In Vitro Fertilization IVF

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     The treatment with certain drugs or the use or exposure to certain toxic substances can temporarily or permanently affect fertility; toxic substances inside the uterus which affect the fetus- dietilstilbestrol (disethylstilboestrolum) and antiandrogens, occupational exposure to toxic substances- carbon disulphide, lead, estrogens, kepone (chlordecone), and ethyl cellosolve; drugs- chemotherapeutic agents, sulfasalazine, androgens; drugs which affect masculine reproductive function- testosterone-synthesis inhibitors (spironolactone, Ketoconazole, cyproterone acetate), androgenic antagonists (spironolactone, cyproterone acetate, flutamide, cimetidine); ejaculatory and erectile function inhibitors: antihypertensive drugs (methyldopa, reserpine, β-blockers, clonidine), antipsychotic or neuroleptic drugs (phenothiazine, butyrophenone, lithium); antidepressive or antidepressant drugs (tricyclic antidepressants, monoamine oxidases inhibitors); anticholinergic agents; and recreational drugs: ethanol, marijuana, opioid substances, and cigarettes.
     There are many scientists who support the theory of environmental factors which lead to the prevalence testicular damage and male infertility.
     Moreover we will analyze testicular dysfunction caused by prescribed drugs, by “street drugs”, like alcohol and opioid substances, by the surrounding environment and occupational toxins, genital tract obstruction, immotile sperm and ejaculatory dysfunctions
          Prescribed Drugs
     Fetal uterine exposure to dietilstilbestrol (disethylstilboestrolum-DES) is associated with epididymal cysts and spermatic function abnormalities.      Spironolactone and Ketoconazole affect testicular biosynthesis; spironolactone, cimetidine, and flutamide attach to the androgenic receptors and block androgen activity. These drugs can cause genital abnormalities in a male fetus and are contraindicated during pregnancy. In adult men these drugs can cause gynecomastia but they don’t affect spermatogenesis. In sportive men, androgen abuse suppresses gonadotropine secretions and produces hypospermiogenesis. Chemotherapeutic agents affect spermatogenesis in young patients.      Particularly, certain chemotherapeutic drugs completely destroy spermatogenesis (mechlorethamine, nitrogen mustards, Merk, West Point, PA), cyclophosphamide and carbamazepine. During the treatment with those drugs azoospermia is a frequent occurrence. Also FSH level raises and, a testicular biopsy show germinal aplasia. Depending on the dose and period of chemotherapeutic treatment, the potential damage to the reproductive system and possibility of recovery are determined. Radiation therapy can have similar effects as chemotherapy. In the case of men who suffer from malignant diseases, semen is collected and cryogenised before the initiation of the treatment.
     Sulfasalazine, a 5-aminosalicylic conjugate, used in the treatment of colitis cankerous is usually associated with reduced sperm motility and density, but this is a reversible condition which disappears after the treatment.
           “Street Drugs”
Chronic alcoholism is associated with testicular volume reduction, seminal volume and density drop, lower sperm motility and morphology. Those abnormalities can be corrected in time if the man stops consuming alcohol, alcohol abstinence leads to reestablishing the semen’s normal parameters. Also in a healthy man, ethanol acute administration leads to the reduction of testosterone production.

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