The effect of short term exposure to outdoor air pollution on fertility.

BACKGROUND: There is evidence to suggest that long term exposure to air pollution could be associated with decreased levels of fertility, although there is controversy as to how short term exposure may compromise fertility in IVF patients and what windows of exposure during the IVF process patients could be most vulnerable. METHODS: This prospective cohort study aimed to evaluate the impact of acute exposure that air pollution have on reproductive outcomes in different moments of the IVF process. Women undergoing IVF living in Barcelona were recruited. Individual air pollution exposures were modelled at their home address 15 and 3 days before embryo transfer (15D and 3D, respectively), the same day of transfer (D0), and 7 days after (D7). The pollutants modelled were: PM2.5 [particulate matter (PM) ≤2.5 µm], PMcoarse (PM between 2.5 and 10µm), PM10 (PM≤10 µm), PM2.5 abs, and NO2 and NOx. Outcomes were analyzed using multi-level regression models, with adjustment for co-pollutants and confouding factors. Two sensitivity analyses were performed. First, the model was adjusted for subacute exposure (received 15 days before ET). The second analysis was based on the first transfer performed on each patient aiming to exclude patients who failed previous transfers. RESULTS: One hundred ninety-four women were recruited, contributing with data for 486 embryo transfers. Acute and subacute exposure to PMs showed a tendency in increasing miscarriage rate and reducing clinical pregnancy rate, although results were not statistically significant. The first sensitivity analysis, showed a significant risk of miscarriage for PM2.5 exposure on 3D after adjusting for subacute exposure, and an increased risk of achieving no pregnancy for PM2.5, PMcoarse and PM10 on 3D. The second sensitivity analysis showed a significant risk of miscarriage for PM2.5 exposure on 3D, and a significant risk of achieving no pregnancy for PM2.5, PMcoarse and PM10 particularly on 3D. No association was observed for nitrogen dioxides on reproductive outcomes. CONCLUSIONS: Exposure to particulate matter has a negative impact on reproductive outcomes in IVF patients. Subacute exposure seems to increase the harmful effect of the acute exposure on miscarriage and pregnancy rates. Nitrogen dioxides do not modify significantly the reproductive success.

Outdoor air pollution and sperm quality.

UNLABELLED: Exposure to air pollution has been clearly associated with a range of adverse health effects, including reproductive toxicity, but its effects on male semen quality are still unclear. We performed a systematic review (up to June 2016) to assess the impact of air pollutants on sperm quality. We included 17 semi-ecological, panel, and cohort studies, assessing outdoor air pollutants, such as PM2.5, PM10, NOx, SO2, and O3, and their effects on DNA fragmentation, sperm count, sperm motility, and sperm morphology. Thirteen studies assessed air pollution exposure measured environmentally, and six used biomarkers of air pollution exposure (two did both). We rated the studies using the Newcastle-Ottawa Scale and assessed with the exposure method. Taking into account these factors and the number of studies finding significant results (positive or negative), the evidence supporting an effect of air pollution on DNA fragmentation is weak but suggestive, on sperm motility is limited and probably inexistent, on lower sperm count is inconclusive, and on sperm morphology is very suggestive. Because of the diversity of air pollutants and sperm parameters, and the studies' designs, we were unable to perform a meta-analysis. In summary, most studies concluded that outdoor air pollution affects at least one of the four semen quality parameters included in the review. However, results lack consistency, and furthermore, studies were not comparable. Studies using standardized air pollution and semen measures are required to obtain more reliable conclusions. PROSPERO REGISTRATION NUMBER: CRD42015007175.

La percepción del hombre cuando acude a un centro de reproducción asistida / Male perception of assisted reproduction treatments

Objetivo: El objetivo de este trabajo es describir la percepción de varones infértiles que se someten a tratamientos de reproducción asistida (RA). Se recogió información acerca de su experiencia antes y después del tratamiento, pruebas realizadas, atención médica recibida, etc. Material y métodos: Se trata de un estudio prospectivo, observacional y descriptivo, donde se entrevistaron un total de 46 hombres de los muchos que acudieron a la I Feria de Reproducción Asistida, celebrada en Valencia. Todos los individuos completaron un cuestionario con un total de 33 preguntas relacionadas con su experiencia personal durante el tratamiento realizado. Resultados: Durante la anamnesis, el 22% de los hombres manifiestan que no se les interrogó, y el 52% de que fue breve. No se realizó una exploración genital al 67% de los casos. Hasta el 55% de los pacientes declaran que han sido poco o nada informados acerca de la causa de su esterilidad. En la mitad de los casos con un tratamiento previo, no se explican las posibles razones del resultado fallido. Conclusiones: Aunque el número de casos es limitado, las conclusiones son claras acerca de la poca participación de andrólogos/urólogos en los centros de reproducción asistida. Se percibe una falta de información general tanto en la fase diagnóstica como durante el tratamiento. Es imprescindible mejorar esta situación, ampliando este tipo de estudios y adecuándolos como herramientas rutinarias para conocer el grado de calidad asistencial de nuestros pacientes (AU)

Objective: The aim of this paper is to describe the perceptions of infertile men who undergo assisted reproduction treatments. Information about their experience (before and after the treatment), diagnostic tests and medical care were collected. Material and methods: A prospective, observational and descriptive study with a total of 46 men who visited the I Assisted Reproduction Fair held in Valencia was carried out. All subjects completed a questionnaire with a total of 33 questions related to their personal experience during the treatment performed. Results: In the anamnesis phase, men reported they had not been questioned adequately in 22% of cases, and questioned briefly in 52% of cases. A genital exploration was performed in 33% of cases. Clinical information received about the cause of infertility was poor or non-existent in 55% of cases. In previously treated patients, up to 50% of cases were not informed of potential causes of failures. Conclusions: Although the number of cases is limited, the findings are clear about the low participation of andrologists/urologists in assisted reproduction centers. A general lack of information on both the diagnostic phase and during treatment is perceived. It is essential to improve this situation, to extend these studies and adapt them as a routine to determine the care quality of our patients (AU)

Diagnostic value of sperm DNA fragmentation and sperm high-magnification for predicting outcome of assisted reproduction treatment.

Over the last years, major improvements in the field of male infertility diagnosis have been achieved. The aim of this study was to determine the diagnostic usefulness of sperm DNA integrity and sperm vacuolisation for predicting outcome in infertile couples undergoing in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI) treatments. A cohort study from 152 infertile couples undergoing sperm DNA fragmentation and high-magnification tests prior to an assisted reproduction treatment was designed. We found that the most predictive cutoff for pregnancy was 25.5% of DNA fragmentation with a negative predictive value of 72.7% (P=0.02). For the degree of vacuolisation, the best predictor of pregnancy was 73.5% of vacuolated sperm grades III+IV with a negative predictive value of 39.4% (P=0.09), which was not statistically significant. In conclusion, sperm DNA fragmentation greater than 25.5% could be associated with higher probability of failure IVF treatment. Regarding the results of the sperm analysis at high magnification, they do not allow us to predict whether or not patients will become pregnant.

Coenzyme Q10 and male infertility: a meta-analysis.

OBJECTIVE: To evaluate the effect of coenzyme Q10 treatments in male infertility, specifically in these parameters: live birth and pregnancy rates, CoQ10 seminal concentration, sperm concentration, and sperm motility. MATERIALS AND METHODS: Systematic review and meta-analysis in male infertility patients with CoQ10 oral treatments. Three trials were included: 149 males in CoQ10 group and 147 males in placebo group. RESULTS: None of the included trials provided any data regarding live births. The results of this meta-analysis show that supplementing infertile men with CoQ10 does not increase pregnancy rates. The analysis showed, among patients receiving CoQ10 treatment, a statistically significant increase in: CoQ10 seminal concentration (RR 49.55, 95 % CI 46.44 to 52.66, I(2) = 17 %), sperm concentration (RR 5.33, 95 % CI 4.18 to 6.47, I(2) = 58 %), and sperm motility (RR 4.50, 95 % CI 3.92 to 5.08, I(2) = 0 %) CONCLUSION: There is no evidence in the literature that CoQ10 increases either live birth or pregnancy rates, but there is a global improvement in sperm parameters. Adequately powered, robust trials of individual and combination antioxidant therapies are required to guide clinical practice.

Use of high-magnification microscopy for the assessment of sperm recovered after two different sperm processing methods.

OBJECTIVE: To compare the quality of sperm samples obtained after density-gradient centrifugation and swim-up by performing a nuclear structural analysis with high magnification microscopy at ×8,000. DESIGN: Prospective and randomized split-sample study. SETTING: Reproductive Medicine Center. PATIENT(S): Sperm samples from 53 male-partners of couples undergoing infertility treatment. INTERVENTION(S): Samples were analyzed by high magnification microscopy before and after preparation and classified according the level of nuclear vacuolization. MAIN OUTCOME MEASURE(S): Recovery rate, motility rate and percentage of sperm scoring each of 4 grades of vacuolization in fresh and processed sample. RESULT(S): Both sperm processing methods, swim-up and density gradient centrifugation, allow the selection of sperm with lower nuclear vacuolization and presumably lower DNA fragmentation than the whole ejaculate. CONCLUSION(S): Swim-up produces samples with less vacuolization, but the recovery rate is also lower. The choice of processing technique would then depend on whether intrauterine insemination, IVF or ICSI/IMSI is to be performed. A prospective randomized study scoring fertility rates would be necessary to directly access the influence of these methods on the fertility outcome.

Paraoxonase-1 is only present in traceable amounts in seminal fluid and does not show any relationship with male subfertility.

UNLABELLED: Study Type - Aetiology (case series). LEVEL OF EVIDENCE: 4. What's known on the subject? and What does the study add? Oxidative stress seems to be one of the biochemical causes of defective sperm function. Paraoxonases are antioxidant enzymes that degrade lipid peroxides. There is a paucity of data on the possible role played by these enzymes in the pathophysiology of male sub-fertility. The present study shows that testicular tissue of sub-fertile patients clearly expresses paraoxonases-1, 2, and 3. These findings suggest a role for these enzymes in the protection against lipid peroxidation inside the cell. However, the concentration and activity of paraoxonase-1 in semen are negligible and are probably the result of cellular catabolism, with no significant biological function. OBJECTIVE: To characterise the immunohistochemical sites of paraoxonase (PON) 1, PON2 and PON3 in human testicular tissue, and to analyse PON1 levels in semen, aiming to investigate the role played by these enzymes in the pathophysiology of male subfertility. PATIENTS AND METHODS: The present study was performed in 41 semen samples from normal donors and in 52 semen samples and ten testicle biopsies from patients who were being evaluated for causes of subfertility. RESULTS: Immunohistochemical analyses showed high levels of PON1 and PON3 expression in testicular tissue. PON2 expression was also detected, albeit at weaker levels. Oxidative stress indicators in biopsies were low and localized in some specific areas of the seminiferous tubules. PON1 was detected in seminal fluid at very low levels but with no significant differences between patients and controls. Receiver-operating characteristic analysis showed a low diagnostic power of semen PON1 levels. CONCLUSIONS: The present study shows high protein expression levels of PON1, PON2 and PON3 in testicular cells. The concentrations and activities of PON1 in semen are negligible and are probably the result of cellular catabolism, with no significant biological function in the testes.