Sperm DNA status in infertile patients with clinical varicocele.

OBJECTIVE: To evaluate if a potential relationship exists between sperm nuclear DNA damage and clinical varicocele and to determine the impact of clinical varicocele on standard semen parameters. MATERIALS AND METHODS: A prospective study involving 30 infertile patients with clinical varicocele and 15 controls patients referred to our laboratory for routine spermiological exploration. Spermograms were performed and analyzed according to World Health Organisation (WHO) guidelines 2010. The DNA fragmentation was detected by the terminal desoxynucleotidyl transferase-mediated deoxyuridine triphosphate biotin nick-end labeling (TUNEL) assay. RESULTS: The DNA fragmentation index (DFI) was significantly higher in patients with clinical varicocele compared to controls (13.3±3.4% versus 6.1±2.5%, P=0.0001). In addition, the DFI was positively and significantly correlated with the degree of severity of varicocele thus the DFI was 15.24±1.9% in patients with grade 3 versus 12.92±3.5% in those with grade 2(P<0.0001). However, an abnormality of at least one of the spermatic parameters was found in 90% of varicocele patients, and all semen characteristics such as sperm count, vitality, mobility and typical forms were decreased compared to the controls. Furthermore, statistically significant negative correlations were noted between sperm DNA fragmentation index and sperm concentration (P=0.0001), motility (P=0.03), and normal sperm morphology (P=0.03). CONCLUSION: Clinical varicocele generates a significant increase of sperm abnormalities and DNA damage, and these changes are positively correlated with varicocele grade. Sperm DNA damage independent of its cause, may affect the quality of the ejaculated sperm and may have implications on patient's fertility potential. LEVEL OF EVIDENCE: 3.

Vascular endothelial growth factor antagonist reduces the early onset and the severity of ovarian hyperstimulation syndrome.

BACKGROUND: Ovarian hyperstimulation syndrome (OHSS) is the most serious complication of controlled ovarian stimulation (COH) during assisted reproductive technology (ART) protocols. This syndrome is a result of ovarian expression of vascular endothelial growth factor (VEGF), which increases vascular permeability. OBJECTIVES: To evaluate the efficiency of prophylactic and therapeutic use of cabergoline in women with higher risk of developing OHSS. MATERIALS AND METHODS: In this prospective randomized study, 146 women undergoing in vitro fertilization (IVF) cycles with GnRH agonist protocols with a higher risk of OHSS diagnosed during the HCG day administration (more than 18 follicles observed larger than 12mm in diameter during COH and/or estradiol levels of 3000-3500pg/ml, previous episodes of OHSS). Women were randomly divided in two groups. The first group included 78 women who received 0.5mg per day of cabergoline (Dostinex®) orally for 7 days starting from hCG administration day. The second group included 68 women who received no medication treatment. Overall, in each group 25 patients have developed OHSS. This defines subgroup 1 that includes 25 cases of OHSS obtained in group 1 and subgroup 2 where 25 cases of OHSS obtained in group 2. Early OHSS was defined as being when the onset of the syndrome was initiated during the first 9 days after hCG administration and late OHSS was defined as being when the onset of the syndrome was initiated from 10 days after hCG administration. Outcome measures of this study were the incidence of moderate and severe OHSS, early or late OHSS and pregnancy rates. RESULTS: There was no evidence of a statistically significant reduction in the incidence of OHSS in cabergoline group (32.05% vs. 36.76%; P>0.05). Late OHSS was observed in 60.6% of cases in cabergoline group while 39.4% of cases in the other group (P=0.036). Early OHSS decreased significantly (P<0.05) in the cabergoline group. Severe OHSS cases were more common within subgroup 2 than subgroup 1 (32% vs. 8%, P=0.000). There was no difference in clinical pregnancy rates (PR) and miscarriages rates between the two subgroups. CONCLUSIONS: The cabergoline administration (Dostinex®) for patients with high-risk of OHSS can reduce the rate of early OHSS and its severity in GnRH agonist IVF cycles, but cannot prevent the incidence of OHSS.

[Sperm immobilizing effect of leaves extracts of Cestrum parqui]. / Effet immobilisant des spermatozoïdes par les extraits des feuilles du Cestrum parqui.

OBJECTIVE: The leaves extracts of Cestrum parqui were reported to have spermicidal activity. The current investigation identified the spermicidal component of the extracts and evaluated its spermicidal potential in vitro, particularly the effects on sperm motility and vitality. METHODS: Sperms were prepared by discontinuous buoyant density gradient centrifugation and incubated with varying concentrations of extract from C. parqui (40-250 µg/ml) at 37°C and 5% CO(2). The mode of spermicidal action was evaluated by sperm motility and vitality at different intervals ranging from 5 to 240 minutes. Morphological changes in human spermatozoa after exposure to the extract were evaluated under transmission electron microscope. RESULTS: A dose- and time-dependent effect of this extract on sperm motility and viability was observed. The mean effective concentration of extracts that induced irreversible immobilization was 250 µg/ml. Transmission electron microscope revealed a significant damage to sperm membrane in head and acrosomal membranes, notable swelling and disruption. CONCLUSION: Our study indicates that this natural extract has potential spermicidal effect in vitro. It can adequately replace nonoxynol-9 in vaginal contraceptives to make them more vaginally safe and ecofriendly.