Sperm DNA fragmentation: A new guideline for clinicians

Sperm DNA integrity is crucial for fertilization and development of healthy offspring. The spermatozoon undergoes extensive molecular remodeling of its nucleus during later phases of spermatogenesis, which imparts compaction and protects the genetic content. Testicular (defective maturation and abortive apoptosis) and post-testicular (oxidative stress) mechanisms are implicated in the etiology of sperm DNA fragmentation (SDF), which affects both natural and assisted reproduction. Several clinical and environmental factors are known to negatively impact sperm DNA integrity. An increasing number of reports emphasizes the direct relationship between sperm DNA damage and male infertility. Currently, several assays are available to assess sperm DNA damage, however, routine assessment of SDF in clinical practice is not recommended by professional organizations

How to diagnose and treat male subfertility

Approximately 80% of subfertile couples still have a chance to conceive naturally and the most important thing is to assess whether any form of medical assistance will increase their chance of pregnancy over continuing natural conception. In couples with male subfertility, IUI, IVF and ICSI are frequently used fertility treatments. Evidence-based guidelines on male subfertility are limited and the use of medically assisted reproduction is generally experience-based. In roughly 1% of subfertile couples the male partner is diagnosed with non-obstructive azoospermia. Men with NOA are able to father their own genetic child by using testicular sperm extraction (TESE) in combination with ICSI. Since both TESE and TESE-ICSI are invasive and costly procedures, patients should be well informed about their chances of successful TESE and their likelihood to conceive after TESE-ICSI before undergoing treatment. In this thesis, we performed several studies on male subfertility and MAR. We concluded that categorizing couples with male subfertility based on the TMSC allows for better classification in terms of chance of spontaneous ongoing pregnancy rate than categorization using the WHO classification system. We also concluded that there is insufficient evidence to determine whether there is any difference in safety and effectiveness between different treatment strategies for male subfertility. Furthermore, we developed a prediction model for obtaining sperm after testicular sperm extraction (TESE) in men suffering from NOA, as well as a prediction model for live birth in TESE-ICSI. Finally, we concluded that the current sperm DNA fragmentation tests have limited capacity to predict the chance of pregnancy in context of MAR

Bomensubstraten en hun toepassing : gebruik van bomengrond, bomenzand en bomengranulaat

De stadsboom krijgt steeds minder groeiruimte. Belangrijkste oorzaak hiervan is de toename van functies in het stedelijk gebied, die allemaal aanspraak maken op dezelfde, beperkte ondergrondse ruimte. Veel gemeenten kiezen dan ook voor het gebruik van bomensubstraat (bomengrond, bomenzand of bomengranulaat). In de loop der jaren zijn op dit gebied zoveel verschillende alternatieven ontwikkeld, dat het voor gemeenten alsmaar moeilijker wordt de juiste keuze te maken. De Praktijkbrochure ‘Bomensubstraten en hun toepassing’ biedt uitkomst. Het biedt een overzicht van de verschillende typen bomensubstraat en richtlijnen voor het gebruik. De dagelijkse situaties worden helder beschreven aan de hand van illustraties en praktijkfoto'

Symptom distress and disability: Different sides of the same coin? An investigation of the relationship between symptom distress and disability over time in patients receiving treatment for internalizing disorders

Background: Most psychotherapy outcome research focuses on symptom reduction as a primary outcome. However, most patients do not seek psychological treatment exclusively for symptom relief, but mainly because they can no longer do what they want to do or used to do. Therefore, besides symptom reduction, also disability in daily functioning should be a focus of psychotherapy outcome research. Yet, until now there is a paucity in research pertaining to the relation between symptom reduction and reduction of disability during psychological treatment. Aims: For this reason, the aim of the current study was to examine the relationship between changes in symptom reduction (reduction in general symptom distress) and changes in self-reported disability over a period of two years in patients that receive psychotherapy for mood and anxiety disorders (N = 1182). Results: We found strong correlations between both outcome measures at all measurement points. Furthermore, results demonstrated a decrease in both outcome measures from start to end of treatment with a moderate effect for symptom distress and a small effect for experienced disability. Cross-lagged panel analysis demonstrated that a decrease in symptom distress predicted a subsequent decrease in self-reported disability, and a decrease in self-reported disability equally predicted a subsequent decrease in experienced symptom distress. Conclusion: Our results seem to indicate that both outcome measures are interchangeable in psychotherapy outcome studies for internalizing disorders