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Lira FT, Campos LR, Roque M, Esteves SC. From pathophysiology to practice: addressing oxidative stress and sperm DNA fragmentation in Varicocele-affected subfertile men. Int Braz J Urol 2024; 50:530-560. [PMID: 39106113 PMCID: PMC11446552 DOI: 10.1590/s1677-5538.ibju.2024.9917] [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: 07/10/2024] [Accepted: 07/18/2024] [Indexed: 08/09/2024] Open
Abstract
Varicocele can reduce male fertility potential through various oxidative stress mechanisms. Excessive production of reactive oxygen species may overwhelm the sperm's defenses against oxidative stress, damaging the sperm chromatin. Sperm DNA fragmentation, in the form of DNA strand breaks, is recognized as a consequence of the oxidative stress cascade and is commonly found in the ejaculates of men with varicocele and fertility issues. This paper reviews the current knowledge regarding the association between varicocele, oxidative stress, sperm DNA fragmentation, and male infertility, and examines the role of varicocele repair in alleviating oxidative-sperm DNA fragmentation in these patients. Additionally, we highlight areas for further research to address knowledge gaps relevant to clinical practice.
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Affiliation(s)
- Filipe Tenório Lira
- Andros RecifeRecifePEBrasilAndros Recife, Recife, PE, Brasil
- Instituto de Medicina Integral Prof. Fernando FigueiraDepartamento de UrologiaRecifePEBrasilDepartamento de Urologia, Instituto de Medicina Integral Prof. Fernando Figueira, Recife, PE, Brasil
- Hospital Santa Joana RecifeRecifeBrasilHospital Santa Joana Recife, Recife, PE, Brasil
| | - Lucas Ribeiro Campos
- Universidade Federal de Minas GeraisDepartamento de UrologiaBelo HorizonteMGBrasilDepartamento de Urologia, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brasil
| | - Matheus Roque
- Mater PrimeDepartamento de Medicina ReprodutivaSão PauloSPBrasilDepartamento de Medicina Reprodutiva, Mater Prime, São Paulo, SP, Brasil
| | - Sandro C. Esteves
- ANDROFERT - Clínica de Andrologia e Reprodução HumanaCentro de Referência. em Reprodução MasculinaCampinasSPBrasilANDROFERT - Clínica de Andrologia e Reprodução Humana, Centro de Referência. em Reprodução Masculina, Campinas, SP, Brasil
- Disciplina de Urologia da Universidade Estadual de CampinasDepartamento de CirurgiaCampinasSPBrasilDepartamento de Cirurgia, Disciplina de Urologia da Universidade Estadual de Campinas - UNICAMP, Campinas, SP, Brasil
- Aarhus UniversityFaculty of HealthDepartment of Clinical MedicineAarhusDenmarkDepartment of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
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2
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Lira Neto FT, Roque M, Esteves SC. Effect of varicocele and varicocelectomy on sperm deoxyribonucleic acid fragmentation rates in infertile men with clinical varicocele. Minerva Obstet Gynecol 2024; 76:49-69. [PMID: 36222786 DOI: 10.23736/s2724-606x.22.05169-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Varicocele is the leading cause of male infertility. It can affect sperm quantity and quality through various non-mutually exclusive pathophysiological mechanisms, mainly oxidative stress. Excessive production of reactive oxygen species may overwhelm the sperm's defenses against oxidative stress and harm the sperm's DNA. Excessive sperm DNA breaks, so-called sperm DNA fragmentation, result from the oxidative stress cascade and are commonly found in the ejaculates of men with varicocele and fertility-related issues. Measuring sperm DNA fragmentation can provide valuable information on the extent of harm and might help select candidates for surgical treatment. Varicocelectomy is beneficial for alleviating oxidative stress-associated infertility and improving sperm DNA integrity. However, reproductive outcomes of infertile men with elevated sperm DNA fragmentation rates and surgically treated varicoceles remain poorly studied, and there is a need for well-designed trials to determine the impact of sperm DNA fragmentation reduction on natural and medically assisted reproduction.
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Affiliation(s)
- Filipe T Lira Neto
- AndrosRecife, Andrology Clinic, Recife, Brazil
- Department of Urology, Prof. Fernando Figueira Institute of Integrative Medicine, Recife, Brazil
| | - Matheus Roque
- Department of Reproductive Medicine, Mater Prime, São Paulo, Brazil
| | - Sandro C Esteves
- ANDROFERT, Andrology and Human Reproduction Clinic, Referral Center for Male Reproduction, Campinas, Brazil -
- Division of Urology, Department of Surgery, University of Campinas (UNICAMP), Campinas, Brazil
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
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Barrea L, Verde L, Annunziata G, Camajani E, Caprio M, Sojat AS, Marina LV, Guarnotta V, Colao A, Muscogiuri G. Role of Mediterranean diet in endocrine diseases: a joint overview by the endocrinologist and the nutritionist. J Endocrinol Invest 2024; 47:17-33. [PMID: 37697017 PMCID: PMC10776748 DOI: 10.1007/s40618-023-02169-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 07/28/2023] [Indexed: 09/13/2023]
Abstract
PURPOSE The purpose of this review is to examine the current evidence on the potential role of Mediterranean diet (MD) in the prevention and management of endocrine disorders and to highlight the importance of interdisciplinary collaboration between endocrinologists and nutritionists. METHODS A literature search was conducted using PubMed and Google Scholar databases to identify relevant studies published in English. Studies were selected based on their relevance to the role of MD in the prevention and management of endocrine disorders. The search terms included "Mediterranean diet," "endocrine disorders," "thyroid disorders," "gonadal disorders," and "neuroendocrine tumors". RESULTS The studies reviewed suggest that MD may have a beneficial effect in the prevention and management of various endocrine disorders, including thyroid disorders, gonadal disorders, and neuroendocrine tumors. MD has been associated with decreased risk of nodular thyroid disease and thyroid cancer, improved male and female reproductive health, and a potential role in the management of neuroendocrine tumors. MD's anti-inflammatory and antioxidant properties, as well as its high levels of phytochemicals, may play a role in its beneficial effects. CONCLUSION Interdisciplinary collaboration between endocrinologists and nutritionists is essential for the optimal management of endocrine disorders, including the potential role of MD in their prevention and management. While further research is needed, the current evidence suggests that MD may have a protective effect against endocrine disorders, and its incorporation into dietary recommendations may be beneficial.
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Affiliation(s)
- L Barrea
- Dipartimento di Scienze Umanistiche, Università Telematica Pegaso, Via Porzio, Centro Direzionale, Isola F2, 80143, Naples, Italy
- Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Dipartimento di Medicina Clinica e Chirurgia, Unità di Endocrinologia, Diabetologia e Andrologia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - L Verde
- Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Dipartimento di Medicina Clinica e Chirurgia, Unità di Endocrinologia, Diabetologia e Andrologia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - G Annunziata
- Department of Pharmacy, Federico II University, 80131, Naples, Italy
| | - E Camajani
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Open University, 00166, Rome, Italy
- Laboratory of Cardiovascular Endocrinology, San Raffaele Research Institute, IRCCS San Raffaele Roma, Via di Val Cannuta, 247, 00166, Rome, Italy
| | - M Caprio
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Open University, 00166, Rome, Italy
- Laboratory of Cardiovascular Endocrinology, San Raffaele Research Institute, IRCCS San Raffaele Roma, Via di Val Cannuta, 247, 00166, Rome, Italy
| | - A S Sojat
- National Centre for Infertility and Endocrinology of Gender, Clinic for Endocrinology Diabetes and Metabolic Diseases, University Clinical Centre of Serbia, Belgrade, Serbia
| | - L V Marina
- National Centre for Infertility and Endocrinology of Gender, Clinic for Endocrinology Diabetes and Metabolic Diseases, University Clinical Centre of Serbia, Belgrade, Serbia
| | - V Guarnotta
- Section of Endocrinology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro" (PROMISE), University of Palermo, Piazza delle Cliniche 2, 90127, Palermo, Italy
| | - A Colao
- Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Dipartimento di Medicina Clinica e Chirurgia, Unità di Endocrinologia, Diabetologia e Andrologia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
- Dipartimento di Medicina Clinica e Chirurgia, Unità di Endocrinologia, Diabetologia e Andrologia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
- Cattedra Unesco "Educazione alla salute e allo sviluppo sostenibile", University Federico II, Naples, Italy
| | - G Muscogiuri
- Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Dipartimento di Medicina Clinica e Chirurgia, Unità di Endocrinologia, Diabetologia e Andrologia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131, Naples, Italy.
- Dipartimento di Medicina Clinica e Chirurgia, Unità di Endocrinologia, Diabetologia e Andrologia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131, Naples, Italy.
- Cattedra Unesco "Educazione alla salute e allo sviluppo sostenibile", University Federico II, Naples, Italy.
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Male infertility and gonadotropin treatment: What can we learn from real-world data? Best Pract Res Clin Obstet Gynaecol 2023; 86:102310. [PMID: 36682942 DOI: 10.1016/j.bpobgyn.2022.102310] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 12/02/2022] [Accepted: 12/19/2022] [Indexed: 12/31/2022]
Abstract
Gonadotropin therapy to treat specific male infertility disorders associated with hypogonadotropic hypogonadism is evidence-based and effective in restoring spermatogenesis and fertility. In contrast, its use to improve fertility in men with idiopathic oligozoospermia or nonobstructive azoospermia remains controversial, despite being widely practiced. The existence of two major inter-related pathways for spermatogenesis, including FSH and intratesticular testosterone, provides a rationale for empiric hormone stimulation therapy in both eugonadal and hypogonadal males with idiopathic oligozoospermia or nonobstructive azoospermia. Real-world data (RWD) on gonadotropin stimulating for these patient subsets, mainly using human chorionic gonadotropin and follicle-stimulating hormone, accumulated gradually, showing a positive therapeutic effect in some patients, translated by increased sperm production, sperm quality, and sperm retrieval rates. Although more evidence is needed, current insights from RWD research indicate that selected male infertility patients might be managed more effectively using gonadotropin therapy, with potential gains for all parties involved.
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Humaidan P, Haahr T, Povlsen BB, Kofod L, Laursen RJ, Alsbjerg B, Elbaek HO, Esteves SC. The combined effect of lifestyle intervention and antioxidant therapy on sperm DNA fragmentation and seminal oxidative stress in IVF patients: a pilot study. Int Braz J Urol 2022. [PMID: 34472769 DOI: 10.1590/s1677-5538.ibju.2021.0604)] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
PURPOSE Sperm DNA fragmentation (SDF) and seminal oxidative stress are emerging measurable factors in male factor infertility, which interventions could potentially reduce. We evaluated (i) the impact of lifestyle changes combined with oral antioxidant intake on sperm DNA fragmentation index (DFI) and static oxidation-reduction potential (sORP), and (ii) the correlation between DFI and sORP. MATERIALS AND METHODS We conducted a prospective study involving 93 infertile males with a history of failed IVF/ICSI. Ten healthy male volunteers served as controls. Semen analysis was carried out according to 2010 WHO manual, whereas seminal sORP was measured using the MiOXSYS platform. SDF was assessed by sperm chromatin structure assay. Participants with DFI >15% underwent a three-month lifestyle intervention program, primarily based on diet and exercise, combined with oral antioxidant therapy using multivitamins, coenzyme Q10, omega-3, and oligo-elements. We assessed changes in semen parameters, DFI, and sORP, and compared DFI results to those of volunteers obtained two weeks apart. Spearman rank correlation tests were computed for sORP and DFI results. RESULTS Thirty-eight (40.8%) patients had DFI >15%, of whom 31 participated in the intervention program. A significant decrease in median DFI from 25.8% to 18.0% was seen after the intervention (P <0.0001). The mean DFI decrease was 7.2% (95% CI: 4.8-9.5%; P <0.0001), whereas it was 0.42% (95%CI; -4.8 to 5.6%) in volunteers (P <0.00001). No differences were observed in sperm parameters and sORP. Based on paired sORP and DFI data from 86 patients, no correlation was observed between sORP and DFI values (rho=0.03). CONCLUSION A 3-month lifestyle intervention program combined with antioxidant therapy reduced DFI in infertile men with elevated SDF and a history of failed IVF/ICSI. A personalized lifestyle and antioxidant intervention could improve fertility of subfertile couples through a reduction in DFI, albeit controlled trials evaluating reproductive outcomes are needed before firm conclusions can be made. Trial registration number and date: clinicaltrials.gov NCT03898752, April 2, 2019.
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Affiliation(s)
- Peter Humaidan
- Department of Clinical Medicine, Aarhus University, Denmark.,The Fertility Clinic Skive, Skive Regional Hospital, Denmark
| | - Thor Haahr
- Department of Clinical Medicine, Aarhus University, Denmark.,The Fertility Clinic Skive, Skive Regional Hospital, Denmark
| | | | - Louise Kofod
- The Fertility Clinic Skive, Skive Regional Hospital, Denmark.,Department of Obstetrics and Gynecology, Regional Hospital Herning, Denmark
| | | | - Birgit Alsbjerg
- Department of Clinical Medicine, Aarhus University, Denmark.,The Fertility Clinic Skive, Skive Regional Hospital, Denmark
| | | | - Sandro C Esteves
- Department of Clinical Medicine, Aarhus University, Denmark.,The Fertility Clinic Skive, Skive Regional Hospital, Denmark.,ANDROFERT, Clínica de Andrologia e Reprodução Humana, Campinas, SP, Brasil.,Departamento de Cirurgia, Divisão de Urologia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brasil
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Humaidan P, Haahr T, Povlsen BB, Kofod L, Laursen RJ, Alsbjerg B, Elbaek HO, Esteves SC. The combined effect of lifestyle intervention and antioxidant therapy on sperm DNA fragmentation and seminal oxidative stress in IVF patients: a pilot study. Int Braz J Urol 2022; 48:131-156. [PMID: 34472769 PMCID: PMC8691235 DOI: 10.1590/s1677-5538.ibju.2021.0604] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 08/20/2021] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Sperm DNA fragmentation (SDF) and seminal oxidative stress are emerging measurable factors in male factor infertility, which interventions could potentially reduce. We evaluated (i) the impact of lifestyle changes combined with oral antioxidant intake on sperm DNA fragmentation index (DFI) and static oxidation-reduction potential (sORP), and (ii) the correlation between DFI and sORP. MATERIALS AND METHODS We conducted a prospective study involving 93 infertile males with a history of failed IVF/ICSI. Ten healthy male volunteers served as controls. Semen analysis was carried out according to 2010 WHO manual, whereas seminal sORP was measured using the MiOXSYS platform. SDF was assessed by sperm chromatin structure assay. Participants with DFI >15% underwent a three-month lifestyle intervention program, primarily based on diet and exercise, combined with oral antioxidant therapy using multivitamins, coenzyme Q10, omega-3, and oligo-elements. We assessed changes in semen parameters, DFI, and sORP, and compared DFI results to those of volunteers obtained two weeks apart. Spearman rank correlation tests were computed for sORP and DFI results. RESULTS Thirty-eight (40.8%) patients had DFI >15%, of whom 31 participated in the intervention program. A significant decrease in median DFI from 25.8% to 18.0% was seen after the intervention (P <0.0001). The mean DFI decrease was 7.2% (95% CI: 4.8-9.5%; P <0.0001), whereas it was 0.42% (95%CI; -4.8 to 5.6%) in volunteers (P <0.00001). No differences were observed in sperm parameters and sORP. Based on paired sORP and DFI data from 86 patients, no correlation was observed between sORP and DFI values (rho=0.03). CONCLUSION A 3-month lifestyle intervention program combined with antioxidant therapy reduced DFI in infertile men with elevated SDF and a history of failed IVF/ICSI. A personalized lifestyle and antioxidant intervention could improve fertility of subfertile couples through a reduction in DFI, albeit controlled trials evaluating reproductive outcomes are needed before firm conclusions can be made. Trial registration number and date: clinicaltrials.gov NCT03898752, April 2, 2019.
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Affiliation(s)
- Peter Humaidan
- Aarhus UniversityDepartment of Clinical MedicineDenmarkDepartment of Clinical Medicine, Aarhus University, Denmark
- Skive Regional HospitalThe Fertility Clinic SkiveDenmarkThe Fertility Clinic Skive, Skive Regional Hospital, Denmark
| | - Thor Haahr
- Aarhus UniversityDepartment of Clinical MedicineDenmarkDepartment of Clinical Medicine, Aarhus University, Denmark
- Skive Regional HospitalThe Fertility Clinic SkiveDenmarkThe Fertility Clinic Skive, Skive Regional Hospital, Denmark
| | - Betina Boel Povlsen
- Skive Regional HospitalThe Fertility Clinic SkiveDenmarkThe Fertility Clinic Skive, Skive Regional Hospital, Denmark
| | - Louise Kofod
- Skive Regional HospitalThe Fertility Clinic SkiveDenmarkThe Fertility Clinic Skive, Skive Regional Hospital, Denmark
- Regional Hospital HerningDepartment of Obstetrics and GynecologyDenmarkDepartment of Obstetrics and Gynecology, Regional Hospital Herning, Denmark
| | - Rita Jakubcionyte Laursen
- Skive Regional HospitalThe Fertility Clinic SkiveDenmarkThe Fertility Clinic Skive, Skive Regional Hospital, Denmark
| | - Birgit Alsbjerg
- Aarhus UniversityDepartment of Clinical MedicineDenmarkDepartment of Clinical Medicine, Aarhus University, Denmark
- Skive Regional HospitalThe Fertility Clinic SkiveDenmarkThe Fertility Clinic Skive, Skive Regional Hospital, Denmark
| | - Helle Olesen Elbaek
- Skive Regional HospitalThe Fertility Clinic SkiveDenmarkThe Fertility Clinic Skive, Skive Regional Hospital, Denmark
| | - Sandro C. Esteves
- Aarhus UniversityDepartment of Clinical MedicineDenmarkDepartment of Clinical Medicine, Aarhus University, Denmark
- Skive Regional HospitalThe Fertility Clinic SkiveDenmarkThe Fertility Clinic Skive, Skive Regional Hospital, Denmark
- ANDROFERTClínica de Andrologia e Reprodução HumanaCampinasSPBrasilANDROFERT, Clínica de Andrologia e Reprodução Humana, Campinas, SP, Brasil
- Universidade Estadual de CampinasFaculdade de Ciências MédicasDepartamento de CirurgiaCampinasSPBrasilDepartamento de Cirurgia, Divisão de Urologia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brasil
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Esteves SC. Time has come to provide infertile men with an optimal fertility pathway. Int Braz J Urol 2021; 47:627-630. [PMID: 33621012 PMCID: PMC7993967 DOI: 10.1590/s1677-5538.ibju.2019.0362.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 01/10/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Sandro C Esteves
- ANDROFERT, Clínica de Andrologia e Reprodução Humana, Centro de Referência para Re-produção Masculina, Campinas, SP, Brasil.,Departamento de Cirurgia (Disciplina de Urologia), Universidade Estadual de Campinas - UNICAMP, Campinas, SP, Brasil.,Faculty of Health, Aarhus University, Aarhus, Denmark
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