Hyperhomocysteinemia in hypofertile male patients can be alleviated by supplementation with 5MTHF associated with one carbon cycle support.

Introduction: Homocysteine (Hcy) is a cellular poison, side product of the hydrolysis of S-Adenosyl Homocysteine, produced after the universal methylation effector S -Adenosylmethionine liberates a methyl group to recipient targets. It inhibits the methylation processes and its rising is associated with multiple disease states and ultimately is both a cause and a consequence of oxidative stress, affecting male gametogenesis. We have determined hyper homocysteinhemia (HHcy) levels can be reliably reduced in hypofertile patients in order to decrease/avoid associated epigenetic problems and protect the health of future children, in consideration of the fact that treatment with high doses of folic acid is inappropriate. Methods: Homocysteine levels were screened in male patients consulting for long-standing infertility associated with at least three failed Assisted Reproductive Technology (ART) attempts and/or repeat miscarriages. Seventy-seven patients with Hcy levels > 15 µM were treated for three months with a combination of micronutrients including 5- MethylTetraHydroFolate (5-MTHF), the compound downstream to the MTHFR enzyme, to support the one carbon cycle; re-testing was performed at the end of a 3 months treatment period. Genetic status for Methylenetetrahydrofolate Reductase (MTHFR) Single nucleotide polymorphisms (SNPs) 677CT (c.6777C > T) and 1298AC (c.1298A > C) was determined. Results: Micronutrients/5-MTHF were highly efficient in decreasing circulating Hcy, from averages 27.4 to 10.7 µM, with a mean observed decrease of 16.7 µM. The MTHFR SNP 677TT (homozygous form) and combined heterozygous 677CT/1298AC status represent 77.9% of the patients with elevated Hcy. Discussion: Estimation HHcy should not be overlooked in men suffering infertility of long duration. MTHFR SNPs, especially 677TT, are a major cause of high homocysteinhemia (HHcy). In these hypofertile patients, treatment with micronutrients including 5-MTHF reduces Hcy and even allows spontaneous pregnancies post treatment. This type of therapy should be considered in order to ensure these patients' quality of life and avoid future epigenetic problems in their descendants.

Quality of life of patients undergoing ovarian stimulation with injectable drugs in relation to medical practice in France.

The French study VISION is a multicentric, prospective and retrospective study, designed first to evaluate patients' quality of life during ovarian stimulation for ovulation induction, intrauterine insemination (IUI) or IVF, and secondly to analyse current medical practice in France. Answers were directly entered on a pocket PC. The study was conducted from January to August 2004 and 186 practitioners filled in a total of 1476 questionnaires. The percentages for the different treatments used were analysed according to type of technique [ovulation induction, IUI, IVF/intracytoplasmic sperm injection (ICSI)], type of product used [urinary gonadotrophins, recombinant FSH (rFSH), gonadotrophin-releasing hormone (GnRH) agonists and antagonists] and methods of administration (intramuscularly, subcutaneously, use of Pen-injector, nurses or self-injections). Initial and total amounts of urinary gonadotrophins per cycle were approximately 30% higher compared with rFSH for IUI and IVF. Generally, the impact of these treatments on professional or social life was less than expected. Patients saw self-injection as a significant improvement in their life, especially when using an injection pen, and when other drugs were also self-injected during treatment (human chorionic gonadotrophin, GnRH agonists or antagonists). Clear information is necessary to increase patient's compliance to the treatment. Simplification will make these procedures more patient-friendly and less of a struggle.