The Role of Exercise to Reduce the Impact of Diabetes in the Seminal Quality: A Systematic Review

Protective Role of Physical Activity and Antioxidant Systems During Spermatogenesis

Oxidative stress is a significant factor that contributes to male infertility and sperm dysfunction. In this condition, an increase in ROS production exceeds the body's antioxidant defenses, resulting in a decline in spermatozoa quality and fertilizing capacity. Furthermore, excessive ROS production has been linked to the promotion of genomic damage, lipid peroxidation, inflammation, altered enzyme activity, and ultimately, irreversible alterations, cell death, and a decline in seminal parameters associated with male infertility. It is established that physical activity (PA), acting on inflammatory parameters and improving antioxidant defense, can alleviate the negative effects caused by free radicals, offering numerous health benefits and positively influencing sperm quality. The objective of this review is to highlight the mechanisms of ROS production, the physiological and pathophysiological roles of ROS in relation to the male reproductive system, and recent knowledge on the impact of some protocols of PA on these systems and the molecular mechanisms involved.

A systematic review and meta-analysis of follicle-stimulating hormone levels among men with type 2 diabetes

BACKGROUND

There are some studies with inconsistent results regarding the association between follicle stimulating hormone (FSH) levels and type 2 diabetes (T2DM) among men. We performed a systematic review and meta-analysis that explored the FSH levels among men with and without T2DM.

RESULTS

Twenty studies with a total sample size of 4,208 (2167diabetic men and 2041 control) were included in this meta-analysis. The standardized mean differences (SMD) in men who had T2DM compared to control group were -0,237 (CI95%: -0,582 to 0,108; P = 0.17; I2: 95,83%; Egger's test: 0.06; Begg's test: 0.15). This finding was significant after sensitivity analysis. Among Asian studies SDM was -0,955 (CI95%: -1,630 to -0,279; p = 0.006; I2: 96.91%; Egger's test: 0.03; Begg's test: 0.01), with diabetic men had lower FSH than control group. African diabetic males the FSH levels was not different than non-diabetics (SMD: 0,386; CI95%: -0,0401 to 0,813; p = 0.07; I2: 94.26%; Egger's test: 0.31; Begg's test: 0.21). Also, among European men the FSH levels was significantly different than non-diabetics (SMD: 0,273; CI95%:0,0960 to 0,450; p = 0.003; I2: 18.41%; Egger's test: P < 0,0001; Begg's test: 0.31).

CONCLUSION

Our meta-analysis of the current literature suggests that serum FSH levels are significantly lower in Asian men diagnosed with T2DM compared to their non-diabetic counterparts. This finding highlights a potential association between altered FSH concentrations and the pathogenesis of T2DM. Future studies should aim to unravel these mechanistic pathways and to assess the clinical utility of FSH as a biomarker for T2DM risk assessment and management in the male population.

Type 2 diabetes mellitus and the risk of male infertility: a Mendelian randomization study

Objective

To assess the causal effect of type 2 diabetes mellitus (T2DM) on male infertility (MI) and erectile dysfunction (ED) by Mendelian randomization (MR) analysis.

Methods

Data for T2DM, MI, and ED were obtained from genome-wide association studies (GWAS) involving 298, 957, 73, 479, and 223, 805 Europeans, respectively. We performed univariate MR analysis using MR Egger, Weighted median (WM) and Inverse variance weighted (IVW) methods to assess causal effects among the three. Through the Genotype Tissue Expression (GTEx) database, single-nucleotide polymorphisms (SNPs) that affect the expression levels of T2DM-related genes were located using expression quantitative trait loci (eQTL).

Results

MR analysis showed a significant causal relationship between T2DM and ED (WM, OR: 1.180, 95%CI: 1.010-1.378, P = 0.037; IVW, OR: 1.190, 95%CI: 1.084-1.300, P < 0.001). There is also a significant causal relationship between T2DM and MI (MR Egger, OR: 0.549, 95%CI: 0.317-0.952, P = 0.037; WM, OR: 0.593, 95%CI: 0.400, P = 0.010; IVW, OR: 0.767, 95%CI: 0.600-0.980, P = 0.034). ED may not cause MI (P > 0.05). We also found that rs6585827 corresponding to the PLEKHA1 gene associated with T2DM is an eQTL variant affecting the expression of this gene.

Conclusion

T2DM has a direct causal effect on ED and MI. The level of PLEKHA1 expression suppressed by rs6585827 is potentially associated with a lower risk of T2DM.

Advances in circadian clock regulation of reproduction

The mammalian circadian clock is an endogenously regulated oscillator that is synchronized with solar time and cycle within a 24-h period. The circadian clock exists not only in the suprachiasmatic nucleus (SCN) of the hypothalamus, a central pacemaker of the circadian clock system, but also in numerous peripheral tissues known as peripheral circadian oscillators. The SCN and peripheral circadian oscillators mutually orchestrate the diurnal rhythms of various physiological and behavioral processes in a hierarchical manner. In the past two decades, peripheral circadian oscillators have been identified and their function has been determined in the mammalian reproductive system and its related endocrine glands, including the hypothalamus, pituitary gland, ovaries, testes, uterus, mammary glands, and prostate gland. Increasing evidence indicates that both the SCN and peripheral circadian oscillators play discrete roles in coordinating reproductive processes and optimizing fertility in mammals. The present study reviews recent evidence on circadian clock regulation of reproductive function in the hypothalamic-pituitary-gonadal axis and reproductive system. Additionally, we elucidate the effects of chronodisruption (as a result of, for example, shift work, jet lag, disrupted eating patterns, and sleep disorders) on mammalian reproductive performance from multiple aspects. Finally, we propose potential behavioral changes or pharmaceutical strategies for the prevention and treatment of reproductive disorders from the perspective of chronomedicine. Conclusively, this review will outline recent evidence on circadian clock regulation of reproduction, providing novel perspectives on the role of the circadian clock in maintaining normal reproductive functions and in diseases that negatively affect fertility.

Influence of physical activity on male fertility

Infertility is a worldwide issue impacting 15% of couples' population. Male-related infertility results in almost 50% of these cases. Considering lifestyle factors associated with infertility, here in this literature review article, we aimed to discuss training/sport effects on male-related infertility. Regarding this issue, human and animal model studies related to the subject were gathered and analysed. Exercise is well known as a general improving factor, however, excessive exercise can result in male infertility due to reduced hypothalamus-pituitary-gonadal axis (HPT) function, increased oxidative stress and chronic inflammation. Consequently, these underlying impacts result in a low testosterone production, and reduced semen quality, and can lead to infertility. In contrast, it has been revealed that exercise can improve male fertility status in lifestyle-induced infertility condition such as obesity and diabetes. Indeed, exercise, by increasing testicular antioxidant defence, reducing pro-inflammatory cytokines level and enhancing the steroidogenesis process, leads to improved spermatogenesis and semen quality in lifestyle-induced infertility. In fact, it seems that individual health status as well as exercise volume, intensity and duration are effective-involved co-factors that influence the impact that exercise will promote on male fertility. Regarding these findings, it is important to study exercise different impacts in further clinical trials in order to generate preservative guidelines for exercise and also considering exercise as a treatment option in lifestyle-induced disease management.

Type 2 diabetes mellitus and the risk of abnormal spermatozoa: A Mendelian randomization study

Abnormal spermatozoa can not only reduce the fertilization rate, but also prolong the natural conception time and even increase the risk of spontaneous miscarriage. Diabetes mellitus (DM) has become a major global health problem, and its incidence continues to rise, while affecting an increasing number of men in their reproductive years. Type 2 Diabetes Mellitus (T2DM), accounting for about 85-95% of DM, is closely related to the development of sperm. However, the exact association between T2DM and abnormal spermatozoa remains unclear. Herein, we designed a Two-sample Mendelian randomization (MR) study to explore the causal association between T2DM and abnormal spermatozoa risk in European population data which come from the GWAS summary datasets. We selected 9 single nucleotide polymorphisms (SNPs) of T2DM (exposure data) as instrumental variables (IVs), and then retrieved the suitable abnormal spermatozoa genome-wide association study (GWAS) data of European from Ieu Open GWAS Project database which includes 915 cases and 209,006 control as the outcome data. Our results indicate that strict T2DM might not result in a higher risk of abnormal spermatozoa genetically in Europeans (OR: 1.017, 95% confidence interval (CI): 0.771-1.342, p=0.902). Our findings demonstrate that only T2DM may not explain the relatively higher risk of abnormal spermatozoa in men with it in Europeans. In subsequent studies, more comprehensive and larger samples need to be studied to reveal the relationship and potential mechanism between T2DM and abnormal spermatozoa.

Human sperm functioning is related to the aquaporin-mediated water and hydrogen peroxide transport regulation

Aquaporins (AQPs) are transmembrane water channels and some of them are permeable in addition to water to other small solutes including hydrogen peroxide. The sperm cells of mammals and fishes express different AQPs, although there is no agreement in the literature on their localization. In humans, AQP3 and AQP11 are expressed mainly in the tail, AQP7 in the head and AQP8 in the midpiece. Thanks to the results of experiments with KO mice and to data obtained by comparing sub-fertile patients with normospermic subjects, the importance of AQPs for the normal functioning of sperms to ensure normal fertility emerged. AQP3, AQP7 and AQP11 appeared involved in the sperm volume regulation, a key role for fertility because osmoadaptation protect the sperm against a swelling and tail bending that could affect sperm motility. AQP8 seems to have a fundamental role in regulating the elimination of hydrogen peroxide, the most abundant reactive oxygen species (ROS), and therefore in the response to oxidative stress. In this review, the human AQPs expression, their localization and functions, as well as their relevance in normal fertility are discussed. To understand better the AQPs role in human sperm functionality, the results of studies obtained in other animal species were also considered.