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Introducción: la infertilidad es un problema global en aumento. Se estima que aproximadamente un 15% de las parejas en edad reproductiva tiene dificultades a la hora de concebir. De estas, alrededor de la mitad presentan uno o varios factores masculinos asociados a infertilidad o subfertilidad, aislados o en combinación con problemas de origen femenino. Durante la última década se ha empezado a estudiar la infertilidad desde una perspectiva multifactorial, considerando las interacciones y conexiones entre diferentes situaciones genéticas, epigenéticas, bioquímicas y fisiológicas del paciente.Objetivo: la presente revisión pretende describir mecanismos epigenéticos que pueden ser modulados mediante aspectos nutricionales y que están relacionados con la etiología de la infertilidad masculina y con la herencia transgeneracional de este fenotipo.Material y métodos: se ha realizado una extensa búsqueda de publicaciones científicas en las principales bases de datos electrónicas especializadas: NBCI, Elsevier, Scielo, Scirus y Science Direct.Resultados y conclusión: varios trabajos que muestran la importancia del estado nutricional en la fertilidad del hombre y, más específicamente, la capacidad de los componentes de la dieta para modificar los perfiles epigenéticos que no únicamente pueden afectar a su fertilidad, sino que también pueden ser transmitidos a la descendencia mediante lo que se ha denominado herencia transgeneracional, ocasionándoles problemas de salud diversos entre los que también se hallan problemas en la fertilidad.

Background: Infertility is a public health disorder affecting 10% of the population worldwide. Research on the impact of body mass index (BMI) on male fertility is very limited as compared to the multiple studies evaluating the impact of overweight in women's fertility. Although 25%-30% of the cases of couples consulting for infertility are attributable to male factors, studies evaluating the association between semen parameters and BMI are controversial., Objective: To assess the impact of BMI on semen parameters in a selected group of men with unexplained infertility., Method: A retrospective analysis of 168 patients during the 2008-2010 period. They all had at least one semen analysis and related studies to rule out known causes of infertility. Median age of patients was 35 years (22-55), and they were divided into three groups: normal weight (BMI: 20-24.9kg/m(2)), overweight (BMI 25-29.9kg/m(2)), and obese (BMI ≥30kg/m(2))., Results: There were no significant differences in semen parameters evaluated between the three groups, and no significant correlation was found between the same parameters and BMI., Conclusions: There was no significant association between BMI and conventional semen parameters, but we cannot exclude an impairment in other semen parameters that are not routinely assessed, which could result in a lower potential fertility in these individuals., (Copyright © 2012 SEEN. Published by Elsevier Espana. All rights reserved.)

Objective: This study evaluated the integrity of the chromatin structure, reactive oxygen species (ROS) levels, mitochondrial membrane potential (MMP), DNA damage and lipid peroxidation of semen samples from infertile men classified as unexplained infertility., Methods: Between February 2010 and July 2011 semen parameters and functional tests were evaluated in 10 subjects with proven fertility, 10 that belong to general population and 8 with idiopathic infertility. In addition to the conventional semen analysis, the following unconventional seminal analysis were conducted: evaluation of ROS, MMP, sperm chromatin structure assay (SCSA) by flow cytometry, assessment of sperm membrane lipid peroxidation by spectrophotometry, and alkaline comet assay by electrophoresis., Results: We observed a significant increase (P<.05) in the production of ROS and the fragmentation or sperm DNA damage in the population of infertile men. There were no statistically significant differences (P>.05) in the analysis of sperm membrane integrity between the groups. Moreover, we observed significant correlations (P<.05) between SCSA and comet assay (r=0.86) and the production of intracellular ROS (r=-0.588)., Conclusion: The sperm from individuals with idiopathic infertility showed high levels of intracellular ROS and increased levels of DNA fragmentation in the sperm. These results suggest that these two parameters are related to unexplained infertility and therefore have clinical importance as a possible diagnostic and prognostic tool in the evaluation of idiopathic male infertility., (Copyright © 2012 AEU. Published by Elsevier España, S.L. All rights reserved.)

Introduction: Previous studies related alterations in non-conventional seminal parameters with recurrent early embryonic death for one couple. A reference standard of clinical assessment is required for the management of these kinds of patients., Objective: Normal semen parameters were established based on functional tests including lipid peroxidation of sperm membranes, antioxidant capacity of seminal plasma and integrity of sperm chromatin to compare with men whose partners have recurrent early embryonic death. These parameters set reference values to identify subfertile individuals whose condition can be attributed to altered semen parameters., Materials and Methods: The conventional and non-conventional semen parameters of 47 samples of semen were evaluated. Thirty-six samples were from subfertile individuals whose partners had a history of early recurrent embryo death, and 11 samples were from individuals with recent evidence of normal fertility., Results: By discriminant analysis, the two groups were classified as follows: a value below 0.50 for 86.1% of individuals in the group of recurrent early embryonic death, and a value above 0.50 to classify 81.8% of individuals in the group of recent fertility., Conclusions: This reference value of 0.5 based on the results of sperm tests can identify infertile male patients whose partners have a history of early embryonic death. This will aid the physician to suggest treatments more focused on the possible cause of subfertility.

Objective: To compare the changes that occurs in the spermatic parameters when a second ejaculate is obtained in the first 60 minutes in patients with a different seminal quality., Material and Method: Infertile patient from andrology service were asked to provide a second sample within 1 hours of the first. All the patients had poor semen characteristics in volumen, density, motility or total motile cells., Results: The patients were divided in subgroup; hipospermia (n = 75), oligospermic (n = 46), asthenospermic (n = 111) and teratospermic (n = 157). A benefic effect from a second ejaculate sample was observed in patients with asthenosperia, oligospermic and a total motile sperm count less than 10 million (p < 0.05)., Conclusions: The second ejaculate must be considered as an alternative in some infertile patients that are looking for an spontaneous pregnancy or in patients that will require an assisted reproductive techniques and have poor seminal parameters.

The main endocrine function of the testis after puberty is testosterone production. In most cases, hypogonadism in adult men can be diagnosed by determining total testosterone concentration. Due to the circadian rhythm of testosterone secretion, blood samples should be extracted early in the morning. The results of commercially available methods for analysis show considerable variability. Furthermore, the threshold for the symptoms of hypogonadism may differ in each individual. For these reasons, moderately low testosterone levels should be interpreted with caution before a diagnosis of hypogonadism can be established. In these cases, determination of either free or bioavailable testosterone can be useful. Direct methods can be used or the respective concentrations can be calculated on the basis of total testosterone and sex hormone-binding globulin (SHBG). This latter method is easy to perform but the results are less reliable. Endocrinological evaluation of the testes should also include analysis of the gonadotropins (follitropin [FSH] and lutropin [LH]), which are described in another article in this series. Inhibin B is a biological marker of the amount and the physiological status of Sertoli cells in the postpubertal testis. Inhibin B may improve the information given by FSH for the determination of spermatogenic reserve in non-obstructive azoospermia, but determination of this glycoprotein is not currently used for routine assessment. The most important laboratory test to study reproductive function in men is semen analysis. However, the predictive power of this test is limited by the analytical imprecision of current methods, all of which are manual, and by the biological variability of most of their components. Special attention should be paid to pre-analytical procedures, because they require the understanding and participation of the patient. Some organizations and societies have proposed standardized methods to help improve the quality of semen analysis and reliable exchange of the results of seminogram. Biochemical markers of the prostate, seminal vesicles and epididymis in seminal plasma can indicate the level of damage in hypospermia or azoospermia. The fertility potential of sperm cells can be investigated with a variety of tests and assays, but none of them can yet be recommended for routine practice. Congenital hypogonadism is frequently caused by chromosome abnormalities, particularly sex chromosomal aneuploidies. Other causes of infertility include structural aberrations of autosomes. The main cytogenetic technique performed to determine chromosome constitution is karyotyping. To detect submicroscopic defects, this test can be performed in conjunction with fluorescent in situ hybridization (FISH).

Background: Cryptorchidism and oligozoospermia are clinical conditions closely associated with impaired fertility. Oxidative stress and related sperm DNA damage have been identified as significant causes of male infertility., Aim: To determine the extent of sperm nuclear DNA damage in patients affected with idiopathic oligozoospermia or undescended testes and to examine its relationship with oxidative stress., Patients and Methods: We studied 20 patients with idiopathic oligozoospermia and 18 with undescended testes (who previously underwent orchiopexy) and 25 normozoospermic healthy controls. All subjects underwent semen analysis. Sperm DNA damage was evaluated by the sperm chromatin structure assay/flow cytometry (SCSA-FCM) and by the dUTP-biotin nick end labeling (TUNEL) assay. Levels of reactive oxygen species (ROS) and total antioxidant capacity (TAC) were assessed by a chemiluminescence assay., Results: DFI (percentage of sperm with denatured DNA) values and percentage of TUNEL positive cells were significantly greater in patients with oligozoospermia (DFI: 28.8+/-5.6; TUNEL+: 26.9+/-3.0) or cryptorchidism (DFI: 26.4+/-10.1; TUNEL+: 29.1+/-3.9), compared with controls (DFI: 7.1+/-0.9; TUNEL+: 14.2+/-1.2). Similarly, both groups of patients had significantly higher (p<0.01) levels of ROS. TAC levels did not differ between control and patient groups, suggesting that the DNA damage occurs before spermiation., Conclusions: Sperm DNA damage is significantly increased in men with idiopathic oligozoospermia and in cryptorchid subjects. The finding of increased ROS levels may indicate that seminal oxidative stress may be involved in the pathogenesis of sperm DNA damage in these patients.

Objective: To evaluate sperm recovery and total sperm motility in three different sperm preparation techniques (density gradient, simple washing and swim-up)., Patients and Methods: A total of 290 subjects were randomly evaluated from November 2001 to March 2003. The density gradient method required Isolate (upper and lower layers). Centrifugation was performed at 400 g for 10 minutes and evaluation was done using the Makler counting chamber. The simple washing method included the use of HTF-M complemented with 7.5% of SSS, with centrifugation at 250 g, obtaining at the end 0.5 mL of the sperm sample. The swim-up method required HTF-M complemented with 7.5% of SSS, with an incubation period of 60 minutes at 37 degrees C., Results: The demographic characteristics evaluated through their standard error, 95% ICC, and 50th percentile were similar. The application of multiple comparison tests and analysis of variance showed significant differences between the sperm preparations before and after capacitation. It was observed a superior recovery rate with the density gradient and swim-up methods; nevertheless, the samples used for the simple washing method showed a diminished sperm recovery from the original sample., Conclusions: Sperm preparation techniques have become very useful in male infertility treatments allowing higher sperm recovery and motility rates. The seminal parameters evaluated from the original sperm sample will determine the best sperm preparation technique in those patients who require it.

An understanding of the physiologic events of male fertility provides a logical and practical organizational framework for dealing with the causes of infertility in men based its pathophysiology. The several disorders that cause male infertility emphasize the heterogeneous nature of infertility and the need for an integral clinical evaluation. Usually, semen analysis provides the first sign that a male factor is contributing to the couple's infertility. The introduction of the intracytoplasmic sperm injection (ICSI) has transformed the clinical management of the male infertility. It is to be expected that the availability of ICSI, will not impede efforts of the andrology to understand, prevent and diagnose male infertility.

Objectives: To review current theories about etiology of varicocele and pathogenic mechanisms leading to a progressive disorder of spermatogenesis in relation to the subfertility or infertility these patients may present with. To evaluate its current anatomical knowledge of the normal venous drain of the testicle and its variations that may condition relapse or failure of the treatment of varicocele. To systematically review pathologic testicular lesions in patients with varicocele. To establish factors that may have prognostic significance on post-treatment fertility., Methods: We performed a systematic search in the Medline database for each of the proposed etiological and pathogenic theories on human varicocele. The evaluation of pathologic testicular lesions in patients with varicocele was obtained from the study of testicular biopsies performed at the Hospital La Paz in Madrid over the lost 30 years., Results: Regarding the anatomical theories of varicocele, congenital absence or incompetence of the internal spermatic vein valves, difficult venous drain, augmented hydrostatic pressure of the internal spermatic vein, disorder of the fascial-muscular pump mechanism, and compression of the venous drainage system are considered, among others, potential etiological factors. Regarding possible pathogenic theories of varicocele, we evaluate disorders of testicular thermoregulation, hypoxia, toxic effect of renal and adrenal metabolites, certain endocrine disorders, obstruction of the spermatic tract, disorders of blood flow and epididymal vasculature, oxidative stress, gonadotoxins, apoptosis, and lastly the effect of varicocele on the contralateral testicle., Conclusions: Available data support the idea that etiopathogenesis of varicocele is multifactorial. Many classic etiopathogenic factors related to anatomy, embryology, obstruction, and hyperthermia still prevail in addition to new factors related to oxygen reactive species and apoptosis. However, many pathogenic and physiopathologic aspects of varicocele need to be elucidated yet. As a matter of fact, neither of these data alone may clearly explain the variable effect varicocele has on spermatogenesis and male fertility. So, it is necessary to establish histological criteria with proved prognostic significance that allow us to detect possible progression of testicular lesions after treatment.

This study was designed to investigate the in vitro effect of L-arginine and polyamines putrescine, spermidine, and spermine on sperm motility of asthenozoospermic idiopathic and diabetic patients. 10 semen samples were obtained from healthy male volunteers. Other 10 samples were from men with idiopathic asthenozoospermia and 13 samples were from men with diabetes mellitus type 1. In vitro effect of L-arginine and polyamines on sperm motility type a was studied. In addition, concentration of L-arginine and polyamine levels was measured in seminal plasma. Addition of L-arginine or polyamines to sperm cells suspensions resulted in significant differences in motility type a. L-arginine concentrations in seminal plasma were similar in the three groups. Putrescine and spermidine levels in seminal plasma of diabetic patients were lower than those of healthy patients (p < or = 0.003 and p < or = 0.004, respectively). In asthenozoospermic patients, only spermidine was lower (p < or = 0.009). We can conclude that under the conditions of this study, the addition of L-arginine and polyamines to human sperm cells obtained from idiopathic or diabetic asthenozoospermic patients showed a beneficial effect on sperm motility.

Objective: To determine the integrity of the plasmatic membrane through phosphatidylserine (PS) translocation in two spermatic fractions and their correlation with the spermatic mitochondrial membrane potential., Material and Methods: The analysis of both spermatic fractions was carried out through a discontinuous gradient separation with Percoli, in order to obtain two samples with high and low mobility (90-40%). Twelve patients were recruited for the initial evaluation of seminal parameters. Mitochondrial membrane integrity was determined using a second antibody (Mitosensor), and was analyzed by fluorescence microscopy, evaluating an average of 200 cells. A 450-490 nm excitation filter was used for this analysis. Cytoplasmatic assessment was carried out by anexine V bonding to PS, in order to determine the initial events of cellular death. Non parameter tests were used in order to determine the differences between mitochondrial potentials and plasmatic membrane processes. Linear correlation tests were used for the anexine V and Mitosensor ratios., Results: Due to the study's design, some differences were observed regarding the displacement parameters and the presence of apoptosis, both, in the plasmatic membrane and in mitochondrial membrane potentials. A positive correlation between both, mitochondrial and cytoplasmic membrane functions was also found., Conclusions: This is the first study performing a comparative analysis between mitochondrial membrane function and cytoplasmatic PS expression as early cellular death markers. The male infertility population is probably associated with an increase in this kind of apoptosis processes.

Objective: To evaluate the effect of Palomo's surgery on the semen quality from oligospermic infertile men with varicocele., Study Design: Retrolective cohort., Setting: Hospital General Regional No. 1, IMSS, Culiacán, Sinaloa., Patients: 39 oligospermic infertile men with varicocele., Interventions: Palomo's surgery., Measurements: A spermatobioscopy before the Palomo's surgery was performed, and after the surgery two spermatobioscopies in different times of six months., Results: Spermatobioscopy before the surgery: Concentration/mL = 8.8 +/- 4.1 millions, Motility = 19.5 +/- 10.0%, Vitality = 66.2 +/- 14.4%. First spermatobioscopy after surgery: Concentration/mL = 29 3 +/- 18 3 Motility = 41 5 +/- 19 1, Vitality = 74.7 +/- 14.5. Second spermatobioscopy after surgery: Concentration/mL = 14.6 +/- 10.3, Motility = 28.0 +/- 14.8, Vitality = 78.7 +/- 16.8. All differences from the spermatobioscopy before the surgery were significant., Conclusion: Palomo's surgery has a favorable effect on the quality of the semen, with a diminishing trend in concentration and motility in the second semester after the surgery. The pregnancy rate was 15%.

Diabetes mellitus is a major cause of morbidity and mortality and it has been studied in relation to the organs that affects, and the reproduction system is not the exception. Scientists had developed experimental animal models to investigate the effects of diabetes using different substances being streptozotocin (STZ) the most effective. STZ is natural compound produced by the Streptomyces achromogenes that selectively destroys the beta cells of the pancreas breaking the DNA. It has been proved that equilibrated solutions of STZ stored at 6 degrees C, are very effective in inducing diabetes to several animal species such as rat, mouse and hamster. In rats, the disorders in reproduction have been associated to dysfunctions in the hipotalamohipofisis-gonadal axis, given by a reduction in the secretion of GnRH, as well as of LH, FSH, prolactin and alterations in the gonadal secretion of steroids (testosterone, estrogens, progesterone). Due to this situation, male production of spermatozoids as well as its' motility is impair. In females, the principal effects are ovaric atrophy, impaired folliculogenesis, insufficiency of the corpora lutea, and problems associated with the maintenance of pregnancy. Many researchers had associated the prevalens of congenital malformation with a hiperglucemic state, being the most common retardation of the development, defects in the closure of the neural tube, micrognatias, heart malformations, etc.

The knowledge and treatment of human reproduction impairments have had an outstanding development during the last 15 years, mainly in topics related with infertility and sterility. Unfortunately in the area of male reproduction development has not been the same and despite the efforts accomplished, progress in the diagnosis and therapeutics of male infertility is limited. The functions of the male gonad are sperm production as well as the synthesis and secretion of steroid hormones, mainly testosterone. The efficient regulation of these functions depends on both the precise pituitary secretion of gonadotropic hormones and the endocrine, paracrine and autocrine responses of the testicular somatic cells to this stimulation. In this review we discuss the main events associated with the spermatogenic process, including the interactions among the testicular somatic cells and some characteristics of the physiological function of the hypothalamus-pituitary-testicle axis, as well as some pathophysiological states related to male infertility due to "pretesticular causes".

Idiopathic oligo-asthenozoospermia is among the most frequent causes of male infertility and has a not very well understood etiopathogenesis. To obtain valuable information about the role of some endocrine factors in the etiology of this kind of infertility, information that is not easy obtain by the traditional analytical methods, we applied some recently proposed mathematical algorithms to analyze with more exactitude the importance of the secretory pulses of three hormones, luteinizing hormone (LH), follicle stimulating hormone (FSH) and testosterone (T). Serum samples were obtained every 10 min for 12 h, from 15 fertile normospermic men and 14 infertile patients with idiopathic oligo-asthenozoospermia; the concentration profiles of FSH and T were analyzed by IRMA and RIA, and the immuno-and bioactive LH concentrations were quantified by IRMA and bioassay (JCEM 42:958, 1976). To assess the pituitary stores of LH and FSH, after 8 h of spontaneous secretion we administered (2 h apart) 2 intravenous pulses containing 10 micrograms of a GnRH analog, and the sampling continued as described. Hormonal pulsatility was assessed by a computerized cluster analysis method (Am J Phys 250:E486, 1986) an by the multiple parameters deconvolution method (JCEM 66: 1291, 1988). In the infertile patients we found a significant diminution in the length and frequency of LH pulses, compared with the normospermic men. However, LH half life, the interpulse interval, the amplitude and the mass secreted per pulse rose in the infertile males compared with the controls. The increase in the LH half life suggests the secretion of a more acidic isoform of this hormone in the infertile group. After the GnRH injection the LH secreted mass and mean concentration rose significantly in both groups; this effect was higher in the infertile oligo-asthenozoospermic men. In this group we also found a decrease in the bioactive LH interpulse interval and therefore more pulses during the sampling interval, that produced a higher concentration of this kind of hormone in these patients. Oligo-asthenozoospermic men secreted approximately 70% more bioactive LH as a response to the first GnRH injection than the normal controls. The desensitization observed with immunoactive LH (diminution in the mass secreted after the second GnRH bolus compared with the first one) was also observed with bioactive LH. In the infertile men group we found a significant reduction in the FSH half life compared with the normospermic controls; this fact suggests that, contrarily to the results observed with LH, a more basic isoform is secreted in these patients.(ABSTRACT TRUNCATED AT 400 WORDS)