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Pozzi E, Belladelli F, Corsini C, Boeri L, Capogrosso P, Fallara G, Candela L, Bertini A, Cattafi F, Raffo M, Cazzaniga W, Ventimiglia E, d'Arma A, Alfano M, Matloob R, Papaleo E, Candiani M, Montorsi F, Salonia A. Contemporary Diagnostic Work-Up for Male Infertility: Emphasizing Comprehensive Baseline Assessment. World J Mens Health 2024; 42:42.e63. [PMID: 39028127 DOI: 10.5534/wjmh.240069] [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: 03/18/2024] [Revised: 03/19/2024] [Accepted: 04/09/2024] [Indexed: 07/20/2024] Open
Abstract
Infertility is a prevalent issue affecting many couples during their reproductive years, with a significant number facing challenges in conceiving despite regular unprotected intercourse. Male factor infertility (MFI) contributes significantly to these cases, with a significant proportion of men lacking an identifiable etiology. As such, a thorough assessment of MFI has become increasingly vital for personalized management. This position paper from the Andrology team at IRCCS Ospedale San Raffaele emphasizes a comprehensive and individualized approach to MFI work-up, addressing the evolving challenges encountered in clinical practice. Our approach involves a thorough diagnostic work-up to identify the underlying causes of MFI, integrating insights from extensive literature review and our proprietary data. Our data demonstrates that an extensive diagnostic assessment allows us to identify at least one underlying cause of MFI in most infertile men. However, challenges persist in diagnosing less severe phenotypes with unclear etiology. We discuss the importance of individualized MFI work-up and its implications for developing rational therapeutic protocols. Lastly, this paper highlights the necessity for a personalized diagnostic assessment, addressing the daily clinical challenges and emphasizing tailored approaches to try to improve outcomes among couples seeking first medical help for infertility.
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Affiliation(s)
- Edoardo Pozzi
- University Vita-Salute San Raffaele, Milan, Italy
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Federico Belladelli
- University Vita-Salute San Raffaele, Milan, Italy
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Christian Corsini
- University Vita-Salute San Raffaele, Milan, Italy
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Luca Boeri
- Department of Urology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Capogrosso
- Department of Urology, Circolo & Fondazione Macchi Hospital - ASST Sette Laghi, Varese, Italy
| | - Giuseppe Fallara
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Luigi Candela
- University Vita-Salute San Raffaele, Milan, Italy
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alessandro Bertini
- University Vita-Salute San Raffaele, Milan, Italy
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Cattafi
- University Vita-Salute San Raffaele, Milan, Italy
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Massimiliano Raffo
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Walter Cazzaniga
- Department of Urology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Eugenio Ventimiglia
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alessia d'Arma
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Massimo Alfano
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Rayan Matloob
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Enrico Papaleo
- Department of Obstetrics and Gynaecology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Massimo Candiani
- University Vita-Salute San Raffaele, Milan, Italy
- Department of Obstetrics and Gynaecology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Montorsi
- University Vita-Salute San Raffaele, Milan, Italy
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Andrea Salonia
- University Vita-Salute San Raffaele, Milan, Italy
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy.
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Tiwari P, Yadav A, Kaushik M, Dada R. Cancer risk and male Infertility: Unravelling predictive biomarkers and prognostic indicators. Clin Chim Acta 2024; 558:119670. [PMID: 38614420 DOI: 10.1016/j.cca.2024.119670] [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: 01/01/2024] [Revised: 04/08/2024] [Accepted: 04/10/2024] [Indexed: 04/15/2024]
Abstract
In recent years, there has been a global increase in cases of male infertility. There are about 30 million cases of male infertility worldwide and male reproductive health is showing rapid decline in last few decades. It is now recognized as a potential risk factor for developing certain types of cancer, particularly genitourinary malignancies like testicular and prostate cancer. Male infertility is considered a potential indicator of overall health and an early biomarker for cancer. Cases of unexplained male factor infertility have high levels of oxidative stress and oxidative DNA damage and this induces both denovo germ line mutations and epimutations due to build up of 8-hydroxy 2 deoxygunaosine abase which is highly mutagenic and also induces hypomethylation and genomic instability. Consequently, there is growing evidence to explore the various factors contributing to an increased cancer risk. Currently, the available prognostic and predictive biomarkers associated with semen characteristics and cancer risk are limited but gaining significant attention in clinical research for the diagnosis and treatment of elevated cancer risk in the individual and in offspring. The male germ cell being transcriptionally and translationally inert has a highly truncated repair mechanism and has minimal antioxidants and thus most vulnerable to oxidative injury due to environmental factors and unhealthy lifestyle and social habits. Therefore, advancing our understanding requires a thorough evaluation of the pathophysiologic mechanisms at the DNA, RNA, protein, and metabolite levels to identify key biomarkers that may underlie the pathogenesis of male infertility and associated cancer. Advanced methodologies such as genomics, epigenetics, proteomics, transcriptomics, and metabolomics stand at the forefront of cutting-edge approaches for discovering novel biomarkers, spanning from infertility to associated cancer types. Henceforth, in this review, we aim to assess the role and potential of recently identified predictive and prognostic biomarkers, offering insights into the success of assisted reproductive technologies, causes of azoospermia and idiopathic infertility, the impact of integrated holistic approach and lifestyle modifications, and the monitoring of cancer susceptibility, initiation and progression. Comprehending these biomarkers is crucial for providing comprehensive counselling to infertile men and cancer patients, along with their families.
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Affiliation(s)
- Prabhakar Tiwari
- Lab for Molecular Reproduction and Genetics, Department of Anatomy, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India.
| | - Anjali Yadav
- Lab for Molecular Reproduction and Genetics, Department of Anatomy, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India
| | - Meenakshi Kaushik
- Lab for Molecular Reproduction and Genetics, Department of Anatomy, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India
| | - Rima Dada
- Lab for Molecular Reproduction and Genetics, Department of Anatomy, All India Institute of Medical Sciences (AIIMS), New Delhi 110029, India.
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Tarzaali D, Khaldoun H, Settar A, Boumahdi Merad Z, Mohamed Said R, Djennane N, Makhlouf C, Oularbi Y, Lahmar A, Kaidi R. Ascorbic acid modulates testicular toxicity of Ampligo® 150 ZC insecticide in male rabbit (Oryctolagus cuniculus). Reprod Toxicol 2023; 121:108455. [PMID: 37557928 DOI: 10.1016/j.reprotox.2023.108455] [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: 05/03/2023] [Revised: 08/04/2023] [Accepted: 08/06/2023] [Indexed: 08/11/2023]
Abstract
The present study was designed to evaluate the protective effects of ascorbic acid (AA) against lambda cyhalothrin insecticide formulation Ampligo® (AP)-induced testicular toxicity in rabbit laboratory strain ITELV2006 (Oryctolagus cuniculus). Twenty rabbits were randomly divided into four equal groups and treated by oral gavage for 21 consecutive days: Group 1 served as a control and received 1 ml of distilled water, group 2 was supplemented with1ml of ascorbic acid (AA) dilution (200 mg/kg b.w), Group 3 was treated with a dose of AP at 20 mg/kg bw (1 µl/1 ml of distilled water/animal), whereas group 4 was co-administered AA and AP as the same dose of group 2 and 3, respectively. Hormonal, histomorphometrical, and immunohistochemical methods were performed at the end of the study to detect testes damage. The results showed that AP exposure significantly reduced body weight, absolute and relative testicular weights, and testosterone levels. AP caused changes in testes tissue, namely incomplete spermatogenic series and necrosis of the spermatogonial cells lining in the seminiferous tubules of rabbits. Co-administrating AA clearly modulated body and testes weights, hormonal parameters, and histopathological damage. Furthermore, the findings revealed a significant increase in alpha-fetoprotein (AFP) level expression in the testes of the AP group. However, supplementation of the AP rabbits with AA modulated the observed result. Taken together, these data suggest that AA may protect against Ampligo-induced testicular damage.
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Affiliation(s)
- Dalila Tarzaali
- Laboratory of Biotechnologies Related to Animal Reproduction (LBRA), Institute of Veterinary Sciences, University of Blida 1, Route de Soumaa, BP270 Blida, Algeria.
| | - Hassina Khaldoun
- Department of Biology, Faculty of Nature and Life Sciences, University of Blida 1, Route de Soumaa, BP270 Blida, Algeria
| | - Amina Settar
- Department of Agri-food, Faculty of Nature and Life Sciences, University of Blida 1, Route de Soumaa, BP270 Blida, Algeria
| | - Zoubeïda Boumahdi Merad
- Laboratory of Biotechnologies Related to Animal Reproduction (LBRA), Institute of Veterinary Sciences, University of Blida 1, Route de Soumaa, BP270 Blida, Algeria
| | - Ramdane Mohamed Said
- Department of Biology, Faculty of Nature and Life Sciences, University of Blida 1, Route de Soumaa, BP270 Blida, Algeria
| | - Nacima Djennane
- Department of Pathological Anatomy, Centre Hospitalo-Universitaire Bab El Oued, Algiers, Algeria
| | - Chahrazed Makhlouf
- Department of Biology, Faculty of Nature and Life Sciences, University of Blida 1, Route de Soumaa, BP270 Blida, Algeria
| | | | - Assala Lahmar
- Department of Biology, Faculty of Nature and Life Sciences, University of Blida 1, Route de Soumaa, BP270 Blida, Algeria
| | - Rachid Kaidi
- Laboratory of Biotechnologies Related to Animal Reproduction (LBRA), Institute of Veterinary Sciences, University of Blida 1, Route de Soumaa, BP270 Blida, Algeria
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Huang HH, Hsieh SJ, Chen MS, Jhou MJ, Liu TC, Shen HL, Yang CT, Hung CC, Yu YY, Lu CJ. Machine Learning Predictive Models for Evaluating Risk Factors Affecting Sperm Count: Predictions Based on Health Screening Indicators. J Clin Med 2023; 12:1220. [PMID: 36769868 PMCID: PMC9917545 DOI: 10.3390/jcm12031220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/13/2023] [Accepted: 02/01/2023] [Indexed: 02/05/2023] Open
Abstract
In many countries, especially developed nations, the fertility rate and birth rate have continually declined. Taiwan's fertility rate has paralleled this trend and reached its nadir in 2022. Therefore, the government uses many strategies to encourage more married couples to have children. However, couples marrying at an older age may have declining physical status, as well as hypertension and other metabolic syndrome symptoms, in addition to possibly being overweight, which have been the focus of the studies for their influences on male and female gamete quality. Many previous studies based on infertile people are not truly representative of the general population. This study proposed a framework using five machine learning (ML) predictive algorithms-random forest, stochastic gradient boosting, least absolute shrinkage and selection operator regression, ridge regression, and extreme gradient boosting-to identify the major risk factors affecting male sperm count based on a major health screening database in Taiwan. Unlike traditional multiple linear regression, ML algorithms do not need statistical assumptions and can capture non-linear relationships or complex interactions between dependent and independent variables to generate promising performance. We analyzed annual health screening data of 1375 males from 2010 to 2017, including data on health screening indicators, sourced from the MJ Group, a major health screening center in Taiwan. The symmetric mean absolute percentage error, relative absolute error, root relative squared error, and root mean squared error were used as performance evaluation metrics. Our results show that sleep time (ST), alpha-fetoprotein (AFP), body fat (BF), systolic blood pressure (SBP), and blood urea nitrogen (BUN) are the top five risk factors associated with sperm count. ST is a known risk factor influencing reproductive hormone balance, which can affect spermatogenesis and final sperm count. BF and SBP are risk factors associated with metabolic syndrome, another known risk factor of altered male reproductive hormone systems. However, AFP has not been the focus of previous studies on male fertility or semen quality. BUN, the index for kidney function, is also identified as a risk factor by our established ML model. Our results support previous findings that metabolic syndrome has negative impacts on sperm count and semen quality. Sleep duration also has an impact on sperm generation in the testes. AFP and BUN are two novel risk factors linked to sperm counts. These findings could help healthcare personnel and law makers create strategies for creating environments to increase the country's fertility rate. This study should also be of value to follow-up research.
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Affiliation(s)
- Hung-Hsiang Huang
- Division of Urology, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan
| | - Shang-Ju Hsieh
- Division of Urology, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan
| | - Ming-Shu Chen
- Department of Healthcare Administration, College of Healthcare & Management, Asia Eastern University of Science and Technology, New Taipei City 220, Taiwan
| | - Mao-Jhen Jhou
- Graduate Institute of Business Administration, Fu Jen Catholic University, New Taipei City 242, Taiwan
| | - Tzu-Chi Liu
- Graduate Institute of Business Administration, Fu Jen Catholic University, New Taipei City 242, Taiwan
| | - Hsiang-Li Shen
- Graduate Institute of Business Administration, Fu Jen Catholic University, New Taipei City 242, Taiwan
| | - Chih-Te Yang
- Department of Business Administration, Tamkang University, New Taipei City 251, Taiwan
| | - Chung-Chih Hung
- Department of Laboratory Medicine, Taipei Hospital, Ministry of Health and Welfare, New Taipei City 242, Taiwan
| | - Ya-Yen Yu
- Department of Medical Laboratory, Chang-Hua Hospital, Ministry of Health and Welfare, Chang Hua County 513, Taiwan
| | - Chi-Jie Lu
- Graduate Institute of Business Administration, Fu Jen Catholic University, New Taipei City 242, Taiwan
- Artificial Intelligence Development Center, Fu Jen Catholic University, New Taipei City 242, Taiwan
- Department of Information Management, Fu Jen Catholic University, New Taipei City 242, Taiwan
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