MARCELLO ANTONIO SIGNORELLI COCUZZA
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/55 - Laboratório de Urologia, Hospital das Clínicas, Faculdade de Medicina - Líder
LIM/55 - Laboratório de Urologia, Hospital das Clínicas, Faculdade de Medicina - Líder
8 resultados
Resultados de Busca
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- Shedding Light on the Controversy Surrounding the Temporal Decline in Human Sperm Counts: A Systematic Review(2014) COCUZZA, Marcello; ESTEVES, Sandro C.We systematically examined the evidence of declining spermcounts and the hypothesis that an increased exposure to environmental pollutants is responsible for such decline. Search engines, including PUBMED, MEDLINE, EMBASE, BIOSIS, and Cochrane library, were used to identify epidemiologic studies published from 1985 to 2013. We concluded that there is no enough evidence to confirm a worldwide decline in sperm counts. Also, there seems to be no scientific truth of a causative role for endocrine disruptors in the temporal decline of sperm production. Such assumptions are based on few meta-analyses and retrospective studies, while other well-conducted researches could not confirm these findings. We acknowledge that difficult-to-control confounding factors in the highly variable nature of semen, selection criteria, and comparability of populations from different time periods in secular-trend studies, the quality of laboratory methods for counting sperm, and apparently geographic variations in semen quality are the main issues that complicate the interpretation of the available evidence. Owing to the importance of this subject and the uncertainties still prevailing, there is a need not only for continuing monitoring of semen quality, reproductive hormones, and xenobiotics, but also for a better definition of fecundity.
- The epidemiology and etiology of azoospermia(2013) COCUZZA, Marcello; ALVARENGA, Conrado; PAGANI, RodrigoThe misconception that infertility is typically associated with the female is commonly faced in the management of infertile men. It is uncommon for a patient to present for an infertility evaluation with an abnormal semen analysis report before an extensive female partner workup has been performed. Additionally, a man is usually considered fertile based only on seminal parameters without a physical exam. This behavior may lead to a delay in both the exact diagnosis and in possible specific infertility treatment. Moreover, male factor infertility can result from an underlying medical condition that is often treatable but could possibly be life-threatening. The responsibility of male factor in couple's infertility has been exponentially rising in recent years due to a comprehensive evaluation of reproductive male function and improved diagnostic tools. Despite this improvement in diagnosis, azoospermia is always the most challenging topic associated with infertility treatment. Several conditions that interfere with spermatogenesis and reduce sperm production and quality can lead to azoospermia. Azoospermia may also occur because of a reproductive tract obstruction. Optimal management of patients with azoospermia requires a full understanding of the disease etiology. This review will discuss in detail the epidemiology and etiology of azoospermia. A thorough literature survey was performed using the Medline, EMBASE, BIOSIS, and Cochrane databases. We restricted the survey to clinical publications that were relevant to male infertility and azoospermia. Many of the recommendations included are not based on controlled studies.
- Summary evidence on the effects of varicocele treatment to improve natural fertility in subfertile men(2016) TISEO, Bruno C.; ESTEVES, Sandro C.; COCUZZA, Marcello S.The objective of this review was to summarize the evidence concerning the benefit of varicocele treatment to improve natural fertility in subfertile males. We also analyzed the effect of varicocele treatment on conventional semen parameters and sperm functional tests. An electronic search to collect the data was performed using the PubMed/MEDLINE databases until July 2015. Data pooled from a variety of study designs indicate that varicocelectomy improves semen parameters in the majority of the treated men with clinical varicocele and abnormal semen parameters regardless of the chosen surgical method. Surgical varicocele repair was beneficial not only for alleviating oxidative stress-associated infertility but also to improve sperm nuclear DNA integrity. However, given the low magnitude of the effect size in sperm DNA integrity, further research is needed to elucidate its clinical significance. Conflicting results on the effect of varicocele treatment on natural fertility seem to be due to heterogeneous study designs and, more importantly, patient selection criteria. When these issues are controlled, current evidence indicates that treatment of subclinical varicocele is not warranted, as it does not seem to improve fertility. On the contrary, fair evidence indicates that varicocele treatment should be offered to infertile patients with palpable varicocele and abnormal semen parameters. This evidence supports the current guidelines issued by the American Urological Association and European Association of Urology, which state that varicocele treatment should be offered to male partners of infertile couples presenting for evaluation with clinical varicocele and semen parameters alterations.
- Varicocele-Associated Infertility and the Role of Oxidative Stress on Sperm DNA Fragmentation(2021) WOOD, Guilherme Jacom Abdulmassih; CARDOSO, Joao Paulo Greco; PALUELLO, Davi Vischi; NUNES, Thiago Fagundes; COCUZZA, MarcelloVaricocele has been extensively described and studied as the most important reversible cause of male infertility. Its impact on semen parameters, pregnancy rates, and assisted reproductive outcomes have been associated with multifactorial aspects, most of them converging to increase of reactive oxygen species (ROS). More recently, sperm DNA fragmentation has gained significant attention and potential clinical use, although the body of evidence still needs further evolution. The associations between sperm DNA damage and a variety of disorders, including varicocele itself, share common pathways to ROS increase. This mini-review discusses different aspects related to the etiology of ROS and its relation to varicocele and potential mechanisms of DNA damage.
- Cutting-Edge Issues in Autoimmune Orchitis(2012) SILVA, Clovis A.; COCUZZA, Marcello; BORBA, Eduardo F.; BONFA, EloisaAutoimmune orchitis is a relevant cause of decreased fecundity in males, and it is defined as a direct aggression to the testis with the concomitant presence of anti-sperm antibodies (ASA). The presence of these specific antibodies has been observed in approximately 5-12% of infertile male partners. Primary autoimmune orchitis is defined by isolated infertility with ASA but without evidence of a systemic disease. Secondary causes of orchitis and/or testicular vasculitis are uniformly associated with autoimmune diseases, mainly in primary vasculitis such as polyarteritis nodosa, Beh double dagger et's disease, and Henoch-Schonlein purpura. The overall frequencies of acute orchitis and ASA in rheumatic diseases are 2-31% and 0-50%, respectively. The pathogenesis of primary/secondary autoimmune orchitis is not completely understood but probably involves the access of immune cells to the testicular microenvironment due to inflammation, infection or trauma, leading to apoptosis of spermatocytes and spermatids. Glucocorticoids and immunosuppressive drugs are indicated in autoimmune orchitis-associated active systemic autoimmune diseases. However, there are no standardized treatment options, and the real significance of ASA in infertile men is still controversial. Assisted reproductive technologies such as intrauterine insemination, in vitro fertilization, and intracytoplasmic sperm injection (ICSI) are therapeutic options for male infertility associated with these autoantibodies. ICSI is considered to be the best choice for patients with severe sperm autoimmunity, particularly in males with low semen counts or motility.
- Male Oxidative Stress Infertility (MOSI): Proposed Terminology and Clinical Practice Guidelines for Management of Idiopathic Male Infertility(2019) AGARWAL, Ashok; PAREKH, Neel; SELVAM, Manesh Kumar Panner; HENKEL, Ralf; SHAH, Rupin; HOMA, Sheryl T.; RAMASAMY, Ranjith; KO, Edmund; TREMELLEN, Kelton; ESTEVES, Sandro; MAJZOUB, Ahmad; ALVAREZ, Juan G.; GARDNER, David K.; JAYASENA, Channa N.; RAMSAY, Jonathan W.; CHO, Chak-Lam; SALEH, Ramadan; SAKKAS, Denny; HOTALING, James M.; LUNDY, Scott D.; VIJ, Sarah; MARMAR, Joel; GOSALVEZ, Jaime; SABANEGH, Edmund; PARK, Hyun Jun; ZINI, Armand; KAVOUSSI, Parviz; MICIC, Sava; SMITH, Ryan; BUSETTO, Gian Maria; BAKIRCIOGLU, Mustafa Emre; HAIDL, Gerhard; BALERCIA, Giancarlo; PUCHALT, Nicols Garrido; BEN-KHALIFA, Moncef; TADROS, Nicholas; KIRKMAN-BROWNE, Jackson; MOSKOVTSEV, Sergey; HUANG, Xuefeng; BORGES JR., Edson; FRANKEN, Daniel; BAR-CHAMA, Natan; MORIMOTO, Yoshiharu; TOMITA, Kazuhisa; SRINI, Vasan Satya; OMBELET, Willem; BALDI, Elisabetta; MURATORI, Monica; YUMURA, Yasushi; VIGNERA, Sandro La; KOSGI, Raghavender; MARTINEZ, Marlon P.; EVENSON, Donald P.; ZYLBERSZTEJN, Daniel Suslik; ROQUE, Matheus; COCUZZA, Marcello; VIEIRA, Marcelo; BEN-MEIR, Assaf; ORVIETO, Raoul; LEVITAS, Eliahu; WISER, Amir; ARAFA, Mohamed; MALHOTRA, Vineet; PAREKATTIL, Sijo Joseph; ELBARDISI, Haitham; CARVALHO, Luiz; DADA, Rima; SIFER, Christophe; TALWAR, Pankaj; GUDELOGLU, Ahmet; MAHMOUD, Ahmed M. A.; TERRAS, Khaled; YAZBECK, Chadi; NEBOJSA, Bojanic; DURAIRAJANAYAGAM, Damayanthi; MOUNIR, Ajina; KAHN, Linda G.; BASKARAN, Saradha; PAI, Rishma Dhillon; PAOLI, Donatella; LEISEGANG, Kristian; MOEIN, Mohamed-Reza; MALIK, Sonia; YAMAN, Onder; SAMANTA, Luna; BAYANE, Fouad; JINDAL, Sunil K.; KENDIRCI, Muammer; ALTAY, Baris; PEROVIC, Dragoljub; HARLEV, AviDespite 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.
- Male fertility potential alteration in rheumatic diseases: a systematic review(2016) TISEO, Bruno Camargo; COCUZZA, Marcello; BONFA, Eloisa; SROUGI, Miguel; SILVA, Clovis A.Background: Improved targeted therapies for rheumatic diseases were developed recently resulting in a better prognosis for affected patients. Nowadays, patients are living longer and with improved quality of life, including fertility potential. These patients are affected by impaired reproductive function and the causes are often multifactorial related to particularities of each disease. This review highlights how rheumatic diseases and their management affect testicular function and male fertility. Materials and Methods: A systematic review of literature of all published data after 1970 was conducted. Data was collected about fertility abnormalities in male patients with systemic lupus erythematosus, rheumatoid arthritis, dermatomyositis, ankylosing spondylitis, Behcet disease and gout. Two independent researchers carried out the search in online databases. Results: A total of 19 articles were included addressing the following diseases: 7 systemic lupus erythematosus, 6 Behcet disease, 4 ankylosing spondylitis, 2 rheumatoid arthritis, 2 dermatomyositis and one gout. Systemic lupus erythematosus clearly affects gonadal function impairing spermatogenesis mainly due to antisperm antibodies and cyclophosphamide therapy. Behcet disease, gout and ankylosing spondylitis patients, including those under anti-TNF therapy in the latter disease, do not seem to have reduced fertility whereas in dermatomyositis, the fertility potential is hampered by disease activity and by alkylating agents. Data regarding rheumatoid arthritis is scarce, gonadal dysfunction observed as consequence of disease activity and antisperm antibodies. Conclusions: Reduced fertility potential is not uncommon. Its frequency and severity vary among the different rheumatic diseases. Permanent infertility is rare and often associated with alkylating agent therapy.
- Diagnosis and classification of autoimmune orchitis(2014) SILVA, C. A.; COCUZZA, M.; CARVALHO, J. F.; BONFA, E.Autoimmune orchitis is characterized by testis inflammation and the presence of specific antisperm antibodies (ASA). It is classified in two categories. Primary autoimmune orchitis is defined by infertility and asymptomatic orchitis associated with ASA (100%) directed to the basement membrane or seminiferous tubules in infertile men, without any systemic disease and usually asymptomatic. Secondary autoimmune orchitis is characterized by symptomatic orchitis and/or testicular vasculiti's associated with a systemic autoimmune disease, particularly vasculitis. These patients typically demonstrate testicular pain, erythema and/or swelling. ASA in secondary autoimmune orchitis have been reported in up to 50% of patients, especially in systemic lupus erythematosus patients. The pathogenesis of primary as well as secondary autoimmune orchitis is still unknown. Although the etiology is likely to be multifactorial, testicular inflammation, infection or trauma may induce T cell response with pro-inflammatory cytokine production with a consequent blood-testis-barrier permeability alteration, ASA production and apoptosis of spermatocytes and spermatids. ASA is known to cause immobilization and/or agglutination of spermatozoa, which may block sperm-egg interaction resulting in infertility. Assisted reproduction has been used as an efficient option in primary cases and immunosuppressive therapy for secondary autoimmune orchitis, although there is no double-blind, randomized trial to confirm the efficacy of any treatment regimens for these conditions.