In May of this year, Hans-Christian Schuppe, Wolfgang Weidner and colleagues from Justus-Liebig University in Germany published the article "Urogenital Infection as a Risk Factor for Male Infertility"
Infertility is a global health issue that affects an estimated 15% of reproductive-age couples. Infertility is defined by the World Health Organization (WHO) as the inability to conceive after 1 full year of unprotected intercourse. The causes of infertility in males and females are numerous, and it is believed that at least half of all cases of infertility in couples are caused by issues with the male partner.
Though there are several identified causes of male infertility such as varicocele (varicose veins in the testis) and chromosome defects, the review article by Schuppe et al. highlighted the contribution of urogenital infections to male infertility. From their literature review that included over 90 articles on the subject, the authors summarized 4 disease presentations caused by urogenital infections:
Schuppe et al. revealed that urogenital infections are diagnosed in roughly four steps. The first is a clinical diagnosis from an examination which includes laboratory tests for white blood cell counts, inflammatory markers, and sex hormone levels. In the next step, the disease is diagnosed by performing a prostatic massage and collecting urine before and after the massage to detect the presence of bacteria or inflammation in the prostate. The third step of diagnosis is by semen analysis which tests for abnormal ejaculate volumes, semen acidity, white blood cell count, and biochemical markers from the epididymis, seminal vesicles, prostate, and check for antibody production. The final diagnostic step is microbiological testing. Although in healthy males, 90% of urogenital samples have non-pathogenic microorganism present, certain pathogenic microorganisms are known to cause urogenital inflammation and can be screened for. Pathogens like enterobacteria, enterococci, Ureaplasma spp., Mycoplasma spp., S. saprophyticus, etc. can be tested for by a combination of cell culturing and PCR amplification.
The review highlights that treatment for patients with urogenital infection-mediated infertility focuses on 1) eliminating the pathogenic infection, 2) reducing inflammation, and 3) improving sperm quality and quantity. Antimicrobials are the first line of treatment for patients and their partners with a detected STI. For patients with symptomatic uropathogens, treatment with fluoroquinolones are primarily used. Successful antibiotic therapy does not always restore fertility in these patients, however. Unfortunately, some antibiotic treatment can be toxic to male gametes and render permanent damage. For the reduction of inflammation, the use of non-steroid anti-inflammatory drugs has been successful in improving white blood cell counts.
Overall, this review summarized important findings in the field over the past two decades. Schuppe et al. provided substantial background on what types of urogenital infections lead to infertility, described how these conditions are diagnosed, and provided insightful commentary on the currently available treatment options. The points addressed in this review highlight some significant research questions that future investigators can pursue to improve the diagnosis of and treatments for these diseases.
Referenced Article:
Infertility is a global health issue that affects an estimated 15% of reproductive-age couples. Infertility is defined by the World Health Organization (WHO) as the inability to conceive after 1 full year of unprotected intercourse. The causes of infertility in males and females are numerous, and it is believed that at least half of all cases of infertility in couples are caused by issues with the male partner.
Though there are several identified causes of male infertility such as varicocele (varicose veins in the testis) and chromosome defects, the review article by Schuppe et al. highlighted the contribution of urogenital infections to male infertility. From their literature review that included over 90 articles on the subject, the authors summarized 4 disease presentations caused by urogenital infections:
- Chronic prostatitis (prostate inflammation): urine bacterial count after a prostate massage is at least 10x higher than urine before the massage. Patients have reduced sperm motility and poor sperm morphology.
- Epididymitis & orchitis (epididymis or testicle inflammation): common urogenital pathogens like E. coli and sexually-transmitted infectious pathogens travel up through the urethra into the epididymis or testes. Patients have oligozoospermia (few living sperm) or azoospermia (no living sperm) and may experience testicular atrophy (wasting away).
- Obstruction of male reproductive tract: blockage of the male urogenital tract resulting from infection and subsequent inflammation, which can cause azoospermia (obstructive azoospermia).
- Asymptomatic patients desiring children: often missed since there are is a lack of noninvasive biomarkers to test for infection. Bacteria in semen samples (bacteriospermia) is not diagnostic for urogenital infection since normal urethral bacteria can get picked up during semen transit.
Schuppe et al. revealed that urogenital infections are diagnosed in roughly four steps. The first is a clinical diagnosis from an examination which includes laboratory tests for white blood cell counts, inflammatory markers, and sex hormone levels. In the next step, the disease is diagnosed by performing a prostatic massage and collecting urine before and after the massage to detect the presence of bacteria or inflammation in the prostate. The third step of diagnosis is by semen analysis which tests for abnormal ejaculate volumes, semen acidity, white blood cell count, and biochemical markers from the epididymis, seminal vesicles, prostate, and check for antibody production. The final diagnostic step is microbiological testing. Although in healthy males, 90% of urogenital samples have non-pathogenic microorganism present, certain pathogenic microorganisms are known to cause urogenital inflammation and can be screened for. Pathogens like enterobacteria, enterococci, Ureaplasma spp., Mycoplasma spp., S. saprophyticus, etc. can be tested for by a combination of cell culturing and PCR amplification.
The review highlights that treatment for patients with urogenital infection-mediated infertility focuses on 1) eliminating the pathogenic infection, 2) reducing inflammation, and 3) improving sperm quality and quantity. Antimicrobials are the first line of treatment for patients and their partners with a detected STI. For patients with symptomatic uropathogens, treatment with fluoroquinolones are primarily used. Successful antibiotic therapy does not always restore fertility in these patients, however. Unfortunately, some antibiotic treatment can be toxic to male gametes and render permanent damage. For the reduction of inflammation, the use of non-steroid anti-inflammatory drugs has been successful in improving white blood cell counts.
Overall, this review summarized important findings in the field over the past two decades. Schuppe et al. provided substantial background on what types of urogenital infections lead to infertility, described how these conditions are diagnosed, and provided insightful commentary on the currently available treatment options. The points addressed in this review highlight some significant research questions that future investigators can pursue to improve the diagnosis of and treatments for these diseases.
Referenced Article:
- Schuppe HC, Pilatz A, Hossain H, Diemer T, Wagenlehner F, Weidner W: Urogenital infection as a risk factor for male infertility. Dtsch Arztebl Int 2017; 114: 339 - 46. DOI: 10.3238/arztebl.2017.0339 PMID: 28597829
Comments
Post a Comment