Male Fertility · Male Factor Causes
Infekcje urogenitalne u mężczyzn jako przyczyna niepłodności
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Abstract
U około 35% par leczących się z powodu niepłodności przyczyną problemów z zajściem w ciążę jest czynnik męski (Agarwal, Mulgund, Hamada, Chyatte, 2015). Nasienie męskie może mieć nieprawidłowe parametry z różnych powodów. Jedną z częstszych przyczyn są infekcje dróg moczowo-płciowych. Niestety objawy zwykle są minimalne lub nie występują wcale, więc mężczyźni nie zgłaszają się do lekarza. Infekcje te mogą powodować zmniejszenie produkcji plemników, zmniejszenie ich ruchliwości lub zmiany w morfologii plemników (zespół oligo-asteno-teratozoospermia, zespół OAT). Epizody ostrego lub przewlekłego zapalenia jąder lub najądrzy mogą skutkować trwałym uszkodzeniem jąder lub niedrożnością przewodów wyprowadzających nasienie. Infekcje dróg moczowo-płciowych u mężczyzn, jeśli są przenoszone drogą płciową, mogą także powodować stan zapalny dróg rodnych u ich partnerek. Może to być przewlekłe zapalenie szyjki macicy i błony śluzowej macicy (endometritis) czy zmiany w wydzielinach dróg rodnych. Ten przewlekły stan zapalny indukuje z kolei szereg cytokin prozapalnych, które zakłócają fizjologię gamet lub zarodków prowadząc do obumarcia zarodków lub poronień. Z czasem powstają również zrosty wewnątrzmaciczne, zrosty otrzewnej, niedrożność jajowodów. Infekcje dróg moczowo-płciowych są również główną przyczyną powstawania przeciwciał przeciwplemnikowych u mężczyzn. Infekcje i związana z nimi obecność przeciwciał przeciwplemnikowych u mężczyzn mogą prowadzić do niepłodności z udziałem układu immunologicznego u kobiet. Ponieważ infekcje są częstą przyczyną niepłodności (Weidner, Pilatz, Diemer, Schuppe, Rusz, Wagenlehner, 2013; WHO, 1987), w każdym przypadku niepłodności należy rozważyć obecność patogenów.
Topics
By this author
Diagnostic Criteria and Classification · Terminology and Definitions
Definition of Infertility and Indications for Fertility Evaluation: Consensus Document
Minjeur M et al., 2026 · Journal of Restorative Reproductive Medicine · Free to read
Infertility is a clinical condition that is recognized by the symptom of an inability to conceive through sexual intercourse or to sustain a pregnancy, with that symptom indicating underlying male and/or female pathology. This definition of infertility was developed through a structured, consensus-informed process involving broad stakeholder engagement. Initially, multiple definitions currently used by various medical professional organizations were reviewed, and a definition document was drafted and submitted to the Board of Directors of the International Institute for Restorative Reproductive Medicine (IIRRM). All IIRRM members were invited to provide feedback on the draft. Approximately 2,500 individuals and 44 organizations from 92 countries were then invited to review the proposed document, representing clinical, scientific, patient, policy, and advocacy perspectives. Submitted comments were reviewed thematically, with suggested revisions evaluated for clarity, clinical relevance, inclusiveness, and consistency with contemporary restorative reproductive medicine. Following this review, 3 substantive changes, 18 minor changes, and 15 citation corrections were incorporated into the final draft which resulted in a revised definition intended to better reflect the medical, social, and practical realities of modern infertility evaluation and care. Final approval by the IIRRM Board of Directors was unanimous.
Risk factors for anxiety and depression among pregnant women during the COVID-19 pandemic: Results of a web-based multinational cross-sectional study
Kajdy A et al., 2022 · Int J Gynaecol Obstet · Free full text on PubMed Central
To assess risk factors for anxiety and depression among pregnant women during the COVID-19 pandemic using Mind-COVID, a prospective cross-sectional study that compares outcomes in middle-income economies and high-income economies. A total of 7102 pregnant women from 12 high-income economies and nine middle-income economies were included. The web-based survey used two standardized instruments, General Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9). Pregnant women in high-income economies reported higher PHQ-9 (0.18 standard deviation [SD], P < 0.001) and GAD-7 (0.08 SD, P = 0.005) scores than those living in middle-income economies. Multivariate regression analysis showed that increasing PHQ-9 and GAD-7 scales were associated with mental health problems during pregnancy and the need for psychiatric treatment before pregnancy. PHQ-9 was associated with a feeling of burden related to restrictions in social distancing, and access to leisure activities. GAD-7 scores were associated with a pregnancy-related complication, fear of adverse outcomes in children related to COVID-19, and feeling of burden related to finances. According to this study, the imposed public health measures and hospital restrictions have left pregnant women more vulnerable during these difficult times. Adequate partner and family support during pregnancy and childbirth can be one of the most important protective factors against anxiety and depression, regardless of national economic status.
Hormone Testing · Serum Panels
Inhibin-B and FSH Are Good Indicators of Spermatogenesis but Not the Best Indicators of Fertility
Jankowska K et al., 2022 · Life (Basel) · Free full text on PubMed Central
Biochemical markers of spermatogenesis and fertility assessment are important in the practical management of infertile males and the determination of an individual’s prognosis. We performed an analysis on 100 males with a male infertility factor. The following study inclusion parameters were analyzed: seminogram, FSH, LH, testosterone, estradiol, prolactin, TSH, and inhibin B concentrations. The patients were subsequently treated by reproductive endocrinologists in accordance with AUA/ASRM and EAU guidelines. The reproductive status was evaluated over a period of 3 years. We found a strong correlation of sperm count with inhibin B (r = 0.74, p < 0.001) and FSH concentration levels (r = −0.46, p < 0.001). Among 95 patients at follow-up, pregnancies occurred for 59 of their partners (48 spontaneous, 5 after IVF−ET, and 6 after IUI). Thirty-six patients remained childless despite the therapy. Sperm count and inhibin B level were the best predictors of natural fertilization (ROC 0.86 and 0.84; cut-off: 2.7 mln/mL and 45 pg/mL). Although inhibin B and FSH can be used to evaluate spermatogenesis and fertility, the initial sperm concentration appeared to be the best predictor of success. Pregnancy was achieved in a surprisingly large proportion of patients with a very low concentration of inhibin B and a low initial sperm count. It is noteworthy that 81% of the pregnancies were achieved without medically assisted reproduction.
Medical Management · Pain Management
Immunology and Immunotherapy of Endometriosis
Maksym RB et al., 2021 · J Clin Med · Free full text on PubMed Central
Endometriosis is one of the most common gynecological and systemic diseases, with a remarkable immune background. Patients suffer from pain and fertility reduction. Due to the distinct immune component, an immunotherapeutic approach may gain importance in the future. In endometriosis, shifts in the cell fractions of the immune system are well known. Moreover, hypoxia concomitant with inflammation causes a disturbed immune response. The removal of endometriosis has a therapeutic effect, normalizes the immune disorders, and remains the most effective causative treatment in terms of pain and infertility. A key issue is whether a similar effect can be achieved for fertility with non-invasive immunotherapy where surgery is inadvisable or cannot be performed for various reasons. Numerous immunotherapy trials, including vaccines, were conducted on animals only, although the research is encouraging. Among the promising methods of non-specific immunotherapy is the administration of an ethiodized oil contrast. Moreover, due to the significant successes of immunotherapy in oncology, the possibility of immunotherapy affecting NK cells has been postulated. NK cells are responsible for the surveillance and apoptosis of ectopic cells. Expanding the arsenal of endometriosis treatment by immunotherapy is promising due to the significant contribution of immunological factors and the limitations of current treatment methods.
Related research
Male Factor Causes · Lifestyle and Environment
Male Tract Microbiota and Male Infertility
Grande G et al., 2024 · Cells · Free full text on PubMed Central
In recent years, several studies have analyzed the composition of the male genital tract microbiota and its changes in infertility or in different situations associated with infertility. The aim of this narrative review is to obtain more insight on this topic; in particular, to describe actual evidence about changes in the semen microbiota in patients with infertility, male tract infections, or HPV infections. In semen, an increase in semen Prevotella spp. is associated with oligozoospermia and with obesity-associated asthenozoospermia; an increase in Pseudomonas is more frequently associated with asthenozoospermia and oligozoospermia; a reduction in Lactobacilli spp. (namely in Lactobacillus crispatus) may represent a marker of low semen quality. However, an increase in Lactobacillus iners is considered a risk factor for a reduced sperm concentration. In patients with prostatitis, there is a reduction in Lactobacillus spp. and an increase in Streptococcus spp., opening important perspectives about the role of probiotic treatments in these patients. Finally, an increase in Fusobacteria spp. was observed in patients with an HPV infection. In the conclusion, we underline the interactions between the seminal and vaginal microbiota, so that further studies should focus on the "couple genital microbiota".
Male Factor Treatment · Medical Management
Terapia del fattore maschile di infertilità
Grande G et al., 2025 · L'Endocrinologo · Free to read
Sommario La diagnosi di infertilità richiede un approccio multidisciplinare che includa entrambi i partner, al fine di individuare le cause e fornire le opzioni terapeutiche più appropriate, limitando quando possibile il ricorso a procedure invasive e costose non necessarie. In particolare, un completo iter diagnostico per il fattore maschile di infertilità (MFI) permette di classificare i pazienti in una o più delle seguenti classi diagnostiche: infezioni e infiammazioni delle ghiandole sessuali accessorie; ostruzione/agenesia dei dotti/eiaculazione retrograda; danno testicolare primitivo; disfunzione testicolare secondaria; varicocele; alterazioni idiopatiche del liquido seminale; infertilità inspiegata. In relazione al quadro di base, dunque, possono essere realizzati trattamenti eziologici o empirici, che sono oggetto del seguente articolo. Gli antibiotici costituiscono il trattamento principale per le infezioni batteriche. La terapia dovrebbe essere basata sull’identificazione del patogeno e sulla determinazione della sensibilità agli antibiotici tramite antibiogramma. In caso di leucocitospermia o in presenza di altri segni infiammatori a livello seminale o di segni a livello ecografico, senza isolamento di patogeni, si può adottare una terapia empirica con farmaci antinfiammatori non steroidei o corticosteroidi, somministrati per via orale o transrettale. La terapia con gonadotropine rappresenta la terapia con il maggior livello di evidenza di efficacia nel campo del MFI. Classicamente, la terapia con gonadotropine viene utilizzata nell’ipogonadismo ipogonadotropo, con ottima risposta sia in termini di miglioramento dei parametri seminali, sia in termini di gravidanza spontanea. Sulla base di tali presupposti, da molti anni è stata proposta la terapia con FSH nel paziente maschile infertile, con quadro seminale di oligozoospermia e/o astenozoospermia, in presenza di livelli di FSH inferiori a 8 UI/L e in assenza di quadro ostruttivo a livello delle vie seminali. In tale situazione la terapia induce un miglioramento significativo del numero e della motilità degli spermatozoi e un miglioramento del tasso di gravidanze spontanee e tramite tecniche di procreazione medicalmente assistita. I selective estrogen receptor modulators (SERMs) e gli inibitori dell’aromatasi (IAs) rappresentano possibili terapie off-label, seppure il loro utilizzo non sia supportato da forti evidenze e il loro uso non sia consigliato dalle più recenti linee guida. Peraltro, tutti gli studi sono concordi nell’evidenziare come la possibile efficacia della terapia si associ a ulteriore incremento dei livelli di FSH, suggerendo quindi che una strategia iperstimolatoria con FSH potrebbe associarsi a ulteriore miglioramento dei parametri seminali anche in pazienti con FSH superiore a 8 UI/L. Pur essendo il varicocele molto frequente nella popolazione generale e nei soggetti infertili, la sua valenza clinica nel management dell’infertilità è ridotta. La diagnosi di varicocele come reale causa di infertilità rappresenta, pertanto, una diagnosi di esclusione, da considerare soprattutto in presenza di varicocele con numerose e/o grosse ectasie venose e reflusso significativamente aumentato, senza altre cause note di infertilità. L’uso di integratori e nutraceutici per migliorare la fertilità maschile è un argomento ancora molto dibattuto. Le attuali linee guida ribadiscono che non è indicata la prescrizione prima della realizzazione di un percorso diagnostico. Al contempo, la sfida in tale ambito rimane la personalizzazione, per un possibile utilizzo evidence-based di nutraceutici nel paziente con infertilità e condizioni associate a stress ossidativo.
Male Factor Causes · Lifestyle and Environment
Inflammatory mediators exert toxic effects of oxidative stress on human spermatozoa
Fraczek M et al., 2007 · Journal of andrology
Epidemiological studies regarding male infertility have revealed that more and more infertile men suffer from acute or chronic inflammation of the genitourinary tract, which often occurs without any symptoms. The inflammatory reactions within the male genital tract are inevitably connected with oxidative stress. Growing evidence indicates that imbalance between prooxidative and anti-oxidative substances in semen leads to metabolic and functional disorders of male germ cells and may be a primary cause of some types of infertility. The infectious factor and local tissue damage can lead to the infiltration of leukocytes to the inflammatory site. This is in an obvious way connected to the production and release of large amounts of reactive oxygen species (ROS), which trigger immune responses directed against the infectious agent, and the simultaneous secretion of numerous biological substances, thereby escalating the inflammation. Some of these factors are proteases and proinflammatory cytokines. Extended exposure of spermatozoa to ROS may lead to the peroxidation of sperm membrane lipids. Many studies point to the combined activities of inflammatory mediators in exerting toxic effects on spermatozoa. The local influences of biologically active substances released by activated leukocytes in the course of the inflammatory response and the mutual interactions of various factors (bacteria, leukocytes, proinflammatory cytokines) at the site represent a complex puzzle.
Male Factor Causes · Lifestyle and Environment
Characterisation and comparison of semen microbiota and bacterial load in men with infertility, recurrent miscarriage, or proven fertility
Mowla S et al., 2025 · eLife · Free full text on PubMed Central
Several studies have associated seminal microbiota abnormalities with male infertility but have yielded differing results owing to their limited sizes or depths of analyses. The semen microbiota during recurrent pregnancy loss (RPL) has not been investigated. Comprehensively assessing the seminal microbiota in men with reproductive disorders could elucidate its potential role in clinical management. We used semen analysis, terminal-deoxynucleotidyl-transferase-mediated-deoxyuridine-triphosphate-nick-end-labelling, Comet DNA fragmentation, luminol reactive oxidative species (ROS) chemiluminescence, and metataxonomic profiling of semen microbiota by 16S rRNA amplicon sequencing in this prospective, cross-sectional study to investigate composition and bacterial load of seminal bacterial genera and species, semen parameters, ROS, and sperm DNA fragmentation in men with reproductive disorders and proven fathers. 223 men were enrolled, including healthy men with proven paternity (n=63), the male partners in a couple encountering RPL (n=46), men with male factor infertility (n=58), and the male partners of couples with unexplained infertility (n=56). Rates of high sperm DNA fragmentation, elevated ROS, and oligospermia were more prevalent in the study group compared with control. In all groups, semen microbiota clustered into three major genera-dominant groups (1, Streptococcus; 2, Prevotella; 3, Lactobacillus and Gardnerella); no species clusters were identified. Group 2 had the highest microbial richness (p<0.001), alpha-diversity (p<0.001), and bacterial load (p<0.0001). Overall bacterial composition or load has not been found to associate with semen analysis, ROS, or DNA fragmentation. Whilst global perturbation of the seminal microbiota is not associated with male reproductive disorders, men with unidentified seminal Flavobacterium are more likely to have abnormal seminal analysis. Future studies may elucidate if Flavobacterium reduction has therapeutic potential.
Male Fertility › Male Factor Causes › Lifestyle and Environment · Infections and the Reproductive Microbiome › Sexually Transmitted Infections › Infection and Tubal Damage · General Gynecology › Infections › Pelvic Inflammatory Disease
Michał Rabijewski, Natalia Suszczewicz
M Rabijewski, N Suszczewicz
DOI 10.34766/fetr.v43i3.338 10.34766/fetr.v43i3.338 Jankowska et al. 2020, Jankowska 2020