The Sperm DNA Integrity assay (SDIA) like the Sperm Chromatin Structure Assay
(SCSA) is a tool for measuring clinically important properties of sperm nuclear chromatin integrity. Chromatin is that portion of the cell nucleus which contains the entire DNA of the nucleus in animal or plant cells.
The results correlate well with the potential of sperm from a given male to produce embryos that would be sufficiently "competent to produce a live birth. The SDIA utilizes the metachromatic features of acridine orange (AO), a DNA probe, and the principles of flow cytometry (FCM).
SDIA data are not well correlated with classical sperm quality parameters and have been solidly shown to predict sub/infertility and poor reproductive performance. The SDIA measures DNA damage. The degree of abnormalities in the genetic material of the sperm is expressed numerically as the DNA Fragmentation Index (DFI). DNA damage may be present in sperm from both fertile and infertile men. Therefore, this sperm DNA damage analysis may reveal a hidden abnormality of sperm DNA in infertile men classified as unexplained based on apparently normal standard sperm parameters.
Infertile men with abnormal sperm characteristics exhibit increased levels of DNA damage in their sperm. Sperm from infertile men with normal-appearing sperm may have DNA damage to a degree comparable to that of infertile men with abnormal-appearing sperm. The data suggests that an abnormal SDI assay is more likely to occur in cases of abnormal semen parameters.
Cancer treatments are well known to adversely affect male fertility. Reduction of sperm output arises from the cytotoxic effects of chemo-or radiotherapy upon the spermatogenic epithelium.
Optimal sperm chromatin packaging seems necessary for full expression of the male fertility potential. SDI assays emerge as predictors of the probability to conceive and carry the pregnancy to viability.
The improvement seen in sperm motility after treatment is not associated with a similar improvement in sperm DNA integrity (SDIA assay results). These data suggest that sperm processing techniques will not minimize sperm DNA damage and the potential transmission of genetic mutations in assisted reproductive cycles.
It is important to add that most current data available on the significance of abnormal SDIA results in infertile couples seeking treatment has emanated from non-IVF pregnancies.
Preliminary data suggests the following:
The viable (>12 weeks) IVF pregnancy rate (and thus presumably also the birth rate) could be as much as 2 times lower in women under 33yrs of age, whose husbands have abnormal SDI assays ( with a DFI of <30%). Results become progressively worse with advancing maternal age such that at 35 yrs+, the viable pregnancy rate could be as much as 3-4 times lower.
Although it is possible for abnormal SDIA results to sometimes spontaneously revert back to normal, this probably occurs quite infrequently.
Although abnormal SDIA results are detected in men with apparently normal semen analyses, abnormal results are more commonly seen in cases of men who have abnormal sperm parameters (abnormal sperm count, motility and/or morphology)
There is some suggestion that the use of antioxidant therapy ( Pycnogenol 200mg daily, L-Carnitine 3 grams per day, acetyl carnitine 500mg per day, Vitamin C 1,000mg per day, Vitamin E 800IU per day and acupuncture and certain herbal medicines) taken for several months, can causes the SDI assay to revert to normal in many cases.
There is some suggestion that men who have varicoceles ( a collection of distended veins in the scrotum) associated with an abnormal SDI assay may experience a reversion of the SDI assay back to normal, 3-6 months following surgical or radiological ablation of the varicocele. Of course acupuncture and herbal medicine will enhance and stimulate blood flow to the testicles facilitating a more rapid recovery with greater possibility of healthy sperm production after a varicocelectomy.
In summary, an abnormal SDI assay augers poorly for the outcome of fertility treatment in general and IVF/ICSI in specific. In such cases, the fertilization rate and pregnancy rates are reduced and the chance of early pregnancy loss appears to be increased significantly. An abnormal SDIA result does not totally preclude a successful pregnancy.
The prognosis worsens progressively as the age of the egg provider advances beyond 33 yrs. Although abnormal SDIA results rarely revert to normal spontaneously this can and does happen on occasion.
Selective surgical ligation of a varicocele and medical anti-oxidant treatment may be effective in restoring the SDIA to normal. Antioxidant properties are to be found in Vitamins C and E and herbal medicine specific to this situation.
It is quite likely that the SDIA or the SCSA will in time become regarded as required baseline tests (to be performed, regardless of their basic traditional semen analysis parameters (count, motility and sperm morphology) in all cases of recurrent pregnancy loss and IVF where the sperm provider has not previously participated in a pregnancy that has proceeded beyond the 12th week (the traditional point of likely viability).
It should be noted that when the typical sperm analysis reveals normal count, morphology and motility this does not mean that sperm DNA fragmentation is not manifest. In other words, unless the SDIA test is specifically run, fragmentation issues will not be revealed. This type of case then may be labeled 'idiopathic' infertility.
It is our opinion based on clinical experience that ideally, both the man and the women should be treated even if there is no apparent male factor evident. The reason for this is that stress has been shown to reduce sperm count. Going through the tortuous trial of trying to conceive leaves many couples extremely stressed out. So, which at the time of sperm analysis everything appears normal, over time, due to the stress inherent with the situation, the sperm quantity may in fact be effected.
Therefore, including acupuncture, herbal medicine and the proper supplements can be seen as either reactive (if pathology is evident) or proactive (if pathology is not evident). It is our opinion that proactive behavior often obviates the need to be reactive. Prevention is key.
About The Author
Dr. Mike Berkley has been treating male factor fertility disorders since 1996 with amazing results. He works exclusively in the area of reproductive medicine and enjoys working in conjunction with some of New York's most prestigious reproductive endocrinologists. Sign up for his free newsletter at www.BerkleyCenter.com.
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Erectile dysfunction
Erectile dysfunction (ED) affects the lives of many middle-aged men and their partners. The term erectile dysfunction covers a range of disorders, but usually refers to the inability to obtain an adequate erection for satisfactory sexual activity.
Although erectile dysfunction, formerly called impotence, is more common in men older than 65, it can occur at any age. An occasional episode of erectile dysfunction happens to most men and is normal. As men age, it's also normal to experience changes in erectile function. Erections may take longer to develop, may not be as rigid or may require more direct stimulation to be achieved. Men may also notice that orgasms are less intense, the volume of ejaculate is reduced and recovery time increases between erections. Erectile dysfunction may also be a sign of a physical or emotional problem that requires treatment.
Erectile dysfunction was once a taboo subject, but more men are seeking help. Doctors are gaining a better understanding of what causes erectile dysfunction and are finding new and better treatments.
This Website discusses all about erectile dysfunction, physiology of the normal erection and the pathophysiology, and treatment of ED.
What is Erectile Dysfunction?
Erectile dysfunction or impotence is a sexual dysfunction characterized by the inability to develop or maintain an erection of the penis for satisfactory sexual intercourse regardless of the capability of ejaculation. There are various underlying causes, such as diabetes, many of which are medically reversible.
The causes may be physiological or psychological. Psychological impotence can often be helped by almost anything that the patient believes in; there is a very strong placebo effect.
Due to its embarrassing nature and the shame felt by sufferers, the subject was taboo for a long time, and is the subject of many urban legends. Folk remedies have long been advocated, with some being advertised widely since the 1930s. The introduction of perhaps the first pharmacologically effective remedy for impotence, sildenafil (trade name Viagra), in the 1990s caused a wave of public attention, propelled in part by the news-worthiness of stories about it and heavy advertising.
The Latin term impotentia coeundi describes simple inability to insert the penis into the vagina. It is now mostly replaced by more precise terms.
Signs and symptoms:
Erectile dysfunction is characterized by the inability to maintain erection. Normal erections during sleep and in the early morning suggest a psychogenic cause, while loss of these erections may signify underlying disease, often cardiovascular in origin. Other things leading to erectile dysfunction are diabetes mellitus (causing neuropathy) or hypogonadism (decreased testosterone levels due to disease affecting the testicles or the pituitary gland).
Here are some causes of Erectile Dysfunction:
* Arousal: The first step is sexual arousal, which men obtain from the senses of sight, touch, hearing and smell, and from thoughts.
* Nervous system response: The brain communicates the sexual excitation to the body's nervous system, which activates increased blood flow to the penis.
* Blood vessel response:. A relaxing action occurs in the blood vessels that supply the penis, allowing more blood to flow into the shafts that produce the erection.
Physiology of normal erections:
Penile erections involve an integration of complex physiologic processes involving the CNS, peripheral nervous system, and hormonal and vascular systems. Any abnormality involving these systems, whether from medication or disease, has a significant impact on the ability to develop and sustain an erection, ejaculate, and experience orgasm. Tumescence, the vascular filling of the cavernous bodies, relies on neural and hormonal mechanisms operating at various levels of the neural axis. This is unique among visceral functions because it requires central neurological input.
Andersson et al summarized some of the information related to the pathways involved in erectile function. The degree of contraction of corpus cavernosal smooth muscle determines the functional state of the penis. The balance between contraction and relaxation is controlled by central and peripheral factors that involve many transmitters and transmitter systems. At the cellular level, smooth muscle relaxation occurs following the release of acetylcholine from the parasympathetic nerves.
Pathophysiology of erectile dysfunction:
Erectile Dysfunction is essentially a vascular disease. It is often associated with other vascular diseases and conditions such as diabetes, hypertension, and coronary artery disease. Other conditions associated with Erectile Dysfunction include neurologic disorders, endocrinopathies, benign prostatic hyperplasia, and depression. Conditions associated with reduced nerve and endothelium function, such as aging, hypertension, smoking, hypercholesterolemia, and diabetes, alter the balance between contraction and relaxation factors. These conditions cause circulatory and structural changes in penile tissues, resulting in arterial insufficiency and defective smooth muscle relaxation. In some patients, sexual dysfunction may be the presenting symptom of these disorders.
Treatment:
Sildenafil Citrate is the way to treat Erectile Dysfunction. Generic Viagra contains sildenafil citrate and contains same ingredients like branded drug.
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