Infertilidad masculina: causas y diagnóstico / Male infertility: causes y diagnosis

En una pareja con infertilidad, la evaluación masculina es fundamental por dos razones principales. En primer lugar, es la única causa de infertilidad en el 20% de las parejas y en el 50% se encuentra asociada a una causa de infertilidad femenina; en segundo lugar, existe evidencia de la relación entre infertilidad masculina y comorbilidades, como enfermedades cardiovasculares, oncológicas, reumatológicas e incluso con aumento de la mortalidad. Por esto, los pacientes deben ser evaluados por urólogos-andrólogos entrenados que permitan llegar al diagnóstico etiológico, como también buscar comorbilidades asociadas. Una correcta historia clínica, examen físico, espermiograma y exámenes complementarios permitirán obtener el diagnóstico etiológico y por lo tanto el tratamiento adecuado. Las causas genéticas de infertilidad son al menos el 15% de las etiologías, aumentando hasta el 25% en casos de azoospermia. A través del desarrollo y avance en biología molecular, en el futuro se podrán identificar otras causas genéticas que actualmente son categorizadas como infertilidad de origen idiopático.

When treating infertility, a study of the male partner is necessary for two main reasons: 1) In 20% of cases of infertility there is only a male root cause and in addition, in 50% of the cases the root cause is associated with the male and the female. 2) There is supporting and growing evidence that male infertility is related to comorbidities, including cardiovascular disease, cancer, rheumatologic disease, and even mortality. A thorough clinical history, physical examination, semen analysis and auxiliary tests will help us identify the cause and the correct treatment. Near 15% of male infertility are attributed to genetic causes, and this goes up to 25% in cases of azoospermia. With evolving advances and development of molecular biology, some causes of male infertility currently classified as idiopathic, will be specifically identified and categorized.

Review of post bariatric surgery effects on common genitourinary physiology

ABSTRACT Background: Obesity is a worldwide challenging health problem. Weight loss through medical management of obesity has not always been successful, thus, giving rise to the need for surgical intervention. Bariatric surgery has been shown to be helpful for morbidly obese patients. However, studies have also shown the effect of surgery on stone formation, fertility and erectile function. This review summarizes the main findings of several studies that analyze stone formation and fertility in men as well as erectile function post bariatric surgery. The underlying pathophysiologic alterations post bariatric surgery include increased absorption of oxalate leading to hyperoxaluria, hypocitraturia and increased urinary calcium oxalate supersaturation. Contradicting data exist on the effect of bariatric surgery on fertility and erectile function. Further studies are needed to analyze the mechanisms.

Male fertility potential alteration in rheumatic diseases: a systematic review

ABSTRACT Background Improved targeted therapies for rheumatic diseases were developed recently resulting in a better prognosis for affected patients. Nowadays, patients are living longer and with improved quality of life, including fertility potential. These patients are affected by impaired reproductive function and the causes are often multifactorial related to particularities of each disease. This review highlights how rheumatic diseases and their management affect testicular function and male fertility. Materials and Methods A systematic review of literature of all published data after 1970 was conducted. Data was collected about fertility abnormalities in male patients with systemic lupus erythematosus, rheumatoid arthritis, dermatomyositis, ankylosing spondylitis, Behçet disease and gout. Two independent researchers carried out the search in online databases. Results A total of 19 articles were included addressing the following diseases: 7 systemic lupus erythematosus, 6 Behçet disease, 4 ankylosing spondylitis, 2 rheumatoid arthritis, 2 dermatomyositis and one gout. Systemic lupus erythematosus clearly affects gonadal function impairing spermatogenesis mainly due to antisperm antibodies and cyclophosphamide therapy. Behçet disease, gout and ankylosing spondylitis patients, including those under anti-TNF therapy in the latter disease, do not seem to have reduced fertility whereas in dermatomyositis, the fertility potential is hampered by disease activity and by alkylating agents. Data regarding rheumatoid arthritis is scarce, gonadal dysfunction observed as consequence of disease activity and antisperm antibodies. Conclusions Reduced fertility potential is not uncommon. Its frequency and severity vary among the different rheumatic diseases. Permanent infertility is rare and often associated with alkylating agent therapy.

La importancia clínica del ADN espermático en el análisis seminal cotidiano / The clinical importance of spermatic DNA in seminal analysis

El objetivo de este reporte es resaltar la importancia de las pruebas funcionales para evaluar la calidad seminal durante el análisis seminal de rutina. Se analizó mediante citometría de flujo el potencial mitocondrial, la integridad de la membrana espermática, la producción de especies reactivas del oxígeno y la suceptibilidad de fragmentación del ADN espermatico, en un paciente que consultó por infertilidad al Grupo Reproducción de la Universidad de Antioquia. Se encontró una producción basal de especies reactivas del oxígeno junto con una actividad mitocondrial alto y un porcentaje elevado de espermatozoides con su membrana plasmatica integra, siendo estos indicadores de una buena calidad espermática; no obstante, se observó una elevada suceptibilidad de fragmentación del material genético (DFI=42%). A pesar que un hombre aparentemente manifiesta características espermáticas de un individuo sano puede que la calidad del material genético de sus espermatozoides esté incidiendo sobre su éxito reproductivo.

The aim of this report is highlighting the importance of functional tests to evaluate semen quality during routine semen analysis. Mitochondrial function, membrane integrity, intracellular reactive oxygen species production and sperm DNA fragmentation were evaluated by flow cytometry in a infertil patient from Reproduction Group at the University of Antioquia.A basal production of reactive oxygen species and mitochondrial activity, and a high percentage of sperm with integrated plasma membrane was found, all indicators of good sperm quality; however, a high susceptibility of genetic material fragmentation (DFI=42%) was observed. Although a men apparently manifested sperm characteristics of a healthy individual may that the quality of genetic material in the spermcells is impacting on their reproductive success.

The incidence and histological characteristics of intratubular germ cell neoplasia in postpubertal cryptorchid testis

PURPOSE: It is well known that testicular germ cell tumors arise with increased frequency in patients with cryptorchidism. In addition, intratubular germ cell neoplasia (ITGCN) is a precursor lesion to testicular germ cell tumor. Approximately 50% of patients with ITGCN will develop an invasive of testicular germ cell tumors within 5 years. Therefore, we evaluated that the incidence of ITGCN in postpubertal cryptorchidism. MATERIALS AND METHODS: Between January 2002 and August 2012, orchiectomy specimens from 31 postpubertalpatients (aged 12 or over) with cryptorchid testis were reviewed. The specimens were evaluated for ITGCN using immunohistochemical stains of placental-like alkaline phosphatase and Oct 3/4 with routine hematoxylin-eosin stain. Additionally, the degree of spermatogenesis was assessed using the Johnsen score. RESULTS: Mean age was 34 years (range, 17 to 74 years) at surgery. All patients were diagnosed as unilateral cryptorchidism. One patient (3.2%) of 20-year-old had ITGCN in surgical specimen with all positive markers. Histological assessment of spermatogenesis showed that mean Johnsen score was 3.42 (range, 1 to 9). Majority of patients (27 of 31) presented impaired spermatogenesis with low Johnsen score lesser than 5. CONCLUSIONS: Considering the risk of malignancy and low spermatogenesis, we should perform immunohistochemical stains and discuss preventative orchiectomy for the postpubertal cryptorchidism.

MAPK immunoreactivity in streptozotocin-induced diabetic rat testis

PURPOSE: To evaluate the alterations of two mitogen-activated protein kinases (MAPK)s, extracellular signal regulated kinase (ERK) and c-Jun NH2 terminal kinase (JNK), in the testes of male rats with experimental diabetes. METHODS: Twenty males Sprague-Dawley rats were randomly divided into a control group (n=8) and a diabetes group (administration of 40 mg/kg/day streptozotocin (STZ) for five sequential days, n=12). After six weeks, testicular biopsy samples were obtained for light microscopy and immunohistochemical methods. RESULTS: The PCNA (proliferating cell nuclear antigen) index was significantly decreased in the diabetes group (p=0.004) when compared to the control group. Both total (t)-ERK and phosphor (p)-ERK immunoreactivities were significantly decreased in the diabetes group (p=0.004, p<0.001, respectively). The t-JNK immunoreactivity was unchanged in both groups (p=0.125), while p-JNK immunoreactivity was significantly increased in the diabetic group (p=0.002). CONCLUSIONS: The decrease of androgen levels in the course of diabetes may contribute to the decrease of the immunoreactivities of t-ERK and p-ERK. JNK may be activated due to the changes in various cytokines and chemochines that participate in the oxidative stress process of diabetes. Therefore, testicular apoptosis may occur and lead to infertility associated with diabetes. .

No CAG repeat expansion of polymerase gamma is associated with male infertility in Tamil Nadu, South India.

Mitochondria contains a single deoxyribonucleic acid (DNA) polymerase, polymerase gamma (POLG) mapped to long arm of chromosome 15 (15q25), responsible for replication and repair of mitochondrial DNA. Exon 1 of the human POLG contains CAG trinucleotide repeat, which codes for polyglutamate. Ten copies of CAG repeat were found to be uniformly high (0.88) in different ethnic groups and considered as the common allele, whereas the mutant alleles (not -10/not -10 CAG repeats) were found to be associated with oligospermia/oligoasthenospermia in male infertility. Recent data suggested the implication of POLG CAG repeat expansion in infertility, but are debated. The aim of our study was to explore whether the not -10/not -10 variant is associated with spermatogenic failure. As few study on Indian population have been conducted so far to support this view, we investigated the distribution of the POLG CAG repeats in 61 infertile men and 60 normozoospermic control Indian men of Tamil Nadu, from the same ethnic background. This analysis interestingly revealed that the homozygous wild type genotype (10/- 10) was common in infertile men (77% - 47/61) and in normozoospermic control men (71.7% - 43/60). Our study failed to confirm any influence of the POLG gene polymorphism on the efficiency of the spermatogenesis.

Asociación entre obesidad abdominal y daño oxidativo seminal en pacientes con síndrome metabólico / Association between abdominal obesity and seminal oxidative damage in adults with metabolic syndrome

Abdominal obesity, metabolic syndrome (MS) and oxidative stress may impair seminal quality leading to derangements in fertility. Aim: To identify an association between abdominal obesity and markers of seminal oxidative damage in adults with MS. Material and Methods: Seventy males aged 25 to 40 years, with MS according to ATP-III criteria volunteered for this cross-sectional study. The control group included 70 healthy and normal weight adults. Semen analysis included volume, sperm concentration, motility and normal morphologic features. Body mass index (BMI) and waist circumference (WC) were measured, fat mass was determined by bioelectrical impedance. Results: Sperm concentration and the percentage of sperms with normal motility and morphology were significantly lower in adults with MS, when compared to their healthy normal weight counterparts. Seminal levels of malondialdehyde and 8-hydroxy-2’-deoxyguanosine were significantly higher among participants with MS. Significant correlations were found between WC and seminal markers of oxidative stress. Conclusions: Individuals with MS had an impaired seminal quality that may be explained, at least in part, by increased seminal oxidative damage.

Enfermedad periodontal como factor de riesgo asociado a la infertilidad / Periodontal disease as a risk factor for infertility

La infertilidad se define como una condición en la que existe incapacidad de una pareja para concebir después de un año de mantener relaciones sexuales sin protección, o para llevar un embarazo a término con un producto vivo. Estudios recientes han demostrado una relación entre la enfermedad periodontal y múltiples condiciones adversas durante el embarazo, incluyendo el parto pretérmino, bajo peso al nacer, restricción del crecimiento fetal, preeclampsia y mortalidad perinatal. Sin embargo, poco se ha estudiado sobre el periodo previo a la concepción, a pesar de que algunos autores han sugerido poco beneficio del tratamiento periodontal durante el embarazo, y esto pudiera ser un indicador de que la intervención está siendo llevada a cabo de forma tardía.Las hipótesis que sugieren los autores acerca de esta relación es que en presencia de una enfermedad periodontal severa, los microorganismos orales se pueden diseminar vía hematológica y llegar a afectar las membranas, impidiendo la implantación, o que, incluso, pueden contaminar el semen, provocando infertilidad; o bien, que la enfermedad periodontal pudiera ser un indicador de hiperrespuesta inflamatoria sistémica ante infecciones a distancia.

Infertility is defined as a condition in which a couple has been unable to conceive after one year of unprotected intercourse or the inability to carry a pregnancy through to a live birth. Recent studies have shown a relationship between periodontal disease and a range of adverse conditions during pregnancy, including preterm birth, low birth weight, restricted fetal growth, preeclampsia, and perinatal mortality. However, little research has been done into the period prior to conception, despite the fact that some authors have suggested that periodontal treatment during pregnancy is of little benefit, which could indicate that the in-tervention is being carried out too late in the process. The hypothesis that such authors suggest in regard to this relationship is that, in cases where there is severe periodontal disease, oral microorganisms can disseminate via the bloodstream and harm membranes, thus impeding implantation and, in the case of males, even contaminate semen, result-ing in infertility. Furthermore, it has been suggested that periodontal disease is an indicator of a systemic inflammatory hyper-response to remote infections.

Effect of Varicocelectomy on Male Infertility

Varicocele is the most common cause of male infertility and is generally correctable or at least improvable by various surgical and radiologic techniques. Therefore, it seems simple and reasonable that varicocele should be treated in infertile men with varicocele. However, the role of varicocele repair for the treatment of subfertile men has been questioned during the past decades. Although varicocele repair can induce improvement of semen quality, the obvious benefit of spontaneous pregnancy has not been shown through several meta-analyses. Recently, a well-designed randomized clinical trial was introduced, and, subsequently, a novel meta-analysis was published. The results of these studies advocate that varicocele repair be regarded as a standard treatment modality in infertile men with clinical varicocele and abnormal semen parameters, which is also supported by current clinical guidelines. Microsurgical varicocelectomy has been regarded as the gold standard compared to other surgical techniques and radiological management in terms of the recurrence rate and the pregnancy rate. However, none of the methods has been proven through well-designed clinical trials to be superior to the others in the ability to improve fertility. Accordingly, high-quality data from well-designed studies are needed to resolve unanswered questions and update current knowledge. Upcoming trials should be designed to define the best technique and also to define how to select the best candidates who will benefit from varicocele repair.

Alteraciones morfológicas de espermatozoides humanos por microscopía electrónica de barrido / Morphological alterations of human spermatozoa detected by scanning electron microscopy

Introducción: las alteraciones morfológicas en los espermatozoides humanos con frecuencia son responsables de la infertilidad masculina. En determinados casos, muchas anormalidades no se observan en los estudios de morfología realizados en los espermogramas de rutina por microscopía óptica convencional, por lo que es necesario recurrir a técnicas alternativas que permitan visualizar con mejor precisión los detalles morfológicos. Objetivo: identificar anormalidades morfológicas mediante microscopía electrónica de barrido, en espermatozoides de hombres que consultan por infertilidad, los cuales fueron reportados como morfológicamente normales por microscopia óptica. Métodos: se utilizaron 140 muestras de semen de hombres con edades entre 20 y 45 años, procedentes de las consultas de infertilidad del Instituto Nacional de Endocrinología. Se realizó el espermograma a las muestras colectadas por masturbación, según criterio de OMS, y se seleccionaron espermatozoides de las muestras con 30 por ciento o más de morfología normal determinadas por microscopía óptica, para el estudio morfológico por microscopía electrónica de barrido. Resultados: de las 140 muestras utilizadas en el estudio, 119 resultaron morfológicamente normales por microscopía óptica. De estas últimas, se encontraron alteraciones morfológicas por microscopía electrónica de barrido en 79 (66,4 por ciento), en relación con 40 (33,6 por ciento) que no mostraron. Las alteraciones espermáticas que predominaron fueron las correspondientes a colas pequeñas y enrolladas, pieza media doblada, cabezas grandes, amorfas y elongadas, con algunos cambios en la estructura acrosomal, así como espermatozoides con cabeza de punta. Las alteraciones de cola aparecen tanto aisladas como mixtas en 47 (59,4 por ciento) de las 79 muestras. Conclusiones: mediante la microscopía electrónica de barrido fue posible identificar anormalidades morfológicas en espermatozoides de hombres que consultan por infertilidad, los cuales fueron reportados como morfológicamente normales por microscopia óptica(AU)

Introduction: morphological alterations of human spermatozoa are a common cause of infertility. Many abnormalities in certain cases are not observed in the morphological studies conducted in the routine spermograms based on the conventional optic microscopy; therefore, it is necessary to resort to alternative techniques that visualize morphological details with more precision. Objective: to identify morphological spermatozoa abnormalities through scanning electron microscopy in patients who were treated in the infertility service and whose spermatozoa had been morphologically reported as normal in the optic microscopy exam. Methods: one hundred forty semen samples taken from men aged 20 to 40 years, who were treated at the infertility service of the National Institute of Endocrinology. According to WHO criteria, the collected samples after masturbation were subjected to spermograms and those spermatozoa from the samples with 30 percent or over of their morphology being normal, according to the optic microscopy results, were selected for the scanning electron microscopy study. Results: of the 140 study samples, 119 were found morphologically normal in the optical miscroscopy. Out of the latter, 79 (66.4 percent) were found to have morphological alterations in the scanning electron microscopy results, and 40 (33.6 percent) were not. Predominant spermatic alterations were short and coiled tails, folded middle piece, big amorphous and elongated heads with some changes in their acrosomal structure as well as pointy-head spermatozoa. Both mixed and isolated tail alterations appeared in 47 (59.4 percent) of the 79 samples. Conclusions: through the scanning electron microscopy, it was possible to identify morphological anomalies in the spermatozoa from men who went to the infertility service. These spermatozoa had been reported as morphologically normal in the optical microscopy exam(AU)

Comparación entre los efectos de la varicocelectomía microquirúrgica subinguinal bilateral vs la unilateral en los parámetros seminales / Comparison of the effects of unilateral vs bilateral microsurgical subinguinal varicocelectomy in seminal parameters

INTRODUCCIÓN: El varicocele es una causa frecuente de infertilidad en el hombre, encontrándose en el 40 por ciento de los hombres que consultan por infertilidad, existiendo diversas teorías que explican esta situación. Numerosos estudios apuntan a que la reparación del varicocele se asociaría a una mejoría en los parámetros seminales e incluso en las tasas de fertilidad. Entre las técnicas reparativas la varicocelectomía microquirúrgica (VM) se ha posicionado como la técnica gold standard dado sus mejores resultados en cuanto a éxito, recidiva y seguridad. OBJETIVO: evaluar el rol de la VM en los parámetros seminales de varones que consultan por infertilidad y que son sometidos a VM bilateral en comparación con aquellos en que se realiza VM unilateral. Materiales y método: se seleccionó a pacientes con varicocele clínico que consultaron por infertilidad y que tenían el espermiograma alterado, a los que se realizó VM uni o bilateral según tuvieran la enfermedad en uno o ambos lados. Se tomó el promedio de los parámetros seminales de 2 espermiogramas pre-operatorios y otras variables clínicas y demográficas y se comparó con los parámetros seminales a 6 meses post-cirugía. Además se comparó los resultados del grupo de VM bilateral con el unilateral. RESULTADOS: no hubo diferencias entre los grupos en el pre-operatorio, evidenciándose una mejoría en ambos grupos al analizar los resultados a los 6 meses post-VM. Esta mejoría fue significativamente mayor en el grupo de VM unilateral en cuanto a la concentración espermática (mediana de 6 mill/ml, comparado con 0.75 mill/ml en el grupo de pacientes sometidos a VM bilateral. p Value = 0.02)...

Introduction: Varicocele is a common cause of infertility in men, present in 40 percent of men with infertility, there are several theories that explain this situation. Numerous studies suggest that varicocele repair would be associated with an improvement in semen parameters and even fertility rates. Among the reparative techniques microsurgical varicocelectomy (VM) has positioned itself as the gold standard technique given the best results in terms of success, recurrence and security. Objective: To evaluate the role of the VM in semen parameters of men consulting for infertility and who undergo bilateral VM compared to those VM is performed unilaterally. Materials and Methods: We enrolled patients with clinical varicocele who consulted for infertility and had altered semen analysis, in which VM was performed unilateral or bilateral depending if they had the disease in one or both sides. The average of 2 pre-operative semen parameters was used and other clinical and demographic variables and they were compared with semen parameters at 6 months post-surgery. We also compared the results of the group with unilateral versus that with bilateral VM. Results: There were no differences between groups in the pre-operative, evidence-dose improvement in both groups in analyzing the results at 6 months post-VM. This improvement was significantly greater in the group of unilateral VM regarding sperm concentration (median of 6 mill / ml, compared with 0.75 million / ml in the group of patients undergoing bilateral VM. P Value = 0.02).Discussion: VM improves seminal parameters in patients with unilateral or bilateral varicocele, being unilateral VM group that benefits the most. This could be explained by a greater cumulative damage spermatogenesis in the case of bilateral varicocele. Randomized controlled prospective studies are needed, allowing to determine the real effect of unilateral vs. bilateral VM.

Micoplasma hominis, Ureaplasma urealyticum y bacterias aeróbicas en el semen de hombres que consultan por infertilidad / Micoplasma hominis, Ureaplasma urealyticum and aerobic bacteria present in the semen from men attending infertility service

Introducción: las infecciones en el semen humano pueden alterar la calidad espermática, y vincularse con problemas de infertilidad masculina. Objetivo: determinar la frecuencia de infecciones por Micoplasma hominis, Ureaplasma urealyticum y bacterias aeróbicas en el semen de hombres que consultan por infertilidad, e identificar si existe relación entre las infecciones encontradas y las alteraciones en las variables de calidad del semen. Métodos: se realizó un estudio descriptivo transversal, para evaluar muestras de semen de 140 hombres, con edades entre 20 y 45 años, provenientes de las consultas de infertilidad del Instituto Nacional de Endocrinología. Se realizó un espermograma completo, que incluyó leucocitospermia, siguiendo los lineamientos de la OMS, para determinar las variables cualitativas y cuantitativas del semen. Las muestras de semen fueron cultivadas en agar sangre y agar chocolate a 37° C en atmósfera de CO2 para investigar bacterias aeróbicas, y se utilizó un juego de reactivos (Mycoplasma System Plus) que permite realizar el cultivo, la identificación, el conteo semicuantitativo y el antibiograma de micoplasmas/ureaplasma urogenitales. Se tuvo en cuenta los aspectos éticos, y los resultados obtenidos se analizaron mediante cálculo de por cientos y la aplicación de la prueba de chi cuadrado. Resultados: de las 140 muestras de semen evaluadas, 58 (41,4 por ciento) mostraron la presencia de infecciones, de ellas 37 correspondieron a Ureaplasma urealyticum (25,7 por ciento), 2 a Micoplasma hominis (1,4 por ciento) y 19 a bacterias aeróbicas (13,8 por ciento ). Al comparar las variables cualitativas y cuantitativas del semen con los sujetos infectados y no infectados, no se observaron diferencias estadísticamente significativas en ninguna de las variables de calidad espermática evaluadas. Conclusiones: la frecuencia total de infecciones, en la muestra estudiada, fue relativamente alta, pero no asociada a alteraciones en las variables seminales(AU)

Introduction: human semen infections can alter the sperm quality and be associated to male infertility disorders. Objectives: to determine the frequency of infections from Micoplasma hominis, Ureaplasma urealyticum and other aerobic bacteria in the semen of men who attended the infertility service, and to identify whether there is some relation between the detected infections and the altered semen quality variables or not. Methods: a cross-sectional descriptive study was performed to evaluate semen samples from 140 men aged 20 to 45 years, who attended the infertility service at the National Institute of Endocrinology. According to the WHO guidelines, a complete spermiogram including leukocytospermia was performed in order to determine the qualitative and quantitative variables in the semen. The semen samples were cultured in blood agar and in chocolate agar at 37oC under CO2 environment to find out possible aerobic bacteria. To this end, a set of reagents known as Mycoplasma System Plus was used, allowing the culture, the identification, the semi-quantitative count and the antibiogram of urogenital mycoplasms/ureaplasms. The ethical aspects were allowed for; the results were analyzed through percentage estimations and the chi square test. Results: out of the 140 evaluated semen samples, 58 (41.4 percent) showed some infection, 37 of them were caused by Ureaplasma urealyticum (25.7 percent), 2 by Micoplasma hominis (1.4 percent) and 19 by the aerobic bacteria (13.8 percent). When making a comparison of the qualitative and quantitative variables of the semen from infected and non-infected subjects, there were not any statistically significant differences in the evaluated variables of the sperm quality. Conclusions: the total frequency of infections in the studied sample was relatively high, but was not associated to altered seminal variables(AU)

Infección seminal y su relación con los parámetros espermáticos en varones de parejas infértiles del Servicio de Bioquímica, Hospital Nacional Arzobispo Loayza / Seminal infection and its relation with sperm parameters in men of infertile couples in the Service of Biochemistry, National Hospital Arzobispo Loayza

La infertilidad es un problema común, cuya incidencia varía notablemente, generalmente afecta a 1 de cada 6 y cerca del 50 por ciento se debe al factor masculino. Las infecciones genitales son una causa potencial, que puede afectar no sólo a la función espermática, sino a la espermatogénesis. En el Perú, existen muy pocos trabajos que evalúen la influencia de la infección seminal en la calidad espermática en hombres con problemas de infertilidad, en el presente estudio se determinará la relación entre la infección seminal y los parámetros espermáticos, con el fin de saber qué consecuencia traería el aislamiento de microorganismos en los parámetros espermáticos, además conocer cuál es el agente más aislado y la prevalencia de infección genital en el grupo estudiado, y de esta manera contribuir al diagnóstico de los pacientes con problemas de infertilidad. Se evaluaron 180 muestras de semen de varones que se realizaron la prueba de espermatograma como parte del estudio de la pareja infértil, en el Servicio de Bioquímica del Departamento de Patología Clínica y Banco de Sangre del Hospital Nacional Arzobispo Loayza en el periodo de octubre del 2012 a marzo del 2013. Se valoraron parámetros seminales como volumen, licuefacción, viscosidad, pH, leucocitospermia, motilidad, concentración espermática, morfología y fructosa seminal, según criterios de la Organización Mundial de la Salud (2010). La evaluación microbiológica se realizó mediante cultivos de semen. La edad promedio en el grupo fue de 38 años. Sólo 31 por ciento de las muestras evaluadas presentaron parámetros espermáticos dentro de la normalidad, los parámetros más afectados fueron la concentración de fructosa seminal (42 por ciento) y el aumento de la viscosidad seminal (37 por ciento). El 22 por ciento de las muestras analizadas presentó algún tipo de infección seminal, este porcentaje de aislamiento fue bajo en comparación con otros estudios. El germen más frecuentemente aislado fue el Enterococcus spp...

Significant effects of smoking habit on male fertility

Smoking is a common health problem worldwide. Many diseases and life threatening conditions have been linked to smoking habits, such as, lung cancer, oral cancer, bronchitis and several gastrointestinal disorders. Infertility link to smoking is still under intensive investigation. To evaluate the effect of smoking on semen parameters of infertile Bahraini males. Open controlled trial. Department of Molecular Medicine, CMMS, Princess Al-Jawhara Center for Molecular Medicine, Genetics and Inherited Diseases, Arabian Gulf University, Bahrain. Semen samples from 52 infertile patients were analyzed by conventional analysis methods, sperm chromatin dispersion test for sperm DNA integrity and colorimetric assay for total antioxidant capacity. Twenty-two [42.3%] were smokers of the study group. The data showed that smokers had more semen analysis abnormalities than the non-smokers. Smokers had more sperm with fragmented DNA than non-smokers [x2=6.17; P<0.002]. Our study used conventional and molecular techniques to investigate male infertility in Bahraini patients and demonstrated that smoking is a contributing factor in the etiology of male infertility

The epidemiology and etiology of azoospermia

The misconception that infertility is typically associated with the female is commonly faced in the management of infertile men. It is uncommon for a patient to present for an infertility evaluation with an abnormal semen analysis report before an extensive female partner workup has been performed. Additionally, a man is usually considered fertile based only on seminal parameters without a physical exam. This behavior may lead to a delay in both the exact diagnosis and in possible specific infertility treatment. Moreover, male factor infertility can result from an underlying medical condition that is often treatable but could possibly be life-threatening. The responsibility of male factor in couple's infertility has been exponentially rising in recent years due to a comprehensive evaluation of reproductive male function and improved diagnostic tools. Despite this improvement in diagnosis, azoospermia is always the most challenging topic associated with infertility treatment. Several conditions that interfere with spermatogenesis and reduce sperm production and quality can lead to azoospermia. Azoospermia may also occur because of a reproductive tract obstruction. Optimal management of patients with azoospermia requires a full understanding of the disease etiology. This review will discuss in detail the epidemiology and etiology of azoospermia. A thorough literature survey was performed using the Medline, EMBASE, BIOSIS, and Cochrane databases. We restricted the survey to clinical publications that were relevant to male infertility and azoospermia. Many of the recommendations included are not based on controlled studies.

Hypogonadotropic Hypogonadism Revisited

Impaired testicular function, i.e., hypogonadism, can result from a primary testicular disorder (hypergonadotropic) or occur secondary to hypothalamic-pituitary dysfunction (hypogonadotropic). Hypogonadotropic hypogonadism can be congenital or acquired. Congenital hypogonadotropic hypogonadism is divided into anosmic hypogonadotropic hypogonadism (Kallmann syndrome) and congenital normosmic isolated hypogonadotropic hypogonadism (idiopathic hypogonadotropic hypogonadism). The incidence of congenital hypogonadotropic hypogonadism is approximately 1-10:100,000 live births, and approximately 2/3 and 1/3 of cases are caused by Kallmann syndrome (KS) and idiopathic hypogonadotropic hypogonadism, respectively. Acquired hypogonadotropic hypogonadism can be caused by drugs, infiltrative or infectious pituitary lesions, hyperprolactinemia, encephalic trauma, pituitary/brain radiation, exhausting exercise, abusive alcohol or illicit drug intake, and systemic diseases such as hemochromatosis, sarcoidosis and histiocytosis X. The clinical characteristics of hypogonadotropic hypogonadism are androgen deficiency and a lack/delay/stop of pubertal sexual maturation. Low blood testosterone levels and low pituitary hormone levels confirm the hypogonadotropic hypogonadism diagnosis. A prolonged stimulated intravenous GnRH test can be useful. In Kallmann syndrome, cerebral MRI can show an anomalous morphology or even absence of the olfactory bulb. Therapy for hypogonadotropic hypogonadism depends on the patient's desire for future fertility. Hormone replacement with testosterone is the classic treatment for hypogonadism. Androgen replacement is indicated for men who already have children or have no desire to induce pregnancy, and testosterone therapy is used to reverse the symptoms and signs of hypogonadism. Conversely, GnRH or gonadotropin therapies are the best options for men wishing to have children. Hypogonadotropic hypogonadism is one of the rare conditions in which specific medical treatment can reverse infertility. When an unassisted pregnancy is not achieved, assisted reproductive techniques ranging from intrauterine insemination to in vitro fertilization to the acquisition of viable sperm from the ejaculate or directly from the testes through testicular sperm extraction or testicular microdissection can also be used, depending on the woman's potential for pregnancy and the quality and quantity of the sperm.