Semen mikrobiatasının semen parametreleri ve erkek infertilitesi ile ilişkisi

İnsanlarda bulunan mikroorganizmaların (bakteri, virüs, mantar) tamamına “mikrobiata”, tüm bu mikroorganizmaların genomuna “mikrobiyom” adı verilmektedir. Bugüne kadar insanlarda 10.000’den fazla bakteri ve mantar, 3000’den fazla virüs türü saptanmıştır. İnsan mikrobiatasının %9u ürogenital sistemde olup hem fertil hem de infertil erkeklerde semenin mikrobiata nedeniyle steril olmadığı bilinmektedir. Prevotella, Finegoldia, Psödomonas, Peptinophilus, Streptococcus, Anaerococcus, Lactobacillus ve Corynebacterium bakteri cinsleri sperm mikrobiyomunun en sık saptanan ana mikrobiata bileşenleri olarak kabul edilmektedir. Semen mikrobiatasının semen parametreleri ile ilişkisi ise halen net olmasa da bakteriyosperminin sperm sayısı, motilitesi ve sperm DNA fragmantasyonu üzerinde olumsuz etkisinin olduğu bilinmektedir. Ancak özellikle NGS (next-generation DNA sequencing) tekniği kullanılan çalışmalarda hem fertil hem de infertil hastaların semen mikrobiataları benzer bulunmuştur. Ancak intratestiküler dokuların standart kültür yöntemlerine göre steril olmasına rağ- men mTESE işlemi ile sperm bulunamayan hastaların intratestiküler dokusunda Firmicutes ve Clostridia türlerinin düşük, Peptoniphilus türünün tamamen yok ve Actinobacteria türünün ise yüksek oranda saptanmaktadır. Ayrıca yardımcı üreme teknikleri ile elde edilen embriyonlar semen mikrobiyatasında Enterobacteriaceae varlığında daha iyi, Alphaproteobacteria ve Gammaproteobacteria varlığında ise daha düşük kaliteli gelişim göstermektedir. Probiyotik kullanımının semende ROS miktarında 3,5 katlık azalma ve sperm motilitesinde altı katlık bir artış sağladığı gösterilse de probiyotik kullanımı ve semen parametreleri arasındaki ilişki halen net değildir. Sonuç olarak semen mikrobiatasının erkek infertilitesi ile ilişkisi mevcut sınırlı kanıtlar göz önüne alındığında halen yeterli olmayıp gelişen teknoloji ve bilgi birikimi ile koruyucu rolü olabilecek patojenik olmayan mikrobiatal organizmaların idiyopatik erkek infertilitesinin tedavisindeki rolü gelecekteki araştırmalar ile aydınlatılmalıdır.

The relationship of semen microbiota with semen parameters and male infertility

All of the microorganisms (bacteria, viruses, fungi) found in humans are called “microbiota”, and the genomes of all these microorganisms are called “microbiomes”. To date, more than 10,000 types of bacteria and fungi, and more than 3000 types of viruses have been identified in humans. Nine percent of human microbiota is present in the urogenital system and it is known that semen in both fertile and infertile men is not sterile due to microbiota. Prevotella, Finegoldia, Pseudomonas, Peptinophilus, Streptococcus, Anaerococcus, Lactobacillus and Corynebacterium bacterial genera are considered to be the most frequently detected major microbiota components of the sperm microbiome. Although the relationship between semen microbiota and semen parameters is still not clear, it is known that bacteriospermia has a negative effect on sperm count, motility and sperm DNA fragmentation. However, especially in studies using NGS (nextgeneration DNA sequencing) technique, semen microbiota of both fertile and infertile patients were found to be similar. Although intratesticular tissues are sterile according to standard culture methods, Firmicutes and Clostridia species are found to be low, Peptoniphilus species completely absent and Actinobacteria species are found to be high in intratesticular tissue of patients who cannot find sperm by mTESE procedure. In addition, embryos obtained by assisted reproduction techniques show better growth in the presence of Enterobacteriaceae in the semen microbiota, but lower quality in the presence of Alphaproteobacteria and Gammaproteobacteria. Although it has been shown that the use of probiotics provides a 3.5-fold decrease in the amount of ROS in semen and a six-fold increase in sperm motility, the relationship between probiotic use and semen parameters is still unclear. In conclusion, the relationship between semen microbiota and male infertility is still not sufficient considering the limited evidence available. With the developing technology and knowledge, the role of non-pathogenic microbiatal organisms that may have a protective role in the treatment of idiopathic male infertility should be evaluated by future research.

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