Eating foods that are rich in certain flavonoids has been associated with a reduced risk of erectile dysfunction in men, especially those under 70, according to research from Harvard University and the University of East Anglia published today in The American Journal of Clinical Nutrition. Of the different flavonoids, anthocyanins (found in blueberries, cherries, blackberries, radishes and blackcurrant), and flavanones and flavones (found in citrus fruits) were found to offer the greatest benefits in preventing the condition, according to a new release on the study.
According to the Cleveland Clinic, as many as 52 percent of all men experience occasional erectile dysfunction. Lead researcher Professor Aedin Cassidy from UEA was quoted in a press release saying, "We already knew that intake of certain foods high in flavonoids may reduce the risk of conditions including diabetes and cardiovascular disease. The top sources of anthocyanins, flavones and flavanones are strawberries, blueberries, red wine, apples, pears, and citrus products.
Broadly defined, epigenetics includes any process that alters gene activity without changing the DNA sequence. Not only that, epigenetic alterations to DNA are heritable and can be passed to offspring. Several kinds of epigenetic changes to DNA have been described, including methylation, acetylation and other “-ations,” but in general, they serve to “mark” areas of DNA so that affected genes either become active or stay quiet.
Technology can now examine epigenetic marks on DNA on a grand scale, and what’s being learned from such work is fascinating. To learn more about Sperm Mapping, please watch the video below or read the following topics. For the last 50 years, the evaluation of men with azoospermia has involved determining if sperm production is normal or not through a surgical procedure called a testis biopsy.
It is a minimally invasive method that offers a wealth of information about a man’s sperm production.
It is clear that testis biopsy patterns as currently reported do not correlate well to either a) the reason for infertility, or b) to the ability to find sperm in the testis. Assisted reproduction (IVF) has advanced such that sperm from the testis are routinely used for pregnancy, further fueling the development of this novel technique as a way for azoospermic men to become biological fathers. After staining, the slides are reviewed for several hours by a team of trained cytologists for the presence or absence of sperm (Figure 4). In addition to finding sperm, many other testis cell types can be readily identified on each mapped slide, including supporting cells such as Sertoli cells, Leydig cells and myoid cells, and various cells of the germ cell sequence that lead up to mature sperm including spermatogonia, primary spermatocytes, spermatids (round and elongating) and mature sperm with tails (Figure 5). In men with nonobstructive azoospermia in which there is no sperm in the ejaculate due to a sperm production problem (and not a blockage), there may still be usable sperm within the testis. Think of Sperm Mapping as “testis GPS” or “testicular cartography” as some patients have put it. Traditionally, the health care response to a couple with infertility has been for the female partner to visit a gynecologist for evaluation. The male partner may or may not be asked to give a semen analysis (often called a “sperm test”). Then, a decision is made to pursue surgical or nonsurgical fertility treatment; if neither is appropriate, assisted reproduction can be used to overcome even the severest forms of male infertility. To learn more about male fertility evaluation and testing, please select one of the following topics. The history reviews medical problems including recent fevers, illnesses, cancer and infections. A social history may elucidate the habitual use of alcohol, tobacco use, recreational drugs and anabolic steroids, all of which can hurt sperm production. This will assess blood pressure, height, weight and body mass as well a body habitus including obesity, gynecomastia and secondary sex characteristics.
Although not a true measure of fertility, the semen analysis, if abnormal, may suggest that the probability of achieving fertility is statistically low. Semen quality varies with collection technique, so follow the instructions as best as you can. If collecting the sample at home, keep it at body termperature during transport (shirt pocket); it should be delivered within 1 hour of collection.
Not only is it more common than people realize, but it also could suggest a serious underlying medical issue.
The researchers took into account a range of factors including weight, level of physical activity, the amount of caffeine consumed, and whether the participants smoked. But those who consumed a diet rich in anthocyanins, flavones and flavanones were less likely to suffer the condition.


The belief that the genome you inherit from your mother and father is faithfully perpetuated in you is not true anymore. Even within our own bodies, it explains how different cells, although all having identical DNA, can perform very different tasks, and maintain those tasks for as long as we live.
This little fact makes epigenetics critical to that long, windy road that got us here, also termed evolution.
These marks are both natural and essential to life, but they can also go awry and lead to adverse behavioral and health effects, like cancer, autoimmunity, schizophrenia and autism. Turek can determine if a man with azoospermia (no sperm in the ejaculate) is a candidate for sperm retrieval to have children.
Sperm Mapping is a non-surgical alternative to the testis biopsy and is done with a technique called fine needle aspiration (FNA).
The sperm mapping template used to locate sperm in the testisSperm Mapping is a small procedure performed in the office on a come-and-go basis.
The small tissue sample is in the middle of the slide and will be smeared to spread out the cells over the entire slide before stainingOnly a very small amount of testis tissue is needed from each mapped site for the Sperm Mapping technique (Figure 3). Importantly, these sperm are stained at this point and cannot be used clinically for pregnancies. Cell types in the germ cell sequence that can be readily identified by sperm mapping include spermatogonia, primary spermatocytes, spermatids, and spermSperm Mapping vs.
If the semen analysis is abnormal, couples are often shuttled straight to assisted reproduction for IUI or IVF, instead of examining (a) why the semen sample may be abnormal and (b) correcting the abnormal semen analysis and therefore the infertility. Prior surgery, including orchidopexy, herniorraphy, trauma, open retroperitoneal, pelvic or bladder procedures and prostate surgeries should be elucidated.
The use of spermicidal lubricants, and incorrect patterns and timing of intercourse may be noted from a sexual history. Several descriptive systems exist to evaluate morphology, and within each system, sperm are designated normal or abnormal based on a list of criteria. Sperm morphology may also be a sensitive indicator of testicular health because sperm shape is largely determined during sperm production within the testis.
Some labs, especially those associated with fertility centers, may be more used to doing a semen analysis and have better quality evaluations and reports. Longer or shorter abstinence than this may result in artificially high or low concentration or motility.
Sperm Mapping also helps to minimize invasive testis sperm retrievals and reduces the potential damage to the testis from these procedures. FNA has been used to examine human tissue for over 100 years, and is very popular now for breast cancer diagnosis. It takes about 45-50 minutes to do (Figure 1) under local anesthesia; oral sedatives can be taken if the patient desires. This is quite different from the much larger samples of testis tissue obtained by open surgical biopsy. Turek’s infertility research has shown that in such instances the sperm may be located in “pockets” and may not be found everywhere (Figure 6).
In the modern era of evidence based care and cost-containment, this sequence of events is now inappropriate. Semen analyses or hormone testing can help 1) avoid duplicating tests, 2) give further evidence (or not) of a male infertility problem and 3) show semen quality trends over time to help identify root causes. Turek is very interested in her history of prior pregnancies, how regular her cycles and menstrual flow are, and whether intercourse was “timed” or simply unprotected. It is believed that sperm morphology may correlate with a man’s fertility potential, but in actuality, it has only been shown in studies to correlate with the ability of sperm to penetrate and fertilize eggs in the setting of in vitro fertilization (IVF) (Figure 2).
The main role of morphology in the male evaluation is to complement the semen analysis data and better estimate the chances of fertility. But epigenomewide studies now suggest that epigenetic patterns in sperm can predict your ability to be a father, both naturally and with the help of assisted reproduction. This has led biotech companies like Episona* to devote their entire existence to figuring out the epigenetic links to fertility. It is a minimally-invasive, non-surgical procedure performed under local anesthesia in one of our clinics. Testis FNA is similar to a testis biopsy in terms of the information gained about sperm production, but much less invasive and less painful than a biopsy.


Slides are shown in the foreground and jars to fix the samples are in the background.Each FNA sample is collected from a specific location in the testis according to a standard template (Figure 1). That is, some places in the testis may have sperm and others may not, like apples on the branches of a tree.
Another reason is that impaired semen quality is now being seen as a “biomarker” of men’s overall health and one that we shouldn’t continue to ignore.
A developmental history of hypospadias, congenital anomalies and DES exposure may also be found. Turek recently published the first research study that convincingly shows that hot tubs and baths can have a major impact on semen quality. The most important piece of information about her is her age, as fertility in women declines after age 35 and is almost certainly decreased at 40. Even more intriguing is the thought that, given the heritability of things, that maybe male infertility is not just about what you’re doing in your life, but also about what your parents’ did in theirs. Because of this, it can be used to sample many places throughout the testis and is therefore more informative than a testis biopsy. Each testis is approached separately and anywhere from 11-18 FNA samples are taken from each side (Figure 1) through the scrotal skin. After sampling, the tissue within the needle is placed on a microscope slide and smeared using standard hematologic technique to spread out the cells over the whole slide (Figure 3). This “patchy” or “focal” nature of sperm production makes finding testis sperm difficult in many cases. The use of medications including finasteride (Propecia), nitrofurantoin, sulfasalazine (and possibly other sulfa drugs), cimetidine, alpha-blockers, calcium channel blockers, allopurinol and many other medications may also impact on fertility. Lastly, an occupational history is important to determine exposure to ionizing radiation, chronic heat, dyes, pesticides, herbicides and heavy minerals (lead, cadmium, mercury). Careful palpation of each vas deferens can show that they are missing, abnormal or inflamed. OK, I’ll stop with the “what’s-beyond-the-universe” thinking, and just leave you with the notion that this epigenetics thing is big in medicine right now, clearly emerging as a ghost-like, parallel universe to the Watson-and-Crick-conceived world of DNA.
Due to this fact, a single testis biopsy, or even multiple testis biopsies, can “miss” finding sperm in men with nonobstructive azooospermia. The vast majority of exposures discovered on the patient history are reversible and so are valuable to find and discontinue. The spermatic cords above the testes should be felt for asymmetry suggestive of a lipoma or varicocele. Pressure is applied for several minutes and the patient is advised to rest for one day after the procedure (post-procedure instructions can be found here). It is then stained with a standard PAP (Papanicolou) stain and reviewed in detail by an experienced team of cytologists who study the slides under high power microscopy to find sperm with tails. Potentially, many more testis biopsies than are currently taken may be needed to find sperm, but adding more biopsies can jeopardize the health and survival of the testis. Lastly, a rectal examination is important in evaluating the prostate (if age appropriate) and identifying large cysts, infections or dilated seminal vesicles all of which may be associated with infertility. Patients are prescribed pain pills and take an average of two pain pills after the procedure. Another issue with finding sperm in biopsies is that many laboratories that receive the fresh biopsy tissue to look for sperm are not looking at the sample with as much effort as is needed to find sperm. And even if the laboratory is very experienced, they do not have the benefit of a PAP stain (used with Mapping) that precisely and accurately distinguishes all of the germ cell types in the testis sample.
Turek has also published that testis biopsies that are sent to a pathologist for review may not be read as accurately for the presence of sperm as one might want. Unlike a biopsy, Sperm Mapping allows for precise, systematic examination of many areas of the testis and can allow men with even the severest forms of infertility, including cancer survivors to become biological fathers.



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