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Guo Y, Dong Y, Zheng R, Yan J, Li W, Xu Y, Yan X, Ke Y, Li Y, Xiang L. Correlation between viral infections in male semen and infertility: a literature review. Virol J 2024; 21:167. [PMID: 39080728 PMCID: PMC11290048 DOI: 10.1186/s12985-024-02431-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 07/06/2024] [Indexed: 08/02/2024] Open
Abstract
Infertility affects approximately one-sixth of couples globally, with the incidence of male infertility steadily increasing. However, our understanding of the impact of viral infections on fertility remains limited. This review consolidates findings from previous studies, outlining 40 viruses identified in human semen and summarizing their key characteristics, modes of transmission, and their effects on both the reproductive and endocrine systems. Furthermore, it elucidates potential pathogenic mechanisms and treatment prospects of viruses strongly associated with male infertility. This synthesis will enhance our comprehension of how viral infections influence male reproductive health, offering valuable insights for future research as well as the diagnosis and treatment of infectious infertility.
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Affiliation(s)
- Yan Guo
- Department of Reproductive Gynecology, NHC Key Laboratory of Healthy Birth and Birth Defect Prevention in Western China, the First People's Hospital of Yunnan Province, Kunming, Yunnan, China
- The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Yunhua Dong
- Department of Reproductive Medicine, NHC Key Laboratory of Healthy Birth and Birth Defect Prevention in Western China, the First People's Hospital of Yunnan Province, Kunming, Yunnan, China
- KUST-YPFPH Reproductive Medicine Joint Research Center, Medical school of Kunming University of Science and Technology, Kunming, Yunnan, China
- The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Runzi Zheng
- Department of Reproductive Medicine, NHC Key Laboratory of Healthy Birth and Birth Defect Prevention in Western China, the First People's Hospital of Yunnan Province, Kunming, Yunnan, China
- KUST-YPFPH Reproductive Medicine Joint Research Center, Medical school of Kunming University of Science and Technology, Kunming, Yunnan, China
- The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Jiacong Yan
- Department of Reproductive Medicine, NHC Key Laboratory of Healthy Birth and Birth Defect Prevention in Western China, the First People's Hospital of Yunnan Province, Kunming, Yunnan, China
- KUST-YPFPH Reproductive Medicine Joint Research Center, Medical school of Kunming University of Science and Technology, Kunming, Yunnan, China
- The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Weiyuan Li
- Department of Reproductive Medicine, NHC Key Laboratory of Healthy Birth and Birth Defect Prevention in Western China, the First People's Hospital of Yunnan Province, Kunming, Yunnan, China
- KUST-YPFPH Reproductive Medicine Joint Research Center, Medical school of Kunming University of Science and Technology, Kunming, Yunnan, China
- The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Ya Xu
- Department of Clinical Laboratory, the First People's Hospital of Yunnan Province, Kunming, Yunnan, China
| | - Xuelan Yan
- Department of Reproductive Gynecology, NHC Key Laboratory of Healthy Birth and Birth Defect Prevention in Western China, the First People's Hospital of Yunnan Province, Kunming, Yunnan, China
- The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Yunmei Ke
- Department of Reproductive Gynecology, NHC Key Laboratory of Healthy Birth and Birth Defect Prevention in Western China, the First People's Hospital of Yunnan Province, Kunming, Yunnan, China
- The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Yantao Li
- Department of Reproductive Gynecology, NHC Key Laboratory of Healthy Birth and Birth Defect Prevention in Western China, the First People's Hospital of Yunnan Province, Kunming, Yunnan, China
- The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China
| | - Lifeng Xiang
- Department of Reproductive Medicine, NHC Key Laboratory of Healthy Birth and Birth Defect Prevention in Western China, the First People's Hospital of Yunnan Province, Kunming, Yunnan, China.
- KUST-YPFPH Reproductive Medicine Joint Research Center, Medical school of Kunming University of Science and Technology, Kunming, Yunnan, China.
- The Affiliated Hospital of Kunming University of Science and Technology, Kunming, Yunnan, China.
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Dabizzi S, Maggi M, Torcia MG. Update on known and emergent viruses affecting human male genital tract and fertility. Basic Clin Androl 2024; 34:6. [PMID: 38486154 PMCID: PMC10941432 DOI: 10.1186/s12610-024-00222-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 02/28/2024] [Indexed: 03/17/2024] Open
Abstract
Many viruses infect the male genital tract with harmful consequences at individual and population levels. In fact, viral infections may induce damage to different organs of the male genital tract (MGT), therefore compromising male fertility. The oxidative stress, induced during viral-mediated local and systemic inflammation, is responsible for testicular damage, compromising germinal and endocrine cell functions. A reduction in sperm count, motility, number of normal sperm and an increase in DNA fragmentation are all common findings in the course of viral infections that, however, generally regress after infection clearance. In some cases, however, viral shedding persists for a long time leading to unexpected sexual transmission, even after the disappearance of the viral load from the blood.The recent outbreak of Zika and Ebola Virus evidenced how the MGT could represent a reservoir of dangerous emergent viruses and how new modalities of surveillance of survivors are strongly needed to limit viral transmission among the general population.Here we reviewed the evidence concerning the presence of relevant viruses, including emergent and re-emergent, on the male genital tract, their route of entry, their adverse effects on male fertility and the pattern of viral shedding in the semen.We also described laboratory strategies to reduce the risk of horizontal or vertical cross-infection in serodiscordant couples undergoing assisted reproductive technologies.
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Affiliation(s)
- Sara Dabizzi
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Center for the Prevention, Diagnosis and Treatment of Infertility, Azienda Ospedaliera Universitaria Careggi Hospital, Florence, Italy.
| | - Mario Maggi
- Endocrinology Unit, Azienda Ospedaliera Universitaria Careggi Hospital, Florence, Italy.
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Viale G. Pieraccini 6, Florence, Italy.
| | - Maria Gabriella Torcia
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Center for the Prevention, Diagnosis and Treatment of Infertility, Azienda Ospedaliera Universitaria Careggi Hospital, Florence, Italy
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
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Corral-Vazquez C, Blanco J, Sarrate Z, Anton E. Unraveling the Intricacies of the Seminal Microbiome and Its Impact on Human Fertility. BIOLOGY 2024; 13:150. [PMID: 38534419 DOI: 10.3390/biology13030150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 02/20/2024] [Accepted: 02/23/2024] [Indexed: 03/28/2024]
Abstract
Although the microbial communities from seminal fluid were an unexplored field some decades ago, their characteristics and potential roles are gradually coming to light. Therefore, a complex and specific microbiome population with commensal niches and fluctuating species has started to be revealed. In fact, certain clusters of bacteria have been associated with fertility and health, while the outgrowth of several species is potentially correlated with infertility indicators. This constitutes a compelling reason for outlining the external elements that may induce changes in the seminal microbiome composition, like lifestyle factors, gut microbiota, pathologies, prebiotics, and probiotics. In this review, we summarize the main findings about seminal microbiome, its origins and composition, its relationship with fertility, health, and influence factors, while reminding readers of the limitations and advantages introduced from technical variabilities during the experimental procedures.
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Affiliation(s)
- Celia Corral-Vazquez
- Genetics of Male Fertility Group, Unitat de Biologia Cel·lular (Facultat de Biociències), Universitat Autònoma de Barcelona, 08193 Cerdanyola del Vallès, Spain
| | - Joan Blanco
- Genetics of Male Fertility Group, Unitat de Biologia Cel·lular (Facultat de Biociències), Universitat Autònoma de Barcelona, 08193 Cerdanyola del Vallès, Spain
| | - Zaida Sarrate
- Genetics of Male Fertility Group, Unitat de Biologia Cel·lular (Facultat de Biociències), Universitat Autònoma de Barcelona, 08193 Cerdanyola del Vallès, Spain
| | - Ester Anton
- Genetics of Male Fertility Group, Unitat de Biologia Cel·lular (Facultat de Biociències), Universitat Autònoma de Barcelona, 08193 Cerdanyola del Vallès, Spain
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de Albuquerque BHDR, de Oliveira MTFC, Aderaldo JF, de Medeiros Garcia Torres M, Lanza DCF. Human seminal virome: a panel based on recent literature. Basic Clin Androl 2022; 32:16. [PMID: 36064315 PMCID: PMC9444275 DOI: 10.1186/s12610-022-00165-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 06/16/2022] [Indexed: 02/06/2023] Open
Abstract
Background The seminal virome and its implications for fertility remain poorly understood. To date, there are no defined panels for the detection of viruses of clinical interest in seminal samples. Results In this study, we characterized the human seminal virome based on more than 1,000 studies published over the last five years. Conclusions The number of studies investigating viruses that occur in human semen has increased, and to date, these studies have been mostly prospective or related to specific clinical findings. Through the joint analysis of all these studies, we have listed the viruses related to the worsening of seminal parameters and propose a new panel with the main viruses already described that possibly affect male fertility and health. This panel can assist in evaluating semen quality and serve as a tool for investigation in cases of infertility.
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Ito T, Kubo Y, Akanuma SI, Hosoya KI. Functional characteristics of 3'-azido-3'-deoxythymidine transport at the blood-testis barrier. Int J Pharm 2022; 625:122044. [PMID: 35902057 DOI: 10.1016/j.ijpharm.2022.122044] [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: 03/28/2022] [Revised: 06/28/2022] [Accepted: 07/19/2022] [Indexed: 11/18/2022]
Abstract
3'-Azido-3'-deoxythymidine (AZT), an antiretroviral drug, is often adopted in the therapy for human immunodeficiency virus (HIV) infection, and the characteristics of AZT transport at the blood-testis barrier (BTB) were investigated in this study. In the integration plot analysis that evaluates the transport activity in vivo, the apparent influx clearance of [3H]AZT was significantly greater than that of [14C]D-mannitol, a non-permeable paracellular transport marker. In the uptake study in vitro with TM4 cells derived from mouse Sertoli cells, [3H]AZT uptake exhibited a time- and concentration-dependent manner, of which Km and Vmax values being 20.3 µM and 102 pmol/(min·mg protein), respectively. In the inhibition analysis, [3H]AZT uptake was not affected by extracellular inorganics and some substrates of transporters putatively involved in AZT transport. In the further inhibition analyses to elucidate the characteristics of AZT transport, [3H]AZT uptake was strongly reduced in the presence of several nucleosides, that are categorized as 2'-deoxynucleosides with pyrimidine, whereas little effect on [3H]AZT uptake was exhibited in the presence of other nucleosides, nucleobases, and antiretrovirals. These results suggest the influx transport of AZT from the circulating blood to the testis, and the involvement of carrier-mediated process at the BTB, which selectively recognizes 2'-deoxynucleosides with a pyrimidine base.
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Affiliation(s)
- Takeru Ito
- Department of Pharmaceutics, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama 930-0194, Japan
| | - Yoshiyuki Kubo
- Department of Pharmaceutics, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama 930-0194, Japan; Laboratory of Drug Disposition & Pharmacokinetics, Faculty of Pharma-Sciences, Teikyo University, Kaga 2-11-1, Tokyo 173-8605, Japan.
| | - Shin-Ichi Akanuma
- Department of Pharmaceutics, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama 930-0194, Japan
| | - Ken-Ichi Hosoya
- Department of Pharmaceutics, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama 930-0194, Japan
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Akhigbe RE, Dutta S, Hamed MA, Ajayi AF, Sengupta P, Ahmad G. Viral Infections and Male Infertility: A Comprehensive Review of the Role of Oxidative Stress. FRONTIERS IN REPRODUCTIVE HEALTH 2022; 4:782915. [PMID: 36303638 PMCID: PMC9580820 DOI: 10.3389/frph.2022.782915] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 01/11/2022] [Indexed: 12/16/2022] Open
Abstract
Viral infections have been a part of human existence to date, though viruses have posed a huge threat with various outbreaks lately. These threats are associated with reproductive health challenges, especially male infertility. The prime focus of this review is to highlight the mechanisms associated with viral infection-induced male infertility/subfertility and identify new treatment strategies with the aim to preserve male fertility. The reviewed data showed that viral infections stimulate inflammatory responses, resulting in the release of proinflammatory cytokines, which induces oxidative stress. This oxido-inflammatory cycle could continue in a vicious cycle and threaten male fertility. Existing data from human and experimental studies show that viral infection-induced oxido-inflammatory response results in testicular damage, atrophy of the seminiferous tubules and Sertoli cells, and reduced Leydig cell mass. This is accompanied by reduced circulatory testosterone, impaired spermatogenesis, reduced sperm motility, lipid peroxidation, DNA fragmentation and apoptosis of the sperm cells. Based on the available pieces of evidence, antioxidant therapy, in vivo and in vitro, may be beneficial and protects against the potential risk of male infertility from viral infection. It is, however recommended that more clinical studies be conducted to demonstrate the possible protective roles of antioxidants used as adjuvant therapy in viral infections, and in the in vitro treatment of semen samples for those utilizing semen washing and artificial reproductive techniques.
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Affiliation(s)
- Roland E. Akhigbe
- Department of Physiology, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
- Reproductive Biology and Toxicology Research Laboratories, Oasis of Grace Hospital, Osogbo, Nigeria
| | - Sulagna Dutta
- Department of Oral Biology and Biomedical Sciences, Faculty of Dentistry, MAHSA University, Jenjarom, Malaysia
| | - Moses A. Hamed
- Reproductive Biology and Toxicology Research Laboratories, Oasis of Grace Hospital, Osogbo, Nigeria
- Brainwill Laboratories, Osogbo, Nigeria
| | - Ayodeji F. Ajayi
- Department of Physiology, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
| | - Pallav Sengupta
- Department of Physiology, Faculty of Medicine, Biosciences and Nursing, MAHSA University, Jenjarom, Malaysia
- *Correspondence: Pallav Sengupta
| | - Gulfam Ahmad
- Redox Biology Group, Discipline of Pathology, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
- Gulfam Ahmad
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Carbone L, Conforti A, La Marca A, Cariati F, Vallone R, Raffone A, Buonfantino C, Palese M, Mascia M, DI Girolamo R, Capuzzo M, Esteves SC, Alviggi C. The negative impact of most relevant infections on fertility and assisted reproduction technology. Minerva Obstet Gynecol 2022; 74:83-106. [PMID: 34137567 DOI: 10.23736/s2724-606x.21.04870-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Infections may act with variable impact on the physiopathology of the reproductive organs, determining infertility or reducing the outcomes of assisted reproduction technology. The aim of this narrative review is to describe the existing evidence regarding the pathogens with a supposed or recognized role in reproductive medicine. Viral hepatitis, as well as HIV, can reduce sperm quality. Syphilis carries a risk of erectile dysfunction and increased endometrial thickness. Chlamydia is the main cause of pelvic inflammatory disease. In relation to Mycoplasma and Ureaplasma spp., only few species seem to show a correlation with infertility and poor in-vitro fertilization outcomes. There is evidence of a role for bacterial vaginosis in early pregnancy loss. HPV infection in males seems to determine infertility. Herpesviruses are more a risk for fetuses than for fertility itself. Zika virus is responsible for altered early embryo development and waiting to conceive is recommended in suspected or confirmed cases. The impact of SARS-CoV-2 is yet to be elucidated. Rubella and toxoplasmosis can provoke important congenital defects and therefore screening is mandatory before conception; a vaccine for Rubella is recommended. Further and well-designed studies are still needed to better elucidate the role of some infectious agents, to improve fertility and its treatments.
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Affiliation(s)
- Luigi Carbone
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy -
| | - Alessandro Conforti
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Antonio La Marca
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Roberta Vallone
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Antonio Raffone
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Cira Buonfantino
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Michela Palese
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Marika Mascia
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Raffaella DI Girolamo
- Center for High-Risk Pregnancy and Fetal Care, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - Martina Capuzzo
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Sandro C Esteves
- Division of Urology, Department of Surgery, University of Campinas (UNICAMP), Campinas, Brazil
- Faculty of Health, Aarhus University, Aarhus, Denmark
- ANDROFERT - Andrology and Human Reproduction Clinic, Campinas, Brazil
| | - Carlo Alviggi
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
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Das S, Roychoudhury S, Roychoudhury S, Agarwal A, Henkel R. Role of Infection and Leukocytes in Male Infertility. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1358:115-140. [DOI: 10.1007/978-3-030-89340-8_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Komijani M, Momeni HR, Shaykh-Baygloo N, Ghafarizadeh AA, Maleki P, Tahsili MR. Association of Herpes simplex virus I&II infections with rs187084 SNP of TLR9 and male infertility. Andrologia 2021; 53:e14163. [PMID: 34216052 DOI: 10.1111/and.14163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/04/2021] [Accepted: 06/08/2021] [Indexed: 11/29/2022] Open
Abstract
Since TLR9 recognises unmethylated CpG motifs in viral DNA, its polymorphisms may contribute to the susceptibility to Herpes simplex virus I&II infection. In the present study, to evaluate the role of rs187084 SNP (single nucleotide polymorphism) of TLR9 in Herpes simplex virus I&II infection and male infertility, 103 infertile and 27 fertile blood and semen samples were analysed. We assessed the micro and macro properties of semen specimens and the presence of HSV immunoglobulins. Tetra-primer ARMS PCR was used to detect SNP and to investigate the genotype distribution of TLR9-rs187084 SNPs, and the correlation between polymorphisms of TLR9 gene and male infertility. Moreover, the odds ratio (OR) and 95% confidence intervals were used to estimate the strength of the association. Based on our finding, a significant correlation was observed between HSV infection, agglutination and polymorphism (TT) under dominant (OR = 1.28, 95% CI = 0.94-1.75) and recessive (OR = 0.44, 95% CI = 0.21-0.94) models for the data, which was complied with Hardy-Weinberg equilibrium (HWE) (OR = 2.91, 95% CI = 1.02-8.30). The result showed a significant association between HSV IgM and agglutination in HSV infection (p < .001), and in addition, there were associations between alleles so that rs187084 SNP might be considered as a risk factor for the incidence of HSV infection.
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Affiliation(s)
- Majid Komijani
- Department of Biology, Faculty of Science, Arak University, Arak, Iran
| | - Hamid Reza Momeni
- Department of Biology, Faculty of Science, Arak University, Arak, Iran
| | | | | | - Parisa Maleki
- Department of Biology, Faculty of Science, Arak University, Arak, Iran
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Kitsou C, Lazaros L, Papoudou-Bai A, Sakaloglou P, Mastora E, Lykovardakis T, Giaka K, Vartholomatos G, Bouba I, Markoula S, Batistatou A, Georgiou I. Reverse Transcriptase Affects Gametogenesis and Preimplantation Development in Mouse. In Vivo 2021; 34:2269-2276. [PMID: 32871749 DOI: 10.21873/invivo.12037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM The expression of reverse transcriptase (RT) in ovaries, testes, gametes and embryos highlights its critical role in cell growth and differentiation. We sought to investigate the effects of the potent RT inhibitor lamivudine in gametogenesis and mouse embryo preimplantation development. MATERIALS AND METHODS Male and female FVB/N mice were treated with the reverse transcriptase inhibitor Lamivudine for seven consecutive weeks. Following treatment, mouse sperm parameters, testicular and ovarian morphology as well as post-IVF embryo development were evaluated. RESULTS Lamivudine impaired the sperm parameters and the testicular structure in male mice, the number of primordial germ cells and primary oocytes in ovaries of female mice, and the embryos' morphology and development up to the blastocyst stage during in vitro culture. CONCLUSION The administration of lamivudine affected the processes of spermatogenesis and oogenesis as well as the in vitro preimplantation development of mouse embryos.
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Affiliation(s)
- Chrysoula Kitsou
- Laboratory of Medical Genetics of Human Reproduction, Medical School, Ioannina University, Ioannina, Greece
| | - Leandros Lazaros
- Laboratory of Medical Genetics of Human Reproduction, Medical School, Ioannina University, Ioannina, Greece.,Genesis Genoma Lab, Genetic Diagnosis-Clinical Genetics-Research, Athens, Greece
| | | | - Prodromos Sakaloglou
- Laboratory of Medical Genetics of Human Reproduction, Medical School, Ioannina University, Ioannina, Greece
| | - Eirini Mastora
- Laboratory of Medical Genetics of Human Reproduction, Medical School, Ioannina University, Ioannina, Greece
| | - Theodoros Lykovardakis
- Laboratory of Medical Genetics of Human Reproduction, Medical School, Ioannina University, Ioannina, Greece
| | - Katerina Giaka
- Laboratory of Medical Genetics of Human Reproduction, Medical School, Ioannina University, Ioannina, Greece
| | - Georgios Vartholomatos
- Laboratory of Hematology, Molecular Biology Unit, Ioannina University Hospital, Ioannina, Greece
| | - Ioanna Bouba
- Laboratory of Medical Genetics of Human Reproduction, Medical School, Ioannina University, Ioannina, Greece
| | - Sofia Markoula
- Department of Neurology, Ioannina University Hospital, Ioannina, Greece
| | - Anna Batistatou
- Department of Pathology, Ioannina University Hospital, Ioannina, Greece
| | - Ioannis Georgiou
- Laboratory of Medical Genetics of Human Reproduction, Medical School, Ioannina University, Ioannina, Greece
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11
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De Vincentis S, Tartaro G, Rochira V, Santi D. HIV and Sexual Dysfunction in Men. J Clin Med 2021; 10:jcm10051088. [PMID: 33807833 PMCID: PMC7961513 DOI: 10.3390/jcm10051088] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 02/22/2021] [Accepted: 03/02/2021] [Indexed: 12/12/2022] Open
Abstract
Sexual issues tend to go unaddressed in human immunodeficiency virus (HIV) management, although overt sexual dysfunctions are more prevalent in people living with HIV than uninfected people. Erectile dysfunction is the most frequent sexual problem, with a prevalence of 30–50% even in men <40 years of age, but other issues such as loss of libido and ejaculatory disorders should not be overlooked. Peculiar factors related to HIV infection (e.g., fear of virus transmission, changes in body image, HIV-related comorbidities, HIV distress and stigma), alongside classical factors non-related to HIV, should be considered when approaching sexual problems in HIV patients. For this reason, the diagnostic and therapeutic workout of sexual dysfunction in the context of HIV requires a multidisciplinary approach, involving specialists in both infectious diseases and sexual medicine. This narrative review presents an overview of current knowledge on sexual dysfunction in HIV men, deepening the factors driving and taking part in these issues, providing advice for the clinical approach, and underlining the importance of caring for sexual health to improve the quality of life of HIV patients.
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Affiliation(s)
- Sara De Vincentis
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giardini 1355, 41126 Modena, Italy; (S.D.V.); (G.T.); (D.S.)
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, 41126 Modena, Italy
| | - Giulia Tartaro
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giardini 1355, 41126 Modena, Italy; (S.D.V.); (G.T.); (D.S.)
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, 41126 Modena, Italy
| | - Vincenzo Rochira
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giardini 1355, 41126 Modena, Italy; (S.D.V.); (G.T.); (D.S.)
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, 41126 Modena, Italy
- Correspondence: ; Tel.: +39-059-396-2453; Fax: +39-059-396-1335
| | - Daniele Santi
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Giardini 1355, 41126 Modena, Italy; (S.D.V.); (G.T.); (D.S.)
- Unit of Endocrinology, Department of Medical Specialties, Azienda Ospedaliero-Universitaria of Modena, 41126 Modena, Italy
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12
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Marston M, Gregson S. Human Immunodeficiency Virus, Antiretroviral Therapy, and Fertility in Sub-Saharan Africa: Pieces Still Missing in the Jigsaw Puzzle. J Infect Dis 2021; 221:1919-1921. [PMID: 31332439 DOI: 10.1093/infdis/jiz363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 07/10/2019] [Indexed: 11/12/2022] Open
Affiliation(s)
- Milly Marston
- Department of Population Health, London School of Hygiene and Tropical Medicine, Imperial College London, United Kingdom
| | - Simon Gregson
- Department of Infectious Disease Epidemiology, Imperial College London, United Kingdom.,Biomedical Research and Training Institute, Harare, Zimbabwe
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13
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Pasvol TJ, Teh J, Balfoussia D, Hall R, Petersen C, Khan M, Ayres S, Jayasena CN, Foster C, Fidler S. Outcomes of fertility investigations in a cohort of adults with perinatally acquired HIV-1 infection: a UK cross-sectional observational study. AIDS 2021; 35:343-345. [PMID: 33165031 PMCID: PMC7810410 DOI: 10.1097/qad.0000000000002745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/31/2020] [Accepted: 10/24/2020] [Indexed: 11/29/2022]
Abstract
There are no published studies of fertility measurements in people living with perinatally acquired HIV (PaHIV). We performed fertility investigations in 25 adults with PaHIV. Seven (78%) men had sperm morphology normal forms (%) below the fifth centile for the general population with four (44%) having no normal forms. Mean (SD) serum anti-Müllerian hormone level was 19.4 (9.5) pmol/l; lower than expected for this age group. A larger study is needed to verify our findings.
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Affiliation(s)
- Thomas J. Pasvol
- Clinical Trials Centre, Winston Churchill Wing, St Mary's Hospital, Imperial College London
- Imperial College Healthcare NHS Trust, London
- Research Department of Primary Care and Population Health, University College London
| | - Jhia Teh
- Clinical Trials Centre, Winston Churchill Wing, St Mary's Hospital, Imperial College London
| | - Danai Balfoussia
- Imperial College Healthcare NHS Trust, London
- Department of Andrology, Hammersmith Hospital & Section of Investigative Medicine, Imperial College London, UK
| | - Rebecca Hall
- Clinical Trials Centre, Winston Churchill Wing, St Mary's Hospital, Imperial College London
- Imperial College Healthcare NHS Trust, London
| | - Claire Petersen
- Clinical Trials Centre, Winston Churchill Wing, St Mary's Hospital, Imperial College London
- Imperial College Healthcare NHS Trust, London
| | - Maryam Khan
- Clinical Trials Centre, Winston Churchill Wing, St Mary's Hospital, Imperial College London
| | - Sara Ayres
- Imperial College Healthcare NHS Trust, London
| | - Channa N. Jayasena
- Imperial College Healthcare NHS Trust, London
- Department of Andrology, Hammersmith Hospital & Section of Investigative Medicine, Imperial College London, UK
| | | | - Sarah Fidler
- Clinical Trials Centre, Winston Churchill Wing, St Mary's Hospital, Imperial College London
- Imperial College Healthcare NHS Trust, London
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14
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Akhigbe RE, Hamed MA, Odetayo AF. HAART and anti-Koch's impair sexual competence, sperm quality and offspring quality when used singly and in combination in male Wistar rats. Andrologia 2021; 53:e13951. [PMID: 33400320 DOI: 10.1111/and.13951] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/23/2020] [Accepted: 12/13/2020] [Indexed: 12/13/2022] Open
Abstract
This study investigated the impact of the administration of HAART and anti-Koch's, singly and in combination, on sexual competence and birth statistics. Adult male Wistar rats were randomised into distilled water-treated control, HAART-treated, anti-Koch's-treated and HAART + anti-Koch's-treated groups. The 56-day oral treatment led to impaired sexual competence evident by significantly reduced motivation to mate, prolonged latencies of mount, intromissions, ejaculations and post-ejaculatory interval, as well as reduced frequencies of mount, intromissions and ejaculations. This was accompanied by significant reductions in penile erection reflex and penile grooming. HAART and anti-Koch's, when administered singly or in combination, also led to significant reductions in the circulatory follicle-stimulating hormone, luteinizing hormone, testosterone and intratesticular testosterone, but a significant rise in prolactin. Also, HAART and/or anti-Koch's significantly reduced sperm count, sperm motility, sperm viability and spermatozoa with normal morphology. Furthermore, HAART and anti-Koch's, separately or in combination, significantly lowered fertility capacity, litter size and litter weight and offspring survival. The deleterious effects of these drugs were more pronounced when combined. Findings of the present study revealed that HAART and/or anti-Koch's impair sexual competence via a testosterone-dependent hyperprolactinemia-mediated mechanism. These events are associated with reduced fertility capacity, poor sperm quality and lowered offspring survival.
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Affiliation(s)
- Roland Eghoghosoa Akhigbe
- Department of Physiology, Ladoke Akintola University of Technology, Ogbomoso, Nigeria.,Reproductive Biology and Toxicology Research Laboratories, Oasis of Grace Hospital, Osogbo, Nigeria.,Department of Chemical Sciences, Kings University, Odeomu, Nigeria
| | - Moses Agbomhere Hamed
- Reproductive Biology and Toxicology Research Laboratories, Oasis of Grace Hospital, Osogbo, Nigeria.,Buntai Medical and Diagnostic Laboratories, Osogbo, Nigeria
| | - Adeyemi Fatai Odetayo
- Reproductive Biology and Toxicology Research Laboratories, Oasis of Grace Hospital, Osogbo, Nigeria.,Department of Physiology, University of Ilorin, Ilorin, Nigeria
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15
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Liu G, Zhang H, Zhu WB, Peng YQ, Ding R, Fan ML, Fan LQ, Li WN. HIV prevalence among 338,432 infertile individuals in Hunan, China, 2012-2018: A cross-sectional study. PLoS One 2020; 15:e0238564. [PMID: 32911499 PMCID: PMC7482923 DOI: 10.1371/journal.pone.0238564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 08/19/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The prevalence of human immunodeficiency virus (HIV) varies markedly among different risk groups in China, spreading fromhigh-risk populations to the general population. Indeed, China is in a critical period of HIV/acquired immunodeficiency syndrome (AIDS) prevention and control; however, data regarding HIV testing, infection and coinfection among infertile couples are lacking. This study aimed to estimate the HIV/AIDS prevalence to identify risk factors among infertile couples in Hunan, China. METHODS A cross-sectional hospital-based study was conducted to evaluate the prevalence of HIV/other infections (hepatitis B virus (HBV), hepatitis C virus (HCV), syphilis, and Chlamydia trachomatis, Neisseria gonorrhoeae, and Mycoplasma genitalium (MG) infections) among 338,432 infertile individuals in Hunan, China, from 2012 to 2018. We calculated linear trends in prevalence using bivariate linear regression. RESULTS The overall prevalence rates of HIV, chlamydia, gonorrhea, MG, syphilis, and HBV and HCV antibody positivity in this study were 0.04%, 1.73%, 0.05%, 2.60%, 2.15%, 12.01% and 0.56%, respectively. The predominant infection was HBV, followed by MG, syphilis, and chlamydia. Only 1.13% of the participants (382/338432) reported sexually transmitted disease (STD) signs and symptoms suggesting genital tract infection. However, from 2012-2018, the variation in HIV prevalence was not significant (β = 0.000, PTREND = 0.907). The characteristics of the HIV-infected infertile population have not shifted dramatically, with women accounting for 32.56% of HIV cases in China. Overall, 87.60% of HIV-infected individuals have a relatively low education. In total, 37.98% of HIV-positive patients engage in high-risk behaviors. CONCLUSIONS This study expands upon existing knowledge of HIV prevalence in the infertile Chinese population. However, much work is needed to achieve popularization of prevention knowledge and change concept. Routine HIV screening is urgently needed for all adults with high-risk behaviors.
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Affiliation(s)
- Gang Liu
- The Institute of Reproduction and Stem Cell Engineering, School of Basic Medical Science, Central South University, Changsha, Hunan, China
| | - Huan Zhang
- Reproductive and Genetic Hospital of CITIC Xiangya, Changsha, Hunan, China.,Clinical Research Center For Reproduction and Genetics In Hunan Province, Changsha, China
| | - Wen-Bing Zhu
- The Institute of Reproduction and Stem Cell Engineering, School of Basic Medical Science, Central South University, Changsha, Hunan, China
| | - Yang-Qin Peng
- Reproductive and Genetic Hospital of CITIC Xiangya, Changsha, Hunan, China.,Clinical Research Center For Reproduction and Genetics In Hunan Province, Changsha, China
| | - Rui Ding
- The Institute of Reproduction and Stem Cell Engineering, School of Basic Medical Science, Central South University, Changsha, Hunan, China
| | - Meng-Lin Fan
- Reproductive and Genetic Hospital of CITIC Xiangya, Changsha, Hunan, China.,Clinical Research Center For Reproduction and Genetics In Hunan Province, Changsha, China
| | - Li-Qing Fan
- The Institute of Reproduction and Stem Cell Engineering, School of Basic Medical Science, Central South University, Changsha, Hunan, China.,Reproductive and Genetic Hospital of CITIC Xiangya, Changsha, Hunan, China.,Clinical Research Center For Reproduction and Genetics In Hunan Province, Changsha, China
| | - Wei-Na Li
- Reproductive and Genetic Hospital of CITIC Xiangya, Changsha, Hunan, China.,Clinical Research Center For Reproduction and Genetics In Hunan Province, Changsha, China.,Hunan Guangxiu Hi-tech Life Technology Co., Ltd., Changsha, China
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16
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Cavarelli M, Le Grand R. The importance of semen leukocytes in HIV-1 transmission and the development of prevention strategies. Hum Vaccin Immunother 2020; 16:2018-2032. [PMID: 32614649 PMCID: PMC7553688 DOI: 10.1080/21645515.2020.1765622] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
HIV-1 sexual transmission occurs mostly through contaminated semen, which is a complex mixture of soluble factors with immunoregulatory functions and cells. It is well established that semen cells from HIV-1-infected men are able to produce the virus and that are harnessed to efficiently interact with mucosal barriers exposed during sexual intercourse. Several cofactors contribute to semen infectivity and may enhance the risk of HIV-1 transmission to a partner by increasing local HIV-1 replication in the male genital tract, thereby increasing the number of HIV-1-infected cells and the local HIV-1 shedding in semen. The introduction of combination antiretroviral therapy has improved the life expectancy of HIV-1 infected individuals; however, there is evidence that systemic viral suppression does not always reflect full viral suppression in the seminal compartment. This review focus on the role semen leukocytes play in HIV-1 transmission and discusses implications of the increased resistance of cell-mediated transmission to immune-based prevention strategies.
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Affiliation(s)
- Mariangela Cavarelli
- Université Paris-Saclay, Inserm, CEA, Center for Immunology of Viral, Auto-immune, Hematological and Bacterial diseases (IMVA-HB/IDMIT) , Fontenay-aux-Roses & Le Kremlin-Bicêtre, France
| | - Roger Le Grand
- Université Paris-Saclay, Inserm, CEA, Center for Immunology of Viral, Auto-immune, Hematological and Bacterial diseases (IMVA-HB/IDMIT) , Fontenay-aux-Roses & Le Kremlin-Bicêtre, France
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17
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Bell M, Edelstein M, Hurwitz S, Irwin R. Accessibility and availability of assistant reproductive technology for people living with HIV in Europe: a thematic literature review. AIDS Care 2019; 32:949-953. [PMID: 31875688 DOI: 10.1080/09540121.2019.1707471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
As antiretroviral therapies have transformed HIV into a manageable chronic disease, many individuals have or will choose to have children, and the use of assisted reproductive technology can serve as an effective risk-reducing strategy. In this thematic literature review, we examine the state of research on access to and availability of assisted reproductive health technologies for people living with HIV in Europe, with the aim of identifying gaps for further research. We find that the existing literature is focused on serodiscordant couples consisting of an HIV-positive man and an HIV-negative women. This is in part because more treatment options are available for men living with HIV than women, reflecting underlying gender discrimination in treatment. The existing scholarship largely ignores reproductive options for seroconcordant couples or single individuals, or for men and women with underlying infertility. Finally, very little research addresses the question of financial affordability, which is a known barrier to infertility treatment.
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Affiliation(s)
| | | | | | - Rachel Irwin
- DIS Study Abroad in Scandinavia, Stockholm, Sweden
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18
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Savasi V, Parisi F, Oneta M, Laoreti A, Parrilla B, Duca P, Cetin I. Effects of highly active antiretroviral therapy on semen parameters of a cohort of 770 HIV-1 infected men. PLoS One 2019; 14:e0212194. [PMID: 30789923 PMCID: PMC6383866 DOI: 10.1371/journal.pone.0212194] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 01/29/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND HIV-1 infected patients show impaired semen parameters. Currently, it is not clear whether HIV-1 infection itself or antiretroviral therapy have an effect on semen parameters. We aim evaluate semen quality in a large cohort of fertile HIV-1 infected men under stable highly active antiretroviral therapy (HAART) and to assess the effect of HAART type and duration on semen parameters. MATERIALS AND METHODS Between January 2010 and June 2014, we enrolled in a retrospective case-control study 770 HIV-1 patients under stable HAART asking a reproductive counselling with their HIV negative partner. Co-infections with HBV or HCV, genital tract infections and known causes of infertility represented exclusion criteria. Semen samples were analysed and compared with the WHO reference values. A multivariate analysis including HAART type and duration, age, viral load and CD4 count, was performed on 600 patients out of 770. RESULTS The median values of all semen parameters were significantly lower among HIV-1 infected patients compared to the WHO reference group, with a significant proportion of patients having values below the 5th percentile of the WHO reference value. In a multivariate analysis, only age and viral load negatively impacted progressive motility (β -0.3 (95% CI: -0.5; -0.0) %, p<0.05) and semen morphology (β -0.00 (95% CI: -0.00; -0.00) %, p≤0.01), while no associations were detected as regards HAART type and duration. CONCLUSIONS HIV-1 infected patients showed a significant impairment of semen parameters compared to the reference values. HAART type and duration showed no associations with semen quality. Further research is needed to investigate implications for clinical care of HIV infected men desiring a child.
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Affiliation(s)
- Valeria Savasi
- Unit of Obstetrics and Gynecology, Department of Biomedical and Clinical Sciences, ASST Fatebenefratelli Sacco, Hospital “L. Sacco”, University of Milan, Milan, Italy
- Centre for Fetal Research Giorgio Pardi, University of Milan, Milan, Italy
- * E-mail:
| | - Francesca Parisi
- Unit of Obstetrics and Gynecology, Department of Biomedical and Clinical Sciences, ASST Fatebenefratelli Sacco, Hospital “L. Sacco”, University of Milan, Milan, Italy
- Centre for Fetal Research Giorgio Pardi, University of Milan, Milan, Italy
| | - Monica Oneta
- Unit of Obstetrics and Gynecology, Department of Biomedical and Clinical Sciences, ASST Fatebenefratelli Sacco, Hospital “L. Sacco”, University of Milan, Milan, Italy
| | - Arianna Laoreti
- Unit of Obstetrics and Gynecology, Department of Biomedical and Clinical Sciences, ASST Fatebenefratelli Sacco, Hospital “L. Sacco”, University of Milan, Milan, Italy
- Centre for Fetal Research Giorgio Pardi, University of Milan, Milan, Italy
| | - Bina Parrilla
- Unit of Obstetrics and Gynecology, Department of Biomedical and Clinical Sciences, ASST Fatebenefratelli Sacco, Hospital “L. Sacco”, University of Milan, Milan, Italy
| | - Piergiorgio Duca
- Statistical and Biometry Unit, Department of Biomedical and Clinical Sciences, Hospital “L. Sacco”, University of Milan, Milan, Italy
| | - Irene Cetin
- Unit of Obstetrics and Gynecology, Department of Biomedical and Clinical Sciences, ASST Fatebenefratelli Sacco, Hospital “L. Sacco”, University of Milan, Milan, Italy
- Centre for Fetal Research Giorgio Pardi, University of Milan, Milan, Italy
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19
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Savasi V, Oneta M, Laoreti A, Parisi F, Parrilla B, Duca P, Cetin I. Effects of Antiretroviral Therapy on Sperm DNA Integrity of HIV-1-Infected Men. Am J Mens Health 2018; 12:1835-1842. [PMID: 30132391 PMCID: PMC6199444 DOI: 10.1177/1557988318794282] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
HIV-1-affected couples' desire to have children and free sexual intercourses with the use of pre-exposure prophylaxis for the negative partner has emerged as an alternative option to assisted reproduction in aviremic patients under highly active antiretroviral therapy (HAART). It is already known that sperm quality may be impaired in HIV-infected men. The underlying physiopathological mechanism is still debated. The aim of this study was to evaluate the effects of HAART on sperm DNA fragmentation, comparing HIV-1-infected patients taking HAART versus naïve HIV-1-infected patients. This is a prospective case-control study. Sperm nuclear DNA fragmentation rate was evaluated by the sperm chromatin dispersion test in 77 HIV-infected men: 53 HIV-1 patients receiving HAART (Group 1) versus 24 naïve HIV-1 patients not receiving HAART (Group 2). Complete semen analysis was performed according to WHO 2010 recommendations. Patients with HBV infection or HCV infection coinfections and genital tract infections wre excluded. All the patients did not present any clinical signs of their disease. Seminal parameters were examined in the two groups, showing no significant differences. Increased sperm DNA fragmentation > 30% was demonstrated in 67.9% of patients in Group 1 and 37.5% of patients in Group 2, respectively ( p = .02). A positive but nonsignificant trend toward increased fragmentation was reported with advancing patients' age. In conclusion, sperm nuclear fragmentation rate is increased in HIV-1-infected patients taking HAART compared to HIV-1 patients not receiving HAART.
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Affiliation(s)
- Valeria Savasi
- Unit of Obstetrics and Gynecology, Department of Biomedical and Clinical Sciences, ASST Fatebenefratelli Sacco, Hospital “L. Sacco,” University of Milan, Italy
- Centre for Fetal Research Giorgio Pardi, University of Milan, Italy
- Valeria Savasi, Unit of Obstetrics and Gynecology, Department of Biomedical and Clinical Sciences, ASST Fatebenefratelli Sacco, Hospital “L. Sacco,” University of Milan, Via G.B. Grassi 74, Milan 20157, Italy.
| | - Monica Oneta
- Unit of Obstetrics and Gynecology, Department of Biomedical and Clinical Sciences, ASST Fatebenefratelli Sacco, Hospital “L. Sacco,” University of Milan, Italy
| | - Arianna Laoreti
- Unit of Obstetrics and Gynecology, Department of Biomedical and Clinical Sciences, ASST Fatebenefratelli Sacco, Hospital “L. Sacco,” University of Milan, Italy
- Centre for Fetal Research Giorgio Pardi, University of Milan, Italy
| | - Francesca Parisi
- Unit of Obstetrics and Gynecology, Department of Biomedical and Clinical Sciences, ASST Fatebenefratelli Sacco, Hospital “L. Sacco,” University of Milan, Italy
- Centre for Fetal Research Giorgio Pardi, University of Milan, Italy
| | - Bina Parrilla
- Unit of Obstetrics and Gynecology, Department of Biomedical and Clinical Sciences, ASST Fatebenefratelli Sacco, Hospital “L. Sacco,” University of Milan, Italy
| | - Piergiorgio Duca
- Statistical and Biometry Unit, Department of Biomedical and Clinical Sciences, Hospital “L. Sacco,” University of Milan, Milan, Italy
| | - Irene Cetin
- Unit of Obstetrics and Gynecology, Department of Biomedical and Clinical Sciences, ASST Fatebenefratelli Sacco, Hospital “L. Sacco,” University of Milan, Italy
- Centre for Fetal Research Giorgio Pardi, University of Milan, Italy
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20
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Li R, Zhao L, Li L, Hou Z, Zhang D, Wan L, Wei L, Yang Y, Lv J, Ma M, Zhu Y. A Preliminary Study about the Potential Effects of Heavy Metals on the Human Male Reproductive Parameters in HIV-Infected Population in China. Biol Trace Elem Res 2017; 180:39-47. [PMID: 28321634 DOI: 10.1007/s12011-017-0998-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 03/14/2017] [Indexed: 12/18/2022]
Abstract
Due to the inconsistent effects of human immunodeficiency virus (HIV) on the human male reproduction in previous studies and the impacts of environmental exposures, such as heavy metals, on male reproduction receiving little attention in HIV-infected population, the aim of present study was to investigate whether heavy metals have potential effects on reproductive parameters in HIV-infected men. The current study assessed the associations between semen quality or serum hormone and concentration of the three heavy metal toxicants (lead (Pb), cadmium (Cd), and zinc (Zn)) in seminal, urine, and serum, and 50 HIV-infected men were recruited in the present study. Concentrations of Pb, Cd, and Zn were measured in three fluids by graphite furnace atomic absorption spectrophotometer. Semen analyses were performed according to World Health Organization criteria. Serum samples were analyzed for follicle-stimulating hormone, luteinizing hormone, and testosterone. HIV RNA viral load was determined by HIV virus loads kit. Spearman's rank correlations were used for correlation analyses. The results showed that the concentrations of Pb, Cd, and Zn were significantly correlated with semen quality and serum hormone. HIV-1 virus loads were significantly associated with increased seminal Pb. However, HIV-1 virus loads were not statistically associated with semen quality and serum hormone. Our findings suggested that environmental heavy metals had potential effects on reproductive parameters in HIV-infected men in China.
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Affiliation(s)
- Renyan Li
- Chongqing institute of Population and Family Planning, Key Laboratory of Birth Defects and Reproductive Health, Chongqing, 400020, China
| | - Letian Zhao
- Chongqing institute of Population and Family Planning, Key Laboratory of Birth Defects and Reproductive Health, Chongqing, 400020, China
| | - Lianbing Li
- Chongqing institute of Population and Family Planning, Key Laboratory of Birth Defects and Reproductive Health, Chongqing, 400020, China
| | - Zhiwei Hou
- Chongqing institute of Population and Family Planning, Key Laboratory of Birth Defects and Reproductive Health, Chongqing, 400020, China
| | - Danyan Zhang
- Chongqing institute of Population and Family Planning, Key Laboratory of Birth Defects and Reproductive Health, Chongqing, 400020, China
| | - Ling Wan
- Chongqing institute of Population and Family Planning, Key Laboratory of Birth Defects and Reproductive Health, Chongqing, 400020, China
| | - Li Wei
- Chongqing institute of Population and Family Planning, Key Laboratory of Birth Defects and Reproductive Health, Chongqing, 400020, China
| | - Yuyou Yang
- Chongqing institute of Population and Family Planning, Key Laboratory of Birth Defects and Reproductive Health, Chongqing, 400020, China
| | - Jing Lv
- Chongqing institute of Population and Family Planning, Key Laboratory of Birth Defects and Reproductive Health, Chongqing, 400020, China
| | - Mingfu Ma
- Chongqing institute of Population and Family Planning, Key Laboratory of Birth Defects and Reproductive Health, Chongqing, 400020, China.
| | - Yijian Zhu
- Chongqing institute of Population and Family Planning, Key Laboratory of Birth Defects and Reproductive Health, Chongqing, 400020, China.
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21
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Semet M, Paci M, Saïas-Magnan J, Metzler-Guillemain C, Boissier R, Lejeune H, Perrin J. The impact of drugs on male fertility: a review. Andrology 2017. [PMID: 28622464 DOI: 10.1111/andr.12366] [Citation(s) in RCA: 139] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Beside cytotoxic drugs, other drugs can impact men's fertility through various mechanisms. Via the modification of the hypothalamic-pituitary-gonadal axis hormones or by non-hormonal mechanisms, drugs may directly and indirectly induce sexual dysfunction and spermatogenesis impairment and alteration of epididymal maturation. This systematic literature review summarizes existing data about the negative impact and associations of pharmacological treatments on male fertility (excluding cytotoxic drugs), with a view to making these data more readily available for medical staff. In most cases, these effects on spermatogenesis/sperm maturation/sexual function are reversible after the discontinuation of the drug. When a reprotoxic treatment cannot be stopped and/or when the impact on semen parameters/sperm DNA is potentially irreversible (Sulfasalazine Azathioprine, Mycophenolate mofetil and Methotrexate), the cryopreservation of spermatozoa before treatment must be proposed. Deleterious impacts on fertility of drugs with very good or good level of evidence (Testosterone, Sulfasalazine, Anabolic steroids, Cyproterone acetate, Opioids, Tramadol, GhRH analogues and Sartan) are developed.
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Affiliation(s)
- M Semet
- Centre clinico-biologique d'Assistance Médicale à la Procréation - CECOS, Pole Femmes-Parents-Enfants, AP-HM La Conception, Marseille, France
| | - M Paci
- Centre clinico-biologique d'Assistance Médicale à la Procréation - CECOS, Pole Femmes-Parents-Enfants, AP-HM La Conception, Marseille, France.,Aix Marseille Univ, INSERM, GMGF UMR_S 910, Marseille, France
| | - J Saïas-Magnan
- Centre clinico-biologique d'Assistance Médicale à la Procréation - CECOS, Pole Femmes-Parents-Enfants, AP-HM La Conception, Marseille, France
| | - C Metzler-Guillemain
- Centre clinico-biologique d'Assistance Médicale à la Procréation - CECOS, Pole Femmes-Parents-Enfants, AP-HM La Conception, Marseille, France.,Aix Marseille Univ, INSERM, GMGF UMR_S 910, Marseille, France
| | - R Boissier
- Aix-Marseille University, Marseille, France.,Department of Urology and Renal Transplantation, APHM, Conception University Hospital, Marseille, France
| | - H Lejeune
- Service de Médecine de la Reproduction, Hôpital Femme Mère, Enfant, CHU de Lyon, Bron, France
| | - J Perrin
- Centre clinico-biologique d'Assistance Médicale à la Procréation - CECOS, Pole Femmes-Parents-Enfants, AP-HM La Conception, Marseille, France.,Aix Marseille Univ, Univ Avignon, CNRS, IRD, IMBE, Marseille, France
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22
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Antivirals and Male Reproduction. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 1034:163-178. [DOI: 10.1007/978-3-319-69535-8_11] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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23
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Jerónimo A, Baza MB, Río I, Vera M, Hernando V, Castilla J, Rodriguez C, Del Romero J. Factors associated with seminal impairment in HIV-infected men under antiretroviral therapy. Hum Reprod 2016; 32:265-271. [PMID: 28007791 DOI: 10.1093/humrep/dew321] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 11/14/2016] [Accepted: 11/23/2016] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION How do semen parameters of HIV-infected men under antiretroviral treatment compare with WHO parameters of normal semen, and what factors are associated with any differences? SUMMARY ANSWER Semen quality in most HIV-infected patients under antiretroviral treatment exceeds WHO limits, but the number falling below them is higher than would be expected in a healthy population. Exposure to efavirenz has a significant association with dysmotility. WHAT IS KNOWN ALREADY Dysmotility is the most frequently described sperm alteration related to HIV infection, and it has recently been linked to treatment with non-nucleoside reverse transcriptase inhibitors, particularly to efavirenz. STUDY DESIGN, SIZE, DURATION Prospective cohort study. Between March 2002 and December 2013, 139 HIV-infected men undergoing antiretroviral therapy were enrolled. PARTICIPANTS/MATERIALS, SETTING, METHODS Participants were male members of serodiscordant couples who attended a clinic for sexually transmitted infections (STIs) in Madrid and requested reproductive counselling. Sociodemographic, behavioural and clinical data were collected. CD4+ lymphocyte count, HIV viral load, serology/viral load of hepatitis B and C viruses, syphilis serology and other STIs diagnosis were performed. Semen parameters were assessed through standard sperm analysis and were compared with WHO 2010 reference values. Factors associated with impaired semen parameters were evaluated by bivariate and multivariate analysis. MAIN RESULTS AND THE ROLE OF CHANCE The median values of all assessed semen parameters were within a normal range, but in up to 19% of HIV-positive males, at least one parameter of semen quality was below the normal range. A significant association between treatment with efavirenz and the presence of dysmotility was detected in the multivariate analysis. LIMITATIONS, REASONS FOR CAUTION Our results cannot demonstrate a causal relationship between exposure to efavirenz and impaired motility. We do not have a real comparison group as the WHO cohort is international and may not reflect local variations in semen characteristics. Subjects who requested reproductive counselling might not be representative of HIV-positive men in general. WIDER IMPLICATIONS OF THE FINDINGS Since efavirenz is still widely used in current therapeutic regimens may be affecting fertility in seropositive men who desire procreation. STUDY FUNDING/COMPETING INTERESTS No external funding was used for this study. The authors have no conflict of interest to declare.
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Affiliation(s)
- A Jerónimo
- Centro Sanitario Sandoval, Instituto de Investigación Sanitaria San Carlos (IdISSC), C/Sandoval 7, 28010 Madrid, Spain
| | - M B Baza
- Centro Sanitario Sandoval, Instituto de Investigación Sanitaria San Carlos (IdISSC), C/Sandoval 7, 28010 Madrid, Spain
| | - I Río
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - M Vera
- Centro Sanitario Sandoval, Instituto de Investigación Sanitaria San Carlos (IdISSC), C/Sandoval 7, 28010 Madrid, Spain
| | - V Hernando
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III (ISCIII), Madrid, Spain.,CIBER Epidemiología y Salud Pública, Madrid, Spain
| | - J Castilla
- CIBER Epidemiología y Salud Pública, Madrid, Spain.,Instituto de Salud Pública de Navarra, IdiSNA, Pamplona, Spain
| | - C Rodriguez
- Centro Sanitario Sandoval, Instituto de Investigación Sanitaria San Carlos (IdISSC), C/Sandoval 7, 28010 Madrid, Spain
| | - J Del Romero
- Centro Sanitario Sandoval, Instituto de Investigación Sanitaria San Carlos (IdISSC), C/Sandoval 7, 28010 Madrid, Spain
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Abstract
Male fertility can be affected by a variety of organs diseases, including the skin. Several genodermatoses affect the skin and several other organs including the male reproductive system, commonly in the form of cryptorchidism and hypogonadism. The most relevant syndromes are associated with dyschromias, such as deSanctis-Cacchione, poikiloderma congenital, LEOPARD, and H syndrome; others with ichthyosis, such as Rud, and trichothiodystrophy; or a group of unrelated genodermatoses, such as ablepharon macrostomia, Coffin-Siris, Gorlin-Goltz, and Werner. Acquired skin diseases may also affect male fertility usually in the form of orchitis or epididymal obstruction or androgen antagonists. These include infections (leprosy and HIV), autoimmune (erythema nodosum leprosum), granulomatous (sarcoidosis, Langerhans cell histiocytosis), nutritional deficiency (zinc), and malignancy. Several therapeutics of skin diseases are notorious for their effects on male fertility, most notably are the cytotoxic drugs (methotrexate), irradiation, and antiandrogens (spironolactone, finasteride). Although the prevalence of these skin diseases is low, the associated male infertility represents a challenge due to the difficulty of its management. Clinical management of the skin diseases should include consideration of their effects not only on the diseases but also on the male reproductive system.
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Affiliation(s)
- M Badawy Abdel-Naser
- Department of Dermatology, Andrology and STIs, Ain Shams University, 4 Al Rahman Tower, El Sawah Square, Cairo, 11281, Egypt.
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany.
| | - Christos C Zouboulis
- Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Dessau, Germany
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25
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Semen residual viral load and reproductive outcomes in HIV-infected men undergoing ICSI after extended semen preparation. Reprod Biomed Online 2016; 32:584-90. [DOI: 10.1016/j.rbmo.2016.02.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 02/17/2016] [Accepted: 02/24/2016] [Indexed: 11/18/2022]
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26
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Jindal SK, Rawlins RG, Muller CH, Drobnis EZ. Guidelines for risk reduction when handling gametes from infectious patients seeking assisted reproductive technologies. Reprod Biomed Online 2016; 33:121-30. [PMID: 27235103 DOI: 10.1016/j.rbmo.2016.04.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 04/22/2016] [Accepted: 04/26/2016] [Indexed: 02/07/2023]
Abstract
According to the Americans with Disabilities Act (1990), couples with blood-borne viruses that lead to infectious disease cannot be denied fertility treatment as long as the direct threat to the health and safety of others can be reduced or eliminated by a modification of policies or procedures. Three types of infectious patients are commonly discussed in the context of fertility treatment: those with human immunodeficiency virus (HIV), hepatitis C or hepatitis B. Seventy-five per cent of hepatitis C or HIV positive men and women are in their reproductive years, and these couples look to assisted reproductive techniques for risk reduction in conceiving a pregnancy. In many cases, only one partner is infected. Legal and ethical questions about treatment of infectious patients aside, the question most asked by clinical embryologists and andrologists is: "What are the laboratory protocols for working with gametes and embryos from patients with infectious disease?" The serostatus of each patient is the key that informs appropriate treatments. This guidance document describes protocols for handling gametes from seroconcordant and serodiscordant couples with infectious disease. With minor modifications, infectious patients with stable disease status and undetectable or low viral load can be accommodated in the IVF laboratory.
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Affiliation(s)
- Sangita K Jindal
- Department Obstetrics, Gynecology and Women's Health, Albert Einstein College of Medicine, Montefiore's Institute for Reproductive Medicine and Health, 1300 Morris Park Avenue, Bronx, NY 10461, USA.
| | - Richard G Rawlins
- Department Obstetrics and Gynecology, Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL 60612
| | - Charles H Muller
- Male Fertility Lab, Department Urology, University of Washington, 4245 Roosevelt Way NE, Seattle, WA 98105
| | - Erma Z Drobnis
- Reproductive Medicine and Fertility, Department Obstetrics, Gynecology and Women's Health, University of Missouri, 500 N. Keene St, Suite 203, Columbia, MO 65201
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27
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Sabeti P, Pourmasumi S, Rahiminia T, Akyash F, Talebi AR. Etiologies of sperm oxidative stress. Int J Reprod Biomed 2016. [DOI: 10.29252/ijrm.14.4.231] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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28
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Moreno-Pérez O, Boix V, Merino E, Picó A, Reus S, Alfayate R, Giner L, Mirete R, Sánchez-Payá J, Portilla J. Biological markers of fertility (inhibin-B) in HIV-infected men: influence of HIV infection and antiretroviral therapy. HIV Med 2015; 17:436-44. [PMID: 26688126 DOI: 10.1111/hiv.12350] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Inhibin B (IB) levels and the IB: follicle-stimulating hormone (FSH) ratio (IFR), biomarkers of global Sertoli cell function, show a strong relationship with male fertility. The aim of the study was to examine the prevalence of impaired fertility potential in HIV-infected men and the influence of antiretroviral therapy (ART) on fertility biomarkers. METHODS A cross-sectional study with sequential sampling was carried out. A total of 169 clinically stable patients in a cohort of HIV-infected men undergoing regular ambulatory assessment in a tertiary hospital were included. The mean [± standard deviation (SD)] age of the patients was 42.6 ± 8.1 years, all were clinically stable, 61.5% had disease classified as Centers for Disease Control and Prevention (CDC) stage A, and were na?ve to ART or had not had any changes to ART for 6 months (91.1%). Morning baseline IB and FSH concentrations were measured using an enzyme-linked immunosorbent assay (ELISA) and an electrochemiluminescent immunoassay (ECLIA), respectively. A multivariate logistic regression model was used to identify factors associated with impaired fertility, defined as IB < 119 pg/mL or IFR < 23.5. RESULTS The mean (± SD) IB level was 250 ± 103 pg/mL, the median [interquartile range (IQR)] FSH concentration was 5.1 (3.3-7.8) UI/L and the median (IQR) IFR was 46.1 (26.3-83.7). The prevalence of impaired fertility was 21.9% [95% confidence interval (CI) 16.3-20.7%]. Negative correlations of body mass index and waist: hip ratio with FSH and IB levels were observed (P < 0.01), while a sedentary lifestyle and previous nevirapine exposure were associated with a decreased risk of IB levels ≤ 25th percentile in multivariate analysis. Only older age, as a risk factor, and sedentary lifestyle, with a protective effect, were independently associated with impaired fertility in multivariate analysis. CONCLUSIONS Global testicular Sertoli cell function and fertility potential, assessed indirectly through serum IB levels and IB: FSH ratio, appear to be well maintained in HIV-infected men and not damaged by ART.
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Affiliation(s)
- O Moreno-Pérez
- Endocrinology and Nutrition Department, Alicante University General Hospital, Alicante, Spain.,Miguel Hernández University, San Juan de Alicante, Alicante, Spain
| | - V Boix
- Miguel Hernández University, San Juan de Alicante, Alicante, Spain.,Infectious Diseases Unit, Alicante University General Hospital, Alicante, Spain
| | - E Merino
- Miguel Hernández University, San Juan de Alicante, Alicante, Spain.,Infectious Diseases Unit, Alicante University General Hospital, Alicante, Spain
| | - A Picó
- Endocrinology and Nutrition Department, Alicante University General Hospital, Alicante, Spain.,Miguel Hernández University, San Juan de Alicante, Alicante, Spain
| | - S Reus
- Miguel Hernández University, San Juan de Alicante, Alicante, Spain.,Infectious Diseases Unit, Alicante University General Hospital, Alicante, Spain
| | - R Alfayate
- Hormone Laboratory, Alicante University General Hospital, Alicante, Spain
| | - L Giner
- Infectious Diseases Unit, Alicante University General Hospital, Alicante, Spain
| | - R Mirete
- Endocrinology and Nutrition Department, Alicante University General Hospital, Alicante, Spain
| | - J Sánchez-Payá
- Preventive Medicine Department, Alicante University General Hospital, Alicante, Spain
| | - J Portilla
- Miguel Hernández University, San Juan de Alicante, Alicante, Spain.,Infectious Diseases Unit, Alicante University General Hospital, Alicante, Spain
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29
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Ciaranello AL, Matthews LT. Safer Conception Strategies for HIV-Serodiscordant Couples: How Safe Is Safe Enough? J Infect Dis 2015; 212:1525-8. [PMID: 26092857 PMCID: PMC4621252 DOI: 10.1093/infdis/jiv275] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 05/05/2015] [Indexed: 01/01/2023] Open
Affiliation(s)
- Andrea L Ciaranello
- Division of Infectious Disease, Department of Medicine Medical Practice Evaluation Center
| | - Lynn T Matthews
- Division of Infectious Disease, Department of Medicine Center for Global Health, Massachusetts General Hospital, Boston
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30
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Frapsauce C, Grabar S, Leruez-ville M, Launay O, Sogni P, Gayet V, Viard J, De Almeida M, Jouannet P, Dulioust E. Impaired sperm motility in HIV-infected men: an unexpected adverse effect of efavirenz? Hum Reprod 2015; 30:1797-806. [DOI: 10.1093/humrep/dev141] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Accepted: 05/26/2015] [Indexed: 12/25/2022] Open
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31
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Male infertility: a public health issue caused by sexually transmitted pathogens. Nat Rev Urol 2014; 11:672-87. [PMID: 25330794 DOI: 10.1038/nrurol.2014.285] [Citation(s) in RCA: 134] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Sexually transmitted diseases (STDs) are caused by several pathogens, including bacteria, viruses and protozoa, and can induce male infertility through multiple pathophysiological mechanisms. Additionally, horizontal transmission of STD pathogens to sexual partners or vertical transmission to fetuses and neonates is possible. Chlamydia trachomatis, Ureaplasma spp., human papillomavirus, hepatitis B and hepatitis C viruses, HIV-1 and human cytomegalovirus have all been detected in semen from symptomatic and asymptomatic men with testicular, accessory gland and urethral infections. These pathogens are associated with poor sperm quality and decreased sperm concentration and motility. However, the effects of these STD agents on semen quality are unclear, as are the effects of herpes simplex virus type 1 and type 2, Neisseria gonorrhoeae, Mycoplasma spp., Treponema pallidum and Trichomonas vaginalis, because few studies have evaluated the influence of these pathogens on male infertility. Chronic or inadequately treated infections seem to be more relevant to infertility than acute infections are, although in many cases the exact aetiological agents remain unknown.
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32
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Ramón M, Jiménez-Rabadán P, García-Álvarez O, Maroto-Morales A, Soler AJ, Fernández-Santos MR, Pérez-Guzmán MD, Garde JJ. Understanding Sperm Heterogeneity: Biological and Practical Implications. Reprod Domest Anim 2014; 49 Suppl 4:30-6. [DOI: 10.1111/rda.12404] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Accepted: 07/14/2014] [Indexed: 11/28/2022]
Affiliation(s)
| | | | | | | | - AJ Soler
- SaBio IREC (UCLM-CSIC-JCCM); Albacete Spain
| | | | | | - JJ Garde
- SaBio IREC (UCLM-CSIC-JCCM); Albacete Spain
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33
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Wang D, Li L, Xie Q, Hou Z, Yu X, Ma M, Huang T. Factors affecting sperm fertilizing capacity in men infected with HIV. J Med Virol 2014; 86:1467-72. [PMID: 24898681 DOI: 10.1002/jmv.23991] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2014] [Indexed: 02/05/2023]
Abstract
Studies on the sperm-fertilizing capacity of HIV-seropositive men show conflicting results for reasons that are not yet clear. The aim of this study was to investigate the effects and relationships of some factors such as patient age, CD4(+) cells count, fathering offspring, concomitant sexually transmitted diseases (STD), and receipt of highly active anti-retroviral therapy (HAART) on sperm fertilizing capacity. Semen samples were collected from 33 HIV-seropositive men. Data on the above factors were acquired from a self-designed questionnaire. Computer-assisted sperm analysis, a hypo-osmotic swelling, and zona-free hamster oocyte penetration tests were performed according to criteria of the World Health Organization. CD4(+) cells in peripheral blood were examined using a flow cytometric (FCM) analyzer. Sperm vitality, sperm motility (grades a + b), total sperm motility, and sperm penetration rates were significantly higher in patients whose CD4(+) counts were ≧350/µl than in those whose CD4(+) counts were <350/µl (P < 0.05), and the parameters mentioned above were also significantly correlated with CD4(+) cell number (all P < 0.05). Significant differences in total sperm count and sperm tail swelling rate between patients co-infected with STD and without STD were observed (P < 0.05). Sperm penetration rate in patients receiving HAART was significantly higher than in those not receiving HAART (P < 0.05). Blood CD4(+) cell counts are an important indicator for evaluating sperm fertilizing capacity of HIV-seropositive men. After receiving HAART, the sperm penetration rate of HIV-seropositive men can be improved.
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Affiliation(s)
- Dian Wang
- Research Center for Reproductive Medicine, Shantou University Medical College, Shantou, China; Department of Forensic Medicine, Shantou University Medical College, Shantou, China
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34
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Barnes A, Riche D, Mena L, Sison T, Barry L, Reddy R, Shwayder J, Parry JP. Efficacy and safety of intrauterine insemination and assisted reproductive technology in populations serodiscordant for human immunodeficiency virus: a systematic review and meta-analysis. Fertil Steril 2014; 102:424-34. [DOI: 10.1016/j.fertnstert.2014.05.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Revised: 04/27/2014] [Accepted: 05/01/2014] [Indexed: 02/05/2023]
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35
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Semen quality in HIV patients under stable antiretroviral therapy is impaired compared to WHO 2010 reference values and on sperm proteome level. AIDS 2014; 28:875-80. [PMID: 24614089 DOI: 10.1097/qad.0000000000000161] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To investigate semen quality in HIV patients under stable antiretroviral therapy (ART) compared with WHO 2010 reference values and on the sperm proteome level. DESIGN Between 2011 and 2013, we prospectively enrolled 116 HIV-positive men without hepatitis B or C co-infections from our outpatient department for infectious diseases. METHODS Patients received a comprehensive andrological work-up. Complete semen analysis was performed according to WHO 2010 recommendations, with each semen variable of the study population being compared with the WHO reference group (n~2000). Correlation analysis was done to investigate the influence of HIV surrogate parameters on semen quality. Two-dimensional gel electrophoresis and subsequent protein identification was performed to determine any differences in the sperm protein composition of the 15 HIV-positive patients and that of 15 age-matched healthy men. RESULTS Median values of all assessed semen parameters were within a normal range. However, for each semen variable, about 25% of patients had values below the fifth percentile of the WHO 2010 reference group. Disease-related parameters (CD4þ cell count, viral load, CDC stage, duration of disease, duration of ART, number and type of antiretroviral drugs) were not significantly correlated with any sperm parameter. Sperm proteome analysis identified 14 downregulated proteins associated with sperm motility and fertility. CONCLUSION This is the first study that compares all standard semen parameters in HIV positive patients under ART to WHO 2010 reference values. It provides evidence of impaired conventional semen parameters and altered sperm protein composition. Finally, HIV surrogate parameters are not suitable for predicting semen quality.
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Raúl Sánchez G. Presente y futuro de la anología. REVISTA MÉDICA CLÍNICA LAS CONDES 2014. [DOI: 10.1016/s0716-8640(14)70005-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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37
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Sullivan-Pyke CS, Nurudeen SK, Grossman LC, Sauer MV, Douglas NC. Fertility treatment options for HIV-infected individuals. Future Virol 2013. [DOI: 10.2217/fvl.13.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Many HIV-serodiscordant couples desire children and physician-assisted techniques can help individuals achieve pregnancy while reducing the risk of seroconversion in their seronegative partner. For HIV-seropositive males, sperm washing with intrauterine insemination (SW-IUI) was introduced in Europe in the early 1990s, while in the USA in vitro fertilization with intracytoplasmic sperm injection (IVF-ICSI) has been primarily used to reduce the risk of viral transmission. When properly applied to well-selected populations, no seroconversion has been reported with either of these methods. Within the last 5 years, randomized controlled studies have demonstrated the efficacy of daily pre-exposure prophylaxis in reducing the risk of seroconversion in couples having intercourse when an HIV-seropositive male has undetectable viral loads. In both the USA and Europe, favorable reproductive outcomes have been reported for HIV-seropositive females undergoing IUI and IVF-ICSI. Herein, we review the use of various contemporary reproductive techniques available to HIV-serodiscordant couples interested in having children, including new data on cumulative clinical pregnancy rates and cumulative live-birth rates after IVF-ICSI for male serodiscordant couples. We conclude by proposing that pre-exposure prophylaxis with SW-IUI may be a safe, economical and effective alternative for achieving pregnancy in well-selected, monogamous HIV-serodiscordant couples where the male partner is seropositive.
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Affiliation(s)
- Chantae S Sullivan-Pyke
- Columbia University, Department of OB-GYN, Division of Reproductive Endocrinology & Infertility, 622 W 168th Street, PH-16, New York, NY 10032, USA
| | - Sahadat K Nurudeen
- Columbia University, Department of OB-GYN, Division of Reproductive Endocrinology & Infertility, 622 W 168th Street, PH-16, New York, NY 10032, USA
| | - Lisa C Grossman
- Columbia University, Department of OB-GYN, Division of Reproductive Endocrinology & Infertility, 622 W 168th Street, PH-16, New York, NY 10032, USA
| | - Mark V Sauer
- Columbia University, Department of OB-GYN, Division of Reproductive Endocrinology & Infertility, 622 W 168th Street, PH-16, New York, NY 10032, USA
| | - Nataki C Douglas
- Columbia University, Department of OB-GYN, Division of Reproductive Endocrinology & Infertility, 622 W 168th Street, PH-16, New York, NY 10032, USA
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38
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Garolla A, Pizzol D, Bertoldo A, Menegazzo M, Barzon L, Foresta C. Sperm viral infection and male infertility: focus on HBV, HCV, HIV, HPV, HSV, HCMV, and AAV. J Reprod Immunol 2013; 100:20-9. [DOI: 10.1016/j.jri.2013.03.004] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 03/20/2013] [Accepted: 03/20/2013] [Indexed: 12/09/2022]
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39
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Abstract
This article provides an overview of infectious and inflammatory conditions associated with male infertility. These conditions may affect several components of the male reproductive tract and therefore have the ability to potentially alter sperm function. The effect of these conditions on male fertility is poorly understood and often underestimated.
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40
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Brookings C, Goldmeier D, Sadeghi-Nejad H. Sexually transmitted infections and sexual function in relation to male fertility. Korean J Urol 2013; 54:149-56. [PMID: 23526114 PMCID: PMC3604566 DOI: 10.4111/kju.2013.54.3.149] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 02/26/2013] [Indexed: 01/03/2023] Open
Abstract
Infertility affects about 8% to 12% of couples, with male infertility being responsible for about 30% of cases. Sexually transmitted infections (STIs) are known to cause complications of pregnancy and are associated with tubal infertility in females, but the association with male fertility is still controversial. The prevalence of curable STIs has risen to an estimated 448 million a year with the number of people living with human immunodeficiency virus (HIV) at 34 million. This review looks at the evidence available to date, regarding the effect of STIs and male accessory gland infections on markers of male fertility and the evidence that STIs negatively affect sexual functioning, thus adversely affecting the ability to conceive. The review will also cover new developments in the use of medications and fertility treatments as an aid to conception in couples serodiscordant for HIV.
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Affiliation(s)
- Claire Brookings
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
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41
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Savasi V, Mandia L, Laoreti A, Cetin I. Reproductive assistance in HIV serodiscordant couples. Hum Reprod Update 2012; 19:136-50. [PMID: 23146867 DOI: 10.1093/humupd/dms046] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Three quarters of individuals infected with human immunodeficiency virus (HIV) are in their reproductive years and may consider pregnancy planning. Techniques have been developed which can minimize the risk of HIV transmission in these couples, and the current literature on this topic is reviewed here. METHODS We reviewed the literature for the following topics: risk of HIV transmission, effects of HIV infection on fertility, reproductive assistance in industrialized and low-income countries, pre-exposure chemoprophylaxis (PrEP) and timed intercourse in HIV-discordant couples for both male and female positivity. Relevant publications were identified through searches of the EMBASE Medline and PubMed databases, the Google-indexed scientific literature and periodic specialized magazines from the on-line Library Service of the University of Milan, Italy. RESULTS In serodiscordant couples in which the man is positive, the primary method used to prevent HIV transmission is 'sperm washing', followed by IUI or IVF. Data show that sperm washing in HIV-positive men has not produced seroconversion in women or their offspring; however, the evidence is limited. Recently, increasing evidence describing PrEP for HIV prevention has been published and PrEP could be an alternative to ART for fertile couples. Usually HIV-infected women undergo self-insemination around the time of ovulation. Few studies have been published on IVF outcome in HIV-infected women. CONCLUSIONS Assisted reproduction programmes should be integrated into global public health services against HIV. For HIV serodiscordant couples with infected men, sperm washing should be the first choice. However, timed intercourse and PrEP for HIV prevention has been reported. Recent data highlight the possible impairment of fertility in HIV-infected women. Efforts to design a multicentric study should be strengthened.
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Affiliation(s)
- V Savasi
- Unit of Obstetrics and Gynecology, Department of Clinical Sciences, Hospital L. Sacco, University of Milan, Via G. B. Grassi, 74, 20157 Milan, Italy.
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Hoyt MJ, Storm DS, Aaron E, Anderson J. Preconception and contraceptive care for women living with HIV. Infect Dis Obstet Gynecol 2012; 2012:604183. [PMID: 23097595 PMCID: PMC3477542 DOI: 10.1155/2012/604183] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Accepted: 06/04/2012] [Indexed: 02/06/2023] Open
Abstract
Women living with HIV have fertility desires and intentions that are similar to those of uninfected women, and with advances in treatment most women can realistically plan to have and raise children to adulthood. Although HIV may have adverse effects on fertility, recent studies suggest that antiretroviral therapy may increase or restore fertility. Data indicate the increasing numbers of women living with HIV who are becoming pregnant, and that many pregnancies are unintended and contraception is underutilized, reflecting an unmet need for preconception care (PCC). In addition to the PCC appropriate for all women of reproductive age, women living with HIV require comprehensive, specialized care that addresses their unique needs. The goals of PCC for women living with HIV are to prevent unintended pregnancy, optimize maternal health prior to pregnancy, improve maternal and fetal outcomes in pregnancy, prevent perinatal HIV transmission, and prevent HIV transmission to an HIV-uninfected sexual partner when trying to conceive. This paper discusses the rationale for preconception counseling and care in the setting of HIV and reviews current literature relevant to the content and considerations in providing PCC for women living with HIV, with a primary focus on well-resourced settings.
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Affiliation(s)
- Mary Jo Hoyt
- François-Xavier Bagnoud Center, School of Nursing, University of Medicine and Dentistry of New Jersey, Newark, NJ 07101, USA.
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Rusz A, Pilatz A, Wagenlehner F, Linn T, Diemer T, Schuppe HC, Lohmeyer J, Hossain H, Weidner W. Influence of urogenital infections and inflammation on semen quality and male fertility. World J Urol 2011; 30:23-30. [DOI: 10.1007/s00345-011-0726-8] [Citation(s) in RCA: 135] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Accepted: 06/22/2011] [Indexed: 11/29/2022] 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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Lambert-Niclot S, Poirot C, Tubiana R, Houssaini A, Soulié C, Dominguez S, Schubert B, Prades M, Bonmarchand M, Calvez V, Flandre P, Peytavin G, Marcelin AG. Effect of antiretroviral drugs on the quality of semen. J Med Virol 2011; 83:1391-4. [DOI: 10.1002/jmv.22119] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Kehl S, Weigel M, Müller D, Gentili M, Hornemann A, Sütterlin M. HIV-infection and modern antiretroviral therapy impair sperm quality. Arch Gynecol Obstet 2011; 284:229-33. [DOI: 10.1007/s00404-011-1898-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Accepted: 03/21/2011] [Indexed: 11/29/2022]
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Ahmad G, Moinard N, Jouanolou V, Daudin M, Gandia P, Bujan L. In vitro assessment of the adverse effects of antiretroviral drugs on the human male gamete. Toxicol In Vitro 2011; 25:485-91. [DOI: 10.1016/j.tiv.2010.11.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2010] [Revised: 11/14/2010] [Accepted: 11/26/2010] [Indexed: 10/18/2022]
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Santulli P, Gayet V, Fauque P, Chopin N, Dulioust E, Wolf JP, Chapron C, de Ziegler D. HIV-positive patients undertaking ART have longer infertility histories than age-matched control subjects. Fertil Steril 2011; 95:507-12. [DOI: 10.1016/j.fertnstert.2010.09.018] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Revised: 08/29/2010] [Accepted: 09/14/2010] [Indexed: 11/17/2022]
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Eke AC, Oragwu C. Sperm washing to prevent HIV transmission from HIV-infected men but allowing conception in sero-discordant couples. Cochrane Database Syst Rev 2011:CD008498. [PMID: 21249711 DOI: 10.1002/14651858.cd008498.pub2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Sperm washing is a term used to describe the process in which individual spermatozoa are separated from the seminal fluid. Sperm washing is used to prevent HIV transmission but allow conception in sero-discordant couples, where the male is HIV positive, but the female is HIV negative. This procedure is based on the observation that HIV cannot attach itself to spermatozoa, but it can be found in the fluid and cells surrounding spermatozoa. OBJECTIVES To determine the benefits and harms of sperm washing of HIV-infected males when used to prevent the transmission of HIV but allowing conception in the HIV-negative female. SEARCH STRATEGY We searched the Cochrane HIV/AIDS Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, SCORPUS, AIDsearch, AJOL, LILACS and INDEX MEDICUS. We also searched the following conference proceedings for relevant abstracts:The International AIDS Conference; The Conference on Retroviruses and Opportunistic Infections (CROI); The British HIV Association (BHIVA) Conference; The International Conference of Obstetricians and Gynecologists (FIGO); The American Academy of HIV Medicine Conference; The Australasian HIV/AIDS Conference; The American Society for Reproductive Medicine (ASRM) conferences and website; The European Society for Human Reproduction and Embryology (ESHRE) conferences and websites, and the British Fertility Society (BFS) conferences and website. We also conducted a search of the website: www.ClinicalTrials.gov. The date of the most recent Cochrane HIV/AIDS Group Controlled Trials Register search was on the 10th of November, 2010. SELECTION CRITERIA We preferentially looked for randomised or quasi-randomised controlled trials on sperm washing, aimed at preventing HIV transmission from HIV infected men but allowing conception in sero-discordant couples, irrespective of publication status, year of publication, or language in the review. DATA COLLECTION AND ANALYSIS No relevant trials were identified for inclusion in this review. MAIN RESULTS Forty four studies were identified, but none of them were suitable for inclusion in this review. AUTHORS' CONCLUSIONS Reports on the use of sperm washing to prevent HIV transmission from HIV infected men but allowing conception in sero-discordant couples is currently limited to observational studies. No randomised controlled trial has assessed the benefit or risk of sperm washing to prevent HIV transmission from HIV infected men but allow conception in sero-discordant couples. Thus, this systematic review identifies the need for a multicentre randomised controlled trial assessing the benefits and possible risks of sperm washing in preventing HIV transmission from HIV infected men but allow conception in sero-discordant couples.
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Affiliation(s)
- Ahizechukwu C Eke
- Department of Health Policy and Management, Masters in Public Health (MPH), Harvard School of Public Health (HSPH), 677 Huntington Avenue, Boston, Massachusetts, USA, 02115
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Nicopoullos JDM, Almeida P, Vourliotis M, Goulding R, Gilling-Smith C. A decade of the sperm-washing programme: where are we now? HUM FERTIL 2010; 13:90-7. [PMID: 20722578 DOI: 10.3109/14647273.2010.495763] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Since 1999, we have treated HIV-positive men with sperm washing as part of a risk-reduction programme with a year-on-year increase in total infectious cycles performed to over 200 in 2008. Four hundred and thirty nine cycles of IUI, 114 cycles of IVF and 117 cycles of ICSI have been performed in HIV positive men over the decade and of the 259 couples treated, a pregnancy rate and ongoing pregnancy rate per couple of 45.4% and 36.3% have been achieved with over 100 children born with no seroconversions. We outline the continued importance of such risk-reduction measures with 9.7% of samples from men with 'stable' disease on anti-retroviral treatment and undetectable viral load demonstrating detectable viral particles in seminal fluid and discuss measures to improve outcome in this patient group.
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