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1. Empirical medical therapy for idiopathic male infertility

Author

Hatim Thaker, M.D., Edmund Y. Ko, M.D., Edmund S. Sabanegh, M.D., Robert E. Brannigan, M.D., Joseph P. Alukal, M.D., and Mary K. Samplaski, M.D.

Subjects
Male infertility, testosterone, empirical medical therapy, clomiphene citrate, sperm analysis, Diseases of the genitourinary system. Urology, RC870-923, Gynecology and obstetrics, RG1-991
Abstract

Objective: To determine if there has been a change in empirical medical therapy (EMT) practices since a 2010 American Urological Association survey reported that 25% of urologists treated infertile men who were pursuing a pregnancy with testosterone (T). Design: Survey-based cohort study of AUA members. Setting: Practice patterns were evaluated of urologists in academic and nonacademic hospital centers. Patient(s): Practice patterns were evaluated in the treatment of men with idiopathic infertility. Interventions(s): None. Main Outcome Measure(s): Subgroup analysis by means of univariate analysis between means (Fisher exact test) and descriptive proportions was used to compare male infertility fellowship–trained urologists (RUs) to general urologists (non-RUs). Result(s): A total of 191 urologists responded (4.7%). Excluding trainees, 164 responses (85.9%) were analyzed: 134 (82.3%) were from non-RUs and 29 from (17.7%) RUs. Over all, 65.9% treated male infertility with a combination of EMT and surgery (93.1% of RU vs. 60.4% of non-RUs). The most common medications used by RUs were clomiphene (100%), anastrozole (85.7%), and hCG/LH (82.1%). Non-RUs used these less frequently. Overall, 24.4% of the urologists reported that they would use T to treat male infertility: 14.4% (n = 4) of RUs and 24.4% (n = 30) of non-RUs. Conclusion(s): A total of 65.9% of urologists would treat male infertility with the use of EMT and surgery. The most common EMTs were clomiphene, anastrozole, and hCG/LH. Of concern, 24.4% of urologists considered T to treat male infertility, a medication with known contraceptive potential. This is unchanged from the 2010 survey, and confirms the need for reproductive medicine guidelines that include the topic of EMT use in infertile men.

Published
2020
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2. Role of reactive oxygen species in male infertility: An updated review of literature

Author

Edmund Y. Ko, Julie W. Cheng, and Hillary Wagner

Subjects
0301 basic medicine, Infertility, ATP, adenosine triphosphate, Etiology, Urology, media_common.quotation_subject, Fertility, Free radicals, GPX, glutathione peroxidase, medicine.disease_cause, Bioinformatics, Antioxidants, Male infertility, Superoxide dismutase, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, ROS, reactive oxygen species, NADH, nicotinamide adenine dinucleotide, SOD, superoxide dismutase, Medicine, media_common, chemistry.chemical_classification, MDA, malondialdehyde, Reactive oxygen species, NO, nitric oxide, 030219 obstetrics & reproductive medicine, biology, business.industry, medicine.disease, Malondialdehyde, Diseases of the genitourinary system. Urology, 030104 developmental biology, chemistry, Catalase, biology.protein, 4-HNE, 4 hydroxy-nonenal, ESR, electron spin resonance, RC870-923, CAT, catalase, business, G-6-PDH, glucose-6-phosphate dehydrogenase, Oxidative stress, MAGI, male accessory gland infections
Abstract

Objectives: To review the literature and provide an updated summary on the role of reactive oxygen species (ROS) in male infertility. Methods: A review of PubMed, Cochrane review, and Web of Science databases for full-text English-language articles published between 1943 and 2017 was performed, focusing on the aetiology of ROS, physiological role of ROS on spermatic function, pathological role of ROS in infertility, evaluation of ROS, and role of antioxidants in oxidative stress. Results: ROS play a role in spermatic function and fertilisation. The literature describes both a physiological and a pathological role of ROS in fertility. A delicate balance between ROS necessary for physiological activity and antioxidants to protect from cellular oxidative injury is essential for fertility. Conclusion: Although elevated levels of ROS are implicated as a cause of infertility, there is no consensus on selecting patients to test for ROS, which test to perform, or if treatment for ROS can have a positive impact on infertility rates and pregnancy. Keywords: Reactive oxygen species, Male infertility, Free radicals, Antioxidants

Published
2017

3. Contributors

Author

Ashok Agarwal, R. John Aitken, Marco G. Alves, Mark A. Baker, Albert D. Bui, Meaghanne Caraballo, Gagan B.N. Chainy, Shu-Jian Chen, Julie W. Cheng, Chak-Lam Cho, Geoffrey N. De Iuliis, Joel R. Drevet, Damayanthi Durairajanayagam, Nicolás Garrido, Sezgin Gunes, Sajal Gupta, Gerhard Haidl, Ralf R. Henkel, James M. Hotaling, Soumya Ranjan Jena, Srikanta Jena, Edmund Y. Ko, Kristian Leisegang, Asli M. Mahmutoglu, Jasmine Nayak, Jacob Netherton, Pedro F. Oliveira, Michael Owyong, Manesh Kumar Panner Selvam, Biren V. Patel, Ranjith Ramasamy, Luís Rato, Rocío Rivera, Edmund Sabanegh, Dipak Kumar Sahoo, Luna Samanta, Rakesh Sharma, Suresh C. Sikka, Branca M. Silva, Michael C. Solomon, Mário Sousa, Nicholas N. Tadros, Gülgez Neslihan Hekim Taşkurt, Jaideep S. Toor, Kelton Tremellen, Eva Tvrda, and Sarah C. Vij

Published
2019

4. Causes of Reductive Stress in Male Reproduction

Author

Julie W. Cheng and Edmund Y. Ko

Subjects
chemistry.chemical_classification, Reactive oxygen species, Antioxidant, chemistry, Male fertility, business.industry, medicine.medical_treatment, medicine, Physiology, Male reproductive system, business, medicine.disease_cause, Oxidative stress
Abstract

As there is concern for oxidative stress and its effects on male fertility, antioxidant supplementation has been used as a means of combating oxidative stress in the modern-day lifestyle. Antioxidant supplementation, however, is currently unregulated and has the potential to cause or perpetuate tissue injury. Shifting the equilibrium of chemical reactions within the human body away from oxidation and toward the other extreme is also not without its risks. While additional studies are needed, there is an emerging understanding of the clinical manifestations of reductive stress. An abundance of reducing agents can result in loss of necessary oxidation mechanisms, promotion of additional tissue injury, and a paradoxical increase in reactive oxygen species. This chapter discusses the antioxidant paradox, identifies enzymatic and nonenzymatic reducing agents within the male reproductive system, and reviews the clinical implications of reductive stress.

Published
2019

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