Kaltsas Aris, Zikopoulos Athanasios, Kojovic Vladimir, Dimitriadis Fotios, Sofikitis Nikolaos, Chrisofos Michael, Zachariou Athanasios
Third Department of Urology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece.
Department of Obstetrics and Gynecology, Royal Cornwall Hospital, Truro TR1 3LJ, UK.
Medicina (Kaunas). 2024 Nov 22;60(12):1920. doi: 10.3390/medicina60121920.
: Recurrent pregnancy loss (RPL) affects numerous couples worldwide and has traditionally been attributed mainly to maternal factors. However, recent evidence highlights significant paternal influences on pregnancy viability and outcomes. This review aims to comprehensively examine male contributions to pregnancy loss, focusing on underlying mechanisms, novel biomarkers, and integrated strategies for improved reproductive success. : A comprehensive narrative review was conducted by searching databases including PubMed and Embase for the literature published from January 2004 to October 2024. Studies focusing on paternal influences in RPL-encompassing oxidative stress, genetic and epigenetic mechanisms, health conditions, lifestyle factors, environmental exposures, and advancements in sperm proteomics-were included. Inclusion criteria were peer-reviewed articles in English that directly addressed paternal factors in RPL; studies not meeting these criteria were excluded. : The review identified that paternal factors such as advanced age, metabolic and cardiovascular health issues, chronic diseases, lifestyle habits (e.g., smoking, alcohol consumption, poor diet), and environmental exposures significantly affect sperm integrity through mechanisms like oxidative stress, DNA fragmentation, and epigenetic alterations. Advanced paternal age and poor health conditions are associated with increased risks of miscarriage and adverse pregnancy outcomes. Novel sperm proteomic biomarkers have been identified, offering potential for enhanced diagnostics and personalized interventions. Integrated approaches involving multidisciplinary assessments, preventive strategies, and genetic counseling are essential for effectively addressing RPL. : Integrating paternal factors into clinical evaluations is crucial for effectively addressing recurrent pregnancy loss. Recognizing and modifying paternal risk factors through lifestyle changes, medical interventions, and environmental management can improve pregnancy outcomes. The findings underscore the need for incorporating paternal assessments into standard care and highlight the importance of future research focusing on standardizing diagnostic protocols, expanding studies on paternal contributions, and integrating proteomic biomarkers into clinical practice to facilitate personalized treatment strategies.
复发性流产（RPL）影响着全球众多夫妇，传统上主要归因于母体因素。然而，最近的证据凸显了父亲对妊娠存活能力和结局的重大影响。本综述旨在全面研究男性因素对流产的影响，重点关注潜在机制、新型生物标志物以及提高生殖成功率的综合策略。
通过检索包括PubMed和Embase在内的数据库，对2004年1月至2024年10月发表的文献进行了全面的叙述性综述。纳入了关注男性因素对RPL影响的研究，包括氧化应激、遗传和表观遗传机制、健康状况、生活方式因素、环境暴露以及精子蛋白质组学的进展。纳入标准为直接探讨RPL中男性因素的英文同行评审文章；不符合这些标准的研究被排除。
该综述发现，诸如高龄、代谢和心血管健康问题、慢性病、生活方式习惯（如吸烟、饮酒、不良饮食）以及环境暴露等男性因素，通过氧化应激、DNA片段化和表观遗传改变等机制，显著影响精子完整性。父亲高龄和健康状况不佳与流产及不良妊娠结局的风险增加有关。已鉴定出新型精子蛋白质组学生物标志物，为增强诊断和个性化干预提供了潜力。涉及多学科评估、预防策略和遗传咨询的综合方法对于有效解决RPL至关重要。
将男性因素纳入临床评估对于有效解决复发性流产至关重要。通过生活方式改变、医学干预和环境管理来识别和改变男性风险因素，可以改善妊娠结局。研究结果强调了将男性评估纳入标准护理的必要性，并突出了未来研究的重要性，即专注于标准化诊断方案、扩大对男性因素影响的研究，以及将蛋白质组学生物标志物纳入临床实践以促进个性化治疗策略。
