Improvement of semen quality by nocturnal scrotal cooling in oligozoospermic men with a history of testicular maldescent

The Impact of High Ambient Temperature on Human Sperm Parameters: A Meta-Analysis

Background

Global warming, lifestyle, or working in a high temperature environment leads to have increased health risk factors. This meta-analysis was conducted to determine the impact of high ambient temperature on male reproductive function.

Methods

Scientific articles were screened in the database including MEDLINE, EMBASE, National center for biotechnology information (NCBI) or Web of Science with relating keywords. Impact data of high ambient temperature on semen parameters were extracted and analyzed by STATA software according to the Random Effects Model. The high ambient temperature exposure group and Non-exposure group were compared using the standard mean difference (SMD). Publications were evaluated for publication bias by Egger test.

Results

Nine articles were finally selected from databases examining the effect of high ambient temperature on male reproductive health of 356 men from Iran, Italy, Thailand, China, Egypt. High ambient temperature showed a significant decrease in the seminal parameters, semen volume during each ejaculation (SMD = -0.74; 95% CI -1.11, -0.36), sperm concentration (SMD = -1.07; 95% CI -1.42, -0.72), total sperm count (SMD = -1.52; 95% CI -2.96, -0.08), sperm motility (SMD = -1.93; 95% CI -2.83, -1.04), sperm progressive motility (SMD = -1.65; 95% CI -2.39, -0.91) and normal morphology (SMD = -2.41; 95% CI -3.30, -1.52).

Conclusion

High ambient temperature negatively affects sperm quality, including decreased semen volume, sperm count, sperm concentration, motility and normal morphology. This might lead to protective strategies to avoid the adverse effects of high ambient temperature on male fertility.

Stay cool! Special underwear for cyclic cooling significantly decreases scrotal skin temperature

Introduction

Male reproductive health is rapidly declining during the past decades and it is well known that scrotal temperature is linked to male infertility.

Material and methods

We performed a prospective data evaluation within a counterfactual analysis study design. Scrotal cooling was performed using Snowballs™ underwear, scrotal temperature was monitored using a wireless temperature sensor (SensorPush, Brooklyn, NY, 11215)

Results

Overall, scrotal skin temperatures were monitored for 1008 hours. Median scrotal skin temperature was 34.6°C (IQR 33.1 to 35.3) and 35.3°C (IQR 34.4 to 35.9) in the experimental (SnowWedge™) period and control period, respectively, which was significantly different (P <0.001).

Conclusions

Cyclic scrotal skin cooling using specialized underwear is feasible and efficacious without impairing the activities of daily living and reduces median scrotal skin temperature significantly by 0.7°C. Given the proven association of scrotal skin temperature and semen quality, cyclic scrotal skin cooling by a device such as Snowballs™ underwear may eventually increase semen quality and fertility.

Evaluation of patient compliance with the use of scrotal cooling devices

Objective

To evaluate the compliance of infertile men with the use of scrotal cooling devices. As a secondary objective, sperm parameters, deoxyribonucleic acid fragmentation, and hormone profiles were examined.

Design

This exploratory study on scrotal cooling provided scrotal cooling devices to men with primary infertility and abnormal semen parameters. Feedback on the devices after their use was gathered in the form of a questionnaire, and semen parameters were examined after device use.

Setting

Single center infertility clinic in Toronto, Ontario, Canada.

Patient(s)

Patients with primary infertility and abnormal semen parameters were prospectively evaluated before and after scrotal cooling.

Intervention(s)

One of two scrotal cooling devices (Underdog or Snowballs) was used, on the basis of patient preference.

Main Outcome Measure(s)

Questionnaires were completed by patients on compliance with device use and concerns about and recommendations for improving the cooling devices. Baseline deoxyribonucleic acid fragmentation index, sperm parameters, and hormones were measured at the initial visit (t = 0) and at subsequent visits (t = 4–12 weeks). Statistical comparison of values before and after scrotal cooling was performed.

Result(s)

Forty patients were enrolled in the study, and the questionnaire was completed by 65.0% (n = 26). Most respondents (76.9%) used scrotal cooling less than the recommended duration. Respondents believed that the devices were uncomfortable (31.5%), impeded work (21.0%), and lost cooling rapidly (14.3%). Significant increases in sperm motility and vitality (from 25.4 % to 29.0% and from 64.8% to 71.7%, respectively) were demonstrated after scrotal cooling.

Conclusion(s)

Most patients were not compliant with the recommended use of the scrotal cooling devices because of issues of comfort, convenience, and concealability. Further work on improving scrotal cooling devices is necessary to enhance their potential as a therapeutic tool for men with abnormal sperm parameters and infertility.

Nuclear heterogeneity is prevalent in high-quality fractionated human sperm cells typically used for assisted conception

STUDY QUESTION

What is the nuclear heterogeneity of high-density purified human spermatozoa typically used for IVF purposes.

SUMMARY ANSWER

The data show that while density gradient separation has improved the overall sperm population, there is still a large degree of nuclear heterogeneity within these cells.

WHAT IS KNOWN ALREADY

Chromomycin A3 (CMA3) is an important DNA binding fluorochrome for the assessment of male-factor fertility. It is typically used to predict IVF outcomes on entire sperm ejaculates with very high receiver operating characteristic. Here we used CMA3 to characterise typical populations of human spermatozoa that would be used for IVF purposes after density gradient separation.

STUDY DESIGN, SIZE, DURATION

We compared the intensity of CMA3 binding within high-dense sperm populations obtained from men. Binding heterogeneity was confirmed through fluorescence microscopy and FACS analysis independently. We also looked at CMA3 staining directly with head morphology in this sperm population. Finally, we looked at electron micrographs of nuclear heterogeneity (vacuoles, chromatin compaction) of spermatozoa following density gradient sorting of CMA3-stained cells.

PARTICIPANTS/MATERIALS, SETTING, METHODS

We used sperm donors who had fathered one or more children. Semen was collected after 2 days abstinence and purified over Percoll gradients. Only the high-quality spermatozoa, the same used for assisted conception, were then used. Cells were stained with CMA3 and sorted using FACS. Following this, electron micrographs were used to assess nuclear heterogeneity of CMA3-dependent sorted spermatozoa.

MAIN RESULTS AND THE ROLE OF CHANCE

CMA3 staining occurs within morphologically normal as well as abnormal spermatozoa. High-intensity CMA3-stained sperm possessed large vacuoles that were not seen in the low-CMA3 population. In addition, the high-CMA3 stained cells possess higher amounts of nuclear granulation.

LIMITATIONS, REASONS FOR CAUTION

The present study only describes the issues within the chromatin of these cells and does not suggest an alternate selection technique.

WIDER IMPLICATIONS OF THE FINDINGS

CMA3 is one of the better reported prognostic assays in predicting pregnancy outcomes, especially in cases where the male is at fault. However, it is clear that even in fractionated populations of human spermatozoa, there are sperm cells that are morphologically normal yet possess high levels of CMA3 staining and chromatin granulation. The implication of this is that the embryologist, whom selects on the basis of sperm morphology, may choose a cell with poor chromatin, which may lead to poor embryo outcomes.

STUDY FUNDING/COMPETING INTEREST(S)

The project was funded by the National Health and Medical Research council, APP1118943. The authors have no conflict of interest to declare.

TRIAL REGISTRATION NUMBER

N/A.

Protective effects of red grape (Vitis vinifera) juice through restoration of antioxidant defense, endocrine swing and Hsf1, Hsp72 levels in heat stress induced testicular dysregulation of Wister rat

Ability of red grape juice (RGJ), a known antioxidant, on testis of adult Wister rat to protect from oxidative stress induced damages by heat stress has been investigated in this study. Heat stress was induced maintaining body and testicular temperature at 43°C for 30min/day for 15 days using a hyperthermia induction chamber. Four groups of rats (n=6 per group) comprising of Group-I (control) -kept at 32°C, Group-II -exposed to heat stress alone, Group-III received RGJ (0.8ml/rat/day) alone and Group-IV -exposed to heat stress and received RGJ at same dose. Analysis of blood and testicular tissue exhibited significant reduction in serum testosterone, testicular superoxide dismutase, testicular catalase and testicular glutathione (all p < 0.001); whereas, significant rise in the level of serum corticosteroid, testicular lipid peroxidase and the apoptotic enzyme caspase-3 of testis (all p < 0.001) were observed along with substantial increase in testicular Hsp72 and Hsf-1, and decrease in 17β-HSD3 were noted in heat stressed rats compared to controls. In Group-IV rats, RGJ administration could restore these parameters to normal levels. The signs of retention were clear in Group-IV rats and found to be significantly different as compared to that of the Group-II rats. In testicular histology of rats exposed to heat stress alone revealed remarkable germ cell degeneration and tubular deformations which were prevented by RGJ treatment (Group-IV). The reduced number of sperm level in Group-II also restored in RGJ treatment (Group-IV). The above results indicate that consumption of RGJ may substantially protect testis from heat stress induce dysfunctions.

Male infertility: lifestyle factors and holistic, complementary, and alternative therapies

While we may be comfortable with an allopathic approach to male infertility, we are also responsible for knowledge about lifestyle modifications and holistic, complementary, and alternative therapies that are used by many of our patients. This paper provides an evidence-based review separating fact from fiction for several of these therapies. There is sufficient literature to support weight reduction by diet and exercise, smoking cessation, and alcohol moderation. Supplements that have demonstrated positive effects on male fertility on small randomized controlled trial (RCT) include aescin, coenzyme Q 10 , glutathione, Korean red ginseng, L-carnitine, nigella sativa, omega-3, selenium, a combination of zinc and folate, and the Menevit antioxidant. There is no support for the use of Vitamin C, Vitamin E, or saffron. The data for Chinese herbal medications, acupuncture, mind-body practice, scrotal cooling, and faith-based healing are sparse or inconclusive.

An Update on Oxidative Damage to Spermatozoa and Oocytes

On the one hand, reactive oxygen species (ROS) are mandatory mediators for essential cellular functions including the function of germ cells (oocytes and spermatozoa) and thereby the fertilization process. However, the exposure of these cells to excessive levels of oxidative stress by too high levels of ROS or too low levels of antioxidative protection will render these cells dysfunctional thereby failing the fertilization process and causing couples to be infertile. Numerous causes are responsible for the delicate bodily redox system being out of balance and causing disease and infertility. Many of these causes are modifiable such as lifestyle factors like obesity, poor nutrition, heat stress, smoking, or alcohol abuse. Possible correctable measures include foremost lifestyle changes, but also supplementation with antioxidants to scavenge excessive ROS. However, this should only be done after careful examination of the patient and establishment of the individual bodily antioxidant needs. In addition, other corrective measures include sperm separation for assisted reproductive techniques. However, these techniques have to be carried out very carefully as they, if applied wrongly, bear risks of generating ROS damaging the germ cells and preventing fertilization.

Scrotal cooling and its benefits to male fertility: a systematic review

The aim of this study was to systematically review the evidence for the impact of scrotal cooling on spermatogenesis. EMBASE (1980-2010) and MEDLINE (1950-Sept. 2010) databases were searched using the terms 'male infertility or subfertility or fertility', combined with a separate search of 'scrotal cooling', without any limits or restrictions. A total of eight articles met the criteria for inclusion in the study. There was insufficient evidence to draw any firm conclusions about the impact of scrotal cooling on male fertility. A positive trend of improved male fertility was however observed. There is therefore a need for well designed randomised controlled trials.

A study of the effect of the FertilMate™ Scrotum Cooling Patch on male fertility. SCOP trial (scrotal cooling patch) - study protocol for a randomised controlled trial

Background

Male infertility is a significant contributor to the need for fertility treatment. Treatment currently involves correcting any identifiable adverse lifestyle factors in men with suboptimal sperm parameters, and if these measures are unsuccessful, assisted conception is offered, which can be quite expensive. Raised scrotal temperature is one of the least studied but easily corrected risk factors for male infertility. In a recent review of the literature, sperm count, motility and morphology improved with scrotal cooling devices. The devices used to achieve testicular cooling were, however, not practical for day-to-day use. A potentially more practical device for scrotal cooling has recently been developed. The Babystart® FertilMate™ Scrotum Cooling Patch is a hydrogel pad which allows for comfortable application. The aims of this study were to investigate whether exposing the scrotum to lower temperatures by means of these new patches could improve semen parameters, thereby improving fertility, and to assess the feasibility of a clinical trial.

Methods/design

This is a randomised controlled trial set in a university teaching hospital in the United Kingdom. The proposed sample size was 40 men with mild, moderate or severe oligoasthenospermia, of whom 20 would be randomised to wearing the scrotum cooling patch for 90 days and 20 men would be acting as controls and not wearing the patches. The primary outcome measure was the change in sperm concentration. Secondary outcome measures included the change in sperm volume, motility and morphology; endocrine parameters; metabolomic biomarkers; testicular volume and blood flow. Reasons for dropping out and non-compliance were also going to be noted and reported.

Discussion

The study started recruiting in October 2011 and as of November 2011 four men had been consented and were participating in the study. No operational challenges had been encountered at the time of the submission of this manuscript. Although the study also aimed to evaluate the feasibility of a definitive study, the change in sperm count after 90 days of wearing the scrotal cooling patches was made the primary outcome measure because a statistically significant improvement in sperm parameters with the scrotal patches would in itself be a definitive finding.

Trial registration

Current Controlled Trials ISRCTN94041896

Success of acupuncture treatment in patients with initially low sperm output is associated with a decrease in scrotal skin temperature

Poor spermatogenesis in patients with inflammation of the genital tract is associated with scrotal hyperthermia. These patients can benefit from acupuncture treatment. We conducted a study to verify whether the influence of acupuncture treatment on sperm output in patients with low sperm density is associated with a decrease in scrotal temperature. The experimental group included 39 men who were referred for acupuncture owing to low sperm output. The control group, which comprised 18 normal fertile men, was used to define a threshold (30.5 degrees C) above which scrotal skin temperature was considered to be high. Accordingly, 34 of the 39 participants in the experimental group initially had high scrotal skin temperature; the other five had normal values. Scrotal skin temperature and sperm concentration were measured before and after acupuncture treatment. The five patients with initially normal scrotal temperatures were not affected by the acupuncture treatment. Following treatment, 17 of the 34 patients with hyperthermia, all of whom had genital tract inflammation, had normal scrotal skin temperature; in 15 of these 17 patients, sperm count was increased. In the remaining 17 men with scrotal hyperthermia, neither scrotal skin temperature nor sperm concentration was affected by the treatment. About 90% of the latter patients suffered from high gonadotropins or mixed etiological factors. Low sperm count in patients with inflammation of the genital tract seems to be associated with scrotal hyperthermia, and, consequently, acupuncture treatment is recommended for these men.

Lifestyle impact and the biology of the human scrotum

The possession of a scrotum to contain the male gonads is a characteristic feature of almost all mammals, and appears to have evolved to allow the testes and epididymis to be exposed to a temperature a few degrees below that of core body temperature. Analysis of cryptorchid patients, and those with varicocele suggest that mild scrotal warming can be detrimental to sperm production, partly by effects on the stem cell population, and partly by effects on later stages of spermatogenesis and sperm maturation. Recent studies on the effects of clothing and lifestyle emphasize that these can also lead to chronically elevated scrotal temperatures. In particular, the wearing of nappies by infants is a cause for concern in this regard. Together all of the evidence indirectly supports the view that lifestyle factors in addition to other genetic and environmental influences could be contributing to the secular trend in declining male reproductive parameters. The challenge will be to provide relevant and targeted experimental results to support or refute the currently circumstantial evidence.

Changes in the scrotal temperature of subjects in a sedentary posture over a heated floor

As Koreans habitually sit on the heated floor in their residential buildings, the male testis is directly exposed, and is therefore affected by the floor surface temperature. The purpose of this study was to investigate the changes in the scrotal temperature of the subjects in a sedentary posture over the heated floor. A rigid screening test was performed to select healthy subjects. Finally, six college students volunteered to participate in the experiments. Two experiments were performed in a controlled environmental chamber. Experiment I was designed for a low metabolism state, with the subjects reading a book in a sedentary posture for 50 min. The floor surface temperature (tf) was controlled by varying the temperature of water (tw) flowing into the floor coil from 15 to 50 degrees C, at 5 degrees C intervals. Experiment I revealed that the final scrotal surface temperature was 32.27, 32.62, 33.51, 33.34, 34.14, 34.28, 34.34 and 35.04 degrees C at the tw 15 degrees C (tf 17.0 degrees C), 20 degrees C (tf 20.8 degrees C), 25 degrees C (tf 24.1 degrees C), 30 degrees C (tf 27.8 degrees C), 35 degrees C (tf 31.7 degrees C), 40 degrees C (tf 35.9 degrees C), 45 degrees C (tf 38.6 degrees C) and 50 degrees C (tf 42.2 degrees C), respectively. At tf 17.0 and 20.8 degrees C, the scrotal temperature exhibited a declining pattern and a low temperature for spermatogenesis. At tf 24.1, 27.8 and 31.7 degrees C, however, the thermal regulatory system of the scrotum and testis was activated appropriately. On the contrary, scrotal temperature ascended at tf 35.9, 38.6 and 42.2 degrees C. Of the six subjects, two subjects demonstrated scrotal temperatures above 35 degrees C at tf 38.6 degrees C and four subjects exhibited scrotal temperatures above 35 degrees C at tf 42.2 degrees C. Experiment II was designed for a high metabolism state, with the subjects playing a card game in a sedentary posture for 180 min. The tf was controlled by varying the tw from 30 to 40 degrees C, at 5 degrees C intervals. Experiment II revealed that the final scrotal temperature was 33.43, 34.78 and 35.61 degrees C, and the difference between the initial and final scrotal temperatures was +0.34, +1.06 and +2.24 degrees C, at tw 30 degrees C (tf 27.8 degrees C), 35 degrees C (tf 31.7 degrees C) and tw 40 degrees C (tf 35.9 degrees C), respectively. The scrotal temperature was affected by the floor surface temperature and by the rate of metabolism of the subject in a sedentary posture. As derived from regression analysis, the recommended surface temperature of a heated floor is within 23-33 degrees C under the assumption that scrotal and consecutively testicular temperature above 35 degrees C impairs spermatogenesis.

Influence of the type of undertrousers and physical activity on scrotal temperature

BACKGROUND

Testicular temperature correlates highly with scrotal temperature. The aim of this study was to evaluate the influence of the type of undertrousers on scrotal temperature during standardized periods of sitting and walking.

METHODS

Fifty volunteers without a history of infertility and normal andrological examination were included for scrotal temperature evaluation. Temperatures were measured every minute with a portable data recorder connected with two thermistor temperature sensors, which were attached on either side of the scrotum. Ambient temperature in the study room was adjusted to 20 degrees C throughout the whole experiment. All volunteers started the experiment at the same time of day. Clothing of the volunteers consisted of standardized cotton wool trousers and shirts fitting to body size. Each volunteer performed six periods of 45 min, either walking on a treadmill (3.0 km/h) or sitting, and wearing in a standardized and randomized manner either tight, loose fitting or no undertrousers respectively.

RESULTS

The following interactions were demonstrated by means of multivariate analysis of variance for repeated measurements: scrotal temperatures were significantly higher for tight versus loose fitting versus absent undertrousers. Furthermore, significantly lower scrotal temperatures were identified for walking versus sitting as well as for the right versus the left scrotal side.

CONCLUSIONS

The present study suggests that wearing tight fitting undertrousers is associated with higher scrotal and consequently testicular temperatures than wearing loose fitting undertrousers or none.