Improvements in Sperm Motility Following Low- or High-Intensity Dietary Interventions in Men With Obesity

INTRODUCTION

Obesity increases risks of male infertility, but bariatric surgery does not improve semen quality. Recent uncontrolled studies suggest that a low-energy diet (LED) improves semen quality. Further evaluation within a randomized, controlled setting is warranted.

METHODS

Men with obesity (18-60 years) with normal sperm concentration (normal count) (n = 24) or oligozoospermia (n = 43) were randomized 1:1 to either 800 kcal/day LED for 16 weeks or control, brief dietary intervention (BDI) with 16 weeks' observation. Semen parameters were compared at baseline and 16 weeks.

RESULTS

Mean age of men with normal count was 39.4 ± 6.4 in BDI and 40.2 ± 9.6 years in the LED group. Mean age of men with oligozoospermia was 39.5 ± 7.5 in BDI and 37.7 ± 6.6 years in the LED group. LED caused more weight loss than BDI in men with normal count (14.4 vs 6.3 kg; P < .001) and men with oligozoospermia (17.6 vs 1.8 kg; P < .001). Compared with baseline, in men with normal count total motility (TM) increased 48 ± 17% to 60 ± 10% (P < .05) after LED, and 52 ± 8% to 61 ± 6% (P < .0001) after BDI; progressive motility (PM) increased 41 ± 16% to 53 ± 10% (P < .05) after LED, and 45 ± 8% to 54 ± 65% (P < .001) after BDI. In men with oligozoospermia compared with baseline, TM increased 35% [26] to 52% [16] (P < .05) after LED, and 43% [28] to 50% [23] (P = .0587) after BDI; PM increased 29% [23] to 46% [18] (P < .05) after LED, and 33% [25] to 44% [25] (P < .05) after BDI. No differences in postintervention TM or PM were observed between LED and BDI groups in men with normal count or oligozoospermia.

CONCLUSION

LED or BDI may be sufficient to improve sperm motility in men with obesity. The effects of paternal dietary intervention on fertility outcomes requires investigation.

PMON259 Weight Loss using a Formula Low Energy Diet Reduces Seminal Oxidative Stress in Men with Obesity and Oligospermia: a Randomised Controlled Study

Background

Poor sperm quality (male infertility) is present in 50% of couples requiring assisted reproductive technologies (ART). Few couples worldwide have access to ART, and there are currently no available drugs to improve sperm function. Obesity is a major cause of male infertility. Semen reactive oxygen species (ROS), is a recently identified mechanism for sperm DNA damage resulting in reduced fertilisation and pregnancy outcomes. Semen levels of ROS are positively correlated with body mass index. However, the acute energy restriction following bariatric surgery may paradoxically reduce sperm function, making it an unsuitable treatment for male infertility. No previous randomised controlled study has been performed investigating the effects of weight loss on sperm function and semen ROS in men with obesity and infertility. We hypothesized that milder weight loss through energy restriction could be a novel treatment to reduce semen ROS and improve sperm function in men with obesity and oligospermia.

Objective

Determine effects of a formula low energy diet (LED) on semen parameters and ROS in men with obesity and oligospermia.

Methods

Thirty-six men with obesity and oligospermia participated in a 16-week randomised, controlled study. After 2-weeks of baseline observation, all men were randomised to either LED (∼800kcal/day) or a control intervention of generalised healthy eating advice lasting 16-weeks; WHO semen analysis, semen ROS, metabolic parameters and reproductive hormones were monitored throughout the study. Semen ROS was measured in relative light years/sec/million sperm (RLU/s/mill) using an in-house, validated chemiluminescent luminol-based assay.

Results

At baseline, men with obesity and oligospermia had significantly elevated semen ROS levels when compared with the reference range generated from healthy men with normal BMI (median (inter-quartile range) ROS in RLU/s/mill: &lt;3.8, healthy men; 60.3(113.1), control at baseline; 82.1(100.6) LED). Participants on the LED lost 9-fold more weight compared with control intervention (weight ± SD in kg: -1.5±4.3, control; -14.3±4.5, LED, p&lt;0.0001). After 16 weeks, median semen ROS was reduced 12-fold greater in the LED versus control group (change in ROS vs. baseline in RLU/s/mill: -0.2(61.9), control; -6.0(137.5), LED; p&lt;0.05). Total and progressive motility, and total motile count increased in the LED group versus the control intervention, but these changes were non-significant.

Conclusions

This is the first randomised controlled study investigating effects of dietary weight loss on spermatogenesis in men with obesity and oligospermia. Our study provides proof-of-concept, and that weight loss could be used therapeutically in men with obesity and infertility, to reduce seminal ROS which is associated with increased sperm DNA damage. These data have important potential implications for management of couples with male infertility. Larger studies are needed to investigate whether weight loss is sufficient to improve pregnancy outcomes in couples affected by male infertility due to obesity.

Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.

Investigating the potential of clinical and biochemical markers to differentiate between functional hypothalamic amenorrhoea and polycystic ovarian syndrome: A retrospective observational study

OBJECTIVES

Functional hypothalamic amenorrhoea (FHA) is a common cause of amenorrhoea, but diagnosis can be challenging. The aim of this study was to investigate the clinical and biochemical features of FHA, compared to that of polycystic ovarian syndrome (PCOS) and assess the diagnostic performance of the different parameters for differentiating the two conditions.

DESIGN AND PATIENTS

This was a retrospective observational study. We analysed clinical and biochemical parameters of women diagnosed with FHA and PCOS following specialist assessment at the reproductive endocrine gynaecology clinic, St Mary's Hospital.

RESULTS

Compared with PCOS, women with FHA had significantly lower body mass index (BMI; 20.1 ± 2.9 vs. 31.1 ± 7.8 kg/m² ; p< .0001) and a thinner endometrium (3.75 ± 2.23 vs. 6.82 ± 3.32 mm; p< .0001). Women with FHA had significantly lower luteinising hormone (LH; 3.46 ± 7.31 vs. 8.79 ± 4.98 IU/L; p< .0001), and lower LH to follicle-stimulating hormone (FSH) ratio, estradiol, thyroid-stimulating hormone, free thyroxine and prolactin levels; there was no significant difference in FSH levels. BMI had the greatest predictive performance for FHA (area under the curve [AUC]: 0.93; p< .001), followed by estradiol (AUC: 0.89; p< .001), LH (AUC: 0.88; p< .001) and LH:FSH ratio (AUC: 0.86; p< .001).

CONCLUSIONS

Our data provides quantification for diagnostic accuracy of clinical parameters to differentiate FHA from PCOS, namely low BMI, estradiol, LH and LH:FSH ratio. These data could help clinicians more reliably diagnose FHA in women with secondary amenorrhoea.

Clinical Utility of Novel Fractional Flow Reserve Pullback for Individual Lesion Contribution in Serial Disease

OBJECTIVES

Fractional flow reserve (FFR) pullback is frequently used to assess serially diseased arteries, but has been shown to be inaccurate due to physiological interaction between individual lesions. We evaluated the clinical utility of a novel solution that improves estimation of true FFR contribution of each stenosis in the presence of serial disease.

METHODS

Ten interventional cardiologists were presented with tiered information for 18 elective patients with serial coronary disease and submitted revascularization strategies and assessment of lesion significance. Operators were first shown clinical and angiographic information only (Angio); then, conventional practice FFR (FFRnorm); and finally, pullback with corrected FFR contributions of each stenosis (FFRpred).

RESULTS

The treatment strategy agreement between operators was k=0.39, k=0.64, and k=0.77 using Angio, FFRnorm, and FFRpred, respectively (P<.001). Lesion significance uncertainty was 26%, 28%, and 3%, respectively. The number of stents per patient was 1.49 ± 0.57, 1.50 ± 0.57, and 1.3 ± 0.5, respectively (P<.001). In total, percutaneous coronary intervention (PCI) strategy changed in over 50% of cases analyzed, with participants opting for shorter stent length with FFRpred (29.5 ± 15.2 mm) compared with FFRnorm (34.1 ± 14.4 mm; P<.001) and Angio (34.6 ± 14.3; P=.04). This was accompanied by significantly less interobserver variability.

CONCLUSION

The ability to quantify the contribution of individual lesions with the novel FFR pullback-based solution significantly increases operator confidence regarding PCI strategy, reduces heterogeneity in practice, and can reduce the planned number of stents and total stent length.

Abstracts of the RCPsych Virtual International Congress 2021, 21-24 June

AIMS

Annually, 1 in 4 people in the UK will experience a mental health problem. Alongside the approach of increasing awareness of the issue amongst the general population, there is a drive to deliver training and education on the recognition and management of mental health crises. Limited resources exist to aid healthcare professionals in delivering mental health first aid (MHFA), with the vast majority focussing on lengthy training courses. Small group problem-based learning (PBL) is utilised widely in medical education and this modality offers advantages in deliverability, audience participation and experiential learning. Our aim was to deliver and explore the effectiveness of a PBL MHFA workshop to various healthcare professionals.

METHOD

As part of an Emergency Medicine Mental Health Education day, we delivered four 30-minute PBL MHFA workshops. These involved an introduction to MHFA, followed by an interactive discussion of 4 mental health simulated cases, whereby participants anonymously answered a range of questions using the web-based platform Mentimeter. We devised a simple MHFA A,B,C,D,E acronym to bring structure to problem solving. Pre- and post-workshop questionnaires were used to assess outcomes using Likert scales to measure various aspects of MHFA (1 = strongly disagree and 5 = strongly agree). Statistical significance was calculated using T-Test with P < 0.05 defining statistical significance.

RESULT

A total of 28 professionals attended the workshops, 20 (72%) completed both the pre and post workshop questionnaire. 19 (76%) were nurses (5 Registered Mental Health Nurses and 14 Registered General Nurses), 3 (12%) were doctors, 2 (8%) were HCA's and 1 was a policeman. 15 (75%) of the participants reported historically having had the need to deliver MHFA but only 3 (15%) had previously received training. After the workshop, participants reported significantly increased understanding [3.0 to 4.3 (p < 0.05)] and confidence in delivering MHFA [3.05 to 4.30 (p < 0.05)]. There was significantly improved confidence in assessing risk [3.03 to 4.05], calling for appropriate help [3.45 to 4.35] and de-escalation techniques [3.05 to 4.15].

CONCLUSION

To our knowledge this is the first mini PBL-based MHFA workshop. We have demonstrated that the PBL workshop setup is an effective means to deliver training on MHFA. We recognise the importance of MHFA training reaching a larger audience and its potential value if incorporated into national healthcare training programmes and made available to the general public.

Intra-coronary Imaging for the Evaluation of Plaque Modifications Induced by Drug Therapies for Secondary Prevention

PURPOSE OF REVIEW

Patients diagnosed with coronary artery disease are at a high risk of subsequent cardiovascular events; therefore, secondary prevention in the form of therapeutic lifestyle changes, and drug therapies is vital. This article aims to review potential application of intra-coronary imaging for the evaluation of plaque modifications, induced by medications for secondary prevention for CAD.

RECENT FINDINGS

Intra-coronary imaging provides detailed information on the atherosclerotic plaque which is the primary pathological substrate for the recurrent ischemic cardiovascular events. These modalities can detect features associated with high risk and allow serial in vivo imaging of lesions. Therefore, intravascular imaging tools have been used in landmark studies and played a role in improving our understanding of the disease processes. Changes in size and plaque composition over time can be evaluated by these tools and may help understanding the impact of a treatment. Moreover, surrogate imaging end points can be used when testing new drugs for secondary prevention.

Coronary Artery Aneurysms: A Review of the Epidemiology, Pathophysiology, Diagnosis, and Treatment

Coronary artery aneurysms (CAAs) are uncommon and describe a localized dilatation of a coronary artery segment more than 1.5-fold compared with adjacent normal segments. The incidence of CAAs varies from 0.3 to 5.3%. Ever since the dawn of the interventional era, CAAs have been increasingly diagnosed on coronary angiography. Causative factors include atherosclerosis, Takayasu arteritis, congenital disorders, Kawasaki disease (KD), and percutaneous coronary intervention. The natural history of CAAs remains unclear; however, several recent studies have postulated the underlying molecular mechanisms of CAAs, and genome-wide association studies have revealed several genetic predispositions to CAA. Controversies persist regarding the management of CAAs, and emerging findings support the importance of an early diagnosis in patients predisposed to CAAs, such as in children with KD. This review aims to summarize the present knowledge of CAAs and collate the recent advances regarding the epidemiology, etiology, pathophysiology, diagnosis, and treatment of this disease.

Fibromatosis of the Sigmoid Colon With CTNNB1 (β-Catenin) Gene Mutation, Arising at the Site of Ileocolic Anastomosis for Resection of Gastrointestinal Stromal Tumor

We describe a case of intra-abdominal fibromatosis, which occurred in a 44-year-old woman who had a previous history of gastrointestinal stromal tumor (GIST) of the sigmoid mesocolon, which was treated with imatinib and resection. A mass was detected at the site of ileocolic anastomosis of the previous small bowel resection and sigmoid colectomy, nearly 3 years later. Clinically, this was suspected to represent recurrent GIST and was excised, but histology and mutational analysis showed desmoid-type fibromatosis with a mutation in codon 41 of exon 3 of the CTNNB1 (β-catenin) gene. The occurrence of fibromatosis at the site of excision of GIST is very rare, but its recognition is important as the treatment of the two neoplasms differs significantly. As imaging cannot reliably distinguish between these 2 entities, histological diagnosis is crucial for correct clinical management.

TAVI: New trials and registries offer further welcome evidence - U.S. CoreValve, CHOICE, and GARY

The introduction of transcatheter aortic valve implantation (TAVI) has resulted in a paradigm shift in the treatment of patients with severe aortic stenosis. Data from the recent U.S CoreValve Trial suggest, for the first time, that TAVI is associated with a significantly higher rate of survival at one year compared to surgical aortic valve replacement (SAVR) in the treatment of high-risk patients affected by severe aortic stenosis. The present review discusses this study and the current evidence about TAVI, for the treatment of severe aortic stenosis, from major trials and real world registries.