Improvement of erectile function by a combination of French maritime pine bark and roburins with aminoacids.

AIM: Primary objective of the study was the evaluation of effects of a combination of plant extracts and aminoacids on erectile function (ED). METHODS: The study was performed as a randomized, placebo-controlled, double-blind, cross-over study. 50 men with moderate ED received a combination of Pycnogenol®, roburins, L-arginine, L-citrulline or placebo. Sexual wellness was evaluated by the International Index of Erectile Function (IIEF). RESULTS: Treatment over a period of one month restored erectile function to normal. CONCLUSION: The combination offers an option for treatment of ED without unwanted effects.

Sperm quality in men is improved by supplementation with a combination of L-arginine, L-citrullin, roburins and Pycnogenol®.

AIM: The aim of this study was to investigate the influence of Prelox®R, a combination of French maritime pine bark extract (Pycnogenol®), L-arginine, L-citrulline and roburins, on male fertility. METHODS: Sperm quality of 50 subfertile men was tested in monthly intervals in a double-blind, randomized, placebo controlled, crossover study. Patients received 2 tablets Prelox®R or placebo twice daily during test periods. Following a run-in period of 1 month, patients received either Prelox®R or a placebo for 1 month. After a wash-out period of 1 month, patients received Prelox®R or a placebo in a crossover manner for 1 month. Sperm volume, concentration of spermatozoa, total count, motility, vitality and morphology were measured by standard methods of calculation of the Fertility Index (FI) in monthly intervals. Activity of e-NOS in sperm was evaluated in parallel by measuring the quantity of L-citulline produced from L-arginine. RESULTS: Supplementation with Prelox®R enhanced sperm volume and concentration, motility, vitality and morphology significantly versus placebo. The Fertility Index rose to normal values during treatment with Prelox®R. e-NOS activity in sperm was elevated by Prelox®R. No adverse effects were reported. CONCLUSION: Prelox®R offers a safe method to improve quality of human spermatozoa in subfertile men.

Improvement of seminal parameters with Prelox: a randomized, double-blind, placebo-controlled, cross-over trial.

In a randomly allocated, double-blind, placebo-controlled, cross-over design, 50 infertile patients were treated for 1 month with placebo or a combination of l-arginine aspartate and Pycnogenol (Prelox). Semen samples were examined at 4 week intervals according to WHO criteria. Treatment with Prelox increased significantly the semen volume, concentration of spermatozoa, percentage of motile spermatozoa and percentage of spermatozoa with normal morphology compared with placebo. The placebo had no influence on the parameters of seminological analysis. Intake of Pycnogenol for 1 month improved the fertility index to normal values. After treatment, the fertility index decreased again to infertile status. No unwanted effects were reported. Prelox seems to be a promising alternative to treat patients with mild infertility.

Improvement of erectile function with Prelox: a randomized, double-blind, placebo-controlled, crossover trial.

In a randomly allocated, double-blind, placebo-controlled, crossover design, 50 patients with mild to moderate erectile dysfunction (ED) were treated for 1 month with placebo or a combination of L-arginine aspartate and Pycnogenol (Prelox). Patients reported sexual function from diaries. Testosterone levels and endothelial NO synthase (e-NOS) were monitored along with routine clinical chemistry. Intake of Pycnogenol for 1 month restored erectile function to normal. Intercourse frequency doubled. e-NOS in spermatozoa and testosterone levels in blood increased significantly. Cholesterol levels and blood pressure were lowered. No unwanted effects were reported. Prelox is a promising alternative to treat mild to moderate ED.

[Sperm parameters in male idiopathic infertility after treatment with prelox].

UNLABELLED: The diagnosis of male infertility is determinate after assessment of sperm quality and clinical study. In nearly 30% of the cases nevertheless detailed clinical and laboratory study it can't be discovered the cause and on the bases of exclusion criteria set the diagnosis idiopathic infertility. The object of our study was investigation of the group patients (n=50) with idiopathic infertility treated with Prelox and to be studied its effects on spermatozoa parameters. MATERIAL AND METHODS: The study design was double-blind, placebo-controlled, cross-over, randomized study, including introduction period (1 month), two therapeutic periods (each one of 1 month) separated with 1 month wash out period and concluding period of 1 month. There was applied a new method for treatment with mechanism of action stimulation the production cGMP of spermatozoa endothelial nitric oxide synthase (eNOS). This is not surprising achieving results show improvement of sperm quality. The methods of the study were: 1. Assessment of the conventional semen analysis (according the criteria of WHO, 1999). 2. Spermatozoa function tests. 3. Spermatozoa-cervical mucus penetration tests. RESULTS: The obtained results showed improvement of sperm quality, in the middle-aged men the therapeutic answers was better than in younger. In conclusion the therapy with Prelox improve sperm parameters in men with idiopathic infertility. Pycnogenol (one of the constituents of Prelox) has powerful antioxidative influence ameliorating spermatozoa function.

[Selecting function of female genital tract in relation with spermatozoa interaction].

The present study includes 50 infertile couples followed sperm parameters: morphology and others indices for ability of penetration in ovulatory cervical mucus during 12 months. It is discussed the possibility of which spermatozoa can participate in the fertilization and the impotence and place of the female genital tract for the selection of morphologically abnormal spermatozoa before reaching the place of fertilization.

Treatment of erectile dysfunction with pycnogenol and L-arginine.

Penile erection requires the relaxation of the cavernous smooth muscle, which is triggered by nitric oxide (NO). We investigated the possibility of overcoming erectile dysfunction (ED) by increasing the amounts of endogenous NO. For this purpose, we orally administered Pycnogenol, because it is known to increase production of NO by nitric oxide syntase together with L-arginine as substrate for this enzyme. The study included 40 men, aged 25-45 years, without confirmed organic erectile dysfunction. Throughout the 3-month trial period, patients received 3 ampoules Sargenor a day, a drinkable solution of the dipeptide arginyl aspartate (equivalent to 1.7 g L-arginine per day). During the second month, patients were additionally supplemented with 40 mg Pycnogenol two times per day; during the third month, the daily dosage was increased to three 40-mg Pycnogenol tablets. We obtained a sexual function questionnaire and a sexual activity diary from each patient. After 1 month of treatment with L-arginine, a statistically nonsignificant number of 2 patients (5%) experienced a normal erection. Treatment with a combination of L-arginine and Pycnogenol for the following month increased the number of men with restored sexual ability to 80%. Finally, after the third month of treatment, 92.5% of the men experienced a normal erection. We conclude that oral administration of L-arginine in combination with Pycnogenol causes a significant improvement in sexual function in men with ED without any side effects.

[Asymptomatic infections of the genital tract and infertility]. / Bezsimptomni infektsii na polovite putishta i infertilitet.

Diagnosis of male genital tract inflammations plays a significant role in andrology. Although genital infections are often silent they can severely impair male infertility. In seminal plasma of 100 patients were determined IgG and SigA (radial immunodiffusion) the number of peroxydase-positive cells in addition to conventional semen parameters and microbiological investigations. There was carried out quantitative determination of alpha-amylase in connection with semen liquefaction. The results showed that exact quantitation of above mentioned parameters distinguish inflammatory male adnexal affections, which is appropriate for control of anti-inflammatory treatment and facilitates the diagnosis of inflammatory process in andrology.

[The postcoital test: clinico-laboratory observations]. / Post-koitalniiat test: klinichno-laboratorni nabliudeniia.

The choice of optimal time, the technique and limitations of the post-coital test (PCT) have been described. They are of important significance for getting reliable information both concerning the cervical mucus, quality and migration of spermatozoa in female genital tract. It has been stressed that a negative PCT does not necessary exclude pregnancy. There are shown data for prognostic value of the PCT. The observation of more than 20 motility spermatozoa per HPF and higher frequency of pregnancy is common finding in comparison to low motility and number of spermatozoa in cervical mucus. The data support the hypothesis of "filtering" mechanism, excluding entrance of abnormal spermatozoa. Observing "shaking" phenomenon directs to searching immunological factor (local or systemic) against male gametes.

[Leukocytes in human seminal fluid]. / Levkotsitite v choveshkata spermalna technost.

The peroxidase method is sufficient for quantification of granulocytes, but immunocytology is the standard for detection of white blood cells (WBC) in semen. Granulocytes are the most prevalent WBC in semen (50 to 60%) followed by macrophages (20 to 30%) and T-lymphocytes (2 to 5%). The frequency of leukocytospermia (> 106 WBC/ml) among male infertility patients is 29%. There are ample evidences for sperm damage by WBC: 1) Seminal WBC numbers were higher in infertile patients than among fertile men; 2) leukocytospermia was associated with decreased sperm numbers and impared sperm motility; 3) WBC damage sperm function and were an important prognostic factor for IVF-ET failure. Approximately 80% of leukocytospermic samples are microbiologically negative. In some cases Chlamydia trachomatis might have triggered a persistent inflammatory reaction. Genital tract inflammation facilitates the formation of sperm antibodies.

[Frequency of anti-sperm antibodies demonstrated by classical tests for sperm antibodies in patients with unexplained infertility]. / Chestota spermoantitelata dokazvani chrez klasicheskite testove za spermoantitela u patsienti s neiziasnena etiologiia na bezplodieto.

The aim of the present investigation was to establish the frequency of sperm antibodies in patients with etiologically unexplained infertility, and to compare the demonstrated frequencies with the results from y control group of y healthy blood donors, as well as with the results of other investigators. The gelatin agglutination test of Kibrick and the tray agglutination test of Friberg were applied to test 244 sera from infertile patients and 50 sera from healthy blood donors at the Laboratory of Immunology of Reproduction, Department of Biology, Medical University of Sofia. For the infertile patients, relevant sperm antibody titers were demonstrated in 2.5% (titer > or = 16) for the Kibrick method, and in 7% (titer > or = 32) for the Fiberg method. The test of Kibrick did not reveal significant antibody titers in the healthy controls, while the test of Friberg showed sperm antibodies in 2% of the blood donors. Fisher's exact test demonstrated extremely significant correlation (p < 0.0001) between the presence of sperm antibodies in sers of patients with unexplained infertility as revealed by the tests of Kibrick and Friberg. Most often mixed agglutinates were demonstrated in the Friberg test. In contrast with the results of other investigators head-to-head agglutinins were observed more often in male sera, while tail-to-tail agglutinins--in female sera. Finally, the results from the present investigation, as well as the analyzed literature data showed a low frequency of anti-sperm immunity in the Bulgarian population. The established high degree of correlation between the tests of Kibrick and Friberg, the good reproducibility of the results and the low cost of these methods confirm their appropriate use for the diagnosis of sperm antibodies in patients with unexplained infertility.

[The protein profile of the cervical mucus: cyclic and ovulatory values]. / Beltuchniiat profil na tservikalnata sluz: tsiklichni i ovulatorni stoinosti.

Immunological and biochemical analysis on cervical mucus requested application of micromethods on sindle small specimens. The following micro-methods in agar gel are applied: immunoelectrophoresis--the normal cervical mucus developed by antiserum against total human serum is presented with 5 precipitin lines: prealbumin, albumin, a1-antitrypsin, transferrin and IgG. The single immunodiffusion technique in agar gel (Mancini et al., 1964) is suitable method to assess these proteins. The same diffusion method is applied for enzyme assessment with special importance like a-amilase and muraminidase (lysozyme). The assessment of these proteins shows pre-ovulatory decrease and post-ovulatory remarkable increase. These changes are not simply due to the increased water content of the cervical mucus during the fertile period but reflects estrogen effect on cervical secretions.

[A clinico-genetic study of male infertility with globozoospermia]. / Kliniko-genetichno prouchvane pri muzhko bezplodie s globozospermia.

Eight patient with male infertility due to isolated or combined with other defects anomaly--round-headed spermatozoa, have been studied. Five of them have been studied. Five of the patients have been sporadic cases, whereas three cases have been familial ones. 100% of the spermatozoa in ejaculates from the patients with familial infertility had morphology of round-headed spermatozoa with lack of any proteolytic activity. In the patients with sporadic infertility the round-headed spermatozoa represented between 60 and 95% of the ejaculated cells. All of the patients were studied by chromosomal analyses (G-banding) and revealed normal male karyotypes 46, XY. The ratio affected: unaffected males in the 8 families studied implicates a monogenetic mode of inheritance (Coefficient of heredity 0.57) of the sperm anomaly. The distribution of the affected males in the three pedigrees with familial character of globozoospermia supports X-linked, sex-restricted dominant, or autosomal recessive modes of inheritance.

[The morphology of human spermatozoa--the norm and pathology]. / Morfologiia na choeshkite spermatozoidi--norma i patologiia.

The careful analysis of sperm morphology is an important part of routine semen examination. Although, there are different classification systems and methods for staining of the semen smears, the prognostic value of this assessment for man's fertility potential requests to be an obligatory part of semen analysis. Literally review shows that there are united attitude towards the significance of this semen parameter in vivo and in vitro. Most promising is development of intracytoplasmic sperm injection (ICSI) as the treatment of first choice in cases of severe teratozoospermia (for example round-headed spermatozoa). This suggests that sperm morphology may be important in spermatozoa-zone binding, penetration and spermatozoon-oocyte fusion, but fails to be of any "normality" once the spermatozoa reaches the cytoplasm of the oocyte.

[The electron microscopic pathology of human spermatozoa]. / Elektronno-mikroskopska patologiia na choveshkite spermatozoidi.

About 8% of our patients reveal predominantly single abnormality-state, known like monomorphic teratozoospermy, which concerns round headed spermatozoa, amorphous heads, small heads, tapering heads, decapitated spermatozoa, middlepieces and tail defects. In the light of electron-microscopy study the quality and information exactness increases significantly in comparison to conventional semen analysis. Such kind of study, however is not acquitted in normal fertile men, although the finding some of the above mentioned defects, but with less frequency. The assessment of human semen quality must be complex and coordinately without depreciation of the other methods of semen analysis.

Anti-seminal plasma antibodies associated with infertility: II. Comparative investigation of human antibody binding to normo-, astheno-, and azoospermic seminal plasma antigens.

PROBLEM: Sera from infertile patients with elevated reactivity against normozoospermic seminal plasma (NSP) have been selected to investigate human antibody binding to seminal fluid antigens present in abnormal ejaculates. METHOD: Sera from 32 idiopathically infertile patients and 44 control sera from fertile individuals were examined by ELISA against: 1) pooled seminal plasma from asthenozoospermic ejaculates (AsthSP), 2) pooled seminal plasma from patients with aspermatogenic azoospermia (AzooSP), and 3) chromatographic fractions from NSP, AsthSP and AzooSP. RESULTS: Of 32 patients positive for anti-NSP antibodies, only four exhibited increased reactivity to whole AsthSP and/or AzooSP, while 14 recognized antigens of different Mr and various distributions in the corresponding chromatographic fractions. CONCLUSION: Targets of human anti-NSP antibodies might be lacking, less concentrated, and/or modified in AsthSP and AzooSP. These findings suggest their physiological importance and the possible relevance of the observed auto- and iso-immune responses to infertility.

Distribution of vimentin in abnormal human spermatozoa.

Vimentin was immunocytochemically detected using a monoclonal anti-vimentin antibody and indirect immunogold electron microscopy. In abnormal human spermatozoa, vimentin was visualized at the level of whole acrosome, post-acrosomal region, neck and initial segment of the mid piece. The distribution of vimentin immunoreactivity was related to a spectrum of structural defects such as large cytoplasmic droplets, binucleated spermatozoa and mitochondrial disassembly in the mid piece.

Male reproductive function in workers exposed to vibration.

Male infertility is a significant health problem. Increasing attention has been paid to the use of semen analysis as an indicator of exposure to potential reproductive hazards. The aim of the current paper was to study the effects of vibrations on the spermatogenesis in workers of different occupational groups (professional drivers, miners, engine drivers, etc.). Semen samples were analyzed for pH, volume, turbidity, sperm density sperm count and sperm morphology. Workers had an increased prevalence of oligospermia and azoospermia. The semen volume and percentage of motile spermatozoa decreased significantly and the incidence of sperm malformation increased in exposed workers.

[Folliculometry as a method for determining ovulation in insemination with frozen sperm]. / Folikulometriiata kato metod za opredeliane na ovulatsiiata pri inseminatsiite sus zamrazena sperma.

The authors carried out studies retrospectively on 57 women, who became pregnant in insemination with donor frozen spermatozoa. Ovulation problems and luteal insufficiency were diagnosed in advance and treated before and during the occurring cycles. Women were divided into two groups. The first group of 25 women were examined by ultrasound transvaginal transducer for follow-up of follicle growth in the ovaries in addition to measurement of body temperature and determination of the cervical factor. The second group of 32 women, in whom follicle-metry was not performed. The frequency of conception was 0.24 in the first group, but 0.26 in the second group. It is concluded that inspite of the significance of follicle-metry for determination of ovulation the traditional methods are still valid criteria for ovulation and can be used as independent methods for determination of the time for insemination with therapeutic donor frozen spermatozoa.

[Immunological studies of patients with chronic nonspecific prostatitis and infertility]. / Imunologichni prouchvaniia pri bolni s khronichen nespetsifichen prostatit i infertilitet.

The authors studied carried out immunological studies on 20 men with chronic nonspecific prostatitis at reproductive age as well as on 10 healthy men included into the control group. Correlative investigations were made on the morphology of the ejaculate as well as on immunological parameters of seminal plasma aiming to establish the degree of the disturbed fertility. The immunological investigations included determination of albumin, transferrin and immunoglobulins in the seminal plasma. In men with chronic prostatitis there was a reduction in the number of spermatozoa up to 39 mln/cm3 combined with lower motility and an increased percentage of teratoforms. The immunological studies showed statistically significant nonincreased values in all men with chronic prostatitis in comparison with healthy men of the control group. These results show that increased permeability of barriers of blood serum proteins participates in the pathogenesis of the disturbed fertility. It is apparent that the cause for sterility in the married couples is due to autoimmune process occurring in men with chronic nonspecific prostatitis.