[First-line management of infertile couple. Guidelines for clinical practice of the French College of Obstetricians and Gynecologists 2022]. / Prise en charge de première intention du couple infertile : mise à jour des RPC 2010 du CNGOF.

OBJECTIVE: To update the 2010 CNGOF clinical practice guidelines for the first-line management of infertile couples. MATERIALS AND METHODS: Five major themes (first-line assessment of the infertile woman, first-line assessment of the infertile man, prevention of exposure to environmental factors, initial management using ovulation induction regimens, first-line reproductive surgery) were identified, enabling 28 questions to be formulated using the Patients, Intervention, Comparison, Outcome (PICO) format. Each question was addressed by a working group that had carried out a systematic review of the literature since 2010, and followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) methodology to assess the quality of the scientific data on which the recommendations were based. These recommendations were then validated during a national review by 40 national experts. RESULTS: The fertility work-up is recommended to be prescribed according to the woman's age: after one year of infertility before the age of 35 and after 6months after the age of 35. A couple's initial infertility work-up includes a single 3D ultrasound scan with antral follicle count, assessment of tubal permeability by hysterography or HyFOSy, anti-Mullerian hormone assay prior to assisted reproduction, and vaginal swabbing for vaginosis. If the 3D ultrasound is normal, hysterosonography and diagnostic hysteroscopy are not recommended as first-line procedures. Chlamydia trachomatis serology does not have the necessary performance to predict tubal patency. Post-coital testing is no longer recommended. In men, spermogram, spermocytogram and spermoculture are recommended as first-line tests. If the spermogram is normal, it is not recommended to check the spermogram. If the spermogram is abnormal, an examination by an andrologist, an ultrasound scan of the testicles and hormonal test are recommended. Based on the data in the literature, we are unable to recommend a BMI threshold for women that would contraindicate medical management of infertility. A well-balanced Mediterranean-style diet, physical activity and the cessation of smoking and cannabis are recommended for infertile couples. For fertility concern, it is recommended to limit alcohol consumption to less than 5 glasses a week. If the infertility work-up reveals no abnormalities, ovulation induction is not recommended for normo-ovulatory women. If intrauterine insemination is indicated based on an abnormal infertility work-up, gonadotropin stimulation and ovulation monitoring are recommended to avoid multiple pregnancies. If the infertility work-up reveals no abnormality, laparoscopy is probably recommended before the age of 30 to increase natural pregnancy rates. In the case of hydrosalpinx, surgical management is recommended prior to ART, with either salpingotomy or salpingectomy depending on the tubal score. It is recommended to operate on polyps>10mm, myomas 0, 1, 2 and synechiae prior to ART. The data in the literature do not allow us to systematically recommend asymptomatic uterine septa and isthmoceles as first-line surgery. CONCLUSION: Based on strong agreement between experts, we have been able to formulate updated recommendations in 28 areas concerning the initial management of infertile couples.

Association of Overweight and Obesity with Semen Parameters and Metabolic and Hormonal Status in Young Men.

We evaluated possible associations of overweight and obesity with semen parameters, sperm DNA fragmentation (SDF), and different indicators of metabolic and hormonal status in young men (n=226, mean age 22.5 years). Overweight and obese men were found to have a significant deterioration of metabolic health, reduced total sperm count and concentration, serum testosterone, and inhibin B levels, and increased serum leptin and seminal zinc levels in comparison with men with normal weight, although sperm DNA fragmentation, motility, and morphology did not change. In overweight and obese men, increased seminal zinc content appears to perform a protective function via reduction of oxidative stress caused by excess body fat. It is assumed that in the absence of individual lifestyle correction and weight loss for a long time, obese subjects are not protected from the development of reproductive comorbidities, in particular, subfertility and infertility.

[Epidemio-clinical and seminal profile of the man consulting for the desire to procreate: current situation in Lubumbashi, in the Democratic Republic of Congo]. / Profil épidémio-clinique et séminal de l'homme consultant pour désir de procréation: état des lieux à Lubumbashi, en République Démocratique du Congo.

Introduction: in Lubumbashi, as in upscale areas where explorations of fertility are very clever, the spermogram remains the essential analysis in the diagnosis of male infertility. This is the cause of 40% of couple infertility. The spermogram is the first step in identifying seminal abnormalities. The objective of this study was to determine the epidemiological-clinical and seminal profile of the man consulting for the desire to procreate in Lubumbashi. Methods: this was a cross-sectional study. We received 202 subjects in Lubumbashi, whose spermogram was performed from August 1st, 2020 to July 31st, 2021. The semen parameters were studied and interpreted according to WHO standards (2010) with studies of factors associated with their disturbance. Bivariate and multivariate analyzes had been carried out. The statistical significance threshold was set at p < 0.05. Results: the epidemiological-clinical profile of the respondents was as follows: the most represented age group was 30 to 39 years; infertility was primary in 80.69% of cases; the duration of the desire for paternity was 2 years at most in 44.55% of cases. The sperm abnormalities found were: oligozoospermia (40.09%), azoospermia (11.38%), asthenozoospermia (18.31%) and teratozoospermia (10.39%). Oligozoospermia was significantly associated with varicocele (ORa = 10.9 [3.0-39.5]; p < 0.0001), genital infection (ORa =2.7 [1.0-7, 2]; p = 0.041) and obesity (ORa = 2.6 [1.0-7.9]; p = 0.020) while azoospermia was the cure for inguinal hernia (ORa = 4.2 [1.0-17.2]; p = 0.049) and malnutrition (ORa =6.0 [1.2-29.7]; p = 0.027). Asthenozoospermia was significantly associated with the age group of 40 to 49 years (ORa = 6.6 [1.2-37.4]; p = 0.034), tobacco (ORa =7.5 [2.7 -21.0]; p = 0.000), undernutrition (ORa = 7.7 [1.0-61.9]; p = 0.045) and overweight (ORa =3.8 [1.3-11, 5]; p=0.019). Teratozoospermia was significantly associated with smoking (ORa = 5.6 [1.8-17.7]; p = 0.003) and overweight (ORa =5.3 [1.2-23.3]; p = 0.027). Conclusion: more than half of the respondents had, of the three main fertility parameters, at least one that was disturbed. Sperm count was the most affected parameter. Alcohol, tobacco, genital infection and malnutrition were the most common risk factors for the abnormalities observed.

Hormonal, clinical, and genetic profile of infertile patients with azoospermia in Morocco.

Introduction: azoospermia affects more than 10%-15% of infertile male subjects attending the infertility center. In Morocco, there have been no studies on male infertility with azoospermia. Thereby, our objective was to evaluate the clinical, hormonal, and genetic characteristics of infertile men with azoospermia in Morocco. Methods: we conducted a retrospective descriptive study performed with a convenience sample of 80 infertile men from 2021 to 2022, in the Assisted Reproductive Technology Unit of the Mohammed VI University Hospital Center in Oujda-Morocco. All patients with azoospermia were subjected to a quantitative hormone assay to evaluate the functionality of the sertolic and leydigial compartments. Human karyotyping and AZF microdeletion analysis are routinely performed in azoospermic patients. Results: the results show that the mean age of patients in the study was 45.7 ± 3.5 years. Primary infertility accounts for the majority, with a rate of 96% (n=77). There were 12 cases of azoospermia of secretory origin, 22 cases of excretory origin, and 3 of undetermined origin. Azoospermia was associated with hydrocele in 29% (n=27) of cases. The average levels of FSH, LH, testosterone, and inhibin B were 15.54 ± 5.5 mIU/mL, 7.71 ± 2.7 mIU/mL, 405.09 ± 6.13 ng/dl and 38.44 ± 5.13 pg/ml, respectively. The prevalence of chromosomal abnormalities was 30.7%. Of these, the sex chromosome aneuploidy with 47, XXY karyotype (Klinefelter syndrome) accounted for 11% (n=9). The incidence of microdeletions of azoospermia factors (AZF) was 9%, and AZFc deletion was the most common at the rate of 3%. Conclusion: our research shows that hydrocele, varicocele, and chromosomal abnormalities are the leading causes of azoospermia. In the Moroccan population, azoospermia is essentially of excretory origin.

[Spermiological Study Of Patients Treated For Infertility At The Medical Biology Laboratory Of Sikasso Hospital]. / Etude Spermiologique Chez Les Patients Suivis Pour Infertilite Au Laboratoire De Biologie Medicale De l'Hopital De Sikasso.

AIM: The aim of this study was to establish the spermiological profile of patients treated for infertility at Sikasso Hospital. MATERIAL AND METHODS: This was a prospective descriptive cross-sectional study, which took place from January to December 2022 at Sikasso Hospital. Interpretation of spermiological parameters was based on standards established by the World Health Organization in 2010. RESULTS: We enrolled 41 patients, 51.22% of whom had disturbed spermiological parameters. The abnormalities were azoospermia (21.92%), asthenooligozoospermia (12.20%), asthenozoospermia (7.32%), oligozoospermia (7.32%) and asthenonecrozoospermia (2.44%). These anomalies were mainly observed in the 34-44 age group (47.62%). CONCLUSION: This study revealed significant disturbances in spermiological parameters, with azoospermia being the most frequent abnormality.

BUT: L'objectif de cette étude était d'établir le profil spermiologique des patients suivis pour infertilité à l'hôpital de Sikasso. MATÉRIEL ET MÉTHODES: Il s'agissait d'une étude transversale prospective descriptive, qui s'est déroulée de janvier à décembre 2022 à l'hôpital de Sikasso. L'interprétation des paramètres spermiologique a fait recours aux normes établies par l'Organisation mondiale de la santé en 2010. RESULTATS: Nous avons colligé 41 patients dont 51,22% avaient ses paramètres spermiologiques perturbés. Les anomalies étaient l'azoospermie (21,92%), l'asthénooligozoospermie (12,20%), l'asthénozoospermie (7,32%), l'oligozoospermie (7,32 %) et l'asthénonécrozoospermie (2,44 %). Ces anomalies étaient observées majoritairement dans la tranche d'âge 34-44 ans avec 47,62%. CONCLUSION: cette étude a révélé des perturbations importantes des paramètres spermiologiques et l'azoospermie a constitué l'anomalie la plus fréquente.

Etude spermiologique chez les patients suivis pour infertilité au laboratoire de biologie médicale de l'hôpital de Sikasso / Spermiological study of patients treate infertility at the medical biology laboratory of Sikasso Hospital

But : L'objectif de cette étude était d'établir le profil spermiologique des patients suivis pour infertilité à l'hôpital de Sikasso. Matériel et méthodes : Il s'agissait d'une étude transversale prospective descriptive, qui s'est déroulée de janvier à décembre 2022 à l'hôpital de Sikasso. L'interprétation des paramètres spermiologique a fait recours aux normes établies par l'Organisation mondiale de la santé en 2010. Resultats : Nous avons colligé 41 patients dont 51,22% avaient ses paramètres spermiologiques perturbés. Les anomalies étaient l'azoospermie (21,92%), l'asthénooligozoospermie (12,20%), l'asthénozoospermie (7,32%), l'oligozoospermie (7,32 %) et l'asthénonécrozoospermie (2,44 %). Ces anomalies étaient observées majoritairement dans la tranche d'âge 34-44 ans avec 47,62%. Conclusion : cette étude a révélé des perturbations importantes des paramètres spermiologiques et l'azoospermie a constitué l'anomalie la plus fréquente.

Aim: The aim of this study was to establish the spermiological profile of patients treated for infertility at Sikasso Hospital. Material and methods: This was a prospective descriptive cross-sectional study, which took place from January to December 2022 at Sikasso Hospital. Interpretation of spermiological parameters was based on standards established by the World Health Organization in 2010. Results: We enrolled 41 patients, 51.22% of whom had disturbed spermiological parameters. The abnormalities were azoospermia (21.92%), asthenooligozoospermia (12.20%), asthenozoospermia (7.32%), oligozoospermia (7.32%) and asthenonecrozoospermia (2.44%). These anomalies were mainly observed in the 34-44 age group (47.62%). Conclusion: This study revealed significant disturbances in spermiological parameters, with azoospermia being the most frequent abnormality

[Vitamin B12 is a diagnostic marker of decreased men reproductive function]. / Vitamin B12 kak diagnosticheskii marker snizheniia reproduktivnoi funktsii u muzhchin.

Although the relationship between the amount of vitamin B12 and the quality of sperm exists, but results are controversial and require several additional research. The objective of our study was to analyse the amount of vitamin B12 in the sperm samples from patients with chronic prostatitis and varicocele with accompanying asthenozoospermia, and to identify the relationship between the amount of vitamin B12 and asthenozoospermia. The research was carried out of men with chronic prostatitis and varicocele with accompanying asthenozoospermia and infertility at the age of 27±2 years. The material of the investigation was spermoplasm. A chemical microscopic examination of the ejaculate was carried out with a sperm analyzer and with the light microscopy. The amount of vitamin B12 in the spermoplasm was determined by the method of competitive ELISA. It was found that the level of vitamin B12 was 3.6 times lower in patients with chronic prostatitis III B and asthenozoospermia then in the control group. Among patients with varicocele of II and III grade and asthenozoospermia, the level of vitamin B12 was 4.4 times lower than in control group. A positive correlation relationship of average strength was revealed (r=0,683; p=0,001). Additionally, it was revealed that among patients with Chronic prostatitis III B and varicocele of II and III grades with accompanying asthenozoospermia, there was the positive correlation relationship of average strength (r=0,690; p=0,001) between the amount of vitamin B12 and sperm mobility. A decrease in vitamin B12 levels may serve as a marker of reproductive dysfunction in men.

[Dynamics of sperm indicators in men with chronic prostatitis associated with secondary infertility based on the use of ANDROEXPERT SV1 suppositories].

INTRODUCTION: Chronic prostatitis (CP) is the most common cause of a disorder of not only sexual, but also reproductive functions in men, which is caused by a decrease in the quality of the ejaculate and is confirmed by a deterioration in spermogram parameters, up to oligoasthenoteratozoospermia and azoospermia. In such a situation, the onset of pregnancy in the natural cycle is impossible - even with a completely preserved reproductive function in a woman. As an active substance in the recovery of men with chronic prostatitis associated with secondary infertility, we proposed oxidised dextran in the form of a pharmaceutical composition, which was developed at Federal Research Centre for Fundamental and Translational Medicine, Novosibirsk, Russia; and produced by ANDROEXPERT Research and Manufacturing Company LTD, Novosibirsk, Russia. The purpose of the study was to evaluate the dynamics of spermogram parameters as a result of the use of suppositories with oxidised dextran "ANDROEXPERT SV1" in men with chronic prostatitis associated with secondary infertility. MATERIAL AND METHODS: The study included 52 patients with chronic prostatitis associated with secondary infertility. The mean age of the patients was 32+/-2.2 years. The examination of patients was carried out in accordance with the algorithm recommended by the Russian Society of Urology, the European Urological Association and the standard of primary health care for chronic prostatitis (Appendix to the order of the Ministry of Health of Russia No. 775n of 09.11.2012). The patients were divided into two groups: the 1st group of patients received oxidised dextran rectally once per day for 10 days, then 20 days every other day; The 2nd (comparison group) received a placebo in the form of rectal suppositories consisting of cocoa butter in a similar way. RESULTS: The volume of ejaculate among patients of the 1st group increased from 2.54+/-0.15 to 3.13+/-0.18 (ml), which amounted to 23.23%; p<0.05. The sperm concentration indicator increased from 26.40+/-4.18 to 41.12+/-5.37 (million/ml) - by 55.75%; p<0.05, which led to an increase in the total number of spermatozoa in the ejaculate by 88.5%, from 65.47+/-8.41 to 123.41+/-12.33 (million pieces); p<0.05. The number of leukocytes in the same group decreased by 2.8 times: from 1.25+/-0.17 to 0.44+/-0.10 (million/ml) - by 64.80%; p<0.05. The indicator of the severity of sperm agglutination decreased by 3 times: from 0.52+/-0.07 to 0.17+/-0.03 - by 0.35 arb. units, which was 67.31%; p<0.05. The indicators of the spermogram in patients with chronic prostatitis of the second group did not change in the course of treatment. CONCLUSION: Assessing the dynamics of spermogram parameters as a result of the use of "ANDROEXPERT SV1" in men with chronic prostatitis associated with secondary infertility, there is a decrease in the number of leukocytes and a significant improvement in the parameters of the ejaculate, both its general properties and the main characteristics of spermatozoa. Thus, ANDROEXPERT SV1 suppositories show high clinical efficacy and safety in monotherapy and may be promising when choosing the management tactics for this group of patients.

Comparison of spermatic and peripheral blood gases and their correlation with spermogram pattern and varicocele grade in patients with a varicocele.

The relationship between infertility and varicocele is still a controversial topic. This study aimed to find the association between the venous blood gas (VBG) pattern of the spermatic veins and peripheral veins with varicocele grade and spermogram variables in infertile patients. A total of 47 patients with a varicocele were enrolled in this study. Blood samples were drawn simultaneously from the spermatic vein and a peripheral vein. The pH, partial pressure of oxygen, the partial pressure of carbon dioxide, oxygen saturation, and bicarbonate values of these samples were analysed. The mean age of participants was 30.48 ± 6.08. The mean volume of semen was 3.92 ± 1.57 mL, and the mean semen pH was 7.88 ± 0.22. The pH was higher (p < 0.01) in the spermatic vein compared with the peripheral vein. However, level of other parameters including pO2 (p = 0.662), pCO2 (p < 0.001), HCO3 concentration of serum (p < 0.01), and base excess (p = 0.172) were lower in the spermatic vein in comparison with the peripheral vein. Correlations between VBGs determinants of the varicocele patients' spermatic vein and sperm morphology and motility were insignificant. In conclusion, although the clinical significance of VBGs is evident, there are limited studies that investigated the VBGs in varicocele patients. We should consider that the deviation in blood gases may be the missing piece in the puzzle to understand the pathophysiology of varicocele. By knowing the pathophysiology more precisely, we can better decide the ideal treatment option for the patients.

[Varicocele and reproductive function: epidemiology and infertility risk (the eamination of 3632 patients)].

Varicocele does not always lead to infertility; varicocelectomy does not always improve sperm. THE STUDY OBJECTIVE: to evaluate the quantitative correlation between varicocele and reproductive function with a large sample. DESIGN: a cross-sectional and case control study. MATERIALS AND METHODS: 3632 patients from infertile couples and 276 fertile males. The ejaculate was tested following WHO recommendations (2010), DNA fragmentation was evaluated with chromatin dispersion in agarose gel. RESULTS: we found weak correlation between varicocele degree (VD) and the spermogram parameters: -0.11 for concentration (<0.001), -0.08 for progressively motile sperm count (PMSC) in the ejaculate (<0.001), 0.11 for DNA fragmentation (<0.01), correlation with other parameters was insignificant (p>0.05). The clinical varicocele (V) prevalence in the fertile (F) and the infertile (I) males was the same: 27.2% (75/276) in the F, 31.4% (101/322) in the I1 with oligoasthenotertozoospermia (OAT) syndrome, 34.4% (43/125) in the I2 with OAT (p>0.05). In the general sample of the males from infertile couples V was found insignificantly more frequently in the I2 than in the I1 31.6% (426/1348) and 28.1% (641/2284), respectively (OR=1.13; p<0.05), because of degree 1 varicocele: 23.5% 20.2%, respectively (OR=1.16; p<0.05). Compared to the males without varicocele, median concentration is 8 mln/ml less in degree I,17mln/ml in degree II and 24 mln/ml in degree III (p<0.001); we found parallel increase in oligozoospermia rate: from 14% without varicocele to 27 and 26% in degree II and III (p<0.05-0.01). The PMSC in degree I varicocele is 10 mln less (-16% of the group without varicocele),in degree II 27 mln less (-44%), in degree III 23 mln less (-38%) (<0.001); the difference between the groups with degrees II and III is insignificant (p>0.05). The DNA fragmentation was significantly lower only in degree III (p<0.05). We found no difference in the sperm motility and morphology among the groups (p>0.05). CONCLUSION: In varicocele, the sperm count decreases but in of cases, concentration is within reference values; there is no difference between degree II and III. The sperm motility and morphology do not depend upon varicocele. The DNA fragmentation is increased in degree III varicocele. The relative risk of infertility in varicocele is low (OR is less or equal 1.13).

[Varicocele and reproductive function: pathozoospermia treatment (a prospective comparative study)].

Varicocele does not always lead to infertility; varicocelectomy does not always improve sperm. OBJECTIVE: to evaluate the standardized effect (Es) of nutrient therapy, microsurgical and laparoscopic varicocelectomy for pathozoospermia. STUDY DESIGN: a multicenter case-control study with stratified randomization. MATERIALS AND METHODS: data of a clinical and laboratory examination of patients with clinical varicocele over a 3-month period in the groups: A) the observation/control group (n=33), B) the group treated with nutrients (n=63), C) the group of patients after microsurgical varicocelectomy with a subinguinal mini access (n=86), D) the group of patients following laparoscopic surgery (n=36). The ejaculate was evaluated according to WHO-2010, DNA fragmentation by chromatin dispersion in an agarose gel. RESULTS: After 3 months, varicocelectomy leads to an increase in sperm concentration and motility: the median of the total number of progressively motile spermatozoa in the ejaculate in A is +0.4 million; B - +1.9 million; C - +17.1 million (p<0.05); D - +21.2 million (p<0.05). A clinically significant increase in this indicator after varicocelectomy was found in 2/3 of cases: 65% (B; p<0.05) and 67% (G; p<0.05) with 38% (A) and 42% (B). Varicocelectomy leads to a decrease in sperm DNA fragmentation by an average of 5.5% (p<0.05) with an improvement in 59% of patients, but a 3-month therapy with nutrients reduces DNA fragmentation in a similar way: 5.5% (p<0.05), 66% of improvement cases. The differences in effect between B and D are insignificant (p>0.05). The laparoscopic surgery demonstrated higher Es than microsurgical operation (Es=0.70 and 0.44, with 0.29 in the patient receiving nutrients and 0.22 in the patients in the control group) Conclusion Varicocelectomy significantly improves sperm quality in 2/3 of cases, including 5.5% decrease in DNA fragmentation. Nutrient therapy produces similar DNA fragmentation improvement. Further research is necessary to identify who really requires varicocelectomy and who does not.

[Age changes in spermogram and fertilizing capacity of spermatosides in persons 26-47 years old.]

The work is devoted to the analysis of age-related changes in human spermatozoa and their functional properties in men aged 26-47 years. The work used ejaculate obtained from 54 men as part of the in vitro fertilization procedure. The patients were divided into three groups (26-29, 30-34 and over 35 years old). In the course of the work, the parameters of the spermogram were collected, as well as the results of assessing the viability of spermatozoa, obtained using the method of flow cytometry, and also a retrospective analysis of the effectiveness of in vitro fertilization was carried out. It was found that the average values of spermogram parameters in groups were within the physiological norm, however, about 59% of patients had individual deviations in terms of 1-3 indicators. Cytometric analysis revealed a rapid increase with age in functional disorders of spermatozoa, affecting the recognition and penetration apparatus (acrosome), the energy apparatus of the cell (its mitochondrion) and the density of chromatin in its nucleus. The result is a decrease in the probability of fertilization from 88% at 26-29 years old to 61% after 35 years, even with in vitro fertilization. The significance of the results obtained for the analysis of age-related changes in the male reproductive system and the practice of treating male infertility is substantiated.

[Prevalence of male infertility in a university hospital in Morocco]. / Prévalence de l´infertilité masculine dans un hôpital universitaire au Maroc.

INTRODUCTION: infertility in couples has become a public health problem in recent years. It can be related to a problem in the male, female or both. Men infertility accounts for 40% of cases. In Morocco, most studies have focused on the causes and risk factors for male infertility. The purpose of our study was to assess the prevalence of male infertility and semen parameters in infertile men or in men at high risk of developing infertility in a tertiary hospital in Rabat. METHODS: we conducted an analysis of 482 patients referred for evaluation of infertility in the couple or as part of preoperative assessment of varicocele or testicular ectopia. Demographic data, risk factors for infertility, primary or secondary infertility were recorded for each patient. Semen parameters were assessed and interpreted according to WHO standards updated in 2010 based on studies of factors associated with their disturbance. RESULTS: the average age of patients was 35.35±8.81 years. Primary infertility was found in 61.8% of cases. The most common risk factors for infertility were tobacco followed by varicocele and infection. Spermogram was altered in 53.1% of cases. The most common abnormality was sperm vitality issues (36.9%) followed by spermatic concentration (29.7%) and morphology (29.3%). Age was the unique factor which had a significant impact on spermogram (p=0.002). Abnormalities in mobility were detected in patients ≥31 years, sperm vitality issues in patients aged 34 years, abnormalities in morphology in patients aged 35 years and concentration in patients aged 37 years. Azoospermia was found in 16.4% of cases and was mainly associated with primary infertility. Oligo-astheno-teratozoospermia was the most common association (26.2%). CONCLUSION: male infertility is common in our context. The major risk factor is age. Mobility is the earliest parameter achieved.

[AFU and SALF recommendations for the evaluation of male infertility]. / Recommandations de l'AFU et de la SALF concernant l'évaluation de l'homme infertile.

BACKGROUND: The aim of these Association Française d'Urologie (AFU) and Société d'Andrologie de Langue Française (SALF) common recommendations are to provide practice guidelines for the French Urological and Andrological community regarding the evaluation of infertile men. MATERIAL AND METHODS: Literature search in PubMed using the keywords "male infertility", "diagnosis", "management" and "evaluation" limited to clinical articles in English and French prior to 1/01/2020. To inform the level of evidence, the HAS grading system (2013) was applied. RESULTS: Concerning the evaluation of infertile men, the AFU and the SALF recommend : (1) a systematic interview exploring the family history, the fertility history of the man outside the couple, the patient's personal history that may have an impact on his fertility, lifestyle habits, treatments, symptoms and possible sexual difficulties of the couple; (2) a general physical examination to assess signs of hypogonadism and secondary sexual characters; (3) a scrotal physical examination performed by an urologist or andrologist to assess (i) the testes for volume and consistency, (ii) vas deferens and epididymes for total or partial absence or nodules, and (iii) presence of varicoceles; (4) Performing two semen analyses, according to World Health Organization guidelines, if the first one has at least one abnormaly; (5) a scrotal ultrasound as part of routine investigation, that can be completed with an endorectal pelvic ultrasound according to the clinic; (6) an endocrine evaluation with at least a Testosterone and FSH serum determination; (7) Karyotype analysis in infertile men with a sperm concentration ≤10 106/mL; (8) assessment of Yq microdeletions in infertile men with a sperm concentration ≤1 106/mL; (9) Cystic fibrosis transmembrane conductance regulator gene evaluation in case of suspicion for bilateral or unilateral congenital agenesis of vas deferens and seminal vesicles. The interest of tests analyzing DNA fragmentation (TUNEL, SCSA) is still under investigation. CONCLUSION: These guidelines can be applied in routine clinical practice in all infertile men.

Associations of Major Dietary Patterns and Dietary Diversity Score with Semen Parameters: A Cross-Sectional Study in Iranian Infertile Men.

BACKGROUND: This cross-sectional study pointed to assess the relationship between major dietary patterns and dietary diversity score with semen parameters, in infertile Iranian males. MATERIALS AND METHODS: In this cross-sectional study, 260 infertile men (18-55 years old) who met the inclusion criteria, entered the study. Four Semen parameters, namely sperm concentration (SC), total sperm movement (TSM), normal sperm morphology (NSM) and sperm volume were considered according to spermogram. A 168-item food frequency questionnaire (FFQ) was used to collect dietary intakes and calculate dietary diversity score. Factor analysis was used to extract dietary patterns. RESULTS: The following four factors were extracted: "traditional pattern", "prudent pattern", "vegetable-based pattern" and "mixed pattern". After adjusting potential confounders, those in the highest quartile of the traditional pattern had 83% less odds for abnormal concentration, compared with the first quartile (OR=0.17, 95% CI: 0.04-00.73); however, subjects in the highest quartile of this pattern had 2.69 fold higher odds for abnormal sperm volume as compared with those of the first quartile (95%Cl: 1.06-6.82). Men in the second quartile of prudent pattern had 4.36 higher odds of an abnormal sperm volume in comparison to the reference category (95%CI: 1.75-10.86), after considering potential confounders. With regard to mixed pattern, men in the second, third and fourth quartile of this pattern had respectively 85 (5%Cl: 0.03-0.76,), 86 (95%Cl: 0.02-0.75) and 83 % (95%Cl: 0.034-0.9) less odds of abnormal concentration, compared with the first quartile. Additionally, no significant association was found between dietary diversity score and sperm quality parameters. CONCLUSION: Higher intake of the traditional diet was linked to lower abnormal semen concentration and poorer sperm volume. Also, the mixed diet was associated with reduced prevalence of abnormal semen concentration.

Dynamics of functional condition seedmans and liver in men with infertility under the influence of arginin therapy with the complex of L-carnitin and betainе.

OBJECTIVE: The aim of this work was to study the hormonal status androgen-dependent indicators of the ejaculate, spermatogram parameters and liver transaminases in the blood of the infertile males for the treatment of arginine, carnitine and betaine. PATIENTS AND METHODS: Materials and methods: The parameters of spermograms, the levels of testosterone, estradiol, alanine aminotransferase and aspartate aminotransferase in the blood, and concentration of fructose in the ejaculate of 31 men with idiopathic pathospermia before and after using the L-Betargin, which contains 1 gram of arginine, 300 mg of L-carnitine and 1 gram of betaine. RESULTS: Results: It is shown that after treatment there is an increase of sperm concentration and their motility, increase the level of fructose in the ejaculate. It is established that the positive effect on spermatogenesis, L-Betargin associated with activation of endocrine function of the testes, improving the androgen-estrogen balance and functional state of the liver in men with infertility. CONCLUSION: Conclusions: The use of L-Betargin for a month in men with idiopathic pathospermia leads to an increase in the concentration of sperm and increase their motility, while normalizing all parameters of the spermogram.

Caracterización de la calidad del semen en hombres atendidos en un centro de reproducción asistida en Guayaquil, Ecuador / Description of the semen quality from men treated in an assisted reproduction center in Guayaquil, Ecuador

RESUMEN Con el objetivo de caracterizar la calidad seminal de hombres en un centro de reproducción asistida de la ciudad Guayaquil (Ecuador), se colectaron 204 muestras de semen de pacientes con problemas de fertilidad de entre 20 y 57 años, atendidos entre mayo de 2017 y septiembre de 2018. Se realizó un espermograma básico a cada muestra, siguiendo las recomendaciones del manual para la examinación y procesamiento de semen humano. El 27,4% de las muestras presentó normozoospermia. Dentro de las alteraciones la teratozoospermia fue de 27,9%, oligoteratozoospermia del 8,8%, evidenciándose mayor número en pacientes de 30 a 39 años. Un alto porcentaje de pacientes presentan una calidad del semen y morfología espermática por debajo los limites de referencia establecidos por la Organización Mundial de la Salud.

ABSTRACT In order to characterize the quality of semen from men in an assisted reproduction center in the city of Guayaquil (Ecuador), 204 semen samples were collected from patients with fertility disorders aged 20 to 57 years, who were admitted between May 2017 and September 2018. A basic spermogram was performed on each sample, following the fabricant recommendations for the examination and processing of human semen. It was found that 27.4% of the samples presented normozoospermia. Among the disorders, it was found that 27.9% had teratozoospermia, 8.8% had oligoteratozoospermia and a higher number of patients were found to be between 30 and 39 years old. A high percentage of patients presented sperm morphology and quality values below the reference limits established by the World Health Organization.

[Favorable impact of left antegrade sclerotherapy of clinical left varicocele on spermogram]. / Impact de la sclérothérapie antégrade de varicocèle gauche clinique sur le spermogramme.

OBJECTIVES: Study the early postoperative course of sperm parameters after antegrade sclerotherapy (AS) of clinical left varicocele (CLV) in men consulting for infertility with sperm disruption, and to validate the efficacy and safety of treatment. MATERIALS AND METHODS: Monocentric retrospective observational study of men with CLV, consultant in medically assisted procreation center for primary or secondary infertility of the couple. All patients were operated by SA via scrotal approach. After clinical and ultrasound checks at 6 weeks, a control spermogram was performed at 3-6 months of surgery. The following parameters were analyzed: sperm count, motility, percent of normal form, and total number of motile sperm ("total motile sperm count" [TMSC]). RESULTS: The study involved 138 men (median age 33 years) with sperm alteration. All patients benefited from AS of their CLV. No Clavian complication > 1 was observed. Postoperative control demonstrated a significant improvement in all spermogram parameters, with a median progression of 40% of the count (55 vs 32×106), 80% of the concentration (20.3 vs 11.1×106/ml), 30% of the motility (34.7% vs 26.5%), 60% of the normal form percentage (4.0 vs 2.5%) and the 75% TMSC (41.5 vs 23%), 7×106) (p<0.005). CONCLUSIONS: SA is an effective and safe technique for treating CLV and improving sperm parameters fertility indicators. Our results suggest that this treatment may be recommended to infertile men with CLV in the management of infertility of the couple. LEVEL OF EVIDENCE: 3.

[Abnormal semen analyses in men undergoing premarital screening and in infertile couples in Butembo-Democratic Republic of Congo]. / Anomalies du spermogramme en consultations prénuptiales et dans les couples infertiles à Butembo, République Démocratique du Congo.

The purpose of this study was to determine the prevalence of spermogram abnormalities in men consulting for premarital screening and in infertile couples in Butembo. We conducted a retrospective descriptive study at the Graben University Diagnostic Center. The study population consisted of 890 male subjects aged 21-57 years, of whom 779 underwent prenuptial screening and 111 subjects fertility tests. The overall prevalence of spermogram anomalies in this population was 25.8%, corresponding to a total incidence of 22.9% of premarital consultants and 46,0% of males in infertile couples. Mean pH was: 7.22+/- 0.22. The average volume of semen collected was: 2.56 +/- 1.41 ml. Abnormalities were detected in all spermogram parameters, with a predominance of abnormalities in the same subject (86.5%), mainly in oligoasthenoteratozoospermia (44.8% of cases). Asthenozoospermia was the most common abnormality (90.9% of cases), followed by oligozoospermia (87.4% of cases), teratozoospermia (66.9% of cases), necrozoospermia (55.6% of cases), and azoospermia (10.4% of cases). This study highlights that the cytological profile of the spermogram of this population in Butembo is dominated by associations of anomalies. Other tests such as bacteriological examinations and biochemical marker assays are necessary, in order to identify the causes of abnormalities and to provide appropriate therapies.

Avaliação seminal na falsa coral Oxyrhopus guibei

The suborder of the snakes is composed of a variety of species that can present different reproductive aspects among themselves, occurring variations correlated to the environment in which they live and the season of the year. To know the real reproductive status of an animal must be taken into account the macro and microscopic morphological study combined with techniques such as histology to analyze minute structures and their functions. False coral (Oxyrhopus guibei) is a sinanthropic and non- venomous animal common in the metropolitan region of São Paulo state and has a continuous reproductive cycle. This project described the sperm cycle in males of Oxyrhopus guibei throughout the year, showing peaks of sperm production between winter and spring. Semen collection occurred monthly in the animals kept in the laboratory of Ecology and Evolution Laboratory (LEEV) of the Butantan Institute.

A subordem das serpentes é composta por uma variedade de espécies que podem apresentar aspectos reprodutivos distintos entre si, ocorrendo variações correlacionadas ao ambiente em que vivem e a estação do ano. Para conhecer o real status reprodutivo de um animal deve ser levado em conta o estudo morfológico macro e microscópico aliado a técnicas como a histologia para analisar estruturas ínfimas e suas funções. A falsa coral (Oxyrhopus guibei) é um animal sinantrópico e não peçonhento comum na região metropolitana de São Paulo e possui um ciclo reprodutivo contínuo. Esse projeto descreveu o ciclo espermático nos machos de Oxyrhopus guibei ao longo do ano, evidenciando picos de produção espermática entre o inverno e a primavera. A coleta de sêmen ocorreu mensalmente nos animais mantidos no biotério do Laboratório de Ecologia e Evolução (LEEV) do Instituto Butantan.