Because of the paucity of studies and inconsistencies regarding the impact of diabetes mellitus (DM) on semen quality, this disease is seldom looked for in the infertile patient. Recently, this view has been challenged by findings showing that DM induces subtle molecular changes that are important for sperm quality and function. This brief review shows the main sperm parameters in patients with DM and presents the mechanisms hypothesized to explain the changes observed in these patients. The data available suggest that DM alters conventional sperm parameters. In addition, DM causes histologic damage of the epididymis, with a negative impact on sperm transit. Various mechanisms may explain the sperm damage observed in patients with DM. These include endocrine disorders, neuropathy, and increased oxidative stress. Many authors suggest that DM decreases serum testosterone levels. This is associated with a steroidogenetic defect in Leydig cells. In addition, diabetic neuropathy seems to cause atonia of seminal vesicles, bladder, and urethra. Furthermore, DM is associated with an increased oxidative stress, which damages sperm nuclear and mitochondrial DNA. Finally, spermatogenesis derangement and germ cell apoptosis in type 1 DM may relate to a local autoimmune damage, whereas insulin resistance, obesity, and other related comorbidities may impair sperm parameters and decrease testosterone serum levels in patients with type 2 DM.Key words: Fertility, hormone, infertility, semen analysis. J Androl 2012;33:145-153A lthough diabetes mellitus (DM) is known to cause many systemic complications, male infertility, based on impotence, retrograde ejaculation, and hypogonadism, is not widely recognized to be one of them. Because of the paucity of studies and inconsistencies regarding the impact of DM on semen quality, this disease is seldom looked for in the infertile patient. Recently, this view has been challenged by findings showing that DM induces subtle molecular changes that are important for sperm quality and function . In a retrospective analysis, we found a very high prevalence of subfertility (51%) among patients with diabetes (La Vignera et al, 2009a). Another study carried out in more than 500 male partners of infertile couples showed a prevalence of DM of <1.2% (Delfino et al, 2007). In a recent study, the prevalence of infertility in type 2 DM men was 35.1%. The prevalence of primary (16%) and secondary (19.1%) infertility was significantly higher in patients with diabetes compared with patients without diabetes. In addition, secondary infertility was higher than primary infertility. About half of the infertile men with diabetes were overweight, and 29.1% of them were obese. The smoking habit was more common in infertile men with diabetes (45.6%) than in fertile men with diabetes (33.6%). Statistical analysis confirmed that age, smoking habits, and obesity were the significant major contributors for infertility in men with diabetes. Obesity was the leading contributor for infertility. Other comorbid fa...

The aim of this study was to determine whether differences occur in seminal concentrations of white blood corpuscles (sWBC) and whether WBC production of reactive oxygen species (ROS) is related to the infiltration of one or more male sexual glands. We studied 70 infertile patients affected by bacterial male accessory gland infections (MAGI) who were divided clinically and, by ultrasound (US), into four well-characterized, aged-matched groups. Three of the groups presented an abnormal US scan (MAGI US+ groups): group P with prostatitis alone (n = 15), group PV with prostato-vesiculitis (n = 19), and group PVE with prostato-vesiculo-epididymitis (n = 22). The fourth group presented with a normal US scan (MAGI US- group) and was diagnosed with presumptive MAGI according to laboratory criteria (n = 14). In addition, 20 fertile males acted as controls. All patients underwent seminal and microbiological analyses as well as US scans. In addition, the WBC concentrations of whole semen and the WBC-rich 45% Percoll fraction (Pf45) as well as WBC-specific ROS production in the same sperm fraction were analysed. Semen samples from the PVE patient group exhibited significantly (P < 0.01) lower values of sperm parameters than those obtained from P, PV, MAGI US- and the control groups. The sWBC and Pf45 WBC concentration as well as baseline and fMLP-stimulated ROS counts in each MAGI US+ group were significantly (P < 0.01) higher than those found in the MAGI US- group and controls.

Male accessory gland infection (MAGI) has been identified among those diagnostic categories which have a negative impact on the reproductive function and fertility in males (Rowe et al., World Health Organization Manual for the Standardised Investigation and Diagnosis of the Infertile Couple, Cambridge University Press, Cambridge, 1993). MAGI is a hypernym which groups the following different clinical categories: prostatitis, prostate-vesiculitis and prostate-vesiculo-epididymitis. Some of the characteristics they share are: common diseases, mainly have a chronic course, rarely cause obstruction of the seminal pathways, can have an unpredictable intracanicular spread to one or more sexual accessory glands of the reproductive tract, as well as to one or both sides. In this review, we show that all components involving the inflammatory response (from the agents which first trigger it to each component of the inflammatory response dynamic) can deteriorate conventional and/or non-conventional sperm parameters arising from one or more of the following mechanisms: altered secretory function of the epididymis, seminal vesicles, and prostate which reduce the antioxidant properties or scavenging role of the seminal plasma; deterioration of spermatogenesis; and (unilateral or bilateral) organic or functional sub-obstruction of the seminal tract.

Oxidative stress (OS) has been recognized as one of the most important cause of male infertility. Despite the antioxidant activity of seminal plasma, epididymis and spermatozoa, OS damages sperm function and DNA integrity. Since antioxidants suppress the action of reactive oxygen species, these compounds have been used in the medical treatment of male infertility or have been added to the culture medium during sperm separation techniques. Nevertheless, the efficacy of such a treatment has been reported to be very limited. This may relate to: (i) patient selection bias; (ii) late diagnosis of male infertility; (iii) lack of double-blind, placebo-controlled clinical trial; and/or (iv) use of end-points that are not good markers of the presence of OS. This review considers the effects of the main antioxidant compounds used in clinical practice. Overall, the data published suggest that no single antioxidant is able to enhance fertilizing capability in infertile men, whereas a combination of them seems to provide a better approach. Taking into account the pros and the cons of antioxidant treatment of male infertility, the potential advantages that it offers cannot be ignored. Therefore, antioxidant therapy should remain in the forefront of preventive medicine, including human reproductive medicine.

These results indicate that carnitines are only an effective treatment in patients with abacterial PVE and elevated ROS production when seminal WBC concentration is normal.

Although with some discrepancy, obese men have been reported to have the worst conventional sperm parameters, but little is known about the effects of body weight on sperm mitochondrial function, chromatin condensation and apoptosis. This study was undertaken to evaluate conventional and nonconventional sperm parameters in nonsmoking overweight or obese men without any other cause known to alter sperm parameters. Fifty overweight, 50 obese, and 50 normal-weight healthy nonsmoking men were carefully selected. Each man underwent up to 2 sperm analyses and evaluation of mitochondrial membrane potential (MMP), phosphatidylserine (PS) externalization, chromatin compactness, and DNA fragmentation by flow cytometry. Overweight and obese men had significantly lower sperm progressive motility and normal forms than controls. They also had a significantly higher percentage of spermatozoa with low MMP. Obese, but not overweight, men showed a significantly higher percentage of spermatozoa with PS externalization, an early sign of apoptosis, and a lower percentage of viable spermatozoa. A significant increased percentage of spermatozoa with abnormal chromatin compactness was found in both overweight and obese men, whereas only obese men had a significantly higher number of spermatozoa with DNA fragmentation compared with controls. Healthy nonsmoking overweight and obese men have worse conventional and nonconventional sperm parameters than normal-weight controls. The important role played by these parameters in a couple's fertility suggests a program of body weight loss among the therapeutic repertoire for male infertility.

Although alcohol is widely used, its impact on the male reproductive function is still controversial. Over the years, many studies have investigated the effects of alcohol consumption on sperm parameters and male infertility. This article reviews the main preclinical and clinical evidences. Studies conducted on the experimental animal have shown that a diet enriched with ethanol causes sperm parameter abnormalities, a number of alterations involving the reproductive tract inhibition, and reduced mouse oocyte in vitro fertilization rate. These effects were partly reversible upon discontinuation of alcohol consumption. Most of the studies evaluating the effects of alcohol in men have shown a negative impact on the sperm parameters. This has been reported to be associated with hypotestosteronemia and low-normal or elevated gonadotropin levels suggesting a combined central and testicular detrimental effect of alcohol. Nevertheless, alcohol consumption does not seem to have much effect on fertility either in in vitro fertilization programs or population-based studies. Finally, the genetic background and other concomitant, alcohol consumption-related conditions influence the degree of the testicular damage. In conclusion, alcohol consumption is associated with a deterioration of sperm parameters which may be partially reversible upon alcohol consumption discontinuation.

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