**6. Conclusions**

Soufir evaluated the markers fructose, acid phosphatase and citric acid as tools in the differential diagnosis of infectious processes and hypogonadism. The decrease of markers suggested that it is necessary to evaluate hormonal status and to rule out infection of accessory glands, which can affect sperm function and inability to achieve pregnancy naturally [64]. Glandular markers tend to be low in the presence of leukocytes and most likely in infection; nevertheless, these are significantly lower in hypogonadism. An infection could cause permanent damage of the secretory epithelium, so even after treatment may remain low [65]. This implies that in cases of seminal vesicle, infection levels of seminal fructose may be increased or decreased.

Male accessory glands infection may alter the elasticity in semen. Changes in levels of oxidative products in semen are related to seminal viscosity. Hyperviscosity has been associated with reactive oxygen species (ROS) generation, levels of cytokines TNF-α, IL-6 and IL-10 and seminal leucocyte concentration, and whether ROS production was related to the extent of infections/inflammations at one PR (prostatitis) or two PV (prostato-vesiculitis) male accessory glands. ROS production in PV was higher than in prostatitis. Seminal IL-10 levels in PV and PR patients were lower than those found in the controls. In PR men, the levels of hyperviscosity are positively related to TNF-α; the seminal hyperviscosity is associated with increased oxidative stress in infertile men and increased pro-inflammatory interleukins in patients with male accessory gland infection, more when the infection was extended to the seminal vesicles [66]. Seminal hyperviscosity is often associated with prostate infection, reduce citric acid and asthenozoospermia [52, 66]. These alterations have been reversed when properly treated with antibiotics, decreasing the concentration of leukocytes and proinflammatory cytokines. Around one-third of cases of seminal hyperviscosity does not respond to treatment with antibiotics because viscosity depends on other glandular factors that have not

Many compounds secreted by the male reproductive tract may be important in the study of infertile man. It is advisable that before choosing any technique of assisted reproduction, the causes of infertility in man are more accurately evaluated, especially in cases of idiopathic infertility. Disorders of the male accessory glands are often associated with bacterial infections. These alterations must be carefully treated with the antibiotic therapy to which these bacteria show susceptibility [67]. The diagnosis and antibiogram would allow controlling resistance to antibiotics, but taking into account that when there is infection of the glands, antimicrobials have limited efficacy because they are anatomical compartments with barriers that can limit their reach, such as blood-prostatic barrier. Tissue lesions are greater as time progresses, for example prostatitis responds faster to treatment than prostate-vesiculitis and prostate-vesicle-epididymitis, that is, more glands are involved as time progresses [68]. In addition, it is possible to find the compartment of some microorganisms that tend to encapsulate or attach more strongly to the glycocalyx of the extracellular matrix of the gland or probably because of changes in local pH of seminal vesicles (alkaline) or prostate (acid), between others that limit antimicrobial efficacy [64]. Treatment of subclinical infections and secretory failure of male accessory glands can improve sperm physiology to achieve spontaneous pregnancies. It should be noted that the cost of assisted reproduction reflects a much lower percentage of live births than other less costly techniques for many infertile couples. Assisted reproduction already accounts for as many as 5% of live births in some European countries [69] so it is not negligible to investigate the factors that modulate the function of gametes.

yet been clarified [52].

110 Spermatozoa - Facts and Perspectives

The study of secretory products of male accessory glands in conjunction with correct seminal evaluation may help to exclude the high percentage of idiopathic infertility. Infectious or post-infectious processes in the epididymis, prostate and seminal vesicles can alter the seminal plasma quality and the physiology of spermatozoa.

The evaluation of compounds of the seminal plasma is useful to understand the process of natural fertilization and to achieve pregnancy naturally when the causes of infertility in man have been clearly established. These evidences suggest that the components of the seminal plasma participate in key events related to sperm function, fertilization and embryonic development in the female reproductive tract. However, the subject of sperm interaction and seminal plasma should continue to be studied to help explain the failure rates in assisted reproduction techniques.
