemical stimuli initiating artificial Ca2+ rises in the cytoplasm of oocytes. AOA in couples with previous failed fertilization and those with globozoospermia has resulted in varying degrees of success. The aim of this review is to examine the available literature on AOA in teratozoospermic men undergoing ICSI-AOA and determine whether the ICSI-AOA should be considered as an adjunct fertility procedure for these patients.
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Affiliation(s)
- Marziyeh Tavalaee
- Department of Animal Biotechnology, Reproductive Biomedicine Research Center, Royan Institute for Biotechnology, ACECR, Isfahan, Iran
| | - Nushin Naderi
- Department of Animal Biotechnology, Reproductive Biomedicine Research Center, Royan Institute for Biotechnology, ACECR, Isfahan, Iran
| | - Navid Esfandiari
- Department of Obstetrics and Gynecology, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Mohammad Hossein Nasr-Esfahani
- Department of Animal Biotechnology, Reproductive Biomedicine Research Center, Royan Institute for Biotechnology, ACECR, Isfahan, Iran.,Isfahan Fertility and Infertility Center, Isfahan, Iran
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22
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Santi D, Spaggiari G, Morini D, Melli B, Dalla Valentina L, Aguzzoli L, Simoni M, Villani MT. Which sperm parameter limits could really guide the clinical decision in assisted reproduction? Andrology 2023; 11:143-154. [PMID: 36251334 DOI: 10.1111/andr.13323] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/16/2022] [Accepted: 10/08/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The predictive role of sperm motility and morphology was recently detected in a large sample of more than 20000 assisted reproductive technology (ART) fresh cycles. However, the complete ART procedure consisted of both fresh and frozen-embryos transfers and only a comprehensive evaluation of the entire process could really confirm if these parameters really predict the ART success. The aim of the study was to evaluate which sperm parameter could predict the success of ART. METHODS A retrospective, real-world data analysis was performed, enrolling all couples attending ART from 2008 to 2021, including both fresh and frozen cycles and both in vitro fertilization (IVF) and intra-cytoplasmic sperm injection (ICSI) procedures. RESULTS Fresh cycles success (considering live birth rate) was predicted by female age (1.04 [1.02-1.06]), injected oocytes (0.96 [0.93-0.99]), embryo number (0.79 [0.75-0.83]) and progressive sperm motility (0.98 [0.97-0.99]). On the contrary, frozen cycle outcomes were predicted only by sperm motility (0.97 [0.95-0.99]). This prediction was confirmed in IVF but not in ICSI cycles. CONCLUSION Both female and male parameters predicted the ART success considering the entire path. However, frozen cycle success was predicted only by progressive sperm motility in IVF cycles, suggesting that the potential amelioration of this male parameter is relevant to improve ART success. Those couples expected to obtain the highest embryos after fertilization (low female age and better semen parameters) will have more attempts with frozen cycles and thus would benefit from a potential treatment focused to improve sperm parameters.
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Affiliation(s)
- Daniele Santi
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Ospedale Civile of Baggiovara, Modena, Italy.,Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Giorgia Spaggiari
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Ospedale Civile of Baggiovara, Modena, Italy
| | - Daria Morini
- Department of Obstetrics and Gynaecology, Fertility Centre, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Beatrice Melli
- Department of Obstetrics and Gynaecology, Fertility Centre, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Leonardo Dalla Valentina
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Ospedale Civile of Baggiovara, Modena, Italy.,Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Lorenzo Aguzzoli
- Department of Obstetrics and Gynaecology, Fertility Centre, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Manuela Simoni
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, Ospedale Civile of Baggiovara, Modena, Italy.,Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Maria Teresa Villani
- Department of Obstetrics and Gynaecology, Fertility Centre, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
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23
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Blaurock J, Baumann S, Grunewald S, Schiller J, Engel KM. Metabolomics of Human Semen: A Review of Different Analytical Methods to Unravel Biomarkers for Male Fertility Disorders. Int J Mol Sci 2022; 23:ijms23169031. [PMID: 36012302 PMCID: PMC9409482 DOI: 10.3390/ijms23169031] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/10/2022] [Accepted: 08/11/2022] [Indexed: 12/01/2022] Open
Abstract
Background: Human life without sperm is not possible. Therefore, it is alarming that the fertilizing ability of human spermatozoa is continuously decreasing. The reasons for that are widely unknown, but there is hope that metabolomics-based investigations may be able to contribute to overcoming this problem. This review summarizes the attempts made so far. Methods: We will discuss liquid chromatography–mass spectrometry (LC-MS), gas chromatography (GC), infrared (IR) and Raman as well as nuclear magnetic resonance (NMR) spectroscopy. Almost all available studies apply one of these methods. Results: Depending on the methodology used, different compounds can be detected, which is (in combination with sophisticated methods of bioinformatics) helpful to estimate the state of the sperm. Often, but not in all cases, there is a correlation with clinical parameters such as the sperm mobility. Conclusions: LC-MS detects the highest number of metabolites and can be considered as the method of choice. Unfortunately, the reproducibility of some studies is poor, and, thus, further improvements of the study designs are needed to overcome this problem. Additionally, a stronger focus on the biochemical consequences of the altered metabolite concentrations is also required.
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Affiliation(s)
- Janet Blaurock
- Training Center of the European Academy of Andrology (EAA), Dermatology, Venerology and Allergology Clinic, University Hospital Leipzig, 04103 Leipzig, Germany
| | - Sven Baumann
- Faculty of Medicine, Institute of Legal Medicine, Leipzig University, 04103 Leipzig, Germany
| | - Sonja Grunewald
- Training Center of the European Academy of Andrology (EAA), Dermatology, Venerology and Allergology Clinic, University Hospital Leipzig, 04103 Leipzig, Germany
| | - Jürgen Schiller
- Faculty of Medicine, Institute for Medical Physics and Biophysics, Leipzig University, 04107 Leipzig, Germany
| | - Kathrin M. Engel
- Training Center of the European Academy of Andrology (EAA), Dermatology, Venerology and Allergology Clinic, University Hospital Leipzig, 04103 Leipzig, Germany
- Faculty of Medicine, Institute for Medical Physics and Biophysics, Leipzig University, 04107 Leipzig, Germany
- Correspondence:
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Paffoni A, Somigliana E, Boeri L, Viganò P. The statistical foundation of the reference population for semen analysis included in the sixth edition of the WHO manual: a critical reappraisal of the evidence. Hum Reprod 2022; 37:2237-2245. [PMID: 35849333 PMCID: PMC9527466 DOI: 10.1093/humrep/deac161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 06/28/2022] [Indexed: 11/28/2022] Open
Abstract
In the most recent version of the ‘WHO Laboratory Manual For The Examination And Processing Of Human Semen’, the updated target population used to infer reference values included 3589 fertile subjects, representative of 12 countries and 5 continents, and 10 studies. We have critically evaluated the newly proposed distribution of semen examination results using an approach borrowed from clinical chemistry laboratories and based on the recommendations of the International Federation of Clinical Chemistry for estimation of reference intervals. Surprisingly, most prerequisites to produce common reference intervals through multicentric data were not met. Moreover, when we assessed with the bootstrap method the descriptive reference values obtained from raw data of the 10 individual studies for sperm concentration, sperm number, motility and normal forms, we found that none of the populations was completely correctly described by the reference centiles. We concluded that aggregated data used to build the reference distribution cannot be considered to originate from the same population, and this can result from real differences among individuals or different methodological approaches used in the various studies. Transferability conditions across studies did not seem to have been met. Our findings strengthen the relevance of concerns regarding the use of reference populations in the World Health Organization manual to discriminate between fertile and infertile men.
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Affiliation(s)
| | - Edgardo Somigliana
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Infertility Unit, Milan, Italy.,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Luca Boeri
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Urology, Milan, Italy
| | - Paola Viganò
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Infertility Unit, Milan, Italy
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25
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Vasconcelos A, Henedi Z, Barratt CLR. WHO 2021 and 2030 reference values for semen assessment: three challenges for andrology in the journey ahead. Reprod Biomed Online 2022; 45:187-190. [DOI: 10.1016/j.rbmo.2022.03.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 03/29/2022] [Indexed: 10/18/2022]
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