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Said Ali-Samani F, Shahrisa A, Tahmasebi-Birgani M, Hajjari M, Ghandil P. Study of the genomics and transcriptomics profiles of male-infertility genes in human prostate cancer: an in silico analysis. Syst Biol Reprod Med 2024; 70:139-149. [PMID: 38870367 DOI: 10.1080/19396368.2024.2354305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 04/30/2024] [Indexed: 06/15/2024]
Abstract
The World Health Organization has considered the infertility as an international public health problem. Infertility affect nearly 1 in 7 couples and male component contributes to 50% of infertility cases. There is a clear link between male infertility and some cancers such as testicular germ cell, prostate and colon cancers. Two possibilities support this finding: 1) Cancer treatments can affect the fertility factors 2) Genetic profile of infertility genes have been altered in cancer patients. Although the previously published researches have mostly focused on the first factor, no article has yet confirmed the role of genetic factors. In this in silico study, we collected the large number of genes (n = 17703) involved in infertility. These genes were collected from NGS panel tests of male infertility and comprehensive literature review or online data base. The Prostate Adenocarcinoma genomic and transcriptomics raw data were downloaded from the cBioPortal Cancer dataset. This included with 494 patients of Prostate Cancer with 494 mutation data, 489 with CNA and 493 with RNA seqV2 data. TCGA RNA-Seq raw data was extracted in R using the cgdsr extension package with a threshold of ±2 relative to normal samples. The observed data showed that male infertility genes have been distributed through the human genome. Among the 17703 analyzed genes of this study, the genomic profile of three genes including OR9Q1, H4C6 and PSG7 were changed approximately in 100% of (n = 493) patients. In most of patients (>98%), genetic alteration was related to change in gene expression. In conclusion, this study showed that the genomic and transcriptomics patterns of some male-infertility genes are notably altered in patients of prostate cancer and suggested a possible role of genetic factors in occurrence of infertility in cancer patients. Our information can be used as a source for the design of genetic database of male-infertility.
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Affiliation(s)
- Farima Said Ali-Samani
- Department of Medical Genetics, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Arman Shahrisa
- Department of Genetics, Faculty of Biological Sciences, Tarbiat Modares University, Tehran, Iran
| | - Maryam Tahmasebi-Birgani
- Department of Medical Genetics, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Cellular and Molecular Research Center, Medical Basic Sciences Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammadreza Hajjari
- Department of Biology, Faculty of Sciences, Shahid Chamran University of Ahvaz, Ahvaz, Iran
| | - Pegah Ghandil
- Department of Medical Genetics, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Saffati G, Thompson LN, Starke N, Khera M, Muthigi A. Can semen analysis be utilized as a screening tool for overall health in young men? Int J Impot Res 2024:10.1038/s41443-024-00949-9. [PMID: 38951639 DOI: 10.1038/s41443-024-00949-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 06/18/2024] [Accepted: 06/25/2024] [Indexed: 07/03/2024]
Abstract
Traditionally, semen analysis has been viewed solely as a tool for assessing male fertility. However, emerging research suggests that abnormal semen parameters may serve as indicators of broader health issues beyond reproductive function. Studies have revealed significant associations between abnormal semen parameters and an increased risk of chronic diseases such as prostate cancer, diabetes, ischemic heart disease, and metabolic disorders. These findings challenge the conventional understanding and position semen analysis as a potential screening tool for overall male health. The correlation between abnormal semen parameters and conditions like erectile dysfunction further underscores the multifaceted implications of semen quality. This suggests that abnormal semen parameters may be a risk factor for poorer overall health and a higher likelihood of developing comorbidities over time. Given these compelling associations, there is a growing call to integrate semen analysis into routine health assessments for young men, particularly in conjunction with established general health screenings. This proactive approach aligns with a preventative healthcare paradigm, facilitating early detection of underlying health concerns and timely interventions. However, overcoming cultural, logistical, and cost-related barriers is crucial for the successful implementation of this shift in reproductive health.
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Affiliation(s)
- Gal Saffati
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA.
| | - Laura N Thompson
- Department of Urology, Houston Methodist Hospital, Houston, TX, USA
| | - Nathan Starke
- Department of Urology, Houston Methodist Hospital, Houston, TX, USA
| | - Mohit Khera
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Akhil Muthigi
- Department of Urology, Houston Methodist Hospital, Houston, TX, USA
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3
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Pozzi E, Belladelli F, Corsini C, Boeri L, Capogrosso P, Fallara G, Candela L, Bertini A, Cattafi F, Raffo M, Cazzaniga W, Ventimiglia E, d'Arma A, Alfano M, Matloob R, Papaleo E, Candiani M, Montorsi F, Salonia A. Contemporary Diagnostic Work-Up for Male Infertility: Emphasizing Comprehensive Baseline Assessment. World J Mens Health 2024; 42:42.e63. [PMID: 39028127 DOI: 10.5534/wjmh.240069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 03/19/2024] [Accepted: 04/09/2024] [Indexed: 07/20/2024] Open
Abstract
Infertility is a prevalent issue affecting many couples during their reproductive years, with a significant number facing challenges in conceiving despite regular unprotected intercourse. Male factor infertility (MFI) contributes significantly to these cases, with a significant proportion of men lacking an identifiable etiology. As such, a thorough assessment of MFI has become increasingly vital for personalized management. This position paper from the Andrology team at IRCCS Ospedale San Raffaele emphasizes a comprehensive and individualized approach to MFI work-up, addressing the evolving challenges encountered in clinical practice. Our approach involves a thorough diagnostic work-up to identify the underlying causes of MFI, integrating insights from extensive literature review and our proprietary data. Our data demonstrates that an extensive diagnostic assessment allows us to identify at least one underlying cause of MFI in most infertile men. However, challenges persist in diagnosing less severe phenotypes with unclear etiology. We discuss the importance of individualized MFI work-up and its implications for developing rational therapeutic protocols. Lastly, this paper highlights the necessity for a personalized diagnostic assessment, addressing the daily clinical challenges and emphasizing tailored approaches to try to improve outcomes among couples seeking first medical help for infertility.
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Affiliation(s)
- Edoardo Pozzi
- University Vita-Salute San Raffaele, Milan, Italy
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Federico Belladelli
- University Vita-Salute San Raffaele, Milan, Italy
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Christian Corsini
- University Vita-Salute San Raffaele, Milan, Italy
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Luca Boeri
- Department of Urology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Capogrosso
- Department of Urology, Circolo & Fondazione Macchi Hospital - ASST Sette Laghi, Varese, Italy
| | - Giuseppe Fallara
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Luigi Candela
- University Vita-Salute San Raffaele, Milan, Italy
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alessandro Bertini
- University Vita-Salute San Raffaele, Milan, Italy
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Cattafi
- University Vita-Salute San Raffaele, Milan, Italy
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Massimiliano Raffo
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Walter Cazzaniga
- Department of Urology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Eugenio Ventimiglia
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alessia d'Arma
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Massimo Alfano
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Rayan Matloob
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Enrico Papaleo
- Department of Obstetrics and Gynaecology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Massimo Candiani
- University Vita-Salute San Raffaele, Milan, Italy
- Department of Obstetrics and Gynaecology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Montorsi
- University Vita-Salute San Raffaele, Milan, Italy
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Andrea Salonia
- University Vita-Salute San Raffaele, Milan, Italy
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy.
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Uzun H, Huner M, Kıvrak M, Zengin E, Ozsagir YÖ, Sönmez B, Akça G. The relationship between anthropometric and metabolic risk factors and testicular function in healthy young men. Clin Exp Reprod Med 2024; 51:48-56. [PMID: 38433014 PMCID: PMC10914502 DOI: 10.5653/cerm.2023.06114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/20/2023] [Accepted: 08/07/2023] [Indexed: 03/05/2024] Open
Abstract
OBJECTIVE This study investigated the relationship of anthropometric and metabolic risk factors with seminal and sex steroidal hormone parameters in a screened population of healthy males. METHODS The participants were healthy young men without chronic or congenital diseases. The body composition parameters that we investigated were measured weight, height, and waist circumference (WC), as well as bioelectrical impedance analysis. Semen samples were analyzed for semen volume, sperm concentration, sperm motility and morphology, seminal pH, and liquefaction time. Biochemistry analysis, including glucose and lipid metabolism parameters, was conducted on fasting blood samples. Testicular volume was calculated separately for each testis using ultrasonography. RESULTS Body mass index exhibited an inverse association with total sperm count. WC showed negative correlations with numerous seminal parameters, including sperm concentration, total sperm count, sperm morphology, and follicle-stimulating hormone levels. The basal metabolic rate was associated with seminal pH, liquefaction time, and sperm motility. WC, fat mass percentage, and triglyceride levels exhibited negative correlations with sex hormone binding globulin. The measures of glucose metabolism were associated with a greater number of seminal parameters than the measures of cholesterol metabolism. C-reactive protein levels were inversely associated with sperm concentration and total sperm count. CONCLUSION Anthropometric and metabolic risk factors were found to predict semen quality and alterations in sex steroidal hormone levels.
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Affiliation(s)
- Hakkı Uzun
- Department of Urology, Recep Tayyip Erdogan University School of Medicine, Rize, Turkey
| | - Merve Huner
- Department of Biochemistry, Recep Tayyip Erdogan University School of Medicine, Rize, Turkey
| | - Mehmet Kıvrak
- Department of Biostatistics, Recep Tayyip Erdogan University School of Medicine, Rize, Turkey
| | - Ertan Zengin
- Department of Radiology, Recep Tayyip Erdogan University School of Medicine, Rize, Turkey
| | - Yusuf Önder Ozsagir
- Department of Urology, Recep Tayyip Erdogan University School of Medicine, Rize, Turkey
| | - Berat Sönmez
- Department of Urology, Recep Tayyip Erdogan University School of Medicine, Rize, Turkey
| | - Görkem Akça
- Department of Urology, Recep Tayyip Erdogan University School of Medicine, Rize, Turkey
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Lindahl-Jacobsen R, Tavlo Petersson M, Priskorn L, Skakkebæk NE, Juul A, Kristensen DM, Eisenberg ML, Jensen TK. Time to pregnancy and life expectancy: a cohort study of 18 796 pregnant couples. Hum Reprod 2024; 39:595-603. [PMID: 38115232 DOI: 10.1093/humrep/dead260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 11/09/2023] [Indexed: 12/21/2023] Open
Abstract
STUDY QUESTION Is fecundity, measured as time to pregnancy (TTP), associated with mortality in parents? SUMMARY ANSWER Prolonged TTP is associated with increased mortality in both mothers and fathers in a dose-response manner. WHAT IS KNOWN ALREADY Several studies have linked both male and female fecundity to mortality. In women, infertility has been linked to several diseases, but studies suggest that the underlying conditions, rather than infertility, increase mortality. STUDY DESIGN, SIZE, DURATION A prospective cohort study was carried out on 18 796 pregnant couples, in which the pregnant women attended prophylactic antenatal care between 1973 and 1987 at a primary and tertiary care unit. The couples were followed in Danish mortality registers from their child's birth date until death or until 2018. The follow-up period was up to 47 years, and there was complete follow-up until death, emigration or end of study. PARTICIPANTS/MATERIALS, SETTING, METHODS At the first antenatal visit, the pregnant women were asked to report the time to the current pregnancy. Inclusion was restricted to the first pregnancy, and TTP was categorised into <12 months, ≥12 months, not planned, and not available. In sub-analyses, TTP ≥12 was further categorized into 12-35, 36-60, and >60 months. Information for parents was linked to several Danish nationwide health registries. Survival analysis was used to estimate the hazard ratios (HRs) with a 95% CI for survival and adjusted for age at the first attempt to become pregnant, year of birth, socioeconomic status, mother's smoking during pregnancy, and mother's BMI. MAIN RESULTS AND THE ROLE OF CHANCE Mothers and fathers with TTP >60 months survived, respectively, 3.5 (95% CI: 2.6-4.3) and 2.7 (95% CI: 1.8-3.7) years shorter than parents with a TTP <12 months. The mortality was higher for fathers (HR: 1.21, 95% CI: 1.09-1.34) and mothers (HR: 1.29, 95% CI: 1.12-1.49) with TTP ≥12 months compared to parents with TTP <12 months. The risk of all-cause mortality during the study period increased in a dose-response manner with the highest adjusted HR of 1.98 (95% CI: 1.62-2.41) for fathers and 2.03 (95% CI: 1.56-2.63) for mothers with TTP >60 months. Prolonged TTP was associated with several different causes of death in both fathers and mothers, indicating that the underlying causes of the relation between fecundity and survival may be multi-factorial. LIMITATIONS, REASONS FOR CAUTION A limitation is that fecundity is measured using a pregnancy-based approach. Thus, the cohort is conditioned on fertility success and excludes sterile couples, unsuccessful attempts and spontaneous abortions. The question used to measure TTP when the pregnant woman was interviewed at her first attended prophylactic antenatal care: 'From the time you wanted a pregnancy until it occurred, how much time passed?' could potentially have led to serious misclassification if the woman did not answer on time starting unprotected intercourse but on the start of wishing to have a child. WIDER IMPLICATIONS OF THE FINDINGS We found that TTP is a strong marker of survival, contributing to the still-emerging evidence that fecundity in men and women reflects their health and survival potential. STUDY FUNDING/COMPETING INTEREST(S) The authors acknowledge an unrestricted grant from Ferring. The funder was not involved in the study design, collection, analysis, interpretation of data, the writing of this article, or the decision to submit it for publication. M.L.E. is an advisor to Ro, VSeat, Doveras, and Next. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- R Lindahl-Jacobsen
- Department of Public Health, Epidemiology, Biostatistics, and Biodemography, University of Southern Denmark, Odense M, Denmark
- Interdisciplinary Center on Population Dynamics (CPop), University of Southern Denmark, Odense C, Denmark
| | - M Tavlo Petersson
- Department of Public Health, Epidemiology, Biostatistics, and Biodemography, University of Southern Denmark, Odense M, Denmark
- Interdisciplinary Center on Population Dynamics (CPop), University of Southern Denmark, Odense C, Denmark
| | - L Priskorn
- Department of Growth and Reproduction, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital-Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - N E Skakkebæk
- Department of Growth and Reproduction, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital-Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - A Juul
- Department of Growth and Reproduction, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health (EDMaRC), Copenhagen University Hospital-Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - D M Kristensen
- Department of Growth and Reproduction, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Inserm (Institut national de la santé et de la recherche médicale), Irset-Inserm UMR 1085, Rennes, France
- Department of Science and Environment, Roskilde University, Roskilde, Denmark
| | - M L Eisenberg
- Male Reproductive Medicine and Surgery, Departments of Urology and Obstetrics & Gynaecology, Stanford University School of Medicine, Stanford, CA, USA
| | - T K Jensen
- Department of Public Health, Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark, Odense M, Denmark
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Kimmins S, Anderson RA, Barratt CLR, Behre HM, Catford SR, De Jonge CJ, Delbes G, Eisenberg ML, Garrido N, Houston BJ, Jørgensen N, Krausz C, Lismer A, McLachlan RI, Minhas S, Moss T, Pacey A, Priskorn L, Schlatt S, Trasler J, Trasande L, Tüttelmann F, Vazquez-Levin MH, Veltman JA, Zhang F, O'Bryan MK. Frequency, morbidity and equity - the case for increased research on male fertility. Nat Rev Urol 2024; 21:102-124. [PMID: 37828407 DOI: 10.1038/s41585-023-00820-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2023] [Indexed: 10/14/2023]
Abstract
Currently, most men with infertility cannot be given an aetiology, which reflects a lack of knowledge around gamete production and how it is affected by genetics and the environment. A failure to recognize the burden of male infertility and its potential as a biomarker for systemic illness exists. The absence of such knowledge results in patients generally being treated as a uniform group, for whom the strategy is to bypass the causality using medically assisted reproduction (MAR) techniques. In doing so, opportunities to prevent co-morbidity are missed and the burden of MAR is shifted to the woman. To advance understanding of men's reproductive health, longitudinal and multi-national centres for data and sample collection are essential. Such programmes must enable an integrated view of the consequences of genetics, epigenetics and environmental factors on fertility and offspring health. Definition and possible amelioration of the consequences of MAR for conceived children are needed. Inherent in this statement is the necessity to promote fertility restoration and/or use the least invasive MAR strategy available. To achieve this aim, protocols must be rigorously tested and the move towards personalized medicine encouraged. Equally, education of the public, governments and clinicians on the frequency and consequences of infertility is needed. Health options, including male contraceptives, must be expanded, and the opportunities encompassed in such investment understood. The pressing questions related to male reproductive health, spanning the spectrum of andrology are identified in the Expert Recommendation.
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Affiliation(s)
- Sarah Kimmins
- Department of Pharmacology and Therapeutics, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
- The Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
- The Département de Pathologie et Biologie Cellulaire, Université de Montréal, Montreal, Quebec, Canada
| | - Richard A Anderson
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - Christopher L R Barratt
- Division of Systems Medicine, School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - Hermann M Behre
- Center for Reproductive Medicine and Andrology, University Hospital, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Sarah R Catford
- Hudson Institute of Medical Research, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, The Royal Women's Hospital, Melbourne, Victoria, Australia
| | | | - Geraldine Delbes
- Institut National de la Recherche Scientifique, Centre Armand-Frappier Sante Biotechnologie, Laval, Quebec, Canada
| | - Michael L Eisenberg
- Department of Urology and Obstetrics and Gynecology, Stanford University, Stanford, CA, USA
| | - Nicolas Garrido
- IVI Foundation, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Brendan J Houston
- School of BioSciences and Bio21 Institute, The University of Melbourne, Parkville, Melbourne, Australia
| | - Niels Jørgensen
- Department of Growth and Reproduction, International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Csilla Krausz
- Department of Experimental and Clinical Biomedical Sciences, 'Mario Serio', University of Florence, University Hospital of Careggi Florence, Florence, Italy
| | - Ariane Lismer
- Department of Pharmacology and Therapeutics, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Robert I McLachlan
- Hudson Institute of Medical Research and the Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia
- Monash IVF Group, Richmond, Victoria, Australia
| | - Suks Minhas
- Department of Surgery and Cancer Imperial, London, UK
| | - Tim Moss
- Healthy Male and the Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Allan Pacey
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Lærke Priskorn
- Department of Growth and Reproduction, International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Stefan Schlatt
- Centre for Reproductive Medicine and Andrology, University of Münster, Münster, Germany
| | - Jacquetta Trasler
- Departments of Paediatrics, Human Genetics and Pharmacology & Therapeutics, McGill University and Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Leonardo Trasande
- Center for the Investigation of Environmental Hazards, Department of Paediatrics, NYU Grossman School of Medicine, New York, NY, USA
| | - Frank Tüttelmann
- Institute of Reproductive Genetics, University of Münster, Münster, Germany
| | - Mónica Hebe Vazquez-Levin
- Instituto de Biología y Medicina Experimental, Consejo Nacional de Investigaciones Científicas y Técnicas de Argentina, Fundación IBYME, Buenos Aires, Argentina
| | - Joris A Veltman
- Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Feng Zhang
- Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai, China
| | - Moira K O'Bryan
- School of BioSciences and Bio21 Institute, The University of Melbourne, Parkville, Melbourne, Australia.
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Sengupta P, Pinggera G, Calogero AE, Agarwal A. Oxidative stress affects sperm health and fertility-Time to apply facts learned at the bench to help the patient: Lessons for busy clinicians. Reprod Med Biol 2024; 23:e12598. [PMID: 39224210 PMCID: PMC11366688 DOI: 10.1002/rmb2.12598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Accepted: 07/01/2024] [Indexed: 09/04/2024] Open
Abstract
Background Increased oxidative stress (OS), resulting from the delicate balance between reactive oxygen species (ROS) production and antioxidant defense, is closely linked to sperm abnormalities and male subfertility. Elevated ROS levels particularly affect sperm quality. The vulnerability of spermatozoa to ROS is due to the absence of DNA repair mechanisms and the high presence of polyunsaturated fatty acids in their membranes. Methods This article updates and advances our understanding of the molecular damage caused by OS in spermatozoa, including lipid peroxidation, DNA damage, motility, and functionality. Additionally, the review discusses the challenges in diagnosing OS in semen and recommends accurate and sensitive testing methods. Case studies are utilized to demonstrate the effective management of male infertility caused by OS. Main findings Highlighting the need to bridge the gap between research and clinical practice, this review suggests strategies for clinicians, such as lifestyle and dietary changes and antioxidant therapies. The review emphasizes lifestyle modifications and personalized care as effective strategies in managing male infertility caused by OS. Conclusion This review calls for early detection and intervention and interdisciplinary collaboration to improve patient care in male infertility cases related to increased OS.
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Affiliation(s)
- Pallav Sengupta
- Global Andrology ForumMoreland HillsOhioUSA
- Department of Biomedical Sciences, College of MedicineGulf Medical UniversityAjmanUAE
| | - Germar‐M. Pinggera
- Global Andrology ForumMoreland HillsOhioUSA
- Department of UrologyMedical University InnsbruckInnsbruckAustria
| | - Aldo E. Calogero
- Global Andrology ForumMoreland HillsOhioUSA
- Division of Endocrinology, Metabolic Diseases and NutritionUniversity of CataniaCataniaItaly
| | - Ashok Agarwal
- Global Andrology ForumMoreland HillsOhioUSA
- Cleveland ClinicClevelandOhioUSA
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8
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Yang D, Yuan L, Ma X, Qi Y, Cheng S, Zhang Y. Histological study of Bactrian camel cryptorchidism and expression of immunoglobulin λ light chain in the testicular and epididymis of cryptorchid Bactrian camel. Reprod Domest Anim 2024; 59:e14512. [PMID: 38069628 DOI: 10.1111/rda.14512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 01/26/2024]
Abstract
Lambda light chains (λ-LCs) are frequently responsible for triggering the activation of inflammatory factors in autoimmune disorders, and an increase in their levels will cause various pathological changes in serum. The aim of this study was to determine the histological differences between the epididymis and testis of normal and cryptorchid Bactrian camels and the differences in λ-LC expression in the epididymis and testis of normal and cryptorchid Bactrian camels. Haematoxylin and eosin (H&E) staining was used to examine the pathological changes in cryptorchidism. The gene and protein levels of λ-LC were determined using RT-qPCR and western blot. The distribution of λ-LCs was assessed by immunohistochemistry and immunofluorescence. Compared with that in normal Bactrian camels, the diameter of the epididymal lumen and the thickness of the epithelium were decreased in the epididymis of cryptorchidic animals. Additionally, no sperm was detected in the cavity of the cryptorchidic epididymis. Meanwhile, the expression of λ-LC was significantly increased in the cryptorchidic epididymis at both the mRNA and protein levels (p < .05). The highest protein expression of λ-LC was found in epididymal epithelial halo cells and testicular Sertoli cells. These findings suggested that the structural changes observed in the epididymal epithelium of cryptorchidic camels affect its secretory and absorptive functions. Additionally, the high level of λ-LC expression recorded in halo cells suggested that these cells play an important role in epithelial immunity in cryptorchidic Bactrian camels. Furthermore, the high λ-LC expression levels detected in normal testicular Sertoli cells indicated that λ-LCs may be involved in spermatogenesis. The results of this study provide clues for an in-depth study of immunological sterility in cryptorchidic Bactrian camels.
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Affiliation(s)
- Dapeng Yang
- College of Veterinary Medicine, Gansu Agricultural University, Lanzhou, China
| | - Ligang Yuan
- College of Veterinary Medicine, Gansu Agricultural University, Lanzhou, China
- Gansu Key Laboratory of Animal Generational Physiology and Reproductive Regulation, Lanzhou, China
| | - Xiaojie Ma
- College of Veterinary Medicine, Gansu Agricultural University, Lanzhou, China
| | - Yumei Qi
- College of Veterinary Medicine, Gansu Agricultural University, Lanzhou, China
| | - Shaoyu Cheng
- College of Veterinary Medicine, Gansu Agricultural University, Lanzhou, China
| | - Yong Zhang
- College of Veterinary Medicine, Gansu Agricultural University, Lanzhou, China
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9
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Shahraki Z, Mohamadi A, Rastkar M, Ghajarzadeh M. Male Factor Infertility and Risk of Multiple Sclerosis (MS): A Systematic Review and Meta-Analysis. J Family Reprod Health 2023; 17:194-198. [PMID: 38807619 PMCID: PMC11128727 DOI: 10.18502/jfrh.v17i4.14590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2024] Open
Abstract
Objective Multiple sclerosis is an autoimmune disease of central nervous system (CNS). There are a few articles studying the risk factors of developing MS in men. Male infertility can stem from a range of etiological factors such as genetics or environment. In the context of MS, research suggests a potential link, possibly due to shared immunological and inflammatory mechanisms. Therefore, we designed this study to evaluate the relationship between male infertility and MS development. Materials and methods We systematically searched PubMed, Embase, Scopus, web of science, Google scholar and gray literature including references of the references as well as conference papers which were published up to June 2021. The search strategy in PubMed was ("Infertility, Male"[Mesh] OR [Male Infertility] OR [Sterility, Male] OR [Male Sterility] OR [Subfertility, Male] OR [Male Subfertility] OR [Sub-Fertility, Male] OR [Male Sub-Fertility] OR [Sub Fertility, Male]) AND ("Multiple Sclerosis"[Mesh] OR [Sclerosis, Multiple] OR [Sclerosis, disseminated] OR [Disseminated Sclerosis] OR [MS] OR [Multiple Sclerosis, Acute Fulminating]) AND ("Testicular Diseases"[Mesh] OR [Disease, Testicular] OR [Diseases, Testicular] OR [Testicular Disease]) AND ("Multiple Sclerosis"[Mesh] OR [Sclerosis, Multiple] OR [Sclerosis, disseminated] OR [Disseminated Sclerosis] OR [Multiple Sclerosis, Acute Fulminating] OR [MS]). Results The literature search revealed 197 articles, after deleting duplicates 109 remained. For the meta-analysis, 3 studies were included. Totally, 2090 MS cases as well as 3895562 healthy subjects were enrolled. One hundred and fourteen infertile men were in MS group and 139716 infertile men were in controls. The pooled OR for male factor infertility and odds of developing MS was1.87 (95% CI: 0.89-3.94) (I2=86.1%, P=0.001). Conclusion The results of this systematic review and meta-analysis show that there is no relationship between male factor infertility and risk of MS.
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Affiliation(s)
- Zahra Shahraki
- Zabol Medicinal Plants Research Center, Zabol University of Medical Sciences, Zabol, Iran
| | - Aida Mohamadi
- Universal Council of Epidemiology (UCE), Universal Scientific Education and Research Network (USERN), Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Rastkar
- Student’s Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahsa Ghajarzadeh
- Universal Council of Epidemiology (UCE), Universal Scientific Education and Research Network (USERN), Tehran University of Medical Sciences, Tehran, Iran
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
- Multiple Sclerosis Research Group (MSRG), Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
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10
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Eisenberg ML, Esteves SC, Lamb DJ, Hotaling JM, Giwercman A, Hwang K, Cheng YS. Male infertility. Nat Rev Dis Primers 2023; 9:49. [PMID: 37709866 DOI: 10.1038/s41572-023-00459-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/09/2023] [Indexed: 09/16/2023]
Abstract
Clinical infertility is the inability of a couple to conceive after 12 months of trying. Male factors are estimated to contribute to 30-50% of cases of infertility. Infertility or reduced fertility can result from testicular dysfunction, endocrinopathies, lifestyle factors (such as tobacco and obesity), congenital anatomical factors, gonadotoxic exposures and ageing, among others. The evaluation of male infertility includes detailed history taking, focused physical examination and selective laboratory testing, including semen analysis. Treatments include lifestyle optimization, empirical or targeted medical therapy as well as surgical therapies that lead to measurable improvement in fertility. Although male infertility is recognized as a disease with effects on quality of life for both members of the infertile couple, fewer data exist on specific quantification and impact compared with other health-related conditions.
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Affiliation(s)
- Michael L Eisenberg
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA.
- Department of Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, CA, USA.
| | - Sandro C Esteves
- ANDROFERT Andrology and Human Reproduction Clinic, Campinas, Brazil
- Division of Urology, Department of Surgery, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Dolores J Lamb
- Center for Reproductive Genomics, Weill Cornell Medical College, New York, NY, USA
- Englander Institute for Precision Medicine, Weill Cornell Medical College, New York, NY, USA
- Department of Urology, Weill Cornell Medical College, New York, NY, USA
| | - James M Hotaling
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | | | - Kathleen Hwang
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Yu-Sheng Cheng
- Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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11
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Alyamani M, Michael P, Hettel D, Thomas L, Lundy SD, Berk M, Patel M, Li J, Rashidi H, McKenney JK, Klein EA, Sharifi N. Elevated periprostatic venous testosterone correlates with prostate cancer progression after radical prostatectomy. J Clin Invest 2023; 133:e171117. [PMID: 37655657 PMCID: PMC10471166 DOI: 10.1172/jci171117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 07/11/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUNDGenerally, clinical assessment of gonadal testosterone (T) in human physiology is determined using concentrations measured in peripheral blood. Prostatic T exposure is similarly thought to be determined from peripheral T exposure. Despite the fact that androgens drive prostate cancer, peripheral T has had no role in the clinical evaluation or treatment of men with localized prostate cancer.METHODSTo assess the role of local androgen delivery in prostate cancer, we obtained blood from the (periprostatic) prostatic dorsal venous complex in 266 men undergoing radical prostatectomy from July 2014 to August 2021 and compared dorsal T (DT) levels with those in circulating peripheral blood (PT) and prostatic tissue. Comprehensive targeted steroid analysis and unbiased metabolomics analyses were performed. The association between the DT/PT ratio and progression-free survival after prostatectomy was assessed.RESULTSSurprisingly, in some men, DT levels were enriched several-fold compared with PT levels. For example, 20% of men had local T concentrations that were at least 2-fold higher than peripheral T concentrations. Isocaproic acid, a byproduct of androgen biosynthesis, and 17-OH-progesterone, a marker of intratesticular T, were also enriched in the dorsal vein of these men, consistent with testicular shunting. Men with enriched DT had higher rates of prostate cancer recurrence. DT/PT concentration ratios predicted worse outcomes even when accounting for known clinical predictors.CONCLUSIONSThese data suggest that a large proportion of men have a previously unappreciated exposure to an undiluted and highly concentrated T supply. Elevated periprostatic T exposure was associated with worse clinical outcomes after radical prostatectomy.FUNDINGNational Cancer Institute (NCI), NIH grants R01CA172382, R01CA236780, R01CA261995, R01CA249279, and R50CA251961; US Army Medical Research and Development Command grants W81XWH2010137 and W81XWH-22-1-0082.
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Affiliation(s)
- Mohammad Alyamani
- Genitourinary Malignancies Research Center, Lerner Research Institute
| | - Patrick Michael
- Genitourinary Malignancies Research Center, Lerner Research Institute
- Department of Urology, Glickman Urological and Kidney Institute
| | - Daniel Hettel
- Genitourinary Malignancies Research Center, Lerner Research Institute
- Department of Urology, Glickman Urological and Kidney Institute
| | - Lewis Thomas
- Genitourinary Malignancies Research Center, Lerner Research Institute
- Department of Urology, Glickman Urological and Kidney Institute
| | - Scott D. Lundy
- Department of Urology, Glickman Urological and Kidney Institute
| | - Mike Berk
- Genitourinary Malignancies Research Center, Lerner Research Institute
| | - Mona Patel
- Genitourinary Malignancies Research Center, Lerner Research Institute
| | - Jianbo Li
- Department of Quantitative Health Sciences, Lerner Research Institute
| | - Hooman Rashidi
- Department of Pathology, Pathology and Laboratory Medicine Institute, and
| | - Jesse K. McKenney
- Department of Pathology, Pathology and Laboratory Medicine Institute, and
| | - Eric A. Klein
- Genitourinary Malignancies Research Center, Lerner Research Institute
- Department of Urology, Glickman Urological and Kidney Institute
| | - Nima Sharifi
- Genitourinary Malignancies Research Center, Lerner Research Institute
- Department of Urology, Glickman Urological and Kidney Institute
- Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
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12
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Mukherjee AG, Gopalakrishnan AV. Unlocking the mystery associated with infertility and prostate cancer: an update. Med Oncol 2023; 40:160. [PMID: 37099242 DOI: 10.1007/s12032-023-02028-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 04/08/2023] [Indexed: 04/27/2023]
Abstract
Male-specific reproductive disorders and cancers have increased intensely in recent years, making them a significant public health problem. Prostate cancer (PC) is the most often diagnosed cancer in men and is one of the leading causes of cancer-related mortality. Both genetic and epigenetic modifications contribute to the development and progression of PC, even though the exact underlying processes causing this disease have yet to be identified. Male infertility is also a complex and poorly understood phenomenon believed to afflict a significant portion of the male population. Chromosomal abnormalities, compromised DNA repair systems, and Y chromosome alterations are just a few of the proposed explanations. It is becoming widely accepted that infertility shares a link with PC. Much of the link between infertility and PC is probably attributable to common genetic defects. This article provides an overview of PC and spermatogenic abnormalities. This study also investigates the link between male infertility and PC and uncovers the underlying reasons, risk factors, and biological mechanisms contributing to this association.
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Affiliation(s)
- Anirban Goutam Mukherjee
- Department of Biomedical Sciences, School of Bio-Sciences and Technology, Vellore Institute of Technology (VIT), Vellore, Tamil Nadu, 632014, India
| | - Abilash Valsala Gopalakrishnan
- Department of Biomedical Sciences, School of Bio-Sciences and Technology, Vellore Institute of Technology (VIT), Vellore, Tamil Nadu, 632014, India.
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13
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Marinaro J, Goldstein M. Microsurgical Management of Male Infertility: Compelling Evidence That Collaboration with Qualified Male Reproductive Urologists Enhances Assisted Reproductive Technology (ART) Outcomes. J Clin Med 2022; 11:jcm11154593. [PMID: 35956208 PMCID: PMC9369943 DOI: 10.3390/jcm11154593] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/02/2022] [Accepted: 08/04/2022] [Indexed: 11/16/2022] Open
Abstract
A male factor plays a significant role in a couple's reproductive success. Today, advances in reproductive technology, such as intracytoplasmic sperm injection (ICSI), have allowed it to be possible for just a single sperm to fertilize an egg, thus, overcoming many of the traditional barriers to male fertility, such as a low sperm count, impaired motility, and abnormal morphology. Given these advances in reproductive technology, it has been questioned whether a reproductive urologist is needed for the evaluation and treatment of infertile and subfertile men. In this review, we aim to provide compelling evidence that collaboration between reproductive endocrinologists and reproductive urologists is essential for optimizing a couple's fertility outcomes, as well as for improving the health of infertile men and providing cost-effective care.
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Affiliation(s)
- Jessica Marinaro
- Department of Urology, Weill Cornell Medicine, New York, NY 10065, USA
| | - Marc Goldstein
- Center for Male Reproductive Medicine and Microsurgery, Weill Cornell Medicine, 525 East 68th St., Starr Pavilion, 9th Floor (Starr 900), New York, NY 10065, USA
- Correspondence:
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14
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Behboudi-Gandevani S, Bidhendi-Yarandi R, Panahi MH, Vaismoradi M. A Systematic Review and Meta-Analysis of Male Infertility and the Subsequent Risk of Cancer. Front Oncol 2021; 11:696702. [PMID: 34722244 PMCID: PMC8551623 DOI: 10.3389/fonc.2021.696702] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 09/21/2021] [Indexed: 11/30/2022] Open
Abstract
Objectives The primary objective of this systemic review and meta-analysis was to investigate the risk of developing composite outcome of all cancers, regardless of the type of cancer among men with infertility diagnosis compared to fertile counterparts. The secondary objective was to compare the pooled risk of developing individual specific cancers between two groups. Methods A systematic literature search was performed on the databases of PubMed (including Medline), Scopus, and Web of Science to retrieve observational studies published in English language from 01.01.1990 to 28. 02. 2021. They assessed cancer events in males with an infertility diagnosis compared to controls without infertility. The outcomes of interest were a composite outcome of cancers including all known cancer types, and also specific individual cancers. The fixed/random effects model was used to analyze heterogeneous and non-heterogeneous results. Publication bias was assessed using the Harbord test, Egger test, Begg test, and funnel plot. The pooled odds ratio of cancers was calculated using the DerSimonian and Laird, and inverse variance methods. Studies’ quality and risk of bias were assessed using structured standard tools. Results We included eight cohort studies involving 168,327 men with the diagnosis of infertility and 2,252,806 men without it. The total number of composite outcome of cancers as well as individual cancers including prostate, testicular and melanoma were 1551, 324, 183 and 121 in the infertile men and 12164, 3875, 849, and 450 in the fertile men, respectively. The pooled OR of the composite outcome of cancers, regardless of the type of cancer, in men with infertility was 1.4 folds higher than those without infertility (pooled OR = 1.43, 95% confidence interval [CI]: 1.25-1.64). Meta-analysis of individual cancers including prostate, testicular and melanoma between two groups was carried out. The pooled ORs of testicular and prostate cancers in men with the diagnosis of infertility were significantly higher than controls without infertility (pooled OR = 1.91, 95% CI: 1.52-2.42 and pooled OR = 1.48, 95% CI: 1.05-2.08, respectively). Additionally, the pooled OR of melanoma in men with infertility was 1.3 folds higher than those without infertility (pooled OR = 1.31, 95% CI: 1.06-1.62). Conclusion A greater risk of cancers in men with male infertility was found suggesting that the history of male infertility might be an important risk factor for developing cancers in later life. Further well-designed long-term population-based prospective studies, considering all known cancers and their accompanying risk factors should be conducted to support our findings.
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Affiliation(s)
| | - Razieh Bidhendi-Yarandi
- Department of Biostatistics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mohammad Hossein Panahi
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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15
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Boeri L, Ventimiglia E, Cazzaniga W, Pederzoli F, Fallara G, Pozzi E, Belladelli F, Baudo A, Frego N, Capogrosso P, Alfano M, Montorsi F, Salonia A. Risk of health status worsening in primary infertile men: a prospective 10-year follow-up study. Andrology 2021; 10:128-136. [PMID: 34369670 DOI: 10.1111/andr.13090] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/13/2021] [Accepted: 07/21/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND A severe male infertility factor has been associated with both lower health status and increased mortality in infertile men. OBJECTIVES To investigate reproductive factors associated with health status impairment in infertile men over a 10-year time frame since first clinical evaluation. MATERIALS AND METHODS Data from 899 infertile men were analysed at baseline between 2003 and 2010. Health-significant comorbidities were scored with the Charlson Comorbidity Index (CCI). Patients were followed-up yearly recording any worsening in their health status until 2019. Cox regression models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) of CCI score increase. RESULTS At a median follow-up of 136 months (IQR 121, 156), 85 men (9.5%) depicted an increase of their baseline CCI score of at least 1 point. The most frequent reason for CCI upgrade was cancer (34%), cardio-vascular diseases (29%) and diabetes mellitus (22%). Compared to patients without a CCI increase, patients with a CCI increase presented with higher BMI and FSH values, a higher rate of baseline CCI ≥ 1 (all p < 0.01) and a greater proportion of non-obstructive azoospermia (p < 0.001). In the Cox regression model, patient's BMI (p < 0.001), baseline CCI ≥ 1 (p < 0.01) and azoospermia status (p = 0.001) were found to be independently associated with CCI increases. CONCLUSIONS Almost 10% of men presenting for primary infertility had a decrease of the overall health status already in the relatively short 10-year time frame after first presentation. Non-obstructive azoospermic men showed the worst health status impairment and should be strictly followed-up regardless of their fertility status. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Luca Boeri
- Division of Experimental Oncology/Unit of Urology, URI; IRCCS Ospedale San Raffaele, Milan, Italy.,Department of Urology, Foundation IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Eugenio Ventimiglia
- Division of Experimental Oncology/Unit of Urology, URI; IRCCS Ospedale San Raffaele, Milan, Italy
| | - Walter Cazzaniga
- Division of Experimental Oncology/Unit of Urology, URI; IRCCS Ospedale San Raffaele, Milan, Italy.,University Vita-Salute San Raffaele, Milan, Italy
| | - Filippo Pederzoli
- Division of Experimental Oncology/Unit of Urology, URI; IRCCS Ospedale San Raffaele, Milan, Italy.,University Vita-Salute San Raffaele, Milan, Italy
| | - Giueppe Fallara
- Division of Experimental Oncology/Unit of Urology, URI; IRCCS Ospedale San Raffaele, Milan, Italy.,University Vita-Salute San Raffaele, Milan, Italy
| | - Edoardo Pozzi
- Division of Experimental Oncology/Unit of Urology, URI; IRCCS Ospedale San Raffaele, Milan, Italy.,University Vita-Salute San Raffaele, Milan, Italy
| | - Federico Belladelli
- Division of Experimental Oncology/Unit of Urology, URI; IRCCS Ospedale San Raffaele, Milan, Italy.,University Vita-Salute San Raffaele, Milan, Italy
| | - Andrea Baudo
- Division of Experimental Oncology/Unit of Urology, URI; IRCCS Ospedale San Raffaele, Milan, Italy
| | - Nicola Frego
- Division of Experimental Oncology/Unit of Urology, URI; IRCCS Ospedale San Raffaele, Milan, Italy
| | - Paolo Capogrosso
- Division of Experimental Oncology/Unit of Urology, URI; IRCCS Ospedale San Raffaele, Milan, Italy.,Department of Urology, Istituto Clinico Humanitas IRCCS-Clinical and Research Hospital, Italy
| | - Massimo Alfano
- Division of Experimental Oncology/Unit of Urology, URI; IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Montorsi
- Division of Experimental Oncology/Unit of Urology, URI; IRCCS Ospedale San Raffaele, Milan, Italy.,University Vita-Salute San Raffaele, Milan, Italy.,Department of Urology, Circolo & Fondazione Macchi Hospital - ASST Sette Laghi, Varese, Italy
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, URI; IRCCS Ospedale San Raffaele, Milan, Italy.,University Vita-Salute San Raffaele, Milan, Italy
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16
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Punjani N, Kang C, Lamb DJ, Schlegel PN. Current updates and future perspectives in the evaluation of azoospermia: A systematic review. Arab J Urol 2021; 19:206-214. [PMID: 34552771 PMCID: PMC8451618 DOI: 10.1080/2090598x.2021.1954415] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 03/29/2021] [Indexed: 11/24/2022] Open
Abstract
Objectives: To provide a summary of the current evaluation of azoospermia and insights into future perspectives in the evaluation and counselling of men with azoospermia. Methods: A search of PubMed, Cochrane Reviews and Web of Science databases was performed for full-text English-language articles published between 1943 and 2020 focussing on 'future perspectives', 'azoospermia' and 'evaluation'. Results: Azoospermia represents a severe form of male infertility characterised by sperm production so impaired that there are no sperm present in the ejaculate. The current evaluation of azoospermia focusses on patient history and physical examination with selected adjunctive laboratory investigations including serum hormones, a karyotype and screening for Y chromosome microdeletions. Future diagnostics are focussed on identifying the underlying genetic aetiologies for azoospermia, as well as a greater emphasis on screening for systemic illness that men with severe infertility may be predisposed to develop. Conclusion: Azoospermia represents an extreme form of male infertility, and evaluation relies heavily on history and physical examination, as genetic evaluations for these individuals remain limited. Future evaluation will focus on next-generation sequencing and more rigorous evaluation for possible co-existing and future risk of systemic disease. ABBREVIATIONS: ADGRG2, adhesion G protein-coupled receptor G2; ASRM: American Society of Reproductive Medicine; AZF: azoospermia factor; CBAVD: congenital bilateral absence of the vas deferens; CFTR: cystic fibrosis transmembrane conductance regulator; CRKL: CRK-like proto-oncogene; E2F1: E2F transcription factor 1; HAUS7: HAUS augmin-like complex subunit 7; HR: hazard ratio; KS: Klinefelter syndrome; MAZ, MYC-associated zinc finger protein; NGS: next-generation sequencing; NOA: non-obstructive azoospermia; OA: obstructive azoospermia; RHOX: reproductive homeobox on the X chromosome; SH2: SRC homology 2; TAF7L: TATA-box binding protein associated factor 7-like; TEX11: testis-expressed 11; WES: whole-exome sequencing.
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Affiliation(s)
- Nahid Punjani
- Department of Urology, Weill Cornell Medical College, New York, NY, USA
| | - Caroline Kang
- Department of Urology, Weill Cornell Medical College, New York, NY, USA
| | - Dolores J. Lamb
- Department of Urology, Weill Cornell Medical College, New York, NY, USA
- Englander Institute for Precision Medicine, Weill Cornell Medical College, New York, NY, USA
- Center for Reproductive Genomics, Weill Cornell Medical College, New York, NY, USA
| | - Peter N. Schlegel
- Department of Urology, Weill Cornell Medical College, New York, NY, USA
- Center for Reproductive Genomics, Weill Cornell Medical College, New York, NY, USA
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17
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Low Levels of Urinary PSA Better Identify Prostate Cancer Patients. Cancers (Basel) 2021; 13:cancers13143570. [PMID: 34298784 PMCID: PMC8303247 DOI: 10.3390/cancers13143570] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/09/2021] [Accepted: 07/13/2021] [Indexed: 01/08/2023] Open
Abstract
Simple Summary Elevated PSA levels in blood tests are the gold standard for early prostate cancer detection, but its lack of specificity limits its clinical use as a mass screening test. The paradox is that it has long been known that advanced prostate cancers can lose PSA expression. We have observed that in the presence of tumors, the prostate produces and secretes less PSA than in healthy or benign conditions. Therefore, the PSA evaluation in urine provided more accurate information on the presence of prostate tumors than the blood test, representing a new method for the screening of prostate cancer. Abstract Serum prostatic specific antigen (PSA) has proven to have limited accuracy in early diagnosis and in making clinical decisions about different therapies for prostate cancer (PCa). This is partially due to the fact that an increase in PSA in the blood is due to the compromised architecture of the prostate, which is only observed in advanced cancer. On the contrary, PSA observed in the urine (uPSA) reflects the quantity produced by the prostate, and therefore can give more information about the presence of disease. We enrolled 574 men scheduled for prostate biopsy at the urology clinic, and levels of uPSA were evaluated. uPSA levels resulted lower among subjects with PCa when compared to patients with negative biopsies. An indirect correlation was observed between uPSA amount and the stage of disease. Loss of expression of PSA appears as a characteristic of prostate cancer development and its evaluation in urine represents an interesting approach for the early detection of the disease and the stratification of patients.
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18
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Mulawkar PM, Maheshwari PN, Agrawal SG. Clinical Andrologists: Do We Really Need Them in the Era of ART? J Hum Reprod Sci 2021; 14:105-112. [PMID: 34316224 PMCID: PMC8279053 DOI: 10.4103/jhrs.jhrs_66_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 05/16/2021] [Accepted: 05/16/2021] [Indexed: 11/29/2022] Open
Abstract
Infertility is on a rise, and so is the availability of assisted reproductive technique (ART) centres. The sole aim of these centers is to help these unfortunate couples achieve pregnancy. Hence, the concentration of the treatment is on the female partner, while the male is relegated to just being a source for sperm. In the era of intracytoplasmic sperm injection, when pregnancy is possible even with a single mature sperm, evaluation and management of male factor infertility (MFI) is often neglected. MFI and poor semen parameters are markers of male health. He could be suffering from erectile or ejaculatory issues or with correctable obstructive azoospermia. A simple timely varicocele correction may help resolve the issue. It is important to understand that MFI is not a disease but may be a symptom of major underlying clinical condition like testicular or brain tumors. Infertility treatment could be the only occasion when a male seeks health-care evaluation. India has a large pool of qualified urologists trained in andrological care. In contrast, gynecologists may not be trained in the management of male patients, hence there is an important place for andrological services to be an integral part of ART centers. Andrologists would offer minimal andrological evaluation and condition-specific treatment. This could avoid or reduce the need for invasive and expensive ART. Andrologists could also choose the most appropriate mode of sperm retrieval. Undoubtedly, availability of andrological services would improve the overall quality of care, reduce the costs and complications, and would also be medicolegally safe.
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Affiliation(s)
- Prashant Motiram Mulawkar
- Department of Urology, Tirthankar Superspeciality Hospital, Akola, Maharashtra, India
- Department of Urology, University of Edinburgh, Edinburgh, Scotland, UK
| | - Pankaj N. Maheshwari
- Department of Urology, Fortis Hospital, Mumbai, Maharashtra, India
- Department of Urology, Grant Medical College, Mumbai, Maharashtra, India
| | - Sumeet Gopal Agrawal
- Department of Urology, Tirthankar Superspeciality Hospital, Akola, Maharashtra, India
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19
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Geczik AM, Kelly SP, Pfeiffer RM, Huang WY, Liao LM, Zhou CK, Brinton LA, Cook MB. Fatherhood status in relation to prostate cancer risks in two large U.S.-based prospective cohort studies. Cancer Med 2020; 10:405-415. [PMID: 33219755 PMCID: PMC7826462 DOI: 10.1002/cam4.3606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 10/19/2020] [Indexed: 11/28/2022] Open
Abstract
Background Despite the high incidence and mortality of prostate cancer (PCa) in the Unites States, few risk factors have been consistently linked with these PCa outcomes. Assessing proxies of reproductive factors may offer insights into PCa pathogenesis. In this study, we examined fatherhood status as a proxy of fertility in relation to total, nonaggressive, aggressive, and fatal PCa. Methods We examined participants of two cohorts, the NIH‐AARP Diet and Health (NIH‐AARP) Study and Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial. We used Cox proportional hazards regression to estimate hazard ratios (HRs) and 95% confidence intervals of associations between fatherhood status and number of children sired in relation to PCa incidence. Results Fatherhood status (one or more children vs. childless) was positively associated with total PCa risk in NIH‐AARP or PLCO, but was not statistically significant (p = 0.06 and 0.55, respectively). Number of children sired indicated a slightly elevated risk of total PCa, but HRs were rarely significant and were of a fairly constant magnitude with no discernable trend relative to the childless referent group. Associations were similar for nonaggressive and aggressive PCa. The trend test for fatal PCa was statistically significant in NIH‐AARP (ptrend < 0.01), despite none of the individual categorical point estimates reaching this threshold. Conclusion This study provides tentative evidence that fathering children is associated with a slightly increased PCa risk. Future research should strive to assess better proxies of reproductive function in relation to aggressive and fatal PCa to provide more specific evidence for this putative relationship.
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Affiliation(s)
- Ashley M Geczik
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - Scott P Kelly
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - Ruth M Pfeiffer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - Wen-Yi Huang
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - Linda M Liao
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - Cindy K Zhou
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - Louise A Brinton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
| | - Michael B Cook
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Bethesda, MD, USA
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20
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Al-Kandari AM, Alenezi A. Cost burden of male infertility investigations and treatments: A survey study. Urol Ann 2020; 12:314-318. [PMID: 33776325 PMCID: PMC7992531 DOI: 10.4103/ua.ua_48_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 06/06/2020] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Male infertility represents 50% of all infertility problems. The management of male infertility is expensive, causing a huge burden on the patients. In this study, we aimed to calculate the cost burden of male infertility investigations and treatments. METHODS A total of 600 infertile male patients from a single center in Kuwait city were asked to fulfill an internet-based survey. The survey encompassed data about the cost of different investigations and treatments of male infertility. Patients were also asked about the preference of covering their condition either through government or by private insurance. RESULTS A total of 145 patients responded to the survey. Most of the patients earned 3295 United States Dollar (USD) to 6590 USD per month. The cost of the outpatient visit ranged from 131.7 to 263.4 USD. The cost of each hormonal test was 164.5 USD while the average cost of each imaging study was 131.8-164.7 USD. Most of the patients (62.8%) received medical therapy with an expense of >988.74 USD. Varicocelectomy cost ranged from 3295 to 6590 USD while the cost of testicular sperm extraction ranged from 1644 to 3294 USD. Most patients (96.3%) did not have health insurance coverage of infertility. On average, patients spent around 18% of their annual income on infertility care, excluding major surgeries. CONCLUSION Male infertility is a worrisome medical condition that causes a huge burden on the Kuwait community. Effective management necessitates insurance coverage and public health support owing to the huge financial burden on the patients and their partners. Thus, policymakers should re-evaluate their protocols of spending on male infertility care.
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Affiliation(s)
- Ahmed M Al-Kandari
- Department of Surgery (Urology), Faculty of Medicine, Kuwait University, Safat, Kuwait
| | - Ahmad Alenezi
- Mubark Hospital, Sabah Al Ahmad Urology Center, Kuwait
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21
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Sommer GJ, Wang TR, Epperson JG, Hatch EE, Wesselink AK, Rothman KJ, Fredriksen LL, Schaff UY, Behr B, Eisenberg ML, Wise LA. At-home sperm testing for epidemiologic studies: Evaluation of the Trak male fertility testing system in an internet-based preconception cohort. Paediatr Perinat Epidemiol 2020; 34:504-512. [PMID: 31838751 PMCID: PMC8052852 DOI: 10.1111/ppe.12612] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 10/08/2019] [Accepted: 10/27/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Semen quality assessment in population-based epidemiologic studies presents logistical and financial challenges due to reliance on centralised laboratory semen analysis. The Trak Male Fertility Testing System is an FDA-cleared and validated at-home test for sperm concentration and semen volume, with a research use only sperm motility test. Here we evaluate the Trak System's overall utility among men participating in Pregnancy Study Online (PRESTO), a web-based study of North American couples planning pregnancy. METHODS US male participants aged ≥21 years with ≤6 months of pregnancy attempt time at study enrolment were invited to participate in the semen testing substudy after completing their baseline questionnaire. Consenting participants received a Trak Engine (battery-powered centrifuge) and two test kits. Participants shared their test results via smartphone images uploaded to online questionnaires. Data were then linked with covariate data from the baseline questionnaire. RESULTS Of the 688 men invited to participate, 373 (54%) provided consent and 271 (73%) completed at least one semen test result. The distributions of semen volume, sperm concentration, motile sperm concentration, total sperm count, and total motile sperm count were similar to 2010 World Health Organization (WHO) semen parameter data of men in the general population. The overall usability score for the Trak System was 1.4 on a 5-point Likert scale (1 = Very Easy, 5 = Difficult), and 92% of participants believed they performed the test correctly and received an accurate result. Lastly, men with higher motile sperm count were more likely to report feeling "at ease" or "excited" following testing, while men with low motile sperm count were more likely to report feeling "concerned" or "frustrated." Overall, 91% of men reported they would like to test again. CONCLUSIONS The Trak System provides a simple and potentially cost-effective means of measuring important semen parameters and may be useful in population-based epidemiologic fertility studies.
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Affiliation(s)
| | - Tanran R. Wang
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | | | - Elizabeth E. Hatch
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Amelia K. Wesselink
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Kenneth J. Rothman
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | | | | | - Barry Behr
- Department of Obstetrics and Gynecology, Stanford University, Stanford, CA, USA
| | - Michael L. Eisenberg
- Department of Obstetrics and Gynecology, Stanford University, Stanford, CA, USA
- Department of Urology, Stanford University, Stanford, CA, USA
| | - Lauren A. Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
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22
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Del Giudice F, Kasman AM, Ferro M, Sciarra A, De Berardinis E, Belladelli F, Salonia A, Eisenberg ML. Clinical correlation among male infertility and overall male health: A systematic review of the literature. Investig Clin Urol 2020; 61:355-371. [PMID: 32665992 PMCID: PMC7329649 DOI: 10.4111/icu.2020.61.4.355] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 04/12/2020] [Indexed: 12/03/2022] Open
Abstract
Purpose Ongoing evidence has suggested the role of male factor infertility as a potential predictor of mortality and general health status. The aim of the present review is to update the current knowledge base regarding the association between male factor infertility and general health through a critical review of the literature. Materials and Methods A systematic review of the literature was carried out from inception to November 2019 in order to evaluate significant associations between male infertility and adverse health outcomes such as cardiovascular, oncologic, metabolic and autoimmune diseases as well as overall mortality. Results In all, 27 studies met inclusion criteria and were critically examined. Five studies examined male infertility and cardiovascular disease risk, 11 examined oncologic risk (e.g., overall cancer risk, testis and prostate cancer), 8 examined aggregate chronic medical diseases and 5 infertility related to incidence of mortality, for a total of 599,807 men diagnosed with any male factor infertility covering a period from 1916 to 2016. Conclusions A man's fertility and overall health appear to be interconnected. Therefore, a diagnosis of male infertility may allow a window into future comorbidity and/or mortality which may help guide clinical decisions and counseling. Several possible etiologies such as genetic, epigenetic, developmental, and lifestyle-based factors need to be further evaluated in order to establish the underlying mechanisms between male infertility and health.
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Affiliation(s)
- Francesco Del Giudice
- Department of Maternal-Infant and Urological Sciences, "Sapienza" Rome University, Policlinico Umberto I Hospital, Rome, Italy.,Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
| | - Alex M Kasman
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
| | - Matteo Ferro
- Division of Urology, European Institute of Oncology (IEO), Milan, Italy
| | - Alessandro Sciarra
- Department of Maternal-Infant and Urological Sciences, "Sapienza" Rome University, Policlinico Umberto I Hospital, Rome, Italy
| | - Ettore De Berardinis
- Department of Maternal-Infant and Urological Sciences, "Sapienza" Rome University, Policlinico Umberto I Hospital, Rome, Italy
| | - Federico Belladelli
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA.,Unit of Urology/Division of Oncology, IRCCS Ospedale San Rafaele, URI, Milan, Italy
| | - Andrea Salonia
- Unit of Urology/Division of Oncology, IRCCS Ospedale San Rafaele, URI, Milan, Italy
| | - Michael L Eisenberg
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA.,Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
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23
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Abstract
Although infertility is now recognized as a disease by multiple organizations including the World Health Organization and the American Medical Association, private insurance companies rarely include coverage for infertility treatments. In this review, the authors assess the current state of care delivery for male infertility care in the United States. They discuss the scope of male infertility as well as the unique burdens it places on patients and review emerging market forces that could affect the future of care delivery for male infertility.
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Affiliation(s)
- Mary Oakley Strasser
- Department of Urology, University of Michigan, 1500 E. Medical Center Drive, SPC 5330 Ann Arbor, Michigan 48109-5330, USA.
| | - James M Dupree
- Department of Urology, University of Michigan, 1500 E. Medical Center Drive, SPC 5330 Ann Arbor, Michigan 48109-5330, USA; Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
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24
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Abstract
There is increasing evidence that male infertility may be a harbinger of comorbid medical illness. Existing studies have shed light on associations between infertility and the prevalence of cardiovascular, metabolic, and oncologic disease, along with rates of hospitalization and overall mortality. Although theorized mechanisms include genetic, developmental, and behavioral precipitants, the exact nature of these associations remains unclear and warrants further investigation.
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Affiliation(s)
- Jeremy T Choy
- Division of Endocrinology, Gerontology, and Metabolism, Stanford University School of Medicine, Stanford, CA, USA
| | - Michael L Eisenberg
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
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25
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Catalase as a Molecular Target for Male Infertility Diagnosis and Monitoring: An Overview. Antioxidants (Basel) 2020; 9:antiox9010078. [PMID: 31963256 PMCID: PMC7022443 DOI: 10.3390/antiox9010078] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 01/12/2020] [Accepted: 01/13/2020] [Indexed: 01/24/2023] Open
Abstract
Catalase (CAT) stands out as one of the most efficient natural enzymes when catalysing the split of H2O2 into H2O and O2; H2O2 is one of the reactive oxygen species (ROS) involved in oxidative stress, a process closely related to aging and several health disorders or diseases like male infertility. Some studies have correlated H2O2 with male infertility and catalase with fertility restoration. However, the number of studies conducted with human beings remains scarce. Considering the use of CAT as a molecular target for biochemical analysis, this review summarises the current knowledge on how CAT influences human beings’ male fertility. Thus, three different databases were consulted—Scopus, PubMed and WOS—using single keywords and combinations thereof. A total of 40,823 articles were identified. Adopting inclusion and exclusion criteria, a final database of 197 articles served to conduct this work. It follows from this analysis that CAT could play an important role in male fertility and could become a good target for male infertility diagnosis and monitoring. However, that potential role of CAT as a tool in diagnosis must be confirmed by clinical trials. Finally, guidelines are suggested to reinforce the use of CAT in daily clinical tests for male fertility diagnosis and monitoring.
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26
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The current status and future of andrology: A consensus report from the Cairo workshop group. Andrology 2019; 8:27-52. [PMID: 31692249 DOI: 10.1111/andr.12720] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 10/24/2019] [Accepted: 10/24/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND In attempting to formulate potential WHO guidelines for the diagnosis of male infertility, the Evidence Synthesis Group noted a paucity of high-quality data on which to base key recommendations. As a result, a number of authors suggested that key areas of research/evidence gaps should be identified, so that appropriate funding and policy actions could be undertaken to help address key questions. OBJECTIVES The overall objective of this Consensus workshop was to clarify current knowledge and deficits in clinical laboratory andrology, so that clear paths for future development could be navigated. MATERIALS AND METHODS Following a detailed literature review, each author, prior to the face-to-face meeting, prepared a summary of their topic and submitted a PowerPoint presentation. The topics covered were (a) Diagnostic testing in male fertility and infertility, (b) Male fertility/infertility in the modern world, (c) Clinical management of male infertility, and (d) The overuse of ICSI. At the meeting in Cairo on February 18, 2019, the evidence was presented and discussed and a series of consensus points agreed. RESULTS The paper presents a background and summary of the evidence relating to these four topics and addresses key points of significance. Following discussion of the evidence, a total of 36 consensus points were agreed. DISCUSSION The Discussion section presents areas where there was further debate and key areas that were highlighted during the day. CONCLUSION The consensus points provide clear statements of evidence gaps and/or potential future research areas/topics. Appropriate funding streams addressing these can be prioritized and consequently, in the short and medium term, answers provided. By using this strategic approach, andrology can make the rapid progress necessary to address key scientific, clinical, and societal challenges that face our discipline now and in the near future.
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27
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Al-Jebari Y, Elenkov A, Wirestrand E, Schütz I, Giwercman A, Lundberg Giwercman Y. Risk of prostate cancer for men fathering through assisted reproduction: nationwide population based register study. BMJ 2019; 366:l5214. [PMID: 31554611 PMCID: PMC6759809 DOI: 10.1136/bmj.l5214] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare the risk and severity of prostate cancer between men achieving fatherhood by assisted reproduction and men conceiving naturally. DESIGN National register based cohort study. SETTING Sweden from January 1994 to December 2014. PARTICIPANTS 1 181 490 children born alive in Sweden during 1994-2014 to the same number of fathers. Fathers were grouped according to fertility status by mode of conception: 20 618 by in vitro fertilisation (IVF), 14 882 by intra-cytoplasmic sperm injection (ICSI), and 1 145 990 by natural conception. MAIN OUTCOME MEASURES Prostate cancer diagnosis, age of onset, and androgen deprivation therapy (serving as proxy for advanced or metastatic malignancy). RESULTS Among men achieving fatherhood by IVF, by ICSI, and by non-assisted means, 77 (0.37%), 63 (0.42%), and 3244 (0.28%), respectively, were diagnosed as having prostate cancer. Mean age at onset was 55.9, 55.1, and 57.1 years, respectively. Men who became fathers through assisted reproduction had a statistically significantly increased risk of prostate cancer compared with men who conceived naturally (hazard ratio 1.64, 95% confidence interval 1.25 to 2.15, for ICSI; 1.33, 1.06 to 1.66, for IVF). They also had an increased risk of early onset disease (that is, diagnosis before age 55 years) (hazard ratio 1.86, 1.25 to 2.77, for ICSI; 1.51, 1.09 to 2.08, for IVF). Fathers who conceived through ICSI and developed prostate cancer received androgen deprivation therapy to at least the same extent as the reference group (odds ratio 1.91; P=0.07). CONCLUSIONS Men who achieved fatherhood through assisted reproduction techniques, particularly through ICSI, are at increased risk for early onset prostate cancer and thus constitute a risk group in which testing and careful long term follow-up for prostate cancer may be beneficial.
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Affiliation(s)
- Yahia Al-Jebari
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Angel Elenkov
- Department of Translational Medicine, Lund University, Malmö, Sweden
- Department of Urology, Medical University Sofia, Sofia, Bulgaria
- Reproductive Medicine Center, Skåne University Hospital Malmö, Malmö, Sweden
| | - Elin Wirestrand
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Indra Schütz
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Aleksander Giwercman
- Department of Translational Medicine, Lund University, Malmö, Sweden
- Reproductive Medicine Center, Skåne University Hospital Malmö, Malmö, Sweden
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28
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Affiliation(s)
- Aditi Sharma
- Section of Investigative Medicine, Imperial College London, Hammersmith Hospital, London, UK
| | - Channa N Jayasena
- Department of Andrology, Hammersmith Hospital, North-West London Pathology and Imperial College Healthcare NHS Trust, London, UK
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29
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Colli LG, Belardin LB, Echem C, Akamine EH, Antoniassi MP, Andretta RR, Mathias LS, Rodrigues SFDP, Bertolla RP, de Carvalho MHC. Systemic arterial hypertension leads to decreased semen quality and alterations in the testicular microcirculation in rats. Sci Rep 2019; 9:11047. [PMID: 31363128 PMCID: PMC6667492 DOI: 10.1038/s41598-019-47157-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 06/19/2019] [Indexed: 11/09/2022] Open
Abstract
Arterial hypertension is a cardiovascular disease that leads to important systemic alterations and drastically impairs normal organ function over time. Hypertension affects around 700 million men of reproductive age and hypertensive men present increased risk for reproductive disorders, such as erectile dysfunction. However, the link between arterial hypertension and male reproductive disorders is associative at best. Moreover, many studies have reported associations between decreased male fertility and/or semen quality and alterations to general male health. In this study we aim to investigate the effect of systemic high blood pressure in sperm quality, sperm functional characteristics and testicular physiology in a rat model. Hypertensive rats presented altered testicular morphology – mainly vascular alterations and impaired testicular vasomotion. Hypertensive rats also presented decrease in sperm concentration, DNA integrity and increased percentages of sperm with dysfunctional mitochondria, intracellular superoxide anion activity and abnormal morphology. This study provides mechanistic insights by which arterial hypertension affects the testes, evidencing the testes as another target organ for hypertension as well as its impact on sperm quality.
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Affiliation(s)
- Lucas Giglio Colli
- Department of Pharmacology, Division of Vascular Biology, Hypertension Section, Instituto de Ciências Biomédicas, Universidade de São Paulo -ICB/USP, São Paulo, SP, Brazil.
| | - Larissa Berloffa Belardin
- Department of Surgery, Division of Urology, Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil
| | - Cinthya Echem
- Department of Pharmacology, Division of Vascular Biology, Hypertension Section, Instituto de Ciências Biomédicas, Universidade de São Paulo -ICB/USP, São Paulo, SP, Brazil
| | - Eliana Hiromi Akamine
- Department of Pharmacology, Division of Vascular Biology, Hypertension Section, Instituto de Ciências Biomédicas, Universidade de São Paulo -ICB/USP, São Paulo, SP, Brazil
| | - Mariana Pereira Antoniassi
- Department of Surgery, Division of Urology, Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil
| | - Rhayza Roberta Andretta
- Department of Surgery, Division of Urology, Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil
| | - Lucas Solla Mathias
- Department of Internal Medicine, Botucatu Medical University, Universidade Estadual Paulista - UNESP, Botucatu, São Paulo, Brazil
| | - Stephen Fernandes de Paula Rodrigues
- Department of Pharmacology, Division of Vascular Biology, Hypertension Section, Instituto de Ciências Biomédicas, Universidade de São Paulo -ICB/USP, São Paulo, SP, Brazil
| | - Ricardo Pimenta Bertolla
- Department of Surgery, Division of Urology, Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil.
| | - Maria Helena Catelli de Carvalho
- Department of Pharmacology, Division of Vascular Biology, Hypertension Section, Instituto de Ciências Biomédicas, Universidade de São Paulo -ICB/USP, São Paulo, SP, Brazil.
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30
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Lo EM, Hotaling JM, Pastuszak AW. Urologic conditions associated with malignancy. Urol Oncol 2019; 38:23-30. [PMID: 30611645 DOI: 10.1016/j.urolonc.2018.12.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 12/11/2018] [Accepted: 12/18/2018] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Recent advances in cancer research have highlighted the role of genetics in malignancy. Genetic dysregulation of core cellular functions similarly influences benign conditions. These common genetic factors have led researchers to identify an association between certain urologic conditions and malignancy. The objective of this review is to evaluate the literature linking benign urologic conditions including male infertility, Peyronie's disease, cryptorchidism, and hypospadias, to malignancy. METHODS A search of PubMed was performed using the following search terms and their combinations: male infertility, female infertility, cancer, malignancy, mortality, male urologic conditions, azoospermia, Peyronie's disease, cryptorchidism, hypospadias, and genetics. Studies were assessed for quality and included or excluded based on study design and relevance to the topic of urologic conditions and malignancy. RESULTS A total of 52 studies were evaluated, of which 38 were included. Associations between male infertility and testicular cancer, prostate cancer, and other cancers including melanoma, bladder cancer, and thyroid cancer were examined. Several genetic alterations were found to be common in the pathogenesis of both male infertility and carcinogenesis. Associations between female infertility and breast, ovarian, and endometrial cancer are also assessed, as are the relationships between Peyronie's disease, cryptorchidism, and hypospadias and malignancy. CONCLUSIONS Recent work has identified associations between a number of malignancies and benign urologic conditions including male infertility, Peyronie's disease, cryptorchidism, and hypospadias. Molecular and genetic mechanisms have been proposed, but no definitive causal relationships have been identified to date. Future work will continue to better define the links between malignancy and benign urologic conditions and ultimately facilitate risk stratification, screening, and treatment of affected men.
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Affiliation(s)
- Eric M Lo
- Baylor College of Medicine, Houston, TX
| | - James M Hotaling
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Alexander W Pastuszak
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT.
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31
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Keihani S, Hanson B, Hotaling JM. Male factor infertility: an opportunity to investigate individual and family health. BJOG 2018; 126:149-151. [DOI: 10.1111/1471-0528.15398] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2018] [Indexed: 12/19/2022]
Affiliation(s)
- S Keihani
- Division of Urology University of Utah Salt Lake City UT USA
| | - B Hanson
- Department of Obstetrics & Gynecology University of Utah Salt Lake City UT USA
| | - JM Hotaling
- Division of Urology University of Utah Salt Lake City UT USA
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32
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Dupree JM. Insurance coverage of male infertility: what should the standard be? Transl Androl Urol 2018; 7:S310-S316. [PMID: 30159237 PMCID: PMC6087851 DOI: 10.21037/tau.2018.04.25] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 04/23/2018] [Indexed: 12/31/2022] Open
Abstract
Infertility is a disease, and the male partner plays a role in approximately 50% of infertility cases. For most patients, infertility care does not receive insurance coverage like other diseases, leaving them to pay out of pocket for their treatments. Because of the lack of insurance coverage, evaluations and treatments are expensive for patients, with costs often approaching the median annual US income. These increased costs reduce access to care and limit the ability to diagnose the cause of infertility, treat the underlying causes, and downgrade the intensity of the intervention needed to achieve the pregnancy. This leaves much of the burden for infertility care on the female partner. In an ideal health care system, evaluations and interventions for male infertility would receive the same insurance coverage as evaluations and interventions for other diseases.
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Affiliation(s)
- James M. Dupree
- Division of Andrology, Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI 48109-5330, USA
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33
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Glazer CH, Bonde JP, Giwercman A, Vassard D, Pinborg A, Schmidt L, Vaclavik Bräuner E. Risk of diabetes according to male factor infertility: a register-based cohort study. Hum Reprod 2018; 32:1474-1481. [PMID: 28486688 PMCID: PMC5850522 DOI: 10.1093/humrep/dex097] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 04/24/2017] [Indexed: 01/23/2023] Open
Abstract
STUDY QUESTION Is male factor infertility associated with an increased risk of developing diabetes? SUMMARY ANSWER The study provides evidence that male factor infertility may predict later occurrence of diabetes mellitus with the risk being related to the severity of the underlying fertility problem. WHAT IS KNOWN ALREADY Previous cross-sectional studies have shown an increased prevalence of comorbidities among infertile men when compared to controls. STUDY DESIGN, SIZE, DURATION In this prospective cohort study, 39 516 men who had since 1994 undergone fertility treatment with their female partner were identified from the Danish national IVF register, which includes data on assumed cause of couple infertility (male/female factor, mixed and unexplained infertility) and type of fertility treatment. With a median follow-up time of 5.6 years, each man was followed for diabetes occurrence from enrollment until 31 December 2012 using the National Diabetes Register (NDR). Men with a history of diabetes prior to their fertility diagnosis were excluded. Hazard ratios (HR) were estimated by Cox proportional hazard models with age as the underlying time scale. In addition to analyzing the data for the entire IVF registration period (1994–2012), separate analyses were performed for men identified from the first (1994–2005) and second (2006–2012) IVF registration period owing to heterogeneity in the reporting of male factor infertility in these two time periods, because the reason for male factor infertility was not available from the first register. PARTICIPANTS/MATERIALS, SETTING, METHODS Male factor infertility was identified from the variable ‘yes’ or ‘no’ from the first IVF register and through a diagnosis code (e.g. oligospermia, azoospermia) from the second IVF register. The reference group was men with male factor infertility (=‘no’) and those with normal semen quality or sterilized men. Of the included men, 18 499 (46.8%) had male factor infertility and 21 017 (53.2%) made up the reference group. MAIN RESULTS AND THE ROLE OF CHANCE A total of 651 (1.6%) diabetes cases were identified during the follow-up period. The adjusted HR's for diabetes risk among men with male factor infertility when compared to the reference group were HR = 1.08 (95% CI: 0.89, 1.31) and HR = 1.45 (95% CI: 1.06, 1.97) for the first and second IVF registration period, respectively. When assessing the effects of individual causes of male factor infertility, the adjusted HR's for men with oligospermia, azoospermia and aspermia were HR = 1.44 (95% CI: 1.01, 2.06), HR = 2.10 (95% 1.25, 3.56) and HR = 3.20 (95% CI 1.00, 10.31), respectively. LIMITATIONS, REASONS FOR CAUTION We found no increased risk among men identified from the first IVF register, which may be related to exposure misclassification as the reason for male factor infertility was not available from this time period. The NDR does not distinguish between type 1 and type 2 diabetes. WIDER IMPLICATIONS OF THE FINDINGS These findings support previous studies that a man's reproductive and somatic health are closely intertwined and highlight the importance for further monitoring of these men. Further, implementation of diabetes screening may be especially relevant among aspermic and azoospermic men. STUDY FUNDING/COMPETING INTERESTS This article is part of the ReproUnion collaborative study, co-financed by the European Union, Intereg V Öresund-Kattegat-Skagerrak. None of the authors declare any conflict of interest. TRIAL REGISTRATION NUMBER None.
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Affiliation(s)
- Clara Helene Glazer
- Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, DK-2400 Copenhagen NV, Denmark
| | - Jens Peter Bonde
- Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, DK-2400 Copenhagen NV, Denmark
| | - Aleksander Giwercman
- Molecular Reproductive Medicine, Department of Translational Medicine, Lund University, Sweden
| | - Ditte Vassard
- Department of Public Health, Section of Social Medicine, University of Copenhagen, DK-1014 Copenhagen K, Denmark
| | - Anja Pinborg
- Department of Obstetrics/Gynaecology, Hvidovre Hospital, Copenhagen University Hospital, DK-2650 Hvidovre, Denmark
| | - Lone Schmidt
- Department of Public Health, Section of Social Medicine, University of Copenhagen, DK-1014 Copenhagen K, Denmark
| | - Elvira Vaclavik Bräuner
- Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, DK-2400 Copenhagen NV, Denmark.,Research Center for Prevention and Health (RCPH), University of Copenhagen, DK-2600 Glostrup, Denmark
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Abstract
Infertility affects up to 12% of all men, and sexual dysfunction occurs frequently in men of reproductive age, causing infertility in some instances. In infertile men, hypoactive sexual desire and lack of sexual satisfaction are the most prevalent types of sexual dysfunction, ranging from 8.9% to 68.7%. Erectile dysfunction and/or premature ejaculation, evaluated with validated tools, have a prevalence of one in six infertile men, and orgasmic dysfunction has a prevalence of one in ten infertile men. In addition, infertile men can experience a heavy psychological burden. Infertility and its associated psychological concerns can underlie sexual dysfunction. Furthermore, general health perturbations can lead to male infertility and/or sexual dysfunction. Erectile dysfunction and male infertility are considered proxies for general health, the former underlying cardiovascular disorders and the latter cancerous and noncancerous conditions. The concept that erectile dysfunction in infertile men might be an early marker of poor general health is emerging. Finally, medications used for general health problems can cause sperm abnormalities and sexual dysfunction. The treatment of some causes of male infertility might improve semen quality and reverse infertility-related sexual dysfunction. In infertile men, an investigation of sexual, general, and psychological health status is advisable to improve reproductive problems and general health.
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Affiliation(s)
- Francesco Lotti
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Mario Maggi
- Sexual Medicine and Andrology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
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Smarr MM, Sapra KJ, Gemmill A, Kahn LG, Wise LA, Lynch CD, Factor-Litvak P, Mumford SL, Skakkebaek NE, Slama R, Lobdell DT, Stanford JB, Jensen TK, Boyle EH, Eisenberg ML, Turek PJ, Sundaram R, Thoma ME, Buck Louis GM. Is human fecundity changing? A discussion of research and data gaps precluding us from having an answer. Hum Reprod 2018; 32:499-504. [PMID: 28137753 DOI: 10.1093/humrep/dew361] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 01/03/2017] [Indexed: 12/14/2022] Open
Abstract
Fecundity, the biologic capacity to reproduce, is essential for the health of individuals and is, therefore, fundamental for understanding human health at the population level. Given the absence of a population (bio)marker, fecundity is assessed indirectly by various individual-based (e.g. semen quality, ovulation) or couple-based (e.g. time-to-pregnancy) endpoints. Population monitoring of fecundity is challenging, and often defaults to relying on rates of births (fertility) or adverse outcomes such as genitourinary malformations and reproductive site cancers. In light of reported declines in semen quality and fertility rates in some global regions among other changes, the question as to whether human fecundity is changing needs investigation. We review existing data and novel methodological approaches aimed at answering this question from a transdisciplinary perspective. The existing literature is insufficient for answering this question; we provide an overview of currently available resources and novel methods suitable for delineating temporal patterns in human fecundity in future research.
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Affiliation(s)
- Melissa M Smarr
- Office of the Director, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6710B Rockledge Dr. Room 3131A, Bethesda, MD 20829, USA
| | - Katherine J Sapra
- Office of the Director, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6710B Rockledge Dr. Room 3131A, Bethesda, MD 20829, USA
| | - Alison Gemmill
- Department of Demography, University of California, Berkeley, CA 94720, USA
| | - Linda G Kahn
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA
| | - Courtney D Lynch
- Department of Obstetrics & Gynecology, The Ohio State University College of Medicine, Columbus, OH 43212, USA
| | - Pam Factor-Litvak
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | - Sunni L Mumford
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD 20829, USA
| | - Niels E Skakkebaek
- Department of Growth and Reproduction and EDMaRC, University of Copenhagen, Rigshospitalet, DK-2100 Copenhagen, Denmark
| | - Rémy Slama
- Team of Environmental Epidemiology, Inserm, CNRS, University Grenoble Alpes, IAB Joint Research Center, F-38000 Grenoble, France
| | - Danelle T Lobdell
- Office of Research and Development, National Health and Environmental Effects Research Laboratory, U.S. Environmental Protection Agency, Research Triangle Park, NC 27709, USA
| | - Joseph B Stanford
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT 84108, USA
| | - Tina Kold Jensen
- Department of Growth and Reproduction and EDMaRC, University of Copenhagen, Rigshospitalet, DK-2100 Copenhagen, Denmark
| | - Elizabeth Heger Boyle
- Department of Sociology and College of Law, University of Minnesota, Minneapolis, MN 55455, USA
| | - Michael L Eisenberg
- Department of Urology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | | | - Rajeshwari Sundaram
- Biostatistics and Bioinformatics Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD 20829, USA
| | - Marie E Thoma
- Department of Family Science, School of Public Health, University of Maryland, College Park, MD 20742, USA
| | - Germaine M Buck Louis
- Office of the Director, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6710B Rockledge Dr. Room 3131A, Bethesda, MD 20829, USA
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Cedars MI, Taymans SE, DePaolo LV, Warner L, Moss SB, Eisenberg ML. The sixth vital sign: what reproduction tells us about overall health. Proceedings from a NICHD/CDC workshop. Hum Reprod Open 2017; 2017:hox008. [PMID: 30895226 DOI: 10.1093/hropen/hox008] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 05/12/2017] [Accepted: 05/28/2017] [Indexed: 12/13/2022] Open
Abstract
STUDY QUESTION Does the fertility status of an individual act as a biomarker for their future health? SUMMARY ANSWER Data support an association between reproductive health and overall health for men and women. WHAT IS ALREADY KNOWN Various chronic conditions, such as diabetes, obesity and cancer, can compromise fertility, but there are limited data for the converse situation, in which fertility status can influence or act as a marker for future health. Data reveal an association between infertility and incident cardiovascular disease and cancer in both men and women. STUDY DESIGN SIZE AND DURATION A National Institute of Child Health and Human Development-Centers for Disease Control and Prevention workshop in April 2016 was convened that brought together experts in both somatic diseases and conditions, and reproductive health. Goals of the workshop included obtaining information about the current state of the science linking fertility status and overall health, identifying potential gaps and barriers limiting progress in the field, and outlining the highest priorities to move the field forward. PARTICIPANTS/MATERIALS SETTING AND METHODS Approximately 40 experts participated in the workshop. MAIN RESULTS AND THE ROLE OF CHANCE While the etiology remains uncertain for infertility, there is evidence for an association between male and female infertility and later health. The current body of evidence suggests four main categories for considering biological explanations: genetic factors, hormonal factors, in utero factors, and lifestyle/health factors. These categories would be key to include in future studies to develop a comprehensive and possibly standardized look at fertility status and overall health. Several themes emerged from the group discussion including strategies for maximizing use of existing resources and databases, the need for additional epidemiologic studies and public health surveillance, development of strategies to frame research so results could ultimately influence clinical practice, and the identification of short and long-term goals and the best means to achieve them. LIMITATIONS REASONS FOR CAUTION Further research may not indicate an association between fertility status and overall health. WIDER IMPLICATIONS OF THE FINDINGS Currently medical care is compartmentalized. Reproductive medicine physicians treat patients for a short period of time before they transition to others for future care. Going forward, it is critical to take an interdisciplinary patient care approach that would involve experts in a broad range of medical specialties in order to more fully understand the complex interrelationships between fertility and overall health. If infertility is confirmed as an early marker of chronic disease then screening practices could be adjusted, as they are for patients with a family history of malignancy. STUDY FUNDING/COMPETING INTERESTS Funding for the workshop was provided by the Fertility and Infertility Branch, National Institute of Child Health and Human Development, National Institutes of Health and the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control. There are no conflicts of interest to declare. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention or the National Institutes of Health. TRIAL REGISTRATION NUMBER Not applicable.
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Affiliation(s)
- Marcelle I Cedars
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA 94143, USA
| | - Susan E Taymans
- Fertility and Infertility Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA
| | - Louis V DePaolo
- Fertility and Infertility Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA
| | - Lee Warner
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control, Atlanta, GA 30341, USA
| | - Stuart B Moss
- Fertility and Infertility Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA
| | - Michael L Eisenberg
- Male Reproductive Medicine and Surgery, Department of Urology, Stanford University, School of Medicine, Stanford, CA 94305, USA
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Pathak P, Chandrashekar A, Hakky TS, Pastuszak AW. Varicocele management in the era of in vitro fertilization/intracytoplasmic sperm injection. Asian J Androl 2017; 18:343-8. [PMID: 27030086 PMCID: PMC4854076 DOI: 10.4103/1008-682x.178482] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Varicocele is the most common surgically treatable cause of male infertility, and often results in alterations in semen parameters, sperm DNA damage, and changes to the seminal milieu. Varicocele repair can result in improvement in these parameters in the majority of men with clinical varicocele; data supporting repair in men with subclinical varicocele are less definitive. In couples seeking fertility using assisted reproductive technologies (ARTs), varicocele repair may offer improvement in semen parameters and sperm health that can increase the likelihood of successful fertilization using techniques such as in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI), or may decrease the level of ART needed to achieve successful pregnancy. Male infertility is an indicator of general male health, and evaluation of the infertile male with an eye toward future health can facilitate optimal screening and treatment of these men. Furthermore, varicocele may represent a progressive lesion, offering an argument for its repair, although this is currently unclear.
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Affiliation(s)
| | | | | | - Alexander W Pastuszak
- Scott Department of Urology, Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX; Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
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38
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Guo D, Li S, Behr B, Eisenberg ML. Hypertension and Male Fertility. World J Mens Health 2017; 35:59-64. [PMID: 28868816 PMCID: PMC5583372 DOI: 10.5534/wjmh.2017.35.2.59] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 06/19/2017] [Accepted: 06/20/2017] [Indexed: 11/15/2022] Open
Abstract
As the age of paternity rises in the developed world, issues of chronic disease may affect prospective fathers. Given the high prevalence of hypertension, researchers have begun to explore the relationship between hypertensive disease and male fertility. The current literature suggests an association between hypertension and semen quality. The use of various antihypertensive medications has also been linked to impaired semen parameters, making it difficult to discern whether the association exists with hypertension or its treatment. Further investigation is warranted to determine whether the observed associations are causal.
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Affiliation(s)
- David Guo
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
| | - Shufeng Li
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
| | - Barry Behr
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Michael L Eisenberg
- Department of Urology, Stanford University School of Medicine, Stanford, CA, USA.,Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA.
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39
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Hanson HA, Mayer EN, Anderson RE, Aston KI, Carrell DT, Berger J, Lowrance WT, Smith KR, Hotaling JM. Risk of childhood mortality in family members of men with poor semen quality. Hum Reprod 2016; 32:239-247. [PMID: 27927843 DOI: 10.1093/humrep/dew289] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 10/14/2016] [Accepted: 10/27/2016] [Indexed: 01/18/2023] Open
Abstract
STUDY QUESTION What is the familial childhood mortality in first-degree (FDR) and second-degree relatives (SDR) of patients undergoing semen analysis (SA)? SUMMARY ANSWER The relationship between infertility and congenital malformations (CM) in offspring is complex, with an increased risk of death due to CM in FDR, but not SDR, of men with lower semen parameters. WHAT IS KNOWN ALREADY Semen quality is an established predictor of men's somatic health. We can gain a better understanding of possible genetic or environmental determinants of the infertility phenotype by exploring familial aggregation of childhood mortality in relatives of men with poor semen quality. STUDY DESIGN, SIZE, DURATION Retrospective cohort study from the Subfertility, Health and Assisted Reproduction study (cohort compiled 1996-2011) linked with patient/familial information from the Utah Population Database (UPDB). Index cases included a clinic-referred sample of 12 889 men who underwent SA and had adequate familial and follow-up data in the UPDB. Parameters of semen quality included: semen concentration, sperm count, motility, total motile count, sperm head morphology, sperm tail morphology and vitality. PARTICIPANTS/MATERIALS, SETTING, METHODS SA data were collected from two tertiary medical center andrology laboratories that have captured ~90% of all SA performed in Utah since 2004. Age- and sex-matched fertile controls were selected to create the comparison group for determining risk of childhood death (to age 20 years) in family members. A total of 79 750 siblings and 160 016 aunts/uncles were used to investigate the familial aggregation of childhood mortality. The main outcome was childhood mortality in FDR and SDR of men with SA and their matched controls. All-cause and cause-specific Cox proportional hazard models were used to test the association between semen quality and childhood mortality in family members. Cause-specific models were considered for cancer and CM. MAIN RESULTS AND THE ROLE OF CHANCE In the cohort of men with SA, there were 406 (1.0%) deaths in FDR and 772 (1.1%) deaths in SDR due to any cause. There was no significant difference in the risk of all-cause childhood mortality between the relatives of men with SA and the fertile control group [hazard ratio (HR)Female = 1.08, 95% CI = 0.88, 1.32; HRMale = 0.88, 95% CI = 0.75, 1.04]. We found no association between semen quality and risk for childhood cancer mortality in FDR or SDR (HRFDR = 0.98, 95% CI = 0.62, 1.54; HRSDR = 1.12, 95% CI = 0.83, 1.50). The FDR of men with SA and fertile controls were followed on average for 19.71 and 19.73 years, respectively. During this period of follow-up, FDR of men with SA had an unadjusted 40% relative risk of increased CM-related death. After stratifying by semen parameters and adjusting for birth year, we found FDR of men with worse semen quality, and notably azoospermic men (HR = 2.69, 95% CI = 1.24,5.84), were at higher risk of CM-related death. LIMITATIONS REASONS FOR CAUTION A large proportion of men with SA in the study had normal semen parameters. It is important to note that these men themselves may not be subfertile, but they were subfertile at the couple level (i.e. the female partner may be infertile). In addition, care is needed when interpreting our results, as we do not have semen measures on our sample of fertile men. Second, we were unable to include potential confounders such as medical comorbidities, smoking status, or environmental exposures. Third, men with SA were seen at the University of Utah or Intermountain Health Care clinics for a fertility evaluation thereby suggesting a more select population. Fourth, we chose to categorize morphology into equally distributed quartiles as a response to the fact that the World Health Organization threshold for normal motility changed multiple times during our study period. Lastly, we do not know the proportion of female partners with diagnosed infertility. We chose not to subcategorize each infertile male by infertile diagnosis because our goal was to understand how semen parameters influenced familial childhood mortality. WIDER IMPLICATIONS OF THE FINDINGS We are not the first study to show a relationship between fertility and CMs. Children conceived through ART may be at higher risk of birth defects, however it is not known if the relationship is causal or if there is some underlying factor linking infertility and birth outcomes. This study provides further evidence that the increased risk of congenital birth defects may not be due to the ART, but rather genetic or environmental factors that link the two outcomes. We encourage further research in order to confirm a relationship between semen quality and increased risk for CM. STUDY FUNDING/COMPETING INTERESTS This work was supported by the National Institutes of Health - National Institute of Aging [Grant numbers 1R21AG036938-01, 2R01 AG022095 and 1K12HD085852-01]. Authors have no competing interests to disclose. TRIAL REGISTRATION NUMBER Not applicable.
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Affiliation(s)
- Heidi A Hanson
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT , USA .,Population Sciences, Huntsman Cancer Institute, University of Utah, 675 Arapeen Drive, 204, Salt Lake City, UT 84112 , USA
| | - Erik N Mayer
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Ross E Anderson
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Kenneth I Aston
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT, USA.,Center for Men's Health and Reconstructive Surgery, Salt Lake City, UT , USA.,Department of Human Genetics, University of Utah School of Medicine, Salt Lake City, UT , USA
| | - Douglas T Carrell
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT, USA.,Department of Human Genetics, University of Utah School of Medicine, Salt Lake City, UT , USA
| | - Justin Berger
- Population Sciences, Huntsman Cancer Institute, University of Utah, 675 Arapeen Drive, 204, Salt Lake City, UT 84112 , USA
| | - William T Lowrance
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Ken R Smith
- Population Sciences, Huntsman Cancer Institute, University of Utah, 675 Arapeen Drive, 204, Salt Lake City, UT 84112 , USA.,Department of Family and Consumer Studies, University of Utah, Salt Lake City, UT, USA
| | - James M Hotaling
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, UT, USA.,Center for Men's Health and Reconstructive Surgery, Salt Lake City, UT , USA
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Boeri L, Ventimiglia E, Capogrosso P, Ippolito S, Pecoraro A, Paciotti M, Scano R, Galdini A, Valsecchi L, Papaleo E, Montorsi F, Salonia A. Low Birth Weight Is Associated with a Decreased Overall Adult Health Status and Reproductive Capability - Results of a Cross-Sectional Study in Primary Infertile Patients. PLoS One 2016; 11:e0166728. [PMID: 27893825 PMCID: PMC5125617 DOI: 10.1371/journal.pone.0166728] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 11/02/2016] [Indexed: 01/09/2023] Open
Abstract
Individuals born with low birth weight (LBW) risk cardiometabolic complications later in life. However the impact of LBW on general health status and male reproductive function has been scantly analysed. We investigated the clinical and seminal impact of different birth weights (BW) in white-European men presenting for primary couple's infertility. Demographic, clinical, and laboratory data from 827 primary infertile men were compared with those of 373 consecutive fertile men. Patients with BW ≤2500, 2500-4200, and ≥4200gr were classified as having LBW, normal (NBW), and high BW (HBW), respectively. Health-significant comorbidities were scored with the Charlson Comorbidity Index (CCI). Testicular volume was assessed with a Prader orchidometer. Semen analysis values were assessed based on 2010 WHO reference criteria. Descriptive statistics and regression models tested associations between semen parameters, clinical characteristics and BW categories. LBW, NBW and HBW were found in 71 (8.6%), 651 (78.7%) and 105 (12.7%) infertile men, respectively. LBW was more frequent in infertile patients than fertile men (p = 0.002). Infertile patients with LBW had a higher rate of comorbidities (p = 0.003), lower mean testicular volume (p = 0.007), higher FSH (p = 0.02) and lower tT levels (p = 0.04) compared to other BW groups. Higher rates of asthenozoospermia (p = 0.02) and teratozoospermia (p = 0.03) were also found in LBW men. At logistic regression models, LBW was univariably associated with pathologic progressive motility (p≤0.02) and pathologic sperm morphology (p<0.005). At multivariable logistic regression analysis, LBW achieved independent predictor status for both lower sperm motility and pathologic sperm morphology (all p≤0.04). Only LBW independently predicted higher CCI values (p<0.001). In conclusion, we found that LBW was more frequent in infertile than in fertile men. Infertile individuals with LBW showed a higher rate of comorbidities and significantly worse clinical, endocrine and semen parameters compared to other BW groups.
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Affiliation(s)
- Luca Boeri
- Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy
| | - Eugenio Ventimiglia
- Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Paolo Capogrosso
- Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Silvia Ippolito
- Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy
| | - Angela Pecoraro
- Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy
| | - Marco Paciotti
- Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy
| | - Roberta Scano
- Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alessandro Galdini
- Department of Obstetrics and Gynaecology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Luca Valsecchi
- Department of Obstetrics and Gynaecology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Enrico Papaleo
- Department of Obstetrics and Gynaecology, IRCCS Ospedale San Raffaele, Milan, Italy
- Infertility Unit, Unit of Obstetrics/Gynecology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Montorsi
- Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
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Nayan M, Hamilton RJ, Macdonald EM, Li Q, Mamdani MM, Earle CC, Kulkarni GS, Jarvi KA, Juurlink DN. Vasectomy and risk of prostate cancer: population based matched cohort study. BMJ 2016; 355:i5546. [PMID: 27811008 PMCID: PMC5094198 DOI: 10.1136/bmj.i5546] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine the association between vasectomy and prostate cancer, adjusting for measures of health seeking behaviour. DESIGN Population based matched cohort study. SETTING Multiple validated healthcare databases in Ontario, Canada, 1994-2012. PARTICIPANTS 326 607 men aged 20 to 65 who had undergone vasectomy were identified through physician billing codes and matched 1:1 on age (within two years), year of cohort entry, comorbidity score, and geographical region to men who did not undergo a vasectomy. MAIN OUTCOMES MEASURES The primary outcome was incident prostate cancer. Secondary outcomes were prostate cancer related grade, stage, and mortality. RESULTS 3462 incident cases of prostate cancer were identified after a median follow-up of 10.9 years: 1843 (53.2%) in the vasectomy group and 1619 (46.8%) in the non-vasectomy group. In unadjusted analysis, vasectomy was associated with a slightly increased risk of incident prostate cancer (hazard ratio 1.13, 95% confidence interval 1.05 to 1.20). After adjustment for measures of health seeking behaviour, however, no association remained (adjusted hazard ratio 1.02, 95% confidence interval 0.95 to 1.09). Moreover, no association was found between vasectomy and high grade prostate cancer (adjusted odds ratio 1.05, 95% confidence interval 0.67 to 1.66), advanced stage prostate cancer (adjusted odds ratio 1.04, 0.81 to 1.34), or mortality (adjusted hazard ratio 1.06, 0.60 to 1.85). CONCLUSION The findings do not support an independent association between vasectomy and prostate cancer.
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Affiliation(s)
- Madhur Nayan
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, 610 University Ave 3-130, Toronto, ON, M5G 2M9, Canada
| | - Robert J Hamilton
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, 610 University Ave 3-130, Toronto, ON, M5G 2M9, Canada
| | | | - Qing Li
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Muhammad M Mamdani
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
| | - Craig C Earle
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Girish S Kulkarni
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, 610 University Ave 3-130, Toronto, ON, M5G 2M9, Canada
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Keith A Jarvi
- Division of Urology, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada; Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Lunenfeld Tannenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada
| | - David N Juurlink
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
- Department of Internal Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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Agarwal A, Roychoudhury S, Bjugstad KB, Cho CL. Oxidation-reduction potential of semen: what is its role in the treatment of male infertility? Ther Adv Urol 2016; 8:302-318. [PMID: 27695529 PMCID: PMC5004233 DOI: 10.1177/1756287216652779] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
The diagnosis of male infertility relies largely on conventional semen analysis, and its interpretation has a profound influence on subsequent management of patients. Despite poor correlation between conventional semen parameters and male fertility potential, inclusion of advanced semen quality tests to routine male infertility workup algorithms has not been widely accepted. Oxidative stress is one of the major mediators in various etiologies of male infertility; it has deleterious effects on spermatozoa, including DNA damage. Alleviation of oxidative stress constitutes a potential treatment strategy for male infertility. Measurement of seminal oxidative stress is of crucial role in the identification and monitoring of patients who may benefit from treatments. Various tests including reactive oxygen species (ROS) assay, total antioxidant capacity (TAC) assay or malondialdehyde (MDA) assay used by different laboratories have their own drawbacks. Oxidation-reduction potential (ORP) is a measure of overall balance between oxidants and antioxidants, providing a comprehensive measure of oxidative stress. The MiOXSYS™ System is a novel technology based on a galvanostatic measure of electrons; it presents static ORP (sORP) measures with static referring to the passive or current state of activity between oxidants and antioxidants. Preliminary studies have correlated sORP to poor semen qualities. It is potentially useful in prognostication of assisted reproductive techniques outcomes, screening of antioxidants either in vivo or during IVF cycles, identification of infertile men who may benefit from treatment of oxidative stress, and monitoring of treatment success. The simplified laboratory test requiring a small amount of semen would facilitate clinical application and research in the field. In this paper, we discuss the measurement of ORP by the MiOXSYS System as a real-time assessment of seminal oxidative stress, and argue that it is a potential valuable clinical test that should be incorporated into the male infertility workup and become an important guide to the treatment of oxidative stress-induced male infertility.
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Affiliation(s)
- Ashok Agarwal
- Director, Andrology Center and American Center for Reproductive Medicine, Lerner College of Medicine, Cleveland Clinic, 10681 Carnegie Avenue, Desk X11, Cleveland, OH 44195, USA
| | - Shubhadeep Roychoudhury
- American Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA Department of Life Science and Bioinformatics, Assam University, Silchar, India
| | | | - Chak-Lam Cho
- Department of Surgery, Kwong Wah Hospital, Hong Kong
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Anderson RE, Hanson HA, Patel DP, Johnstone E, Aston KI, Carrell DT, Lowrance WT, Smith KR, Hotaling JM. Cancer risk in first- and second-degree relatives of men with poor semen quality. Fertil Steril 2016; 106:731-8. [PMID: 27336212 PMCID: PMC5617641 DOI: 10.1016/j.fertnstert.2016.05.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 05/21/2016] [Accepted: 05/24/2016] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To further characterize the association of male infertility with health risks by evaluating semen quality and cancer risk in family members. DESIGN Retrospective, cohort study. SETTING Not applicable. PATIENT(S) A total of 12,889 men undergoing SA and 12,889 fertile control subjects that had first-degree relative (FDR) data (n = 130,689) and 8,032 men with SA and 8,032 fertile control subjects with complete second-degree relative (SDR) data (n = 247,204) were identified through the UPDB. An equal number of fertile population control subjects were matched. INTERVENTIONS None. MAIN OUTCOME MEASURE(S) Adult all-site, testicular, thyroid, breast, prostate, melanoma, bladder, ovarian, and kidney cancer diagnoses in FDRs and SDRs. RESULT(S) The FDRs of men with SA had a 52% increased risk of testicular cancer compared with the FDRs of fertile population control subjects. There was no significant difference in testicular cancer risk for the SDRs based on any of the semen parameters. The FDRs and SDRs of azoospermic men had a significantly increased risk of thyroid cancer compared with fertile population control subjects. CONCLUSION(S) These data suggest a link between male infertility and selected cancer risk in relatives. This highlights the possibilities of shared biologic mechanisms between the two diseases, exposure to environmental factors, and an increased level of genetic and/or epigenetic burden in subfertile men and their relatives that may be associated with risk of cancer.
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Affiliation(s)
- Ross E Anderson
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, Utah.
| | - Heidi A Hanson
- Department of Family and Preventive Medicine and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Darshan P Patel
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, Utah
| | - Erica Johnstone
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah
| | - Kenneth I Aston
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, Utah
| | - Douglas T Carrell
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, Utah; Department of Human Genetics, University of Utah School of Medicine, Salt Lake City, Utah
| | - William T Lowrance
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, Utah
| | - Ken R Smith
- Department of Family and Consumer Studies and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - James M Hotaling
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, Utah
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Dupree JM. Insurance coverage for male infertility care in the United States. Asian J Androl 2016; 18:339-41. [PMID: 27030084 PMCID: PMC4854074 DOI: 10.4103/1008-682x.177838] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 01/25/2016] [Accepted: 02/08/2016] [Indexed: 11/15/2022] Open
Abstract
Infertility is a common condition experienced by many men and women, and treatments are expensive. The World Health Organization and American Society of Reproductive Medicine define infertility as a disease, yet private companies infrequently offer insurance coverage for infertility treatments. This is despite the clear role that healthcare insurance plays in ensuring access to care and minimizing the financial burden of expensive services. In this review, we assess the current knowledge of how male infertility care is covered by insurance in the United States. We begin with an appraisal of the costs of male infertility care, then examine the state insurance laws relevant to male infertility, and close with a discussion of why insurance coverage for male infertility is important to both men and women. Importantly, we found that despite infertility being classified as a disease and males contributing to almost half of all infertility cases, coverage for male infertility is often excluded from health insurance laws. Excluding coverage for male infertility places an undue burden on their female partners. In addition, excluding care for male infertility risks missing opportunities to diagnose important health conditions and identify reversible or irreversible causes of male infertility. Policymakers should consider providing equal coverage for male and female infertility care in future health insurance laws.
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Affiliation(s)
- James M Dupree
- Department of Urology, Divisions of Andrology and Health Services Research and Department of Obstetrics and Gynecology, University of Michigan, 1500 E Medical Center Drive, 3875 Taubman Center, SPC 5330, Ann Arbor, MI 48109-5330, USA
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45
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Hanson HA, Anderson RE, Aston KI, Carrell DT, Smith KR, Hotaling JM. Subfertility increases risk of testicular cancer: evidence from population-based semen samples. Fertil Steril 2016; 105:322-8.e1. [PMID: 26604070 PMCID: PMC4744156 DOI: 10.1016/j.fertnstert.2015.10.027] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 10/26/2015] [Accepted: 10/27/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To further understand the association between semen quality and cancer risk by means of well defined semen parameters. DESIGN Retrospective cohort study. SETTING Not applicable. PATIENT(S) A total of 20,433 men who underwent semen analysis (SA) and a sample of 20,433 fertile control subjects matched by age and birth year. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Risk of all cancers as well as site-specific results for prostate cancer, testicular cancer, and melanoma. RESULT(S) Compared with fertile men, men with SA had an increased risk of testicular cancer (hazard rate [HR] 3.3). When the characterization of infertility was refined using individual semen parameters, we found that oligozoospermic men had an increased risk of cancer compared with fertile control subjects. This association was particularly strong for testicular cancer, with increased risk in men with oligozoospermia based on concentration (HR 11.9) and on sperm count (HR 10.3). Men in the in the lowest quartile of motility (HR 4.1), viability (HR 6.6), morphology (HR 4.2), or total motile count (HR 6.9) had higher risk of testicular cancer compared with fertile men. Men with sperm concentration and count in the 90th percentiles of the distribution (≥178 and ≥579 × 10(6)/mL, respectively), as well as total motile count, had an increased risk of melanoma (HRs 2.1, 2.7, and 2.0, respectively). We found no differences in cancer risk between azoospermic and fertile men. CONCLUSION(S) Men with SA had an increased risk of testicular cancer which varied by semen quality. Unlike earlier work, we did not find an association between azoospermia and increased cancer risk.
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Affiliation(s)
- Heidi A Hanson
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah; Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah.
| | - Ross E Anderson
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, Utah
| | - Kenneth I Aston
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, Utah; Center for Men's Health and Reconstructive Surgery, University of Utah, Salt Lake City, Utah; Department of Human Genetics, University of Utah School of Medicine, Salt Lake City, Utah
| | - Douglas T Carrell
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, Utah; Center for Men's Health and Reconstructive Surgery, University of Utah, Salt Lake City, Utah; Department of Human Genetics, University of Utah School of Medicine, Salt Lake City, Utah
| | - Ken R Smith
- Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah; Department of Family and Consumer Studies and Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - James M Hotaling
- Center for Men's Health and Reconstructive Surgery, University of Utah, Salt Lake City, Utah
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46
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Abstract
Men with severe oligospermia (<5 million sperm/mL ejaculate fluid) or azoospermia should receive genetic testing to clarify etiology of male infertility prior to treatment. Categorization by obstructive azoospermia (OA) or non-obstructive azoospermia (NOA) is critical since genetic testing differs for the former with normal testicular function, testicular volume (~20 mL), and follicle-stimulating hormone (FSH) (1-8 IU/mL) when compared to the latter with small, soft testes and increased FSH. History and physician examination along with laboratory testing (following appropriate genetic counseling) is critical to accurate selection of genetic testing appropriate for azoospermia due to primary testicular failure as compared with congenital hypogonadotropic hypogonadism (HH). Genetic testing options include cystic fibrosis transmembrane conductance regulator (CFTR) testing for men with congenital absence of the vas, while karyotype, Y chromosome microdeletions (YCMD), and other specific genetic tests may be warranted depending on the clinical context of severe oligospermia or NOA. The results of genetic testing guide management options. The most recent techniques for genetic analysis, including sperm microRNA (miRNA) and epigenetics, are forming the foundation for future genetic diagnosis and therapeutic targets in male infertility.
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Affiliation(s)
- Matthew S Wosnitzer
- Male Reproductive Medicine and Microsurgery, Instructor and Fellow. Department of Urology and Institute for Reproductive Medicine, Weill Cornell Medical College of Cornell University, 525 East 68 Street, New York, NY 10065, USA
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47
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Lu J, Gu H, Tang Q, Wu W, Yuan B, Guo D, Wei Y, Sun H, Xia Y, Ding H, Hu L, Chen D, Sha J, Wang X. Common SNP in hsa-miR-196a-2 increases hsa-miR-196a-5p expression and predisposes to idiopathic male infertility in Chinese Han population. Sci Rep 2016; 6:19825. [PMID: 26805933 PMCID: PMC4726409 DOI: 10.1038/srep19825] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 12/07/2015] [Indexed: 01/05/2023] Open
Abstract
MicroRNA plays an important role in spermatogenesis. Whether pre-miRNAs polymorphisms are associated with idiopathic male infertility remains obscure. In this study, 1378 idiopathic infertile males and 486 fertile controls were included between 2006 and 2014. Genotype of three polymorphisms (hsa-mir-146a rs2910164, hsa-mir-196a-2 rs11614913, and hsa-mir-499 rs3746444) and expression of miRNA in seminal plasma were examined by TaqMan method. The role of hsa-miR-196a-5p in cell proliferation, apoptosis and cell cycle were also examined in GC-2 cells. Our results demonstrated that rs11614913 of hsa-miR-196a-2 was significantly associated with idiopathic infertility (TT vs. CT: P = 0.014; TT vs. CC: P = 0.005; TT vs. CT + CC: P = 0.003). In following stratified analysis, we found that rs11614913 exhibited a significantly higher risk of asthenospermia, oligozoospermia and azoospermia. However, no significant association was observed between the other two polymorphisms and idiopathic male infertility risk. In a genotype-expression correlation analysis, rs11614913 CC was significantly associated with elevated expression of hsa-miR-196a-5p (P < 0.05). Additionally, apoptosis levels were significantly increased in hsa-miR-196a-5p mimic treated GC-2 cells, while decreased in hsa-miR-196a-5p inhibitor treated GC-2 cells. Our data revealed a significant relationship between hsa-miR-196a-2 polymorphism and idiopathic male infertility.
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Affiliation(s)
- Jing Lu
- State Key Laboratory of Reproductive Medicine, Department of Reproduction, Nanjing Maternal and Child Health Care Hospital Affiliated to Nanjing Medical University, Nanjing 210004, China
| | - Hao Gu
- State Key Laboratory of Reproductive Medicine, Institute of Toxicology, Nanjing Medical University, Nanjing 210029, China.,Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing 210029, China
| | - Qiuqin Tang
- State Key Laboratory of Reproductive Medicine, Department of Obstetrics, Nanjing Maternal and Child Health Care Hospital Affiliated to Nanjing Medical University, Nanjing 210004, China
| | - Wei Wu
- State Key Laboratory of Reproductive Medicine, Institute of Toxicology, Nanjing Medical University, Nanjing 210029, China.,Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing 210029, China.,Wuxi Maternal and Child Health Hospital Affiliated to Nanjing Medical University, Wuxi 214002, China
| | - Beilei Yuan
- State Key Laboratory of Reproductive Medicine, Institute of Toxicology, Nanjing Medical University, Nanjing 210029, China.,Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing 210029, China
| | - Dan Guo
- State Key Laboratory of Reproductive Medicine, Institute of Toxicology, Nanjing Medical University, Nanjing 210029, China.,Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing 210029, China
| | - Yongyue Wei
- Department of Epidemiology and Biostatistics, Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, 210029, China
| | - Hong Sun
- Department of Microbial and Molecular Systems, KULeuven, Kasteelpark Arenberg 20, B-3001 Leuven, Belgium
| | - Yankai Xia
- State Key Laboratory of Reproductive Medicine, Institute of Toxicology, Nanjing Medical University, Nanjing 210029, China.,Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing 210029, China
| | - Hongjuan Ding
- State Key Laboratory of Reproductive Medicine, Department of Obstetrics, Nanjing Maternal and Child Health Care Hospital Affiliated to Nanjing Medical University, Nanjing 210004, China
| | - Lingqing Hu
- Wuxi Maternal and Child Health Hospital Affiliated to Nanjing Medical University, Wuxi 214002, China
| | - Daozhen Chen
- Wuxi Maternal and Child Health Hospital Affiliated to Nanjing Medical University, Wuxi 214002, China
| | - Jiahao Sha
- State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing 210029, China
| | - Xinru Wang
- State Key Laboratory of Reproductive Medicine, Institute of Toxicology, Nanjing Medical University, Nanjing 210029, China.,Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing 210029, China
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48
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Mao Y, Xu X, Zheng X, Xie L. Reduced risk of prostate cancer in childless men as compared to fathers: a systematic review and meta-analysis. Sci Rep 2016; 6:19210. [PMID: 26752096 PMCID: PMC4707492 DOI: 10.1038/srep19210] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 12/07/2015] [Indexed: 11/22/2022] Open
Abstract
The previously reported association between fatherhood status and prostate cancer risk was controversial. We carried out the present meta-analysis of all relevant studies to summarize evidence on this association. A comprehensive literature search of studies was performed in PubMed, Web of Science, and the Chinese National Knowledge Infrastructure (CNKI) databases, covering all the papers published from their inception to September 2015. The combined risk estimates with 95% confidence intervals (CIs) were calculated using a random effects model. Heterogeneity and publication bias were also evaluated. A total of 11 studies were finally included in this meta-analysis. We found a significantly reduced risk of prostate cancer associated with being childless (OR 0.91, 95% CI 0.87–0.96). There was statistically significant heterogeneity across the studies (P < 0.001, I2 = 88.2%). In summary, this meta-analysis supports that being fatherless is associated with a lower risk of prostate cancer. Because of the substantial heterogeneity and residual confounding, using other study designs to further explore this association and the underling mechanism is warranted.
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Affiliation(s)
- Yeqing Mao
- Department of Urology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Xin Xu
- Department of Urology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Xiangyi Zheng
- Department of Urology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Liping Xie
- Department of Urology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, China
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49
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Hanson HA, Smith KR, Zimmer Z. Reproductive History and Later-Life Comorbidity Trajectories: A Medicare-Linked Cohort Study From the Utah Population Database. Demography 2015; 52:2021-49. [PMID: 26527471 PMCID: PMC4655204 DOI: 10.1007/s13524-015-0439-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Reproductive lives of men and women may provide significant insight into later-life morbidity and mortality. Sociological, biological, and evolutionary theories predict a relationship between reproductive history and later-life health; however, current research is lacking consensus on the direction of the relationship. Parity, early age at first birth and last birth, birth weight of offspring, having a child die as an infant, and having a preterm birth may have long-term effects on health for both men and women. In this study, the relationship between these measures of reproductive history and later-life health is examined using the Utah Population Database (a rich source of longitudinal data), and Medicare claims data from 1992-2009. Later-life health is measured using annual Charlson comorbidity index scores, a construct that summarizes most serious illnesses afflicting older individuals. Group-based trajectory modeling that accounts for nonrandom attrition due to death is used to identify the number and types of morbidity trajectories by sex and age for 52,924 individuals aged 65-84 in 1992. For females, early age at first birth, high parity, and having a preterm or high-birth-weight baby are associated with increased risks of comorbidity; later age at last birth is associated with a decreased risk of comorbidity. For males, early age at first birth and having a child with an abnormal birth weight leads to increased risk of comorbidity. The results suggest that both biological and social factors play important roles in the relationships between fertility and morbidity profiles at older ages.
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Affiliation(s)
- Heidi A Hanson
- Division of Public Health, University of Utah, 675 Arapeen, Suite 200, Salt Lake City, UT, 84112, USA.
- Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.
| | - Ken R Smith
- Population Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
- Department of Family and Consumer Studies, University of Utah, Salt Lake City, UT, USA
| | - Zachary Zimmer
- University of California, San Francisco, San Francisco, CA, USA
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50
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Male reproductive cancers and infertility: a mutual relationship. Int J Mol Sci 2015; 16:7230-60. [PMID: 25837470 PMCID: PMC4425014 DOI: 10.3390/ijms16047230] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 03/29/2015] [Accepted: 03/29/2015] [Indexed: 12/14/2022] Open
Abstract
Reproductive dysfunction and malignancies related to the male gender represent a serious health concern, whose incidence has significantly risen over the past years. Prior to treatment, testicular or prostate cancer patients often display poor semen characteristics similar to subfertile or infertile patients. This fact is underscored by cases where the malignancy is often diagnosed in males who undergo a general fertility screening. This review aims to examine the associations between male infertility and reproductive cancers focusing on common etiologies and biological mechanisms underlining these pathologies. Furthermore, we discuss compelling epidemiological data hypothesizing that male reproductive failure may act as a precursor of future andrological malignancies, including testicular or prostate cancer, thus providing a stimulus for a more specific research in male reproductive health and emphasizing the importance of this relation for physicians taking care of male patients with a reproductive disease.
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