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Birowo P, Rahendra Wijaya J, Atmoko W, Rasyid N. The effects of varicocelectomy on the DNA fragmentation index and other sperm parameters: a meta-analysis. Basic Clin Androl 2020; 30:15. [PMID: 32944248 PMCID: PMC7488296 DOI: 10.1186/s12610-020-00112-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/17/2020] [Indexed: 01/04/2023] Open
Abstract
Background Varicocele is one of the most common causes of reversible male infertility, and 15% of the varicocele patients with normal semen analysis are diagnosed as infertile. According to the current guidelines, varicocelectomy is indicated based on abnormal sperm parameters and not abnormal DNA fragmentation index (DFI) values. Thus, in this study, we performed a meta-analysis of the effects of varicocelectomy on the DFI and other conventional sperm parameters, and determined whether DFI could be used to indicate varicocelectomy for varicocele patients. Results Through an electronic search of the PubMed, Scopus, EBSCO, and Cochrane databases, we included 7 prospective studies including a total of 289 patients in this meta-analysis. The results showed that varicocelectomy significantly reduced DNA fragmentation (mean difference: − 6.86; 95% confidence interval [CI]: − 10.04, − 3.69; p < 0.00001) and improved sperm concentration (mean difference: 9.59; 95% CI: 7.80, 11.38; p < 0.00001), progressive motility (mean difference: 8.66; 95% CI: 6.96, 10.36; p < 0.00001), and morphology (mean difference: 2.73; 95% CI: 0,65, 4.80; p = 0.01). Conclusion Varicocelectomy reduced DNA fragmentation and improved sperm concentration, progressive motility, and morphology. Additionally, the analysis showed that an abnormal DFI measurement should be considered as an indication for varicocelectomy.
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Affiliation(s)
- Ponco Birowo
- Department of Urology, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Pangeran Diponegoro Street No. 71, Senen Subdistrict, Central Jakarta District, Jakarta, 10430 Indonesia
| | - J Rahendra Wijaya
- Department of Urology, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Pangeran Diponegoro Street No. 71, Senen Subdistrict, Central Jakarta District, Jakarta, 10430 Indonesia
| | - Widi Atmoko
- Department of Urology, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Pangeran Diponegoro Street No. 71, Senen Subdistrict, Central Jakarta District, Jakarta, 10430 Indonesia
| | - Nur Rasyid
- Department of Urology, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo Hospital, Pangeran Diponegoro Street No. 71, Senen Subdistrict, Central Jakarta District, Jakarta, 10430 Indonesia
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Mohammadi Z, Tavalaee M, Gharagozloo P, Drevet JR, Nasr-Esfahani MH. Could high DNA stainability (HDS) be a valuable indicator of sperm nuclear integrity? Basic Clin Androl 2020; 30:12. [PMID: 32817794 PMCID: PMC7425160 DOI: 10.1186/s12610-020-00110-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 07/13/2020] [Indexed: 12/17/2022] Open
Abstract
Background The Sperm Chromatin Structure Assay (SCSA®), in addition to identifying the DNA Fragmentation Index (DFI) also identifies High DNA satiability (HDS), supposed to reflect the nuclear compaction of spermatozoa. However, data on what exactly this parameter reveals, its relevance and usefulness are contradictory. In order to shed light on this situation, spermatozoa of a cohort (N = 397) of infertile men were subjected to the SCSA®, TUNEL (terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate-biotin nick end labeling) and CMA3 (Chromomycin A3) tests. In a smaller subcohort (N = 100), aniline blue (AB) and toluidine blue (TB) staining were performed in addition. The objective of this study was thus to answer the question of whether HDS is a relevant and reliable parameter to be taken into account? Results HDS does not appear to be a reliable indicator of nuclear immaturity because it shows a weak correlation with the CMA3, AB and TB stains. The low correlation of HDS with sperm DNA fragmentation (TUNEL and SCSA®) and DNA condensation (CMA3, AB and TB) tests suggests that these two parameters could be decoupled. Unlike DFI and TUNEL, HDS has not been shown to correlate with classic clinical situations of male infertility (asthenozoospermia, teratozoospermia or astheno-teratozoospermia). Conclusion HDS correlates poorly with most tests that focus specifically on the level of maturity of the sperm nucleus. To our knowledge, this study is the first to compare SCSA®, TUNEL, AB, TB and CMA3 assays on identical samples. It shows the potency, consistency and limitations of each test and the care that must be taken in their interpretation.
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Affiliation(s)
- Z Mohammadi
- Department of Reproductive Biotechnology, Reproductive Biomedicine Research Center, Royan Institute for Biotechnology, ACECR, Isfahan, Iran
| | - M Tavalaee
- Department of Reproductive Biotechnology, Reproductive Biomedicine Research Center, Royan Institute for Biotechnology, ACECR, Isfahan, Iran
| | - P Gharagozloo
- CellOxess LLC, 830 Bear Tavern Road, Ewing, NJ 08628 USA
| | - J R Drevet
- GReD Institute, Faculty of Medicine, INSERM-CNRS-Université Clermont Auvergne, Clermont-Ferrand, France
| | - M H Nasr-Esfahani
- Department of Reproductive Biotechnology, Reproductive Biomedicine Research Center, Royan Institute for Biotechnology, ACECR, Isfahan, Iran.,Isfahan Fertility and Infertility Center, Isfahan, Iran
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Fernandez-Encinas A, García-Peiró A, del Rey J, Ribas-Maynou J, Abad C, Amengual MJ, Prada E, Navarro J, Benet J. Proteomic Analysis in Seminal Plasma of Fertile Donors and Infertile Patients with Sperm DNA Fragmentation. Int J Mol Sci 2020; 21:ijms21145046. [PMID: 32708913 PMCID: PMC7404047 DOI: 10.3390/ijms21145046] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/13/2020] [Accepted: 07/15/2020] [Indexed: 02/06/2023] Open
Abstract
Seminal plasma proteomics studies could represent a new approach for the determination of molecular elements driving male infertility, resulting in a better male infertility characterization. The aim of this study is to investigate proteomic differences in seminal plasma samples from fertile and infertile individuals. For that, semen samples were selected according to semen analysis, clinical pathology, and values of sperm DNA fragmentation (alkaline and neutral Comet assay and Sperm Chromatin Dispersion test). A total of 24 seminal plasma samples classified in four groups were processed: fertile donors (FD), recurrent miscarriage patients (RM), asthenoteratozoospermic patients (ATZ), and asthenoteratozoospermic patients with varicocele (ATZ-VAR). Results obtained by 2D-differential gel electrophoresis (2D-DIGE) revealed 26 spots significantly increased in fertile donors when compared to patient groups. Also, eight spots in the ATZ group and two in the ATZ-VAR group were decreased compared to the other groups. Twenty-eight proteins were identified by mass spectrometry (MS), most of them involved in metabolic and cellular processes and with a catalytic or binding function. Protein-protein interactions through Search Tool for the Retrieval of Interacting Genes/Proteins (STRING) tool suggest that a large part of them were associated with each other. Furthermore, most of them were associated with ubiquitin C, indicating that it could play an important regulation role, resulting in a potential male infertility biomarker.
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Affiliation(s)
- Alba Fernandez-Encinas
- Departament de Biologia Cel·lular, Fisiologia i Immunologia, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain; (A.F.-E.); (J.d.R.); (J.R.-M.); (J.N.)
| | - Agustín García-Peiró
- Centro de Infertilidad Masculina y Análisis de Barcelona (CIMAB), 08192 Sant Quirze del Vallès, Spain;
| | - Javier del Rey
- Departament de Biologia Cel·lular, Fisiologia i Immunologia, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain; (A.F.-E.); (J.d.R.); (J.R.-M.); (J.N.)
| | - Jordi Ribas-Maynou
- Departament de Biologia Cel·lular, Fisiologia i Immunologia, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain; (A.F.-E.); (J.d.R.); (J.R.-M.); (J.N.)
| | - Carlos Abad
- Servei d’Urologia, Corporació Sanitària Parc Taulí, Sabadell, Institut Universitari Parc Taulí—UAB, 08208 Sabadell, Spain;
| | - Maria José Amengual
- UDIAT, Centre Diagnòstic, Corporació Sanitària Parc Taulí, Sabadell, Institut Universitari Parc Taulí—UAB, 08208 Sabadell, Spain;
| | - Elena Prada
- Servei de Ginecologia, Hospital Universitari Mútua de Terrassa, 08221 Terrassa, Spain;
| | - Joaquima Navarro
- Departament de Biologia Cel·lular, Fisiologia i Immunologia, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain; (A.F.-E.); (J.d.R.); (J.R.-M.); (J.N.)
| | - Jordi Benet
- Departament de Biologia Cel·lular, Fisiologia i Immunologia, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain; (A.F.-E.); (J.d.R.); (J.R.-M.); (J.N.)
- Correspondence: ; Tel.: +34-935-811-773
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Esteves SC, Santi D, Simoni M. An update on clinical and surgical interventions to reduce sperm DNA fragmentation in infertile men. Andrology 2019; 8:53-81. [DOI: 10.1111/andr.12724] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 09/17/2019] [Accepted: 10/08/2019] [Indexed: 12/18/2022]
Affiliation(s)
- Sandro C. Esteves
- ANDROFERT, Andrology and Human Reproduction Clinic Referral Center for Male Reproduction Campinas Brazil
- Department of Surgery (Division of Urology) University of Campinas (UNICAMP) Campinas Brazil
- Faculty of Health Aarhus University Aarhus Denmark
| | - Daniele Santi
- Department of Biomedical, Metabolic, and Neural Sciences University of Modena and Reggio Emilia Modena Italy
- Unit of Endocrinology Department of Medical Specialties Azienda Ospedaliero Universitaria Modena Italy
| | - Manuela Simoni
- Department of Biomedical, Metabolic, and Neural Sciences University of Modena and Reggio Emilia Modena Italy
- Unit of Endocrinology Department of Medical Specialties Azienda Ospedaliero Universitaria Modena Italy
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Gill K, Rosiak A, Gaczarzewicz D, Jakubik J, Kurzawa R, Kazienko A, Rymaszewska A, Laszczynska M, Grochans E, Piasecka M. The effect of human sperm chromatin maturity on ICSI outcomes. Hum Cell 2018; 31:220-231. [PMID: 29594950 DOI: 10.1007/s13577-018-0203-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 02/10/2018] [Indexed: 01/03/2023]
Abstract
Because sperm chromatin may play a key role in reproductive success, we verify the associations between sperm chromatin abnormalities, embryo development and the ability to achieve pregnancy. The evaluation of sperm chromatin maturity using aniline blue (AB), chromomycin A3 (CMA3) and toluidine blue (TB) staining were carried out in group of males from infertile couples that underwent ICSI. Low levels of sperm chromatin abnormalities (< 16%) were found in most subjects (> 50%). A higher percentage of TB-positive sperm cells were discovered in the men from couples who achieved ≤ 50% fertilized oocytes compared to men who achieved > 50%. No significant differences were discovered by the applied tests between the men from couples who achieved ≤ 50% and those who achieved > 50% high-quality embryos on the 3rd or 5th day after fertilization, nor between the men from couples who achieved pregnancy and those who failed. The sperm chromatin maturity did not correlate with the ICSI results. However, the ROC analysis revealed a significant predictive value of TB-positive spermatozoa only for fertilization. Therefore, the TB assay can be considered as a useful test for the prediction of fertilization. Our findings suggest that the level of sperm chromatin abnormalities of the examined men was not clinically significant. No found associations between sperm chromatin maturity and embryo development and the ability to achieve pregnancy. We could not exclude the effects of the repairing processes in the fertilized oocyte. The use of complementary tests that verify the status of the sperm chromatin seems justified.
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Affiliation(s)
- Kamil Gill
- Department of Histology and Developmental Biology, Pomeranian Medical University, Zolnierska 48, 71-210, Szczecin, Poland
| | - Aleksandra Rosiak
- Department of Histology and Developmental Biology, Pomeranian Medical University, Zolnierska 48, 71-210, Szczecin, Poland.,VitroLive Fertility Clinic, 70-001, Szczecin, Poland
| | - Dariusz Gaczarzewicz
- Department of Animal Reproduction, Biotechnology and Environmental Hygiene, West Pomeranian University of Technology, 71-270, Szczecin, Poland
| | - Joanna Jakubik
- Department of Histology and Developmental Biology, Pomeranian Medical University, Zolnierska 48, 71-210, Szczecin, Poland
| | - Rafal Kurzawa
- Department of Gynecology and Procreative Health, Pomeranian Medical University, 71-210, Szczecin, Poland.,VitroLive Fertility Clinic, 70-001, Szczecin, Poland
| | - Anna Kazienko
- Department of Histology and Developmental Biology, Pomeranian Medical University, Zolnierska 48, 71-210, Szczecin, Poland
| | - Anna Rymaszewska
- Department of Genetics, Faculty of Biology, University of Szczecin, 71-412, Szczecin, Poland
| | - Maria Laszczynska
- Department of Histology and Developmental Biology, Pomeranian Medical University, Zolnierska 48, 71-210, Szczecin, Poland
| | - Elzbieta Grochans
- Department of Nursing, Pomeranian Medical University, 71-210, Szczecin, Poland
| | - Malgorzata Piasecka
- Department of Histology and Developmental Biology, Pomeranian Medical University, Zolnierska 48, 71-210, Szczecin, Poland.
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Affiliation(s)
- Ashok Agarwal
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Chak-Lam Cho
- Division of Urology, Department of Surgery, Kwong Wah Hospital, Hong Kong, China
| | - Ahmad Majzoub
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
| | - Sandro C Esteves
- ANDROFERT, Andrology and Human Reproduction Clinic, Referral Center for Male Reproduction, Campinas, SP, Brazil
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Esteves SC, Agarwal A, Cho CL, Majzoub A. A Strengths-Weaknesses-Opportunities-Threats (SWOT) analysis on the clinical utility of sperm DNA fragmentation testing in specific male infertility scenarios. Transl Androl Urol 2017; 6:S734-S760. [PMID: 29082207 PMCID: PMC5643602 DOI: 10.21037/tau.2017.08.20] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Sperm DNA fragmentation (SDF) is recognized as a leading cause of male infertility because it can impair the paternal genome through distinct pathophysiological mechanisms. Current evidence supports SDF as a major factor in the pathophysiology of several conditions, including varicocele, unexplained infertility, assisted reproductive technology failure, and environmental lifestyle factors, although the mechanisms involved have not been fully described yet. Measurement of the levels of DNA fragmentation in semen provides valuable information on the integrity of paternal chromatin and may guide therapeutic strategies. A recently published clinical practice guideline (CPG) highlighted how to use the information provided by SDF testing in daily practice, which triggered a series of commentaries by leading infertility experts. These commentaries contained an abundance of information and conflicting views about the clinical utility of SDF testing, which underline the complex nature of SDF. Methods A search of papers published in response to the CPG entitled “Clinical utility of sperm DNA fragmentation testing: practice recommendations based on clinical scenarios” was performed within the Translational Andrology and Urology (TAU) website (http://tau.amegroups.com/). The start and end dates for the search were May 2017 and August 2017, respectively. Each commentary meeting our inclusion criteria was rated as “supportive without reservation”, “supportive with reservation”, “not supportive” or “neutral”. We recorded whether articles discussed either SDF characteristics as a laboratory test method or clinical scenarios, or both. Subsequently, we extracted the particulars from each commentary and utilized the ‘Strengths-Weaknesses-Opportunities-Threats’ (SWOT) analysis to understand the perceived advantages and drawbacks of SDF as a specialized sperm function method in clinical practice. Results Fifty-eight fertility experts from six continents and twenty-two countries contributed commentaries. Overall, participants (87.9%; n=51) were supportive of the recommendations provided by the CPG on the utility of SDF testing based on clinical scenarios. The majority of participants made explicit remarks about both the clinical scenarios and SDF assays’ characteristics. Among ‘not supportive’ and ‘supportive with reservation’ participants, 75% (n=30/40) and 77.5% (n=31/40) expressed concerns related to technical limitations of SDF testing methods and clinical utility of the test in one or more clinical scenarios discussed in the CPG, respectively. The SWOT analysis revealed that the CPG provides a reasonable evidence-based proposal for integration of SDF testing in the routine daily practice. It also uncovered gaps of knowledge and threats limiting the widespread application of SDF in everyday practice, thus allowing the identification of opportunities to further refine SDF testing and its clinical utility. Conclusions The understanding of the role of SDF in male infertility requires an in-depth analysis of the multifactorial pathophysiological processes and the theories involved. The SWOT analysis allowed an objective evaluation of CPG on the clinical utility of SDF testing based on clinical scenarios and its accompanying commentaries written by global experts in all possible angles. Implementation of SDF testing in the clinic may not only increase the outcome of ART but more importantly improve the health of both fathers to be and resulting offspring.
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Affiliation(s)
- Sandro C Esteves
- ANDROFERT, Andrology and Human Reproduction Clinic, Referral Center for Male Reproduction, Campinas, SP, Brazil.,Division of Urology, Department of Surgery, Universtity of Campinas (UNICAMP), SP, Brazil.,Faculty of Health, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Ashok Agarwal
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Chak-Lam Cho
- Division of Urology, Department of Surgery, Kwong Wah Hospital, Hong Kong, China
| | - Ahmad Majzoub
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
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