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Franco A, Proietti F, Palombi V, Savarese G, Guidotti M, Leonardo C, Ferro F, Manna C, Franco G. Varicocele: To Treat or Not to Treat? J Clin Med 2023; 12:4062. [PMID: 37373755 DOI: 10.3390/jcm12124062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/07/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023] Open
Abstract
Varicocele treatment in infertility still remains controversial. It is clear, in fact, that in many patients, varicocele has no impact on fertility. Recent scientific evidence demonstrated that varicocele treatment is beneficial in improving semen parameters and pregnancy rate when an appropriate selection of patients is made. The purpose of treating varicocele in adults is mainly to improve current fertility status. On the other hand, the goal of treatment in adolescents is to prevent testicular injury and maintain testicular function for future fertility. Hence, the key to the success of varicocele treatment seems to be a correct indication. The aim of this study is to review and summarize current evidence in managing varicocele treatment focusing on the controversies regarding surgical indications in adolescent and adult patients, and in other specific situations such as azoospermia, bilateral or subclinical varicocele, and prior to ART.
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Affiliation(s)
- Antonio Franco
- Department of Urology, Sant'Andrea Hospital, "Sapienza" University of Rome, 00185 Rome, Italy
| | - Flavia Proietti
- Department of Maternal and Child Health and Urological Sciences, Policlinico Umberto I, "Sapienza" University of Rome, 00185 Rome, Italy
| | - Veronica Palombi
- Department of Maternal and Child Health and Urological Sciences, Policlinico Umberto I, "Sapienza" University of Rome, 00185 Rome, Italy
| | - Gabriele Savarese
- Department of Maternal and Child Health and Urological Sciences, Policlinico Umberto I, "Sapienza" University of Rome, 00185 Rome, Italy
| | - Michele Guidotti
- Department of Urology, Nuovo Ospedale dei Castelli, 00040 Rome, Italy
| | - Costantino Leonardo
- Department of Maternal and Child Health and Urological Sciences, Policlinico Umberto I, "Sapienza" University of Rome, 00185 Rome, Italy
| | | | - Claudio Manna
- Biofertility IVF and Infertility Center, 00198 Rome, Italy
| | - Giorgio Franco
- Department of Maternal and Child Health and Urological Sciences, Policlinico Umberto I, "Sapienza" University of Rome, 00185 Rome, Italy
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Davies R, Jayasena CN, Rai R, Minhas S. The Role of Seminal Oxidative Stress in Recurrent Pregnancy Loss. Antioxidants (Basel) 2023; 12:antiox12030723. [PMID: 36978971 PMCID: PMC10045000 DOI: 10.3390/antiox12030723] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 03/01/2023] [Accepted: 03/07/2023] [Indexed: 03/17/2023] Open
Abstract
Recurrent pregnancy loss is a distressing condition affecting 1–2% of couples. Traditionally investigations have focused on the female, however more recently researchers have started to explore the potential contribution of the male partner. Seminal reactive oxygen species have a physiological function in male reproduction but in excess are suspected to generate structural and functional damage to the sperm. Evidence is mounting to support an association between elevated seminal reaction oxygen species and recurrent pregnancy loss. Studies suggest that the rates of sperm DNA damage are higher in the male partners of women affected by recurrent pregnancy loss compared with unaffected men. However, the available pool of data is conflicting, and interpretation is limited by the recent change in nomenclature and the heterogeneity of study methodologies. Furthermore, investigation into the effects of oxidative stress on the epigenome show promise. The value of antioxidant therapy in the management of recurrent pregnancy loss currently remains unclear.
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Affiliation(s)
- Rhianna Davies
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London W12 0NN, UK
| | - Channa N. Jayasena
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London W12 0NN, UK
| | - Raj Rai
- Department of Obstetrics and Gynaecology, St Mary’s Hospital, Imperial College NHS Trust, London W2 1NY, UK
| | - Suks Minhas
- Department of Urology, Charing Cross Hospital, Imperial College NHS Trust, London W6 8RF, UK
- Correspondence:
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Jayasena CN, Radia UK, Figueiredo M, Revill LF, Dimakopoulou A, Osagie M, Vessey W, Regan L, Rai R, Dhillo WS. Reduced Testicular Steroidogenesis and Increased Semen Oxidative Stress in Male Partners as Novel Markers of Recurrent Miscarriage. Clin Chem 2019; 65:161-169. [DOI: 10.1373/clinchem.2018.289348] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 09/17/2018] [Indexed: 12/14/2022]
Abstract
Abstract
BACKGROUND
Recurrent pregnancy loss, (RPL) affecting 1%–2% of couples, is defined as ≥3 consecutive pregnancy losses before 20-week' gestation. Women with RPL are routinely screened for etiological factors, but routine screening of male partners is not currently recommended. Recently it has been suggested that sperm quality is reduced in male partners of women with RPL, but the reasons underlying this lower quality are unclear. We hypothesized that these men may have underlying impairments of reproductive endocrine and metabolic function that cause reductions in sperm quality.
METHODS
After ethical approval, reproductive parameters were compared between healthy controls and male partners of women with RPL. Semen reactive oxygen species (ROS) were measured with a validated inhouse chemiluminescent assay. DNA fragmentation was measured with the validated Halosperm method.
RESULTS
Total sperm motility, progressive sperm motility, and normal morphology were all reduced in the RPL group vs controls. Mean ±SE morning serum testosterone (nmol/L) was 15% lower in RPL than in controls (controls, 19.0 ± 1.0; RPL, 16.0 ± 0.8; P < 0.05). Mean ±SE serum estradiol (pmol/L) was 16% lower in RPL than in controls (controls, 103.1 ± 5.7; RPL, 86.5 ± 3.4; P < 0.01). Serum luteinizing hormone and follicle-stimulating hormone were similar between groups. Mean ±SE ROS (RLU/sec/106 sperm) were 4-fold higher in RPL than in controls (controls, 2.0 ± 0.6; RPL, 9.1 ± 4.1; P < 0.01). Mean ±SE sperm DNA fragmentation (%) was 2-fold higher in RPL than in controls (controls, 7.3 ± 1.0; RPL, 16.4 ± 1.5; P < 0.0001).
CONCLUSIONS
Our data suggest that male partners of women with RPL have impaired reproductive endocrine function, increased levels of semen ROS, and sperm DNA fragmentation. Routine reproductive assessment of the male partners may be beneficial in RPL.
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Affiliation(s)
- Channa N Jayasena
- Section of Investigative Medicine, Department of Medicine, Imperial College London, Hammersmith Hospital, London, UK
- Department of Andrology, Hammersmith Hospital, London, UK
- Department of Obstetrics & Gynecology, St. Mary's Hospital, London, UK
| | - Utsav K Radia
- Section of Investigative Medicine, Department of Medicine, Imperial College London, Hammersmith Hospital, London, UK
| | - Monica Figueiredo
- Section of Investigative Medicine, Department of Medicine, Imperial College London, Hammersmith Hospital, London, UK
- Department of Andrology, Hammersmith Hospital, London, UK
| | | | - Anastasia Dimakopoulou
- Section of Investigative Medicine, Department of Medicine, Imperial College London, Hammersmith Hospital, London, UK
- Department of Andrology, Hammersmith Hospital, London, UK
| | - Maria Osagie
- Department of Obstetrics & Gynecology, St. Mary's Hospital, London, UK
| | - Wayne Vessey
- Department of Andrology, Hammersmith Hospital, London, UK
| | - Lesley Regan
- Department of Obstetrics & Gynecology, St. Mary's Hospital, London, UK
| | - Rajendra Rai
- Department of Obstetrics & Gynecology, St. Mary's Hospital, London, UK
| | - Waljit S Dhillo
- Section of Investigative Medicine, Department of Medicine, Imperial College London, Hammersmith Hospital, London, UK
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Abstract
Evaluation and surgical treatment of male infertility has evolved and expanded, now leading to more precise diagnoses and tailored treatments with diminished morbidity and greater success. Surgeries for male infertility are divided into four major categories: (i) diagnostic surgery; (ii) surgery to improve sperm production; (iii) surgery to improve sperm delivery; and (iv) surgery to retrieve sperm for use with in vitro fertilization and intracytoplasmic sperm injection (IVF-ICSI). While today we are more successful than ever in treating male infertility, pregnancy is still not always achieved likely due to factors that remain poorly understood. Clinicians treating infertility should advocate for couple-based therapy, and require that both partners have a thorough evaluation and an informed discussion before undergoing specific surgical therapies.
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