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A unique view on male infertility around the globe

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Infertility affects an estimated 15% of couples globally, amounting to 48.5 million couples. Males are found to be solely responsible for 20-30% of infertility cases and contribute to 50% of cases overall. However, this number does not accurately represent all regions of the world. Indeed, on a global level, there is a lack of accurate statistics on rates of male infertility. Our report examines major regions of the world and reports rates of male infertility based on data on female infertility. Our search consisted of systematic reviews, meta-analyses, and population-based studies by searching the terms "epidemiology, male infertility, and prevalence." We identified 16 articles for detailed study. We typically used the assumption that 50% of all cases of infertility are due to female factors alone, 20-30% are due to male factors alone, and the remaining 20-30% are due to a combination of male and female factors. Therefore, in regions of the world where male factor or rates of male infertility were not reported, we used this assumption to calculate general rates of male factor infertility. Our calculated data showed that the distribution of infertility due to male factor ranged from 20% to 70% and that the percentage of infertile men ranged from 2·5% to 12%. Infertility rates were highest in Africa and Central/Eastern Europe. Additionally, according to a variety of sources, rates of male infertility in North America, Australia, and Central and Eastern Europe varied from 4 5-6%, 9%, and 8-12%, respectively. This study demonstrates a novel and unique way to calculate the distribution of male infertility around the world. According to our results, at least 30 million men worldwide are infertile with the highest rates in Africa and Eastern Europe. Results indicate further research is needed regarding etiology and treatment, reduce stigma & cultural barriers, and establish a more precise calculation.
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... Eighty-seven (46.5%) and 84 (44.9%) of the women had secondary and tertiary level education, respectively. Most of the women were traders (77, 41.2%); others were civil servants (41, 21.9%), and professionals (16,8.6%), while 42 (22.5%) of the women were unemployed. ...
... The incidence varies widely from one region to another, and it is highest in the infertility belt of Africa, of which Nigeria is part. 16 Our study revealed an infertility incidence rate of 18.2%, which was similar to the 18.5% reported by Nwajiaku et al in Nnewi. 17 The differences in rates may be related to the sociocultural differences, differences in healthseeking behaviour and genetic makeup of the people residing in the various regions of the world. ...
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Background: Infertility is a socially distressing medical condition that remains a public health concern in many developing countries, including Nigeria. The objective of the study was to evaluate the pattern of infertility among infertile couples in a tertiary hospital in South-South Nigeria. Methods: A retrospective, descriptive, cross-sectional study of infertile couples evaluated at the Infertility Clinic of the Federal Medical Centre, Yenagoa, Bayelsa State, South-South Nigeria, between January and December, 2021, was conducted. Case records of all the infertile couples evaluated during the study period were retrieved, and relevant data were extracted from the case records using a pre-designed proforma. Data obtained was analysed using Statistical Product and Service Solutions for Windows® version 25 (SPSS Inc.; Chicago, USA). Results: The incidence rate of infertility was 18.2%. Tubal factor was the most common (104, 55.6%) cause of infertility, with tubal blockage being the commonest (92, 49.2%) tubal pathology. Male factor was implicated in 81, 43.3%, of the cases, a combination of male and female factors in 45, 24.1%, while 5, 2.7%, of the cases were unexplained. Female factor alone was responsible for infertility in 101, 54.0%, of the cases, while male factor alone was identified in 36, 19.2%, of the cases. Conclusions: Our study’s incidence rate for infertility was similar to those reported in other studies in our region. To reduce the incidence of infertility, social reorientation to improve sociocultural practices and poor health-seeking behaviour of couples, should be pursued vigorously. Keywords: Infertility, Incidence, Couple, Tubal, South-South, Nigeria
... Reproductive dysfunction resulting from pathological conditions in males is a complex physiological process that is associated with different risks and pathological mechanisms that could directly or indirectly affect male reproductive functions and predispose to the development of infertility [3]. Globally, male reproductive infertility has been a significant health problem since the mid-1950s which is on the rise and seriously becoming a public health concern in this age, attracting the focus of clinicians and researchers in recent decades [1,4]. ...
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This study reported reproductive pathologies associated with Echis ocellatus venom in animal model. Twenty male Wistar rats with body weight between 180 and 220 g were selected randomly into two groups (n = 10). Rats in group 1 served as the control while rats in group 2 were envenomed with a single intraperitoneal injection of 0.055 mg/kg−1 (LD6.25) of E. ocellatus venom on the first day and a repeated dose on the twenty fifth day. Both control and envenomed rats were monitored for fifty consecutive days. The venom caused a significant (p < 0.05) reduction in sperm motility, count, and volume, with increased sperm anomalies in envenomed rats compared to the control. Likewise, serum concentrations of male reproductive hormones were significantly (p < 0.05) higher in envenomed rats. Increased levels of malondialdehyde were accompanied by a significant (p < 0.05) decrease in reduced glutathione and catalase activity in the epididymis and testis tissues of envenomed rats. The venom enhanced the release of epididymal and testicular tumor necrosis factor-alpha and interleukin1-beta compared to the control. Furthermore, severe pathological defects were noticed in tissues of the testis and epididymis of envenomed rats. This study demonstrated that E. ocellatus venom toxins can induce reproductive dysfunction in male victims of snake envenoming.
... Occupational exposure to certain persistent organic pollutants (POPs), household chemicals, and toxic metals often causes deterioration of reproductive health. Some lifestyle factors include smoking, smoke-free tobacco (chewing), and alcohol consumption can adversely affect reproductive health (Sharma et al. 2013;Agarwal et al. 2015). ...
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... It is well known that the excessive reactive oxygen species (ROS) had contributed to male infertility (Moretti et al., 2017). The ROS are produced endogenously through normal metabolism, daily lifestyle and diet (Agarwal et al., 2015). It can cause damage to the sperm DNA and affects gene expressions that is the primary cause of impairing sperm function and male infertility (Bisht et al., 2017). ...
Article
Glyceryl trinitrate (GTN) and isosorbide mononitrate (IM) are organic nitrates which release nitric oxide upon metabolism with potential to adversely affect male reproductive function. Therefore, this study was designed to evaluate the sub-chronic effect of these antianginal drugs on reproductive system in male rats. Wistar rats were separately treated with GTN and IM at 2.5, 5 and 7.5 mg/kg/day by oral gavage for 45 days. At the end of treatment, serum blood samples were taken from anaesthetized rats for assessment of hormonal profile. Epididymis from rat testes was removed to analyze sperm parameters. Rat testes were dissected to perform histopathological evaluation and oxidative stress biomarkers. The GTN and IM treated groups showed a significant decrease in sperm parameters (count, motility and viability) and serum testosterone in comparison to normal control group. The GTN and IM treatment also altered sperm morphology such as bent tail and head deformities as compared to control. A significant alteration in catalase activity and, increase in nitric oxide and malondialdehyde were observed in all drug treated groups. Moreover, a significant increase in follicle stimulating hormone and luteinizing hormone were also evident in all drug treated groups. Histological study showed oligospermia, vacuolization of sperm cells and, degeneration of seminiferous tubules. It is concluded that GTN and IM treatment adversely affected the male reproductive function by altering sperm parameters and endocrine disruption which may be attributed to the increased level of nitric oxide and oxidative stress.
... Infertility is defined as the failure to conceive a child after 1 year of regular sexual activity, and it affects 8% to 15% of reproductive-aged couples worldwide; male factors account for approximately half of infertility cases. 1,2 Although semen analysis is widely acknowledged as a standard procedure for assessing male fertility, the results do not provide evidence of sperm function. Because the sperm parameters evaluated in semen analysis are insufficient for evaluating male fertility, it is impossible to anticipate the outcome of assisted reproductive technology. ...
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... Male infertility is a global problem affecting about 4%-12% of men; it contributes to 20%-70% of cases worldwide with Africa and Eastern Europe having the highest rates [43]. There is growing evidence that one of the causes of male reproductive disorders and infertility is due to exposure to endocrine-disrupting chemicals such as bisphenol A (BPA) [13,44,45]. ...
Article
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The number and quality of sperm are decreased due to bisphenol A (BPA) exposure, an endocrine-disrupting chemical on the male reproductive system, especially in advanced paternal age (APA). Procyanidin C-1 (PCY-1), an antioxidant from grape seed (Vitis vinifera L.), has demonstrated anti-viral, anti-melanogenic and immunostimulatory effects. Therefore, this study aims to determine the effects of PCY-1 intervention on sperm parameters, testis morphological changes, serum testosterone, oestradiol, and luteinizing hormone (LH) concentrations and the expression of apoptotic (Bax and Bcl-2) and mitochondria-related (Mfn1 and Opa1) genes in BPA-exposed aged mice. Results revealed that PCY-1 intervention improves aged male fertility in BPA-exposed conditions by decreasing abnormal sperms percentage and increasing spermatogenic cell diameter and epithelial height. PCY-1 also decreased oestradiol, and increased LH and testosterone levels. The gene expression of Bax was significantly down-regulated by PCY-1 intervention. In contrast, Bcl-2 was substantially up-regulated. Expression of Mfn1 and Opa1 genes were also significantly up-regulated in the PCY intervention group. Hence, it is demonstrated that PCY-1 was able to mitigate the adverse effects of BPA on reproductive parameters of aged mice. Collectively, we postulated that PCY-1 has a potential role in protecting the ageing male reproductive system against the damaging impacts of BPA.
... About one in every seven couples in the world suffers from infertility, and at least 30-50% of the cases are related to men (Cui, 2010;Agarwal et al., 2015). An effective method to solve infertility is intracytoplasmic sperm injection (ICSI), which provides the most effective solution for males with severe infertility and accounts for 70-80% of in vitro fertilization (IVF) treatments (Rubino et al., 2015). ...
Article
The selection of high-quality sperms is critical to intracytoplasmic sperm injection, which accounts for 70-80% of in vitro fertilization (IVF) treatments. So far, sperm screening is usually performed manually by clinicians. However, the performance of manual screening is limited in its objectivity, consistency, and efficiency. To overcome these limitations, we have developed a fast and noninvasive three-stage method to characterize morphology of freely swimming human sperms in bright-field microscopy images using deep learning models. Specifically, we use an object detection model to identify sperm heads, a classification model to select in-focus images, and a segmentation model to extract geometry of sperm heads and vacuoles. The models achieve an F1-score of 0.951 in sperm head detection, a z-position estimation error within ±1.5 μm in in-focus image selection, and a Dice score of 0.948 in sperm head segmentation, respectively. Customized lightweight architectures are used for the models to achieve real-time analysis of 200 frames per second. Comprehensive morphological parameters are calculated from sperm head geometry extracted by image segmentation. Overall, our method provides a reliable and efficient tool to assist clinicians in selecting high-quality sperms for successful IVF. It also demonstrates the effectiveness of deep learning in real-time analysis of live bright-field microscopy images.
... Current epidemiological data suggest an increase in the prevalence of male infertility. According to Agarwal et al., the prevalence of infertile men ranges from 2.5% to 12% depending on the geographical area [1]. There are many factors involved in male infertility. ...
Article
Demographic data regarding male infertility suggest an increase in prevalence. This is an entity with multifactorial etiology, hormonal causes are often encountered. Although treatment with clomiphene was advocated to stimulate gametogenesis, it is still used off-label. We aimed to evaluate data from literature related to the effect of clomiphene as a single therapy, on the improvement of sperm count in infertile patients. Out of the 4,017 results of the search, only eight articles have been selected. The selected studies have been published between 1983 and 2020, and have included a total of 616 patients. From data reported, the treatment with clomiphene lead to a significant improvement of sperm concentration compared with placebo or with the level before starting the therapy (p<0.00001). Out of the 616 patients, in 369 (59.90%) cases improved sperm concentration was reported. In our meta-analysis, the selected studies had a high heterogeneity (I2 = 97%). Nevertheless, clomiphene is not an ideal treatment, paroxysmal effects have been reported. Our findings encourage the use of clomiphene on male infertility, although the potential side effects should be clearly explained to patients.
... Infertility is a worldwide health problem affecting about 15% reproductive-aged couples (Agarwal et al., 2015;Yeste et al., 2016). Assisted reproduction techniques (ARTs), especially intracytoplasmic sperm injection (ICSI), have allowed severe infertility couples to conceive. ...
Article
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The SEPTIN12 gene has been associated with male infertility. Male Septin12 +/− chimera mice were infertile, supporting the prevailing view that SEPTIN12 haploinsufficiency causes male infertility. In this study, we identified a heterozygous mutation on SEPTIN12, c.72C>A (p.Cys24Ter) in the male partner of a patient couple, who had a previous fertilization failure (FF) after intracytoplasmic sperm injection (ICSI) and became pregnant after ICSI together with artificial oocyte activation (AOA). To investigate the role of SEPTIN12 in FF and oocyte activation, we constructed Septin12 knockout mice. Surprisingly, Septin12 −/− male mice, but not Septin12 +/− male mice, are infertile, and have reduced sperm counts and abnormal sperm morphology. Importantly, AOA treatment enhances the 2-cell embryo rate of ICSI embryos injected with Septin12 −/− sperm, indicating that FF caused by male Septin12 deficiency is overcome by AOA. Mechanistically, loss of PLCζ around the acrosome might be the reason for FF of Septin12 −/− sperm. Taken together, our data indicated that homozygous knockout of Septin12, but not Septin12 haploinsufficiency, leads to male infertility and FF.
... Most notably, over the past several decades, testicular germ cell cancers have risen by about 400% in the West (Richiardi et al. 2004;Brenner et al. 2019;Batool et al. 2019) while sperm counts have dropped by up to 60% in young men born to industrialized nations (Levine et al. 2017). Infertility has been estimated to affect ~ 15% of couples globally, about half of which are due to the male factors (Agarwal et al. 2015;Sun et al. 2019). These alarming changes have emerged too quickly to be explained by genetic aberrations or improved detection technologies alone; lifestyle and environmental factors may also play a causative role (Sharpe 2010). ...
Article
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Implantation of testis cell aggregates from various donors under the back skin of recipient mice results in de novo formation of testis tissue. We used this implantation model to study the putative in vivo effects of six different growth factors on testis cord development. Recipient mice (n = 7/group) were implanted with eight neonatal porcine testis cell aggregates that were first exposed to a designated growth factor: FGF2 at 1 µg/mL, FGF9 at 5 µg/mL, VEGF at 3.5 µg/mL, LIF at 5 µg/mL, SCF at 3.5 µg/mL, retinoic acid (RA) at 3.5 × 10⁻⁵ M, or no growth factors (control). The newly developed seminiferous cords (SC) were classified based on their morphology into regular, irregular, enlarged, or aberrant. Certain treatments enhanced implant weight (LIF), implant cross-sectional area (SCF) or the relative cross-sectional area covered by SC within implants (FGF2). RA promoted the formation of enlarged SC and FGF2 led to the highest ratio of regular SC and the lowest ratio of aberrant SC. Rete testis-like structures appeared earlier in implants treated with FGF2, FGF9, or LIF. These results show that even brief pre-implantation exposure of testis cells to these growth factors can have profound effects on morphogenesis of testis cords using this implantation model.
... Infertility is defined by the World Health Organization (WHO) as the failure to achieve a pregnancy after at least 12 months of regular unprotected intercourse [1], and it has become a growing health concern for couples in present times. It is estimated that 20-70% of fertility problems are caused by the male partner, and at least 30 million men worldwide are infertile [2][3][4]. ...
Article
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Infertility is a growing public health problem. Consumption of antioxidant bioactive food compounds (BFCs) that include micronutrients and non-nutrients has been highlighted as a potential strategy to protect against oxidative and inflammatory damage in the male reproductive system induced by obesity, alcohol, and toxicants and, thus, improve spermatogenesis and the fertility parameters. Paternal consumption of such dietary compounds could not only benefit the fathers but their offspring as well. Studies in the new field of paternal origins of health and disease show that paternal malnutrition can alter sperm epigenome, and this can alter fetal development and program an increased risk of metabolic diseases and breast cancer in adulthood. BFCs, such as ascorbic acid, α-tocopherol, polyunsaturated fatty acids, trace elements, carnitines, N-acetylcysteine, and coenzyme Q10, have been shown to improve male gametogenesis, modulate epigenetics of germ cells, and the epigenetic signature of the offspring, restoring offspring metabolic health induced by stressors during early life. This indicates that, from a father’s perspective, preconception is a valuable window of opportunity to start potential nutritional interventions with these BFCs to maximize sperm epigenetic integrity and promote adequate fetal growth and development, thus preventing chronic disease in adulthood.
... Infertility is defined as the failure to achieve a clinical pregnancy following 12 months of regular unprotected sexual intercourse (Zegers-Hochschild et al., 2009). Male factor infertility affects 18 million men globally and is recognized by the World Health Organization (WHO) as a critical public health issue (Mascarenhas et al., 2012;Winters and Walsh, 2014;Agarwal et al., 2015;Lotti and Maggi, 2018). Identifiable and therefore potentially modifiable causes of male factor infertility include congenital (genetic), acquired, idiopathic and many other causes (Kovac and Lamb, 2014;Tüttelmann et al., 2018;European Association of Urology, 2019). ...
... Infertility has always been a problem of concern. According to the statistics of the World Health Organization, 50-80 million couples in the world are troubled by infertility, about 20%-30% of which are caused by male factors [8,9]. The pathogenesis of male infertility is complex. ...
Article
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This study is to verify the effect of asthma on sperm quality and explore its potential underlying mechanism. We randomly categorized the Sprague-Dawley (SD) rats into control (Group C) and asthma model (Group M) groups. Rats in the asthma model group were induced allergic asthma by intraperitoneal injection of ovalbumin solution. We evaluated the sperm motility and sperm concentration. The expression of the Interleukin-6 (IL6), phosphorylation-signal transducer and activator of transcription 3 (p-Stat3), and hypoxia-inducible factor-1α (HIF-1α) proteins and mRNAs in the testicular tissue was detected by western blotting and RT-qPCR. Compared with group C, sperm concentration and sperm motility in group M rats were significantly decreased ( P < 0.05 ). Meanwhile, compared with group C, the expression levels of IL6, Stat3, and HIF-1α proteins and mRNAs in group M rats were significantly increased ( P < 0.05 ). Asthma can regulate the HIF-1 signaling pathway, promoting the expression of IL6, Stat3, and HIF-1α protein and mRNAs, so as to promote sperm apoptosis and ultimately causing male infertility.
... Infertility is defined as the failure to achieve a clinical pregnancy following 12 months of regular unprotected sexual intercourse (Zegers-Hochschild et al., 2009). Male factor infertility affects 18 million men globally and is recognized by the World Health Organization (WHO) as a critical public health issue (Mascarenhas et al., 2012;Winters and Walsh, 2014;Agarwal et al., 2015;Lotti and Maggi, 2018). Identifiable and therefore potentially modifiable causes of male factor infertility include congenital (genetic), acquired, idiopathic and many other causes (Kovac and Lamb, 2014;Tüttelmann et al., 2018;European Association of Urology, 2019). ...
Article
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Study question: We aim to develop, disseminate and implement a minimum data set, known as a core outcome set, for future male infertility research. What is known already: Research into male infertility can be challenging to design, conduct and report. Evidence from randomized trials can be difficult to interpret and of limited ability to inform clinical practice for numerous reasons. These may include complex issues, such as variation in outcome measures and outcome reporting bias, as well as failure to consider the perspectives of men and their partners with lived experience of fertility problems. Previously, the Core Outcome Measure for Infertility Trials (COMMIT) initiative, an international consortium of researchers, healthcare professionals and people with fertility problems, has developed a core outcome set for general infertility research. Now, a bespoke core outcome set for male infertility is required to address the unique challenges pertinent to male infertility research. Study design size duration: Stakeholders, including healthcare professionals, allied healthcare professionals, scientists, researchers and people with fertility problems, will be invited to participate. Formal consensus science methods will be used, including the modified Delphi method, modified Nominal Group Technique and the National Institutes of Health's consensus development conference. Participants/materials setting methods: An international steering group, including the relevant stakeholders outlined above, has been established to guide the development of this core outcome set. Possible core outcomes will be identified by undertaking a systematic review of randomized controlled trials evaluating potential treatments for male factor infertility. These outcomes will be entered into a modified Delphi method. Repeated reflection and re-scoring should promote convergence towards consensus outcomes, which will be prioritized during a consensus development meeting to identify a final core outcome set. We will establish standardized definitions and recommend high-quality measurement instruments for individual core outcomes. Study funding/competing interests: This work has been supported by the Urology Foundation small project award, 2021. C.L.R.B. is the recipient of a BMGF grant and received consultancy fees from Exscentia and Exceed sperm testing, paid to the University of Dundee and speaking fees or honoraria paid personally by Ferring, Copper Surgical and RBMO. S.B. received royalties from Cambridge University Press, Speaker honoraria for Obstetrical and Gynaecological Society of Singapore, Merk SMART Masterclass and Merk FERRING Forum, paid to the University of Aberdeen. Payment for leadership roles within NHS Grampian, previously paid to self, now paid to University of Aberdeen. An Honorarium is received as Editor in Chief of Human Reproduction Open. M.L.E. is an advisor to the companies Hannah and Ro. B.W.M. received an investigator grant from the NHMRC, No: GNT1176437 is a paid consultant for ObsEva and has received research funding from Ferring and Merck. R.R.H. received royalties from Elsevier for a book, consultancy fees from Glyciome, and presentation fees from GryNumber Health and Aytu Bioscience. Aytu Bioscience also funded MiOXYS systems and sensors. Attendance at Fertility 2020 and Roadshow South Africa by Ralf Henkel was funded by LogixX Pharma Ltd. R.R.H. is also Editor in Chief of Andrologia and has been an employee of LogixX Pharma Ltd. since 2020. M.S.K. is an associate editor with Human Reproduction Open. K.Mc.E. received an honoraria for lectures from Bayer and Pharmasure in 2019 and payment for an ESHRE grant review in 2019. His attendance at ESHRE 2019 and AUA 2019 was sponsored by Pharmasure and Bayer, respectively. The remaining authors declare no competing interests. Trial registration number: Core Outcome Measures in Effectiveness Trials (COMET) initiative registration No: 1586. Available at www.comet-initiative.org/Studies/Details/1586.
... Infertility, defined as a couple's inability to achieve pregnancy following 1 year of regular and unprotected intercourse, may induce a loss of self-confidence and social withdrawal in couples (Jungwirth et al., 2012). Generally, in the aetiology of infertility, isolated factors may be reported for females (30-40%) or males (20%), suggesting that male factor infertility is present in approximately half of all infertile couples (Agarwal et al., 2015). ...
Article
Azoospermia consists of a significant proportion of infertility aetiology in males. Although known genetic abnormalities may explain roughly the third of infertility cases, the exact aetiology is still unclear. Chromosomal microarrays are widely used to detect sub chro-mosomal abnormalities (e.g., microdeletions and microduplications). This study aimed to investigate aetiology in patients with idiopathic azoospermia by using the chromosomal microarray method to detect possible sub chromosomal changes. Twenty-eight patients (with a mean age of 30.4 ± 9 years) that had been diagnosed with idiopathic azoospermia between January 2019 and December 2020 were included in the study. Genomic DNA isolated from the blood of patients were amplified using polymerase chain reaction and was subjected to chromosomal microarray analysis. A total of six microdeletions were identified as clinically significant: one pathogenic copy number variation (CNV), four likely pathogenic CNVs, and one CNV of unknown clinical significance. However, clinical findings indicated that these microdeletions, with variable expression levels, may affect the spermatogenesis process and induce azoospermia. Future investigations regarding the functional effect of these deletions may contribute to our understanding of azoospermia aetiology.
... In recent years, it has been estimated that approximately 48.5 million couples worldwide are confronted with pregnancy failure [27], and this social and medical issue is becoming increasingly urgent. A male factor is involved in nearly half of cases of couple's infertility, corresponding to 7 to 10% of men of the world population suffering from infertility [6,28]. ...
Article
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In mammals, sperm fertilization potential relies on efficient progression within the female genital tract to reach and fertilize the oocyte. This fundamental property is supported by the flagellum, an evolutionarily conserved organelle that provides the mechanical force for sperm propulsion and motility. Importantly several functional maturation events that occur during the journey of the sperm cells through the genital tracts are necessary for the activation of flagellar beating and the acquisition of fertilization potential. Ion transporters and channels located at the surface of the sperm cells have been demonstrated to be involved in these processes, in particular, through the activation of downstream signaling pathways and the promotion of novel biochemical and electrophysiological properties in the sperm cells. We performed a systematic literature review to describe the currently known genetic alterations in humans that affect sperm ion transporters and channels and result in asthenozoospermia, a pathophysiological condition defined by reduced or absent sperm motility and observed in nearly 80% of infertile men. We also present the physiological relevance and functional mechanisms of additional ion channels identified in the mouse. Finally, considering the state-of-the art, we discuss future perspectives in terms of therapeutics of asthenozoospermia and male contraception.
... Infertility seems to be one of the genuine reproductive health hazards with the development of age. This threat counts for infertility prevalence of 15% amongst the couples where 50% is solely male infertility [1]. Many spermatic dysfunctions due to hormonal and metabolic disorders, stressful lifestyle, diet, sleep apnea, or other pathologic conditions may account for infertility [2,3] where decline in semen quality is a potent feature [4][5][6][7][8][9]. ...
Article
Background The global prevalence of obesity has soared to a concerning height in the past few decades. Interestingly, the global decline in semen quality is a parallel occurrence that urges researchers to evaluate if obesity is among the most essential causatives of male infertility or subfertility. Main body Obesity may alter the synchronized working of the reproductive-endocrine milieu, mainly the hypothalamic-pituitary-gonadal (HPG) axis along with its crosstalks with other reproductive hormones. Obesity-mediated impairment in semen parameters may include several intermediate factors, which include physical factors, essentially increased scrotal temperature due to heavy adipose tissue deposits, and systemic inflammation and oxidative stress (OS) initiated by various adipose tissue-derived pro-inflammatory mediators. Obesity, via its multifaceted mechanisms, may modulate sperm genetic and epigenetic conformation, which severely disrupt sperm functions. Paternal obesity reportedly has significant adverse effects upon the outcome of assisted reproductive techniques (ARTs) and the overall health of offspring. Given the complexity of the underlying mechanisms and rapid emergence of new evidence-based hypotheses, the concept of obesity-mediated male infertility needs timely updates and pristine understanding. Conclusions The present review comprehensively explains the possible obesity-mediated mechanisms, especially via physical factors, OS induction, endocrine modulation, immune alterations, and genetic and epigenetic changes, which may culminate in perturbed spermatogenesis, disrupted sperm DNA integrity, compromised sperm functions, and diminished semen quality, leading to impaired male reproductive functions.
... Infertility is a worldwide public health concern, affecting approximately 15% of couples during their childbearing years [1]. Among these couples, up to 50% are related to male-factor infertility [2]. ...
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Background Severe or complete asthenozoospermia is a rare entity that can lead to male infertility. In this study, we explored whether different extents of severe or complete asthenozoospermia could affect intracytoplasmic sperm injection (ICSI) outcomes and compared the ICSI outcomes using testicular spermatozoa with those using ejaculated spermatozoa in couples with complete asthenozoospermia. Results Ninety-seven couples with severe or complete asthenozoospermia who underwent ICSI between January 2014 and December 2018 were included. According to the sperm category used in ICSI, patients were categorized into four groups: ejaculated progressive motile sperm group (Ep-group), ejaculated non-progressive motile sperm group (En-group), ejaculated immotile sperm group (Ei-group), and testicular sperm group (TESE-group). We compared the baseline characteristics, hormone profile, semen parameters, normal fertilization, good-quality embryos on day 3, transferred embryos, and ICSI outcomes in the four groups. The clinical pregnancy rate was significantly increased in the Ep-group (65.4%, P = 0.019) and TESE-group (63.6%, P = 0.035) compared with that in the Ei-group (23.1%). The ongoing pregnancy rate in the Ei-group was significantly lower than that in the Ep-group (23.1% vs. 61.5%, P = 0.041). Moreover, the biochemical pregnancy rate, ongoing pregnancy rate, and live birth rate were much lower in the Ei-group than in the TESE-group (30.8% vs. 63.6%, 23.1% vs. 40.4% and 23.1% vs. 40.4%, respectively). Conclusions In couples with complete asthenozoospermia, testicular spermatozoa should be preferred to ejaculated spermatozoa for obtaining a better ICSI outcome. With the appropriate selection of testicular spermatozoa, the extent of severe or complete asthenozoospermia may not affect the ICSI outcomes. Future studies with a larger sample size are warranted to validate these findings.
... To date, about 48.5 million couples worldwide suffer from infertility, 50% of which are attributed to male factors [1]. It has been estimated that about 10% of infertile men are affected by azoospermia, which is the most severe form of male infertility [2]. ...
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Non-obstructive azoospermia (NOA), characterized by spermatogenesis failure and the absence of sperm in ejaculation, is the most severe form of male infertility. However, the etiology and pathology between meiosis-associated monogenic alterations and human NOA remain largely unknown. A homozygous MSH5 mutation (c.1126del) was identified from two idiopathic NOA patients in the consanguineous family. This mutation led to the degradation of MSH5 mRNA and abolished chromosome axial localization of MutSγ in spermatocytes from the affected males. Chro-mosomal spreading analysis of the patient's meiotic prophase I revealed that the meiosis progression was arrested at a zygotene-like stage with extensive failure of homologous synapsis and DSB repair. Therefore, our study demonstrates that the MSH5 c.1126del could cause meiotic recombina-tion failure and lead to human infertility, improving the genetic diagnosis of NOA clinically. Furthermore , the study of human spermatocytes elucidates the meiosis defects caused by MSH5 variant , and reveals a conserved and indispensable role of MutSγ in human synapsis and meiotic re-combination, which have not previously been well-described.
... It is estimated that over 180 million couples are affected by infertility worldwide, and the male factor contributes to almost 50% of the cases (Agarwal et al., 2015). Male infertility has immense and complex nature and can be caused by a broad spectrum of disorders. ...
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There is increasing evidence from the literature that indicates the association between impaired sperm DNA integrity and male infertility. However, the data is insufficient regarding recurrent implantation failure (RIF) and sperm DNA damage. This study aimed to investigate the association between sperm DNA fragmentation and RIF cases. Basic semen parameters and sperm DNA fragmentation index (DFI) of men whose partner was suffering from RIF were compared with men whose partner was diagnosed with unexplained infertility (UEI) but had clinical pregnancies following IVF treatment. A retrospective analysis from a large‐volume IVF center has been performed, and a total of 197 couples underwent analysis. Two groups were formed, couples with RIF and couples diagnosed with UEI but had clinical pregnancies (controls) following IVF cycles. The mean number of cycles showed significant differences between the groups. However, no statistical difference was observed between RIF and the control group regarding patient characteristics, semen parameters, and sperm DNA fragmentation index (DFI). Also, no statistically significant correlation was found between sperm DFI and clinical pregnancies in the unexplained infertility cohort. Our results show that sperm DNA fragmentation may not be an important contributing factor to RIF cases.
... Infertility can be defined as the failure to attain clinical pregnancy after having unprotected sexual intercourse for one year or more [189]. Globally, approximately 15% couples of reproductive age suffer from infertility, and male factor infertility contributes to 50% of the cases [4]. Male infertility is a multifactorial, complex reproductive disease, and urogenital infections are believed to be a contributory factor in 12-35% of the cases [163], thereby affecting several parts of the urogenital system such as testis, epididymis, prostate, and accessory sex glands [105]. ...
Chapter
Male infertility is considered as a multifactorial complex reproductive illness, and male urogenital infection and inflammation are crucial etiologies contributing up to 35% of all cases. Mostly triggered by sexually transmitted diseases and uropathogens, chronic manifestation of such infection may cause irreversible infertility in the male. Male urogenital infection involves bacterial, viral, protozoal, and fungal infections many of which remain asymptomatic most of the time and are passed to the sexual partner leading to fertilization failure, pregnancy loss, and even development of illness in the offspring. The abundance of leukocytes in semen can be used as an indicator of urogenital infection. Its contribution in male infertility can be as high as 30% and the clinical condition is referred to as leukocytospermia. Seminal bacterial load together with increased leukocytes contribute to the impairment of male fertility parameters such as, sperm motility, DNA integrity, acrosome reaction, and damage sperm molecular structure. Pathophysiology of bacteriospermia-induced impairment of male infertility is probably mediated by the involvement of bacterial pathogens in the intrinsic apoptotic pathway resulting in sperm death, whereas that of seminal leukocytes operates through excessive generation of ROS. Although the application of antibiotics forms the frontline therapeutic approach, the growing resistance to antibiotics poses a concern in the management of microbes-induced male urogenital infection. Complementary and alternative medicine may offer additional management options in combating such infections. On the other hand, both broad spectrum antibiotics and antioxidant therapy have showed promising results in the management of infertile men with leukocytospermia. Use of herbal medicine may also play a promising role in the management of such patients. However, recent molecular biology techniques have noted the association of elevated levels of IL-8 with both the Chlamydial infection of the male urogenital tract as well as the clinical condition of leukocytospermia. On the basis of such common pathogenesis, further research involving advanced molecular techniques may pave the way towards the development of better diagnostic tools in the clinical management of male urogenital infection and leukocytospermia.
... Infertility affects around 15% of couples of reproductive age [1]. ...
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... Plusieurs études mettent en évidence un déclin des paramètres spermatiques dans le monde (Agarwal et al., 2015;Levine et al., 2017;Virtanen et al., 2017) et en France (Geoffroy-Siraudin et al., 2012;Rolland et al., 2013). Cependant cette baisse globale de la qualité du sperme est toujours débattue. ...
Thesis
L’infertilité concerne plus de 50 millions de couples dans le monde et le facteur masculin est incriminé dans 50% des cas. Les mitochondries sont reconnues comme essentielles aux spermatozoïdes, notamment pour la motilité flagellaire, la capacitation, la réaction acrosomique et la fusion gamétique. L’altération des fonctions mitochondriales pourraient être liées à la baisse de la qualité du sperme et à l’infertilité. L’objectif principal de ce travail était d’approfondir nos connaissances sur le lien entre le génome mitochondrial des spermatozoïdes et l’infertilité masculine, mais aussi d’évaluer l’environnement métabolique des spermatozoïdes en cas d’altération des paramètres spermatiques. Nous avons mis en évidence, avec le séquençage haut débit, une fréquence de grands réarrangements plus importante dans l’ADNmt les spermatozoïdes de meilleure qualité, parallèlement à la diminution significative de leur taux d'ADNmt. Nous pensons que cette découverte est le résultat d'un phénomène physiologique d'élimination active de l'ADNmt paternel dans les spermatozoïdes contribuant à la transmission uniparentale maternelle de l'ADNmt. L’étude métabolomique du liquide séminal nous a permis d’obtenir un aperçu global des défauts métaboliques contribuant à l'altération structurelle et fonctionnelle des spermatozoïdes dans l'oligoasthénospermie sévère. Ces résultats offrent de nouvelles perspectives sur la compréhension de l'infertilité masculine qui pourraient aider à développer des outils diagnostiques et de futurs traitements spécifiques.
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Oxidative stress in spermatozoa is a major contributor to male subfertility, which makes it an informed choice to generate animal models of male subfertility with targeted modifications of the antioxidant systems. However, the critical male germ cell-specific antioxidant mechanisms have not been well defined yet. Here we identify LanCL1 as a major male germ cell-specific antioxidant gene, reduced expression of which is related to human male infertility. Mice deficient in LanCL1 display spermatozoal oxidative damage and impaired male fertility. Histopathological studies reveal that LanCL1-mediated antioxidant response is required for mouse testicular homeostasis, from the initiation of spermatogenesis to the maintenance of viability and functionality of male germ cells. Conversely, a mouse model expressing LanCL1 transgene is protected against high-fat-diet/obesity-induced oxidative damage and subfertility. We further show that germ cell-expressed LanCL1, in response to spermatogenic reactive oxygen species, is regulated by transcription factor specific protein 1 (SP1) during spermatogenesis. This study demonstrates a critical role for the SP1–LanCL1 axis in regulating testicular homeostasis and male fertility mediated by redox balance, and provides evidence that LanCL1 genetically modified mice have attractive applications as animal models of male subfertility.
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Heat stress (HS) affects spermatogenesis and sperm maturation, decreasing sperm quality. Yet sperm morpho-functional changes caused by HS in Nellore bulls are not fully elucidated. This study aimed to show the chronological effects on sperm quality of HS during spermatogenesis and sperm maturation until recovery of the seminiferous epithelium in Nellore bulls. Nine Nellore bulls were distributed into control and heat stress (HS-scrotal bags/96 h) groups. The study was divided into five Periods: 1. Control (14-7 days before HS); 2. Stored sperm (0–7 days after HS); 3. Sperm maturation and late spermatogenesis (14–42 days after HS); 4. Early spermatogenesis (49–63 days after HS), and 5. Recovery (70–77 days after HS). Semen was collected once a week and evaluated for sperm motility, morphology, plasma, acrosome, and mitochondrial membranes, lipid peroxidation, and DNA fragmentation. Sperm characteristics were similar between groups in Periods 1 (control). During Period 2, HS increased detached normal head defect and decreased mitochondrial membrane potential, denoting effects on the sperm stored at the epididymis cauda. In Period 3, HS decreased sperm motility, plasma membrane integrity, and mitochondrial membrane potential and increased abnormal sperm, lipid peroxidation, and DNA fragmentation; reflecting the effects on sperm that were in the epididymis body and head and late spermatogenesis (spermiogenesis and meiosis). In Period 4, HS maintained a reduction in the mitochondrial membrane potential and an increase in abnormal sperm; injuries that could occur during early spermatogenesis (mitosis). Finally, in Period 5, the groups were similar, confirming the recovery of the seminiferous epithelium after HS. This study provides insights on the effects of HS on the complete process of sperm maturation and spermatogenesis, until recovery in sperm from Nellore bulls.
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Emerging evidence indicates that ambient particulate matter (PM) is harmful to male fertility, but the associations between ambient PM exposure and semen quality were inconsistent. This study aimed to quantitatively evaluate the association between ambient PM exposure and semen quality based on a large prospective cohort. Using data from the prospective assisted reproduction cohort in Anhui province, China, we included 15,112 males with 28,267 semen tests, whose partner has undergone assisted reproductive technology from September 1, 2015 to September, 22 2020. Individual ambient PM, gaseous air pollutants, and temperature exposures of the participants during 0–90, 0–9, 10–14, and 70–90 days before semen quality tests were evaluated using inverse distance weighting interpolation. Linear mixed-effects models were conducted to evaluate the relationship between PM2.5 and PM10 exposures and standardized semen quality parameters. Models were adjusted for age, body mass index, smoking, drinking, education attainment, occupation type, sampling month, temperature and the principal component of gaseous air pollutants. PM2.5 and PM10 were inversely associated with sperm concentration, total sperm count, total motility, progressive motility, total motile sperm count, and progressively motile sperm count during 0–90, 0–9, and 70–90 days period (all p < 0.05), but not 10–14 days period. The regression coefficients of PM2.5 exposure on semen quality parameters during 0–90 days period were larger than 0–9 and 70–90 days periods, and the effects of PM2.5 on semen quality parameters were stronger than PM10. Our results showed that ambient PM2.5 and PM10 exposures were associated with semen quality, during 70–90 days and 0–9 days before sampling, and the entire spermatogenesis process. The effects of PM2.5 on semen quality parameters were stronger than PM10, and the long-term effects of PM2.5 and PM10, throughout spermatogenesis, were stronger than the short-term effects.
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Introduction: Nearly 50% of infertile couples' cases are due to male factors. Male infertility is pluri-etiological and as such, it is important to understand the role of seminal plasma novel biomarkers and viral infection in male infertility. The main objective of this study was to compare the fructose and citric acid levels in men with HBV, HCV, HIV amongst those seeking fertility evaluation. Methods: A prospective cross-sectional study was performed on consenting male participants. The semen samples from patients were collected properly and analyzed according to the World Health Organization-2010 manual. Later samples were assayed for biochemical markers and viral antigens and antibodies following their standard protocols. Statistical analysis of the findings was performed using IBM SPSS-24.0 software. Significant statistical difference between median sperm parameters of both groups of men and biomarker levels were considered at p < 0.05. Results: the prevalence of hepatitis B, C and Human Immune deficiency Virus were 6.3% (5), 2.5% (2) and 3.8% (3) respectively. The study highlighted that there is no significant difference in the fructose and citric acid levels amongst HBV, HCV, and HIV patients (p >0.05). Conclusion: The assessment of biochemical markers of seminal fluid for fertility evaluation didn't give a clear understanding of the effect of viral infection on the accessory glands. It important to investigate in a larger population to have more pertinent information.
Article
The conventional semen parameter analysis is widely used to assess male fertility. However, studies have found that ~15% of infertile patients show no abnormalities in conventional semen parameters. Additional technologies are needed to explain the idiopathic infertility and detect subtle sperm defects. Currently, biomarkers of sperm function, including sperm apoptosis, mitochondrial membrane potential (MMP), and DNA damage, reveal sperm physiology at the molecular level and are capable of predicting male fertility. With flow cytometry (FCM) techniques, each of these markers can be rapidly, accurately, and precisely measured in human semen samples, but time costs substantially increase and results could be obstructed if all the biomarkers need to be tested with a single cytometer. In this protocol, after collection and immediate incubation at 37 °C for liquefication, semen samples were further analyzed for sperm apoptosis using Annexin V-fluorescein isothiocyanate (FITC)/propidium iodide (PI) staining. The MMP was labeled with 5,5′,6,6′-tetrachloro-1,1′,3,3′-tetraethyl-benzimidazolylcarbocyanine iodide (JC-1) probe, and DNA damage was assessed using the sperm chromatin structure assay (SCSA) with acridine orange (AO) staining. Thus, flow cytometric analysis of sperm function markers can be a practical and reliable toolkit for the diagnosis of infertility and evaluation of sperm function at both bench and bed.
Article
BACKGROUND: Infertility and obesity are actual and at the same time occurring problems of many couples. Conflicting data have been obtained on ejaculate parameters and the results of infertility treatment using in vitro fertilization treatment (IVF) in overweight and obese men. AIM: To evaluate the results of examination and treatment using ART, depending on the body mass index (BMI) of men in infertile couples. MATERIALS AND METHODS: A retrospective analysis of the results of treatment at the International Center for Reproductive Medicine in 368 infertile couples was carried out. The mean age of men and women was 36.4 6.2 and 33.9 5 years, respectively. Previous treatment for varicocele, sexually transmitted infections, prostatitis and cryptorchidism was performed in 58 (15.7%), 43 (11.7%), 42 (11.4%) and 11 (2.9%) men, respectively. Height and weight were measured for all patients, and BMI was calculated. The ejaculate was processed using a gradient medium (SupraSperm, Origio), IVF or ICSI were used in 110 (29.9%) and 258 (70.1%) couples, respectively, signs of good embryo quality were determined according to recommendations of professional societies for reproductive medicine. The onset of pregnancy was confirmed by the results of ultrasound sonography of the uterus. The results were subjected to statistical analysis. RESULTS: The BMI mean was 27.4 4.4 kg/m2, overweight and obesity of the 1st and 2nd degrees were observed in 161 (43%), 58 (15.8%) and 23 (7%) men respectively. Higher BMI values of men corresponded to higher BMI values of women (p 0.001), BMI values did not depend on ejaculate volume, concentration, total number and number of motile spermatozoa, proportion of high-quality embryos, and pregnancy rate. The highest pregnancy rate was noted after treatment of couples with younger women and higher values of the total number, concentration and number of progressively motile spermatozoa and ejaculate volume (p = 0.037, p = 0.028, p 0.001, p = 0.003, p 0.0001, respectively). CONCLUSIONS: Overweight and obese men prevail in infertile couples seeking IVF treatment. IVF treatment can overcome infertility in couples with overweight and obese men.
Article
In around half of couples affected by infertility, a descriptive diagnosis can be established in the male partner. Genetic analyses can help to establish a causal diagnosis, enable individual counseling and treatment of the couple, and guide treatment decisions. Based on the clinical findings, chromosomal analysis, screening for Y chromosome azoospermia factor (AZF) deletions, and panel analyses of multiple genes are indicated. Before medically assisted reproduction (MAR) and after exclusion of other causes, a chromosomal analysis should be conducted in both partners, independent of the following, specific indications. Common genetic causes for male infertility are Klinefelter syndrome (47,XXY), chromosomal translocations, Y chromosome AZF microdeletions, and obstructive azoospermia due to bi-allelic pathogenic variants (mutations) in the CFTR gene. In recent years, a number of genes in association with morphological and functional aberrations of sperm have been identified. In addition, several genes are known to be associated with non-obstructive azoospermia (NOA) and congenital hypogonadotropic hypogonadism (CHH). The detection of the underlying genetic cause of male infertility helps to estimate the chances for MAR treatments and the recurrence risk for the offspring of affected men.
Chapter
Around the world, the number and proportion of people without their own biological children has increased. The increase partly reflects an increase in fertility problems (primarily due to people postponing when they first try to have a baby), but also an increase in the desire and ability to remain “childfree.” More often than not, however, contemporary childlessness is “coincidental”; that is, people often end up childless without explicitly intending to do so. In many countries, childlessness has also become more of a male than a female phenomenon. In this chapter, I discuss recent trends in childlessness around the world, the causes and consequences of childlessness across contexts, and consider whether contemporary childlessness is a problem.
Article
Introduction: Several antioxidants are available for the treatment of male infertility. Although the benefit of myo-inositol (MYO) and D-chiro-inositol (DCI) for female infertility is recognized, their role in male infertility is a matter of debate. Areas covered: The authors review the impact that treatment with MYO and/or DCI may have on conventional and bio-functional sperm parameters [mitochondrial membrane potential (MMP), sperm chromatin compactness, and sperm DNA fragmentation (SDF)], seminal oxidative stress (OS) and pregnancy, miscarriage, and live birth rates, and the possible mechanisms involved. Furthermore, the authors gather evidence on the effects of MYO and/or DCI on sperm function in vitro. Expert opinion: MYO can improve sperm count, motility, capacitation, acrosome reaction, and MMP. No data are currently available on the effects of DCI in vivo. Both MYO and DCI ameliorate sperm motility and MMP in vitro. Therefore, the use of inositols should be preferred in patients with idiopathic asthenozoospermia, especially in case of impaired sperm mitochondrial function. Due to their insulin-sensitizing action, a role for these molecules may be envisaged for the treatment of infertility caused by carbohydrate metabolism derangement.
Chapter
Smoking contributes to the death of around one in 10 adults worldwide. Specifically, cigarettes are known to contain around 4000 toxins and chemicals that are hazardous in nature. The negative effects of smoking on human health and interest in smoking-related diseases have a long history. Among these concerns are the harmful effects of smoking on reproductive health. Thirteen percent of female infertility is due to smoking. Female smoking can lead to gamete mutagenesis, early loss of reproductive function, and thus advance the time to menopause. It has been also associated with ectopic pregnancy and spontaneous abortion. Even when it comes to assisted reproductive technologies cycles, smokers require more cycles, almost double the number of cycles needed to conceive as non-smokers. Male smoking is shown to be correlated with poorer semen parameters and sperm DNA fragmentation. Not only active smokers but also passive smokers, when excessively exposed to smoking, can have reproductive problems comparable to those seen in smokers. In this book chapter, we will approach the effect of tobacco, especially tobacco smoking, on male and female reproductive health. This aims to take a preventive approach to infertility by discouraging smoking and helping to eliminate exposure to tobacco smoke in both women and men.
Chapter
Andrology is an interdisciplinary medical specialty that primarily deals with the reproductive health of men. In addition to diagnosis and therapy in cases of an unfulfilled desire to have children (infertility), endocrine dysfunction of the testis (hypogonadism), including age-related aspects (puberty, senescence), sexual disorders (erectile dysfunction), and diseases of the male breast (gynecomastia) are important issues in andrology. Basic knowledge of andrological diseases and their sequelae should be available in every field of medicine. This becomes particularly evident when possible adverse effects of drugs, other exogenous noxae, or surgical procedures on male fertility have to be considered and options for the cryopreservation of germ cells (fertility protection) should be provided. Moreover, impairment of testicular and/or sexual functions can be a harbinger of systemic diseases or aggravated by comorbidities.
Chapter
Male factor issues are responsible for 50% of couples infertility. Seminal oxidative stress is one of the major factors that affect the normal physiological aspects of sperm function such as motility and progression, hyperactivation, capacitation, acrosome reaction and zona-pellucida penetration prior to fertilization. In recent times, high-throughput proteomic platforms are used to identify the proteins associated with these aspects of sperm function as associated with oxidative stress. In this review, we have provided a workflow that includes an overview of advanced proteomic techniques and bioinformatic tools used to interpret proteomic results. Furthermore, we have highlighted proteins associated with dysregulated molecular pathways in sperm and seminal plasma due to oxidative stress. We have also described the molecular interactions between proteins associated with oxidative stress and their potential role in male infertility.
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Obstructive sleep apnea (OSA) is a rising problem, with important implications for public health. Recent evidence has revealed a link between OSA and reduced male fertility. We investigated the association between OSA and sexual and erectile function, as well as semen quality, and the effect of treatment by continuous positive airway pressure (CPAP). A total of 41 male subjects, who underwent polysomnography for suspected OSA, participated in the study. Erectile and sexual function were assessed with the 15-item International Index of Erectile Function (IIEF-15) questionnaire, blood samples, and sperm analysis. OSA patients after the initiation of CPAP treatment were followed for a period of 1 year. Thirty-two patients were diagnosed with OSA, and nine subjects without OSA were used as a control group. OSA patients demonstrated significantly impaired erectile function, reduced testosterone levels, and lower semen quality. Multivariable regression analysis showed that BMI and IIEF score were independent determinants of AHI. Sexual function improved after a year of CPAP therapy in OSA patients. This study provides further evidence regarding the association between OSA and erectile function impairment, as well as semen quality. Longitudinal adherence to CPAP treatment has a beneficial effect on erectile function.
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Collection of epidemiological data has become a crucial step in every fertility evaluation, especially regarding idiopathic male infertility. Information on data such as tobacco smoking, alcohol intake, and body mass index can provide crucial information regarding the dynamics between fertility status and everyday practices. We aim to set the base for epidemiological studies on male infertility in the Greek population. Four hundred and fourteen Greek volunteers were asked to fill in a questionnaire regarding their characteristics and lifestyle preferences, followed by a seminogram. Depending on their answers, they were divided into groups and data were analyzed for correlation with seminogram parameters using Spearman's rank correlation test. Our results indicate that a high body mass index (BMI) is negatively correlated with all three seminogram parameters (number, motility, and morphology) and exposure to radiation or chemicals is negatively correlated with sperm motility, with a p < 0.01. These findings indicate negative correlations of BMI and exposure to radiation/chemicals with semen parameters in the Greek population. Such information can be used to plan a diagnostic approach or even therapeutic interventions.
Chapter
Assisted Reproductive Technology (ART) has gained pace over the last 40 years, with 0.1% of the global population estimated to have been born as a result of ART services (Faddy MJ, Gosden MD, Gosden RG, Reprod Biomed Online 36:455–458, 2018). ART spans a greater suite of technologies beyond in vitro fertilisation (IVF) pioneered by Steptoe and Edwards, with superovulation, intracytoplasmic sperm injection (ICSI), cryopreservation and genetic testing all conventional techniques offered in fertility clinics worldwide. Despite technological advancement, the ART process is lengthy, with no guarantee of success – often bestowing significant emotional stress on those undertaking treatment. The application of AI to the field looks strongly positioned to augment success rates, with the process of embryo selection already significantly improved by the assistance of AI in several clinical trials. This chapter explores the use of AI across other parts of the ART journey, such as gamete selection, as well as key challenges in the future development of AI products for ART.
Article
Studies on gene regulation and signaling transduction pathways of human spermatogonial stem cells (SSCs) are of the utmost significance for unveiling molecular mechanisms underlying human spermatogenesis and gene therapy of male infertility. We have demonstrated, for the first time, that RNF144B stimulated cell proliferation and inhibited the apoptosis of human SSCs. The target of RNF144B was identified as FCER2 by RNA sequencing. We revealed that RNF144B interacted with FCER2 by immunoprecipitation. Consistently, overexpression of FCER2 reversed the phenotype of proliferation and apoptosis of human SSCs caused by RNF144B knockdown. Interestingly, FCER2 pulled down N2ICD (NOTCH2 intracellular domain), while N2ICD could bind to FCER2 in human SSCs. The levels of NOTCH2, FCER2, HES1, and HEY1 were reduced by RNF144B siRNA in human SSCs. Significantly, RNF144B was expressed at a lower level in nonobstructive azoospermia (NOA) patients than in the obstructive azoospermia (OA) patients with normal spermatogenesis, and 52 patients with heterozygous mutations of RNF144B were detected in 1,000 NOA patients. These results implicate that RNF144B promotes the proliferation of human SSCs and suppresses their apoptosis via the FCER2/NOTCH2/HES1 pathway and that the abnormality of RNF144B is associated with spermatogenesis failure. This study thus provides novel molecular mechanisms regulating the fate determinations of human SSCs, and it offers new biomarkers for the diagnosis and treatment of male infertility.
Article
The inability to conceive due to male infertility is a complex issue with a wide variety of etiologies. Sperm DNA damage can be both a barrier to natural pregnancy and successful assisted reproductive technology (ART). The aim of this narrative review was to describe and highlight the effects of sperm DNA fragmentation and the most recent data on various treatment strategies to decrease sperm DNA damage. Finally, we proposed a management algorithm for couples undergoing ART with increased sperm DNA fragmentation.
Article
We aimed to analyze the role of the common genetic variants located in the PIN1 locus, a relevant prolyl isomerase required to control the proliferation of spermatogonial stem cells and the integrity of the blood–testis barrier, in the genetic risk of developing male infertility due to a severe spermatogenic failure (SPGF). Genotyping was performed using TaqMan genotyping assays for three PIN1 taggers (rs2287839, rs2233678 and rs62105751). The study cohort included 715 males diagnosed with SPGF and classified as suffering from non-obstructive azoospermia (NOA, n = 505) or severe oligospermia (SO, n = 210), and 1058 controls from the Iberian Peninsula. The allelic frequency differences between cases and controls were analyzed by the means of logistic regression models. A subtype specific genetic association with the subset of NOA patients classified as suffering from the Sertoli cell-only (SCO) syndrome was observed with the minor alleles showing strong risk effects for this subset (ORaddrs2287839 = 1.85 (1.17–2.93), ORaddrs2233678 = 1.62 (1.11–2.36), ORaddrs62105751 = 1.43 (1.06–1.93)). The causal variants were predicted to affect the binding of key transcription factors and to produce an altered PIN1 gene expression and isoform balance. In conclusion, common non-coding single-nucleotide polymorphisms located in PIN1 increase the genetic risk to develop SCO.
Chapter
Idiopathic male infertility (IMI) refers to the condition where semen quality declines, but exact causatives are not identified. This occurs in almost 30–40% of infertile men. Traditional semen analyses are extensively used for determining semen quality, but these bear critical shortcomings such as poor reproducibility, subjectivity, and reduced prediction of fertility. Oxidative stress (OS) has been identified as the core common mechanism by which various endogenous and exogenous factors may induce IMI. Male oxidative stress infertility (MOSI) is a term used to describe infertile males with abnormal semen parameters and OS. For the treatment of MOSI, antioxidants are mostly used which counteract OS and improve sperm parameters with appropriate combinations, dosage, and duration. Diagnosis and management of male infertility have witnessed a substantial improvement with the advent in the omics technologies that address at genetic, molecular, and cellular levels. Incorporation of oxidation-reduction potential (ORP) can be a useful clinical biomarker for MOSI. Moreover, various modulations of male fertility status can be achieved via stem cell and next-generation sequencing (NGS) technologies. However, several challenges must be overcome before the advanced techniques can be utilized to address IMI, including ethical and religious considerations, as well as the possibility of genetic abnormalities. Considering the importance of robust understanding of IMI, its diagnosis, and possible advents in management, the present article reviews and updates the available information in this realm, emphasizes various facets of IMI, role of OS in its pathophysiology, and discusses the novel concept of MOSI with a focus on its diagnostic and therapeutic aspects.
Article
The purposes of the presents study were to investigate the impact of alcohol consumption and cigarette smoking on semen parameters and sperm DNA quality, as well as to determine whether tobacco smoking, or alcohol consumption causes more deterioration of sperm quality. Two hundred and eleven semen samples of men were included in this study. Four groups were studied: heavy smokers (N = 48), heavy drinkers (N = 52), non‐smokers (n = 70), and non‐drinkers (n = 41). Semen parameters were determined according to WHO guidelines, protamine deficiency assessed by chromomycin (CMA3) staining, and sperm DNA fragmentation (sDF) evaluated by TUNEL assay. Sperm parameters were significantly higher in non‐smokers versus smokers and in non‐drinkers versus drinkers (p < 0.005). However, protamine deficiency and sDF were significantly lower in non‐smokers versus smokers and in non‐drinkers versus drinkers (p < 0.0001). No significant difference in the semen analysis parameters was observed between heavy smokers and heavy drinkers (semen volume: 3.20 ± 1.43 vs. 2.81 ± 1.56 ml, semen count: 65.75 ± 31.32 vs. 53.51 ± 32.67 mill/ml, total motility: 24.27 ± 8.18 vs. 23.75 ± 1.75%, sperm vitality: 36.15 ± 18.57 vs. 34.62 ± 16.65%, functional integrity: 41.56 ± 18.57 vs. 45.96 ± 17.98% and the morphologically normal spermatozoa: 28.77 ± 11.82 vs. 27.06 ± 13.13%, respectively). However, protamine deficiency was significantly higher among drinkers than smokers (37.03 ± 9.75 vs. 33.27 ± 8.56%, p = 0.020). The sDF was also significantly higher among drinkers than smokers (22.37 ± 7.60 vs. 15.55 ± 3.33%, p < 0.0001). Thus, cigarette smoking, and heavy alcohol intake can deteriorate sperm quality. However, alcohol consumption deteriorates sperm maturity and damages DNA integrity at significantly higher rates than cigarette smoking.
Article
BACKGROUND Meiosis is an essential stage in the life cycle of sexually reproducing species, underlying formation of haploid gametes and serving as the basis of genetic diversity. A central mechanism of meiosis is recombination between homologous chromosomes, during which programmed DNA double-strand breaks (DSBs) are sequentially repaired to form the crossovers essential for faithful chromosomal segregation. Aberrant meiotic recombination often leads to gametogenic failure or produces aneuploid gametes resulting in subfertility or infertility, miscarriage or birth defects. OBJECTIVE AND RATIONALE The goal of this review was to characterize the molecular mechanisms of meiotic recombination and related human infertility disorders, particularly male infertility caused by non-obstructive azoospermia (NOA). SEARCH METHODS Our search included PubMed database articles, focusing mainly on English-language publications dated between January 2016 and February 2022. The search term ‘meiosis’ was combined with the following keywords: meiotic initiation, chromosome pairing, homologous recombination, chromosome axis, DSB, DSB repair, crossover, meiotic sex chromosome inactivation, meiotic checkpoints, meiotic arrest, NOA, premature ovarian insufficiency (POI) or premature ovarian failure, treatment and cancer. In addition, references within these articles were used to identify additional studies. OUTCOMES The preliminary search generated ∼3500 records. The majority of articles were identified as meeting abstracts or duplicates, contained non-English text or provided insufficient data and were therefore eliminated. A total of 271 articles associated with meiotic recombination were included in the final analysis. This review provides an overview of molecules and mechanisms involved in meiotic recombination processes, specifically meiosis-specific chromosome structures, DSB formation, homology search, formation of recombination intermediates and crossover formation. The cumulative results suggest that meiosis is regulated sequentially by a series of meiotic recombination genes and proteins. Importantly, mutations in these genes often affect meiotic progression, activating meiotic checkpoints, causing germ cell arrest and leading to subfertility or infertility. At least 26 meiotic recombination-related genes have been reported to be mutated in NOA in men, and 10 of these genes are mutated in POI in women. This suggests that variants of meiotic recombination-related genes can cause human subfertility or infertility, especially NOA. WIDER IMPLICATIONS Understanding the processes of homologous chromosome pairing, recombination and timely resolution of homologous chromosomes may provide guidance for the analysis of potential monogenetic causes of human subfertility or infertility and the development of personalized treatments. In clinical practice, we can develop a meiotic recombination-related gene panel to screen for gene mutations in individuals with subfertility or infertility. Testicular sperm extraction should not be recommended when an NOA-affected individual carries definite disease-causing mutations of a meiotic gene, so as to avoid the unnecessary invasive diagnosis. Risk of ovarian dysfunction should be evaluated if a woman carries meiotic recombination-related gene mutations. It may be possible to improve or restore fertility through manipulation of meiotic recombination-related genes in the future.
Article
Temephos (O,O,O',O'-tetramethyl O,O'-thiodi-p-phenylene bis(phosphorothioate)) is a larvicide belonging to the family of organophosphate pesticides used for the control of different vectors of diseases, such as dengue, Zika, chikungunya, and dracunculiasis. The aim of this review was to discuss the available published information about temephos toxicokinetics and toxicity in mammals. Temephos is quickly absorbed in the gastrointestinal tract, distributed to all organs, and then it accumulates mainly in adipose tissue. It is metabolized by S-oxidation, oxidative desulfuration, and hydrolysis reactions, with the possible participation of cytochrome P450 (CYP). Temephos is mainly eliminated by feces, whereas some of its metabolites are eliminated by urine. The World Health Organization classifies it as class III: slightly dangerous with a NOAEL (no-observed adverse effect level) of 2.3 mg/kg/day for up to 90 days in rats, based on brain acetylcholinesterase (AChE) inhibition. A LOAEL (lowest observable adverse effect level) of 100 mg/kg/day for up to 44 days in rats was proposed based on cholinergic symptoms. However, some studies have shown that temephos causes toxic effects in mammals. The inhibition of the enzyme acetylcholinesterase (AChE) is one of its main demonstrated effects; however, this larvicide has also shown genotoxic effects and some adverse effects on male reproduction and fertility, as well as liver damage, even at low doses. We performed an extensive review through several databases of the literature about temephos toxicokinetics, and we recommend to revisit current assessment of temephos with the new available data.
Article
Immunity-related GTPases (IRGs), also known as p47 GTPases, are a family of interferon-inducible proteins that play roles in immunity defense against intracellular pathogens. Although the molecular functions of IRGs have been well studied, the function of the family member, IRGC1, remains unclear. IRGC1 is unique among IRGs because its expression is not induced by interferon and it is expressed predominantly in the testis. Further, IRGC1 is well conserved in mammals unlike other IRGs. Here, we knocked out (KO) Irgc1 in mice using the CRISPR/Cas9 system and found that the fertility of Irgc1 KO males was severely impaired because of abnormal sperm motility. Further analyses with a transmission electron microscope reveal that the fibrous sheath (FS), an accessory structure of the sperm tail, was disorganized in Irgc1 KO mice. In addition, IRGC1 was detected in the sperm tail and fractionated with FS proteins. These results suggest that IRGC1 is a component of the FS and is involved in the correct formation of the FS.
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Male infertility is an increasing and serious medical concern, though the mechanism remains poorly understood. Impaired male reproductive function affects approximately half of infertile couples worldwide. Multiple factors related to the environment, genetics, age, and comorbidities have been associated with impaired sperm function. Present-day clinicians rely primarily on standard semen analysis to diagnose male reproductive potential and develop treatment strategies. To address sperm quality assessment bias and enhance analysis accuracy, the World Health Organization (WHO) has recommended standardized sperm testing; however, conventional diagnostic and therapeutic options for male infertility, including physical examination and semen standard analysis, remain ineffective in relieving the associated social burden. Instead, assisted reproductive techniques are becoming the primary therapeutic approach. In the post-genomic era, multiomics technologies that deeply interrogate the genome, transcriptome, proteome, and/or the epigenome, even at single-cell level, besides the breakthroughs in robotic surgery, stem cell therapy, and big data, offer promises towards solving semen quality deterioration and male factor infertility. This review highlights the complex etiology of male infertility, especially the roles of lifestyle and environmental factors, and discusses advanced technologies/methodologies used in characterizing its pathophysiology. A comprehensive combination of these innovative approaches in a global and multi-centric setting and fulfilling the suitable ethical consent could ensure optimal reproductive and developmental outcomes. These combinatorial approaches should allow for the development of diagnostic markers, molecular stratification classes, and personalized treatment strategies. Since lifestyle choices and environmental factors influence male fertility, their integration in any comprehensive approach is required for safe, proactive, cost-effective, and noninvasive precision male infertility theranostics that are affordable, accessible, and facilitate couples realizing their procreation dream.
Article
Background: Addiction is a global problem that has many negative consequences on human health as well as the quality of life. Objectives: This review aimed to assess the effect of addiction on human male fertility. Methods: A systematic review was conducted on various electronic sites. Results: The initial literature search identified a total of 5239 articles in all searched databases. After removing duplicates and application of inclusion/exclusion criteria,177 were potential articles, 112 were omitted because no direct relevance was encountered. Finally, 65 studies were retained for review. They were classified according to the type of addiction into; opioids and cannabinoids (18 articles), alcohol (7 articles), cocaine (2 articles), Androgenic Anabolic steroids AAS (15 articles), tobacco (10 articles) and caffeine (13 articles). Most of these recruited articles demonstrated a negative impact of the addressed substance on male fertility with variable levels of evidence. Conclusions: It was concluded that addiction harms human male fertility that should be put into consideration. More future studies are needed after a proper methodological and statistical approach, including logistic regression analysis, to predict the effect of a specific substance on human male fertility. This article is protected by copyright. All rights reserved.
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The purpose of this review is to integrate understanding of epidemiology and infertility. A primer on epidemiologic science and an example disease for which the design of epidemiologic investigations is readily apparent are provided. Key features of infertility that limit epidemiologic investigation are described and a survey of available data on the epidemiology of infertility provided. Finally, the work that must be completed to move this area of research forward is proposed, and, with this new perspective of "infertility as a disease," improvements envisioned in public health that may be gained through improved understanding of the epidemiology of male infertility.
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Global, regional, and national estimates of prevalence of and tends in infertility are needed to target prevention and treatment efforts. By applying a consistent algorithm to demographic and reproductive surveys available from developed and developing countries, we estimate infertility prevalence and trends, 1990 to 2010, by country and region. We accessed and analyzed household survey data from 277 demographic and reproductive health surveys using a consistent algorithm to calculate infertility. We used a demographic infertility measure with live birth as the outcome and a 5-y exposure period based on union status, contraceptive use, and desire for a child. We corrected for biases arising from the use of incomplete information on past union status and contraceptive use. We used a Bayesian hierarchical model to estimate prevalence of and trends in infertility in 190 countries and territories. In 2010, among women 20-44 y of age who were exposed to the risk of pregnancy, 1.9% (95% uncertainty interval 1.7%, 2.2%) were unable to attain a live birth (primary infertility). Out of women who had had at least one live birth and were exposed to the risk of pregnancy, 10.5% (9.5%, 11.7%) were unable to have another child (secondary infertility). Infertility prevalence was highest in South Asia, Sub-Saharan Africa, North Africa/Middle East, and Central/Eastern Europe and Central Asia. Levels of infertility in 2010 were similar to those in 1990 in most world regions, apart from declines in primary and secondary infertility in Sub-Saharan Africa and primary infertility in South Asia (posterior probability [pp] ≥0.99). Although there were no statistically significant changes in the prevalence of infertility in most regions amongst women who were exposed to the risk of pregnancy, reduced child-seeking behavior resulted in a reduction of primary infertility among all women from 1.6% to 1.5% (pp = 0.90) and a reduction of secondary infertility among all women from 3.9% to 3.0% (pp>0.99) from 1990 to 2010. Due to population growth, however, the absolute number of couples affected by infertility increased from 42.0 million (39.6 million, 44.8 million) in 1990 to 48.5 million (45.0 million, 52.6 million) in 2010. Limitations of the study include gaps in survey data for some countries and the use of proxies to determine exposure to pregnancy. We analyzed demographic and reproductive household survey data to reveal global patterns and trends in infertility. Independent from population growth and worldwide declines in the preferred number of children, we found little evidence of changes in infertility over two decades, apart from in the regions of Sub-Saharan Africa and South Asia. Further research is needed to identify the etiological causes of these patterns and trends. Please see later in the article for the Editors' Summary.
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Infertility seems to be a great worldwide problem. Many publications present the epidemiology of infertility, but the percentage distribution of factors responsible for infertility varies significantly. The objective was to define infertility profiles in Poland assessed according to the information provided by 4 large infertility centers: Bialystok, Poznan, Szczecin and Warsaw. Multicenter study was performed. Couples with primary infertility, attending one of the four centers in Poland, were asked to fulfill a questionnaire. Overall 1517 questionaires were analysed: Bialystok - 468, Poznan - 325, Szczecin - 341, Warsaw - 383. Only semen analyses fulfilling WHO Manual 1999 criteria were used in the study and were afterwards compared with 2010 WHO standards. Results from 4 Polish centers showed that the average age of infertile women was 31.41 years and of infertile men 33.2 years. The mean duration of infertility equaled 3.31 years. Among 1517 surveyed women, no pathological findings concerning reproductive abilities were observed in 1088 cases (71.72%). In the remaining patients the following were diagnosed: uterine factor in 26 (6.02%) women, ovulation disorders in 134 (31.33%), including 70 (16.27%) of PCOS patients, tubal factor in 165 (38.55%) and endometriosis in 145 (33.73%). The average of 18.9% of couples had a mixed cause of infertility, while idiopathic factor was assigned to 15.99%. In the study male factor accounted for 55.73% of cases. Change of reference values for semen analysis implemented in 2010 caused an increase in the number of normal results and asthenozoospermia. According to the data provided by Polish infertility centers the rate of male factor as a reason of infertility has reached 55.73%. However, the implementation of new reference values for semen analysis in 2010 led to the decrease in male factor frequency and the increase in the rate of idiophatic infertility. Anovulatory cycles and endometriosis are the main reasons affecting the female reproductive potential.
Article
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In 2010, the World Health Organization established new reference values for human semen characteristics that are markedly lower than those previously reported. Despite using controlled studies involving couples with a known time to pregnancy to establish the new limits, the reference studies are limited with regard to the population analyzed and the methods used for semen evaluation. The present review discusses concerns related to the new reference values for semen characteristics, including the effect on patient referral, diagnosis, and treatment of recognized conditions, such as varicocele, and on the indications for assisted reproductive technologies.
Article
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Semen quality is taken as a surrogate measure of male fecundity in clinical andrology, male fertility, reproductive toxicology, epidemiology and pregnancy risk assessments. Reference intervals for values of semen parameters from a fertile population could provide data from which prognosis of fertility or diagnosis of infertility can be extrapolated. Semen samples from over 4500 men in 14 countries on four continents were obtained from retrospective and prospective analyses on fertile men, men of unknown fertility status and men selected as normozoospermic. Men whose partners had a time-to-pregnancy (TTP) of < or =12 months were chosen as individuals to provide reference distributions for semen parameters. Distributions were also generated for a population assumed to represent the general population. The following one-sided lower reference limits, the fifth centiles (with 95th percent confidence intervals), were generated from men whose partners had TTP < or = 12 months: semen volume, 1.5 ml (1.4-1.7); total sperm number, 39 million per ejaculate (33-46); sperm concentration, 15 million per ml (12-16); vitality, 58% live (55-63); progressive motility, 32% (31-34); total (progressive + non-progressive) motility, 40% (38-42); morphologically normal forms, 4.0% (3.0-4.0). Semen quality of the reference population was superior to that of the men from the general population and normozoospermic men. The data represent sound reference distributions of semen characteristics of fertile men in a number of countries. They provide an appropriate tool in conjunction with clinical data to evaluate a patient's semen quality and prospects for fertility.
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Background: Infertility is defined as one year unprotected intercourse without pregnancy. It greatly affects couples' quality of life, and has great impact on their careers, everyday activities, sexual and non-sexual relationships. Objective: To study the prevalence of both primary and secondary infertility and demographic characteristics of it in Yazd province.Materials and Methods: We studied 5200 married defined couples in 260 randomized clusters. These couples were interviewed based on using a structured questionnaire. Then, for etiological evaluation, infertile couples were referred to the Research and Clinical Center for Infertility.Results: Among these couples, 277 cases of infertility were encountered and the overall prevalence of infertility was 5.52% (95% CI from 4.9% to 6.1%). In total 170 couples (3.48%) had primary and 107 (2.04%) had secondary infertility. The prevalence of infertility in rural and urban areas was 5.3% and 6.8% respectively. Female factors were more common (57.5%) in etiologic assessment of infertility.Conclusion: Our data showed a lower total prevalence of infertility in our people compared to the other countries. Furthermore, there was significant difference in infertility prevalence between geographic parts of the province. Female factors and among them ovarian disorders were the main cause of infertility in central part of Iran.
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Primary infertility is a key issue in the developed world, while the developing world has high rates of secondary infertility. The impact of HIV/AIDS on fertility is insufficiently explored. One of the most important barriers to access to infertility treatment is cost; at the same time the role of social and cultural factors in restricting access should not be underestimated. IVF has become the standard therapy for female infertility, and ICSI for infertility of the male partner. However, the use of these therapies should not be initiated without a thorough investigation and, whenever possible, individual diagnosis of the underlying causes of infertility. Multiple gestation remains one of the most challenging and controversial issues in the treatment of infertility. Current IVF practices are often blamed for this; in this respect, attention should also be focused on the role of ovarian stimulation in ovulation induction. National guidelines and national registries for assisted reproductive technology (ART) are becoming more widespread and are expected to play an important role in promoting best practice in ART in the future.
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Worldwide, male infertility contributes to more than half of all cases of childlessness; yet, it is a reproductive health problem that is poorly studied and understood. This article examines the problem of male infertility in two Middle Eastern locales, Cairo, Egypt, and Beirut, Lebanon, where men may be at increased risk of male infertility because of environmental and behavioral factors. It is argued that male infertility may be particularly problematic for Middle Eastern men in their pronatalist societies; there, both virility and fertility are typically tied to manhood. Thus, male infertility is a potentially emasculating condition, surrounded by secrecy and stigma. Furthermore, the new reproductive technology called intracytoplasmic sperm injection (ICSI), designed specifically to overcome male infertility, may paradoxically create additional layers of stigma and secrecy, due to the complex moral and marital dilemmas associated with Islamic restrictions on third-party donation of gametes.
Article
This report presents national estimates of the fertility of men and women aged 15-44 years in the United States in 2006-2010 based on the National Survey of Family Growth (NSFG). Data are compared with similar measures for 2002. Descriptive tables of numbers, percentages, and means are presented and discussed. Data were collected through in-person interviews of a nationally representative sample of the household population aged 15-44 years in the United States between July 2006 and June 2010. The 2006-2010 NSFG sample is comprised of 22,682 respondents including 10,403 men and 12,279 women. The overall response rate for the 2006-2010 NSFG was 77%, 75% for men and 78% for women. Many of the fertility measures among men and women aged 15-44 based on the 2006-2010 NSFG were generally similar to those reported based on the 2002 NSFG. The mean age at first child's birth for women was 23 and the mean age at first child's birth for men was 25. One-half of first births to women were in their 20s and two-thirds of first births were fathered by men who were in their 20s. On average, women aged 15-44 have 1.3 children as of the time of the interview. By age 40, 85% of women had had a birth, and 76% of men had fathered a child. In 2006-2010, 22% of first births to women occurred within cohabiting unions, up from 12% in 2002. These measures differed by Hispanic origin and race and other demographic characteristics.
Article
Context: New data regarding the diagnosis and treatment of male infertility have emerged and led to an update of the European Association of Urology (EAU) guidelines for Male Infertility. Objective: To review the new EAU guidelines for Male Infertility. Evidence acquisition: A comprehensive work-up of the literature obtained from Medline, the Cochrane Central Register of Systematic Reviews, and reference lists in publications and review articles was developed and screened by a group of urologists and andrologists appointed by the EAU Guidelines Committee. Previous recommendations based on the older literature on this subject were taken into account. Levels of evidence and grade of guideline recommendations were added, modified from the Oxford Centre for Evidence-based Medicine Levels of Evidence. Evidence summary: These EAU guidelines are a short comprehensive overview of the updated guidelines of male infertility as recently published by the EAU (http://www.uroweb.org/guidelines/online-guidelines/), and they are also available in the National Guideline Clearinghouse (http://www.guideline.gov/).
Article
An understanding of the medical causes of infertility is crucial in order to reduce incidences of Infertility and for improving the clinical management of infertility. Although there were much data on infertility in other African countries, no data exist on infertility in Sudan. Seven hundred and ten Sudanese couples were investigated for the infertility in Khartoum Fertility Center, Sudan: 443 (62.4%) had primary infertility and 267 (37.6%) had secondary infertility. The mean (standard deviation) duration of the infertility was 5.2 (4.3) years. A positive male factor alone was found in 257 (36.2%) couples and a female factor in 350 (49.3%) couples: eleven (1.5%) couples had a combination of male and female factors: and the cause of infertility was unexplained in 92 (13.0%) couples. Oligozoospermia and asthenozoospermia were factors responsible for 16.8% and 17.5% of male infertility, respectively. Failure of ovulation (60.3%) was the most common cause of female infertility. The study revealed a high proportion of secondary infertility and a greater contribution of the female factors to infertility.
Article
To estimate the prevalence and main causes of infertility, a multicentre survey was conducted over 1 year (July 1988-June 1989) in three regions of France. All the 1686 couples in these regions, who consulted a practitioner for primary or secondary infertility during this period, were included in the investigation. The prevalence rate of infertility was found to be 14.1%, indicating that one woman out of seven in France will consult a doctor for an infertility problem during her reproductive life. The main causes of female infertility were ovulation disorders (32%) and tubal damage (26%), and of male infertility oligo-terato-asthenozoospermia (21%), asthenozoospermia (17%), teratozoospermia (10%) and azoospermia (9%). Infertility was also found to be caused by disorders in both the male and female partners together; thus in 39% of cases both the man and woman presented with disorders. The woman alone was responsible for infertility in one-third of cases and the man alone in one-fifth. Unexplained infertility was found in 8% of the couples surveyed.
Article
The World Health Organisation sponsored a multicentre, collaborative investigation of a standard approach to evaluating infertile couples. The study was conducted between 1979 and 1984 in thirty-three medical centres in twenty-five countries throughout the developed and developing world. Over 5800 couples completed the investigation. African centres had a pattern of infertility different from those in other developing regions or the developed countries. African couples were more likely than those from elsewhere to have secondary infertility or longer duration, a history of sexually transmitted diseases or pregnancy complications, and infertility diagnoses (such as bilateral tubal occlusion or pelvic adhesions) suggestive of previous genital infections.
Article
Determinants of infertility were studied in 340 women in Eastern Gabon, an area situated in the "infertility belt" of Central Africa. Fallopian tube occlusion was diagnosed in 82.8% of cases, showing the importance of infection-related causes. Women with tubal occlusion did not differ significantly from women with normal tubes in obstetrical history or prevalence of Neisseria gonorrhoeae or Chlamydia trachomatis on endocervical culture. Antecedents of pelvic inflammatory disease or a pelvic mass were significantly more common in the group with tubal occlusion. This group also had a significantly higher prevalence of serum chlamydial antibodies at a titer of 1/64 or higher. Hormonal factors were found in 31.7% of women, a cervical factor in 29.0% and mechanical factors in 5.6%. No diagnosis could be made in 12.2% of cases. During the investigation, 4.4% of women became pregnant. The predominance of infectious related causes of infertility makes it imperative to focus resources on prevention programs of upper genital tract infections in women.
Article
Infertility in the developing world has been relatively neglected as an international health problem and a topic of social scientific and epidemiological inquiry. In this study, we examine factors placing poor urban Egyptian men and women at risk of infertility, and we explore the sociocultural and political-economic contexts in which these health-demoting factors are perpetuated. Our approach to the problem of Egyptian infertility attempts an explicit merging of ethnographic and epidemiological research designs, methods of data collection and analysis, and interpretive insights to provide improved understanding of the factors underlying infertility in the urban Egyptian setting.
Article
To study care-seeking behavior for infertility treatment in different European countries. Multicenter surveys of randomly selected women in the child bearing age. Five countries participated in the study: Denmark, Germany, Italy, Poland, and Spain. Data were collected from 1991 to 1993 as part of a concerted action. Population-based samples of women 25 to 44 years of age. The sample sizes ranged from 442 women in Poland to 2,729 in Italy. Participation rates ranged from 54% in Germany to 87% in Denmark. Data were collected by means of a highly structured questionnaire used at a face-to-face interview. Waiting time to pregnancy, time, and type of treatment for infertility. Less than half of the infertile couples seek medical help in most European countries. The lowest proportion seeking help was found in Poland and the highest in Denmark. The increasing demand for infertility treatment is expected to continue, because the potential unmet need is outspoken in most European countries.
Article
The study examined the epidemiology and causes of infertility in Tomsk, Western Siberia, using methodological approaches recommended by WHO and was based on the findings for a randomly selected sample of 2000 married women aged 18-45 years. Among the respondents, 333 couples were considered infertile since they had not conceived after 12 months or more of unprotected intercourse. This group of infertile couples was offered comprehensive clinical investigations but only 186 couples completed them. The infertility rate in Tomsk was 16.7%, being caused by diseases of the female reproduction system in 52.7% of the couples and by male reproductive diseases in 6.4%. In 38.7% of couples, both spouses suffered from infertility, while in 2.2% of cases the cause of infertility was not determined. Among the causes of female infertility, secondary infertility dominated (12.9% of all the women questioned), while primary infertility affected 3.8% of the women. The most frequent causes of female infertility were disturbances to tubal patency (36.5%) and pelvic adhesions (23.6%). Endocrine pathology was found in 32.8% of cases. The most frequent cause of male infertility was inflammatory disease of male accessory glands (12.9%). In 8.6% of cases infection resulted in obstructive azoospermia. Varicocele was registered in 11.3% of cases, and idiopathic pathospermia in 20.9%. Inflammatory complications among females were 4.2 times more frequent than among males.
Article
The Practice Guidelines Committee of the American Urological Association, Inc. (AUA) commissioned a Male Infertility Best Practice Policy Committee (MIBPPC) in 1998 to bridge the gap in male infertility between leading edge science and clinical practice, and provide urologists, gynecologists, reproductive endocrinologists, primary care practitioners, reproductive researchers and other health care providers with guidance for excellence of care in this rapidly changing field. The MIBPPC chose not to create a comprehensive treatise on male infertility, but rather to focus on areas that are new, poorly understood, poorly standardized, controversial and/or rapidly changing. The MIBPPC divided its efforts into 4 interrelated sections: 1) optimal evaluation of the infertile male, 2) evaluation of the azoospermic male, 3) management of obstructive azoospermia, and 4) varicocele and infertility. A separate report was created for each topic. The reports were submitted to peer review by 125 physicians and researchers from the disciplines of urology, gynecology, reproductive endocrinology, primary care and family medicine, andrology and reproductive laboratory medicine. The reports were then reviewed and approved by the Practice Guidelines Committee of the AUA the Practice Committee of the American Society for Reproductive Medicine (ASRM) and the boards of the 2 organizations. The reports were printed and distributed jointly by the AUA and ASRM in 2001. We reviewed each report of the MIBPPC.
Article
Poland has been considered a representative country for the population of Central and Eastern Europe as it has genetically homogenous population and reveals profound similarities in economical and historical processes common for all countries of the region. According to our observations there is approximately 20% of infertile couples in Poland (lack of concentration after at least 12 month of unprotected intercourse) and 40-60% of them are infertile because of the male factor. However, studies of infertility in Poland that have been conducted so far need to be verified. The changes connected with the style of life and new tendencies observed during the tedious political changes had considerable influence on childbearing rate in Poland. Additional factors diminishing the fertility rate are: the change of the status of women in a society, raising amount of everyday stress, the high rate (17%) of unemployment and the low average income. Furthermore, in Poland, the diagnostics and treatment (assisted reproductive technology) are entirely financed from the private funds of a patient. Summing up, the problem of childlessness in Central and Eastern Europe is a complex one and very alarming therefore it is necessary to work out and to implement research, preventative and therapeutic programmes strengthened through the international cooperation of specialized centers of excellence.
Article
Infertility is of public health importance in Nigeria and many other developing nations because of its high prevalence and especially due to its serious social implications. A review of the epidemiology of infertility in Nigeria and other parts of Sub-Saharan Africa is presented and socio-cultural issues including the social impact on couples are discussed. The major cause of infertility in Africa is infection--STDs, post-abortal and puerperal sepsis. Beliefs about causes, and failure of orthodox methods of treatment have led many couples to seek solution from traditional doctors and faith healers without success. Infertility causes marital disharmony, which often leads to divorce. Women are often blamed for the infertility and men engage in polygyny in an attempt to have children. The couple can also suffer stress from the management of the infertility. Adoption is not popular and assisted reproduction has medico-legal implications. Preventive measures are suggested, including counselling at every stage of the management.
Article
Three hundred and fourteen Nigerian couples were evaluated thoroughly for the cause of their infertility in our clinics located at Nnewi and Awka in Southeastern Nigeria. Two hundred and four (65.0%) of them had primary infertility and 110 (35%) had secondary infertility. The median duration of the infertility was 5 years and majority of the female patients (67.2%) were aged between 25 and 34 years. A positive male factor alone was found in 133 (42.4%) couples and female factor alone in 81 (25.8%) couples (P<0.01). Sixty-five (20.7%) couples had a combination of male and female factors, while the cause of infertility was unexplained in 35 (11.1%) couples. Oligozoospermia (35.9%) and asthenozoospermia (32.3%) were the most common aetiological factors responsible for male infertility. Tubal occlusion (49.0%) was the most common cause of female infertility. Genital tract infection resulting from sexual promiscuity and poorly treated sexual transmitted diseases were responsible for these abnormalities. In this part of the world, the wife is commonly blamed whenever there is infertility. However, this study has revealed the greater contribution of male factors to infertility. More attention should be paid to male partners whenever a couple presents for infertility. Men should also be a major target of any intervention aim at prevention.
Article
To determine the clinical patterns and major causes of infertility in Mongolia, based on the clinical and laboratory findings of both partners, and to compare the findings with data from the published World Health Organization (WHO) multicenter study. Four hundred and thirty infertile couples who attended the Infertility Clinic of the State Research Center on Maternal Child Health in 1998-2002 were included in the study. The couples had not had a viable birth after at least 1 year of unprotected intercourse and agreed to be fully investigated according to the WHO protocol 'Standardized Investigation of the Infertile Couple'. The mean duration of infertility of couples was 4.9 +/- 0.2 years. 43.7% of women had secondary infertility. In the females, the prevalence of past history of sexually transmitted infection (STI) and pelvic inflammatory disease were 33.5% and 25.1%, respectively. In the male partner, 44.2% reported a history of STI and 27.7% had previous testicular damage. 32.8% of women had a tubal factor. The most common causes of male infertility were obstructive azoospermia (8.4%), male accessory gland infection (6.7%) and acquired testicular damage (5.4%). In 45.8% of couples, infertility was due to a female factor and in 25.6% of cases, infertility was due to a male factor. 9.8% of couples had no demonstrable cause in either partner and 18.8% of couples had an infertility diagnosis in both partners. Patterns of female infertility did not differ significantly from those in the WHO study. Male infertility had a unique pattern, as there was a high prevalence of obstructive azoospermia and previous testicular damage.
Fertility and pregnancy: an epidemiologic perspective
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Infecundity, infertility, and childlessness in developing countries
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