The safety of ultrasonically guided testis aspiration biopsies and efficacy of use to predict varicocelectomy outcome

Risk assessment of heavy metals in marine fish and seafood from Kedah and Selangor coastal regions of Malaysia: a high-risk health concern for consumers

The heavy metals namely Fe, As, Cu, Cd, and Pb were investigated in two marine fishes silver pomfret (Pampus argentus) and torpedo scad (Megalaspis cordyla), and three seafoods sibogae squid (Loligo sibogae), Indian white prawn (Fenneropenaeus indicus), and mud crab (Scylla serrata) by using inductively coupled plasma spectrophotometer (ICP-MS) from two renowned fish harvesting coastal area of Malaysia named as Kedah and Selangor. Among the target heavy metals, highest mean concentration of As and Fe were found in Scylla serrata (72.14±7.77 μg/g) in Kedah and Megalaspis cordyla (149.40±2.15 μg/g) in Selangor. Pearson's correlation results showed As-Fe-Cd-Cu originated from the same source. Maximum estimated daily intake (EDI) values of Scylla serrata were found 175.25 μg/g/day and 100.81 μg/g/day for child in both Kedah and Selangor areas respectively. Hazard quotient (HQ) and hazard index (HI) results revealed that local consumers of Kedah and Selangor will face high chronic risk if they consume Scylla serrata, Fenneropenaeus indicus, and Megalaspis cordyla on regular basis in their diet. Carcinogenic risk results suggested that all the studied species pose very high risk of cancer occurrences to the consumers in both areas. Therefore, it could be recommended that consumers should be aware when they are consuming these marine species since they can pose serious health risk associated with prolonged consumption.

Cut-off values of the Johnsen score and Copenhagen index as histopathological prognostic factors for postoperative semen quality in selected infertile patients undergoing microsurgical correction of bilateral subclinical varicocele

Background

It remains challenging to determine which individuals are likely to benefit from microsurgical correction of subclinical varicocele, as basic semen parameters often do not improve postoperatively. We aimed to develop an easily accessible tool for prognostic stratification of infertile men indicated for microsurgical correction of bilateral subclinical varicocele characterized by prolonged and clear venous reflux and no other cause for infertility.

Methods

We retrospectively analyzed the testicular biopsy, seminal analysis, and ultrasound evaluation records of 20 men managed between 2006 and 2014. Subclinical varicocele was diagnosed through bilateral testicular palpation and auscultation of venous reflux using a Doppler stethoscope, with confirmation on color Doppler sonography. We conducted receiver operating characteristic curve analysis to identify the optimal combinations of cut-offs for the Johnsen score, Copenhagen index, and testicular volume defining histological patterns with positive prognostic value for improved postoperatively reproductive capacity.

Results

Positive prognostic value was noted for the following combinations of parameters: (I) Johnsen score >8.2 in the left testicle and right testicular volume >12.8 mL predicted improved sperm concentration; (II) Johnsen score >8.2 and Copenhagen index digit II <2.5 bilaterally predicted improved total sperm motility; (III) Johnsen score >9.1 and Copenhagen index digit III <1.5 bilaterally predicted improved progressive sperm motility; (IV) Johnsen score >7.9 and right testicular volume >13.6 mL predicted improved sperm morphology.

Conclusions

Johnsen score and Copenhagen index as histopathological prognostic factors can be easily obtained upon evaluation of testicular biopsy specimens and can be simple and reliable tool to establish a more realistic prognosis for reproductive capacity in men who undergo microsurgical correction of subclinical varicocele with no other detectable cause for infertility.

Antioxidative effects of cerium dioxide nanoparticles ameliorate age-related male infertility: optimistic results in rats and the review of clinical clues for integrative concept of men health and fertility

Background

Male infertility has largely idiopathic, multifactorial origin. Oxidative stress is a major factor that affects spermatogenesis, in particular in aging. Cerium dioxide nanoparticles (CNPs) due to their antioxidative properties are promising to impact on the development of male infertility. The aims of this study were to investigate the effects of CNPs on fertility parameters in 24-month male rats and to overview relevant literature in the field of personalized treatments, predictive diagnosis, and preventive measures for male health and fertility.

Methods

We included 30 24-month-old male rats. After a week of adaptation to the standard diet, the rats were randomly divided into three groups with ten rats in each. Group 1 (controls) received only a standard diet. The rats of group 2 and 3 in adjunct to the standard diet during 10 days received intragastrically 10 % sodium citrate and citrate-coated CNPs in dose 1 mg/kg, respectively. We assessed sex hormones, epididymal sperm parameters and spermatogenesis, ultrasound, and morphological data of rat reproductive organs.

Results

After a 10-day administration of CNPs, we revealed significant decrease of lipid peroxidation product levels in serum and increase of catalase and SOD activity, associated with increase of sperm count (p < 0.001) and improvement in quantitative sperm parameters (motility, viability, and percentage of spermatozoa). We found no significant changes between sperm quantitative parameters in citrate-treated rats and controls and observed age-related decrease of activated Leydig cell number and focal atrophy of the seminiferous tubules. In CNP group, we observed regeneration of seminiferous tubules, increase number and activation of Leydig cells, and 2.5-fold significant increase of serum testosterone. Ultrasound data showed the slight increase of linear measurement and volume of rat testes in CNP group. Review highlights the benefits for predictive diagnosis, preventive measures, and personalized approaches to manage male infertility in the general concept of male health also related to aging.

Conclusion

Citrate-coated 2–5-nm CNPs lead to increase in sex hormones levels, sperm count, and quality, as well as the activation of spermatogenesis in 24-month-old male rats. Nanoceria demonstrated the perspectives to be an effective infertility treatment via reduction of oxidative stress in male reproductive organs, in particular in aging.

Adolescent varicocoele management controversies

Varicocoele is defined as excessive dilatation of the pampiniform venous plexus of the spermatic cord. Varicocoele frequently appears during early puberty and is recognized to be the most common surgically correctable cause of male infertility. However, the actual incidence in adolescents, pathophysiology and the association with male factor infertility all remain somewhat controversial. The most accurate diagnostic technique for identifying young men who will benefit from surgical treatment has yet to be established. Observations of testicular asymmetry and deteriorating semen quality helped establish current guidelines and recommendations for surgical treatment. Further studies, comparing observation with surgical intervention, are needed to refine the current indications for varicocoele repair in the adolescent male.

Relationship between varicocele and sperm DNA damage and the effect of varicocele repair: a meta-analysis

Varicocele, a cause of male infertility, occurs in nearly 40% of infertile males. It has been postulated that varicoceles may cause sperm DNA damage. Sperm DNA integrity has been recognized as one of the important determinants of normal fertilization and embryo growth in natural and assisted conception. Eighty-three human studies were identified after an extensive literature search involving the role of varicoceles in sperm DNA damage. Of the 83 studies, 12 were selected that measured similar types of reactive sperm DNA damage. Seven studies determined the damage of sperm DNA in varicocele-associated patients and six studies evaluated the efficacy of varicocelectomy. One study was a duplicate because both outcomes were included. Data were analysed using RevMan software. The overall estimate showed that patients with varicoceles have significantly higher sperm DNA damage than controls, with a mean difference of 9.84% (95% CI 9.19 to 10.49; P<0.00001). A varicocelectomy can improve sperm DNA integrity, with a mean difference of -3.37% (95% CI -4.09 to -2.65; P<0.00001). In conclusion, there is increased sperm DNA damage in patients with varicoceles and varicocelectomy may be a possible treatment; however, more studies with appropriate controls are needed to confirm this finding. A varicocele is an important cause of male infertility and occurs in nearly 40% of infertile males. The recent understanding of the effect of varicoceles in male reproduction has led some researchers to postulate varicoceles as the possible cause of sperm DNA damage. Eighty-three human studies were identified after an extensive literature search involving the role of varicoceles in sperm DNA damage. Of the 83 studies, 12 were selected that measured similar types of reactive sperm DNA damage by a similar method. Seven studies determined the damage of sperm DNA in varicocele-associated patients and six studies evaluated the efficacy of varicocelectomy. One study was a duplicate because both outcomes were included. The data were then entered in the RevMan software for analysis. The overall estimate showed that patients with varicoceles have significantly higher sperm DNA damage than controls, with a mean difference of 9.84% (95% CI 9.19 to 10.49; P<0.00001). A varicocelectomy can improve sperm DNA integrity, with a mean difference of -3.37% (95% CI -4.09 to -2.65; P<0.00001). Based on the results, it can be concluded that there is increased sperm DNA damage in patients with varicoceles and that varicocelectomy may be a possible treatment; however, more studies with appropriate controls are needed to confirm this finding.

The role of varicocele sclerotherapy in men with severe oligo-astheno-teratozoospermia

The aim of this study was to verify the role of antegrade scrotal sclerotherapy for the treatment of varicoceles in infertile men with severe oligo-astheno-teratozoospermia (OAT). The 59 patients with severe OAT in this study underwent antegrade scrotal sclerotherapy for the treatment of varicoceles. The outcome was assessed in terms of improvement in semen parameters and spontaneous conception rate. Semen parameters and reproductive hormones were evaluated before antegrade sclerotherapy (AS) and 6 months after AS. After an average follow-up time of 34.8±3.2 months, significant improvement was noted in the mean sperm concentration, motility and morphology in 36 patients (61%). Spontaneous pregnancy occurred in nine couples (15%). Six months after treatment, inhibin B levels were significantly higher (P<0.04), whereas follicle-stimulating hormone (FSH) levels were significantly lower (P<0.001) than before treatment. Antegrade internal spermatic vein sclerotherapy can significantly improve seminal parameters and hormonal parameters in men with severe OAT and may even result in spontaneous pregnancy in couples who would otherwise be candidates for intracytoplasmic sperm injection (ICSI).

Surgical sperm retrieval: Techniques and their indications

Men with azoospermia can father a child through intra-cytoplasmic sperm injection if sperm can be retrieved from their epididymis or testis. Several percutaneous and open surgical procedures have been described to retrieve sperm. The various techniques and their merits are discussed in this review. In men with obstructive azoospermia, epididymal sperm can usually be retrieved by percutaneous epididymal sperm aspiration (PESA). If PESA fails then testicular sperm are obtained by needle aspiration biopsy (NAB). In men with non-obstructive azoospermia, there will be no sperm in the epididymis and testicular sperm retrieval is required. Percutaneous retrieval by NAB can be tried first. If that fails then testicular sperm extraction (TESE) from open microsurgical biopsies is performed using the single seminiferous tubule (SST) or the microdissection TESE techniques. The simplest, least invasive procedure should be tried first.

Cadmium concentrations in blood and seminal plasma: correlations with sperm number and motility in three male populations (infertility patients, artificial insemination donors, and unselected volunteers)

To investigate a possible common environmental exposure that may partially explain the observed decrease in human semen quality, we correlated seminal plasma and blood cadmium levels with sperm concentration and sperm motility. We studied three separate human populations: group 1, infertility patients (Long Island, NY, USA); group 2, artificial insemination donors (AID) (Rochester, NY, USA); and group 3, general population volunteers (Rochester, NY, USA). Information about confounding factors was collected by questionnaire. Seminal plasma cadmium did not correlate with blood cadmium (Spearman correlation, n = 91, r = -0.092, P = 0.386, NS). Both blood and seminal plasma cadmium were significantly higher among infertility patients than the other subjects studied (for example, median seminal plasma cadmium was 0.282 microg/L in infertility patients versus 0.091 microg/L in AID and 0.092 microg/L in general population volunteers; Kruskal-Wallis test, P < 0.001). The percentage of motile sperm and sperm concentration correlated inversely with seminal plasma cadmium among the infertility patients (r = -0.201, P < 0.036 and r = -0.189, P < 0.05, respectively), but not in the other two groups. Age (among infertility patients) was the only positive confounder correlating with seminal plasma cadmium. To validate our human findings in an animal model, we chronically exposed adolescent male Wistar rats to low-moderate cadmium in drinking water. Though otherwise healthy, the rats exhibited decreases in epididymal sperm count and sperm motility associated with cadmium dose and time of exposure. Our human and rat study results are consistent with the hypothesis that environmental cadmium exposures may contribute significantly to reduced human male sperm concentration and sperm motility.

Link between low-dose environmentally relevant cadmium exposures and asthenozoospermia in a rat model

OBJECTIVE

To define the mechanism(s) underlying an association between asthenozoospermia and elevated blood, seminal plasma, and testicular cadmium levels in infertile human males using a rat model of environmentally relevant cadmium exposures.

SETTING

University medical center andrology research laboratory.

ANIMAL(S)

Male Wistar rats (n = 60), documented to be sensitive to the testicular effects of cadmium.

INTERVENTION(S)

Rats were given ad libitum access to water supplemented with 14% sucrose and 0 mg/L, 5 mg/L, 50 mg/L, or 100 mg/L cadmium for 1, 4, or 8 weeks beginning at puberty.

MAIN OUTCOME MEASURE(S)

Testicular cadmium levels were determined by atomic absorption, cauda epididymal sperm motility by visual inspection, and testicular gene expression by DNA microarray hybridization.

RESULT(S)

Chronic, low-dose cadmium exposures produced a time- and dose-dependent reduction in sperm motility. Transcription of genes regulated by calcium and expression of L-type voltage-dependent calcium channel mRNA splicing variants were altered by cadmium exposure. Expression of calcium binding proteins involved in modulation of sperm motility was unaffected.

CONCLUSION(S)

A causal relationship between elevated testicular cadmium and asthenozoospermia was identified. Aberrrant sperm motility was correlated with altered expression of L-type voltage-dependent calcium channel isoforms found on the sperm tail, which regulate calcium and cadmium influx.

Reassessing the value of varicocelectomy as a treatment for male subfertility with a new meta-analysis

OBJECTIVE

To determine the efficacy of varicocelectomy as a treatment for male factor infertility by improving the chance of spontaneous pregnancy.

DESIGN

Meta-analysis.

SETTING

Cleveland Clinic's Glickman Urological Institute.

PATIENT(S)

Infertile men with abnormal results on semen analyses and a palpable varicocele.

INTERVENTION(S)

Surgical varicocelectomy.

MAIN OUTCOME MEASURE(S)

Spontaneous pregnancy outcome.

RESULT(S)

The odds of spontaneous pregnancy after surgical varicocelectomy, compared with no or medical treatment for palpable varicocele, were 2.87 (95% confidence interval [CI], 1.33-6.20) with use of a random-effects model or 2.63 (95% CI, 1.60-4.33) with use of a fixed-effects model. The number needed to treat was 5.7 (95% CI, 4.4-9.5).

CONCLUSION(S)

Surgical varicocelectomy in infertile men with palpable lesions and at least one abnormal semen parameter improves the odds of spontaneous pregnancy in their female partners. Five studies were included (two randomized, three observational). All were scored for bias. Our study suggests that varicocelectomy in selected patients does indeed have beneficial effects on fertility status.