Micronutritients ivf oct engl short 2012

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Micronutritients ivf oct engl short 2012

  1. 1. Imhof MartinGeneral Public Teaching Hospital Korneuburg/ViennaMicronutritientsandMale Subfertility
  2. 2. 9th International iCSiConference: Budapest 2008replacement level and very low fertility1,241,271,311,311,311,321,321,331,341,351,351,351,381,391,401,411,431,471,551,641,651,701,831,841,841,851,901,932,002,051,01,11,21,31,41,51,61,71,81,92,02,1SlovakiaPolandLithuaniaRomaniaSloveniaGermanyItalyCzechRepublicHungaryLatviaPortugalSpainBulgariaGreeceAustriaMaltaSwitzerlandCyprusEstoniaBelgiumLuxembourgNetherlandsDenmarkFinlandUnitedKingdomSwedenNorwayIrelandFranceIcelandTFR (Total fertility rate in 2006)simple reproductionlowest low fertilitylow fertility
  3. 3. Developement of SpermQuality
  4. 4. Swan et. al. – National Institute of environmental healthsciences•Review of 61 published studies•Data collected over 52 years (1938 to 1990)•Decline in average sperm density in U.S. and other WesterncountriesAverage annual decrease ofU.S. 1.5 mio/ml = minus 1.5%/yearEuropa minus 3.1%/yearDECREASE IN SPERM QUALITY
  5. 5. Semen quality and spermDNA damagein relation to urinarybisphenol Aamong menfrom an infertility clinic.Bisphenol AJohn D. Meekera et al. Reproductive Toxicology 2010
  6. 6. Decline of FertilityEnvironmental hormonesOxidative stressChange of life styleChange in nutrition habitsLack of micronutritients
  7. 7. LACK OF MICRONUTRITIENS IN FOOD
  8. 8. MALE SUBFERTILITY AND NUTRITION
  9. 9. MALE SUBFERTILITY AND NUTRITIONReduction of Sperm Quality• No Disease?• Defiency Syndrom?Could therapy be Supplementation ?
  10. 10. LACK OF MICRONUTRITIENS IN FOODGuidelines on food fortificationwith micronutrientsLindsay Allen et al.World Health Organization2006Male factor subfertility: possible causes and theImpact of nutritional factors.Wong WY et al.Fertil Steril 2000 73:435-442
  11. 11. DECREASE IN SPERM QUALITYDietary intake of antioxidant nutrients is associated withsemen quality in young university studentsMínguez-Alarcón, Hum Reprod. 2012 Sep;27(9):2807-14In this cross-sectional study, 215 young menOur study suggests that some sperm parameters are sensitiveto dietary intake of antioxidant nutrients
  12. 12. EFFECT OF MICRONUTRITIENTSCochrane Database Syst Rev. 2011 Jan19;1:CD007411.Antioxidants for male subfertility.Showell et al.AUTHORS CONCLUSIONS: The evidence suggests thatantioxidant supplementation in subfertile males mayimprove the outcomes of live birth and pregnancy ratefor subfertile couples undergoing ART cycles….
  13. 13. SPERMIOGENESISDay 1 Day 18 Day 36 Day 54 Day 72Spermiogenesis
  14. 14. 2x1 Capsule daily for 3 Month L-Carnitin 440 mg L-Arginine 250mg Vitamin E 120 mg Folic-acid 800 μg Zinc 40 mg Selenium 60 μg Glutathione 80 mg Coenzyme Q10 15 mgStudy Medication „PROFERTIL“
  15. 15. EFFECTS ON SPERMIOGENESISHormonalRegulationMorphology/DensityEnergy/MotilityEnzym/CapazitationL-Carnitin 440 mgL-Arginine 250 mgVitamin E 120 mgFolic-acid 800 ugZinc 40 mgSelenium 60 ugGlutathione 80 mgCoenyme Q 10 15 mg
  16. 16. Inclusion – criteriaInfertility for > 1 years2 pathological spermiogramsInformed consentExclusion - criteriaVaricosisInfectionAspermiaHormonal disorderCONTROLLED STUDY – STUDY SETTING
  17. 17. Therapy Group 132 men, age Ø 34 a (18-43)2 Capsules/day MICRONUTRITIENTS (PROFERTIL) for 3 monthControl Group 73 men, age Ø 38 a (22-52)No TREATMENT / CHANGE OF LIFE STYLECONTROLLED STUDY – STUDY SETTING
  18. 18. 2 path spermiogr.Questionare QuestionareTreatment groupProfertil 2 capsulesControl groupChange life styleObservation periodTelephoneFollow upEnd of study12 monthInclusion3 monthStudy period6 monthFollow up
  19. 19. RESULTS OVERALL
  20. 20. Tot. Motility47%32%20 %10 %50 %40 %30 %RESULTS THERAPY GROUPProg. Motility49%30,5%0 %25 %+83,1%+36,4%
  21. 21. THERAPY COMPARED TO CONTROL
  22. 22. After 3 month treatmentStudy Group Control Group132 7434 preg.(25,8%) 11 preg.(14,8%)Improvement with Micronutritientsafter 3 Month
  23. 23. DNA Fragmentationsperm chromatin structure analysis< 15% normal15-30% IUI necessary> 30% ICSI necessary
  24. 24. EFFECT OF MICRONUTRITIENTSCochrane Database Syst Rev. 2011 Jan19;1:CD007411.Antioxidants for male subfertility.Showell et al.AUTHORS CONCLUSIONS: The evidence suggests thatantioxidant supplementation in subfertile males mayimprove the outcomes of live birth and pregnancy ratefor subfertile couples undergoing ART cycles….
  25. 25. Oxidative DNA damage impairs global sperm DNAmethylation in infertile men.Tunc O, J Assist Reprod Genet. 2009 Sep-Oct;26(9-10)CONCLUSIONS:..... while antioxidant supplementation appears to havethe potential to reduce DNA damage and normalize spermDNA methylation.EFFECT OF MICRONUTRITIENTS
  26. 26. Antioxidants and sperm DNA damage: a clinicalperspective.Zini A, J Assist Reprod Genet. 2009 Aug;26(8):427-32.RESULTS: . the data suggest that dietary antioxidants maybe beneficial in reducing sperm DNA damage, particularly,in men with high levels of DNA fragmentation ...EFFECT OF MICRONUTRITIENTS
  27. 27. Schuetz a, H. Kurz a, M. Imhof b67 sub-fertile males (active treatment group)40 Sub-fertile men receiving no active treatment served ascontrolsMain outcome measure was change in sperm-hyaluronanbinding assay indicating DNA fragmentation index after 3months.SPERM DNA FRAGMENTATION INDEX DECREASES AFTERMICRONUTRIENT SUPPLEMENTATION
  28. 28. Micronutrients intake is associated with improved spermDNA quality in older men.Schmid et al Fertil Steril 2012 Aug 23.PATIENT(S): 22-80-year-old nonsmoking men (n = 80)CONCLUSION(S): Men with higher dietary and supplementintake of certain micronutrients may produce sperm with lessDNA damage, especially among older men.DNA EFFECT OF MICRONUTRITIENTS
  29. 29. CONCLUSIONSperm quality and male fertility is decreasingMedical treatment of sperm quality unsuccessfulDecline of sperm quality may be adefiency syndrome not a disease
  30. 30. CONCLUSIONMicronutritients are lacking in western countriesChange of life style may improve sperm qualityMicronutritients improve sperm quality in literatureControlled prospective study prooves significantimprovement compared to control groupMicronutritients improve DNA sperm quality

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