Semen Parameters In Men Research Articles

Pharmacological non-hormonal treatment options for male infertility: a systematic review and network meta-analysis

BackgroundMale factor infertility affect up to 50% of couples unable to conceive spontaneously. Several non-hormonal pharmacological treatments have been proposed to boost spermatogenesis and increase chances of conception in men with infertility. Still, no clear evidence exists on the most effective treatment strategy.ObjectiveWe aimed to compare the effectiveness of non-hormonal pharmacological treatment options for men with infertility using a systematic review and network meta-analysis.MethodsWe searched MEDLINE, EMBASE, and CENTRAL until October 2023 for randomised/quasi-randomised trials that evaluated any non-hormonal pharmacological treatment options for men with idiopathic semen abnormalities or those with hypogonadism. We performed pairwise and network meta-analyses using a random effect model. We assessed risk of bias, heterogeneity, and network inconsistency. We calculated the mean rank and the surface under the cumulative ranking curve (SUCRA) for each intervention the maximum likelihood to achieve each of reported outcomes. We reported primarily on sperm concentration and other important semen and biochemical outcomes using standardised mean difference (SMD) and 95% confidence-intervals(CI).ResultsWe included 14 randomised trials evaluating four treatments (Clomiphene citrate, Tamoxifen, Aromatase inhibitors, anti-oxidants) and their combinations in 1342 men. The overall quality of included trials was low. Sperm concentration improved with clomiphene compared to anti-oxidants (SMD 2.15, 95%CI 0.78–3.52), aromatase inhibitor (SMD 2.93, 95%CI 1.23–4.62), tamoxifen (SMD − 1.96, 95%CI -3.57; -0.36) but not compared to placebo (SMD − 1.53, 95%CI -3.52- 0.47). Clomiphene had the highest likelihood to achieve the maximum change in sperm concentration (SUCRA 97.4). All treatments showed similar effect for sperm motility, semen volume, and normal sperm morphology. FSH levels showed significant improvement with clomiphene vs.anti-oxidant (SMD 1.48, 95%CI 0.44–2.51) but not compared to placebo. The evidence networks for LH and testosterone suffered from significant inconsistency (p = 0.01) with similar trend of improvement with clomiphene compared to other treatments but not compared to placebo.ConclusionThere is insufficient evidence to support the routine use of Clomiphene, tamoxifen, and aromatase inhibitors to optimise semen parameters in men with infertility. Future randomised trials are needed to confirm the efficacy of clomiphene in improving fertility outcomes in men.PROSPEROCRD42023430179.

The short-term effect of COVID-19 infection history on semen parameters in men referred to infertility centres.

Context In recent years, the COVID-19 pandemic became a threat to human health and induced global concern. The SARS-CoV-2 virus causes various disorders in the body's systems, and the reproductive system is no exception. Further, the rate of infertile couples is increasing and part of this is related to male infertility. Aims The aim of the present study was to investigate the impacts of COVID-19 infection history on semen quality in men referred to public and private infertility centres. Methods In this research, patients were divided into two groups: 88 men with a history of COVID-19 (Covid+) and 51 men without (Covid-). After semen collection, sperm parameters, fertilisation rate and oxidative stress were investigated. Key results Sperms with normal morphology and mature chromatin in patients with COVID-19 infection history decreased, and seminal oxidative stress and sperm DNA fragmentation were increased; moreover, the fertilisation rate in the Covid+ group decreased in compare to the Covid- group. Conclusion COVID-19 infection increases oxidative stress in the semen, so has a negative effect on some sperm parameters and fertilisation rate. Implications COVID-19 infection impairs semen quality by increasing in oxidative stress, thus reducing the fertility potential.

The Effects of Varicocelectomy on Sperm DNA Fragmentation and Conventional Semen Parameters in Men with Severe Oligoasthenoteratozoospermia: A Prospective Study.

The dilation and torsion of testicular veins in the plexus pampiniformis causes Varicocele, which is a surgically repairable cause of male infertility. This study assessed the impact of varicocelectomy on semen characteristics, total motile sperm count (TMSC) and sperm DNA integrity in patients with severe oligoasthenoteratozoospermia (OAT). In this prospective study, semen samples of 360 men with severe OAT who underwent varicocelectomy according to World Health Organization (WHO) criteria 2021 were studied (pre-operatively and at 6, 12, and 18 months post-operatively). The average age of our patients was 38.5 years. The mean spermatozoa concentration was found to be 1.60 ± 0.83 million/ml pre-operatively, while the mean post-operative concentration was 5.17 ± 1.23 million/ml at 6 months, 8.32 ± 0.98 million/ml at 12 months, and 13.51 ± 1.48 million/ml at 18 months (P<0.0001). The mean percentage of A+B motile spermatozoa was 2.92 ± 1.17% pre-operatively, 6.10 ± 1.51% at six months, 9.58 ± 1.49% at 12 months and 13.92 ± 1.88% at 18 months postoperatively (P<0.0001). The mean Modified David's morphology score was 3.80 ± 1.43% pre-operatively, 5.95 ± 1.23% at 6 months, 7.94 ± 1.18% at 12 months, and 10.82 ± 1.91% at 18 months post-operatively (P<0.0001). The mean of total motile sperm count (TMSC) was statistically improved after varicocelectomy (P<0.001). The mean of DNA fragmentation index (DFI) of the spermatozoa was 31.40 ± 0.52% pre-operatively, and post-operatively at 28.20 ± 0.32% at 6 months, 25.90 ± 0.31% at 12 months and 20.50 ± 0.40% at 18 months (P<0.001). Varicocelectomy was associated with significant improvement of sperm parameters and DNA fragmentation resulting in significant improvement of spermatogenesis quality. We believe that universalization in the routinely used sperm dispersion chromatin (SDC) test could be beneficial in the treatment of infertility.

Associations between tobacco inhalation and semen parameters in men with primary and secondary infertility: a cross-sectional study.

To examine the impact of tobacco smoking on seminal parameters in men with both primary and secondary infertility. This cross-sectional study analyzed 1938 infertile men from China who were categorized as nonsmokers (n=1,067) and smokers (n=871), with the latter group further divided into moderate smokers (1-10 cigarettes per day) (n=568) and heavy smokers (>10 cigarettes per day) (n=303). We assessed semen volume, concentration, total sperm count, progressive motility, and normal morphology following World Health Organization (WHO 2010) guidelines. A logistic regression model was used to analyze the relationships between smoking and seminal parameters while also controlling for lifestyle factors. The analysis demonstrated a statistically significant correlation between smoking and adverse seminal parameters in both primary and secondary infertility patients. Specifically, primary infertile men who smoked had a lower semen concentration, with heavy smokers showing a median sperm concentration of 59.2×10^6/ml compared to 68.6×10^6/ml in nonsmokers (P=0.01). The secondary infertile men who smoked exhibited reduced forward sperm motility, with heavy smokers demonstrating a median progressive motility of 44.7%, which was significantly lower than the 48.1% observed in nonsmokers (P=0.04). Smoking is significantly associated with detrimental effects on seminal parameters in infertile men, thus highlighting the need for cessation programs as part of fertility treatment protocols. Encouraging smoking cessation could substantially improve semen quality and fertility outcomes in this population.

Effects of Calorie Restriction on Preserving Male Fertility Particularly in a State of Obesity.

Highlight the importance of exploring nutritional interventions that could be applied as alternative or supplementary therapeutic strategies to enhance men's fertility. Lifestyle choices haveprompted extensive discussions regarding its implications and applications as a complementary therapy. The growing concern over the decline in sperm quality underscores the urgency of investigating these alternative interventions. Calorie restriction (CR) has emerged as a promising strategy to improve male fertility. The efficacy of CR depends on factors like age, ethnicity and genetics. Clinical studies, such as CALERIE,have shown an improvement in serum testosterone level and sexual drive in men with or without obesity. Additionally, CR has been shown to positively impact sperm count and motility; however, its effects on sperm morphology and DNA fragmentation remain less clear, and the literature has shown discrepancies, mainly due to the nature of technically dependent assessment tools. The review advocates a personalized approach to CR, considering individual health profiles to maximize its benefits. It underscores the need for routine, accessible diagnostic techniques in male reproductive health. Itsuggests that future research should focus on personalized dietary interventions to improve male fertility and overall well-being in individuals with or without obesity and unravel CR's immediate and lasting effects on semen parameters in men without obesity.

Experiences and Outcomes of Fertility Testing in Male Adolescents and Young Adults with Sickle Cell Disease

Introduction: Most adolescents and young adults (AYAs) with sickle cell disease (SCD) desire future biological parenthood. Recent research shows abnormal semen parameters in men with SCD, yet few studies have been conducted to elucidate fertility related impacts of SCD and its treatments among male AYAs with SCD. AYAs face many barriers to receiving care that could also impact their ability to complete fertility testing (i.e., via semen analysis). Thus, the aims of this study were to: 1) assess the feasibility of obtaining semen samples at a reproductive diagnostic center from male AYAs with SCD, 2) describe AYAs' and caregivers' experiences with testing, and 3) examine semen parameters among AYAs who completed testing. Methods Male AYAs with SCD (14-22 years, any genotype) and their caregivers were recruited to a single site study from November 2022-April 2023; the protocol involved completion of a novel web-based reproductive health program (i.e., FUTURES) describing potential fertility-related aspects of SCD and its treatments. AYA participants ≥18 years of age and AYA-caregiver dyads (if the AYA was &amp;lt;18 years old) were subsequently informed of the option for the AYA to obtain a semen analysis at an off-site reproductive diagnostic center (with costs of testing and transportation covered). Up to three attempts were made to contact AYA participants about their interest in testing. If interested, an order was sent to the testing center who then coordinated testing with the AYA. Research staff made up to three attempts to follow up with AYAs who reported interest but did complete testing. AYAs (and caregivers, if &amp;lt;18) who completed testing were notified of their results by a hematologist and invited to complete a facilitators interview. AYAs (and caregivers, if &amp;lt;18) who did not complete testing were invited to complete a barriers interview. Research staff conducted, transcribed, and analyzed interview transcripts for themes that demonstrated strong interrater reliability (κ=.94). Testing was considered feasible if ≥25% of AYAs completed testing. Demographic and treatment characteristics were abstracted from the medical record. Results Thirty-three AYAs completed FUTURES; five (15%) completed testing (Table 1) and a facilitators interview. Ten AYAs completed a barriers interview. Of the 18 enrolled caregivers, one completed a facilitators interview and seven completed a barriers interview. Facilitators included: 1) interest in learning about reproductive health [“ I told him ... sometimes people don't know if it is too late {to have a biological child} and if we checked we could have done something about it.” - Caregiver], 2) assistance coordinating testing appointments [“ Helping to coordinate {made testing easier} because I kept on missing the appointments.” -AYA] 3) alleviating costs [“ It {the funding} helped a lot because they {research team} had to pay and we didn't have to worry about it.” - Caregiver]. Barriers included: 1) discomfort [“ I don't think anything could have helped with the decision... he was just a little uncomfortable.” -Caregiver], 2) time [“ It is something I'm interested in, but not at the moment. I'm catching up on a lot of things.” -AYA], 3) transportation [e.g., “ I don't have a car. I didn't have a way to get there.” -AYA], and 4) forgetting the appointment [“ We just forgot about the appointment.” -Caregiver]. Conclusions Despite providing reproductive health education, compensation, and access to a local testing center, obtaining semen samples at an offsite center from male AYAs with SCD was not feasible. Abnormal semen parameters were noted across genotypes. While azoospermia and cryptozoospermia were noted in those on prolonged hydroxyurea treatment, oligospermia was also found in an individual with less severe disease and no hydroxyurea exposure. These findings underscore the importance of larger, longitudinal studies to examine semen parameters in male AYAs with SCD, ideally starting in mid-puberty. Further, qualitative findings highlight the need for: 1) developmentally and culturally appropriate fertility education, 2) innovative methods to collect semen samples (e.g., mail-in testing), and 3) advocacy to increase access to affordable reproductive healthcare. This is crucial to elucidate the fertility impacts of SCD and hydroxyurea and because the curative options that can also affect fertility are expanding for this underserved minority population.

The Correlation of Urine Bisphenol A with Semen Parameters in Men Referred to Infertility Centers: A Cross-Sectional Study.

Bisphenol A (BPA) is known as an endocrine disruptor that has harmful effects on general health. It is commonly used in various industrial products. In this study we tried to evaluate the amount of BPA in urine samples of the men referred to an infertility center. The cross-sectional study population consisted of male partners of infertile couples, who were referred to infertility clinic in Mazandaran, a northern state of Iran. Questionnaires included demographic characteristics, medical history, lifestyle factors, physical examinations. A semen sample and a spot urine sample were taken from each participant. In the initial study group of 240 men, 3 groups were excluded, and 122 men remained for the analysis. Highperformance liquid chromatography (HPLC) was applied to measure the amount of BPA in the urine samples. BPA was not detected in about half of the samples (53.3%). Multiple linear regression analysis showed that no significant relationship existed between the urine concentrations of BPA, semen parameters and male reproductive hormones. However, in a comparison with semen parameters in people with detectable urine BPA versus nondetectable ones, an inverse association was noticed with sperm concentration. In other parameters, differences were not significant. Smoking had no effects on sperm parameters, but body mass index (BMI) ≥25 reduced the percentage of normal sperm parameters. In most participants, urinary BPA was not detected. Probably in this study low environmental exposure to BPA is the cause of lower urine BPA concentrations compared to other industrially developed countries. Therefore, no overall relationship was observed between BPA level and male infertility.

Efficacy of Clomiphene Citrate Versus Enclomiphene Citrate for Male Infertility Treatment: A Retrospective Study.

Introduction Infertility and hypogonadism in males can greatly affect their reproductive health and overall well-being. Since exogenous testosterone administration for hypogonadism management may disrupt the normal hormonal cascade necessary for spermatogenesis, clomiphene citrate (CC) and enclomiphene citrate (EC) are medications often used to manage hypogonadism and male infertility. This study aims to directly compare the effects of CC and EC on serum testosterone levels and semen parameters in men to determine which medication may have an advantage in managing these conditions. Materials and methods We retrospectively analyzed ≥18-year-old men presenting with primary infertility, abnormal semen parameters, or hypogonadism who received CC or EC monotherapy for at least three months between January 2021 and December 2022. We compared baseline and follow-up hormone levels, semen parameters, and demographics. Variables were compared using paired and unpaired t-tests. Significance was assessed at p<0.05. Results A total of 46 men received EC and 32 men received CC. The median age was 42 (IQR: 34-47.75) years in men who received EC and 41 (IQR: 36-44) years in men who received CC (p=0.450). The two treatment groups exhibited a significant increase in serum total testosterone, while only EC had a statistically significant increase in FSH and LH. Semen volume and concentration did not significantly change with either treatment. Sperm motility increased in both groups, but total motile sperm count (TMSC) only significantly increased in men who received EC. Conclusions Our study found that EC and CC are effective treatments in increasing total testosterone without negatively affecting spermatogenesis. EC demonstrated to be more effective in raising gonadotropinlevels and TMSC.

Effect of oestrogen modulation on semen parameters in men with secondary hypogonadism: Systematic review and meta-analysis.

Selective oestrogen receptor modulators and aromatase inhibitors stimulate endogenous gonadotrophins and testosterone in men with hypogonadism. There are no systematic reviews/meta-analyses assessing the effects of selective oestrogen receptor modulators/aromatase inhibitors on semen parameters in men with secondary hypogonadism. To assess the effect of monotherapy or a combination of selective oestrogen receptor modulators/aromatase inhibitors on sperm parameters and/or fertility in men with secondary hypogonadism. A systematic search was conducted in PubMed, MEDLINE, Cochrane Library and ClinicalTrials.gov. Study selection and data extraction were performed by two reviewers independently. Randomised controlled trials and non-randomised studies of interventions reporting effects of selective oestrogen receptor modulators and/or aromatase inhibitors on semen parameters or fertility in men with low testosterone with low/normal gonadotrophins were selected. The risk of bias was assessed using ROB-2 and ROBINS-I tools. The results of randomised controlled trials were summarised using vote counting while summarising effect estimates where available. Non-randomised studies of intervention meta-analysis were conducted using the random-effect model. The certainty of evidence was assessed using GRADE. Five non-randomised studies of interventions (n=105) of selective oestrogen receptor modulators showed an increase in sperm concentration (pooled mean difference 6.64 million/mL; 95% confidence interval 1.54, 11.74, I2 =0%) and three non-randomised studies of interventions (n=83) of selective oestrogen receptor modulators showed an increase in total motile sperm count (pooled mean difference 10.52; 95% confidence interval 1.46-19.59, I2 =0%), with very low certainty of evidence. The mean body mass index of participants was >30kg/m2 . Four randomised controlled trials (n=591) comparing selective oestrogen receptor modulators to placebo showed a heterogeneous effect on sperm concentration. Three included men with overweight or obesity. The results were of very low certainty of evidence. Limited pregnancy or live birth data were available. No studies comparing aromatase inhibitors with placebo or testosterone were found. Current studies are of limited size and quality but suggest that selective oestrogen receptor modulators may improve semen parameters in those patients, particularly when associated with obesity.

P-005 Association between aging and semen parameters: a retrospective study on over 2,500 men

Abstract Study question Is there an association between advancing male age and worsening seminal parameters (If so, is it possible to define an age-threshold for semen quality decline)? Summary answer Only sperm morphology and motility-related parameters exhibited a significant negative association with age, particularly from the age of 40 years. What is known already While the importance of advanced maternal age on reduced fertility and higher reproductive risks is well documented, scarce and controversial are the information regarding the role of aging on male fertility potential. Indeed, growing concerns arise from the trend in the advancing average parenthood age in Western countries. Study design, size, duration A retrospective study was conducted in 11,307 consecutive semen samples obtained from men who attended the Andrology Unit of the University Hospital of L’Aquila, during the period from January 1992 to January 2022 for evaluation of their fertility potential. Participants/materials, setting, methods Semen samples were collected by masturbation into sterile containers after a sexual abstinence of 2-7 days. Total sperm count (TSC) was calculated by multiplying sperm concentration and the volume of the ejaculate, motile sperm concentration (MSC) was calculated by multiplying sperm concentration and progressive motility (%), and the total motile sperm count (TMSC) was calculated by multiplying MSC and volume. Leukocytospermia was defined as &amp;gt; 1x106 peroxidase-positive cells/mL. Main results and the role of chance Three hundred and forty-nine patients with azoospermia or severe oligozoospermia (&amp;lt;5x106 spz/ml) were excluded. Moreover, 8,450 were excluded because they were only subjected to semen analysis without concomitant clinical evaluation. Therefore, 2,508 subjects have been included in the final analysis. Significant inverse correlations were observed between male age and semen volume (p=0.04), total (p&amp;lt;0.0001) and progressive sperm motility (p&amp;lt;0.0001), TMSC (p=0.01), total progressive motile count (p=0.008), and percentage of spermatozoa with normal morphology (p=0.001), but not with sperm concentration (p=0.8) and TSC (p=0.2). After adjustment for abstinence time, smoking, history of genital tract infections, genital trauma, varicocele, cryptorchidism, orchiectomy, and the year the semen analysis, a significant negative association was found for total (p&amp;lt;0.0001) and progressive motility (p=0.0003), TSC (p=0.001), total progressive motile count (p=0.001), and normal morphology (p=0.035). The comparison of seminal parameters among age quartiles revealed that the age group above 40 years was associated with a significant reduction in total and progressive motility, total motile, and total progressive motile count, while the decline in the percentage of normal forms appeared to be earlier. Limitations, reasons for caution The present study did not analyze couple reproductive outcomes. Moreover, since sperm DNA fragmentation was available only for a limited number of subjects, it was not possible to assess its possible association with male aging. Wider implications of the findings In the light of the possible role of oxidative stress in affecting semen parameters in men aged over 40, the optimization of paternal lifestyle combined with targeted antioxidants treatments could be valuable preventive tools in the couple infertility work-up. Trial registration number not applicable

O-015 Spontaneous alterations in semen parameters are associated with age, accessory gland function and the FSHB c.-211G&amp;gt;T variant

Abstract Study question Which parameters are associated with spontaneous alterations in semen analysis in infertile men? Summary answer Changes in semen parameters are modulated by abstinence time, accessory gland function and fluctuations in FSH serum concentration, which is bound to FSHB c.-211G&amp;gt;T variant. What is known already There is a strong within-subject alteration of semen parameters in men with infertility. The WHO therefore recommends two ejaculate analyses. However, it remains unknown in which subgroup variations are likely to occur and which semen parameters are affected. We assume that in some men with idiopathic infertility, ejaculate parameters may spontaneously change without interventional medication apart from regression to the mean effects. The study aims to identify factors in conventional semen analysis based on the patients’ clinical data, including reproductive hormones like follicle stimulating hormone (FSH), and factors impacting endocrine activity, like the FSHB-211 promoter gene. Study design, size, duration In this retrospective longitudinal study we selected 3456 deeply phenotyped men with idiopathic infertility who had visited our centre for fertility workup from 2010-2020. The patients were selected from our well curated database Androbase© for analysis of repeated ejaculate samples. Participants/materials, setting, methods Men with idiopathic infertility and at least two ejaculate analyses (70-90 days distance) were included. Exclusion criteria comprised: sperm concentration &amp;lt;1 million/ml, abnormal FSH or low testosterone, bitesticular volume (bTV) &amp;lt;10ml, orchiectomy, cryptorchidism, varicocele testis, oncological disease, genetic findings (i.e. abnormal karyotype, AZF deletions), medication affecting spermatogenesis. Grouped linear 2-level nested mixed-effect models were applied. Analyzed parameters included: somatic, hormonal (including FSH and FSHB c.-211 variants), and semen parameters (including abstinence time, accessory gland markers). Main results and the role of chance Groups were built according to sperm concentration: A (n = 397): ≥1.0 to &amp;lt; 5.0 mill/ml, B (n = 708): ≥5.0 to &amp;lt; 15.0 mill/ml, C (n = 2351): ≥15.0 mill/ml. A, B and C: changes in ejaculate volume were associated with alterations in total sperm count and motility (p &amp;lt; 0.003). Changes were, controlled for abstinence time (p &amp;lt; 0.001), related to alpha-glucosidase, fructose or zinc (p = 0.005-0.02). A+B: fluctuations in FSH concentration influenced sperm concentration/count (p = 0.004-0.02), albeit only in men with FSHB c.-211 GG (p = 0.007-0.02). T-allele carriers did not show changes in FSH concentration (p &amp;gt; 0.1). B: age &amp;lt;50 years (p = 0.007-0.01) and normal bTV (p = 0.008-0.02) were associated with spontaneous increases of sperm concentration, count and motility. Semen parameters exhibit intra-individual alterations associated with organic, hormonal and genetic variables. Changes are pronounced in younger men with normal bTV and oligo- to almost normozoospermia. The effect is modulated by abstinence time, accessory gland function and fluctuations in FSH concentrations which, in turn, are bound to the FSHB-211 promotor gene polymorphism. Limitations, reasons for caution A limitation of our approach is the retrospective nature of the study, which cannot exclude the possibility of bias within the data set. Wider implications of the findings Judgement of semen analysis should be based on two semen samples, with abstinence time between 4-5 days. In future clinical trials, abstinence time should be kept constant. It might be investigated if younger men with normal bTV and FSHB c.-211 GT/TT benefit from improving accessory gland function and increasing FSH. Trial registration number not applicable

(181) Combination Clomiphene Citrate and Anastrozole Therapy Iimproves Semen Parameters in a Multi-institutional Cohort of Men with Idiopathic Infertility

Abstract Introduction Clomiphene citrate (CC), a selective estrogen receptor modulator, and anastrozole, a selective aromatase inhibitor, are common empiric medical therapies for men with idiopathic infertility. The effects of jointly administering these agents are not well understood. Objective The objective of this study is to compare semen parameters in men treated with clomiphene citrate and anastrozole (CC-A) combination therapy to those in men taking anastrozole alone. Methods We performed a multi-center, retrospective cohort study of men with idiopathic infertility prescribed anastrozole at two tertiary referral institutions. Demographic, laboratory, and prescription data were captured. The subset of patients taking CC at the time of anastrozole initiation were identified. Patients with pre-treatment normozoospermia, recent or current exogenous testosterone or human chorionic gonadotropin use, previous orchiectomy, and scrotal surgery during the treatment period were excluded. Outcome measures included changes in World Health Organization sperm concentration category (WHO-SCC) following initiation of anastrozole therapy. Linear and logistic regression models were constructed to evaluate the association of combination therapy with these outcomes. Results 72 men were included in the analysis cohort, including 54 men taking anastrozole alone and 18 men on CC therapy who subsequently started taking anastrozole (CC-A). Men on CC-A relative to anastrozole monotherapy were older (40 vs. 35 years, p=0.03) and had a lower BMI (30 vs. 34 kg/m^2, p=0.05), respectively. Pre-treatment LH levels (5.6 vs. 7.6 IU/L, p=0.25) and testosterone (336 vs 263 ng/dL, p=0.32) were similar. Baseline semen parameters including sperm concentration (3.7 vs. 2.3 M/mL, p=0.26) and motility (41 vs. 36%, p= 0.17) were also comparable. However, post-treatment median sperm concentration (6.9 vs. 3.4M/mL, p=0.02) and the change in mean sperm concentration (17.5 vs. 6.2 M/mL, p=0.03) were significantly higher in the CC-A combination group. Univariate linear regression also revealed an association between the use of CCA combination therapy and increase in sperm concentration (p=0.05). Despite these differences, WHO-SCC upgrade rates between groups were comparable (56 vs. 39%, p=0.22) in the setting of similar post-treatment levels of LH (7.4 vs. 8.6 IU/L, p=0.5), FSH (8.6 vs. 9.4 IU/mL, p=0.19), and testosterone (537 vs. 415 ng/dL, p=0.09). Conclusions Combination therapy with clomiphene citrate and anastrozole was associated with modest benefits in post-treatment sperm concentration when compared to anastrozole monotherapy. Combination empiric medical therapy using clomiphene citrate and anastrozole offers a small, but significant, clinical benefit over anastrozole alone for infertile men Disclosure No

Prolactin and spermatogenesis: new lights on the interplay between prolactin and sperm parameters.

To clarify the relationship between one the most gender-specific hormone, i.e. prolactin (PRL), and semen parameters in men. A retrospective, observational, cohort, real-world study was carried out, enrolling all men performing a semen analysis and PRL examination from 2010 to 2022. For each patient, the first semen analys was extracted, associated to PRL, total testosterone (TT), follicle stimulating hormone (FSH) and luteinizing hormone (LH). Hyperprolactinaemia (>35 ng/mL) was excluded. 1211 subjects were included. PRL serum levels were lower in normozoospermia compared to azoospermia (p = 0.002) and altered semen parameters (p = 0.048) groups. TT serum levels were not different among groups (p = 0.122). Excluding azoospermic men, PRL serum levels were lower in normozoospermic patients, when compared to other groups of semen alterations. An inverse correlation was detected between PRL and sperm concentration. Considering normozospermic subjects, PRL was directly related to both non-progressive sperm motility (p = 0.014) and normal sperm morphology (p = 0.040). Subdiving the cohort in quartiles according to PRL distribution, the highest motilities were observed in the second PRL quartile (8.30-11.10 ng/mL) and asthenozoospermia was significantly predicted by FSH (p < 0.001) and second PRL quartile (p = 0.045). The PRL-spermatogenesis connection seems to be mild, although low-normal PRL levels are associated with the best spermatogenetic profile. PRL serum levels could mirror the immunoregulatory status within the testis, suggesting that there is a sort of 'PRL optimal window' reflecting an efficent spermatogenesis. Alternatively, men with good semen parameters might have a higher central dopaminergic tone resulting in low PRL levels.

Effect of selective oestrogen receptor modulators/aromatase inhibitors on semen parameters in men with secondary hypogonadism; systematic review and meta-analysis

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Seminal Calbindin 2 in Infertile Men With Varicocele: A Prospective Comparative Study

The present study compared seminal calbindin 2 (CALB 2) levels and semen parameters in men with and without varicocele. CALB 2 is also known as calretinin and 29 kDa calbindin. The study was a case-control study conducted from April (2021) to March (2022) in the andrology department at Beni-Suef University hospital. The study included four matched groups: group (I) were controls (fertile normozoospermic men without varicocele) (n=24). Group (II) were fertile normozoospermic men with varicocele (n=24). Group (III) were infertile oligoasthenoteratozoospermia (OAT) men without varicocele (n=24). Group (IV) were infertile OAT men with varicocele (n=24). The lowest levels of seminal CALB 2 were found in patients with severe oligozoospermia which showed a statistically significant difference when compared to seminal CALB 2 in patients with normal, mildly low, or moderately low sperm counts. There were significant negative correlations between sperm concentration, sperm motility and percentage of normal sperm forms and seminal CALB 2. Seminal plasma CALB 2 may play a role in the negative impact of varicocele on the semen parameters especially sperm concentration, sperm motility and percentage of sperm normal forms. Future studies are needed to verify these findings.

The Impact of Herpes Simplex Virus on Semen Parameters in Men with Idiopathic Infertility: A Systematic Review.

Infertility due to the male factor is one of the major problems of infertile couples. One of the factors contributing to male infertility could be the herpes simplex virus (HSV). The aim of this systematic review was to evaluate the impact of HSV on semen parameters. This systematic review was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). Different English and Persian databases including Web of Science, PubMed, Scopus, Cochrane Library, EMBASE, ProQuest as well as SID, Magiran and Iranmedex were searched by two researchers, independently, without time limit until April 15, 2022. Observational studies that reported the relationship between HSV and semen parameters in men with idiopathic infertility were included in this review. The Newcastle-Ottawa Quality Assessment Scale was used for quality assessment of the included studies. Out of 356 retrieved articles, 12 observational studies comprising a total of 1460 patients were reviewed. Four studies examined the effect of HSV1 virus, two studies examined the effect of HSV2 virus and five studies examined the effect of both viruses on semen parameters. Seven studies reported at least one significant association between HSV infection and semen parameters. Sperm count and sperm motility were semen parameters further affected by the virus. In conclusion, HSV can be one of the risk factors for male infertility and it can affect semen parameters. However, due to the dearth of studies, further research with more robust designs are recommended.

PD11-12 THE EFFECT OF CLOMIPHENE CITRATE ON PATIENT REPORTED OUTCOME MEASURES

You have accessJournal of UrologyCME1 Apr 2023PD11-12 THE EFFECT OF CLOMIPHENE CITRATE ON PATIENT REPORTED OUTCOME MEASURES Jessica Schardein, Kia Fendereski, Zane Randell, Soren Keihani, Joshua Horns, and James Hotaling Jessica SchardeinJessica Schardein More articles by this author , Kia FendereskiKia Fendereski More articles by this author , Zane RandellZane Randell More articles by this author , Soren KeihaniSoren Keihani More articles by this author , Joshua HornsJoshua Horns More articles by this author , and James HotalingJames Hotaling More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003251.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Clomiphene Citrate (CC) is a medication that can be used in hypogonadal men in lieu of testosterone to increase testosterone levels while preserving or improving fertility. Patient reported outcome measures for this medication are limited, especially regarding sexual functioning. Our objective is to assess whether self-reported changes in androgen deficiency symptoms and erectile function are observed along with changes in hormone levels and semen parameters in men taking CC. METHODS: We performed a retrospective review of all patients on CC between 2014 and 2018 for hypogonadism and/or infertility. Patient characteristics including age and body mass index (BMI) along with hormone levels, semen parameters, and self-reported questionnaire scores were obtained. Patients who completed blood work for total testosterone and bioavailable testosterone, a semen analysis, and hypogonadism and erectile function questionnaires including Androgen Deficiency in Aging Male (ADAM) and Sexual Health Inventory for Men (SHIM) before and 3 months after the initiation of CC were included in the analysis. Patients with documented exogenous testosterone, human chorionic gonadotrophin, or anastrozole use were excluded. Changes in baseline and follow-up data were analyzed using paired-sample t-tests. RESULTS: A total of 97 men were identified and included in the analysis. The mean age and body mass index (BMI) were 33.7 ± 6 years and 31.2 ± 7.3 kg/m2, respectively. All patients were followed for at least 3 months. The use of CC significantly increased both mean total and bioavailable testosterone levels by 236.5 ng/dL and 115.6 ng/dL, respectively (p<0.05). Concentration, total progressive motility and morphology all significantly improved as well (p<0.05). Clinical manifestations included a significant improvement in ADAM scores (p=0.025) and no change in SHIM scores (p=0.278). CONCLUSIONS: As more men are placed on CC for hypogonadism and/or infertility, characterizing patient reported outcomes regarding androgen deficiency symptoms and erectile function are important. The medication is able to raise testosterone levels while increasing semen parameters in addition to improving self-reported hypogonadal symptoms and maintaining erectile function scores. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e337 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jessica Schardein More articles by this author Kia Fendereski More articles by this author Zane Randell More articles by this author Soren Keihani More articles by this author Joshua Horns More articles by this author James Hotaling More articles by this author Expand All Advertisement PDF downloadLoading ...

Spontaneous alterations in semen parameters are associated with age, accessory gland function and the FSHB c.-211G>T variant.

There is a strong within-subject alteration of semen parameters in men with infertility. However, it remains unknown in which subgroup variations are likely to occur and which semen parameters are affected. To evaluate parameters associated with spontaneous alterations in semen analysis. We retrospectively selected 3456 men with infertility without known causes affecting spermatogenesis or sperm output for analysis of repeated ejaculate samples. Exclusion criteria comprised sperm concentration <1 million/mL, abnormal follicle-stimulating hormone or low testosterone, and low bitesticular volume (<10mL). Grouped linear two-level nested mixed-effect models were applied. The analyzed parameters included abstinence time, bitesticular volume, age, accessory gland markers, follicle-stimulating hormone, and FSHB c.-211 variants. Groups include A (n=397): ≥1.0 to <5.0 million/mL, B (n=708): ≥5.0 to <15.0 million/mL, and C (n=2351): ≥15.0 million/mL. Groups A, B, and C: changes in ejaculate volume were associated with alterations in total sperm count and motility (p<0.003). Changes were, controlled for abstinence time (p<0.001), related to α-glucosidase, fructose, or zinc (p=0.005-0.02). Group A+B: fluctuations in follicle-stimulating hormone level influenced sperm concentration/count (p=0.004-0.02), albeit only in men with FSHB c.-211 GG (p=0.007-0.02). T-allele carriers did not show changes in follicle-stimulating hormone levels (p>0.1). Group B: age <50 years (p=0.007-0.01) and normal bitesticular volume (p=0.008-0.02) were associated with spontaneous increases in sperm concentration, count, and motility. Semen parameters exhibit intra-individual alterations associated with organic, hormonal, and genetic variables. Changes are pronounced in younger men with normal bitesticular volume and oligozoospermia to almost normozoospermia. The effect is modulated by abstinence time, accessory gland function, and fluctuations in follicle-stimulating hormone level, which is bound to FSHB c.-211G>T variant. Judgment of semen analysis should be based on two semen samples, with abstinence times between 4 and 5 days. As a future perspective, it might be investigated whether younger men with normal bitesticular volume who are unable to elicit increases in serum follicle-stimulating hormone (FSHB c.-211 genotype of GT/TT) benefit from improving accessory gland function and increasing follicle-stimulating hormone.

Expression of Concern: Effects of the Reduced Form of Coenzyme Q10 (Ubiquinol) on Semen Parameters in Men with Idiopathic Infertility: a Double-Blind, Placebo Controlled, Randomized Study.

No AccessJournal of UrologyExpression of Concern10 Jan 2023Expression of Concern: Effects of the Reduced Form of Coenzyme Q10 (Ubiquinol) on Semen Parameters in Men with Idiopathic Infertility: a Double-Blind, Placebo Controlled, Randomized Studyis a expression-of-concern ofEffects of the Reduced Form of Coenzyme Q10 (Ubiquinol) on Semen Parameters in Men with Idiopathic Infertility: a Double-Blind, Placebo Controlled, Randomized Study Mohammad Reza Safarinejad, Shiva Safarinejad, Nayyer Shafiei, and Saba Safarinejad Mohammad Reza SafarinejadMohammad Reza Safarinejad *Correspondence: P.O. Box 19395-1849, Tehran, Iran telephone: 0098 21 22454499; FAX: 0098 21 22456845; E-mail Address: [email protected] More articles by this author , Shiva SafarinejadShiva Safarinejad More articles by this author , Nayyer ShafieiNayyer Shafiei More articles by this author , and Saba SafarinejadSaba Safarinejad More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003143AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookLinked InTwitterEmail "Expression of Concern: Effects of the Reduced Form of Coenzyme Q10 (Ubiquinol) on Semen Parameters in Men with Idiopathic Infertility: a Double-Blind, Placebo Controlled, Randomized Study." The Journal of Urology, Publish Ahead of Print, pp. – Supported by the Kaneka Company, Japan. Study received medical ethics committee approval. Supplementary material for this article can be obtained at www.safarinejad.com. From the Clinical Center for Urological Disease Diagnosis, and a private clinic specializing in urological and andrological genetics, Tehran, Iran© 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsRelated articlesJournal of Urology15 Jun 2012Effects of the Reduced Form of Coenzyme Q10 (Ubiquinol) on Semen Parameters in Men with Idiopathic Infertility: a Double-Blind, Placebo Controlled, Randomized Study Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mohammad Reza Safarinejad *Correspondence: P.O. Box 19395-1849, Tehran, Iran telephone: 0098 21 22454499; FAX: 0098 21 22456845; E-mail Address: [email protected] More articles by this author Shiva Safarinejad More articles by this author Nayyer Shafiei More articles by this author Saba Safarinejad More articles by this author Expand All Supported by the Kaneka Company, Japan. Study received medical ethics committee approval. Supplementary material for this article can be obtained at www.safarinejad.com. Advertisement PDF downloadLoading ...

An Updated Role of Anastrozole in Male Factor Infertility for Avoidance of Need for Assisted Reproductive Technology (ART): A Short Communication

Male factor infertility causes infertility in about 50% couples. Aromatase hampering agents, like anastrozole restricts the transformation of testosterone (T) to estradiol (E2), minimize negative hampering on pituitary accessibility, and escalate endogenous Gn generation. Aromatase hampering agents have been offered historically to patients with a T: E2 ratio &lt;10. Anastrozole, a more selective hampering agent in contrast to prior agents, has been illustrated to decrease serum E2 quantities and improvement of semen parameters in men with a low T: E2 ratio . Despite, escalated utilization of anastrozole for the treatment of infertile men with escalated peripheral estrogen, it is uncertain if a broader cohort may benefit also from therapy. For corroborating that Naelitz BD, et al. revealed in a multi institutional retrospective cohort study with regards to infertile men with the objective to evaluate the anticipative factors for World Health Organization -sperm concentration category (WHO-SCC)upgrade in case of male patients receiving anastrozole treatment. Their observations were that anastrozole Initiation was correlated with decreased serum estradiol (E2), escalated serum gonadotropin (Gn) quantities, and clinical improvement of semen paradigms in approximately 50% of infertile men. Baseline generation of sperms and greater T: LH ratios anticipated an upgrade of WHO-SCC. E2 quantities, E2: T ratio, and BMI revealed poor anticipative power in this cohort. Men with pretreatment azoospermia displayed poor response to anastrozole needing other treatment modalities. Non-azoospermic infertile men with a T-LH ratio ≥100 (in addition to a lesser degree those with a ratio &lt;100) might gain advantage from treatment with anastrozole and get counseled regarding the anticipated probability of a clinically significant enhancement in semen paradigm. This might expand the availability of different therapies to couples who present with male factor infertility also aid in a trial of lesser invasive / costly fertility treatments.