Environmental exposure to cadmium but not lead is associated with decreased semen quality parameters: quality regionalism of sperm properties.

Environmental factors may negatively contribute to a progressive worsening of semen quality, and differences in semen quality may result from different environmental exposures (regional differences) or lifestyle differences. Heavy metals are factors with a confirmed negative influence on male fertility. Among them, lead and cadmium are commonly found in human surroundings. Thus, we analyzed semen parameters (according to the World Health Organization 2010 recommendations) and semen lead and cadmium concentrations in 188 men from two different regions in Poland, a typical agricultural area and an industrial area, in couples that had been diagnosed with infertility. The assays were performed using flameless electrothermal atomic absorption spectrometry. In the statistical analysis, regional comparisons and then taxonomic comparisons based on three parameters (age, semen concentration, and sperm morphology) were applied. We showed that more cadmium than lead accumulated in semen, a higher cadmium concentration was observed in semen obtained from men from the agricultural region, and better semen quality and lower cadmium concentrations were found in the semen of men from the industrial, more polluted region. We thus showed an existing regionalism in the sperm quality properties. However, semen parameters such as morphology and progressive and nonprogressive motility followed the same trends, regardless of the patient's age, region, or class. We could conclude that the environment has a minor impact on sperm morphology and progressive and nonprogressive motility and that other existing factors could have an indirect influence on semen quality.

The Role of Oxidative Stress, Selected Metals, and Parameters of the Immune System in Male Fertility.

The aim of the study was to investigate the associations between standard semen parameters and the parameters reflecting oxidative stress intensity, antioxidant defense functions, levels of selected macro and trace elements, and parameters characterizing immune system function. The study group consisted of 103 fertile males. Based on semen volume, sperm concentration, total sperm count, and percentage of motile sperm at 1 hour postcollection, the individuals were divided into two equal groups-those with excellent (EX) semen quality and those with mediocre (ME) semen quality. The remaining measured parameters characterizing motility and the percentage of normal morphology were higher in the EX group than in the ME group; however, the seminal plasma pH did not differ between the examined groups. The phosphate level was 31% lower in the EX group than in the ME group, whereas there was a tendency toward a 25% lower level of Fe in the EX group than in the ME group (p = 0.064). The activities of enzymes involved in antioxidant defense, CuZn-SOD, CAT, and G6PD, were 14%, 63%, and 39%, respectively, higher in the EX group than in the ME group. However, the level of alpha-tocopherol was 32% lower in the EX group than in the ME group. The other measured parameters characterizing antioxidant defense and the parameters of oxidative stress intensity and immune system function were not significantly different. The value of seminal plasma pH is not related to the semen quality of fertile males. Higher fertility potential estimated based on standard semen parameters in fertile males is associated with lower levels of Fe and higher activities of some antioxidant enzymes.

Magnesium and selected parameters of the non-enzymatic antioxidant and immune systems and oxidative stress intensity in the seminal plasma of fertile males.

INTRODUCTION: The present study investigated associations between environmental exposure to magnesium (Mg) and the levels of oxidative stress parameters and selected cytokines, and the antioxidant defense system in the seminal plasma of fertile males. MATERIALS AND METHODS: The study population consisted of 57 healthy, non-smoking, fertile men from the southern region of Poland. Based on the median magnesium levels in seminal plasma, subjects were divided into two groups: those with low (Mg-L) and high (Mg-H) magnesium concentrations. RESULTS: Differences were not observed between the Mg-L and Mg-H groups as regards semen volume, pH, count, motility, or morphology of sperm cells. In the Mg-H group, cholesterol levels were significantly higher (77%) compared with the Mg-L group: however, γ-glutamyltranspeptidase activity was significantly lower (21%). The values of total oxidant status were significantly different between the two groups, with 78% higher values observed in the Mg-H group compared with the Mg-L group, whereas malondialdehyde levels did not differ significantly. The values for total antioxidant capacity and uric acid levels were significantly lower in the Mg-H group compared with the Mg-L group (14% and 17%, respectively). However, levels of bilirubin, albumin, thiol groups and α-tocopherol were significantly higher in the Mg-H group (71%, 44%, 35% and 47%, respectively). CONCLUSION: No associations between Mg levels in the seminal plasma of fertile males and standard semen parameters were found. However, Mg levels may be associated with altered function of the non-enzymatic antioxidant system.

Environmental exposure to lead induces oxidative stress and modulates the function of the antioxidant defense system and the immune system in the semen of males with normal semen profile.

We investigated the associations between environmental exposure to lead and a repertoire of cytokines in seminal plasma of males with normal semen profile according to the WHO criteria. Based on the median lead concentration in seminal plasma, 65 samples were divided into two groups: low (LE) and high exposure to lead (HE). Differences in semen volume and the pH, count, motility and morphology of sperm cells were not observed between the examined groups. The total oxidant status value and the level of protein sulfhydryl groups as well as the activities of manganese superoxide dismutase and catalase were significantly higher in the HE group, whereas the total antioxidant capacity value and the activities of glutathione reductase and glutathione-S-transferase were depressed. IL-7, IL-10, IL-12, and TNF-α levels were significantly higher in the HE group compared with the LE group. Environmental exposure to lead is sufficient to induce oxidative stress in seminal plasma and to modulate antioxidant defense system.

The influence of macro and trace elements on sperm quality.

The aim of this study was to examine the association between combined concentrations of macro and trace elements and markers of oxidative stress and antioxidative defense system function together with selected cytokine levels. Based on the combined medians of the seminal plasma levels of calcium, magnesium, zinc, copper, iron, and selenium, the study subjects (88 fertile male volunteers) were divided into the following two subgroups: the Me-L group (low level of metals) and the Me-H group (high level of metals). There was a tendency toward reduced motility in the Me-H group compared to that in the Me-L group. The total protein, albumin, and total oxidation status (TOS) levels were significantly higher in the Me-H group than in the Me-L group. The total superoxide dismutase (SOD), Mn-SOD, and CuZn-SOD, activity in spermatozoa were significantly lower in the Me-H group than in the Me-L group. In seminal plasma, the Mn-SOD activity was significantly higher in the Me-H group, whereas the CuZn-SOD activity was significantly lower. Additionally, the activity levels of glutathione peroxidase (GPx) and glutathione-S-transferase (GST) were lower in the Me-H group. The medians of IL-1ß, IL-10, and IL-12 were significantly higher in the Me-H group than in the Me-L group, whereas the medians of IL-2, IL-5, and IL-13 were significantly lower. Higher levels of macro and trace elements in the seminal plasma of fertile males may be associated with decreased motility. Higher levels of the examined metals are associated with elevated oxidative stress accompanied by decreased activities of some of the antioxidant enzymes and increased pro-inflammatory cytokine levels.

Comparison of prenatal and postnatal treatments of spina bifida in Poland--a non-randomized, single-center study.

OBJECTIVE: The aim of this study was a comparison of the outcomes of intrauterine myelomeningocele (MMC) repairs (IUMR) in type II Chiari malformation (II CM) fetuses with clinical data of newborns and infants operated on postnatally. METHODS: The study group (SG) comprised 46 pregnant women whose type II CM children underwent IUMR, while 47 pregnant women whose type II CM children were operated on postnatally constituted the control group (CG). A total of 24 SG and 20 CG patients reached the endpoint of the study. RESULTS: High incidence of prelabor rupture of membranes (24 (52.2%), CI: 3.74 (1.69-8.26) (p < 0.001) was noted in the group of prenatal surgeries as compared to controls. The need for ventriculoperitoneal shunt implantation was statistically significantly lower (p < 0.008) in the group of children after IUMR as compared to controls (5 (27.8%) and 16 (80%), respectively, CI: 0.35 (0.16-0.75). None of the postnatally treated CG children can walk without adaptive equipment. In contrast, two children from the SG (2 (11.1%) CI: 1.86 (1.00-3.48) p < 0.05) are able to walk independently. CONCLUSIONS: Prenatal MMC closure significantly lowers further adverse evolution of the II CM. Further studies are needed, especially on preventive measures for preterm labor and iatrogenic preterm prelabor rupture of membranes (iPPRM) in the postoperative course of IUMR.

[Total pelvic exenteration in vaginal cancer--case report]. / Calkowite wytrzewienie narzadów miednicy mniejszej z powodu raka pochwy--opis przypadku.

Vaginal cancer is a rare neoplasm and in about 65% to 90% of cases it is a metastatic one. It is diagnosed in women aged from 60 to 70 years, but it can also appear in younger patients. Squamous cell carcinoma is the most frequently found histopathological type. Risk factors for the development of vaginal cancer are thought to be similar to those of cervical cancer. We present a case of a 52-year old woman with vaginal cancer treated with brachytherapy. Due to neoplasm recurrence, additional examinations were performed in the course of one year. The patient was qualified for total pelvic exenteration. A leakage from the abdominal wound was observed post operatively. It was successfully noninvasively treated. In 3 months time she was hospitalized because of the superficial abdominal abscess which was located next to the left ureterostomy. The patient undergoes regular gynecological, surgical and urological control examinations. So far the results do not show any recurrence of the neoplastic process. Total pelvic exenteration should be considered in selected groups of patients.

Efficacy of photodynamic therapy in vulvar lichen sclerosus treatment based on immunohistochemical analysis of CD34, CD44, myelin basic protein, and Ki67 antibodies.

INTRODUCTION: Lichen sclerosus (LS) is a chronic skin and mucosa inflammatory disease. It affects mainly the female anogenital area especially in postmenopausal period. The main symptoms include pruritus, burning, pain, sometimes urinary problems, or difficulties in defecation. Usually, porcelain-white plaques are seen in the skin and mucosa. The etiology and pathogenesis of LS are still uncertain. There are some research studies on possible genetic predisposition, yet autoimmune, hormonal, or infectious factors are not excluded. The typical treatment of LS is mainly pharmacological, although the alternative treatment method used in LS is photodynamic therapy (PDT), which is noninvasive technique based on selective destruction of lesions. Our study is focused on molecule markers of vascularisation (CD34), nervous cell function (myelin basic protein [MBP]), keratinocyte function (CD44), and proliferation index (Ki67) in cases treated with photodynamic method. MATERIALS AND METHODS: A group of 100 patients treated in our department was included in the study. All 100 women had LS on the basis of clinical and histological criteria. All the subjects underwent PDT. In all cases, skin biopsies were taken before and after treatment, and samples were analyzed with CD34, CD44, MBP, and Ki67 antibodies using immunohistochemical staining. RESULTS: The study shows the high efficacy of PDT in LS treatment including beneficial changes to CD34, CD44, and MBP immunostained molecules. The Ki67 proliferation index did not change significantly. A significant increase of CD34 (microvessel density), MBP, and CD44 expression was confirmed in the histological images and in the partial or full remission of clinical objective and subjective symptoms. CONCLUSIONS: The PDT is a very effective therapeutic method in LS treatment.

[Seven-weeks cervical pregnancy treated successfully with methotrexate - a case report]. / 7-Tygodniowa ciaza szyjkowa leczona zachowawczo z zastosowaniem metotreksatu- opis przypadku.

The paper presents the case of a 7-weeks-cervical pregnancy treated successfully with methotrexate. A 16 years-old nullipara girl was admitted to the hospital, because of moderate bleeding from the vagina and mild lower abdominal pain. The last menstruation was 56 days before admission. The vaginal part of the cervix was bluish and thickened. 0 x 03B2-hCG concentration in blood serum was 2.65 IU/ml. In the endovaginal USG the pregnancy follicle was not seen in the uterine cavity, but the uterine cervix was expanded in the middle part by an echo negative follicle 10.5 mm in diameter. The foetal heart beat was not visible. Because of the patient's young age, 50mg of methotrexate (MTX) was applied intravenously. 0 x 03B2-hCG concentration decreased to 1.18 IU/ml on 4th day, but the follicle halo in USG was still visible so an additional dose of 25 mg methotrexate i.v. was applied. 0x03B2-hCG fell to 0,0485 IU/ml on the 10th day and USG showed, tissues of differentiated echogenicity and faint contour of the follicle in the cervical canal. Curettage of the cervix and uterus was made without any complications. Subsequent examinations showed decreasing concentration of 0 x 03B2-hCG. The patient, in good condition, was discharged from the hospital after five days. Methotrexate in treatment of cervical pregnancy is safe and allows to preserve the uterus and fertility in young nullipara adolescent women with cervical pregnancy. Few reports in the literature describe the use of methotrexate in ectopic pregnancy in teenagers, but no reported cases of cervical pregnancy treated with methotrexate have been found.

[Vulvovaginitis in young girls]. / Stany zapalne narzadów plciowych u dziewczynek.

Vulvovaginitis is the most common cause of gynecological complaints in young girls. Factors which cause vulvovaginitis include, among other things, low level of sexual hormones (hypoestrogenism), the anatomical proximity of the rectum and delicate vulvar skin and vaginal mucosa. Usually vulvovaginitis in young girls is caused by non-specific factors. The aim of the study was to present the most frequent causes of vulvovaginitis in young girls.

[Abdominal wall endometrioma in the cesarean section scar]. / Guzy endometrialne w bliznach po cieciu cesarskim.

OBJECTIVES: The study presents a retrospective review of patients diagnosed with abdominal wall endometrioma in the cesarean section scar between the years 2001-2006. MATERIAL AND METHODS: The study presented age symptoms, size of tumor, time between cesarean section and symptoms, results of treatment. RESULTS: Between 2001-2006, 34 patients, all of which suffered from abdominal pain and palpable mass, were diagnosed and treated in our hospital. In 8 cases the disease returned and reoperation was necessary. In one case we observed adenocarcinoma papillare. CONCLUSIONS: Endometriosis in postoperative abdominal wall scar after cesarean section is rarely observed. Because to the fact that the number of cesarean sections is constantly increasing, this complication becomes more frequent. The treatment of choice is surgical resection.

The fertilization potential of donor semen between 1982 and 2004 in the industrial area of Upper Silesia (Poland).

The industrial area of Upper Silesia is the most polluted region in Poland. To assess if these conditions could influence male fertility, a retrospective analysis of the fertilization potential of donor semen was performed, taking as an outcome measure the pregnancy rate after donor inseminations in 1982-2004. Data on contamination of air and soil in the region were collected and compared with those of the rest of the country. In total 2,100 inseminations using fresh semen from 44 healthy donors with proven fertility in 1,617 cycles in 290 infertile couples were performed in 1982-1995 and 2,010 inseminations using frozen semen from 20 healthy donors with proven fertility in 1,994 cycles in 414 infertile couples were performed in 1996-2004. Significantly higher values of air and soil pollution compared to the rest of the country were stated. Pregnancies occurred in 125 patients inseminated by fresh semen and in 85 patients inseminated by frozen banked semen. The insemination efficiency was lower than expected and a distinct declining trend was observed in both groups. Significant rise in the number of cycles necessary for achieving pregnancy was noted. The fertilization potential of fresh and frozen donor semen in Upper Silesia is low and seems still to be diminishing. It might be speculated that this phenomenon could be caused by the high degree of industrial pollution.

Assessment of semen function and lipid peroxidation among lead exposed men.

The study population included healthy, fertile men, employees of Zinc and Lead Metalworks (n=63). Workers exposed to lead were divided into two groups: a group with moderate exposure to lead (ME) - blood lead level (PbB) 25-40 microg/dl and a group with high exposure to lead (HE) PbB=40-81 microg/dl. The control group consisted of office workers with no history of occupational exposure to lead. Evaluation of lead, cadmium and zinc level in blood and seminal plasma, zinc protoporphyrin in blood (ZPP), 5-aminolevulinic acid in urine (ALA), malondialdehyde (MDA) in seminal plasma and sperm analysis were performed. No differences were noted in the concentration of cadmium and zinc in blood and seminal plasma in the study population. Lipid peroxidation in seminal plasma, represented as MDA concentration, significantly increased by about 56% in the HE group and the percentage of motile sperm cells after 1 h decreased by about 34% in comparison to the control group. No statistically significant correlation between other parameters of sperm analysis and lead exposure parameters nor between lead, cadmium and zinc concentration in blood and seminal plasma were found. A positive association between lead intoxication parameters (PbB, ZPP, lead seminal plasma) and MDA concentration in sperm plasma and inverse correlation with sperm cells motility (PbB, ZPP) was found. An increased concentration of MDA was accompanied by a drop in sperm cells motility. In conclusion, we report that high exposure to lead causes a decrease of sperm motility in men most likely as a result of increased lipid peroxidation, especially if the level in the blood surpasses the concentration of 40 microg/dl.

Sperm DNA adducts impair fertilization during ICSI but not during IVF.

Many studies emphasize the influence of the status of spermatozoal nucleus on fertilization, mainly with regard to DNA fragmentation. This study was undertaken to analyze the influence of DNA adducts content in spermatozoa on fertilization during assisted reproduction. Ovarian hyperstimulation, oocyte retrieval and laboratory work-up in 61 IVF (in vitro fertilization) and 118 ICSI (intracytoplasmic sperm injection) first cycles were performed according to the same protocol. Semen analysis was made according to WHO Manual (1999). DNA adducts assay in spermatozoa was performed by 32Ppostlabeling method. In total 331 fertilizable oocytes were obtained during IVF and 659 during ICSI. Both groups differed significantly by sperm count, motility and morphology but not by the concentration of DNA adducts in spermatozoa (0.0306 +/- 0.0217 in IVF versus 0.0373 +/- 0.0321 in ICSI). The fertilization rate during IVF was significantly influenced by sperm count (p=0.0002) and motility (p=0.0037) but not by DNA adducts concentration (p=0.30528), whereas during ICSI was positively influenced by sperm motility (p=0.04669) and negatively by DNA adducts concentration (p=0.00796). DNA adducts concentration in spermatozoa significantly negatively influences fertilization rate during ICSI, but not during IVF.

Bulky DNA adducts in human sperm: relationship with fertility, semen quality, smoking, and environmental factors.

The integrity of DNA of spermatogenic cells can be affected by endogenous and exogenous genotoxic factors. Resulting DNA damage in spermatozoa may significantly contribute to impaired fertility. Here, the 32P-postlabeling method was used to analyze the levels of bulky DNA adducts in sperm cells in a group of 179 males, either healthy donors or patients with an impaired fertility. When all donors were analyzed, the levels of bulky DNA adducts was 1.2-fold higher in smokers than in non-smokers, but the difference was not statistically significant (P=0.054). However, a statistically significant difference existed between current smokers and never smokers among the healthy individuals (1.7-fold increase, P=0.008). No correlation between alcohol or coffee consumption and sperm DNA adducts was found. The levels of DNA adducts in sperm seemed to be unaffected by environmental and occupational factors. On the other hand, groups of healthy persons and patients with male-factor infertility differed significantly with respect to the level of bulky DNA adducts (P=0.012). A significant negative correlation between DNA adducts and sperm concentration or sperm motility existed among patients with an impaired fertility (n=93; P<0.029, r(S)=-0.225). These results suggest that DNA adducts in sperm cells can be applied as potential biomarkers in studies of human infertility.

High levels of bulky DNA adducts in human sperm correlate with impaired fertility.

Progressive decline in fertility and sperm quality has been reported over the last few decades, especially in industrialized nations. It has been proposed that exposure to factors that induce damage in DNA of spermatogenic cells may significantly contribute to impaired fertility. Here, the (32)P-postlabelling method was used to analyze the levels of bulky DNA adducts in sperm cells in a group of 179 volunteers, either healthy subjects or patients with an impaired fertility. The levels of DNA adducts were 1.35-fold higher in the infertile group as compared to healthy individuals (P = 0.012). Similarly, a significant negative correlation between the levels of DNA adducts and measures of semen quality (sperm concentration and motility) has been observed (P

[Comparison of the efficacy of ICSI using either spermatozoa aspired microsurgically from the epididymis (MESA-ICSI) or obtained from the ejaculation]. / Porównanie skutecznosci ICSI z uzyciem plemników pobranych na drodze mikrochirurgicznej aspiracji z najadrza (MESA-ICSI) oraz ICSI przy uzyciu plemników uzyskanych z ejakulatu.

OBJECTIVE: Microsurgical epididymal sperm aspiration and intracytoplasmic sperm injection (MESA-ICSI) is a viable alternative to the treatment of couple sterility caused by obstructive azoospermia. Because there are structural differences between epididymal and ejaculated spermatozoa and it is not univocally stated, if this fact influences positively or negatively the results of ICSI, it was decided to compare the efficacies of ICSI using both the kinds of spermatozoa at the same setting. DESIGN: Retrospective comparative analysis. MATERIALS AND METHODS: The MESA group consisted of 27 couples and the control ICSI group of 154 couples--both matched in age, duration of sterility, health status, stimulation protocols and luteal supplementation. The trial was performed at the same period in one center, keeping the same laboratory and personal conditions in both the groups. RESULTS: In the MESA group the fertilization rate was 53.9%, the cleavage rate 87.6% and pregnancy rates 37.0% per microinjection and 43.5% per embryotransfer. In the control group the corresponding values were 50.1%, 90.0%, 28.0% and 31.7%. The differences between the groups were insignificant. CONCLUSIONS: It may be concluded, that the structural differences between epididymal and ejaculated spermatozoa do not significantly influence the efficacy of ICSI, however further investigations are still needed.