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Peel A, Saini A, Deluao JC, McPherson NO. Sperm DNA damage: The possible link between obesity and male infertility, an update of the current literature. Andrology 2023; 11:1635-1652. [PMID: 36789664 DOI: 10.1111/andr.13409] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/13/2023] [Accepted: 02/08/2023] [Indexed: 02/16/2023]
Abstract
Obesity prevalence worldwide is increasing significantly. Whilst maternal obesity has clear detrimental impacts on fertility, pregnancy and foetal outcomes, more recently there has been an increasing focus on the role of paternal obesity in human fertility. Recent meta-analyses have indicated that obesity in men negatively affects basic sperm parameters such as sperm count, concentration and motility, increases the incidence of infertility and reduces the chances of conception. Sperm DNA damage, typically characterised by DNA strand breaks and oxidation of DNA nucleotides, is a specialised marker of sperm quality that has been independently associated with recurrent miscarriage, reduced assisted reproduction success and increased mutational loads in subsequent offspring. Whilst, there are still conflicting data in humans as to the association of obesity in men with sperm DNA damage, evidence from rodent models is clear, indicating that male obesity increases sperm DNA damage. Human data are often conflicting because of the large heterogeneity amongst studies, the use of body mass index as the indicator of obesity and the methods used for detection of sperm DNA damage. Furthermore, comorbidities of obesity (i.e., heat stress, adipokines, insulin resistance, changes in lipids, hypogonadism and obstructive sleep apnoea) are also independently associated with increased sperm DNA damage that is not always modified in men with obesity, and as such may provide a causative link to the discrepancies amongst human studies. In this review, we provide an update on the literature regarding the associations between obesity in men and fertility, basic sperm parameters and sperm DNA damage. We further discuss potential reasons for the discrepancies in the literature and outline possible direct and indirect mechanisms of increased sperm DNA damage resulting from obesity. Finally, we summarise intergenerational obesity through the paternal linage and how sperm DNA damage may contribute to the transmission.
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Affiliation(s)
- Andrew Peel
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
- Freemasons Centre for Male Health and Wellbeing, The University of Adelaide, Adelaide, South Australia, Australia
- Adelaide Health and Medical School, School of Biomedicine, Discipline of Reproduction and Development, The University of Adelaide, Adelaide, South Australia, Australia
| | - Anmol Saini
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
- Adelaide Health and Medical School, School of Biomedicine, Discipline of Reproduction and Development, The University of Adelaide, Adelaide, South Australia, Australia
| | - Joshua C Deluao
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
- Freemasons Centre for Male Health and Wellbeing, The University of Adelaide, Adelaide, South Australia, Australia
- Adelaide Health and Medical School, School of Biomedicine, Discipline of Reproduction and Development, The University of Adelaide, Adelaide, South Australia, Australia
| | - Nicole O McPherson
- Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
- Freemasons Centre for Male Health and Wellbeing, The University of Adelaide, Adelaide, South Australia, Australia
- Adelaide Health and Medical School, School of Biomedicine, Discipline of Reproduction and Development, The University of Adelaide, Adelaide, South Australia, Australia
- Repromed IVF Adelaide, Dulwich, South Australia, Australia
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Calogero AE, Cannarella R, Agarwal A, Hamoda TAAAM, Rambhatla A, Saleh R, Boitrelle F, Ziouziou I, Toprak T, Gul M, Avidor-Reiss T, Kavoussi P, Chung E, Birowo P, Ghayda RA, Ko E, Colpi G, Dimitriadis F, Russo GI, Martinez M, Calik G, Kandil H, Salvio G, Mostafa T, Lin H, Park HJ, Gherabi N, Phuoc NHV, Quang N, Adriansjah R, La Vignera S, Micic S, Durairajanayagam D, Serefoglu EC, Karthikeyan VS, Kothari P, Atmoko W, Shah R. The Renaissance of Male Infertility Management in the Golden Age of Andrology. World J Mens Health 2023; 41:237-254. [PMID: 36649928 PMCID: PMC10042649 DOI: 10.5534/wjmh.220213] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 10/15/2022] [Indexed: 01/18/2023] Open
Abstract
Infertility affects nearly 186 million people worldwide and the male partner is the cause in about half of the cases. Meta-regression data indicate an unexplained decline in sperm concentration and total sperm count over the last four decades, with an increasing prevalence of male infertility. This suggests an urgent need to implement further basic and clinical research in Andrology. Andrology developed as a branch of urology, gynecology, endocrinology, and, dermatology. The first scientific journal devoted to andrological sciences was founded in 1969. Since then, despite great advancements, andrology has encountered several obstacles in its growth. In fact, for cultural reasons, the male partner has often been neglected in the diagnostic and therapeutic workup of the infertile couple. Furthermore, the development of assisted reproductive techniques (ART) has driven a strong impression that this biotechnology can overcome all forms of infertility, with a common belief that having a spermatozoon from a male partner (a sort of sperm donor) is all that is needed to achieve pregnancy. However, clinical practice has shown that the quality of the male gamete is important for a successful ART outcome. Furthermore, the safety of ART has been questioned because of the high prevalence of comorbidities in the offspring of ART conceptions compared to spontaneous conceptions. These issues have paved the way for more research and a greater understanding of the mechanisms of spermatogenesis and male infertility. Consequently, numerous discoveries have been made in the field of andrology, ranging from genetics to several "omics" technologies, oxidative stress and sperm DNA fragmentation, the sixth edition of the WHO manual, artificial intelligence, management of azoospermia, fertility in cancers survivors, artificial testis, 3D printing, gene engineering, stem cells therapy for spermatogenesis, and reconstructive microsurgery and seminal microbiome. Nevertheless, as many cases of male infertility remain idiopathic, further studies are required to improve the clinical management of infertile males. A multidisciplinary strategy involving both clinicians and scientists in basic, translational, and clinical research is the core principle that will allow andrology to overcome its limits and reach further goals. This state-of-the-art article aims to present a historical review of andrology, and, particularly, male infertility, from its "Middle Ages" to its "Renaissance", a golden age of andrology.
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Affiliation(s)
- Aldo E Calogero
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Rossella Cannarella
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
- Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ashok Agarwal
- Global Andrology Forum, Moreland Hills, OH, USA
- Cleveland Clinic Foundation, Cleveland, OH, USA.
| | - Taha Abo-Almagd Abdel-Meguid Hamoda
- Department of Urology, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Urology, Faculty of Medicine, Minia University, Minia, Egypt
| | - Amarnath Rambhatla
- Department of Urology, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA
| | - Ramadan Saleh
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt
- Ajyal IVF Center, Ajyal Hospital, Sohag, Egypt
| | - Florence Boitrelle
- Reproductive Biology, Fertility Preservation, Andrology, CECOS, Poissy Hospital, Poissy, France
- Department of Biology, Reproduction, Epigenetics, Environment and Development, Paris Saclay University, UVSQ, INRAE, BREED, Jouy-en-Josas, France
| | - Imad Ziouziou
- Department of Urology, College of Medicine and Pharmacy, Ibn Zohr University, Agadir, Morocco
| | - Tuncay Toprak
- Department of Urology, Fatih Sultan Mehmet Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Murat Gul
- Department of Urology, Selcuk University School of Medicine, Konya, Turkey
| | - Tomer Avidor-Reiss
- Department of Biological Sciences, University of Toledo, Toledo, OH, USA
- Department of Urology, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA
| | - Parviz Kavoussi
- Austin Fertility & Reproductive Medicine/Westlake IVF, Austin, TX, USA
| | - Eric Chung
- Department of Urology, Princess Alexandra Hospital, University of Queensland, Brisbane, Australia
| | - Ponco Birowo
- Department of Urology, Cipto Mangunkusumo General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Ramy Abou Ghayda
- Urology Institute, University Hospitals, Case Western Reserve University, Cleveland, OH, USA
| | - Edmund Ko
- Department of Urology, Loma Linda University Health, Loma Linda, CA, USA
| | | | - Fotios Dimitriadis
- Department of Urology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Marlon Martinez
- Section of Urology, Department of Surgery, University of Santo Tomas Hospital, Manila, Philippines
| | - Gokhan Calik
- Department of Urology, Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | | | - Gianmaria Salvio
- Department of Endocrinology, Polytechnic University of Marche, Ancona, Italy
| | - Taymour Mostafa
- Department of Andrology, Sexology and STIs, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Haocheng Lin
- Department of Urology, Peking University Third Hospital, Peking University, Beijing, China
| | - Hyun Jun Park
- Department of Urology, Pusan National University School of Medicine, Busan, Korea
- Medical Research Institute of Pusan National University Hospital, Busan, Korea
| | - Nazim Gherabi
- Faculty of Medicine, Algiers University, Algiers, Algeria
| | | | - Nguyen Quang
- Center for Andrology and Sexual Medicine, Viet Duc University Hospital, Hanoi, Vietnam
- Department of Urology, Andrology and Sexual Medicine, University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
| | - Ricky Adriansjah
- Department of Urology, Faculty of Medicine Universitas Padjadjaran, Hasan Sadikin General Hospital, Banding, Indonesia
| | - Sandro La Vignera
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Sava Micic
- Department of Andrology, Uromedica Polyclinic, Belgrade, Serbia
| | - Damayanthi Durairajanayagam
- Department of Physiology, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Selangor, Malaysia
| | - Ege Can Serefoglu
- Department of Urology, Biruni University School of Medicine, Istanbul, Turkey
| | | | - Priyank Kothari
- Department of Urology, B.Y.L Nair Ch Hospital, Mumbai, India
| | - Widi Atmoko
- Department Department of Urology, Dr. Cipto Mangunkusumo General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Rupin Shah
- Division of Andrology, Department of Urology, Lilavati Hospital and Research Centre, Mumbai, India
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Bastug Y, Tokuc E, Bastug N, Artuk I, Tosun C, Cakiroglu HS, Aykan S. Systemic immune-inflammation index, neutrophil-lymphocyte ratio and platelet-lymphocyte ratio are predictors of sperm presence in microdissection testicular sperm extraction. Andrologia 2022; 54:e14419. [PMID: 35266170 DOI: 10.1111/and.14419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/25/2022] [Accepted: 03/01/2022] [Indexed: 12/18/2022] Open
Abstract
The aim of this study is to evaluate the value of the haematologic inflammatory parameters in predicting sperm retrieval rates during microdissection testicular sperm extraction (micro-TESE).159 patients diagnosed with non-obstructive azoospermia were included in the study. After excluding the patients that do not fit the inclusion criteria, age, smoking status, body-mass index, serum luteinizing hormone, follicle-stimulating hormone, total testosterone levels and neutrophil, lymphocyte and platelet counts were recorded. Neutrophil-lymphocyte ratio, platelet-lymphocyte ratio and systemic immune-inflammation index were calculated. The primary outcome was defined as the presence of spermatozoa during the procedure and the association between the candidate predictors and primary endpoint were evaluated by logistic regression analysis. Then, a baseline model from age, smoking, body-mass index and hormonal levels was built. Ratios and indexes were included, respectively, and were compared by multivariate analyses. Each of all three parameters was an independent predictor of obtaining spermatozoa during micro-TESE procedure (all p < 0.001). Even though all three parameters were significant, neutrophil-lymphocyte ratio and systemic immune-inflammation index stood out as more powerful than platelet-lymphocyte ratio (p < 0.08, p < 0.08 respectively). Additionally, adding these parameters individually to the baseline model significantly empowered the predictive value (all p < 0.001). Using haematologic inflammatory parameters in the prediction of sperm presence during microdissection testicular sperm extraction may be helpful when consulting the patient with having a better foresight of the procedural outcomes.
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Affiliation(s)
- Yavuz Bastug
- Department of Urology, Haydarpasa Numune SUAM, University of Health Sciences, Istanbul, Turkey
| | - Emre Tokuc
- Department of Urology, Haydarpasa Numune SUAM, University of Health Sciences, Istanbul, Turkey
| | - Nesrin Bastug
- Department of Gynecology and Obstetrics and IVF Unit, Emsey Hospital, Istanbul, Turkey
| | - Ilker Artuk
- Department of Urology, Haydarpasa Numune SUAM, University of Health Sciences, Istanbul, Turkey
| | - Cagatay Tosun
- Department of Urology, Haydarpasa Numune SUAM, University of Health Sciences, Istanbul, Turkey
| | - Halime Sena Cakiroglu
- Department of Gynecology and Obstetrics, Zeynep Kamil SUAM, University of Health Sciences, Istanbul, Turkey
| | - Serdar Aykan
- Urology Clinic, Emsey Hospital, Istanbul, Turkey
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