ABSTRACT
BACKGROUND: This study investigates the effect of letrozole on hormone profiles, semen parameters, body mass index (BMI), degree of oxidative stress and sperm chromatin integrity in men with idiopathic oligo/astheno/teratozoospermia (iOAT) and T:E2 ratio ≤ 10. MATERIALS AND METHODS: This study is a longitudinal, prospective, interventional and open-labelled clinical trial. Semen samples were collected from 20 iOAT men with low serum testosterone (T) to estradiol (E2) ratio (T:E2 ratio ≤ 10). The participants were treated with 2.5 mg letrozole orally per day for 3 months. Then, sperm parameters, hormone profiles, BMI, chromatin integrity and intracellular reactive oxygen species (ROS) level were assessed pre- and post- treatment. The chromatin integrity was evaluated by assessment of DNA fragmentation (with TUNEL assay) and protamine deficiency (with Chromomycin A3, CMA3). Also, the intracellular ROS levels were investigated by 2', 7'-dichlorodihydrofluorescein diacetate (DCFH-DA) staining. Finally, the differences between the parameters evaluated before and after letrozole treatment were analyzed with the t-test and the Wilcoxon signed-rank test. RESULTS: Sperm concentration, percentage of sperm motility and its normal morphology increased significantly after letrozole treatment. Moreover, serum testosterone level increased but estradiol level decreased significantly following treatment. The mean of T:E2 ratio improved 1600%. Also, letrozole treatment significantly reduced the percentage of sperm TUNEL positivity and sperm CMA3 positivity. While no significant difference was observed between intracellular ROS levels and BMI before and after treatment. Finally, as a notable result, four spontaneous pregnancies (20%) were achieved after treatment. CONCLUSIONS: Letrozole treatment can effectively increase spontaneous pregnancies by improving sperm parameters and sperm chromatin integrity in men with iOAT and T:E2 ratio ≤ 10. TRIAL REGISTRATION: Trial registration: IRCT, IRCT20191030045283N1. Registered 16 November 2019 - Retrospectively registered, https://fa.irct.ir/user/trial/43484/view.
Subject(s)
Chromatin/drug effects , Infertility, Male/drug therapy , Letrozole/therapeutic use , Reactive Oxygen Species/metabolism , Spermatozoa/drug effects , Adult , Asthenozoospermia/drug therapy , Asthenozoospermia/metabolism , Asthenozoospermia/physiopathology , Chromatin/metabolism , DNA Fragmentation/drug effects , Humans , Infertility, Male/metabolism , Infertility, Male/physiopathology , Letrozole/pharmacology , Longitudinal Studies , Male , Oligospermia/drug therapy , Oligospermia/metabolism , Oligospermia/physiopathology , Oxidative Stress/drug effects , Semen Analysis , Sperm Count , Sperm Motility/drug effects , Spermatozoa/metabolism , Teratozoospermia/drug therapy , Teratozoospermia/metabolism , Teratozoospermia/physiopathology , Testosterone/blood , Young AdultABSTRACT
Papillary serous cystadenocarcinoma of the ovary is a common tumor but occurrence of ovarian type papillary serous cystadenocarcinoma in the testis is very rare. Herein we report such a case in a 49-year-old man presenting with testicular swelling. In this tumor, mesothelioma of tunica vaginalis should be excluded by immunohistochemistry. The best treatment is radial orchiectomy and it is very resistant to chemoradiation. Our case was well after orchiectomy and now after a year he is doing well and completely symptom free.