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      The Negative Impact of Varicocele on Basic Semen Parameters, Sperm Nuclear DNA Dispersion and Oxidation-Reduction Potential in Semen

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          Abstract

          Since varicocele is so common in infertile men, this study intends to analyse the relationships between varicocele and conventional semen characteristics, sperm nuclear DNA dispersion and oxidation-reduction potential (ORP) in semen. Varicocele-positive and varicocele-negative infertile men (study groups) showed significantly lower standard sperm parameters and higher sperm DNA fragmentation (SDF) and ORP in semen than healthy volunteers and subjects with proven fertility (control groups). A lower proportion of low SDF levels (0–15% SDF) and higher incidence of high SDF levels (>30% SDF), as well as a higher prevalence of high ORP values (>1.37 mV/10 6 sperm/mL), were found in the study groups vs. the control groups. Moreover, infertile men had significantly lower odds ratios (ORs) for low SDF levels and significantly higher ORs for high SDF levels and high ORP. SDF and ORP were negatively correlated with sperm number, morphology, motility and vitality. Furthermore, a significant positive correlation was found between SDF and ORP. The obtained results suggest that disorders of spermatogenesis may occur in varicocele-related infertility. These abnormalities are manifested not only by reduced standard semen parameters but also by decreased sperm DNA integrity and simultaneously increased oxidative stress in semen.

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          Male infertility

          It is estimated that infertility affects 8-12% of couples globally, with a male factor being a primary or contributing cause in approximately 50% of couples. Causes of male subfertility vary highly, but can be related to congenital, acquired, or idiopathic factors that impair spermatogenesis. Many health conditions can affect male fertility, which underscores the need for a thorough evaluation of patients to identify treatable or reversible lifestyle factors or medical conditions. Although semen analysis remains the cornerstone for evaluating male infertility, advanced diagnostic tests to investigate sperm quality and function have been developed to improve diagnosis and management. The use of assisted reproductive techniques has also substantially improved the ability of couples with infertility to have biological children. This Seminar aims to provide a comprehensive overview of the assessment and management of men with infertility, along with current controversies and future endeavours.
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            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.
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              Sperm DNA fragmentation testing: Summary evidence and clinical practice recommendations

              Abstract We herein summarise the evidence concerning the impact of sperm DNA fragmentation in various clinical infertility scenarios and the advances on sperm DNA fragmentation tests. The collected evidence was used to formulate 41 recommendations. Of these, 13 recommendations concern technical aspects of sperm DNA fragmentation testing, including pre‐analytical information, clinical thresholds and interpretation of results. The remaining 28 recommendations relate to indications for sperm DNA fragmentation testing and clinical management. Clinical scenarios like varicocele, unexplained infertility, idiopathic infertility, recurrent pregnancy loss, intrauterine insemination, in vitro fertilisation/intracytoplasmic sperm injection, fertility counselling for men with infertility risk factors and sperm cryopreservation have been contemplated. The bulk evidence supporting the recommendations has increased in recent years, but it is still of moderate to low quality. This guideline provides clinicians with advice on best practices in sperm DNA fragmentation testing. Also, recommendations are provided on possible management strategies to overcome infertility related to sperm DNA fragmentation, based on the best available evidence. Lastly, we identified gaps in knowledge and opportunities for research and elaborated a list of recommendations to stimulate further investigation.
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                Author and article information

                Contributors
                Role: Academic Editor
                Journal
                Int J Environ Res Public Health
                Int J Environ Res Public Health
                ijerph
                International Journal of Environmental Research and Public Health
                MDPI
                1661-7827
                1660-4601
                02 June 2021
                June 2021
                : 18
                : 11
                : 5977
                Affiliations
                [1 ]Department of Histology and Developmental Biology, Pomeranian Medical University, 71-210 Szczecin, Poland; kamil.gill@ 123456pum.edu.pl (K.G.); michalkups1@ 123456gmail.com (M.K.); patryk.harasny@ 123456gmail.com (P.H.); tomasz.machalowski@ 123456poczta.onet.pl (T.M.); martag@ 123456pum.edu.pl (M.G.)
                [2 ]TFP Fertility Vitrolive in Szczecin, 70-483 Szczecin, Poland
                [3 ]Department of Urology and Oncological Urology, Regional Specialist Hospital in Szczecin, 71-455 Szczecin, Poland
                [4 ]Department of Urology and Urological Oncology, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland
                [5 ]Department of Perinatology, Obstetrics and Gynecology, Pomeranian Medical University, 72-010 Police, Poland
                [6 ]Healthcare Center Nowe Orlowo, 81-525 Gdynia, Poland; m.lukaszuk@ 123456gumed.edu.pl
                [7 ]Invicta Fertility Clinic, 80-850 Gdansk, Poland
                [8 ]Department of Urology, Medical University in Gdansk, 80-214 Gdansk, Poland; marcin.matuszewski@ 123456gumed.edu.pl
                [9 ]Department of Aesthetic Dermatology, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland; educhnik@ 123456pum.edu.pl
                [10 ]Institute of Human Genetics, Polish Academy of Sciences, 60-479 Poznan, Poland; monika.fraczek@ 123456igcz.poznan.pl (M.F.); maciej.kurpisz@ 123456igcz.poznan.pl (M.K.)
                Author notes
                Author information
                https://orcid.org/0000-0002-1655-5065
                https://orcid.org/0000-0003-0861-0738
                https://orcid.org/0000-0003-1212-4230
                https://orcid.org/0000-0003-3275-3245
                https://orcid.org/0000-0002-5914-2121
                Article
                ijerph-18-05977
                10.3390/ijerph18115977
                8199719
                34199549
                a869b367-ff39-4b2c-9490-4da952c7b4e6
                © 2021 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( https://creativecommons.org/licenses/by/4.0/).

                History
                : 29 April 2021
                : 01 June 2021
                Categories
                Article

                Public health
                varicocele,infertility,sperm dna fragmentation,oxidative stress
                Public health
                varicocele, infertility, sperm dna fragmentation, oxidative stress

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