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In Assisted Reproductive Technologies (ART), efficient sperm preparation is vital for successful fertilization, with washing media enhancing the process. This pilot study examines the molecular-level impact of a new serotonin-containing sperm-washing medium (Prototype) on sperm motility and ROS metabolism, comparing it with commercially available media (Origio and Irvine). Semen samples from thirty-one individuals underwent preparation using the swim-up method post-semen analysis. Each sample was separately washed with the Prototype, Origio and Irvine mediums. ROS formation was determined through flow cytometric, and AT2R and PRDX2 protein levels, associated with sperm motility, were assessed via Western blot. Statistical evaluation compared the findings among the three outlined media. Significant differences were found among three washing media in terms of total and progressive motility. The Prototype medium showed the highest increase in both total (66%) and progressive motility (59%), while the control group exhibited the lowest increases (41% and 27.7%, respectively). Regarding ROS levels, the prototype (11.5%) and Origio (10.7%) groups demonstrated a notable decrease, contrasting with Irvine (25.8%). Molecular assessment revealed a significant elevation in AT2R protein levels in the prototype medium (59%), compared to other media. Additionally, an increase in PRDX2 protein levels was observed in the prototype medium, although this didn’t reach statistical significance. Serotonin-activated washing media for sperm preparation can be a suitable choice for selecting high-quality sperm in ART. A broader molecular analysis with a larger sample size is required to explore the mechanisms and effectiveness of using a serotonin-containing sperm-washing medium in routine ART.
Substance use refers to the consumption of drugs that have varying degrees of impact on a persons’ physical, mental and emotional well-being. While the adverse health effects of drugs have been extensively documented, further research is needed to understand their impact on fertility. Studies have indicated that substance use affects both the male and female reproductive systems. As substance use is more prevalent among young adults compared with the elderly, it appears that individuals of reproductive age are particularly vulnerable to the reproductive impairments associated with substance use. Although numerous studies have reported detrimental effects of substance use on pregnant women and their foetus during the post-implantation stages, there are limited studies on critical pre-implantation period and gamete stages. In this narrative review, we aimed to focus on the most significant evidence regarding the impact of substances on gametes and pre-implantation embryos.
This chapter examines the law of nullity of marriage to consider how deception has affected the existence or validity of consent. It articulates important differences between void and voidable marriages, arguing that these speak to the public and private sides of marriage, respectively. It also showcases the range of deceptions that have been considered legally significant, situating these within the cultural framework outlined in Chapter 1. On top of this, the chapter argues that the range of qualifying deceptions has often been justified with reference to public policy or convention on the basis that the relevant information would typically be important to an intimate partner or that its disclosure would serve a collective interest or value. The chapter concludes by suggesting that changes in the law of nullity, and a small number of related areas of law, demonstrate that there is still a desire for legal recognition of the wrongs and harms associated with inducing intimate relationships, even as these have shifted over time.
The role of depression in subsequent infertility, miscarriage and stillbirth remains unclear. This study aimed to examine the association of a history of depression with these adverse outcomes using a longitudinal cohort study of women across their reproductive life span.
Methods
This study used data from participants in the Australian Longitudinal Study on Women’s Health who were born in 1973–1978. Participants (N = 8707) were followed up every 3 years from 2000 (aged 22–27) to 2018 (aged 40–45). Information on a diagnosis of depression was collected from each survey, and antidepressant medication use was identified through pharmaceutical prescription data. Histories of infertility, miscarriage, and stillbirth were self-reported at each survey. Time-lagged log-binomial models with generalized estimating equations were used to assess the association of a history of depression up to and including in a given survey with the risk of fertility issues in the next survey.
Results
Women with a history of depression (excluding postnatal depression) were at higher risk of infertility [risk ratio (RR) = 1.34, 95% confidence interval (CI): 1.21–1.48], miscarriage (RR = 1.22, 95%CI: 1.10–1.34) and recurrent miscarriages (≥2; RR = 1.39, 95%CI: 1.17–1.64), compared to women without a history of depression. There were too few stillbirths to provide clear evidence of an association. Antidepressant medication use did not affect the observed associations. Estimated RRs of depression with infertility and miscarriage increased with age.
Conclusions
A history of depression was associated with higher risk of subsequent infertility, miscarriage and recurrent miscarriages.
Edited by
Laurie J. Mckenzie, University of Texas MD Anderson Cancer Center, Houston,Denise R. Nebgen, University of Texas MD Anderson Cancer Center, Houston
Improvements in multimodality treatment of anal and colorectal cancer has led to increased numbers of women survivors who experience gynecologic problems in long-term survivorship. The etiology of gynecologic problems after anal and colorectal cancer treatment is complex and multifactorial. Pelvic radiation, surgery and chemotherapy can all cause anatomic, hormonal and psychological changes. Consideration of preventative measures can ideally reduce the risk of vaginal stenosis, dyspareunia, sexual dysfunction, infertility, premature menopause and pelvic pain after therapy. Proactive screening and appropriate treatment of cancer therapy late effects can improve patients’ quality of life during survivorship.
Edited by
Laurie J. Mckenzie, University of Texas MD Anderson Cancer Center, Houston,Denise R. Nebgen, University of Texas MD Anderson Cancer Center, Houston
Premature ovarian insufficiency (POI) is a heterogeneous diagnosis caused by a multitude of factors including genetic, autoimmune, iatrogenic, social, and environmental. It is defined as loss of ovarian function prior to 40 years of age with subsequent secondary amenorrhea for at least 4−6 months in conjunction with elevated follicle stimulating hormone levels on two different measurements. Prompt recognition of symptoms should encourage thorough history-taking and work-up, as some causes of POI are associated with conditions requiring additional screening or medical management. Early initiation of hormone replacement therapy is necessary to prevent long-term sequelae from chronic hypoestrogenism such as cardiovascular events, poor bone health, and cognitive dysfunction. Extensive counseling with regards to future fertility and family building options is necessary as the diagnosis of POI can be psychologically devastating to many women.
Sperm infertility or subfertility is detrimental to the precious highland germplasm like yak whose population has been gradually declining in India. Understanding the ‘omic’ landscape of infertile or subfertile yak sperm can reveal some interesting insights. In an attempt to do the same, this study considered the semen of infertile or subfertile yak bulls for whole-genome and transcriptome evaluations. DNA sequencing revealed that the yak sperm genome contains the necessary genes to carry out all the important biological processes related to the growth, development, survival and multiplication of an organism. Interestingly, RNA Seq results highlighted that genes like VAMP7, MYLK, ARAP2 and MARCH6 showed increased expression, while biological processes related to immune response (GO:0043308, GO:0002447, GO:0002278, GO:0043307, GO:0043312, GO:0002283, GO:0043299 and GO:0002446) were significantly overrepresented. These findings hint at a possible role played by immune system in regulating infertility or subfertility in yaks. Further, in-depth studies can validate these findings and help in improving our biological understanding in this area.
Chapter 2 considers the story of the prophet Samuel, God’s relationship with his mother Hannah, the way God related to people at the shrine at Shiloh, Samuel’s family relationships and God’s relationship with his family, and the significance of the call of Samuel.
While there is a recognised role of optimising lifestyle behaviours such as diet and physical activity in the management of infertility, the best practice for lifestyle management of infertility remains unknown, and factors influencing the lifestyle behaviours of people with infertility are not well understood. The aim of this systematic review is to evaluate the barriers and enablers to a healthy lifestyle in people with infertility, from the perspectives of people with infertility and health professionals, in order to inform optimal behavioural change strategies for lifestyle management of infertility. Ovid MEDLINE(R), PsycINFO, EMBASE, EBM Reviews, and CINAHL Plus were searched from inception to 12th September 2022. Eligible studies were qualitative, quantitative or mixed-methods primary studies which explored barriers and/or enablers to lifestyle for infertility management, from the perspectives of people with infertility and/or health professionals. Two independent reviewers performed quality assessment, using the Centre for Evidence-Based Management Critical Appraisal of a Survey Tool (quantitative and mixed-methods studies) and the Critical Appraisal Skills Programme Qualitative Checklist (qualitative and mixed-methods studies). Data were analysed by inductive thematic analysis with themes mapped to the Capability, Opportunity, Motivation and Behaviour (COM-B) model(1) and Theoretical Domains Framework (TDF)(2). Relevant behaviour change techniques (BCTs)(3) to target the identified enablers and barriers were suggested. After screening 10703 citations and 82 full-texts, 22 studies were included (12 quantitative, 7 mixed-methods and 3 qualitative) with 18 studies including women with infertility (n = 2442), 10 including men with infertility (n = 1372) and 6 including health professionals (n = 261). From the perspectives of people with infertility, themes related to capability (e.g. strategies for behaviour change), opportunity (e.g. limited time, resources and money) and motivation (e.g. interplay between lifestyle and emotional state); themes mapped to 8 TDF domains. From the perspectives of health professionals, themes related to capability (e.g. identification of patients appropriate for lifestyle intervention), opportunity (e.g. mode of delivery) and motivation (e.g. professional responsibility); themes mapped to 6 TDF domains. 34 BCTs were identified across the suggested interventions. This systematic review found that several interacting factors influence lifestyle in people with infertility as well as health professional behaviour with regards to provision of lifestyle interventions for infertility. These factors can be targeted for optimisation of interventions. In light of the limited number of qualitative studies, there is a need for more qualitative research to gain deeper insights into the perspectives of people with infertility and health professionals for further exploration of the complex and interacting factors which shape lifestyle during the fertility journey.
Chapter 2 explores the right to make use of medically assisted procreation to conceive a child, upheld by the Strasbourg Court as an expression of private and family life. It discusses limitations based on ‘the rights of others’ (e.g. the other gamete provider in disputes over embryos) and ‘morals’ (e.g. public policy objections to heterologous fertilisation, surrogacy and the posthumous use of cryopreserved gametes/embryos). The chapter argues that the refusal to treat couples with donated gametes imposes a choice between genetic parenthood and the continuance of marriage to an infertile spouse, affecting both prospective and existing family life. It further maintains that reproductive autonomy should extend to posthumous reproduction where the deceased left advance directions and there are no overriding child welfare concerns. The chapter notes the recognition of legal ties between children and genetic parents in foreign surrogacy cases, albeit exclusively through the lens of children’s privacy (identity) rights.
Infertility affects 15% of all couples worldwide and 50% of cases of infertility are solely due to male factors. A decrease in motility in the semen is considered one of the main factors that is directly related to infertility. The use of supplementation to improve the overall sperm quality has become increasingly popular worldwide. The purpose of this study was to evaluate whether sperm motility was affected by the combination of serotonin (5-HT), selenium (Se), zinc (Zn), and vitamins D, and E supplementation. Semen samples were incubated for 75 min at 37°C in medium containing varying concentrations of 5-HT, Se, Zn, vitamin D, and E. 5-HT (200 μM), Se (2 μg/ml), Zn (10 μg/ml), vitamin D (100 nM), and vitamin E (2 mmol) have also been shown to increase progressive sperm motility. Three different mixtures of supplements were also tested for their combined effects on sperm motility and reactive oxygen species (ROS) production. While the total motility in the control group was 71.96%, this was found to increase to 82.85% in the first mixture. In contrast the average ROS level was 8.97% in the control group and decreased to 4.23% in the first mixture. Inclusion of a supplement cocktail (5-HT, Se, Zn, vitamins D and E) in sperm processing and culture medium could create an overall improvement in sperm motility while decreasing ROS levels during the incubation period. These molecules may enhance the success of assisted reproduction techniques when present in sperm preparation medium.
In this chapter, we will review how men’s health has evolved into a distinct subspecialty of medicine and changed over the past two decades. There exists a large disparity between men and women when it comes to health. However, as the drivers for men seeking health care are changing, the urologist is in a unique position to help quarterback men’s health initiatives. Men’s health advocacy and the creation of men’s health centers are on the rise. Areas of advancement in the field include prostate cancer diagnosis and treatment, erectile dysfunction therapies, surgical treatment for chronic testicular pain, and new approaches to male factor infertility. The burgeoning field of men’s health has seen many advancements in the past two decades and will continue to make significant gains in the years to come.
Given the wide spectrum in practice standards and patterns, array of covered versus out-of-pocket conditions, and role of adjunct streams of revenue, the business landscape of men’s health is diverse. Fundamental to the fiscal success of many providers is the efficacy of direct to consumer marketing in the setting of inelastic demand for solutions to aging, erectile dysfunction (ED), and Peyronie’s disease; this has created enormous markets surrounding supplemental testosterone, online platforms for ED treatment, and out-of-pocket products such as platelet-rich plasma, stem-cell therapy, and shock wave treatments. The contemporary story of men’s health has been defined by the gender health gap; uncovering the link between coronary artery disease (CAD) and ED unveiled a touchpoint for establishing holistic men’s health. University and large hospital systems have the infrastructure to support comprehensive Men’s Health Centers and have therefore maximized the downstream revenue associated with prescriptions, long-term screening, and future hospitalizations.
A diagnosis of infertility in the male or female partner within a couple can cause significant stress, leading to sexual dysfunction in either or both partners. The causes of infertility and the related sexual dysfunction can be organic or psychosocial in nature but are frequently linked. Here, we discuss the interplay between infertility and sexual dysfunction, specifically in the man and the couple, and focus on psychosocial interventions for the couple as they struggle to build their family.
The office evaluation of the infertile male involves a comprehensive history and physical structured to uncover all potential causes including congenital, medical, surgical, environmental, genetic, and psychosocial etiologies. The physical exam begins with the patient’s general appearance, body habitus, and progresses to the genital exam in which the testicles are examined for size, consistency, and location. Prior surgical scars, absence of the vas deferens, or the presence of varicoceles may be identifiable causes of infertility. The semen analysis is the cornerstone laboratory evaluation of the male undergoing an infertility workup. The semen is evaluated for several key parameters including volume as well as sperm concentration, number, motility, and form. An endocrine evaluation is indicated in men with oligospermia, azoospermia, or a history of physical examination findings suggestive of hormonal abnormalities including sexual dysfunction, decreased libido, or physical evidence of impair androgenization. Pending the initial workup genetic testing may be indicated.
Over the past 20 years, there has been growing interest in understanding the genomic integrity of human spermatozoa and the clinical relevance of sperm chromatin and DNA defects. We have learned that the etiology of human sperm DNA damage is multi-factorial and that sperm DNA defects are associated with abnormal semen parameters. While we have observed that tests of sperm DNA integrity are correlated with reproductive outcomes, use of these complementary biomarkers in the management of male infertility remains controversial. In this chapter, we review the etiologic factors associated with sperm DNA damage and the utility of these tests in clinical practice. We also review the treatment options for infertile men with sperm DNA damage.
This review discusses epigenetic mechanisms and the relationship of infertility in men and women in relation to parameters pertaining to nutrition. The prevalence of infertility worldwide is 8–12 %, and one out of every eight couples receives medical treatment. Epigenetic mechanisms, aging, environmental factors, dietary energy and nutrients and non-nutrient compounds; more or less energy intake, and methionine come into play in the occurrence of infertility. It also interacts with vitamins B12, D and B6, biotin, choline, selenium, zinc, folic acid, resveratrol, quercetin and similar factors. To understand the molecular mechanisms regulating the expression of genes that affect infertility, the environment, the role of genotype, age, health, nutrition and changes in the individual's epigenotype must first be considered. This will pave the way for the identification of the unknown causes of infertility. Insufficient or excessive intake of energy and certain macro and micronutrients may contribute to the occurrence of infertility as well. In addition, it is reported that 5–10 % of body weight loss, moderate physical activity and nutritional interventions for improvement in insulin sensitivity contribute to the development of fertility. Processes that pertain to epigenetics carry alterations which are inherited yet not encoded via the DNA sequence. Nutrition is believed to have an impact over the epigenetic mechanisms which are effective in the pathogenesis of several diseases like infertility. Epigenetic mechanisms of individuals with infertility are different from healthy individuals. Infertility is associated with epigenetic mechanisms, nutrients, bioactive components and numerous other factors.
Infertility is a reproductive health condition that is often not openly discussed. By not discussing this condition, many stigmas and stereotypes may be ascribed. For example, many think that infertility pertains only to women, although men may also receive an infertility diagnosis. Race and ethnicity can impact how male factor infertility is understood, communicated, and managed. The aim of this chapter is to synthesize available research regarding biopsychosocial variables of male factor infertility with African American men while offering support considerations.
The fertility journey for Black lesbian couples can be both challenging and rewarding. Clinicians must be able to assist their clients therapeutically while they are going through the procedures as well as managing the biological, psychological, social, and emotional aspects of the process. This chapter seeks to help therapists acquire an understanding of the process of conceiving a child within a Black lesbian relationship. It will help clinicians understand how women reconcile being labeled infertile or having issues of infertility when there may be nothing physically wrong. It will explain how gender expression could impact the decision of who should carry the child in Black lesbian relationships. The chapter discusses the process of intrauterine insemination (IUI), in vitro fertilization (IVF), and adoption within the lesbian community and specifically the Black lesbian community. Clinicians will learn how the journey to conceive a child impacts the Black lesbian relationship and what helping professionals need to do in order to effectively help their clients weather the storm.
Fertilization failure (FF) and zygotic arrest after ICSI have a huge effect on both patients and clinicians, but both problems are usually unexpected and cannot be properly diagnosed. Fortunately, in recent years, gene sequencing has allowed the identification of multiple genetic variants underlying failed ICSI outcomes, but the use of this approach is still far from routine in the fertility clinic. In this systematic review, the genetic variants associated with FF, abnormal fertilization and/or zygotic arrest after ICSI are compiled and analyzed. Forty-seven studies were included. Data from 141 patients carrying 121 genetic variants affecting 16 genes were recorded and analyzed. In total, 27 variants in PLCZ1 (in 50 men) and 26 variants in WEE2 (in 24 women) are two of the factors related to oocyte activation failure that could explain a high percentage of male-related and female-related FF. Additional variants identified were reported in WBP2NL, ACTL9, ACTLA7, and DNAH17 (in men), and TUBB8, PATL2, TLE6, PADI6, TRIP13, BGT4, NLRP5, NLRP7, CDC20 and ZAR1 (in women). Most of these variants are pathogenic or potentially pathogenic (89/121, 72.9%), as demonstrated by experimental and/or in silico approaches. Most individuals carried bi-allelic variants (89/141, 63.1%), but pathogenic variants in heterozygosity have been identified for PLCZ1 and TUBB8. Clinical treatment options for affected individuals, such as chemical-assisted oocyte activation (AOA) or PLCZ1 cRNA injection in the oocyte, are still experimental. In conclusion, a genetic study of known pathogenic variants may help in diagnosing recurrent FF and zygotic arrest and guide patient counselling and future research perspectives.