Maternal Sleeping Problems Before and After Childbirth - A Systematic Review.

The perinatal and postpartum period is of great significance for women due to physiological changes, shifts in circadian rhythms, social setting, and psychological well-being, all of which affect the quality and quantity of their sleep. A mixed-studies systematic review was undertaken to enhance our understanding of sleep disturbances and mood disorders in women in late pregnancy and the postpartum period, their connection with breastfeeding, and the assessment of interventions for sleep disturbance. Three electronic databases (PUBMED, EMBASE and Google Scholar) were searched for qualitative, observational, and mixed-method studies from the year 2016 to June 2023. Twenty-nine articles were included in the analysis. The results were synthesized into four overarching themes: (і) the sleep quality of women in the perinatal period; (ii) the relationship between sleep and breastfeeding; (iii) the relationship between sleep quality and emotional disturbance in the perinatal period; (iv) sleep interventions in the researched group. The subjective nature of the perception of sleep disturbances, along with the absence of an objective measurement tool is clearly an inconvenience. It is advisable to include the assessment of maternal sleep hygiene and family sleep patterns during postpartum healthcare provider appointments to develop strategies not only for women's sleep quality but also for their mental well-being.

The Effects of Breastfeeding and Gestational Diabetes Mellitus on Body Mass Composition and the Levels of Selected Hormones after Childbirth.

Breastfeeding may have a positive effect on glucose metabolism and insulin sensitivity, which may reduce the risk of developing diabetes following gestational diabetes mellitus (GDM). This study aimed to evaluate the effect of breastfeeding and GDM on the body mass composition of the studied women, the levels of leptin, ghrelin, adiponectin, resistin, and insulin, and weight loss during the 6-8-week postpartum period and 1 year after childbirth. MATERIALS AND METHODS: The study group included 42 women with a singleton pregnancy, diagnosed with GDM between the 24th and 28th week of gestation. The control group consisted of 28 non-diabetic women with a singleton pregnancy. This study was carried out at 6-8 weeks as well as at 1 year postpartum. The women were subjected to body weight measurements and body composition analysis performed using a professional body composition analyzer TANITA DC-430 S MA. Waist circumference and subcutaneous fat was measured. Blood for laboratory tests was taken in the morning, on an empty stomach. RESULTS: It was shown that, regardless of diabetes, exclusive breastfeeding had a significant impact on weight loss at 6-8 weeks postpartum (p = 0.014785) and lower insulin levels (p = 0.047). However, there was no effect of breastfeeding on the women's anthropometric measurements or hormone levels one year after delivery, except for the thickness of subcutaneous adipose tissue, which was significantly lower in breastfeeding women (p = 0.03). One year after delivery, breastfeeding women had a lower BMI (p = 0.0014), less-thick subcutaneous adipose tissue (p < 0.001), and a lower risk of obesity (p = 0.016). There were also higher insulin and ghrelin levels in both breastfeeding and non-breastfeeding women (p < 0.001), and lower resistin levels in non-breastfeeding women (p = 0.004). Women who had diabetes during pregnancy had a significantly reduced waist circumference and subcutaneous fat thickness after one year (p < 0.001 and p = 0.05, respectively). CONCLUSIONS: Having diabetes during pregnancy did not significantly affect the results of anthropometric measurements and hormone levels noted at 6-8 weeks after delivery (the only exception was the thickness of subcutaneous fat tissue, which was greater in women without GDM). This may indicate normalization of carbohydrate metabolism after childbirth; however, the observation period is too short to elucidate long-term metabolic effects. This suggests the need for further research related to GDM and breastfeeding.

Preoperative Oral Carbohydrate (CHO) Supplementation Is Beneficial for Clinical and Biochemical Outcomes in Patients Undergoing Elective Cesarean Delivery under Spinal Anaesthesia-A Randomized Controlled Trial.

BACKGROUND: Preoperative fasting and surgery cause metabolic stress, insulin resistance with ketosis, and postoperative nausea and vomiting (PONV). Oral carbohydrate loading strategy (CHO) improves outcomes in labor and general surgery. We aimed to compare the effectiveness of CHO with standard fasting in patients undergoing elective cesarean delivery (CD) under spinal anesthesia. METHODS: A single-center, parallel, prospective randomized controlled trial (RCT) was conducted in a tertiary university obstetrics department at Pomeranian Medical University in Szczecin, Poland. Patients were randomly assigned (1:1 ratio) to the CHO group (oral carbohydrate 2 h before elective CD, n = 75) or the SF group (control-standard fasting, n = 73). The main outcome measures were incidence and severity of PONV at 6 and 24 h after CD, time to the first peristalsis, time to first bowel movement, and biochemical parameters indicating ketosis in mothers and their children. RESULTS: A total of 148 adult females with singleton pregnancies undergoing elective CD under spinal anesthesia (ASA I and II) were included in the final analysis. At 24 h after CD, 8.0% from the CHO group vs. 20.55% reported three or more episodes of vomiting or dry retching as compared to patients in the SF group (p = 0.041). Preoperative CHO supplementation decreased preoperative feelings of hunger (p < 0.001) and thirst (p < 0.001). Laboratory results in the CHO group showed higher plasma pH (p = 0.001) and glucose (p < 0.001), lower F2-isoprostane in plasma (p = 0.049) and urine (p = 0.018), lower urine F2-isoprostane/creatinine ratio (p = 0.045) than in the SF group. HOMA-IR (p < 0.001) and lactate (p < 0.001) were higher in the CHO group than in the control group. CONCLUSIONS: There was no significant difference in the incidence or severity of early PONV at 6 h. The incidence of vomiting or dry retching at 24 h after cesarean delivery was lower in the CHO group as compared to standard starvation, but the combined results of PONV frequency and severity on the Wengritzky scale did not differ between the two study groups. Preoperative CHO supplementation decreased preoperative feelings of hunger and thirst, enhancing the comfort of pregnant women. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT04069806.

Assessment of Fatty Acid Content in the Milk of Women from the West Pomeranian Region of Poland with Regard to Supplementation and the Amount of Adipose Tissue.

The total amount of fat in the milk of nursing mothers depends on maternal reserves, as well as food intake and its synthesis in the mammary glands. The aim of this study was to assess the contents of fatty acids in the milk of women from the West Pomeranian region of Poland with regards to supplementation and the amount of adipose tissue. We also wanted to find out whether these women, who have direct access to the sea and potential access to fresh marine fish, have higher levels of DHA. METHODS: We analyzed milk samples obtained 6-7 weeks postpartum from 60 women. The content of fatty acid methyl esters (FAME) in lipids was determined by gas chromatography-mass spectrometry (GC/MS) using a Clarus 600 device (PerkinElmer). RESULTS: Women using dietary supplements had significantly higher levels of docosahexaenoic acid (DHA) (C22:6 n-3) (p = 0.000) and eicosapentaenoic acid (EPA) (20:5 n-3) (p = 0.000). The levels of eicosatrienoic acid (ETA) (C20:3 n-3) and γ-linolenic acid (GLA) increased with the amount of body fat, and the level of DHA was lowest in subjects where body fat exceeded 40% (p = 0.036). CONCLUSIONS: The contents of fatty acids in the milk of women from the West Pomeranian region of Poland were similar to that reported by other authors. The levels of DHA in women using dietary supplements was also comparable to the values reported worldwide. BMI had an effect on the levels of ETE and GLA acids.

Weight Gain during and after Pregnancy in Women with Gestational Diabetes Mellitus-A Preliminary Study.

Appropriate gestational weight gain (GWG) favors fewer complications related to pregnancy, delivery, puerperium, and the condition of the fetus and newborn baby. The aim of this study was to evaluate weight gain in women during and after pregnancy, including both women with and without gestational diabetes mellitus (GDM). MATERIALS AND METHODS: The study involved 42 singleton pregnant women diagnosed with GDM between the 24th and 28th week of pregnancy. The control group consisted of 28 nondiabetic women with a singleton pregnancy. The pre-pregnancy BMI, intra-pregnancy weight gain, and postpartum body weight were assessed in the participants. RESULTS: There were no statistically significant differences in the values of intra-pregnancy weight gain. Only diabetic women who were also overweight or obese had a significantly higher percentage of weight gain during pregnancy. The analysis of the percentage of weight gain during the entire pregnancy showed differences only in the group of women with pre-pregnancy BMI over 30. CONCLUSIONS: There were no significant differences in total pregnancy or mid-pregnancy weight gain between women with and without GDM. Most of the women had too high or too low total-pregnancy and mid-pregnancy weight gain. Therefore it is necessary to control GWG and educate pregnant women about it.

Telemedicine in Emergency Medicine in the COVID-19 Pandemic-Experiences and Prospects-A Narrative Review.

Even before the year 2020, telemedicine has been proven to contribute to the efficacy of healthcare systems, for example in remote locations or in primary care. However, with the outbreak of the COVID-19 pandemic, telehealth solutions have emerged as a key component in patient healthcare delivery and they have been widely used in emergency medicine ever since. The pandemic has led to a growth in the number of telehealth applications and improved quality of already available telemedicine solutions. The implementation of telemedicine, especially in emergency departments (EDs), has helped to prevent the spread of COVID-19 and protect healthcare workers. This narrative review focuses on the most important innovative solutions in emergency care delivery during the COVID-19 pandemic. It outlines main categories of active telehealth use in daily practice of dealing with COVID-19 patients currently, and in the future. Furthermore, it discusses benefits as well as limitations of telemedicine.

Musculoskeletal diseases as the basis for disability certificates in Lublin (Poland) in 2006-2021.

Introduction: Musculoskeletal diseases are not a leading cause of death but one of the common causes of disability and therefore play an important role in the global burden of diseases producing financial costs, need for hospitalization, treatment, rehabilitation, and hiring numerous medical personnel and caregivers. Patients who obtain a moderate or severe disability certificate may more easily find a job, have shorter working hours, apply for reduced tax, parking cards, co-financing of rehabilitation or renovation of the bathroom in order to adapt it to their disability. The aim of the study was to investigate the characteristics of people obtaining a disability certificate due to diseases of the locomotor system in Lublin within the last 16 years. Material and methods: The authors asked the Municipal Disability Adjudication Council in Lublin to provide data on the number of disability certificates issued in the years 2006-2021. Results: In the years 2006-2021 the Municipal Disability Adjudication Council in Lublin issued 76,581 disability certificates. The most common was the moderate degree of disability (36,458 certificates). The most common reason for being diagnosed with disability was diseases of the locomotor system. In the years 2006-2013, 41% of people obtaining disability certificates because of bone and joint diseases were in the 41-50 age group. From 2014, people over 60 years predominated. Of these, 57% were women. The majority of them had a secondary education. As many as 74% were unemployed, while only 36% were employed. Conclusions: Musculoskeletal diseases are a leading reason for issuing disability certificates in Lublin within the last 16 years. The certificates most often let patients obtain parking cards, facilitate the search for employment and enable them to apply for tax reductions.

Body Composition and Biological Functioning in Polish Perimenopausal Women with Type 2 Diabetes.

BACKGROUND AND OBJECTIVES: The aim was to compare body composition and levels of biochemical blood parameters and identify relationships between biochemical parameters and body composition of women with type 2 diabetes and healthy ones, both in perimenopausal period (172 women aged between 45 and 65 come from the West Pomeranian Voivodeship, Poland). MATERIALS AND METHODS: The study consisted of an interview, body composition analysis with Jawon Medical IOI-353 (Yuseong, South Korea) analyser and venous blood biochemical analysis (lipid profile, levels of glucose, insulin, CRP, glycated haemoglobin). RESULTS: The vast majority of body composition measurements varied between study and control groups in a statistically significant way (p < 0.05) except protein and soft lean mass of the torso. Statistically significant differences between the two groups have been observed in case of all biochemical parameters (p < 0.001). CONCLUSIONS: Body composition of women suffering from type 2 diabetes significantly varied from body composition of healthy women. Results of the first group were characterised by higher values, especially in case of general parameters, abdominal area, content of adipose tissue and soft tissues. Relationship between body composition and biochemical results may be observed, especially in level of triglycerides, CRP and insulin. Higher concentrations of these parameters were associated with increased values of majority of body composition measurements regardless of type 2 diabetes incidence.

How Knowledge about Stem Cells Influences Attitudes towards Breastfeeding: Case Study of Polish Women.

Maternal breastfeeding is associated with multiple health benefits, both for the child and the mother. Since breastfeeding rates are declining, finding new, future-oriented strategies to strengthen and support mothers' positive attitudes towards breastfeeding need to be developed. In this paper, we describe how information about the presence of stem cells in breast milk can influence the willingness to breastfeed in the population of Polish pregnant women. A cross-sectional study involving a group of 150 pregnant women was conducted to assess the correlation between their knowledge about stem cells and their attitude towards breastfeeding. Among the respondents, only 6% claimed that they did not know anything about stem cells, but general knowledge about stem cells in the research group was poor. The survey results indicated that city residence, university degree, maternal experience and advanced pregnancy correlated with higher general knowledge regarding stem cells. Most respondents (77.3%) had no knowledge regarding the presence of stem cells in breast milk. Approximately two-thirds of mothers with earlier negative breastfeeding experience declared that information about the presence of stem cells in breast milk could have influenced the decision to continue and extend the time of breastfeeding. Hence highlighting the presence of stem cells in breast milk can be used to encourage breastfeeding as a unique activity.

MEDICAL STAFF IN THE CARE OF A PREGNANT PATIENT DIAGNOSED WITH FETAL DEFECT.

OBJECTIVE: The aim: The research conducted aims at evaluating the way the medical staff functions in the care of the pregnant patient diagnosed with fetal defects. PATIENTS AND METHODS: Material and methods: 158 midwives took part in the study. The MINI-COPE standardized questionnaire and author's questions were used. RESULTS: Results: During the period when the care was provided for the pregnant patients diagnosed with fetal defects, nearly 50% of the midwives under examination complained about the decline of their wellbeing. 75,3% of the respondents seek help and advice on how to deal with a stressful situation. Ideal for providing a systemic support, the midwives most often chose a psychologist and a psychotherapist. The surveyed who reported no need for a systemic support for the medical staff at the workplace, as the causes of their attitude pointed to their diminished trust in the ward nurse and no place for honest conversations. Most of the midwives surveyed during the care of the patient with the fetal defects experienced stress and bigger mental exhaustion. Over half of the surveyed reported lack of systemic psychological support provided for the medical staff at the workplace. CONCLUSION: Conclusions: The research indicates the need to introduce courses and training on topics related to how to deal with stressful situations into the education system of medical staff.

Analysis of the Impact of Type 2 Diabetes on the Psychosocial Functioning and Quality of Life of Perimenopausal Women.

Menopause is a natural period resulting from the decrease in hormonal activity of the ovaries. Growing hormonal deficiencies and changes in the body influence a variety of functions in women, leading to depression and decreased quality of life. The relationship between body composition, the severity of depressive and climacteric symptoms and the quality of life of women with type 2 diabetes and healthy women in the perimenopausal period was studied. Statistically significant differences were observed between the study and control groups regarding all body composition parameters except for protein and the content of torso soft tissues (p < 0.05). In both the study and control groups, resulting symptoms were significantly correlated with numerous body composition parameters (e.g., body mass, fat tissue mass, minerals, abdominal circumference), while symptoms of depression were significantly correlated with similar parameters only in the control group. A statistically relevant relationship was observed between the study and control groups with respect to quality of life in certain domains. The quality of life of women suffering from type 2 diabetes was worse compared with healthy women. Analysis of body composition showed significant differences between healthy women and those with type 2 diabetes. Healthy women showed a tendency to establish a link between body composition and depressiveness.

The Relationship between the HLA-G Polymorphism and sHLA-G Levels in Parental Pairs with High-Risk Pregnancy.

Human leukocyte antigen G (HLA-G) is observed in immune system cells and other organs. It is a class Ib molecule, which plays a pivotal role in the implantation and maintenance of pregnancy. The aim of this study was to assess the relationship between serum sHLA-G levels and the HLA-G allele in parental pairs with complicated obstetric histories. The clinical material consisted of 210 women and 190 men with the experience of a complicated or an unsuccessful pregnancy. The control group included parents-89 women and 86 men-lacking complicated obstetric histories. We applied genetic analysis methods: isolation of genomic DNA, sequencing, and determination of serum sHLA-G levels. There were no statistically significant differences in the frequencies of the HLA-G -725 C>G polymorphism between particular experimental groups compared with the control group (p > 0.05). The median sHLA-G levels in the women with the HLA-G10101 allele (15.4 U/mL) were significantly higher than in the women with other alleles (p < 0.05). The HLA-G 10101 allele seems to protect against antiphospholipid syndrome, which may be associated with increased serum sHLA-G levels in its carriers. The relationship between serum sHLA-G levels and the HLA-G polymorphisms in the Polish population requires further investigation.

Milk Therapy: Unexpected Uses for Human Breast Milk.

BACKGROUND: Human breast milk provides a child with complete nutrition but is also a popular therapeutic remedy that has been used in traditional, natural pharmacopeia, and ethnomedicine for many years. The aim of this current review is to summarize studies of non-nutritional uses of mothers' milk. METHODS: Two databases (PubMed and Google Scholar) were searched with a combination of twelve search terms. We selected articles that were published between 1 January 2010, and 1 January 2019. The language of publication was limited to English. RESULTS: Fifteen studies were included in the systematic review. Ten of these were randomized controlled trials, one was a quasi-experimental study, two were in vitro studies, and four employed an animal research model. CONCLUSIONS: Many human milk components have shown promise in preclinical studies and are undergoing active clinical evaluation. The protective and treatment role of fresh breast milk is particularly important in areas where mothers and infants do not have ready access to medicine.

Non-nutritional use of breast milk.

Mammals milk, in addition to nutrients, contains many biologically active substances including immunoglobulins, growth factors, cytokines, acute phase proteins, and antimicrobial and antiviral proteins. Thanks to its unique composition, for hundreds of years it is used in post-natal care, treatment of wounds, as well as to fight bacterial and viral infections. The discovery of stem cells and HAMLET complex in breast milk resulted in increased interest in human breast milk as a natural medicine. Milk therapy is devoid of side effects, and breast milk banks may serve as a potential source of milk as a drug substance. In this study we collected information about the possible non-nutritional use of breast milk.

Cells of human breast milk.

Human milk is a complex fluid that has developed to satisfy the nutritional requirements of infants. In addition to proteins, lipids, carbohydrates and other biologically active components, breast milk contains a diverse microbiome that is presumed to colonize the infant gastrointestinal tract and a heterogeneous population of cells with unclear physiological roles and health implications. Noteworthy cellular components of breast milk include progenitor/stem cells. This review summarizes the current state of knowledge of breast milk cells, including leukocytes, epithelial cells, stem cells and potentially probiotic bacteria.

[Views and expectations of women regarding gynaecological examinations].

Introduction: It has long been known that gynaecological examination causes a lot of negative emotions for most women. The aim of the study was to learn the views of women on the issue of gynaecological examination. Materials and methods: The study involved 1200 women from the West Pomeranian and Lódz provinces in Poland. Results: The majority of non-pregnant women considered gynaecological examination to be embarrassing. The most embarrassing moment of the visit for the respondents from both groups was lying down on the gynaecological chair, and the most unpleasant stage of examination was palpation through the vagina. The greatest sense of security and mental comfort during the examination was provided by the presence of only the gynaecologist. Most pregnant respondents prefer to be examined by a male gynaecologist. Respondents would most willingly have examinations with a doctor who is nice, talkative, calm, smiling and mature. Most of the pregnant surveyed women claimed that the gynaecological examination is very necessary, while only 49% would appear for it once every 6 months. Conclusions: 1. Gynaecological examination was significantly more embarrassing and stressful for women who were not pregnant. 2. In the opinion of pregnant women, breast examination is the least embarrassing stage of the examination. 3. Pregnant women significantly more often chose a man as their gynaecologist. 4. The frequency of having a gynaecological examination depended significantly on the status of pregnancy. 5. The expectations of the surveyed women to a gynaecologist focused mainly on him/her maintaining a sense of intimacy and security, on informing the women on the procedures taken, as well as on a nice and individual approach.

[Perinatal sources of stem cells]. / Okoloporodowe zródla komórek macierzystych.

Recently, stem cell biology has become an interesting topic. Several varieties of human stem cells have been isolated and identified in vivo and in vitro. Successful application of hematopoietic stem cells in hematology has led to the search for other sources of stem cells and expanding the scale of their application. Perinatal stem cells are a versatile cell population, and they are interesting for both scientific and practical objectives. Stem cells from perinatal tissue may be particularly useful in the clinic for autologous transplantation for fetuses and newborns, and after banking in later stages of life, as well as for in utero transplantation in the case of genetic disorders. In this review paper we focus on the extraction and therapeutic potential of stem cells derived from perinatal tissues such as the placenta, the amnion, amniotic fluid, umbilical cord blood and Wharton's jelly.

α2ß1 integrin-mediated mechanical signals during osteodifferentiation of stem cells from the Wharton's jelly of the umbilical cord.

INTRODUCTION: The formation and maintenance of tissues is regulated by various signals triggered by biological, chemical, and physical factors. Data increasingly confirm that matrix or tissue elasticity plays an influential role in regulating numerous cell functions. The aim of the present study was to better understand the regulation of cellular differentiation by mechanical cues. We studied the influence of matrix stiffness on the osteodifferentiation of two cell lineages characterized by different responses: mesenchymal stromal/stem cells isolated from the Wharton's jelly of the umbilical cord (UC-MSCs) with strong stiffness-dependent responses; and bone-derived cells (BDCs), which are insensitive to changes in matrix rigidity. The study also aimed to delineate how matrix stiffness affects intracellular signaling through focal adhesion kinase (FAK) activity­one of the key components in integrin-mediated signaling pathways. MATERIAL AND METHODS: The effect of substrate stiffness on the expression of α2, α5, and ß1 integrin was studied using real time PCR and Western blot using cells cultured in an osteogenic medium on tunable polyacrylamide gels coated with type I collagen, with elasticities corresponding to Young's moduli of 1.46 kPa and 26.12 kPa. FAK activity was monitored using ELISA assays. RESULTS: We demonstrate for the first time the changes in the expression of α2, α5, and ß1 integrin subunits in perinatal stem cells and in adult osteoblast precursor cells during in vitro osteogenic differentiation on surfaces characterized by different stiffness. We found that matrix rigidity significantly affects the osteogenic differentiation of UC-MSCs through α2 integrin-mediated mechanotransduction events, though not through the α5 integrin subunit. In BDCs, there were no significant changes in the expression levels of the tested protein associated with varying stiffness. CONCLUSIONS: Our results provide evidence that matrix rigidity affects the osteogenic differentiation of UC-MSCs via mechanotransduction events mediated by α2 integrin subunits.

Effect of substrate stiffness on the osteogenic differentiation of bone marrow stem cells and bone-derived cells.

There is a profound dependence of cell behaviour on the stiffness of its microenvironment. To gain a better understanding of the regulation of cellular differentiation by mechanical cues, we investigated the influence of matrix stiffness (E = 1.46 kPa and E = 26.12 kPa) on differentiated osteogenic cell lineage of bone marrow stem cells (BM-MSCs) and bone-derived cells (BDCs) using flexible collagen-coated polyacrylamide substrates. Differentiation potential was determined by measuring alkaline phosphatase activity, expression of osteoblast-specific markers including alkaline phosphatase, osteocalcin, Runx2 and collagen type I, as well as assessment of mineralisation (Alizarin Red S staining). We found that osteogenic differentiation can be regulated by the rigidity of the substrate, which may depend on the commitment in multi- or uni-potent targeting cells. Osteogenic differentiation of BM-MSCs was enhanced on a stiff substrate compared to a soft one, whereas BDCs osteogenic differentiation did not vary depending on the substrate stiffness. The data help in understanding the role of the external mechanical determinants in stem cell differentiation, and can also be useful in translational approach in functional tissue engineering.

[Verification of the effectiveness of the dietary supplementation in infertility treatment]. / Ocena skutecznosci suplementacji zywieniowej w terapii nieplodnosci.

UNLABELLED: Fertility problems are observed in a growing number of couples in many countries, including Poland. The treatment of infertile couple should be comprehensive and apart from medical procedures also other factors affecting fertility potential should be taken into account. There is increasing evidence that a properly balanced diet and/or administration of specifically composed supplements may increase the chances of conceiving both naturally as well as in result of assisted reproductive techniques. THE AIM OF STUDY: Preliminary verification of the effectiveness of vitamin preparation to improve the quality of semen and the number of pregnancies achieved. MATERIAL AND METHODS: In total 28 infertile couples were included to the study. Within 6 months from the start of diet supplementation seminological studies and the assessment of getting pregnant have been conducted. RESULTS: The consumption of vitamin and mineral ingredients improves sperm quality and increases pregnancy rate. CONCLUSIONS: Dietary supplement may help to conceive by increasing the number and improving sperm motility.