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World J Mens Health. 2019 May 8. doi: 10.5534/wjmh.190055. [Epub ahead of print]

Male Oxidative Stress Infertility (MOSI): Proposed Terminology and Clinical Practice Guidelines for Management of Idiopathic Male Infertility.

Author information

1
American Center for Reproductive Medicine, Cleveland Clinic, OH, USA.
2
Department of Urology, Cleveland Clinic, Cleveland, OH, USA. agarwaa@ccf.org.
3
Department of Urology, Cleveland Clinic, Cleveland, OH, USA.
4
Department of Medical Bioscience, University of the Western Cape, Cape Town, South Africa.
5
Department of Urology, Lilavati Hospital and Research Centre, Mumbai, India.
6
School of Biosciences, University of Kent, Canterbury, UK.
7
Department of Urology, University of Miami, Miami, FL, USA.
8
Department of Urology, Loma Linda University Health, Loma Linda, CA, USA.
9
Department of Obstetrics Gynaecology and Reproductive Medicine, Flinders University, Bedford Park, Australia.
10
Division of Urology, Department of Surgery, University of Campinas (UNICAMP), Campinas, Brazil.
11
Faculty of Health, Aarhus University, Aarhus, Denmark.
12
Department of Urology, Hamad Medical Corporation and Weill Cornell Medicine-Qatar, Doha, Qatar.
13
Centro Androgen, La Coruña, Spain and Harvard Medical School, Boston, MA, USA.
14
School of BioSciences, University of Melbourne, Parkville, Australia.
15
Section of Investigative Medicine, Imperial College London, UK.
16
Department of Andrology, Hammersmith Hospital, London, UK.
17
Department of Surgery, Union Hospital, Shatin, Hong Kong.
18
Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt.
19
Boston IVF, Waltham, MA, USA.
20
Department of Urology, University of Utah, Salt Lake City, UT, USA.
21
Cooper University Hospital, Camden, NJ, USA.
22
Departamento de Biología, Universidad Autónoma de Madrid, Madrid, Spain.
23
Department of Urology, Pusan National University School of Medicine, Busan, Korea.
24
Medical Research Institute of Pusan National University Hospital, Busan, Korea.
25
Department of Surgery, McGill University, Montreal, QC, Canada.
26
Austin Fertility & Reproductive Medicine/Westlake IVF, Austin, TX, USA.
27
Uromedica Polyclinic, Kneza Milosa, Belgrade, Serbia.
28
Department of Urology, University of Virginia, Charlottesville, VA, USA.
29
Sapienza University of Rome, Rome, Italy.
30
Istanbul Florence Nightingale Hospital, Istanbul, Turkey.
31
Department of Dermatology, University Hospital Bonn, Bonn, Germany.
32
Division of Endocrinology, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Umberto I Hospital, Ancona, Italy.
33
IVI Foundation Edificio Biopolo - Instituto de Investigación Sanitaria la Fe, Valencia, Spain.
34
University Hospital, School of Médicine and PERITOX Laboratory, Amiens, France.
35
Division of Urology, Southern Illinois University School of Medicine, Springfield, IL, USA.
36
Centre for Human Reproductive Science, IMSR, College of Medical & Dental Sciences, The University of Birmingham Edgbaston, UK.
37
The Birmingham Women's Fertility Centre, Birmingham Women's and Children's NHS Foundation Trust, Mindelsohn Drive, Edgbaston, UK.
38
Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON, Canada.
39
Reproductive Medicine Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
40
Fertility Medical Group, São Paulo, Brazil.
41
Department of Obstetrics & Gynecology, Andrology Unit Faculties of Health Sciences, Tygerberg Hospital, Tygerberg, South Africa.
42
Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
43
IVF Japan Group, Horac Grand Front Osaka Clinic, Osaka, Japan.
44
Manipal Fertility, Bangalore, India.
45
Genk Institute for Fertility Technology, Genk, Belgium.
46
Hasselt University, Biomedical Research Institute, Diepenbeek, Belgium.
47
Department of Experimental and Clinical Medicine, Center of Excellence DeNothe, University of Florence, Italy.
48
Department of Experimental and Clinical Biomedical Sciences "Mario Serio", Unit of Sexual Medicine and Andrology, Center of Excellence DeNothe, University of Florence, Florence, Italy.
49
Department of Urology, Reproduction Center, Yokohama City University Medical Center, Yokohama, Japan.
50
Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.
51
Androbest Andrology & Urology Center, Hyderabad, India.
52
Section of Urology, University of Santo Tomas Hospital, Manila, Philippines.
53
SCSA Diagnostics, Brookings, SD, USA.
54
Fleury Group and Hospital Israelita Albert Einstein, São Paulo, Brazil.
55
Origen, Center for Reproductive Medicine, Rio de Janeiro, Brazil.
56
Department of Urology, University of São Paulo (USP), Brazil.
57
Division of Urology, Infertility Center ALFA, São Paulo, Brazil.
58
Head of Male Infertility Division, Andrology Department, Brazilian Society of Urology, Rio de Janeiro, Brazil.
59
Fertility and IVF Unit, Department of Obstetrics and Gynecology, Hebrew-University Hadassah Medical Center, Jerusalem, Israel.
60
Infertility and IVF Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center (Tel Hashomer), Ramat Gan, Israel.
61
Tarnesby-Tarnowski Chair for Family Planning and Fertility Regulation, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
62
Soroka University Medical Center, Ben-Gurion University of the Negev Beer-Sheva, Beersheba, Israel.
63
IVF Unit, Meir Medical Center, Kfar Sava, Israel.
64
Sackler Medicine School, Tel Aviv University, Tel Aviv, Israel.
65
Department of Urology, Hamad Medical Corporation, Doha, Qatar.
66
Department of Andrology and Urology, Diyos Hospital, New Delhi, India.
67
PUR Clinic, South Lake Hospital, Clermont, FL, USA.
68
University of Central Florida, Orlando, FL, USA.
69
Baby Center, Institute for Reproductive Medicine, São Paulo, Brazil.
70
College Institute of Clinical Research and Teaching Development, São Paulo, Brazil.
71
Lab for Molecular Reproduction and Genetics, Anatomy, All India Institute of Medical Sciences, New Delhi, India.
72
Department of Reproductive Biology, Hôpitaux Universitaires Paris Seine Saint-Denis, Bondy, France.
73
Department of Reproductive Medicine and Embryology, Manipal Hospital, New Delhi, India.
74
Department of Urology, Hacettepe University Faculty of Medicine, Ankara, Turkey.
75
Department of Endocrinology/ Andrology, University Hospital Ghent, Ghent, Belgium.
76
Department of Reproductive Medicine, Hannibal International Clinic, Tunis, Tunisia.
77
Department of Obstetrics, Gynecology and Reproductive Medicine, Pierre Cherest and Hartman Clinics, Paris, France.
78
Clinic of Urology, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
79
Department of Physiology, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Jalan Hospital, Selangor, Malaysia.
80
Department of Embryology, Faculty of Medicine, University of Sousse, Sousse, Tunisia.
81
Department of Pediatrics, New York University School of Medicine, New York, NY, USA.
82
Department of Obstetrics and Gynaecology, Lilavati Hospital and Research Centre, Mumbai, India.
83
Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy.
84
School of Natural Medicine, University of the Western Cape, Cape Town, South Africa.
85
Department of Andrology, Shahid Sadoughi Medical University, Yazd, Iran.
86
Southend Fertility & IVF, Delhi, India.
87
Department of Urology, School of Medicine, University of Ankara, Ankara, Turkey.
88
Redox Biology Laboratory, Department of Zoology and Center of Excellence in Environment and Public Health, Ravenshaw University, Cutrack, India.
89
Marrakech Fertility Institute, Marrakech, Morocco.
90
Jindal Hospital, Meerut, India.
91
Department of Urology, Istinye University Faculty of Medicine, Liv Hospital Ulus, Istanbul, Turkey.
92
Department of Urology, Ege University School of Medicine, İzmir, Turkey.
93
Center of Urology, CODRA Hospital, Podgorica, Montenegro.
94
Fertility and IVF Unit, Soroka University Medical Center, Ben Gurion University of the Negev, Beer Sheva, Israel.

Abstract

Despite advances in the field of male reproductive health, idiopathic male infertility, in which a man has altered semen characteristics without an identifiable cause and there is no female factor infertility, remains a challenging condition to diagnose and manage. Increasing evidence suggests that oxidative stress (OS) plays an independent role in the etiology of male infertility, with 30% to 80% of infertile men having elevated seminal reactive oxygen species levels. OS can negatively affect fertility via a number of pathways, including interference with capacitation and possible damage to sperm membrane and DNA, which may impair the sperm's potential to fertilize an egg and develop into a healthy embryo. Adequate evaluation of male reproductive potential should therefore include an assessment of sperm OS. We propose the term Male Oxidative Stress Infertility, or MOSI, as a novel descriptor for infertile men with abnormal semen characteristics and OS, including many patients who were previously classified as having idiopathic male infertility. Oxidation-reduction potential (ORP) can be a useful clinical biomarker for the classification of MOSI, as it takes into account the levels of both oxidants and reductants (antioxidants). Current treatment protocols for OS, including the use of antioxidants, are not evidence-based and have the potential for complications and increased healthcare-related expenditures. Utilizing an easy, reproducible, and cost-effective test to measure ORP may provide a more targeted, reliable approach for administering antioxidant therapy while minimizing the risk of antioxidant overdose. With the increasing awareness and understanding of MOSI as a distinct male infertility diagnosis, future research endeavors can facilitate the development of evidence-based treatments that target its underlying cause.

KEYWORDS:

Infertility, male; MOSI; Oxidation reduction potential; Oxidative stress; Semen

PMID:
31081299
DOI:
10.5534/wjmh.190055
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Conflict of interest statement

None of the authors declares competing financial interests. The authors do not have any potential interest in promoting MiOXSYS.

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