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Martínez FAM, Ruiz MM, Velarde EEA, Martínez OHV, Lizola SPP, Hernández LHS. An acute oral administration of Sildenafil in asthenozoospermic patients improves sperm motility after density gradient centrifugation. JBRA Assist Reprod 2021; 25:390-393. [PMID: 33624488 PMCID: PMC8312304 DOI: 10.5935/1518-0557.20200076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective: Investigate the possible effect of an acute sildenafil dose in asthenozoospermic patients. Methods: We ran this experimental, descriptive, prospective and non-blinded study in 32 patients diagnosed with asthenozoospermia according to the WHO criteria, after two consecutive semen analyses (samples 1 and 2), and we asked them to provide a new semen sample two weeks after the initial exams (sample 3). One hour prior to the semen collection, we gave the patients 100mg oral sildenafil. Samples 2 and 3 were allowed to liquefy and density gradients centrifugation was performed. We assessed sperm motility by Computer-assisted sperm analysis (CASA). Results: There were no significant differences between the samples obtained before (sample2) or after sildenafil administration (sample3). However, a single oral 100 mg sildenafil dose in asthenozoospermic patients increase the percentage of motile sperm recovered after density gradient centrifugation. Conclusions: An acute administration of sildenafil enhances sperm recovery after density gradient centrifugation in asthenozoospermic patients, and it may produce more available mobile sperm to perform intra uterine insemination or to improve the chances of success in this procedure. This approach may be used as an alternative strategy in assisted reproductive programs. Sildenafil was well tolerated and no patient was withdrawn from the study due to adverse events attributed to sildenafil.
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Affiliation(s)
- Felipe A Morales Martínez
- Universidad Autónoma de Nuevo León Hospital Universitario "Dr. José Eleuterio González" Centro Universitario de Medicina Reproductiva Monterrey Nuevo León México Centro Universitario de Medicina Reproductiva, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Martha Merino Ruiz
- Universidad Autónoma de Nuevo León Hospital Universitario "Dr. José Eleuterio González" Centro Universitario de Medicina Reproductiva Monterrey Nuevo León México Centro Universitario de Medicina Reproductiva, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Eddy E Angulo Velarde
- Universidad Autónoma de Nuevo León Hospital Universitario "Dr. José Eleuterio González" Centro Universitario de Medicina Reproductiva Monterrey Nuevo León México Centro Universitario de Medicina Reproductiva, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Otto H Valdés Martínez
- Universidad Autónoma de Nuevo León Hospital Universitario "Dr. José Eleuterio González" Centro Universitario de Medicina Reproductiva Monterrey Nuevo León México Centro Universitario de Medicina Reproductiva, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Sara P Peña Lizola
- Universidad Autónoma de Nuevo León Hospital Universitario "Dr. José Eleuterio González" Centro Universitario de Medicina Reproductiva Monterrey Nuevo León México Centro Universitario de Medicina Reproductiva, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Luis H Sordia Hernández
- Universidad Autónoma de Nuevo León Hospital Universitario "Dr. José Eleuterio González" Centro Universitario de Medicina Reproductiva Monterrey Nuevo León México Centro Universitario de Medicina Reproductiva, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
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Capogrosso P, Jensen CFS, Rastrelli G, Torremade J, Russo GI, Raheem AA, Frey A, Fode M, Maggi M, Reisman Y, Bettocchi C, Corona G. Male Sexual Dysfunctions in the Infertile Couple-Recommendations From the European Society of Sexual Medicine (ESSM). Sex Med 2021; 9:100377. [PMID: 34090242 PMCID: PMC8240351 DOI: 10.1016/j.esxm.2021.100377] [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: 11/18/2020] [Revised: 03/31/2021] [Accepted: 04/03/2021] [Indexed: 02/09/2023] Open
Abstract
Introduction Sexual dysfunctions (SDs) have been frequently reported among male partners of infertile couples due to psychogenic, relational and/or organic issues related with the inability to conceive. Likewise, male infertility (MI) could be a consequence of sexual dysfunctions. Aim To review the evidence on the prevalence and treatment of male SDs in men of infertile couples and provide clinical recommendations on behalf of the European Society of Sexual Medicine (ESSM). Methods The MEDLINE database was searched in September 2019 for randomized clinical trials (RCTs), meta-analyses and open-label prospective or retrospective studies investigating the presence of erectile dysfunction (ED) and/or ejaculatory dysfunctions (EjDs) and/or low sexual desire (LSD) in conjunction with infertility. Main Outcome Measure The panel provided statements on: (i) Prevalence and association between SDs and MI; (ii) Treatment of male SDs in men of infertile couples. Results ED has been reported in 9% to 62% of male partners of infertile couples, with severe impairment observed in only 1% to 3% of ED cases. Moreover, worse semen parameters have been associated with greater ED severity. Phosphodiesterase type 5 inhibitors (PDE5is) can be safely used to treat ED among patients seeking fatherhood. Male partners of infertile couples are at higher risk of premature ejaculation (PE). Retrograde ejaculation (RE) and anejaculation are a cause of MI and can be managed with electroejaculation (EEJ) or penile vibratory stimulation (PVS) or, alternatively, with oral treatments, however the latter with limited documented success. Low sexual desire has been reported by one third of men of infertile couples. Conclusion ED could significantly affect male partners of infertile couple; PDE5is should be suggested to ensure an effective and satisfactory sexual relationship of the couple. Anejaculation and RE should be considered as a possible cause of MI and treated accordingly. Low sexual desire is frequently reported among men of infertile couple and could be a symptom of other systemic conditions or psychological distress. Capogrosso P, Jensen CFS, Rastrelli G, et al. Male Sexual Dysfunctions in the Infertile Couple–Recommendations From the European Society of Sexual Medicine (ESSM). J Sex Med 2021;9:100377.
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Affiliation(s)
- Paolo Capogrosso
- Department of Urology, Circolo & Fondazione Macchi Hospital, University of Insubria, Varese, Italy.
| | | | - Giulia Rastrelli
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Florence, Italy
| | | | | | - Amr Abdel Raheem
- Department of Andrology, The Institute of Urology, University College London Hospitals, London, UK
| | - Anders Frey
- Department of Urology, University of Southern Denmark, Esbjerg, Odense
| | - Mikkel Fode
- Department of Urology, Zealand University Hospital, Roskilde; Department of Clinical Medicine, University of Copenhagen
| | - Mario Maggi
- Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence
| | - Yacov Reisman
- Men's Health Clinic, Amstelland Hospital, Amsterdam, The Netherlands
| | - Carlo Bettocchi
- Division of Urology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Giovanni Corona
- Endocrinology Unit, Medical Department, Azienda USL, Maggiore-Bellaria Hospital, Bologna, Italy
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Dong L, Zhang X, Yan X, Shen Y, Li Y, Yu X. Effect of Phosphodiesterase-5 Inhibitors on the Treatment of Male Infertility: A Systematic Review and Meta-Analysis. World J Mens Health 2021; 39:776-796. [PMID: 33663030 PMCID: PMC8443990 DOI: 10.5534/wjmh.200155] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/04/2020] [Accepted: 10/08/2020] [Indexed: 11/15/2022] Open
Abstract
Purpose Male infertility is a worldwide problem with limitations in the treatment. Phosphodiesterase-5 inhibitors (PDE5is) is the first choice for the treatment of erectile dysfunction, more and more studies show that it has a certain effect on male infertility in recent years. But there was currently no high quality of systematic review to evaluate the effects of PDE5is on semen quality. Materials and Methods We retrieved the electronic databases of MEDLINE, PubMed, Web of Science, EMBASE, etc. Related randomized controlled trials (RCTs) were collected and selected up to May 20, 2020. We have searched literature with terms “male infertility”, “phosphodiesterase-5 inhibitors”, “PDE5i”, “Tadalafil”, “Sildenafil”, “Vardenafil”, “Udenafil”, “Avanafil”, “semen”, and “sperm”. Mean value and its standard deviation were used to perform quantitative analysis. All statistical analyses were conducted by RevMan 5.3 and Stata software. Results There were a total of 1,121 participants in the nine included studies. There was a statistically significant improvement treated with PDE5is compared with sham therapy, which including sperm concentration (mean difference [MD]=1.96, 95% confidence interval [CI]=1.70–2.21, p<0.001; MD=3.22, 95% CI=1.96–4.48, p<0.001), straight progressive motility (%) Grade A (MD=3.71, 95% CI=2.21–5.20, p<0.001), sperm motility (MD=8.09, 95% CI=7.83–8.36, p<0.001), morphologically normal spermatozoa (%) (MD=0.67, 95% CI=0.20–1.15, p=0.005; MD=1.27, 95% CI=0.02–2.52, p=0.05), sperm abnormalities (%) (MD=−0.64, 95% CI=−0.81–−0.47, p<0.001), and progressive motile sperm (MD=5.34, 95% CI=3.87–6.81, p<0.001). Conclusions In this meta-analysis of nine RCTs, treatment with PDE5is could improve some indicators of male sperm.
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Affiliation(s)
- Liang Dong
- TCM Regulating Metabolic Diseases Key Laboratory of Sichuan Province, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, P. R. China.,Department of Andrology, School of Medical and Life Sciences/Reproductive & Women-Children Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, P. R. China
| | - Xiaojin Zhang
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, P. R. China
| | - Xuhong Yan
- TCM Regulating Metabolic Diseases Key Laboratory of Sichuan Province, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, P. R. China
| | - Yifeng Shen
- TCM Regulating Metabolic Diseases Key Laboratory of Sichuan Province, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, P. R. China
| | - Yulin Li
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, P. R. China
| | - Xujun Yu
- TCM Regulating Metabolic Diseases Key Laboratory of Sichuan Province, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, P. R. China.,Department of Andrology, School of Medical and Life Sciences/Reproductive & Women-Children Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, P. R. China.
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Song SH, Shin DH, Her YS, Oh MH, Baek JW, Sung S, Eum JH, Heo Y, Kim DS. Effect of phosphodiesterase type 5 inhibitors on sperm motility and acrosome reaction: An in vitro study. Investig Clin Urol 2021; 62:354-360. [PMID: 33943054 PMCID: PMC8100009 DOI: 10.4111/icu.20200394] [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: 09/01/2020] [Revised: 12/14/2020] [Accepted: 01/10/2021] [Indexed: 12/02/2022] Open
Abstract
Purpose Phosphodiesterase type 5 (PDE5) inhibitors are effective treatments for erectile dysfunction, and several recent studies have reported positive effects of PDE5 inhibitors on semen parameters as well. However, the data are still controversial. We investigated the effect of PDE5 inhibitors on sperm function by analyzing sperm motility and acrosome reaction. Materials and Methods This study included young healthy men who underwent fertility evaluation; 32 cases were finally included. Men were excluded if they used a PDE5 inhibitor within 2 weeks or if they had insufficient semen volume (≤2 mL), leukocytospermia, or a genitourinary infection. Changes in sperm motility and acrosome reaction were determined after in vitro exposure to the maximal semen concentration of oral intake of sildenafil (100 mg) or tadalafil (20 mg). Results Mean age of the participants was 35.4±4.9 years, mean sperm concentration was 68.7±32.4 ×106/mL, and mean sperm motility was 50.38%±8.41%. All three groups (control, sildenafil, tadalafil) experienced trends of decreased average sperm motility over time, but these changes were not significant. There were no significant differences between the three groups in the acrosome reaction after 120 minutes of drug exposure, either. The maximal semen concentration of oral intake of sildenafil (100 mg) or tadalafil (20 mg) did not substantially affect sperm motility or acrosome reaction. Conclusions Our results suggest that on-demand use of a PDE5 inhibitor is safe and useful for the male partner of an infertile couple; however, further studies are warranted for daily PDE5 inhibitor use.
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Affiliation(s)
- Seung Hun Song
- Department of Urology, Fertility Center, CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | - Dong Hyuk Shin
- Fertility Center, CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | - Young Sun Her
- Fertility Center, CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | - Mi Hee Oh
- Fertility Center, CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | - Jung Won Baek
- Fertility Center, CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | - Suye Sung
- Fertility Center, CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | - Jin Hee Eum
- Fertility Center, CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | - Yohan Heo
- Department of Urology, Fertility Center, CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | - Dong Suk Kim
- Department of Urology, Fertility Center, CHA Gangnam Medical Center, CHA University, Seoul, Korea.
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Drobnis EZ, Nangia AK. Phosphodiesterase Inhibitors (PDE Inhibitors) and Male Reproduction. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 1034:29-38. [PMID: 29256125 DOI: 10.1007/978-3-319-69535-8_5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The nonspecific PDE inhibitors, particularly the methylxanthines: caffeine, pentoxifylline (PTX), and theophylline, are known to stimulate sperm motility in vitro and have been used to treat sperm prior to insemination. The in vivo effects are less dramatic. A beneficial effect of caffeine, which is a constituent of some medications, remains controversial. Very high doses of caffeine do have negative effects on fertility endpoints in men and experimental species. The specific PDE5 inhibitors, particularly sildenafil and tadalafil, are prescribed for erectile dysfunction, as well as pulmonary hypertension, lower urinary tract symptoms, and premature ejaculation. PDE5 is expressed throughout the contractile tissues of the male reproductive tract, generally increasing contractility. Some PDE5 inhibitors tend to increase circulating testosterone levels somewhat. For short-term exposure consistent with use prior to intercourse, there appears to be minimal effects on semen quality. Several large, randomized controlled trials (RCTs) in healthy men have not found adverse effects of long-term use of these drugs on semen quality. RCTs in infertile men have demonstrated a modest increase in semen quality. Animal studies at human equivalent doses (HED) have produced similar results in young males, but a study in aging male rats found progressive decreases in epididymal sperm quality accompanied by consistent degeneration of the seminal tubules suggesting that studies in older men might be warranted. A concerning study in mice found lower fertilization rates in males treated with HED of sildenafil and mated the next day to untreated females than for control males. Fertility studies in humans are needed.
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Affiliation(s)
- Erma Z Drobnis
- Obstetrics, Gynecology and Women's Health, University of Missouri School of Medicine, Columbia, MO, USA
| | - Ajay K Nangia
- Department of Urology, University of Kansas Medical Center, Kansas City, KS, USA
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Ciocca G, Limoncin E, Mollaioli D, Gravina GL, Carosa E, Di Sante S, Gianfrilli D, Lombardo F, Lenzi A, Jannini EA. SIAMS survey on sexological screening during the assisted reproductive technologies in Italy. J Endocrinol Invest 2015; 38:999-1005. [PMID: 25894866 DOI: 10.1007/s40618-015-0286-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 04/02/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE The assessment of sexual function is fundamental to the Assisted Reproductive Technology (ART). Nevertheless, it is still not a common clinical routine among infertility centres. The aim of this survey is to describe the main aspects of sexological screening that are considered in Italian centres of ART. METHODS After the consensus of the Italian Society of Andrology and Sexual Medicine (SIAMS), a mailing list of reproductive medicine centres was created. Then, we sent a questionnaire concerning the essential characteristics of sexological screening. The respondents to compilers of the questionnaire sent back the information from their centres, and an analysis of absolute frequencies and percentages was performed. RESULTS First, 16 centres completed and returned the questionnaire, while 5 ignored the invitation. The main findings concerned the wide use consideration of vardenafil 10 mg (68.7%; 11/16) for the treatment of erectile dysfunction in comorbidity with reproductive problems, the diffuse administration of International Index of Erectile Function (68.2%; 11/16) and Structured Interview for the Erectile Dysfunction (50%; 8/16) as psychometric tools and lesser use of Female Sexual Function Index (31.2%; 5/16) for the evaluation of female sexuality in the infertile couple. CONCLUSIONS To conclude, we noticed a major focus on male sexuality and the eventual treatment or evaluation of sexual dysfunction compared to female sexuality. This aspect highlights an important issue for clinical practice to strongly consider and eventually reinforce. In this regard, improvement of the assessment and treatment of possible female sexual problems in reproductive medicine seems necessary.
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Affiliation(s)
- G Ciocca
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
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Abstract
To provide a critical contemporary review of daily PDE5-inhibitor (PDE5-I) use in urological and nonurological conditions. PDE5-Is can be taken up to once a day. However, at present only tadalafil is approved for use in both erectile dysfunction (ED) and benign prostate hyperplasia (BPH) with lower urinary tract symptoms (LUTS). Evolving research in penile rehabilitation, Peyronie's disease, male infertility, pulmonary arterial hypertension, muscular dystrophy and Raynaud's phenomenon shows these therapeutic areas may also benefit from PDE5i therapy. This review examines the role of chronic PDE5 inhibition in ED, BPH-LUTS and other therapeutic targets which may shape our clinical practice in the years to come.
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Affiliation(s)
- King Chien Joe Lee
- Department of Urology, National University Hospital, 1E Kent Ridge Road, NUHS Tower Block, Level 8, Singapore, 119228, Singapore.
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