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Men seeking fatherhood

When pregnancy does not occur

The lack of a pregnancy after a long period of unprotected intercourses configures a problem of couple infertility that may be of male or female origin, or combined between the two partners. According to the latest guidelines of the European Society of Urology (EAU), a component of male infertility is found in 50% of couples involuntarily childless.

In 30-40% of cases, the seminal data are normal and this is defined as idiopathic male infertility.

Therefore, if the pregnancy does not come, the investigation of the male partner fertility has at least equal importance and priority as the search for female causes. The medical specialist will carry out a series of investigations to identify possible endocrine, chromosomal, anatomical, vascular and inflammatory causes. The doctor will also prescribe a semen analysis that can present abnormalities related to one of these diseases or appear within normal limits.

When semen analysis is affected

The analysis of seminal fluid considers many aspects but the most important for a diagnosis of infertility are: the absence (azoospermia) or a small number (oligospermia) of viable sperm; reduced motility of the same (asthenospermia) and; a high amount of morphologically abnormal cells (teratospermia). Adding these information to the results of other investigations the specialist will often be able to make a diagnosis and in many cases to start a medical or surgical treatment that can address the problem. In other cases, the abnormalities of the seminal fluid are not linked to a specific disease and it is not possible to establish a targeted treatment.

In the majority of patients with abnormal semen analysis there is however also a component of oxidative damage. This may persist after the elimination of the primary cause and slow-down or prevent a full recovery of fertility. For this reason, men with abnormal semen parameters are ideal candidates for antioxidant support, that is the only possible intervention when a specific cause cannot be identified. In some cases, the anomalies of the seminal fluid are entirely related to problems of oxidative stress and the execution of tests suitable to demonstrate a sperm damage of oxidative nature, as the index of ‘sperm DNA Fragmentation Index (DFI) o l’Sperm nuclear Decondensation Index (SDI) may provide useful indications.

When everything looks “normal”

The most frequent cases are however infertile couples in which the male partner is “normal” at diagnostic investigations with a female partner carrying reproductive problems or apparently healthy. When the male partner is apparently healthy and the woman has a known issue, it is a common mistake to focus only on the female side whereas the coexistence of problems on both sides is highly likely.

All male partners of couples unable to have children are potential carriers of sperm oxidative damage. Some damages are present to varying degrees in all men but in some of them they reach a pathological level because of constitutional/genetic or environmental factors, including exposure to toxic agents and eating habits, or a combination thereof.

It is for this reason that the male partners of infertile couples should be particularly careful in their feeding so to minimize the impact of possible genetic factors and environmental exposure regardless of any other consideration about the presence and possible source of infertility. In practice, they can recur to nutritional supplements to ensure intake of the substances needed to physiological functions.

For the same reason, in cases of male infertility with normal semen analysis it may be useful to run the tests designed to show a spermatic damage of oxidative nature as the study of sperm DNA fragmentation index (DFI) or the index of nuclear decondensation (SDI). It is up to the doctor to define together with the patient a cost to benefit balance and to establish the usefulness of such tests.

When you take antioxidants

The awareness of the oxidative nature of sperm damage leads to the simple deduction that antioxidants will correct the problem: it is not true.

All cells, and first of all the male gametes, need a perfectly balanced oxy-redox equilibrium, which can be obtained only through a normalization of cellular activities.

While a balanced diet provides all the substances contributing to the cell balance (several hundred) in quantities and combinations selected by evolution, the intake of antioxidants in the form of supplements, even worse if highly active, only serves to stress in reductive sense the specific chemical reactions in which each of these substances is involved. This means blocking these reactions for the opposite reason. There are no magic remedies nor special substances that correct all the biochemical derangements.

Effective support of cellular redox equilibrium can instead be achieved by providing the cell, rather than pre-formed antioxidants, the substances that the same cell needs to produce its own antioxidants when and where they are needed, in the right amounts and as long as they are needed. This is precisely the principle backing the formulation of Condensyl and that, for the first time, made it possible to obtain clinically measurable results.

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When ART is necessary

Medical and surgical treatments may not be able to restore a fertility by natural routes, this may cause the use of Assisted Reproductive Technologies (ART). Depending on the specific case the specialist will target first level techniques, i.e. the Intra Uterine Insemination (IUI), or more complex IVF treatments like In Vitro Fertilization with Embryo Transfer (IVF) and Intra Cytoplasmic Sperm Injection (ICSI).

Couples whose male partner suffers from oxidative sperm damage, i.e. with a high degree of sperm DNA fragmentation (DFI) or nuclear decondensation (SDI), have little chance of success with IUI technique. This technique is indeed entirely dependent on the good quality of the spermatozoa. In particular, if the SDI is above 30% the chances of success of IUI are close to zero. Therefore, infertile couples should not accept to undergo IUI practices before the sperm oxidative damage has been tested.

In any case sperm, oxidative damage can be improved and/or corrected with an antioxidant support. However, the assumption of direct antioxidants, that can improve the fragmentation index (SDI) on one hand, on the other hand very often cause a rebound increase of the decondensation index (named reductive stress) causing a net worsening of fertility. If you only get checked the DFI in the absence of a control of the SDI, this phenomenon is not detected, and the patient may appear as “improved” whereas in reality the chances of success are diminished.

Condensyl and indirect anti-oxidants

Aiming to overcome this problem Condensyl is based on indirect antioxidants (no risk of reductive stress) and therefore can be taken also without engaging in the above complex testing, which remains however recommended. Support with Condensyl can restore the damaged sperm indexes and, if the female partner is normo-ovulating, can lift up the success rate of IUI close to that of IVF and ICSI. In addition, Condensyl can greatly increase the chances of success of IUI also in subjects not exerting evident signs of sperm oxidative damages.

The alternative techniques, IVF and even more ICSI, may be of help to increase the chances of fertilization but are not able to render good an ejaculate that was of low quality.

In the case of IVF, where fertilization is obtained merging in the same tube an aliquot of semen together with one or more oocytes, there is still some natural competition among several million sperms, which increases the chances to fertilise with the best one. This is paid with a fertilization rate somehow lower than that resulting from ICSI.

In the case of ICSI, the fertilising sperm is selected by the embryologist in the lack of any natural selection only based on morphology. The issue of sperm quality gets minimized by sperm selection techniques intended to screen the ejaculate so to obtain a fraction enriched of potentially good cells. Thereafter, the final selection is again based on morphological criteria.

The fertilization rates are very good and almost always ICSI results in the generation of some embryos. The problem is that sperm selection techniques do not select based on oxidative damage so that a well-looking sperm from the good fraction may still harbor a serious oxidative damage, which may affect the viability of the embryo that was generated. Criticisms to the ICSI technique refer to it as a fertilization “forced” with sperm cells that natural selection would have certainly avoided.

These concerns are further relevant because, with good reasons, ICSI is considered the elective method in case of serious male infertility. Thus, assumed that in some couples ICSI is necessary, it is always advisable to include an effective support to spermatogenesis so to further minimise the problem.

indirect oxidant - how it works
indirect oxidant - how it works

In the clinical studies concluded so far Condensyl and Procrelia have doubled the number of births in couples resistant to IVF and ICSI (Amar et al. 2015; Cornet et al. 2015), and the majority of the pregnancies were obtained spontaneously, i.e. without ART.

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