[Male infertility, environment and lifestyle]

BACKGROUND

Since the 1970s, there has been a quantitative and qualitative decline in sperm parameters. The main hypothesis to explain such a rapid evolution is the involvement of environmental and behavioral phenomena.

METHODS

A bibliographic search limited to English and French literature in men published before 7/2023 was carried out on the links between fertility and pollution, xenobiotics, tobacco, narcotics, cannabis, alcohol, weight, sport, sedentary lifestyle, sleep and anabolics.

RESULTS

Profound changes in lifestyle have occurred over the past 50 years: reduced sleep time, sedentary lifestyle, dietary changes, tobacco consumption, use of narcotics and anabolics. These changes have a proven impact on spermogram parameters, and should be corrected in an effort to optimize reproductive health. Other environmental parameters: pollution, exposure to heavy metals, exposure to xenobiotics, phthalates and pesticides… will be more difficult to exclude from patients' daily lives, but deserve to be taken more into account.

CONCLUSION

This review should help the urologist to assess and counsel patients in order to improve their reproductive health. These factors should be routinely investigated in infertile men.

P-014 Thermal Male Contraception: A Study Of Users’ Motivation, Experience And Satisfaction

Study question

What are the motivations, experience, and acceptability of thermal male contraception (TMC) in men using TMC as the only couple contraceptive ?

Summary answer

Men wished to share the role of providing contraception in a couple and to avoid the use of hormones. Sexual satisfaction was significantly improved.

What is known already

Two male contraceptive methods inducing spermatogenesis suppression have achieved contraceptive efficacy, on a large population for hormonal contraception and a smaller one for thermal contraception (TC). The suppression of sperm counts to below 1 million/mL results in fertility rates commensurate with female pills. TC is obtained by wearing 15 hours/day a contraceptive underwear (CU) inducing a 2°C increase in testicular temperature (Mieusset & Bujan 1994). As no commercially available male thermal contraceptive exists, little information regarding the acceptability of this approach to men has been reported and only one publication analysed the hypothetical acceptability of TMC (Amouroux et al. 2018).

Study design, size, duration

We contacted 72 men who had started the CU testing phase between June 2011 and September 2019. The participants completed an anonymous online survey of 93 questions exploring population characteristics, contraceptive histories, motivations for choosing TC, patient experience at the successive phases of use, relations with partner and environment, and satisfaction with TC. Sexual life was evaluated by rating (1 to 4): frequency and pleasure of sexual intercourse, sexual desire, morning and intercourse erections.

Participants/materials, setting, methods

Among men who had reached the contraception use phase, the quality ratings of sexual life were compared over time, from the contraceptive method used before TC (“N-1” method) to the 2 previous methods (“N-2” and “N-3”)): “N-3” versus “contraception use phase”, “N-3” versus “CU testing phase,” and “CU testing phase” versus “contraception use phase.” These comparisons were made for all 5 sexual life parameters by a paired samples Wilcoxon signed rank test.

Main results and the role of chance

Sixty-seven men responded (93% response rate);63 participated in the survey (94% participation rate). The median age was 31 [21-52], 30 men (48%) had a Master’s degree or more, 49 (78%) had no child and 24 (38%) no parental project. Among the men whose couple's contraception method immediately before TC (N-1) was a female method (n = 36/63, 57%), the 2 main reasons for switching to a male method were the wish to share the role of providing contraception in a couple (n = 31/36, 86%) and the willingness to take responsibility for contraception (n = 21/36, 58%). The main motivations for choosing TC were “not using hormones” (n = 59/63, 94%) and using a method regarded as “natural” (n = 49/63, 78%). Most of men (68%) adopted the method in less than 2 weeks. During the contraception use phase (n = 59 men), they described: i) significantly improved sexual satisfaction (3,49±0,29/4) compared to that experienced with previous contraceptive methods (3,27±0,58/4;p<0,01); ii) high female partner confidence (100% rather/totally confident partner) and support (88% rather/totally supporting partner); iii) improved self-esteem (n = 35/59, 59%). The main negative point was discomfort, reported by 24% of the men.

The overall satisfaction score of using TC was 3.78±0.46/4, and 100% would recommend TC to other men.

Limitations, reasons for caution

The study population may seem small (63 men). However, it is not different from that of the previously pubished studies on men using hormonal contraception, which included 20, 38, 79 and 57 men, respectively. Our study also lacked a similar questionnaire for the female partners.

Wider implications of the findings

Men using TC successfully assumed the responsibility for and performed a daily task to provide couple contraception. This positive evaluation of TC together with its previously published contraceptive efficacy and reversibility on a small population, should encourage the development of this method.

Trial registration number

IRB No. 2020-09-10-005

P-454 Less than half of men with testicular cancer or lymphomas banked sperm before gonadotoxic treatment in France in 2018

Study question

What is the proportion of men treated for testicular cancer or lymphoma who banked sperm before gonadotoxic treatment in France?

Summary answer

In 2018, 41% of men with testicular cancer and 28% of men with lymphoma banked sperm before gonadotoxic treatment in France.

What is known already

Cancer treatments significantly improved survival rates in men. In Europe, the 5-year survival rate is above 90% for testicular cancer (TC) and Hodgkin lymphoma (HL), which, with Non Hodgkin Lymphoma (NHL), are the most frequent cancers in men of reproductive age. However, surgery, chemotherapy and/or radiotherapy may damage male fertility: between 15% and 30% of men remain permanently infertile after treatment. Since 2011, the French bioethics law recommends and guarantees free access to fertility preservation for all patients needing gonadotoxic treatments. Few international data are available about the rate of male cancer patients who receive sperm cryopreservation before cancer treatment.

Study design, size, duration

We analyzed the data of male cancer incidence in 2018 published by the French National Institute of Cancer (INCa), only available and latest French national data, estimated from cancer registers of selected metropolitan departments (Defossez et al. 2019). We organized a survey among the 27 metropolitan centers of the CECOS network (public centers for study and conservation of human eggs and sperm) to collect the annual number of sperm cryopreservations for TC, HL or NHL.

Participants/materials, setting, methods

We compared the number of 0-59 years-old men with TC, HL or NHL in metropolitan France (extracted from 2018 INCa data) and the number of sperm banking for TC, HL or NHL in metropolitan centers of the CECOS network.

Main results and the role of chance

INCa estimated that 38,048 new cancers were diagnosed in metropolitan France in 2018 in men aged 0-59 years. TC accounted for 2,630 new cases and lymphomas for 3,913 new cases (943 HL and 2,970 NHL).

Twenty-six out of 27 metropolitan CECOS centers answered the survey (96% participation rate): in 2018, 1,079 men banked sperm for TC, 375 for HL and 211 for NHL.

In 2018, the fertility preservation rate in metropolitan France was 41% for TC and 28% for lymphomas (51% for HL, and 15% for NHL). The results of our national study are in accordance with Uçar et al. 2020, a monocentric study on 110 TC patients showing a 43% fertility preservation rate, but differ from those of Abdel-Razek et al. 2020, a monocentric study on 59 NHL and 26 HL patients, showing respectively 32% and 14% fertility preservation rates.

A limit of our study is to be based on estimated cancer incidence from INCa reports without stratification on age and parenthood; sperm banking activity was measured in the CECOS network, which performs 90% of French male fertility preservation (French Biomedicine Agency 2018 data). This design may induce an underestimation of cancer incidence and of sperm banking activity.

Limitations, reasons for caution

Our study did not consider patients who were informed of fertility preservation but did not want to/could not bank ejaculated sperm (azoospermia, sperm collection failure, no-show). In CECOS network, the estimated rate of such patients is 10%.

French overseas regions were not studied (lack of INCa data).

Wider implications of the findings

Our results suggest that despite the recommendations and facilities offered by the French bioethics law, the male patients’ pathway for fertility preservation before cancer treatments could be improved. Further study should evaluate if this suboptimal rate of fertility preservation is homogeneous on French territory or related to postal code.

Trial registration number

Not applicable

Tonoplast and Peroxisome Targeting of γ-tocopherol N-methyltransferase Homologs Involved in the Synthesis of Monoterpene Indole Alkaloids

Many plant species from the Apocynaceae, Loganiaceae and Rubiaceae families evolved a specialized metabolism leading to the synthesis of a broad palette of monoterpene indole alkaloids (MIAs). These compounds are believed to constitute a cornerstone of the plant chemical arsenal but above all several MIAs display pharmacological properties that have been exploited for decades by humans to treat various diseases. It is established that MIAs are produced in planta due to complex biosynthetic pathways engaging a multitude of specialized enzymes but also a complex tissue and subcellular organization. In this context, N-methyltransferases (NMTs) represent an important family of enzymes indispensable for MIA biosynthesis but their characterization has always remained challenging. In particular, little is known about the subcellular localization of NMTs in MIA-producing plants. Here, we performed an extensive analysis on the subcellular localization of NMTs from four distinct medicinal plants but also experimentally validated that two putative NMTs from Catharanthus roseus exhibit NMT activity. Apart from providing unprecedented data regarding the targeting of these enzymes in planta, our results point out an additional layer of complexity to the subcellular organization of the MIA biosynthetic pathway by introducing tonoplast and peroxisome as new actors of the final steps of MIA biosynthesis.

A Rapid and Efficient Vacuum-Based Agroinfiltration Protocol for Transient Gene Overexpression in Leaves of Catharanthus roseus

Functional genomics analyses in planta can be hampered in non-model plants that are recalcitrant to the genetic transformation such as the medicinal plant Catharanthus roseus (Apocynaceae). No stable transformation and regeneration of plantlets have been achieved with a high efficiency in this plant to date. In addition, while virus-mediated transient gene silencing has been reported a decade ago in C. roseus, tools for transient overexpression remain scarce. Here, we describe an efficient and reliable methodology for transiently overexpressing any gene of interest in C. roseus leaves. This protocol combines a vacuum-based Agroinfiltration approach and the high translational efficiency of a deconstructed virus-based binary vector (pEAQ-HT). The described methodology is robust, easy to perform, and results in high amount of transient expression in C. roseus. This protocol is expected to serve as valuable tool to enhance the in planta characterization of gene functions or even transiently knock-in novel enzymatic activities.

P–047 Knowledge, professional attitudes and training of health professionals on male contraceptive methods

Study question

Among health professionals involved in contraceptive prescribing, what are the knowledge, professional attitudes and training on male contraceptive methods?

Summary answer

The health professionals involved in prescribing contraception are not sufficiently trained in male contraception and almost all of them want more.

What is known already

The most recent large-scale studies show that 70% of couple contraception is provided by women and that the majority of men and women would be willing to adopt male contraception as couple contraception. The medicalization of contraception places the medical profession at the forefront of the acceptability of and information regarding a contraceptive method. However, only one study have evaluated health professionals’ knowledge of the various methods of male contraception (MC), including male hormonal contraception (MHC) and male thermal contraception (MTC).

Study design, size, duration

Between April 2020 and June 2020, we carried out a descriptive prospective multicentre study in a medical population of 2243 prescribers of couple contraception in France.

Participants/materials, setting, methods

The participants were obstetrician-gynaecologists, medical gynaecologists, general practitioners or midwives. They completed a three-part numerical questionnaire, including i) sociodemographic characteristics and personal experiences with contraception, ii) knowledge and professional attitudes about male contraception and iii) training on male contraception.

Main results and the role of chance

The overall participation rate was 19% (340/2243). Condoms and withdrawal were known by 98% and 89% of the population, respectively. Vasectomy was known by 75% of the population and significantly better known by obstetrician-gynaecologists than by medical gynaecologists and general practitioners (p = 0.026). Male hormonal contraception (MHC) and male thermal contraception (MTC) were known by 10% and 23% of the population, respectively, and were significantly better known by medical gynaecologists and general practitioners than by other specialties (p < 0.001). More than half (55%) of the population never or infrequently offered MC during a couple’s contraceptive request consultation. Female practitioners offered MC significantly more often than male practitioners (48% vs. 26%; p = 0.033). Only 14% of the population had ever participated in training on MC, 96% wished to be better trained on MC, and 86% expressed a willingness to participate in such a training.

Limitations, reasons for caution

The population was mainly representative of medical health practitioners of southeastern France. There was an over-representation of women in all medical specialties, except for midwives.

Wider implications of the findings: Our study shows that health professionals involved in contraception have limited knowledge about MC and are eager to have more information about it. To advance the acceptability and dissemination of such contraceptive methods, it seems imperative to provide health professionals with an adapted training program on male contraception.

Trial registration number

2020–01–23–03

P–733 In infertile patients, risk factors for environmental reprotoxic exposure are widespread, limited in number and modifiable

Study question

What are the risk factors for environmental reprotoxic exposure in infertile patients?

Summary answer

The most represented categories of reprotoxic risk factors (RRF) were dietary exposures (86% of patients), overweight (46%), psychoactive substances (38%) and male occupational exposures (63%).

What is known already

Numerous studies have reported the deleterious effects of environmental reprotoxic exposures on male or female fertility.

These studies most often focus on the impact of a limited number of reprotoxic risk factors (body mass index (BMI), dietary habits, tobacco or alcohol consumption) or a limited number of chemical or physical reprotoxic exposures: phthalates, occupational exposures, or pesticides.

Despite the call of several reproductive health professional societies and public health agencies for taking environmental health into account in women of childbearing age, this approach remains little realized in current practice.

Study design, size, duration

We conducted a prospective, monocentric study between June 2018 and February 2020 in women and men visiting the fertility unit of our University Hospital for assisted reproduction technique (ART) treatment.

Participants/materials, setting, methods

Patients completed a self-questionnaire to collect information about i) the various types of exposure to RRF, and ii) frequency and intensity of exposures (qualitative and semi-quantitative approach).

We performed a literature search in order to define the environmental factors and the exposure level thresholds associated with a “recognized” or “suspected” RRF and we analyzed their nature and number in patients.

Main results and the role of chance

During the inclusion period, we received 545 couples in consultation, and 405 were included in this study (810 patients/1090, participation rate: 74%). 65% of women and 68% of men self-reported at least one “recognized” RRF. In men, they were from exposure to solvents, heat, psychoactive substances and a BMI>25; in women, from exposure to poor indoor air quality, psychoactive substances and a BMI>25. A limited number of recognized risk factors were recorded in the majority of patients (one, two or three risk factors in 65% of patients).

Men were more often exposed than women to occupational risk factors (63% of men versus 28% of women) such as solvents and ambient heat, and women were more often exposed than men to poor indoor air quality and volatile organic compounds (49% of women versus 30% of men). We note that the majority of the risk factors for reprotoxic exposure found were modifiable, specifically dietary, occupational, overweight and psychoactive substance exposures.

Limitations, reasons for caution

One limitation is the collection of data via a self-administered questionnaire, which makes it possible to estimate the risk factors for reprotoxic exposure, but not to detect them in a measurable way, for example, through exposure biomarkers. In addition, no data is available about all RRF in the general population.

Wider implications of the findings: We suggest that if the individual screening of each infertile patient’s RRF was done before ART, most patients could act on a limited number of modifiable RRF, in the aim of increasing their chances of natural pregnancy and improving ART outcomes.

Trial registration number

N° 2018–13–06–004 (Ethics Committee of the University of Aix Marseille) and N° 2020–27 (Assistance Publique - Hôpitaux de Marseille General Regulation on Data Protection).

[Prognostic factors of live-birth after in vitro fertilization for unexplained infertility: A cohort study]

OBJECTIVES

For 15 to 30% of infertile couples, no etiology can be found, leading to the diagnosis of "unexplained infertility". The aim of our study was to identify prognostic factors for live birth following in vitro fertilization (IVF) for these couples.

METHODS

A retrospective, monocentric study on a cohort of couples undergoing IVF for unexplained infertility with the woman aged≤40 years old. Primary analysis compared couples with a live birth following IVF versus childless couples following IVF.

RESULTS

Between January 2014 and December 2018, 104 couples were included, 196 transvaginal oocyte pickup were performed, followed by 234 embryo transfers (fresh or cryopreserved) which resulted in 43 deliveries. The cumulative live birth rate was 40.4% per couple. Before IVF attempts, no clinical or paraclinical prognostic factors between the two groups was observed. However, multivariate analysis showed several biological factors of good prognosis in course of treatment, such as a higher number of mature oocytes and better quality embryos in "live birth" group.

CONCLUSIONS

For a couple, the chances of having a child following IVF unexplained infertility are 40.4%. However, no clinical characteristic enabled us to identify favourable or unfavourable prognosis factors before starting ART. The prognostic factors identified during IVF cycle are interesting to advise or not to pursue IVF.

Anti-tumor efficacy of a combination therapy with PD-L1 targeted alpha therapy and adoptive cell transfer of PD-1 deficient melanoma-specific human T-lymphocytes

The optimization of adoptive transfer approaches of anti-tumor T cells requires both the functional improvement of the injected T cells and the modulation of the tumor microenvironment, favoring the recruitment of these T cells and their activation. We have recently shown the therapeutic benefit of two approaches tested individually in a melanoma model wich were on one hand the adoptive transfer of specific T cells deficient for the expression of the inhibitory receptor PD-1, and on the other hand PD-L1 targeted alpha therapy (TAT). In this study, we sought to investigate the efficacy of these two therapies combined, compared to each monotherapy, in order to evaluate the synergy between these two approaches, in the same melanoma model. Here we used melanoma-specific T-cell clones, previously validated for the edition of PDCD1 gene and with previously demonstrated superior anti-tumor activity than their wild-type counterparts, after adoptive transfer in NSG mice engrafted with PD-L1 expressing human melanoma tumors. We also used a previously validated TAT approach, using a ²¹³Bi-anti-human-PD-L1 mAb, alone or in combination with adoptive cell transfer, in the same mouse model. We confirmed previous results obtained with each monotherapy and documented the safety and the superior ability of a combination between the adoptive transfer of PD-1 deficient T cells and TAT targeting PD-L1 to control the growth of melanoma tumors in NSG mice. This study provides the first proof-of-concept of the efficacy of a combination therapy using TAT, adoptive cell transfer and genomic editing of IC-coding genes.

Exploiting Spermidine N-Hydroxycinnamoyltransferase Diversity and Substrate Promiscuity to Produce Various Trihydroxycinnamoyl Spermidines and Analogues in Engineered Yeast

Trihydroxycinnamoyl spermidines (THCSpd) are plant specialized metabolites with promising pharmacological activities as antifungals, antibacterial, antiviral, and antidepressant drugs. However, their characterization and potential pharmaceutical exploitation are greatly impaired by the sourcing of these compounds, restricted to the pollen of core Eudicot plant species. In this work, we developed a precursor-directed biosynthesis of THCSpd in yeast using a dual enzymatic system based on 4-coumarate-CoA ligases (4CL) and spermidine N-hydroxycinnamoyltransferases (SHT). The system relies on the yeast endogenous spermidine pool and only requires hydroxycinnamic acids as exogenous precursors. By exploring 4CL isoforms and SHT diversity among plants, we have driven the production of 8 natural THCSpd, using single or mixed hydroxycinnamic acid precursors. Substrate promiscuities of 4CL and SHT were genuinely exploited to produce 8 new-to-nature THCSpd from exotic hydroxycinnamic and dihydrohydroxycinnamic acids, together with 3 new-to-nature THCSpd containing halogenated hydroxycinnamoyl moieties. In this work, we established a versatile and modular biotechnological production platform allowing the tailor-made THCSpd synthesis, constituting pioneer metabolic engineering for access to these valuable natural products.

A French network for prevention and reduction of reproductive risk in couples and pregnant women

Background

Since 2013, several international (ASRM, FIGO, ACOG) and French (ANSES) learned societies and the French National Health and Environment Plan (2015-2019) urged to take into account exposures to environmental reprotoxic substances during standard care of infertile couples and pregnant women. However perinatal health professionals hardly incorporate this recommendation into practice.

Objectives

To create a network of platforms to addressing the environmental aspects that can impact the pregnancy chances of infertile couples after ART and pregnancy outcomes.

We asked regional health authorities in France to provide funding for multidisciplinary hospital structures, in conjunction with clinical-biological reproductive health and gynecology-obstetric centers. Expertise, as well as information leaflets and risk detection tools have been shared.

Results

Platforms of counselling and prevention have been set up in the University Hospitals of Bordeaux, Marseille, Rennes, Créteil and Paris Fernand-Widal. Infertile couples and pregnant women, referred by reproductive physicians, benefit from personalized management of their domestic/professional reprotoxic exposures by addictology/tobacco, dietetics, occupational health and environmental pathology professionals. The network organizes an annual scientific day and a common database of exposure is being set up.

Conclusions

The PREVENIR (PREVENTION - ENVIRONMENT - Reproduction) network of platforms allows perinatal health professionals to refer their patients in order to optimize their chance of pregnancy through personalized and multidisciplinary care. The lifestyle changes initiated through this approach will also improve pregnancy outcomes and child health.

Key messages

A French network for the prevention and reduction of reproductive risk in infertile couples and pregnant women: the PREVENIR platforms (PREVENTION - ENVIRONMENT - Reproduction) is being established. Perinatal health professionals of multidisciplinary platforms engage into preventive actions to limit the exposure to environmental hazards during preconception and pregnancy.

Environmental Health: Knowledge and Practice of Perinatal Health Professionals in Southern France

Background

The exposure of adults of reproductive age as well as of pregnant women and children to environmental contaminants is of particular concern, as it can impact fertility, in utero development, pregnancy outcomes and child health. Although worrying, this knowledge provides an opportunity to enforce interventions during these critical reproductive/developmental times, when they may have the greatest effect. Consequently, the World Health Organization (WHO) and international societies advocate including Environmental Health (EH) in perinatal care.

Objectives

Our aim was to paint a picture of the current attitudes, representation, knowledge, and training expectations among Perinatal Health Professionals in south-eastern France.

Results

In 2017, a cross-sectional study was performed in a large panel of perinatal HPs. Quantitative and qualitative information was collected via auto-questionnaire. Questionnaires were completed by 962 participants, mainly midwives (41.1%), physicians (25.6%) and nursery nurses (11%). Indoor/outdoor air quality and endocrine disruptors were the best-mastered topics, whereas electromagnetic fields and diet gave rise to unsure responses. Overall, perinatal HPs were ill-trained and -informed about the reproductive risks linked to daily environmental exposure. HPs reported scarce knowledge, fear of patient reaction and lack of solutions as the main barriers to providing information regarding EH to the public.

Conclusions

In South-eastern France perinatal Health Professionals are eager to incorporate EH in their current practice. Our findings highlight the need to set up EH training programs focused on scientific knowledge and to provide simple messages and tips to help perinatal HPs deliver advice to populations to mitigate exposure to environmental toxicants.

Key messages

In South-eastern France perinatal Health Professionals are eager to incorporate EH in their current practice but ask for training. We are currently providing training programs combining practical sessions as well as basic and advanced scientific training adapted to the demand of medical and non-medical professional groups.

Prevalence and management of chronic breathlessness in COPD in a tertiary care center

Background

Breathlessness is the prominent symptom of chronic obstructive pulmonary disease (COPD). Despite optimal therapeutic management including pharmacological and non-pharmacological interventions, many COPD patients exhibit significant breathlessness. Chronic breathlessness is defined as breathlessness that persists despite optimal treatment of the underlying disease. Because of the major disability related to chronic breathlessness, symptomatic treatments including opioids have been recommended by several authors. The prevalence of chronic breathlessness in COPD and its management in routine clinical practice have been poorly investigated. Our aim was to examine prevalence, associated characteristics and management of chronic breathlessness in patients with COPD recruited in a real-life tertiary hospital-based cohort.

Methods

A prospective study was conducted among 120 consecutive COPD patients recruited, in stable condition, at Nancy University Hospital, France. In parallel, 88 pulmonologists of the same geographical region were asked to respond to an on-line questionnaire on breathlessness management.

Results

Sixty four (53%) patients had severe breathlessness (modified Medical Research Council scale≥3), despite optimal inhaled medications for 94% of them; 40% had undergone pulmonary rehabilitation within the past 2 years. The severity of breathlessness increased with increasing airflow limitation. Breathlessness was associated with increased symptoms of anxiety, depression and with osteoporosis. No relation was found with other symptoms, exacerbation rate, or cardiovascular comorbidities. Among the patients with chronic breathlessness and Hospitalized Anxiety and/or Depression score > 10, only 25% were treated with antidepressant or anxiolytic. Among the pulmonologists 46 (52%) answered to the questionnaire and expressed a high willingness to prescribe opioids forchronic breathlessness, which contrasted with the finding that none of these patients received such treatments against breathlessness.

Conclusion

Treatment approaches to breathlessness and associated psychological distress are insufficient in COPD. This study highlights underuse of pulmonary rehabilitation and symptomatic treatment for breathlessness.

Electronic supplementary material

The online version of this article (10.1186/s12890-019-0851-5) contains supplementary material, which is available to authorized users.

Very low concentration of cerium dioxide nanoparticles induce DNA damage, but no loss of vitality, in human spermatozoa

Cerium dioxide nanoparticles (CeO₂NP) are widely used for industrial purposes, as in diesel, paint, wood stain and as potential therapeutic applications. The Organization for Economic Cooperation and Development included CeO₂NP in the priority list of nanomaterials requiring urgent evaluation. As metal nanoparticles can cross the blood-testis barrier, CeO₂NP could interact with spermatozoa. The genotoxicity of CeO₂NP was demonstrated in vitro on human cell lines and mouse gametes. However, the effects of CeO₂NP on human spermatozoa DNA remain unknown. We showed significant DNA damage induced in vitro by CeO₂NP on human spermatozoa using Comet assay. The genotoxicity was inversely proportional to the concentration (0.01 to 10 mg·L^-1). TEM showed no internalization of CeO₂NP into the spermatozoa. This study shows for the first time that in vitro exposure to very low concentrations of cerium dioxide nanoparticles can induce significant DNA damage in human spermatozoa. These results add new and important insights regarding the reproductive toxicity of priority nanomaterials, which require urgent evaluation.

Comet assay on thawed embryos: An optimized technique to evaluate DNA damage in mouse embryos

Our objective was to optimize the CA technique on mammal embryos.

MATERIALS AND METHODS

1000 frozen 2-cell embryos from B6CBA mice were used. Based on a literature review, and after checking post-thaw embryo viability, the main outcome measures included: 1) comparison of the embryo recovery rate between 2 CA protocols (2 agarose layers and 3 agarose layers); 2) comparison of DNA damage by the CA on embryos with (ZP+) and without (ZP-) zona pellucida; and 3) comparison of DNA damage in embryos exposed to 2 genotoxic agents (H₂O₂ and simulated sunlight irradiation (SSI)). DNA damage was quantified by the % tail DNA.

RESULTS

1) The recovery rate was 3,3% (n=5/150) with the 2 agarose layers protocol and 71,3% (n=266/371) with the 3 agarose layers protocol. 2) DNA damage did not differ statistically significantly between ZP- and ZP+ embryos (12.60±2.53% Tail DNA vs 11.04±1.50 (p=0.583) for the control group and 49.23±4.16 vs 41.13±4.31 (p=0.182) for the H₂O₂ group); 3) H₂O₂ and SSI induced a statistically significant increase in DNA damage compared with the control group (41.13±4.31% Tail DNA, 36.33±3.02 and 11.04±1.50 (p<0.0001)). The CA on mammal embryos was optimized by using thawed embryos, by avoiding ZP removal and by the adjunction of a third agarose layer.

The impact of drugs on male fertility: a review

Beside cytotoxic drugs, other drugs can impact men's fertility through various mechanisms. Via the modification of the hypothalamic-pituitary-gonadal axis hormones or by non-hormonal mechanisms, drugs may directly and indirectly induce sexual dysfunction and spermatogenesis impairment and alteration of epididymal maturation. This systematic literature review summarizes existing data about the negative impact and associations of pharmacological treatments on male fertility (excluding cytotoxic drugs), with a view to making these data more readily available for medical staff. In most cases, these effects on spermatogenesis/sperm maturation/sexual function are reversible after the discontinuation of the drug. When a reprotoxic treatment cannot be stopped and/or when the impact on semen parameters/sperm DNA is potentially irreversible (Sulfasalazine Azathioprine, Mycophenolate mofetil and Methotrexate), the cryopreservation of spermatozoa before treatment must be proposed. Deleterious impacts on fertility of drugs with very good or good level of evidence (Testosterone, Sulfasalazine, Anabolic steroids, Cyproterone acetate, Opioids, Tramadol, GhRH analogues and Sartan) are developed.

Evaluation of OSMOCELLS, a new semi-automatic device for osmotic fragility assessment

INTRODUCTION

The osmotic fragility (OF) test was a central test for the diagnosis of hereditary red blood cell (RBC) disorders (mostly hereditary spherocytosis (HS), but thalassaemia as well). Nowadays although the traditional multitubes method has lost a prominent place, many laboratories still perform such a laboured test, despite the lack of standardization. In fact, the evaluation of OF may offer an inexpensive screening for RBC disorders. We present a new semi-automatic device, allowing the continuous recording of OF, by an updated dialysis method.

METHODS

Repeatability, stability over time, influence of the anticoagulant were evaluated among a population of healthy blood donors. The test was then performed among patients presenting inherited RBC disorders (HS or haemoglobinopathies) where OF is typically altered.

RESULTS

Repeatability was excellent; the parameters were greatly influenced by the nature of the anticoagulant and interestingly appeared stable for 48 h. Patients with RBC disorders displayed the expected profile in regard with their disease: patients with HS all presented an increased OF while patients with haemoglobinopathy displayed resistant profiles.

CONCLUSION

The device offers a substantial improvement in terms of standardization and consistency of the results and may offer a considerable gain for general laboratories.

[Female age - related fertility decline: Far from the myth of the "selfish working-girl" and the "right to have a child"]

OBJECTIVES

To study the social dimension of age-related female infertility through an analysis of three key themes: the personal life histories of infertile women over 40 years of age; representations of age and the desire to become pregnant after age 40; opinions of French legislations framing Assisted Reproductive Technologies, age limits, egg donation, and egg freezing for non-medical reasons.

METHODS

This qualitative sociological study was based on semi-structured interviews with infertile women over age 40 going through fertility treatments. The interviews contained three parts: personal and relationship histories; experiences related to age; opinions related to French legislation.

RESULTS

Twenty-three interviews were conducted; each lasting between 90 to 120minutes. Far from having similar life histories, the women interviewed had very different backgrounds leading to their desire for a pregnancy after 40 years of age. From the beginning of their fertility treatments, they perceived a "race against the clock". This feeling of urgency accompanied their experiences and was related to the desire to not be too old for their future child. The women interviewed were mainly in favor of loosening French bioethical laws in order to avoid the need to travel abroad to pursue fertility treatments.

CONCLUSION

The profiles studied attest to a growing gap between biological and biographical temporalities, as well as an inability of women to reduce their desire for a child. Faced with this disparity, egg donation and egg freezing were seen as practical solutions.

[Association between sperm abnormalities and occupational environment among male consulting for couple infertility]

Alteration of sperm parameters related to occupational exposures is the subject of several studies, often on a case-control approach. The study populations usually comprise men consulting in infertility clinics for couple infertility. The objective of this review is to identify, from these case-control studies, the main occupational factors that may be associated with altered sperm parameters. We selected 13 articles in the PubMed database. Participation in these studies varied from 61 to 2619 subjects, with great methodological heterogeneity, particularly in the characterization of exposure. The main occupations that appear significantly associated with a risk of altered sperm parameters are workmen, painters, farmers, welders, plumbers and technicians. When analysis focuses on occupational exposures, a significant result is reported for solvents, heavy metals, heat, vibrations and non-ionizing radiation. None of the selected studies has found a link with exposure to pesticides.

[Should we better inform young women about fertility? A state-of-knowledge study in a student population]

OBJECTIVES

To assess midwifery students' knowledge in the field of female fertility and to study their decision if they had diagnosis of diminished ovarian reserve (DOR).

SUBJECTS AND METHODS

A prospective observational study by self-administered questionnaire was conducted among female midwifery students of seven French schools from June to December 2013. The questionnaire had three parts: (1) questions designed to gather information on the study population; (2) a questionnaire consisting of 10 items to test knowledge about female fertility and ovarian reserve; (3) a self-administered questionnaire simulating a DOR diagnosis and quantifying the decision that students would make using a Likert scale of 5 points.

RESULTS

The participation rate was 72.5% (n=285/393). The average age was 22, 6 years±1.9. Among the 285 participants, the ovarian reserve concept was known by 93% of them (n=265) thanks to the midwifery studies (77%, n=204), the media (9%, n=24) and other sources of information. In total, 83.5% of midwifery students (n=238) were interested in assessing their ovarian reserve, and 48.3% of them were interested in evaluating it immediately (n=115). Among midwifery students, 22.5% of them (n=64) reported that female fertility began to decline from the age of 35 years old; 85.6% (n=244) thought that in vitro fertilization allowed women to conceive if fertility is related to a diminished ovarian reserve; 43.9% (n=125) answered that physical activity and a healthy diet had a beneficial effect on the ovarian reserve. If a DOR was diagnosed to them, 76.8% of students (n=219) would be likely to conceive their first child earlier than expected. Among them, 57.9% (n=165) would agree to have oocyte freezing in this context.

CONCLUSION

This study is the first in France that assessed students' knowledge on fertility. We observed: (1) gaps and misconceptions about female fertility despite a medical training in midwifery students; (2) a belief that in vitro fertilization is effective to overcome infertility related to age; (3) that some of these young students would be favorable to oocyte social freezing (technique not allowed in France); (4) that an adequate information on the decrease of fertility with age could lead some students to anticipate their first pregnancy. Specific information regarding the decrease of fertility with age should be offered to all reproductive-aged young women.

A new approach for the oocyte genotoxicity assay: adaptation of comet assay on mouse cumulus–oocyte complexes

Conventional genotoxicity tests are technically difficult to apply to oocytes, and results obtained on somatic cells cannot be extrapolated to gametes. We have previously described a comet assay (original–CA) on denuded mouse oocytes, but, in vivo, oocytes are not isolated from their surrounding follicular cells. Our objective was to develop a comet assay on cumulus–oocyte complexes (COC–CA) for a more physiological approach to study the genotoxicity of environmental factors on oocytes. For COC–CA, whole COC were exposed directly to exogenous agents after ovulation and removal from oviducts. Three conditions were studied: a negative control group, and two positive control groups, one of which was exposed to hydrogen peroxide (H2O2) and the other group was incubated with cerium dioxide nanoparticles (CeO2 NPs). With both tests, DNA damage was significant in the presence of both H2O2 and CeO2 NPs compared with the negative control. COC–CA offers an interesting tool for assaying the genotoxicity of environmental agents towards germinal cells. Furthermore, COC–CA is less time-consuming and simplifies the protocol of the original–CA, because COC-CA is easier to perform without the washing-out procedure.

In vivo exposure to benzo(a)pyrene induces significant DNA damage in mouse oocytes and cumulus cells

STUDY QUESTION

Does in vivo exposure to benzo(a)pyrene (BaP) induce DNA damage in oocytes and cumulus cells (CCs) in mice?

SUMMARY ANSWER

Significant increases in DNA strand breaks in oocytes and CCs and in BaP-induced DNA adducts in CCs were detected in exposed mice compared with controls.

WHAT IS KNOWN ALREADY

BaP has well-known mutagenic and carcinogenic effects on somatic cells, and is also registered as potential reproductive toxicant by several environmental protection agencies. It has been shown to cause a significant increase in DNA adducts in ovarian tissues; however, to our knowledge, the genotoxic effects of BaP on oocytes and CCs have not been studied to date.

STUDY DESIGN, SIZE, DURATION

Female CD1 mice were exposed to BaP via the oral administration of a single dose of 13 mg/kg body weight (bw); matched controls were exposed to the vehicle only (soya oil). A total of 15 groups of 6 mice (exposed or controls) were sacrificed 2, 4, 6, 15 or 22 days after BaP exposure, and after collection of oviducts, the oocyte-CC complexes (COC) were released.

PARTICIPANTS/MATERIALS, SETTING, METHODS

The alkaline comet assay was used to quantify the DNA breaks in oocytes and CCs; DNA damage was expressed as the Olive Tail Moment (OTM). Immunofluorescent staining was used to quantify BaP-induced DNA adducts in CCs. Fluorescence was expressed as the average grey value (AGVA; arbitrary units). The differences between the exposed and control groups were assessed using analysis of variance (ANOVA) and the non-parametric Mann-Whitney test.

MAIN RESULTS AND THE ROLE OF CHANCE

Higher levels of DNA damage were observed in the oocytes and CCs of BaP-exposed mice than in those of vehicle controls. Significant increases in OTM (mean ± SE) were detected in (i) oocytes from females exposed for 4 (10.5 ± 0.9 versus 3.1 ± 0.4, P < 0.0001) or 6 days before collection (15.6 ± 2.0 versus 3.6 ± 0.9, P < 0.0001) and (ii) CCs from females exposed 2 (6.4 ± 0.6 versus 2.1 ± 0.2, P < 0.0001), 4 (7.8 ± 0.4 versus 2.4 ± 0.1, P < 0.0001) or 6 days before collection (7.3 ± 0.3 versus 3.2 ± 0.5, P < 0.0001) compared with controls. A significant increase in benzo(a)pyrene-7,8-9,10 diol epoxide (BPDE)-DNA adducts and higher AGVA (mean ± SE) scores were observed in CCs from females exposed 2 (6.1 ± 0.3 versus 3.6 ± 0.5, P < 0.0001), 4 (7.5 ± 0.1 versus 3.4 ± 0.1, P < 0.0001) or 6 days before collection (11.6 ± 0.4 versus 3.7 ± 0.1, P < 0.0001) compared with control mice.

LIMITATIONS, REASONS FOR CAUTION

Mice were given one treatment via the oral route because this dose and mode of administration have been shown to induce detectable BPDE-DNA adduct levels in mouse organs and sperm cells. Additional data are needed to assess DNA damage in oocytes and CCs after chronic exposure to BaP in vivo.

WIDER IMPLICATIONS OF THE FINDINGS

To our knowledge, this is the first study examining the in vivo genotoxicity of BaP in oocytes and CCs. We observed significant DNA damage in the oocytes and CCs of mice after acute BaP exposure. BPDE-DNA adducts result directly from BaP metabolism while DNA breaks could result mainly from BPDE-DNA adduct excision and repair and/or through direct genotoxicity from increased reactive oxygen species. These results add new and important insights regarding the recently suggested toxicity of chronic BaP exposure in the ovary.

STUDY FUNDING/COMPETING INTEREST(S)

This work was supported by a grant (93-CPQ 2012-05) from the DIRRECTE, Provence Alpes Côte d'Azur, France. None of the authors have any conflict of interest to declare.

[Genotoxicity risk assessment and oocytes: basis of genetic toxicology and application in reproductive science]

The aim of genotoxicity tests in germ cells is to assess the impact of exposure to environmental mutagens that may represent a risk for the fertility or for the offspring of exposed subject. The comet assay on mature mouse oocytes is a simple, reproductive and rapid test to study primary DNA damage in oocytes. This test is used to complete toxicology assays applied in first line to somatic cells, and could find many applications in reproductive toxicology to study impact of environmental factors on female germ cells. We describe a practical application of comet assay in reproductive biology to assess the genotoxicity of cryoprotectants used at high concentrations in oocyte vitrification protocols. This test allowed us to demonstrate that dimethylsulfoxide and ethylene glycol are non-genotoxic for the mouse oocytes and led us to hypothesize a genotoxic effect of 1,2-propanediol (PrOH) at high concentrations after having observed induction of significant DNA damage on CHO cell line and on mouse oocytes.

Sperm cryopreservation before cancer treatment: a 15-year monocentric experience

Sperm banking is an important procedure to preserve fertility before cancer therapy. The aim of this study was to comprehensively analyse cryopreservation activity retrospectively for 1080 patients referred to the sperm bank for sperm cryopreservation before cancer treatment. This study included 1007 patients diagnosed with testicular cancer (TC) (41.7%), lymphoma (26%), other haematological cancers (9.4%) or other types of cancer (22.8%); of these, 29 patients did not produce any semen sample and cryopreservation was impossible for 67 patients. Semen characteristics before treatment were within normal ranges, except moderate asthenospermia. Sperm concentration was significantly lower in TC than in non-TC. Straws from 57 patients (6.3%) were used in assisted reproductive technologies, which led to a 46.8% cumulative birth rate. Straws were destroyed for 170 patients (18.7%) and 140 patients performed semen analyses after cancer therapy. After an average delay of 22.5 months after the end of therapy, 43 patients (30.7%) exhibited azoospermia. This study of a large population of cancer patients revealed a high level of successful sperm storage. Utilization of cryopreserved spermatozoa led to good chances of fatherhood. Nevertheless, sperm banks should be aware of the low rates of straw use and straw destruction by cancer patients.

Evolution of the GaAs(001) Surface Physico-Chemical Characteristics and Electrical Properties of the Si3N4/GaAs Interface with the NH3Photolysis Treatment of the GaAs Surface

Cleaning treatments of GaAs(001) by UV decomposition of NH3 has been studied by means of X-ray photoemission spectroscopy (XPS) and X-ray photoelectron diffraction (XPD). This photolysis treatment is shown to decompose the surperficial oxides and to remove the carbon of contamination. The surface cleaning is followed by the formation of gallium nitride overlayers. When used prior to UVCVD silicon nitride deposition, this treatment is shown to improve the electrical characteristics of the Si3N4/GaAs MIS structure.

A Global Electricai-Optical Model of Thin Film Solar Cells on Textured Substrates

In order to simulate the performance of the present day state-of-the-art multijunction solar cells in its entirety, an integrated electrical-optical model has been developed. The one-dimensional ab initio electrical model for the analysis of the transport properties of such devices can handle a very general semiconductor device structure where the material properties vary with position and the gap state properties with position and energy. The original semi-empirical optical model used takes into account both specular interference effects, and diffused reflectances and transmittances due to interface roughness. The latter are derived from angular-resolved photometric measurements and used as input parameters to the numerical programme. Comparison of the illuminated current density-voltage (J-V) characteristics, calculated on the basis of (a) a simple exponential absorption law and (b) the optical model, reveals an increase of ˜1 mA cm−2 in the short-circuit current and ˜8% in the cell conversion efficiency for case (b). Also the long wavelength quantum efficiency (QE) shows a marked improvement, while the blue QE decreases since proper account is taken of the absorption in the transparent conducting oxide and reflection from the device. The combined model is being applied to simulate the characteristics of wideband-gap-emitter-layer solar cells deposited in a three chamber conventional glow discharge reactor onto (i) highly textured SnO2 and (ii) weakly textured indium tin oxide substrates. The cells have been characterised experimentally by J-V and QE measurements. Preliminary results indicate that the integrated model matches the experimental J-V and QE data with a more realistic set of material parameters as compared to case (a).