4. Implementación del sistema integrado ERP y su impacto
4.3. Módulos financieros implementados y casos de uso
4.4.4. Mejoras logradas en los procesos de tesorería
Chronic symptomatic, or more common- ly asymptomatic MAGI may lead to male infertility when the noxae, acting for long periods of time, produce sperm and extend- ed (to more accessory glands) glandular phlogosis/infection -related effects, enhanc- ing a host inflammatory response, in terms of semen ROS and pro-inflammator y cytokine (IL-1β; IL-6; IL-8; TNFα) hyperpro- duction. These bioactive substances may persist even following antimicrobials, since the initial antioxidant capacity (mainly based on epididymal biological micronutri- ents of the seminal plasma) is progressively exhausted, thereby impairing sperm func- tion by inducing DNA damage and/or apoptosis (Agarwal et al., 2003; Sanocka et
al., 2003).
The approach to the infertile patients with MAGI requires a comprenhensive clinical investigation, including the charac- terization of the different MAGI infertile subgroups by ultrasound scans, microbio- logical investigation, immunocytological leukocyte determination, and biochemical measurement of ROS production (Vicari,
1999). Only when infertile men show a
clear clinical evidence of MAGI, a sequen- tial step-wise pharmacological treatment
(antibiotics ➞ NSAI ➞ antioxidants) may
be established.
Microbiological investigations and sup- pletive cytological (immunocitochemistry leukocyte assessment; ROS analysis) are not necessary if the suspected pathogens (microbiotes, leukocytes) are not able to induce severe and extented glandular infec- tions, proven through the lack of a significa- tive number of didymo-epididymal and prostato-vesicular post-phlogistic abnormal- ities at the ultrasound scans. These condi- tions may be defined as transitory phlogis- tic processes, due to noxae with low glan-
Male infertility today #4 148
dular reactive impact and have a negligible impairment on fertility.
Taken in these terms, infertile patients with proven clinical MAGI represent a group of patients who may be treated rationally. Furthermore, a carefull approach including ultrasound (didymo-epididymal and rectal prostato-vesicular) investigation always helps to prevent a further extension of the inflammatory process, which in turn may lead to a worst reproductive prognosis.
A difference must be made when the influence of bacteria is evaluated in-vitro
conditions. During ART, sperm processing (wash and swim-up) in an antibiotic rich cul- ture medium effectively eliminates organ- isms and seems to be devoid of effects in IVF or ICSI outcome. However, the addition of antioxidant compounds to culture media or during sperm preparation (Aitken et al.,
1991; Guerin et al., 2001) could be useful
to reduce oxidative stress during sperm centrifugation, even in the specimens obtained from patients with well-diagnosed PV or PVE, in whom ART is indicated fol- lowing in vivo unsuccessfull treatment.
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