Male Subfertility; Challenges and advancement in the andrology clinic at Khyber Pakhtunkhwa, Pakistan

Objective: This study is aimed to discuss the challenges in dealing the infertile male and advances in the treatment of male infertility. Material and methods: The study included infertile male patients who presented to andrology outpatient as primary or secondary infertility between December 2018 and January 2021. The data detailed different aspects of challenges and advances in male infertility treatment. The data analysisone with SPSS. Results: Total 289 patients included, most of them (74%) presented as primary infertility and a quarter presented as secondary infertility. The mean delay in presentation was 6.8 years which were due to treatment from non-andrologist doctors of different specialities (53.9%), hakims (15.2%), quacks (13.8%), gynaecologists (10.3%) and some were reluctant to tell their problem (6.5%). The diagnosis was N.O.A (42.9%), unexplained infertility (24.2%), varicocele (22.8%), OA (6.2%), OAT syndrome (2.7%) and CABVD (1%). Different treatment option opted were vasography plus vasovasostomy or vasoepididmostomy (31.1%), ART (23.9%), MSV (22.8%) and medical treatment (22.1%). Vasography plus vasovasostomy or vasoepididmostomy and medical treatment were the available options provided. There was no ART facility and those who were counseled for referral either their unwillingness or cost resulted in a hurdle in their provision. Conclusion: There are still a number of challenges in treating infertile men. Recently provision of medical and microsurgical treatment at andrology clinic resulted in proper treatment of a large number of infertile men who previously received treatment from un- related facilities.

Aneuploidy in sperm of fertile men and patients with impaired fertility

The review presents generalized current data on sperm aneuploidy in healthy (fertile) men and infertile male patients with a normal karyotype and with chromosomal abnormalities. The mechanisms of aneuploidy in germ cells, factors affecting of its level, the relationship with defects of spermatogenesis, meiosis, decreased sperm parameters, as well as the effect of sperm aneuploidy on male fertility, embryo development and gestation are discussed.

Effectiveness of mesenchymal stem cells cultured under hypoxia to increase the fertility rate in rats (Rattus norvegicus)

Background and Aim: Mesenchymal stem cells (MSCs) transplanted into the testes of rats with testicular failure can help rescue fertility. However, the low viability of transplanted MSCs limits the success of this treatment. This study aimed to determine the effectiveness of MSCs cultured under hypoxia to increase the fertility rate in rats (Rattus norvegicus). Materials and Methods: Bone marrow-derived MSCs (200 million cells/rat) were transplanted into male rat models with induced infertility (10 rats/treatment group) after 4 days of culture in 21% O2 (normoxia) and 1% O2 (hypoxia). Ten fertile and 10 untreated infertile rats served as controls. In the infertile male rats that had been fasted from food for 5 days, the fasting condition induced malnutrition and then resulted in testicular failure. Results: The results indicated that the MSCs cultured under hypoxic conditions were more effective than those cultured in normoxic conditions as a treatment for testicular failure in infertile male rats based on the increased number of cells expressing p63 as a quiescent cell marker and ETV5 as a transcription factor expressed in Sertoli and germ cells. Furthermore, the structure of the seminiferous tubules, which contain spermatogonia, primary and secondary spermatocytes, and spermatid, Sertoli, and Leydig cells, was improved in infertile male rats treated with the MSCs cultured under hypoxic conditions. Conclusion: The testicular transplantation of MSCs cultured under hypoxic conditions was an effective treatment for testicular failure in rats.

A Comparative Analysis of the Altered Levels of Human Seminal Plasma Constituents as Contributing Factors in Different Types of Male Infertility

(1) Background: The relationships between the biochemical and immunological components in seminal plasma and their physiological effects on male reproductive system have been underreported. In this study, we evaluated the potential of several seminal plasma biochemical and immunological markers in the pathophysiological developments of the infertile male patients. The study was designed to identify and assess different markers that may be associated with semen functions in different types of male infertility. (2) Methods: A total of 50 infertile male patients who underwent checkup for fertility assessment and 50 fertile controls were included in this study. The complete medical history of each recruited participant was reviewed. The infertile sub-groups (non-obstructive azoospermia (NOA), asthenozoospermia (AS), normozoospermic infertile (NI), and oligozoospermia (OZ)) were characterized based on sperm motility and concentration, while NI patients were included after a thorough check up of their female partners as well. We investigated each sample for 21 different analytes, enzymes, trace elements, and immunological markers to find crucial markers posing as contributing factors to a specific type of male infertility. (3) Results: The levels of 15 out of 21 markers, assayed from the seminal plasma of infertile males, were significantly altered in comparison to fertile controls (p < 0.05). For the first time, microprotein levels were also analyzed. The presence of monocytes, lymphocytes, and granulocytes was limited to semen from NOA patients, while a significant increase in the level of platelets was observed in AS. Hierarchical clustering and ROC-AUC analysis identified the three most significant markers (zinc, LDH, and TG) for the healthy control group and asthenozoospermic group (AUC, of 0.92 and 0.81, respectively). (4) Conclusions: The altered levels of biochemical and immunological markers in seminal plasma might be associated with the different male infertility profiles and could be required for the sperm metabolism and maintenance. However, a larger sample size and follow up analysis is required for establishing the hypothesized panel of markers as biomarkers at clinical stage.

THE COMPARISON OF CIGARETTE CONSUMPTION TOWARDS SEMEN ANALYSIS IN ANDROLOGY POLYCLINIC OF DR. SOETOMO GENERAL ACADEMIC HOSPITAL, SURABAYA, INDONESIA IN 2017

Background: The habit of smoking tobacco is a lifestyle that has become a necessity for some people. Sometimes, social needs is the main reason for someone to have a smoking habit. Based on this problem, the level of cigarette consumption in the community has increased. Nowadays, the total number of couples visiting an infertility clinic is on the rise. This have led to an assumption among the community that smoking tobacco is one of the main factors causing male infertility. Objective: to compare light smokers and heavy smokers towards the results of semen analysis in infertile male patients. Materials and Methods: This study was an observational analytics, with a retrospective-cross sectional. The instrument used in this study was taken from medical records of the patients who visited the Andrology Clinic of Dr. Soetomo General Academic Hospital, Surabaya, Indonesia, for the period from January to December 2017. The observed semen analysis parameters were concentration, motility, and morphology for microscopic examination and liquefaction, pH, and volume for macroscopic examination, by following the inclusion and exclusion criteria. Results: Ninety-two samples of infertile male participants (50 light smokers and 42 heavy smokers) were included in this study. Semen analysis on its concentration, motility, spermatozoa morphology, as well as liquefaction, pH, and volume) towards the number of cigarette consumption showed no significant difference (p>0.05) between light smokers and moderate smokers. Conclusion: There was no significant difference between the light smoker and heavy smoker groups on the results of the semen analysis.

Semen testis expressed protein 101 and spermatid-specific thioredoxin reductase 3 levels may be biomarkers in infertile male

Objectives We aimed to determine the differences between normozoospermic and oligozoospermic individuals according to levels of spermatid-specific thioredoxin reductase 3 (SPTRXR3/STRX3/TXNDC8/TXNRD3) and testis expressed protein 101 (TEX-101), and to evaluate the correlations between spermiogram data and biochemical parameters. Methods The study was carried out at the Andrology Laboratory of Medicine Faculty of Selcuk University. Two groups were designed: Group 1: Normozoospermia (n=40, sperm concentration ≥ 15 million/mL), Group 2: Oligozoospermia; (n=40, sperm concentration < 15 million/mL). Seminal plasma SPTRXR3 and TEX-101 levels were analyzed with ELISA method. Spermiogram analysis was evaluated according to WHO 2010 Kruger criteria. Results TEX-101 protein levels were significantly different in normozoospermia (2.12 ± 0.08 ng/mL) compared to oligozoospermia (1.55 ± 0.04 ng/mL). SPTRXR3 levels (6.98 ± 0.46 ng/mL) were higher in oligozoospermia than normozoospermia (3.07 ± 0.35 ng/mL). Both TEX-101 and SPTRXR3 levels were correlated statistically with most of the spermiogram parameters. Conclusions High SPTRXR3 and low TEX-101 levels may be a biomarker in evaluation of male infertility. The relations between spermiogram parameters indicates that results present a new clinical approach in biology of oligozoospermic male.