[The urologist's role in assisted reproductive technology (ART)]. / Place de l'urologue dans le parcours d'aide médicale à la procréation (AMP).

BACKGROUND: Following on from the Rapport vers une stratégie nationale de lutte contre l'infertilité (Report on a national strategy to combat infertility) submitted to the French Minister of Health in 2022, whose objective 13 is: to better identify and diagnose male infertility, we wanted to clarify with reproductive specialists what role the urologist should play in the management of the infertile couple. METHODS: An expert consensus was reached with the Pedagogical Committee and pilots of the Transversal Specialized Training in Reproductive Medicine and Biology - Andrology, and with the presidents, board and scientific council of the French Federation for Reproductive Study (FFER). RESULTS: In the case of infertility in a couple, the fertility of both partners should be assessed from the outset, and in the event of abnormality or failure of ART, the patient should be referred to a uro-andrologist for expert management. The uro-andrologist will set up medical or surgical treatments to improve the prognosis of the man's fertility, in conjunction with the entire ART team. It is also important for the urologist/andrologist to take charge of the man's health before conception, because of the benefits for the patient himself and for his offspring. CONCLUSION: This expert consensus has shed light on the role of the uro-andrologist in the ART pathway, on the need for training in Andrology and on the medical demography required.

Effects of Ureaplasma urealyticum infection on semen quality and sperm morphology.

Introduction: Ureaplasma urealyticum (U. urealyticum) infection is primarily associated with damage to male fertility through its effects on male sperm parameters. However, its effects on sperm semiological variables remain unclear. Therefore, this study aimed to investigate whether U. urealyticum infection was associated with semen quality and sperm morphology. Methods: From 2019 to 2021, this cross-sectional study analyzed infective pathogens and semen variables in 1064 males (22-30 years old) recruited from our reproductive center and the general public. Routine semen parameters and normal sperm morphology rate were analyzed using methods outlined by the World Health Organization. The associations between semen quality, sperm morphology, and U. urealyticum infection were studied using general linear models. Results: The participants were categorized into three groups: (i) U. urealyticum infection (n=328), (ii) non-U. urealyticum infection (including males with urogenital tract infection symptoms but no U. urealyticum detected in their semen samples, n=377), and (iii) normal volunteers (males without symptoms of urogenital tract infection and no pathogens detected in semen samples, n=359). U. urealyticum in semen samples was observed to be associated with lower sperm concentrations (p<0.001) and a lower ratio of anterograde motile spermatozoa (p<0.001). Semen cultures positive for U. urealyticum were associated with lower normal sperm morphology (p<0.001) compared to semen cultures negative for U. urealyticum. Conclusion: This study shows the importance of proper investigations for U. urealyticum during routine clinical examinations and diagnoses of males with infertility.

The Association Between Self-Reported Household Renovation and Semen Parameters Among Infertile Men: A Cross-Sectional Study.

Previous studies have indicated that outdoor air pollution has a negative impact on semen quality; however, few studies have examined whether living in a recently renovated residence is one of the factors influencing semen parameters. We aimed to examine the association between household renovation and semen parameters among infertile men. Our study was conducted at the Reproductive Medicine Center, The First Hospital of Jilin University (Changchun, China) from July 2018 to April 2020. A total of 2267 participants were enrolled in the study. The participants completed the questionnaire and provided a semen sample. Univariate and multiple logistic regression models were used to estimate the association between household renovations and semen parameters. Of the participants, about one-fifth (n = 523, 23.1%) had undergone renovations in the last 24 months. The median progressive motility was 34.50%. There was a significant difference between participants whose residences had been renovated in the last 24 months and those whose residences had not been recently renovated (z = -2.114, p = .035). Compared with participants whose residences were not recently renovated, participants who moved into the residence within 3 months after renovation had a higher risk of abnormal progressive motility after adjusting for age and abstinence time (odds ratio [OR] = 1.537, 95% confidence interval [CI]: 1.088-2.172). Our findings indicated that progressive motility was significantly associated with household renovations.

The Effect of Palm Pollen and Black Seed Pollen on Male Sex Hormones and Sperm Quality: A Single-Blind, Placebo-Controlled Clinical Trial Study.

BACKGROUND: Nowadays, using medicinal properties is a good alternative for infertility treatment to use them is increasing in the world. The aim of this study was to determine the effects of Herbal oral capsules included palm pollen extract (DPP) and Nigella Sativa extract (NS) on sex hormones in adult infertile men. MATERIALS AND METHODS: In this a single-blind, placebo-controlled clinical trial study, a total of 62 infertile men between 22 and 42 years of age were randomly selected and tested for sex hormones and prolactin. Thirty people in the case group received two 500 mg/kg capsules on a daily basis containing an herbal composition of palm pollen extract (350 mg) and black seed powder extract (250 mg) and the 20 in the control group received a placebo in the morning and at night for 3 months. The herbal composition capsules were manufactured by the Golbadistan Company. At the end of the three -month period, blood and semen tests were performed before and after the intervention in the case group that was compared with the control group. Hormonal assays were performed by Immunoradiometric Assay (IRMA) method. The data entered SPSS statistical software and the level of significance was set at P≤0.05. RESULTS: The spermiogram test results showed significant changes in the sperm count, progressive motility and rapid progressivity of the case group at the end of a quarterly period after consuming plant composition except for morphology (P=0.001, P=0.001, P=0.02, P=0.23). In addition, in the case group, the concentration of testosterone, follicle stimulating hormone (FSH), luteinizing hormone (LH) was significantly increased compared to the control group (P=0.000, P=0.004, P=0.012). CONCLUSION: It seems that taking one 500 mg/kg capsule of DPP and NS extract can significantly increase sperm parameters and testosterone (registration number: IRCT2015020120895N1).

Effects of diabetes mellitus on sperm quality and fertility outcomes: Clinical evidence.

BACKGROUND: Diabetes mellitus is a global epidemic characterized by high morbidity and mortality. Diabetes mellitus can lead to acute and chronic systemic complications. Among them, a negative effect of diabetes mellitus on sperm quality and male/couple fertility has been suggested. However, available studies in diabetes mellitus men evaluated relatively small cohorts with discordant results. OBJECTIVES: To evaluate the clinical evidences of the effects of diabetes mellitus on sperm quality and fertility outcomes. METHODS: An extensive Medline search was performed identifying studies in the English language. RESULTS: The prevalence of diabetes mellitus in infertile men ranges from 0.7% to 1.4%, while the prevalence of infertility in diabetes mellitus men, evaluated in a few studies, ranges from 35% to 51%. Male diabetes mellitus seems to play a negative effect on couple fecundity, while being childless or subfertile men might increase the risk of diabetes mellitus. Available cross-sectional studies investigating semen parameters and male sexual hormones in men with diabetes mellitus are heterogeneous, assessed relatively small cohorts, show often discordant results and frequently are not directly comparable to derive robust conclusions. Two meta-analyses support a negative effect of diabetes mellitus on sperm normal morphology and no effect on sperm total count, with contradictory results regarding other semen parameters. Considering only studies on type 1 diabetes mellitus men, meta-analyses support a negative effect of diabetes mellitus on sperm motility and no effect on sperm total count, with contradictory results regarding other semen parameters. The rate of children observed among type 1 diabetes mellitus men was lower than controls, especially in subjects with a longer diabetes mellitus duration. Couples with a diabetes mellitus male partner undergoing assisted reproduction techniques showed lower pregnancy rates than controls. No study evaluated the impact of diabetes mellitus treatment on semen quality and male fertility. CONCLUSIONS: Overall, available data show that diabetes mellitus might impair male reproductive health and couple fertility. However, further larger and full of details studies are needed.

The effectiveness of cognitive-behavioural group therapy on infertile men, a randomised clinical trial.

BACKGROUND: Infertility can result in the emergence of depression and anger, the loss of one's identity, and the feeling of guilt in the infertile person. Present study aimed to investigate the effects of cognitive behavioural group therapy (CBGT) on infertile men's anger and positive and negative affect. MATERIALS AND METHODS: Forty-three men with infertility for at least five years were selected for the present randomised clinical study. Spielberger's State-Trait Anger Expression Inventory-II (STAXI-II) and the PANAS scale (positive and negative affect) were filled out by the participants, and they were randomly divided into the experimental (22) and control (21) groups. The experimental group received 18 ninety-minute sessions of hybrid group therapy held twice a week, while the control group received no intervention. When the intervention program was over, all participants performed the post-test. Moreover, the post-hoc stage was held two months later. RESULTS: The effects of the intervention were significant in terms of state anger, trait anger, anger expression in, anger expression out, positive effects, and negative effects (p < 0.004), but they were not significant concerning the anger control out index (p = 0.241). The significant differences between the two groups were also observed in the post-hoc stage. CONCLUSIONS: The CBGT therapy seems to be helpful for infertile men to reduce their anger and negative affect and increase their positive affect by implementing a set of techniques like cognitive regeneration, assertiveness, daily joyful activities, exercises to relax one's muscles, diaphragm respiration, the identification of various fillings, and emotional expression.

Does Infertility Stress Impair Sexual Function in Infertile Women and Men? A Cross-Sectional Study in Iran.

Background: The issue of infertility is a worldwide challenge, estimated to affect around 50 million couples. This study aimed to evaluate the relationship between infertility stress and sexual function in men and women with infertility. Methods: In this cross-sectional study, 300 men and women with infertility were recruited. A demographic questionnaire, the Fertility Problem Inventory, the Female Sexual Function Scale (FSFI), and the International Index of Erectile Function (IIEF) were used to collect data. Independent t-test, Chi-square, and linear and logistic regressions were used to assess the data. Results: The total score of sexual function in women and men was 22.18 ± 7.86 and 57.7 ± 17.8, respectively. Infertility duration and the ability to pay for the costs of infertility treatment had a significant relationship with sexual function in women. A significant association was found between communication concerns and sexual function scores in men with infertility. Infertile women had more sexual concerns, while infertile men had more communication concerns. Conclusion: This study showed that women with infertility had more infertility stress than men with infertility. Women with higher infertility duration and the inability to pay for the infertility treatment costs impaired sexual function. Women with infertility had more sexual concerns, while Men with infertility had more communication concerns. Policymakers need to consider strategies such as counseling for men and women with infertility to help them cope with their problems, especially their psychological problems. The lack of random enrollment of participants and lack of control group were the limitations of this study.

Vitamin D Supplementation Improves Fasting Insulin Levels and HDL Cholesterol in Infertile Men.

CONTEXT: Vitamin D has been linked with glucose and lipid metabolism. Men with impaired gonadal function have a higher risk of metabolic syndrome and mortality, and vitamin D status may be a reversible modulator. OBJECTIVE: This work aimed to determine the effect of daily vitamin D and calcium supplementation for 150 days on glucose and lipid homeostasis in infertile men. METHODS: A single-center, double-blinded, randomized clinical trial (NCT01304927) was conducted. A total of 307 infertile men were randomly assigned (1:1) to a single dose of 300 000 IU cholecalciferol followed by 1400 IU cholecalciferol + 500 mg of calcium daily (n = 151) or placebo (n = 156) for 150 days. Reported metabolic parameters including fasting plasma glucose, glycated hemoglobin A1c, fasting serum insulin, homeostatic model assessment of insulin resistance (HOMA-IR), fasting plasma cholesterols, and triglycerides were secondary end points. The primary end point semen quality has previously been reported. RESULTS: Men receiving vitamin D supplementation improved their vitamin D status, whereas vitamin D status was aggravated in the placebo group characterized by higher serum parathyroid hormone. At the end of the trial, men receiving vitamin D supplementation had 13% lower fasting serum insulin concentrations compared with the placebo-treated group (65 vs 74 pmol/L, P = .018) and 19% lower HOMA-IR (2.2 vs 2.7, P = .025). Moreover, men in the vitamin D group had higher high-density lipoprotein (HDL) cholesterol levels (1.38 vs 1.32 mmol/L, P = .008) compared with the placebo group. CONCLUSION: High-dose vitamin D supplementation has beneficial effects on glucose homeostasis and HDL cholesterol levels in infertile men.

Human papillomavirus detected in sperm of Japanese infertile males affects reproductive parameters.

OBJECTIVES: The effects of human papillomavirus (HPV) infection on male reproductive parameters are currently a matter of controversy. In order to clarify the issue in Japanese infertile men, the prevalence and localization of HPV in semen, sperm parameters, and superoxide dismutase (SOD) activity in seminal plasma were examined in 216 Japanese infertile men. METHODS: DNA was extracted from liquid-based cytological semen samples. The ß-globin gene was amplified by polymerase chain reaction (PCR), and HPV-DNA was amplified using nested PCR with MY09/MY11 as outer primers and GP5+/GP6+ as inner primers. HPV genotyping was performed in the HPV-positive samples. In addition, SOD levels in seminal plasma were analysed quantitatively. In-situ hybridization (ISH) was performed to localize HPV-DNA in sperm from HPV-positive samples. RESULTS: Any-risk and high-risk prevalence rates of HPV in semen were 12.5% and 6.9%, respectively. No significant difference in the prevalence of HPV was observed between azoospermic and non-azoospermic subjects. Among non-azoospermic patients, those with HPV detected in semen had significantly lower sperm motility and concentration compared with subjects without HPV detected in semen. SOD levels in seminal plasma were significantly higher in HPV-positive patients compared with HPV-negative patients. ISH analysis of HPV-positive samples revealed that HPV-DNA was localized to the head and mid-piece of sperm. HPV-DNA was present in the sperm of young infertile men. CONCLUSION: HPV infection of sperm was associated with reduced sperm motility and concentration, and resulted in an increase in seminal SOD activity.

Evaluation of the effect of vitamin D supplementation on spermatogram, seminal and serum levels of oxidative stress indices in asthenospermia infertile men: a study protocol for a triple-blind, randomized controlled trial.

BACKGROUND: It is suggested that vitamin D may have a beneficial role in male reproduction. The male reproductive system is a target tissue for vitamin D. This study will aim to evaluate the effects of vitamin D supplementation on sperm parameters, seminal and serum levels of oxidative stress and serum endocrine factors in asthenospermia infertile men. METHODS/DESIGN: This randomized, triple-blind, placebo-controlled clinical trial will be conducted on 86 infertile men with idiopathic asthenozoospermia (the mobility of sperm < 40% and rapid progressive sperm motility < 32%), with serum levels of vitamin D less than 30 ng / ml in the "Infertility Clinic of Ahvaz Jahad daneshgahi", Iran. MAIN OUTCOMES MEASURE (S): Demographic data, dietary intake, physical activity, sun exposure, anthropometric indices, serum and seminal levels of MDA (Malondialdehyde), 8-hydroxy-2- Dioxy Guanosine (8-OHDG), Total Antioxidant Capacity (TAC) and calcium, sperm DNA fragmentation index (DFI), serum 25-OHD, luteinizing hormone (LH), follicle-stimulating hormone (FSH), total testosterone (T), estradiol (E2), sex hormone-binding globulin (SHBG), free androgen index (FAI = T/SHBG. 100), T/LH and T/E2 ratios, prolactin (PRO), parathyroid hormone (PTH), osteocalcin (OCN), phosphorus and sperm parameters. DISCUSSION: The deficiency of vitamin D as an antioxidant is common all over the world. Numerous observational studies have shown a positive association between vitamin D levels and semen quality. However, few clinical studies have been conducted in this area. So considering with the high prevalence of this antioxidant deficiency specifically in infertile men, it seems that the supplementation of vitamin D in infertile men with insufficient levels or deficiency may improve the status of oxidative stress and thereby may affect sperm parameters and endocrine factors involved in male fertility. TRIAL REGISTRATION: Iran Clinical Trials Registry, ID: IRCT20151128025274N4 , registered on 28 March 2018.

Assessment of Blood Plasma Free-amino Acid Levels in Infertile Men.

BACKGROUND/AIM: The objective of this study was to investigate the significance of the blood levels of free amino acids (AAs) in infertile men. PATIENTS AND METHODS: Ninety-three men who underwent examinations for infertility were included. The concentrations of 20 AAs were measured and compared in four groups (normospermia, obstructive azoospermia, oligozoospermia, non-obstructive azoospermia) based on semen analysis and clinical parameters. RESULTS: When the 93 men were divided into normospermia, obstructive azoospermia, oligozoospermia, and non-obstructive azoospermia groups, no significant differences were found in the concentrations of the 20 AAs between them. We then compared 49 men diagnosed with normozoospermia or oligozoospermia according to the median sperm motility and morphology abnormalities rates (30% and 20%, respectively). Men with low motility rates had significantly lower levels of tryptophan and alanine, and men with high abnormal morphology rates had significantly lower levels of aspartate and glutamate. CONCLUSION: AAs are probably involved in the pathogenesis of male infertility, particularly oligozoospermia.

The role of N-acetyl-cysteine (NAC) orally daily on the sperm parameters and serum hormones in idiopathic infertile men: A systematic review and meta-analysis of randomised controlled trials.

The meta-analysis was performed to access the role of N-acetyl-cysteine (NAC) orally daily on the sperm parameters and serum hormones in idiopathic infertile men. Randomised controlled trials (RCTs) were retrieved using PubMed, EMBASE and Cochrane register databases. The references of included studies were also searched. Finally, three articles including 431 infertile men were analysed. The results indicated that the NAC group had a considerable improvement in sperm concentration (mean difference [MD], 3.80; p < .00001), ejaculate volume (MD, 0.69; p = .002), sperm motility (MD, 4.69; p < .0001) and normal morphology (MD, 1.68; p = .0002) compared with the placebo group. However, in terms of serum hormones, the NAC group did not show significant difference in increasing the serum levels of testosterone (MD, 1.35; p = .21), luteinising hormone (MD, 0.82; p = .40), follicle-stimulating hormone (MD, -7.48; p = .29) and prolactin (MD, -0.34; p = .32) compared with the placebo group. In conclusion, NAC orally daily produced a greater improvement in sperm concentration, ejaculate volume, sperm motility and normal morphology for idiopathic infertile men, whereas no significant influence in serum hormones, which required more high-quality RCTs with sufficient sample sizes and statistics to prove.

Effect of lipoic acid supplementation on gene expression and activity of glutathione S-transferase enzyme in infertile men.

Oxidative stress has become the focus of interest as a potential cause of male infertility. We evaluate effects of lipoic acid (LA) supplementation on glutathione S-transferase (GST) expression. This randomized, triple-blind, placebo-controlled clinical trial was conducted on 44 infertile males with idiopathic asthenozoospermia. Men were randomized to receive 600 mg LA or placebo once daily for 12 weeks and semen samples and venous blood samples were obtained. GST expression, reactive oxygen species (ROS) levels, GST activity and reproductive hormone profiles were also measured. GST expression in the intervention group were significantly higher than the control group. Also, at the end of the study, GST activity increased, and ROS levels decreased significantly compared to the baseline. Additionally, the intervention group showed an increase in testosterone and decrease in serum follicle-stimulating hormone (FSH), luteinizing hormone (LH) and prolactin after 12 weeks, but this difference was not significant. We conclude a 12-week treatment with LA leads to improvements in reproductive hormones in serum, and significantly reduces the generation of ROS and increases the gene expression and activity of GST in seminal fluid.

Application of leukocyte subsets and sperm DNA fragment rate in infertile men with asymptomatic infection of genital tract.

BACKGROUND: About 15% of male infertility is due to genital tract infection and inflammation, some of them have no clinical symptoms, but manifested as leukocytospermia (LCS). Leukopenia will lead to functional impairment of male sperm and integrity damage of sperm morphology. A large amount of reactive oxygen species (ROS) produced by leukocytes can damage sperm nuclear DNA. The aim of this study was to investigate the correlation between leukocyte subsets and sperm DNA fragmentation rate in semen of infertile men with asymptomatic infection of genital tract. METHODS: One hundred and eight cases of infertile men were enrolled, who were admitted to our hospital from May 2016 to September 2018, and all had genital tract infections. After routine sperm analysis, realtime PCR was performed for detecting the infection of chlamydia trachoma (CT) and Ureaplasma urealyticum (UU). Furthermore, total leukocyte count in semen was evaluated by detection of CD45 molecules using immunocytochemistry. Flow cytometry was used for subset analysis, monocyte/macrophages were evaluated by CD14, and activated macrophages were evaluated by HLA-DR antigen. Sperm DNA fragmentation index (DFI) were evaluated by SCD method and 8-hydroxydeoxyguanosine (8-OHdG) expression were evaluated by chromatin diffusion method and TUNEL method; the correlation analysis was conducted between semen leukocyte subsets, sperm DNA fragment rate and conventional semen parameters. RESULTS: There was a significant correlation among the concentrations of cells expressing HLA-DR antigen and those expressing CD14 (P<0.01), but the concentrations of differential leukocyte subsets all had no significant correlation with sperm DFI, the percentage of 8-OHdG-expressing cells and routine semen parameters. The percentage of 8-OHdG-expressing sperm was positively correlated with the percentage of sperm fragments (r=0.42, P<0.01), and negatively correlated with sperm concentration (r=-0.32, P<0.01). After adjustment for possible confounders including age, abstinence time and smoking, the percentage of 8-OHdG-expressing sperms independently associated with sperm concentration (ß=-0.30; P=0.006) and DFI (ß=0.180, P=0.06). CONCLUSIONS: Among infertile men with genital tract infection, the sperm DFI is associated with decreased semen quality and not the concentration of differential leukocyte subsets.

Serum estradiol levels in infertile men with non-obstructive azoospermia.

PURPOSE: To report the different patterns of estradiol levels in infertile men with non-obstructive azoospermia and correlate these levels with their clinical and laboratory findings. MATERIALS AND METHODS: A retrospective study was launched, and a retrieval of data for infertile men with non-obstructive azoospermia (n = 166) and fertile controls (n = 40) was performed. The retrieved data included demographics, clinical findings, scrotal duplex, semen analysis, and hormonal assay (testosterone, follicle-stimulating hormone, luteinizing hormone, prolactin, and estradiol). RESULTS: Our findings showed a wide spectrum of estradiol concentrations. The patients were arranged into three groups (high, normal, and low estradiol groups). The normal estradiol group was the most prevalent (71.1%). Testosterone, gonadotrophins, testicular volumes, and the number of patients with jobs in polluted workplaces showed significant differences among the study groups (p = 0.001, <0.001, <0.001, and 0.004, respectively). Age, body mass index, varicocele prevalence, prolactin, and smoking habits did not show any significant differences among the groups. Obesity was lacking in the low estradiol group, but it had significantly higher prevalence in the normal (p = 0.013) or high group (p = 0.023) compared with the controls. CONCLUSION: Serum estradiol, in infertile men with non-obstructive azoospermia, may be present at different levels. It is recommended that estradiol be measured in infertile men with non-obstructive azoospermia when there is an alteration in testosterone concentration, obesity, a polluted workplace occupation, or before trying hormonal therapy. Extended studies are highly recommended to provide a clear clue whether alterations in estradiol concentrations in men with non-obstructive azoospermia are the cause or a consequence of the condition.

The association between the two more common genetic causes of spermatogenic failure: a 7-year retrospective study.

Chromosomal abnormalities and Y chromosome microdeletions are considered to be the two more common genetic causes of spermatogenic failure. However, the relationship between chromosomal aberrations and Y chromosome microdeletions is still unclear. This study was to investigate the incidence and characteristics of chromosomal aberrations and Y chromosome microdeletions in infertile men, and to explore whether there was a correlation between the two genetic defects of spermatogenic failure. A 7-year retrospective study was conducted on 5465 infertile men with nonobstructive azoospermia or oligozoospermia. Karyotype analysis of peripheral blood lymphocytes was performed by standard G-banding techniques. Y chromosome microdeletions were screened by multiplex PCR amplification with six specific sequence-tagged site (STS) markers. Among the 5465 infertile men analyzed, 371 (6.8%) had Y chromosome microdeletions and the prevalence of microdeletions in azoospermia was 10.5% (259/2474) and in severe oligozoospermia was 6.3% (107/1705). A total of 4003 (73.2%) infertile men underwent karyotyping; 370 (9.2%) had chromosomal abnormalities and 222 (5.5%) had chromosomal polymorphisms. Karyotype analysis was performed on 272 (73.3%) patients with Y chromosome microdeletions and 77 (28.3%) had chromosomal aberrations, all of which involved sex chromosomes but not autosomes. There was a significant difference in the frequency of chromosomal abnormalities between men with and without Y chromosome microdeletions (P< 0.05).

Colonisation of the male reproductive tract in asymptomatic infertile men: Effects on semen quality.

The objective was to explore presence/detection of microorganisms in the male reproductive tract (PMMRT) in asymptomatic patients undergoing infertility treatment and their effects on semen quality in our region. This study enrolled 205 men (mean age, 35.9 years) in a single-centre, tertiary university hospital from December 2015 to December 2016. We used the modified Meares-Stamey test, real-time polymerase chain reaction (rt-PCR) and the National Institutes of Health Chronic Prostatitis Sympton Index (NHI-CPSI) questionnaire to address this issue. No patient met the prostatitis criteria by the modified Meares-Stamey 4-sample test, 33 (16.1%) were positive for rt-PCR in the first-voided urine for any of the Mycoplasma (Ureaplasma urealyticum/parvum, Mycoplasma hominis/genitalium) and C. trachomatis was detected in two cases (1%), and three for rt-PCR in semen for HPV high-risk genotypes non-16/18 (1.5%). Significant statistical differences were reported among patients with and without PMMRT in terms of lower rate of progressive spermatozoa (PR) (p < .034), total motile sperm count (p < .028), normal morphologic forms, especially in the sperm head (p < .001) and highest viscosity (p < .012). It was concluded that PMMRT, specially Mycoplasmas, in asymptomatic infertility men, affects semen quality. The NIH-CPSI questionnaire was not a valid initial screening to subsequently evaluate the presence of prostatitis/PMMRT.

Nitric oxide, 8-hydroxydeoxyguanosine, and total antioxidant capacity in human seminal plasma of infertile men and their relationship with sperm parameters.

OBJECTIVE: Oxidative stress plays a key role in the pathogenesis of male infertility. But, the adverse effects of oxidative biomarkers on sperm quality remain unclear. This study aimed to investigate the levels of nitric oxide (NO), 8-hydroxydesoxyguanosine (8-OHdG), and total antioxidant capacity (TAC) oxidative biomarkers in seminal plasma and their relationship with sperm parameters. METHODS: A total of 77 volunteers participated in the study, including fertile (n=40) and infertile men (n=37). NO, 8-OHdG, and TAC levels were measured using the ferric reducing ability of plasma, Griess reagent method and an enzyme-linked immunosorbent assay kit, respectively. RESULTS: The mean values of sperm parameters in the infertile group were significantly lower than those in the fertile group (p<0.001). The mean 8-OHdG in the seminal plasma of infertile men was significantly higher (p=0.013) than those of controls, while the mean TAC was significantly lower (p=0.046). There was no significant difference in NO level between the two groups. The elevated seminal 8-OHdG levels were negatively correlated with semen volume, total sperm counts and morphology (p<0.001, p=0.001 and p=0.052, respectively). NO levels were negatively correlated with semen volume, total sperm counts and morphology (p=0.014, p=0.020 and p=0.060, respectively). Positive correlations between TAC and both sperm count and morphology (p=0.043 and p=0.025, respectively) were also found. CONCLUSION: These results suggested that increased levels of NO and 8-OHdG in seminal plasma could have a negative effect on sperm function by inducing damage to the sperm DNA hence their fertility potentials. Therefore, these biomarkers can be useful in the diagnosis and treatment of male infertility.

Correlations of phthalate metabolites in urine samples from fertile and infertile men: Free-form concentration vs. conjugated-form concentration.

In previous studies, the total content of urinary phthalate metabolites was commonly used to evaluate human exposure to phthalates. However, phthalate metabolites are mainly present in urine in two forms, conjugated and free. These metabolite forms in urine are more relevant to the biotransformation pathways of the phthalates in humans. Therefore, the concentration of these forms is more relevant to exposure related health outcomes than total content. In this study, instead of measuring total content, the free- and conjugated-form concentrations of phthalate metabolites in the urine of fertile and infertile men were measured. The main metabolites in urine of both groups are monoethyl phthalate (MEP) and the di-(2-ethylhexyl) phthalate (DEHP) metabolites. The geometric means of their both conjugated- and free-forms in the infertile group were higher than in the fertile group, specifically, 24.3 and 43.4 µg/g creatinine vs 8.5 and 28.9 µg/g creatinine, respectively, for MEP, and 50.0 and 9.1 µg/g creatinine vs 39.1 and 8.4 µg/g creatinine, respectively for total DEHP metabolites. We investigated the correlations of free- and conjugated-form phthalate metabolite concentrations between the infertile and fertile group as well as among different phthalate metabolites. The results showed that there was a statistically significant difference between the infertile and fertile group for monobenzyl phthalate (MBzP) in both free-form and conjugated-form. However, there was only a statistically significant difference between the two groups for conjugated-form MEP and MEHP, and no statistically significant difference between the two groups for free-form MEP and MEHP. The results of the Pearson correlation test revealed that the correlations between DEHP metabolites and the correlations between mid-sized phthalate metabolites (mono-n-butyl phthalate (MnBP), mono-isobutyl phthalate (MiBP) and mono-benzyl phthalate (MBzP)) were stronger than between these two clusters of metabolites. This study is the first attempt to examine possible effects of conjugated-form concentrations of phthalate metabolites on human fertility. The results of this study suggest that conjugated-form and free-form concentrations of urinary phthalate metabolites may be appropriate biomarkers for assessing human exposure to phthalates and association with health outcomes.

Y chromosome microdeletion screening using a new molecular diagnostic method in 1030 Japanese males with infertility.

The azoospermia factor (AZF) region is important for spermatogenesis, and deletions within these regions are a common cause of oligozoospermia and azoospermia. Although several studies have reported this cause, the present research, to the best of our knowledge, is the first large-scale study assessing this factor in Japan. In this study, 1030 male patients with infertility who were examined for Y chromosome microdeletion using the polymerase chain reaction-reverse sequence-specific oligonucleotide (PCR-rSSO) method, a newly developed method for Y chromosome microdeletion screening, were included. The study enrolled 250 patients with severe oligospermia and 717 patients with azoospermia. Among the 1030 patients, 4, 4, 10, and 52 had AZFa, AZFb, AZFb+c, and AZFc deletions, respectively. The sperm recovery rate (SRR) of microdissection testicular sperm extraction in patients with AZFc deletions was significantly higher than that in those without AZF deletions (60.0% vs 28.7%, P = 0.04). In patients with gr/gr deletion, SRR was 18.7%, which was lower than that in those without gr/gr deletion, but was not statistically significant. In conclusion, our study showed that the frequency of Y chromosome microdeletion in male patients in Japan was similar to that reported in patients from other countries, and SRR was higher in patients with AZFc deletion.