From pathophysiology to practice: addressing oxidative stress and sperm DNA fragmentation in Varicocele-affected subfertile men.

Varicocele can reduce male fertility potential through various oxidative stress mechanisms. Excessive production of reactive oxygen species may overwhelm the sperm's defenses against oxidative stress, damaging the sperm chromatin. Sperm DNA fragmentation, in the form of DNA strand breaks, is recognized as a consequence of the oxidative stress cascade and is commonly found in the ejaculates of men with varicocele and fertility issues. This paper reviews the current knowledge regarding the association between varicocele, oxidative stress, sperm DNA fragmentation, and male infertility, and examines the role of varicocele repair in alleviating oxidative-sperm DNA fragmentation in these patients. Additionally, we highlight areas for further research to address knowledge gaps relevant to clinical practice.

A multi-faceted exploration of unmet needs in the continuing improvement and development of fertility care amidst a pandemic.

PURPOSE: The continuous improvement and development of fertility care, internationally, requires ongoing monitoring of current delivery processes and outcomes in clinical practice. This descriptive and exploratory mixed-methods study was conducted in eight countries (Brazil, China, France, Germany, Italy, Mexico, Spain and the United Kingdom) to assess the unmet needs of fertility patients (male and female), and existing challenges, barriers and educational gaps of physicians and laboratory specialists involved in human fertility care during the COVID-19 pandemic. MATERIALS AND METHODS: The study was deployed sequentially in two phases: 1) in-depth 45-minute semi-structured interviews (n=76), transcribed, coded and thematically analysed using an inductive reasoning approach, 2) an online survey (n=303) informed by the findings of the qualitative interviews, face validated by experts in reproductive medicine, and analysed using descriptive and inferential statistical methods. RESULTS: The integrated results of both phases indicated numerous areas of challenges, including: 1) investigating male-related infertility; 2) deciding appropriate treatment for men and selective use of assisted reproductive technology; and 3) maintaining access to high-quality fertility care during a pandemic. CONCLUSIONS: The paper presents a reflective piece on knowledge and skills that warrant ongoing monitoring and improvement amongst reproductive medicine healthcare professionals amidst future pandemics and unanticipated health system disruptions. Moreover, these findings suggest that there is an additional need to better understand the required changes in policies and organizational processes that would facilitate access to andrology services for male infertility and specialized care, as needed.

From pathophysiology to practice: addressing oxidative stress and sperm DNA fragmentation in Varicocele-affected subfertile men

ABSTRACT Varicocele can reduce male fertility potential through various oxidative stress mechanisms. Excessive production of reactive oxygen species may overwhelm the sperm's defenses against oxidative stress, damaging the sperm chromatin. Sperm DNA fragmentation, in the form of DNA strand breaks, is recognized as a consequence of the oxidative stress cascade and is commonly found in the ejaculates of men with varicocele and fertility issues. This paper reviews the current knowledge regarding the association between varicocele, oxidative stress, sperm DNA fragmentation, and male infertility, and examines the role of varicocele repair in alleviating oxidative-sperm DNA fragmentation in these patients. Additionally, we highlight areas for further research to address knowledge gaps relevant to clinical practice.

A multi-faceted exploration of unmet needs in the continuing improvement and development of fertility care amidst a pandemic

ABSTRACT Purpose: The continuous improvement and development of fertility care, internationally, requires ongoing monitoring of current delivery processes and outcomes in clinical practice. This descriptive and exploratory mixed-methods study was conducted in eight countries (Brazil, China, France, Germany, Italy, Mexico, Spain and the United Kingdom) to assess the unmet needs of fertility patients (male and female), and existing challenges, barriers and educational gaps of physicians and laboratory specialists involved in human fertility care during the COVID-19 pandemic. Materials and Methods: The study was deployed sequentially in two phases: 1) in-depth 45-minute semi-structured interviews (n=76), transcribed, coded and thematically analysed using an inductive reasoning approach, 2) an online survey (n=303) informed by the findings of the qualitative interviews, face validated by experts in reproductive medicine, and analysed using descriptive and inferential statistical methods. Results: The integrated results of both phases indicated numerous areas of challenges, including: 1) investigating male-related infertility; 2) deciding appropriate treatment for men and selective use of assisted reproductive technology; and 3) maintaining access to high-quality fertility care during a pandemic. Conclusions: The paper presents a reflective piece on knowledge and skills that warrant ongoing monitoring and improvement amongst reproductive medicine healthcare professionals amidst future pandemics and unanticipated health system disruptions. Moreover, these findings suggest that there is an additional need to better understand the required changes in policies and organizational processes that would facilitate access to andrology services for male infertility and specialized care, as needed.

Cambios morfofuncionales de los espermatozoides y factores de riesgo asociados a la infertilidad masculina

Introducción: En la actualidad muchos estudios han mostrado un declinar en la calidad del semen humano y un riesgo incrementado de subfertilidad masculina. Objetivo: Evaluar el grado de asociación de los cambios morfofuncionales de los espermatozoides con los factores de riesgo en la infertilidad masculina. Métodos: Se realizó un estudio descriptivo transversal a los 123 pacientes con alteraciones en el espermograma que acudieron al Centro Territorial de Atención a la Pareja Infértil de la provincia Holguín en el año 2021 que cumplían con los criterios de inclusión y exclusión establecidos. La información fue obtenida a partir de la revisión de las historias clínicas y la realización de un cuestionario. Se utilizó la prueba de correlación de Spearman para identificar la relación entre las variables estudiadas a un nivel de significancia (=0,05. Resultados: La teratozoospermia fue el cambio morfofuncional que predominó con 69 casos (56,09 %), al ser más frecuente en el grupo de edad de 30 a 39 años (22, 76 %), la exposición a temperaturas elevadas con 19,51 % y el varicocele con un 43,9 %. En la correlación de las variables estudiadas mostró una mayor asociación la malnutrición por exceso y la teratozoospermia en 44 pacientes. Conclusiones: La evaluación de los cambios morfofuncionales de los espermatozoides permitió́ conocer un predominio de los relacionados a la morfología. Factores de riesgo como la edad mayor de 30 años, la malnutrición por exceso, la exposición a altas temperaturas y el varicocele se asocian a la infertilidad masculina.

Introduction: As of the present moment many studies have evidenced a decline in the quality of the human semen and an incremented risk masculine sub-fertility. Objective: To evaluate the association's grade of the morphologic and functional changes of the spermatozoa with the risk factors in the masculine infertility. Methods: A descriptive transverse study was carried out in the 123 patients with alterations in the spermogram attended in the Territorial Center of Attention to the Infertile Couple in Holguín in the year 2021, and that fulfilled the established criteria of inclusion and exclusion. The information was gotten from the revision of the case histories and the realization of a questionnaire. Spearman's correlation to identify the relation between the studied variables was used. Results: The teratozoospermia was the morphofunctional change that predominated with 69 cases (56.09 %), being more frequent in the age bracket of 30 to 39 years (22 for a 76 %), the exposition to temperatures raised with 19.51 % and the varicocele with a 43.9 %. The malnutrition for excess and teratozoospermic in 44 patients evidenced a bigger association in the correlation of the studied variables. Conclusions: The evaluation of the changes allowed morphologic and functional of spermatozoa knowing a predominance of the related to the morphology. Risk factors like an age older than 30 years, the malnutrition for excess, the exposition to loud temperatures and the varicocele correlate to the masculine infertility.

Recombinant gonadotropin therapy to improve spermatogenesis in nonobstructive azoospermic patients - A proof of concept study

ABSTRACT Purpose: Nonobstructive azoospermia (NOA) associated with primary spermatogenic failure is a common cause of male infertility usually considered untreatable; however, some reports have suggested that hormonal stimulation to boost the intra-testicular testosterone level and spermatogenesis might increase the chance of achieving pregnancy using homologous sperm. Materials and Methods: We report a series of eight NOA males who received long-term treatment with recombinant human chorionic gonadotropin twice a week for spermatogenesis stimulation. Six males received additional recombinant follicle-stimulating hormone (FSH) supplementation 150-225 IU twice weekly. Results: After recombinant gonadotropin therapy, viable spermatozoa were retrieved from the ejaculate in two patients and by testicular sperm aspiration (TESA) in another two subjects. Singleton spermatozoon retrieved from testes were frozen by vitrification on Cell-Sleeper devices. Two live births were obtained after intracytoplasmic sperm injection with ejaculated spermatozoa and one live birth and an ongoing pregnancy using thawed spermatozoa from TESA. Conclusion: Our proof-of-concept study indicates that hormonal therapy with recombinant gonadotropins could be considered in infertile men with NOA as an alternative to sperm donation. Large-scale studies are needed to substantiate hormone stimulation therapy with recombinant gonadotropins in routine clinical practice for this severe form of male infertility.

Recombinant gonadotropin therapy to improve spermatogenesis in nonobstructive azoospermic patients - A proof of concept study.

PURPOSE: Nonobstructive azoospermia (NOA) associated with primary spermatogenic failure is a common cause of male infertility usually considered untreatable; however, some reports have suggested that hormonal stimulation to boost the intra-testicular testosterone level and spermatogenesis might increase the chance of achieving pregnancy using homologous sperm. MATERIALS AND METHODS: We report a series of eight NOA males who received long-term treatment with recombinant human chorionic gonadotropin twice a week for spermatogenesis stimulation. Six males received additional recombinant follicle-stimulating hormone (FSH) supplementation 150-225 IU twice weekly. RESULTS: After recombinant gonadotropin therapy, viable spermatozoa were retrieved from the ejaculate in two patients and by testicular sperm aspiration (TESA) in another two subjects. Singleton spermatozoon retrieved from testes were frozen by vitrification on Cell-Sleeper devices. Two live births were obtained after intracytoplasmic sperm injection with ejaculated spermatozoa and one live birth and an ongoing pregnancy using thawed spermatozoa from TESA. CONCLUSION: Our proof-of-concept study indicates that hormonal therapy with recombinant gonadotropins could be considered in infertile men with NOA as an alternative to sperm donation. Large-scale studies are needed to substantiate hormone stimulation therapy with recombinant gonadotropins in routine clinical practice for this severe form of male infertility.

Oxidative origin of sperm DNA fragmentation in the adult varicocele

ABSTRACT Purpose: Sperm DNA fragmentation is a major cellular mechanism underlying varicocele-related male infertility. However, the type of DNA fragmentation - whether oxidative or of another nature - remains unknown. Thus, the aim of this study was to evaluate single- and double-stranded sperm DNA fragmentation, and oxidative-induced sperm DNA damage in men with varicocele. Materials and Methods: A cross-sectional study was performed, including 94 normozoospermic adults, of which 39 men without varicocele (controls) and 55 men with varicocele grades II or III, uni- or bilaterally. All men collected semen by masturbation. After semen analysis, the remaining volume was used for evaluation of three types of sperm DNA damage: (i) total DNA fragmentation, using an alkaline comet assay, (ii) double-stranded DNA fragmentation, using a neutral comet assay, and (iii) oxidative DNA damage, using an alkaline comet assay associated with the DNA glycosylase formamidopyrimidine enzyme. In each assay, percentage of sperm with any degree of DNA fragmentation, and with high DNA fragmentation were compared between the groups using an unpaired Student's t test or a Mann-Whitney test. Results: The varicocele group presented a higher rate of sperm with fragmented DNA (both any and high DNA fragmentation), considering single-stranded DNA fragmentation, double-stranded DNA fragmentation, or a combination of both, as well as oxidative- induced DNA fragmentation. Conclusions: Patients with varicocele have an increase in sperm DNA fragmentation levels, particularly in oxidative stress-induced sperm DNA damage.

The association of seminal oxidation reduction potential with sperm parameters in patients with unexplained and male factor infertility

ABSTRACT Purpose: Understanding the effects of high oxidation reduction potential (ORP) levels on sperm parameters will help to identify patients with unexplained and male factor infertility who may have seminal oxidative stress and determine if ORP testing is needed. This study aimed to evaluate the association between seminal ORP and conventional sperm parameters. Materials and Methods: A total of 58 patients who provided a semen sample for simultaneous evaluation of sperm parameters and ORP between January and September 2019 were enrolled in this retrospective study. To identify normal and high ORP levels, a static ORP (sORP) cut-off value of 1.36mV/106sperm/mL was used. Sperm parameters were compared between infertile men with normal sORP (control group, n=23) and high sORP values (study group, n=35). Results: Men with sORP values >1.36mV/106sperm/mL had significantly lower total sperm count (TSC) (p <0.001), sperm concentration (p <0.001) and total motile sperm count (TMSC) (p <0.001). In addition, progressive motility (p=0.04) and fast forward progressive motility (p <0.001) were significantly lower in the study group. A negative correlation was found between sORP and TSC (r=-0.820, p <0.001), sperm concentration (r=-0.822, p <0.001), TMSC (r=-0.808, p <0.001) and progressive motility (r=-0.378, p=0.004). Non-progressive motility positively correlated with sORP (r=0.344, p=0.010). Conclusions: This study has shown that TSC, sperm concentration, progressive motility and TMSC are associated with seminal oxidative stress, indicated by a sORP cut-off of 1.36mV/106sperm/mL. Presence of oligozoospermia, reduced progressive motilty or low TMSC in sperm analysis should raise the suspicion of oxidative stress and warrants seminal ROS testing.

The association of seminal oxidation reduction potential with sperm parameters in patients with unexplained and male factor infertility.

PURPOSE: Understanding the effects of high oxidation reduction potential (ORP) levels on sperm parameters will help to identify patients with unexplained and male factor infertility who may have seminal oxidative stress and determine if ORP testing is needed. This study aimed to evaluate the association between seminal ORP and conventional sperm parameters. MATERIALS AND METHODS: A total of 58 patients who provided a semen sample for simultaneous evaluation of sperm parameters and ORP between January and September 2019 were enrolled in this retrospective study. To identify normal and high ORP levels, a static ORP (sORP) cut-off value of 1.36mV/106sperm/mL was used. Sperm parameters were compared between infertile men with normal sORP (control group, n=23) and high sORP values (study group, n=35). RESULTS: Men with sORP values >1.36mV/106sperm/mL had significantly lower total sperm count (TSC) (p <0.001), sperm concentration (p <0.001) and total motile sperm count (TMSC) (p <0.001). In addition, progressive motility (p=0.04) and fast forward progressive motility (p <0.001) were significantly lower in the study group. A negative correlation was found between sORP and TSC (r=-0.820, p <0.001), sperm concentration (r=-0.822, p <0.001), TMSC (r=-0.808, p <0.001) and progressive motility (r=-0.378, p=0.004). Non-progressive motility positively correlated with sORP (r=0.344, p=0.010). CONCLUSIONS: This study has shown that TSC, sperm concentration, progressive motility and TMSC are associated with seminal oxidative stress, indicated by a sORP cut-off of 1.36mV/106sperm/mL. Presence of oligozoospermia, reduced progressive motilty or low TMSC in sperm analysis should raise the suspicion of oxidative stress and warrants seminal ROS testing.

Oxidative origin of sperm DNA fragmentation in the adult varicocele.

PURPOSE: Sperm DNA fragmentation is a major cellular mechanism underlying varicocele-related male infertility. However, the type of DNA fragmentation - whether oxidative or of another nature - remains unknown. Thus, the aim of this study was to evaluate single- and double-stranded sperm DNA fragmentation, and oxidative-induced sperm DNA damage in men with varicocele. MATERIALS AND METHODS: A cross-sectional study was performed, including 94 normozoospermic adults, of which 39 men without varicocele (controls) and 55 men with varicocele grades II or III, uni- or bilaterally. All men collected semen by masturbation. After semen analysis, the remaining volume was used for evaluation of three types of sperm DNA damage: (i) total DNA fragmentation, using an alkaline comet assay, (ii) double-stranded DNA fragmentation, using a neutral comet assay, and (iii) oxidative DNA damage, using an alkaline comet assay associated with the DNA glycosylase formamidopyrimidine enzyme. In each assay, percentage of sperm with any degree of DNA fragmentation, and with high DNA fragmentation were compared between the groups using an unpaired Student's t test or a Mann-Whitney test. RESULTS: The varicocele group presented a higher rate of sperm with fragmented DNA (both any and high DNA fragmentation), considering single-stranded DNA fragmentation, double-stranded DNA fragmentation, or a combination of both, as well as oxidative-induced DNA fragmentation. CONCLUSIONS: Patients with varicocele have an increase in sperm DNA fragmentation levels, particularly in oxidative stress-induced sperm DNA damage.

Protocolo para el manejo de la pareja infértil con implantación de catgut en puntos de acupuntura / Protocol for the management of infertile couples with catgut implantation in acupuncture points

RESUMEN Introducción: en la mujer, el hallazgo inmediato más importante en los estudios de infertilidad es la ausencia de ovulación y aunque en su tratamiento existen alternativas, aún son ineficaces debido a limitaciones diagnósticas y terapéuticas. En las causas masculinas, las alteraciones idiopáticas de la calidad del semen predominan, son más frecuentes la astenozoospermia y oligozoospermia, asociado al diagnóstico de varicocele. Las razones por las cuales el potencial de fertilidad no siempre se mejora después de tratamiento quirúrgico oportuno y adecuado del varicocele, están todavía en estudio, y los tratamientos convencionales propuestos son costosos y no siempre efectivos. Objetivo: elaborar un protocolo para el manejo de la pareja infértil con implantación de catgut en puntos de acupuntura. Desarrollo: se analizaron temáticas sobre la atención a la mujer con ciclos anovulatorios y a hombres infértiles después del tratamiento quirúrgico del varicocele y con infertilidad idiopática y los tratamientos tradicionales propuestos. Se generaron preguntas científicas para confeccionar el protocolo. Protocolo para el manejo de la pareja infértil con implantación de catgut en puntos de acupuntura que incluye: profesionales a quienes va dirigido, población diana, recursos necesarios, equipo de trabajo, papel de los miembros del equipo, secuencia de actuación, modo de realización, ventajas, desventajas y contraindicaciones de la implantación de catgut, diferenciación y tratamiento en cada caso según el diagnóstico tradicional chino e indicadores de evaluación. Conclusiones: la modalidad terapéutica propuesta, es una alternativa inocua y poco costosa que contribuye a mejorar la fecundidad y la natalidad de la pareja infértil.

ABSTRACT Introduction: in women, the most important immediate finding in infertility studies is the nonexistence of ovulation and although there are alternatives in their treatment, they are still ineffective due to diagnostic and therapeutic limitations. In male causes, idiopathic alterations in semen quality predominate, the most frequent being asthenozoospermia and oligozoospermia associated with the diagnosis of varicocele. The reasons why fertility potential is not always improved after timely and adequate surgical treatment of varicocele are still under study, and the proposed conventional treatments are expensive and not always effective. Objective: to elaborate a protocol for the management of the infertile couples with catgut implantation in acupuncture points. Development: topics regarding this protocol were analyzed on the care of women with anovulatory cycles and infertile men after surgical treatment of varicocele along with idiopathic infertility as well as the proposed traditional treatments, generating scientific questions to draw up the protocol. The protocol for the management of infertile couples with implantation of catgut in acupuncture points includes: professionals to whom it is directed, target population, necessary resources, teamwork, role of team members, sequence of action, approach for its implementation, advantages, disadvantages and contraindications concerning the implantation of catgut, differentiation and treatment in each case according to the traditional Chinese diagnosis and assessment indicators. Conclusions: the proposed therapeutic modality is an innocuous and inexpensive alternative that contributes to the improvement of fertility and birth rate in the infertile couples.

Are specialized sperm function tests clinically useful in planning assisted reproductive technology?

CASE STUDY 40-year-old male patient and 32-year-old female partner, with a history of primary infertility of two years duration. The workup revealed idiopathic mild oligoasthenotheratozoospermia, and no apparent female infertility factors. The couple has failed three intrauterine insemination (IUI) cycles, planning more IUI cycles but also considering in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI).

LaMedicina Tradicional China en la infertilidad masculina / Chinese Traditional Medicine in male infertility

RESUMEN Introducción: la oligoastenozoospermia es causa común de infertilidad masculina. El riñón según la Medicina Tradicional China es uno de los órganos más afectado en esta enfermedad. Objetivo: describir los síndromes tradicionales asociados a la infertilidad masculina, en la búsqueda de tratamientos individualizados más efectivos. Métodos: se realizó un estudio observacional y descriptivo en el servicio de Medicina Natural y Tradicional del Hospital General Docente Abel Santamaría Cuadrado de Pinar del Río, en el año 2016. Se estudiaron 86 pacientes infértiles que cumplieron los criterios de inclusión propuestos.El universo se caracterizó según: alteraciones del régimen trabajo-descanso, alimentación inadecuada, hábitos tóxicos, actividad sexual intemperante, síntomas y signos tradicionales, características de lengua y pulso, y síndromes de órganos Zang-Fu, según cuatro métodos diagnósticos. Resultados: el 61,6% de los pacientes manifestaron alteraciones del régimen trabajo descanso, el 54,6% alimentación inadecuada con aumento de alimentos grasos, y el41% ingieren bebidas alcohólicas. En el 80, 2% predominó la lasitud y dolor en región lumbar y rodillas, la lengua pálida con saburra blanca fina (27,5%)y el pulso profundo y filiforme (34%). Los síndromes según órganos Zang Fu, que prevalecieron fueron: deficiencia de Yang de Riñón (34,9%), deficiencia de Jing de Riñón (29,1%) y deficiencia de Yin de Riñón (24,4%). Conclusiones: los síndromes de deficiencia de Riñón predominaron en los pacientes infértiles. La diferenciación de los síndromes en estos pacientes es de gran importancia para la adecuada selección del tratamiento tradicional y su efectividad.

Abstract Introduction: oligoasthenozoospermiais a common cause of male infertility. The kidney according to Chinese Traditional Medicine is one of the most affected organs associated with this health condition. Objective: to describe the traditional syndromes associated with male infertility, searching for more effective individualized treatments. Methods: an observational and descriptive study was carried out in the Natural and Traditional Medicine Service at Abel Santamaria Cuadrado General Teaching Hospital in Pinar del Río during 2016; 86 infertile patients who met the inclusion criteria were included in the study. The sample was distinguished according to: adjustment of the work-rest regime, inadequate diet, toxic habits, intemperate sexual activity, symptoms and traditional signs, characteristics of tongue and pulse, and syndromes of Zang-Fu organs, according to four diagnostic methods. Results: 61,6 % of the patients manifested alterations of the work-rest regime, 54,6 % inadequate food intake with increase of fatty foods, and 41 % ingestion of alcoholic beverages; 80,2 % showed lassitude and pain in the lumbar region and knees predominantly, pale tongue with fine-white coating (27,5 %) and the deep and filiform pulse (34 %). The prevailing syndromes according to Zang Fu organs were: Kidney Yang deficiency (34,9 %), Kidney Jing deficiency (29,1 %) and Kidney Yin deficiency (24,4 %). Conclusions: kidney deficiency syndromes predominated in infertile patients. The differentiation of the syndromes in these patients is of great importance for the adequate alternative of traditional treatment and its effectiveness.

Clinical features of carriers of reciprocal chromosomal translocations involving chromosome 2: report of nine cases and review of the literature.

OBJECTIVE: To explore the clinical features of carriers of chromosome 2 translocations, enabling informed genetic counseling of these patients. MATERIALS AND METHODS: Eighty-two male carriers of a translocation who were infertile or receiving fertility counseling were recruited. Cytogenetic analyses were performed using G-banding. A search of PubMed was performed to determine whether the identified translocations on chromosome 2 are involved in male infertility. The relationships of translocation breakpoints with male infertility and recurrent pregnancy loss were analyzed. RESULTS: Of the 82 translocation carriers, 9 (11%) were carriers of a chromosome 2 translocation. Four cases had oligozoospermia or infertility, while five had normal semen. In an analysis of the literature, 55 patients who were carriers of chromosome 2 translocations were also reviewed. Breakpoints at 2p13 and 2q31 were observed in six patients each, and were the most common. Breakpoints at 2p23, 2p13, 2p11.2, 2q31, and 2q37 were associated to both pre-gestational and gestational infertility, while other breakpoints were associated with gestational infertility. CONCLUSIONS: All breakpoints at chromosome 2 were correlated with gestational infertility. Carriers of chromosome 2 translocations should therefore receive counseling to continue with natural conception and use of different technologies available via assisted reproductive technology, such as preimplantation genetic diagnosis.

Polimorfismo del cromosoma 9. Presentación de dos casos / Polymorphism of chromosome 9. Presentation of two cases

Las variantes polimórficas en los cromosomas 1, 9, 16, y en el cromosoma Y son más frecuentes en la persona infértil que en la población general; la presencia de estas variantes en uno o ambos miembros de la pareja podría incrementar la frecuencia de infertilidad de causa idiopática. El cromosoma 9 es estructuralmente muy polimórfico y contiene la región más larga de heterocromatina que hay en los seres humanos. Por tales razones y por la indiscutible importancia que cobra el estudio citogenético en varones con alteraciones seminales severas, como parte del diagnóstico certero y oportuno de la pareja con fallo reproductivo, se presentan los casos de dos pacientes que fueron atendidos en el Centro Territorial de Reproducción Asistida de Cienfuegos, para estudio de una infertilidad. Se les realizó estudio citogenético y se diagnosticó polimorfismo del cromosoma 9.

Polymorphic variants on chromosomes 1, 9, 16, and on the Y chromosome are more frequent in the infertile person than in the general population; the presence of these variants in one or both members of the couple could increase the frequency of idiopathic cause infertility. Chromosome 9 is structurally highly polymorphic and contains the longest region of heterochromatin in humans. For these reasons and because of the indisputable importance of the cytogenetic study in men with severe seminal disorders, as part of the accurate and timely diagnosis of the couple with reproductive failure, the cases of two patients who were treated at the Cienfuegos Regional Center of Assisted Reproduction , for an infertility study. A cytogenetic study was performed and chromosome 9 polymorphism was diagnosed.

Randomized crossover trial of amoxapine versus vitamin B12 for retrograde ejaculation

ABSTRACT Objective To compare the efficacy and safety of amoxapine and vitamin B12 for treating retrograde ejaculation (RE). Materials and Methods Between May 2009 and November 2012, this open-label, randomized, crossover study enrolled 26 men suffering with RE at Department of Reproductive Medicine, Omori Hospital. Patients were randomly allocated into two groups (n=13 each). The amoxapine-B12 group received amoxapine (50 mg daily for 4 weeks, orally) followed (after a 1-week washout period) by vitamin B12 (500 μg three-times daily for 4 weeks). The B12-amoxapine group received the opposite regimen. All patients masturbated to ejaculation at least twice during each treatment period. The primary outcome was antegrade ejaculation of semen, as reported by the patient, on more than one occasion during either treatment period (defined as treatment success). Any adverse events were noted. Success rates were compared between treatments using Fisher’s exact test. Results One patient (B12-amoxapine group) withdrew for personal reasons (breakdown of marital relations); all other patients completed the study. Overall success rate was 88% (22/25). Success rate was higher for amoxapine than for vitamin B12 (80%, 20/25 vs 16%, 4/25; P<0.0001). 18 patients were responsive to amoxapine but not to vitamin B12, 2 patients were responsive to vitamin B12 but not amoxapine, 2 patients were responsive to both drugs, and 3 patients had no response to either drug. One patient (4%) reported sleepiness and 2 (8%) reported constipation while receiving amoxapine. No adverse events were reported during vitamin B12 treatment. Conclusions Amoxapine may be an effective, safe and well-tolerated therapy for RE.

Homens que vivenciam a infertilidade: clientes da "cegonha tecnológica" / Men who experiences infertility: clients of "stork technological" / Hombres que experimentan la infertilidad: clientes de la "cigueña tecnologica"

A presente pesquisa teve como objetivo compreender a experiência de homens inférteis, os quais participam de um serviço de Reprodução Assistida. De natureza qualitativa, esta investigação está afinada à perspectiva fenomenológica hermenêutica, privilegiando a compreensão interpretativa fundada na Hermenêutica Filosófica, proposta elaborada por Gadamer. Para acesso à experiência utilizaram-se a entrevista narrativa e os registros feitos no "diário de bordo" das pesquisadoras, a partir da sua inserção no lócus da pesquisa. Os relatos dos colaboradores apontaram para dificuldades vividas durante a tentativa de métodos de Reprodução Assistida, as quais levaram a experiências de desconforto, estranheza, bem como de desesperança frente à burocracia e morosidade dos serviços prestados no hospital. Os interlocutores narraram sua vivência frente aos procedimentos técnicos/médicos, desvelando de um lado a utilidade da técnica no projeto parental e, de outro, o seu domínio na hegemonia do discurso científico e na compreensão do corpo masculino como matéria-prima a ser explorada e aperfeiçoada.

This research aimed to understand the experience of infertile men, who participate in a Assisted Reproduction Service. Qualitative, this research is in tune to the hermeneutic phenomenological perspective, focusing on interpretive understanding founded in Philosophical Hermeneutics, proposal made by Gadamer. For access to the experience we used the narrative interviews and the records made in the "logbook" of the researchers, from its insertion into the locus of research. The accounts of the employees pointed to difficulties experienced while trying to assisted reproduction methods, which led to discomfort experiences, strangeness, and of hopelessness against the bureaucracy and slowness of services in the hospital. The interlocutors narrated his experience forward to the technical /medical procedures, unveiling the one hand the technical usefulness of the parental project and on the other, its dominance in the hegemony of scientific discourse and understanding of the male body as a raw material to be exploited and improved.

Esta investigación tuvo como objetivo comprender la experiencia de los hombres infértiles, que participan en un Servicio de Reproducción Asistida. Cualitativa, esta investigación está en sintonía con la perspectiva fenomenológica hermenéutica, centrándose en la comprensión interpretativa fundada en la hermenéutica filosófica, propuesta hecha por Gadamer. Para el acceso a la experiencia se utilizaron las entrevistas narrativas y los registros realizados en el "cuaderno de bitácora" de los investigadores, a partir de su inserción en el locus de la investigación. Las cuentas de los empleados señalaron las dificultades experimentadas al tratar de los métodos de reproducción asistida, lo que llevó a la incomodidad experiencias, extrañeza, y de desesperanza contra la burocracia y la lentitud de los servicios en el hospital. Los interlocutores narran su experiencia con interés los procedimientos técnicos /medicina, revelando un lado la utilidad técnica del proyecto de los padres y por el otro, su dominio en la hegemonía del discurso científico y la comprensión del cuerpo masculino como materia prima para ser explotados y mejorado.

Research prioritization of men's health and urologic diseasess

ABSTRACT Objectives We sought to determine whether disease representation in the Cochrane Database of Systematic Reviews (CDSR) reflects disease burden, measured by the Global Burden of Disease (GBD) Study as disability-adjusted life-years (DALYs). Materials and Methods Two investigators performed independent assessment of ten men’s health and urologic diseases (MHUDs) in CDSR for systematic review and protocol representation, which were compared with percentage of total 2010 DALYs for the ten conditions. Data were analyzed for correlation using Spearman rank analysis. Results Nine of ten MHUDs were represented by at least one CDSR review. There was a poor and statistically insignificant positive correlation between CDSR representation and disease burden (rho = 0.42, p = 0.23). CDSR representation was aligned with disease burden for three conditions, greater than disease burden for one condition, and less than disease burden for six conditions. Conclusions These results yield high-quality estimates to inform future research prioritization for MHUDs. While prioritization processes are complex and multi-faceted, disease burden should be strongly considered. Awareness of research priority setting has the potential to minimize research disparities on a global scale.