Male factor infertility and assisted reproductive technologies: indications, minimum access criteria and outcomes

Two dynamical models for male infertility and their stability and sensitivity analysis

Mathematical models can estimate the success rate of assisted reproductive technology (ART) and determine which treatment suits the best. In this study, the authors introduce two new dynamic models that can predict the success rate of ART models for each individual based on the etiology of their infertility, clinical findings, and lab tests. The study shows that the equilibrium point free of disease is asymptotically stable and forward bifurcation occurs. Our dynamical models evaluate ART success rates in our subgroups considering couples under Intrauterine insemination (IUI), In Vitro Fertilization-Embryo Transfer (IVF), Intra-Cytoplasmic Sperm Injection (ICSI) treatment methods. Sensitivity analysis of parameters suggests that an increase in infertile couples who use IUI and ICSI treatment methods can result in better disease control and a more favorable outcome. It should be noted that the proposed models provide a systematic framework for simulating the dynamics of infertility and assessing the effectiveness of various ART. From a clinical perspective, these models have the potential to enhance decision-making by predicting the probability of ART success under diverse treatment scenarios. Such predictions may facilitate the personalization of treatment strategies based on individual patient profiles and contribute to more efficient resource allocation and planning within fertility centers.

Temporal Trends in the Burden of Disease for Male Infertility from 1990 to 2021 in the BRICS

Background

Over the past three decades, male infertility has become a significant burden on global public health. As an international organization with nearly half of the world's population, BRICS plays a crucial role in global health. This study investigates the trend of male infertility burden in BRICS countries from 1990 to 2021, providing valuable information for prevention and treatment strategies.

Methods

Data on male infertility in BRICS countries were obtained from the Global Burden of Disease database. Joinpoint regression, decomposition analysis, and prediction models were applied to analyze the data and assess the disease burden trends.

Results

The global prevalence of male infertility has worsened significantly between 1990 and 2021, with projections indicating this trend will continue for the next 15 years. While this global trend is based on data from a range of countries, the results of this study specifically focus on the BRICS countries. In these countries, while China and the Russian Federation have had high prevalence rates, improvements were observed over the past 30 years. India and Brazil, though unable to control male infertility in this period, have managed to halt its worsening in recent years. South Africa experienced substantial fluctuations from 2001 to 2015, with further significant changes projected in the next 15 years.

Conclusion

This study provides valuable insights into the evolving burden of male infertility in BRICS countries. It underscores the importance of targeted prevention and treatment strategies for these countries based on national and global trends.

High risk of low birth weight in couples with advanced paternal age in in vitro fertilization treatment

BACKGROUND

With the development of socio-economic conditions and a shift in attitudes towards fertility, there has been a gradual increase in delayed childbearing since the 2000s. Age plays a significant role in the decline of fertility. However, we know very little about the association of paternal age with reproductive outcomes.

OBJECTIVES

To investigate the correlation between advanced paternal age and semen quality, embryo quality, pregnancy, and neonatal outcomes in IVF cycles.

MATERIALS AND METHODS

In this study, after excluding female partners aged ≥35 years, we analyzed data from 761 infertile couples who underwent in vitro fertilization cycles at the First Affiliated Hospital of USTC between June 2020 and March 2023. Cases were classified into three groups according to the age of the male: <35 years (530 infertile couples), 35 years ≤ paternal age <40 years (125 infertile couples), and ≥40 years (106 infertile couples). Then, we compared the general clinical data arising from in vitro fertilization cycles between the three groups, including semen parameters, embryonic parameters, and pregnancy and neonatal birth outcomes.

RESULTS

Data analysis showed that the duration of infertility and the incidence of secondary infertility were significantly higher in paternal age ≥35 years groups than those aged <35 years (all p < 0.05). We also observed a significant difference between ≥40 years and <35 years groups in terms of the normal fertilization rate, high-quality embryo rate, clinical pregnancy rate, miscarriage rate, live birth rate, Apgar scores, and the low birth weight neonatal rate (all p < 0.05). The group with paternal age ≥40 years showed statistically significant differences in terms of clinical pregnancy rate, miscarriage rate, live birth rate, and low birth weight on multivariable logistic regression (all p < 0.05).

CONCLUSION

The results of our study indicate that advanced paternal age (≥40 years) has a significant impact on the embryo quality, pregnancy outcome, and neonatal outcome. Paternal age over 40 years is a risk for in vitro fertilization success rate.

Non-Invasive Preimplantation Genetic Testing

To minimise the influence of chromosomal abnormalities during IVF treatment, embryos can be screened before transfer using preimplantation genetic testing. This typically involves an invasive trophectoderm biopsy at the blastocyst stage, where 4-8 cells are collected and analysed. However, emerging evidence indicates that, as embryos develop in vitro in culture media, they release cell-free DNA into the media, providing an alternative source of genetic material that can be accessed non-invasively. Spent blastocyst media samples that contain embryo cell-free DNA demonstrate high informativity rates and ploidy concordance when compared with the corresponding trophectoderm, inner cell mass, or whole blastocyst results. However, optimising this non-invasive approach requires several changes to embryo culture protocols, including additional embryo washes to tackle contamination and extending embryo culture time to maximise the amount of cell-free DNA released into the culture media. In this review, we discuss this novel non-invasive approach for aneuploidy detection and embryo prioritisation, as well as the current data and future prospects for utilising cell-free DNA analysis to identify structural rearrangements and single gene disorders.

Role of miRNA polymorphisms on male and female infertility and recurrent implantation failure

PURPOSE

MiRNAs regulate gene expression, impacting reproductive health, such as infertility and implantation failure. This study investigated the association between miRNA polymorphisms and male infertility (azoospermia, oligospermia), female infertility (endometriosis), and recurrent implantation failure in IVF.

METHODS

In order to find relevant articles, a search was conducted in PubMed, WOS, Scopus, and the Cochrane Library databases using Mesh terms and Entry terms with the keywords (miRNA OR microRNA polymorphism) AND (abortion OR miscarriage OR infertility OR sterility OR pregnancy loss OR implantation failure).

RESULTS

The study revealed miRNA polymorphisms linked to a higher risk of male and female infertility and repeated implantation failure in IVF. These results underscore the significance of genetic variations in miRNAs in developing reproductive issues and the promise of personalized treatment strategies guided by genetic profiles.

CONCLUSION

These results provide valuable insights into the genetic basis of infertility and emphasize the need for further research to develop targeted diagnostic tools and therapies. Understanding the role of miRNA polymorphisms in reproductive health has significant implications for improving outcomes for couples struggling with infertility. By elucidating the genetic factors contributing to infertility, this study paves the way for personalized approaches to diagnosis and treatment, ultimately enhancing reproductive care.

First clinical pregnancy and delivery achieved after using a new 3D imaging technology for sperm selection: a case report

Objective

To report a case of a patient who, after experiencing recurrent failed implantations, underwent a novel technological intervention-using the Q300 device-which successfully led to a pregnancy and delivery of a healthy baby.

Design

Case report.

Setting

Barzilai University Medical Center.

Patient s

A 33-year-old woman with primary infertility experienced recurrent implantation failure (RIF), while her 32-year-old male partner was diagnosed with severe oligo-astheno-teratozoospermia (OTA) syndrome.

Intervention

Using Q300 device for selection of the morphologically compliant sperm cells for intracytoplasmic sperm injection (ICSI).

Main outcome measures

Successful pregnancy and delivery.

Results

A unique case of clinical pregnancy and delivery involving a couple facing RIF and severe OTA. In this case, a new technology for sperm selection was used. The semen sample was examined using the Q300 device to choose WHO2021-morphologically compliant sperm cells for micro-injection. The resulting embryos were developed and then frozen. Later, a frozen-thawed embryo transfer was performed during the following natural menstrual cycle, leading to successful pregnancy and delivery.

Conclusion

The utilization of this new 3D imaging technology underscores the evolving landscape of reproductive medicine and the potential it holds for transforming outcomes in challenging cases. By documenting such cases, we contribute to the ongoing dialogue to refine assisted reproductive technology (ART) protocols and improve reproductive outcomes for individuals facing similar challenges.

Trial registration

NCT06232720 https://clinicaltrials.gov/study/NCT06232720. Date of registration: 15 Feb 2023. Date of enrollment of the first subject: 20 August 2023.

Attrition rates of in vitro fertilization in patients with male factor infertility using testicular sperm

Objective

To assess the oocyte to blastocyst attrition rate in patients undergoing in vitro fertilization (IVF) with male factor infertility (MFI) using testicular sperm.

Design

Retrospective cohort study.

Subjects

Patients who underwent IVF using testicular sperm for MFI between January 1, 2017, and March 23, 2023.

Intervention

Testicular sperm extraction (TESE) with intracytoplasmic sperm injection.

Main Outcome Measures

The fertilization and blastulation outcomes.

Results

A total of 120 IVF cycles using testicular sperm were identified. For comparison, 122 IVF cycles in patients with unexplained infertility who had normal semen analysis and used ejaculated sperm for intracytoplasmic sperm injection were reviewed as a control group. Testicular sperm cycles were further grouped by prognosis on the basis of the indication for TESE: good prognosis (n = 42, obstructive azoospermia); moderate prognosis (n = 67, increased deoxyribonucleic acid fragmentation, prior failed IVF, and recurrent pregnancy loss); and poor prognosis (n = 11, cryptozoospermia or nonobstructive azoospermia). Female baseline characteristics were similar among the groups except for body mass index. The fertilization rate was lower in all TESE groups than in the control group; however, no differences in fertilization rates were noted within the TESE groups (good vs. moderate vs. poor). The blastulation rates were similar between the good-prognosis TESE and control groups. However, the moderate- and poor-prognosis TESE groups had lower blastulation rates than the control group.

Conclusion

This model may help practitioners counsel patients with MFI using testicular sperm to appropriately set expectations for blastocyst outcomes on the basis of the diagnosis.

Serum and Seminal Plasma Zinc Levels and Immunopositivity of the ZIP6 and ZIP14 Transporters in Men with Normo- and Teratozoospermia

Zinc plays a crucial role in spermatogenesis, sperm function, and fertilisation. Zinc homeostasis is regulated by ZIP and ZnT transporter proteins, which mediate Zn2+ influx and efflux across sperm cell membranes. This study analysed total Zn concentration in seminal plasma and serum of 10 normozoospermic and 32 teratozoospermic men involved in the process of infertility treatment, using inductively coupled plasma mass spectrometry. In addition, the expression of Zn transporters ZIP6 and ZIP14 in the sperm of two normozoospermic and two teratozoospermic men was analysed using immunofluorescence. Applying Student's t test and the Mann-Whitney U test, we found no significant differences in Zn concentrations in seminal plasma and serum between groups. ZIP6 was mainly localised in the sperm head, with slightly higher immunopositivity in normozoospermic than teratozoospermic samples, but there was no statistically significant difference between the groups. ZIP14 was mainly found in the sperm head, and some teratozoospermic samples showed immunopositivity in the tail, although there were no significant differences in ZIP14 immunopositivity between normozoospermic and teratozoospermic samples. The results suggest that Zn concentrations in seminal plasma and serum, and the expression of ZIP6 and ZIP14, do not differ in normo- and teratozospermic samples, and emphasise the complex interplay of factors underlying male fertility.

Artificial intelligence and clinical guidance in male reproductive health: ChatGPT4.0's AUA/ASRM guideline compliance evaluation

BACKGROUND

Male infertility is defined as the inability of a male to achieve a pregnancy in a fertile female by the American Urological Association (AUA) and the American Society for Reproductive Medicine (ASRM). Artificial intelligence, particularly in language processing models like ChatGPT4.0, offers new possibilities for supporting clinical decision-making. This study aims to assess the effectiveness of ChatGPT4.0 in responding to clinical queries regarding male infertility, which is aligned with AUA/ASRM guidelines.

METHODS

This observational study employed a design to evaluate the performance of ChatGPT4.0 across 1073 structured clinical queries categorized into true/false, multiple-choice, and open-ended. Two independent reviewers specializing in reproductive medicine assessed the responses using a six-point Likert scale to evaluate accuracy, relevance, and guideline adherence.

RESULTS

In the true/false category, the initial accuracy was 92%, which increased to 94% by the end of the study period. For multiple-choice questions, accuracy improved from 85% to 89%. The most significant gains were seen in open-ended questions, where accuracy rose from 78% to 86%. Initially, some responses did not fully align with the AUA/ASRM guidelines. However, by the end of the 60 days, these responses had become more comprehensive and clinically relevant, indicating an improvement in the model's ability to generate guideline-conformant answers (p < 0.05). The depth and accuracy of responses for higher difficulty questions also showed enhancement (p < 0.01).

CONCLUSION

ChatGPT4.0 can serve as a valuable support tool in managing male infertility, providing reliable, guideline-based information that enhances the accuracy of clinical decision-making tools and supports patient education.

Research progress of main components from Epimedii Folium (Yinyanghuo) in the treatment of male reproductive dysfunction and application & development status of Epimedii Folium

ETHNOPHARMACOLOGICAL RELEVANCE

Epimedii Folium (Yinyanghuo) is a commonly used Chinese herb that plays a significant role in a lot of herbal formulae used to treat sexual dysfunction. Recently, an increasing amount of research on Epimedii Folium related to male reproductive dysfunction has been reported, and the exploration and application of Epimedium are also expanding rapidly. Flavonoids make up the vast majority of the chemical composition of Epimedii Folium, with small amounts of icarsides series, alkaloids, polysaccharide, volatile oils and other natural compounds. Among them, icariin (ICA) has the highest concentration and the most potent effects on male reproductive dysfunction, icariin II (ICA II), total flavones and polysaccharides from Epimedium have also been reported.

AIM OF STUDY

In this review, we focus on the research progress of the main components from Epimedii Folium in the treatment of male reproductive dysfunction, as well as the application and development status of Epimedii Folium in China, aiming to provide ideas for future in-depth research and product development of Epimedii Folium.

METHODS

On the one hand, we collected literature published from 2003 to May 2024 from various databases, including China National Knowledge Infrastructure (CNKI), the Database of Chinese Sci-Tech Periodicals (VIP), Wanfang Database, Web of Science, Elsevier ScienceDirect, SpringerLink, and the National Center for Biotechnology Information (NCBI) of the USA. On the other hand, we retrieved the data query system of the National Medical Products Administration, Special Food Information Query Platform of the State Administration for Market Regulation, Yaozhi.com, Baidu, China Patent Net, as well as JD.com and Tmall, categorized all epimedia-related products sold in China into medicine, health food, dietary supplements, and animal feed.

RESULTS

A total of 3578 studies were obtained, of which 161 were selected for further analysis. Subsequently, the current status of the main components of Epimedii Folium in the treatment of male reproductive dysfunction was summarized in three sections: research progress on the chemical components of Epimedium, research progress on the pharmacological effects and mechanisms of the main active ingredients, and development and application of the main ingredients of Epimedium.

CONCLUSION

The flavonoids in Epimedii Folium have a beneficial effect on male reproductive dysfunction. However, to date, the primary components of Epimedii Folium have not been directly developed into clinical drugs for treating this condition. This may be due to the lack of a systematic evaluation of their safety. In the field of dietary supplements, products developed using Epimedii Folium as raw materials often face challenges such as low added value and limited international recognition, which hinder its development in the global reproductive health market. We believe that with more in-depth and systematic basic research, Epimedii Folium can make significant contributions to human reproductive health.

Serum FSH levels can predict sperm identification in semen once diagnosed azoospermia

Graphical abstract

Abstract

Multiple semen analyses are important for identifying patients with severe oligozoospermia (SOS) or cryptozoospermia (CZO). Moreover, clinical predictive factors for CZO and SOS are warranted. Therefore, we aimed to identify predictors of sperm retrieval in patients with a prior diagnosis of nonobstructive azoospermia (NOA) based on repeat semen analysis. We retrospectively included 209 patients diagnosed with NOA. Data regarding age at diagnosis, body mass index, testicular volume, serum luteinizing hormone, follicle-stimulating hormone (FSH) and testosterone levels, smoking history and testicular microlithiasis were analyzed. Patients were classified into the falsely reported azoospermia (FAZO) and true azoospermia (TAZO) groups. Furthermore, FAZO-related factors were evaluated using the Mann-Whitney U test and univariate and multivariate analysis logistic regression models. Regarding FAZO-related factors, the cut-off level was determined using receiver operating characteristic (ROC) curve analysis. Among 209 patients with NOA, 33 (15.8%) had spermatozoa identified in subsequent semen analyses. Multivariate analysis revealed that the FAZO group had significantly lower FSH levels than the TAZO group. ROC curve analysis showed that the cut-off value for the FSH level was 15.3 mIU/mL, with 26 (78.8%) and 29 (16.5%) patients in the FAZO and TAZO groups, respectively, having FSH levels ≤15.3 mIU/mL. In conclusion, the FSH level was a predictive factor for FAZO. In patients diagnosed with azoospermia who have relatively low FSH levels, multiple semen analyses might facilitate identification of sperm in ejaculated semen.

Lay summary

We evaluated 209 patients diagnosed with spermless semen at prior medical institutions. After thorough semen analyses at our hospital, sperm were identified in the ejaculates of 33 (15.8%) patients. We performed comparisons between patients with and without identified sperm. The serum FSH level was identified as a significant predictive factor for sperm presence. FSH stimulates testicular growth and function and promotes sperm development. Patients who had relatively low and high FSH levels for patients with spermless semen had an increased and decreased chance, respectively, of having sperm identified in ejaculated semen through repeat thorough semen analyses. Sperm might be identified in ejaculates of patients diagnosed with spermless semen who have relatively low FSH levels.

Riluzole Reverses Blood-Testis Barrier Loss to Rescue Chemotherapy-Induced Male Infertility by Binding to TRPC

Cancer treatments, including cytotoxic therapy, often result in male infertility, necessitating the development of safe and effective strategies to preserve male reproductive potential during chemotherapy. Notably, our study uncovers the potential of repurposing riluzole, an FDA-approved drug for amyotrophic lateral sclerosis (ALS), in enhancing spermatogenesis. Hence, this research aims to explore the feasibility of utilizing riluzole to alleviate male infertility induced by busulfan (BSF), a commonly used chemotherapy drug. We established a BSF-induced oligospermia model in 4-week-old male mice and found that riluzole could effectively counter the detrimental effects of BSF on sperm production in mice with oligospermia. By restoring blood-testis barrier (BTB) functionality, riluzole improves sperm quality and reduces testicular atrophy. Through transcriptomic and molecular docking analyses, we identify transient receptor potential canonical subfamily member 5 (TRPC5) as a potential target for riluzole-mediated regulation of blood-testis barrier function. These findings propose riluzole as a promising therapeutic option for chemotherapy-induced male infertility, thereby addressing the fertility challenges associated with cancer treatments. Moreover, repurposing riluzole could streamline the drug development process, providing a cost-effective approach with reduced risk compared to developing entirely new drugs.

Panax ginseng nanoemulsion for counteracting male infertility via modulating sex hormones and oxidative stress in a rat model

This study end to develop nanoemulsions of Panax ginseng dry extract and to evaluate the potential impact of these nanoemulsions versus free Panax ginseng dry extract and Vit.E in recovering male infertility induced in rats. Nanoemulsions of Panax ginseng dry extract were prepared by oil in water method. The designed samples were characterized by TEM, zeta sizer, FTIR, and TGA. The in vitro study included DPPH assay to estimate the free radical scavenging activity of the suggested treatments. The in vivo study included 100 adult male Wistar rats which were assigned into 10 equal groups; five groups of young rats weighting (150-200 g) and five groups of aged rats weighting (350-400 g). Group I, negative control. Group II, bisphenol-A (BPA). Group III, BPA+ Panax ginseng dry extract nanoemulsion. Group IV, BPA+ free Panax ginseng dry extract. Group V, BPA +Vit.E. After 40 days, serum total testosterone, free testosterone, MDA, 8-OHdG and AGEs were estimated. Besides, the histological investigation of testicular tissue sections was performed. TEM imaging of Panax ginseng dry extract nanoemulsions indicated spherical shape with diameter range from 2 to 50 nm, and the size distribution was in the range from 62 to 123 d.nm. The zeta potential of the designed nanoemulsions was -32.8 to -38.9 mV. FTIR spectra revealed the common active groups in the prepared nanoemulsions. The thermal stability of the nanoemulsions was up to 207 ºC. The in vitro results of DPPH assay showed % inhibition of DPPH free radical for Panax ginseng nanoemulsions samples was 49.38% (for young-treated group Sample A) and 72.28% (for aged-treated group Sample B), while for free Panax ginseng dry extract samples was 30.27% (for young-treated group Sample C) and 56.76% (for aged-treated group Sample D), for Vit.E samples was 32.36% (for young-treated group Sample E) and 36.39% (for aged-treated group Sample F).Thus the nanoemulsions exhibit free radicals scavenging activity more than free Panax ginseng dry extract and Vit.E. The in vivo findings elucidated that Panax ginseng dry extract nanoemulsions and Vit.E successfully revers the progressive insult of BPA on male fertility by significantly enhance total testosterone (2.87±0.318) and free testosterone (1.63±0.033) serum levels, and significantly decrease MDA (2.77±0.018), 8-OHdG (6.76±0.174) and AGEs (92.60±1.701) serum levels. Interestingly, the most promising outcomes were recorded upon the treatment with Panax ginseng dry extract nanoemulsions. In conclusion the developed Panax ginseng dry extract nanoemulsion could be used as a promising strategy in improving potential male infertility defects by rescuing male sex hormones, neutralizing oxidative stress and retrieving the structural organization of the testes.

Assessing the efficacy of a novel sperm-washing medium enriched with serotonin, L-carnitine, and coenzyme Q10: an observational cohort study

ABSTRACT

This observational cohort study investigated the potential of a novel sperm-washing medium (SWM) enriched with serotonin (5-HT), L-carnitine (L-C), and coenzyme Q10 (CoQ10) to enhance sperm motility and reduce DNA damage. It compared this innovative medium (5-HT/L-C/CoQ10 SWM) with two widely used commercial media (SWM 1 and SWM 2). Ninety-eight volunteers from an infertility clinic provided semen samples, which were divided into three aliquots for analysis in different SWMs: group 1, SWM was composed of hydroxyethyl piperazineethanesulfonic acid (HEPES), sodium bicarbonate, human serum albumin (HSA), taurine, and gentamicin sulfate (SWM 1); group 2, SWM was composed of HEPES, sodium bicarbonate, and HSA (SWM 2); and group 3, SWM was composed of HEPES-buffered human tubal fluid supplemented with 5-HT, L-C, and CoQ10 (5-HT/L-C/CoQ10 SWM). Sperm motility was categorized as progressive, nonprogressive, or immotile. Apoptosis, reactive oxygen species (ROS) production, and DNA fragmentation were also assessed. There were no significant differences in total or progressive sperm motility among the groups. Spermatozoa in group 3 exhibited reduced apoptosis, necrosis, and ROS levels and increased viability. No significant differences were observed in the DNA fragmentation index among groups. The 5-HT/L-C/CoQ10 SWM reduced sperm oxidative stress and apoptosis compared with those of the two commercially available SWMs, suggesting that 5-HT/L-C/CoQ10 SWM could be useful for enhancing in vitro fertilization success rates.

Microfluidics-A novel technique for high-quality sperm selection for greater ART outcomes

Microfluidics represent a quality sperm selection technique. Human couples fail to conceive and this is so in a significant population of animals worldwide. Defects in male counterpart lead to failure of conception so are outcomes of assisted reproduction affected by quality of sperm. Microfluidics, deals with minute volumes (μL) of liquids run in small-scale microchannel networks in the form of laminar flow streamlines. Microfluidic sperm selection designs have been developed in chip formats, mimicking in vivo situations. Here sperms are selected and analyzed based on motility and sperm behavioral properties. Compared to conventional sperm selection methods, this selection method enables to produce high-quality motile sperm cells possessing non-damaged or least damaged DNA, achieve greater success of insemination in bovines, and achieve enhanced pregnancy rates and live births in assisted reproduction-in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). Besides, the concentration of sperm available to oocyte can be controlled by regulating the flow rate in microfluidic chips. The challenges in this technology are commercialization of chips, development of fully functional species-specific microfluidic tools, limited number of studies available in literature, and need of thorough understanding in reproductive physiology of domestic animals. In conclusion, incorporation of microfluidic system in assisted reproduction for sperm selection may promise a great success in IVF and ICSI outcomes. Future prospectives are to make this technology more superior and need to modify chip designs which is cost effective and species specific and ready for commercialization. Comprehensive studies in animal species are needed to be carried out for wider application of microfluidic sperm selection in in vitro procedures.

Male infertility is associated with differential DNA methylation signatures of the imprinted gene GNAS and the non-imprinted gene CEP41

PURPOSE

To investigate whether the DNA methylation profiles of GNAS(20q13.32), MEST(7q32.2), MESTIT1(7q32.2), IGF2(11p15.5), H19 (7q32.2), and CEP41(7q32.2) genes are related to the transcriptomic and epigenomic etiology of male infertility.

METHODS

The DNA methylation levels of spermatozoa were obtained from fertile (n = 30), oligozoospermic (n = 30), and men with normal sperm count (n = 30). The methylation status of each CpG site was categorized as hypermethylated or hypomethylated. Expression levels of target gene transcripts were determined using real-time PCR.

RESULTS

The oligozoospermia showed a higher frequency of hypermethylation at GNASAS 1st, 3rd, and 5th CpG dinucleotides (66.7%, 73.3%, 73.3%) compared to the fertile group (33.3%, 33.3%, 40%, respectively). The normal sperm count exhibited a higher frequency of hypermethylation at the 3rd CpG of CEP41 (46.7%) than the fertile group (16.7%). Normal sperm count was predicted by CEP41 hypermethylation (OR = 1.750, 95%CI 1.038-2.950) and hypermethylation of both CEP41 and GNASAS (OR = 2.389, 95%CI 1.137-5.021). Oligozoospermia was predicted solely by GNASAS hypermethylation (OR = 2.460, 95%CI 1.315-4.603). In sperms with decreased IGF2 expression in the fertile group, we observed hypomethylation in the 2nd CpG of IGF2 antisense (IFG2AS), and hypermethylation in the 1st, 2nd, and 4th CpGs of H19. No significant relationship was found between IGF2 expression and methylation status of IGF2AS and H19 in infertile groups.

CONCLUSION

The disappearance of the relationship between IGF2 expression and IGF2AS and H19 methylations in the infertile group provides new information regarding the disruption of epigenetic programming during spermatogenesis. A better understanding of sperm GNASAS and CEP41 hypermethylation could advance innovative diagnostic markers for male infertility.

Network pharmacology and molecular docking reveal potential mechanisms of ginseng in the treatment of diabetes mellitus-induced erectile dysfunction and asthenospermia

Diabetes mellitus (DM) is a chronic metabolic disease that predisposes to chronic damage and dysfunction of various organs, including leading to erectile dysfunction (ED) and asthenospermia. Literature suggests that ginseng plays an important role in the treatment and management of DM. Ginseng may have a therapeutic effect on the complications of DM-induced ED and asthenospermia. The study aimed to explore the mechanisms of ginseng in the treatment of DM-induced ED and asthenospermia following the Traditional Chinese Medicine (TCM) theory of "treating different diseases with the same treatment." This study used network pharmacology and molecular docking to examine the potential targets and pharmacological mechanism of Ginseng for the treatment of DM-induced ED and asthenospermia. The chemical ingredients and targets of ginseng were acquired using the Traditional Chinese Medicine Systems Pharmacology database and analysis platform. The targets of DM, ED, and asthenospermia were extracted with the GeneCards and Online Mendelian Inheritance in Man databases. A protein-protein interaction network analysis was constructed. The Metascape platform was applied for analyzing the gene ontology and Kyoto Encyclopedia of Genes and Genomes pathways. AutoDock Vina was used to perform molecular docking. Network pharmacology revealed that the main active components of the target of action were kaempferol, beta-sitosterol, ginsenoside rh2, stigmasterol, and fumarine. Core targets of the protein-protein interaction network included TNF, IL-1β, AKT1, PTGS2, BCL2, and JUN. Kyoto Encyclopedia of Genes and Genomes enrichment analysis showed that they were mainly involved in AGE-RAGE signaling pathway in diabetic complications, TNF signaling pathway, Lipid and atherosclerosis. The interactions of core active components and targets were analyzed by molecular docking. Ginseng may play a comprehensive therapeutic role in the treatment of DM-induced ED and asthenospermia through "multicomponent, multi-target, and multi-pathway" biological mechanisms such as inflammation and oxidative stress.

Seminological, Hormonal and Ultrasonographic Features of Male Factor Infertility Due to Genetic Causes: Results from a Large Monocentric Retrospective Study

Objectives: Evaluate the prevalence of genetic factors in a large population of infertile subjects and define the seminological, hormonal, and ultrasonographic features for each alteration. Methods: This single-center retrospective study included male partners of infertile couples undergoing genetic investigations due to oligozoospermia or azoospermia evaluated from January 2012 to January 2022. The genetic investigations consist of karyotype, CFTR gene mutations plus variant of the IVS8-5T polymorphic trait, Y chromosome microdeletion, and Next Generation Sequencing panel to analyze genes implicated in congenital hypogonadotropic hypogonadism (CHH). Results: Overall, 15.4% (72/466) of patients received a diagnosis of genetic cause of infertility. Specifically, 23 patients (31.9%) harbor mutations in the CFTR gene, 22 (30.6%) have a 47, XXY karyotype, 14 (19.4%) patients show a Y chromosome microdeletion, 7 (9.7%) have structural chromosomal anomalies, and 6 (8.3%) have CHH. Overall, 80.6% of patients were azoospermic and 19.4% oligozoospermic (sperm concentration 3.5 ± 3.8 million/mL). Almost all patients presented hormonal alterations related to the specific genotype, while the main ultrasound alterations were testicular hypoplasia, calcifications/microcalcifications, and enlarged/hyperechoic epididymis. Conclusions: The prevalence of genetic abnormalities in males of infertile couples was 15.4% in our Center. CFTR gene disease-causing variants resulted in more frequent, with various clinical features, highlighting the complexity and heterogeneity of the presentation. Other investigations are needed to understand if conditions like ring chromosomes and other translocations are related to infertility or are incidental factors.

Advanced Sperm Selection Techniques for Assisted Reproduction

Male infertility accounts for approximately 40% of infertility cases. There are many causes of male infertility, including environmental factors, age, lifestyle, infections, varicocele, and cancerous pathologies. Severe oligozoospermia, cryptozoospermia, and azoospermia (obstructive and non-obstructive) are identified as severe male factor infertility, once considered conditions of sterility. Today, in vitro fertilization (IVF) techniques are the only treatment strategy in cases of male factor infertility for which new methodologies have been developed in the manipulation of spermatozoa to achieve fertilization and increase success rates. This review is an update of in vitro manipulation techniques, in particular sperm selection, emphasizing clinical case-specific methodology. The success of an IVF process is related to infertility diagnosis, appropriate choice of treatment, and effective sperm preparation and selection. In fact, selecting the best spermatozoa to guarantee an optimal paternal heritage means increasing the blastulation, implantation, ongoing pregnancy and live birth rates, resulting in the greater success of IVF techniques.

Sperm YOLOv8E-TrackEVD: A Novel Approach for Sperm Detection and Tracking

Male infertility is a global health issue, with 40-50% attributed to sperm abnormalities. The subjectivity and irreproducibility of existing detection methods pose challenges to sperm assessment, making the design of automated semen analysis algorithms crucial for enhancing the reliability of sperm evaluations. This paper proposes a comprehensive sperm tracking algorithm (Sperm YOLOv8E-TrackEVD) that combines an enhanced YOLOv8 small object detection algorithm (SpermYOLOv8-E) with an improved DeepOCSORT tracking algorithm (SpermTrack-EVD) to detect human sperm in a microscopic field of view and track healthy sperm in a sample in a short period effectively. Firstly, we trained the improved YOLOv8 model on the VISEM-Tracking dataset for accurate sperm detection. To enhance the detection of small sperm objects, we introduced an attention mechanism, added a small object detection layer, and integrated the SPDConv and Detect_DyHead modules. Furthermore, we used a new distance metric method and chose IoU loss calculation. Ultimately, we achieved a 1.3% increase in precision, a 1.4% increase in recall rate, and a 2.0% improvement in mAP@0.5:0.95. We applied SpermYOLOv8-E combined with SpermTrack-EVD for sperm tracking. On the VISEM-Tracking dataset, we achieved 74.303% HOTA and 71.167% MOTA. These results show the effectiveness of the designed Sperm YOLOv8E-TrackEVD approach in sperm tracking scenarios.

Primary mediastinal seminoma with azoospermia: case report and review of the literature

Introduction

Since the first report, primary mediastinal seminoma has a low incidence in the population, and it mainly affects young and middle-aged men, is clinically rare, and accounts for a very small proportion of mediastinal tumors. In this study, we describe the first case of primary mediastinal seminoma with azoospermia and hypothesize that the coexistence of the two disorders may not be a coincidence.

Case report

A 16-year-old man presented with chest tightness and chest pain, a mediastinal mass on chest CT, and abnormal 18F-fluoro-deoxyglucose uptake on a PET-CT scan. By biopsy of the mass, the pathological diagnosis was a primary mediastinal seminoma. Because chemotherapy is included in the treatment of the tumor, the patient underwent sperm freezing before treatment, considering that chemotherapy can affect fertility, but the patient was diagnosed with azoospermia. Finally, the patient underwent tumor resection and postoperative chemotherapy. No tumor recurrence was observed at the current follow-up.

Conclusion

Primary mediastinal seminoma is mainly confirmed by histopathological examination, and surgery and chemoradiotherapy are the current treatments. In patients with mediastinal seminoma or azoospermia, doctors should be aware that the two disorders may coexist, especially in men who have fertility requirements or long-term infertility, and that examination of the mediastinum and semen may lead to unexpected findings in the diagnosis and treatment. For mediastinal germ cell tumors, genetic testing is of great value in the treatment of tumors and the prediction of associated diseases. Future studies exploring the potential correlation between mediastinal seminoma and azoospermia will be prospective.

Cancer risk and male Infertility: Unravelling predictive biomarkers and prognostic indicators

In recent years, there has been a global increase in cases of male infertility. There are about 30 million cases of male infertility worldwide and male reproductive health is showing rapid decline in last few decades. It is now recognized as a potential risk factor for developing certain types of cancer, particularly genitourinary malignancies like testicular and prostate cancer. Male infertility is considered a potential indicator of overall health and an early biomarker for cancer. Cases of unexplained male factor infertility have high levels of oxidative stress and oxidative DNA damage and this induces both denovo germ line mutations and epimutations due to build up of 8-hydroxy 2 deoxygunaosine abase which is highly mutagenic and also induces hypomethylation and genomic instability. Consequently, there is growing evidence to explore the various factors contributing to an increased cancer risk. Currently, the available prognostic and predictive biomarkers associated with semen characteristics and cancer risk are limited but gaining significant attention in clinical research for the diagnosis and treatment of elevated cancer risk in the individual and in offspring. The male germ cell being transcriptionally and translationally inert has a highly truncated repair mechanism and has minimal antioxidants and thus most vulnerable to oxidative injury due to environmental factors and unhealthy lifestyle and social habits. Therefore, advancing our understanding requires a thorough evaluation of the pathophysiologic mechanisms at the DNA, RNA, protein, and metabolite levels to identify key biomarkers that may underlie the pathogenesis of male infertility and associated cancer. Advanced methodologies such as genomics, epigenetics, proteomics, transcriptomics, and metabolomics stand at the forefront of cutting-edge approaches for discovering novel biomarkers, spanning from infertility to associated cancer types. Henceforth, in this review, we aim to assess the role and potential of recently identified predictive and prognostic biomarkers, offering insights into the success of assisted reproductive technologies, causes of azoospermia and idiopathic infertility, the impact of integrated holistic approach and lifestyle modifications, and the monitoring of cancer susceptibility, initiation and progression. Comprehending these biomarkers is crucial for providing comprehensive counselling to infertile men and cancer patients, along with their families.

APHRODITE criteria: addressing male patients with hypogonadism and/or infertility owing to altered idiopathic testicular function

RESEARCH QUESTION

Can a novel classification system of the infertile male - 'APHRODITE' (Addressing male Patients with Hypogonadism and/or infeRtility Owing to altereD, Idiopathic TEsticular function) - stratify different subgroups of male infertility to help scientists to design clinical trials on the hormonal treatment of male infertility, and clinicians to counsel and treat the endocrinological imbalances in men and, ultimately, increase the chances of natural and assisted conception?

DESIGN

A collaboration between andrologists, reproductive urologists and gynaecologists, with specialization in reproductive medicine and expertise in male infertility, led to the development of the APHRODITE criteria through an iterative consensus process based on clinical patient descriptions and the results of routine laboratory tests, including semen analysis and hormonal testing.

RESULTS

Five patient groups were delineated according to the APHRODITE criteria; (1) Hypogonadotrophic hypogonadism (acquired and congenital); (2) Idiopathic male infertility with lowered semen analysis parameters, normal serum FSH and normal serum total testosterone concentrations; (3) A hypogonadal state with lowered semen analysis parameters, normal FSH and reduced total testosterone concentrations; (4) Lowered semen analysis parameters, elevated FSH concentrations and reduced or normal total testosterone concentrations; and (5) Unexplained male infertility in the context of unexplained couple infertility.

CONCLUSION

The APHRODITE criteria offer a novel and standardized patient stratification system for male infertility independent of aetiology and/or altered spermatogenesis, facilitating communication among clinicians, researchers and patients to improve reproductive outcomes following hormonal therapy. APHRODITE is proposed as a basis for future trials of the hormonal treatment of male infertility.

Diagnosis and management of infertility: NICE-adapted guidelines from the Italian Society of Human Reproduction

In Italy the fertility rate is very low, and an increasing number of patients are infertile and require treatments. The Italian Law concerning the safety of patient care, and the professional liability of health professionals, indicates that health professionals must comply with the recommendations set out in the guidelines developed by public and private bodies and institutions, as well as scientific societies and technical-scientific associations of the health professions, except for specific cases. Unfortunately, no guideline for the diagnosis and the management of infertility is currently available in Italy. In 2019, the Italian Society of Human Reproduction pointed out the need to produce Italian guidelines and subsequently approved the establishment of a multidisciplinary and multiprofessional working group (MMWG) to develop such a guideline. The MMWG was representative of 5 scientific societies, one national federation of professional orders, 3 citizens' and patients' associations, 5 professions (including lawyer, biologist, doctor, midwife, and psychologist), and 3 medical specialties (including medical genetics, obstetrics and gynecology, and urology). The MMWG chose to adapt a high-quality guideline to the Italian context instead of developing one from scratch. Using the Italian version of the Appraisal of Guidelines for Research and Evaluation II scoring system, the National Institute of Clinical Excellence guidelines were selected and adapted to the Italian context. The document was improved upon by incorporating comments and suggestions where needed. This study presents the process of adaptation and discusses the pros and cons of the often-neglected choice of adapting rather than developing new guidelines.

Bridging the Gap: Animal Models in Next-Generation Reproductive Technologies for Male Fertility Preservation

This review aims to explore advanced reproductive technologies for male fertility preservation, underscoring the essential role that animal models have played in shaping these techniques through historical contexts and into modern applications. Rising infertility concerns have become more prevalent in human populations recently. The surge in male fertility issues has prompted advanced reproductive technologies, with animal models playing a pivotal role in their evolution. Historically, animal models have aided our understanding in the field, from early reproductive basic research to developing techniques like artificial insemination, multiple ovulation, and in vitro fertilization. The contemporary landscape of male fertility preservation encompasses techniques such as sperm cryopreservation, testicular sperm extraction, and intracytoplasmic sperm injection, among others. The relevance of animal models will undoubtedly bridge the gap between traditional methods and revolutionary next-generation reproductive techniques, fortifying our collective efforts in enhancing male fertility preservation strategies. While we possess extensive knowledge about spermatogenesis and its regulation, largely thanks to insights from animal models that paved the way for human infertility treatments, a pressing need remains to further understand specific infertility issues unique to humans. The primary aim of this review is to provide a comprehensive analysis of how animal models have influenced the development and refinement of advanced reproductive technologies for male fertility preservation, and to assess their future potential in bridging the gap between current practices and cutting-edge fertility techniques, particularly in addressing unique human male factor infertility.

Environmental and Genetic Traffic in the Journey from Sperm to Offspring

Recent advancements in the understanding of how sperm develop into offspring have shown complex interactions between environmental influences and genetic factors. The past decade, marked by a research surge, has not only highlighted the profound impact of paternal contributions on fertility and reproductive outcomes but also revolutionized our comprehension by unveiling how parental factors sculpt traits in successive generations through mechanisms that extend beyond traditional inheritance patterns. Studies have shown that offspring are more susceptible to environmental factors, especially during critical phases of growth. While these factors are broadly detrimental to health, their effects are especially acute during these periods. Moving beyond the immutable nature of the genome, the epigenetic profile of cells emerges as a dynamic architecture. This flexibility renders it susceptible to environmental disruptions. The primary objective of this review is to shed light on the diverse processes through which environmental agents affect male reproductive capacity. Additionally, it explores the consequences of paternal environmental interactions, demonstrating how interactions can reverberate in the offspring. It encompasses direct genetic changes as well as a broad spectrum of epigenetic adaptations. By consolidating current empirically supported research, it offers an exhaustive perspective on the interwoven trajectories of the environment, genetics, and epigenetics in the elaborate transition from sperm to offspring.

Male infertility with muscle weakness: a point of view

Introduction and importance

The most common causes of infertility are idiopathic spermatogenetic disorders, occurring in multiple reproductive or systemic diseases. The underlying genetic disorders influence the treatment and transmission of the disease to the offspring.

Case presentation

A 32-year-old Syrian male, married for 6 years, presented with primary infertility. The patient had a history of muscle dystrophy for 12 years. He had no previous medical or drug addiction or family history. He had gynecomastia. Semen analysis revealed oligospermia in the patient. Follicle-stimulating hormone was elevated. Gene analysis could not be done due to funding issues. The percutaneous testicular biopsy revealed hypospermatogenesis, atrophy, and marked hyalinization of the seminiferous tubules. Electromyography of the upper extremities demonstrated myotonic discharges, with a waxing-waning frequency, amplitude, and a characteristic 'engine revving' sound.

Clinical discussion

Myotonic dystrophy (MD) is an autosomal dominant inheritance disease with adult onset. Muscle weakness is the predominant presenting feature, with early involvement of the distal limbs and neck muscles and a characteristic facial appearance.Systemic clinical manifestations may include cardiac conduction defects, cataracts, insulin resistance and diabetes, testicular atrophy with impaired spermatogenesis, and others. Testicular biopsy findings are specific. To our knowledge, this is the first case of male infertility associated with MD in Syria. However, there are no data on the prevalence of myotonic dystrophy type 1 (MD1) in Syria.

Conclusion

The practicing physician should keep in mind the frequent association between MD and infertility.

Potency Assays for Mesenchymal Stromal Cell Secretome-Based Products for Tissue Regeneration

Adult stem cells maintaining tissue homeostasis and regeneration are tightly regulated by their specific microenvironments or stem cell niches. The dysfunction of niche components may alter the activity of stem cells and ultimately lead to intractable chronic or acute disorders. To overcome this dysfunction, niche-targeting regenerative medicine treatments such as gene, cell, and tissue therapy are actively investigated. Here, multipotent mesenchymal stromal cells (MSCs), and particularly their secretomes, are of high interest due to their potency to recover and reactivate damaged or lost stem cell niches. However, a workflow for the development of MSC secretome-based products is not fully covered by regulatory authorities, and and this issue significantly complicates their clinical translation and has possibly been expressed in a huge number of failed clinical trials. One of the most critical issues in this regard relates to the development of potency assays. In this review, guidelines for biologicals and cell therapies are considered to be applied for the development of potency assays for the MSC secretome-based products that aim for tissue regeneration. Specific attention is paid to their possible effects on stem cell niches and to a spermatogonial stem cell niche in particular.