1
|
Faja F, Pallotti F, Bianchini S, Buonacquisto A, Cicolani G, Conflitti AC, Fracella M, Cavallari EN, Sciarra F, Pierangeli A, Paoli D, Lenzi A, Antonelli G, Lombardo F, Gianfrilli D. Molecular study of the presence and transcriptional activity of HPV in semen. J Endocrinol Invest 2024; 47:557-570. [PMID: 37584897 PMCID: PMC10904563 DOI: 10.1007/s40618-023-02167-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 07/24/2023] [Indexed: 08/17/2023]
Abstract
PURPOSE Human Papillomavirus (HPV) in semen represents a controversial topic. Recent evidence suggests a correlation with poor semen quality, but its detection is still unstandardized in this biological fluid. Thus, the aims of this study were to verify the ability of nested PCR to reveal HPV-DNA in semen; to evaluate association of seminal HPV with sperm parameters and risk factors for infection; to investigate the rate of HPV-DNA positivity in patients with and without risk factors; to assess HPV transcriptional activity. METHODS We enrolled sexually active men and collected clinical and anamnestic data during andrological and sexually transmitted infections (STIs) evaluation. For each patient, we performed semen analysis and nested PCR to detect HPV-DNA in semen. In positive semen samples, we proceeded with genotyping and RNA quantification to detect HPV transcriptional activity. RESULTS We enrolled 185 men (36.0 ± 8.3 years), of which 85 with (Group A) and 100 without HPV risk factors (Group B). Nested PCR was able to reveal HPV-DNA in semen, discovering a prevalence of 8.6% (11.8% in Group A and 6% in Group B, respectively). We observed no correlation between sperm quality and seminal HPV. Genital warts and previous anogenital infection were significantly associated with the risk of HPV positivity in semen. Moreover, no viral transcriptional activity was detected in positive semen samples. CONCLUSIONS Our study suggests that searching for seminal HPV could be important in patients both with and without risk factors, especially in assisted reproduction where the risk of injecting sperm carrying HPV-DNA is possible.
Collapse
Affiliation(s)
- F Faja
- Laboratory of Seminology - "Loredana Gandini" Sperm Bank, Department of Experimental Medicine, "Sapienza" University of Rome, 00161, Rome, Italy
| | - F Pallotti
- Laboratory of Seminology - "Loredana Gandini" Sperm Bank, Department of Experimental Medicine, "Sapienza" University of Rome, 00161, Rome, Italy
- Faculty of Medicine and Surgery, University of Enna "Kore", 94100, Enna, Italy
| | - S Bianchini
- Laboratory of Seminology - "Loredana Gandini" Sperm Bank, Department of Experimental Medicine, "Sapienza" University of Rome, 00161, Rome, Italy
| | - A Buonacquisto
- Laboratory of Seminology - "Loredana Gandini" Sperm Bank, Department of Experimental Medicine, "Sapienza" University of Rome, 00161, Rome, Italy
| | - G Cicolani
- Laboratory of Seminology - "Loredana Gandini" Sperm Bank, Department of Experimental Medicine, "Sapienza" University of Rome, 00161, Rome, Italy
| | - A C Conflitti
- Laboratory of Seminology - "Loredana Gandini" Sperm Bank, Department of Experimental Medicine, "Sapienza" University of Rome, 00161, Rome, Italy
| | - M Fracella
- Laboratory of Microbiology and Virology, Department of Molecular Medicine, "Sapienza" University of Rome, 00185, Rome, Italy
| | - E N Cavallari
- Laboratory of Microbiology and Virology, Department of Molecular Medicine, "Sapienza" University of Rome, 00185, Rome, Italy
| | - F Sciarra
- Section of Medical Pathophysiology and Endocrinology, Department of Experimental Medicine, "Sapienza" University of Rome, 00161, Rome, Italy
| | - A Pierangeli
- Laboratory of Microbiology and Virology, Department of Molecular Medicine, "Sapienza" University of Rome, 00185, Rome, Italy
| | - D Paoli
- Laboratory of Seminology - "Loredana Gandini" Sperm Bank, Department of Experimental Medicine, "Sapienza" University of Rome, 00161, Rome, Italy.
| | - A Lenzi
- Laboratory of Seminology - "Loredana Gandini" Sperm Bank, Department of Experimental Medicine, "Sapienza" University of Rome, 00161, Rome, Italy
| | - G Antonelli
- Laboratory of Microbiology and Virology, Department of Molecular Medicine, "Sapienza" University of Rome, 00185, Rome, Italy
| | - F Lombardo
- Laboratory of Seminology - "Loredana Gandini" Sperm Bank, Department of Experimental Medicine, "Sapienza" University of Rome, 00161, Rome, Italy
| | - D Gianfrilli
- Section of Medical Pathophysiology and Endocrinology, Department of Experimental Medicine, "Sapienza" University of Rome, 00161, Rome, Italy
| |
Collapse
|
2
|
Sucato A, Buttà M, Bosco L, Di Gregorio L, Perino A, Capra G. Human Papillomavirus and Male Infertility: What Do We Know? Int J Mol Sci 2023; 24:17562. [PMID: 38139389 PMCID: PMC10744208 DOI: 10.3390/ijms242417562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/12/2023] [Accepted: 12/14/2023] [Indexed: 12/24/2023] Open
Abstract
In recent years, increasing attention has been paid to understanding the causes of infertility, which is being recognized as a growing health problem affecting large numbers of couples worldwide. Male infertility is a contributing factor in approximately 30-40% of cases, and one of its etiological causes is sexually transmitted infections (STIs). Among sexually transmitted pathogens, human papillomavirus (HPV) can contribute in various ways to the failure of spontaneous and assisted reproduction, acting in the different phases of conception, especially in the early ones. In particular, HPV infection can affect sperm DNA integrity, sperm motility, count, viability, and morphology and can induce the production of anti-sperm antibodies (ASAs). In this narrative review, we aimed to provide an overview of existing research on the potential adverse effects of HPV infection on male reproductive health. Furthermore, we analyzed how limiting the spread of the infection, particularly with gender-neutral vaccination, could be a possible therapeutic tool to counteract male and female fertility problems.
Collapse
Affiliation(s)
- Arianna Sucato
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE) “G. D’Alessandro”, University of Palermo, Piazza delle Cliniche 2, 90127 Palermo, Italy; (A.S.); (M.B.)
| | - Michela Buttà
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE) “G. D’Alessandro”, University of Palermo, Piazza delle Cliniche 2, 90127 Palermo, Italy; (A.S.); (M.B.)
| | - Liana Bosco
- Section of Biology and Genetics, Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D), University of Palermo, 90133 Palermo, Italy;
| | | | - Antonio Perino
- IVF Unit, Department of Obstetrics and Gynecology, Villa Sofia Cervello Hospital, University of Palermo, 90146 Palermo, Italy;
| | - Giuseppina Capra
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE) “G. D’Alessandro”, University of Palermo, Piazza delle Cliniche 2, 90127 Palermo, Italy; (A.S.); (M.B.)
- UOC of Microbiology and Virology, Polyclinic Hospital, Via del Vespro 133, 90127 Palermo, Italy
| |
Collapse
|
3
|
Zullo F, Fiano V, Gillio-Tos A, Leoncini S, Nesi G, Macrì L, Preti M, Rolfo A, Benedetto C, Revelli A, De Marco L. Human papillomavirus infection in women undergoing in-vitro fertilization: effects on embryo development kinetics and live birth rate. Reprod Biol Endocrinol 2023; 21:39. [PMID: 37095514 PMCID: PMC10123972 DOI: 10.1186/s12958-023-01091-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 04/07/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUD Several studies showed that human papillomavirus (HPV) affects male fertility, but its impact on female fertility and in vitro fertilization (IVF) outcome is not yet clear. METHODS Objective of this observational, prospective, cohort study was to evaluate the prevalence of HPV infection in women candidate to IVF, and the effects of HPV infection on the kinetic of embryonic development and on IVF outcome. A total number of 457 women candidate to IVF were submitted to HR-HPV test; among them, 326 underwent their first IVF cycle and were included in the analysis on IVF results. RESULTS 8.9% of women candidate to IVF were HPV-positive, HPV16 being the most prevalent genotype. Among the infertility causes, endometriosis was significantly more frequent in HPV-positive than in negative women (31.6% vs. 10.1%; p < 0.01). Granulosa and endometrial cells resulted HPV-positive in 61% and 48% of the women having HPV-positive cervical swab, respectively. Comparing HPV-positive and negative women at their first IVF cycle, no significant difference was observed in the responsiveness to controlled ovarian stimulation (COS) in terms of number and maturity of retrieved oocytes, and of fertilization rate. The mean morphological embryo score was comparable in the two groups; embryos of HPV-positive women showed a quicker development in the early stages, with a significantly shorter interval between the appearance of pronuclei and their fusion. In the following days, embryo kinetic was comparable in the two groups until the early blastocyst stage, when embryos of HPV-positive women became significantly slower than those of HPV-negative women. Overall, these differences did not affect live birth rate/started cycle, that was comparable in HPV-positive and negative women (22.2 and 28.1%, respectively). CONCLUSIONS (a) the prevalence of HPV infection in women candidate to IVF is similar to that observed in the general female population of the same age range; (b) HPV infection migrates along the female genital apparatus, involving also the endometrium and the ovary, and perhaps participates in the genesis of pelvic endometriosis; (c) HPV slightly affects the developmental kinetic of in vitro-produced embryos, but does not exert an effect on live birth rate.
Collapse
Affiliation(s)
- Federica Zullo
- Gynecology and Obstetrics 1U, Physiopathology of Reproduction and IVF Unit, Dept. of SurgicalSciences, Sant'Anna Hospital, University of Torino, Torino, Italy
| | - Valentina Fiano
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO Piemonte, Turin, Italy
| | - Anna Gillio-Tos
- Centre for Cervical Cancer Screening, City of Health and Science Hospital, Turin, Italy
| | - Sara Leoncini
- Gynecology and Obstetrics 1U, Physiopathology of Reproduction and IVF Unit, Dept. of SurgicalSciences, Sant'Anna Hospital, University of Torino, Torino, Italy
| | - Ginevra Nesi
- Gynecology and Obstetrics 1U, Physiopathology of Reproduction and IVF Unit, Dept. of SurgicalSciences, Sant'Anna Hospital, University of Torino, Torino, Italy
| | - Luigia Macrì
- Centre for Cervical Cancer Screening, City of Health and Science Hospital, Turin, Italy
| | - Mario Preti
- Gynecology and Obstetrics 1U, Physiopathology of Reproduction and IVF Unit, Dept. of SurgicalSciences, Sant'Anna Hospital, University of Torino, Torino, Italy
| | - Alessandro Rolfo
- Gynecology and Obstetrics 2U, Physiopathology of Reproduction and IVF Unit, Dept. of Surgical Sciences, Sant'Anna Hospital, University of Torino, Via Ventimiglia 3, Torino, 10126, Italy
| | - Chiara Benedetto
- Gynecology and Obstetrics 1U, Physiopathology of Reproduction and IVF Unit, Dept. of SurgicalSciences, Sant'Anna Hospital, University of Torino, Torino, Italy
| | - Alberto Revelli
- Gynecology and Obstetrics 2U, Physiopathology of Reproduction and IVF Unit, Dept. of Surgical Sciences, Sant'Anna Hospital, University of Torino, Via Ventimiglia 3, Torino, 10126, Italy.
| | - Laura De Marco
- Centre for Cervical Cancer Screening, City of Health and Science Hospital, Turin, Italy
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO Piemonte, Turin, Italy
| |
Collapse
|
4
|
Zhaffal M, Salame A. Semen human papillomavirus (HPV) shedding in males: frequency, clinical significance, and reproductive outcomes—literature review. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2023. [DOI: 10.1186/s43043-023-00131-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
Abstract
Background
The interest in the HPV status of the male has risen after the discovery of HPV shedding in the semen. To date, there is no consensus on the true prevalence of male HPV infection, yet there is a rising body of evidence suggesting that male HPV infection might negatively affect the sperm parameters.
Main body
The concern that HPV can lead to a couple’s infertility and affect reproductive outcomes had increased after the multiple publications of semen criteria perturbations specifically the asthenospermia associated with HPV infection. An extensive literature review was performed to define the actual frequency of male HPV infection as well as the true extent of sperm analysis perturbations related to the HPV illness. We also intended to define the impact of these infections on reproductive outcomes and to highlight any treatment plans for affected couples.
Conclusion
HPV is a prevalent disease with a rising concern among the male populations given the suggested impact on sperm motility as well as the pregnancy and miscarriage rates post-ART treatment. Vaccines are being studied now as a possible infertility adjunct treatment for males who are already infected.
Collapse
|
5
|
Tramontano L, Sciorio R, Bellaminutti S, Esteves SC, Petignat P. Exploring the potential impact of human papillomavirus on infertility and assisted reproductive technology outcomes. Reprod Biol 2023; 23:100753. [PMID: 36889139 DOI: 10.1016/j.repbio.2023.100753] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/27/2023] [Accepted: 03/03/2023] [Indexed: 03/08/2023]
Abstract
Human papillomavirus (HPV) is a common sexually transmitted disease that has been linked to both cancer and reproductive health issues. While its impact on fertility and pregnancy success has been studied, there is still too little evidence about the influence of HPV on assisted reproductive technology (ART). Therefore, there exists a need for HPV testing in couples undergoing infertility treatments. Infertile men have been found to have a higher prevalence of seminal HPV infection, which can compromise sperm quality and reproductive function. As such, it could be important to investigate the correlation between HPV and ART outcomes in order to improve the quality of evidence. Understanding the potentially detrimental effects of HPV on ART outcomes may have promising important implications for the management of infertility. This minireview summarizes the so far limited developments in this area and highlights the major need for further well-designed studies to address this issue.
Collapse
Affiliation(s)
- Luca Tramontano
- Department of Women, Infants and Adolescents, Division of Obstetrics, Geneva University Hospitals, Boulevard de la Cluse 30, 1211 Genève 14, Switzerland
| | - Romualdo Sciorio
- Edinburgh Assisted Conception Programme, EFREC, Royal Infirmary of Edinburgh, UK.
| | - Serena Bellaminutti
- Department of Gynaecology and Obstetrics, Ospedale Regionale di Lugano, Lugano, Switzerland; Gynecology and Fertility Unit, Procrea Institute, Lugano, Switzerland; Gynecology Unit, Centro Medico, Lugano, Switzerland
| | - Sandro C Esteves
- ANDROFERT, Andrology and Human Reproduction Clinic, Campinas, Brazil; Department of Surgery (Division of Urology), University of Campinas, Brazil; Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Patrick Petignat
- Department of Women, Infants and Adolescents, Division of Obstetrics, Geneva University Hospitals, Boulevard de la Cluse 30, 1211 Genève 14, Switzerland
| |
Collapse
|
6
|
Gholizadeh O, Yekanipour Z, Kivi S, Farahbod F, Aqayinejad M, Tasoujizade Y, Yasamineh S, Amini P, Akbarzadeh S, Hajiesmaeili M, Poortahmasebi V. Review of the evidence of the effects of human papillomavirus infection and Gardnerella vaginalis, and their co-infection on infertility. Microb Pathog 2023; 175:105980. [PMID: 36642287 DOI: 10.1016/j.micpath.2023.105980] [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: 11/03/2022] [Revised: 01/03/2023] [Accepted: 01/04/2023] [Indexed: 01/14/2023]
Abstract
A prevalent sexually transmitted infection, the human papillomavirus (HPV) is typically obtained just after the first sexual activity. The majority of HPV infections are asymptomatic and temporary. Cervical, anal, penile, vaginal, vulvar, and oropharyngeal cancers can occur due to recurrent infections with high-risk (hr)-HPV strains, generally decades later. Infections with HPV are significantly associated with reproductive function abnormalities. Per recent research, HPV infections may result in male infertility by reducing sperm motility. The hr-HPV infection was a risk factor for miscarriage, and the indiscriminate HPV genotype increased the probability of premature labor unexpectedly. Women's endometrial trophoblastic cell implantation is decreased by HPV. Gardnerella vaginalis (GV), an anaerobic bacterium that is a component of the natural vaginal flora, can be associated with bacterial vaginosis (BV) when it starts to overgrow and emerge as the dominant species. Reduced Lactobacillus species abundance and GV are linked to female infertility. Data from in vitro studies suggests that sialidase produced by GV may facilitate the entry and growth of papilloma and other sexually transmitted viruses. Also, based on some studies conducted in the past, it can be said that GV and BV are associated with the development of uterine cancer. However, there is still not enough information about the exact mechanism of GV and HPV in causing infertility, which requires more research.
Collapse
Affiliation(s)
- Omid Gholizadeh
- Department of Bacteriology and Virology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran; Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zahra Yekanipour
- Department of Microbiology, Marand Branch, Islamic Azad University, Marand, Iran
| | - Setareh Kivi
- Department of Microbiology, Faculty of Science Islamic Azad University, Arak, Iran
| | - Farnoosh Farahbod
- Obstetric & Gynecologist Specialist, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohadeseh Aqayinejad
- Reproductive Health Research Center, Al-Zahra Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Yalda Tasoujizade
- Health System Research (HSR), Khoy University of Medical Sciences, Khoy, Iran
| | - Saman Yasamineh
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Parya Amini
- Cellular and Molecular Research Center and Department of Microbiology, Faculty of Medicine, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Sama Akbarzadeh
- Department of Animal Biology, Faculty of Natural Science, University of Tabriz, Tabriz, Iran
| | - Mehrnaz Hajiesmaeili
- Department of Microbiology, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Vahdat Poortahmasebi
- Department of Bacteriology and Virology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran; Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
| |
Collapse
|
7
|
Intra Uterine Insemination in Two Couples with HPV Detection by Hyaluronidase-Based Swim-up Washing: Cases Report. J Pers Med 2022; 13:jpm13010006. [PMID: 36675667 PMCID: PMC9864692 DOI: 10.3390/jpm13010006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/14/2022] [Accepted: 12/18/2022] [Indexed: 12/24/2022] Open
Abstract
Human papillomavirus (HPV) infection is the most common sexually transmitted disease worldwide and is associated with negative reproductive outcomes because of which it is recommended to postpone medically assisted reproduction (MAR). This raises major concerns for elder infertile couples. We showed that a hyaluronidase-based sperm washing (IALu) procedure blunted the HPV viral load in semen. Here, were report two cases of couples with long-term idiopathic infertility, ascribed to persistent semen HPV detection, finding a beneficial outcome from the use of IALu protocol applied to intra-uterine insemination (IUI). Case 1: A Caucasian couple (female aged 32, male aged 35), complained of having been attempting pregnancy for 4 years. HPV-DNA (genotypes 51 and 54) was detected on sperms. After a first unsuccessful IUI cycle attempt, using standard swim-up selection of spermatozoa, a second IUI cycle using the IALu procedure was associated with a pregnancy and a successful trimester of gestation. Case 2: A Caucasian couple (female aged 43, male aged 52) complained of having been attempting pregnancy for 3 years and showed the detection of HPV-DNA (genotype 66) on sperms. After a first unsuccessful standard IUI cycle attempt, two further IUI cycles using IALu procedure were pursued. The last cycle was associated with a pregnancy and a successful trimester of gestation. Although preliminary, the IALu procedure is a promising approach for straightforward fertility treatments in cases of recurrent HPV-DNA semen detection, avoiding critical latencies.
Collapse
|
8
|
Cannarella R, Aversa A, Condorelli RA, De Cristofaro S, Greco E, Grillo A, Calogero AE, La Vignera S. Impact of seminal low-risk human papillomavirus infection on sperm parameters of adult men. Aging Male 2022; 25:17-22. [PMID: 34978266 DOI: 10.1080/13685538.2021.2023126] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Aim: We aimed to evaluate the impact of seminal low-risk human Papillomavirus (LR-HPV) infection on sperm conventional parameters.Material and methods: This was a retrospective case-control study including patients attending to our center for infertility. Patients with evidence for high risk (HR)-HPV infection previously or at the time of enrollment, and/or with severe oligozoospermia (sperm concentration <5 mil/ml) were ruled out. Twenty selected patients positive for a LR-HPV and 20 control subjects with no evidence of HPV DNA and with available results of sperm analysis were consecutively enrolled.Results: Patients positive for LR-HPV had a mean age of 31.0 + 11.0 years, while controls were 35.0 + 8.0-year-old (p > .05). Sperm concentration, total sperm count, sperm progressive motility, morphology, and leukocyte concentration did not differ between patients and controls. However, the prevalence of oligozoospermia was significantly higher in patients than controls (50% vs. 15%). No difference in the prevalence of astenozoospermia (30% vs. 40%) or teratozoospermia (15% vs. 15%) was found.Conclusion: We found no difference in sperm conventional parameters in LR-HPV infected patients than in controls. These data might prompt to research the impact on LR-HPV genotype on male fertility. Particularly, evidence on sperm DNA fragmentation (SDF) and pregnancy outcome is needed.
Collapse
Affiliation(s)
- Rossella Cannarella
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Antonio Aversa
- Department of Experimental and Clinical Medicine, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Rosita A Condorelli
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Silvia De Cristofaro
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Emanuela Greco
- Department of Health Sciences, University "Magna Graecia", Catanzaro, Italy
| | - Agata Grillo
- Labogen (Specialized Human Genetics Laboratory), Catania, Italy
| | - Aldo E Calogero
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Sandro La Vignera
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| |
Collapse
|
9
|
Human Papillomavirus (HPV) Infection and Its Impact on Male Infertility. LIFE (BASEL, SWITZERLAND) 2022; 12:life12111919. [PMID: 36431054 PMCID: PMC9697777 DOI: 10.3390/life12111919] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 11/12/2022] [Accepted: 11/15/2022] [Indexed: 11/19/2022]
Abstract
Nowadays, the striking numbers of infertile couples that turn to assisted reproductive technologies (ART) drive the research toward a more comprehensive understanding of the underlying causes. Male factors contribute to the inability to conceive in half of the cases, and it has been suggested that sexually transmitted infections could have a role in the onset of spermatozoa impairments. Since the impact of HPV infection on sperm quality and sperm DNA integrity is debated, we wanted to analyze its impact on conventional seminal parameters and the sperm DNA fragmentation index (DFI). Therefore, 117 semen samples of patients undergoing IVF were evaluated for the following characteristics: HPV DNA detection and sperm DNA fragmentation, concentration, motility, and morphology. The results showed a higher rate of HPV-negative patients (59.8% vs. 40.2%) and no HPV-related effect on DFI, sperm concentration, total sperm number, and total motility. Only progressive motility and morphology were found as significantly influenced by HPV positivity. Moreover, we observed a statistically significant difference in DFI when comparing high-risk HPV (HR-HPV) and low-risk HPV (LR-HPV) genotypes. Our data suggest that the presence of any HPV type, whatever the exact localization of the virions, can impair some sperm parameters, while HR-HPVs specifically affect the integrity of spermatozoa DNA.
Collapse
|
10
|
Gunderson S, Eskew AM, Stoutenburg D, Riley JK, Stout MJ, Schrimpf J, Jungheim ES, Wylie KM. Association of the human semen DNA virome with successful in vitro fertilization. F&S SCIENCE 2022; 3:2-9. [PMID: 35559992 DOI: 10.1016/j.xfss.2021.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/27/2021] [Accepted: 10/29/2021] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To comprehensively characterize the DNA virome in semen samples collected for in vitro fertilization (IVF). DESIGN A descriptive clinical study. SETTING Single academic fertility center. PATIENT(S) Twenty-four male partners from couples undergoing IVF. INTERVENTION(S) Couples were randomized to receive 1 g of azithromycin (standard of care) or no azithromycin at the time of baseline IVF assessment. Semen samples were collected at the time of the female partners' egg retrieval, and 100 μL of the sample was used for the virome analysis. MAIN OUTCOME MEASURE(S) Detection of viruses by ViroCap enrichment of viral nucleic acid and sequencing. Association between the virome, semen parameters, and pregnancy outcomes. RESULT(S) We detected viruses in 58% of the participants. Viruses included polyomaviruses, papillomaviruses, herpesviruses, and anelloviruses. Viromes detected in semen had little overlap with the viromes detected in vaginal samples from their female partners collected at the time of embryo transfer, which were analyzed in a previous study. A lower viral diversity in semen samples was positively associated with pregnancy (Hodges-Lehmann estimate of difference, 1; 95% confidence interval, 2-0.00003). There was no association between viral diversity and sperm concentration, motility, or fertilization rates. CONCLUSION(S) This comprehensive characterization of the DNA virome in semen reveals an association between virome diversity and pregnancy in couples undergoing IVF. However, no association was found with specific semen parameters or fertilization rates, suggesting that viral exposure may negatively affect pregnancy after fertilization. Future studies should be undertaken to evaluate the associations between the semen virome with IVF outcomes in larger cohorts.
Collapse
Affiliation(s)
- Stephanie Gunderson
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Washington University in St Louis, St Louis, Missouri
| | - Ashley M Eskew
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Washington University in St Louis, St Louis, Missouri
| | - Dylan Stoutenburg
- Department of Pediatrics, Division of Infectious Diseases, Washington University in St Louis, St. Louis, Missouri
| | - Joan K Riley
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Washington University in St Louis, St Louis, Missouri
| | - Molly J Stout
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Washington University in St Louis, St. Louis, Missouri
| | - Jane Schrimpf
- Department of Pediatrics, Division of Infectious Diseases, Washington University in St Louis, St. Louis, Missouri
| | - Emily S Jungheim
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Washington University in St Louis, St Louis, Missouri
| | - Kristine M Wylie
- Department of Pediatrics, Division of Infectious Diseases, Washington University in St Louis, St. Louis, Missouri; McDonnell Genome Institute, Washington University in St Louis, St Louis, Missouri.
| |
Collapse
|
11
|
Jaworek H, Koudelakova V, Oborna I, Zborilova B, Brezinova J, Ruzickova D, Vrbkova J, Kourilova P, Hajduch M. Impact of human papillomavirus infection on semen parameters and reproductive outcomes. Reprod Biol Endocrinol 2021; 19:156. [PMID: 34627284 PMCID: PMC8501609 DOI: 10.1186/s12958-021-00840-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 09/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV) has been shown to adversely affect human reproduction. We aimed to evaluate the prevalence of human papillomavirus (HPV) infection in men and its correlation with semen parameters and reproductive outcomes. METHODS Semen samples and penile swabs were collected from potential sperm donors (SD, n = 97) and male partners of infertile couples (IM, n = 328). The presence of HPV DNA in semen samples and penile swabs was analyzed. Associations between hrHPV positive status and fertility outcomes as well as socio-behavioral and health characteristics were evaluated using the R software package. RESULTS High-risk HPV (hrHPV) genotypes were detected in 28.9% of SD and 35.1% of IM (P = 0.312). Penile swabs were more frequently positive for hrHPV genotypes than semen samples in both IM (32.3% vs. 11.9%, P < 0.001) and SD (26.8% vs. 6.2%, P = 0.006). Men with hrHPV positive semen samples had lower semen volume (median volume 2.5 ml vs. 3 ml, P = 0.009), sperm concentration (median concentration 16 × 106/ml vs. 31 × 106/ml, P = 0.009) and total sperm count (median count 46 × 106 vs. 82 × 106, P = 0.009) than men with hrHPV negative samples. No association was identified between penile hrHPV status and semen parameters. CONCLUSIONS Our findings indicate that penile HPV infection is common in both potential sperm donors and men from infertile couples. Although HPV positivity is higher in penile swabs, only HPV infection in semen samples affects sperm parameters. However, there was no association between hrHPV positivity in semen and fertility outcomes including abortion rate.
Collapse
Affiliation(s)
- Hana Jaworek
- Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 1333/5, 779 00, Olomouc, Czech Republic
| | - Vladimira Koudelakova
- Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 1333/5, 779 00, Olomouc, Czech Republic.
| | - Ivana Oborna
- Fertimed Ltd., Boleslavova 2, 776 00, Olomouc, Czech Republic.
- SpermBank International, Katerinska 13, 779 00, Olomouc, Czech Republic.
| | | | - Jana Brezinova
- SpermBank International, Katerinska 13, 779 00, Olomouc, Czech Republic
| | - Dagmar Ruzickova
- Arleta IVF Ltd., Komenskeho 702, 517 41, Kostelec nad Orlici, Czech Republic
| | - Jana Vrbkova
- Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 1333/5, 779 00, Olomouc, Czech Republic
| | - Pavla Kourilova
- Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 1333/5, 779 00, Olomouc, Czech Republic
| | - Marian Hajduch
- Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 1333/5, 779 00, Olomouc, Czech Republic
| |
Collapse
|
12
|
Ciavattini A, Marconi C, Giannella L, Delli Carpini G, Sopracordevole F, Di Giuseppe J. The Impact of 9-Valent HPV Vaccination on Couple Infertility Prevention: A Comprehensive Review. Front Med (Lausanne) 2021; 8:700792. [PMID: 34485336 PMCID: PMC8415838 DOI: 10.3389/fmed.2021.700792] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 07/22/2021] [Indexed: 11/17/2022] Open
Abstract
A comprehensive literature review was performed to determine the relationship between HPV infection and infertility and the eventual role of the 9-valent vaccine for infertility prevention. The search was extended from January 1997 through July 2021. Data collected from selected articles focused on three main topics: statistical associations between HPV prevalence and assisted reproductive technology (ART) outcome, association between HPV and characteristics of semen, and associations between HPV and miscarriage. Articles that identified HPV genotypes were selected for this review to study the possible role of the 9-valent vaccine in infertility prevention. To date, there is no agreement on the implication HPV female infection has on the fertility and miscarriage rate. Although it can be stated that HPV prevalence among couples with infertility undergoing ART treatment is consistent, it does not seem to affect the performance of oocytes. Otherwise, HPV infection affects sperm parameters, in particular spermatozoa motility. When an association can be found, most cases of HR-HPV involved are those included in the 9-valent vaccine. The correlation between HPV male infection both with asthenozoospermia and increased risk of pregnancy loss could recommend the extension of anti-HPV vaccination to adolescent males along with cancer prevention. Despite the fact that the relation between 9-valent HPV genotypes involved in female infection and miscarriage/infertility is not clear, the impact of this virus on health reproduction is evident. Considering this, the importance of HPV vaccination in adolescent females is confirmed. A vaccine efficacy study could be useful to confirm the importance of primary prevention for couple reproductive health.
Collapse
Affiliation(s)
- Andrea Ciavattini
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, Ancona, Italy
| | - Chiara Marconi
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, Ancona, Italy
| | - Luca Giannella
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, Ancona, Italy
| | - Giovanni Delli Carpini
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, Ancona, Italy
| | - Francesco Sopracordevole
- Gynecological Oncology Unit, Istituto di Ricovero e Cura a Carattere Scientifico Centro di Riferimento Oncologico (IRCCS CRO) Centro di Riferimento Oncologico - National Cancer Institute, Aviano, Italy
| | - Jacopo Di Giuseppe
- Woman's Health Sciences Department, Gynecologic Section, Polytechnic University of Marche, Ancona, Italy
| |
Collapse
|
13
|
Wang S, Liu L, Zhang A, Song Y, Kang J, Liu X. Association between human papillomavirus infection and sperm quality: A systematic review and a meta-analysis. Andrologia 2021; 53:e14034. [PMID: 33666259 DOI: 10.1111/and.14034] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 02/06/2021] [Accepted: 02/16/2021] [Indexed: 12/14/2022] Open
Abstract
Human papillomavirus (HPV) has a high incidence rate in both males and females. HPV infection in women has been shown to affect fertility and lead to foetal death and pregnancy loss. However, research on HPV infection in men is limited. The aim of this study was to study the effect of HPV infection in semen on sperm quality and present the findings of previous studies through a meta-analysis. Databases including PubMed, MEDLINE, EMBASE, Web of Science, Cochrane Library, WanFang data and China National Knowledge Infrastructure were searched for relevant studies. A systematic review and meta-analysis were performed, and 17 studies were included for analyses based on a set criterion. Meta-analyses indicated that HPV infection in semen significantly reduced sperm concentration (SMD = -0.12, 95% CI: -0.21 to -0.03, p = .009), sperm motility (SMD = -0.55, 95% CI: -0.780 to -0.33, p = .000), sperm viability (SMD = -0.55, 95% CI: -0.780 to -0.33, p = .000) and sperm morphology (SMD = -0.34, 95% CI: -0.61 to -0.07, p = .015). The high-risk HPV (HrHPV) infection could significantly reduce sperm count (SMD = -0.65, 95% CI: -1.11 to -0.18, p = .007) compared with high-risk HPV (LrHPV) infection. In conclusion, HPV infection in semen significantly reduced sperm quality, and the HrHPV infection could significantly reduce sperm count compared with LrHPV.
Collapse
Affiliation(s)
- Shangren Wang
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
| | - Li Liu
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
| | - Aiqiao Zhang
- Department of Neonatology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yuxuan Song
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
| | - Jiaqi Kang
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
| | - Xiaoqiang Liu
- Department of Urology, Tianjin Medical University General Hospital, Tianjin, China
| |
Collapse
|
14
|
Weinberg M, Sar-Shalom Nahshon C, Feferkorn I, Bornstein J. Evaluation of human papilloma virus in semen as a risk factor for low sperm quality and poor in vitro fertilization outcomes: a systematic review and meta-analysis. Fertil Steril 2021; 113:955-969.e4. [PMID: 32386620 DOI: 10.1016/j.fertnstert.2020.01.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 12/19/2019] [Accepted: 01/02/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To analyze the effect of human papilloma virus (HPV) sperm infection on sperm parameters and in vitro fertilization (IVF) outcomes. DESIGN Systematic review and meta-analysis. SETTING Not applicable. PATIENTS Men with HPV sperm infection and couples undergoing IVF. INTERVENTIONS Searches were conducted in the following databases: Medline(R), PubMed, Embase, Web of Science, Scopos, and the Cochrane Library. We included studies examining sperm parameters and IVF results in patients with and without HPV sperm infection. MAIN OUTCOME MEASURES Sperm analysis (concertation, count, volume, motility, morphology), according to the World Health Organization manual, pregnancy rate (PR), and miscarriage rate (MR). RESULTS Sixteen studies were included in this meta-analysis. The presence of HPV had a significant association with impaired sperm parameters in terms of concentration (mean difference [MD] -4.48, 95% confidence interval [CI] - 6.12 to -2.83), motility (MD -11.71, 95% CI - 16.15 to -7.26), and morphology (MD -2.44, 95% CI - 4.08 to -0.79. A review of the literature regarding ART outcomes showed an association between HPV infection and decreased PR, and an even stronger association between HPV infection and increased MR. CONCLUSION Our meta-analysis shows a negative effect of HPV on sperm concentration, motility, and morphology. Further subgroup and categorical analysis confirmed the clinical significance of impaired sperm motility in HPV-infected sperm, although the sperm count and morphology must be carefully analyzed. The studies reviewed reported lower PR and increased MR in couples with HPV-infected sperm. As most studies had a moderate risk of bias, these observations warrant further large, well-designed studies before introducing clinical management recommendations. PROSPERO REGISTRATION NUMBER CRD42019127419.
Collapse
Affiliation(s)
- May Weinberg
- Department of Obstetrics and Gynecology, Galilee Medical Center, Faculty of Medicine, Bar Ilan University, Nahariya, Israel
| | - Chen Sar-Shalom Nahshon
- Division of Reproductive Endocrinology - IVF, Department of Obstetrics and Gynecology, Carmel Medical Center, Bruce & Ruth Rappaport Faculty of Medicine, Haifa, Israel.
| | - Ido Feferkorn
- Division of Reproductive Endocrinology - IVF, Department of Obstetrics and Gynecology, Carmel Medical Center, Bruce & Ruth Rappaport Faculty of Medicine, Haifa, Israel
| | - Jacob Bornstein
- Department of Obstetrics and Gynecology, Galilee Medical Center, Faculty of Medicine, Bar Ilan University, Nahariya, Israel
| |
Collapse
|
15
|
Depuydt C, Donders G, Verstraete L, Beert J, Salembier G, Bosmans E, Dhont N, Kerkhofs C, Ombelet W. Negative Impact of Elevated DNA Fragmentation and Human Papillomavirus (HPV) Presence in Sperm on the Outcome of Intra-Uterine Insemination (IUI). J Clin Med 2021; 10:jcm10040717. [PMID: 33670283 PMCID: PMC7917808 DOI: 10.3390/jcm10040717] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/02/2021] [Accepted: 02/08/2021] [Indexed: 01/04/2023] Open
Abstract
We wanted to determine the sperm DNA fragmentation index (DFI) cutoff for clinical pregnancies in women receiving intra-uterine insemination (IUI) with this sperm and to assess the contribution of Human Papillomavirus (HPV) infection on sperm DNA damage and its impact on clinical pregnancies. Prospective non-interventional multi-center study with 161 infertile couples going through 209 cycles of IUI in hospital fertility centers in Flanders, Belgium. Measurement of DFI and HPV DNA with type specific quantitative PCRs (HPV 6, 11, 16, 18, 31, 33, 35, 39, 45, 51, 52, 53, 56, 58, 59, 66 and 68) in sperm before its use in IUI. Clinical pregnancy (CP) rate was used as the outcome to analyze the impact on fertility outcome and to calculated the clinical cutoff value for DFI. A DFI criterion value of 26% was obtained by receiver operating characteristic (ROC) curve analysis. Couples with a male DFI > 26% had significantly less CPs than couples with DFI below 26% (OR 0.0326; 95% CI 0.0019 to 0.5400; p = 0.017). In sperm, HPV prevalence was 14.8%/IUI cycle. Sperm samples containing HPV had a significantly higher DFI compared to HPV negative sperm samples (29.8% vs. 20.9%; p = 0.011). When HPV-virions were present in sperm, no clinical pregnancies were observed. More than 1 in 5 of samples with normal semen parameters (17/78; 21.8%) had an elevated DFI or was HPV positive. Sperm DFI is a robust predictor of clinical pregnancies in women receiving IUI with this sperm. When DFI exceeds 26%, clinical pregnancies are less likely and in vitro fertilization techniques should be considered.
Collapse
Affiliation(s)
- Christophe Depuydt
- Department of Hormonology and Reproductive Health, AML, Sonic Healthcare, 2020 Antwerp, Belgium; (C.D.); (L.V.); (J.B.); (E.B.)
- Intermediate Structure for Human Body Material, AML, Sonic Healthcare, 2020 Antwerp, Belgium
| | - Gilbert Donders
- Femicare, Clinical Research for Women, 3300 Tienen, Belgium
- University Hospital Antwerpen, 2650 Antwerp, Belgium
- Department of Obstetrics and Gynecology, Regional Hospital Heilig Hart, 3300 Tienen, Belgium
- Correspondence: or ; Tel.: +32-16-808102
| | - Ludo Verstraete
- Department of Hormonology and Reproductive Health, AML, Sonic Healthcare, 2020 Antwerp, Belgium; (C.D.); (L.V.); (J.B.); (E.B.)
- Intermediate Structure for Human Body Material, AML, Sonic Healthcare, 2020 Antwerp, Belgium
| | - Johan Beert
- Department of Hormonology and Reproductive Health, AML, Sonic Healthcare, 2020 Antwerp, Belgium; (C.D.); (L.V.); (J.B.); (E.B.)
- Intermediate Structure for Human Body Material, AML, Sonic Healthcare, 2020 Antwerp, Belgium
- Department of Clinical and Molecular Pathology, AML, Sonic Healthcare, 2020 Antwerp, Belgium;
| | - Geert Salembier
- Department of Clinical and Molecular Pathology, AML, Sonic Healthcare, 2020 Antwerp, Belgium;
| | - Eugene Bosmans
- Department of Hormonology and Reproductive Health, AML, Sonic Healthcare, 2020 Antwerp, Belgium; (C.D.); (L.V.); (J.B.); (E.B.)
- Intermediate Structure for Human Body Material, AML, Sonic Healthcare, 2020 Antwerp, Belgium
| | - Nathalie Dhont
- Genk Institute for Fertility Technology, ZOL Hospitals, 3600 Genk, Belgium; (N.D.); (C.K.); (W.O.)
| | - Carmen Kerkhofs
- Genk Institute for Fertility Technology, ZOL Hospitals, 3600 Genk, Belgium; (N.D.); (C.K.); (W.O.)
| | - Willem Ombelet
- Genk Institute for Fertility Technology, ZOL Hospitals, 3600 Genk, Belgium; (N.D.); (C.K.); (W.O.)
- Faculty of Medicine and Life Sciences, Hasselt University, 3500 Hasselt, Belgium
| |
Collapse
|
16
|
Batiha O, Al-Deeb T, Al-Zoubi E, Alsharu E. Impact of COVID-19 and other viruses on reproductive health. Andrologia 2020; 52:e13791. [PMID: 32790205 PMCID: PMC7435575 DOI: 10.1111/and.13791] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/07/2020] [Accepted: 07/12/2020] [Indexed: 12/15/2022] Open
Abstract
Male infertility is linked to some viral infections including human papillomavirus (HPV), herpes simplex viruses (HSV) and human immunodeficiency viruses (HIVs). Almost nothing is known about severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) effect on fertility. The possible risk factors of coronavirus disease 2019 (COVID‐19) infection on fertility comes from the abundance of angiotensin‐Converting Enzyme‐2 (ACE2), receptor entry of the virus, on testes, a reduction in important sex hormone ratios and COVID‐19‐associated fever. Recent studies have shown a gender difference for COVID‐19 rates and comorbidity. In this review, we will discuss the potential effect of COVID‐19 on male fertility and talk about what needs to be done by the scientific community to tackle our limited understanding of the disease. On the other side, we will focus on what is known so far about the risk of COVID‐19 on pregnancy, neonatal health and the vertical transfer of the virus between mothers and their neonates. Finally, because reproduction is a human right and infertility is considered a health disease, we will discuss how assisted reproductive clinics can cope with the pandemic and what guidelines they should follow to minimise the risk of viral transmission.
Collapse
Affiliation(s)
- Osamah Batiha
- Department of Biotechnology and Genetic Engineering, Jordan University of Science and Technology, Irbid, Jordan
| | - Taghleb Al-Deeb
- Department of Biological Sciences, Al al-Bayt University, Mafraq, Jordan
| | - Esra'a Al-Zoubi
- Department of Biotechnology and Genetic Engineering, Jordan University of Science and Technology, Irbid, Jordan
| | - Emad Alsharu
- Reproductive Endocrinology and IVF Unit, King Hussein Medical Center, Amman, Jordan
| |
Collapse
|
17
|
Boeri L, Capogrosso P, Ventimiglia E, Pederzoli F, Cazzaniga W, Chierigo F, Pozzi E, Clementi M, Viganò P, Montanari E, Montorsi F, Salonia A. High-risk human papillomavirus in semen is associated with poor sperm progressive motility and a high sperm DNA fragmentation index in infertile men. Hum Reprod 2020; 34:209-217. [PMID: 30517657 DOI: 10.1093/humrep/dey348] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 11/07/2018] [Indexed: 01/15/2023] Open
Abstract
STUDY QUESTION Does the presence of human papillomavirus (HPV) in semen impact seminal parameters and sperm DNA quality in white European men seeking medical help for primary couple's infertility? SUMMARY ANSWER HPV seminal infections involving high-risk (HR) genotypes are associated with impaired sperm progressive motility and sperm DNA fragmentation (SDF) values. WHAT IS KNOWN ALREADY HPV is commonly present in semen samples. However, whether the presence of HPV in semen is actually associated with impaired sperm parameters and SDF values have yet to be elucidated. STUDY DESIGN, SIZE, DURATION In this cross-sectional study, complete demographic, clinical and laboratory data from 729 infertile men were analysed. PARTICIPANTS/MATERIALS, SETTING, METHODS Health-significant comorbidities were scored with the Charlson comorbidity index (CCI). Serum hormones and SDF index (measured by the sperm chromatin structure assay [SCSA]) were measured in every patient (SDF ≥30% was defined as pathological). Semen analysis was based on 2010 World Health Organisation reference criteria. Amplification by nested PCR was used to detect HPV-DNA sequences in semen samples. Descriptive statistics and linear regression models were used to test the association between the presence of HPV and clinical and seminal characteristics in the whole cohort. MAIN RESULTS AND THE ROLE OF CHANCE The overall rate of HPV positivity was 15.5% (113/729). Overall, 78/729 (10.7%) and 35/729 (4.8%) patients had HR HPV+ and low-risk HPV+, respectively. HPV16 was the most prevalent type (22.1%), followed by HPV43 (10.6%), HPV56 and HPV42 (both 8.8%). No differences were found in terms of clinical and hormonal characteristics between patients with or without seminal HPV. Sperm progressive motility was significantly lower (P = 0.01) while SDF values were higher (P = 0.005) in HPV+ men compared to those with no HPV. In particular, HR HPV+ men had lower sperm progressive motility (P = 0.007) and higher SDF values (P = 0.003) than those with a negative HPV test. Univariable analysis showed that HR HPV+ was associated with impaired sperm progressive motility (P = 0.002) and SDF values (P = 0.003). In the multivariable analysis, age, FSH levels and testicular volume were significantly associated with impaired sperm progressive motility (all P ≤ 0.04). Conversely BMI, CCI, smoking habits and HPV status were not. Only age (P = 0.02) and FSH (P = 0.01) were significantly associated with SDF, after accounting for BMI, CCI, testicular volume, smoking habits and HPV status. LIMITATIONS, REASONS FOR CAUTION Main limitations are the cross-sectional design of our study and the relatively small sample size of the subgroups. Additional limitations are the lack of a control group of normal fertile men and the lack of follow-up testing to check the clearance or the persistence of HPV in semen after a 6-12 months. WIDER IMPLICATIONS OF THE FINDINGS Overall, these observations point out the importance of an accurate investigation of seminal HPV presence in everyday clinical practice in the diagnostic work-up of infertile men. STUDY FUNDING/COMPETING INTEREST(S) No external funding was used. There are no competing interests.
Collapse
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
| | - Paolo Capogrosso
- 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.,University Vita-Salute San Raffaele, Milan, Italy
| | - Filippo Pederzoli
- 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
| | - Francesco Chierigo
- 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
| | - Massimo Clementi
- University Vita-Salute San Raffaele, Milan, Italy.,Laboratory of Microbiology and Virology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Paola Viganò
- Infertility Unit, Unit of Obstetrics/Gynecology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Emanuele Montanari
- Department of Urology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, 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
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,University Vita-Salute San Raffaele, Milan, Italy
| |
Collapse
|
18
|
HPV Infection Affects Human Sperm Functionality by Inhibition of Aquaporin-8. Cells 2020; 9:cells9051241. [PMID: 32429588 PMCID: PMC7291193 DOI: 10.3390/cells9051241] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/11/2020] [Accepted: 05/14/2020] [Indexed: 12/20/2022] Open
Abstract
Human sperm cells express different aquaporins (AQPs), AQP3, 7, 8, 11, which are localized both in the plasma membrane and in intracellular structures. Besides cell volume regulation and end stage of cytoplasm removal during sperm maturation, the role of AQPs extends also to reactive oxygen species (ROS) elimination. Moreover, oxidative stress has been shown to inhibit AQP-mediated H2O2 permeability. A decrease in AQPs functionality is related to a decrease in sperm cells number and motility. Here we investigate the possible effect of human Papillomavirus (HPV) on both expression and function of AQPs in human sperm cells of patients undergoing infertility couple evaluation. Stopped-flow light-scattering experiments demonstrated that HPV infection heavily reduced water permeability of sperm cells in normospermic samples. Confocal immunofluorescence experiments showed a colocalization of HPV L1 protein with AQP8 (Pearson’s correlation coefficient of 0.61), confirmed by co-immunoprecipitation experiments. No interaction of HPV with AQP3 and AQP7 was observed. A 3D model simulation of L1 protein and AQP8 interaction was also performed. Present findings may suggest that HPV infection directly inhibits AQP8 functionality and probably makes sperm cells more sensitive to oxidative stress.
Collapse
|
19
|
Xiong YQ, Chen YX, Cheng MJ, He WQ, Chen Q. The risk of human papillomavirus infection for male fertility abnormality: a meta-analysis. Asian J Androl 2019; 20:493-497. [PMID: 29623908 PMCID: PMC6116676 DOI: 10.4103/aja.aja_77_17] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Human papillomavirus (HPV) is the most common sexually transmitted virus in males and females worldwide; yet its impact upon male fertility remains unclear. The objective of this study was to evaluate the potential impact of HPV infection in semen on male fertility abnormality. A systematic literature search was performed in PubMed, Medline, Embase, Web of Science, and the Cochrane Library database for relevant publications up to May 6, 2017. The odds ratio (OR), and its corresponding 95% confidence interval (CI), was selected to represent the effect size. Statistical analysis was conducted using STATA 12.0. In total, eight articles, providing data on 1955 participants, were included in this meta-analysis. Collectively, the data suggested that HPV infection of semen was a risk factor for male fertility abnormality with an OR of 3.02 (95% CI: 2.11-4.32; I2 = 6.9%). Sensitivity analysis revealed that the results of this study were robust. In conclusion, HPV infection of semen represents a risk factor for male fertility abnormality.
Collapse
Affiliation(s)
- Yi-Quan Xiong
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangdong Provincial Key Laboratory of Tropical Disease Research, Guangzhou 510515, China
| | - Yan-Xia Chen
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangdong Provincial Key Laboratory of Tropical Disease Research, Guangzhou 510515, China
| | - Ming-Ji Cheng
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangdong Provincial Key Laboratory of Tropical Disease Research, Guangzhou 510515, China
| | - Wen-Qiao He
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangdong Provincial Key Laboratory of Tropical Disease Research, Guangzhou 510515, China
| | - Qing Chen
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangdong Provincial Key Laboratory of Tropical Disease Research, Guangzhou 510515, China
| |
Collapse
|
20
|
Bossi RDL, Valadares JBF, Puerto HLD, Rocha MGL, Braga LC, Sampaio MAC, França PP, Alvarenga DM, Geber S. Prevalence of human papillomavirus (HPV) in the semen of patients submitted to assisted reproductive technology treatment in a private clinic in Brazil. JBRA Assist Reprod 2019; 23:205-209. [PMID: 30875170 PMCID: PMC6724393 DOI: 10.5935/1518-0557.20190009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Objective: The aim of our study was to identify the prevalence of HPV in the semen of
men submitted to ART treatment and look into the possible impacts of the
virus on sperm parameters. Methods: Thirty-five patients treated for infertility from March to August 2016 were
invited to join the study. Samples with a minimum concentration of
40x106 spermatozoa per milliliter were included in the study.
After the evaluation of semen parameters, DNA extraction and PCR were
performed to verify the presence of HPV by electrophoresis in 8%
polyacrylamide gel. Results: Patient age ranged from 27 to 68 years (mean 39.2 years). Semen analysis
showed a mean volume of 2.5mL; mean concentration of 58.9x106;
and mean motility of 51.8%. HPV DNA was identified in seven semen samples
from 25 patients (28%). Ten samples with DNA concentrations below
10ng/µL were excluded from the study due to poor amplification
quality. There was no statistical difference in sperm concentration when
HPV-negative and HPV-positive samples were compared (65.9x106 vs.
62.3x106; p=0.70). However, sperm motility
was significantly higher in HPV-positive semen (65% vs. 46.6%;
p=0.02). Conclusions: HPV prevalence was 28% in the semen of patients submitted to ART treatment.
HPV-positive samples had statistically increased motility compared to
negative samples (65% vs. 46.6%; p=0.02).
Collapse
Affiliation(s)
| | | | - Helen Lima Del Puerto
- Departamento de Patologia Geral do Instituto de Ciências Biológicas da Universidade Federal de Minas Gerais- Brazil
| | - Maria Gabrielle Lima Rocha
- Departamento de Análises Clinicas e Toxicológicas da Faculdade de Farmácia da Universidade Federal de Minas Gerais - Brazil
| | | | | | | | | | - Selmo Geber
- Centro de Medicina Reprodutiva- Belo Horizonte/MG- Brazil
| |
Collapse
|
21
|
Human Papilloma Virus (HPV) and Fertilization: A Mini Review. ACTA ACUST UNITED AC 2018; 54:medicina54040050. [PMID: 30344281 PMCID: PMC6174353 DOI: 10.3390/medicina54040050] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 07/19/2018] [Accepted: 07/24/2018] [Indexed: 12/12/2022]
Abstract
Human papilloma virus (HPV) is one of the most prevalent viral sexually transmitted diseases. The ability of HPV to induce malignancy in the anogenital tract and stomato-pharyngeal cavity is well documented. Moreover, HPV infection may also affect reproductive health and fertility. Although, the impact of HPV on female fertility has not been thoroughly studied it has been found also to have an impact on semen parameters. Relative information can be obtained from studies investigating the relationship between HPV and pregnancy success. Furthermore, there is an ongoing debate whether HPV alters the efficacy of assisted reproductive technologies. An association between HPV and assisted reproductive technologies (ART) programs has been reported. Nevertheless, due to conflicting data and the small number of existing studies further research is required. It remains to be clarified whether HPV detection and genotyping could be included in the diagnostic procedures in couples undergoing in vitro fertilization (IVF)/intrauterine insemination (IUI) treatments. Vaccination of both genders against HPV can reduce the prevalence of HPV infection and eliminate its implications on human fertility. The aim of the present mini-review is to reiterate the association between HPV and human fertility through a systematic literature review.
Collapse
|
22
|
Tangal S, Taşçı Y, Pabuçcu EG, Çağlar GS, Haliloğlu AH, Yararbaş K. DNA fragmentation index and human papilloma virus in males with previous assisted reproductive technology failures. Turk J Urol 2018; 45:12-16. [PMID: 29975635 DOI: 10.5152/tud.2018.96393] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 02/15/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVE This study was designed to evaluate the prevalence of Human Papilloma Virus (HPV) in semen and document the cycle outcomes in couples with previous intra-cytoplasmic sperm injection (ICSI) failures. MATERIAL AND METHODS One hundred and seventeen couples with at least two ICSI attempts were included in the study. HPV infection in semen and DNA fragmentation in samples were analyzed by commercially available kits. The percentage of spermatozoa with fragmented DNA (DNA fragmentation index: DFI) was determined during fluorescence microscopic examination as previously described. The cycle outcomes of couples with or without HPV infected male partners were recorded. RESULTS According to our results, the prevalence of HPV was 7.7% in asymptomatic males with at least two previous ICSI failures. The increased DFI (>30%) was observed in 82.9% of the cases. In HPV-positive cases significantly lower number of good quality embryos were obtained. The implantation and pregnancy rates were similar in infected and non-infected males (p>0.05). The early miscarriage rate was slightly higher in HPV- positive group (33% vs. 10%, p>0.05). CONCLUSION In cases with previous ICSI failures, the prevalence of HPV infection in semen is not higher than previously reported infertile populations. The reproductive outcome might be impaired in HPV-positive semen due to lower number of good quality embryos, which needs to be clarified by further large population-based studies.
Collapse
Affiliation(s)
- Semih Tangal
- Department of Urology, Ufuk University School of Medicine, Ankara, Turkey
| | - Yasemin Taşçı
- Department of Obstetrics and Gynecology, Zekai Tahir Burak Training and Research Hospital, Ankara, Turkey
| | - Emre Göksan Pabuçcu
- Department of Obstetrics and Gynecology, Ufuk University School of Medicine, Ankara, Turkey
| | - Gamze Sinem Çağlar
- Department of Obstetrics and Gynecology, Ufuk University School of Medicine, Ankara, Turkey
| | | | - Kanay Yararbaş
- Department of Genetic, Acıbadem University School of Medicine, İstanbul, Turkey
| |
Collapse
|
23
|
Çağlar GS, Garrido N. The implications of male human papilloma virus infection in couples seeking assisted reproduction technologies. J Turk Ger Gynecol Assoc 2018; 19:48-52. [PMID: 29503262 PMCID: PMC5838778 DOI: 10.4274/jtgga.2017.0031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Human papilloma virus (HPV) is one of the most common viral sexually-transmitted diseases worldwide. The prevalence of HPV is higher in infertile males when compared with fertile men and ranges between 10 and 35.7% in men affected by unexplained infertility. HPV can bind to spermatozoa and can potentially be transferred to fertilized oocytes. Viral detection in blastocysts and trophoblastic cells is associated with impaired embryo development and poor pregnancy outcomes. Nevertheless, attempts to eliminate HPV-DNA from sperm samples through routine washing techniques have failed. In assisted reproduction technologies (ART), intracytoplasmic sperm injection involves no natural selection of the sperm cell, which means that these procedures have a plausible risk of injecting sperm containing HPV. The possible detrimental effects of HPV on ART in couples with infected male partners are summarized in this review.
Collapse
Affiliation(s)
- Gamze Sinem Çağlar
- Department of Obstetrics and Gynecology, Ufuk University School of Medicine, Ankara, Turkey
| | - Nicolas Garrido
- Andrology Laboratory and Sperm Bank at the Instituto Valenciano de Infertilidad, Valencia, Spain
| |
Collapse
|
24
|
Cortés-Gutiérrez EI, Dávila-Rodríguez MI, Fernández JL, de la O-Pérez LO, Garza-Flores ME, Eguren-Garza R, Gosálvez J. The presence of human papillomavirus in semen does not affect the integrity of sperm DNA. Andrologia 2017; 49. [DOI: 10.1111/and.12774] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2016] [Indexed: 01/18/2023] Open
Affiliation(s)
- E. I. Cortés-Gutiérrez
- Department of Genetics; Centro de Investigación Biomédica del Noreste; Instituto Mexicano del Seguro Social, IMSS; Monterrey México
| | - M. I. Dávila-Rodríguez
- Department of Genetics; Centro de Investigación Biomédica del Noreste; Instituto Mexicano del Seguro Social, IMSS; Monterrey México
| | - J. L. Fernández
- Genetics Unit; INIBIC; Complejo Hospitalario Universitario A Coruña; La Coruña Spain
- Laboratorio de Genética Molecular y Radiobiología; Centro Oncológico de Galicia; La Coruña Spain
| | - L. O. de la O-Pérez
- Department of Biology Reproduction; Unidad Médica de Alta Especialidad No. 23; IMSS; Monterrey México
| | - M. E. Garza-Flores
- Department of Biology Reproduction; Unidad Médica de Alta Especialidad No. 23; IMSS; Monterrey México
| | - R. Eguren-Garza
- Department of Biology Reproduction; Unidad Médica de Alta Especialidad No. 23; IMSS; Monterrey México
| | - J. Gosálvez
- Unit of Genetics; Department of Biology; Universidad Autónoma de Madrid; Madrid Spain
| |
Collapse
|
25
|
Human Papillomavirus Infection, Infertility, and Assisted Reproductive Outcomes. J Pathog 2015; 2015:578423. [PMID: 26609434 PMCID: PMC4644557 DOI: 10.1155/2015/578423] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 09/30/2015] [Indexed: 01/10/2023] Open
Abstract
The human papillomavirus (HPV) is a sexually transmitted infection common among men and women across all geographic and socioeconomic subgroups worldwide. Recent evidence suggests that HPV infection may affect fertility and alter the efficacy of assisted reproductive technologies. In men, HPV infection can affect sperm parameters, specifically motility. HPV-infected sperm can transmit viral DNA to oocytes, which may be expressed in the developing blastocyst. HPV can increase trophoblastic apoptosis and reduce the endometrial implantation of trophoblastic cells, thus increasing the theoretical risk of miscarriage. Vertical transmission of HPV during pregnancy may be involved in the pathophysiology of preterm rupture of membranes and spontaneous preterm birth. In patients undergoing intrauterine insemination for idiopathic infertility, HPV infection confers a lower pregnancy rate. In contrast, the evidence regarding any detrimental impact of HPV infection on IVF outcomes is inconclusive. It has been suggested that vaccination could potentially counter HPV-related sperm impairment, trophoblastic apoptosis, and spontaneous miscarriages; however, these conclusions are based on in vitro studies rather than large-scale epidemiological studies. Improvement in the understanding of HPV sperm infection mechanisms and HPV transmission into the oocyte and developing blastocyst may help explain idiopathic causes of infertility and miscarriage.
Collapse
|
26
|
Garolla A, Engl B, Pizzol D, Ghezzi M, Bertoldo A, Bottacin A, Noventa M, Foresta C. Spontaneous fertility and in vitro fertilization outcome: new evidence of human papillomavirus sperm infection. Fertil Steril 2015; 105:65-72.e1. [PMID: 26453270 DOI: 10.1016/j.fertnstert.2015.09.018] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 09/12/2015] [Accepted: 09/14/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To evaluate the reproductive outcome of infertile couples undergoing assisted reproduction techniques (ART) with or without human papillomavirus (HPV) semen infection. DESIGN Cross-sectional clinical study. SETTING Units of andrology, reproductive medicine, and gynecology. PATIENT(S) A total of 226 infertile couples. INTERVENTION(S) Male partners were evaluated by means of fluorescence in situ hybridization (FISH) for HPV on semen. After a diagnostic period, female partners underwent intrauterine insemination (IUI) or intracytoplasmic sperm injection (ICSI). MAIN OUTCOME MEASURE(S) Seminal parameters and FISH analysis for HPV in sperm head. Spontaneous or assisted pregnancies, live births, and miscarriages were recorded. Statistical analysis included unpaired Student t test and chi-square test. RESULT(S) Fifty-four male partners (23.9%) had HPV semen infection confined to sperm, confined to exfoliated cells, or in both cells. During the diagnostic period, noninfected couples showed spontaneous pregnancies. IUI and ICSI treatments were performed in, respectively, 60 and 98 noninfected and in 21 and 33 infected couples, with 38.4% and 14.2% cumulative pregnancy rates, respectively. The follow-up of pregnancies showed a higher miscarriage rate in infected couples (62.5% vs. 16.7%). Ongoing pregnancies of the latter group were characterized by HPV infection confined to exfoliated cells. CONCLUSION(S) A reduction in natural and assisted cumulative pregnancy rate and an increase in miscarriage rate are related to the presence of HPV at sperm level. Although the exact mechanism by which sperm infection is able to impair fertility remains unclear, this aspect is worthy of further investigations. If confirmed, these results could change the clinical and diagnostic approach to infertile couples.
Collapse
Affiliation(s)
- Andrea Garolla
- Unit of Andrology and Reproductive Medicine, Department of Medicine, University of Padova, Padova, Italy.
| | - Bruno Engl
- Obstetrics and Gynecology Unit, Brunico, Italy
| | - Damiano Pizzol
- Unit of Andrology and Reproductive Medicine, Department of Medicine, University of Padova, Padova, Italy
| | - Marco Ghezzi
- Unit of Andrology and Reproductive Medicine, Department of Medicine, University of Padova, Padova, Italy
| | - Alessandro Bertoldo
- Unit of Andrology and Reproductive Medicine, Department of Medicine, University of Padova, Padova, Italy
| | - Alberto Bottacin
- Unit of Andrology and Reproductive Medicine, Department of Medicine, University of Padova, Padova, Italy
| | - Marco Noventa
- Department of Woman and Child Health, University of Padova, Padova, Italy
| | - Carlo Foresta
- Unit of Andrology and Reproductive Medicine, Department of Medicine, University of Padova, Padova, Italy
| |
Collapse
|
27
|
Abstract
Background HPV is the most prevalent sexually transmitted infection and its effect in cancer induction is well documented. HPV infections are mostly asymptomatic, but it is unclear whether HPV infections can result in alterations of reproductive health. Objective To determine the relationship between human papillomavirus infections and reproductive health in both men and women. Methods A systematic literature review was performed in PubMed and ScienceDirect data bases from January 1994 through August 2014. Results HPV infections are shown to be significantly associated to many adverse effects in the reproductive function. These adverse effects were reported in different levels from cells production to pregnancy and may be related to the infecting genotype. Conclusions It appears from this study that HPV detection and genotyping could be of great value in infertility diagnosis at least in idiopathic infertility cases. Like for the risk of carcinogenesis, another classification of HPV regarding the risk of fertility alteration may be considered after deep investigations.
Collapse
|
28
|
Foresta C, Noventa M, De Toni L, Gizzo S, Garolla A. HPV-DNA sperm infection and infertility: from a systematic literature review to a possible clinical management proposal. Andrology 2014; 3:163-73. [PMID: 25270519 DOI: 10.1111/andr.284] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 07/25/2014] [Accepted: 09/01/2014] [Indexed: 01/26/2023]
Abstract
The objectives of this study were to investigate the implications of human papillomavirus (HPV) sperm infection on male fertility, impairment of sperm parameters, and possible alteration of sperm nuclear status and to identify a possible effective management of infertile men with HPV sperm infection. We employed a systematic review and clinical management proposal at the Centers for Reproductive and Health care for treating infertile male patients with HPV infection. Literature search was carried out in electronic databases in the last two decades. We focused our attention on: (i) HPV sperm prevalence (ii) HPV-related alteration of sperm parameters; (iii) molecular mechanisms of HPV semen infection and infertility. The main outcome measures were HPV prevalence in infertile male patients and semen parameters. The prevalence of HPV sperm infection ranges between 2 and 31% in men from general population and between 10 and 35.7% in men affected by unexplained infertility. The presence of HPV in semen is associated with an impairment of sperm motility and the presence of anti-sperm antibodies. The molecular mechanisms underlying impairment of sperm motility apparatus need further evaluations. A greater attention should be applied to assess HPV sperm infection, particularly in men undergoing assisted reproduction techniques cycle for male infertility or sperm banking. It would be useful to perform HPV test and fluorescent in situ hybridization analysis for HPV in semen from these patients both at first admission, to define the possible presence and localization of semen infection, and after 6 months, to assess the possible virus clearance retrieval on normal sperm parameters.
Collapse
Affiliation(s)
- C Foresta
- Department of Medicine and Centre for Human Reproduction Pathology, University of Padova, Padova, Italy
| | | | | | | | | |
Collapse
|
29
|
High HPV infection prevalence in men from infertile couples and lack of relationship between seminal HPV infection and sperm quality. BIOMED RESEARCH INTERNATIONAL 2014; 2014:956901. [PMID: 24809062 PMCID: PMC3997886 DOI: 10.1155/2014/956901] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 03/12/2014] [Accepted: 03/14/2014] [Indexed: 12/24/2022]
Abstract
Human papillomaviruses (HPV) are the most frequently sexually transmitted viruses and etiological agents of several human cancers. Controversial results of the role of HPV in infertile population on sperm parameters have been published. The aim of this study was to estimate the type-specific prevalence of HPV DNA infection of the external genitalia and semen in 340 Slovenian men from infertile couples and to establish the relationship between seminal HPV DNA infection and abnormal sperm parameters. Self-taken swabs of the entire penile surface and semen samples were collected, and HPV detection and genotyping were performed. HPV DNA was detected in 37.12% of external genitalia and in 13.61% of semen samples with high HPV type concordance of both sampling sites. The most prevalent HPV types in the male external genitalia were HPV-CP6108 and HPV-84. The most prevalent HPV types in semen were HPV-53 and HPV-CP6108. The prevalence of HPV infection between normozoospermic men and men with abnormal sperm parameters did not differ significantly. Sperm quality did not differ significantly between men with seminal HPV infection and uninfected men. In conclusion, the men from infertile couples are equally susceptible to HPV infection regardless of their fertile potential; seminal HPV infection does not impair sperm quality.
Collapse
|
30
|
Male and couple fertility impairment due to HPV-DNA sperm infection: update on molecular mechanism and clinical impact--systematic review. BIOMED RESEARCH INTERNATIONAL 2014; 2014:230263. [PMID: 24783196 PMCID: PMC3982419 DOI: 10.1155/2014/230263] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Accepted: 02/10/2014] [Indexed: 01/21/2023]
Abstract
Recent evidences identify Human Papillomavirus (HPV) sperm infection as a possible cause of male and couple infertility. It acts through different mechanisms at various steps of human conception and early gestational development. We performed a systematic review to assess the role of HPV semen infection on male and couple infertility. Analysis of available and eligible data does not permit us to fund clear evidences about clinical impact of HPV infection on fertility, although sperm parameters impairment is the most widely recognized effect. Regarding biomolecular implications, the available data are often conflicting. More studies are required to define the role of HPV sperm infection in clinical practice. The great majority of evidences are obtained by in vitro studies and this fact represents a limitation for the clinical management of HPVDNA sperm infection. Understanding the biological significance of HPV-DNA semen infection could permit us to explain most of the idiopathic male and couple infertility, leading to a better management of infertile men and a better timing for sperm banking storage before ART cycles.
Collapse
|
31
|
Silva MAR, Silva ECB, Gurgel APAD, Nascimento KCG, Freitas AC. Bovine papillomavirus E2 and E5 gene expression in sperm cells of healthy bulls. Virusdisease 2014; 25:125-8. [PMID: 24426320 PMCID: PMC3889234 DOI: 10.1007/s13337-013-0185-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 11/14/2013] [Indexed: 10/26/2022] Open
Abstract
Papillomaviruses are found in epithelial lesions and are linked to different carcinogenic processes in humans and other animals. Although BPV has been characterized as epitheliotropic, the presence of viral DNA has been detected in other tissues and fluids, such as fresh semen. The aim of this study was to evaluate the presence and expression of BPV in sperm cells of bulls (Bos taurus) asymptomatic for papillomatosis. A PCR assay was carried out with specific primers to test BPV2 in 26 semen samples. The presence of BPV transcripts was assessed by RT-PCR to E2 and E5 genes. BPV2 DNA was detected in nine out of 26 samples and the expression of E2 and E5 were detected in five out of nine BPV positive samples. This is the first record of BPV2 expression in bull sperm cells.
Collapse
Affiliation(s)
- M. A. R. Silva
- />Laboratório de Estudos Moleculares e Terapia Experimental, Departamento de Genética, Centro de Ciências Biológicas, Universidade Federal de Pernambuco, Recife, PE Brazil
| | - E. C. B. Silva
- />Laboratório de Andrologia, Departamento de Medicina Veterinária, Universidade Federal Rural de Pernambuco, Recife, PE Brazil
| | - A. P. A. D. Gurgel
- />Laboratório de Estudos Moleculares e Terapia Experimental, Departamento de Genética, Centro de Ciências Biológicas, Universidade Federal de Pernambuco, Recife, PE Brazil
| | - K. C. G. Nascimento
- />Laboratório de Estudos Moleculares e Terapia Experimental, Departamento de Genética, Centro de Ciências Biológicas, Universidade Federal de Pernambuco, Recife, PE Brazil
| | - A. C. Freitas
- />Laboratório de Estudos Moleculares e Terapia Experimental, Departamento de Genética, Centro de Ciências Biológicas, Universidade Federal de Pernambuco, Recife, PE Brazil
| |
Collapse
|
32
|
Garolla A, Lenzi A, Palu G, Pizzol D, Bertoldo A, De Toni L, Foresta C. Human papillomavirus sperm infection and assisted reproduction: a dangerous hazard with a possible safe solution. Hum Reprod 2012; 27:967-73. [DOI: 10.1093/humrep/des009] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
|
33
|
Kim CH, Kim JH, Kim HJ, Kim KW, Lee JY, Yang SH, Choe J, Hwang D, Kim KC, Hwang ES. Detection of Adeno-associated Virus from Semen Suffering with Male Factor Infertility and Having Their Conception Partners with Recurrent Miscarriages. ACTA ACUST UNITED AC 2012. [DOI: 10.4167/jbv.2012.42.4.339] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Chung Hyon Kim
- Hamchoon Women's Clinic, Seoul, Korea
- Department of Microbiology and Immunology, Seoul National University College of Medicine, Seoul, Korea
| | - Jung Heon Kim
- Department of Microbiology and Immunology, Seoul National University College of Medicine, Seoul, Korea
- Institute of Endemic Diseases, Seoul National University Medical Research Center, Seoul, Korea
| | | | | | | | | | - Jin Choe
- Hamchoon Women's Clinic, Seoul, Korea
| | | | | | - Eung Soo Hwang
- Department of Microbiology and Immunology, Seoul National University College of Medicine, Seoul, Korea
- BK21 Division of Human Life Science, Seoul National University College of Medicine, Seoul, Korea
- Institute of Endemic Diseases, Seoul National University Medical Research Center, Seoul, Korea
| |
Collapse
|
34
|
Silva M, Pontes N, Da Silva K, Guerra M, Freitas A. Detection of bovine papillomavirus type 2 DNA in commercial frozen semen of bulls (Bos taurus). Anim Reprod Sci 2011; 129:146-51. [DOI: 10.1016/j.anireprosci.2011.11.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Revised: 11/09/2011] [Accepted: 11/14/2011] [Indexed: 10/15/2022]
|
35
|
La Vignera S, Vicari E, Condorelli RA, D'Agata R, Calogero AE. Male accessory gland infection and sperm parameters (review). ACTA ACUST UNITED AC 2011; 34:e330-47. [PMID: 21696400 DOI: 10.1111/j.1365-2605.2011.01200.x] [Citation(s) in RCA: 126] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Male accessory gland infection (MAGI) has been identified among those diagnostic categories which have a negative impact on the reproductive function and fertility in males (Rowe et al., World Health Organization Manual for the Standardised Investigation and Diagnosis of the Infertile Couple, Cambridge University Press, Cambridge, 1993). MAGI is a hypernym which groups the following different clinical categories: prostatitis, prostate-vesiculitis and prostate-vesiculo-epididymitis. Some of the characteristics they share are: common diseases, mainly have a chronic course, rarely cause obstruction of the seminal pathways, can have an unpredictable intracanicular spread to one or more sexual accessory glands of the reproductive tract, as well as to one or both sides. In this review, we show that all components involving the inflammatory response (from the agents which first trigger it to each component of the inflammatory response dynamic) can deteriorate conventional and/or non-conventional sperm parameters arising from one or more of the following mechanisms: altered secretory function of the epididymis, seminal vesicles, and prostate which reduce the antioxidant properties or scavenging role of the seminal plasma; deterioration of spermatogenesis; and (unilateral or bilateral) organic or functional sub-obstruction of the seminal tract.
Collapse
Affiliation(s)
- S La Vignera
- Section of Endocrinology, Andrology and Internal Medicine and Master in Andrological, Human Reproduction and Biotechnology Sciences, Department of Internal Medicine and Systemic Diseases, University of Catania, Catania, Italy.
| | | | | | | | | |
Collapse
|
36
|
Foresta C, Pizzol D, Bertoldo A, Menegazzo M, Barzon L, Garolla A. Semen washing procedures do not eliminate human papilloma virus sperm infection in infertile patients. Fertil Steril 2011; 96:1077-82. [PMID: 21536283 DOI: 10.1016/j.fertnstert.2011.04.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Revised: 03/23/2011] [Accepted: 04/05/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To determine the effectiveness of three sperm washing protocols for removing human papillomavirus (HPV)-infected cells from semen samples of infertile patients. DESIGN Cross-sectional clinical study. SETTING Andrology and microbiology sections at a university hospital. PATIENT(S) A group of 32 infertile patients positive for semen HPV, detected with polymerase chain reaction (PCR) and in-situ hybridization in sperm and exfoliated cells. INTERVENTION(S) Semen analysis and in-situ hybridization for HPV detection were performed before and after sperm washing, discontinuous Ficoll gradients, and swim-up protocols. Statistical analysis was performed with a two-tailed Student's t-test. MAIN OUTCOME MEASURE(S) Evaluation of sperm parameters and presence of HPV, performed in semen samples before and after procedures of sperm selection. RESULT(S) All native samples showed the presence of infected sperm with a mean percentage of positivity (24.7% ± 8.9%) higher than exfoliated cells (13.8% ± 4.3%). Fifteen samples had HPV DNA on sperm and exfoliated cells. Sperm washing centrifugation showed no changes in the number of infected samples and in the percentage of infected cells. Ficoll and swim-up protocols induced a slight reduction in the number of infected samples (30 and 26, respectively). CONCLUSION(S) This study demonstrated that conventional sperm selection rarely eliminates HPV sperm infection. More attention should be paid to the reproductive health of infected patients because, not only can HPV be transmitted, but it may also have a negative effect on development of the fetus.
Collapse
Affiliation(s)
- Carlo Foresta
- Department of Histology, Microbiology and Medical Biotechnologies, Clinical Pathology Section & Centre for Male Gamete Cryopreservation, University of Padova, Italy.
| | | | | | | | | | | |
Collapse
|
37
|
Kaspersen MD, Larsen PB, Ingerslev HJ, Fedder J, Petersen GB, Bonde J, Höllsberg P. Identification of multiple HPV types on spermatozoa from human sperm donors. PLoS One 2011; 6:e18095. [PMID: 21479232 PMCID: PMC3066218 DOI: 10.1371/journal.pone.0018095] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Accepted: 02/21/2011] [Indexed: 01/05/2023] Open
Abstract
Human papillomaviruses (HPV) may cause sexually transmitted disease. High-risk types of HPV are involved in the development of cervical cell dysplasia, whereas low-risk types may cause genital condyloma. Despite the association between HPV and cancer, donor sperm need not be tested for HPV according to European regulations. Consequently, the potential health risk of HPV transmission by donor bank sperm has not been elucidated, nor is it known how HPV is associated with sperm. The presence of 35 types of HPV was examined on DNA from semen samples of 188 Danish sperm donors using a sensitive HPV array. To examine whether HPV was associated with the sperm, in situ hybridization were performed with HPV-6, HPV-16 and -18, and HPV-31-specific probes. The prevalence of HPV-positive sperm donors was 16.0% and in 66.7% of these individuals high-risk types of HPV were detected. In 5.3% of sperm donors, two or more HPV types were detected. Among all identified HPV types, 61.9% were high-risk types. In situ hybridization experiments identified HPV genomes particularly protruding from the equatorial segment and the tail of the sperm. Semen samples from more than one in seven healthy Danish donors contain HPV, most of them of high-risk types binding to the equatorial segment of the sperm cell. Most HPV-positive sperm showed decreased staining with DAPI, indicative of reduced content of DNA. Our data demonstrate that oncogenic HPV types are frequent in men.
Collapse
Affiliation(s)
- Maja D. Kaspersen
- Department of Medical Microbiology and Immunology, Aarhus University, Aarhus, Denmark
| | | | | | - Jens Fedder
- Laboratory of Reproductive Biology, Scientific Unit and Fertility Clinic, The Regional Hospital Horsens, Horsens, Denmark
| | | | - Jesper Bonde
- Pathology Division, Clinical Research Center, Hvidovre Hospital, Hvidovre, Denmark
| | - Per Höllsberg
- Department of Medical Microbiology and Immunology, Aarhus University, Aarhus, Denmark
- * E-mail:
| |
Collapse
|
38
|
Foresta C, Patassini C, Bertoldo A, Menegazzo M, Francavilla F, Barzon L, Ferlin A. Mechanism of human papillomavirus binding to human spermatozoa and fertilizing ability of infected spermatozoa. PLoS One 2011; 6:e15036. [PMID: 21408100 PMCID: PMC3051064 DOI: 10.1371/journal.pone.0015036] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2010] [Accepted: 10/05/2010] [Indexed: 12/17/2022] Open
Abstract
Human papillomaviruses (HPVs) are agents of the most common sexually transmitted diseases in females and males. Precise data about the presence, mechanism of infection and clinical significance of HPV in the male reproductive tract and especially in sperm are not available. Here we show that HPV can infect human sperm, it localizes at the equatorial region of sperm head through interaction between the HPV capsid protein L1 and syndecan-1. Sperm transfected with HPV E6/E7 genes and sperm exposed to HPV L1 capsid protein are capable to penetrate the oocyte and transfer the virus into oocytes, in which viral genes are then activated and transcribed. These data show that sperm might function as vectors for HPV transfer into the oocytes, and open new perspectives on the role of HPV infection in males and are particularly intriguing in relation to assisted reproduction techniques.
Collapse
Affiliation(s)
- Carlo Foresta
- Section of Clinical Pathology and Centre for Male Gamete Cryopreservation, Department of Histology, Microbiology and Medical Biotechnologies, University of Padova, Padova, Italy.
| | | | | | | | | | | | | |
Collapse
|
39
|
Perino A, Giovannelli L, Schillaci R, Ruvolo G, Fiorentino FP, Alimondi P, Cefalù E, Ammatuna P. Human papillomavirus infection in couples undergoing in vitro fertilization procedures: impact on reproductive outcomes. Fertil Steril 2010; 95:1845-8. [PMID: 21167483 DOI: 10.1016/j.fertnstert.2010.11.047] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2010] [Revised: 10/05/2010] [Accepted: 11/16/2010] [Indexed: 12/29/2022]
Abstract
A prospective study was performed to assess the relationship between human papillomavirus (HPV) infection in 199 infertile couples and outcome of assisted reproductive technologies (ARTs). A highly statistically significant correlation between pregnancy loss rate (proportion of pregnancies detected by β-hCG that did not progress beyond 20 weeks) and positive HPV DNA testing in the male partner of infertile couples, compared with HPV negatives, was observed (66.7% vs. 15%).
Collapse
Affiliation(s)
- Antonio Perino
- Dipartimento Materno Infantile, University of Palermo, Palermo, Italy
| | | | | | | | | | | | | | | |
Collapse
|
40
|
Foresta C, Pizzol D, Moretti A, Barzon L, Palù G, Garolla A. Clinical and prognostic significance of human papillomavirus DNA in the sperm or exfoliated cells of infertile patients and subjects with risk factors. Fertil Steril 2010; 94:1723-7. [DOI: 10.1016/j.fertnstert.2009.11.012] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2009] [Revised: 11/03/2009] [Accepted: 11/04/2009] [Indexed: 11/26/2022]
|
41
|
Foresta C, Ferlin A, Bertoldo A, Patassini C, Zuccarello D, Garolla A. Human papilloma virus in the sperm cryobank: an emerging problem? ACTA ACUST UNITED AC 2010; 34:242-6. [DOI: 10.1111/j.1365-2605.2010.01075.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
42
|
Foresta C, Garolla A, Zuccarello D, Pizzol D, Moretti A, Barzon L, Palù G. Human papillomavirus found in sperm head of young adult males affects the progressive motility. Fertil Steril 2010; 93:802-6. [DOI: 10.1016/j.fertnstert.2008.10.050] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2008] [Revised: 10/14/2008] [Accepted: 10/16/2008] [Indexed: 10/21/2022]
|
43
|
Bocharova EN, Abdumalikov RA, Bragina EE, Klimova RR, Adueva SM, Medzhidova MG, Kurilo LF, Kushch AA. Determination of the proteins and capsids of herpes simplex virus in human spermatozoa. DOKLADY BIOLOGICAL SCIENCES : PROCEEDINGS OF THE ACADEMY OF SCIENCES OF THE USSR, BIOLOGICAL SCIENCES SECTIONS 2004; 391:379-83. [PMID: 14556538 DOI: 10.1023/a:1025179307236] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- E N Bocharova
- Central Research Institute of Dermatovenerologic Studies, Ministry of Public Health of the Russian Federation, ul. Korolenko 3, Moscow, Russia
| | | | | | | | | | | | | | | |
Collapse
|