دانلود رایگان مقاله لاتین گرمای مرطوب به عنوان علت برگشت پذیر کیفیت پائین اسپرم از سایت الزویر
عنوان فارسی مقاله:
قرارگرفتن در معرض گرمای مرطوب: یکی از علل برگشت پذیر بالقوه کیفیت پائین مایع اسپرم در مردان نابارور
عنوان انگلیسی مقاله:
Wet Heat Exposure: A Potentially Reversible Cause of Low Semen Quality in Infertile Men
سال انتشار : 2007
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بخشی از مقاله انگلیسی:
COMMENTS
The removal of wet heat exposure resulted in improvement in semen quality in nearly one-half of subjects studied. The improvement was largely the results of increases in sperm motility, and appeared to persist beyond 3 months, although a continuous improvement was not observed in all subjects. The extra-abdominal position of the scrotum and the proximity of the pampiniform venous plexus to the testicular arteries contribute to the efficient dissipation and transfer of heat away from the testes and resultant lower testicular temperature (8). However, in the presence of extreme elevation of extra-testicular temperature, as when immersed in hot liquid, these same characteristics make the scrotum particularly susceptible to deleterious thermal effect. It is therefore not surprising that semen quality might be susceptible to the effects of wet hyperthermia. The deleterious effect of dry heat on semen quality and, by extrapolation, male fertility, has been recognized medically for decades, and to the traditional medicine community for millennia. Carlsen et al., in examining the effect of febrile illness on semen quality, demonstrated a dose-response relationship between the number of days with fever and sperm concentration (8). Similarly, Mieusset & Bujan examined mild testicular heating (about 1°C) as a form of contraception, an idea originally conceived of by Robinson et al. (14,15). Both studies found that sperm concentration rebounded to baseline in 12 to 18 months following cessation of increased testicular temperatures. None of these studies, however, were designed to replicate the frequent, significant wet hyperthermia that is the fate of the habitual hot-tuber, thus forming the rationale for this study. In reviewing our data on the recovery of semen quality in infertile males following the cessation of wet heat exposure, we found that there were two distinct groups of patients: those that responded to intervention and those that did not. Among responders, improvements in semen quality were witnessed well beyond the 3 month period typically ascribed to a single cycle of spermatogenesis. This finding is entirely consistent with the time course of recovery noted after varicocele repair and exposure to other gonadotoxins (16). Interestingly, the semen analysis parameter that exhibited the largest change among responders was sperm motility, and this increase reached statistical significance after intervention. This suggests that heat-induced motility dysfunction may be the parameter most vulnerable to wet hyperthermic exposure. Although statistical significance was not achieved in the overall increase in TMC after intervention, the changes observed could be considered clinically significant, as more men could qualify for IUI instead of IVF for infertility treatment following intervention. Given that intrauterine insemination (IUI) can be considered for low semen quality in men with TMC > 8-10 x 106 sperm, the number of men who would qualify for IUI in the responder group increased from 1/5 preintervention to 4/5 post-intervention. Two of the responders had TMC > 20 x 106 after intervention and were advised to consider unprotected intercourse before IUI. This “shift of care” to less intensive forms of assisted reproduction has also been described for varicocele repair (16). We acknowledge that even statistically significant changes in semen parameters are always problematic to assess, given the naturally high intra-individual variability of semen parameters in both fertile and infertile men. However, the potential clinical value of these changes must also be considered, as we have outlined.
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کلمات کلیدی:
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