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Agarwal Ashok,Cannarella Rossella,Saleh Ramadan,Harraz Ahmed M.,Kandil Hussein,Salvio Gianmaria,Boitrelle Florence,Kuroda Shinnosuke,Farkouh Ala’a,Rambhatla Amarnath,Zini Armand,Colpi Giovanni,Gül Mur 대한남성과학회 2023 The World Journal of Men's Health Vol.41 No.1
Purpose: Seminal oxidative stress (OS) is a recognized factor potentially associated with male infertility, but the efficacy of antioxidant (AOX) therapy is controversial and there is no consensus on its utility. Primary outcomes of this study were to in-vestigate the effect of AOX on spontaneous clinical pregnancy, live birth and miscarriage rates in male infertile patients. Sec-ondary outcomes were conventional semen parameters, sperm DNA fragmentation (SDF) and seminal OS. Materials and Methods: Literature search was performed using Scopus, PubMed, Ovid, Embase, and Cochrane databases. Only randomized controlled trials (RCTs) were included and the meta-analysis was conducted according to PRISMA guide-lines. Results: We assessed for eligibility 1,307 abstracts, and 45 RCTs were finally included, for a total of 4,332 infertile patients. We found a significantly higher pregnancy rate in patients treated with AOX compared to placebo-treated or untreated con-trols, without significant inter-study heterogeneity. No effects on live-birth or miscarriage rates were observed in four studies. A significantly higher sperm concentration, sperm progressive motility, sperm total motility, and normal sperm morphology was found in patients compared to controls. We found no effect on SDF in analysis of three eligible studies. Seminal levels of total antioxidant capacity were significantly higher, while seminal malondialdehyde acid was significantly lower in patients than controls. These results did not change after exclusion of studies performed following varicocele repair. Conclusions: The present analysis upgrades the level of evidence favoring a recommendation for using AOX in male infertility to improve the spontaneous pregnancy rate and the conventional sperm parameters. The failure to demonstrate an increase in live-birth rate, despite an increase in pregnancy rates, is due to the very few RCTs specifically assessing the impact of AOX on live-birth rate. Therefore, further RCTs assessing the impact of AOX on live-birth rate and miscarriage rate, and SDF will be helpful.
Sharma Rakesh Kumar,Gupta Sajal,Agarwal Ashok,Finelli Renata,Kuroda Shinnosuke,Saleh Ramadan,Boitrelle Florence,Kavoussi Parviz,Gül Murat,Tadros Nicholas,Ko Edmund,Farkouh Ala’a,Henkel Ralf,Arafa Moha 대한남성과학회 2022 The World Journal of Men's Health Vol.40 No.4
Purpose: Azoospermia is defined as the absence of spermatozoa in the pellet of a centrifuged semen sample. In fact, when a basic semen analysis fails to detect sperm in the ejaculate, there is still the possibility of detecting rare sperm after centrifugation of the sample and examination of the pellet. In this study, we assessed the role of Cytospin centrifugation in combination with the nuclear fast picroindigocarmine (NF-PIC) staining in identifying sperm in azoospermic samples. Materials and Methods: Semen samples of 251 men diagnosed as having azoospermia after standard examination were further analyzed by Cytospin centrifugation in combination with NF-PIC staining. Results: Sperm were detected in 60 men (23.9%), thus changing their diagnosis to cryptozoospermia. Conclusions: By identifying sperm in the semen of men who were thought to have total azoospermia, the Cytospin NF-PIC test can alter the diagnosis and further treatment of these men.
Sperm DNA Fragmentation: A Critical Assessment of Clinical Practice Guidelines
Agarwal Ashok,Farkouh Ala'a,Parekh Neel,Zini Armand,Arafa Mohamed,Kandil Hussein,Tadros Nick,Busetto Gian Maria,Ambar Rafael,Parekattil Sijo,Boitrelle Florence,Sallam Hassan N.,Jindal Sunil,Ko Edmund 대한남성과학회 2022 The World Journal of Men's Health Vol.40 No.1
Sperm DNA fragmentation (SDF) is implicated in male infertility and adverse reproductive outcomes. With the publication of many studies regarding the etiologies and contributors to SDF, as well as the effects of SDF, guidelines are necessary to aid clinicians in the application of SDF for male fertility evaluation. Two recent clinical practice guidelines were published by Agarwal et al and Esteves et al. In this article, we have evaluated and compared both guidelines. We have found fairly similar recommendations between the two guidelines and have also highlighted the differences between them. Finally, we have summarized and combined the best practice recommendations from both guidelines.