Elena Giacchi

Biochemical alterations in semen of varicocele patients: a review of the literature.

Oxidative stress is a mechanism underlying different kinds of infertility in human males. However, different results can be observed in relation to the method used for its evaluation. Varicocele patients show a number of biochemical abnormalities, including an altered distribution of coenzyme Q between seminal plasma and sperm cells and also an apparent defect in the utilization of antioxidants. Moreover, an influence of systemic hormones on seminal antioxidant system was observed too. Finally, the effects of surgical treatment on oxidativestress indexes and the possible usefulness of some medical therapies, like coenzyme Q supplementation, are discussed. In conclusion, published data show a role of oxidative stress in varicocele-related male infertility, but at present we do not know the precise molecular mechanisms underlying these phenomena.

Coenzyme Q10 supplementation in infertile men with low-grade varicocele: an open, uncontrolled pilot study

Many conditions associated with male infertility are inducers of oxidative stress, including varicocele. Antioxidants, such as coenzyme Q10, may be useful in this case. To evaluate the antioxidant capacity of seminal plasma of infertile men with varicocele before and after an oral supplementation with coenzyme Q10, 38 patients were recruited from a pilot clinical trial. A standard semen analysis was also performed at baseline and 3 months after an oral supplementation with exogenous coenzyme Q10 100 mg per die. Seminal plasma antioxidant capacity was measured using a spectroscopic method. Coenzyme Q10 therapy improved semen parameters and antioxidant status. This study highlights the importance of oxidative stress in the pathogenesis of male infertility, namely in varicocele, and strengthens the possibility of the usefulness of the antioxidant therapy.

Hypothyroidism, Oxidative Stress and Reproduction

In women, both hyperand hypo-thyroidism may result in menstrual disturbances. In hyperthyroidism the most common manifestations are simple oligomenorrhea and anovulatory cycles. Hypothyroidism results in changes in cycle length, amount of bleeding, and usually is associated with abnormal menstrual cycles characterized mainly by polymenorrhea and anovulatory cycles (Krassas et al., 1999). Also subclinical hypothyroxinemia can be associated with short luteal phase and insufficient progesterone secretion (Bohnet et al., 1981); similar pictures are present in a variety of situations characterized by low T3 levels (malnutrition, chronic illness, exercise), known as “nonthyroidal illness” (De Groot, 2006).

O575 The billings ovulation method as a useful tool in diagnostic evaluation of endocrine and cervical pathologies affecting fertility

A 37 year old woman presented to the emergency department with pain in the right lower abdomen and vomiting. She was discharged earlier that day following term spontaneous vaginal delivery with previous caesarean section. On admission she was apyrexial with normal vital signs. There was tenderness in epigastrium and right iliac fossa. Her full blood count showed leucocytosis (23.2) with raised C-Reactive protein (277.4). She was commenced on intravenous fluids and antibiotics. She was referred to the surgeons with provisional diagnosis of acute appendicitis. They suspected pelvic abscess or haematoma at the site of her previous caesarean section scar. As her pain was getting better, she was continued on analgesics and antibiotics. Two days later, she developed fever with severe pain and localised erythema in the right iliac fossa. Ultrasound showed a heterogeneous mass in the right iliac fossa with possibility of ileitis or appendicitis. CT appearance was also suggestive of appendiceal mass. Conservative management was carried on as the pain was getting better with no increase in size of the mass and she was discharged. On follow up two weeks later, she was asymptomatic and the mass had significantly decreased in size. Discussion: Appendicitis is the most common nonobstetric surgical diagnosis in pregnancy, but the diagnosis during immediate postpartum period is exceptionally rare. Appendicitis in the postpartum period can be difficult to diagnose because of its frequent atypical presentation, and overlap of symptoms with other postpartum conditions. An appendix mass results from localised walled-off perforation of the appendix. Management of appendiceal mass in a systemically well patient is controversial. A conservative management approach will be successful in the majority of patients presenting with an appendix mass. In this particular case if the diagnosis had been confirmed on admission and an appendicectomy performed, perhaps the sequelae of an appendicular mass may have been avoided.

Nuovi problemi derivanti dall’impiego delle tecniche di fecondazione artificiale

Le tecniche di fecondazione artificiale (PMA) pongono al medico che opera nel campo delle metodiche della riproduzione e al bioeticista notevoli problemi di ordine morale, per la cui risoluzione e necessaria una base scientifica a monte della valutazione etica. Questo studio analizza, dunque, gli aspetti piu propriamente scientifici in merito alla Intra Cytoplasmic Sperm Injection (ICSI). Tale tecnica e oggi quella piu usata nei centri di PMA ed ha rivoluzionato l’approccio alla sterilita di coppia. Pur tuttavia essa pone notevoli problemi, sia in merito all’impiego di seme di soggetti infertili sia connessi alla stessa tecnica. Per quanto riguarda i primi, si distinguono aspetti correlati: 1. alla presenza di anomalie citogenetiche parentali e delle cellule spermatiche, onde e stato dimostrato che pazienti infertili ammessi a programmi ICSI hanno un alto tasso di aneuploidie negli spermatozoi, inversamente correlate con i parametri seminali e il numero di forme morfologicamente normali dopo selezione; 2. all’esistenza di microdelezioni del cromosoma Y. Su tale aspetto ci si sofferma, evidenziando il ruolo dei segmenti genici coinvolti, nonche il rischio di trasmissione della microdelezione ai figli concepiti via ICSI. Sono quindi descritte le principali problematiche connesse sia alla tecnica sia all’abilita dell’operatore, evidenziando il carattere di sperimentalita della tecnica in esame. Considerando, poi, i risultati delle procedure ICSI, occorre considerare sia il tasso di fecondazione e l’outcome ostetrico sia il seppur lieve aumento di incidenza di malformazioni ed anomalie citogenetiche. Inoltre, il tentativo di ottenere gravidanze da situazioni maschili sempre piu severe, pone il problema di valutare i risultati in rapporto al quadro eziologico di partenza, ma vi sono poche osservazioni in tal senso. In conclusione vengono valutati i nuovi campi di indagine, con particolare riferimento alla round spermatid injection (ROSI), alla round spermatid nuclear injection (ROSNI) ed all’impiego di spermatogoni, fino alle forme di “semi-clonazione”, e gli ulteriori problemi che permangono ancora aperti, quali gli aspetti immunologici o la trasmissibilita dell’infezione da Human Immunodeficency Virus (HIV). ---------- The reproductive technologies (RTs) puts to the physician, involved in the reproductive medicine, and the bioethicist remarkable moral problems; therefore a solid scientific ground is necessary for an ethical evaluation. This study analyses the more properly scientific aspects, particularly related to Intracytoplasmic Sperm Injection (ICSI). Such technique, that is today the more used in the RTs centres, upsets the approach to couple sterility. It places, however, remarkable problems, both about the use of infertile man sperm and about the same technique. As to the first point, we can distinguish aspects connected to the presence of parental citogenetic anomalies and in sperm cells, so it was demonstrated that infertile patients admitted to ICSI programs have a high rate of aneuploidies in the spermatozoa, inversely correlated with the sperm parameters and the number of morphologically normal shapes after selection, and to the existence of micro-deletion of the Y chromosome. About this we meant to stop to us, evidencing the role of the deleted genic segments and the risk of transmission of the microdeletion to sons conceived via ICSI. Then the authors describe the major problems connected to the technique and to the ability of the operator, evidencing the experimentation of this technology. Considering, then, the outcomes of ICSI procedures, it is necessary to consider both the fecondation rate and the obstetrical outcome, and the slight increase of the incidence of malformations and citogenetical anomalies. Moreover, the attempt to obtain pregnancies from more and more severe male situations places the problem to estimate the outcome referred with the etiology, but there are only few observations about it. In conclusion we considered the new perspectives, specially about round spermatid injection (ROSI), round spermatid nuclear injection (ROSNI) and the use of spermatogonia, until “the semi-cloning reproduction” and the other problems still opened, as the immunological aspects or the transmission of the Human Immunodeficiency Virus (HIV).