Biomedical subjects

Ashok Agarwal

Publications and source records attributed to Ashok Agarwal.

At least 73 records · Page 4Linked to original sources

PubMed2004

Fertility after cancer: a prospective review of assisted reproductive outcome with banked semen specimens.

OBJECTIVE: To examine the outcome of assisted reproduction techniques (ART) using cryopreserved semen from patients with cancer. DESIGN: Prospective. SETTING: Therapeutic semen banking program at a tertiary healthcare center. PATIENT(S): Twenty-nine men with cancer who cryopreserved their sperm before treatment at our facility from 1982 to 2001 and withdrew their samples for assisted reproduction (IUI, IVF, or intracytoplasmic sperm injection [ICSI]). INTERVENTION(S): Sperm bank records were used to identify the patients. Information on fertility potential indices was obtained from medical records and through interviews. Of the 29 patients, 9 had testicular cancer, 12 had Hodgkin's disease, and 8 had other types of cancer. MAIN OUTCOME MEASURE(S): Pregnancy and live births. RESULT(S): A total of 87 ART cycles (42 IUI, 26 IVF, and 19 ICSI) was performed. Of those cycles, 18.3% resulted in pregnancy (7% IUI, 23% IVF, and 37% ICSI), and 75% of the pregnancies resulted in a live birth (100% IUI, 83% IVF, and 57% ICSI). There was no significant difference in the outcomes when the results were stratified by type of ART and malignancy. None of the 11 infants who were born had congenital anomalies. CONCLUSION(S): Our findings emphasize the need for physicians to discuss the issue of semen cryopreservation with all men of reproductive age who have cancer before antineoplastic therapy is started.

Antineoplastic Agents↗

PubMed2004

Activation pattern of caspases in human spermatozoa.

OBJECTIVE: We investigated the activation of caspases 8, 9, 1, and 3 in human ejaculated spermatozoa to study main pathways of apoptosis. Potential functional impact of this phenomenon and possible activation mechanisms were examined by [1] subjecting cells to freezing and thawing, and [2] testing the dependence of caspase activity on membrane integrity. DESIGN: Experimental study. SETTING: Andrology Center Leipzig (European Academy of Andrology). PATIENT(S): Ten healthy volunteers, 40 semen samples. INTERVENTION(S): Sperm populations were separated by annexin V magnetic activated cell sorting (MACS) according to externalized phosphatidylserine. MAIN OUTCOME MEASURE(S): Active caspases 8, 9, 1, and 3 were examined in human ejaculated spermatozoa before and after cryopreservation. RESULT(S): The active caspases were localized in the postacrosomal region (caspases 8, 1, and 3) or in the midpiece (caspase 9). Cryopreservation led to a significant increase in the number of cells showing activation of all caspases. The MACS separation resulted in a significant depletion of sperm positive for activated caspases within the externalized phosphatidylserine-negative fraction. CONCLUSION(S): Caspases 8, 9, 1, and 3, representing the main pathways of apoptosis, are present in human spermatozoa and can become activated, particularly after freezing and thawing, and are associated with changes in the outer cell membrane. Spermatozoa showing these changes and caspase activation can be efficiently removed from semen samples by the annexin V MACS technique.

Annexin A5↗

PubMed2004

A placebo-controlled double-blind randomized trial of the use of combined l-carnitine and l-acetyl-carnitine treatment in men with asthenozoospermia.

OBJECTIVE: To determine the efficacy of combined l-carnitine and l-acetyl-carnitine therapy in infertile males with oligo-astheno-teratozoospermia. DESIGN: Placebo-controlled double-blind randomized trial. SETTING: University tertiary referral center. PATIENT(S): Sixty infertile patients (aged 20-40 years) with the following baseline sperm selection criteria: concentration, 10 to 40 x 10(6)/mL; forward motility, <15%; total motility, 10% to 40%; and atypical forms, <80%. Fifty-six patients completed the study. INTERVENTION(S): Patients were submitted to a combined treatment of l-carnitine (2 g/d) and l-acetyl-carnitine (1 g/d) or of placebo; the study design was 2 months' wash-out, 6 months of therapy or of placebo, and 2 months' follow-up. MAIN OUTCOME MEASURE(S): Variation in the semen parameters that were used for patient selection. RESULT(S): Even though increases were seen in all sperm parameters after combined carnitine treatment, the most significant improvement in sperm motility (both forward and total) was present in patients who had lower initial absolute values of motile sperm (<4 x 10(6) forward or <5 x 10(6) total motile spermatozoa per ejaculate). CONCLUSION(S): Combined treatment with l-carnitine and l-acetyl-carnitine in a controlled study of efficacy was effective in increasing sperm motility, especially in groups with lower baseline levels.

Acetylcarnitine↗

PubMed2004

Effect of oxidative stress in follicular fluid on the outcome of assisted reproductive procedures.

OBJECTIVE(S): To measure levels of lipid peroxidation (LPO) and total antioxidant capacity (TAC) in the follicular fluid from patients undergoing IVF and to examine the association among LPO and TAC and oocyte maturity, embryo quality, fertilization, cleavage, and pregnancy rates. DESIGN: Prospective study. SETTING: Tertiary care medical center. PATIENT(S): Forty-one patients undergoing IVF. INTERVENTION(S): Clear follicular fluid specimens were collected at oocyte retrieval. MAIN OUTCOME MEASURE(S): Follicular fluid LPO and TAC levels measured by the thiobarbituric acid and the chemiluminescence method, respectively. RESULT(S): The mean LPO level was 0.95 micromol malonaldehyde/L, and the mean TAC level was 819.16 Trolox equivalents. No correlation was seen among LPO or TAC levels and oocyte maturity, fertilization, cleavage, and embryo quality. The pregnancy rate was 31.7%. Pregnant patients were significantly younger than the patients who did not become pregnant (30.53 +/- 3.5 years vs. 34.32 +/- 3.98 years). After adjusting for age, a positive correlation was seen between pregnancy rate and LPO and between pregnancy rate and TAC. CONCLUSION(S): Both LPO and TAC levels were positively correlated with the pregnancy rate. Lipid peroxidation may be a good marker of metabolic activity within the follicle, and some amounts may be necessary to establish a pregnancy.

Adult↗

PubMed2004

Novel associations between specific sperm morphological defects and leukocytospermia.

OBJECTIVE: To examine the relationship between leukocyte concentrations in semen and sperm morphology in a group of infertile men and healthy fertile donors. DESIGN: A prospective clinical study. SETTING: Male infertility clinic at a tertiary care teaching hospital and a reproductive medicine unit at a Women's Hospital in the United Kingdom. PATIENT(S): Fifty-six infertile men and 13 healthy fertile sperm donors (control). INTERVENTION(S): Standard semen analysis, seminal leukocyte concentration, and the assessment of sperm morphology and sperm deformity index (SDI), applying Tygerberg's strict criteria. MAIN OUTCOME MEASURE(S): Granulocyte concentrations in semen, percentages of different sperm morphological abnormalities, and SDI scores. RESULT(S): Leukocyte concentrations were statistically significantly and negatively correlated with the proportion of sperm with damaged acrosomes, cytoplasmic droplet, tail defects, and SDI scores with normal and borderline morphology. The percentage sperm motility was significantly and negatively correlated with leukocytic concentration in semen. However, the leukocytic concentration was not significantly correlated with sperm concentration. CONCLUSION(S): This is the first study to report a significant positive correlation between leukocytospermia and sperm tail defects, acrosomal damage, and high SDI scores. These observations suggest that leukocytospermia is associated with compromised sperm structural integrity.

Acrosome↗

PubMed2004

Use of semen quality scores to predict pregnancy rates in couples undergoing intrauterine insemination with donor sperm.

OBJECTIVE: To establish semen quality scores in a population of sperm donors and determine whether the scores can be used to predict pregnancy rates after donor insemination. DESIGN: Retrospective study. SETTING: Infertility clinic at a tertiary care teaching hospital between 1993-2001. PATIENT(S): One hundred eleven women who underwent IUI with sperm from 27 anonymous donors. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): The semen analysis results before freezing and after thawing were analyzed, and overall donor insemination semen quality (DI-SQ) and donor insemination relative quality (DI-RQ) scores were calculated. After adjusting for female characteristics, the scores were compared with samples that did and did not result in pregnancy. RESULT(S): Of 111 patients, 70 had at least one pregnancy, and 60 had at least one live birth, with a mean of 6.52 +/- 4.67 IUI cycles per patient. Five significant risk factors for low pregnancy and live birth rates were identified: female infertility factor, positive laparoscopy, older maternal age, low number of previous births, and lack of ovulatory stimulation. After adjusting for these factors, both prefreeze and postthaw DI-SQ scores were statistically significantly associated with IUI live birth rates. Using only the samples with a DI-SQ score of >110 doubled the expected live birth rate, compared with using samples with a DI-SQ score less than 100, from 8.5% to 16.1%. CONCLUSION(S): The DI-SQ score was an effective predictor of pregnancy and live birth outcomes in IUI patients who underwent artificial insemination with anonymous donor semen. The DI-SQ score could also be used by sperm banks to help select donors.

Adult↗

PubMed2004

Differential growth of human embryos in vitro: role of reactive oxygen species.

OBJECTIVE: To examine the relationship of early human embryonic development with the level of reactive oxygen species (ROS) in the culture media on the first day (day 1 ROS) after insemination. DESIGN: A prospective study. SETTING: Patients undergoing assisted reproduction in a teaching hospital. PATIENT(S): Patients undergoing conventional IVF (n = 104; 115 cycles) and intracytoplasmic sperm injection (ICSI) (n = 91; 96 cycles) were included. Both fertilization and early cultures were performed in human tubal fluid with 5% serum substitute supplement. INTERVENTION(S): Day 1 ROS levels in the central well (sample) and the outer well (control) of each embryo culture dish were measured after overnight incubation by chemiluminescence assay using luminol as the probe. MAIN OUTCOME MEASURE(S): Fertilization rate and embryo quality at day 3 and 5 were recorded for each cycle. Age, parity, and demographic features were also compared. RESULT(S): High day 1 ROS levels in culture media were associated with low blastocyst rate, low fertilization rate, low cleavage rate, and high embryonic fragmentation with ICSI but not with conventional IVF. High day 1 ROS levels in culture media were associated with lower pregnancy rates in both IVF and ICSI cycles. CONCLUSION(S): Reactive oxygen species generated in culture media by day 1 may be an important biochemical marker for early embryonic growth. Increased embryonic fragmentation and slow cleavage rate may be partially attributed to early exposure of embryos to high ROS levels in ICSI cycles. Differential growth of ICSI embryos incubated under identical conditions may be in part due to differences in ROS levels of the culture medium surrounding these embryos.

Blastocyst↗

PubMed2004

Cryopreservation of human spermatozoa: comparison of two cryopreservation methods and three cryoprotectants.

OBJECTIVE: To evaluate the ability of two cryopreservation methods and three cryoprotectants to preserve sperm quality. DESIGN: A prospective clinical study. SETTING: Male infertility clinic at a tertiary healthcare center. PATIENT(S): Twenty infertile men and 10 healthy donors. INTERVENTION(S): In the first experiment, semen was cryopreserved by either the Irvine Scientific method (IS) or the Cleveland Clinic Foundation (CCF) method. In the second experiment, semen was cryopreserved by the IS method and one of three cryoprotectants: TES and Tris yolk buffer, Sperm Freezing Medium, or Enhance Sperm Freeze. MAIN OUTCOME MEASURE(S): Postthaw sperm motility, cryosurvival, and kinematics. RESULT(S): Percentages of postthaw sperm motility and cryosurvival were higher in the IS cryopreservation method compared with in the CCF method (15.94 +/- 9.19 vs. 12.07 +/- 7.31 and 47.42 +/- 17.44 vs. 35.76 +/- 17.56). However, the CCF method resulted in significantly better sperm kinematics. Postthaw motility in the donors and patients was highest in the samples frozen in TES and Tris yolk buffer medium. CONCLUSION(S): The IS method was associated with more flash freezing compared with the CCF method and resulted in better preservation of sperm motility and a higher cryosurvival rate. TES and Tris yolk buffer was most effective at protecting sperm from the negative effects of the cryopreservation process. This may be due to the presence of egg yolk along with glycerol.

Cryopreservation↗

PubMed2004

Human sperm superoxide anion generation and correlation with semen quality in patients with male infertility.

OBJECTIVE: To measure levels of reactive oxygen species (ROS) including H(2)O(2) and O(2)(.-) generation in infertile men and determine whether sperm quality is correlated with levels of ROS triggered by the exogenous reduced form of beta nicotinamide adenine dinucleotide phosphate (NADPH). DESIGN: Prospective study. SETTING: Male infertility clinic at a tertiary healthcare center. PATIENT(S): Eleven infertile men and six healthy donors. INTERVENTION(S): Chemiluminescence assay using luminol and lucigenin as probes before and after incubating sperm samples with 5 mM and 10 mM of NADPH. MAIN OUTCOME MEASURE(S): The ROS generation (10(6) counted photons per minute/10(6) sperm). RESULT(S): Baseline levels of O(2)(.-) generation were significantly higher in the infertile patients than in the healthy donors (r = 0.73, 95% confidence interval [median (25th, 75th percentiles): 0.73 (0.5, 5.5) vs. 0.2 (0.0, 0.5)] when lucigenin was used as the probe. Compared with basal levels, O(2)(.-) generation was significantly higher after coincubation with NADPH (5 mM and 10 mM) in the entire combined study population, and patients only but not donors. The O(2)(.-) generation was negatively correlated with sperm concentration (r = -0.75, 95% CI 0.38-1), motility (r = -0.69, 95% CI 0.28-1), and percentage of normal morphology (r = -0.78, 95% CI 0.36-1). CONCLUSION(S): Spermatozoa from infertile men produce higher levels of O(2)(.-) in the presence of exogenous NADPH compared to healthy donors. The ability of spermatozoa to generate O(2)(.-) increases as the semen quality declines.

Acridines↗

PubMed2004

Increased seminal reactive oxygen species levels in patients with varicoceles correlate with varicocele grade but not with testis size.

Increased levels of reactive oxygen species (ROS) are associated with clinical varicoceles; however, its correlation with varicocele grade and testis size is unknown. In our study, seminal ROS levels showed significant correlation with left varicocele grade and significantly elevated seminal ROS levels were seen in men with left varicocele grade 2 and 3 compared to grade 1.

Adult↗

PubMed2004

Long-term intracavernous therapy responders can potentially switch to sildenafil citrate after radical prostatectomy.

OBJECTIVES: To assess whether long-term users of intracavernous (IC) injections after radical prostatectomy can switch to oral therapy with sildenafil citrate. METHODS: Forty-nine patients (mean age 60.9 years) with erectile dysfunction after radical prostatectomy were identified as long-term users of IC injections (3.7 +/- 1.9 years). These patients received open-label treatment with sildenafil citrate (50 to 100 mg) for a minimum of 4 weeks or five attempts. The primary outcome measure of our study was assessed by the Sexual Health Inventory of Men (SHIM) questionnaire (International Index of Erectile Function-5 [IIEF]). A successful switch was prospectively defined as erection sufficient for vaginal penetration after sildenafil use and compliance to therapy. Patients were designated as responders or nonresponders on the basis of their ability to achieve vaginal penetration. RESULTS: Of 49 patients, only 36 agreed to receive oral open-label sildenafil (50 to 100 mg) for a minimum of 4 weeks or five attempts. Prostaglandin E1 (PGE1) was used in 70% and triple therapy (PGE1, papaverine, and phentolamine) in the remaining 30%. Of the 36 patients, 15 (41%) successfully switched to sildenafil and discontinued IC injections. When the results were stratified by the type of IC solution, patients with high-dose triple therapy had a poor success rate of switch (7%) compared with patients using PGE1 treatment (67%). Of the 36 patients, 14 (38%) found sildenafil ineffective and continued using IC injections. Patients who switched to oral therapy had had a greater (P <0.001) total mean SHIM (IIEF-5) score with IC injections than those who did not switch (12.3 +/- 7.8 versus 20.0 +/- 4.9). Of the 36 patients, 7 (19%) found sildenafil alone to be suboptimal but continued using it, enhancing the efficacy of IC injections alone. The three predictive factors for a successful switch were high preoperative SHIM (IIEF-5) score, high post-IC injection SHIM score, and type of IC medication used (PGE1 alone versus high-dose triple therapy). CONCLUSIONS: Long-term users of IC injection therapy can potentially switch to sildenafil citrate with acceptable sexual satisfaction. Patients will accept a lower degree of sexual satisfaction as measured by the IIEF-5 (SHIM) score if oral therapy is effective.

Administration, Oral↗

PubMed2004

Efficacy and factors associated with successful outcome of sildenafil citrate use for erectile dysfunction after radical prostatectomy.

OBJECTIVES: To assess the efficacy and factors associated with successful treatment of sildenafil citrate for erectile dysfunction after radical prostatectomy (RP). METHODS: Of the 470 patients who underwent RP at our institution between July 1998 and January 2000, 227 (48%) sought treatment for erectile dysfunction, and 174 (37%) were prescribed sildenafil citrate. The starting dose was 50 mg, which was increased to 100 mg if the patient did not have a positive response. Of the 174 patients, 104 (59.8%) had undergone a bilateral nerve-sparing (NS) procedure, 28 (16.1%) had undergone a unilateral NS procedure, and 42 (24.1%) had undergone a non-NS procedure. Erectile function was assessed by the abridged five-item version of the International Index of Erectile Function questionnaire, referred to as the Sexual Health Inventory for Men (SHIM), at baseline and 1 year after sildenafil use. The patients' charts were retrospectively reviewed to find factors associated with a successful outcome, which was defined as successful vaginal intercourse. Association with success was assessed by chi-square analysis and the Cochran Armitage test for trend. Bonferroni correction for multiple comparisons was used, with an overall significance level of 0.05 for each factor assessed. RESULTS: The mean age was 60.1 +/- 6.25 years, and the mean interval from RP to drug use was 3 months. After treatment with sildenafil, 100 (57%) of 174 patients responded to the drug: 79 (76%) of 104 in the bilateral NS group, 15 (53.5%) of 28 in the unilateral NS group, and 6 (14.2%) of 42 in the non-NS group. SHIM analysis showed that the magnitude of the improvement was greater in the bilateral NS group (19.97 +/- 1.12) than in the unilateral NS (15.89 +/- 3.38) or non-NS (10.06 +/- 2.0) groups (P <0.020). Four factors were significantly associated statistically with a successful outcome: the presence of at least one neurovascular bundle, a preoperative SHIM score of 15 or greater, age 65 years old or younger, and interval from RP to drug use of more than 6 months (P <0.001). CONCLUSIONS: The efficacy of sildenafil citrate after RP correlated with the degree of neurovascular bundle preservation, preoperative erectile function status, age, and interval before starting treatment.

3',5'-Cyclic-GMP Phosphodiesterases↗

PubMed2004

Female sexual dysfunction after radical cystectomy: a new outcome measure.

OBJECTIVES: To assess, in our contemporary radical cystectomy (RC) series, female sexual dysfunction and whether the type of diversion affected the occurrence of sexual dysfunction. Outcome data after RC with and without orthotopic diversion has focused primarily on cure, urethral recurrence, and continence. METHODS: The baseline and follow-up data from 27 sexually active female patients (mean age 54.79 +/- 12.7 years) who underwent RC from 1997 to 2002 for transitional cell carcinoma of the bladder (16 with Stage T1-T2 and 11 with Stage T3-T4) were obtained. Thirteen patients were premenopausal before RC. Of the 27 patients, 10 (37%) underwent Studor orthotopic diversion, 7 (26%) Indiana cutaneous diversion, and 10 (37%) ileal conduit diversion. A 10-item version of the self-administered Index of Female Sexual Function questionnaire was used to assess sexual dysfunction. The specific domains analyzed in the Index of Female Sexual Function include the degree of vaginal lubrication, ability to achieve orgasm, degree of pain during intercourse, overall sexual desire and interest, and overall sexual satisfaction, with responses graded on a scale of 1 (almost never, never) to 5 (almost always, always). RESULTS: With a mean follow-up of 24.2 months (range 15 to 65.1), the total mean baseline Index of Female Sexual Function score decreased from 17.4 +/- 7.23 to 10.6 +/- 6.62 after RC (P < or =0.05). The most common symptoms reported by the patients included diminished ability or inability to achieve orgasm in 12 (45%), decreased lubrication in 11 (41%), decreased sexual desire in 10 (37%), and dyspareunia in 6 patients (22%). Only 13 (48%) of the 27 patients were able to have successful vaginal intercourse, with 14 (52%) reporting decreased satisfaction in overall sexual life after RC. Eight partners (30%) had a decrease in desire for sexual activity owing to apprehension after cancer diagnosis and treatment. Although the numbers were small, the preliminary data suggested no differences in sexual function between patients undergoing Studor orthotopic diversions and those undergoing Indiana cutaneous diversions. CONCLUSIONS: Sexual dysfunction is a prevalent problem after female RC. The nature of the dysfunction involves multiple domains, including decreased orgasm, decreased lubrication, lack of sexual desire, and dyspareunia. Our early results suggest that the type of continent diversion does not affect sexual function. Surgical modifications such as urethral and vaginal sparing, neurovascular preservation, and tubular vaginal reconstruction sparing may improve female sexual function after RC.

Carcinoma, Transitional Cell↗

PubMed2004

Relationship of interleukin-6 with semen characteristics and oxidative stress in patients with varicocele.

OBJECTIVES: To examine levels of interleukin-6 (IL-6) in fertile semen donors and patients with varicocele and examine its association with semen characteristics and levels of reactive oxygen species (ROS). METHODS: We conducted a prospective study consisting of 15 fertile donors (controls) and 35 infertile patients with varicocele. Semen analysis was performed according to the World Health Organization guidelines. IL-6 levels were measured using the enzyme-linked immunosorbent assay. ROS (x10(4) counted photons per minute per 20 x 10(6) sperm) and total antioxidant capacity (molar trolox equivalents) were measured using a chemiluminescence assay. RESULTS: The sperm concentration and motility were significantly greater in the donors compared with the infertile patients with varicocele (P <0.0001 and P = 0.01, respectively). The IL-6 (log10 [IL-6 +1]) and ROS (log10 [ROS +1]) levels were significantly greater in infertile patients with varicocele than in the donors (IL-6: 2.1 [1.7, 2.4] versus 0.7 [0, 1.9], P = 0.003; ROS: 1.8 [1.2, 2.6] versus 1.0 [0.7, 1.6], P = 0.04). The total antioxidant capacity levels were significantly lower in the varicocele patients (1166.7 +/- 366.2) than in the donors (1556.4 +/- 468.1; P = 0.003). The IL-6 levels correlated significantly with the ROS levels in the infertile patients with varicocele (r = -0.39; P = 0.01). CONCLUSIONS: Infertile patients with varicocele exhibited elevated levels of IL-6 and ROS and decreased levels of total antioxidant capacity. Pro-inflammatory cytokine IL-6 and oxidative stress may play a role in the pathophysiology of infertility in these patients.

Adult↗

PubMed2004

Sexual function after male radical cystectomy in a sexually active population.

OBJECTIVES: To assess sexual dysfunction in sexually active men after radical cystectomy (RC) and to determine whether sildenafil citrate can improve erectile dysfunction after surgery. METHODS: The baseline and follow-up data from 49 sexually active male patients (mean age 57.8 +/- 9.1 years) undergoing RC (1995 to 2002) were obtained. Of the 49 patients, 16 (33%) had undergone nerve-sparing RC; 38 (78%) had undergone orthotopic diversion; 8 (16%) had undergone ileal conduit diversion; and 3 (6%) had undergone cutaneous continent diversion. The data were assessed using the abridged 5-item International Index of Erectile Function questionnaire, referred to as the Sexual Health Inventory for Men (SHIM). RESULTS: At a mean follow-up of 47.6 +/- 22.7 months, the total mean SHIM score decreased from 22.08 +/- 3.96 to 4.33 +/- 5.72 after RC (P <0.05). Of the 49 patients, 42 (86%) did not have erections sufficient for vaginal penetration. Of these 42 patients, 22 (52%) tried sildenafil citrate. Of these 22 patients, only 2 (9%) responded positively, with a total mean SHIM score of 23.50 +/- 2.12. Although the mean SHIM score after orthotopic substitution (5.24 +/- 6.21) was statistically significant compared with that after ileal conduit (1.13 +/- 0.33) and cutaneous continent (1.33 +/- 0.58) diversions, this was not clinically significant. CONCLUSIONS: Male erectile dysfunction after RC is a prevalent problem. In our series, only 9 (14%) of 49 sexually active men were potent after surgery. Of these 9 potent patients, 8 (89%) had undergone nerve-sparing RC. Of concern, only 52% of the patients with erectile dysfunction sought treatment after RC.

Aged↗

PubMed2004

Chemiluminescence technique for measuring reactive oxygen species.

Accurate assessment of reactive oxygen species (ROS) concentrations may help in the diagnosis of infertility. The chemiluminescence technique, which uses a luminometer to measure ROS, is a common method of assessment. A better understanding of the chemiluminescence technique will allow its proper application in reproductive medicine. A wide range of luminometers are available in the market, and laboratories should select the instruments that suit their individual needs.

Female↗

PubMed2004

Role of antioxidants in treatment of male infertility: an overview of the literature.

Seminal oxidative stress in the male reproductive tract is known to result in peroxidative damage of the sperm plasma membrane and loss of its DNA integrity. Normally, a balance exists between concentrations of reactive oxygen species and antioxidant scavenging systems. One of the rational strategies to counteract the oxidative stress is to increase the scavenging capacity of seminal plasma. Numerous studies have evaluated the efficacy of antioxidants in male infertility. In this review, the results of different studies conducted have been analysed, and the evidence available to date is provided. It was found that although many clinical trials have demonstrated the beneficial effects of antioxidants in selected cases of male infertility, some studies failed to demonstrate the same benefit. The majority of the studies suffer from a lack of placebo-controlled, double-blind design, making it difficult to reach a definite conclusion. In addition, investigators have used different antioxidants in different combinations and dosages for varying durations. Pregnancy, the most relevant outcome parameter of fertility, was reported in only a few studies. Most studies failed to examine the effect of antioxidants on a specific group of infertile patients with high oxidative stress. Multicentre, double-blind studies with statistically accepted sample size are still needed to provide conclusive evidence on the benefit of antioxidants as a treatment modality for patients with male infertility.

Antioxidants↗

PubMed2004

Implications of systemic malignancies on human fertility.

Cancer patients have now longer life expectancy due to improved treatment modalities. As the mortality rate decreased and the survival rate increased, the consequences of cancer treatment in terms of impaired fertility became more frequently encountered. The objective of this review is to highlight fertility issues associated with systemic malignancies. Systemic malignancies lead to deterioration of human fertility directly or indirectly as a result of cytotoxic treatment regimens. A variety of measures may be used to decrease the incidence of fertility decline that occurs. Gamete cryopreservation represents a widely accepted method for fertility preservation in cancer patients. In addition, other procedures such as germ cell transplantation and ovarian cryopreservation, which are currently being developed, are expected to make significant contribution in these cases. However, there are some ethical issues that should be considered before offering patients any of these options.

Cryopreservation↗