Luciano Negri

ICSI outcome is significantly better with testicular spermatozoa in patients with necrozoospermia: a retrospective study

Abstract Objective: To determine whether intracytoplasmic sperm injection (ICSI) outcome with testicular sperm is superior to that of ejaculated sperm in men with incomplete necrozoospermia, defined as sperm viability ≥5 to ≤45%. Study design: Retrospective study at a Reproductive Medicine Center of a tertiary referral hospital. A total of 231 couples with male infertility due to incomplete necrozoospermia underwent 342 ICSI cycles with freshly ejaculated sperm (ICSI-ejaculated) and 182 cycles with testicular sperm (ICSI-TESE). Results: Overall 1624 MII oocytes were injected in the ICSI-ejaculated group with a fertilisation rate of 60.8%, while in ICSI- TESE cycles the fertilisation rate was 59.6% in 874 MII oocytes. The cleavage rate was higher in ICSI-ejaculated cycles than in ICSI-TESE cycles (96.3% versus 92.9%; p = 0.004). However, the pregnancy and implantation rates per cycle were significantly higher in the ICSI-TESE group (67/182, 36.8% versus 68/342, 19.9% (p = 0.0001); and 23.7% versus 12.7% (p = 0.0001), respectively). The miscarriage rate was similar (ICSI-ejaculated 26.5% versus ICSI-TESE 17.9%, p = 0.301). Live birth rate per cycle in the ICSI-ejaculated group was significantly lower than in the ICSI-TESE (13.7% versus 28.6%, p = 0.0001). Conclusions: In cases of persistent necrozoospermia, testicular sperm should be favoured over ejaculated sperm. These data call for more research to understand the pathophysiology of refractory necrozoospermia.

Fertility restoration by seminal tract washout in ejaculatory duct obstruction.

A complex case of secondary sterility due to excretory azoospermia-dry ejaculation is reported. Transrectal ultrasonography and vaso-vesiculography revealed post-inflammatory total obstruction of the right ejaculatory duct. Excluding small radiolucent concrements in the seminal vesicle, no anatomical anomalies were identified on the left side. By performing antegrade seminal tract washout with saline solution it was possible to clear both seminal ducts and restore fertility in our patient. In select cases seminal tract washout may be a valid alternative to the conventional transurethral surgical approach for acquired obstruction of the ejaculatory ducts.

Effect of superoxide dismutase supplementation on sperm DNA fragmentation

BACKGROUND antioxidants supplementation improves sperm quality, but few trials have analyzed the effects on sperm DNA fragmentation (SDF). This study compares the effectiveness of SOD-based antioxidant supplementation plus hydroxytyrosol and carnosol in reducing SDF with other antioxidants without SOD, hydroxytyrosol, and carnosol. MATERIALS AND METHODS men with high SDF at baseline were selected in our clinical database. The patients taken into account had a 2-month control. SDF was measured by Sperm Chromatin Dispersion test (SCD). Untreated men were used as a control group. The remaining subjects received some oral antioxidant supplements (12 different combinations of both hydrophilic and lipophilic antioxidants), with some of them receiving nutritional support with a SOD-based antioxidant supplementation plus hydroxytyrosol and carnosol. RESULTS 118 men were selected for a retrospective study. Mean age 39.3 ± 5.4 years. Fifteen had no treatment, 55 were treated with a SOD-based antioxidant supplementation plus hydroxytyrosol and carnosol, and 48 took some antioxidant supplements for 2 months. Clinically, variations of at least 10% in baseline values of classic semen parameters and sperm DNA fragmentation were taken into consideration. Classic seminal parameters did not vary significantly in the three groups, with the exception of viability (p = 0.001). We assessed which of the active substances (no. 19) in different formulations were associated with variations in SDF. In the multivariable analysis of the 7 active substances that passed the univariable analysis, only the SOD molecule appeared to be linked to an improvement in SDF (< 0.0001). In detail, only one patient in the control group showed a spontaneous improvement in SDF (6%), compared to 16/48 (33%) of those taking various oral antioxidant supplements, and 31/55 (56%) of those taking a SOD-based antioxidant supplementation plus hydroxytyrosol and carnosol. CONCLUSIONS SOD-based antioxidant supplementation plus hydroxytyrosol and carnosol seems to provide a better chance of improving sperm DNA integrity than other classical antioxidant molecules.

Levothyroxine supplementation on assisted reproduction technology (ART) outcomes in women with subtle hypothyroidism: a retrospective study

Abstract The need for treating subclinical hypothyroidism (SCH) in women undergoing assisted reproduction technology (ART) is under debate. Moreover, it is known that controlled ovarian hyperstimulation (COH) protocols may impair the thyroidal axis. Therefore, we evaluated if levothyroxine (L-T4) supplementation in SCH women before undergoing ART positively affects the main reproductive outcomes. We retrospectively analyzed in vitro fertilization (IVF) data of 4147 women submitted to 6545 cycles in a tertiary care IVF Center (January 2009–December 2014). L-T4 (1.4–2.0 mcg/kg) treatment was offered to all women with a pre-cycle TSH >2.5 mIU/L before starting COH and main ART outcomes were compared in euthyroid and L-T4-treated women undergoing ART. Among 4147 women, 1074 (26%) were affected by SCH and were treated with L-T4 before COH was started. No statistically significant differences among L-T4-treated and euthyroid women group were observed regarding pregnancy rate, respectively, per cycle (27.67% vs 26.37%; p = .314) and per embryo transfer (30.13% vs 29.17%; p = .489), live birth rate, respectively, per cycle (21.58% vs 20.38%; p = .304) and per embryo transfer (23.49 vs 22.54%; p = .449) and the rest of primary and secondary efficacy endpoints. Early L-T4 treatment for infertile women with a subtle thyroid dysfunction may mitigate and protect from the negative effects of SCH in the setting of ART, and may preventively overcome also the negative impact of COH on thyroidal axis. 摘要 目前对于接受辅助生殖技术（ART）的妇女治疗亚临床甲状腺功能减退症（SCH）的必要性是有争议的。此外, 已知的控制性超促排卵（COH）方案可能损害甲状腺轴。因此, 我们评估了在接受ART之前, 对SCH女性补充左旋甲状腺素（L-T4）是否会对辅助生殖结局产生积极影响。我们回顾性分析了在一家三级医疗IVF中心（2009年1月至2014年12月）接受了6545个周期的4147名女性的体外受精（IVF）数据。在开始COH之前, 对所有TSH> 2.5 mIU / L的女性提供L-T4（1.4-2.0 mcg / kg）治疗, 比较甲状腺功能正常和接受L-T4治疗的女性的ART结局。在4147名女性中, 有1074名（26％）诊断为SCH, 并在开始COH之前接受L-T4治疗。L-T4治疗组和甲状腺功能正常组女性的妊娠率在每个周期（27.67％vs 26.37％; p = .314）和每次胚胎移植（30.13％vs 29.17％; p =.489）中的差异均无统计学意义。活产率分别为每个周期（21.58％vs 20.38％; p = .304）和每次胚胎移植（23.49 vs 22.54％; p = .449）, 差异无统计学意义。其余的主要和次要疗效终点之间的差异均无统计学意义。对于具有亚临床甲状腺功能减退的不孕妇女, 早期L-T4治疗可以减轻SCH对ART治疗中的负面影响, 并且还可以预防性地减少COH对甲状腺轴的负面影响。

Sindrome post-finasteride: tra mito e realtà

SommarioNumerosi studi hanno dimostrato l’associazione tra l’uso di finasteride e la comparsa di disfunzioni sessuali e sindrome depressiva, che possono persistere dopo la sospensione del farmaco (Sindrome post-finasteride). I ridotti livelli di DHT e dei metaboliti della 5AR ad azione neuroattiva, in aree del SNC fondamentali per l’attività sessuale e il tono dell’umore, sembrerebbero essere i responsabili della sindrome. In questo lavoro viene caratterizzata la sindrome, al fine di migliorarne la gestione.