Clinical Efficacy of Prodom-Assisted Urokinase in the Treatment of Male Infertility Caused by Impaired Semen Liquefaction

Expression and correlation of male reproductive hormone levels with abnormal semen liquefaction time

OBJECTIVE

To explore the reproductive hormone levels and their correlation in males with abnormal semen liquefaction time, providing evidence-based medical insights for the diagnosis and treatment of abnormal semen liquefaction.

METHODS

A total of 36 male patients who exhibited a sperm liquefaction time exceeding 60 min in the Maternal and Child Health Hospital of Hubei Province from January 2021 to January 2023 were included. They were classified into the delayed liquefaction group. During the same period, 138 male patients with a sperm liquefaction time of ≤60 min were assigned to a normal liquefaction group. Comparative analysis was performed on reproductive hormone levels between the two groups, including follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone (T), estradiol (E2), prolactin (PRL), as well as semen parameters such as normal morphology sperm rate, forward motility sperm rate, and sperm concentration. Pearson's correlation analysis was employed to investigate the relationship between reproductive hormones and semen liquefaction time. The effectiveness of biomarkers in predicting delayed semen liquefaction time was assessed using receiver operating characteristic (ROC) curves.

RESULTS

Patients with delayed semen liquefaction had significantly lower rates of normal morphology sperm, forward progressive motility, and sperm concentration when compared to patients with normal liquefaction. Significantly lower FSH, LH, and T levels were observed in patients with delayed semen liquefaction than those with normal liquefaction. Furthermore, a negative correlation was identified between serum FSH and T levels in male infertility patients and semen liquefaction time. The sensitivity of FSH for predicting semen liquefaction defects is 72.2%, whereas testosterone exhibits a sensitivity of 94.4%.

CONCLUSION

The semen liquefaction time of male infertility patients is closely correlated with semen parameters and reproductive hormone levels. Specifically, FSH and T exhibit a negative correlation with semen liquefaction time.

Ejaculation: the Process and Characteristics From Start to Finish

Purpose of Review

Semen analysis serves as the initial step in the evaluation of male infertility. However, given the difficulty in interpreting abnormal findings, physicians and patients often struggle with understanding the results. In this review, we aim to review the normal physiology of ejaculation and create an accessible resource for interpreting abnormal semen volume, viscosity, liquefaction, pH, appearance, and color.

Recent Findings

Emerging evidence has revealed that men with genitourinary tract infections have a greater number of seminal leukocytes, which may result in clumping of motile sperm and altered morphology. Hence, these patients may have abnormal sperm parameters secondary to their health status. Recent findings have further characterized the semen liquefaction process, suggesting that increased levels of semenogelin and decreased levels of proteases and plasminogen activators (e.g., urokinase and chymotrypsin) may be associated with the failure of semen to convert to a watery consistency.

Summary

This article creates a resource which may be referenced when abnormalities in semen analysis are encountered. We offer a comprehensive overview of normal ejaculation physiology and abnormal variants in male ejaculate volume-including aspermia, anejaculation, retrograde ejaculation, and hypo- and hyperspermia-and their potential etiologies. Additionally, we discuss several processes (infection, inflammation, and dysfunction of male sex glands) which may affect semen viscosity, liquefaction, and pH. Finally, our discussion of the potential colors of male ejaculate is meant to reduce the anxiety of both patient and provider. Through a better understanding of the process and varying characteristics of ejaculation, physicians may adequately counsel their patients on abnormal findings and concerns regarding infertility.

Studies on improving semen quality and increasing pregnancy chances through the in vitro addition of L-carnitine and coenzyme Q10 to semen in patients with asthenozoospermia

Background

At present, L-carnitine (LC) and coenzyme Q10 (CoQ10), as used clinically to treat male infertility caused by asthenozoospermia (ASZ) is still mainly administered orally, but some patients with ASZ still show no significant improvement in sperm motility and spouse pregnancy rate. Prodom is a device used to assist reproduction, which is temporarily fitted onto the penis to facilitate conception by helping the wife inject a certain drug into the vagina. This study used Prodom-assisted LC/CoQ10 in the treatment of patients with ASZ and evaluated the effect of this method on sperm motility and clinical pregnancy, with the goal of finding a comfortable, low-cost, effective method.

Results

During the trial period, 232 cases completed the trial, while 25 cases did not. During in vitro testing, the progressive sperm motility in the LC group, CoQ10 group, LC combined with CoQ10 group, and the semen blank control group was 24.3 ± 4.6% and 38.1 ± 5.1%, 23.0 ± 4.8% and 36.9 ± 4.4%, 28.4 ± 5.0% and 43.8 ± 5.4%, 19.7 ± 4.4% and 26.0 ± 4.9%, respectively. There were statistically significant differences in progressive sperm motility among the groups (all P values < 0.05). The pregnancy rates of the Prodom-assisted LC treatment group, Prodom-assisted CoQ10 treatment group, Prodom-assisted LC combined with CoQ10 treatment group, and oral LC combined with CoQ10 treatment group in the clinical treatment stage were 38.2, 35.4, 57.1, and 30.3%, respectively; the time to conception was 6.1 ± 1.8, 6.2 ± 1.8, 3.4 ± 0.9, and 7.9 ± 2.0, months respectively; and the treatment costs were $2350 ± 457, $2455 ± 434, $1348 ± 411, and $2684 ± 334, respectively. The differences in pregnancy rate, time to conception, and treatment costs among the groups were statistically significant (all P values < 0.05).

Conclusions

The supplementation of in vitro semen with LC/CoQ10 can improve sperm motility. LC/CoQ10 injected into the spouse’s vagina with the assistance of a Prodom can increase the pregnancy rate, shorten the time to conception, and reduce the cost of treatment in patients with ASZ.

Trial registration

ChiCTR2000040349 (registry: http://www.chictr.org.cn/).

Date of registration: November 28, 2020.