P-072 Collecting semen samples at home for fertility assessment has a positive effect on sperm quality

Study question

Does site of semen collection (home/clinic) affect semen parameters?

Summary answer

Semen collection is superior when performed at home as compared with at a clinic in terms of sample volume, sperm concentration, and total sperm count.

What is known already

In fertility clinics the standard approach to semen collection for diagnostic analysis and use in ART involves a private room close to the andrological/embryological laboratory. In fact, WHO recommends that semen samples should be collected at clinic to avoid fluctuations in temperature and to control the time between collection and processing. On the other hand, today - due to the COVID-19 pandemic - semen collection at home is widely advised to reduce the time of stay of patients at clinic. There are still no firm conclusions whether collecting semen at home has any influence on sperm quality and reproductive competence.

Study design, size, duration

This retrospective longitudinal cohort study performed at a tertiary level public fertility center included 8634 semen samples from 5880 men undergoing fertility assessment from 2015 to 2021: 5530 samples were collected at clinic from 3773 men, and 3104 at home from 2107 men. For a subgroup analysis comparing clinic to home collection within the same patient, we included 1260 samples from 428 men. Possible effect of seasonal variation on semen parameters was also investigated.

Participants/materials, setting, methods

The impact of sample collection site on endpoints (semen volume, concentration, motility) was evaluated using a generalized linear model for repeated measures in which the following covariates were included: age, BMI, days of sexual abstinence, smoke habit. Paired comparisons between home- and clinic-collected samples within individuals were made by paired t-test or Wilcoxon signed rank test, as appropriate. The effect of seasonality on sperm parameters was investigated plotting the time series of differences between samples.

Main results and the role of chance

Samples collected at home had significantly higher semen volume (p = 0.016), sperm concentration (p < 0.0001), and total sperm count (p < 0.0001) respect to samples collected at clinic. The abstinence period, known to potentially influence these parameters, was similar for all patients. There was no difference in sperm motility. Paired comparisons of semen characteristics in the 428 patients with home-collected (n = 583) and clinic-collected (n = 677) samples confirmed the aforementioned results. The semen sample collections were distributed among all months over 5 years: regarding seasonal variations in semen quality, we did not find any evidence of variations of sample parameters by month.

Limitations, reasons for caution

Some weaknesses should be considered: i) only men undergoing fertility check-up were assessed and it remains to be validated whether our conclusions are applicable to men attempting pregnancy by ART; ii) we did not measure type and degree of psychological stress that may have affected the men in our study.

Wider implications of the findings

Our observation of decrease in semen quality of clinic-collected samples may be the result of an acute psychological stress experienced by patients, as suggested by previous reports. Thus, when possible, semen collection at home should be encourage at least for men who undergo fertility assessment.

Trial registration number

not applicable

P–092 The more, the merrier: does ejaculatory frequency influence seminal parameters in oligospermic men?

Study question

Does ejaculatory frequency during the three months preceding semen collection influence semen parameters in oligospermic men?

Summary answer

A frequency of 2–3 ejaculations/week during the three months preceding semen collection significantly optimizes sperm motility, without any reduction in sperm concentration.

What is known already

Male gametes undergo crucial physiological and biochemical changes during epididymal transit, but a longer storage is known to have negative effects on semen quality, especially on motility. Previous studies focused on abstinence prior to semen collection, while few data are available on the effect of ejaculation frequency. On one hand, a longer storage could increase exposure to reactive oxygen species and a pro-inflammatory environment, with a reduction in vitality and motility. On the other, an increased ejaculation frequency could cause a reduction in sperm volume and concentration. The effects of ejaculatory frequency are particularly understudied in men with oligospermia.

Study design, size, duration

This is a retrospective study performed at a tertiary level public infertility center. We included all semen samples, collected both for diagnostic purposes and ART cycles between September 2019 and September 2020, with a sperm concentration of 15 million/ml or less, and an abstinence of 3- 5 days. Exclusion criteria were surgically collected or collected for fertility preservation semen samples.

Participants/materials, setting, methods

Standard demographic and clinical data were recorded, as well as semen parameters. Ejaculation frequency was considered “optimal” (at least 2–3/week) or “reduced” (<1/week). The potential predictive role of ejaculation frequency, age, BMI, smoking habits, previous cryptorchidism, varicocele, days of abstinence on semen parameters was evaluated by univariate and then by multivariate analysis for all factors significant in the univariate models. P < 0.05 was considered statistically significant. Main results and the role of chance: Out of 738 men, 491 reported an optimal ejaculation frequency, 247 had <1 ejaculation/week, no one reported everyday ejaculations. Total sperm mobility (35.91±22.84% vs. 32.28±16.91%, p = 0.02) and sperm rapid progressive motility (5.56±6.09% vs. 4.20±6.1%, p = 0.006) were significantly higher in the group with optimal ejaculation frequency. Ejaculation frequency remained predictive of total mobility (p = 0.04) and rapid progressive mobility (p = 0.03) in a multivariate linear regression model with age and sperm concentration. Sperm volume (2.92±1.56 ml vs. 2.91±1.54 ml, p=NS) and concentration (5.74±5.05 mil/ml vs. 6.05±4.78 mil/ml, p=NS) did not significantly differ depending on the declared ejaculation frequency.

Limitations, reasons for caution

The study is retrospective and ejaculatory frequency was self-reported as an estimate of the mean of the number of ejaculations per week.

Wider implications of the findings: Optimizing ejaculatory frequency may improve ART outcomes as well as success of spontaneous conceptions. There is no reason to limit ejaculatory frequency in oligospermic men for a hypothesized benefic in sperm concentration.

Trial registration number

Not applicable

P–255 Hyaluronic acid-sperm selection significantly improves the clinical outcome of couples with previous ICSI cycles failure

Study question

Does hyaluronic acid (HA) sperm selection improve the intracytoplasmic sperm injection outcome of couples with previous ICSI cycles failure?

Summary answer

In couples where previous first ICSI failed, selection of HA-bound spermatozoa significantly improved clinical outcomes respect to further standard ICSI.

What is known already

HA is the major component of the matrix surrounding the human oocyte and in physiological fertilization it plays an important role in sperm selection since only mature spermatozoa express specific binding protein and are able to bind to HA. Although several studies demonstrated better outcomes of ICSI with selection of mature HA-bound spermatozoa, such a beneficial effect of HA-ICSI is still controversial and to date no firm clinical guidance for the routine use of HA can be drawn. Further studies are needed to categorize patients that really might benefit from HA sperm selection before ICSI.

Study design, size, duration

A retrospective, longitudinal cohort study performed at a tertiary level public infertility center. We selected 164 couples who performed one or more failed ICSI cycles with low fertilization rate and poor embryo quality in the period 2010–2020 (n = 164 cycles, group A), followed by other standard ICSI (n = 99, group B) and/or HA-ICSI (n = 96 group C) cycles. We included only fresh ejaculated sperm and fresh oocytes.

Participants/materials, setting, methods

Endpoints were fertilization, cleavage, top quality embryo, implantation (IR), clinical pregnancy (CPR), pregnancy loss (PLR), and live birth (LBR) rates. Comparisons among groups were performed using a generalized estimating equation model performed at patient level, to take into account the correlation between observations originating from the same woman. A p-value <0.05, after correction by female age at oocyte retrieval, was considered statistically significant.

Main results and the role of chance

The three groups were similar for number of retrieved, MII and injected oocytes. As regarding embryological outcomes, there was no difference in fertilization and cleavage rates between group A and C (fertilization: 47.55 + 29.88% versus 54.10 + 28.51%, p = 0.096; cleavage: 96.19 + 12.70% versus 97.52 + 10.50%, p = 0.519), nor between group B and C (fertilization: 60.30 + 30.73% versus 53.71 + 28.61%, p = 0.112; cleavage: 92.26 + 20.540% versus 97.55 + 10.44%, p = 0.106). Selection of HA-bound spermatozoa in ICSI significantly improved the embryo quality rate (63.78 + 35.55% versus 51.42 + 34.31% p = 0.024) and the blastulation rate (43.44 + 25.55% versus 17.93 + 25.52%, p = 0.001) respect to standard ICSI. Comparisons of clinical outcomes between group B and group C highlighted significant higher IR (26.16 + 40.47% versus 7.34 + 22.16%, p = 0.0001), CPR/cycle (32.29% (31/96) versus 12.12% (12/99), p = 0.0007, chi-square test), and lower PLR (12.90% (4/31) versus 41.67% (5/12), p = 0.0398, chi-square test) in HA-ICSI respect to standard ICSI cycles. The LBR/cycle in group B was 10.10% (10/99) and in group C was 32.29% (31/96) (p = 0.0029, chi-square test). No stillbirths as well as no malformations in newborns were recorded.

Limitations, reasons for caution

We are aware of the retrospective nature of the study performed in a single ART center.

Wider implications of the findings: This study identified couples with previous ICSI cycles failure as a category of infertile patients that really may benefit from HA sperm selection before ICSI.

Trial registration number

Not applicable

Combined treatment with myo-inositol, alpha-lipoic acid, folic acid and vitamins significantly improves sperm parameters of sub-fertile men: a multi-centric study

OBJECTIVE

Reduction in motility and number of spermatozoa and change in their morphology are some of the most relevant causes of male infertility. Production of reactive oxygen species may affect motility, morphology and DNA stability of spermatozoa. This study aimed at evaluating the effect of combined treatment with myo-inositol, alpha-lipoic acid, folic acid, betaine and vitamins (namely, Sinopol®) on semen parameters of sub-fertile men.

PATIENTS AND METHODS

We recruited 143 sub-fertile men, 26-53 years aged, no-smokers, without any testicular pathologies, with a normal endocrinological/metabolic profile, and no concomitant consumption of drugs. Out of them, 25 patients did not meet study inclusion criteria mainly due to the history of genital diseases that came to light after Sinopol® prescription. Among the 118 men that fulfilled inclusion criteria, 10 (8.4%) patients were lost at follow-up and in 8 (6.8%) cases the partner got pregnant spontaneously. Thus, 100 patients completed the study and semen analysis was performed before and after 90 days of treatment.

RESULTS

Semen quality improved after 90 days of treatments, with a statistically significant increase of sperm concentration (p=0.0009), of number of spermatozoa (p=0.0017), of progressive motility (p=0.0047), of total motile sperm count (p=0.0010), and of normal sperm morphology (p<0.0001).

CONCLUSIONS

For the first time we reported that a combination of nutraceuticals composed of myo-inositol, alpha-lipoic acid, folic acid, betaine and vitamins improves sperm parameters in sub-fertile men. We are aware that to clarify the clinical relevance of the data studies with larger sample sizes and longer durations are needed, as well as evaluation of myo-inositol and alpha-lipoic acid co-treatment effectiveness in improving the chances to obtain a pregnancy spontaneously or following assisted reproduction.

Gastrointestinal stromal tumours: experience with multislice CT

PURPOSE

The aim of this study was to evaluate the possibilities of multislice computed tomography (MSCT) in the identification and characterisation of gastrointestinal stromal tumours (GISTs).

MATERIALS AND METHODS

MSCT images of 27 patients affected by GIST were analysed. MSCT scans were performed before and after contrast medium injection, and bowel distension was obtained with the administration of water, air or a diluted Gastrografin solution. Images were evaluated for presence and site of the tumour, origin and growth pattern relative to the bowel wall, density, relationship with adjacent structures and evidence of lymph nodes and metastases.

RESULTS

GISTs were located in the stomach in 18/27 patients, in the small bowel in seven, in the oesophagus in one and in the rectum in one. Tumour size ranged from 1.5 cm to 21 cm. An extramucosal origin was definitely established in 23/27 cases. In 15/27 cases, the lesions exhibited extramural growth, and in 17/27 cases, they were homogeneous after contrast medium injection. The borders were regular in 17 cases. Hepatic metastases were detected in 5/27 cases, and lymphadenomegaly was found in one case only.

CONCLUSIONS

Nowadays, MSCT can be considered an essential tool for the diagnosis of GISTs, as it enables one to detect the disease, define its relationships and search for possible metastases.

The Von Restorff effect in ageing and Alzheimer’s disease

The purpose of the study was to evaluate the Von Restorff effect in normal ageing and in Alzheimer's disease (AD). A shortened paradigm was administered to three groups of subjects: young volunteers, elderly volunteers and patients with early-stage AD (MMSE>20). Each subject was presented with 25 lists of 10 words each, the target word appearing in double font size. A free recall phase followed the presentation of each list; after completion of the battery, a size recognition test was administered and subjects were inquired regarding the strategy employed and perception of target words. The total number of recalled words differed significantly among the three groups (young volunteers 144.4+/-38.6, elderly volunteers 86.5+/-17.6, patients 44.2+/-14.6). A significant difference in percentage of recall was found between target and non-target words in young (60.0+/-13.8% vs. 45.7%+/-15.0%, p<0.001) and in elderly (31.2+/-11.4% vs. 20.2+/-6.9%, p<0.001) volunteers, but not in patients (10.7+/-6.9% vs. 11.8+/-7.3%). The present study highlights that the Von Restorff effect can be detected in healthy elderly subjects, and that it is significantly reduced in patients in the early stage of AD. On the basis of the findings of the present study it is not possible to disentangle the contribution of visual-perceptual and encoding impairment, both of them potentially contributing to the observed reduction.

Psychological and social aspects in management of Alzheimer’s patients: an inquiry among caregivers

A survey in the cities of Genoa and Savona (Italy) was performed to examine stress levels in caregivers of patients with Alzheimer's disease in the context of a project of the Italian Ministry of Health named Cronos. It offered free anticholinesterase inhibitor therapy to patients who addressed dedicated Neurological Units; in this occasion caregivers could be invited to express the main difficulties encountered in managing demented people during an interview conducted by health personnel of the Neurophysiology Service. Caregivers were mainly women, daughters or spouses, with a medium educational level, retired, housekeepers, employees or teachers; they claimed a lowering of economic standard of living of the family owing to extra expenses for assistance. Satisfaction was expressed towards specialists, while support by general practitioners and other sanitary services was usually lacking and money contribution from the government or territorial services was considered inadequate. From the emotional point of view, caregivers claim loss of free time, friendships and hobbies, and feel isolated in the social context; sometimes the patient's death is thought of as a solution. A strong need for information and support is clearly emerging and any further interventions should take these requirements into consideration.

[Tinea faciei in a newborn]

Dermatophytosis in newborns and infants has been regarded as very unusual; a case recently observed of a 2-month-old child affected by tinea faciei is described. Twenty days before, localized erythematous infiltrated patches at the upper left eyelid and eyebrows with papules and pustules, were observed. Rarefaction of the eyebrows and partially loss of the eyelashes associated with scattered areas of erythematopapulous lesions on the face, were seen. Mycological examination was positive and trichophyton rubrum colonies grew. Tinea capitis is more common than tinea faciei in newborn and infants. Differential diagnosis includes: seborrheic dermatitis, atopic dermatitis with associated impetigo, candidiasis, bacterial folliculitis. The interhuman transmission by relatives is the most probable modality of trans-mission, as previously reported in the literature. A widespread of the dermatoses was due to previous application of topical corticosteroids. The lesions resolved completely after treatment with miconazole cream, applied twice daily for three weeks.

HLA class I and class II alleles and haplotypes in Mexican mestizos established from serological typing of 50 families

We describe new information on the frequency and association of class II antigens (HLA-DR and HLA-DQ) of the major histocompatibility complex (MHC) in Mexicans. The study includes HLA-B typing and its association with the HLA-DR antigens determined in 50 families, which included 100 individuals. This family study allowed the establishment of the precise composition of the 200 HLA haplotypes, which cannot be obtained from unrelated individuals. The predominant antigens in decreasing order of frequency were B35, B39, and B61 at the B locus; DR4, DR5, and DR8 at the DR locus; and DQ3 at the DQ locus. The most common HLA-B,HLA-DR haplotype (considering broad specificities) was B16,DR4, with a frequency of 8.0%. Five HLA-B,HLA-DR haplotypes showed significant delta values (observed vs. expected frequencies) after correcting for the number of comparisons. On the other hand, the most common HLA-DR,HLA-DQ haplotypes were DR4,DQ3 and DR5,DQ3 with a frequency higher than 10%. Ten of the 17 HLA-DR,HLA-DQ haplotypes had significant postcorrection delta values.

Interaction of Candida albicans, macrophages and fluconazole: in vitro and ex vivo observations

In recent years, medical interest in evaluating the interaction among mycetes, phagocytes, and antimycotic drugs has increased notably due to higher incidences of fungal infections in immunocompromised subjects and to the long-term therapy they require. In this study the in vitro and ex vivo interaction of fluconazole, at plasma concentrations, with mouse macrophages was evaluated in the presence of different inocula of Candida albicans. The results showed that fluconazole did not interfere negatively with phagocyte functions; conversely, according to different experimental conditions, it was able to increase both phagocytosis and intracellular killing of candida, probably exerting its action on the yeast rather than on the phagocyte. A higher enhancement of macrophage functions was observed in vitro when the drug was present in the medium with macrophages and candida in a 1:1 ratio.

Effect of rufloxacin upon non-specific immune defences: in-vitro, ex-vivo and in-vivo results

This study investigated in-vitro, ex-vivo and in-vivo the immunomodulatory effects of rufloxacin. 0.5 MIC of rufloxacin significantly enhanced human macrophage phagocytosis and increased intracellular killing of Klebsiella pneumoniae in vitro. Pre-incubation of K. pneumoniae with rufloxacin made the bacteria more susceptible to both phagocytosis and intracellular killing by human macrophages than control organisms. Following pre-exposure of macrophages to 0.5 MIC of rufloxacin, there was a significant increase in the intracellular killing of K. pneumoniae compared with the controls, indicating the ability of rufloxacin to cross biological membranes and to remain active within phagocytes. Ex-vivo experiments show that iv administration of rufloxacin in mice lead to an increase in both phagocytic and microbicidal intracellular activity by phagocytes. In-vivo models of experimental infections showed that prophylactic administration of rufloxacin increased the survival of mice after challenge with Candida albicans.

An analysis of peripheral type benzodiazepine receptors on blood mononuclear cells during high dose steroid treatment of multiple sclerosis

We report here a study of peripheral type benzodiazepine receptors (pBZr) in mononuclear cells (MNC) from blood of patients with multiple sclerosis (MS) during periods of stable and active disease and from normal controls. Most active MS patients were retested in a longitudinal study, both during a treatment with high dose steroids and while medication free. Active MS produces a significant decrease of receptor density compared with the controls whereas remission of the disease shows no effect. Four weeks of steroid treatment restore binding density to normal levels, and two weeks of drug withdrawal result in a small, but significant increase in number of the binding sites compared with the control value. We suggest that the number of pBZr in blood MNC might change during the clinical course and steroid therapy of MS.

Prevalence of Streptococcus mutans and dental decay in schoolchildren living in Genoa (Italy)

In this study population (105 schoolchildren aged 5.5-11.5 yrs), dental decay was detected in 75.2% and S. mutans in 55.2% of the subjects. The presence of S. mutans was assessed - using the selective GSTB medium - in unstimulated saliva and in pooled occlusal and pooled buccal plaques from the four most posterior teeth. All three samples showed association between S. mutans presence and caries prevalence. Of the two types of plaque, the occlusal not only had a higher frequency of isolation but also a significantly higher proportion of S. mutans. The presence of S. mutans was significantly associated with both caries prevalence and extent of caries experience. Both S. mutans prevalence and S. mutans proportion in plaque increased with the number of decayed teeth present among those sampled. Sucrose consumption between meals appeared to be more correlated with the degree of caries experience rather than with caries or S. mutans prevalence. A second clinical examination was scheduled six months after the first for S. mutans-positive children who either were free of active carious lesions, or were caries-active but without signs of dental decay in the sampled teeth. Caries-active subjects proved to be more prone to new carious lesions than caries-free subjects, who tended to remain caries-free even when they had a high proportion of S. mutans in plaque, thus indicating the basic importance of the host factor in the caries process.

Enhancement of mutagenesis in gamma ray exposed Escherichia coli by plasmids of different incompatibility groups

We have analyzed the correlation between plasmid incompatibility group and enhanced mutagenesis in gamma ray exposed Escherichia coli WP2. The data reported indicate that plasmids of different incompatibility groups are involved in DNA repair mechanisms and suggest that the damage of the DNA produced by gamma rays or other physical agents and by chemical mutagens stimulates a common mechanism of bacterial DNA repair.