{"id":49346,"date":"2023-06-30T10:02:31","date_gmt":"2023-06-30T10:02:31","guid":{"rendered":"https:\/\/biomedpharmajournal.org\/?p=49346"},"modified":"2023-07-11T06:55:36","modified_gmt":"2023-07-11T06:55:36","slug":"male-infertility-in-patients-with-post-traumatic-stress-is-associated-with-increased-serum-lipid-concentration","status":"publish","type":"post","link":"https:\/\/biomedpharmajournal.org\/staging\/vol16no2\/male-infertility-in-patients-with-post-traumatic-stress-is-associated-with-increased-serum-lipid-concentration\/","title":{"rendered":"Male Infertility in Patients with Post-Traumatic Stress is Associated with Increased Serum Lipid Concentration"},"content":{"rendered":"\n

Introduction<\/strong><\/p>\n\n\n\n

Post-traumatic stress disorder (PTSD) is a\npsychiatric disorder that can occur after experiencing or witnessing\nlife-threatening events such as war, combat operations, terrorist attacks,\naccidents or violent physical attacks, rape, etc1<\/sup>.  Its prevalence is high and it often occurs in\ncomorbidity with other psychiatric and physical disorders2<\/sup>. Numerous\nstudies have examined the comorbidity of pain and PTSD in the general\npopulation or among war veterans and the impact of this on quality of life 3,4<\/sup>\n. PTSD refers to the transmission of nightmares, intrusive thoughts, flashbacks,\nand other symptoms typically experienced by traumatized individuals5<\/sup>. Elevated\nserum lipid concentrations have been found in studies of patients with\npost-traumatic stress disorder (PTSD). However, epidemiological as well as\nclinical studies have shown that PTSD often co-occurs with other psychiatric\ndisorders6<\/sup>. Studies have shown that approximately 80% of individuals\nwith PTSD meet the criteria for at least one additional psychiatric diagnosis.\nMajor depressive disorder (MDD) is one of the most frequent comorbid conditions\nwith PTSD, and the prevalence of MDD in PTSD patients is as high as 70%7<\/sup>.\nPrevious studies have suggested that sexual dysfunction is associated with trauma-related\nmental illness, including PTSD8<\/sup>. Lipids play important roles in the\nbrain, including neurogenesis, synaptogenesis, myelin formation, and impulse\nconduction9<\/sup>. Impaired lipid metabolism promotes infertility10<\/sup>.\nAs a result of the war in Kosovo (1998-1999) PTSD, depression and emotional\ndistress still remained high within the population11<\/sup>. As of 2013,\nPTSD prevalence rates were still as high as 17.9%. These findings suggest that\nPTSD constitutes a major public health issue in Kosovo12<\/sup>. Kosovo\ncurrently has the youngest population in Europe. However, in recent years, the\nrate of population growth in Kosovo has begun to slow, and the birth rate has\ndecreased as a result of the increase in the rate of infertility with multiple\ncauses among diagnosed male Kosovo war veterans. with PTSD 13<\/sup>.<\/p>\n\n\n\n

Objective<\/strong><\/p>\n\n\n\n

Determination of the concentration of lipids; TC=Total Cholesterol, TG = Total triglyceride, LDL-C = Low-density lipoprotein cholesterol, HDL-C= high-density lipoprotein cholesterol in the serum of patients with post-traumatic stress disorder, veterans of the war in Kosovo. Fat concentrations of patients treated for male infertility and diagnosed with PTSD.<\/p>\n\n\n\n

 Materials and methods<\/strong><\/p>\n\n\n\n

Our\nstudy included 72 patients with primary and secondary infertility, with\npermanent residence in the Dukagjin Region (Pej, Istok, De\u00e7an, Klin\u00eb cities) in\nthe Republic of Kosovo. This research was carried out at the Biolab Zafi\nPolyclinic in Klina and at the Biolab-Zafi-F Medical Laboratory in Pej. Kosovo.\nCriteria that must be met to confirm the diagnosis of PTSD. During the patient\nencounter, a 15-20 minute interview was conducted by the Psychiatrist to meet\nthe need for a short but accurate and structured psychiatric interview in\nmulticenter clinical trials. The patients agreed to enter the study in a\nstructured questionnaire on sociodemographic characteristics, health somatics\nand medication use. The following instruments were used in the research: ITQ (International\nTrauma Questionnaire)14<\/sup>. To determine male fertility, we analyzed\nhuman ejaculate (spermiogram), WHO (2021) lists the criteria for the analysis\nof human ejaculate 15<\/sup>. Serum lipid concentrations were determined on\nthe COBAS INTEGRA 400 plus, introduced in 2019 by Roche Diagnostics (Basel,\nSwitzerland). Determination of lipidogram parameters was performed using the\nmethod: Enzymatic colorimetric test16<\/sup>.<\/p>\n\n\n\n

Statistical analysis<\/strong><\/p>\n\n\n\n

BMI and lipid data were analyzed using the t-test for independent samples, taking into account the fact that the lipid value follows a normal distribution curve. All data were saved in Excel and statistical analysis was performed using SPSS software (SPSS for Windows 11.0, Chicago, IL, USA). The obtained values of biochemical analyzes of serum lipids were presented as mean \u00b1 standard deviation and compared with the test \ud835\udc43 <0.05 was considered a significant difference.<\/p>\n\n\n\n

Results<\/strong><\/p>\n\n\n\n

All patients (72) were in infertility treatment with the male factor as an infertility factor divided into two groups. The first group of 34 patients was diagnosed with PTSD, and this group consisted of 11 patients who were included in our study in 2015 (13), and 23 patients diagnosed with PTSD from 2016-2022. The second group was the control of 38 patients without PTSD diagnosis but in the treatment of male infertility from 2016 -2022. According to the type of infertility, there were 19 patients with primary infertility in the first group and 15 patients with secondary infertility. In the second control group, there were even more patients with primary infertility 22 patients, against 16 patients with secondary infertility. Patients with PTSD were aged 49.3 \u00b1 1.6 years, mean age of patients without PTSD was 47.8 \u00b1 1.5. The research subject was quite homogeneous in terms of nationality, all of them were Albanians, veterans of the last war in Kosova.<\/p>\n\n\n\n

Tabel 1: BMI parameters, CT, LDL, HDL, and TG concentration in patients with PTSD, control group without PTSD, Kosovar veterans in infertility treatment procedure<\/strong>.<\/p>\n\n\n\n\n\n\n\n\n\n\n
\n

Parameters<\/strong><\/p>\n<\/td>\n

\n

With  Post-traumatic stress disorder<\/strong><\/p>\n

          (34)<\/strong><\/p>\n<\/td>\n

\n

Without Post-traumatic stress disorder <\/strong><\/p>\n

         (38)<\/strong><\/p>\n<\/td>\n

\n

p-value<\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

TC (mmol\/L)<\/strong><\/p>\n<\/td>\n

\n

6.38 \u00b1 1.20<\/p>\n<\/td>\n

\n

5.28 \u00b1 0.37<\/p>\n<\/td>\n

\n

0.018<\/p>\n<\/td>\n<\/tr>\n

\n

TG (mmol\/L)<\/strong><\/p>\n<\/td>\n

\n

2.43 \u00b1 0.64<\/p>\n<\/td>\n

\n

1.78 \u00b1 0.45<\/p>\n<\/td>\n

\n

0.036<\/p>\n<\/td>\n<\/tr>\n

\n

HDL (mmol\/L)<\/strong><\/p>\n<\/td>\n

\n

1.17 \u00b1 0.40<\/p>\n<\/td>\n

\n

2.47 \u00b1 0.50<\/p>\n<\/td>\n

\n

0.021<\/p>\n<\/td>\n<\/tr>\n

\n

LDL (mmol\/L)<\/strong><\/p>\n<\/td>\n

\n

4.16 \u00b1 0.31<\/p>\n<\/td>\n

\n

3.65 \u00b1 0.49<\/p>\n<\/td>\n

\n

0.016<\/p>\n<\/td>\n<\/tr>\n

\n

BMI (kg\/m\u00b2)<\/strong><\/p>\n<\/td>\n

\n

26.2<\/p>\n<\/td>\n

\n

25.6<\/p>\n<\/td>\n

\n

0.430<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n

TC=Total Cholesterol, TG = Total triglyceride, LDL-C = Low density lipoprotein cholesterol, HDL-C= high density lipoprotein cholesterol <\/p>\n\n\n\n

The obtained results showed that PTSD patients showed higher CT\nconcentrations (6.38 \u00b1 1.20) than the non-PTSD group (5.28 \u00b1 0.37) (p=0.018).\nOur results showed that HDL concentrations in the serum of patients with PTSD\n(1.17 \u00b1 0.40) was significantly lower than in patients without -PTSD (2.47 \u00b1\n0.50) (p = 0.021). In contrast, mean LDL concentrations were higher in the\ngroup of with-PTSD patients versus without-PTSD patients (4.16 \u00b1 0.31 vs 3.65 \u00b1\n0.49) (p= 0.016). TG in with-PTSD patients had higher concentrations (2.43 \u00b1\n0.64) than without-PTSD patients (1.78 \u00b1 0.45), this was statistically\nsignificant (p = 0.036). BMI had no statistically significant differences\nbetween the two groups; (26.2 vs 25.6) (p=0.430).<\/p>\n\n\n\n

Table 2: The distribution of PTSD and non-PTSD patients according to spermiogram parameters<\/strong><\/p>\n\n\n\n\n\n\n\n
\n

Group<\/strong><\/p>\n<\/td>\n

\n

Nr<\/strong><\/p>\n<\/td>\n

\n

Abstinence<\/strong><\/p>\n

(day)<\/strong><\/p>\n<\/td>\n

\n

Volume<\/strong><\/p>\n

(ml)<\/strong><\/p>\n<\/td>\n

\n

*OS<\/strong><\/p>\n

 <\/strong><\/p>\n<\/td>\n

\n

**AS<\/strong><\/p>\n

 <\/strong><\/p>\n<\/td>\n

\n

***OAS<\/strong><\/p>\n

 <\/strong><\/p>\n<\/td>\n

\n

****TS<\/strong><\/p>\n

 <\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

Patients with PTSD<\/strong><\/p>\n

% (n)<\/strong><\/p>\n<\/td>\n

\n

34<\/p>\n<\/td>\n

\n

9-13<\/p>\n

(10)<\/p>\n<\/td>\n

\n

3.8-7.5<\/p>\n

(6.5)<\/p>\n<\/td>\n

\n

26.47 %<\/p>\n

(9)<\/p>\n<\/td>\n

\n

50 %<\/p>\n

(17)<\/p>\n<\/td>\n

\n

20.58 %<\/p>\n

(7)<\/p>\n<\/td>\n

\n

2.95 %<\/p>\n

(1)<\/p>\n<\/td>\n<\/tr>\n

\n

Patient without PTSD % (n)<\/strong><\/p>\n<\/td>\n

\n

38<\/p>\n<\/td>\n

\n

2-6<\/p>\n

(4)<\/p>\n<\/td>\n

\n

2.3-6.0<\/p>\n

(4.3)<\/p>\n<\/td>\n

\n

37.50 %<\/p>\n

(18)<\/p>\n<\/td>\n

\n

29. 18 %<\/p>\n

(14)<\/p>\n<\/td>\n

\n

33.32 %<\/p>\n

(16)<\/p>\n<\/td>\n

\n

0.00 %<\/p>\n

(0)<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n

*Oligoasthenozosperia.**Asthenozospermia.\n***Oligoasthenozospermia. ****Teratozoospermia<\/p>\n\n\n\n

The results of spermiogram parameters divided into two groups with PTSD\nand without PTSD showed distinct percentages between the two groups and within\nthe group itself when it comes to the infertility status of the patients who\nwere the subject of our study. Oligospermia (37.50% vs 26.47%) was greater in\npatients without PTSD (18 patients) versus those with PTSD (9 patients).\nAsthenozospermia (50% vs 29.18%) showed a greater presence in patients with\nPTSD (17 patients) than those without PTSD (14 patients). Oligoasthenozospermia\n(33.32% vs 20.58%) was greater in percentage in patients without PTSD (16\npatients) than those with PTSD (7 patients). There was only one patient with\nteratozoospermia (2.95%) in the group of PTSD patients.<\/p>\n\n\n\n

Table 3: Lipid profile in patients with PTSD and without PTSD according to spermiogram parameters<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n
\n

                                  Patients with PTSD      <\/strong><\/p>\n<\/td>\n

\n

                              Patients-without PTSD<\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

Lipids<\/strong><\/p>\n<\/td>\n

\n

*OS<\/p>\n<\/td>\n

\n

**AS<\/p>\n<\/td>\n

\n

***OAS<\/p>\n<\/td>\n

\n

****TS<\/p>\n<\/td>\n

\n

*OS<\/p>\n<\/td>\n

\n

**AS<\/p>\n<\/td>\n

\n

***OAS<\/p>\n<\/td>\n

\n

****TS<\/p>\n<\/td>\n

\n

p<\/p>\n<\/td>\n<\/tr>\n

\n

TC <\/strong><\/p>\n<\/td>\n

\n

6.38\u00b10.37<\/p>\n<\/td>\n

\n

6.47\u00b10.35<\/p>\n<\/td>\n

\n

6.39\u00b10.43<\/p>\n<\/td>\n

\n

6.31\u00b1067<\/p>\n<\/td>\n

\n

5.17\u00b10.26<\/p>\n<\/td>\n

\n

5.28\u00b10.42<\/p>\n<\/td>\n

\n

5.26\u00b10.37<\/p>\n<\/td>\n

\n

5.24\u00b10.57<\/p>\n<\/td>\n

\n

0.018<\/p>\n<\/td>\n<\/tr>\n

\n

TG<\/strong><\/p>\n<\/td>\n

\n

2.39\u00b1 0.34<\/p>\n<\/td>\n

\n

2.58\u00b1 0.49<\/p>\n<\/td>\n

\n

2.41 \u00b1 0.64<\/p>\n<\/td>\n

\n

2.24 \u00b1 0.54<\/p>\n<\/td>\n

\n

1.67 \u00b1 0.47<\/p>\n<\/td>\n

\n

1.91 \u00b1 0.45<\/p>\n<\/td>\n

\n

1.81 \u00b1 0.45<\/p>\n<\/td>\n

\n

1.76 \u00b1 0.45<\/p>\n<\/td>\n

\n

0.036<\/p>\n<\/td>\n<\/tr>\n

\n

HDL<\/strong><\/p>\n<\/td>\n

\n

1.19 \u00b1 0.45<\/p>\n<\/td>\n

\n

1.14 \u00b1 0.75<\/p>\n<\/td>\n

\n

1.18 \u00b1 0.55<\/p>\n<\/td>\n

\n

1.20 \u00b1 0.35<\/p>\n<\/td>\n

\n

1.53 \u00b1 0.50<\/p>\n<\/td>\n

\n

1.48 \u00b1 0.50<\/p>\n<\/td>\n

\n

1.47 \u00b1 0.50<\/p>\n<\/td>\n

\n

1.37 \u00b1 0.50<\/p>\n<\/td>\n

\n

0.021<\/p>\n<\/td>\n<\/tr>\n

\n

LDL<\/strong><\/p>\n<\/td>\n

\n

4.11 \u00b1 0.41<\/p>\n<\/td>\n

\n

4.19 \u00b1 0.31<\/p>\n<\/td>\n

\n

4.16 \u00b1 0.48<\/p>\n<\/td>\n

\n

4.18 \u00b1 0.67<\/p>\n<\/td>\n

\n

3.55 \u00b1 0.59<\/p>\n<\/td>\n

\n

3.85 \u00b1 0.59<\/p>\n<\/td>\n

\n

3.45 \u00b1 0.59<\/p>\n<\/td>\n

\n

3.58 \u00b1 0.59<\/p>\n<\/td>\n

\n

0.016<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n

*Oligoasthenozosperia.**Asthenozospermia. ***Oligoasthenozospermia.\n****Teratozoospermia<\/p>\n\n\n\n

TC=Total Cholesterol, TG = Total triglyceride, LDL-C = Low density lipoprotein cholesterol, HDL-C= high density lipoprotein cholesterol <\/p>\n\n\n\n

The results showed that the higher values of lipid status in significant\ndegree of all groups of patients with PTSD compared to the values of lipid\nstatus of patients without PTSD (p < 0.05). However, the results obtained\nwithin the groups of patients divided according to lipid parameters and\nspermogram parameters did not show significant changes (p>0.50).<\/p>\n\n\n\n

 Discussion<\/strong><\/p>\n\n\n\n

PTSD is unique among psychiatric\ndisorders because of the great importance given to the etiological factor, i.e.,\nthe traumatic stressor17<\/sup>. The problem of post-traumatic stress\ndisorder (PTSD) caused by war trauma is present in the Republic of Kosovo in\nthe last twenty-three years after the post-war period. Our results cannot be\ngeneralized to patients who developed PTSD in a non-military setting. Our\nsample consisted only of male patients, veterans of the last war in Kosovo, who\nwere being treated for infertility with primary or secondary male factors such\nas Oligospermia (reduction in the number of spermatozoa in the human\nejaculate), Asthenospermia (decreased sperm motility), Teratozoospermia\n(decreased normal sperm morphology in human ejaculate) or their combination and\nthis condition was associated with sexual dysfunction (disordered impotence) in\nPTSD patients. Eliahu Levitas, M.D. et al., (2005) concluded that erectile\ndysfunction is the most common symptom in PTSD patients. Erection is a\nhormonally and psychologically controlled neurovascular phenomenon18<\/sup>.\nMale factor infertility is reported to account for 30-40% of couple infertility\ncases. Infertility is defined as the inability to achieve a successful\npregnancy after 12 months of unprotected intercourse or therapeutic donor\ninsemination19<\/sup>. Our study is the first study conducted in Kosovo on\nthe relationship between serum lipids; CT, HDL, LDL, and TG in men with\ninfertility and post-traumatic stress disorder (PTSD). It is important to note\nthat our study sample consists of 72 patients, which can be considered small,\nbut our explanation is based on the criteria that the patients of the first\ngroup had to fulfill. Limitations were related to the first group (PTSD + male\ninfertility). In terms of control, we could increase it several times more, but\nthey thought it would be a numerical issue. In our study, the mean age of all\nPTSD and non-PTSD patients was (49.3 \u00b1 1.6 vs 47.8 \u00b1 1.5). Other authors\n(Iwasaki A, et al. 1992) have concluded that the proportion of men who were 45\nyears or older with PTSD had a high TC\/HDL ratio20<\/sup>. Our patients of\nboth groups had slightly overweight BMI values (26.2 vs 25.6), but the values\nwere not statistically significant between the two groups of patients\n(p=0.430). In 2017, our group was the author of a study that addressed the role\nof obesity in male infertility in Kosovar men from the Dugagjin Region. The results\nof this study show that obesity in our country, the Republic of Kosovo, is a\ngrowing problem in the development of public health and is an important risk\nfactor for the occurrence of male infertility. The increase in BMI values\ncontributes to the deterioration of sperm parameters in the human ejaculate;\ndecrease in number, decrease in movement, and normal morphology21<\/sup>.\nEven other authors such as Sharain Suliman et al., reported their findings in a\nsystematic review and meta-analysis, suggesting that there is a relationship\nbetween PTSD and BMI22<\/sup>.<\/p>\n\n\n\n

Our results (Tab 1.) show that\npatients with PTSD, regardless of type, have an increase in total cholesterol\n(6.38 \u00b1 1.20 versus 5.28 \u00b1 0.37) of the control group (p=0.018). LDL values in\npatients with PTSD were higher (4.16 \u00b1 0.31 vs 3.65 \u00b1 0.49) than in patients\nwithout PTSD (p=0.016). HDL values were lower in patients with PTSD compared to\npatients without PTSD and (1.17\u00b10.40 vs 2.47 \u00b1 0.50) (p=0.021), TG also had\nhigher values in patients with PTSD (2.43\u00b10.64 vs 1.78 \u00b1 0.45). p=0.036). Our\nresults showed that PTSD has a negative relationship with serum HDL\nconcentration and a positive relationship with CT, LDL and TG. Our results\ncorresponded to the results published in the 2022 meta-analysis study by Veni Bharti\net al., the authors concluded that their results show that patients with PTSD\nshow an increase in total cholesterol, LDL and TG, and a decrease in HDL levels23<\/sup>.\nA year ago, the same authors Beharti  Vet\nal.,  (2021) in the publication; model of\nlipid profiles of patients with major depressive disorder (MDD) found that\npatients with MDD showed a decrease in TC levels, an increase in TG and VLDL\nlevels, and no change in LDL and HDL levels 24<\/sup>. Maia et al.., (2008)\nalso reported that people with PTSD showed higher levels of serum total\ncholesterol, LDL, and TG than those without PTSD25<\/sup>. Even the other\nauthor Hua Jin et.al, (2009) has concluded that posttraumatic stress disorder\ncan be associated with deterioration of the metabolic profile26<\/sup>.<\/p>\n\n\n\n

During the treatment of patients with\nPTSD, depending on the clinical picture, the psychiatrist has prescribed\nantipsychotic therapy. Patients have stated that they have received these\nmedications, but we have not had a convincing response to receive antipsychotic\ntherapy continuously. Regarding the impact of antipsychotic therapy on the\nconcentration of lipids in the serum, groups of different authors give\ndifferent results. No large-scale trials have quantified the effects of\natypical antipsychotic drugs on lipid metabolism several studies suggest that\nchanges are concordant with weight changes and that clozapine and olanzapine\ntend to be associated with adverse changes in serum concentrations of\ntriglyceride and cholesterol27<\/sup>. The largest increases in\ntriglycerides appear to occur with clozapine, olanzapine and quetiapine28<\/sup>.\nBruce L Kagan et al., (1999) concluded that no evidence of elevated cholesterol\nlevels has been reported in PTSD, but elevated cholesterol levels have been\nreported in panic disorder and anger attacks, but not in depression big. Lipid\nlevels may result from activation of the noradrenergic system29<\/sup>. Another\nstudy by Lewis GF., et al (2005) reported that antipsychotic medications\nincrease lipid levels by stimulating sterol regulatory element binding protein,\nwhich increases the expression of genes related to lipid biosynthesis30<\/sup>.\nThe group of Croatian authors Ana Kovak-Mufi\u0107 et al., in their study published\nin 2007 concluded that some atypical antipsychotics are associated with weight\ngain, the occurrence of diabetes and high concentrations of cholesterol and\ntriglycerides31<\/sup>.<\/p>\n\n\n\n

The authors Lydia A. Chwastiak, et\nal., (2011) concluded that there are three predisposing conditions for PTSD,\nphysical activity, obesity, and smoking32<\/sup>. Smoking among PTSD\npatients in our study was in a high percentage (85%), according to our\nhypothesis, this may be a consequence of the feeling of guilt from not being\nable to have children. The authors of a Systematic Review publication (Amaury C\net.al.2022) emphasized the need for more research regarding the mechanisms\nunderlying the combination of PTSD symptoms and alcohol consumption, especially\nprospective longitudinal studies, as the literature on this topic is scarce33<\/sup>.\nThe reason why we did not reflect data on alcohol consumption among our\npatients lies precisely in the “truths” of the answer we would\nreceive (the religious faith of our patients, most of whom are Albanian\nMuslims). Alcohol can significantly increase triglyceride levels34<\/sup>.<\/p>\n\n\n\n

The diagnosis of male infertility\nrelies on sperm analysis, based on the reference limits proposed by the World Health\nOrganization (WHO, 6th edition, 2021) (11). In the laboratory of our Polyclinic\n(Biolab-Zafi), we performed the analysis of human ejaculate. The normal status\nof male fertility is called Normospermia; the sperm count in 1.0 ml must be\nequal to or greater than 15 million\/ml. Oligospermia; decrease in sperm count\nin human ejaculate <15 mil\/ml. Asthenozospermia; Total sperm motility\n<42% (category a+b =32%), Teratozoospermia; normal morphology <4%.\nOligoasthenozospermia; number and reduced mobility15<\/sup>. According to\nthe results of the ejaculate analysis, each patient was placed into the group\nof patients with PTSD and patients without PTSD (Table 2). The highest\npercentage within the group of patients with PTSD were with Asthenozospermia,\nthe difference between the groups was 50% patients with PTSD versus 29.18%\npatients without PTSD, in our opinion this is related to erectile dysfunction\nin these patients because they had a longer time abstinence time >10 days\nand larger ejaculate volume (6.5 ml vs. 4.3 ml). According to current\nguidelines, semen samples for analysis should be collected after a minimum of 2\ndays and a maximum of 7 days of sexual abstinence15<\/sup>.<\/p>\n\n\n\n

Eliahu Levitas, et al (2004) have\ndiscovered a significant deterioration of sperm parameters with a prolonged\nperiod of sexual abstinence, expressed by a decrease in the percentage of\nmotility and normal morphology18<\/sup>. In our group of authors in 2015, a\npublication related to this topic (Shk\u00eblzen E., Zafer G., etc.) concluded that\nthese pathologies can explain the prolonged stay of spermatozoa in the genital\ntract of patients with infertility, especially in patients with varicocele13<\/sup>.\nReduced sperm motility in the ejaculate (asthenozospermia) can also occur after\nsperm damage as a result of DNA fragmentation, infection, and leukocyte\ninfiltration as a source of ROS presentation resulting in reduced sperm\nmotility35-36<\/sup>. Atypical sperm morphology (Teratozoospermia) is very\nrarely found in normospermic men, usually found in Asthenozoospermia and Oligoasthenozospermia,\nsevere degree of male infertility. In our study, there was only one patient\nwith teratozoospermia (2.95%) in the group of patients with PTSD. In 2021, our\ngroup of authors for the first time in Kosovo discovered an 11-year-old\ninfertile man who had severe Globospermia (genetic defect such as acrosomal\nmalformation of sperm) that is actually classified as Teratozoospermia37<\/sup>.\nGlobozoospermia is a rare condition estimated to affect 1 in 65,000 men. It is\nmost common in North Africa, where it accounts for approximately 1 in 100 cases\nof male infertility. Globozoospermia is most commonly caused by mutations in\nthe DPY19L2 gene, which are found in about 70 percent of men with the\ncondition. Mutations in other genes are also likely to cause globozoospermia38<\/sup>.\nThe results in Table 3 present the lipid profile in PTSD and non-PTSD patients\naccording to ejaculatory parameters. The results obtained within the groups of\npatients divided according to lipid parameters and spermogram parameters did\nnot show significant differences (p>0.50).<\/p>\n\n\n\n

Conclusions <\/strong><\/p>\n\n\n\n

At the end of our study, we conclude that the\ntreatment of male infertility in men with PTSD is more complex than in patients\nwithout PTSD. The psychiatric specialist treats PTSD patients with adequate therapy,\nthe Urologist or Endocrinologist prescribes the appropriate therapy for the\ntreatment of infertility, and the increased lipid status in these patients\nappears as an additional condition that requires attention and training. To\ncomplete the male infertility treatment regimen, hyperlipidemia should be\ntreated simultaneously where it occurs, as well as erectile dysfunction in men\nwith primary or secondary infertility diagnosed with PTSD.<\/p>\n\n\n\n

 Recommendations: Biochemical analyzes of the\nlipid profile of PTSD patients will help clinicians to reduce the possibility\nof vascular disease in this population during the treatment of male infertility.\nIn further studies, it will be necessary to include larger samples of research\nsubjects.<\/p>\n\n\n\n

Acknowledgment<\/strong><\/p>\n\n\n\n

We\nthank all study participants.<\/p>\n\n\n\n

Conflict of Interest <\/strong><\/p>\n\n\n\n

All authors declare no\nconflict of interest<\/p>\n\n\n\n

Funding Source<\/strong><\/p>\n\n\n\n

No sources of funding\nfor this research.<\/p>\n\n\n\n

References<\/strong><\/p>\n\n\n\n

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