A New Option for the Diagnosis and Treatment of Male Infertility

According to studies, sperm count in men is decreasing worldwide every year, and has dropped by approximately 50% compared to 50 years ago. As a result of this decline, the World Health Organization was forced to lower the thresholds for what is considered a normal sperm count in 2010. It is believed that cell phones, hormone-containing foods, increased consumption of fatty foods, and increased exposure to environmental toxins (heavy metals and pesticides) play a significant role in the deterioration of normal sperm values.

When comparing countries worldwide, it is observed that as the level of industrialization increases, so does the deterioration in sperm values. Statistically, in 30–40% of couples who are unable to conceive despite regular intercourse (infertility), the cause lies with the male partner, and in one out of every five infertile couples, the male factor is the sole cause of infertility. It is estimated that one in every 20 men has sperm count and/or function issues to varying degrees, and azoospermia (the absence of sperm in semen) is observed in 1% of men.

The primary causes of impaired sperm production include chromosomal and genetic abnormalities, undescended testicles, and infectious causes. Varicocele, a condition commonly known among the general public that can also cause pain in the genital area, can lead to reduced sperm production. Varicocele is observed in 15% of healthy men and 40% of infertile men. Other factors that reduce sperm production include hormonal issues, medications, chemical substances, radiation damage, alcohol, and smoking. Smoking introduces cadmium into the body, which damages the testicles.

When evaluating a couple unable to conceive, if all findings related to the woman are normal, the course of treatment is determined based on the man’s sperm parameters. The two most commonly used methods in treatment are intrauterine insemination (IUI) and in vitro fertilization (IVF). In cases of mild male factor infertility, pregnancy can be achieved in 10–15% of cases through IUI. However, when sperm parameters fall below certain threshold values, the only viable options are in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI).

A new cause has recently been added to the known causes of male infertility. This condition, known as oxidative stress, can cause infertility by causing DNA damage in sperm. It has been shown that patients with poor sperm quality have elevated levels of free oxidative radicals, which cause oxidative stress. DNA damage in sperm increases with age, and it has been shown that increased DNA damage plays a significant role in male infertility.

Although free oxidative radicals are necessary for fertilization, their excessive production impairs sperm function by causing loss of motility and DNA damage. Consequently, they can trigger numerous pathological processes in the male reproductive system. It has been shown that sperm DNA damage contributes significantly to infertility in 30–80% of infertile men. It is believed that this harmful effect can be reduced by using dietary supplements such as vitamin C, vitamin E, and beta-carotene.

Current oxidative stress detection models do not include a complete measurement system and are not practical for clinical applications. Devices suitable for clinical use have been developed to measure DNA damage in sperm. The MİOXSYS device is based on the Oxidation-Reduction Potential principle and measures electron transfer. The ability to predict sperm DNA damage in approximately 4 minutes allows us to select the appropriate treatment approach. In particular, in IVF treatment, using sperm without DNA damage in the microinjection method can result in higher pregnancy rates.

References:

• World Health Organization. (2010). WHO Laboratory Manual for the Examination and Processing of Human Semen (5th Edition).

• World Health Organization. (2021). WHO Laboratory Manual for the Examination and Processing of Human Semen (6th Edition).

• European Association of Urology. (Güncel). EAU Guidelines on Male Infertility.

• American Society for Reproductive Medicine. (Güncel). Evaluation and Treatment of Male Infertility – Practice Committee Guideline.

• European Society of Human Reproduction and Embryology. (Güncel). Male Factor Infertility Guideline.

• Levine H, Jørgensen N, Martino-Andrade A, et al. (2017). Temporal trends in sperm count: A systematic review and meta-regression analysis. Human Reproduction Update.

• Agarwal A, et al. (2014). Oxidative stress and its implications in male infertility. Reproductive Biology and Endocrinology.

• Turkish Urological Association. (Current). Guidelines for the Diagnosis and Treatment of Male Infertility.