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Al Wattar BH, Rimmer MP, Teh JJ, Mackenzie SC, Ammar OF, Croucher C, Anastasiadis E, Gordon P, Pacey A, McEleny K, Sangster P. Pharmacological non-hormonal treatment options for male infertility: a systematic review and network meta-analysis. BMC Urol 2024; 24:158. [PMID: 39075435 PMCID: PMC11285325 DOI: 10.1186/s12894-024-01545-1] [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: 04/19/2024] [Accepted: 07/17/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND Male factor infertility affect up to 50% of couples unable to conceive spontaneously. Several non-hormonal pharmacological treatments have been proposed to boost spermatogenesis and increase chances of conception in men with infertility. Still, no clear evidence exists on the most effective treatment strategy. OBJECTIVE We aimed to compare the effectiveness of non-hormonal pharmacological treatment options for men with infertility using a systematic review and network meta-analysis. METHODS We searched MEDLINE, EMBASE, and CENTRAL until October 2023 for randomised/quasi-randomised trials that evaluated any non-hormonal pharmacological treatment options for men with idiopathic semen abnormalities or those with hypogonadism. We performed pairwise and network meta-analyses using a random effect model. We assessed risk of bias, heterogeneity, and network inconsistency. We calculated the mean rank and the surface under the cumulative ranking curve (SUCRA) for each intervention the maximum likelihood to achieve each of reported outcomes. We reported primarily on sperm concentration and other important semen and biochemical outcomes using standardised mean difference (SMD) and 95% confidence-intervals(CI). RESULTS We included 14 randomised trials evaluating four treatments (Clomiphene citrate, Tamoxifen, Aromatase inhibitors, anti-oxidants) and their combinations in 1342 men. The overall quality of included trials was low. Sperm concentration improved with clomiphene compared to anti-oxidants (SMD 2.15, 95%CI 0.78-3.52), aromatase inhibitor (SMD 2.93, 95%CI 1.23-4.62), tamoxifen (SMD - 1.96, 95%CI -3.57; -0.36) but not compared to placebo (SMD - 1.53, 95%CI -3.52- 0.47). Clomiphene had the highest likelihood to achieve the maximum change in sperm concentration (SUCRA 97.4). All treatments showed similar effect for sperm motility, semen volume, and normal sperm morphology. FSH levels showed significant improvement with clomiphene vs.anti-oxidant (SMD 1.48, 95%CI 0.44-2.51) but not compared to placebo. The evidence networks for LH and testosterone suffered from significant inconsistency (p = 0.01) with similar trend of improvement with clomiphene compared to other treatments but not compared to placebo. CONCLUSION There is insufficient evidence to support the routine use of Clomiphene, tamoxifen, and aromatase inhibitors to optimise semen parameters in men with infertility. Future randomised trials are needed to confirm the efficacy of clomiphene in improving fertility outcomes in men. PROSPERO CRD42023430179.
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Affiliation(s)
- Bassel H Al Wattar
- Beginning Assisted Conception Unit, Epsom and St Helier University Hospitals, London, UK.
- Comprehensive Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, UK.
- Clinical Trials Unit, Faculty of Health, Medicine and Social Care, Anglia Ruskin University, Chelmsford, UK.
| | - Michael P Rimmer
- Centre for Reproductive Health, Institute of Regeneration and Repair, University of Edinburgh, Edinburgh, UK
| | - Jack J Teh
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Scott C Mackenzie
- Centre for Reproductive Health, Institute of Regeneration and Repair, University of Edinburgh, Edinburgh, UK
| | | | - Carolyn Croucher
- Beginning Assisted Conception Unit, Epsom and St Helier University Hospitals, London, UK
| | | | - Patrick Gordon
- Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Allan Pacey
- School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Kevin McEleny
- Newcastle Fertility Centre at LIFE, Newcastle-upon-Tyne Hospitals, Newcastle upon Tyne, UK
| | - Phillipa Sangster
- Reproductive Medicine Unit, Elizabeth Garrett Anderson Wing, University College London Hospitals NHS Trust, London, UK
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Abouelgreed TA, Amer MA, Mamdouh H, El-Sherbiny AF, Aboelwafa H, Fahmy SF, Omar OA, Abdelshakour M, Elesawy M, Sonbol M, Maawad AN, Elsayed OK. The influence of oral antioxidants on men with infertility: a systemic review. Arch Ital Urol Androl 2024; 96:12323. [PMID: 38700012 DOI: 10.4081/aiua.2024.12323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 02/18/2024] [Indexed: 05/05/2024] Open
Abstract
OBJECTIVE This study aims to investigate the current evidence regarding the impact of oral antioxidant supplementation on semen parameters of infertile men. MATERIALS AND METHODS We conducted a systematic search of PubMed, and Cochrane electronic databases, adhering to modified Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The focus was on studies exploring the effects of antioxidant therapy on infertile men, with an examination of antioxidants in terms of types, doses, rationale for use, and their impact on semen parameters measures. RESULTS A total of 18 studies that met the inclusion criteria were included in this study. Out of these, 14 studies reported a significantly positive influence of antioxidant therapy on basic semen parameters and advanced sperm function. These comprised 11 randomized clinical trials and 7 prospective studies. Commonly utilized antioxidants included Vitamin E, Vitamin C, carnitines, co-enzyme Q10, N-acetyl cysteine, zinc, selenium, folic acid, and lycopene. CONCLUSIONS Overall, antioxidants generally demonstrate a favorable effect on semen parameters of infertile men. However, further research is necessary to pinpoint the optimal antioxidant regimen that can be applied safely and effectively in clinical practice.
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Affiliation(s)
| | - Mohamed A Amer
- Department of Dermatology & Andrology, Al-Azhar University, Cairo.
| | - Hassan Mamdouh
- Department of Dermatology & Andrology, Al-Azhar University, Cairo.
| | - Ahmed F El-Sherbiny
- Department of Andrology, International Islamic Center for Population Studies and Research, Al-Azhar University, Cairo.
| | - Hany Aboelwafa
- Department of Dermatology & Andrology, Al-Azhar University, Cairo.
| | - Sameh F Fahmy
- Department of Dermatology & Andrology, Al-Azhar University, Cairo.
| | - Omar A Omar
- Department of Dermatology & Andrology, Al-Azhar University, Cairo.
| | | | - Mohammad Elesawy
- Department of Dermatology & Andrology, Al-Azhar University, Cairo.
| | - Mohamed Sonbol
- Department of Dermatology & Andrology, Al-Azhar University, Cairo.
| | - Ahmed N Maawad
- Department of Dermatology & Andrology, Al-Azhar University, Cairo.
| | - Osama K Elsayed
- Department of Dermatology & Andrology, Al-Azhar University, Cairo.
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Kallinikas G, Tsoporis JN, Haronis G, Zarkadas A, Bozios D, Konstantinopoulos V, Kozyrakis D, Mitiliniou D, Rodinos E, Filios A, Filios P, Vlassopoulos G. The role of oral antioxidants in the improvement of sperm parameters in infertile men. World J Urol 2024; 42:71. [PMID: 38315192 DOI: 10.1007/s00345-023-04766-5] [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: 07/31/2023] [Accepted: 12/28/2023] [Indexed: 02/07/2024] Open
Abstract
PURPOSE A variety of pathologic conditions may increase oxidative stress in semen resulting in structural modifications to spermozoa's plasma membrane that interfere with sperm motility, morphology, and count. Antioxidants are currently being marketed to treat male infertility. In semen, antioxidants may decrease oxidative stress and potentially improve sperm parameters. In this narrative, mini-review we evaluated the effectiveness of antioxidants in infertility. METHODS This mini-review of the current literature has been carried out through searching of the PubMed and Google scholar databases. RESULTS AND CONCLUSIONS The literature review suggests that there is evidence that oral antioxidants such as selenium, carnitine, zinc, coenzymeQ10, vitamins E and C, etc. alone or in combinations, improve sperm count, motility, morphology as well as pregnancy rates in infertile men with idiopathic oligoasthenospermia. Unfortunately, most of these studies are poorly designed, limited by sample size, varying in dosage, differing in primary end points, and most notably lacking live birth data. Importantly, large randomized, well-designed, placebo-controlled trials are needed.
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Affiliation(s)
- Georgios Kallinikas
- Department of Urology, General hospital Konstantopouleio-Patision, N Ionia, Attika, Greece
| | - James N Tsoporis
- St. Michael's Hospital, Unity Health Toronto, Li Ka Shing Knowledge Institute, Keenan Research Centre for Biomedical Science, 30 Bond St., Toronto, ON, M5B 1W8, Canada.
| | - Georgios Haronis
- Department of Urology, General hospital Konstantopouleio-Patision, N Ionia, Attika, Greece
| | - Anastasios Zarkadas
- Department of Urology, General hospital Konstantopouleio-Patision, N Ionia, Attika, Greece
| | - Dimitrios Bozios
- Department of Urology, General hospital Konstantopouleio-Patision, N Ionia, Attika, Greece
| | | | - Diomidis Kozyrakis
- Department of Urology, General hospital Konstantopouleio-Patision, N Ionia, Attika, Greece
| | - Despoina Mitiliniou
- Department of Urology, General hospital Konstantopouleio-Patision, N Ionia, Attika, Greece
| | - Evangelos Rodinos
- Department of Urology, General hospital Konstantopouleio-Patision, N Ionia, Attika, Greece
| | - Athanasios Filios
- Department of Urology, General hospital Konstantopouleio-Patision, N Ionia, Attika, Greece
| | - Panagiotis Filios
- Department of Urology, General hospital Konstantopouleio-Patision, N Ionia, Attika, Greece
| | - Gerasimos Vlassopoulos
- Department of Urology, General hospital Konstantopouleio-Patision, N Ionia, Attika, Greece
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Alharbi M. Impact of Antioxidants on Conventional and Advanced Sperm Function Parameters: An Updated Review. Cureus 2024; 16:e54253. [PMID: 38362038 PMCID: PMC10869131 DOI: 10.7759/cureus.54253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2024] [Indexed: 02/17/2024] Open
Abstract
Antioxidants include diverse exogenous and endogenous compounds that can neutralize free radical activity, which ultimately protects sperm from oxidative stress (OS). Nevertheless, a controlled balance between oxidation and reduction is of paramount importance for cellular function. Excessive use of antioxidants should be avoided. A combination of antioxidants has been utilized to obtain a synergetic effect in the treatment of male infertility. Antioxidants have been shown to have a positive effect on semen parameters with a decrease in DNA damage. Future large randomized controlled trials are needed to determine the real impact of antioxidants on semen parameters, reproductive outcomes, and DNA integrity.
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Affiliation(s)
- Mohannad Alharbi
- Department of Urology, College of Medicine, Qassim University, Qassim, SAU
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Alhamam A, Garabed LR, Julian S, Flannigan R. The association of medications and supplements with human male reproductive health: a systematic review. Fertil Steril 2023; 120:1112-1137. [PMID: 37898470 DOI: 10.1016/j.fertnstert.2023.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/20/2023] [Accepted: 10/23/2023] [Indexed: 10/30/2023]
Abstract
Some medications used to treat comorbidities and conditions in reproductive-aged individuals could have a negative impact on fertility. This may occur through hormonal disruption, toxicity to germ cells and spermatozoa, functional impact on the sperm, teratogenicity potential, or ejaculatory abnormalities. Having knowledge of these potential interactions between medications and reproductive potential is important for clinicians to be aware of and guide the patient, along with their treating clinicians, to reproductively favorable alternatives when available. This review aims to summarize the state of the literature regarding medication interactions with human male reproduction using the Anatomical Therapeutic Chemical Classification System of medications.
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Affiliation(s)
- Abdullah Alhamam
- Department of Urologic Sciences, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Department of Urology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Laurianne Rita Garabed
- Division of Urology, Department of Surgery, University of Montreal, Montreal, Quebec, Canada
| | - Sania Julian
- Department of Urologic Sciences, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ryan Flannigan
- Department of Urologic Sciences, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Department of Urology, Weill Cornell Medicine, New York, New York.
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Methorst C, Faix A, Huyghe E. [Medical treatments for male infertility]. Prog Urol 2023; 33:653-680. [PMID: 38012910 DOI: 10.1016/j.purol.2023.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/12/2023] [Accepted: 09/15/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Treatments to stimulate spermatogenesis and antioxidant food supplements are often offered to infertile patients either before sperm extraction surgery to improve results, or as part of medically assisted reproduction or spontaneous fertility to increase the likelihood of a live birth. METHODS A bibliographic search limited to English-language literature on men published before 5/2023 was carried out, including clinical trials, literature reviews and meta-analyses on spermatogenesis-stimulating molecules and antioxidant treatments. RESULTS Several medical treatments seem capable of improving male fertility: they act mainly by stimulating spermatogenesis through hormones, or by reducing the effects of oxidative stress. With regard to oligoasthenozoospermia, the literature shows that certain hormonal treatments stimulating spermatogenesis are useful. In the case of non-obstructive azoospermia, the value of treatment depends on the patient's FSH and testosterone levels. AOX supplementation appears to improve certain spermogram parameters and have an impact on pregnancy and live birth rates. CONCLUSION This review should help urologists gain a better understanding of the various medical treatments and enable them to define an appropriate therapeutic strategy, tailored to the patient and the couple, in order to obtain the best results.
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Affiliation(s)
- C Methorst
- Service de médecine de la reproduction, hôpital des 4-villes, Saint-Cloud, France
| | - A Faix
- Clinique Saint-Roch, 560 avenue du Colonel-Pavelet-dit-Villars 34000 Montpellier, France
| | - E Huyghe
- Département d'urologie, hôpital de Rangueil, CHU de Toulouse, Toulouse, France; Service de médecine de la reproduction, hôpital Paule-de-Viguier, CHU de Toulouse, Toulouse, France; UMR DEFE, Inserm 1203, université de Toulouse, université de Montpellier, Montpellier, France.
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Chen Y, Xu D, Ma Y, Chen P, Hu J, Chen D, Yu W, Han X. Sertoli cell-derived extracellular vesicles traverse the blood-testis barrier and deliver miR-24-3p inhibitor into germ cells improving sperm mobility. J Control Release 2023; 362:58-69. [PMID: 37595666 DOI: 10.1016/j.jconrel.2023.08.031] [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: 06/21/2023] [Revised: 08/09/2023] [Accepted: 08/14/2023] [Indexed: 08/20/2023]
Abstract
Asthenozoospermia, characterized by poor sperm motility, is a common cause of male infertility. Improving energy metabolism and alleviating oxidative stress through drug regimens are potential therapeutic strategies. In this study, we observed upregulated miR-24-3p levels in asthenozoospermia spermatozoa, contributing to energy metabolism disorder and oxidative stress by reducing GSK3β expression. Thus, reducing miR-24-3p levels using drugs is expected to improve sperm motility. The blood-testis barrier (BTB) protects the testis from xenobiotics and drugs. In this study, we found that Sertoli cell-derived small extracellular vesicles (SC-sEV) can traverse the BTB and enter germ cells. We successfully loaded miR-24-3p inhibitor into SC-sEV, creating the nano-drug SC-sEV@miR-24-3p inhibitor, which effectively delivers miR-24-3p inhibitor into germ cells. In a gossypol-induced mouse asthenozoospermia model, administration of SC-sEV@miR-24-3p inhibitor significantly improved sperm motility, in vitro fertilization success, and blastocyst formation rates. As anticipated, it also improved the litter size of asthenozoospermia mice. These results suggest that SC-sEV@miR-24-3p inhibitor holds promise as a potential clinical treatment for asthenospermia.
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Affiliation(s)
- Yabing Chen
- Immunology and Reproduction Biology Laboratory & State Key Laboratory of Analytical Chemistry for Life Science, Medical School, Nanjing University, Nanjing, China; Jiangsu Key Laboratory of Molecular Medicine, Medical School, Nanjing University, Nanjing, China
| | - Dihui Xu
- Immunology and Reproduction Biology Laboratory & State Key Laboratory of Analytical Chemistry for Life Science, Medical School, Nanjing University, Nanjing, China; Jiangsu Key Laboratory of Molecular Medicine, Medical School, Nanjing University, Nanjing, China
| | - Yuhan Ma
- Immunology and Reproduction Biology Laboratory & State Key Laboratory of Analytical Chemistry for Life Science, Medical School, Nanjing University, Nanjing, China; Jiangsu Key Laboratory of Molecular Medicine, Medical School, Nanjing University, Nanjing, China
| | - Peilin Chen
- Immunology and Reproduction Biology Laboratory & State Key Laboratory of Analytical Chemistry for Life Science, Medical School, Nanjing University, Nanjing, China; Jiangsu Key Laboratory of Molecular Medicine, Medical School, Nanjing University, Nanjing, China
| | - Jianhang Hu
- Immunology and Reproduction Biology Laboratory & State Key Laboratory of Analytical Chemistry for Life Science, Medical School, Nanjing University, Nanjing, China; Jiangsu Key Laboratory of Molecular Medicine, Medical School, Nanjing University, Nanjing, China
| | - Deyan Chen
- Immunology and Reproduction Biology Laboratory & State Key Laboratory of Analytical Chemistry for Life Science, Medical School, Nanjing University, Nanjing, China.
| | - Wen Yu
- Department of Andrology, Affiliated Drum Tower Hospital, School of Medicine, Nanjing University, Nanjing, China.
| | - Xiaodong Han
- Immunology and Reproduction Biology Laboratory & State Key Laboratory of Analytical Chemistry for Life Science, Medical School, Nanjing University, Nanjing, China; Jiangsu Key Laboratory of Molecular Medicine, Medical School, Nanjing University, Nanjing, China.
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Huijben M, Huijsmans RLN, Lock MTWT, de Kemp VF, de Kort LMO, van Breda JHMK. Clomiphene citrate for male infertility: A systematic review and meta-analysis. Andrology 2023; 11:987-996. [PMID: 36680549 DOI: 10.1111/andr.13388] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/30/2022] [Accepted: 01/11/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND Male infertility is a prevalent and worldwide problem with various difficulties in treatment. Clomiphene citrate is a selective estrogen receptor modulator and may improve semen quality by stimulating hormone synthesis and spermatogenesis. There is lack of evidence on the efficacy of clomiphene citrate as therapy for male infertility. OBJECTIVES Therefore, a systematic review and meta-analysis was performed to assess the efficacy of clomiphene citrate on sperm quality in infertile men. METHODS A search was conducted in the PubMed, EMBASE and Cochrane databases for effectiveness in infertile males treated with clomiphene citrate. Both intervention and observational studies were included. Primary outcome measures were semen parameters (concentration, motility and morphology). Secondary outcomes included hormonal evaluation, pregnancy rate and side effects. Studies were included for meta-analysis if they provided absolute numbers for outcomes before and during treatment with appropriate SD or SE. RESULTS Total 1799 studies were identified during the search, 18 studies remained for qualitative analysis (n = 731) and 15 studies for meta-analysis (n = 566). Study populations ranged between 11 and 140 participants. Sperm concentration was higher during treatment, with a mean difference 8.38 × 106 /ml (95% confidence interval: 5.17-11.59; p < 0.00001; I2 = 87%). Total sperm motility was higher during treatment, with a mean difference of 8.14% (95% confidence interval: 3.83-12.45; p < 0.00001; I2 = 76%). There was no difference in sperm morphology before and during treatment. Total testosterone, follicle-stimulating hormone, luteinizing hormone and estradiol were higher during clomiphene citrate treatment. During follow-up, no serious adverse effects occurred. In 10 studies, pregnancy rate was reported and yielded a mean of 17% during clomiphene citrate treatment (range: 0%-40%). CONCLUSIONS Clomiphene citrate increased sperm concentration and motility and could be considered as a safe therapy for improving sperm parameters in infertile males.
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Affiliation(s)
- Manou Huijben
- Department of Urology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Roel L N Huijsmans
- Department of Urology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - M Tycho W T Lock
- Department of Urology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Vincent F de Kemp
- Department of Urology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Laetitia M O de Kort
- Department of Urology, University Medical Centre Utrecht, Utrecht, The Netherlands
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Zafar MI, Mills KE, Baird CD, Jiang H, Li H. Effectiveness of Nutritional Therapies in Male Factor Infertility Treatment: A Systematic Review and Network Meta-analysis. Drugs 2023; 83:531-546. [PMID: 36943634 DOI: 10.1007/s40265-023-01853-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Nutritional therapies are effective alternative treatments for male infertility or subfertility. These are cost-effective and easily implementable, unlike other advanced invasive treatments. Even moderate improvements in sperm quality could improve spontaneous pregnancy. OBJECTIVE We aimed to compare the effectiveness of all nutritional therapies in male infertility/subfertility treatment and ranked their efficacy based on type and etiology. We intend to aid clinicians with an evidence-based approach to affordable and safer initial infertility treatment for those who mainly do not wish to have other advanced invasive treatments or could not afford or have access to them. METHODS We included 69 studies with 94 individual study arms identified from bibliographic databases and registries. We included studies in adult men with proven infertility or subfertility that investigated nutritional or dietary supplement therapies compared with control or placebo and at least reported on a sperm parameter. We undertook a network meta-analysis and performed a pairwise meta-analysis on all sperm parameter outcomes and meta-regression. No language or date restriction was imposed. A systematic article search was concluded on August 29, 2022. RESULTS Our network meta-analysis is the first to compare all dietary interventions in a single analysis, sub-grouped by intervention type and type of infertility. L-Carnitine with micronutrients, antioxidants, and several traditional herbal supplements showed statistically and clinically significant improvement in sperm quality. Meta-regression identified that improvement in the sperm count, motility and morphology translated into increased pregnancy rates (p < 0.001; p < 0.001; p < 0.002, respectively). In particular, L-carnitine with micronutrient therapy (risk ratio [RR]: 3.60, 95% CI 1.86, 6.98, p = 0.0002), followed by zinc (RR 5.39, 95% CI 1.26, 23.04, p = 0.02), significantly improved pregnancy rates. Men with oligozoospermia (RR 4.89), followed by oligoasthenozoospermia (RR 4.20) and asthenoteratozoospermia (RR 3.53), showed a significant increase in pregnancy rates. CONCLUSION We ranked nutritional therapies for their ability to improve sperm quality in men with infertility. Nutritional therapies, particularly L-carnitine alone or combined with micronutrients, significantly improved sperm parameters and pregnancy rates even under severe conditions. We believe these affordable solutions may be valuable for people without access to or who do not wish to undergo more invasive and costly fertility treatments.
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Affiliation(s)
- Mohammad Ishraq Zafar
- Institute of Reproductive Health/Center of Reproductive Medicine, Tongji Medical College, Huazhong University of Science and Technology, 13 Hang Kong Road, Wuhan, 430030, China
- Reproductive Medicine Center, Fourth Affiliated Hospital Zhejiang University School of Medicine, Yiwu, China
| | - Kerry E Mills
- Department of Science and Technology, University of Canberra, Bruce 2617, Canberra, Australia.
- TruDataRx, White River Junction, Vermont, USA.
| | | | - Huahua Jiang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Honggang Li
- Institute of Reproductive Health/Center of Reproductive Medicine, Tongji Medical College, Huazhong University of Science and Technology, 13 Hang Kong Road, Wuhan, 430030, China.
- Wuhan Huake Reproductive Hospital, Wuhan, China.
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Medical Treatment in Men with Infertility Can Be Misinterpreted as Doping Practice: A Case of Unintentional World Anti-Doping Agency (WADA) Code Violation. Asian J Sports Med 2022. [DOI: 10.5812/asjsm-121004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Introduction: Clomiphene, a selective estrogen receptor modulator (SERM), is a drug which is primarily used for the treatment of anovulatory infertility in female patients. Although as an off-label use, some authorities and physicians use this drug for the treatment of idiopathic oligoasthenospermia in male patients. Clomiphene has two isomers and multiple metabolites, and its cis isomer (Zuclomiphene) can be detected in urine for as long as eight months in some cases. Case Presentation: A 30-year-old male futsal player used clomiphene for infertility for two months. After 17 weeks from the last dose, his urine sample result came out as an adverse analytical finding for clomiphene. Despite the initial ruling on a four-year ban by the national anti-doping agency, the appeals committee reduced the athlete's ban to two years after receiving explanations from the athlete, his appropriate doping record, and the fact that no trace of other substances, such as anabolic androgenic steroids (AAS) was found in the player's sample. Conclusions: In this article, the authors try to show the importance of athletes' familiarity with the anti-doping code and try to emphasize the importance of the fact that athletes should receive therapeutic use exemption (TUE) if they take any drugs with doping potential.
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11
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Krishan A, Vukina J, Pearce I, Modgil V. Male factor infertility: A contemporary overview of investigation, diagnosis and management. JOURNAL OF CLINICAL UROLOGY 2022. [DOI: 10.1177/20514158221078474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Infertility, defined as the failure to achieve a clinical pregnancy after 1 year of regular, unprotected sexual intercourse, is a public health issue of global concern. It affects up to 12% of couples worldwide. While traditionally, research and treatment have focused on female causes of infertility, male factors contribute to up to 70% of cases and therefore deserve appropriate recognition. The purpose of this comprehensive review is to detail the diagnostic work-up, investigations and management of male factor infertility. We discuss much-debated pathologies, such as varicocele, and novel investigations, including sperm DNA fragmentation and reactive oxygen species. Level of evidence: Not applicable
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Affiliation(s)
- Anil Krishan
- University Hospitals Birmingham NHS Foundation Trust, UK
| | - Josip Vukina
- University of Pittsburgh School of Medicine, USA
| | - Ian Pearce
- Manchester University NHS Foundation Trust, UK
| | - Vaibhav Modgil
- Manchester University NHS Foundation Trust, UK
- Department of Urology, Manchester Royal Infirmary, UK
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12
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Zhou X, Shi H, Zhu S, Wang H, Sun S. Effects of vitamin E and vitamin C on male infertility: a meta-analysis. Int Urol Nephrol 2022; 54:1793-1805. [DOI: 10.1007/s11255-022-03237-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 05/05/2022] [Indexed: 11/28/2022]
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Rimmer MP, Howie RA, Subramanian V, Anderson RA, Bertolla RP, Beebeejaun Y, Bortoletto P, Sunkara SK, Mitchell RT, Pacey A, van Wely M, Farquhar CM, Duffy JMN, Niederberger C. Outcome reporting across randomized controlled trials evaluating potential treatments for male infertility: a systematic review. Hum Reprod Open 2022; 2022:hoac010. [PMID: 35386119 PMCID: PMC8982407 DOI: 10.1093/hropen/hoac010] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 02/18/2022] [Indexed: 11/12/2022] Open
Abstract
STUDY QUESTION What are the primary outcomes and outcome measures used in randomized controlled trials (RCTs) evaluating potential treatments for male infertility in the last 10 years? SUMMARY ANSWER Outcome reporting across male infertility trials is heterogeneous with numerous definitions and measures used to define similar outcomes. WHAT IS KNOWN ALREADY No core outcome set for male infertility trials has been developed. Male infertility trials are unique in that they have potentially three participants, a man, a female partner and their offspring and this will likely lead to significant variation in outcome reporting in randomized trials. STUDY DESIGN SIZE DURATION A systematic review of RCTs mapping outcomes and outcome measures evaluating potential treatments for men with infertility registered in the Cochrane Register of Controlled Trials (CENTRAL) between January 2010 and July 2021. PARTICIPANTS/MATERIALS SETTING METHODS Abstract screening and study selection was undertaken in duplicate using a review protocol that was developed prior to commencing the review. No risk of bias assessment was undertaken as this review aims to report on outcome reporting only. MAIN RESULTS AND THE ROLE OF CHANCE One hundred and seventy-five RCTs were identified, and given the large number of studies we limited our review to the 100 largest trials. Seventy-nine different treatments were reported across the 100 largest RCTs including vitamin and dietary supplements (18 trials), surgical treatments (18 trials) and sperm selection techniques (22 trials). When considering the largest 100 trials (range: 80-2772 participants), 36 primary and 89 secondary outcomes were reported. Forty-seven trials reported a primary outcome and 36 trials clearly defined their primary outcome. Pregnancy outcomes were inconsistently reported and included pregnancy rate (51 trials), pregnancy loss including miscarriage, ectopic pregnancy, stillbirth (9 trials) and live birth (13 trials). Trials consistently reporting the same outcome frequently used different definitions. For example, semen quality was reported by 75 trials and was defined in 7 different ways, including; the World Health Organization (WHO) 2010 criteria (32 trials), WHO 1999 criteria (18 trials), WHO 1992 criteria (3 trials), WHO 1999 and 1992 criteria (1 trial) and the Kruger strict morphology criteria (1 trial). LIMITATIONS REASONS FOR CAUTION We only evaluated the 100 largest trials published in the last 10 years and did not report outcomes on the remaining 75. An outcome was included as a primary outcome only if clearly stated in the manuscript and we did not contact authors to clarify this. As our review mapped outcomes and outcome measures, we did not undertake an integrity assessment of the trials included in our review. WIDER IMPLICATIONS OF THE FINDINGS Most randomized trials evaluating treatments for male infertility report different outcomes. Only half of the RCTs reported pregnancy rate and even fewer reported live birth; furthermore, the definitions of these outcomes varies across trials. Developing, disseminating and implementing a minimum data set, known as a core outcome set, for male infertility research could help to improve outcome selection, collection and reporting. STUDY FUNDING/COMPETING INTERESTS A.P.-chairman of external scientific advisory committee of Cryos International Denmark ApS, member of the scientific advisory board for Cytoswim LDT and ExSeed Health. Guest lecture at the 'Insights for Fertility Conference', funded by MERK SERONO Limited. M.v.W.-holds a ZON-MW research grant. No external funding was obtained for this study.
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Affiliation(s)
| | | | - Venkatesh Subramanian
- King’s Fertility, The Fetal Medicine Research Unit, King’s College London, London, UK
| | - Richard A Anderson
- MRC Centre for Reproductive Health, Queens Medical research Institute, University of Edinburgh, Edinburgh, UK,Edinburgh Fertility Centre, Simpsons Centre for Reproductive Health, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Ricardo Pimenta Bertolla
- Division of Urology, Department of Surgery, Universidade Federal de Sao Paulo, São Paulo, Brazil
| | - Yusuf Beebeejaun
- King’s Fertility, The Fetal Medicine Research Unit, King’s College London, London, UK
| | - Pietro Bortoletto
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Sesh K Sunkara
- Division of Women’s Health, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Rod T Mitchell
- MRC Centre for Reproductive Health, Queens Medical research Institute, University of Edinburgh, Edinburgh, UK
| | - Allan Pacey
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Madelon van Wely
- Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Cindy M Farquhar
- Cochrane Gynaecology and Fertility Group, Auckland, New Zealand,Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - James M N Duffy
- Correspondence address. King’s Fertility, The Fetal Medicine Research Unit, King’s College London, London, UK. Tel: +44-7949-066806; E-mail:
| | - Craig Niederberger
- Department of Urology, University of Illinois at Chicago, Chicago, IL, USA,Department of Bioengineering, University of Illinois at Chicago College of Engineering, Chicago, IL, USA
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Superior effect of broccoli methanolic extract on control of oxidative damage of sperm cryopreservation and reproductive performance in rats: A comparison with vitamin C and E antioxidant. Theriogenology 2022; 181:50-58. [DOI: 10.1016/j.theriogenology.2022.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 12/31/2021] [Accepted: 01/08/2022] [Indexed: 12/17/2022]
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15
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Lundy SD, Doolittle J, Farber NJ, Njemanze S, Munoz-Lopez C, Vij SC. Follicle-stimulating hormone modestly predicts improvement in semen parameters in men with infertility treated with clomiphene citrate. Andrologia 2022; 54:e14399. [PMID: 35187689 DOI: 10.1111/and.14399] [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: 11/27/2021] [Revised: 01/10/2022] [Accepted: 01/27/2022] [Indexed: 11/29/2022] Open
Abstract
Clomiphene citrate is a commonly prescribed empiric medical therapy for male infertility, but outcomes data and response rates remain incompletely understood. We retrospectively reviewed our single-institutional experience of infertile men prescribed clomiphene. Clomiphene treatment in the final cohort of 140 men was associated with a modest increase in median sperm concentration from 2.2 to 2.5 million/ml (p < 0.001). A total of 46/140 (33%) of men upgraded according to World Health Organization concentration categories. Clomiphene treatment in 26/113 (23%) of previously ineligible men became eligible for intrauterine insemination. Using both univariate and multivariable regression, pre-treatment follicle-stimulating hormone was inversely associated with change in semen concentration with clomiphene treatment. On binary logistic regression, follicle-stimulating hormone level was inversely related to World Health Organization concentration category upgrade (p = 0.01). Unfortunately, 17/140 (12%) of men paradoxically worsened on clomiphene, but no predictors for this could be identified. In summary, clomiphene citrate confers a clinically relevant but modest benefit in a subset (1/3rd ) of infertile men, particularly those with lower pre-treatment follicle-stimulating hormone levels. Men with elevated follicle-stimulating hormone over 15 IU/ml are less likely to benefit from treatment and should be counselled on other relevant treatment alternatives.
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Affiliation(s)
- Scott D Lundy
- Department of Urology, Glickman Urologic and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | | | - Nicholas J Farber
- Department of Urology, Glickman Urologic and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | | | | | - Sarah C Vij
- Department of Urology, Glickman Urologic and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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16
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Alahmar AT, Naemi R. Predictors of pregnancy and time to pregnancy in infertile men with idiopathic oligoasthenospermia pre- and post-coenzyme Q10 therapy. Andrologia 2022; 54:e14385. [PMID: 35102599 PMCID: PMC9286548 DOI: 10.1111/and.14385] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/29/2021] [Accepted: 01/11/2022] [Indexed: 12/23/2022] Open
Abstract
Different antioxidants including coenzyme Q10 (CoQ10) have been tried to treat idiopathic male infertility (IMI) with variable results. Therefore, this study aimed to determine the clinical and biochemical predictors of pregnancy outcome and time to pregnancy (TTP) in infertile men with idiopathic oligoasthenospermia (OA) pre‐ and post‐CoQ10 therapy. This prospective controlled clinical study included 178 male patients with idiopathic OA and 84 fertile men (controls). Patients received 200 mg of oral CoQ10 once daily for 6 months. Demographics, semen parameters, seminal CoQ10 levels, reactive oxygen species (ROS) levels, total antioxidant capacity (TAC), catalase (CAT), glutathione peroxidase (GPx), sperm DNA fragmentation (SDF) and body mass index were measured and compared at baseline and after 6 months. All participants were followed up for another 18 months for pregnancy outcome and TTP. CoQ10 therapy for 6 months significantly improved semen parameters, antioxidant measures and reduced SDF. The pregnancy rate was 24.2% and TTP was 20.52 ± 6.72 months in patients as compared to 95.2% and 5.73 ± 6.65 months in fertile controls. After CoQ10 therapy, CoQ10 level, sperm concentration, motility and ROS were independent predictors of pregnancy outcome and CoQ10 level, male age, sperm concentration, motility, ROS and GPx were independent predictors of TTP in patients. In conclusion, CoQ10 therapy of 6 months is a potential treatment for men with idiopathic OA. CoQ10 level, male age, semen parameters, ROS and GPx could potentially be used as diagnostic biomarkers for male fertility and predictors for pregnancy outcome and TTP in these patients.
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Affiliation(s)
- Ahmed T Alahmar
- College of Medicine, University of Babylon, Hillah, Iraq.,School of Health, Science and Wellbeing, Science Centre, Staffordshire University, Stoke-on-Trent, UK
| | - Roozbeh Naemi
- School of Health, Science and Wellbeing, Science Centre, Staffordshire University, Stoke-on-Trent, UK
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17
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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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18
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Alrabeeah K, Addar A, Alothman A, Melha SA, Alkhayal A. Effect of hormonal manipulation using clomiphene citrate prior to microdissection testicular sperm retrieval. Urol Ann 2021; 13:254-257. [PMID: 34421260 PMCID: PMC8343278 DOI: 10.4103/ua.ua_129_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 12/30/2020] [Indexed: 11/06/2022] Open
Abstract
Introduction: Microdissection Testicular Sperm Extraction (micro-TESE) is a surgical method used for retrieving sperm from men with non-obstructive azoospermia. Clomiphene citrate (CC) is a selective estrogen receptor modulator (SERM) that stimulates luteinizing hormone (LH) and follicle-stimulating hormone (FSH) production. It is believed that treating patients with CC prior to micro-TESE increases the chance of sperm retrieval. Methods: This retrospective study was conducted in a tertiary care center in Riyadh, Saudi Arabia and included all patients who underwent Micro-TESE from August 2015 to November 2018. Data related to the pre-surgery hormonal levels, testicular volume, and associated genetic abnormalities were collected. chi-square and t-test were used to compare variables. A p-value of less than 0.05 was considered significant. Results: A total of 122 patients were included in this study, with 30.0% (n=37) treated with CC. The overall sperm retrieval rate was 44.3%. Micro-TESE results were not statistically affected by age, testosterone levels, Klinefelter syndrome, or taking CC. However, higher testicular volumes and lower LH and FSH levels had more positive micro-TESE results. Conclusion: In conclusion, Micro-TESE results were not affected by CC, age or testicular volume.
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Affiliation(s)
- Khalid Alrabeeah
- Department of Surgery, Division of Urology, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Department of Surgery, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdulmalik Addar
- Department of Surgery, Division of Urology, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Department of Surgery, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Ali Alothman
- Department of Surgery, Division of Urology, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Department of Surgery, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Saad Abu Melha
- Department of Surgery, Division of Urology, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Department of Surgery, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdullah Alkhayal
- Department of Surgery, Division of Urology, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.,Department of Surgery, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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19
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Shahid MN, Khan TM, Neoh CF, Lean QY, Bukhsh A, Karuppannan M. Effectiveness of Pharmacological Intervention Among Men with Infertility: A Systematic Review and Network Meta-Analysis. Front Pharmacol 2021; 12:638628. [PMID: 34483894 PMCID: PMC8415454 DOI: 10.3389/fphar.2021.638628] [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: 12/07/2020] [Accepted: 07/09/2021] [Indexed: 01/18/2023] Open
Abstract
Background. Infertility is an emerging health issue for men. Comparative efficacy of different pharmacological interventions on male infertility is not clear. The aim of this review is to investigate the efficacy of various pharmacological interventions among men with idiopathic male infertility. All randomized control trials evaluating the effectuality of interventions on male infertility were included for network meta-analysis (NMA) from inception to 31 April 2020, systematically performed using STATA through the random effect model. The protocol was registered at PROSPERO (CRD42020152891). Results. The outcomes of interest were semen and hormonal parameters. Treatment effects (p < 0.05) were estimated through WMD at the confidence interval of 95%. Upon applying exclusion criteria, n=28 RCTs were found eligible for NMA. Results from NMA indicated that consumption of supplements increases sperm concentration levels [6.26, 95% CI 3.32, 9.21] in comparison to SERMs [4.97, 95% CI 1.61, 8.32], hormones [4.14, 95% CI 1.83, 6.46], and vitamins [0.15, 95% CI -20.86, 21.15)] with placebo, whereas the use of SERMs increased percentage sperm motility [6.69, 95% CI 2.38, 10.99] in comparison to supplements [6.46, 95% CI 2.57, 10.06], hormones [3.47, 95% CI 0.40, 6.54], and vitamins [-1.24, 95% CI -11.84, 9.43] with placebo. Consumption of hormones increased the sperm morphology [3.71, 95% CI, 1.34, 6.07] in contrast to supplements [2.22, 95% CI 0.12, 4.55], SERMs [2.21, 95% CI -0.78, 5.20], and vitamins [0.51, 95% CI -3.60, 4.62] with placebo. Supplements boosted the total testosterone levels [2.70, 95% CI 1.34, 4.07] in comparison to SERMs [1.83, 95% CI 1.16, 2.50], hormones [0.40, 95% CI -0.49, 1.29], and vitamins [-0.70, 95% CI -6.71, 5.31] with placebo. SERMs increase the serum FSH levels [3.63, 95% CI 1.48, 5.79] better than hormones [1.29, 95% CI -0.79, 3.36], vitamins [0.03, 95% CI -2.69, 2.76], and supplements [-4.45, 95% CI -7.15, -1.76] in comparison with placebo. Conclusion. This review establishes that all interventions had a significantly positive effect on male infertility. Statistically significant increased sperm parameters were noted in combinations of zinc sulfate (220 mg BID), clomiphene citrate (50 mg BID), and testosterone undecanoate and CoQ10; tamoxifen citrate and FSH were shown to improve the hormonal profile in infertile males.
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Affiliation(s)
- Muhammad Nabeel Shahid
- Department of Pharmacy Practice, Faculty of Pharmacy, Universiti Teknologi MARA (UiTM), Bandar Puncak Alam, Malaysia
- Department of Pharmacy Practice, Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Tahir Mehmood Khan
- Department of Pharmacy Practice, Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
- School of Pharmacy, Monash University, Subang Jaya, Malaysia
| | - Chin Fen Neoh
- Department of Pharmacy Practice, Faculty of Pharmacy, Universiti Teknologi MARA (UiTM), Bandar Puncak Alam, Malaysia
| | - Qi Ying Lean
- Faculty of Pharmacy, Universiti Teknologi MARA (UiTM), Pulau Pinang, Malaysia
- Vector-Borne Diseases Research Group (VERDI), Pharmaceutical and Life Sciences CoRe, Universiti Teknologi MARA (UiTM), Shah Alam, Malaysia
| | - Allah Bukhsh
- Department of Pharmacy Practice, Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
- School of Pharmacy, Monash University, Subang Jaya, Malaysia
| | - Mahmathi Karuppannan
- Department of Pharmacy Practice, Faculty of Pharmacy, Universiti Teknologi MARA (UiTM), Bandar Puncak Alam, Malaysia
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Deciphering the Therapeutic Mechanisms of Wuzi Ershen Decoction in Treating Oligoasthenozoospermia through the Network Pharmacology Approach. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:5591844. [PMID: 34394386 PMCID: PMC8363445 DOI: 10.1155/2021/5591844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 07/19/2021] [Indexed: 12/27/2022]
Abstract
Background Infertility affects approximately 15% of couples around the world, and male factors are accounted for 40–50%. Oligoasthenozoospermia is the most common reason for male infertility. Unfortunately, effective drug therapy is still lacking except for assisted reproductive technology (ART). Previous researchers found that Wuzi Ershen decoction (WZESD) can increase sperm count, enhance sperm vitality, and improve semen quality. However, the pharmacological mechanisms remain unclear. Methods In this study, we screened compounds and predicted the targets of WZESD based on the TCMSP and BATMAN-TCM database combined with literature searching in the PubMed database. We obtained proteins related to oligoasthenozoospermia through GeneCards and submitted them to STRING to obtain the protein-protein interaction (PPI) network. Potential targets of WZESD were mapped to the network, and the hub targets were screened by topology. We used online platform Metascape and Enrichr for GO and KEGG enrichment analyses. AutoDock Vina was utilized for further verification of the binding mode between compounds and targets. Results Totally, 276 bioactive compounds were obtained and targeted 681 proteins. 446 oligoasthenozoospermia disease-specific proteins were acquired, and further bioinformatics analysis found that they were mainly involved in the formation of gametes, meiosis, and sperm differentiation. Protein interaction network analysis revealed that target proteins of WZESD were associated with oligoasthenozoospermia disease-specific proteins. The 79 targets of disease-specific proteins, which were anchored by WZESD, mainly participate in the cellular response to the organic cyclic compound, regulation of the apoptotic process, nitricoxide biosynthetic and metabolic process, oxidative stress, and protein phosphorylation regulation, which are the causes for oligoasthenozoospermia. Molecular docking simulation further validated that bioactive compounds originated from WZESD with targeted proteins showed high binding efficiency. Conclusions This study uncovers the therapeutic mechanisms of WZESD for oligoasthenozoospermia treatment from the perspective of network pharmacology and may provide a valuable reference for further experimental research studies and clinical applications.
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21
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An M, Liu Y, Zhang M, Hu K, Jin Y, Xu S, Wang H, Lu M. Targeted next-generation sequencing panel screening of 668 Chinese patients with non-obstructive azoospermia. J Assist Reprod Genet 2021; 38:1997-2005. [PMID: 33728612 PMCID: PMC8417191 DOI: 10.1007/s10815-021-02154-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 03/10/2021] [Indexed: 12/29/2022] Open
Abstract
PURPOSE We aimed (1) to determine the molecular diagnosis rate and the recurrent causative genes of patients with non-obstructive azoospermia (NOA) using targeted next-generation sequencing (NGS) panel screening and (2) to discuss whether these genes help in the prognosis for microsurgical testicular sperm extraction (micro-TESE). METHODS We used NGS panels to screen 668 Chinese men with NOA. Micro-TESE outcomes for six patients with pathogenic mutations were followed up. Functional assays were performed for two NR5A1 variants identified: p.I224V and p.R281C. RESULTS Targeted NGS panel sequencing could explain 4/189 (2.1% by panel 1) or 10/479 (2.1% by panel 2) of the patients with NOA after exclusion of karyotype abnormalities and Y chromosome microdeletions. Almost all mutations detected were newly described except for NR5A1 p.R281C and TEX11 p.M156V. Two missense NR5A1 mutations-p.R281C and p.I244V-were proved to be deleterious by in vitro functional assays. Mutations in TEX11, TEX14, and NR5A1 genes are recurrent causes of NOA, but each gene explains only a very small percentage (less than 4/668; 0.6%). Only the patient with NR5A1 mutations produced viable spermatozoa through micro-TESE, but other patients with TEX11 and TEX14 had poor micro-TESE prognoses. CONCLUSIONS A targeted NGS panel is a feasible diagnostic method for patients with NOA. Because each gene implicated explains only a small proportion of such cases, more genes should be included to further increase the diagnostic rate. Considering previous reports, we suggest that only a few genes that are directly linked to meiosis can indicate poor micro-TESE prognosis, such as TEX11, TEX14, and SYCE1.
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Affiliation(s)
- Miao An
- Department of Urology and Andrology, Renji Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, 200001, People's Republic of China
| | - Yidong Liu
- Department of Urology and Andrology, Renji Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, 200001, People's Republic of China
| | - Ming Zhang
- Department of Urology and Andrology, Renji Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, 200001, People's Republic of China
| | - Kai Hu
- Department of Urology and Andrology, Renji Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, 200001, People's Republic of China
| | - Yan Jin
- Department of Urology and Andrology, Renji Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, 200001, People's Republic of China
| | - Shiran Xu
- Department of Urology and Andrology, Renji Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, 200001, People's Republic of China
| | - Hongxiang Wang
- Department of Urology and Andrology, Renji Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, 200001, People's Republic of China.
| | - Mujun Lu
- Department of Urology and Andrology, Renji Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, 200001, People's Republic of China.
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22
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THE EFFECT OF CONSUMING AVOCADO (Persea americana) ON MICE (Mus musculus) SPERM QUALITY. BIOVALENTIA: BIOLOGICAL RESEARCH JOURNAL 2021. [DOI: 10.24233/biov.7.1.2021.201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The nutrients such as protein and vitamin are proven to improve the sperm quality. One nutrient rich fruit is avocado round green variety, which contains vitamins A, C and E higher than other varieties. This study aimed to determine the effect of consuming avocado on the mice sperm quality. This experimental study was using a Completely Randomized Design with four treatments, each with eight replications. Avocado dosage treatments were control, 75 % w/v, 100% w/v, and 133% w/v , with the number of mice were 32 age four weeks. Avocado was given three times a day, each 0.5 mL for six weeks besides the main food. The observed response was the sperm quality including number, motility and morphology. Sperm was taken from the epididymis after the mice were killed by cervical dislocation method. Sperm was made a suspension using 0.9% NaCl solution and a smear preparation to observe the sperm morphology while staining with basic stain crystal violet. The sperm quality was observed by Neubauer's counting rooms through a multimedia microscope. Data was analyzed using Kurskal Wallis test for the sperm number and Anova test for motility and morphological responses. The result showed that avocado had a significant influence for reproductive health, particularly for increasing spermatozoa quality, including concentration, motility and morphology of sperm. The higher dose of avocado given the higher quantity and quality of sperm resulted.
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23
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Tsampoukas G, Gkeka K, Dellis A, Brown D, Katsouri A, Alneshawy A, Moussa M, Papatsoris A, Buchholz N. Vitamins as primary or adjunctive treatment in infertile men with varicocele: A systematic review. Arab J Urol 2021; 19:264-273. [PMID: 34552778 PMCID: PMC8451598 DOI: 10.1080/2090598x.2021.1932124] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 03/08/2021] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To investigate the usage and the efficacy of vitamins as primary or adjuvant treatment in infertile men with varicocele. METHODS A systematic search in PubMed, the Medical Literature Analysis and Retrieval System Online (MEDLINE) and Cochrane Library with the terms (varicocele) AND (vitamins) was performed. We searched for studies: a) reporting the administration of vitamins (individually or as part of a complex) in men with varicocele and infertility, b) primarily or adjuvant to invasive treatment, and c) reporting the impact on semen parameters and/or pregnancy rates. Exclusion criteria were animal, adolescent and non-English studies, grey literature and trials reporting abstracts only. RESULTS Seven studies were identified eligible for qualitative analysis. All studies were randomised except one (case series). Vitamins were administered dominantly as part of antioxidant complex and only two studies used vitamins (C and E, respectively) as sole agent. In two studies, vitamin monotherapy resulted in improvement in semen quality, but the effect on pregnancy rates is unknown. One study reported no efficacy of adjuvant multivitamin treatment after embolisation in terms of both semen quality and pregnancy rates. Finally, four studies reported a positive effect of vitamins on semen parameters after varicocelectomy, but the effect on pregnancy rates is conflicting; one study reported improved pregnancy rates with adjuvant treatment, two studies did not evaluate the pregnancy rates, and in one study the outcome was unclear due to missing data. CONCLUSIONS Vitamins have been used mostly as part of an antioxidant panel for the management of infertile men with varicocele. Most studies have found a positive impact on semen parameters in selected men with varicocele and infertility, as primary or adjuvant treatment. However, the clinical benefit of vitamins administration on pregnancy rate is under-evaluated and should be the target of future research.
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Affiliation(s)
- Georgios Tsampoukas
- U-merge Ltd. (Urology for Emerging Countries), London, UK
- Department of Urology, Princess Alexandra Hospital, Harlow, UK
| | - Kristiana Gkeka
- Department of Urology, General Hospital of Patras, Patras, Greece
| | - Athanasios Dellis
- U-merge Ltd. (Urology for Emerging Countries), London, UK
- Department of Urology, Aretaieion Academic Hospital, Athens, Greece
| | - Dominic Brown
- Department of Urology, Princess Alexandra Hospital, Harlow, UK
| | | | - Ahmed Alneshawy
- U-merge Ltd. (Urology for Emerging Countries), London, UK
- Department of Urology, Princess Alexandra Hospital, Harlow, UK
| | - Mohamad Moussa
- Al Zahraa Hospital, University Medical Center, Lebanese University, Beirut, Lebanon
| | - Athanasios Papatsoris
- U-merge Ltd. (Urology for Emerging Countries), London, UK
- Second Department of Urology, University Hospital of Athens, Athens, Greece
| | - Noor Buchholz
- U-merge Ltd. (Urology for Emerging Countries), London, UK
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Antioxidant-Based Therapies in Male Infertility: Do We Have Sufficient Evidence Supporting Their Effectiveness? Antioxidants (Basel) 2021; 10:antiox10020220. [PMID: 33540782 PMCID: PMC7912982 DOI: 10.3390/antiox10020220] [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: 12/16/2020] [Revised: 01/28/2021] [Accepted: 01/29/2021] [Indexed: 12/19/2022] Open
Abstract
Under physiological conditions, reactive oxygen species (ROS) play pivotal roles in various processes of human spermatozoa. Indeed, semen requires the intervention of ROS to accomplish different stages of its maturation. However, ROS overproduction is a well-documented phenomenon occurring in the semen of infertile males, potentially causing permanent oxidative damages to a vast number of biological molecules (proteins, nucleic acids, polyunsaturated fatty acids of biological membrane lipids), negatively affecting the functionality and vitality of spermatozoa. ROS overproduction may concomitantly occur to the excess generation of reactive nitrogen species (RNS), leading to oxidative/nitrosative stress and frequently encountered in various human pathologies. Under different conditions of male infertility, very frequently accompanied by morpho-functional anomalies in the sperm analysis, several studies have provided evidence for clear biochemical signs of damages to biomolecules caused by oxidative/nitrosative stress. In the last decades, various studies aimed to verify whether antioxidant-based therapies may be beneficial to treat male infertility have been carried out. This review analyzed the results of the studies published during the last ten years on the administration of low-molecular-weight antioxidants to treat male infertility in order to establish whether there is a sufficient number of data to justify antioxidant administration to infertile males. An analysis of the literature showed that only 30 clinical studies tested the effects of the administration of low-molecular-weight antioxidants (administered as a single antioxidant or as a combination of different antioxidants with the addition of vitamins and/or micronutrients) to infertile males. Of these studies, only 33.3% included pregnancy and/or live birth rates as an outcome measure to determine the effects of the therapy. Of these studies, only 4 were case–control studies, and only 2 of them found improvement of the pregnancy rate in the group of antioxidant-treated patients. Additionally, of the 30 studies considered in this review, only 43.3% were case–control studies, 66.7% enrolled a number of patients higher than 40, and 40% carried out the administration of a single antioxidant. Therefore, it appears that further studies are needed to clearly define the usefulness of antioxidant-based therapies to treat male infertility.
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Bahmyari R, Ariafar A, Sayadi M, Hossieni S, Azima S. The Effect of Daily Intake of Selenium, Vitamin E and Folic Acid on Sperm Parameters in Males with Idiopathic Infertility: A Single-Blind Randomized Controlled Clinical Trial. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2021; 15:8-14. [PMID: 33497041 PMCID: PMC7838762 DOI: 10.22074/ijfs.2021.6236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 07/07/2020] [Indexed: 11/04/2022]
Abstract
Background Male infertility may originate from a wide spectrum of conditions while in 30-40 percent of cases, no significant reason can be identified. Thereby, it is recognized as male idiopathic infertility. This study was undertaken to investigate the effect of daily intake of selenium, vitamin E and folic acid on sperm parameters in males with idiopathic infertility. Materials and Methods Seventy infertile men were selected to participate in this single-blind, randomized controlled clinical trial using convenience sampling. They were equally divided into two groups via permuted block randomization method. The intervention group received selenium tablet (200 μg per day, oral), vitamin E capsule (400 IU per day, oral) and folic acid tablet (5 mg per day, oral).The placebo group received matching placebo for three months. Semen volume, total sperm motility, sperm concentration, progressive sperm motility, normal sperm morphology, sperm motility index (SMI) and functional sperm concentration (FSC) were assessed by sperm quality analyzer-v (SQAV) before and after the intervention. Paired t test, and independent t test were used to compare the results within and between the groups, respectively. The IBM SPSS V.16.005 was used for data analysis. A P<0.05 was considered statistically significant. Results After three months, according to within-group analysis, a significant difference was found in mean SMI (P=0.007) and FSC (P=0.001) in the intervention group. According to between-group analysis, no significant difference was found in mean semen volume (P=0.610), sperm concentration (P=0.126), total sperm motility (P=0.765), progressive sperm motility (P=0.767), normal sperm morph (P=0.403), SMI (P=0.556) or FSC (P=0.706) between the groups. Conclusion Consumption of selenium, vitamin E and folic acid in infertile men with asthenozoospermia was not effective (Registration number: IRCT2017012432153N1).
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Affiliation(s)
- Rezvan Bahmyari
- Department of Midwifery, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Ariafar
- Department of Urology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehrab Sayadi
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shirzad Hossieni
- Department of Anatomy, Tehran University of Medical Sciences, Tehran, Iran
| | - Sara Azima
- Department of Midwifery, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran.
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26
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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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27
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Akomolafe SF, Aina B, Bajulaye J, Ogundare I, Olulade D, Adeniji R, Fatuase F, Olojo-Kosoko A, Ganiyu O, Asogwa NT. Modulatory effect of cashew (Anacardiumoccidentale L.) nut supplemented diet on fertility activity of clomiphene citrate in male rats. Biomed J 2021; 44:190-200. [PMID: 33451960 PMCID: PMC8178598 DOI: 10.1016/j.bj.2019.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 06/19/2019] [Accepted: 12/18/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Increasing concern has been expressed about the declining sperm count of humans and the potential fertility effects of clomiphene citrate, a synthetic oestrogen-antagonist on human reproductive health in the last few decades. This study aims to investigate the influence of cashew nut supplemented diet on fertility activity of clomiphene citrate in male rats. METHODS The rats were divided into six groups n = 6: rats fed basal diet; rats fed basal diet and then given clomiphene citrate (cc) orally; rats fed diet supplemented with 10% processed cashew nut and given cc orally; and rat fed diet supplemented with 20% processed cashew nut and given cc orally; rats fed diet supplemented with 10% processed cashew nut and rat fed diet supplemented with 20% processed cashew nut for fourteen days. RESULTS The results revealed that there was a significant (p < 0.05) improvement of total testosterone level and epididymal sperm count, viability and progressive motility in all the groups, in comparison to control, with more significance in combination therapy groups. Similarly, increased testicular and epididymal total antioxidant capacity (TAC), nitric oxide (NO), total thiol (T-SH), non protein thiol (NPSH) levels, Glutathione-S-transferase (GST) and steroidogenic enzymes activities with concomitant decrease in reactive oxygen species (ROS) level, thiobarbituric acid reactive substances (TBARS) production and arginase activity, as well as non-observable histopathologic changes in the testes were observed in all the groups when compared with control, with more significance in combination therapy groups. CONCLUSION Therefore, this present study shows that the combination of cashew nut supplemented diet and clomiphene citrate could modulate vital biomolecules associated with male reproductive function. Thus, this finding supports the concept that the combination therapy of cashew nut and clomiphene citrate may be used to treat male partners suffering from infertility.
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Affiliation(s)
| | - Babatunde Aina
- Department of Biochemistry, Ekiti State University, Ado - Ekiti, Nigeria
| | - Jumoke Bajulaye
- Department of Biochemistry, Ekiti State University, Ado - Ekiti, Nigeria
| | - Iyadunni Ogundare
- Department of Biochemistry, Ekiti State University, Ado - Ekiti, Nigeria
| | - Damola Olulade
- Department of Biochemistry, Ekiti State University, Ado - Ekiti, Nigeria
| | - Rebecca Adeniji
- Department of Biochemistry, Ekiti State University, Ado - Ekiti, Nigeria
| | - Faith Fatuase
- Department of Biochemistry, Ekiti State University, Ado - Ekiti, Nigeria
| | | | - Oboh Ganiyu
- Department of Biochemistry, Federal University of Technology, Akure, Nigeria
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28
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Dcunha R, Hussein RS, Ananda H, Kumari S, Adiga SK, Kannan N, Zhao Y, Kalthur G. Current Insights and Latest Updates in Sperm Motility and Associated Applications in Assisted Reproduction. Reprod Sci 2020; 29:7-25. [PMID: 33289064 PMCID: PMC7721202 DOI: 10.1007/s43032-020-00408-y] [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: 07/22/2020] [Revised: 10/08/2020] [Accepted: 11/01/2020] [Indexed: 02/07/2023]
Abstract
Spermatozoon is a motile cell with a special ability to travel through the woman’s reproductive tract and fertilize an oocyte. To reach and penetrate the oocyte, spermatozoa should possess progressive motility. Therefore, motility is an important parameter during both natural and assisted conception. The global trend of progressive reduction in the number and motility of healthy spermatozoa in the ejaculate is associated with increased risk of infertility. Therefore, developing approaches for maintaining or enhancing human sperm motility has been an important area of investigation. In this review we discuss the physiology of sperm, molecular pathways regulating sperm motility, risk factors affecting sperm motility, and the role of sperm motility in fertility outcomes. In addition, we discuss various pharmacological agents and biomolecules that can enhance sperm motility in vitro and in vivo conditions to improve assisted reproductive technology (ART) outcomes. This article opens dialogs to help toxicologists, clinicians, andrologists, and embryologists in understanding the mechanism of factors influencing sperm motility and various management strategies to improve treatment outcomes.
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Affiliation(s)
- Reyon Dcunha
- Department of Clinical Embryology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104, India
| | - Reda S Hussein
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.,Department of Obstetrics and Gynecology, Assiut University, Assiut City, Egypt
| | - Hanumappa Ananda
- Department of Clinical Embryology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104, India
| | - Sandhya Kumari
- Department of Clinical Embryology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104, India
| | - Satish Kumar Adiga
- Department of Clinical Embryology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104, India
| | - Nagarajan Kannan
- Division of Experimental Pathology and Laboratory Medicine, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA.,Center for Regenerative Medicine, Mayo Clinic, Rochester, MN, 55905, USA.,Mayo Clinic Cancer Center, Mayo Clinic, Rochester, MN, 55905, USA
| | - Yulian Zhao
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Guruprasad Kalthur
- Department of Clinical Embryology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, 576104, India. .,Division of Experimental Pathology and Laboratory Medicine, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA.
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29
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Gundewar T, Kuchakulla M, Ramasamy R. A paradoxical decline in semen parameters in men treated with clomiphene citrate: A systematic review. Andrologia 2020; 53:e13848. [PMID: 33108678 DOI: 10.1111/and.13848] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 08/23/2020] [Accepted: 08/26/2020] [Indexed: 11/30/2022] Open
Abstract
Clomiphene, a selective oestrogen receptor modulator, has been utilised in managing male sub-fertility since 1967. Numerous controlled and uncontrolled studies have been published regarding the efficacy of clomiphene citrate in male sub-fertility cohorts. Although the primary intention of treating men with clomiphene citrate is to improve sperm parameters and testosterone levels, some studies have reported paradoxical decline in semen parameters. The information available on decline in sperm parameters following treatment with clomiphene is sparse. We conducted a systemic review using PubMed, Embase, Cochrane Library and Scopus databases for original studies reporting adverse effects of clomiphene citrate therapy on sperm parameters. This systematic review includes 384 men from 11 different studies that reported adverse effects of clomiphene citrate therapy. Of the men included in these studies, 19%, 21%, 17% and 24% of clomiphene-treated men demonstrated a decrease in sperm count, concentration, motility and total motile sperm count respectively. In up to 17% of patients, deterioration of semen parameters did not recover following discontinuation of therapy. In the future, more studies should report on this aspect so the magnitude of this effect can be more clearly understood.
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Affiliation(s)
- Tejas Gundewar
- Department of Reproductive Medicine & Surgery, Sri Ramachandra Medical College, Sri Ramachandra Institute of Higher Education & Research, Chennai, India
| | - Manish Kuchakulla
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Ranjith Ramasamy
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL, USA
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30
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Hau RK, Miller SR, Wright SH, Cherrington NJ. Generation of a hTERT-Immortalized Human Sertoli Cell Model to Study Transporter Dynamics at the Blood-Testis Barrier. Pharmaceutics 2020; 12:pharmaceutics12111005. [PMID: 33105674 PMCID: PMC7690448 DOI: 10.3390/pharmaceutics12111005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 12/13/2022] Open
Abstract
The blood-testis barrier (BTB) formed by adjacent Sertoli cells (SCs) limits the entry of many chemicals into seminiferous tubules. Differences in rodent and human substrate-transporter selectivity or kinetics can misrepresent conclusions drawn using rodent in vitro models. Therefore, human in vitro models are preferable when studying transporter dynamics at the BTB. This study describes a hTERT-immortalized human SC line (hT-SerC) with significantly increased replication capacity and minor phenotypic alterations compared to primary human SCs. Notably, hT-SerCs retained similar morphology and minimal changes to mRNA expression of several common SC genes, including AR and FSHR. The mRNA expression of most xenobiotic transporters was within the 2-fold difference threshold in RT-qPCR analysis with some exceptions (OAT3, OCT3, OCTN1, OATP3A1, OATP4A1, ENT1, and ENT2). Functional analysis of the equilibrative nucleoside transporters (ENTs) revealed that primary human SCs and hT-SerCs predominantly express ENT1 with minimal ENT2 expression at the plasma membrane. ENT1-mediated uptake of [3H] uridine was linear over 10 min and inhibited by NBMPR with an IC50 value of 1.35 ± 0.37 nM. These results demonstrate that hT-SerCs can functionally model elements of transport across the human BTB, potentially leading to identification of other transport pathways for xenobiotics, and will guide drug discovery efforts in developing effective BTB-permeable compounds.
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Affiliation(s)
- Raymond K. Hau
- College of Pharmacy, Department of Pharmacology & Toxicology, University of Arizona, Tucson, AZ 85719, USA; (R.K.H.); (S.R.M.)
| | - Siennah R. Miller
- College of Pharmacy, Department of Pharmacology & Toxicology, University of Arizona, Tucson, AZ 85719, USA; (R.K.H.); (S.R.M.)
| | - Stephen H. Wright
- College of Medicine, Department of Physiology, University of Arizona, Tucson, AZ 85719, USA
- Correspondence: (S.H.W.); (N.J.C.); Tel.: +1-(520)-626-4253 (S.H.W.); +1-(520)-626-0219 (N.J.C.)
| | - Nathan J. Cherrington
- College of Pharmacy, Department of Pharmacology & Toxicology, University of Arizona, Tucson, AZ 85719, USA; (R.K.H.); (S.R.M.)
- Correspondence: (S.H.W.); (N.J.C.); Tel.: +1-(520)-626-4253 (S.H.W.); +1-(520)-626-0219 (N.J.C.)
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31
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Zerbinati C, Caponecchia L, Fiori C, Sebastianelli A, Salacone P, Ciacciarelli M, Iuliano L. Alpha‐ and gamma‐tocopherol levels in human semen and their potential functional implications. Andrologia 2020; 52:e13543. [DOI: 10.1111/and.13543] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 01/07/2020] [Accepted: 01/11/2020] [Indexed: 12/21/2022] Open
Affiliation(s)
- Chiara Zerbinati
- Vascular Biology & Mass Spectrometry Laboratory Department of Medico‐Surgical Sciences and Biotechnologies Sapienza University of Rome LatinaItaly
| | - Luisa Caponecchia
- Andrology and Pathophysiology of Reproduction S.M. Goretti Hospital LatinaItaly
| | - Cristina Fiori
- Andrology and Pathophysiology of Reproduction S.M. Goretti Hospital LatinaItaly
| | | | - Pietro Salacone
- Andrology and Pathophysiology of Reproduction S.M. Goretti Hospital LatinaItaly
| | - Marco Ciacciarelli
- Vascular Biology & Mass Spectrometry Laboratory Department of Medico‐Surgical Sciences and Biotechnologies Sapienza University of Rome LatinaItaly
- UOC of Internal Medicine ICOT University Hospital Sapienza University of Rome Latina Italy
| | - Luigi Iuliano
- Vascular Biology & Mass Spectrometry Laboratory Department of Medico‐Surgical Sciences and Biotechnologies Sapienza University of Rome LatinaItaly
- UOC of Internal Medicine ICOT University Hospital Sapienza University of Rome Latina Italy
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32
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Wang M, Wang Q, Du Y, Jiang H, Zhang X. Vitamins combined with traditional Chinese medicine for male infertility: A systematic review and meta-analysis. Andrology 2020; 8:1038-1050. [PMID: 32170803 DOI: 10.1111/andr.12787] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/04/2020] [Accepted: 03/12/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Male infertility is a tough problem in medicine. This article aims to provide the latest evidence for the efficacy and safety of traditional Chinese medicine (TCM) combined with vitamins in the treatment of male infertility. METHOD All randomized controlled trials (RCTs) that used TCM combined with vitamins for male infertility treatment were included in databases of China National Knowledge Infrastructure (CNKI), Wanfang, VIP Database, China Biology Medicine disc (CBM), MEDLINE, EMBASE, and Cochrane Library. The quality of the included articles was evaluated using the Cochrane Reviewer's Handbook 5.3, and meta-analysis was performed using Stata 15. RESULTS A total of 14 eligible studies with 1488 patients were included in this meta-analysis. The results suggested that, compared with vitamin E or vitamin E + C alone, combination of TCM with vitamins increased significantly sperm concentration, sperm motility, sperm viability, liquefaction time of semen, the activity of acrosome enzyme, and the pregnancy rate of patients with male infertility. Three kinds of TCM (Shengjing capsule, Huanshao capsule, and compound Xuanju capsule) showed significant improvement for male infertility in terms of pregnancy rate, sperm concentration, or sperm motility. In addition, the results of the publication bias test demonstrated that no significant bias occurred. CONCLUSION Traditional Chinese medicine combined with vitamins has significant efficacy in the treatment of male infertility with no increase in side effects. The specific implementing regulations still need more long-term, multicenter, randomized, and double-blind clinical trials.
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Affiliation(s)
- Ming Wang
- Fuyang People's Hospital, Anhui Medical University, Fuyang, China
| | - Qi Wang
- Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yongqiang Du
- Fuyang People's Hospital, Anhui Medical University, Fuyang, China
| | - Hui Jiang
- The Department of Urology, Peking University Third Hospital, Andrology, Peking, China
| | - Xiansheng Zhang
- Department of Urology, First Affiliated Hospital of Anhui Medical University, Hefei, China
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33
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Arafa M, Agarwal A, Majzoub A, Panner Selvam MK, Baskaran S, Henkel R, Elbardisi H. Efficacy of Antioxidant Supplementation on Conventional and Advanced Sperm Function Tests in Patients with Idiopathic Male Infertility. Antioxidants (Basel) 2020; 9:E219. [PMID: 32155908 PMCID: PMC7139646 DOI: 10.3390/antiox9030219] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 02/23/2020] [Accepted: 03/02/2020] [Indexed: 12/20/2022] Open
Abstract
Antioxidants are used in the empirical treatment of infertile men. The aim of this study was to evaluate the effects of antioxidant therapy on conventional semen parameters and advanced sperm function tests in men seeking fertility treatment. A total of 148 infertile men of unknown etiology were divided into idiopathic (n = 119) and unexplained male infertility (UMI; n = 29). All participants were treated with the antioxidant supplement 'FH PRO for Men' for a period of three months. Compared with pretreatment results, there was a significant improvement in conventional semen parameters including sperm concentration, total and progressive motility and normal morphology, and seminal oxidation reduction potential (ORP), and sperm DNA fragmentation (SDF) in idiopathic infertile men. The changes were more prominent in idiopathic infertile men positive for ORP and SDF. UMI patients showed an improvement in progressive motility, ORP, and SDF after antioxidant treatment. Statistical analysis revealed that the efficacy of FH PRO for Men was significant in idiopathic male infertility compared with UMI. Treatment of idiopathic male infertility patients with the FH PRO for Men antioxidant regimen for three months resulted in a significant improvement in conventional semen parameters and sperm function. Therefore, FH PRO for Men offers promise for the medical treatment of idiopathic male infertility.
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Affiliation(s)
- Mohamed Arafa
- Male Infertility Unit, Urology Department, Hamad General Hospital, 00974 Doha, Qatar; (A.M.); (H.E.)
- Urology Department, Weill Cornell Medical-Qatar, 00974 Doha, Qatar
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH 44195, USA; (A.A.); (M.K.P.S.); (S.B.); (R.H.)
- Andrology Department, Cairo University, 11562 Cairo, Egypt
| | - Ashok Agarwal
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH 44195, USA; (A.A.); (M.K.P.S.); (S.B.); (R.H.)
| | - Ahmad Majzoub
- Male Infertility Unit, Urology Department, Hamad General Hospital, 00974 Doha, Qatar; (A.M.); (H.E.)
- Urology Department, Weill Cornell Medical-Qatar, 00974 Doha, Qatar
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH 44195, USA; (A.A.); (M.K.P.S.); (S.B.); (R.H.)
| | - Manesh Kumar Panner Selvam
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH 44195, USA; (A.A.); (M.K.P.S.); (S.B.); (R.H.)
| | - Saradha Baskaran
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH 44195, USA; (A.A.); (M.K.P.S.); (S.B.); (R.H.)
| | - Ralf Henkel
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH 44195, USA; (A.A.); (M.K.P.S.); (S.B.); (R.H.)
- Department of Medical Bioscience, University of the Western Cape, 7535 Bellville, South Africa
| | - Haitham Elbardisi
- Male Infertility Unit, Urology Department, Hamad General Hospital, 00974 Doha, Qatar; (A.M.); (H.E.)
- Urology Department, Weill Cornell Medical-Qatar, 00974 Doha, Qatar
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Sadaghiani S, Fallahi S, Heshmati H, Teshnizi SH, Chaijan HA, Ebrahimi FFA, Khorrami F, Poorrezaeian M, Alizadeh F. Effect of antioxidant supplements on sperm parameters in infertile male smokers: a single-blinded clinical trial. AIMS Public Health 2020; 7:92-99. [PMID: 32258192 PMCID: PMC7109539 DOI: 10.3934/publichealth.2020009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 01/19/2020] [Indexed: 12/05/2022] Open
Abstract
Introduction Naturally, in human body, there is a balance between free radicals and the antioxidant system. Yet, cigarette consumption in smokers increases free radicals and decreases antioxidants. A vast body of research showed that the ROS level of seminal fluid is reduced using oral antioxidant complements through enhancing the clearing capacity of free radicals. Thus, the present research aimed to explore the effect of vitamin complement consumption on changing male infertility indices among smokers. Methods In the present randomized clinical trial which was single-blinded, 50 infertile oligospermic and asthenospermic men participated. They were selected in a randomized convenient sampling method. Before the study began, a semen sample was taken from all participants for analysis. Subsequently, the patients received 30 mg of Q10 coenzyme, 8 mg of zinc, 100 mg of vitamin C, 12 mg of vitamin E, 400 mg of folic acid for a whole duration of 3 months on a daily basis (once a day) and 200 mg of selenium every other day after lunch. A second sample of seminal fluid was taken from patients and semen parameters were compared between the pre- and post-test. The relevant statistical analyses were conducted in SPSS.23. Results A comparison of pre-test and post-test results revealed that all sperm parameters including the volume, morphology, motion, count and progressive motility were significantly increased after the intervention (p ≥ 005). Moreover, a statistically significant improvement was observed in the pH and concentration of seminal fluid. Conclusion The present research showed that consuming vitamin complements (30 mg of Q10, mg of zinc, 100 mg of vitamin C, 12 mg of vitamin E, 400 mg of folic acid) once a day as well as 200 mg of selenium every other day can effectively improve the qualitative parameters (pH and concentration) and quantitative parameters (volume, motion, morphology, count and progressive motility) in infertile male smokers.
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Affiliation(s)
- Safa Sadaghiani
- Department of Nursing, Faculty of Nursing and Midwifery, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Soghra Fallahi
- Fertility and Infertility Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Hossein Heshmati
- Fertility and Infertility Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Saeed Hosseini Teshnizi
- Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | | | | | - Farhad Khorrami
- Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | | | - Faezeh Alizadeh
- Hormozgan University of Medical Sciences, Bandar Abbas, Iran
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Wang F, Gao QH, Geng Q, Han Q, Zhao JY, Yu GJ, Zhang JW, Yan B, Guo J, Song CS. Effectiveness and Safety Evaluation of Qixiong Zhongzi Decoction () in Idiopathic Asthenozoospermia Treatment: A Randomized Controlled Trial. Chin J Integr Med 2020; 26:146-151. [PMID: 31997237 DOI: 10.1007/s11655-020-3211-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the clinical effectiveness and safety of the Chinese medicine (CM) Qixiong Zhongzi Decoction (, QZD) in the treatment of patients with idiopathic asthenozoospermia. METHODS A total number of 66 patients with idiopathic asthenozoospermia were included and randomly divided into treatment and control groups by SAS-generated code from January 2015 to August 2016, 33 patients in each group. Patients in the treatment group were administered with 150 mL of QZD twice a day, whereas those in the control group were given 1 g of levocarnitine oral liquid twice a day. The two groups received the indicated medication for 12 weeks and were then followed up for 4 weeks. The primary outcome was sperm motility, and the secondary therapeutic indices were sperm volume, density, pregnancy probability, and CM syndrome score. The comparison between groups was carried out at 4, 8 and 12 weeks, respectively. The safety was determined before and after treatment. RESULTS (1) Drop-off: 5 cases (7.58%) were lost after treatment (2 from the treatment group and 3 from the control group). (2) Primary outcomes: after 8- and 12-week treatment, the progressive sperms in the two groups were significantly higher than the baseline (all P<0.05); however, the treatment group showed greater improvement compared with the control group at 12-week treatment (22.7% ± 9.0% vs. 14.1% ±8.8%, P<0.05). The increasement of non-progressive grade sperms at both groups was observed at 8- and 12-week treatment with statistical difference (all P<0.05), however, the treatment group showed remarkable improvement compared with the control group at 12-week treatment (38.7% ±14.1% vs. 26.2% ±15.4%, P<0.05). (3) Secondary outcomes: no significant statistical differences were found in semen volume and density (4, 8, and 12-week treatment) and pregnancy probability of patients' wives (12-week treatment) between two groups (all P>0.05), however, the CM syndrome score of the treatment group significantly declined compared with baseline level at each time points (all P<0.05). (4) Safety: no obvious side reactions were found during the treatment in both groups. CONCLUSION QZD could improve the progressive and non-progressive grade sperm in the treatment of idiopathic asthenozoospermia. It is safe with no obvious side effects.
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Affiliation(s)
- Fu Wang
- Department of Andrology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Qing-He Gao
- Department of Andrology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Qiang Geng
- Department of Andrology, The First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China
| | - Qiang Han
- Department of Andrology, Beijing Traditional Chinese Medicine Hospital Affiliated to Capital Medical University, Beijing, 100010, China
| | - Jia-You Zhao
- Graduate School, China Academy of Chinese Medical Sciences, Beijing, 100700, China
| | - Guo-Jin Yu
- Department of Andrology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Ji-Wei Zhang
- Department of Andrology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Bin Yan
- Department of Andrology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Jun Guo
- Department of Andrology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Chun-Sheng Song
- Graduate School, China Academy of Chinese Medical Sciences, Beijing, 100700, China.
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Terai K, Horie S, Fukuhara S, Miyagawa Y, Kobayashi K, Tsujimura A. Combination therapy with antioxidants improves total motile sperm counts: A Preliminary Study. Reprod Med Biol 2020; 19:89-94. [PMID: 31956290 PMCID: PMC6955581 DOI: 10.1002/rmb2.12308] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 10/23/2019] [Accepted: 11/08/2019] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Optimal strategies to treat idiopathic male infertility have remained unclear. The aim of this study was to evaluate the effectiveness of combination antioxidant therapy with several vitamins and supplements on semen parameters. METHODS Thirty-one men with oligozoospermia and/or asthenozoospermia evaluated by a Makler counting chamber were randomly assigned to two treatment groups: a combination of antioxidant supplements (L-carnitine, zinc, astaxanthin, coenzyme Q10, vitamin C, vitamin B12, and vitamin E) and a Chinese herbal medicine, hochu-ekki-to (HE). Serum endocrinological profiles and semen parameters, especially total motile sperm count, were compared between before and after 12 weeks of treatment in both groups. RESULTS In the supplement group, endocrinological findings were not significantly improved. The semen parameters of semen volume, sperm concentration, and sperm motility were not statistically significantly improved, whereas total motile sperm count was significantly improved. In contrast, none of the endocrinological factors or semen findings were significantly improved by the Chinese herbal medicine although semen concentration, semen motility, and total motile sperm count showed a tendency to increase. CONCLUSION Because combination antioxidant therapy could improve sperm motility significantly for patients with idiopathic oligoasthenozoospermia, our supplement could be one treatment option for idiopathic male infertility.
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Affiliation(s)
- Kazutaka Terai
- Department of UrologyJuntendo University Graduate School of MedicineTokyoJapan
- Men's Health Clinic TokyoTokyoJapan
| | - Shigeo Horie
- Department of UrologyJuntendo University Graduate School of MedicineTokyoJapan
- Men's Health Clinic TokyoTokyoJapan
| | | | - Yasushi Miyagawa
- Department of UrologyOsaka University Graduate School of MedicineOsakaJapan
| | | | - Akira Tsujimura
- Men's Health Clinic TokyoTokyoJapan
- Department of UrologyJuntendo University Urayasu HospitalChibaJapan
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Shahrokhi SZ, Salehi P, Alyasin A, Taghiyar S, Deemeh MR. Asthenozoospermia: Cellular and molecular contributing factors and treatment strategies. Andrologia 2019; 52:e13463. [DOI: 10.1111/and.13463] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 09/13/2019] [Accepted: 09/22/2019] [Indexed: 12/18/2022] Open
Affiliation(s)
- Seyedeh Zahra Shahrokhi
- Department of Laboratory Medicine School of Allied Medical Sciences Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Peyman Salehi
- Infertility Center Shahid Beheshti Hospital Isfahan Iran
| | | | | | - Mohammad Reza Deemeh
- Andrology Department Nobel Laboratory Isfahan Iran
- Department of Clinical Biochemistry Faculty of Medical Sciences Tarbiat Modares University Tehran Iran
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38
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Agarwal A, Panner Selvam MK, Samanta L, Vij SC, Parekh N, Sabanegh E, Tadros NN, Arafa M, Sharma R. Effect of Antioxidant Supplementation on the Sperm Proteome of Idiopathic Infertile Men. Antioxidants (Basel) 2019; 8:E488. [PMID: 31623114 PMCID: PMC6827009 DOI: 10.3390/antiox8100488] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 10/07/2019] [Accepted: 10/11/2019] [Indexed: 12/17/2022] Open
Abstract
Antioxidant supplementation in idiopathic male infertility has a beneficial effect on semen parameters. However, the molecular mechanism behind this effect has not been reported. The objective of this study was to evaluate the sperm proteome of idiopathic infertile men pre- and post-antioxidant supplementation. Idiopathic infertile men were provided with oral antioxidant supplementation once daily for a period of 6 months. Of the 379 differentially expressed proteins (DEPs) between pre- and post-antioxidant treatment patients, the majority of the proteins (n = 274) were overexpressed following antioxidant treatment. Bioinformatic analysis revealed the activation of oxidative phosphorylation pathway and upregulation of key proteins involved in spermatogenesis, sperm maturation, binding of sperm, fertilization and normal reproductive function. In addition, the transcriptional factors associated with antioxidant defense system (PPARGC1A) and free radical scavenging (NFE2L2) were predicted to be functionally activated post-treatment. Key DEPs, namely, NDUFS1, CCT3, PRKARA1 and SPA17 validated by Western blot showed significant overexpression post-treatment. Our novel proteomic findings suggest that antioxidant supplementation in idiopathic infertile men improves sperm function at the molecular level by modulating proteins involved in CREM signaling, mitochondrial function and protein oxidation. Further, activation of TRiC complex helped in nuclear compaction, maintenance of telomere length, flagella function, and expression of zona pellucida receptors for sperm-oocyte interaction.
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Affiliation(s)
- Ashok Agarwal
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH 44195, USA.
- Department of Urology, Cleveland Clinic, Cleveland, OH 44195, USA.
| | - Manesh Kumar Panner Selvam
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH 44195, USA.
- Department of Urology, Cleveland Clinic, Cleveland, OH 44195, USA.
| | - Luna Samanta
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH 44195, USA.
- Redox Biology Laboratory, Department of Zoology, Ravenshaw University, Cuttack 753003, India.
| | - Sarah C Vij
- Department of Urology, Cleveland Clinic, Cleveland, OH 44195, USA.
| | - Neel Parekh
- Department of Urology, Cleveland Clinic, Cleveland, OH 44195, USA.
| | - Edmund Sabanegh
- Department of Urology, Cleveland Clinic, Cleveland, OH 44195, USA.
| | - Nicholas N Tadros
- Division of Urology, Southern Illinois University School of Medicine, Springfield, IL 62769, USA.
| | - Mohamed Arafa
- Department of Urology, Hamad Medical Corporation, Doha 00974, Qatar.
| | - Rakesh Sharma
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH 44195, USA.
- Department of Urology, Cleveland Clinic, Cleveland, OH 44195, USA.
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39
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Hassani-Bafrani H, Tavalaee M, Arbabian M, Dattilo M, Nasr-Esfahani MH. The effect of vitamin E & vitamin B on sperm function in rat varicocele model. Andrologia 2019; 51:e13429. [PMID: 31613021 DOI: 10.1111/and.13429] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/01/2019] [Accepted: 08/21/2019] [Indexed: 01/15/2023] Open
Abstract
We assessed the effect of vitamin E and vitamin B (Vit E & Vit B) and their combination on sperm functional parameters in the rat varicocele model. Male rats (n = 120) were divided into control (n = 30), sham (n = 30) and varicocele induction (n = 60) groups. After 2 months, 10 rats from each group were sacrificed to verify varicocele model. This part of results showed that sperm parameters, DNA damage, lipid peroxidation and residual histone were adversely effected in the varicocele group. From the 50 remaining rats in varicocele group, 10 rats received Vit B complex (6, 9.6, 30.4, 9.6 and 0.006 mg/kg for B6, B2, B9, B1 and B12 respectively), 10 rats received Vit E (40 mg/kg), 10 rats received Vit B & E, 10 rats only received water and 10 rats were only received sesame oil as a solvent for Vit E, for 2 months. From 40 remaining rats in control and sham groups, 20 rats only received water and other 20 rats only received sesame oil for 2 months. Then, all the aforementioned parameters were assessed. These results showed that Vit B antioxidant was more efficient in improvement of sperm parameters, chromatin integrity and lipid peroxidation in varicocelized rats compared with Vit E.
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Affiliation(s)
- Hassan Hassani-Bafrani
- Anatomical Sciences Research Center, Kashan University of Medical Sciences, Kashan, Iran.,Gametogenesis Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Marziyeh Tavalaee
- Department of Reproductive Biotechnology, Reproductive Biomedicine Research Center, Royan Institute for Biotechnology, ACECR, Isfahan, Iran
| | - Maryam Arbabian
- Department of Reproductive Biotechnology, Reproductive Biomedicine Research Center, Royan Institute for Biotechnology, ACECR, Isfahan, Iran
| | | | - Mohammad Hossein Nasr-Esfahani
- Department of Reproductive Biotechnology, Reproductive Biomedicine Research Center, Royan Institute for Biotechnology, ACECR, Isfahan, Iran.,Parthenogen, Lugano, Switzerland
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40
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Agarwal A, Parekh N, Panner Selvam MK, Henkel R, Shah R, Homa ST, Ramasamy R, Ko E, Tremellen K, Esteves S, Majzoub A, Alvarez JG, Gardner DK, Jayasena CN, Ramsay JW, Cho CL, Saleh R, Sakkas D, Hotaling JM, Lundy SD, Vij S, Marmar J, Gosalvez J, Sabanegh E, Park HJ, Zini A, Kavoussi P, Micic S, Smith R, Busetto GM, Bakırcıoğlu ME, Haidl G, Balercia G, Puchalt NG, Ben-Khalifa M, Tadros N, Kirkman-Browne J, Moskovtsev S, Huang X, Borges E, Franken D, Bar-Chama N, Morimoto Y, Tomita K, Srini VS, Ombelet W, Baldi E, Muratori M, Yumura Y, La Vignera S, Kosgi R, Martinez MP, Evenson DP, Zylbersztejn DS, Roque M, Cocuzza M, Vieira M, Ben-Meir A, Orvieto R, Levitas E, Wiser A, Arafa M, Malhotra V, Parekattil SJ, Elbardisi H, Carvalho L, Dada R, Sifer C, Talwar P, Gudeloglu A, Mahmoud AMA, Terras K, Yazbeck C, Nebojsa B, Durairajanayagam D, Mounir A, Kahn LG, Baskaran S, Pai RD, Paoli D, Leisegang K, Moein MR, Malik S, Yaman O, Samanta L, Bayane F, Jindal SK, Kendirci M, Altay B, Perovic D, Harlev A. Male Oxidative Stress Infertility (MOSI): Proposed Terminology and Clinical Practice Guidelines for Management of Idiopathic Male Infertility. World J Mens Health 2019; 37:296-312. [PMID: 31081299 PMCID: PMC6704307 DOI: 10.5534/wjmh.190055] [Citation(s) in RCA: 233] [Impact Index Per Article: 46.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 04/02/2019] [Indexed: 12/29/2022] Open
Abstract
Despite advances in the field of male reproductive health, idiopathic male infertility, in which a man has altered semen characteristics without an identifiable cause and there is no female factor infertility, remains a challenging condition to diagnose and manage. Increasing evidence suggests that oxidative stress (OS) plays an independent role in the etiology of male infertility, with 30% to 80% of infertile men having elevated seminal reactive oxygen species levels. OS can negatively affect fertility via a number of pathways, including interference with capacitation and possible damage to sperm membrane and DNA, which may impair the sperm's potential to fertilize an egg and develop into a healthy embryo. Adequate evaluation of male reproductive potential should therefore include an assessment of sperm OS. We propose the term Male Oxidative Stress Infertility, or MOSI, as a novel descriptor for infertile men with abnormal semen characteristics and OS, including many patients who were previously classified as having idiopathic male infertility. Oxidation-reduction potential (ORP) can be a useful clinical biomarker for the classification of MOSI, as it takes into account the levels of both oxidants and reductants (antioxidants). Current treatment protocols for OS, including the use of antioxidants, are not evidence-based and have the potential for complications and increased healthcare-related expenditures. Utilizing an easy, reproducible, and cost-effective test to measure ORP may provide a more targeted, reliable approach for administering antioxidant therapy while minimizing the risk of antioxidant overdose. With the increasing awareness and understanding of MOSI as a distinct male infertility diagnosis, future research endeavors can facilitate the development of evidence-based treatments that target its underlying cause.
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Affiliation(s)
- Ashok Agarwal
- American Center for Reproductive Medicine, Cleveland Clinic, OH, USA
- Department of Urology, Cleveland Clinic, Cleveland, OH, USA.
| | - Neel Parekh
- Department of Urology, Cleveland Clinic, Cleveland, OH, USA
| | - Manesh Kumar Panner Selvam
- American Center for Reproductive Medicine, Cleveland Clinic, OH, USA
- Department of Urology, Cleveland Clinic, Cleveland, OH, USA
| | - Ralf Henkel
- American Center for Reproductive Medicine, Cleveland Clinic, OH, USA
- Department of Medical Bioscience, University of the Western Cape, Cape Town, South Africa
| | - Rupin Shah
- Department of Urology, Lilavati Hospital and Research Centre, Mumbai, India
| | - Sheryl T Homa
- School of Biosciences, University of Kent, Canterbury, UK
| | | | - Edmund Ko
- Department of Urology, Loma Linda University Health, Loma Linda, CA, USA
| | - Kelton Tremellen
- Department of Obstetrics Gynaecology and Reproductive Medicine, Flinders University, Bedford Park, Australia
| | - Sandro Esteves
- Division of Urology, Department of Surgery, University of Campinas (UNICAMP), Campinas, Brazil
- Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Ahmad Majzoub
- American Center for Reproductive Medicine, Cleveland Clinic, OH, USA
- Department of Urology, Hamad Medical Corporation and Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Juan G Alvarez
- Centro Androgen, La Coruña, Spain and Harvard Medical School, Boston, MA, USA
| | - David K Gardner
- School of BioSciences, University of Melbourne, Parkville, Australia
| | - Channa N Jayasena
- Section of Investigative Medicine, Imperial College London, UK
- Department of Andrology, Hammersmith Hospital, London, UK
| | | | - Chak Lam Cho
- Department of Surgery, Union Hospital, Shatin, Hong Kong
| | - Ramadan Saleh
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt
| | | | - James M Hotaling
- Department of Urology, University of Utah, Salt Lake City, UT, USA
| | - Scott D Lundy
- Department of Urology, Cleveland Clinic, Cleveland, OH, USA
| | - Sarah Vij
- Department of Urology, Cleveland Clinic, Cleveland, OH, USA
| | | | - Jaime Gosalvez
- Departamento de Biología, Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Hyun Jun Park
- Department of Urology, Pusan National University School of Medicine, Busan, Korea
- Medical Research Institute of Pusan National University Hospital, Busan, Korea
| | - Armand Zini
- Department of Surgery, McGill University, Montreal, QC, Canada
| | - Parviz Kavoussi
- Austin Fertility & Reproductive Medicine/Westlake IVF, Austin, TX, USA
| | - Sava Micic
- Uromedica Polyclinic, Kneza Milosa, Belgrade, Serbia
| | - Ryan Smith
- Department of Urology, University of Virginia, Charlottesville, VA, USA
| | | | | | - Gerhard Haidl
- Department of Dermatology, University Hospital Bonn, Bonn, Germany
| | - Giancarlo Balercia
- Division of Endocrinology, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Umberto I Hospital, Ancona, Italy
| | - Nicolás Garrido Puchalt
- IVI Foundation Edificio Biopolo - Instituto de Investigación Sanitaria la Fe, Valencia, Spain
| | - Moncef Ben-Khalifa
- University Hospital, School of Médicine and PERITOX Laboratory, Amiens, France
| | - Nicholas Tadros
- Division of Urology, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Jackson Kirkman-Browne
- Centre for Human Reproductive Science, IMSR, College of Medical & Dental Sciences, The University of Birmingham Edgbaston, UK
- The Birmingham Women's Fertility Centre, Birmingham Women's and Children's NHS Foundation Trust, Mindelsohn Drive, Edgbaston, UK
| | - Sergey Moskovtsev
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON, Canada
| | - Xuefeng Huang
- Reproductive Medicine Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | | | - Daniel Franken
- Department of Obstetrics & Gynecology, Andrology Unit Faculties of Health Sciences, Tygerberg Hospital, Tygerberg, South Africa
| | - Natan Bar-Chama
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Kazuhisa Tomita
- IVF Japan Group, Horac Grand Front Osaka Clinic, Osaka, Japan
| | | | - Willem Ombelet
- Genk Institute for Fertility Technology, Genk, Belgium
- Hasselt University, Biomedical Research Institute, Diepenbeek, Belgium
| | - Elisabetta Baldi
- Department of Experimental and Clinical Medicine, Center of Excellence DeNothe, University of Florence, Italy
| | - Monica Muratori
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", Unit of Sexual Medicine and Andrology, Center of Excellence DeNothe, University of Florence, Florence, Italy
| | - Yasushi Yumura
- Department of Urology, Reproduction Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Sandro La Vignera
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | | | - Marlon P Martinez
- Section of Urology, University of Santo Tomas Hospital, Manila, Philippines
| | | | | | - Matheus Roque
- Origen, Center for Reproductive Medicine, Rio de Janeiro, Brazil
| | | | - Marcelo Vieira
- Division of Urology, Infertility Center ALFA, São Paulo, Brazil
- Head of Male Infertility Division, Andrology Department, Brazilian Society of Urology, Rio de Janeiro, Brazil
| | - Assaf Ben-Meir
- Fertility and IVF Unit, Department of Obstetrics and Gynecology, Hebrew-University Hadassah Medical Center, Jerusalem, Israel
| | - Raoul Orvieto
- Infertility and IVF Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan, Israel
- Tarnesby-Tarnowski Chair for Family Planning and Fertility Regulation, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Eliahu Levitas
- Soroka University Medical Center, Ben-Gurion University of the Negev Beer-Sheva, Beersheba, Israel
| | - Amir Wiser
- IVF Unit, Meir Medical Center, Kfar Sava, Israel
- Sackler Medicine School, Tel Aviv University, Tel Aviv, Israel
| | - Mohamed Arafa
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
| | - Vineet Malhotra
- Department of Andrology and Urology, Diyos Hospital, New Delhi, India
| | - Sijo Joseph Parekattil
- PUR Clinic, South Lake Hospital, Clermont, FL, USA
- University of Central Florida, Orlando, FL, USA
| | | | - Luiz Carvalho
- Baby Center, Institute for Reproductive Medicine, São Paulo, Brazil
- College Institute of Clinical Research and Teaching Development, São Paulo, Brazil
| | - Rima Dada
- Lab for Molecular Reproduction and Genetics, Anatomy, All India Institute of Medical Sciences, New Delhi, India
| | - Christophe Sifer
- Department of Reproductive Biology, Hôpitaux Universitaires Paris Seine Saint-Denis, Bondy, France
| | - Pankaj Talwar
- Department of Reproductive Medicine and Embryology, Manipal Hospital, New Delhi, India
| | - Ahmet Gudeloglu
- Department of Urology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ahmed M A Mahmoud
- Department of Endocrinology/ Andrology, University Hospital Ghent, Ghent, Belgium
| | - Khaled Terras
- Department of Reproductive Medicine, Hannibal International Clinic, Tunis, Tunisia
| | - Chadi Yazbeck
- Department of Obstetrics, Gynecology and Reproductive Medicine, Pierre Cherest and Hartman Clinics, Paris, France
| | - Bojanic Nebojsa
- Clinic of Urology, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Damayanthi Durairajanayagam
- Department of Physiology, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Jalan Hospital, Selangor, Malaysia
| | - Ajina Mounir
- Department of Embryology, Faculty of Medicine, University of Sousse, Sousse, Tunisia
| | - Linda G Kahn
- Department of Pediatrics, New York University School of Medicine, New York, NY, USA
| | - Saradha Baskaran
- American Center for Reproductive Medicine, Cleveland Clinic, OH, USA
| | - Rishma Dhillon Pai
- Department of Obstetrics and Gynaecology, Lilavati Hospital and Research Centre, Mumbai, India
| | - Donatella Paoli
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Kristian Leisegang
- School of Natural Medicine, University of the Western Cape, Cape Town, South Africa
| | | | | | - Onder Yaman
- Department of Urology, School of Medicine, University of Ankara, Ankara, Turkey
| | - Luna Samanta
- Redox Biology Laboratory, Department of Zoology and Center of Excellence in Environment and Public Health, Ravenshaw University, Cutrack, India
| | - Fouad Bayane
- Marrakech Fertility Institute, Marrakech, Morocco
| | | | - Muammer Kendirci
- Department of Urology, Istinye University Faculty of Medicine, Liv Hospital Ulus, Istanbul, Turkey
| | - Baris Altay
- Department of Urology, Ege University School of Medicine, İzmir, Turkey
| | | | - Avi Harlev
- Fertility and IVF Unit, Soroka University Medical Center, Ben Gurion University of the Negev, Beer Sheva, Israel
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41
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Cannarella R, Condorelli RA, Mongioì LM, Barbagallo F, Calogero AE, La Vignera S. Effects of the selective estrogen receptor modulators for the treatment of male infertility: a systematic review and meta-analysis. Expert Opin Pharmacother 2019; 20:1517-1525. [PMID: 31120775 DOI: 10.1080/14656566.2019.1615057] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Selective estrogen receptor modulators (SERMs) represent a poorly investigated class of drugs for the treatment of male infertility. The aim of this study was to assess the effects of SERMs on conventional sperm parameters, serum gonadotropin and testosterone levels, and pregnancy rate in patients with idiopathic infertility. Methods: The authors performed a comprehensive systematic review with meta-analysis of all available controlled and not-controlled studies of the literature reporting sperm conventional parameters, gonadotropin and testosterone levels, and/or the pregnancy rate following SERM administration in normogonadotropic patients with idiopathic oligozoospermia. Results: From the 418 papers retrieved, 16 controlled and not-controlled trials were lastly included. SERM administration increased significantly sperm concentration, total sperm count, and serum luteinizing hormone, follicle-stimulating hormone, and total testosterone levels compared with baseline values. In contrast, SERMs did not have any significant effect on sperm concentration and progressive and total motility, but improved total sperm count, sperm morphology, and increased the pregnancy rate compared to the control group, which included studies done with placebo or other treatments. Conclusions: The results of this meta-analysis suggest that SERMs may be effective in the treatment of infertile patients with idiopathic infertility. However, the paucity of data does not allow to draw a definitive conclusion.
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Affiliation(s)
- Rossella Cannarella
- Department of Clinical and Experimental Medicine, University of Catania , Catania , Italy
| | - Rosita A Condorelli
- Department of Clinical and Experimental Medicine, University of Catania , Catania , Italy
| | - Laura M Mongioì
- Department of Clinical and Experimental Medicine, University of Catania , Catania , Italy
| | - Federica Barbagallo
- Department of Clinical and Experimental Medicine, University of Catania , Catania , Italy
| | - Aldo E Calogero
- Department of Clinical and Experimental Medicine, University of Catania , Catania , Italy
| | - Sandro La Vignera
- Department of Clinical and Experimental Medicine, University of Catania , Catania , Italy
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42
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Clomiphene citrate effect on testosterone level and semen parameters in 18 infertile men with low testosterone level and normal/low gonadotropines level. Eur J Obstet Gynecol Reprod Biol 2019; 238:104-109. [PMID: 31128532 DOI: 10.1016/j.ejogrb.2019.05.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 04/11/2019] [Accepted: 05/10/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine the effect of a 3-month course of clomiphene citrate (CC) on plasma testosterone (T) level and on semen parameters in 18 infertile men with low T level and normal or low gonadotropines level. STUDY DESIGN A retrospective study was conducted by reviewing the medical records of men referred to a university fertility medicine unit for infertility management between January 2010 and March 2015. Men treated with CC for at least 3 months were included if they presented with: RESULTS: 18 patients met the inclusion criteria. CC was prescribed for 3 months at the dose of 50 mg every 48 h. Plasma T level was assessed at baseline and after 1 month of CC administration. Semen parameters were assessed at baseline and after 3 months of CC administration. The median pre-treatment T level was 9.1 nmol/l; after 1 month of CC treatment the median post-treatment T level increased to 20.2 nmol/l (p = <0.001). Median baseline sperm concentration was 7 millions/ml with a median progressive motility of 18%. After 3 months of CC, the median post-treatment sperm concentration was 17.5 millions/ml (p = 0.024) and the median post-treatment progressive sperm motility was 18% (p = 0.40). Three natural pregnancies occurred during the treatment period. CONCLUSION CC is an effective and inexpensive treatment to increase plasma T level in infertile men with low T level and normal or low gonadotropines level. Our study suggests that CC could increase sperm concentration even in oligospermic infertile men, without, however, a significant effect on progressive sperm motility. More powered randomized controlled trials are needed to definitively assess CC effect on sperm parameters and on natural pregnancy rates.
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43
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Wheeler KM, Sharma D, Kavoussi PK, Smith RP, Costabile R. Clomiphene Citrate for the Treatment of Hypogonadism. Sex Med Rev 2019; 7:272-276. [DOI: 10.1016/j.sxmr.2018.10.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 09/25/2018] [Accepted: 10/04/2018] [Indexed: 01/07/2023]
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44
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Omar MI, Pal RP, Kelly BD, Bruins HM, Yuan Y, Diemer T, Krausz C, Tournaye H, Kopa Z, Jungwirth A, Minhas S. Benefits of Empiric Nutritional and Medical Therapy for Semen Parameters and Pregnancy and Live Birth Rates in Couples with Idiopathic Infertility: A Systematic Review and Meta-analysis. Eur Urol 2019; 75:615-625. [DOI: 10.1016/j.eururo.2018.12.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 12/13/2018] [Indexed: 12/12/2022]
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45
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Sharma D, Zillioux J, Khourdaji I, Reines K, Wheeler K, Costabile R, Kavoussi P, Smith R. Improvements in semen parameters in men treated with clomiphene citrate-A retrospective analysis. Andrologia 2019; 51:e13257. [PMID: 30779195 DOI: 10.1111/and.13257] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 01/15/2019] [Accepted: 01/29/2019] [Indexed: 01/10/2023] Open
Abstract
Clomiphene citrate (CC) is commonly used off-label for the treatment of male infertility, yet there is limited data to guide patient selection. To identify a subset of patients more likely to benefit from CC, we aimed to define predictors of improvement in semen parameters among men receiving CC. We retrospectively analysed 151 men treated with at least 25 mg CC daily for male infertility and/or hypogonadism at two institutions between 2004 and 2014. Men previously on testosterone were excluded. The primary outcome was change in semen parameters. Variables included baseline patient characteristics, pre-treatment hormone profiles and pre-treatment semen analyses. A total of 77 men met inclusion criteria. Median length of therapy was 2.8 months. There was significant improvement in sperm concentration (14-21 million/ml; p = 0.002) and total motile count (TMC; 13-28 million; p = 0.04). One third of patients who began with fewer than 5 million motile spermatozoon improved to a TMC > 5 million, increasing reproductive options to include intrauterine insemination. Patient characteristics, pre-treatment hormone profile and degree of oligozoospermia did not predict treatment response. While no predictors of improvement were identified, clinically useful response rates are described for use in shared decision-making.
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Affiliation(s)
- Devang Sharma
- Department of Urology, University of Virginia, Charlottesville, Virginia
| | | | - Iyad Khourdaji
- Department of Urology, University of Virginia, Charlottesville, Virginia
| | - Katy Reines
- Department of Urology, University of Virginia, Charlottesville, Virginia
| | - Karen Wheeler
- Department of Urology, University of Virginia, Charlottesville, Virginia
| | - Raymond Costabile
- Department of Urology, University of Virginia, Charlottesville, Virginia
| | | | - Ryan Smith
- Department of Urology, University of Virginia, Charlottesville, Virginia
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46
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Abstract
Current evidence links oxidative stress (OS) to male infertility, reduced sperm motility, sperm DNA damage and increased risk of recurrent abortions and genetic diseases. A review of PubMed, Medline, Google Scholar, and Cochrane review databases of published articles from years 2000–2018 was performed focusing on physiological and pathological consequences of reactive oxygen species (ROS), sperm DNA damage, OS tests, and the association between OS and male infertility, pregnancy and assisted reproductive techniques outcomes. Generation of ROS is essential for reproductive function, but OS is detrimental to fertility, pregnancy, and genetic status of the newborns. Further, there is a lack of consensus on selecting OS test, type, and duration of antioxidants treatment as well as on the target patients group. Developing advanced diagnostic and therapeutic options for OS is essential to improve fertility potential and limit genetic diseases transmitted to offspring.
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Affiliation(s)
- Ahmed T Alahmar
- Department of Pathological Analysis, College of Science, University of Sumer, Thi-Qar, Iraq
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47
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Duca Y, Calogero AE, Cannarella R, Condorelli RA, La Vignera S. Current and emerging medical therapeutic agents for idiopathic male infertility. Expert Opin Pharmacother 2018; 20:55-67. [DOI: 10.1080/14656566.2018.1543405] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Ylenia Duca
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Aldo E. Calogero
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Rossella Cannarella
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Rosita A. Condorelli
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Sandro La Vignera
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
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48
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Kobayashi M, Hori T, Kawakami E. Therapeutic effects of oral clomiphene citrate in 2 dogs with low plasma testosterone levels and poor semen quality. J Vet Med Sci 2018; 80:1233-1235. [PMID: 29937459 PMCID: PMC6115249 DOI: 10.1292/jvms.18-0108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Two dogs with low plasma testosterone (T) levels and poor semen quality were administered
one tablet of 12.5 mg clomiphene citrate orally per day at 2-day intervals for 4 weeks.
Plasma T levels, total sperm count, and sperm motility in both dogs temporarily increased
between 3 and 6 weeks after the start of treatment. These results indicate that poor semen
quality in dogs with low plasma T level can be improved by oral administration of
clomiphene citrate.
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Affiliation(s)
- Masanori Kobayashi
- Laboratory of Reproduction, Faculty of Veterinary Medicine, Nippon Veterinary and Life Science University, 1-7-1 Kyonan-cho, Musashino-shi, Tokyo 180-8602, Japan
| | - Tatsuya Hori
- Laboratory of Reproduction, Faculty of Veterinary Medicine, Nippon Veterinary and Life Science University, 1-7-1 Kyonan-cho, Musashino-shi, Tokyo 180-8602, Japan
| | - Eiichi Kawakami
- Laboratory of Reproduction, Faculty of Veterinary Medicine, Nippon Veterinary and Life Science University, 1-7-1 Kyonan-cho, Musashino-shi, Tokyo 180-8602, Japan
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49
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Alahmar AT. The effects of oral antioxidants on the semen of men with idiopathic oligoasthenoteratozoospermia. Clin Exp Reprod Med 2018; 45:57-66. [PMID: 29984205 PMCID: PMC6030611 DOI: 10.5653/cerm.2018.45.2.57] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 03/29/2018] [Accepted: 04/16/2018] [Indexed: 11/06/2022] Open
Abstract
It has been estimated that approximately 15% of reproductive-age couples suffer from infertility. Male factors contribute to almost half of infertility cases, and in many patients the underlying cause of oligoasthenoteratozoospermia is unknown. Accumulating evidence suggests that oxidative stress plays a role as a contributing factor to male infertility, and reactive oxygen species have been shown to impair sperm function and motility and to damage sperm membrane and DNA. Therefore, this review explored the evidence provided by studies published from 2002 to 2017 on the impact of oral antioxidants (vitamin C, vitamin E, L-carnitine, coenzyme Q10, zinc, selenium, and pentoxifylline) on seminal fluid parameters in men with idiopathic oligoasthenoteratozoospermia. Most of the studies were randomized controlled studies that investigated the effect of single or combined antioxidants and reported improvements in at least one semen parameter. The most noteworthy effect that was found was that the use of multiple antioxidants increased sperm motility and concentration. Nonetheless, there is a lack of agreement on the dose, the duration of treatment, and whether individual or combined oral antioxidants should be used. Therefore, the current review provides evidence supporting the use of oral antioxidants in the treatment of infertile men with idiopathic oligoasthenoteratozoospermia.
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Affiliation(s)
- Ahmed T Alahmar
- Department of Pharmacology and Toxicology, College of Pharmacy, University of Babylon, Babylon, Iraq
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50
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Pan X, Wang X, Wang X, Zhang W, Sun Z, Liang X, Zhang X, Li W, Li Z. Protective effects of new Wenshen Shengjing Decoction on cyclosporine-induced impairment of testosterone synthesis and spermatogenic apoptosis. Exp Ther Med 2018; 15:813-821. [PMID: 29399088 PMCID: PMC5772751 DOI: 10.3892/etm.2017.5473] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 03/31/2017] [Indexed: 12/14/2022] Open
Abstract
The aim of the present study was to investigate the potential protective effects of new Wenshen Shengjing Decoction (new WSSJD; including Cornu Cervi Nippon Parvum, Panax ginseng, Cynomorium songaricum, Cistanche deserticola, Radix Astragali, Epimedium brevicornum and Angelica sinensis) on cyclosporine-induced impairment of testosterone synthesis and spermatogenic apoptosis in mice. A total of 90 adult male Kunming mice were divided into the following 6 groups: Control (no intervention), dimethylsulfoxide (DMSO; received only DMSO), cyclosporine A (CsA), clomifene citrate (CC; CsA + CC, 15 mg/kg/day), WSSJD (CsA + WSSJD, crude drug 12 g/kg/day) and new WSSJD (CsA + new WSSJD, crude drug 12 g/kg/day). All mice were treated for 30 days via oral gavage. The testes were subsequently fixed and stained with hematoxylin & eosin to assess the development of seminiferous epithelia. Immunohistochemical techniques were used to detect the expression of luteinizing hormone receptor (LHR) and P450 side chain cleavage (P450scc) in testicular Leydig cells. In addition, the apoptosis of spermatogenic cells in the testes was detected using a terminal dexynucleotidyl transferase-mediated dUTP nick-end labeling assay, and flow cytometry was used to analyze the survival rate and early apoptosis of sperm in the epididymis. Compared with the CsA and CC groups, new WSSJD administration significantly increased levels of serum testosterone and the expressions of LHR and P450scc in testicular Leydig cells (P<0.05), while the apoptosis of spermatogenic cells in the seminiferous tubules and early apoptosis of mature sperm were significantly decreased (P<0.05). These results suggest that new WSSJD may ameliorate CsA-induced spermatogenic damage in male mice by enhancing testosterone synthesis and the secretion of testicular Leydig cells, and by reducing the apoptosis of spermatogenic cells.
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Affiliation(s)
- Xiaoyan Pan
- Department of Histology and Embryology, Jilin Medical University, Jilin, Jilin 132013, P.R. China
| | - Xiyan Wang
- Medical Experimental Center, Jilin Medical University, Jilin, Jilin 132013, P.R. China
| | - Xuenan Wang
- Reproductive Medicine Center of The Affiliated Hospital of Jining Medical College, Jining, Shandong 272029, P.R. China
| | - Wansheng Zhang
- Department of Urology, Affiliated Hospital of Jilin Medical University, Jilin, Jilin 132013, P.R. China
| | - Zhanxuan Sun
- Department of Histology and Embryology, Jilin Medical University, Jilin, Jilin 132013, P.R. China
| | - Xuanxuan Liang
- Department of Histology and Embryology, Jilin Medical University, Jilin, Jilin 132013, P.R. China
| | - Xue Zhang
- Department of Histology and Embryology, Jilin Medical University, Jilin, Jilin 132013, P.R. China
| | - Wenjun Li
- Department of Histology and Embryology, Jilin Medical University, Jilin, Jilin 132013, P.R. China
| | - Zhixin Li
- Department of Histology and Embryology, Jilin Medical University, Jilin, Jilin 132013, P.R. China
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