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INTRODUÇÃO: A saúde reprodutora masculina pode ser influenciada devida à prática de atividade física, e com isso tem-se aumentado o número de estudos que analisam o efeito da atividade física na qualidade seminal. Descobertas apontam que mudanças significativas na qualidade do sêmen podem ocorrer com a prática de atividade física, que pode alterar sua qualidade de acordo com o tipo de atividade física, a intensidade e a duração. OBJETIVO: Neste contexto, o presente estudo realizou uma análise detalhada da literatura atual com o objetivo de verificar o efeito de diferentes atividades físicas sobre a saúde reprodutora masculina. MÉTODO: Trata-se de uma revisão sistemática feita nas bases de dados do PubMed. Utilizou-se os itens propostos pelo PRISMA para a busca, seleção e extração de dados. De acordo com o fluxograma proposto, 244 artigos foram identificados e, destes, 12 foram selecionados. RESULTADOS: Apoiada por fortes evidências clínicas, esta revisão sugere que a atividade física intensa pode provocar fortes alterações hormonais e prejudicar a qualidade seminal. Já a atividade física moderada parece ter um efeito neutro ou benéfico para a qualidade do sêmen. Além disso, o efeito da atividade física na qualidade do sêmen pode ser diferente de acordo com o tipo de atividade física. CONCLUSÃO: Frente às evidências, ainda existe falta de conclusões sólidas sobre esse assunto, devido ao fato de existir muita contradição entre os estudos existentes e da atividade física não ser facilmente quantificada. ABSTRACT. Effect of physical activity on seminal quality, BACKGROUND: Male reproductive health may be influenced by physical activity, and this has increased the number of studies that analyze the effect of physical activity on seminal quality. Findings indicate that significant changes in semen quality can occur due to the practice of physical activity, which can alter its quality according to the type of physical activity, intensity and duration. OBJECTIVE: In this context, the present study performed a detailed analysis of the current literature with the objective of verifying the effect of different physical activity on male reproductive health. METHODS: A systematic review performed on the PubMed databases. The items proposed by PRISMA were used for searching, selecting and extracting data. According to the proposed flowchart, 244 articles were indentified and, of these, 12 were selected. RESULTS: Supported by strong clinical evidence, this review shows that intense physical activity can cause strong hormonal changes and impair seminal quality. On the other hand, moderate physical activity seems to have a neutral or beneficial effect on semen quality. In addition, the effect of physical activity on semen quality may differ according to the type of physical activity. CONCLUSION: Faced with the evidence, there is still a lack of solid conclusions on this subject, due to the fact that there is a lot of contradiction between the existing studies and that physical activity can not be easily quantified.

Background: The PD-1/PD-L1 signaling axis is currently the most elucidated mechanism for tumor evasion of T-cell-mediated immunity. Nevertheless, few data are available regarding its impact on cervical cancer and the relationship with lymphocytic infiltrates. Methods: A retrospective assessment of all cases of cervical neoplasia treated in Caxias do Sul General Hospital, Brazil, between 2012 and 2016 was performed. Clinical and pathological data were collected from electronic records and analyzed. Original slides were independently reviewed by three pathologists to confirm diagnoses and to assess the immunohistochemical expression of PD-L1 and FoxP3 in tumor cells and lymphocytic infiltrates. Results: PD-L1 staining was present in 32.2% of the 59 cervical samples. Median overall survival time of the PD-L1-negative group was 47.8 months, a time point not yet reached by the PD-L1-positive group (p=0.968). Median progression-free survival was 24.3 months for PD-L1-negative and 11.5 months for PD-L1-positive patients (p=0.263). PD-L1 staining was found in 27.1% of the lymphocytic infiltrates, and survival analysis revealed no difference between PD-L1-positive and PD-L1-negative samples. There was no impact on survival related to FoxP3 staining in neither tumor samples nor lymphocytic infiltrates. Conclusion: Although the median progression-free survival times differed, the difference was not statistically significant. Our study corroborates the rationale that PD-L1 expression in cervical neoplasms has no impact on survival. PD-L1 expression in peritumoral lymphocytes revealed no impact on infiltration volume nor survival. Keywords: uterine cervical neoplasms, tumor-infiltrating lymphocytes, cancer, tumor microenvironment, survival.

Critical challenges for the public and private health, research, and medical communities have been posed by the COVID-19 outbreak. Some of these challenges are related to the possible adverse effects of SARS-CoV-2 on male reproductive health, and whether other potential modes of transmission may occur, such as sexual transmission. Moreover, concerns have been raised in terms of whether the COVID-19 outbreak may have an impact on fertility worldwide. In this study, we will discuss the origins of SARS-CoV-2. We will further describe its mechanism of action, diagnosis, symptoms, and potential effects on the male reproductive system.

Background Infertility is one of many complications of spinal cord injury (SCI) in male patients, who are often at the peak of their reproductive life. This study evaluated effects of hyperbaric therapy (HT) on quality of sperm of rats with SCI and correlated the findings with histologic analysis of the testicles. Methods This experimental study comprised 18 rats that were submitted to SCI with a MASCIS Impactor and randomly allocated to either a HT or a control group. Testicular biopsies were performed on the first and 28th day of the study; 4 parameters were evaluated: concentration of sperm per mL, number of round cells per field, number of inflammatory cells per field (peroxidase [Endtz] test), and sperm viability (hypo-osmotic swelling test). Results There was no difference in sperm concentration between the HT group (P = 0.41) and control group (P = 0.74) during 28 days. From day 1 to day 28, sperm viability decreased twice as much in the control group (P = 0.001) compared with the HT group (P = 0.017). There was no difference between the groups in mean sperm concentration and number of round and inflammatory cells. On the first day, there was no difference in sperm viability between groups. There was a significantly higher (P = 0.001) percentage of viable sperm in the HT group (86.8 ± 5.6) compared with the control group (48.8 ± 21.8) on day 28. Conclusions SCI increased the number of round and inflammatory cells and diminished sperm viability in both groups. HT promoted greater sperm viability in rats with SCI.

Background The medical management of low-grade squamous intraepithelial lesions (LSIL) is variable, thus a biomarker could assist with the clinical conduct. Type 2 transglutaminase (TG2) has been proposed as a cellular-interfering factor in HPV infection and carcinogenesis. Therefore, this study has the objective of evaluating TG2 expression in LSIL and high-grade squamous intraepithelial lesions (HSIL) and of relating it to the different HPV viral types. Methods This study included 146 patients with suspected LSIL or HSIL detected in routine conventional Papanicolaou tests. The presence of HPV DNA and viral typing was defined by the polymerase chain reaction method (PCR). TG2 Immunohistochemistry (IHC) was conducted according to the manufacturer's instructions; IHC was carried out in an Autosteiner-Link 48 Dako equipment. IHC quantitation was performed by relative expression and by using the software Image J. Qualitative variables, such as frequencies and proportions, were compared by using the χ2 test for independent samples. For comparison of the qualitative to the quantitative data, nonparametric Mann-Whitney test was used. Results The association between histopathological examination and TG2 was statistically significant (p 50% (p

The association of occupational exposure to current-use pesticides with reproductive hormones, semen quality, and genital measures was investigated among young men in the South of Brazil. A cross-sectional study was conducted in 99 rural and 36 urban men aged 18-23 years. Information on pesticide use was obtained through questionnaire. Serum and semen samples were analyzed for sex hormones and sperm parameters, respectively, and measurement of anogenital distance (AGD) and testis volume (TV) were performed. Associations were explored using multivariate linear regression. Rural men had poorer sperm morphology, higher sperm count, and lower LH levels relative to urban subjects. Lifetime use of pesticides, especially herbicides and fungicides, was associated with poorer morphology and reduced LH and prolactin, with evidence of a linear pattern. Maternal farming during pregnancy was associated with larger AGD and TV. Chronic occupational exposure to modern pesticides may affect reproductive outcomes in young men.

e17511Background: Cervical cancer is the 4th most common cause of cancer-related deaths in women worldwide. PD-1 is expressed on tumor-infiltrating lymphocytes (TILs) from many different tumor type...

Objective To evaluate the effect of male age on clinical outcomes of intracytoplasmic sperm injection (ICSI) cycles, according to sperm concentration. Design Retrospective, observational study. Setting Assisted reproduction center. Patient(s) The study included 1,024 couples undergoing ICSI cycles with fresh spermatozoa. Intervention(s) The influence of paternal age on ICSI outcomes of oligozoospermic and normozoospermic patients was evaluated. Main Outcome Measure(s) Rates of high-quality embryos, pregnancy, implantation, and miscarriage were evaluated through linear logistic regression analyses. Result(s) When the sperm concentration was abnormal, paternal age influenced implantation (regression coefficient value=−0.7009) and pregnancy rates (odds ratio=0.95, 95% confidence interval 0.91–0.99). However, in normozoospermic patients, no influence of paternal age was observed on implantation (regression coefficient value=0.0566) or pregnancy rates (odds ratio=1.00, 95% confidence interval 0.97–1.03). Conclusion(s) For couples in which the men are oligozoospermic, the implantation rate could be impaired by increased paternal age. In these couples, the chance of pregnancy decreased 5% for each year of paternal age. When men are normozoospermic, this effect is not observed.

An azoospermic man suffers from an absence of sperm in the ejaculate and this condition is present in about 10% of infertile men. Obstructive azoospermia (OA) is characterized by an occlusion or partial absence of the reproductive tract with the presence of normal spermatogenesis. On the other hand, non-obstructive azoospermia (NOA) is characterized by impaired spermatogenesis. In these cases, spermatozoa can be obtained by percutaneous epididymal or testicular sperm aspiration (PESA and TESA, respectively) and used for intracytoplasmic injection (ICSI). To compare ICSI outcomes using spermatozoa that were surgically retrieved by PESA and TESA, azoospermic patients were divided into the following categories: (i) TESA-NOA (n = 102), (ii) TESA-OA (n = 103), and (iii) PESA-OA (n = 171). Fertilization, pregnancy, and implantation rates were compared between the groups. We noted a lower normal fertilization rate (p = 0.0017) and a higher abortion rate (p = 0.0387) among men in the TESA group who had OA when compared with men in the PESA group who had OA. On the other hand, a lower normal fertilization rate (p = 0.05) and a lower rate of non-cleaved embryos (p = 0.034) was found in the TESA group of NOA patients as compared to the TESA group of OA patients. No statistically significant differences were detected between the TESA and PESA groups and the OA and NOA groups, respectively. The clinical outcomes of embryos arising from ICSI cycles using spermatozoa harvested via PESA and TESA were similar, regardless of whether the patient had obstructive or non-obstructive azoospermia.

PURPOSE: Report the characteristics of cryopreserved semen from a cohort of male cancer patients, attitudes towards cryopreservation and outcomes of semen samples based on a 12-year cryopreservation program. MATERIAL AND METHODS: Data from 98 male cancer patients whose sperm samples were banked were evaluated. Demographic parameters, semen characteristics, destination of sperm banked samples and questionnaires answered by the patients regarding cryopreservation time were evaluated. RESULTS: The cancer diagnoses were testicle (56.1%), prostate (15.3%), Hodgkin’s lymphomas (9.2%), non-Hodgkin’s lymphomas (7.1%), leukemia (3.1%) and other malignancies (9.2%). The patients with testicular cancer presented lower sperm concentration (p < 0.001); however, there were no differences with the percentage of normozoospermic patients among cancer type groups (p = 0.185). A shorter time between cancer diagnosis and sperm banking was observed for testicular and prostate cancer patients (p < 0.001). Most of the patients (89.5%) favored sperm banking as a fertility preservation method. CONCLUSIONS: Although less than 20% of banked sperm samples were disposed of, the majority of patients related sperm banking with safe for fertility preservation. Our results show that all male cancer patients of reproductive age facing cancer treatment could be offered sperm banking.

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.

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.

Objective To examine whether the presence of birefringent spindles in living human oocytes can be used as a predictive factor associated with embryo morphology to allow embryo selection before transfer and its association with IVF outcomes. Design Prospective study. Setting Assisted reproduction center in Brazil. Patient(s) One hundred fifty-seven patients undergoing intracytoplasmic sperm injection cycles, resulting in 1,097 metaphase II oocytes. Intervention(s) Meiotic spindles were evaluated before intracytoplasmic sperm injection in all metaphase II oocytes. Main Outcome Measure(s) Meiotic spindles' imaging and fertilization rate, embryo development, and implantation rate. Result(s) Birefringent spindles were detected in 65.9% (SD group). The normal fertilization rate and rate of early-cleavaged embryos were higher in the SD group compared with in the spindle–non-detected (SND) group. When only embryos from the SD group were selected for transfer, the pregnancy and implantation rates were 44.4% and 23.0%, and when only embryos from the SND group were transferred, those rates were 18.2% and 8.7%, respectively (statistically significant differences). Conclusion(s) Spindle visualization can be an important tool for predicting better fertilization potential, embryo development, and clinical outcomes, suggesting that embryo selection for transfer may be based not only on embryo morphology but also on oocyte nuclear maturity.

Objectives: To evaluate the effects of vasectomy on the human testis by serum follicle-stimulating hormone, luteinizing hormone and total testosterone levels, testicular volume and

Objective: To compare semen quality and levels of seminal oxidative stress among three groups: infertile men with varicocele, fertile men with varicocele, and healthy semen donors (controls) without varicocele. Design: Prospective study. Setting: Academic medical centers. Intervention(s): None. Patient(s): Semen specimens were obtained from 21 infertile patients with varicocele, 15 fertile men with varicocele, and 17 healthy fertile men with normal semen characteristics. Main Outcome Measure(s): Principal component analysis was applied to nine semen characteristics to provide a standardized semen quality score. Reactive oxygen species (ROS) production and total antioxidant capacity (TAC) were measured by chemiluminescence assays to create an ROS-TAC score. Result(s): The mean semen quality scores of the infertile patients with varicocele were lower than those of the control subjects but similar to those of the fertile men with varicocele. Compared with the healthy subjects, the infertile men with varicocele had higher ROS levels but lower TAC levels. They also had significantly lower ROS-TAC scores compared with control subjects, but the scores were not significantly different than those seen in fertile men with varicocele. Conclusion(s): These findings not only provide us with valuable information regarding semen quality but also can serve as a warning that the fertility potential in fertile varicocele patients can decline due to oxidative stress. (Fertil Steril� 2008;89:602–7. � 2008 by American Society for Reproductive Medicine.)

Introduction: To compare the semen quality score and the seminal oxidative stress reactive oxygen species (ROS) and total antioxidant capacity (ROS-TAC score) in men with idiopathic infertility with normal donors and to a known group of fertile and infertile men. Material and Methods: Principal component analysis was applied to provide a standardized score in 36 men with idiopathic infertility and 19 controls attending our infertility clinic. A logistic regression analysis comparing the fertile and infertile men was used. Results: Compared to controls, patients with idiopathic infertility had significantly lower sperm concentration, sperm motility and normal morphology (p < 0.05) and lower semen quality scores (83.0 ± 14.5 vs. 100.0 ± 10.0; p < 0.001). Compared to controls, the ROS levels were higher in the idiopathic infertility group (2.3 ± 0.21 vs. 1.3 ± 0.3; p = 0.006), whereas the TAC levels were lower in the idiopathic infertility (1,014.75 ± 79.22 vs. 1,653 ± 115.29; p = 0.001). Idiopathic infertility patients had lower ROS-TAC scores (32.8 ± 14.2) than controls (50.0 ± 10.0) (p < 0.001). 64% of men with idiopathic infertility will remain infertile during 1-year follow-up. Conclusions: Patients with idiopathic infertility have lower scores of semen quality and ROS-TAC.

Professionals involved in assisted reproductive technologies (ART) have in-depth awareness and knowledge of the risks of multiple pregnancies at the conclusion of in vitro fertilization (IVF) treatment. The aim of the study was to investigate ART professionals' attitudes towards the awareness of the risk of infertility, as well as the decision-making process in IVF issues.Seventy ART professionals answered a questionnaire covering demographic data, infertility awareness and attitudes towards IVF.Approximately half (50.8%) of the participants thought that they were not at risk of infertility. However, if they received a diagnosis of infertility, none would accept childlessness and almost all would undergo IVF. In an IVF cycle, the number of high-quality embryos transferred would be around three, but if treatment was extended to a third cycle, a higher percentage of participants would elect to transfer four or more embryos. All participants would prefer to undergo IVF and accept the risk of multiple pregnancy than remaining childless. It was found that less than a third of ART professionals considered triplets to be an unacceptable complication of IVF.Diagnosis of infertility affects all participants psychosocially, supporting the idea that the emotional aspects of wanting a biological child, and decision making about whether to undertake ART, outweigh the medical position regarding the risks and benefits of IVF.

Male infertility affects 10% of couples in the reproductive age worldwide and is treatable in many cases. In addition to other well-described etiologies, genetic causes of male infertility are now more commonly diagnosed. In men with prior vasectomy or varicocele, microsurgical reconstruction of the reproductive tract or varicocelectomy is more cost-effective than sperm retrieval with in vitro fertilization and intracytoplasmic sperm injection if no female fertility risk factors are present. If epididymal obstruction after vasectomy is detected or advanced female age is present, the decision to use either microsurgical reconstruction or sperm retrieval with in vitro fertilization and intracytoplasmic sperm injection should be individualized. Sperm retrieval with in vitro fertilization and intracytoplasmic sperm injection is preferred to surgical treatment when female factors requiring in vitro fertilization are present or when the chance for success with sperm retrieval and intracytoplasmic sperm injection exceeds the chance for success with surgical treatment.

Introduction: Pesticides currently used in agriculture have the ability to interfere with human endocrine reproductive system, resulting in changes in hormone secretion and adverse outcomes such as...

The horseshoe kidney is a congenital fusion anomaly of the kidneys with an incidence of 0.25% in the general population. We present an anatomical and histological study of a horseshoe kidney with abnormal vascular supply found during a routine dissection at a formalin-fixed male human body at the School of Medicine of the University of Caxias do Sul. This horseshoe kidney was joined at the lower poles by an isthmus of parenchymatous tissue. The vascular and excretory system is also discussed. We also present an embryologic review and the clinical and surgical importance of this anomaly.

OBJETIVOS: determinar se a história prévia de fertilidade pode predizer o atual status de fertilidade de um paciente masculino examinado por infertilidade do casal. MÉTODOS: estudo retrospectivo envolvendo análises seminais de 183 pacientes consecutivos subférteis avaliados entre setembro de 2002 e março de 2004. Foram excluídos do estudo os pacientes que haviam se submetido a radioterapia, quimioterapia, orquiectomia ou vasectomia. Os valores médios de todas as análises foram usados em pacientes com múltiplas análises de sêmen. Pacientes com concentração espermática superior a 20x10(6) espermatozóides/mL, motilidade superior a 50% e espermatozóides com morfologia estrita superior a 14% foram considerados normais. Os pacientes foram divididos em dois grupos, segundo o status de fertilidade: infertilidade primária (118 pacientes) e infertilidade secundária (65 pacientes). Os dados foram analisados pelos testes estatísticos chi2 e teste t de Student. RESULTADOS: não houve diferença na idade média entre os pacientes com infertilidade primária, 37,3±6,3, e infertilidade secundária, 38,1±5,9; p=0,08. No grupo de pacientes com infertilidade primária, 51,9% (61 pacientes) tiveram uma concentração espermática normal, 70,3% (83 pacientes) tiveram a motilidade espermática normal e 26,37% (31 pacientes), por sua vez, morfologia normal. No grupo de pacientes com infertilidade secundária, 53,8% (35 pacientes) tiveram concentração espermática normal, 75,4% (49 pacientes) tiveram motilidade espermática normal e 32,3% (21 pacientes), morfologia normal. Nenhuma diferença significativa foi detectada na concentração espermática (21,3x10(6)/mL versus 23,1x10(6)/mL; p=0,07), motilidade (45,2 versus 48,1%; p=0,08) e morfologia (6,1 versus 6,4%; p=0,09) entre os grupos de pacientes com infertilidade primária e secundária. CONCLUSÕES: a análise seminal deve ser solicitada mesmo em casos de fertilidade masculina prévia. Os médicos não devem presumir que um paciente possui uma análise seminal normal, baseados no fato de este possuir história de estabelecimento de uma gravidez no passado.

Objective To assess the treatment outcome after varicocele repair in azoospermic men and to correlate this outcome with the testicular histology patterns. Design Prospective study. Setting Academic medical centers. Patient(s) Medical records of 27 azoospermic men, who underwent testis biopsy and microsurgical repair of clinical varicocele between July 1999 and May 2004, were reviewed. Intervention(s) Twenty-seven azoospermic men underwent testis biopsy and microsurgical repair of clinical varicocele. All patients had at least two semen analyses showing azoospermia taken before the surgery and two semen analyses postoperatively. Main Outcome Measure(s) Semen analysis after varicocelectomy. Result(s) Hypospermatogenesis was identified in 9, maturation arrest in 8, and germ cell aplasia in 10 men. Induction of spermatogenesis was achieved in nine men (33.3%). Of these, four had germ cell aplasia, three had maturation arrest, and two had hypospermatogenesis. The improvement in sperm concentration and motility ranged from 1.2 × 10 6 /mL to 8.9 × 10 6 /mL, and from 24% to 75.7%, respectively. Of these nine patients with improvement in semen quality, five relapsed into azoospermia 6 months after the recovery of spermatogenesis (four germ cell aplasia and one maturation arrest). One patient with maturation arrest established pregnancy. Conclusion(s) Azoospermic patients may have an improvement in semen quality after varicocelectomy. Semen samples may be cryopreserved after an initial improvement after varicocelectomy.

This prospective study was performed to evaluate the relationship between interleukin-6 (IL-6), oxidative stress and sperm function following vasectomy reversal. We included 22 patients who underwent vasectomy reversal and 15 healthy sperm donors (controls) with normal sperm morphology criteria. Levels of IL-6 in the semen were measured by the enzyme-linked immunosorbent assay, and levels of reactive oxygen species (ROS) and total antioxidant capacity were measured by the chemiluminescence assay. The mean sperm concentration in the vasectomy reversal group was significantly lower than control group (45.3 +/- 39.1 versus 63.1 +/- 28.5; P = 0.02). Motility was also significantly lower in the vasectomy reversal group (32.1 +/- 19.9 versus 54.6 +/- 18.9; P = 001). Levels of IL-6 were significantly higher in the vasectomy reversal group (2.09 +/- 0.87 versus 0.99 +/- 0.97; P = 0.007) as were mean ROS levels (2.25 +/- 0.97 versus 1.2 +/- 0.7; P = 0.009). Significant positive correlation was observed between the IL-6 and ROS levels in vasectomy reversal patients compared with donors (r = 0.41, P = 0.05 versus r = 0.38, P = 0.15). We conclude that patients who undergo vasectomy reversal have elevated levels of IL-6 and ROS, which may contribute to decreased sperm motility and concentration and possibly lead to sub-fertility.

Objectives. To examine levels of interleukin-6 (IL-6) in fertile semen donors and patients with varicocele and examine its association with semen characteristics and levels of reactive oxygen species (ROS). Methods. We conducted a prospective study consisting of 15 fertile donors (controls) and 35 infertile patients with varicocele. Semen analysis was performed according to the World Health Organization guidelines. IL-6 levels were measured using the enzyme-linked immunosorbent assay. ROS (10 4 counted photons per minute per 20 10 6 sperm) and total antioxidant capacity (molar trolox equivalents) were measured using a chemiluminescence assay. Results. The sperm concentration and motility were significantly greater in the donors compared with the infertile patients with varicocele (P 0.0001 and P 0.01, respectively). The IL-6 (log10 [IL-6 1]) and ROS (log10 [ROS 1]) levels were significantly greater in infertile patients with varicocele than in the donors (IL-6: 2.1 [1.7, 2.4] versus 0.7 [0, 1.9], P 0.003; ROS: 1.8 [1.2, 2.6] versus 1.0 [0.7, 1.6], P 0.04). The total antioxidant capacity levels were significantly lower in the varicocele patients (1166.7 366.2) than in the donors (1556.4 468.1; P 0.003). The IL-6 levels correlated significantly with the ROS levels in the infertile patients with varicocele (r 0.39; P 0.01). Conclusions. Infertile patients with varicocele exhibited elevated levels of IL-6 and ROS and decreased levels of total antioxidant capacity. Pro-inflammatory cytokine IL-6 and oxidative stress may play a role in the pathophysiology of infertility in these patients. UROLOGY 64: 1010‐1013, 2004. © 2004 Elsevier Inc.

Objective To examine the outcome of assisted reproduction techniques (ART) using cryopreserved semen from patients with cancer. Design Prospective. Setting Therapeutic semen banking program at a tertiary healthcare center. Patient(s) Twenty-nine men with cancer who cryopreserved their sperm before treatment at our facility from 1982 to 2001 and withdrew their samples for assisted reproduction (IUI, IVF, or intracytoplasmic sperm injection [ICSI]). Intervention(s) Sperm bank records were used to identify the patients. Information on fertility potential indices was obtained from medical records and through interviews. Of the 29 patients, 9 had testicular cancer, 12 had Hodgkin's disease, and 8 had other types of cancer. Main outcome measure(s) Pregnancy and live births. Result(s) A total of 87 ART cycles (42 IUI, 26 IVF, and 19 ICSI) was performed. Of those cycles, 18.3% resulted in pregnancy (7% IUI, 23% IVF, and 37% ICSI), and 75% of the pregnancies resulted in a live birth (100% IUI, 83% IVF, and 57% ICSI). There was no significant difference in the outcomes when the results were stratified by type of ART and malignancy. None of the 11 infants who were born had congenital anomalies. Conclusion(s) Our findings emphasize the need for physicians to discuss the issue of semen cryopreservation with all men of reproductive age who have cancer before antineoplastic therapy is started.

PROPOSITO: Infertilidade e um dos padroes incomuns associados com tumores de testiculo. Nos avaliamos os achados histologicos, bioquimicos, e gravidez em pacientes com infertilidade nos quais foram detectados tumores de testiculo. METODOS: Sete pacientes com infertilidade nos quais câncer de testiculo foi detectado em um periodo acima de 15 anos. Todos os pacientes foram avaliados com ultra-sonografia. As indicacoes para ultra-sonografia foram dor testicular em dois pacientes, suspeita de massa palpavel em quatro, e descartar a presenca de neoplasia de celulas germinativas em um paciente com carcinoma in situ detectado em biopsia previa. Exame fisico, achados histologicos, niveis hormonais, marcadores tumorais, e resultados de gravidez foram avaliados nos prontuarios dos pacientes. RESULTADOS: Dois homens tinham niveis sericos elevados de hormonio foliculo-estimulante e hormonio luteinizante; um destes tinha niveis anormalmente baixos de testosterona. Marcadores tumorais estavam normais em todos os pacientes. Em quatro pacientes, o tumor estava localizado no testiculo direito e em tres no esquerdo. Os diagnosticos histologicos foram seminoma (n = 5), tumor de celulas de Leydig (n = 1) e carcinoma in situ (n = 1). Dos sete pacientes, cinco foram submetidos a radioterapia. Dois pacientes congelaram seus espermatozoides. Acompanhamento no estado de fertilidade estava disponivel em seis pacientes. Um paciente estabeleceu gravidez e cinco nao conseguiram engravidar apos tratamento do câncer. CONCLUSOES: A maioria dos homens com câncer de testiculo e infertilidade possui um seminoma. Homens que se apresentam com infertilidade devem ser cuidadosamente investigados para descartar doencas concomitantes e serias juntamente com a infertilidade.

Purpose: We assessed fertilization, pregnancy and miscarriage rates in patients with obstructive and nonobstructive azoospermia who underwent intracytoplasmic sperm injection.Materials and Methods: From June 1996 to March 2000, 166 consecutive patients (198 intracytoplasmic sperm injection cycles) with azoospermia were studied. Of these 198 cycles 68 were performed due to nonobstructive azoospermia using testicular spermatozoa and 130 were performed due to obstructive azoospermia using epididymal spermatozoa.Results: The normal (2 pronuclei) and abnormal (1 plus 3 pronuclei) fertilization rates for obstructive and nonobstructive azoospermia were 60.5% and 16.6%, and 54% and 16.4%, respectively (p >0.05). The pregnancy rate per cycle, pregnancy rate per patient and abortion rate were 30%, 39.8% and 28% for obstructive azoospermia, and 22%, 28.3% and 40% for nonobstructive azoospermia (p

Alcohol consumption has health and social consequences. Alcoholism is linked to many diseases, and a possible association between alcohol consumption and both male and female infertility has been suggested. Infertility affects 10–15 % of couples attempting to conceive, and a male factor is identifiable in 40–60 % of couples seeking infertility treatments. Despite extensive research, it is still not well known which maternal and especially paternal lifestyle and sociodemographic factors are predictors of a couple’s fecundity. The aim of the following chapter is to discuss different aspects of the effect of alcohol consumption on male infertility. Experimental and clinical studies suggest that alcohol consumption may alter both testosterone secretion and spermatogenesis. These effects may be due to alteration of the endocrine system controlling hypothalamic–pituitary–gonadal axis function and/or to a direct effect on the testis and/or male accessory glands.

Ureaplasma urealyticum is a commensal of the lower genitourinary tract of many sexually active adults. The organism is more common in partners of infertile than fertile marriages. We conducted a prospective study at our tertiary care center to confirm a possible association between U. urealyticum and abnormal sperm function parameters.A total of 50 consecutive male patients seeking general urology consultation for lower urinary tract symptoms characteristic of chronic prostatitis were evaluated. Urine and semen localization cultures were performed with additional semen cultures for U. urealyticum, Chlamydia trachomatis and Mycoplasma hominis. Specimens from 21 healthy men were used as controls. Specimens were analyzed by a computer assisted semen analyzer, and verified manually for concentration, percent motility and morphology. Leukocytospermia was measured by the Endtz test. Semen specimens were also analyzed for reactive oxygen species (ROS), acrosome reaction and mannose binding assay.Of the patients 17 had positive U. urealyticum cultures and the other cultures were negative. Patients with U. urealyticum had significantly higher ROS levels (log [ROS + 1] = 2.52 +/- 0.25) than those without U. urealyticum (1.49 +/- 0.20, p = 0.002) or controls (1.31 +/- 0.19, p = 0.002). Leukocytospermia was detected in only 1 of the 17 (6%) positive specimens and 4 (12%) negative specimens.Seminal ROS levels are elevated among patients with U. urealyticum. ROS induces lipid peroxidation, which reduces membrane fluidity and sperm fertilization capability, and may be the mechanism by which U. urealyticum impairs sperm function. Absence of leukocytospermia does not exclude U. urealyticum.

To determine whether particular semen characteristics in various clinical diagnoses of infertility are associated with high oxidative stress and whether any group of infertile men is more likely to have high seminal oxidative stress. Reactive oxygen species (ROS) play an important role in sperm physiological functions, but elevated levels of ROS or oxidative stress are related to male infertility.Measurement of sperm concentration, motility, morphology, seminal ROS, and total antioxidant capacity (TAC) in patients seeking infertility treatment and controls.Male infertility clinic of a tertiary care center.One hundred sixty-seven infertile patients and 19 controls.None.Semen characteristics, seminal ROS, and TAC in samples from patients with various clinical diagnoses and controls.Fifteen patients (9.0%) were Endtz positive and 152 (91.0%) Endtz negative. Sperm concentration, motility, and morphology were significantly reduced in all groups compared with the controls (P =.02), except in varicocele associated with infection group. Mean (+/-SD) ROS levels in patient groups ranged from 2.2 +/- 0.13 to 3.2 +/- 0.35, significantly higher than controls (1.3 +/- 0.3; P.005). Patient groups had a significantly lower mean (+/-SD) TAC from 1014.75 +/- 79.22 to 1173.05 +/- 58.07 than controls (1653 +/- 115.28, P.001), except in the vasectomy reversal group (1532.02 +/- 74.24). Sperm concentration was negatively correlated with ROS both overall and within all groups (P/=.007), with the exception of idiopathic infertility.Irrespective of the clinical diagnosis and semen characteristics, the presence of seminal oxidative stress in infertile men suggests its role in the pathophysiology of infertility. Medical or surgical treatments for infertility in these men should include strategies to reduce oxidative stress.

To determine whether the response to sildenafil citrate (Viagra) in patients with erectile dysfunction after radical prostatectomy was influenced by the presence or absence of neurovascular bundles, the interval from surgery to the initiation of drug therapy, and the dose of the drug.Baseline and follow-up data from 91 patients presenting with erectile dysfunction after radical prostatectomy were obtained. The patients were stratified according to the type of nerve-sparing (NS) procedure: bilateral NS, unilateral NS, and non-NS. They were interviewed using the Cleveland Clinic Post Prostatectomy (CCPP) questionnaire and the International Index of Erectile Function (IIEF) questionnaire.The presence or absence of the neurovascular bundles influenced the ability to achieve vaginal intercourse. In the patients who had undergone bilateral NS, 71.7% (38 of 53) responded; in those with unilateral NS, 50% (6 of 12) responded; and in those with non-NS, 15.4% (4 of 26) responded. The IIEF questionnaire confirmed the quality of the positive responses, with significant improvements in response to question 3 (frequency of penetration), question 4 (frequency of maintenance of erection), and question 7 (satisfaction with intercourse). The magnitude of improvement in responses was higher in the bilateral NS group than in the unilateral NS and non-NS groups (P0.05). When the data of the 48 positive responders were analyzed, no difference in the response rate was found when the interval from surgery to drug therapy was stratified by the following three intervals: 0 to 6 months (44%), 6 to 12 months (55%), and greater than 12 months (53%). Of the positive responders, 14 (29.1%) required the 50-mg dose, and 34 (70.9%) required the 100-mg dose. The most common side effects were transient headaches (28.6%), flushing (21.9%), dizziness (8.8%), dyspepsia (6.5%), and nasal congestion (5.4%), with an increase in the incidence of headaches seen at the higher dose (P = 0.04).Successful treatment of erectile dysfunction with sildenafil citrate after radical prostatectomy depends on the presence of the neurovascular bundles. Our data suggest that the response to sildenafil is not related to the interval between the surgery and initiation of drug therapy but is related to the dose.

Purpose: More than 30 million couples throughout the world are using vasectomy as a method of birth control. It is estimated that up to 6% of men who undergo voluntary sterilization will eventually request reversal, despite the high cost and relatively low success rate of the procedure. We identified characteristics that predict which vasectomy patients may request reversal. We also examined the cost and effectiveness of pre-vasectomy sperm cryopreservation followed by intrauterine insemination as an alternative method of achieving pregnancy.Materials and Methods: We reviewed medical charts of 365 patients who underwent vasectomy and 290 who underwent vasectomy reversal between 1990 and 1997. Data were collected on patient age at the time of vasectomy, religion, occupation, wife employment status, number of marriages, number of children, reason for reversal, and number of years between vasectomy and reversal. Based on previously reported values, pregnancy rates and cost per successful pregnancy we...

OBJECTIVE To evaluate the semen quality and hormonal levels in fertile men according to their level of cigarette smoking. SUBJECTS AND METHODS We evaluated 889 fertile men who came for a vasectomy for sterilization purposes. The men included 522 non-smokers, 143 mild smokers ( 20/day). We evaluated sperm concentration, motility, motion variables and hormonal levels in these men. RESULTS There were no significant differences among the groups in sperm concentration or motility, or in levels of follicle-stimulating hormone, luteinizing hormone, or serum total testosterone. Also, sperm motion characteristics did not differ across the groups. Semen volume was the only semen variable which tended to decrease according to the number of cigarettes smoked. CONCLUSIONS Cigarette smoking had no apparent effect on sperm concentration, motility or reproductive hormonal levels, but tended to reduce semen volume.

Some urologists who perform vasectomy reversals are not experienced with performing VE. A model to preoperatively identify patients who may require referral to an experienced VE surgeon was created (). We tested the model at multiple institutions.The model had previously been designed in 483 patients who underwent vasectomy reversal at 1 institution (100% sensitive and 59% specific for predicting the need for VE). It was based on time since vasectomy and patient age. We tested it prospectively in 33 patients and retrospectively in a total of 312 at 6 other institutions. The predictive accuracy of the model was compared to using a simple duration from vasectomy cutoff alone, as is used in clinical practice.The model had 84% sensitivity and 58% specificity for detecting the need for VE in a total of 345 patients at 7 institutions. If using only a duration from vasectomy cutoff of 10 years to predict the need for VE, sensitivity was only 69%. At a cutoff of 4 years sensitivity was 99% but specificity was only 23%. Thus, the model performed better than any specific duration cutoff alone.The predictive model provides 84% sensitivity for detecting patients who may require VE during vasectomy reversal across 7 institutions (58% specificity). The model more accurately predicts the need for VE than using a specific duration from vasectomy cutoff alone.

As life expectancy increases and our lives become busier every day, many couples are waiting longer to establish their families. Female fecundity declines slowly after age 30 and more rapidly after 40 and is considered the main limiting factor in the treatment of infertility. Also, the effects of paternal age on a couple’s fertility are real and may be greater than have previously been thought. After adjustments for other factors, it has been demonstrated that the probability that a fertile couple will take >12 months to conceive nearly doubles from 8% when the man is 35 years; thus, paternal age is a further factor to be taken into account when deciding the prognosis of infertile couples. Also, the increased male age is associated with a significant decline in fertility ­(fivefold longer time to pregnancy at the age of 45 years), which is independent of the woman’s age, coital frequency, and lifestyle effect, as well as the effect of other subfertility risk factors. Furthermore, fathering at older ages may have significant effects on the viability and genetic health of human pregnancies and offspring, primarily as a result of structural chromosomal aberrations in sperm. The evidence for sex chromosomal aneuploidy suggests that there may be about a twofold increase in risk at the age of 50. In fact, the risk for a father over 40 years old to have a child with an autosomal dominant mutation equals the risk of Down syndrome for a child whose mother is 35–40 years old. Recent reports have raised concern about decreasing male fertility caused by genomic abnormalities. There are reports of increased congenital anomalies and testicular cancer in children. Sperm DNA is known to contribute one half of the genomic material to offspring. Thus, normal sperm genetic material is required for fertilization, embryo and fetal development, and postnatal child well-being. Abnormal DNA can lead to derangements in any of these processes. The abnormality or defect in the genomic material may take the form of condensation or nuclear maturity defects, DNA breaks or DNA integrity defects, and sperm chromosomal aneuploidy. Evidence for the decline in men’s fertility with increasing age and its quantification are provided.

As life expectancy increases and our lives become busiest every day, many couples are ­waiting longer to establish their families. The recent trend toward delayed parenthood raises concerns because of the adverse effects of aging on fertility. The effects of paternal age on a couple’s fertility are real and may be greater than has previously been thought. After adjustments for other factors, it has been demonstrated that the probability of a fertile couple will take >12 months to conceive nearly doubles from 8% when the man is 35 years; thus, paternal age is a further factor to be taken into account when deciding the prognosis for infertile couples. Also, the increased male age is associated with a significant decline in fertility (fivefold longer time to pregnancy at age of 45 years), which is independent of the woman’s age, coital frequency, and lifestyle effect, as well as the effect of other subfertility risk factors. Furthermore, fathering at older ages may have significant effects on the viability and genetic health of human pregnancies and offspring, primarily as a result of structural chromosomal aberrations in sperm. The evidence for sex chromosomal aneuploidy suggests that there may be about a twofold increase in risk at the age of 50. In fact, the risk for a father over 40 years old to have a child with an autosomal dominant mutation equals the risk of Down syndrome for a child whose mother is 35–40 years old. Although individual Leydig cell volume does change with age, the total Leydig cell volume and the absolute number of Leydig cells decrease significantly with age. Also, anatomical studies of Sertoli cell populations in humans show that the young adult male testis is endowed with 500 million Sertoli cells and appears to decline to approximately 300 million cells in the older adult, suggesting that there is also an age-related decline in Sertoli cell numbers in the human testis. Furthermore, estimations of individual germ cell populations in younger and older men suggest that the age-related decrease in sperm production results from an absolute decrease in primary spermatocytes or a decrease in spermatogonial proliferation rather than a cellular degeneration in the spermatid to mature sperm stages of spermatogenesis. Mechanisms of cell senescence have been well studied in the last decade, and the free radical theory has brought considerable attention. Despite the established effects of free radicals on biomarkers of aging, their correlation with male infertility is not completely elucidated.

Oxidative stress is caused by an imbalance between the production of reactive oxygen species (ROS) and antioxidant capacity of the cell. Oxidative stress appears to be the major cause of DNA damage in the male germ line. Furthermore, many studies have indicated a significant correlation between DNA damage and high levels of ROS in infertile patients. Male reproductive health is already under threat from a range of environmental factors including endocrine disruptors, toxic pollutants, ionizing and lifestyle factors such as sexually transmitted infections, alcoholism, smoking, and anabolic steroid use. Further hazards such as fast food, recreational drugs, and stress levels may also impair male fertility. Recreational drugs such as alcohol, barbiturates, amphetamines, THC, PCP, cocaine, and heroin, but also includes caffeine in coffee and cola beverages, and environmental factors may increase ROS production, leading to DNA damage and further male infertility.

There are many studies in the literature suggesting an acquired, apparently progressive infertility due to varicocele. In fact, varicocelectomy has become the most commonly performed male infertility surgery. Assisted reproductive technologies such as intracytoplasmic sperm injection (ICSI) are also important for couples with male factor infertility associated with varicocele. Therefore, the aim of this study was to evaluate the effect of varicocelectomy on sperm quality and pregnancy rate with ICSI. Data were analyzed from 248 patients who had varicocele or underwent a previous varicocelectomy and were treated with ICSI between 2000 and 2008. Patients with varicocele were divided into two groups: men with clinical varicocele (group 1, n = 79) and men who underwent varicocelectomy before ICSI (group 2, n = 169). In all cases, female infertility was not detected. We evaluated and compared the two groups' semen characteristics as defined by the World Health Organization and Tygerberg's strict criteria: the female partner's age; the number of oocytes retrieved; and the fertilization, implantation, pregnancy, and miscarriage rates. We used the Wilcoxon signed rank test or the Mann-Whitney test for these analyses. No differences were detected in the age of the female partners between group 1 (33.0 ± 0.46 years) and group 2 (33.8 ± 0.38 years; P = .1872). Semen volume was higher in group 1 (3.3 ± 0.3 mL) than it was in group 2 (2.5 ± 0.14; P = .0043). No differences were detected between groups 1 and 2 with regard to sperm concentration (30.08 ± 4.01 million/mL and 24.1 ± 2.42 million/mL, respectively; P = .138), sperm motility (38.2% ± 2.69% and 38.7% ± 2.08%, respectively; P = .881), and morphology according to Tygerberg's strict criteria (2.6% ± 0.44% and 2.4% ± 0.37%, respectively; P = .7202). Also, no differences were detected in the number of oocytes retrieved between group 1 (14.8 ± 1.74) and group 2 (14.9 ± 1.04; P = .9515). The fertilization rate was higher in group 1 (73.2%) than it was in group 2 (64.9%; P = .0377); however, no differences were detected in the pregnancy rates (31.1% vs 30.9%; P = .9806), implantation rates (22.1% vs 17.3%; P = .5882), or miscarriage rates (21.7% vs 23.9%; P = .8401) between groups 1 and 2. Although a varicocelectomy should always be performed before assisted reproduction is pursued, this surgery does not increase pregnancy rates or decrease miscarriage rates following ICSI.

INTRODUCTION AND OBJECTIVES: Despite intrauterine insemination (IUI) often has been used as a treatment for male factor infertility, seminal characteristics indicative of IUI success have not been defined clearly. Recently, the 5th World Health Organization (WHO) data described lower reference limits for the number of morphologically normal spermatozoa. The aim of our study was to assess the likelihood of IUI success as a function of the sperm morphology according to the new reference values defined by the recently published WHO guideline. METHODS: We performed a retrospective study among 300 couples that completed their first IUI cycle, using father’s fresh sperm as a result of cervical infertility, relative male factor infertility, anovulation or unexplained infertility. Pregnancy rates were compared between the patients characterized as having normal and abnormal sperm morphology values according to the previous and the recent WHO reference values and the number of inseminated motile sperm was compared between the patients who did and did not achieve a pregnancy. RESULTS: The overall pregnancy rate was 12.3%. Women older than 35 years showed a lower pregnancy rate as compared to women younger than 35 years (6.5% vs 18.2%, p 0.017). The presence of two or more preovulatory follicles on the day of hCG administration resulted in higher pregnancy rate when compared to cases in which only one preovulatory follicle was present (18.6% vs 8.2%, p 0.011). There were no significant differences between the mean total number of inseminated sperm (26.4 21.7 vs 34.86 33.12, p 0.1237) and the mean number of inseminated motile sperm (22.3 18.6 vs 27.0 24.5, p 0.3156) between the patients who did and did not achieve a pregnancy. The number of inseminated motile sperm 1x106 M/mL positively influenced pregnancy occurrence (OD: 1.47; CI: 0.88–3.14, p 0.027). Pregnancy rates did not differed neither when the male partners were characterized as having normal or abnormal sperm morphology according to the previous WHO reference values (9.8% vs 11.6%, p 0.6584), nor when the male partners were characterized as having normal or abnormal sperm morphology according to the recent WHO reference values (9.4% vs 11.3%, p 0.7469). Finally, normal sperm morphology had no influence on pregnancy rate (OD: 1.05; CI: 0.56–3.02, p 0.936). CONCLUSIONS: Our results suggest that even after the establishment of new reference values for semen parameters, sperm morphological normalcy still does not have any predictive value on IUI outcomes.

Objective To analyze oxidative stress markers and seminal standard parameters after using resveratrol (0.1, 1.0, and 10.0 mM), an important antioxidant, in the cryopreservation of human semen. Design In vitro prospective study. Setting Institutional study. Patient(s) Infertile and fertile men. Intervention(s) None. Main Outcome Measure(s) Levels of thiobarbituric acid-reactive species (TBARS), superoxide dismutase (SOD), and catalase (CAT) activities and spermatozoa concentration, motility, and morphology. Result(s) Increased TBARS levels were observed in the post-thawing semen in both fertile and infertile men. Infertile men had lower CAT and SOD activities in prefreezing and post-thawing samples when compared with fertile men. The addition of resveratrol in all the concentrations assayed was able to prevent post-thawing lipoperoxidation in both fertile and infertile men. However, this effect was not dose dependent. The cryopreservation process was not able to change sperm concentration or morphology. However, a decrease in sperm motility was observed in both the fertile and infertile men. The addition of resveratrol was not able to prevent this effect. Conclusion(s) Resveratrol avoids oxidative damages induced by the cryopreservation of human semen, but it is not able to restore the decrease in sperm motility.