Advances in the management of male infertility

Male infertility can be treated by surgical procedures (e.g., varicocelectomy) or by administration of drugs if causal factors (e.g., seminal tract infections) are detected. In more severe cases, methods of assisted fertilization often have to be applied, but even these have only a limited success rate. Recent studies have demonstrated that disturbances of sperm DNA integrity (determined by the acridine orange test) can explain certain cases of fertilization failure and failure to achieve pregnancy following in vitro fertilisation with intracytoplasmic sperm injection. The evaluation of DNA integrity should be considered when diagnosing male infertility as it has been shown to be an independent factor and can be used as a supplement to standard semen analysis. Analysis of DNA integrity may, therefore, provide further information about altered male fertility and lead to administration of more appropriate therapy

Preparativne modifikacije askomicina. V. Dobivanje novih derivata pomoću zamjene cikloheksilvinilidenske podjedinice

Starting from the easily accessible 24-O-tert-butyldimethylsilyl-22(R)-dihydro-28-oxoascomycin, methodologies that allow replacement of the cyclohexylvinylidene moiety of ascomycin by various other substituents are described. In addition, a so far unknown reactivity of the masked tricarbonyl moiety of ascomycin towards a stabilized Wittig reagent is reported.Opisani su postupci koji počinju s lako pristupačnim 25-O-tert-butildimetilsilil-22(R)-dihidro-28-oksoaskomicinom i omogućuju zamjenu askomicinske cikloheksilvinilidenske podjedinice različitim substituentima

Male Oxidative Stress Infertility (MOSI): Proposed Terminology and Clinical Practice Guidelines for Management of Idiopathic Male Infertility

Despite advances in the field of male reproductive health, idiopathic male infertility, in which a man has altered semen characteristics without an identifiable cause and there is no female factor infertility, remains a challenging condition to diagnose and manage. Increasing evidence suggests that oxidative stress (OS) plays an independent role in the etiology of male infertility, with 30% to 80% of infertile men having elevated seminal reactive oxygen species levels. OS can negatively affect fertility via a number of pathways, including interference with capacitation and possible damage to sperm membrane and DNA, which may impair the sperm’s potential to fertilize an egg and develop into a healthy embryo. Adequate evaluation of male reproductive potential should therefore include an assessment of sperm OS. We propose the term Male Oxidative Stress Infertility, or MOSI, as a novel descriptor for infertile men with abnormal semen characteristics and OS, including many patients who were previously classified as having idiopathic male infertility. Oxidation-reduction potential (ORP) can be a useful clinical biomarker for the classification of MOSI, as it takes into account the levels of both oxidants and reductants (antioxidants). Current treatment protocols for OS, including the use of antioxidants, are not evidence-based and have the potential for complications and increased healthcare-related expenditures. Utilizing an easy, reproducible, and cost-effective test to measure ORP may provide a more targeted, reliable approach for administering antioxidant therapy while minimizing the risk of antioxidant overdose. With the increasing awareness and understanding of MOSI as a distinct male infertility diagnosis, future research endeavors can facilitate the development of evidence-based treatments that target its underlying cause

New WHO-reference limits-revolution or storm in a teapot?

Since release of the latest WHO manual with the new lower reference values of semen parameters, a lot of discussion has been raised about their usefulness and appropriateness for assessment of male fertility. As with the previous reference values the new limits do neither allow an andrological diagnosis based on nosological criteria nor clear-cut differentiation between fertility and sub-/infertility. Therefore, considering the fact that fertility is a continuum, the new lower reference limits should not be overestimated. Most probably, more sperm function tests, such as determination of DNA integrity, and-in the future-assessment of biomarkers, such as sperm proteomics will be included into andrological work-up, thus resulting in a more personalized approach of infertility management. On the other hand, the detailed instructions for standard and advanced semen analysis provided in the new manual are very much appreciated and should be adopted by each seriously working laboratory. Asian Journal of Andrology INTRODUCTION Recently the new WHO laboratory manual for the examination and processing of human semen (5th edition) has been published 1 and a Special Issue of the Asian Journal of Andrology to mark that occasion has highlighted in a series of papers the controversies arising from that new edition. This new version of the manual provides substantial changes and improvements compared with the previous versions and contains more detailed information and instruction, thus facilitating the work in the andrological laboratory. Along with a large series of instructive photographs, including those demonstrating normal spermatozoa according to strict criteria and respective pathomorphology, it contains very detailed and clear explanations of all the basic techniques. Moreover, new chapters on sperm preparation for assisted reproduction techniques and cryopreservation have been included. The text also incorporates a series of detailed standardized protocols for more advanced assessments of additional elements of semen analysis, such as the detection of leukocytes, the identification of precursor germ cells and the determination of antisperm antibodies. Most importantly, there is a completely revised chapter on quality control. 2 The most striking changes in this new edition of the WHO manual, however, concern the reference values for semen quality. Whereas the previous reference values were based, more or less, on expert opinion, the new ones were acquired by analysing semen samples from 1800 recent fathers (time to pregnancy of f12 months) living in eight countries on three continents. From these data, one-sided lower reference limits were generated from the fifth percentile of the data distribution. 3 The development of evidence-based reference ranges for semen analysis resolves one of the major concerns of previous editions. These new reference values reveal some drastic differences from the previous ones; for example, progressive motility is considere

Special Issue “Molecular Immunology of the Male Reproductive System”

The immunological aspects of male infertility have gradually become the focus of both basic and clinical research [...