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Henkel R. Leukocytospermia and/or Bacteriospermia: Impact on Male Infertility. J Clin Med 2024; 13:2841. [PMID: 38792382 PMCID: PMC11122306 DOI: 10.3390/jcm13102841] [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: 04/05/2024] [Revised: 05/07/2024] [Accepted: 05/07/2024] [Indexed: 05/26/2024] Open
Abstract
Infertility is a globally underestimated public health concern affecting almost 190 million people, i.e., about 17.5% of people during their lifetime, while the prevalence of male factor infertility is about 7%. Among numerous other causes, the prevalence of male genital tract infections reportedly ranges between 10% and 35%. Leukocytospermia is found in 30% of infertile men and up to 20% in fertile men. Bacterial infections cause an inflammatory response attracting leukocytes, which produce reactive oxygen species (ROS) and release cytokines, both of which can cause damage to sperm, rendering them dysfunctional. Although leukocytospermia and bacteriospermia are both clinical conditions that can negatively affect male fertility, there is still debate about their impact on assisted reproduction outcomes and management. According to World Health Organization (WHO) guidelines, leukocytes should be determined by means of the Endtz test or with monoclonal antibodies against CD15, CD68 or CD22. The cut-off value proposed by the WHO is 1 × 106 peroxidase-positive cells/mL. For bacteria, Gram staining and semen culture are regarded as the "gold standard", while modern techniques such as PCR and next-generation sequencing (NGS) are allowing clinicians to detect a wider range of pathogens. Whereas the WHO manual does not specify a specific value as a cut-off for bacterial contamination, several studies consider semen samples with more than 103 colony-forming units (cfu)/mL as bacteriospermic. The pathogenic mechanisms leading to sperm dysfunction include direct interaction of bacteria with the male germ cells, bacterial release of spermatotoxic substances, induction of pro-inflammatory cytokines and ROS, all of which lead to oxidative stress. Clinically, bacterial infections, including "silent" infections, are treatable, with antibiotics being the treatment of choice. Yet, non-steroidal antiphlogistics or antioxidants should also be considered to alleviate inflammatory lesions and improve semen quality. In an assisted reproduction set up, sperm separation techniques significantly reduce the bacterial load in the semen. Nonetheless, contamination of the semen sample with skin commensals should be prevented by applying relevant hygiene techniques. In patients where leukocytospermia is detected, the causes (e.g. infection, inflammation, varicocele, smoking, etc.) of the leukocyte infiltration have to be identified and addressed with antibiotics, anti-inflammatories or antioxidants in cases where high oxidative stress levels are detected. However, no specific strategy is available for the management of leukocytospermia. Therefore, the relationship between bacteriospermia and leukocytospermia as well as their specific impact on functional sperm parameters and reproductive outcome variables such as fertilization or clinical pregnancy must be further investigated. The aim of this narrative review is to provide an update on the current knowledge on leukocytospermia and bacteriospermia and their impact on male fertility.
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Affiliation(s)
- Ralf Henkel
- LogixX Pharma Ltd., Merlin House, Brunel Road, Theale, Reading RG7 4AB, UK;
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London W12 0HS, UK
- Department of Medical Bioscience, University of the Western Cape, Bellville 7535, South Africa
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2
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Alhamam A, Garabed LR, Julian S, Flannigan R. The association of medications and supplements with human male reproductive health: a systematic review. Fertil Steril 2023; 120:1112-1137. [PMID: 37898470 DOI: 10.1016/j.fertnstert.2023.10.021] [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: 09/07/2023] [Revised: 10/20/2023] [Accepted: 10/23/2023] [Indexed: 10/30/2023]
Abstract
Some medications used to treat comorbidities and conditions in reproductive-aged individuals could have a negative impact on fertility. This may occur through hormonal disruption, toxicity to germ cells and spermatozoa, functional impact on the sperm, teratogenicity potential, or ejaculatory abnormalities. Having knowledge of these potential interactions between medications and reproductive potential is important for clinicians to be aware of and guide the patient, along with their treating clinicians, to reproductively favorable alternatives when available. This review aims to summarize the state of the literature regarding medication interactions with human male reproduction using the Anatomical Therapeutic Chemical Classification System of medications.
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Affiliation(s)
- Abdullah Alhamam
- Department of Urologic Sciences, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Department of Urology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Laurianne Rita Garabed
- Division of Urology, Department of Surgery, University of Montreal, Montreal, Quebec, Canada
| | - Sania Julian
- Department of Urologic Sciences, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ryan Flannigan
- Department of Urologic Sciences, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Department of Urology, Weill Cornell Medicine, New York, New York.
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3
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Saint F, Huyghe E, Methorst C, Priam A, Seizilles de Mazancourt E, Bruyère F, Faix A. [Infections and male infertility]. Prog Urol 2023; 33:636-652. [PMID: 38012909 DOI: 10.1016/j.purol.2023.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/08/2023] [Accepted: 09/12/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND The role of urogenital infections in male infertility has long been the subject of debate. METHODS A bibliographic search limited to English-language literature on human subjects published before 5/2023 resulted in the selection of 189 articles. RESULTS Male infertility is often of multifactorial aetiology, and to optimise the prognosis it is important to manage all the factors that can be corrected, including infectious causes, which represent one of the most frequent aetiologies. The infectious agents involved in urogenital infections are most often bacterial or viral, and more rarely parasitic. They can infect the seminal tract, male accessory glands and/or testicles, and usually result in inflammation and increased oxidative stress. These infections reduce male fertility, in particular by altering spermogram parameters and increasing sperm DNA fragmentation. For these reasons, the search for a urogenital infection should be systematic, involving a careful history and clinical examination, ultrasound and systematic bacteriological tests guided by clinical findings. Aetiological treatment may be proposed depending on the picture and the germ involved. CONCLUSION This review should help the urologist to establish an accurate diagnosis of the form and extent of the infection, and enable him to define an appropriate therapeutic strategy, tailored to the patient, in order to obtain the best chances of improving male fertility.
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Affiliation(s)
- F Saint
- Service d'urologie-transplantation, CHU Amiens Picardie, Amiens, France; Laboratoire EPROAD EA 4669, université Picardie Jules-Verne, Amiens, France
| | - E Huyghe
- Département d'urologie, hôpital de Rangueil, CHU de Toulouse, Toulouse, France; Service de médecine de la reproduction, hôpital Paule-de-Viguier, CHU de Toulouse, Toulouse, France; UMR DEFE, Inserm 1203, université de Toulouse, université de Montpellier, Montpellier, France.
| | - C Methorst
- Service de médecine de la reproduction, hôpital des 4 villes, Saint-Cloud, France
| | - A Priam
- Service d'urologie-transplantation, CHU Amiens Picardie, Amiens, France
| | | | - F Bruyère
- Urologie, CHRU de Tours, Tours, France
| | - A Faix
- Clinique Saint-Roch, 560, avenue du Colonel-Pavelet-dit-Villars, 34000 Montpellier, France
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4
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Wang Y, Su M, Chen Y, Huang X, Ruan L, Lv Q, Li L. Research progress on the role and mechanism of DNA damage repair in germ cell development. Front Endocrinol (Lausanne) 2023; 14:1234280. [PMID: 37529603 PMCID: PMC10390305 DOI: 10.3389/fendo.2023.1234280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 06/28/2023] [Indexed: 08/03/2023] Open
Abstract
In the complex and dynamic processes of replication, transcription, and translation of DNA molecules, a large number of replication errors or damage can occur which lead to obstacles in the development process of germ cells and result in a decreased reproductive rate. DNA damage repair has attracted widespread attention due to its important role in the maintenance and regulation of germ cells. This study reports on a systematic review of the role and mechanism of DNA damage repair in germline development. First, the causes, detection methods, and repair methods of DNA damage, and the mechanism of DNA damage repair are summarized. Second, a summary of the causes of abnormal DNA damage repair in germ cells is introduced along with common examples, and the relevant effects of germ cell damage. Third, we introduce the application of drugs related to DNA damage repair in the treatment of reproductive diseases and related surgical treatment of abnormal DNA damage, and summarize various applications of DNA damage repair in germ cells. Finally, a summary and discussion is given of the current deficiencies in DNA damage repair during germ cell development and future research development. The purpose of this paper is to provide researchers engaged in relevant fields with a further systematic understanding of the relevant applications of DNA damage repair in germ cells and to gain inspiration from it to provide new research ideas for related fields.
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Affiliation(s)
- Yan Wang
- College of Basic Medical Sciences, China Three Gorges University, Yichang, Hubei, China
- College of Biology & Pharmacy, Yulin Normal University, Yulin, China
| | - Mengrong Su
- College of Basic Medical Sciences, China Three Gorges University, Yichang, Hubei, China
- College of Biology & Pharmacy, Yulin Normal University, Yulin, China
| | - Yujie Chen
- College of Biology & Pharmacy, Yulin Normal University, Yulin, China
| | - Xinyu Huang
- College of Biology & Pharmacy, Yulin Normal University, Yulin, China
| | - Lian Ruan
- College of Biology & Pharmacy, Yulin Normal University, Yulin, China
| | - Qizhuang Lv
- College of Basic Medical Sciences, China Three Gorges University, Yichang, Hubei, China
- College of Biology & Pharmacy, Yulin Normal University, Yulin, China
| | - Li Li
- College of Biology & Pharmacy, Yulin Normal University, Yulin, China
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5
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Rivero MJ, Kulkarni N, Thirumavalavan N, Ramasamy R. Evaluation and management of male genital tract infections in the setting of male infertility: an updated review. Curr Opin Urol 2023; 33:180-186. [PMID: 36861760 PMCID: PMC10073322 DOI: 10.1097/mou.0000000000001081] [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] [Indexed: 03/03/2023]
Abstract
PURPOSE OF REVIEW Male infertility may be secondary to male genital tract infection (MGTI) in an estimated 15% of cases. In the absence of overt clinical signs, evaluation for MGTI beyond semen analysis is not well established. Therefore, we review the literature on the evaluation and management of MGTI in the setting of male infertility. RECENT FINDINGS A set of international guidelines recommends semen culture and PCR testing, but the significance of positive results remains unclear. Clinical trials evaluating anti-inflammatory or antibiotic treatment report improvements in sperm parameters and leukocytospermia, but data on the effect on conception rates are lacking. Human papillomavirus (HPV) and the novel coronavirus (SARS-CoV-2) have been associated with poor semen parameters and decreased conception rates. SUMMARY The finding of leukocytospermia on semen analysis prompts further evaluation for MGTI, including focused physical examination. The role of routine semen culture is controversial. Treatment options include anti-inflammatories; frequent ejaculation; and antibiotics, which should not be used in the absence of symptoms or microbiological infection. SARS-CoV-2 represents a subacute threat to fertility that should be screened for in the reproductive history along with HPV and other viruses.
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Affiliation(s)
- Marco-Jose Rivero
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL
- Case Western Reserve University School of Medicine, Cleveland, OH
| | - Nikhil Kulkarni
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL
| | - Nannan Thirumavalavan
- Case Western Reserve University School of Medicine, Cleveland, OH
- Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Ranjith Ramasamy
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL
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Noweir HA, Modgil V, Pearce I. Male accessory gland inflammation (MAGI): an evolving entity. JOURNAL OF CLINICAL UROLOGY 2022. [DOI: 10.1177/2051415820987687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Male accessory gland infection (MAGI) is a generic acronym indicating inflammatory conditions affecting the prostate gland, seminal vesicles, the ductus deferens and the epididymis. It is a frequent disease, mostly with a chronic course. Majority of the MAGIs remain asymptomatic, thereby leading to a debate whether to treat these patients or not. The primary criterion for MAGI was suggested by Comhaire and colleagues in 1980. The role of MAGI in causing infertility and sexual dysfunctions has long been a matter of debate. The most recent studies show that MAGI could alter, with various mechanisms, both conventional and biofunctional sperm parameters, and determine worst reproductive outcome. This article provides an overview of up-to-date research findings about MAGI with special focus on data published on its impact on fertility; and diagnostic criteria including cellular and seminal biomarkers along with the promising results of emerging proteomic platforms for the identification of MAGI.
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Affiliation(s)
- Hosam A. Noweir
- Manchester Royal Infirmary, Manchester University Foundation Trust, UK
| | - Vaibhav Modgil
- Manchester Royal Infirmary, Manchester University Foundation Trust, UK
| | - Ian Pearce
- Manchester Royal Infirmary, Manchester University Foundation Trust, UK
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7
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Ferlin A, Calogero AE, Krausz C, Lombardo F, Paoli D, Rago R, Scarica C, Simoni M, Foresta C, Rochira V, Sbardella E, Francavilla S, Corona G. Management of male factor infertility: position statement from the Italian Society of Andrology and Sexual Medicine (SIAMS) : Endorsing Organization: Italian Society of Embryology, Reproduction, and Research (SIERR). J Endocrinol Invest 2022; 45:1085-1113. [PMID: 35075609 DOI: 10.1007/s40618-022-01741-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 01/05/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE Infertility affects 15-20% of couples and male factors are present in about half of the cases. For many aspects related to the diagnostic and therapeutic approach of male factor infertility, there is no general consensus, and the clinical approach is not uniform. METHODS In the present document by the Italian Society of Andrology and Sexual Medicine (SIAMS), endorsed by the Italian Society of Embryology, Reproduction, and Research (SIERR), we propose evidence-based recommendations for the diagnosis, treatment, and management of male factor infertility to improve patient and couple care. RESULTS Components of the initial evaluation should include at minimum medical history, physical examination, and semen analysis. Semen microbiological examination, endocrine assessment, and imaging are suggested in most men and recommended when specific risk factors for infertility exist or first-step analyses showed abnormalities. Full examination including genetic tests, testicular cytology/histology, or additional tests on sperm is clinically oriented and based on the results of previous investigations. For treatment purposes, the identification of the specific cause and the pathogenetic mechanism is advisable. At least, distinguishing pre-testicular, testicular, and post-testicular forms is essential. Treatment should be couple-oriented, including lifestyle modifications, etiologic therapies, empirical treatments, and ART on the basis of best evidence and with a gradual approach. CONCLUSION These Guidelines are based on two principal aspects: they are couple-oriented and place high value in assessing, preventing, and treating risk factors for infertility. These Guidelines also highlighted that male infertility and in particular testicular function might be a mirror of general health of a man.
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Affiliation(s)
- A Ferlin
- Department of Medicine, Unit of Andrology and Reproductive Medicine, University of Padova, Via Giustiniani 2, 35121, Padua, Italy.
| | - A E Calogero
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - C Krausz
- Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', University of Florence, Florence, Italy
| | - F Lombardo
- Department of Experimental Medicine, Laboratory of Seminology-Sperm Bank "Loredana Gandini", University of Rome "La Sapienza", Rome, Italy
| | - D Paoli
- Department of Experimental Medicine, Laboratory of Seminology-Sperm Bank "Loredana Gandini", University of Rome "La Sapienza", Rome, Italy
| | - R Rago
- Department of Gender, Parenting, Child and Adolescent Medicine, Physiopathology of Reproduction and Andrology Unit, Sandro Pertini Hospital, Rome, Italy
| | - C Scarica
- European Hospital, Centre for Reproductive Medicine, Rome, Italy
| | - M Simoni
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - C Foresta
- Department of Medicine, Unit of Andrology and Reproductive Medicine, University of Padova, Via Giustiniani 2, 35121, Padua, Italy
| | - V Rochira
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - E Sbardella
- Department of Experimental Medicine, University of Rome "La Sapienza", Rome, Italy
| | - S Francavilla
- Department of Life, Health and Environmental Sciences, Unit of Andrology, University of L'Aquila, L'Aquila, Italy
| | - G Corona
- Medical Department, Endocrinology Unit, Maggiore-Bellaria Hospital, Azienda Usl, Bologna, Italy
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8
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Minhas S, Bettocchi C, Boeri L, Capogrosso P, Carvalho J, Cilesiz NC, Cocci A, Corona G, Dimitropoulos K, Gül M, Hatzichristodoulou G, Jones TH, Kadioglu A, Martínez Salamanca JI, Milenkovic U, Modgil V, Russo GI, Serefoglu EC, Tharakan T, Verze P, Salonia A. European Association of Urology Guidelines on Male Sexual and Reproductive Health: 2021 Update on Male Infertility. Eur Urol 2021; 80:603-620. [PMID: 34511305 DOI: 10.1016/j.eururo.2021.08.014] [Citation(s) in RCA: 223] [Impact Index Per Article: 74.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 08/20/2021] [Indexed: 12/19/2022]
Abstract
CONTEXT The European Association of Urology (EAU) has updated its guidelines on sexual and reproductive health for 2021. OBJECTIVE To present a summary of the 2021 version of the EAU guidelines on sexual and reproductive health, including advances and areas of controversy in male infertility. EVIDENCE ACQUISITION The panel performed a comprehensive literature review of novel data up to January 2021. The guidelines were updated and a strength rating for each recommendation was included that was based either on a systematic review of the literature or consensus opinion from the expert panel, where applicable. EVIDENCE SYNTHESIS The male partner in infertile couples should undergo a comprehensive urological assessment to identify and treat any modifiable risk factors causing fertility impairment. Infertile men are at a higher risk of harbouring and developing other diseases including malignancy and cardiovascular disease and should be screened for potential modifiable risk factors, such as hypogonadism. Sperm DNA fragmentation testing has emerged as a novel biomarker that can identify infertile men and provide information on the outcomes from assisted reproductive techniques. The role of hormone stimulation therapy in hypergonadotropic hypogonadal or eugonadal patients is controversial and is not recommended outside of clinical trials. Furthermore, there is insufficient evidence to support the widespread use of other empirical treatments and surgical interventions in clinical practice (such as antioxidants and surgical sperm retrieval in men without azoospermia). There is low-quality evidence to support the routine use of testicular fine-needle mapping as an alternative diagnostic and predictive tool before testicular sperm extraction (TESE) in men with nonobstructive azoospermia (NOA), and either conventional or microdissection TESE remains the surgical modality of choice for men with NOA. CONCLUSIONS All infertile men should undergo a comprehensive urological assessment to identify and treat any modifiable risk factors. Increasing data indicate that infertile men are at higher risk of cardiovascular mortality and of developing cancers and should be screened and counselled accordingly. There is low-quality evidence supporting the use of empirical treatments and interventions currently used in clinical practice; the efficacy of these therapies needs to be validated in large-scale randomised controlled trials. PATIENT SUMMARY Approximately 50% of infertility will be due to problems with the male partner. Therefore, all infertile men should be assessed by a specialist with the expertise to not only help optimise their fertility but also because they are at higher risk of developing cardiovascular disease and cancer long term and therefore require appropriate counselling and management. There are many treatments and interventions for male infertility that have not been validated in high-quality studies and caution should be applied to their use in routine clinical practice.
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Affiliation(s)
- Suks Minhas
- Department of Urology, Imperial Healthcare NHS Trust, Charing Cross Hospital, London, UK.
| | | | - Luca Boeri
- Department of Urology, Foundation IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Paolo Capogrosso
- Department of Urology and Andrology, Ospedale di Circolo and Macchi Foundation, Varese, Italy
| | - Joana Carvalho
- CPUP: Center for Psychology of Porto University, Faculty of Psychology and Educational Sciences, Porto University, Porto, Portugal
| | - Nusret Can Cilesiz
- Department of Urology, Taksim Training & Research Hospital, Istanbul, Turkey
| | - Andrea Cocci
- Department of Minimally Invasive and Robotic Urologic Surgery and Kidney Transplantation, University of Florence, Florence, Italy
| | - Giovanni Corona
- Endocrinology Unit, Medical Department, Maggiore-Bellaria Hospital, Bologna, Italy
| | - Konstantinos Dimitropoulos
- Academic Urology Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK; Department of Urology, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
| | - Murat Gül
- School of Medicine, Department of Urology, Selcuk University, Konya, Turkey
| | | | - Thomas Hugh Jones
- Centre for Diabetes and Endocrinology, Barnsley Hospital NHS Trust, Barnsley, UK
| | - Ates Kadioglu
- Department of Urology, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | | | - Uros Milenkovic
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Vaibhav Modgil
- Manchester Andrology Centre, Manchester Royal Infirmary, Manchester University Hospitals NHS Foundation Trust, UK
| | - Giorgio Ivan Russo
- Urology Section, Department of Surgery, University of Catania, Catania, Italy
| | - Ege Can Serefoglu
- Department of Urology, Biruni University School of Medicine, Istanbul, Turkey
| | - Tharu Tharakan
- Department of Urology, Imperial Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - Paolo Verze
- Department of Medicine and Surgery, Scuola Medica Salernitana, University of Salerno, Fisciano, Italy
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; University Vita-Salute San Raffaele, Milan, Italy
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9
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La Vignera S, Crafa A, Condorelli RA, Barbagallo F, Mongioì LM, Cannarella R, Compagnone M, Aversa A, Calogero AE. Ultrasound evaluation of patients with male accessory gland inflammation: a pictorial review. Andrology 2021; 9:1298-1305. [PMID: 33794059 PMCID: PMC8596784 DOI: 10.1111/andr.13011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/17/2021] [Accepted: 03/25/2021] [Indexed: 01/23/2023]
Abstract
Male accessory gland infection/inflammation (MAGI) is a major cause of male infertility. The importance of ultrasound evaluation in these patients is highly controversial, although evidence of its relevance has increased in recent years. Ultrasound criteria are an important element for confirming the clinical diagnosis. Furthermore, they help to localize the anatomical site or sites of the inflammatory process and in assessing its extension which, in turn, have different consequences on the seminological and symptomatic aspects. This article summarizes the clinical interpretations related to ultrasound aspects in patients with MAGI and the possible effects on the seminological, microbiological, endocrinologic, urological, sexological, and internist aspects.
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Affiliation(s)
- Sandro La Vignera
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Andrea Crafa
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Rosita A Condorelli
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Federica Barbagallo
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Laura M Mongioì
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Rossella Cannarella
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Michele Compagnone
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Antonio Aversa
- Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Aldo E Calogero
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
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10
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Haddad M, Stewart J, Xie P, Cheung S, Trout A, Keating D, Parrella A, Lawrence S, Rosenwaks Z, Palermo GD. Thoughts on the popularity of ICSI. J Assist Reprod Genet 2020; 38:101-123. [PMID: 33155089 PMCID: PMC7823003 DOI: 10.1007/s10815-020-01987-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 10/18/2020] [Indexed: 12/17/2022] Open
Abstract
Purpose Intracytoplasmic sperm injection (ICSI) is the most widely utilized assisted reproductive technique (ART) worldwide. In this feature, we review the early assisted fertilization attempts that eventually led to the development of ICSI, and discuss its current utilization in cases of male and non-male factor infertility. Methods We researched the literature related to the development, indications, and current use of ICSI, such as sperm structural abnormalities, male genetic indications, surgically retrieved sperm, high sperm chromatin fragmentation, oocyte dysmorphism, and preimplantation genetic testing (PGT). We also describe the potential future applications of ICSI. Results This review summarizes the early micromanipulation techniques that led to the inception of ICSI. We also explore its current indications, including non-male factor infertility, where its use is more controversial. Finally, we consider the benefits of future advancements in reproductive biology that may incorporate ICSI, such as in vitro spermatogenesis, neogametogenesis, and heritable genome editing. Conclusion The versatility, consistency, and reliability of ICSI have made it the most prevalently utilized ART procedure worldwide.
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Affiliation(s)
- Mounia Haddad
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Joshua Stewart
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Philip Xie
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Stephanie Cheung
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Aysha Trout
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Derek Keating
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Alessandra Parrella
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Sherina Lawrence
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Zev Rosenwaks
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Gianpiero D Palermo
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, NY, USA.
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11
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Panner Selvam MK, Ambar RF, Agarwal A, Henkel R. Etiologies of sperm DNA damage and its impact on male infertility. Andrologia 2020; 53:e13706. [PMID: 32559347 DOI: 10.1111/and.13706] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 05/11/2020] [Accepted: 05/15/2020] [Indexed: 12/12/2022] Open
Abstract
Male factor is responsible for up to 50% of infertility cases in the world. Semen analysis is considered the cornerstone of laboratory evaluation of male infertility, but it has its own drawbacks and fails to predict the male fertility potential with high sensitivity and specificity. Different etiologies have been linked with male infertility, of which sperm DNA damage has gained significant attention with extensive research on sperm function tests. The associations between sperm DNA damage and a variety of disorders such as varicocele, obesity, cancer, radiation and lifestyle factors are explored in this review. Furthermore, we discuss the mechanisms of DNA damage as well as its impact in different scenarios of male infertility, associated with spontaneous and assisted reproduction. Finally, we review the clinical applicability of sperm DNA fragmentation testing in the management of male infertility.
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Affiliation(s)
| | - Rafael F Ambar
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA.,Sexual and Reproductive Medicine - Department of Urology, Faculdade de Medicina do ABC, Santo André, Brazil
| | - Ashok Agarwal
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Ralf Henkel
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA.,Department of Medical Bioscience, University of the Western Cape, Bellville, South Africa
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12
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Microbial contamination in assisted reproductive technology: source, prevalence, and cost. J Assist Reprod Genet 2019; 37:53-61. [PMID: 31823133 DOI: 10.1007/s10815-019-01640-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 11/21/2019] [Indexed: 10/25/2022] Open
Abstract
Even the strictest laboratories and clinics are prone to the occurrence of microbial contamination. In the case of in vitro fertilization (IVF) research and practice facilities, the number of possible sources is particularly vast. In addition to ambient air, personnel, and non-sterilized materials, follicular fluid and semen from patients are a very common gateway for a diverse range of bacteria and fungi into embryo cultures. Even so, reports of contamination cases are rare, what leads many clinics to see the issue as a negligible risk. Microbiological contamination may result in the demise of the patient's embryos, leading to additional costs to both the patient and the clinics. Regardless of financial loss, emotional costs, and stress levels during IVF are highly distressing. Other worrisome consequences include DNA fragmentation, poor-quality embryos, early pregnancy loss or preterm birth, and possible long-term damages that need further investigation. In this review, we aimed to shed a light on the issue that we consider largely underestimated and to be the underlying cause of poor IVF outcomes in many cases. We also discuss the composition of the microbiome and how its interaction with the reproductive tract of IVF-seeking patients might influence their outcomes. In conclusion, we urge clinics to more rigorously identify, register, and report contamination occurrences, and highlight the role of the study of the microbiome to improve overall results and safety of assisted reproduction.
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13
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Esteves SC, Santi D, Simoni M. An update on clinical and surgical interventions to reduce sperm DNA fragmentation in infertile men. Andrology 2019; 8:53-81. [DOI: 10.1111/andr.12724] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 09/17/2019] [Accepted: 10/08/2019] [Indexed: 12/18/2022]
Affiliation(s)
- Sandro C. Esteves
- ANDROFERT, Andrology and Human Reproduction Clinic Referral Center for Male Reproduction Campinas Brazil
- Department of Surgery (Division of Urology) University of Campinas (UNICAMP) Campinas Brazil
- Faculty of Health Aarhus University Aarhus Denmark
| | - Daniele Santi
- Department of Biomedical, Metabolic, and Neural Sciences University of Modena and Reggio Emilia Modena Italy
- Unit of Endocrinology Department of Medical Specialties Azienda Ospedaliero Universitaria Modena Italy
| | - Manuela Simoni
- Department of Biomedical, Metabolic, and Neural Sciences University of Modena and Reggio Emilia Modena Italy
- Unit of Endocrinology Department of Medical Specialties Azienda Ospedaliero Universitaria Modena Italy
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14
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The current status and future of andrology: A consensus report from the Cairo workshop group. Andrology 2019; 8:27-52. [PMID: 31692249 DOI: 10.1111/andr.12720] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 10/24/2019] [Accepted: 10/24/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND In attempting to formulate potential WHO guidelines for the diagnosis of male infertility, the Evidence Synthesis Group noted a paucity of high-quality data on which to base key recommendations. As a result, a number of authors suggested that key areas of research/evidence gaps should be identified, so that appropriate funding and policy actions could be undertaken to help address key questions. OBJECTIVES The overall objective of this Consensus workshop was to clarify current knowledge and deficits in clinical laboratory andrology, so that clear paths for future development could be navigated. MATERIALS AND METHODS Following a detailed literature review, each author, prior to the face-to-face meeting, prepared a summary of their topic and submitted a PowerPoint presentation. The topics covered were (a) Diagnostic testing in male fertility and infertility, (b) Male fertility/infertility in the modern world, (c) Clinical management of male infertility, and (d) The overuse of ICSI. At the meeting in Cairo on February 18, 2019, the evidence was presented and discussed and a series of consensus points agreed. RESULTS The paper presents a background and summary of the evidence relating to these four topics and addresses key points of significance. Following discussion of the evidence, a total of 36 consensus points were agreed. DISCUSSION The Discussion section presents areas where there was further debate and key areas that were highlighted during the day. CONCLUSION The consensus points provide clear statements of evidence gaps and/or potential future research areas/topics. Appropriate funding streams addressing these can be prioritized and consequently, in the short and medium term, answers provided. By using this strategic approach, andrology can make the rapid progress necessary to address key scientific, clinical, and societal challenges that face our discipline now and in the near future.
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Medikamentöse Therapie primär nichthormonell bedingter männlicher Fertilitätsstörungen. GYNAKOLOGISCHE ENDOKRINOLOGIE 2019. [DOI: 10.1007/s10304-019-00273-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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16
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Esteves SC. Interventions to Prevent Sperm DNA Damage Effects on Reproduction. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1166:119-148. [PMID: 31301050 DOI: 10.1007/978-3-030-21664-1_8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Excessive oxidation and antioxidant imbalance resulting from several conditions may cause sperm DNA damage, which, in turn, affect male fertility, both natural and assisted. Sperm DNA damage transferred to the embryo might also affect the health of offspring. Several conditions associated with excessive oxidative stress are modifiable by the use of specific treatments, lifestyle changes, and averting exposure to environmental/occupational toxicants. Here, we discuss the strategies to reduce sperm DNA damage with a focus on clinical and surgical interventions.
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Affiliation(s)
- Sandro C Esteves
- ANDROFERT, Andrology and Human Reproduction Clinic, Referral Center for Male Reproduction, Campinas, SP, Brazil. .,Department of Surgery (Division of Urology), University of Campinas (UNICAMP), Campinas, SP, Brazil. .,Faculty of Health, Aarhus University, Aarhus, Denmark.
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Brunner RJ, Demeter JH, Sindhwani P. Review of Guidelines for the Evaluation and Treatment of Leukocytospermia in Male Infertility. World J Mens Health 2018; 37:128-137. [PMID: 30644236 PMCID: PMC6479086 DOI: 10.5534/wjmh.180078] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 11/20/2018] [Accepted: 12/05/2018] [Indexed: 11/15/2022] Open
Abstract
Leukocytospermia is an ill-defined and poorly understood condition affecting up to 30% of male factor infertility. Current guidelines on leukocytospermia vary significantly, although it has been linked to increased rates of infertility, uncertainty about its clinical significance, diagnosis, and treatment remains. The guidelines are conflicting with sparse data scattered across different specialties and continents. This study aims to compare and contrast available international guidelines and recommendations. In addition to these guidelines, we sought to consolidate the findings of trials over the last several decades. English language articles on human observational studies, retrospective, prospective, clinical trials and randomized control trials were searched for using the following terms: "leukocytospermia, pyospermia, and male infertility." Articles about treatment and management of leukocytospermia that were published between January 2010 and April 2018 were included, as well as four articles referenced in best practice and guideline statements from urological and andrological associations. Disagreements on this topic are highlighted as some guidelines describe no correlation between leukocytospermia and infertility while others show that treatment leads to improvement of sperm quality by many measures including improved pregnancy rate. Various treatments have been suggested including antibiotics, anti-inflammatory medications, and frequent ejaculation. There is a need for definitive characterization of Leukocytospermia as an infectious or inflammatory marker and a re-evaluation of the leukocyte concentration threshold. Additional studies investigating rates of conception as a measure of outcome are needed, to provide greater level of evidence and generalizability of leukocytopsermia management.
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Affiliation(s)
- Robert J Brunner
- College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA
| | - Jonathan H Demeter
- Department of Urology, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA.
| | - Puneet Sindhwani
- Department of Urology, College of Medicine and Life Sciences, University of Toledo, Toledo, OH, USA
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Rayburn ER, Gao L, Ding J, Ding H, Shao J, Li H. FDA-approved drugs that are spermatotoxic in animals and the utility of animal testing for human risk prediction. J Assist Reprod Genet 2018; 35:191-212. [PMID: 29063992 PMCID: PMC5845034 DOI: 10.1007/s10815-017-1062-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 10/05/2017] [Indexed: 01/18/2023] Open
Abstract
PURPOSE This study reviews FDA-approved drugs that negatively impact spermatozoa in animals, as well as how these findings reflect on observations in human male gametes. METHODS The FDA drug warning labels included in the DailyMed database and the peer-reviewed literature in the PubMed database were searched for information to identify single-ingredient, FDA-approved prescription drugs with spermatotoxic effects. RESULTS A total of 235 unique, single-ingredient, FDA-approved drugs reported to be spermatotoxic in animals were identified in the drug labels. Forty-nine of these had documented negative effects on humans in either the drug label or literature, while 31 had no effect or a positive impact on human sperm. For the other 155 drugs that were spermatotoxic in animals, no human data was available. CONCLUSION The current animal models are not very effective for predicting human spermatotoxicity, and there is limited information available about the impact of many drugs on human spermatozoa. New approaches should be designed that more accurately reflect the findings in men, including more studies on human sperm in vitro and studies using other systems (ex vivo tissue culture, xenograft models, in silico studies, etc.). In addition, the present data is often incomplete or reported in a manner that prevents interpretation of their clinical relevance. Changes should be made to the requirements for pre-clinical testing, drug surveillance, and the warning labels of drugs to ensure that the potential risks to human fertility are clearly indicated.
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Affiliation(s)
| | - Liang Gao
- Department of Clinical Laboratory Sciences, Nantong Maternity and Child Health Hospital, Nantong, 226018, China
| | - Jiayi Ding
- Department of Reproductive Medicine, Nantong Maternity and Child Health Hospital, Nantong, 226018, China
| | - Hongxia Ding
- Pharmacodia (Beijing) Co., Ltd, Beijing, 100085, China
| | - Jun Shao
- Department of Reproductive Medicine, Nantong Maternity and Child Health Hospital, Nantong, 226018, China
| | - Haibo Li
- Department of Clinical Laboratory Sciences, Nantong Maternity and Child Health Hospital, Nantong, 226018, China.
- Department of Reproductive Medicine, Nantong Maternity and Child Health Hospital, Nantong, 226018, China.
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Calogero AE, Duca Y, Condorelli RA, La Vignera S. Male accessory gland inflammation, infertility, and sexual dysfunctions: a practical approach to diagnosis and therapy. Andrology 2017; 5:1064-1072. [PMID: 28992374 DOI: 10.1111/andr.12427] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 07/09/2017] [Accepted: 08/14/2017] [Indexed: 11/26/2022]
Abstract
The role of urogenital inflammation in causing infertility and sexual dysfunctions has long been a matter of debate in the international scientific literature. The most recent scientific evidences show that male accessory gland infection/inflammation could alter, with various mechanisms, both conventional and biofunctional sperm parameters, and determine worst reproductive outcome. At the same time, the high prevalence of erectile dysfunction and premature ejaculation in patients with male accessory gland infection/inflammation underlines the close link between these diseases and sexual dysfunctions. The aim of this review was to provide the reader the basis for a correct diagnosis of male accessory gland infection/inflammation and a subsequent appropriate therapeutic approach, particularly in patients with infertility and/or sexual dysfunction.
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Affiliation(s)
- A E Calogero
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Y Duca
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - R A Condorelli
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - S La Vignera
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
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20
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Schuppe HC, Pilatz A, Hossain H, Diemer T, Wagenlehner F, Weidner W. Urogenital Infection as a Risk Factor for Male Infertility. DEUTSCHES ARZTEBLATT INTERNATIONAL 2017; 114:339-346. [PMID: 28597829 PMCID: PMC5470348 DOI: 10.3238/arztebl.2017.0339] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 07/13/2015] [Accepted: 03/13/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Infections of the genital tract are considered common causes of male fertility disorders, with a prevalence of 6-10%. Most of the affected men are asymptomatic. The diagnostic evaluation is based mainly on laboratory testing. Inconsistent diagnostic criteria have been applied to date, and this may explain the controversial debate about the role of infection and inflammation in the genital tract as a cause of infertility. The risk of an irreversible fertility disorder should not be underestimated. METHODS This review is based on pertinent publications retrieved by a selective literature search in PubMed, including guidelines from Germany and abroad and systematic review articles. RESULTS The main causes of inflammatory disease of the male genital tract are ascending sexually transmitted infections (STIs) and uropathogens. Chronic prostatitis has no more than a limited influence on ejaculate variables. By contrast, approximately 10% of men who have had acute epididymitis develop persistent azoospermia thereafter, and 30% have oligozoospermia. Obstruction of the excurrent ducts can ensue, as can post-infectious disturbances of spermatogenesis. The differential diagnostic evaluation includes the determination of testicular volumes, hormone concentrations, and ejaculate variables. Epidemiological data are lacking with regard to infertility after primary orchitis of infectious origin; however, up to 25% of testicular biopsies obtained from infertile men reveal focal inflammatory reactions. Multiple studies have suggested a deleterious effect of leukocytes and inflammatory mediators on sperm para - meters. On the other hand, the clinical significance of bacteriospermia remains unclear. CONCLUSION Any suspicion of an infectious or inflammatory disease in the male genital tract should prompt a systematic diagnostic evaluation and appropriate treatment. For patients with obstructive azoospermia, the etiology and site of the obstruction determine the surgical approach to be taken. In the near future, the elucidation of underlying pathophysiological mechanisms and the identification of suitable biomarkers may enable new strategies for conservative treatment.
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Affiliation(s)
- Hans-Christian Schuppe
- Department of Urology, Pediatric Urology and Andrology, Universitätsklinikum Gießen und Marburg GmbH – Site Gießen, Justus-Liebig University, Gießen, Germany
| | - Adrian Pilatz
- Department of Urology, Pediatric Urology and Andrology, Universitätsklinikum Gießen und Marburg GmbH – Site Gießen, Justus-Liebig University, Gießen, Germany
| | - Hamid Hossain
- Institute of Medical Microbiology, Universitätsklinikum Gießen und Marburg GmbH – Site Gießen, Justus-Liebig University, Gießen, Germany
| | - Thorsten Diemer
- Department of Urology, Pediatric Urology and Andrology, Universitätsklinikum Gießen und Marburg GmbH – Site Gießen, Justus-Liebig University, Gießen, Germany
| | - Florian Wagenlehner
- Department of Urology, Pediatric Urology and Andrology, Universitätsklinikum Gießen und Marburg GmbH – Site Gießen, Justus-Liebig University, Gießen, Germany
| | - Wolfgang Weidner
- Department of Urology, Pediatric Urology and Andrology, Universitätsklinikum Gießen und Marburg GmbH – Site Gießen, Justus-Liebig University, Gießen, Germany
- Institute of Medical Microbiology, Universitätsklinikum Gießen und Marburg GmbH – Site Gießen, Justus-Liebig University, Gießen, Germany
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21
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Jung JH, Kim MH, Kim J, Baik SK, Koh SB, Park HJ, Seo JT. Treatment of Leukocytospermia in Male Infertility: A Systematic Review. World J Mens Health 2016; 34:165-172. [PMID: 28053945 PMCID: PMC5209556 DOI: 10.5534/wjmh.2016.34.3.165] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 11/01/2016] [Accepted: 11/11/2016] [Indexed: 11/30/2022] Open
Abstract
Male factors account for 20% to 50% of infertility cases, and infection in the genitourinary tract may play a contributing role in up to 15% of male infertility. Leukocytospermia is a well-known indicator of infection or inflammation in the male sex glands and the urogenital tract. Although great deal of effort has been expended to elucidate definite management strategies in infertile men with leukocytospermia, the gold standard of treatment remains unclear. Until recently, broad spectrum antibiotics and antioxidants have been used in the treatment of leukocytospermia for male infertility to eliminate infection and reduce reactive oxygen free radicals produced inside cellular mitochondria as a result of inflammation. The present review reveals that antibiotics might improve sperm parameters, the rate of resolution of leukocytospermia, the bacteriologic cure rate, and even the pregnancy rate, although some reports conflict. Antioxidants might also have clinical benefits for sperm function as shown by in vitro studies. However, the data are insufficient to conclude whether antibiotics and antioxidants for the treatment of infertile men with leukocytospermia are effective or not. Better designed investigations into leukocytospermia are needed.
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Affiliation(s)
- Jae Hung Jung
- Department of Urology, Yonsei University Wonju College of Medicine, Wonju, Korea.; Institute of Evidence Based Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Myung Ha Kim
- Institute of Evidence Based Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.; Yonsei Wonju Medical Library, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jiye Kim
- Institute of Evidence Based Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.; Department of Plastic Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Soon Koo Baik
- Institute of Evidence Based Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.; Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Sang-Baek Koh
- Institute of Evidence Based Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.; Department of Preventive Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Hyun Jun Park
- Department of Urology, Pusan National University School of Medicine, Busan, Korea
| | - Ju Tae Seo
- Department of Urology, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, Seoul, Korea
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Njomnang Soh P, Vidal F, Huyghe E, Gourdy P, Halimi J, Bouhanick B. Urinary and genital infections in patients with diabetes: How to diagnose and how to treat. DIABETES & METABOLISM 2016; 42:16-24. [DOI: 10.1016/j.diabet.2015.07.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 07/03/2015] [Accepted: 07/14/2015] [Indexed: 01/05/2023]
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Vicari LO, Castiglione R, Salemi M, Vicari BO, Mazzarino MC, Vicari E. Effect of levofloxacin treatment on semen hyperviscosity in chronic bacterial prostatitis patients. Andrologia 2015; 48:380-8. [DOI: 10.1111/and.12456] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2015] [Indexed: 12/31/2022] Open
Affiliation(s)
- L. O. Vicari
- Section of Endocrinology and Andrology; Department of Experimental and Clinical Medicine; International Master in Experimental and Clinical Medicine and Cellular Physiopathology; University of Catania; Catania Italy
| | - R. Castiglione
- Section of Endocrinology and Andrology; Department of Experimental and Clinical Medicine; International Master in Experimental and Clinical Medicine and Cellular Physiopathology; University of Catania; Catania Italy
| | - M. Salemi
- IRCCS Oasi Institute for Research on Mental Retardation and Brain Aging; Troina (EN) Italy
| | - B. O. Vicari
- Department of Bio-Medical Sciences; University of Catania; Catania Italy
| | - M. C. Mazzarino
- Department of Bio-Medical Sciences; University of Catania; Catania Italy
| | - E. Vicari
- Section of Endocrinology and Andrology; Department of Experimental and Clinical Medicine; International Master in Experimental and Clinical Medicine and Cellular Physiopathology; University of Catania; Catania Italy
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Vicari E, La Vignera S, Castiglione R, Condorelli RA, Vicari LO, Calogero AE. Chronic bacterial prostatitis and irritable bowel syndrome: effectiveness of treatment with rifaximin followed by the probiotic VSL#3. Asian J Androl 2015; 16:735-9. [PMID: 24969056 PMCID: PMC4215680 DOI: 10.4103/1008-682x.131064] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
This study was undertaken to evaluate the influence of treatment with rifaximin followed by the probiotic VSL#3 versus no treatment on the progression of chronic prostatitis toward chronic microbial prostate-vesiculitis (PV) or prostate-vesiculo-epididymitis (PVE). A total of 106 selected infertile male patients with bacteriologically cured chronic bacterial prostatitis (CBP) and irritable bowel syndrome (IBS) were randomly prescribed rifaximin (200 mg, 2 tablets bid, for 7 days monthly for 12 months) and probiotic containing multiple strains VSL#3 (450 × 109 CFU per day) or no treatment. Ninety-five of them (89.6%) complied with the therapeutic plan and were included in this study. Group A = “6Tx/6-”: treatment for the initial 6 and no treatment for the following 6 months (n = 26); Group B = “12Tx”: 12 months of treatment (n = 22); Group C = “6-/6Tx”: no treatment for the initial 6 months and treatment in the last 6 months (n = 23); Group D = “12-”: no treatment (n = 24). The patients of Groups A = “6Tx/6-” and B = “12Tx” had the highest frequency of chronic prostatitis (88.5% and 86.4%, respectively). In contrast, group “12-”: patients had the lowest frequency of prostatitis (33.4%). The progression of prostatitis into PV in groups “6Tx/6-” (15.5%) and “6-/6Tx” (13.6%) was lower than that found in the patients of group “12-” (45.8%). Finally, no patient of groups “6Tx/6-” and “6-/6Tx” had PVE, whereas it was diagnosed in 20.8% of group “12-” patients. Long-term treatment with rifaximin and the probiotic VSL#3 is effective in lowering the progression of prostatitis into more complicated forms of male accessory gland infections in infertile patients with bacteriologically cured CBP plus IBS.
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Affiliation(s)
| | - Sandro La Vignera
- Section of Endocrinology, Andrology and Internal Medicine, Department of Medical and Pediatric Sciences, University of Catania, Catania, Italy
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25
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Reactive Oxygen Species (ROS) in human semen: determination of a reference range. J Assist Reprod Genet 2015; 32:757-64. [PMID: 25749739 DOI: 10.1007/s10815-015-0454-x] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Accepted: 02/22/2015] [Indexed: 12/27/2022] Open
Abstract
PURPOSE High levels of reactive oxygen species (ROS) are a leading cause of male factor infertility. Measurement of ROS has been hampered by a lack of standardisation and confounding variables including choice of controls and sample selection. This study aimed to determine a reference range for ROS in human semen. METHODS Semen samples were obtained from men attending for routine semen analysis who gave informed consent for the study. Samples were assigned groups: Group 1 (N = 94) normal semen parameters, no leucocytospermia; Group 2 (N = 100) abnormal semen parameters, no leucocytospermia; Group 3 (N = 41) any semen parameters with leucocytospermia. ROS levels were assayed in fresh neat semen using a chemiluminescence assay measured in a single tube luminometer. Data are reported in relative light units (RLU)/sec/10(6) sperm RESULTS ROS levels were significantly different between Groups 1, 2 and 3 (19.75 ± 8.12, 95.03 ± 33.63, 890.17 ± 310.23 RLU/sec/10(6) sperm respectively; p < 0.001). Group 3 gave the highest value confirming this group as the optimum choice for positive controls. The reference range < 24.1 RLU/sec/10(6) sperm was determined by ROC analysis that differentiates a reference population (Group 1) from a positive control group (Group 3), optimising the sensitivity and specificity (80.5 and 87.2% respectively) of the test. CONCLUSIONS We have determined a reference range for ROS in human semen and identified a patient population that falls outside the normal range. This simple, cost effective assay can be incorporated into routine diagnostic testing to aid in the diagnosis of male infertility, especially with regard to unexplained infertility.
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Castiglione R, Salemi M, Vicari LO, Vicari E. Relationship of semen hyperviscosity with IL-6, TNF-α, IL-10 and ROS production in seminal plasma of infertile patients with prostatitis and prostato-vesiculitis. Andrologia 2013; 46:1148-55. [DOI: 10.1111/and.12207] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2013] [Indexed: 12/22/2022] Open
Affiliation(s)
- R. Castiglione
- Section of Endocrinology and Andrology; Department of Medical and Pediatric Science; International Master in Experimental and Clinical Medicine and Cellular Physiopathology; University of Catania; Catania Italy
| | - M. Salemi
- Laboratory of Cytogenetics; Oasi Institute for Research on Mental Retardation and Brain Aging; Troina Enna Italy
| | - L. O. Vicari
- Section of Endocrinology and Andrology; Department of Medical and Pediatric Science; International Master in Experimental and Clinical Medicine and Cellular Physiopathology; University of Catania; Catania Italy
| | - E. Vicari
- Section of Endocrinology and Andrology; Department of Medical and Pediatric Science; International Master in Experimental and Clinical Medicine and Cellular Physiopathology; University of Catania; Catania Italy
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Oxidative stress, spermatozoa and leukocytic infiltration: relationships forged by the opposing forces of microbial invasion and the search for perfection. J Reprod Immunol 2013; 100:11-9. [DOI: 10.1016/j.jri.2013.06.005] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Revised: 06/10/2013] [Accepted: 06/26/2013] [Indexed: 11/22/2022]
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Kullisaar T, Türk S, Kilk K, Ausmees K, Punab M, Mändar R. Increased levels of hydrogen peroxide and nitric oxide in male partners of infertile couples. Andrology 2013; 1:850-8. [DOI: 10.1111/j.2047-2927.2013.00123.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 07/01/2013] [Accepted: 07/22/2013] [Indexed: 12/01/2022]
Affiliation(s)
- T. Kullisaar
- Department of Biochemistry; University of Tartu; Tartu Estonia
| | - S. Türk
- Department of Microbiology; University of Tartu; Tartu Estonia
| | - K. Kilk
- Department of Biochemistry; University of Tartu; Tartu Estonia
| | | | - M. Punab
- Andrology Centre; Tartu University Hospital; Tartu Estonia
| | - R. Mändar
- Department of Microbiology; University of Tartu; Tartu Estonia
- Competence Centre on Reproductive Medicine and Biology; Tartu Estonia
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Abstract
BACKGROUND Chronic bacterial prostatitis (CBP) is frequently diagnosed in men of fertile age, and is characterized by a disabling array of symptoms, including pain in the pelvic area (for example, perineum, testicles), voiding symptoms (increased frequency and urgency, also at night; pain or discomfort at micturition), and sexual dysfunction. Cure of CBP can be attempted by long-term therapy with antibacterial agents, but relapses are frequent. Few antibacterial agents are able to distribute to the prostatic tissue and achieve sufficient concentrations at the site of infection. These agents include fluoroquinolones, macrolides, tetracyclines and trimethoprim. After the introduction of fluoroquinolones into clinical practice, a number of studies have been performed to optimize the antimicrobial treatment of CBP, and to improve eradication rates and symptom relief. OBJECTIVES To assess and compare the efficacy and harm of antimicrobial treatments for chronic bacterial prostatitis. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (PubMed), EMBASE, other national or international databases and abstracts from conference proceedings on 8 August 2012. SELECTION CRITERIA We included all randomized controlled comparisons of one antimicrobial agent versus placebo or one or more comparator antimicrobial agents, combined or not with non-antimicrobial drugs. We also included trials comparing different doses, treatment durations, dosing frequencies, or routes of administration of antimicrobial agents. We excluded studies in which patients were not diagnosed according to internationally recommended criteria, or were not subjected to lower urinary tract segmented tests. DATA COLLECTION AND ANALYSIS Study data were extracted independently by two review authors. Study outcomes were microbiological efficacy (pathogen eradication), clinical efficacy (symptom cure or improvement, or symptom scores) at test-of-cure visits or at follow-up, or both, and adverse effects of therapy. Secondary outcomes included microbiological recurrence rates.Statistical analysis was performed using a fixed-effect model for microbiological outcomes and a random-effects model for clinical outcomes and adverse effects. The results were expressed as risk ratios for dichotomous outcomes (with 95% confidence intervals) or as standardized mean differences for continuous or non-dichotomous variables. MAIN RESULTS We identified 18 studies, enrolling a total of 2196 randomized patients. The oral fluoroquinolones ciprofloxacin, levofloxacin, lomefloxacin, ofloxacin and prulifloxacin were compared. There were no significant differences in clinical or microbiological efficacy or in the rate of adverse effects between these fluoroquinolones. In chlamydial prostatitis, (i) azithromycin showed improved eradication rates and clinical cure rates compared to ciprofloxacin, with no significant differences regarding adverse effects; (ii) azithromycin was equivalent to clarithromycin, both microbiologically and clinically; (iii) prulifloxacin appeared to improve clinical symptoms, but not eradication rates, compared to doxycycline. In ureaplasmal prostatitis, the comparisons ofloxacin versus minocycline and azithromycin versus doxycycline showed similar microbiological, clinical and toxicity profiles. AUTHORS' CONCLUSIONS The microbiological and clinical efficacy, as well as the adverse effect profile, of different oral fluoroquinolones are comparable. No conclusions can be drawn regarding the optimal treatment duration of fluoroquinolones in the treatment of CBP caused by traditional pathogens.Alternative antimicrobial agents tested for the treatment of CBP caused by traditional pathogens are co-trimoxazole, beta-lactams and tetracyclines, but no conclusive evidence can be drawn regarding the role of non-fluoroquinolone antibiotics in the treatment of CBP caused by traditional pathogens.In patients with CBP caused by obligate intracellular pathogens, macrolides showed higher microbiological and clinical cure rates compared to fluoroquinolones.
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Affiliation(s)
- Gianpaolo Perletti
- Laboratory of Toxicology and Pharmacology, Biomedical Research Division, Dept. of Theoretical and Applied Sciences, Università degli Studi dell'Insubria, Via A. da Giussano, 10, Busto A, Province of Varese, Italy, 21052
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Lavranos G, Balla M, Tzortzopoulou A, Syriou V, Angelopoulou R. Investigating ROS sources in male infertility: A common end for numerous pathways. Reprod Toxicol 2012; 34:298-307. [DOI: 10.1016/j.reprotox.2012.06.007] [Citation(s) in RCA: 128] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2012] [Revised: 05/15/2012] [Accepted: 06/15/2012] [Indexed: 01/09/2023]
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Persistence of ultrasound alterations after antibiotic treatment with levofloxacin in patients with male accessory gland infection. Asian J Androl 2012; 14:879-83. [PMID: 23064686 DOI: 10.1038/aja.2012.49] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
No studies have evaluated the ultrasound features of the male sex accessory glands in infertile patients with bacterial male accessory gland infection (MAGI) according to the microbiological outcomes of bacterial cultures (absent, partial or complete) following antibiotic therapy administration. Therefore, the aim of this study was to evaluate the ultrasound characteristics of the prostate, seminal vesicles, and epididymal tracts after treatment with levofloxacin (a common quinolone antibiotic), in patients with infections caused by Escherichia coli (a Gram-negative bacterium) according to the Naber's classification, which includes the following categories: eradication, eradication with superinfection, persistence and persistence with superinfection. The study was conducted in 100 patients aged 25±8 years (range: 20-40 years) with bacterial MAGI and bacterial cultures positive only for E. coli (colony forming units ≥10(6) per ml). Retrospective analysis was conducted only on patients treated with oral levofloxacin (500 mg) administered once daily for 28 days who were recruited over the last 5 years. Following antibiotic treatment, patients with microbiological persistence or persistence with superinfection had a significantly higher percentage of ultrasound abnormalities suggestive of prostato-vesiculitis (PV) (30.2% and 36.0%, respectively) or prostato-vesiculo-epididymitis (PVE) (60.2% and 70.0%, respectively) compared with patients with microbiological eradication (PV=10.2% and PVE=8.2%, respectively) or eradication with superinfection (PV=18.8% and PVE=21.2%, respectively). In conclusion, patients with microbiological persistence or persistence plus superinfection showed the highest prevalence of complicated forms of MAGI (PV and PVE), compared with patients with microbiological eradication or eradication with superinfection.
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Boitrelle F, Robin G, Lefebvre C, Bailly M, Selva J, Courcol R, Lornage J, Albert M. Les bactériospermies en AMP : comment réaliser et interpréter une spermoculture ? Qui traiter ? Pourquoi ? Comment ? ACTA ACUST UNITED AC 2012; 40:226-34. [DOI: 10.1016/j.gyobfe.2012.01.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Accepted: 12/12/2011] [Indexed: 11/26/2022]
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La Vignera S, Condorelli R, D'Agata R, Vicari E, Calogero AE. Semen alterations and flow-citometry evaluation in patients with male accessory gland infections. J Endocrinol Invest 2012; 35:219-23. [PMID: 21946047 DOI: 10.3275/7924] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Male accessory gland infections (MAGI) represent a major cause of male infertility mainly through the secretory dysfunction of the prostate, seminal vesicles, and epididymis. This study was undertaken to evaluate conventional and nonconventional sperm parameters in these patients, therefore 150 patients with MAGI were selected. Each of them underwent to two sperm analyses and evaluation of DNA fragmentation mitochondrial membrane potential (MMP), phosphatidylserine (PS) externalization, chromatin compactness, by flow cytometry. Results showed that patients with MAGI had a lower sperm progressive motility (11.4 ± 5.0 vs 34.0 ± 7.0%), and percentage of normal forms (9.0 ± 3.7 vs 33.0 ± 13.0%) compared to controls, instead, these patients showed higher number of seminal white blood cells (2.2 ± 1.0 vs 0.4 ± 0.6 106/ml). Patients with MAGI showed a higher number of spermatozoa with DNA fragmentation compared to controls (8.2 ± 3.0 vs 1.0 ± 1.0%). In addition, they have also a higher percentage of spermatozoa with low MMP (28.0 ± 4.0 vs 2.0 ± 2.0%). Patients with MAGI, showed a higher percentage of spermatozoa with PS externalization (8.0 ± 4.0 vs 3.0 ± 3.0%), an early sign of apoptosis, and lower percentage of viable spermatozoa (64.5 ± 12.0 vs 88.0 ± 10.0%). An increased percentage of spermatozoa with abnormal chromatin compactness (18.0 ± 4.0 vs 5.0 ± 3.0%) was found in patients with MAGI. In conclusion, patients with MAGI show alterations of conventional and biofunctional sperm parameters compared to controls. These results suggest to consider the flow cytometry evaluation among the diagnostic tools for male infertility.
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Affiliation(s)
- S La Vignera
- Section of Endocrinology, Andrology and Internal Medicine and Master in Andrological, Human Reproduction and Biotechnology Sciences, Department of Biomedical Sciences, University of Catania, Italy.
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La Vignera S. Male accessory gland infections: anatomical extension of inflammation and severity of symptoms evaluated by an original questionnaire. Andrologia 2011; 44 Suppl 1:739-46. [DOI: 10.1111/j.1439-0272.2011.01260.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Hamada A, Agarwal A, Sharma R, French DB, Ragheb A, Sabanegh ES. Empirical Treatment of Low-level Leukocytospermia With Doxycycline in Male Infertility Patients. Urology 2011; 78:1320-5. [DOI: 10.1016/j.urology.2011.08.062] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Revised: 07/22/2011] [Accepted: 08/30/2011] [Indexed: 11/25/2022]
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La Vignera S, Vicari E, Condorelli R, D'Agata R, Calogero AE. Hypertrophic-congestive and fibro-sclerotic ultrasound variants of male accessory gland infection have different sperm output. J Endocrinol Invest 2011; 34:e330-5. [PMID: 22234181 DOI: 10.1007/bf03346729] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Male accessory gland infection (MAGI) exerts a negative influence on male fertility which depends upon its extension. Indeed, we have shown that patients with MAGI involving prostate, seminal vesicles and epididymis have worse sperm parameters compared with patients with prostatitis alone or prostate-vesiculitis. Similarly, MAGI extending bilaterally is associated with a worse sperm output. The aims of this study were to evaluate the prevalence of two different additional ultrasound (US) findings (hypertrophic- congestive and a fibro-sclerotic US form) and to evaluate their semen quality. MATERIALS AND METHODS One hundred infertile patients with MAGI, diagnosed according to the World Health Organization (WHO) 1993 criteria, were evaluated by scrotal and transrectal ultrasound scans. The control group consisted of 100 healthy, age-matched men. RESULTS The ultrasound examination confirms two separate US variants of MAGI: a hypertrophic-congestive (prevalence of 56%) and a fibro-sclerotic form (prevalence of 29%). Patients with hypertrophic-congestive MAGI showed higher sperm concentration, motility and normal forms, but also higher sperm leukocytes concentration and seminal reactive oxygen species compared to patients with fibro-sclerotic MAGI. However, all these parameters were significantly worse than those observed in the control group. DISCUSSION Infertile patients with hypertrophic-congestive MAGI have a better sperm quality compared with patients with fibrosclerotic MAGI; however, they showed higher oxidative stress in semen.
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Affiliation(s)
- S La Vignera
- Section of Endocrinology, Andrology and Internal Medicine, and Master in Andrological, Human Reproduction and Biotechnology Sciences, Department of Internal Medicine and Systemic Diseases, University of Catania, 95123 Catania, Italy.
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Xu B, Li P, Niu X, Zhang X, Wang Z, Qin C, Li J, Jia Y, Wu H, Zhang W. A New Method of Chronic and Recurrent Seminal Vesiculitis Treatment. J Endourol 2011; 25:1815-8. [PMID: 21870960 DOI: 10.1089/end.2010.0456] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Bin Xu
- State Key Laboratory of Reproductive Medicine, Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, and Jiangsu Shengze Hospital, Wujiang, China
| | - Pengchao Li
- State Key Laboratory of Reproductive Medicine, Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, and Jiangsu Shengze Hospital, Wujiang, China
| | - Xiaobing Niu
- State Key Laboratory of Reproductive Medicine, Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, and Jiangsu Shengze Hospital, Wujiang, China
| | - Xiangxiang Zhang
- State Key Laboratory of Reproductive Medicine, Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, and Jiangsu Shengze Hospital, Wujiang, China
| | - Zengjun Wang
- State Key Laboratory of Reproductive Medicine, Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, and Jiangsu Shengze Hospital, Wujiang, China
| | - Chao Qin
- State Key Laboratory of Reproductive Medicine, Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, and Jiangsu Shengze Hospital, Wujiang, China
| | - Jie Li
- State Key Laboratory of Reproductive Medicine, Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, and Jiangsu Shengze Hospital, Wujiang, China
| | - Yuejun Jia
- State Key Laboratory of Reproductive Medicine, Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, and Jiangsu Shengze Hospital, Wujiang, China
| | - Hongfei Wu
- State Key Laboratory of Reproductive Medicine, Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, and Jiangsu Shengze Hospital, Wujiang, China
| | - Wei Zhang
- State Key Laboratory of Reproductive Medicine, Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, and Jiangsu Shengze Hospital, Wujiang, China
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La Vignera S, Calogero AE, Condorelli RA, Vicari LO, Catanuso M, D'Agata R, Vicari E. Ultrasonographic evaluation of patients with male accessory gland infection. Andrologia 2011; 44 Suppl 1:26-31. [PMID: 21919940 DOI: 10.1111/j.1439-0272.2010.01132.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
MAGI is the inflammation of the accessory male glands that notoriously exerts a negative influence on male fertility. The diagnosis is integrated by clinical, laboratory and ultrasound evaluation. In particular, the ultrasound criteria were published in 1999. The aim of this study was to analyse the sensitivity and specificity of additional diagnostic ultrasound criteria as well as of conventional criteria in a selected category of infertile patients with MAGI. To accomplish this, 100 patients with MAGI were evaluated by scrotal and transrectal ultrasound by three different operators. The control group consisted of 100 age-matched healthy men. Statistical analysis was performed to evaluate sensitivity, specificity, positive and negative predictive values, and ROC curve analysis. The results showed that additional ultrasound criteria had a diagnostic accuracy similar to traditional criteria. The threshold value of two criteria for each diagnostic category (traditional and additional criteria) obtained high values of sensitivity and specificity. In conclusion, this study confirms the validity of the ultrasound criteria of MAGI previously published; in addition, it suggests the clinical utility of other indicators in clinical practice with good diagnostic accuracy and finally it establishes a clear threshold ultrasonographic value for the diagnosis of MAGI.
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Affiliation(s)
- S La Vignera
- Section of Endocrinology, Andrology and Internal Medicine and Master in Andrological, Human Reproduction and Biotechnology Sciences, Department of Internal Medicine and Systemic Diseases, Catania University, Catania, Italy.
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La Vignera S, Condorelli R, Vicari E, D’Agata R, Calogero AE. High frequency of sexual dysfunction in patients with male accessory gland infections. Andrologia 2011; 44 Suppl 1:438-46. [DOI: 10.1111/j.1439-0272.2011.01202.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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41
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Rybar R, Prinosilova P, Kopecka V, Hlavicova J, Veznik Z, Zajicova A, Rubes J. The effect of bacterial contamination of semen on sperm chromatin integrity and standard semen parameters in men from infertile couples. Andrologia 2011; 44 Suppl 1:410-8. [DOI: 10.1111/j.1439-0272.2011.01198.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
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La Vignera S, Vicari E, Condorelli RA, D'Agata R, Calogero AE. Male accessory gland infection and sperm parameters (review). ACTA ACUST UNITED AC 2011; 34:e330-47. [PMID: 21696400 DOI: 10.1111/j.1365-2605.2011.01200.x] [Citation(s) in RCA: 126] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Male accessory gland infection (MAGI) has been identified among those diagnostic categories which have a negative impact on the reproductive function and fertility in males (Rowe et al., World Health Organization Manual for the Standardised Investigation and Diagnosis of the Infertile Couple, Cambridge University Press, Cambridge, 1993). MAGI is a hypernym which groups the following different clinical categories: prostatitis, prostate-vesiculitis and prostate-vesiculo-epididymitis. Some of the characteristics they share are: common diseases, mainly have a chronic course, rarely cause obstruction of the seminal pathways, can have an unpredictable intracanicular spread to one or more sexual accessory glands of the reproductive tract, as well as to one or both sides. In this review, we show that all components involving the inflammatory response (from the agents which first trigger it to each component of the inflammatory response dynamic) can deteriorate conventional and/or non-conventional sperm parameters arising from one or more of the following mechanisms: altered secretory function of the epididymis, seminal vesicles, and prostate which reduce the antioxidant properties or scavenging role of the seminal plasma; deterioration of spermatogenesis; and (unilateral or bilateral) organic or functional sub-obstruction of the seminal tract.
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Affiliation(s)
- S La Vignera
- Section of Endocrinology, Andrology and Internal Medicine and Master in Andrological, Human Reproduction and Biotechnology Sciences, Department of Internal Medicine and Systemic Diseases, University of Catania, Catania, Italy.
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Vicari E, La Vignera S, Arcoria D, Condorelli R, Vicari LO, Castiglione R, Mangiameli A, Calogero AE. High frequency of chronic bacterial and non-inflammatory prostatitis in infertile patients with prostatitis syndrome plus irritable bowel syndrome. PLoS One 2011; 6:e18647. [PMID: 21494624 PMCID: PMC3072990 DOI: 10.1371/journal.pone.0018647] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Accepted: 03/10/2011] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Although prostatitis syndrome (PS) and irritable bowel syndrome (IBS) are common disorders, information on the prevalence of IBS in infertile patients with PS is relatively scanty. Therefore, this study was undertaken to estimate the frequency of PS and IBS and to evaluate the prevalence of the various diagnostic categories of prostatitis. METHODOLOGY/PRINCIPAL FINDINGS This study enrolled 152 patients with PS, diagnosed by the NIH-Chronic Prostatitis Symptom Index (NIH-CPSI) in an andrological setting, and 204 patients with IBS, diagnosed according to the Rome III diagnostic criteria in a gastroenterological setting. The patients with PS were asked to fulfill the Rome III questionnaire for IBS, whereas patients with IBS were asked to complete the NIH-CPSI. The simultaneous presence of PS and IBS was observed in 30.2% and 31.8% of the patients screened by andrologists and gastroenterologists, respectively. Altogether, 111 patients had PS plus IBS (31.2%). They had a total NIH-CPSI and pain subscale scores significantly higher than patients with PS alone. Gastrointestinal symptoms in patients with PS plus IBS were similar to those reported by patients with IBS alone and significantly greater in patients with PS alone. Patients with PS plus IBS had a significantly higher frequency of chronic bacterial prostatitis (category II) and lower of non-inflammatory prostatitis (category IIIB), compared to patients with PS alone. The frequency of inflammatory prostatitis (category IIIA) resulted similar. CONCLUSIONS/SIGNIFICANCE Prostatitis syndromes and IBS are frequently associated in patients with PS- or IBS-related symptoms. These patients have an increased prevalence of chronic bacterial and non-inflammatory prostatitis.
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Affiliation(s)
- Enzo Vicari
- Section of Endocrinology, Andrology and Internal Medicine, Department of Internal Medicine and Systemic Diseases, University of Catania, Catania, Italy
| | - Sandro La Vignera
- Section of Endocrinology, Andrology and Internal Medicine, Department of Internal Medicine and Systemic Diseases, University of Catania, Catania, Italy
| | - Domenico Arcoria
- Section of Gastroenterology, Department of Internal Medicine, University of Catania, Catania, Italy
| | - Rosita Condorelli
- Section of Endocrinology, Andrology and Internal Medicine, Department of Internal Medicine and Systemic Diseases, University of Catania, Catania, Italy
| | - Lucia O. Vicari
- Section of Endocrinology, Andrology and Internal Medicine, Department of Internal Medicine and Systemic Diseases, University of Catania, Catania, Italy
| | - Roberto Castiglione
- Section of Endocrinology, Andrology and Internal Medicine, Department of Internal Medicine and Systemic Diseases, University of Catania, Catania, Italy
| | - Andrea Mangiameli
- Section of Gastroenterology, Department of Internal Medicine, University of Catania, Catania, Italy
| | - Aldo E. Calogero
- Section of Endocrinology, Andrology and Internal Medicine, Department of Internal Medicine and Systemic Diseases, University of Catania, Catania, Italy
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Mahfouz R, Sharma R, Thiyagarajan A, Kale V, Gupta S, Sabanegh E, Agarwal A. Semen characteristics and sperm DNA fragmentation in infertile men with low and high levels of seminal reactive oxygen species. Fertil Steril 2010; 94:2141-6. [DOI: 10.1016/j.fertnstert.2009.12.030] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2009] [Revised: 12/04/2009] [Accepted: 12/10/2009] [Indexed: 10/19/2022]
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Frequency and severity of sperm DNA damage in patients with confirmed cases of male infertility of different aetiologies. Reprod Biomed Online 2010; 20:759-63. [DOI: 10.1016/j.rbmo.2010.03.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2009] [Revised: 12/03/2009] [Accepted: 02/03/2010] [Indexed: 11/19/2022]
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Moskovtsev SI, Lecker I, Mullen JBM, Jarvi K, Willis J, White J, Lo KC. Cause-specific treatment in patients with high sperm DNA damage resulted in significant DNA improvement. Syst Biol Reprod Med 2009; 55:109-15. [PMID: 19462290 DOI: 10.1080/19396360902787944] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Assessment of sperm DNA damage has been suggested as a negative predictor of fertility potential. Multiple pathological factors acting at both the intra-testicular and post-testicular levels may contribute to sperm DNA damage. The relative contribution of each of these factors in an individual with high DNA damage (>30%) is unclear. The management of patients with elevated DNA damage is also challenging. The purpose of our retrospective study was to evaluate the clinical course of patients with sperm DNA damage over 30% and to assess the effect of non-specific (oral antioxidant) and cause-specific treatments on the quality of their sperm DNA. Results of our retrospective study suggest that the evaluated group with high DNA damage was diagnostically heterogeneous and comprised patients with varicoceles, bacteriospermia and idiopathic infertility. A three month course of antioxidant therapy reduced sperm DNA damage in only 30/61 (49%) patients with significant improvement between the initial and post-treatment DNA Fragmentation Index (DFI) results (46.8%+/-14.1 vs. 36.7%+/-16.6, p < .001). The positive effect of antioxidants could be age-dependent, as patients older that 40 years of age showed no improvement after such treatment. The cause-specific treatments showed superior results compared to antioxidants alone. Improvement was observed in 7/9 (78%) of patients after surgical varicocele repair between the initial and post-treatment DFI results (44.7%+/-12.8 vs. 28.4%+/-9.5, p < .03). The majority of the patients 13/14 (93%) with bacteriospermia had improvement in sperm DFI results after antibiotic treatment (50.4%+/-19.1 vs. 38.6%+/-18.7, p < .001).
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Affiliation(s)
- Sergey I Moskovtsev
- Andrology Laboratory, Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada.
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Everaert K, Mahmoud A, Depuydt C, Maeyaert M, Comhaire F. Chronic prostatitis and male accessory gland infection - is there an impact on male infertility (diagnosis and therapy)? Andrologia 2009. [DOI: 10.1111/j.1439-0272.2003.tb00867.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Abd-Allah ARA, Helal GK, Al-Yahya AA, Aleisa AM, Al-Rejaie SS, Al-Bakheet SA. Pro-inflammatory and oxidative stress pathways which compromise sperm motility and survival may be altered by L-carnitine. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2009; 2:73-81. [PMID: 20357928 PMCID: PMC2763248 DOI: 10.4161/oxim.2.2.8177] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2009] [Revised: 02/14/2009] [Accepted: 02/16/2009] [Indexed: 12/31/2022]
Abstract
The testis is an immunologically privileged organ. Sertoli cells can form a blood-testis barrier and protect sperm cells from self-immune system attacks. Spermatogenesis may be inhibited by severe illness, bacterial infections and chronic inflammatory diseases but the mechanism(s) is poorly understood. Our objective is to help in understanding such mechanism(s) to develop protective agents against temporary or permanent testicular dysfunction. Lipopolysaccaride (LPS) is used as a model of animal sepsis while L-carnitine (LCR) is used as a protective agent. A total of 60 male Swiss albino rats were divided into four groups (15/group). The control group received Saline; the 2(nd) group was given LCR (500 mg/kg i.p, once). The third group was treated with LPS (5 mg/kg i.p once) and the fourth group received LCR then LPS after three hours. From each group, five rats were used for histopathological examination. Biochemical parameters were assessed in the remaining ten rats. At the end of the experiment, animals were lightly anaesthetized with ether where blood samples were collected and testes were dissected on ice. Sperm count and motility were evaluated from cauda epididymis in each animal. Also, oxidative stress was evaluated by measuring testicular contents of reduced glutathione (GSH), malondialdehyde (MDA) and 8-hydroxydeoxyguanosine (8-HDG, the DNA adduct for oxidative damage) in testicular DNA. The pro-inflammatory mediator nitric oxide (NO) in addition to lactate dehydrogenase (LDHx) isoenzyme-x activity as an indicator for normal spermatozoal metabolism were assessed in testicular homogenate. Serum interlukin (IL)-2 level was also assessed as a marker for T-helper cell function. The obtained data revealed that LPS induced marked reductions in sperm's count and motility, obstruction in seminiferous tubules, hypospermia and dilated congested blood vessels in testicular sections concomitant with decreased testicular GSH content and LDHx activity. Moreover, the testicular levels of MDA, 8-HDG (in testicular DNA) and NO as well as serum IL-2 level were increased. Administration of LCR before LPS returned both sperm count and motility to normal levels. Also, contents of testicular GSH, MDA, 8-HDG and NO returned back to the corresponding control values. In addition, serum IL-2 level as well as histological abnormalities were markedly improved in LCR + LPS-treated rats. In conclusion, LPS increased proinflammatory and oxidative stress markers in the testis leading to a marked testicular dysfunction. L-carnitine administration ameliorates these effects by antioxidant and/or anti-inflammatory mechanisms suggesting a protective role against male infertility in severely infected or septic patients.
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Affiliation(s)
- Adel R A Abd-Allah
- Department of Pharmacology, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia.
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La Vignera S, Calogero AE, Arancio A, Castiglione R, De Grande G, Vicari E. Transrectal ultrasonography in infertile patients with persistently elevated bacteriospermia. Asian J Androl 2008; 10:731-40. [DOI: 10.1111/j.1745-7262.2008.00425.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Pimentel H, Niederberger C. A practical update on bulk semen analysis. CURRENT SEXUAL HEALTH REPORTS 2008. [DOI: 10.1007/s11930-008-0007-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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