SRHR Evidence (Best practice, Systematic reviews)
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Item Dietary cholesterol and lipid overload: impact on male fertility(Oxidative Medicine and Cellular Longevity, 2019-12-06) Saez, Fabrice; Drevet, Joël R.Lipid metabolic disorders due to poor eating habits are on the rise in both developed and developing countries, with a negative impact of the “Western diet” on sperm count and quality. Dietary lipid imbalance can involve cholesterol, fatty acids, or both, under different pathophysiological conditions grouped under the term dyslipidemia. The general feature of dyslipidemia is the development of systemic oxidative stress, a well-known deleterious factor for the quality of male gametes and associated with infertility. Sperm are particularly rich in polyunsaturated fatty acids (PUFA), an important characteristic associated with normal sperm physiology and reproductive outcomes, but also targets of choice for oxidative thrust. This review focuses on the effects of dietary cholesterol or different fatty acid overload on sperm composition and function in both animals and humans. The links between oxidative stress induced by dyslipidemia and sperm dysfunction are then discussed, including possible preventive or therapeutic strategies to preserve gamete quality, longevity when stored in cryobanking, and male fertility.Item Bisphenol A and male fertility: myths and realities(Frontiers in Endocrinology, 2020-06-12) Castellini, Chiara; Totaro, Maria; Parisi, Antonio; D'Andrea, Settimio; Lucente, Liana; Cordeschi, Giuliana; Francavilla, Sandro; Francavilla, Felice; Barbonetti, ArcangeloBisphenol A (BPA) represents the main chemical monomer of epoxy resins and polycarbonate plastics. The environmental presence of BPA is widespread, and it can easily be absorbed by the human body through dietary and transdermal routes, so that more than 90% of the population in western countries display detectable BPA levels in the urine. As BPA is qualified as an endocrine disruptor, growing concern is rising for possible harmful effects on human health. This review critically discusses the available literature dealing with the possible impact of BPA on male fertility. In rodent models, the in vivo exposure to BPA negatively interfered with the regulation of spermatogenesis throughout the hypothalamic–pituitary–gonadal axis. Furthermore, in in vitro studies, BPA promoted mitochondrial dysfunction and oxidative/apoptotic damages in spermatozoa from different species, including humans. To date, the claimed clinical adverse effects on male fertility are largely based on the results from studies assessing the relationship between urinary BPA concentration and conventional semen parameters. These studies, however, produced controversial evidence due to heterogeneity in the extent of BPA exposure, type of population, and enrollment setting. Moreover, the cause–effect relationship cannot be established due to the cross-sectional design of the studies as well as the large spontaneous between- and within-subject variability of semen parameters. The best evidence of an adverse effect of BPA on male fertility would be provided by prospective studies on clinically relevant endpoints, including natural or medically assisted pregnancies among men either with different exposure degrees (occupational/environmental) or with different clinical conditions (fertile/subfertile).Item Approaches and technologies in male fertility preservation(International Journal of Molecular Sciences, 2020-07-31) Huleihel, Mahmoud; Lunenfeld, EitanMale fertility preservation is required when treatment with an aggressive chemo-/-radiotherapy, which may lead to irreversible sterility. Due to new and efficient protocols of cancer treatments, surviving rates are more than 80%. Thus, these patients are looking forward to family life and fathering their own biological children after treatments. Whereas adult men can cryopreserve their sperm for future use in assistance reproductive technologies (ART), this is not an option in prepubertal boys who cannot produce sperm at this age. In this review, we summarize the different technologies for male fertility preservation with emphasize on prepubertal, which have already been examined and/or demonstrated in vivo and/or in vitro using animal models and, in some cases, using human tissues. We discuss the limitation of these technologies for use in human fertility preservation. This update review can assist physicians and patients who are scheduled for aggressive chemo-/radiotherapy, specifically prepubertal males and their parents who need to know about the risks of the treatment on their future fertility and the possible present option of fertility preservation.Item Minimal access to male fertility prices online: an analysis of the Society for Assisted Reproductive Technology (SART) clinics(Translational Andrology and Urology, 2020-10) Larsen, Ryan G.; Bowdino, Cole S.; Mathes, Melissa A.; Gustin, Stephanie L.; Deibert, Christopher M.Background: Though insurance coverage is evolving for male infertility services, most patients continue to pay out of pocket. These costs such as semen analysis and intracytoplasmic sperm injection preparation may affect the utilization of those services. We sought to determine online price transparency specifically for male infertility services on the websites of in-vitro fertilization (IVF) clinics in the US. Methods: In this cross-sectional analysis, pricing data was acquired from each clinic on the Society for Assisted Reproductive Technology (SART) website as of July 2019. Each website was examined for availability and cost of services. Pricing data that required applying for a quote or a phone call was excluded. Mean price was calculated for each service. Additionally, practice location in an insurance coverage mandated state (ICMS) was also analyzed to evaluate for any effect on price transparency. Results: Only 24.7% (89/361) of SART clinic websites included any pricing information. Of clinics with websites (361/383), 16.3% (59/361) had ≥2 prices reported and only 5.0% (18/361) had ≥6 prices reported. Only 3.6% (13/361) reported prices for male-related infertility services. Average semen analysis price was $161 of 10 reporting clinics. Four clinics reported sperm cryopreservation or annual sperm storage price, $388 and $555, respectively. Sperm retrieval cost $244 at the two reporting clinics. ICMS did not affect male price transparency, ICMS 3.1% (6/194) vs. non-ICMS 4.2% (7/167) (P=0.576). Conclusions: Price transparency of SART clinics on websites is relatively poor with only about one-quarter of clinics providing any cost information at all. Male infertility related pricing information is even more rarely reported compared to other IVF services potentially causing a stronger barrier for males to pursue infertility treatment.Item Regulation of male fertility by the renin-angiotensin system(International Journal of Molecular Sciences, 2020-10-26) Gianzo, Marta; Subirán, NereaThe renin-angiotensin system (RAS) is a peptidic system known mainly for its roles in the maintenance of blood pressure and electrolyte and fluid homeostasis. However, several tissues and cells have been described to possess an intrinsic RAS that acts locally through different paracrine and autocrine mechanisms. In the male reproductive system, several components of this system have been observed in various organs and tissues, such as the testes, spermatozoa and seminal fluid. Some functions attributed to this local RAS are maintenance of seminal plasma electrolytes, regulation of steroidogenesis and spermatogenesis, and sperm functions. However, their specific actions in these locations are not fully understood. Therefore, a deep knowledge of the functions of the RAS at both the testicular and seminal levels could clarify its roles in male infertility and sperm physiology, and the different RAS elements could be used to design tools enabling the diagnosis and/or treatment of male infertility.