Edmund Sabanegh

Effects of radiofrequency electromagnetic waves (RF-EMW) from cellular phones on human ejaculated semen: an in vitro pilot study

OBJECTIVE To evaluate effects of cellular phone radiofrequency electromagnetic waves (RF-EMW) during talk mode on unprocessed (neat) ejaculated human semen. DESIGN Prospective pilot study. SETTING Center for reproductive medicine laboratory in tertiary hospital setting. SAMPLES Neat semen samples from normal healthy donors (n = 23) and infertile patients (n = 9). INTERVENTION(S) After liquefaction, neat semen samples were divided into two aliquots. One aliquot (experimental) from each patient was exposed to cellular phone radiation (in talk mode) for 1 h, and the second aliquot (unexposed) served as the control sample under identical conditions. MAIN OUTCOME MEASURE(S) Evaluation of sperm parameters (motility, viability), reactive oxygen species (ROS), total antioxidant capacity (TAC) of semen, ROS-TAC score, and sperm DNA damage. RESULT(S) Samples exposed to RF-EMW showed a significant decrease in sperm motility and viability, increase in ROS level, and decrease in ROS-TAC score. Levels of TAC and DNA damage showed no significant differences from the unexposed group. CONCLUSION(S) Radiofrequency electromagnetic waves emitted from cell phones may lead to oxidative stress in human semen. We speculate that keeping the cell phone in a trouser pocket in talk mode may negatively affect spermatozoa and impair male fertility.

The effect of obesity on sperm disorders and male infertility

The results of several studies point to an increased likelihood of abnormal semen parameters among overweight men, and an elevated risk for subfertility among couples in which the male partner is obese. Obesity is, therefore, associated with a higher incidence of male factor infertility. Several mechanisms might account for the effect of obesity on male infertility, both directly and indirectly, by inducing sleep apnea, alterations in hormonal profiles (reduced inhibin B and androgen levels accompanied by elevated estrogen levels) and increased scrotal temperatures, ultimately manifesting as impaired semen parameters (decreased total sperm count, concentration and motility; increased DNA fragmentation index). Neither the reversibility of obesity-associated male infertility with weight loss nor effective therapeutic interventions have been studied in-depth. The increasing prevalence of obesity calls for greater clinical awareness of its effects on fertility, better understanding of underlying mechanisms, and exploration into avenues of treatment.

ROLE OF ANTIOXIDANTS IN THE TREATMENT OF MALE INFERTILITY

Male infertility continues to be a clinical challenge of increasing significance. While male factors such as decreased semen quality are responsible for 25% of all infertility issues, the etiology of suboptimal semen quality is poorly understood. Many physiological, environmental, and genetic factors have been implicated, including oxidative stress. Oxidative stress is induced by reactive oxygen species (ROS), or free radicals, and although ROS are required for critical aspects of sperm function, excessive levels of ROS can negatively impact sperm quality. The origin of ROS generation, and the etiologies of increased ROS in men with suboptimal sperm quality have only recently been elucidated, offering multiple targets for potential therapy. Here, we present a critical review of the literature describing the role of oxidative stress on decreased sperm function, as well as the role of antioxidants in the treatment of male factor infertility.

Role of Oxidative Stress in Pathogenesis of Varicocele and Infertility

This review summarizes the published literature about the role of oxidative stress in the pathophysiology of varicocele and the beneficial effects of varicocele repair on oxidative stress. Literature survey was performed using the Medline, EMBASE, BIOSIS, and Cochrane databases between 1993 and 2008 that were relevant to oxidative stress and varicocele. Varicocele treatment can reduce reactive oxygen species levels and improve sperm parameters and pregnancy rates, although it is still controversial with Assisted Reproductive Techniques outcomes. We conclude that spermatozoal dysfunction in varicocele patients could be multifactorial, and oxidative stress-induced injury appears to be one of the main causes.

SEMEN CHARACTERISTICS AND SPERM DNA FRAGMENTATION IN INFERTILE MEN WITH LOW AND HIGH LEVELS OF SEMINAL REACTIVE OXYGEN SPECIES

OBJECTIVE To examine sperm motility, total antioxidant level (TAC), DNA fragmentation, and medical history in infertile men with high seminal high reactive oxygen species (ROS). DESIGN Prospective study. SETTING(S) Tertiary care hospital. PATIENT(S) Infertile men (n=101). INTERVENTION(S) Group I (n=57) included men with seminal ROS (<250 relative light units/sec/×10(6) sperm) while group II (n=44) included men with seminal ROS levels (≥250 relative light units/sec/×10(6) sperm). MAIN OUTCOME MEASURE(S) Seminal ROS, TAC, sperm DNA fragmentation, ROS/TAC score were measured. RESULT(S) Group II had a high incidence of sperm DNA fragmentation than group I. The odds ratio of 1.25 for elevated ROS levels corresponded to >10% greater DNA fragmentation in our patients (95% confidence interval 1.01-1.53). Group II showed poor motility, a higher incidence of leukocytospermia, and higher ROS-TAC scores compared with group I. ROS was negatively correlated with sperm curvilinear velocity (r=-.24), linearity (r=-.24), and sperm motility (r=-.31). Sperm motility was correlated with %TUNEL(+ve) sperm (r=-.39). CONCLUSION(S) An increase in seminal ROS levels by 25% was associated with a 10% increase in sperm DNA fragmentation. Sperm motility was affected by seminal ROS and sperm DNA fragmentation.

TUNEL as a Test for Sperm DNA Damage in the Evaluation of Male Infertility

OBJECTIVES To standardize the TUNEL assay by establishing inter- and intraobserver variability, interassay variability, cutoff values, sensitivity and specificity of the assay, and studying the distribution of the DNA damage in a population of infertile men referred to a clinical andrology laboratory. METHODS Seminal ejaculates from 25 healthy male volunteers (controls) and 194 infertile men (with male factor infertility) referred to an andrology laboratory were examined for DNA damage by TUNEL assay using flow cytometric analysis. RESULTS Both the inter- and intraobserver variability and interassay variability was small (<10%). DNA damage in the controls was 11.9 ± 6.8% vs. 29.5 ± 18.7% in patients (P <.001). The cut-off value of 19.25% maximized the observed sensitivity (64.9%) and specificity (100%) of the assay. The distribution of DNA damage in the patients was as follows: 14.9% (29 of 194) with DNA damage between 0% and 10%; 22.7% (44 of 194) between 10% and 20%; 8.8% (17 of 194) between 20% and 30%; and 17.5% (34 of 194) between 30% and 40%. Finally, 27.3% (53 of 194) had TUNEL values >40%. CONCLUSIONS We report a detailed standardization of the TUNEL assay for clinical use, as well as reference ranges for DNA damage in normal healthy donors and infertile men. A cut-off of 19.25% with observed 100% specificity established in our program can differentiate infertile men with DNA damage from healthy men. This test can be offered to infertile patients who are idiopathic, have severe oxidative stress-related abnormal semen quality, and contribute to the infertility problem of the couple who are considering assisted reproductive techniques.

Critical Appraisal of World Health Organization's New Reference Values for Human Semen Characteristics and Effect on Diagnosis and Treatment of Subfertile Men

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.

Diagnostic value of the total antioxidant capacity (TAC) in human seminal plasma

OBJECTIVE To establish cutoff value, sensitivity, specificity and intra- and interobserver variability of total antioxidant capacity (TAC) in seminal plasma from healthy donors (controls) and infertile patients. DESIGN Seminal plasma from proven fertile donors (n = 55), nonproven fertile donors (n = 45), and infertile patients (n = 42) were examined for TAC level. SETTING Reproductive research center in a tertiary care hospital. PATIENT(S) Infertile patients from male infertility clinic of various diagnoses. INTERVENTION(S) Seminal plasma TAC measurement by a colorimetric assay using the TAC assay kit, receiver operating characteristics curve. MAIN OUTCOME MEASURE(S) Seminal plasma TAC levels, cutoff value, sensitivity, and specificity. RESULT(S) Proven fertile donors showed higher TAC values (median and range): 1700 (1440-2290 microM); compared with the infertile patients: 1310 (1040-1600 microM). The best cutoff to distinguish between fertile controls and infertile men was 1420 microM. At this threshold, specificity was 64% and sensitivity 76%. CONCLUSION(S) Total antioxidant capacity of the seminal plasma as measured by the colorimetric assay is a reliable and simple test for the diagnosis and management of male infertility.

Male infertility testing: reactive oxygen species and antioxidant capacity

Reactive oxygen species (ROS) are an integral component of sperm developmental physiology, capacitation, and function. Elevated ROS levels, from processes such as infection or inflammation, can be associated with aberrations of sperm development, function, and fertilizing capacity. We review the impact of ROS on sperm physiology, its place in infertility evaluation, the implications for reproductive outcomes, and antioxidant therapy. Our systematic review of PubMed literature from the last 3 decades focuses on the physiology and etiology of ROS and oxidative stress (OS), evaluation of ROS, and antioxidants. ROS is normally produced physiologically and is used to maintain cellular processes such as sperm maturation, capacitation, and sperm-oocyte interaction. When ROS production exceeds the buffering capacity of antioxidants, OS occurs and can have a negative impact on sperm and fertility. ROS and antioxidant capacity testing can potentially add additional prognostic information to standard laboratory testing for the infertile male, although its role as standard part of an evaluation has yet to be determined. Elevated ROS levels have been implicated with abnormal semen parameters and male infertility, but the impact of ROS on fertilization rates and pregnancy is controversial. This is partly because of the lack of consensus on what type of patients may be suitable for ROS testing and assay standardization. Routine ROS testing for the infertile male is not currently recommended.

Physiologic and pathologic levels of reactive oxygen species in neat semen of infertile men

OBJECTIVE To define physiologic levels of reactive oxygen species in infertile men and establish a cutoff value of reactive oxygen species level in neat semen with a high sensitivity and specificity to differentiate infertile men from fertile donors (controls). DESIGN Reactive oxygen species levels were measured in the neat semen samples (n = 51) from fertile donors and infertile patients (n = 54). SETTING Reproductive research laboratory at a tertiary care hospital. PATIENT(S) Infertile patients from male infertility clinic. INTERVENTION(S) Reactive oxygen species measurement in neat semen sample using luminol-based chemiluminescence method, receiver operating characteristic curves. MAIN OUTCOME MEASURE(S) Seminal reactive oxygen species levels, cutoff value, sensitivity and specificity, positive and negative predictive values. RESULT(S) The best cutoff value to distinguish between healthy fertile donors and infertile men was 0.0185 x 10(6) counted photons per minute/20 x 10(6) sperm. At this threshold, the specificity was 82% and the sensitivity was 78%. This value can be defined as basal reactive oxygen species level in infertile men. CONCLUSION(S) Reactive oxygen species levels in neat semen samples as measured by luminol-based chemiluminescence are a highly specific and sensitive test in the diagnosis of infertility. This test also may help clinicians treat patients with seminal oxidative stress.