Prostatitis and male factor infertility: A review of the literature

Prostatitis is the most common urologic diagnosis in men under the age of 50 years. Given the prostate’s intimate association with male reproductive function, prostatitis has long been suspected of playing a role in male subfertility. Strong evidence for a direct impact of prostatitis on male fertility is lacking. This article presents a brief overview of the disease entities known collectively as prostatitis and a review of the current literature on the association between prostatitis and seminal fluid variables, sperm morphology and function, seminal reactive oxygen species, antisperm antibodies, and their impact on male fertility.     

瘦素与男性不育症的关系

瘦素是由肥胖基因编码的一种蛋白质产物,属于Ⅰ型细胞因子,瘦素受体广泛分布于下丘脑、脂肪、睾丸、胎盘等组织,具有不同的生物功能.瘦素需与靶细胞膜上的瘦素受体结合,并通过多种信号转导途径才能发挥多种生物学效应.瘦素缺乏及瘦素受体的异常均可使生殖器官形态异常和导致与生殖相关的性激素分泌异常,进而引起男性不育症.目前研究发现,瘦素水平升高与精索静脉曲张、慢性前列腺炎、肥胖引起的男性不育,以及免疫相关性不育有关.     

Effectiveness of acupuncture for asthenozoospermia: A protocol for systematic review and meta-analysis

Background:According to the World Health Organization, the global incidence of infertility is about 15%, and more than 50% of infertility cases are caused by male infertility. Asthenozoospermia is caused by male fertility decline and male infertility. Due to work pressure, environmental pollution, sexual diseases, and other factors, the number of patients with asthenozoospermia has increased in recent years. It has been confirmed that acupuncture has a certain effect on patients with asthenozoospermia. Acupuncture and moxibustion can be an adjuvant treatment plan for the treatment of asthenozoospermia in addition to drug treatment.Methods:Randomized controlled trials of acupuncture for asthenozoospermia will be searched in the relevant database, including PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Database, Chinese Biomedical Literature Database (CBM), and Chinese Scientific Journal Database (VIP database). The studies of electronic searches will be exported to EndNote V.9.1 software. We will run meta-analyses using the Review Manager (RevMan) V.5.3 software. Any disagreements will be solved in consultation with a third reviewer.Results:Our study aims to explore the efficacy of acupuncture for asthenozoospermia and to provide up-to-date evidence for clinical of asthenozoospermia.Conclusion:This study will perform a comprehensive systematic review and meta-analysis on the efficacy of acupuncture for asthenozoospermia, making up for the lack of relevant evidence of the clinical use of acupuncture.INPLASY registration number:INPLASY 202140032.     

Growth hormone in the management of female infertility

Growth hormone (GH) is involved in the regulation of male and female infertility and has been used in the management of both male and female infertility. GH is also produced by the ovary apart from it being produced from pituitary. GH helps in monofollicular growth. GH therapy is one of the adjuvant treatment used in ovarian stimulation and Assisted Reproductive Technologies Assisted Reproductive Technology (ART). GH supplementation has been shown to improve pregnancy rates in poor responders. Growth hormone cotherapy has a definite role to play in ovarian stimulation and is effective in appropriately selected cases. However, it cannot be recommended indiscriminately in every patient undergoing ovarian stimulation or assisted reproductive technology.     

The cystic fibrosis transmembrane regulator gene and male infertility

Congenital bilateral absence of the vas deferens (CBAVD) is a relatively frequent cause of male infertility accounting for 1-2% of cases of male sterility and at least 6% of cases of obstructive azoospermia. In the last decade a genetic basis for CBAVD has been provided by its association with cystic fibrosis (CF) and nowadays CBAVD is in most cases considered to be a mild or incomplete form of CF disease. Many individuals with CBAVD show usually mild CF-compatible clinical manifestations, but the long-term prognosis could possibly not be as innocuous as it presently looks: more data will be available through medium or long-term follow-up studies. Once a correct diagnosis of CBAVD has been formulated and if the couple is planning a pregnancy by artificial reproductive technology, it is crucial to test both the affected male and his partner for CFTR mutations. Such testing has a number of complex implications and should always be performed together with genetic counselling. Other issues are debated in this article including CF mutations in non-CBAVD forms of male infertility, and the potentially misleading role of CF genetic analysis when used to rule out other possible causes of infertility in azoospermic men.     

Aeromonas sobria prostatitis and septic shock in a healthy man with chronic alcoholic consumption

Prostate infection caused by Aeromonas sobria has not been reported in the literature. We presented a 44-year-old healthy man with a habit of alcoholic consumption who was admitted because of primary A. sobria prostatitis with septicemia. The patient was successfully treated with intravenous ofloxacin and was uneventful after a half-year follow-up. Based on our rare case, we suggest to clinical physicians that prostatitis might be considered in healthy male patients with A. sobria bacteremia and a vague primary infection focus.     

Role of cytokines in testicular function

Inflammatory disease has been established to affect male reproductive function and fertility. Relevant inflammatory diseases include general and chronic infectious diseases as well as localized acute or chronic infections of the male genitourinary tract. Male accessory gland infections account for almost 15% of all cases of male infertility seen in infertility clinics while fertility usually is not a clinical objective among patients with acute systemic infections such as Gramnegatives sepsis. Infections of the male accessory glands frequently are associated with increased counts of white blood cells in semen and elevated levels of proinflammatory cytokines in semen and the testis. There is a mounting body of evidence that demonstrates the importance of cytokines and chemokines in the regulation of testicular and glandular function during pathophysiological states as well as under normal physiological conditions when cytokines act as growth and differentiation factors. The purpose of this review is to examine the role of cytokines in the regulation of steroidogenesis and spermatogenesis in the testis under physiological and pathophysiological conditions and considers clinical investigations that help to improve the evaluation and treatment of male infertility.     

Association between chromosome 22q11.2 translocation and male oligozoospermia

Chromosomal aberrations in peripheral blood are a major cause of reproductive disorders for the infertile couples. Reciprocal translocation is closely related to male infertility. The breakpoint of translocation may disrupt or dysregulate important genes related to spermatogenesis. The relationship between some breakpoints of chromosome and male infertility has been paid attention. Chromosome 22q11.2 translocation has not been reported with male infertility. The purpose of this study is to evaluate the relationship between chromosome 22q11.2 translocation and male infertility. All patients were collected from the second hospital of Jilin University. Semen parameters were detected using the computer-aided semen analysis system. Cytogenetic analysis was performed using standard operating procedure. Related genes on chromosomal breakpoints were searched using online mendelian inheritance in man (OMIM). The association between this breakpoint and spermatogenesis is also discussed. We report 6 cases of translocation in chromosome 22. Of 7 breakpoints involved in these translocations, the common feature is that they all included chromosome 22q11.2 translocation and presented with oligozoospermia. The analysis of breakpoint related genes showed testis-specific serine/threonine kinase 2 (TSSK2) gene is associated with human spermatogenesis impairment. Overall, these results suggest that the breakpoint involved in translocation deserves attention from physicians in genetic counseling. The breakpoint rearrangement has the possibility of disrupting spermatogenesis. The relationship between 22q11.2 breakpoint and male infertility deserves further study.     

Sulfasalazine-induced abnormal sperm penetration assay reversed on changing to 5-aminosalicylic acid enemas

Sulfasalazine, a drug used in the treatment of inflammatory bowel disease, has been associated with male infertility, an effect attributed to sulfapyridine rather than to 5-aminosalicylic acid (5-ASA), the presumed therapeutically active component of sulfasalazine. Recently, the sperm penetration assay (SPA) has been found to be an accurate method of quantitating male fertilization potential. We report the case of a man with ulcerative colitis in whom infertility and a markedly abnormal SPA were demonstrated while he was taking sulfasalazine. Shortly after discontinuing sulfasalazine and initiating treatment with 5-ASA enemas, his SPA became normal and his wife became pregnant. The SPA is a useful screening test for sulfasalazine-induced male infertility. On the other hand, 5-ASA enemas do not appear to be associated with an abnormal SPA.     

Self-reported history of sexually transmitted infection and chronic prostatitis symptoms: a cross-sectional study of a Nigerian undergraduate population

The aetiology of chronic prostatitis is poorly understood. A cross-sectional study of a population of male undergraduates in Nigeria, using a questionnaire containing the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) and some other relevant sex-related questions, was conducted. A total of 14.9% of the population had chronic prostatitis symptoms (CPSs) defined as a pain score of four or more on the NIH-CPSI pain subscale. Approximately 26 or 12% of the population had at least one, or ≥ 2 location(s) of pain, respectively. The presence of CPS was found to correlate with a self-reported history of sexually transmitted infection (STI) (r = +0.237; P < 0.05) and 73% of those with a self-reported history of STI had CPS. Both voiding scores and quality-of-life scores were significantly higher in subjects with CPS, compared with those without CPS. Self-reported history of STI may be an important aetiological factor for chronic prostatitis/chronic pelvic pain symptoms.     

Lessons from knockout and transgenic mice for infertility in men

This review concentrates on the clear cases where knocking out a gene in mice has caused male infertility and thus comes near to proving that the gene plays a role in the development of sperm. Knockout mice have been created with primary defects at every stage of spermatogenesis thus creating a framework for decoding the genetic hierarchy that causes male germ cell differentiation. As well as defining essential genes in vivo experiments have defined promoter and untranslated sequences responsible for the expression of proteins at all the spermatogenic stages. In conclusion knockout mice remain the ultimate test of spermatogenic hypotheses as well as providing detailed information about this complex process.     

The Y chromosome-linked copy number variations and male fertility

Since the first definition of the AZoospermia Factor (AZF) regions, the Y chromosome has become an important target for studies aimed to identify genetic factors involved in male infertility. This chromosome is enriched with genes expressed exclusively or prevalently in the testis and their absence or reduction of their dosage is associated with spermatogenic impairment. Due to its peculiar structure, full of repeated homologous sequences, the Y chromosome is predisposed to structural rearrangements, especially deletions/ duplications. This review discusses what is currently known about clinically relevant Y chromosome structural variations in male fertility, mainly focusing on copy number variations (CNVs). These CNVs include classical AZF deletions, gr/gr deletion and TSPY1 CNV. AZF deletions are in a clear-cut causeeffect relationship with spermatogenic failure and they also have a prognostic value for testis biopsy. gr/gr deletion represents the unique example in andrology of a proven genetic risk factor, providing an eight-fold increased risk for oligozoospermia in the Italian population. Studies on TSPY1 CNV have opened new perspectives on the role of this gene in spermatogenic efficiency. Although studies on the Y chromosome have importantly contributed to the identification of new genetic causes and thus to the improvement of the diagnostic work-up for severe male factor infertility, there is still about 50% of infertile men in whom the etiology remains unknown. While searching for new genetic factors on other chromosomes, our work on the Y chromosome still needs to be completed, with special focus on the biological function of the Y genes.     

α-Blockers in prostatitis

Chronic prostatitis affects up to 16% of the male population. The pathophysiologic etiology of chronic prostatitis is unclear, but dysfunctional voiding appears to be associated with the problem. The bladder, bladder neck, and prostate are richly innervated with adrenergic fibers (α-1d in the bladder and α-1a at the bladder neck and prostate). α-Blockers have been used for more than 20 years with mixed results. Overall, the data support a trial of α-blockers for patients with chronic prostatitis. In addition, if the drug appears to work, continued use for 6 months is warranted. Limited data suggest that 6 months of α-blockers in patients with chronic bacterial prostatitis may have fewer recurrences, again supporting the hypothesis of dysfunctional voiding.     

Lactate and energy metabolism in male germ cells.

Various alterations in germ cell proliferation/differentiation, survival and energy metabolism are potentially involved in hypospermatogenesis leading to male infertility. Several reviews have been devoted to the different processes whose alteration might underlie hypospermatogenesis, except for energy metabolism in the testis. Energy metabolism in the testis exhibits some specificity in that lactate is the central energy metabolite used by germ cells. This metabolite is produced by somatic Sertoli cells, transported and used by germ cells in the context of an active cooperation under the control of the endocrine system and local cytokines. In this review, we present and discuss relevant published data on energy metabolism in male germ cells with a specific emphasis on lactate.     

Genetically determined male infertility and assisted reproduction techniques

This is a review of the common chromosome and genetic disorders associated with male infertility that need to be considered by the clinician and the couple in the context of treatment. Until recently the most relevant disorders have been those inherited from parents, however, with the advent of technologies enabling recovery of sperm from the testicle in men with severely damaged spermatogenesis there is increased interest in those genetic abnormalities that may occur in mitosis and meioses. It is likely that over the next ten years there will be increasing focus on this aspect of male fertility genetic disorders. This article needs to be read in conjunction with the specific in depth reviews in this journal edition.     

Genetic causes of male infertility

Male infertility, affecting around half of the couples with a problem to get pregnant, is a very heterogeneous condition. Part of patients are having a defect in spermatogenesis of which the underlying causes (including genetic ones) remain largely unknown. The only genetic tests routinely used in the diagnosis of male infertility are the analyses for the presence of Yq microdeletions and/or chromosomal abnormalities. Various other single gene or polygenic defects have been proposed to be involved in male fertility. Yet, their causative effect often remains to be proven. The recent evolution in the development of whole genome-based techniques may help in clarifying the role of genes and other genetic factors involved in spermatogenesis and spermatogenesis defects.     

Contemporary concepts in the evaluation and management of male infertility

Infertility in men is a common condition. At the core of the medical evaluation of the male partner in a couple who are unable to conceive is the history and physical examination. Special attention should be directed to the patient's developmental history and any use of testosterone products. The physical examination focuses on the genitals, and includes assessments of the size and consistency of the testicles, epididymis, vas deferens, and presence of varicoceles. Although many sophisticated tests are available, semen analysis is still the most important diagnostic tool used to assess fertility, and includes parameters such as sperm count, motility and viability. Treatment of male factor infertility can involve targeted agents, in the case of specific conditions such as hypogonadotropic hypogonadism, or it can be empirical-using medical therapy or assisted conception techniques-for patients in whom no underlying cause has been identified. Although an all-encompassing treatment for male factor infertility has not yet been developed, the field offers many promising avenues of research.     

The new age of prostatitis

Prostatitis has long been a poorly understood and poorly characterized entity. Characterized in 1980 as a "wastebasket of clinical ignorance," it has only recently begun to be studied effectively. Prostatitis represents over 2 million medical office visits per year in the United States, and is the diagnosis given to 8% of urology clinic patients. Its prevalence may be as high as 10% among the male population at large. Sufferers report a sickness impact of prostatitis that is similar to myocardial infarction or Crohn’s disease. Less than 10% of cases of prostatitis are easily demonstrable to have a bacterial cause; these respond to conventional antimicrobial treatment. The etiology, pathogenesis, and optimum treatment for the remaining 90% of sufferers of this disease complex are quite unclear. Application of clinical research techniques and molecular biology promise new insight into this challenging and difficult problem.     

The methylenetethrahydrofolate reductase (MTHFR) C677T polymorphism and male infertility in Italy

The 677T allele of the MTHFR gene has been suggested to represent a factor of risk for male infertility. In order to confirm this association, we investigated the presence of the 677T allele in 93 Italian infertile patients, selected after the exclusion of other possible genetic causes of infertility, and in 105 Italian fertile controls. The homozygous 677TT genotype was present in 20.4% of patients and 27.6% of controls. These results do not support an association between the MTHFR 677T allele and male infertility in Italy.     

Questionnaire survey of male infertility in cystic fibrosis

Most male cystic fibrosis (CF) patients are infertile due to obstructive azospermia but little is known about the best time to counsel patients on infertility. All male patients attending the Adult Nottingham CF unit were invited to complete an anonymous questionnaire on infertility. The response rate was 60%. The median age that the patients first became aware of male infertility was 17 years (range 13-24) but the preferred age of receiving this information was 14 years (range 8-16). Patients first learnt about male infertility from the CF team (six patients), parents (five), from written information (two) or unexpectedly (five). Five out of 18 patients had undergone seminal analysis at a median age of 26 years but 17/18 patients felt that this should be offered routinely. Our survey has shown that patients would like infertility discussions at a younger age and routine seminal analysis.