[Acupuncture treatment of oligoasthenozoospermia].

Studies show that acupuncture can significantly elevate the level of serum testosterone (T), reduce the concentrations of follicle-stimulating hormone (FSH), luteinizing hormone (LH) and estradiol (E2), initiate spermatogenesis, enhance testicular blood flow, maintain a relative low temperature in the testis, increase the concentration, motility and antioxidative injury capability of spermatozoa by raising the levels of seminal α-glucosidase, fructose and super oxide dismutase, and eventually improve semen quality and the rate of conception in the treatment of oligoasthenozoospermia. Currently, the quality of the clinical studies of acupuncture treatment of oligoasthenozoospermia is relatively poor, the existing evidence remains at a low level, its clinical application is limited, and its therapeutic effect has to be further verified. The present paper summarizes the literature from domestic and international databases about acupuncture treatment of oligoasthenozoospermia, and offers an overview of the effects of acupuncture on the reproductive endocrine system, testicular blood flow, semen quality, and rate of conception in the treatment of the patient.

Tri-nucleotide consortium of androgen receptor is associated with low serum FSH and testosterone in asthenospermic men.

Androgen mediating signaling is implicated in regulating the expression of reproductive related genes. Any deviation in the gene expression might be the ignitable precursor for genomic instability that inflames the genomic rearrangements and a leading cause of cancer. The main goal of this study was to determine the relationships between trinucleotide repeats of androgen receptor (AR), sex steroids, and sexual function in men presenting with reduced sperm motility. We investigated the singleton or combinatorial effects of the length of trinucleotide repeats of AR on reproductive hormones, clinical parameters, semen analyses, as well as sexual assessment function of 210 asthenospermic outpatients along with 125 normal subjects. Sexual assessment was executed using the International Index of Erectile Function (IIEF-15 score) which measures erectile function (EF), orgasmic function (OR), sexual desire (SD), intercourse satisfaction (IS), and overall satisfaction. Our findings suggest that long (>26 CAG)n repeats have an inverse correlation with circulatory FSH and T, whereas long (>25 GGC)n repeats have moderated affiliation with reduced sperm concentration. The study revealed a novel finding by exploring the negative correlation between elongated (CAG)n repeats and the cumulative IIEF-15 score, orgasm function (OR), and erectile function (EF) in asthenospermic men. This study examines the tri-nucleotide correlation with sexual function in Punjabi men enhancing our understanding of the regulatory mechanisms of sexual performance. ABBREVIATIONS: AR: androgen receptor; IIEF-15 score: International Index of Erectile Function; EF: erectile function; OR: orgasmic function; SD: sexual desire; IS: intercourse satisfaction; FSH: follicular stimulating hormone; T: testosterone; NTD: N-terminal transactivation domain; DBD: DNA-binding domain; LBD: ligand binding domain; TNR: tri-nucleotide repeat.

[Mid-frequency transcutaneous electrical acupoint stimulation combined with tamoxifen for the treatment of oligoasthenozoospermia].

OBJECTIVE: To explore the feasibility, safety and clinical effect of mid-frequency transcutaneous electrical acupoint stimulation (TEAS) combined with oral tamoxifen (TAM) in the treatment of oligoasthenozoospermia. METHODS: We randomly and equally assigned 120 patients with idiopathic oligoasthenozoospermia to receive oral TAM, mid-frequency TEAS, or TAM+TEAS, all for 8 weeks. Before and after treatment, we recorded the semen volume, total sperm count, sperm concentration, sperm motility, percentage of progressively motile sperm (PMS), and the levels of follicle-stimulating hormone (FSH), luteotrophic hormone (LH) and testosterone (T) in the peripheral serum and compared these parameters among the three groups of patients. RESULTS: Compared with the baseline, none of the patients showed significant improvement in the semen volume (P >0.05) but all exhibited remarkably elevated levels of serum FSH, LH and T after treatment (P <0.05); TAM significantly improved the total sperm count (ï¼»25.16 ± 2.05ï¼½ vs ï¼»42.65 ± 5.78ï¼½ ×106, P <0.05) and sperm concentration (ï¼»12.15 ± 2.51ï¼½ vs ï¼»24.31 ± 2.59ï¼½ ×106/ml, P <0.05), but not total sperm motility (ï¼»21.78 ± 8.81ï¼½ vs ï¼»22.61 ± 5.75ï¼½ %, P >0.05) or PMS (ï¼»15.87 ± 7.81ï¼½ vs ï¼»16.76 ± 5.86ï¼½ %, P >0.05); TEAS markedly increased total sperm motility (ï¼»24.81 ± 8.27ï¼½ vs ï¼»32.43 ± 4.97ï¼½ %, P <0.05) and PMS (ï¼»19.71 ± 9.15ï¼½ vs ï¼»27.17 ± 5.09ï¼½%, P <0.05), but not the total sperm count (ï¼»23.23 ± 3.14ï¼½ vs ï¼»25.87 ± 4.96ï¼½ ×106, P >0.05) or sperm concentration (ï¼»11.27 ± 2.24ï¼½ vs ï¼»14.12 ± 2.47ï¼½ ×106/ml, P >0.05); TAM+TEAS, however, improved not only the total sperm count (ï¼»26.17 ± 5.05ï¼½ vs ï¼» 51.14 ± 3.69ï¼½×106, P <0.05) and sperm concentration (ï¼»12.78 ± 2.41ï¼½ vs ï¼»27.28 ± 1.98ï¼½ ×106/ml, P <0.05), but also total sperm motility (ï¼»23.89 ± 9.05ï¼½ vs ï¼»37.12 ± 5.33ï¼½%, P <0.05) and PMS (ï¼»17.14 ± 8.04ï¼½ vs ï¼»31.09 ± 7.12ï¼½%, P <0.05). The total effectiveness rate was significantly higher in the TAM+TEAS group than in the TAM and TEAS groups (97.5% vs 72.5% and 75.0%, P <0.05). CONCLUSIONS: Mid-frequency TEAS combined with tamoxifen can significantly improve semen quality and increase sex hormone levels in patients with idiopathic oligoasthenozoospermia.

Insight into the serum kisspeptin levels in infertile males.

BACKGROUND: Regulation of reproduction is now considered to be carried out by the kisspeptin and its receptor, GPR54 or Kiss1r. Mutations of either Kiss1 or Kiss1r in humans and mice result in profound hypogonadotropic hypogonadism. The present study was aimed to determine whether the levels of kisspeptin are associated with male infertility. METHODOLOGY: The study involved 176 male subjects aged 18 - 50 years including 26 fertile and 150 infertile. Infertile subjects were further subdivided according to WHO guidelines of semen analysis into 22 asthenozoospermia, 08 asthenoteratozoospermia, 18 azoospermia, 58 normozoospermia, 06 oligozoospermia, 12 oligoasthenozoospermia and 26 oligoasthenoteratozoospermia. Thorough clinical examinations excluded those suffering from chronic health problems. Serum kisspeptin levels were measured by enzyme immunoassay (EIA) and follicle stimulating hormone (FSH), luteinizing hormone (LH) and testosterone were estimated by chemiluminescence assay (CLIA). RESULTS: The results of the present study have revealed that kisspeptin levels were significantly lower in all infertile males as compared to the fertile males. Significantly low LH and testosterone levels were observed in all infertile groups as compared to fertile group. FSH levels were significantly lower in normozoospermic and azoospermic as compared to fertile males, while no significant difference was observed between the other infertile and fertile group. CONCLUSION: The study revealed that serum kisspeptin levels were observed significantly lower in the infertile as compared to fertile males, indicating that the kisspeptin might be associated with the fertility problems in males.

Triorchidism: two case reports.

In this study, two cases of triorchidism are reported. The first case (29 years) had two right discrete ovoid nontender, firm, mobile lumps with testicular sensation. The second case (32 years) had two left discrete ovoid nontender, firm, mobile lumps with normal testicular sensation. They were subjected to the estimation of serum follicle-stimulating hormone, luteinising hormone, free and total testosterone, alpha-fetoprotein, prostate-specific antigen, karyotyping and semen analysis. Imaging included ultrasonography, transrectal ultrasound, magnetic resonance imaging and intravenous pyelography. The first case had two testes in the right side. Each one had an epididymis where one vas deferens was palpated. The second case had two left testes with normal testicular sensation. The lower left lump represented normal-sized testis attached to its epididymis and a single palpated vas deferens. Diagnosis of the first case was triorchidism associated with left varicocele (grade I) with oligoasthenoteratozoospermic semen profile. Intracytoplasmic sperm injection was carried out resulting in a twin. Diagnosis of the second case was triorchidism with accessory testis on the left side associated with left varicocele (grade I) and asthenozoospermic semen profile that was submitted to medical treatment. It is concluded that triorchidism is an uncommon congenital anomaly that should be not overlooked in diagnosing scrotal masses.

Evidence for a stimulatory role of high doses of recombinant human follicle-stimulating hormone in the treatment of male-factor infertility.

The efficacy of recombinant human follicle-stimulating hormone (rhFSH) in the treatment of normogonadotropic patients with male-factor infertility was assessed. Forty-five infertile men with moderate/severe oligoasthenozoospermia and normal FSH, luteinizing hormone (LH) and testosterone (T) levels were treated with high rhFSH dose (300 IU) on alternate days for ≥4 months. In all, the seminal parameters, endocrine profile (FSH, LH, prolactin (PRL), total and free T and estradiol) and pregnancy rate were evaluated before, during and after rhFSH treatment. Fifteen infertile men were treated with placebo and studied in the same way, as control group. rhFSH treatment induced a marked increase in sperm count and no change in sperm motility, morphology and viability. No changes in seminal parameters were observed in the placebo group. FSH levels increased during treatment with rhFSH and not with placebo. No variations in LH, PRL, free and total T and estradiol were evidenced during treatment. A significant pregnancy rate in rhFSH versus placebo patients was also highlighted. Prolonged treatment with high rhFSH doses leads to increase sperm count and improve the spontaneous pregnancy rate in normogonadotropic infertile patients with oligoasthenozoospermia. rhFSH may represent a rational and useful tool in the treatment of male-factor infertility.

Significant association of TNFα and IL-6 gene with male infertility--an explorative study in Indian populations of Uttar Pradesh.

In this study were aimed to identify the association of SNPs candidate genes of TNF-α and IL-6 with hormones levels and sperm cells death in infertile subjects of Uttar Pradesh population in North India. The study population comprised, fertile donor (control group) and infertile group patients i.e. normozoospermic (idiopathic unexplained), oligozoospermic and asthenozoospermic groups, with 260 subjects in each group. Subjects were selected from the Departments of Urology, K.G's Medical University and Urology, SGPGIMS, Lucknow, India. The allele-specific polymerase chain reaction (PCR) and PCR-RFLP were used to investigate the substitution of the guanine (G)-to-adenosine (A) at position-308 and guanine (G)-to-cytosine (C) at position-174 in the promoter regions of the TNF-α and IL-6 genes, respectively. Further their relation to male fertility and sperm function were also investigated. It was found that the substitution levels from G to A and from G to C in the TNF-α and IL-6 genes, respectively, were significantly higher in the infertile subjects as compared to that of control group. The apoptosis and necrosis levels were also higher in oligozoospermic and asthenozoospermic infertile subjects. Further it was found to be associated with increased level of reactive oxygen species as observed in oligozoospermic and asthenozoospermic subjects. However, a significant decrease in testosterone and luteinizing hormone with increased prolactin and follicle stimulating hormones was observed in infertile subjects. The study populations indicating a strong association between TNF-α G-308A and IL-6 G-174C substitution with infertile men which is further supported by allele and genotype meta-analysis and thus established it as a risk factor.

The role of hormones on semen parameters in patients with idiopathic or varicocele-related oligoasthenoteratozoospermia (OAT) syndrome.

BACKGROUND: Oligoasthenoteratozoospermia (OAT) syndrome is the most frequently seen phenotype in male infertility. Spermatogenesis relies closely on hormone regulation. The aim of this study was to assess the correlation between hormone profile and semen parameters in infertile men with idiopathic or varicocele-related OAT syndrome. We tried to illustrate the correlative factors for better semen parameters in these patients. METHODS: A total of 96 patients with idiopathic or varicocele-related OAT were included for assessment. Serum levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone (T), estradiol (E2), prolactin (PRL), and the combinative ratios of these hormones, such as T/E2, T/FSH, T/LH, T/(FSH × LH), PRL × T/FSH, PRL × T/LH, PRL × T/(FSH × LH), were compared individually with sperm parameters. The parameters included sperm concentration, total sperm count (TC), percent motile sperm count, percent normal sperm count, total motile sperm count (TMC), total normal sperm count (TNC), and total motile normal sperm count (TMNC). RESULTS: T correlated well with percent normal sperm count (p = 0.031). PRL positively correlated with sperm concentration (p = 0.019), TMC (p < 0.001), TNC (p = 0.003), and TMNC (p < 0.001). In hormonal combinative ratios, T/FSH, T/LH, T/(FSH × LH), PRL × T/FSH, PRL × T/LH, and PRL × T/(FSH × LH) all showed significant correlations to concentration and count-related parameters including TC, TMC, TNC, and TMNC. CONCLUSION: For patients with OAT syndrome, T, PRL, T/FSH, T/LH, T/(FSH × LH), PRL × T/FSH, PRL × T/LH, and PRL × T/(FSH × LH) may be used as predictive markers for better semen quality. This investigation could be a catalyst for future studies on the extent to which manipulating the hormonal combinative ratios can affect the quality of spermatogenesis in infertile males with OAT syndrome.

Metformin improves semen characteristics of oligo-terato-asthenozoospermic men with metabolic syndrome.

To examine the appropriate treatment of oligo-terato-asthenozoospermic patients with metabolic syndrome, 45 patients were treated with metformin for 6 months. The use of metformin was associated with a statistically significant reduction in insulin resistance and sex hormone-binding globulin levels, a statistically significant increase in serum androgen levels, and a consequent improvement in semen characteristics.