Chronic Administration of Tadalafil Improves the Symptoms of Patients with Amicrobic MAGI: An Open Study

Aim of this study was to evaluate the effects of pharmacological treatment with Tadalafil 5 mg daily on symptoms and quality of sperm parameters in selected patients with amicrobic MAGI (male accessory gland inflammation). 120 patients with amicrobic MAGI (mean age 27.0 ± 6.0 years) with mild-moderate ED (erectile dysfunction) according to IIEF-5 (International Index of Erectile Function 5 Items) scores underwent pharmacological treatment with Tadalafil 5 mg daily for six months. Before and after treatment these patients were evaluated through IIEF-5, semen analysis (according to WHO Criteria, 2010), SI-MAGI (Structured Interview about Male Accessory Gland Inflammation), and ultrasound evaluation. Patients with PVE (prostate-vesciculo-epididymitis) showed a significant increase in the percentage of spermatozoa with total (16.0 ± 8.0 versus 30.0 ± 6.0%) and progressive motility (8.00 ± 10.0 versus 25.0 ± 6.00%). It was a significant reduction of the number of patients with complicated ultrasound forms (30.0 versus 52.0) and a significant increase of the number of patients with uncomplicated ultrasound form (90.0 versus 68.0). Finally, there was a significant reduction in the percentage of patients with alterations of sexual function different from DE, such as premature ejaculation (4.00 versus 8.00%), painful ejaculation (4.00 versus 10.0%), delayed ejaculation (12.50 versus 8.00%), and decreased libido (10.0 versus 25.0%)

Poor Efficacy of L-Acetylcarnitine in the Treatment of Asthenozoospermia in Patients with Type 1 Diabetes

Introduction. In recent years, research has focused on the impact that diabetes mellitus (DM) has on male reproductive function. The available evidence has mainly considered type 2 DM (DM2). However, we have previously shown that type 1 DM (DM1) also affects male reproductive health. Given the efficacy of carnitine in the treatment of male infertility, a topic that merits further investigation is its role in the treatment of infertile patients with DM1. Aim. To investigate the efficacy of carnitines for the treatment of asthenozoospermia in DM1 patients. Methods. This was a two-arm single-blind, randomized control trial. The patients enrolled in this study were assigned to the group receiving L-acetylcarnitine (LAC) (1.5 g daily for 4 months) or to the group receiving LAC (same dosage) plus L-carnitine (LC) (2 g daily for 4 months). Serum-glycated hemoglobin levels did not differ significantly after either of the two treatments given. Administration of LAC plus LC showed greater efficacy on progressive sperm motility than single therapy (increase 14% vs. 1% after treatment, respectively). Discussion. The results of this study showed that the administration of LAC plus LC is more effective than the administration of LAC alone. The lower efficacy of LAC alone could be due to the lower overall administered dosage. Alternatively, a selective defect of carnitine transporters at an epididymal level could be hypothesized in patients with DM1. Further studies are needed to clarify this point

Consequences on aging process and human wellness of generation of nitrogen and oxygen species during strenuous exercise

Impairment of antioxidant defense system and increase in metabolic rate and production of reactive oxygen species have been demonstrated in strenuous exercise. Both at rest and during contractile activity, skeletal muscle generates a very complex set of reactive nitrogen and oxygen species; the main generated are superoxide and nitric oxide. The nature of the contractile activity influences the pattern and the magnitude of this reactive oxygen and nitrogen species (ROS) generation. The intracellular pro-oxidant/antioxidant homeostasis undergoes alteration owing to strenuous exercise and the major identified sources of intracellular free radical generation during physical activity are the mitochondrial electron transport chain, polymorphoneutrophil, and xanthine oxidase. Reactive oxygen species increased tissue susceptibility to oxidative damage and pose a serious threat to the cellular antioxidant defense system. The possible dangerous consequences of the aging process and human wellness are emphasized in this review

Real-world management of male idiopathic infertility in indication for FSH treatment: a multicenter, longitudinal, observational cohort study (open registry)

Objective: The management of male idiopathic infertility is challenging. The Italian Medicines Agency (AIFA) note 74 regulates the empirical administration of follicle-stimulating hormone (FSH), although its application in clinical practice remain conflicting. The aim was to explore the management of male idiopathic infertility and to assess the actual use of FSH. Methods: A multicenter longitudinal prospective observational study (open-registry), involving 10 Italian Andrological and Gynecological Centers was carried out. Adult men with idiopathic infertility and serum FSH levels <8 IU/L were considered. Semen and hormonal parameters were recorded at baseline and after treatment. Results: 718 patients were enrolled (age 37.6±6.5 years). FSH treatment was prescribed in 55.3% of patients, with a significant difference between Andrological (61.3%) and Gynecological (30.3%) Centers (P<0.001). Recombinant-FSH was chosen in 64.5% and the urinary form in 35.5%. When prescribed, the adherence to regimen suggested by AIFA note (FSH at the dosage of 150 IU every other day) was almost complete (>90%). Concomitant hormonal treatment was prescribed to 23 patients (3.2%), nutraceuticals alone to 109 patients (15.2%), and nutraceuticals plus FSH for 42 patients (5.9%). Sperm concentration significantly increase compared to baseline (P=0.016) in patients treated with FSH. Conclusions: Only half of infertile patients are treated with FSH, although the note 74 guarantees this therapeutic approach. FSH treatment is more frequently prescribed by Andrological Centers, confirming the heterogeneous management of male infertility. This real-life analysis confirms the beneficial effect of FSH in male idiopathic infertility, although future properly-designed studies are needed to confirm this improvement