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Benkhalifa M.,University of Picardie Jules Verne | Ferreira Y.J.,Fertilys Inc. Laval | Chahine H.,Andrology Unit | Louanjli N.,IVF and Genetics Laboratory | And 3 more authors.
International Journal of Biochemistry and Cell Biology | Year: 2014

Mitochondria is a powerhouse organelle involved in ATP synthesis, calcium signaling, reactive oxygen species (ROS) by oxidative stress production, cell cycle arrest via apoptosis and sex steroid hormones biosynthesis. Improvement of sperm parameters such as motility, capacitation, acrosome reaction, and oocyte interaction, involve regulation of ROS levels by the mitochondria. In human, the relation between the quantitative level of mitochondrial DNA (mtDNA), oocyte cytoplasm maturation and fertilization potential, is not clear. It has been hypothesized that oocytes without sufficient wild type mtDNA and therefore able to generate ATP, would not normally be ovulated. This is reflected in the low numbers of mtDNA observed in degenerate oocytes obtained through super ovulation protocols during assisted reproductive technology programs. Different theories place mitochondria in a central role of oxidative damage to cells and tissues related to infertility declining and aging. Mitochondria-dependent apoptosis seems to be responsible for the pre and post-natal decline in germ cells, embryo development, implantation failure, and miscarriages. © 2014 Published by Elsevier Ltd.


Byun J.S.,Andrology Unit | Byun J.S.,Zaii Urological Institute | Yoon T.K.,CHA Medical University | Rhee H.W.,Andrology Unit | And 7 more authors.
Journal of Andrology | Year: 2012

Chronic prostatitis/chronic pelvic pain syndrome (CP/ CPPS) is a common condition that adversely affects men across a wide range of ages. A number of pharmacologic and nonpharmacologic therapies for CP/CPPS have been investigated. Our study aimed to evaluate the prevalence of CPPS in Korean men in their thirties and to investigate the effect of CPPS and medical treatment on semen quality. Of 314 men with prostatitis, 74 patients with CPPS class IIIA (23.6%) were eligible for the study; these patients underwent combined α-blocker and cyclo-oxygenase 2 inhibitor therapy. These 74 men were prospectively studied at a medical center in Seoul, Korea. A number of parameters, including ejaculations per month, semen variables, and the levels of hormones (such as follicle-stimulating hormone, estradiol [E2], luteinizing hormone [LH], testosterone, and prolactin) were evaluated. The mean number of ejaculations per month, the mean number of daily hours spent sitting at work, smoking, body mass index, LH and E2 levels, and semen parameters all showed significant differences (P < .0001) between the study patients and the controls. The combined regimen was effective in improving all aspects of semen quality except morphology (P < .05). CPPS class IIIA, which is notably prevalent among Korean men in the fourth decade of life, affects semen quality and poses a challenge to fertility. Proper treatment of CPPS class IIIA results in improved semen quality. Men with CPPS therefore require proper evaluation and treatment by andrologists/ urologists before planning a natural conception. © American Society of Andrology.


PubMed | IVF & Genetics Laboratory, University of Picardie Jules Verne, Fertilys Inc. and Andrology unit
Type: | Journal: The international journal of biochemistry & cell biology | Year: 2014

Mitochondria is a powerhouse organelle involved in ATP synthesis, calcium signaling, reactive oxygen species (ROS) by oxidative stress production, cell cycle arrest via apoptosis and sex steroid hormones biosynthesis. Improvement of sperm parameters such as motility, capacitation, acrosome reaction, and oocyte interaction, involve regulation of ROS levels by the mitochondria. In human, the relation between the quantitative level of mitochondrial DNA (mtDNA), oocyte cytoplasm maturation and fertilization potential, is not clear. It has been hypothesized that oocytes without sufficient wild type mtDNA and therefore able to generate ATP, would not normally be ovulated. This is reflected in the low numbers of mtDNA observed in degenerate oocytes obtained through super ovulation protocols during assisted reproductive technology programs. Different theories place mitochondria in a central role of oxidative damage to cells and tissues related to infertility declining and aging. Mitochondria-dependent apoptosis seems to be responsible for the pre and post-natal decline in germ cells, embryo development, implantation failure, and miscarriages.


Belloc S.,Reproductive Biology Unit | Hazout A.,Reproductive Biology Unit | Zini A.,McGill University | Merviel P.,University of Picardie Jules Verne | And 4 more authors.
Maturitas | Year: 2014

The recent trend toward delayed parenthood raises major safety concerns because of the adverse effects of aging on couple fertility. Studies have demonstrated that aging clearly affects female fertility, but can also affect male fertility. Although several theories have been proposed, the exact mechanisms responsible for the observed age-related decline in male fertility remain to be elucidated. It has been shown that advanced paternal age (PA) is associated with reduced semen volume as well as, reduced sperm count, motility and morphology. Recent studies have also reported that paternal aging is associated with a significant increase in the prevalence of both genomic and epigenomic sperm defects. In the context of natural and intrauterine insemination (IUI) conception, advanced paternal age has been associated with lower pregnancy rates and increased rates of spontaneous abortion (independent of maternal age). In IVF and oocyte donation programs, a significant decrease in late blastocyst development has been seen in those cycles using spermatozoa of men older than 55. However, no significant relationship between paternal age and IVF or ICSI pregnancy rates has been observed. Although there are no treatments that can fully restore the age-related decline in male fertility, various measures have been shown to optimize male fertility potential. Specific therapies (e.g. varicocelectomy) and lifestyle changes (e.g. dietary antioxidant supplements) may help minimize some of the age-related deleterious effects on spermatogenesis, such as, oxidative stress and endocrine abnormalities. © 2014 Elsevier Ireland Ltd.


Borghesi M.,University of Bologna | Brunocilla E.,University of Bologna | Schiavina R.,University of Bologna | Gentile G.,University of Bologna | And 6 more authors.
Actas Urologicas Espanolas | Year: 2015

Introduction Radical orchiectomy (RO) is still considered the standard of care for malignant germ cell tumors, which represent the vast majority of the palpable testicular masses. In those patients diagnosed with small testicular masses (STMs), testis-sparing surgery (TSS) could be an alternative treatment to RO. The aim of this updated review is to evaluate the current indications for TSS, and discuss the oncological and functional results of patients who had undergone organ-sparing surgery for STMs. Evidence acquisition A non-systematic review of the Literature using the Medline database has been performed, including a free-text protocol using the terms «testis sparing surgery», «testicular sparing surgery», «partial orchiectomy», «testis tumor», «sex cord tumor», and «testis function». Other significant studies cited in the reference lists of the selected papers were also evaluated. Evidence synthesis No randomized controlled trials comparing TSS with radical orchiectomy have been reported yet. In those patients with normal contra-lateral testis, the use of TSS is still controversial. In selected cases of gonadal masses < 2 cm, TSS seems to be a safe and feasible treatment option. Frozen section examination allows us to discriminate between benign and malignant neoplasms during TSS. Intermediate and long-term follow-up results showed no significant risk of local and distant recurrences in the main series reported in the literature. Conclusions TSS is an effective treatment for STMs in selected patients, limiting the unnecessary surgical over-treatments, without compromising the oncological and functional outcomes. Further studies are needed in order to confirm the oncological safety. © 2013 AEU.


PubMed | University of Bologna and Andrology Unit
Type: Journal Article | Journal: Actas urologicas espanolas | Year: 2015

Radical orchiectomy (RO) is still considered the standard of care for malignant germ cell tumours, which represent the vast majority of the palpable testicular masses. In those patients diagnosed with small testicular masses (STMs), testis-sparing surgery (TSS) could be an alternative treatment to RO. The aim of this updated review is to evaluate the current indications for TSS, and discuss the oncological and functional results of patients who had undergone organ-sparing surgery for STMs.A non-systematic review of the Literature using the Medline database has been performed, including a free-text protocol using the terms testis-sparing surgery, testicular sparing surgery, partial orchiectomy, testis tumour, sex cord tumour, and testis function. Other significant studies cited in the reference lists of the selected papers were also evaluated.No randomized controlled trials comparing TSS with radical orchiectomy have been reported yet. In those patients with normal contra-lateral testis, the use of TSS is still controversial. In selected cases of gonadal masses < 2 cm, TSS seems to be a safe and feasible treatment option. Frozen section examination allows us to discriminate between benign and malignant neoplasms during TSS. Intermediate and long-term follow-up results showed no significant risk of local and distant recurrences in the main series reported in the literature.TSS is an effective treatment for STMs in selected patients, limiting the unnecessary surgical over-treatments, without compromising the oncological and functional outcomes. Further studies are needed in order to confirm the oncological safety.


Elzinga-Tinke J.E.,Andrology Unit | Sirre M.E.,Andrology Unit | Looijenga L.H.J.,Rotterdam University | Van Casteren N.,Andrology Unit | And 2 more authors.
International Journal of Andrology | Year: 2010

Testicular microlithiasis (TM) is sometimes observed during scrotal ultrasound examinations in men. It has been suggested that TM is more prevalent in testes of men at risk for testicular carcinoma in situ (CIS), the precursor cells of all testicular germ cell tumours (TGCT). We have performed a retrospective analysis of ultrasound images and additional clinical data of a selected cohort of men and have determined the risk factor of TM and other ultrasound abnormalities for testicular CIS. Between 2002 and 2007, 176 testicular biopsies were performed in men with abnormalities found on the scrotal ultrasound. TM was found in 76/176 men (43.2%) and CIS was diagnosed in 20 of these men (26.3%). Here, we focused on the group of 76 men with TM to determine additional risk factors, besides TM, for CIS. In both groups, those with and without CIS, reproductive hormones, scrotal ultrasound images and patient history were compared. Predictive ultrasound findings for CIS were TM (sensitivity 100%, 95% CI: 0.8-1.0; specificity 64.1%, 95% CI: 0.6-0.7; PPV 26.3%, 95% CI: 0.2-0.4) and within this group an inhomogeneous testicular parenchyma (OR 16.1, 95% CI 2.4-106.8; sensitivity 75.0%, 95% CI: 0.5-0.9; specificity 79.0%, 95% CI: 0.7-0.9; PPV 50.0%, 95% CI: 0.3-0.7). Other significantly ultrasound characteristics for CIS in this population with TM were clusters of TM (p = 0.02) and intra-testicular lesions (p = 0.01). Men with CIS were found to have significantly lower values of inhibin-B (p = 0.02). Clusters of TM, intra-testicular lesions and lower values of inhibin-B were not significantly different in logistic regression analysis. TM on scrotal ultrasound of men with risk factors for TGCT and men with clinical signs of testicular maldevelopment has a high predictive value for CIS. However, the predictive value of an inhomogeneous testicular parenchyma, besides TM, for CIS is much higher. © 2010 European Academy of Andrology.


Smit M.,Andrology Unit | Romijn J.C.,Andrology Unit | Wildhagen M.F.,Andrology Unit | Veldhoven J.L.M.,Andrology Unit | And 2 more authors.
Journal of Urology | Year: 2010

Purpose: We prospectively evaluated changes in sperm chromatin structure in infertile patients before and after surgical repair of varicocele, and the impact on the pregnancy rate. Materials and Methods: Included in the study were 49 men with at least a 1-year history of infertility, a palpable varicocele and oligospermia. World Health Organization semen analysis and sperm DNA damage expressed as the DNA fragmentation index using the sperm chromatin structure assay were assessed preoperatively and postoperatively. Pregnancy (spontaneous and after assisted reproductive technique) was recorded 2 years after surgery. Results: Mean sperm count, sperm concentration and sperm progressive motility improved significantly after varicocelectomy from 18.3 × 10 6 to 44.4 × 10 6, 4.8 × 10 6/ml to 14.3 × 10 6/ml and 16.7% to 26.6%, respectively (p <0.001). The DNA fragmentation index decreased significantly after surgery from 35.2% to 30.2% (p = 0.019). When the definition of greater than 50% improvement in sperm concentration after varicocelectomy was applied, 31 of 49 patients (63%) responded to varicocelectomy. After varicocelectomy 37% of the couples conceived spontaneously and 24% achieved pregnancy with assisted reproductive technique. The mean postoperative DNA fragmentation index was significantly higher in couples who did not conceive spontaneously or with assisted reproductive technique (p = 0.033). Conclusions: After varicocelectomy sperm parameters significantly improved and sperm DNA fragmentation was significantly decreased. Low DNA fragmentation index values are associated with a higher pregnancy rate (spontaneous and with assisted reproductive technique). We suggest that varicocelectomy should be considered in infertile men with palpable varicocele, abnormal semen analysis and no major female factors. © 2010 American Urological Association.


PubMed | Andrology Unit
Type: | Journal: Urologia | Year: 2016

Distal extrusion of cylinders is a potential complication of the penile prosthesis implantation. Several methods have been proposed for repairing a distal penile erosion. We present our preliminary experience in Distal corporoplasty technique.We enrolled 18 consecutive patients whose underwent a distal corporoplasty with simultaneous reimplantation of an AMS 700 inflatable penile prosthesis (LGX) from January 2013 to November 2015 at our hospital. All procedures were performed by a single surgical team. Intraoperative and postoperative complications have been classified and reported according to Satava6 and Clavien-Dindo (CD) system.7 Mean values with standard deviations (SD) were computed and reported for all items.Mean age of the patients was 53.61 (11.90) years. Mean body max index (BMI) was 24.22 (2.51). Mean operative time was 85.2 (13.1) minutes. Blood losses were minimal. No intraoperative complications are reported according to Satava classification. Four out of 18 patients (22.22%) experienced postoperative complications according to CD system. All patients had sexual intercourse for the first time postsurgery after a mean of 59.11 2.08 days. Mean follow-up was 22.11 (9.95).Distal extrusion of cylinders is a potential complication of the penile prosthesis implantation. Distal corporoplasty was first described by Mulcahy. He reported a series of 14 patients with a follow-up of about 2 years with optimal functional outcomes. Moreover, distal corporoplasty resulted in shorter operative time, better function, less pain, and fewer recurrences than Gortex windsock repair.10 In our experience, distal corporoplasty is a simple and safe procedure in the treatment of distal cylinders extrusion when the prosthetic material is not exposed to the exterior.


PubMed | Andrology Unit
Type: Journal Article | Journal: Best practice & research. Clinical endocrinology & metabolism | Year: 2011

Infertility affects about 7% of all men. The etiology of impaired sperm production and function can be related to factors acting at pre-testicular, post-testicular or directly at the testicular level. Primary testicular failure accounts for about 75% of all male factor infertility. Genetic factors can be identified in about 15% of cases (congenital hypogonadotrophic hypogonadism, congenital absence of vas deferens, primitive testicular failure). Despite progresses, mainly in the field of genetics, the etiology is still unknown in about 50% cases and it is termed idiopathic infertility. A part from few exceptions, the only available therapy for male factor infertility is assisted reproduction which allows conception also in severe male factor, including azoospermia following testicular sperm extraction. The complete diagnostic workup is important for: i) the identification of treatable/reversible or health-threatening conditions; ii) selection of patients for assisted reproductive techniques; iii) for appropriate genetic counselling including preventive measures (preimplanatation or prenatal diagnosis) to safeguard the health of future offspring.

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