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Medicine Dec 2021Acupuncture is widely used for oligospermia and asthenozoospermia in China, but its effect is unclear. We aimed to determine the effectiveness and safety of acupuncture... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Acupuncture is widely used for oligospermia and asthenozoospermia in China, but its effect is unclear. We aimed to determine the effectiveness and safety of acupuncture in treating oligospermia and asthenozoospermia.
METHODS
An electronic search for randomized controlled trials evaluating acupuncture treatment in patients with oligospermia and asthenozoospermia published from database inception to October 2018 was conducted in PubMed, EMBASE, the Chinese Biomedical Literature Database, the Chinese Scientific Journal Database (VIP Database), the Wan-Fang Database, the China National Knowledge Infrastructure and the Cochrane Library. We established search terms related to 3 areas (oligospermia, asthenozoospermia, and acupuncture). Two authors independently screened all identified citations and extracted the data. The methodological quality of the included trials was assessed using the Cochrane criteria.
RESULTS
Seven studies with a total of 527 subjects were screened according to inclusion and exclusion standards, and most of the studies had significant methodological weaknesses. Seven randomized controlled trials tested the effects of acupuncture compared with placebo acupuncture and conventional medications in patients with oligospermia and asthenozoospermia. The results of this study suggest that acupuncture alone has no clear superiority in improving sperm motility (standard mean difference [SMD] = 1.13, 95% confidence interval [CI]: -0.64 to 2.89), the sperm concentration (SMD = 0.32, 95% CI: 0.27-0.92) or semen volume compared with placebo acupuncture. No significant difference was found between acupuncture alone and conventional medications in improving sperm motility (SMD = -0.53, 95% CI: -2.54 to 1.48), the sperm concentration (SMD = -1.10, 95% CI: -1.48 to -0.72) or semen volume. However, adjuvant acupuncture may enhance the effect of medications on improving sperm motility (SMD = 4.10, 95% CI: 1.09-7.12) and the sperm concentration (SMD = 1.07, 95% CI: 0.739-1.40), but the study heterogeneity was too high to establish robust conclusions.
CONCLUSION
These results suggest that the current evidence does not support acupuncture as an effective treatment for oligospermia and asthenozoospermia; therefore, acupuncture is not currently recommended as a treatment for these conditions. However, owing to the high risk of bias among the included studies, the evidence is limited, and more large-scale, high-quality clinical trials are needed in the future.
TRIAL REGISTRATION NUMBER
PROSPERO CRD42018083885.
Topics: Acupuncture Therapy; Asthenozoospermia; Humans; Male; Oligospermia; Randomized Controlled Trials as Topic; Sperm Motility; Treatment Outcome
PubMed: 35049183
DOI: 10.1097/MD.0000000000027816 -
Qatar Medical Journal 2021Infertility is defined as the inability of heterosexual couples to achieve a successful clinically recognizable pregnancy after 12 months or more of regular, unprotected...
BACKGROUND/AIM
Infertility is defined as the inability of heterosexual couples to achieve a successful clinically recognizable pregnancy after 12 months or more of regular, unprotected sexual intercourse. Infertility estimations are very important to inform the healthcare policymakers and governments to implement appropriate social and economic policies. Thus, this study aimed to estimate the pooled prevalence of infertility (primary and secondary) and its etiologic factors in Sudan.
METHODS
This study included all published and unpublished studies written in Arabic or English. Electronic sources (namely, PubMed, MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov) and nonelectronic sources (direct Google search, Google Scholar, OpenGrey, OATD, WorldCat log, and university websites) were used from their inception to May 16, 2021. A total of 1955 studies were reviewed, of which only 20 studies were eligible for the meta-analysis. Studies were eligible if they provided the prevalence of infertility in Sudan. The Joanna Briggs Institute Quality Assessment Tool was used to evaluate each study. Data synthesis and statistical analysis were conducted using Jeffrey's Amazing Statistics Program version 0.14.1.0.
RESULTS
The pooled prevalence of overall infertility, primary infertility, and secondary infertility in Sudan were 13% (I = 96.45, < 0.001), 65% (I = 98.5, < 0.001), and 35% (I = 98.5, < 0.001), respectively, and the prevalence of infertility factors were 41%, 27%, 16%, and 17% for female, male, combined factors, and unexplained factors, respectively. Women with infertility were mainly present because of ovulatory disorders (ovulatory factors, 36%; polycystic ovary syndrome, 38%). By contrast, spermatic disorders such as azoospermia (37%), oligozoospermia (30%), and asthenozoospermia (30%) were the main causes of male infertility.
CONCLUSION
In Sudan, the prevalence of primary infertility is higher than that of secondary infertility. Female factors were the most common causes of infertility in Sudan, and this study found a high prevalence of unexplained factors. Polycystic ovary syndrome and azoospermia were the most common causes of female and male infertility in Sudan, respectively. The interpretation of these findings should take into consideration the presence of substantial heterogeneity between the included studies.
PubMed: 34650907
DOI: 10.5339/qmj.2021.47 -
Fertility Research and Practice Dec 2020Infertility is a practical concern of Africans due to social disgrace and exclusion. This meta-analysis aims to analyze the proportion of primary and secondary...
BACKGROUND
Infertility is a practical concern of Africans due to social disgrace and exclusion. This meta-analysis aims to analyze the proportion of primary and secondary infertility and identify the etiologic factors based on the studies conducted in Africa.
METHODS
An internet-based search was conducted on the following databases; PubMed/Medline, EMBASE, Cochrane library, and google scholar. Both population and institution-based studies conducted among African couples, males, and females were included. Data extraction and critical appraisal of the articles were done by two independent investigators. Meta-analysis using a random effect model was conducted by Stata version 14. Forest plot, heterogeneity test, and funnel plot for publication bias were performed.
RESULTS
The pooled proportion of primary and secondary infertility in Africa was 49.91% (I = 98.7, chi-square = 1509.01, degree of freedom = 19 and p < 0.001) and 49.79% (I = 98.7, chi-square = 1472.69, degree of freedom = 19 and p < 0.001) respectively. The pooled prevalence of the causes of infertility indicated that 54.01% and 22.26% of the infertility cases were respectively due to female and male-related problems. In 21.36% of infertility cases, both sexes were affected, while 10.4% of the causes of infertility were unexplained. The pooled prevalence of mostly reported causes of male infertility was 31% (oligospermia), 19.39% (asthenozoospermia), and 19.2% (varicocele). The most commonly identified causes of female infertility were pelvic inflammatory disease, tubal factors, and abortion with a pooled prevalence of 39.38%, 39.17%, and 36.41% respectively.
CONCLUSIONS
In Africa, the proportion of primary and secondary infertility is approximately equal. Infertility is mostly due to female-related causes like; pelvic inflammatory diseases, uterine tube related problems, and abortion. Oligospermia, asthenozoospermia, and varicocele were the commonest causes of male-related infertility. It is suggested that interpretation and utilization of these findings should consider the presence of substantial heterogeneity between the included studies.
PubMed: 33292584
DOI: 10.1186/s40738-020-00090-3 -
International Journal of Biological... Apr 2020Several complex rearrangements such as deletions in mitochondrial DNA (mtDNA) have been identified in sperm deficiencies. This study aimed to investigate the association... (Review)
Review
Several complex rearrangements such as deletions in mitochondrial DNA (mtDNA) have been identified in sperm deficiencies. This study aimed to investigate the association of common mtDNA deletions with male infertility using a meta-analysis approach. Standard databases were systematically searched to discover relevant studies. Pooled odds ratios (ORs) with corresponding 95% confidence intervals (CI) were estimated to analyze the association of mtDNA deletions with male infertility. Our data revealed a significant association between a common 4977-bp deletion and an increased risk of male infertility. A similar association was observed in an Asian population. Stratified analysis by infertility phenotype showed significant associations between the 4977-bp deletion and increased risk of asthenozoospermia, oligoasthenoteratozoospermia, and asthenoteratozoospermia. In addition, significant associations were found in studies with sample sizes >100, age of participants <45 years, subject selection according to WHO criteria, and studies of moderate to high quality. Regarding the other common mtDNA deletions, significant associations were observed between 7436-bp, 7599-bp, and 4866-bp deletions and the risk of male infertility. Our findings suggest that the 4977-bp deletion might be a risk factor for male infertility, especially in an ethnic and infertility phenotype dependent manner.
PubMed: 32360203
DOI: 10.1016/j.ijbiomac.2020.04.216 -
Journal of Assisted Reproduction and... Apr 2020Infertility is a major health problem across the world. One of the main reasons for male infertility are defects in sperm. Semen analysis is the most common test...
Infertility is a major health problem across the world. One of the main reasons for male infertility are defects in sperm. Semen analysis is the most common test utilized to evaluate male fertility and since it suffers from multiple drawbacks, reproduction scientists have tried to find new molecular markers for detecting sperm defects. MicroRNAs (miRNAs) are small molecules in cells which take part in regulating gene expression. Various studies have confirmed miRNAs to have a role in defining multiple sperm characteristics, including sperm count, motility, and morphology. In this paper, we have systematically reviewed the role of miRNAs in infertile men with sperm defects including azoospermia, oligospermia, asthenozoospermia, and teratozoospermia. Also, we have assembled various bioinformatics tools to come up with a pipeline for predicting novel miRNAs which could possibly participate in sperm count, motility, and morphology. Also, related KEGG and GO terms for predicted miRNAs have been included in order to highlight their role in sperm function. Our study emphasizes the potential role of miRNAs in male infertility and provides a general overview for future studies aiming to find robust molecular markers for this condition.
Topics: Asthenozoospermia; Azoospermia; Humans; Infertility, Male; Male; MicroRNAs; Oligospermia; Semen Analysis; Sperm Motility; Teratozoospermia
PubMed: 32189180
DOI: 10.1007/s10815-019-01674-9 -
Efficacy and safety of acupuncture for the treatment of oligoasthenozoospermia: A systematic review.Andrologia Feb 2020Oligoasthenozoospermia is a common factor leading to male infertility. Acupuncture has been applied for treating male infertility for several thousand years in China,...
Oligoasthenozoospermia is a common factor leading to male infertility. Acupuncture has been applied for treating male infertility for several thousand years in China, but clinical evidence of its efficacy and safety in treating oligoasthenozoospermia is yet to be established. This review aimed to systematically assess the evidence on the effect of acupuncture in males with oligoasthenozoospermia. Databases (PubMed, EMBASE, SINOMED, CNKI, Wanfang database and Cochrane Library) were searched to identify related studies published before 30th June 2019. The Cochrane risk of bias tool and Jadad score was adopted to assess the methodological quality of included studies. Twelve randomised controlled trials (RCTs) with 1,088 participants were included in this review. The aim of this study was to perform a meta-analysis, but it was not possible due to considerable clinical heterogeneity among the included studies. According to the narrative analysis, acupuncture or acupuncture combined with another intervention was effective in improving the semen quality based on the included studies. However, this result should be interpreted with caution due to high risk. The methodological quality of most included studies was low. The current evidence on acupuncture for oligoasthenozoospermia is inadequate to draw a solid conclusion due to the poor methodological quality. Rigorous full-scale RCTs are needed to validate the therapeutic efficacy and safety of acupuncture in treating oligoasthenozoospermia.
Topics: Acupuncture Therapy; Asthenozoospermia; Humans; Male; Oligospermia; Randomized Controlled Trials as Topic; Semen Analysis; Treatment Outcome
PubMed: 31670423
DOI: 10.1111/and.13415 -
Reproductive Biomedicine Online Aug 2019This meta-analysis and systematic review investigated evidence of the effect of oral micronutrient supplementation on male fertility. Following searches of PubMed,... (Meta-Analysis)
Meta-Analysis
This meta-analysis and systematic review investigated evidence of the effect of oral micronutrient supplementation on male fertility. Following searches of PubMed, Ovid/Ovid Medline(r) and Embase, 18 randomized, double-blind, placebo-controlled trials were included in the meta-analysis (seven studies) and/or the systematic review (12 studies). The meta-analysis showed significant improvement in semen parameters for selenium (200µg/day and 100µg/day) (standard mean difference [SMD] 0.64 for oligozoospermia, 1.39 for asthenozoospermia), L-carnitine (2 g/day) and acetyl-L-carnitine (LAC; 1 g/day) combined (SMD 0.57 for asthenozoospermia), and co-enzyme Q10 (200 and 300 mg/day) (SMD 0.95 for oligozoospermia, 1.48 for asthenozoospermia, 0.63 for teratozoospermia). The systematic review identified promising data for supplementation with 66 mg/day zinc combined with folic acid (5 mg/day), and the polyunsaturated fatty acids eicosapentaenoic acid (EPA; 1.12 g/day) and docosahexaenoic acid (DHA; 0.72 g/day). Pregnancy rate was evaluated in a limited number of trials (four in the meta-analysis, three in the systematic review). This analysis suggests supplementation with selenium (alone or combined with N-acetylcysteine), co-enzyme Q10 and the combinations L-carnitine + acetyl-L-carnitine, folic acid + zinc and EPA + DHA is beneficial in the treatment of male infertility. Because of the small number of available studies and low number of participants, further well-designed clinical studies are needed to obtain a better overview of efficient methods of treating male infertility.
Topics: Acetylcysteine; Administration, Oral; Ascorbic Acid; Dietary Supplements; Docosahexaenoic Acids; Eicosapentaenoic Acid; Folic Acid; Humans; Infertility, Male; Male; Minerals; Randomized Controlled Trials as Topic; Selenium; Spermatozoa; Ubiquinone; Vitamin E; Vitamins
PubMed: 31160241
DOI: 10.1016/j.rbmo.2019.03.099 -
BMC Public Health Jan 2019Nowadays, the total number of couples visiting an infertility clinic is on the rise. Tobacco smoking is considered one of the major factors leading to male infertility.... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Nowadays, the total number of couples visiting an infertility clinic is on the rise. Tobacco smoking is considered one of the major factors leading to male infertility. In this study, we aimed to systematically investigate the impact of tobacco smoking on semen quality in infertile male participants.
METHODS
Online databases (Cochrane Central database of Randomized Controlled Trials and the databases of MEDLINE and EMBASE respectively) were searched for relevant English publications that satisfied the inclusion and exclusion criteria of this analysis. The clinical endpoints which were assessed included semen parameters (oligozoospermia, asthenozoospermia, teratozoospermia, and azoospermia), morphological defects of spermatozoa and the hormones involved in reproduction. RevMan 5.3 software was used to analyze the data whereby mean difference (MD) and risk ratios (RR) with 95% confidence intervals (CI) were generated to represent the results.
RESULTS
Sixteen studies with a total number of 10,823 infertile male participants (5257 smokers and 5566 non-smokers) were included. Results of this analysis showed oligozoospermia to be significantly higher in smokers (RR: 1.29, 95% CI: 1.05-1.59; P = 0.02). Morphological defect of spermatozoa (MD: 2.44, 95% CI: 0.99-3.89; P = 0.001) was also significantly higher in smokers whereby significant head (MD: 1.76, 95% CI: 0.32-3.20; P = 0.02), neck (MD: 1.97, 95% CI: 0.75-3.18; P = 0.002) and tail (MD: 1.29, 95% CI: 0.35-2.22; P = 0.007) defects were observed. However, smoking did not affected the pH (MD: 0.04, 95% CI: [- 0.03-0.11]; P = 0.30) and motility (RR: 1.42, 95% CI: 0.97-2.09; P = 0.07) of spermatozoa. Additionally, tobacco smoking did not cause any dis-balance in hormones which were involved in reproduction.
CONCLUSIONS
In conclusion, with reference to the clinical endpoints which were studied in this analysis, tobacco smoking was associated with a lower sperm count and an increase in the number of morphological defects of spermatozoa. However, the pH and motility of spermatozoa as well as the production of hormones which were involved in reproduction were not affected in this population of infertile males.
Topics: Humans; Infertility, Male; Male; Randomized Controlled Trials as Topic; Semen Analysis; Tobacco Smoking
PubMed: 30621647
DOI: 10.1186/s12889-018-6319-3 -
Reproductive Biomedicine Online Nov 2018The use of testicular spermatozoa in men without azoospermia has been proposed as a means to increase the chances of pregnancy following assisted reproductive treatment....
The use of testicular spermatozoa in men without azoospermia has been proposed as a means to increase the chances of pregnancy following assisted reproductive treatment. The purpose of this systematic review is to assess whether clinical outcomes are better when testicular rather than ejaculated spermatozoa are used for intracytoplasmic sperm injection in patients with abnormal semen parameters without azoospermia. A literature search identified four eligible studies out of 757 initially found. In a prospective study in men with high DNA fragmentation index (DFI) and oligozoospermia, the probability of live birth was significantly higher with testicular compared to ejaculated spermatozoa (risk ratio [RR]: 1.75, 95% confidence interval [CI]: 1.14-2.70). This was not the case in a retrospective study in men with high DFI only (RR: 2.36, 95% CI: 0.98-5.68). Clinical pregnancy rates were similar in a randomized controlled trial in men with asthenozoospermia with or without teratozoospermia (RR: 2.85, 95% CI: 0.76-10.69) and in a retrospective study in men with isolated asthenozoospermia (RR: 1.09, 95% CI: 0.56-2.14). Currently, there is limited, low-quality evidence suggesting that a higher probability of pregnancy might be expected using testicular rather than ejaculated spermatozoa, only in men with high DFI and oligozoospermia.
Topics: Adult; DNA Fragmentation; Ejaculation; Female; Humans; Male; Oligospermia; Pregnancy; Pregnancy Rate; Semen Analysis; Sperm Injections, Intracytoplasmic; Sperm Retrieval; Testis
PubMed: 30539719
DOI: 10.1016/j.rbmo.2018.08.017 -
Human Reproduction Update 2016ICSI is currently the most commonly used assisted reproductive technology, accounting for 70-80% of the cycles performed. This extensive use, even excessive, is partly... (Review)
Review
BACKGROUND
ICSI is currently the most commonly used assisted reproductive technology, accounting for 70-80% of the cycles performed. This extensive use, even excessive, is partly due to the high level of standardization reached by the procedure. There are, however, some aspects that deserve attention and can still be ameliorated. The aim of this systematic review was to evaluate the results of available publications dealing with the management of specific situations during ICSI in order to support embryologists in trying to offer the best laboratory individualized treatment.
METHODS
This systematic review is based on material obtained by searching PUBMED between January 1996 and March 2015. We included peer-reviewed, English-language journal articles that have evaluated ICSI outcomes in the case of (i) immature oocytes, (ii) oocyte degeneration, (iii) timing of the various phases, (iv) polar body position during injection, (v) zona-free oocytes, (vi) fertilization deficiency, (vii) round-headed sperm, (viii) immotile sperm and (ix) semen samples with high DNA fragmentation.
RESULTS
More than 1770 articles were obtained, from which only 90 were specifically related to the issues developed for female gametes and 55 for the issues developed for male gametes. The studies selected for this review were organized in order to provide a guide to overcome roadblocks. According to these studies, the injection of rescue metaphase I oocytes should be discouraged due to poor clinical outcomes and a high aneuploidy rates; laser-assisted ICSI represents an efficient method to solve the high oocyte degeneration rate; the optimal ICSI timing and the best polar body position during the injection have not been clarified; injected zona-free oocytes, if handled carefully, can develop up to blastocyst stage and implant; efficient options can be offered to patients who suffered fertilization failure in previous conventional ICSI cycles. Most controversial and inconclusive are data on the best method to select a viable spermatozoa when only immotile spermatozoa are available for ICSI and, to date, there is no reliable approach to completely filter out spermatozoa with fragmented DNA from an ejaculate. However, most of the studies do not report essential clinical outcomes, such as live birth, miscarriage and fetal abnormality rate, which are essential to establish the safety of a procedure.
CONCLUSIONS
This review provides the current knowledge on some controversial technical aspects of the ICSI procedures in order to improve its efficacy in specific contexts. Notwithstanding that embryologists might benefit from the approaches presented herein in order to improve ICSI outcomes, this area of expertise still demands a greater number of well-designed studies, especially in order to solve open issues about the safety of these procedures.
Topics: Asthenozoospermia; DNA Fragmentation; Female; Fertilization; Humans; Male; Metaphase; Microinjections; Oocytes; Pregnancy; Sperm Injections, Intracytoplasmic; Spermatozoa
PubMed: 26586241
DOI: 10.1093/humupd/dmv050