E.B. Pasqualotto

Cigarette smoking is related to a decrease in semen volume in a population of fertile men

To evaluate the semen quality and hormonal levels in fertile men according to their level of cigarette smoking.

Effects of medical therapy, alcohol, smoking, and endocrine disruptors on male infertility

Infertility affects up to 15% of the sexually active population, and in 50% of cases, a male factor is involved, either as a primary problem or in combination with a problem in the female partner. Because many commonly encountered drugs and medications can have a detrimental effect on male fertility, the medical evaluation should include a discussion regarding the use of recreational and illicit drugs, medications, and other substances that may impair fertility. With the knowledge of which drugs and medications may be detrimental to fertility, it may be possible to modify medication regimens or convince a patient to modify habits to decrease adverse effects on fertility and improve the chances of achieving a successful pregnancy. Concern is growing that male sexual development and reproduction have changed for the worse over the past 30 to 50 years. Although some reports find no changes, others suggest that sperm counts appear to be decreasing and that the incidence of developmental abnormalities such as hypospadias and cryptorchidism appears to be increasing, as is the incidence of testicular cancer. These concerns center around the possibility that our environment is contaminated with chemicals--both natural and synthetic--that can interact with the endocrine system.

Effect of cigarette smoking on antioxidant levels and presence of leukocytospermia in infertile men: a prospective study.

OBJECTIVE To evaluate the effect of cigarette smoking on antioxidant levels and the presence of leukocytospermia in infertile men. DESIGN Prospective study. SETTING Academic medical center. PATIENT(S) Ten fertile donors and 112 infertile patients were included in the study. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Semen analysis was performed according to the World Health Organization guideline. The activity of the superoxide dismutase was based on the adrenochrome concentration, and the catalase activity was determined by the velocity of hydrogen peroxide consumption. RESULT(S) Lower levels of superoxide dismutase and catalase were seen in infertile patients compared with fertile donors. Superoxide dismutase was significantly correlated with sperm concentration and negatively correlated with leukocytospermia. In addition, leukocytospermia was inversely correlated with sperm motility. Superoxide dismutase levels were negatively related to cigarette smoking. CONCLUSION(S) Cigarette smoking may impair sperm motility and decrease the antioxidant activity (negative correlation with superoxide dismutase) in the seminal plasma.

Sperm concentration and normal sperm morphology decrease and follicle‐stimulating hormone level increases with age

To assess hormone levels, testicular volume, and semen characteristics of fertile men of various age groups.

Is it worthwhile to operate on subclinical right varicocele in patients with grade II-III varicocele in the left testicle?

Purpose: To determine whether repair of subclinical varicoceles in the right testicle results in significant seminal improvement in patients with clinical left varicocele.Methods: Patients were divided into two groups: Group I (unilateral varicocelectomy) and Group II (bilateral varicocelectomy—subclinical left varicocele). The mean sperm concentration before treatment was higher in Group I (21.01 ± 19.1) compared to Group II (5.7 ± 10.7) (p = 0.04).Results: An increase in volume was detected in the left testicle of patients in Group I (17 ± 7.9 vs. 22.81 ± 8.2; p = 0.04) and in the right testicle of patients in Group II (18.4 ± 6.2 vs. 22.3 ± 6.5; p = 0.04). Although the mean postoperative sperm concentration in Group I increased slightly (25.7 ± 22.8), the mean sperm concentration in Group II increased significantly (30.32 ± 9.8; p = 0.03). Pregnancy rate was higher in Group II (66.7%) compared to Group I (33.3%).Conclusions: Even a small, subclinical unrepaired varicocele continues to have a detrimental effect on bilateral testis function in a patient with grade II–III left varicocele.

Clinical Diagnosis in Men Undergoing Infertility Investigation in a University Hospital

Introduction: It was the aim of this study to assess whether the changes in the diagnostic techniques and treatment modalities have altered the epidemiology of male factor infertility in the last decade. Material and Methods: From September 1999 to July 2003, 822 patients were evaluated for infertility in a University Hospital. We divided our infertility patients according to the clinical diagnosis. Results: Most of the patients presented with varicocele (n = 282, 34.3%), idiopathic infertility (n = 260, 31.6%), or had had seminal tract obstruction (n = 85, 10.34%). Least common but equally important causes found were mumps (n = 43, 5.23%), pyospermia (n = 37, 4.5%), systemic diseases (n = 36, 4.37%), testicular failure (n = 34, 4.13%), cryptorchidism (n = 14, 1.7%), ejaculatory dysfunction (n = 11, 1.3%), genetics (n = 9, 1.1%), endocrinopathies (n = 4, 0.5%), testicular cancer (n = 4, 0.5%), and testicular torsion (n = 3, 0.36%). Conclusions: Even with the changes in reproductive healthcare in the last years, varicocele and seminal tract obstruction remain the leading causes of male infertility. However, clinicians should not forget other treatable causes of male infertility such as pyospermia, systemic diseases, or testicular cancer.

The role of enzymatic antioxidants detected in the follicular fluid and semen of infertile couples undergoing assisted reproduction.

The follicular fluid environment surrounding the oocytes may play a critical role in fertilization and subsequent embryo development. The goal of our study was to evaluate the oxidative stress markers in the semen, blood serum, and follicular fluid of couples undergoing Intracytoplasmic Sperm Injection (ICSI). Two hundred and eight infertile couples underwent ICSI and the levels of superoxide dismutase (SOD) and catalase and lipid peroxidation (LPO) were evaluated. Semen Catalase was highly correlated with fertilization and cleavage rates, but not with pregnancy rates. Fertilization and cleavage rates were correlated with the levels of SOD and Catalase in the follicular fluid. After adjusting for age, a negative correlation was detected between LPO levels in follicular fluid and pregnancy rates. Follicular fluid LPO levels may be a marker as a metabolic activity within the follicle need for establishing a pregnancy.

Relationship between the number of veins ligated in a varicocelectomy with testicular volume, hormonal levels and semen parameters outcome

Purpose: Correlate semen analysis, hormones, and testicular volume with the number of veins ligated.Methods: Patients were divided into three groups: Group 1 (≤5 veins), Group 2 (6–10 veins), and Group 3 (> 10 veins). We evaluated testicular volume, hormonal levels, sperm concentration, and motility before and after the surgical procedure.Results: In Group 1, even though there was an improvement in both testicular volume and sperm concentration; testosterone levels and sperm motility did not improve with surgery. In Group 2, no changes were detected in the both testicular volumes, in sperm concentration, motility, and testosterone levels. In Group 3, an improvement was seen in the right testicle volume, testosterone levels, and sperm concentration. Follicle-stimulating hormone levels decreased following the surgical procedure in all groups.Conclusion: Patients with more than 10 ligated veins have better chances to improve sperm concentration. FSH levels decreased in all groups of patients.

Azoospermia after treatment with clomiphene citrate in patients with oligospermia

OBJECTIVE To describe three cases of azoospermia in patients with oligospermia after clomiphene citrate (CC) intake. DESIGN Case report. SETTING(S) Academic medical center. PATIENT(S) Three patients with oligospermia. INTERVENTION(S) Three oligospermic men used CC, resulting in azoospermia. MAIN OUTCOME MEASURE(S) Semen analysis after CC use and after discontinuation of CC. RESULT(S) Three patients were sent to our clinic for investigation of their azoospermia after use of CC. They had severe oligozoospermia (sperm concentrations of 3.4, 2.8, and 4.1 x 10(6)/mL, respectively) before treatment with CC. These patients were re-evaluated with two new semen analyses, showing azoospermia. After 3 months without use of the drug, the mean sperm concentration was 2.5 +/- 1.1 x 10(6)/mL. CONCLUSION(S) The benefits of empiric treatment with CC must be balanced with the possible undesirable effects, such as azoospermia.

The male biological clock is ticking: a review of the literature

The term biological clock is usually used by physicians and psychologists to refer to the declining fertility, increasing risk of fetal birth defects and alterations to hormone levels experienced by women as they age. Female fecundity declines slowly after the age of 30 years and more rapidly after 40 and is considered the main limiting factor in treating infertility. However, there are several scientific reports, chapters in books and review articles suggesting that men may also have a biological clock. The aim of our study was to conduct a review of the literature, based on the Medical Literature Analysis and Retrieval System Online (Medline), to evaluate the male biological clock. After adjustments for other factors, the data demonstrate that the likelihood that a fertile couple will take more than 12 months to conceive nearly doubles from 8% when the man is < 25 years old to 15% when he is > 35 years old. Thus, paternal age is a further factor to be taken into account when deciding on the prognosis for infertile couples. Also, increasing male age is associated with a significant decline in fertility (five times longer to achieve pregnancy at the age of 45 years). Patients and their physicians therefore need to understand the effects of the male biological clock on sexual and reproductive health, in that it leads to erectile dysfunction and male infertility, as well as its potential implications for important medical conditions such as diabetes and cardiovascular diseases.