We evaluated the development of embryos generated from the fertilisation of oocytes with spermatozoa isolated from animals with primary testicular damage (PTD). Embryos derived in vivo or in vitro from oocytes fertilised with spermatozoa produced by PTD rats that had undergone surgical treatment for the PTD (group A1), or PTD rats (group A2), or control rats (group B) were cultured and transferred to recipients. At the end of the experimental period, the fertilisation potential of each rat was assessed in vitro (IVF trials). Sperm 8-oxodG/dG ratio (a marker of DNA oxidative status) was significantly larger in group A2 than in groups A1 and B. Blastocysts of the group A2 transferred to recipients demonstrated a significantly larger loss before implantation than transferred blastocysts of groups A1 or B. In addition, the proportion of implanted blastocysts that could not complete the intrauterine development was significantly larger in group A2 than in groups A1 and B. This study reveals a post-fertilisation detrimental effect in animals with PTD on the capacity of oocytes (fertilised either in vitro or in vivo) to develop in vitro and implant after transferring them to recipients probably attributable to sperm DNA oxidative damage.

Normal testicular function is dependent upon hormones acting through endocrine and paracrine pathways both in vivo and in vitro. Sertoli cells provide factors necessary for the successful progression of spermatogonia into spermatozoa. Sertoli cells have receptors for follicle stimulating hormone (FSH) and testosterone which are the main hormonal regulators of spermatogenesis. Hormones such as testosterone, FSH and luteinizing hormone (LH) are known to influence the germ cell fate. Their removal induces germ cell apoptosis. Proteins of the Bcl-2 family provide one signaling pathway which appears to be essential for male germ cell homeostasis. In addition to paracrine signals, germ cells also depend upon signals derived from Sertoli by direct membrane contact. Somatostatin is a regulatory peptide playing a role in the regulation of the proliferation of the male gametes. Activin A, follistatin and FSH play a role in germ cell maturation during the period when gonocytes resume mitosis to form the spermatogonial stem cells and differentiating germ cell populations. In vitro cultures systems have provided evidence that spermatogonia in advance stage of differentiation have specific regulatory mechanisms that control their fate. This review article provides an overview of the literature concerning the hormonal pathways regulating spermatogenesis.

PURPOSE:The macroscopic examination of urine constituted a lasting diagnostic method from the time of Hippocrates and Galen until the Renaissance. The Byzantines, as the carriers of ancient Greek medical knowledge, adopted uroscopy.MATERIALS AND METHODS:We reviewed the medical and historical bibliography as well as the original texts of Byzantine doctors.RESULTS:The outcome was impressive since, at that time, uroscopy was considered a main tool of clinical diagnosis. The Byzantines influenced the Arabs and Western Europe, their scriptures were considered points of reference, and they were regarded as experts on the subject of uroscopy.CONCLUSIONS:Byzantine doctors added new elements to the concept of uroscopy, which was based on ancient Greek knowledge. Throughout the centuries uroscopy was established as an irreplaceable diagnostic method which affected medical thinking as well as the perception of examination and cure since it practically isolated doctor and patient, especially in Western Europe.

The aim of this review study is to elucidate the effects that phosphodiesterase 5 (PDE5) inhibitors exert on spermatozoa motility, capacitation process and on their ability to fertilize the oocyte. Second messenger systems such as the cAMP/adenylate cyclase (AC) system and the cGMP/guanylate cyclase (GC) system appear to regulate sperm functions. Increased levels of intracytosolic cAMP result in an enhancement of sperm motility and viability. The stimulation of GC by low doses of nitric oxide (NO) leads to an improvement or maintenance of sperm motility, whereas higher concentrations have an adverse effect on sperm parameters. Several in vivo and in vitro studies have been carried out in order to examine whether PDE5 inhibitors affect positively or negatively sperm parameters and sperm fertilizing capacity. The results of these studies are controversial. Some of these studies demonstrate no significant effects of PDE5 inhibitors on the motility, viability, and morphology of spermatozoa collected from men that have been treated with PDE5 inhibitors. On the other hand, several studies demonstrate a positive effect of PDE5 inhibitors on sperm motility both in vivo and in vitro. In vitro studies of sildenafil citrate demonstrate a stimulatory effect on sperm motility with an increase in intracellular cAMP suggesting an inhibitory action of sildenafil citrate on a PDE isoform other than the PDE5. On the other hand, tadalafil's actions appear to be associated with the inhibitory effect of this compound on PDE11. In vivo studies in men treated with vardenafil in a daily basis demonstrated a significantly larger total number of spermatozoa per ejaculate, quantitative sperm motility, and qualitative sperm motility; it has been suggested that vardenafil administration enhances the secretory function of the prostate and subsequently increases the qualitative and quantitative motility of spermatozoa. The effect that PDE5 inhibitors exert on sperm parameters may lead to the improvement of the outcome of assisted reproductive technology (ART) programs. In the future PDE5 inhibitors might serve as adjunct therapeutical agents for the alleviation of male infertility.

To estimate the global lifetime prevalence rate of anabolic-androgenic steroid (AAS) use and investigate moderators of the prevalence rate.A meta-analysis and meta-regression analysis was performed using studies gathered from searches in PsycINFO, PubMed, ISI Web of Science, and Google Scholar among others. Included were 187 studies that provided original data on 271 lifetime prevalence rates. Studies were coded for publication year, region, sample type, age range, sample size, assessment method, and sampling method. Heterogeneity was assessed by the I2 index and the Q-statistic. Random effect-size modeling was used. Subgroup comparisons were conducted using Bonferroni correction.The global lifetime prevalence rate obtained was 3.3% (95% confidence interval [CI], 2.8–3.8; I2 = 99.7, P < .001). The prevalence rate for males, 6.4% (95% CI, 5.3–7.7, I2 = 99.2, P < .001), was significantly higher (Qbet = 100.1, P < .001) than the rate for females, 1.6% (95% CI, 1.3–1.9, I2 = 96.8, P < .001). Sample type (athletes), assessment method (interviews only and interviews and questionnaires), sampling method, and male sample percentage were significant predictors of AAS use prevalence. There was no indication of publication bias.Nonmedical AAS use is a serious widespread public health problem.

Introduction: The use of gonadotrophin-releasing hormone (GnRH) analogues for pituitary suppression in in vitro fertilization (IVF) significantly decreased the incidence of premature luteinizing hormone (LH) surge. Despite pituitary downregulation, a rise in serum progesterone levels on the day of human chorionic gonadotrophin (hCG) administration above a threshold level has been described as premature luteinization. However, there is no consensus on whether progesterone elevation on the day of hCG administration is associated with the outcome of IVF. In a recent metanalysis, it has been found that there was no statistically significant association between progesterone elevation and clinical pregnancy. Materials and methods: In this retrospective study, the impact of premature luteinization on clinical outcome was analyzed in IVF cycles with long GnRH a, GnRH anta, and microdose flare protocols in a cohort of infertile population in an university IVF clinic. Premature luteinization was diagnosed when serum progesterone level was 1.5 ng/mL. on the day of hCG. The cycles were cancelled when serum progesterone level was 2.5 ng/mL. on the day of hCG. The outcome measures were clinical and ongoing pregnancy rates. Results: Six hundred ninety one cycles of 589 patients were retrospectively analyzed. Five hundred two patients had one cycle, 73 patients had 2 cycles and 10 patients had 3 cycles and 1 patient had 4 cycles. Long luteal suppression was used in 444 cycles (64.3%), others were microdose flare (25.2%) and antagonist (5. 8%) cycles. A serum progesterone level was available at the day of hCG administration in 87.8% of the cycles. The incidence of premature luteinization was 6.09%, when the cut-off was chosen as 1.5 ng/mL. One hundred seventy four cycles were cancelled for various reasons; 9 cycles were cancelled for premature luteinization (serum progesterone level .2.5 ng/mL.). Embryo transfer was performed on day 3 in 62% of the cycles, others were performed on day 2. Clinical and ongoing pregnancy rates were lower in patients with premature luteinization (32% and 28%, respectively) as compared to patients with progesterone level ,1.5 ng/mL (41.3% and 33.5%, respectively), but the differences were not statistically significant. Conclusions: Serum progesterone levels between 1.5–2.5 ng/mL. on the day of hCG administration did not adversely effect clinical outcome in cleavage stage embryo transfer cycles.

PURPOSE:In this article we present the medical methods of lithotripsy applied by ancient Greek and Byzantine physicians, and their influence on the development of surgery after that time. MATERIALS AND METHODS:Study and analysis of the original texts of the Byzantine medical writers, written in Greek and containing the knowledge of the ancient Greek, Hellenistic and Roman periods, were performed. RESULTS:The Byzantine method of lithotripsy was the result of the eternal knowledge of the spasmolytic, analgesic and lithotriptic effect of various herbs, together with ancient surgical techniques of stone removal from Hellenistic and Roman periods. No operation was attempted for the extraction of stones from kidneys. Rather the idea was to drop the stones to the bladder or into the urethra, or dilute them into smaller pieces with various herbs. CONCLUSIONS:Ancient Greek and Byzantine physicians described conservative and surgical methods, derived from the texts of early surgeons, to which they added their own observations.

Pregnancies achieved by assisted reproduction technologies and particularly by ooplasmic injections of either in vivo or in vitro generated immature male germ cells are susceptible to genetic risks inherent to the male population treated with assisted reproduction and additional risks inherent to these innovative procedures. The documented, as well as the theoretical risks, are discussed in this review. These risks represent mainly the consequences of genetic abnormalities underlying male infertility and may become stimulators for the development of novel approaches and applications in the treatment of infertility. Recent data suggest that techniques employed for in vitro spermatogenesis, male somatic cell haploidisation, stem cell differentiation in vitro and assisted reproductive technology may also affect the epigenetic characteristics of the male gamete, the female gamete, or may have an impact on early embryogenesis. They may be also associated with an increased risk for genomic imprinting abnormalities. Production of haploid male gametes in vitro may not allow the male gamete to undergo all the genetic and epigenetic alterations that the male gamete normally undergoes during in vivo spermatogenesis.

Pregnancies achieved by assisted reproduction technologies, particularly by intracytoplasmic sperm injection (ICSI) procedures, are susceptible to genetic risks inherent to the male population treated with ICSI and additional risks inherent to this innovative procedure. The documented, as well as the theoretical, risks are discussed in the present review study. These risks mainly represent that consequences of the genetic abnormalities underlying male subfertility (or infertility) and might become stimulators for the development of novel approaches and applications in the treatment of infertility. In addition, risks with a polygenic background appearing at birth as congenital anomalies and other theoretical or stochastic risks are discussed. Recent data suggest that assisted reproductive technology might also affect epigenetic characteristics of the male gamete, the female gamete, or might have an impact on early embryogenesis. It might be also associated with an increased risk for genomic imprinting abnormalities.