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Asero V, Scornajenghi CM, Iaconis S, Sicignano E, Falcone A, Dinacci F, Pagano G, Carino D, Corvino R, Tresh A. Interplay between male gonadal function and overall male health. J Basic Clin Physiol Pharmacol 2024; 0:jbcpp-2024-0054. [PMID: 38830206 DOI: 10.1515/jbcpp-2024-0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 04/23/2024] [Indexed: 06/05/2024]
Abstract
The process-of-male reproduction is intricate, and various medical conditions-have the potential to disrupt spermatogenesis. Moreover, infertility in males can serve as an indicator of-potential future health issue. Numerous conditions with systemic implications have been identified, encompassing genetic factors (such as Klinefelter Syndrome), obesity, psychological stress, environmental factors, and others. Consequently, infertility assessment-presents an opportunity for comprehensive health counseling, extending-beyond discussions about reproductive goals. Furthermore, male infertility has been suggested as a harbinger of future health problems, as poor semen quality and a diagnosis of-male infertility are associated with an increased risk of hypogonadism, cardiometabolic disorders, cancer, and even mortality. This review explores the existing-literature on the relationship between systemic illnesses and male fertility, impacting both clinical-outcomes and semen parameters. The majority of the literature analyzed, which compared gonadal function with genetic, chronic, infectious or tumoral diseases, confirm the association between overall male health and infertility.
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Affiliation(s)
- Vincenzo Asero
- Department of Maternal Infant and Urologic Sciences, 9311 University of Rome La Sapienza , Rome, Lazio, Italy
| | - Carlo Maria Scornajenghi
- Department of Maternal Infant and Urologic Sciences, 9311 University of Rome La Sapienza , Rome, Lazio, Italy
| | - Salvatore Iaconis
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, 165474 Federico II University Hospital , Napoli, Italy
| | - Enrico Sicignano
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, 165474 Federico II University Hospital , Napoli, Italy
| | - Alfonso Falcone
- Department of Neurosciences, Science of Reproduction and Odontostomatology, 9307 University of Naples Federico II , Napoli, Campania, Italy
| | - Fabrizio Dinacci
- Department of Neuroscience and Reproductive and Odontostomatological Sciences, 165474 Federico II University Hospital , Napoli, Campania, Italy
| | - Giovanni Pagano
- Department of Neurosciences, Science of Reproduction and Odontostomatology, 9307 University of Naples Federico II , Napoli, Italy
| | - Dalila Carino
- Department of Maternal Infant and Urologic Sciences, 9311 University of Rome La Sapienza , Rome, Italy
| | - Roberta Corvino
- Department of Maternal Infant and Urologic Sciences, 9311 University of Rome La Sapienza , Rome, Italy
| | - Anas Tresh
- Department of Urology, 10624 Stanford University School of Medicine , Stanford, CA, USA
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Busetto GM, Rodrigues BF, Virmani A, Checchia A, Ninivaggi A, Ricapito A, Barbieri G, Fischetti P, Falagario UG, Annese P, d’Altilia N, Mancini V, Ferro M, Crocetto F, Porreca A, Bettocchi C, Cormio L, Agarwal A, Carrieri G. Antioxidant treatment for oligoasthenoteratozoospermia and varicocele: a DBPC trial to evaluate the impact of age and body mass index. Asian J Androl 2024; 26:00129336-990000000-00160. [PMID: 38305695 PMCID: PMC11156455 DOI: 10.4103/aja202381] [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: 10/11/2023] [Accepted: 12/03/2023] [Indexed: 02/03/2024] Open
Abstract
ABSTRACT Oxidative stress is one of the main mechanisms responsible for male infertility. Various conditions such as varicocele, obesity, advanced age, and lifestyle can lead to an increase in reactive oxygen species, causing an oxidative imbalance in the reproductive environment. Spermatozoa are sensitive to reactive oxygen species and require energy to carry out their main function of fertilizing the egg. Excessive reactive oxygen species can affect sperm metabolism, leading to immobility, impaired acrosome reaction, and cell death, thereby impairing reproductive success. This double-blind randomized study evaluated the effect of supplementation with L-carnitine, acetyl-L-carnitine, vitamins, and other nutrients on semen quality in 104 infertile patients with or without varicocele, while also investigating the impact of factors such as obesity and advanced age on treatment. Sperm concentration significantly increased in the supplemented group compared to the placebo group (P = 0.0186). Total sperm count also significantly increased in the supplemented group (P = 0.0117), as did sperm motility (P = 0.0120). The treatment had a positive effect on patients up to 35 years of age in terms of sperm concentration (P = 0.0352), while a body mass index (BMI) above 25 kg m-2 had a negative effect on sperm concentration (P = 0.0110). Results were not showing a net benefit in stratifying patients in accordance with their BMI since sperm quality increase was not affected by this parameter. In conclusion, antioxidant supplementation may be beneficial for infertile patients and has a more positive effect on younger patients with a normal weight.
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Affiliation(s)
- Gian Maria Busetto
- University of Foggia, Foggia 71122, Italy
- Department of Urology and Renal Transplantation, Policlinico of Foggia, Foggia 71122, Italy
| | - Bernarde F Rodrigues
- Department of Urology, Human Reproduction Section, Federal University of Sao Paulo, Sao Paulo 05403-000, Brazil
| | - Ashraf Virmani
- Alfasigma Healthscience, Utrecht 3528 BG, The Netherlands
| | - Andrea Checchia
- University of Foggia, Foggia 71122, Italy
- Urology Unit, “G. Tatarella” Hospital, Cerignola 71042, Italy
| | - Antonella Ninivaggi
- University of Foggia, Foggia 71122, Italy
- Department of Urology and Renal Transplantation, Policlinico of Foggia, Foggia 71122, Italy
| | - Anna Ricapito
- University of Foggia, Foggia 71122, Italy
- Department of Urology and Renal Transplantation, Policlinico of Foggia, Foggia 71122, Italy
| | - Giovanni Barbieri
- University of Foggia, Foggia 71122, Italy
- Department of Urology and Renal Transplantation, Policlinico of Foggia, Foggia 71122, Italy
| | - Piero Fischetti
- University of Foggia, Foggia 71122, Italy
- Department of Urology and Renal Transplantation, Policlinico of Foggia, Foggia 71122, Italy
| | | | - Pasquale Annese
- Department of Urology and Renal Transplantation, Policlinico of Foggia, Foggia 71122, Italy
| | - Nicola d’Altilia
- Department of Urology and Renal Transplantation, Policlinico of Foggia, Foggia 71122, Italy
| | - Vito Mancini
- Department of Urology and Renal Transplantation, Policlinico of Foggia, Foggia 71122, Italy
| | - Matteo Ferro
- Urology Unit, European Institute of Oncology (IEO) IRCCS, Milan 20142, Italy
| | | | - Angelo Porreca
- Department of Oncological Urology, Veneto Institute of Oncology (IOV) IRCCS, Padua 35039, Italy
| | - Carlo Bettocchi
- University of Foggia, Foggia 71122, Italy
- Department of Urology and Renal Transplantation, Policlinico of Foggia, Foggia 71122, Italy
| | - Luigi Cormio
- University of Foggia, Foggia 71122, Italy
- Urology Unit, “L. Bonomo” Hospital, Andria 70031, Italy
| | - Ashok Agarwal
- Global Andrology Forum, Moreland Hills, OH 44022, USA
| | - Giuseppe Carrieri
- University of Foggia, Foggia 71122, Italy
- Department of Urology and Renal Transplantation, Policlinico of Foggia, Foggia 71122, Italy
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Huang D, Zhang Y, Wang X, Guo R, Leng X, Du Q, Wu Q, Pan B, Zhao Y. Dietary total antioxidant capacity and the risk of developing asthenozoospermia: a hospital-based case-control study in China. Hum Reprod 2023; 38:537-548. [PMID: 36728412 DOI: 10.1093/humrep/dead010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 01/06/2023] [Indexed: 02/03/2023] Open
Abstract
STUDY QUESTION Is dietary total antioxidant capacity (DTAC) associated with the odds of developing asthenozoospermia in Chinese men? SUMMARY ANSWER There is no statistically significant association between DTAC indices and the odds of developing asthenozoospermia. WHAT IS KNOWN ALREADY Both diet and oxidative stress may be related to sperm quality; however, few studies have investigated the association between DTAC and sperm quality. STUDY DESIGN, SIZE, DURATION This case-control study was conducted from June 2020 to December 2020. Those diagnosed with asthenozoospermia were assigned to the case group, whereas those with normal sperm parameters were assigned to the control group. Data from a total of 553 cases and 586 controls were included in the final analysis. PARTICIPANTS/MATERIALS, SETTING, METHODS Men who had been referred to the infertility clinic of Shengjing Hospital of China Medical University were enrolled. Dietary intake was assessed using a validated food frequency questionnaire. DTAC was based on ferric-reducing ability of plasma (FRAP), total oxygen radical absorbance capacity (T-ORAC), hydrophilic oxygen radical absorbance capacity (H-ORAC), lipophilic oxygen radical absorbance capacity (L-ORAC), total phenolics (TP), total radical-trapping antioxidant parameter (TRAP), and Trolox equivalent antioxidant capacity (TEAC). Asthenozoospermia was defined according to the criteria published in the fifth edition of the World Health Organization laboratory manual for the examination and processing of human semen. MAIN RESULTS AND THE ROLE OF CHANCE No significant association was observed between the DTAC indices and the odds of asthenozoospermia after multivariable adjustment (T3 vs T1, odds ratio (OR) = 0.99, 95% CI: 0.73-1.33 for FRAP; OR = 1.05, 95% CI: 0.77-1.42 for T-ORAC; OR = 0.88, 95% CI: 0.65-1.18 for H-ORAC; OR = 0.98, 95% CI: 0.71-1.34 for L-ORAC; OR = 1.03, 95% CI: 0.76-1.39 for TP; OR = 1.18, 95% CI: 0.87-1.59 for TRAP; and OR = 1.15, 95% CI: 0.85-1.55 for TEAC). Both additive and multiplicative interaction analyses suggested that smoking might modify the association of T-ORAC with the odds of developing asthenozoospermia (relative excess risk due to interaction = 0.45, 95% CI: 0.07-0.83, attributable proportion due to interaction = 0.46, 95% CI: 0.07-0.84 for additive interaction; P = 0.033 for multiplicative interaction). LIMITATIONS, REASONS FOR CAUTION Recall bias and protopathic bias were inevitable in this retrospective case-control study. The estimation accuracy of the DTAC indices may have also affected the findings. WIDER IMPLICATIONS OF THE FINDINGS To the best of our knowledge, this is the first study to specifically investigate whether an association exists between DTAC and the odds of developing asthenozoospermia. Although no significant association was found, this study provides novel information pertaining to the fields of nutrition and human reproduction. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by the JieBangGuaShuai Project of Liaoning Province (2021JH1/10400050), the Shengjing Hospital Clinical Research Project (M0071), and the Outstanding Scientific Fund of Shengjing Hospital (M1150). All authors have no competing interests to disclose. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Donghui Huang
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
- Liaoning Key Laboratory of Precision Medical Research on Major Chronic Disease, Liaoning, China
| | - Yixiao Zhang
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xiaobin Wang
- Center for Reproductive Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Renhao Guo
- Center for Reproductive Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xu Leng
- Center for Reproductive Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Qiang Du
- Center for Reproductive Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Qijun Wu
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
- Liaoning Key Laboratory of Precision Medical Research on Major Chronic Disease, Liaoning, China
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
- Key Laboratory of Reproductive and Genetic Medicine (China Medical University), National Health Commission, Shenyang, China
| | - Bochen Pan
- Center for Reproductive Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yuhong Zhao
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
- Liaoning Key Laboratory of Precision Medical Research on Major Chronic Disease, Liaoning, China
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de Ligny W, Smits RM, Mackenzie-Proctor R, Jordan V, Fleischer K, de Bruin JP, Showell MG. Antioxidants for male subfertility. Cochrane Database Syst Rev 2022; 5:CD007411. [PMID: 35506389 PMCID: PMC9066298 DOI: 10.1002/14651858.cd007411.pub5] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND The inability to have children affects 10% to 15% of couples worldwide. A male factor is estimated to account for up to half of the infertility cases with between 25% to 87% of male subfertility considered to be due to the effect of oxidative stress. Oral supplementation with antioxidants is thought to improve sperm quality by reducing oxidative damage. Antioxidants are widely available and inexpensive when compared to other fertility treatments, however most antioxidants are uncontrolled by regulation and the evidence for their effectiveness is uncertain. We compared the benefits and risks of different antioxidants used for male subfertility. OBJECTIVES To evaluate the effectiveness and safety of supplementary oral antioxidants in subfertile men. SEARCH METHODS The Cochrane Gynaecology and Fertility (CGF) Group trials register, CENTRAL, MEDLINE, Embase, PsycINFO, AMED, and two trial registers were searched on 15 February 2021, together with reference checking and contact with experts in the field to identify additional trials. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared any type, dose or combination of oral antioxidant supplement with placebo, no treatment, or treatment with another antioxidant, among subfertile men of a couple attending a reproductive clinic. We excluded studies comparing antioxidants with fertility drugs alone and studies that included men with idiopathic infertility and normal semen parameters or fertile men attending a fertility clinic because of female partner infertility. DATA COLLECTION AND ANALYSIS We used standard methodological procedures recommended by Cochrane. The primary review outcome was live birth. Clinical pregnancy, adverse events and sperm parameters were secondary outcomes. MAIN RESULTS We included 90 studies with a total population of 10,303 subfertile men, aged between 18 and 65 years, part of a couple who had been referred to a fertility clinic and some of whom were undergoing medically assisted reproduction (MAR). Investigators compared and combined 20 different oral antioxidants. The evidence was of 'low' to 'very low' certainty: the main limitation was that out of the 67 included studies in the meta-analysis only 20 studies reported clinical pregnancy, and of those 12 reported on live birth. The evidence is current up to February 2021. Live birth: antioxidants may lead to increased live birth rates (odds ratio (OR) 1.43, 95% confidence interval (CI) 1.07 to 1.91, P = 0.02, 12 RCTs, 1283 men, I2 = 44%, very low-certainty evidence). Results in the studies contributing to the analysis of live birth rate suggest that if the baseline chance of live birth following placebo or no treatment is assumed to be 16%, the chance following the use of antioxidants is estimated to be between 17% and 27%. However, this result was based on only 246 live births from 1283 couples in 12 small or medium-sized studies. When studies at high risk of bias were removed from the analysis, there was no evidence of increased live birth (Peto OR 1.22, 95% CI 0.85 to 1.75, 827 men, 8 RCTs, P = 0.27, I2 = 32%). Clinical pregnancy rate: antioxidants may lead to increased clinical pregnancy rates (OR 1.89, 95% CI 1.45 to 2.47, P < 0.00001, 20 RCTs, 1706 men, I2 = 3%, low-certainty evidence) compared with placebo or no treatment. This suggests that, in the studies contributing to the analysis of clinical pregnancy, if the baseline chance of clinical pregnancy following placebo or no treatment is assumed to be 15%, the chance following the use of antioxidants is estimated to be between 20% and 30%. This result was based on 327 clinical pregnancies from 1706 couples in 20 small studies. Adverse events Miscarriage: only six studies reported on this outcome and the event rate was very low. No evidence of a difference in miscarriage rate was found between the antioxidant and placebo or no treatment group (OR 1.46, 95% CI 0.75 to 2.83, P = 0.27, 6 RCTs, 664 men, I2 = 35%, very low-certainty evidence). The findings suggest that in a population of subfertile couples, with male factor infertility, with an expected miscarriage rate of 5%, the risk of miscarriage following the use of an antioxidant would be between 4% and 13%. Gastrointestinal: antioxidants may lead to an increase in mild gastrointestinal discomfort when compared with placebo or no treatment (OR 2.70, 95% CI 1.46 to 4.99, P = 0.002, 16 RCTs, 1355 men, I2 = 40%, low-certainty evidence). This suggests that if the chance of gastrointestinal discomfort following placebo or no treatment is assumed to be 2%, the chance following the use of antioxidants is estimated to be between 2% and 7%. However, this result was based on a low event rate of 46 out of 1355 men in 16 small or medium-sized studies, and the certainty of the evidence was rated low and heterogeneity was high. We were unable to draw conclusions from the antioxidant versus antioxidant comparison as insufficient studies compared the same interventions. AUTHORS' CONCLUSIONS In this review, there is very low-certainty evidence from 12 small or medium-sized randomised controlled trials suggesting that antioxidant supplementation in subfertile males may improve live birth rates for couples attending fertility clinics. Low-certainty evidence suggests that clinical pregnancy rates may increase. There is no evidence of increased risk of miscarriage, however antioxidants may give more mild gastrointestinal discomfort, based on very low-certainty evidence. Subfertile couples should be advised that overall, the current evidence is inconclusive based on serious risk of bias due to poor reporting of methods of randomisation, failure to report on the clinical outcomes live birth rate and clinical pregnancy, often unclear or even high attrition, and also imprecision due to often low event rates and small overall sample sizes. Further large well-designed randomised placebo-controlled trials studying infertile men and reporting on pregnancy and live births are still required to clarify the exact role of antioxidants.
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Affiliation(s)
- Wiep de Ligny
- Department of Gynaecology and Obstetrics, Radboud University Medical Center, Nijmegen, Netherlands
| | - Roos M Smits
- Department of Gynaecology and Obstetrics, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Vanessa Jordan
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Kathrin Fleischer
- Department of Gynaecology and Obstetrics, Radboud University Medical Center, Nijmegen, Netherlands
| | - Jan Peter de Bruin
- Department of Obstetrics and Gynaecology, Jeroen Bosch Hospital, 's-Hertogenbosch, Netherlands
| | - Marian G Showell
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
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Oxidative Stress-Induced Male Infertility: Role of Antioxidants in Cellular Defense Mechanisms. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1391:275-309. [PMID: 36472828 DOI: 10.1007/978-3-031-12966-7_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Male infertility is linked to several environmental and mutagenic factors. Most of these factors, i.e., lifestyle, radiations, and chemical contaminations, work on the fundamental principles of physics, chemistry, and biology. Principally, it may induce oxidative stress (OS) and produce free radicals within the cells. The negative effect of OS may enhance the reactive oxygen species (ROS) levels in male reproductive organs and impair basic functions in a couple's fertility. Evidence suggests that infertile men have significantly increased ROS levels and a reduced antioxidant capacity compared with fertile men. Although, basic spermatic function and fertilizing capacity depend on a delicate balance between physiological activity of ROS and antioxidants to protect from cellular oxidative injury in sperm, that is essential to achieve pregnancy. The ideal oxidation-reduction (REDOX) equilibrium requires a maintenance of a range of ROS concentrations and modulation of antioxidants. For this reason, the chapter focuses on the effects of ROS in sperm functions and the current concepts regarding the benefits of medical management in men with diminished fertility and amelioration of the effect to improve sperm function. Also, this evidence-based study suggests an increasing rate of infertility that poses a global challenge for human health, urging the need of health care professionals to offer a correct diagnosis, comprehension of the process, and an individualized management of the patients.
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Madej D, Granda D, Sicinska E, Kaluza J. Influence of Fruit and Vegetable Consumption on Antioxidant Status and Semen Quality: A Cross-Sectional Study in Adult Men. Front Nutr 2021; 8:753843. [PMID: 34722613 PMCID: PMC8554053 DOI: 10.3389/fnut.2021.753843] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/15/2021] [Indexed: 11/13/2022] Open
Abstract
The influence of fruit and vegetable consumption on semen quality by reducing oxidative stress is inconsistent. Thus, the association between the consumption of these products, antioxidant status, and semen quality was investigated in 90 men aged 18–40. The consumption of fruit and vegetables was collected using the 3-day food record method. Antioxidant status: total antioxidant capacity in semen (TAC-s) and blood (TAC-b), blood superoxide dismutase (SOD-b), glutathione reductase (GR-b), glutathione peroxidase (GPx-b), catalase (CAT-b) activity, and malondialdehyde concentration in blood (MDA-b) were measured. Sperm concentration, leukocytes in the ejaculate, vitality, motility, and sperm morphology were examined using computer-aided semen analysis (CASA). The consumption of fruit and vegetables was positively correlated with sperm concentration, vitality, motility, TAC-s, TAC-b, and SOD-b activity. The TAC-s and TAC-b were positively related to motility, TAC-s was inversely correlated with sperm tail defects. The SOD-b activity was positively correlated with vitality, motility, sperm morphology, and inversely with sperm tail defects and leukocytes in the ejaculate. Compared to the men in the first quartile of fruit and vegetable consumption (<318 g/day), those in the highest quartile (>734 g/day) had the highest sperm concentration, vitality, motility, TAC-s, TAC-b, GPx-b activity, and the lowest MDA-b concentration (based on multivariate regression models). A high consumption of fruit and vegetables may positively influence selected sperm quality parameters by improving the antioxidant status of semen and blood.
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Affiliation(s)
- Dawid Madej
- Department of Human Nutrition, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences-SGGW, Warsaw, Poland
| | - Dominika Granda
- Department of Human Nutrition, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences-SGGW, Warsaw, Poland
| | - Ewa Sicinska
- Department of Human Nutrition, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences-SGGW, Warsaw, Poland
| | - Joanna Kaluza
- Department of Human Nutrition, Institute of Human Nutrition Sciences, Warsaw University of Life Sciences-SGGW, Warsaw, Poland
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Agarwal A, Leisegang K, Majzoub A, Henkel R, Finelli R, Panner Selvam MK, Tadros N, Parekh N, Ko EY, Cho CL, Arafa M, Alves MG, Oliveira PF, Alvarez JG, Shah R. Utility of Antioxidants in the Treatment of Male Infertility: Clinical Guidelines Based on a Systematic Review and Analysis of Evidence. World J Mens Health 2021; 39:233-290. [PMID: 33474843 PMCID: PMC7994666 DOI: 10.5534/wjmh.200196] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 12/08/2020] [Accepted: 12/16/2020] [Indexed: 12/11/2022] Open
Abstract
It is widely accepted that oxidative stress plays an important role in the pathophysiology of male infertility and that antioxidants could have a significant role in the treatment of male infertility. The main objectives of this study are: 1) to systematically review the current evidence for the utility of antioxidants in the treatment of male infertility; and 2) propose evidence-based clinical guidelines for the use of antioxidants in the treatment of male infertility. A systematic review of the available clinical evidence was performed, with articles published on Scopus being manually screened. Data extracted included the type of antioxidant used, the clinical conditions under investigation, the evaluation of semen parameters and reproductive outcomes. The adherence to the Cambridge Quality Checklist, Cochrane Risk of Bias for randomized controlled trials (RCTs), CONSORT guidelines and JADAD score were analyzed for each included study. Further, we provided a Strength Weakness Opportunity Threat (SWOT) analysis to analyze the current and future value of antioxidants in male infertility. Of the 1,978 articles identified, 97 articles were included in the study. Of these, 52 (53.6%) were uncontrolled (open label), 12 (12.4%) unblinded RCTs, and 33 (34.0%) blinded RCTs, whereas 44 (45.4%) articles tested individual antioxidants, 31 (32.0%) a combination of several products in variable dosages, and 22 (22.6%) registered antioxidant products. Based on the published evidence, we 1) critically examined the necessity of additional double-blind, randomized, placebo-controlled trials, and 2) proposed updated evidence-based clinical guidelines for antioxidant therapy in male infertility. The current systematic review on antioxidants and male infertility clearly shows that antioxidant supplementation improves semen parameters. In addition, it provides the indications for antioxidant treatment in specific clinical conditions, including varicocele, unexplained and idiopathic male infertility, as well as in cases of altered semen quality.
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Affiliation(s)
- Ashok Agarwal
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA.
| | - Kristian Leisegang
- School of Natural Medicine, Faculty of Community and Health Sciences, University of the Western Cape, Bellville, South Africa
| | - Ahmad Majzoub
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA.,Department of Urology, Hamad Medical Corporation, Doha, Qatar.,Department of Urology, Weill Cornell Medicine - Qatar, Doha, Qatar
| | - Ralf Henkel
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA.,Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK.,Department of Medical Bioscience, University of the Western Cape, Bellville, South Africa
| | - Renata Finelli
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | | | - Nicholas Tadros
- Division of Urology, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Neel Parekh
- Department of Urology, Cleveland Clinic, Cleveland, OH, USA
| | - Edmund Y Ko
- Department of Urology, Loma Linda University, Loma Linda, CA, USA
| | - Chak Lam Cho
- Department of Surgery, Union Hospital, Hong Kong.,S. H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong
| | - Mohamed Arafa
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA.,Department of Urology, Hamad Medical Corporation, Doha, Qatar.,Andrology Department, Cairo University, Giza, Egypt
| | - Marco G Alves
- Department of Anatomy & Unit for Multidisciplinary Research in Biomedicine (UMIB), Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal
| | | | - Juan G Alvarez
- Centro Androgen, La Coruña, Spain and Harvard Medical School, Boston, MA, USA
| | - Rupin Shah
- Department of Urology, Lilavati Hospital and Research Centre, Mumbai, India
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8
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Kasman A, Del Giudice F, Shkolyar E, Porreca A, Busetto GM, Lu Y, Eisenberg ML. Modeling the contribution of the obesity epidemic to the temporal decline in sperm counts. ACTA ACUST UNITED AC 2020; 92. [PMID: 33348967 DOI: 10.4081/aiua.2020.4.357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 10/15/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Total sperm count (TSC) has been declining worldwide over the last several decades due to unknown etiologies. Our aim was to model the contribution that the obesity epidemic may have on declining TSC. MATERIALS AND METHODS Obesity rates were determined since 1973 using the WHO's Global Health Observatory data. A literature review was performed to determine the association between TSC and obesity. Using the measured obesity rates and published TSC since 1973, a model was created to evaluate the association between temporal trends in obesity/temperature and sperm count. RESULTS Since 1973, obesity prevalence in the United States was increased from 41% to 67.9%. A review of the literature showed that body mass index (BMI) categories 2, 3, and 4 were associated with TSC (millions) of 164.27, 155.71, and 142.29, respectively. The contribution to change over time for obesity from 1974 to 2011 was modeled at 1.8%. When the model was changed to represent the most extreme possible contribution to obesity reported, the modeled change over time rose to 7.2%. When stratified according to fertility status, the contribution that BMI had to falling sperm counts for all comers was 1.7%, while those presenting for fertility evaluation was 2.1%. CONCLUSIONS While the decline in TSC may be partially due to rising obesity rates, these contributions are minimal which highlights the complexity of this problem.
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Affiliation(s)
- Alex Kasman
- Department of Urology, Stanford University School of Medicine, Stanford, California.
| | - Francesco Del Giudice
- Department of Urology, "Sapienza" University of Rome; Department of Maternal-Infant and Urological Sciences, "Sapienza" Rome University, Policlinico Umberto I Hospital, Rome.
| | - Eugene Shkolyar
- Department of Urology, Stanford University School of Medicine, Stanford, California.
| | - Angelo Porreca
- Department of Urology, Policlinico Abano Terme, Abano Terme (PD).
| | - Gian Maria Busetto
- Department of Maternal-Infant and Urological Sciences, "Sapienza" Rome University, Policlinico Umberto I Hospital, Rome.
| | - Ying Lu
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford.
| | - Michael L Eisenberg
- Department of Urology, Stanford University School of Medicine, Stanford; Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California.
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9
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Del Giudice F, Kasman AM, Ferro M, Sciarra A, De Berardinis E, Belladelli F, Salonia A, Eisenberg ML. Clinical correlation among male infertility and overall male health: A systematic review of the literature. Investig Clin Urol 2020; 61:355-371. [PMID: 32665992 PMCID: PMC7329649 DOI: 10.4111/icu.2020.61.4.355] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 04/12/2020] [Indexed: 12/03/2022] Open
Abstract
Purpose Ongoing evidence has suggested the role of male factor infertility as a potential predictor of mortality and general health status. The aim of the present review is to update the current knowledge base regarding the association between male factor infertility and general health through a critical review of the literature. Materials and Methods A systematic review of the literature was carried out from inception to November 2019 in order to evaluate significant associations between male infertility and adverse health outcomes such as cardiovascular, oncologic, metabolic and autoimmune diseases as well as overall mortality. Results In all, 27 studies met inclusion criteria and were critically examined. Five studies examined male infertility and cardiovascular disease risk, 11 examined oncologic risk (e.g., overall cancer risk, testis and prostate cancer), 8 examined aggregate chronic medical diseases and 5 infertility related to incidence of mortality, for a total of 599,807 men diagnosed with any male factor infertility covering a period from 1916 to 2016. Conclusions A man's fertility and overall health appear to be interconnected. Therefore, a diagnosis of male infertility may allow a window into future comorbidity and/or mortality which may help guide clinical decisions and counseling. Several possible etiologies such as genetic, epigenetic, developmental, and lifestyle-based factors need to be further evaluated in order to establish the underlying mechanisms between male infertility and health.
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Affiliation(s)
- Francesco Del Giudice
- Department of Maternal-Infant and Urological Sciences, "Sapienza" Rome University, Policlinico Umberto I Hospital, Rome, Italy.,Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
| | - Alex M Kasman
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
| | - Matteo Ferro
- Division of Urology, European Institute of Oncology (IEO), Milan, Italy
| | - Alessandro Sciarra
- Department of Maternal-Infant and Urological Sciences, "Sapienza" Rome University, Policlinico Umberto I Hospital, Rome, Italy
| | - Ettore De Berardinis
- Department of Maternal-Infant and Urological Sciences, "Sapienza" Rome University, Policlinico Umberto I Hospital, Rome, Italy
| | - Federico Belladelli
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA.,Unit of Urology/Division of Oncology, IRCCS Ospedale San Rafaele, URI, Milan, Italy
| | - Andrea Salonia
- Unit of Urology/Division of Oncology, IRCCS Ospedale San Rafaele, URI, Milan, Italy
| | - Michael L Eisenberg
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA.,Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
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10
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Busetto GM, Del Giudice F, Virmani A, Sciarra A, Maggi M, Ferro M, Porreca A, Chung BI, Agarwal A, De Berardinis E. Body mass index and age correlate with antioxidant supplementation effects on sperm quality: Post hoc analyses from a double-blind placebo-controlled trial. Andrologia 2020; 52:e13523. [PMID: 32017167 PMCID: PMC7065376 DOI: 10.1111/and.13523] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 01/04/2020] [Accepted: 01/07/2020] [Indexed: 01/03/2023] Open
Abstract
Spermatozoa are vulnerable to lack of energy and oxidative stress as a result of elevated levels of reactive oxygen species. Therefore, it is essential that appropriate nutrients are available during maturation. This randomised, double‐blind, placebo‐controlled trial investigated the effect of 6‐month supplementation with carnitines and other micronutrients on sperm quality in 104 subjects with oligo‐ and/or astheno‐ and/or teratozoospermia with or without varicocele. Semen analyses were done at the beginning and end of the treatment. In addition to main analyses, post hoc analyses for age and body mass index (BMI) were carried out. Results were interpreted by dividing the population into two age and BMI classes. In 94 patients who completed the study, all sperm parameters increased in supplemented patients compared to the placebo group. A significant (p = .0272) difference in supplementation efficacy was observed for total motility on patients with varicocele and BMI < 25. In the same group, also the progressive motility was significantly superior (p = .0159). For Responder analysis, total motility results were confirmed in both the cited group (p = .0066) and in the varicocele group with BMI < 25 and age < 35 (p = .0078). This study suggests that supplementation is more effective in subjects with varicocele younger than 35 years with BMI < 25.
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Affiliation(s)
| | | | | | | | - Martina Maggi
- Department of Urology, Sapienza Rome University, Rome, Italy
| | - Matteo Ferro
- Division of Urology, European Institute of Oncology, Milan, Italy
| | - Angelo Porreca
- Department of Urology, Policlinico Abano Terme, Abano Terme, Italy
| | - Benjamin I Chung
- Department of Urology, Stanford University Medical Center, Palo Alto, CA, USA
| | - Ashok Agarwal
- American Center for Reproductive Medicine, Andrology Center, Cleveland, OH, USA
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