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Busetto GM, Rodrigues BF, Virmani A, Checchia A, Ninivaggi A, Ricapito A, Barbieri G, Fischetti P, Falagario UG, Annese P, d’Altilia N, Mancini V, Ferro M, Crocetto F, Porreca A, Bettocchi C, Cormio L, Agarwal A, Carrieri G. Antioxidant treatment for oligoasthenoteratozoospermia and varicocele: a DBPC trial to evaluate the impact of age and body mass index. Asian J Androl 2024; 26:239-244. [PMID: 38305695 PMCID: PMC11156455 DOI: 10.4103/aja202381] [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: 10/11/2023] [Accepted: 12/03/2023] [Indexed: 02/03/2024] Open
Abstract
Oxidative stress is one of the main mechanisms responsible for male infertility. Various conditions such as varicocele, obesity, advanced age, and lifestyle can lead to an increase in reactive oxygen species, causing an oxidative imbalance in the reproductive environment. Spermatozoa are sensitive to reactive oxygen species and require energy to carry out their main function of fertilizing the egg. Excessive reactive oxygen species can affect sperm metabolism, leading to immobility, impaired acrosome reaction, and cell death, thereby impairing reproductive success. This double-blind randomized study evaluated the effect of supplementation with L-carnitine, acetyl-L-carnitine, vitamins, and other nutrients on semen quality in 104 infertile patients with or without varicocele, while also investigating the impact of factors such as obesity and advanced age on treatment. Sperm concentration significantly increased in the supplemented group compared to the placebo group ( P = 0.0186). Total sperm count also significantly increased in the supplemented group ( P = 0.0117), as did sperm motility ( P = 0.0120). The treatment had a positive effect on patients up to 35 years of age in terms of sperm concentration ( P = 0.0352), while a body mass index (BMI) above 25 kg m -2 had a negative effect on sperm concentration ( P = 0.0110). Results were not showing a net benefit in stratifying patients in accordance with their BMI since sperm quality increase was not affected by this parameter. In conclusion, antioxidant supplementation may be beneficial for infertile patients and has a more positive effect on younger patients with a normal weight.
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Affiliation(s)
- Gian Maria Busetto
- University of Foggia, Foggia 71122, Italy
- Department of Urology and Renal Transplantation, Policlinico of Foggia, Foggia 71122, Italy
| | - Bernarde F Rodrigues
- Department of Urology, Human Reproduction Section, Federal University of Sao Paulo, Sao Paulo 05403-000, Brazil
| | - Ashraf Virmani
- Alfasigma Healthscience, Utrecht 3528 BG, The Netherlands
| | - Andrea Checchia
- University of Foggia, Foggia 71122, Italy
- Urology Unit, “G. Tatarella” Hospital, Cerignola 71042, Italy
| | - Antonella Ninivaggi
- University of Foggia, Foggia 71122, Italy
- Department of Urology and Renal Transplantation, Policlinico of Foggia, Foggia 71122, Italy
| | - Anna Ricapito
- University of Foggia, Foggia 71122, Italy
- Department of Urology and Renal Transplantation, Policlinico of Foggia, Foggia 71122, Italy
| | - Giovanni Barbieri
- University of Foggia, Foggia 71122, Italy
- Department of Urology and Renal Transplantation, Policlinico of Foggia, Foggia 71122, Italy
| | - Piero Fischetti
- University of Foggia, Foggia 71122, Italy
- Department of Urology and Renal Transplantation, Policlinico of Foggia, Foggia 71122, Italy
| | | | - Pasquale Annese
- Department of Urology and Renal Transplantation, Policlinico of Foggia, Foggia 71122, Italy
| | - Nicola d’Altilia
- Department of Urology and Renal Transplantation, Policlinico of Foggia, Foggia 71122, Italy
| | - Vito Mancini
- Department of Urology and Renal Transplantation, Policlinico of Foggia, Foggia 71122, Italy
| | - Matteo Ferro
- Urology Unit, European Institute of Oncology (IEO) IRCCS, Milan 20142, Italy
| | | | - Angelo Porreca
- Department of Oncological Urology, Veneto Institute of Oncology (IOV) IRCCS, Padua 35039, Italy
| | - Carlo Bettocchi
- University of Foggia, Foggia 71122, Italy
- Department of Urology and Renal Transplantation, Policlinico of Foggia, Foggia 71122, Italy
| | - Luigi Cormio
- University of Foggia, Foggia 71122, Italy
- Urology Unit, “L. Bonomo” Hospital, Andria 70031, Italy
| | - Ashok Agarwal
- Global Andrology Forum, Moreland Hills, OH 44022, USA
| | - Giuseppe Carrieri
- University of Foggia, Foggia 71122, Italy
- Department of Urology and Renal Transplantation, Policlinico of Foggia, Foggia 71122, Italy
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Lahimer M, Gherissi O, Ben Salem N, Ben Mustapha H, Bach V, Khorsi-Cauet H, Khairi H, Ben Ali H, BenKhalifa M, Ajina M. Effect of Micronutrients and L-Carnitine as Antioxidant on Sperm Parameters, Genome Integrity, and ICSI Outcomes: Randomized, Double-Blind, and Placebo-Controlled Clinical Trial. Antioxidants (Basel) 2023; 12:1937. [PMID: 38001791 PMCID: PMC10669279 DOI: 10.3390/antiox12111937] [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: 08/10/2023] [Revised: 10/23/2023] [Accepted: 10/26/2023] [Indexed: 11/26/2023] Open
Abstract
The evaluation of sperm DNA integrity is recommended in the sixth edition of the 2021 World Health Organization guidelines. Oxidative stress has been identified as a crucial factor leading to genome decay, lipid peroxidation, and nucleoprotein oxidation. This double-blind, placebo-controlled clinical trial aimed to assess the effect of oral antioxidant treatment (Fertilis), which contains L-carnitine and some micronutrients, in the improvement of conventional sperm parameters, sperm DNA integrity and in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) outcomes. A total of 263 participants were enrolled and randomly divided into two groups: 131 participants received the antioxidant treatment, while 132 participants received a placebo. The male partners in both groups underwent the antioxidant treatment or the placebo for a duration of three months. For each participant, we performed a hormonal test, an infectious test, a spermogram, a TUNEL assay for sperm DNA fragmentation, a toluidine blue staining for sperm DNA decondensation, and an IVF/ICSI procedure. Sperm characteristics analysis (volume, count, motility, and vitality), sperm DNA fragmentation, and sperm DNA decondensation were assessed and compared to the results preceding the antioxidant treatment. The study outcome revealed a significant decrease in the DNA fragmentation index and a significant increase in sperm motility after 3 months of treatment (p = 0.01 and p = 0.02, respectively). Additionally, a significant improvement in clinical pregnancy rate (p = 0.01) and life birth rate (p = 0.031) was observed. No significant changes were observed in conventional sperm parameters (volume, count, and vitality) or sperm DNA decondensation (SDI). Antioxidant therapy has a beneficial impact on achieving pregnancy, whether through spontaneous conception or assisted reproductive procedures (ART).
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Affiliation(s)
- Marwa Lahimer
- Service of Reproductive Biology, University Hospital Farhat Hached, Sousse, University of Sousse, Sousse 4000, Tunisia; (O.G.); (N.B.S.); (H.B.M.)
- Exercise Physiology and Physiopathology: From Integrated to Molecular “Biology, Medicine and Health” (Code: LR19ES09), Sousse 4002, Tunisia
- PERITOX-(UMR-I 01), UPJV/INERIS, UPJV, CURS, Chemin du Thil, 80025 Amiens, France; (V.B.); (H.K.-C.); (M.B.)
| | - Oumaima Gherissi
- Service of Reproductive Biology, University Hospital Farhat Hached, Sousse, University of Sousse, Sousse 4000, Tunisia; (O.G.); (N.B.S.); (H.B.M.)
| | - Nesrine Ben Salem
- Service of Reproductive Biology, University Hospital Farhat Hached, Sousse, University of Sousse, Sousse 4000, Tunisia; (O.G.); (N.B.S.); (H.B.M.)
| | - Henda Ben Mustapha
- Service of Reproductive Biology, University Hospital Farhat Hached, Sousse, University of Sousse, Sousse 4000, Tunisia; (O.G.); (N.B.S.); (H.B.M.)
| | - Véronique Bach
- PERITOX-(UMR-I 01), UPJV/INERIS, UPJV, CURS, Chemin du Thil, 80025 Amiens, France; (V.B.); (H.K.-C.); (M.B.)
| | - Hafida Khorsi-Cauet
- PERITOX-(UMR-I 01), UPJV/INERIS, UPJV, CURS, Chemin du Thil, 80025 Amiens, France; (V.B.); (H.K.-C.); (M.B.)
- ART and Reproductive Biology Laboratory, University Hospital and School of Medicine, Picardie University Jules Verne, CHU Sud, 80025 Amiens, France
| | - Hedi Khairi
- Faculty of Medicine Ibn Eljazzar of Sousse, Department of Obstetrics & Gynecology Sousse University, Sousse 4000, Tunisia;
| | - Habib Ben Ali
- Laboratory Histology Embryologiy, Faculty of Medicine Sousse, University of Sousse, Sousse 4000, Tunisia;
| | - Moncef BenKhalifa
- PERITOX-(UMR-I 01), UPJV/INERIS, UPJV, CURS, Chemin du Thil, 80025 Amiens, France; (V.B.); (H.K.-C.); (M.B.)
- ART and Reproductive Biology Laboratory, University Hospital and School of Medicine, Picardie University Jules Verne, CHU Sud, 80025 Amiens, France
| | - Mounir Ajina
- Service of Reproductive Biology, University Hospital Farhat Hached, Sousse, University of Sousse, Sousse 4000, Tunisia; (O.G.); (N.B.S.); (H.B.M.)
- Exercise Physiology and Physiopathology: From Integrated to Molecular “Biology, Medicine and Health” (Code: LR19ES09), Sousse 4002, Tunisia
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Liu H, Luo Z, Chen J, Zheng H, Zeng Q. Treatment progress of cryptozoospermia with Western Medicine and traditional Chinese medicine: A literature review. Health Sci Rep 2022; 6:e1019. [PMID: 36582629 PMCID: PMC9793827 DOI: 10.1002/hsr2.1019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 12/05/2022] [Accepted: 12/14/2022] [Indexed: 12/28/2022] Open
Abstract
Background and Aims Cryptozoospermia is an extreme oligozoospermia with an unsatisfactory treatment effect, with an incidence rate of approximately 8.73% in male infertility, whose effective solution has become the call of the times. Western Medicine has achieved certain effects through drugs, surgery, and assisted reproductive therapy, but this is still not ideal. Traditional Chinese medicine (TCM) has made many achievements in other disciplines; however, there is still a lack of evidence-based medical evidence to improve sperm production. Methods The relevant literatures from the China National Knowledge Internet (CNKI) and PubMed in the past 10 years were collected in this article, of which the mechanisms, advantages, or current controversies of various treatment methods of Western Medicine and TCM were analyzed, to find new treatment methods and research directions. Results With the development of modern science and technology, medical treatments for cryptozoospermia have become increasingly abundant; however, there is still no universally recognized unified and effective guiding plan. Although TCM has not been fully verified by evidence-based medicine, most TCM combined with Western Medicine can achieve unexpected results. Conclusion The combination of TCM and Western Medicine may become a bane for cryptozoospermia and bring good news to infertile men worldwide.
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Affiliation(s)
- Huang Liu
- The First School of Clinical MedicineNanjing University of Chinese MedicineNanjingChina,NHC Key Laboratory of Male Reproduction and Genetics, Department of Andrology, Guangdong Provincial Reproductive Science Institute (Guangdong Provincial Fertility Hospital)Human Sperm Bank of Guangdong ProvinceGuangzhouChina
| | - Zefang Luo
- NHC Key Laboratory of Male Reproduction and Genetics, Department of Andrology, Guangdong Provincial Reproductive Science Institute (Guangdong Provincial Fertility Hospital)Human Sperm Bank of Guangdong ProvinceGuangzhouChina
| | - Jinghua Chen
- Reproductive Medical Centre of Sun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Houbin Zheng
- NHC Key Laboratory of Male Reproduction and Genetics, Department of Andrology, Guangdong Provincial Reproductive Science Institute (Guangdong Provincial Fertility Hospital)Human Sperm Bank of Guangdong ProvinceGuangzhouChina
| | - Qingqi Zeng
- The First School of Clinical MedicineNanjing University of Chinese MedicineNanjingChina,Department of Integrated Chinese and Western MedicineJiangsu Health Vocational CollegeNanjingChina
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Gou C, Zhou Z, Chen Z, Wang K, Chen C, Chen B, Pan N, He X. Studies on improving semen quality and increasing pregnancy chances through the in vitro addition of L-carnitine and coenzyme Q10 to semen in patients with asthenozoospermia. Basic Clin Androl 2022; 32:17. [PMID: 36192679 PMCID: PMC9531415 DOI: 10.1186/s12610-022-00167-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/24/2022] [Indexed: 11/23/2022] Open
Abstract
Background At present, L-carnitine (LC) and coenzyme Q10 (CoQ10), as used clinically to treat male infertility caused by asthenozoospermia (ASZ) is still mainly administered orally, but some patients with ASZ still show no significant improvement in sperm motility and spouse pregnancy rate. Prodom is a device used to assist reproduction, which is temporarily fitted onto the penis to facilitate conception by helping the wife inject a certain drug into the vagina. This study used Prodom-assisted LC/CoQ10 in the treatment of patients with ASZ and evaluated the effect of this method on sperm motility and clinical pregnancy, with the goal of finding a comfortable, low-cost, effective method. Results During the trial period, 232 cases completed the trial, while 25 cases did not. During in vitro testing, the progressive sperm motility in the LC group, CoQ10 group, LC combined with CoQ10 group, and the semen blank control group was 24.3 ± 4.6% and 38.1 ± 5.1%, 23.0 ± 4.8% and 36.9 ± 4.4%, 28.4 ± 5.0% and 43.8 ± 5.4%, 19.7 ± 4.4% and 26.0 ± 4.9%, respectively. There were statistically significant differences in progressive sperm motility among the groups (all P values < 0.05). The pregnancy rates of the Prodom-assisted LC treatment group, Prodom-assisted CoQ10 treatment group, Prodom-assisted LC combined with CoQ10 treatment group, and oral LC combined with CoQ10 treatment group in the clinical treatment stage were 38.2, 35.4, 57.1, and 30.3%, respectively; the time to conception was 6.1 ± 1.8, 6.2 ± 1.8, 3.4 ± 0.9, and 7.9 ± 2.0, months respectively; and the treatment costs were $2350 ± 457, $2455 ± 434, $1348 ± 411, and $2684 ± 334, respectively. The differences in pregnancy rate, time to conception, and treatment costs among the groups were statistically significant (all P values < 0.05). Conclusions The supplementation of in vitro semen with LC/CoQ10 can improve sperm motility. LC/CoQ10 injected into the spouse’s vagina with the assistance of a Prodom can increase the pregnancy rate, shorten the time to conception, and reduce the cost of treatment in patients with ASZ. Trial registration ChiCTR2000040349 (registry: http://www.chictr.org.cn/). Date of registration: November 28, 2020.
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Lv MQ, Wang HX, Yang YQ, Sun RF, Ge P, Zhang J, Zhao WB, Han SP, Zhou DX. Semen Quality Following Long-term Occupational Exposure to Formaldehyde in China. JAMA Netw Open 2022; 5:e2230359. [PMID: 36069982 PMCID: PMC9453542 DOI: 10.1001/jamanetworkopen.2022.30359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
IMPORTANCE The potential effects of long-term occupational exposure to formaldehyde (FA) on human semen quality is not clear. OBJECTIVE To assess whether long-term occupational exposure to FA is associated with semen quality. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study was conducted from June 1 to June 30, 2021, in Xi'an, China. Participants were adults aged 23 to 40 years who had lived in the study area for 24 months or longer. Data analysis was performed from September 1 to October 1, 2021. EXPOSURES Long-term occupational exposure to FA was measured using a formaldehyde detector, and the FA exposure index (FEI) was calculated as follows: FEI = final concentration of FA (mg/m3) × work time during a workday (hour) × cumulative workdays (year). MAIN OUTCOMES AND MEASURES Semen samples were collected by masturbation after 3 to 7 days of abstinence and were then assessed by the computer-automated semen analysis system, Baso-Papanicolaou staining, and sperm-chromatin structure assay. RESULTS A total of 205 men (mean [SD] age, 29.49 [3.64] years), with 124 individuals in the FA exposure group (mean [SD] FEI, 73.72 [54.86]) and 81 age-matched controls, were included in the final analysis. Long-term personal occupational exposure to FA was significantly associated with poor semen quality. Specifically, a 1-unit increase in FEI was associated with a change of -0.99% (95% CI, -1.00% to -0.98%) in total sperm motility, -0.99% (95% CI, -0.99% to -0.97%) in progressive sperm motility, -0.05% (95% CI, -0.08% to -0.02%) in curvilinear velocity, -0.07% (95% CI, -0.10% to -0.04%) in straight line velocity, -0.07% (95% CI, -0.10% to -0.04%) in time-average velocity, -0.98% (95% CI, -0.99% to -0.93%) in normal sperm morphology, -0.24% (95% CI, -0.35% to -0.11%) in seminal neutral glucosidase, -0.61% (95% CI, -0.66% to -0.56%) in seminal plasma zinc, 0.52% (95% CI, 0.15% to 1.02%) in beat cross frequency, and 0.10% (95% CI, 0.06% to 0.14%) in the DNA fragmentation index. These associations remained significant after adjusting for confounding factors. Furthermore, subgroup analysis found that high levels of oxidative stress might promote the associations between FA exposure and semen quality. CONCLUSIONS AND RELEVANCE This study found an association between long-term occupational exposure to FA and semen quality. This deterioration was dose and time dependent and might be induced by oxidative stress.
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Affiliation(s)
- Mo-qi Lv
- Department of Pathology, School of Basic Medical Sciences, Medical School, Xi’an Jiaotong University, Xi’an, China
- Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi’an, China
| | - Hai-xu Wang
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of the Fourth Military Medical University, Xi’an, China
| | - Yan-qi Yang
- Department of Pathology, School of Basic Medical Sciences, Medical School, Xi’an Jiaotong University, Xi’an, China
- Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi’an, China
| | - Rui-fang Sun
- Department of Pathology, School of Basic Medical Sciences, Medical School, Xi’an Jiaotong University, Xi’an, China
- Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi’an, China
| | - Pan Ge
- Department of Pathology, School of Basic Medical Sciences, Medical School, Xi’an Jiaotong University, Xi’an, China
- Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi’an, China
| | - Jian Zhang
- Department of Pathology, School of Basic Medical Sciences, Medical School, Xi’an Jiaotong University, Xi’an, China
- Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi’an, China
| | - Wen-bao Zhao
- Department of Pathology, School of Basic Medical Sciences, Medical School, Xi’an Jiaotong University, Xi’an, China
- Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi’an, China
| | - Shui-ping Han
- Department of Pathology, School of Basic Medical Sciences, Medical School, Xi’an Jiaotong University, Xi’an, China
- Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi’an, China
| | - Dang-xia Zhou
- Department of Pathology, School of Basic Medical Sciences, Medical School, Xi’an Jiaotong University, Xi’an, China
- Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi’an, China
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