Effect of antidepressant medications on semen parameters and male fertility

Antidepressant medications are commonly used in males of reproductive age for long-term treatment of depression, as well as other disorders. Although antidepressants are known to be associated with sexual side-effects, their effects on semen parameters and other markers of male fertility have been less thoroughly described. The majority of available studies have focused on selective serotonin reuptake inhibitors, which have been shown to negatively impact semen quality in in vitro, animal and human studies. Fluoxetine, in particular, has been the subject of multiple studies and has been associated with gonadotoxic effects, including decreased sperm concentration and motility, increased deoxyribonucleic acid fragmentation, and decreased reproductive organ weights. Studies of several other selective serotonin reuptake inhibitors have yielded similar results. Reassuringly, this effect does seem to be reversible. The data regarding serotonin–norepinephrine reuptake inhibitors, norepinephrine–dopamine reuptake inhibitors, tricyclic antidepressants, monoamine oxidase inhibitors and atypical antidepressants are sparse, varied and conflicting. Given the widespread and often long-term use of antidepressant medications, there is a clear need for further data regarding their impact on semen quality and male fertility.     

Time to improvement of semen parameters after microscopic varicocelectomy: When it occurs and its effects on fertility

While ligation of clinical varicoceles has been clearly shown to improve semen parameters in subfertile men, evidence describing when to expect improvement and the potential effects on fertility following surgery are sparse. A chart review was undertaken to identify men who had undergone a microscopic subinguinal varicocelectomy from January 1, 2006, to June 30, 2018. Semen analyses were reviewed to determine if a significant improvement occurred post-operatively and when the improvement was seen. Pregnancy data were reviewed to determine if fecundity rates were affected by semen parameter improvement or the interval at which improvement occurred. A total of 170 men met criteria for inclusion, including pregnancy data on 140. 69.4% of patients experienced a significant improvement in total progressive sperm count (TPSC), 78.8% of which occurred after 3 months. The overall pregnancy rate was 40.7%. When comparing men whose TPSC improved to those who did not, there was an odds ratio (OR) of 5.89 (2.28–15.28, 0.0003) for achieving pregnancy, while an OR of 2.05 (0.80–5.28, 0.13) was found when comparing pregnancy rates between early and late improvement in semen parameters. Pregnancy rates were not affected by time to improvement, but were higher in men who had a significant improvement in TPSC after surgery.     

Age is a significant predictor of early and late improvement in semen parameters after microsurgical varicocele repair

Accumulating evidence indicates that varicocele repair improves sperm quality. However, longitudinal changes in sperm parameters and predictors of improved semen characteristics after surgery have not been fully investigated. We retrospectively reviewed data from 100 men who underwent microsurgical subinguinal varicocele repair at a single centre. Follow‐up semen examinations were carried out at 3, 6 and 12 months post‐operatively. Logistic regression was used to identify predictors of early (3 months) and late (≥6 months) improvement in semen parameters after varicocele repair. At 3 months post‐operatively, 76.1% of the patients had improved total motile sperm counts, which continued to improve significantly up to 12 months post‐operatively (p = .016). When comparing changes in semen parameters between younger (<37 years) and older (≥37 years) men, post‐operative improvements in sperm concentration and motility were greater among younger men. Multivariate analysis showed that younger age was associated with early (p = .043) and late (p = .010) post‐operative improvement in total motile sperm count. Our findings indicate that early varicocele repair improved semen parameters after surgery.     

Decreased semen quality in a male infected with malaria

A 33-year-old male of proven fertility suffered six attacks of malaria while resident in an African country. For this he received anti-malarial drugs. Semen analysis performed after the fourth attack, and repeated during the following 2 years after his return to Israel, revealed severe oligozoospermia, necrozoospermia and occasionally even azoospermia. Immunological examination of the patient revealed an inverse ratio of T-cell subsets and mast cell degranulation in response to palludrin. Twenty-five months after the last attack of malaria a significant improvement was found in semen quality and there was an increase in the ratio of T-helper to T-suppressor cytotoxic cells. These observations indicate that although malaria and its treatment may affect spermatogenesis, recovery may be expected eventually.     

男性生育力与精液参数的变化趋势

近年来,男性生育力与精液参数的变化趋势不仅是学术界争论的焦点,也是公众舆论关注的热点。尽管评价男性生育力的"金标准"是配偶妊娠,但是临床与科研工作中常常使用精液参数检测作为男性生育力评估的替代指标和间接证据。目前,国内所使用的正常人群精液参数参考值范围均是WHO从国外人群获得的数据,缺乏中国正常人群的精液参数参考值。国内外对于精液参数变化趋势的研究结果表明,世界范围内精液质量总的变化趋势没有明确结论,但部分地区的精液质量下降已经被许多学者所接受。需要进行长期连续性前瞻性研究对精液质量变化趋势作出评估与预测。     

Evaluation of trend in semen analysis for 11 years in subjects attending a fertility clinic in India

Aim: The data on semen analysis of subjects attending the Fertility Clinic at NIHFW (National Institute of Health and Family Welfare) Munirka, New Delhi for the last 11 years were analyzed to verify the claims and speculations on declining sperm counts in men. Methods: Approximately 10 % of the records every year starting from 1990 to 2000 (numbering 1176 in total) were randomly selected for analysis. Subjects with azoospermia or severe oligozoospermia were excluded from analysis. Results: The average age of the men attending the infertility clinic was 31.2 years. The average semen volume and sperm count were found to be (2.6 ±0.1) mL and (60.6 ± 0.9) × 106/mL, respectively. No significant decline in sperm counts was observed in any year during the entire study period. Only 1.8 % of the total number of sperm counts in the random sampling were less then 20 × 106/mL. On the basis of WHO criteria on motility, the total percentage of non-progressive and non-motile sperm in the ejaculate was higher (63 %)     

Selenium and vitamin E supplementation enhances the antioxidant status of spermatozoa and improves semen quality in male dogs with lowered fertility

Studies showed a beneficial effect of supplementation with selenium (Se) and vitamin E on semen quality. The aim of the study was to investigate the effect of Se and vitamin E supplementation on the antioxidant status of spermatozoa and semen quality in dogs with lowered fertility. Ten dogs were supplemented daily with Se (6 μg/kg organic Se yeast) and vitamin E (5 mg/kg) per os for 60 days. Control group consisted of 10 males without the supplementation. Semen was collected on day 0, 30, 60 and 90. Sperm quality parameters were evaluated using CASA and a microscope. Concentrations of Se and vitamin E in blood as well as glutathione peroxidase (GSH‐Px) activity and total antioxidant capacity (TAC) in the spermatozoa were determined. After 60 days of supplementation the concentration of spermatozoa, the majority of motility indicators and the percentage of normal morphology and live spermatozoa increased significantly (p < .05). An increase (p < .05) in concentration of Se and vitamin E in blood and GSH‐Px‐activity and TAC in the spermatozoa was detected. The study results indicate that Se and vitamin E supplementation for 60 days enhances the antioxidant status of spermatozoa and improves the quality of the semen in dogs with lowered fertility.     

2343例男科就诊患者精子动态参数分析

目的探讨精子动态参数在评价男性生育能力方面的应用价值。方法严格按照WHO技术规范，用计算机辅助精液分析（CASA）系统对本院2343例男科门诊就诊的患者精液进行常规指标和精子动态参数分析。结果①正常精液组和异常精液组各项精子动态参数比较，均存在统计学差异；②随着精子存活率的下降，曲线速度（VCL）、直线速度（VSL）、平均路径速度（VAP）、平均移动角度（MAD）、侧摆幅度（ALH）、前向性（STR）下降明显，鞭打频率（BCF）呈上升趋势，而直线性（LIN）、摆动性（WOB）差异无显著性；③与密度活力正常组比较：少精组除LIN、STR有所增加，MAD、BCF有所下降，差别有统计学意义外，其余五项参数差别无统计学意义；弱精组除MAD无统计学差异外，其余八项参数均有统计学差异；少弱精组除MAD和ALH无统计学差异外，其余七项参数均有统计学差异。结论精子动态参数是评估精液质量的重要指标，为男性不育的诊断、治疗和研究提供了充分的依据。     

Detection of DNA fragmentation in human spermatozoa: correlation with semen parameters

To determine the prevalence of high levels of sperm DNA damage among infertile men with normal and abnormal semen parameters, 90 patients were subdivided into the following three groups. Group A ( n  = 30): men with normal semen parameters who acted as the controls. Group B ( n  = 30): asthenozoospermic men and group C ( n  = 30): teratozoospermic men, suffering from male infertility. DNA damage was evaluated by the rate of DNA fragmentation index (DFI) as assessed by the terminal desoxynucleotidyl transferase-mediated dUTP nick-end labelling assay. It was found that the difference was not significant between the percentage of DFI in patients with asthenozoospermia and the normospermic men (9.46% ± 8.68 and 8.19 ± 6.84 respectively, P- value not significant). The patients with teratozoospermia showed a significantly higher percentage of DNA fragmentation compared with the controls (respectively 21.37 ± 17.26% and 8.19 ± 6.84%, P  < 0.001). There was a positive correlation between abnormal sperm morphology and the DFI ( r  = 0.44, P  < 0.01) in group C. It is concluded that the impairments of sperm parameters were associated with an increase of DNA fragmentation; this association was strictly related to atypical forms.     

Colonisation of the male reproductive tract in asymptomatic infertile men: Effects on semen quality

The objective was to explore presence/detection of microorganisms in the male reproductive tract (PMMRT) in asymptomatic patients undergoing infertility treatment and their effects on semen quality in our region. This study enrolled 205 men (mean age, 35.9 years) in a single-centre, tertiary university hospital from December 2015 to December 2016. We used the modified Meares–Stamey test, real-time polymerase chain reaction (rt-PCR) and the National Institutes of Health Chronic Prostatitis Sympton Index (NHI-CPSI) questionnaire to address this issue. No patient met the prostatitis criteria by the modified Meares–Stamey 4-sample test, 33 (16.1%) were positive for rt-PCR in the first-voided urine for any of the Mycoplasma (Ureaplasma urealyticum/parvum, Mycoplasma hominis/genitalium) and C. trachomatis was detected in two cases (1%), and three for rt-PCR in semen for HPV high-risk genotypes non-16/18 (1.5%). Significant statistical differences were reported among patients with and without PMMRT in terms of lower rate of progressive spermatozoa (PR) (p < .034), total motile sperm count (p < .028), normal morphologic forms, especially in the sperm head (p < .001) and highest viscosity (p < .012). It was concluded that PMMRT, specially Mycoplasmas, in asymptomatic infertility men, affects semen quality. The NIH-CPSI questionnaire was not a valid initial screening to subsequently evaluate the presence of prostatitis/PMMRT.     

Clinical and biological aspects of male immune infertility: a case-controlled study of 86 cases

Summary. A case-control study of clinical, endocrine and seminal characteristics in 86 infertile men and a prospective study of conception rates during 804 follow-up cycles among 75 infertile couples with male immune infertility were performed. Genito-urethral infections or surgery, and palpable epididymal abnormalities were more common among the immunological cases than among the non-immunological infertile controls ( n = 180), but sperm concentration, motility and morphology were similar. The spontaneous conception rate in 70 cases was 1.7% per cycle. Treatment by intra-uterine insemination (IUI) resulted in 8.6% pregnancies per cycle, conventional in vitro fertilization (IVF) had a 18.4% success rate per attempt, and two out of three couples treated by intracytoplasmic sperm injection (ICSI) attained pregnancy. Minimal sperm quality required for successful IUI was not lower than that recorded in couples with spontaneous conception.
It is concluded that immunological infertility, as diagnosed by a positive mixed antiglobulin reaction (MAR) test, is associated with a low spontaneous conception rate. Techniques of assisted reproduction are useful in the management of couples with infertility resulting from this pathology, but sperm characteristics required for successful IUI are much higher than those needed for successful IVF. A strategy for the logical management of this pathology is proposed.     

生育与不育男性精浆总抗氧化能力分析

目的:分析生育与不育男性精浆中总抗氧化能力(TAC)及其在男性生育中意义。方法:225例男性不育患者分为6组,分别为:梗阻性无精子症组(n=10),非梗阻性无精子症组(n=42),少精子症组(n=20),弱精子症组(n=78),少弱精子症组(n=57),以及正常精子症组(n=18)。28例正常生育男性作为对照(生育组)。分别采用计算机辅助精液分析(CASA)系统进行精液参数分析,采用比色法检测精浆TAC水平。结果:生育组男性精浆TAC为(19.82±6.33)U,梗阻性无精子症组(1.71±1.33)U,非梗阻性无精子症组(12.73±9.44)U,少精子症组(10.85±6.64)U,弱精子症组(13.88±8.24)U,少弱精子症组(11.20±7.02)U,正常精子症组(18.07±8.73)U;与生育组精浆TAC[(19.82±6.33)U]相比,在各不育症组中,除正常精子症组精浆TAC与生育组差异无显著性外,其余各组均显著低于生育组(P<0.01)。精浆TAC与精子密度(r=0.182,P<0.05)和a级精子(r=0.150,P<0.05)呈显著正相关。结论:精浆中TAC水平与男性不育密切相关,精浆中过低的TAC水平可能是引起男性不育的病因之一。     

Pro-oxidative and anti-oxidative imbalance in human semen and its relation with male fertility

Oxidative stress is a common condition suffered by biological systems in aerobic conditions.Human semen also has its own molecular guard against the free radicals created by normal respiratory process or from immune reactions.The equilibrium of the creation and scavenging of free radicals is mandatory in the spermatozoa to fertilize and initiate a full-term pregnancy.The paper is a systematic review of publications that evaluate oxidative stress in semen.The Cochrane Library,Medline (1966-2003),Embase (1988-2003),SciSearch (1981-2003) and the conference papers were searched,When sperm samples from fertile and infertile males were analyzed,some of the mechanisms that determine the oxidative stress level were found to be impaired while others were unaltered.In conclusion,the literature as a whole provides contradictory findings and it is necessary to carry out more work to identify all the enzymatic and non-enzymatic systems involved in oxidative stress in the ejaculate,in order to develop new diagnostic systems and therapeutic strategies for combating detrimental free radical imbalance in the semen.(Asian J Androl 2004 Mar;6:59-65)     

Twenty‐four hours abstinence and the quality of sperm parameters

Patients with abnormal basic parameters and mainly low concentration can be expected to have improved parameters on the second consecutive day. As the number of abnormal basic parameters increases, the more significant improvement can be expected. On the other hand, patients with normal or few abnormal basic semen parameters show a decrease after 24 h. Furthermore, the magnitude of change to both directions in TMC and TNMC values in these patients emphasises these conclusions. Based on the type and mainly the combined number of abnormal basic semen parameters, insemination strategy can be tailored to male fertility patients. Those with abnormal concentration or multiple abnormal semen parameters may benefit from 2 consecutive day intercourses or inseminations or a short period of abstinence due to a significant improvement in the semen parameters on second day insemination. In those with normal basic semen parameters, a reduction in semen quality is expected after 24 h, and a single‐timed insemination and longer abstinence can be recommended.     

不育男性精浆总抗氧化能力与精子运动功能的关系

目的:研究不育男性精浆总抗氧化能力(TAC)与精子运动能力和方式之间的关系,探讨精浆TAC水平在男性生育中的临床意义。方法:113例精子密度正常的不育男性,28例正常生育男性作为对照组。精液于37℃液化后采用计算机辅助精液分析(CASA)系统进行精液常规分析,采用比色法进行精浆TAC分析。结果:正常生育组精浆TAC为(19.82±6.33)U,不育男性精子密度正常组精浆TAC为(14.37±8.45)U,不育男性精子密度正常组与正常生育组比较存在显著性差异(P<0.01)。精浆TAC与a级精子百分率(r=0.208,P<0.05)和(a+b)级精子百分率(r=0.231,P<0.05)呈显著正相关,精浆TAC与精子运动参数中的前向性(r=0.200,P<0.05)、直线性(r=0.208,P<0.05)、曲线速度(r=0.189,P<0.05)、直线速度(r=0.210,P<0.05)、平均移动速度(r=0.215,P<0.05)及鞭打频率(r=-0.248,P<0.01)之间有显著的相关性,其中前向性、直线性、直线速度、曲线速度、平均移动速度与TAC呈正相关(P<0.05),而鞭打频率与TAC呈负相关(P<0.01)。精浆TAC与摆动性、侧摆幅度、平均移动角度之间无显著相关。结论:精浆中TAC水平与精子运动能力和运动方式密切相关,适宜的精浆TAC为精子运动提供了良好的外部环境,精浆中过低的TAC水平与精子运动能力下降和运动方式改变有关,可能是引起男性不育的病因之一。精浆中TAC分析可为探讨男性不育的发病机制以及临床用药提供依据。     

广东某市农村地区正常生育力男性精液参数的研究

目的探索现阶段正常生育力的健康男性精液的各项参数及其相互关系。方法采用WHO最新推荐的方法,对广东某市农村312例具有生育力的健康志愿者进行精液检测分析。结果(1)具有(a+b)级活动力精子率(60.63±11.76)%;(2)精子存活率(80.89±10.49)%;(3)精子密度(60.09±30.25)×106/ml;(4)不同年龄组间(a+b)级活动力精子、精子存活率及精子密度的参数比较,无显著差异(P>0.05);(5)禁欲时间与(a+b)级活动力精子、精子存活率间的关系呈负相关(P<0.05),与精子密度间的关系呈正相关(P<0.01),但不同禁欲时间组间与(a+b)级活动力精子、精子存活率及精子密度的比较,无显著差异(P>0.05);(6)精子密度与(a+b)级活动力精子和精子存活率无明显的相关关系(P>0.05),且(a+b)级活动力精子和精子存活率始终保持着平衡状态,并在50%以上。结论(1)(a+b)级活动力精子>50%、精子存活率>50%,即使精子密度偏低或<20×106/ml仍不影响正常男性的生育能力;(2)(a+b)级活动力精子、精子存活率以及精子密度与年龄(20~45岁)无关;(3)精子密度的高低对(a+b)级活动力精子和精子存活率无明显影响。     

海岛不育男性精液质量及其影响因素的研究

目的探讨海岛不育男性精液质量及其影响因素。方法采用统一调查表,对舟山市生殖研究中心门诊的228例不育症男性患者进行流行病学问卷调查及精液常规分析(SFA);并对数据进行统计学处理。结果研究对象的平均精子密度、a级、b级精子和正常形态精子的百分率分别为23.34×106/ml、35.16%、9.38%和59.27%。对精液质量异常的可能危险因素进行多因素logistic回归分析显示,吸烟:OR=1.169,95%CI=(1.044~1.310);饮酒:OR=1.186,95%CI=(1.055~1.333);不育时间:OR=0.822,95%CI=(0.719~0.940);以蔬菜水果为主要摄入副食类:OR=0.284,95%CI=(0.090~0.894);以混合副食为主要摄入类:OR=0.365,95%CI=(0.175~0.762)。结论研究对象的精子数量、活力和形态基本达到WHO建议的参考值范围,但精子前向运动的能力偏低。吸烟与饮酒行为可能是精液质量的危险因素;副食品摄入类型与精液质量有关,其中,与海产品为主要摄入类型相比,以蔬菜水果类和混合副食品为主要摄入类型的饮食习惯可能对精液质量具有保护作用。     

慢性前列腺炎合并男性不育患者精浆生化指标的变化

目的探讨慢性前列腺炎(CP)所致男性不育患者精液生化指标以及电解质的变化。方法自门诊选择无CP正常生育健康志愿者对照组(A组)17例;以及慢性前列腺炎患者54例,按精液液化时间分为B组(液化时间正常组)和C组(延迟液化组),分别测定精浆中前列腺特异性抗原、酸性磷酸酶、唾液酸以及果糖的浓度,并测定钾、钠、钙、氯等浓度。结果正常生育组、CP液化正常组及CP液化异常组精浆PSA浓度有显著性差异(P<0.001)。K 浓度有差异性(P<0.05)。Ca2 浓度有差异性(P<0.05)。PAP浓度无统计学意义(P>0.05)。唾液酸以及果糖浓度无差异性(P>0.05)。Na 浓度无差异性(P>0.05)。Cl-浓度无差异性(P>0.05)。结论CP所致男性不育患者与健康正常组相比,精浆PSA以及K 、Ca2 存在差异。