Lipoperoxidation damage of spermatozoa polyunsaturated fatty acids (PUFA): scavenger mechanisms and possible scavenger therapies

The lipid metabolism in sperm cells is important both as one of the main sources for energy production and for cell structure. The double leaflets of the membrane should be considered not simply as a passive lipid film, but as a very specialized structure. The complete maturation of the sperm cell membrane is attained after testicular lipid biosynthetic processes and after passage through the epididymis. A special composition of membrane phospholipids, rich in polyunsaturated fatty acids (PUFA), and the different composition of sperm and immature germ cell membrane are described and discussed. Testis germ cells as well as epididymal maturing spermatozoa are endowed with enzymatic and non-enzymatic scavenger systems to prevent lipoperoxidative damage. Catalase, superoxide dismutase and GSH-dependent oxidoreductases are present in variable amounts in the different developmental stages. Phospholipid hydroperoxide GSH peroxidase (PHGPx) activity and alpha tochopherol of epididymal spermatozoa are considered in detail. Their distribution and roles in caput and cauda epididymal sperm cells are discussed. Seminal plasma also has a highly specialized scavenger system that defends the sperm membrane against lipoperoxidation and the degree of PUFA insaturation acts to achieve the same goal. Systemic predisposition and a number of pathologies can lead to an anti-oxidant/pro-oxidant disequilibrium. Scavengers, such as GSH, can be used to treat these cases as they can restore the physiological constitution of PUFA in the cell membrane. The results of GSH therapy are presented and discussed.

Is hyperdiploidy of immature ejaculated germ cells predictive of testis malignancy? A comparative study in healthy normozoospermic, infertile, and testis tumor suffering subjects

The possibility of diagnosing neoplastic testis pathologies by studying immature germ cells released from the seminiferous epithelium and present in the semen has been reported. It has been suggested that carcinoma in situ (CIS) of the testis and testis tumor may be identified by studying specific surface antigenic determinants or ploidy of chromosome 1 of malignant germ cells recovered from the semen. A noninvasive diagnostic approach of this type would be of great interest if we consider that CIS is supposed to precede the development of testicular germ cell tumors and that the frequency of that preneoplastic condition is increased in specific andrologic pathologies. To evaluate the reliability of this diagnostic approach, we have quantified the presence of immature hyperdiploid germ cells in the seminal fluid of normal healthy subjects, of infertile oligozoospermic patients affected by maldescended testis or left vancocele, and of patients suffering from CIS or testis tumor. Cell ploidy was evaluated on seminal cell fractions highly enriched in immature germ cells, by means of in situ hybridization with a DNA-probe specific for chromosome 1. Our observations indicate that chromosome 1 hyperdiploidy is not necessarily a predictive parameter of testis tumoral pathologies. The percentage of hyperdiploid immature seminal germ cells is in fact increased in nontumoral pathologies associated with infertility, such as cryptorchidism and left varicocele.

Immature germ cell separation using a modified discontinuous Percoll gradient technique in human semen

The difficulty of identifying immature germ cells in unstained, fresh semen has led most laboratories to use the broad definition 'round cells' to indicate cells other than spermatozoa, thus grouping together both leukocytes and immature germ cells. This is also the case in research andrology, where very little attention has been given to immature germ cells in the semen apart from some rare exceptions, such as the attempts to study meiosis. Here we report on the use of a discontinuous Percoll gradient method modified to enable the best separation possible of immature germ cells from the other cells found in the ejaculate, in order to obtain a cellular suspension free of spermatozoa. Our technique (intra-assay variation in duplicates < 10%) demonstrated a high immature germ cell concentration in gradient fractions with 30% to 45% Percoll with a small contamination (1.5-6%) of leukocytes, confirmed by May-Grünwald-Giemsa staining, immunofluorescence and cytofluorimetry. The concentrations of immature germ cells ranged from zero in obstructive azoospermia to 2.0 x 10(6)/ml in oligozoospermia and genital tract infection. The purified immature germ cell suspensions obtained can be useful for diagnostic and research purposes.

Nuclear chromatin variations in human spermatozoa undergoing swim-up and cryopreservation evaluated by the flow cytometric sperm chromatin structure assay

The sperm chromatin structure assay (SCSA) is a flow cytometric (FCM) technique which exploits the metachromatic properties of Acridine Orange to monitor the susceptibility of sperm chromatin DNA to in-situ acid denaturation. SCSA was used to study the chromatin structure variations of human spermatozoa in semen, both before and after swim-up and after cryopreservation. Semen samples were provided by 19 healthy normozoospermic subjects attending pre-marriage checks. Each sample was divided into three aliquots: the first aliquot was evaluated without further treatment, the second underwent swim-up, and the third was stored according to standard cryopreservation techniques in liquid nitrogen at -196 degrees C. Samples were also analysed by light and fluorescence microscopy (after Acridine Orange staining to evaluate the number of green fluorescent sperm heads), and by computer-assisted semen analysis. The results showed that post-rise spermatozoa represent a subpopulation characterized by a general improvement of the morphological (reduction of the percentage of abnormal forms and heads, increase of the green head sperm percentage) and kinetic parameters. This subpopulation also exhibited improved chromatin structure properties, confirming that these cells have the best structural and functional characteristics, indicative of optimal fertilizing ability. On the other hand, overall sperm quality deteriorates after cryopreservation. When thawed spermatozoa underwent an additional swim-up round, a general improvement of nuclear maturity was seen in the post-rise spermatozoa.

Sperm parameters after early left varicocele treatment

OBJECTIVE

We evaluated whether early treatment for left varicocele can improve sperm parameters.

DESIGN

Patient follow-up and comparison with control groups.

SETTING

Surgical department of a Children's Hospital and a university infertility-care center.

PATIENT(S)

Nineteen patients who underwent surgery for left varicocele as adolescents (mean +/- SD, 14.11 +/- 1.59 years) were followed up as adults (mean +/- SD, 19.37 +/- 1.16 years).

MAIN OUTCOME MEASURE(S)

A testicular examination was performed and varicocele staging was done at the time of surgery. Andrologic examination and semen analysis were done 2-8 years later. Semen results were compared with those of two age-matched control groups of 19 healthy, randomly selected subjects and 19 unoperated patients suffering from left varicocele of the same degree.

RESULT(S)

The mean values of sperm parameters in the patient study group were similar to those of the healthy controls except that the sperm concentration was significantly lower. However, sperm motility and morphology mean values in the patient study group were significantly higher than those of the unoperated patients.

CONCLUSION(S)

This study indicates that surgery in adolescence can be useful, possibly because the testis is developing at that age. Large-scale, double-blind controlled trials on early treatment of left varicocele are needed to identify possible markers of disease severity.

Follicular fluid and human granulosa cell cultures: influence on sperm kinetic parameters, hyperactivation, and acrosome reaction

OBJECTIVE

To evaluate the influence of human granulosa cell (GC) cultures and follicular fluid (FF) on sperm kinetic parameters, hyperactivation, and the acrosome reaction compared with the influence of human tubal fluid (HTF) and Ham's F-10 medium.

DESIGN

Sperm kinetic parameters, hyperactivation, and the acrosome reaction were evaluated after 6 hours of incubation in HTF, Ham's F-10 medium, FF, and GC cultures.

SETTING

Infertility and In Vitro Fertilization Centre, Reproductive Endocrinology Unit, Institute of Obstetrics and Gynaecology.

PATIENT(S)

Sixteen normal semen samples.

INTERVENTION(S)

Sperm kinetic parameters and hyperactivation were analyzed using an automated videomicrography system, the acrosome reaction was performed using a triple-stain technique, and progesterone and 17OH-progesterone levels were measured with the use of commercially available kits.

MAIN OUTCOME MEASURE(S)

Sperm kinetic parameters, hyperactivation, acrosome reaction.

RESULT(S)

The percentage of motile sperm, the mean curvilinear velocity, and the mean of the maximum amplitude of lateral head movement were increased significantly after 6 hours of incubation in FF or GC cultures compared with incubation in HTF or Ham's F-10 medium, whereas the mean linearity was decreased significantly. Follicular fluid and GC cultures significantly increased hyperactivation and the acrosome reaction compared with the values obtained using HTF and Ham's F-10 medium. Progesterone and 17OH-progesterone levels were increased significantly after incubation in FF and GC cultures compared with HTF and Ham's F-10 medium.

CONCLUSION(S)

Follicular fluid and GC cultures increase sperm motility parameters, hyperactivation, and the acrosome reaction. This effect may be related to GC detoxification of the microenvironement or GC secretion of peptides, glycoproteins, growth factors (insulin-like growth factors 1 and 2), or steroids (progesterone and 17OH-progesterone).

Results of long-term carcinogenicity studies of chlorine in rats

Four groups, each of 50 male and 50 female Sprague-Dawley rats, of the colony used in the Cancer Research Center of Bentivoglio of the Ramazzini Foundation, 12 weeks old at the start of the study, received drinking water containing sodium hypochlorite, resulting in concentrations of active chlorine of 750, 500, and 100 mg/l (treated groups), and tap water (active chlorine < 0.2 mg/l) (control group), respectively, for 104 weeks. Among the female rats of the treated groups, an increased incidence of lymphomas and leukemias has been observed, although this is not clearly dose related. Moreover, sporadic cases of some tumors, the occurrence of which is extremely unusual among the untreated rats of the colony used (historical controls), were detected in chlorine-exposed animals. The results of this study confirm the results of the experiment of the United States National Toxicology Program (1991), which showed an increase of leukemia among female Fischer 344/N rats following the administration of chlorine (in the form of sodium hypochlorite and chloramine) in their drinking water. The data here presented call for further research aimed at quantifying the oncogenic risks related to the chlorination of drinking water, to be used as a basis for consequent public health measures.

Antisperm antibody detection: 2. Clinical, biological, and statistical correlation between methods

PROBLEM

In clinical andrology, the detection of antisperm antibodies (ASA) is regarded as one of the most important steps in the study of male infertility. This practice is generally accepted even though there is still some disagreement about the true meaning of antisperm immunity, and there remains a good deal of controversy about the test regarded as the most suitable for the detection of antibodies directed against sperm antigens. International Workshops have tried to standardize universally accepted protocols. A panel of three or four methods is generally advised to provide a correct and complete screening of patients with antisperm immunity. The aim of the present paper is to report our studies on the correlation between direct methods (IBT, MAR test) and indirect methods (gelatin agglutination test [GAT], and tray agglutination test [TAT]) and to establish whether biological models can explain the antibody test results. An attempt was also made to establish a "predictive threshold" to explain even apparently discordant direct and indirect results.

Antisperm antibody detection: 1. Methods and standard protocol

PROBLEM

Today, antisperm antibody (ASA) detection is one of the most important steps in the evaluation of male infertility. This practice is generally accepted even though there is still some disagreement about the meaning of antisperm immunity and a good deal of controversy about the test regarded as the most suitable for the detection of antibodies directed against sperm antigens. International workshops have tried to standardize universally accepted protocols. A panel of three or four methods is generally advised to provide a correct and complete screening of patients with antisperm immunity.

METHOD OF STUDY

This paper reports on the results of a serum exchange workshop for the standardization of the ASA detection in the sera carried out under the auspices of the Italian Society of Endocrinology, which was used as reference laboratory. A careful description of the most widely used methods is reported and proposed as a standard protocol also on the basis of the results of the correlation studies carried out by our group is also reported.

CONCLUSIONS

If the proposed methods and procedures will be accepted by the members of the Alps-Adria Society for Immunology of Reproduction, a Study Group for Sperm Antibody Testing, could start its activity having the goal of reaching a consensus on methodology and carrying out a European serum exchange workshop.

Unilateral cryptorchidism corrected in prepubertal age: evaluation of sperm parameters, hormones, and antisperm antibodies in adult age

OBJECTIVE

To evaluate whether prepubertal orchidopexy for unilateral cryptorchidism can reduce adult dysspermia.

DESIGN

Patient follow-up comparison with control groups.

SETTING

Surgical and endocrinologic sections of a children's hospital and a university infertility-care center.

PATIENT(S)

Seventy-one patients with unilateral cryptorchidism who underwent orchidopexy in prepubertal age (6.4 +/- 2.8 years) were followed up as adults (20.0 +/- 2.8 years).

MAIN OUTCOME MEASURE(S)

Patients underwent testicular examination and hormonal evaluation, 49 of these had semen analysis and antisperm antibody tests. Semen results were compared with those of two age-matched control groups: a group of 20 healthy, randomly selected subjects and a group of 20 patients operated on in postpubertal age for cryptorchidism.

RESULT(S)

Unilateral reduced testis size was found in 30.1% of patients, eight patients had a low LH level, eight had a low T level, and none had abnormal FSH values. Antisperm antibodies were found in 1 of 49 cases. Cluster analysis of sperm parameters showed that the mean values of patients were worse than those of the healthy controls but better than those of the subjects operated on in postpubertal age.

CONCLUSION(S)

This study indicates that prepubertal orchidopexy can given better results than postpubertal correction.

The in-vitro effects of nicotine and cotinine on sperm motility

Swim-up spermatozoa from the seminal samples of non-smokers, usually not exposed to passive smoking, were treated in vitro with nicotine (NIC) and cotinine (COT) at the average levels found in smokers' seminal plasma and at levels 500 times higher than this average. This was done to evaluate the action of these drugs on sperm motility. Each sample was allowed to swim up in Tyrode's solution with or without the drug; the study was carried out at time 0 and +1, +2, +4, +8 and +24 h of incubation, using a light microscope and a CASA system (experiment 1). In addition, the direct action of smoke on spermatozoa was studied using aspirated cigarette smoke (experiment 2). Kinetic parameters were then measured at 30 min, 45 min and 60 min starting from the last smoke injection. The first experiment showed that NIC and COT at average levels did not produce statistically significant variations of the kinetic parameters studied up to 24 h. However, the much higher concentration significantly altered all the kinetic variables in relation to the time of incubation. The second experiment with smoke in toto demonstrated a sharp reduction in all the sperm kinetic parameters. This reduction was seen after 30 min exposure to smoke and increased progressively until almost complete immotility at 1 h of exposure. These results suggest that NIC and COT are not responsible for the harmful effects of cigarette smoke on sperm kinetic parameters reported in the literature.

Comparison of aggressive behavior between men and women in sport

A group of 33 sportsmen and 43 sportswomen and a group of 488 subjects (less than 30 years old) selected from a sample of 816 subjects representative of the general Italian population were compared using the factor scores and total scores on the Italian version of the Buss and Durkee questionnaire. Analysis suggests a positive correlation between aggressiveness and sport and are compatible with the hypothesis that sporting activities serve as a means of controlling aggressiveness of women and help the individual psychosocial development of men. The decision to practice sports would seem to be connected with the needs to conform to cultural stereotypes, which portray the man as aggressive and the women as gentle and submissive.

Effects of prolonged autovehicle driving on male reproduction function: a study among taxi drivers

This study had the purpose of exploring the possible association between the work exposures of professional drivers and their reproductive health, by studying a group of 201 taxi drivers in the city of Rome. Data on work and reproductive history were collected by interviews. Biological markers examined in 72 subjects included salivary testosterone levels, sperm quality (i.e., sperm concentration, sperm morphology, and motility), and fertility experience, including time to pregnancy. Their spermatologic profile was compared with that of a control group of 50 healthy subjects of similar age and smoking habits. The results showed that taxi drivers, compared to the controls, had a significantly lower prevalence of normal sperm forms (45.8% vs. 64.0%); this was particularly true for those with a longer time on this job. This result was confirmed by a multivariate analysis in which confounders such as age, smoking, and alcohol consumption were controlled. The other sperm parameters did not differ in the study and the control groups. Among the life-style factors, we found smoking to be associated with poorer sperm morphology. Moderate alcohol consumption was associated with a better seminologic profile, while the pattern in respect to coffee intake was inconclusive. Subjects with poor semen quality also more frequently exhibited longer time to pregnancy of their partner. The results suggest that prolonged urban automobile driving might be a risk factors for sperm quality, and particularly for sperm morphology, but the finding needs further confirmation.

Luteinizing hormone pulsatility and computer-assisted analysis of sperm features in patients with Hodgkin's disease

The aim of this work was to characterize further the impairment of the reproductive function reported in untreated male patients with Hodgkin's disease. We evaluated the pattern of luteinizing hormone pulsatility and unconventional sperm features by computer-assisted sperm analysis (CASA) in 20 adult patients affected by biopsy-proven Hodgkin's disease before they were submitted to any therapeutic approach. Changes of luteinizing hormone pulsatility were documented and consisted mainly in an increase in pulse number in comparison with control subjects (P < 0.05). On CASA, 1/3 of the patients showed a reduction in the sperm number but, when motility, velocity and linearity of progression were evaluated, the number of patients with seminal alterations rose to 2/3. Sperm velocity and linearity were already impaired in stages I and II, whereas sperm number was reduced only in stage III. Symptomatic patients, regardless of the stage, showed a significant deterioration of all parameters. Our study supports the view that in Hodgkin's disease, before any treatment, a disorder of the reproductive system is present, both at hypothalamic/hypophysial and the gonadal level, having a pathogenesis that deserves to be elucidated by further study.

Lipids of the sperm plasma membrane: from polyunsaturated fatty acids considered as markers of sperm function to possible scavenger therapy

This article is, in part, a review of present knowledge regarding the lipid metabolism of the sperm cell and the lipid composition of the sperm plasma membrane. It is also a summary of our research on this topic, reporting published and unpublished data. The article tries to cover both basic and clinical research. Sperm cells use lipid metabolic pathways for the production of part of their energy. The double leaflets of the membrane are not simply a passive, bilayer, lipidic film in which the receptors receive their molecular specific signals, but are a very specialized structure. Complete maturation of the lipids of the sperm cell membrane is reached after passage of the spermatozoon through the epididymis. A specific composition of phospholipids and a significant concentration of polyunsaturated fatty acids (PUFA) have been shown to be present in sperm membranes. Plasmalogen is a special kind of phospholipid found exclusively in spermatozoa and other cells with the capacity to react promptly to stimuli. In addition, we have found a high concentration of the n-3 PUFA family in the sperm membrane. Seminal plasma has a highly specialized scavenger system that defends the sperm membrane against lipoperoxidation. Various pathologies and systemic predisposition can lead to an antioxidant/pro-oxidant disequilibrium. Clinical trials with natural scavengers could be a useful research area in which to seek a treatment for these pathologies. Of the natural scavengers, glutathione has been shown to restore the physiological constitution of PUFA in the cell membrane under certain conditions.

Study of antisperm antibodies bound to the sperm cell surface and their relationship to circulating ASA

PROBLEM

Direct and indirect tests for antisperm antibody (ASA) detection are commonly used in laboratories for the diagnosis of male immunological infertility. Even though the two kinds of tests study the same immunological phenomena, frequently no perfect correlation is found even on large series of patients and with precise statistical models. The aim of the present investigation was to try to establish whether biological models can explain the antibody test results and if a predictive threshold can be established for expected positivity/negativity.

METHOD

The data relate to 667 patients, who were screened using the Direct Immunobead test (d-IBT) for ASA bound to the sperm surface and with the gelatin and tray agglutination test (GAT and TAT) in sera for circulating ASA. Correlation were studied and cases of no correlation were further analyzed.

RESULTS

The number of patients with a clinically significant positivity to d-IBT (binding percentage > or = 20%) was 134 (20.1% of total patients). The analysis of the results of direct and indirect tests shows that the discordances are due to differences in the Ig class of immunization or to the site of epitopes involved. In fact, as far the Ig class is concerned, if d-IBT shows a prevalent or exclusive IgG or IgA positivity, this results in a poor correlation between binding percentage to d-IBT and GAT-TAT titers. If both the Ig classes are involved, the level of positivity of the two kinds of test are strictly related. As far as the site of Ag-Ab reaction on the sperm surface is concerned, the wide immunization involving all the surface sperm antigens (mixed), shown by d-IBT, is related to higher indirect test titers.

CONCLUSION

Local and systemic antisperm immunizations are strictly related and a predictive threshold of expectation can be established to explain even apparently discordant direct and indirect results.

Effectiveness of the combination verapamil and chlorpromazine in the treatment of severe manic or mixed patients

1. The authors investigated the possible antimanic properties of a Calcium channel blocker, Verapamil, in 15 in-patients admitted consecutively to the female psychiatric ward at Pisa University for a manic episode. 2. The results showed that most of the patients presented a global improvement of the manic symptoms and, in some cases, even a complete clinical remission. 3. Although it was necessary to add chlorpromazine for the severe conditions of several patients, verapamil appeared to speed the positive outcome and to lead to a faster resolution of the symptoms. In addition, the association of verapamil and chlorpromazine did not produce any relevant side-effect. These preliminary findings thus indicate that verapamil by itself does not seem to be sufficient in the treatment of a severe affective episode, but it may constitute an alternative to lithium salts in association with neuroleptics.

Synergistic effect of a clozapine-nimodipine association

A thirty-eight year old woman, suffering from schizoaffective disorder for approximately 17 years, improved significantly with the association of clozapine (CPZ) and nimodipine.

Environmental tobacco smoke: nicotine and cotinine concentration in semen

Forty-three nonsmokers attending an infertility clinic reported their degree of passive exposure to environmental tobacco smoke (ETS) and provided samples of blood and seminal plasma. Levels of nicotine and cotinine in biological fluid were evaluated by a radioimmunoassay. The data indicate that exposure to ETS results in measurable nicotine and cotinine levels in seminal plasma. Seminal plasma cotinine concentration also shows a significant positive correlation with degree of reported exposure.

Glutathione treatment of dyspermia: effect on the lipoperoxidation process

We recently introduced reduced glutathione into the therapeutic protocols in some selected cases of dyspermia. This therapy improved semen quality both in a pilot follow-up study and in a double-blind cross-over trial. This improvement was seen in patients with varicocele and germ-free genital tract inflammation, two pathologies in which production of reactive oxygen species or other toxic compounds could have a pathogenic role. Polyunsaturated fatty acids of phospholipids play a major role in membrane constitution and function and are one of the main targets of the lipoperoxidative process. Therefore, to understand the therapeutic action of reduced glutathione, we selected infertile patients and studied the modifications produced by the therapy in seminal parameters, biochemical sperm membrane parameters, and the pattern of fatty acids of phospholipids from blood serum and red blood cell membranes (a model widely accepted as representative of general cell membrane status). The results showed an improvement in both sperm parameters and cell membrane characteristics. This study suggests that biochemical modifications in membrane constitution could explain the seminal results of glutathione therapy. On the other hand, it seems likely that only subjects with systemic membrane disturbances associated with andrological pathologies express this membrane damage in spermatozoa, resulting in dyspermia. This sperm alteration can be partially reversed by glutathione therapy if the structural cell membrane damage is not too severe.

L-carnitine in idiopathic asthenozoospermia: a multicenter study. Italian Study Group on Carnitine and Male Infertility

The aim of the study described here was to evaluate any possible effect of L-carnitine on spermatozoal motility in a group of patients with unexplained asthenozoospermia in four different infertility centres. One hundred patients received 3 g d-1 of oral L-carnitine for 4 months. Sperm parameters were studied before, during and after this treatment. Motility was also studied by means of a computer-assisted sperm analysis. The results of the study indicate that L-carnitine is able to increase spermatozoal motility, both in a quantitative and in a qualitative manner (per cent motile spermatozoa increased from 26.9 +/- 1.1% to 37.7 +/- 1.1% [P < 0.001]; per cent spermatozoa with rapid linear progression increased from 10.8 +/- 0.6% to 18.0 +/- 0.9% [P < 0.001]; mean velocity increased from 28.4 +/- 0.6 microns s-1 to 32.5 +/- 0.8 microns s-1 [P < 0.001]; linearity index increased from 3.7 +/- 0.1 to 4.1 +/- 0.1 [P < 0.001], especially in the subgroup of patients with poor rapid linear progression of spermatozoa (per cent of motile spermatozoa increased from 19.3 +/- 1.9% to 40.9 +/- 1.4% [P < 0.001], and per cent of spermatozoa with rapid linear progression increased from 3.1 +/- 0.4% to 20.3 +/- 1.6% [P < 0.001]) An increase in spermatozoal output was also observed (total number of ejaculated spermatozoa increased from 142.4 +/- 10.3 10(6) to 163.3 +/- 11.0 x 10(6) [P < 0.001]). The authors conclude that oral administration of L-carnitine may improve sperm quality at least in patients with idiopathic asthenozoospermia.

Computer assisted sperm motility analysis at the moment of induced pregnancy during gonadotropin treatment for hypogonadotropic hypogonadism

Two azoospermic patients with isolated hypogonadotropic hypogonadism (IHH) no. 1,24-year-old, and no. 2,31-year-old), never treated before, were given gonadotropin therapy (GT), (FSH, 225 IU/week, and HCG, 4000 IU/week) and followed up monthly for sperm characteristics. After 6 (no. 1) and 9 (no. 2) months of treatment, immotile spermatozoa appeared in the semen. Two months later motile spermatozoa also appeared. A motile sperm concentration sufficiently high for computer motion analysis (CASA) was achieved 1 month later 9th and 12th month, respectively. At the 13th (no. 1) and 17th (no. 2) month of GT, CASA showed a small population of spermatozoa with a very good motility pattern. In the next ovulatory cycle the patients' partners became pregnant.

Nicotine, cotinine, and trans-3-hydroxycotinine levels in seminal plasma of smokers: effects on sperm parameters

Sperm samples from 44 cigarette smokers and 50 nonsmokers attending an infertility clinic were examined by high-performance liquid chromatography (HPLC) assay and HPLC-mass spectrometry for the presence of nicotine (NIC), cotinine (COT), and trans-3'-hydroxycotinine (THOC) in seminal plasma. Smokers were found to have levels of COT and THOC in seminal plasma that were similar to those found in serum. The level of NIC was significantly increased in seminal plasma compared to serum. Total motility of spermatozoa was significantly and negatively correlated to COT and THOC levels in seminal plasma. Forward motility of spermatozoa was correlated only with cotinine semen levels. On the basis of these results, we suggest that the presence of tobacco smoke constituents in seminal plasma could provide a warning of the adverse effects of cigarette smoke on the physiology of reproduction.

Placebo-controlled, double-blind, cross-over trial of glutathione therapy in male infertility

Glutathione therapy was used for 2 months in a placebo-controlled double-blind cross-over trial of 20 infertile patients with dyspermia associated with unilateral varicocele (VAR) or germ-free genital tract inflammation (INF). The patients received either glutathione (group 1) or placebo (group 2) for 2 months, then they crossed over to the alternative treatment for a further 2 months. The patients were randomly and blindly assigned to treatment (one i.m. injection every other day of either 600 mg glutathione or an equal volume of a placebo preparation). The standard semen analysis and the computer-assisted sperm motility analyses were carried out before treatment and during the trial. Statistical cross-over analysis, case-control study and treatment efficacy test were carried out on groups 1 and 2 and differences in the effects of therapy between VAR and INF patients with varicocele or inflammation were tested. Glutathione therapy demonstrated a statistically significant positive effect on sperm motility, in particular on the percentage of forward motility, the kinetic parameters of the computerized analysis and on sperm morphology. The findings of this study indicate that glutathione therapy could represent a possible therapeutical tool for both of the selected andrological pathologies.

Social class and mood disorders: clinical features

We examined clinical features in 877 in- and outpatients affected by depression who were enrolled in psychopharmacological trials, subdivided according to Hollingshead's method into five social classes. The results showed that social class correlated significantly with the subtypes of mood disorders, with bipolar disorder being more frequent amongst the upper than the lower social classes. Furthermore, as already reported in other countries, social class appeared to influence the psychopathological pattern of depressive symptoms: somatization and anxiety were more frequent amongst the lower social classes, while psychic and cognitive symptoms were more common amongst the upper classes.

Statistical andrology: standard semen analysis and computer-assisted sperm motility analysis

Results are reported of a statistical evaluation of the variables obtained by standard microscopic semen analysis and by computer-assisted sperm motility analysis. Descriptive statistical analysis and cluster analysis were carried out on both sets of data. A contingency table was created to compare the classifications obtained by the two clustering procedures. A canonical correlation analysis was performed to evaluate the classification power of the variables obtained by the two semen analyses. The results show that the two techniques of semen analysis are complementary and not substitutive and that the correlated variables "percentage forward motility" and "sperm velocity" are the most discriminating.

A single electroconvulsive treatment affects platelet serotonin uptake in bipolar I patients

We evaluated serotonin (5HT) uptake parameters in platelets of a group of bipolar I patients in both a depressive phase and a mixed state, before (t0) and after (t1) the first electroconvulsive treatment (ECT). The results showed the presence of significant changes in the number of the carrier proteins for 5HT at t1, which in most cases preceded the clinical improvement. Although other mechanisms are certainly involved, these data suggest that ECT may influence the 5HT transport through platelet membranes.

Epidural Electrical Stimulation on Neurogenic Bladder

In 1967 Shealy first used electrical stimulation of the spinal cord to treat spasticity and pain. This therapy proved to be effective for bladder dysfunction too. The effect of electrical stimulation of the spinal cord at thoracic level has been evaluated in 18 neurogenic patients suffering from hyperreflexia with detrusor-sphincter dyssynergia. Bladder function improved significantly in 13 (73%). Partial or complete relief of bladder hyperreflexia, marked increased of bladder capacity and reduction of residual urine were recorded. The beneficial effect of stimulation indicates that it is a safe and effective alternative treatment for the neuropathic bladder and careful trials with further investigations should be carried out.

Lack of immunization after intraperitoneal insemination of spermatozoa

Twenty infertile patients with normal tubal patency were inseminated intraperitoneally (11 once, seven twice, and two three times) with spermatozoa (mean 14 x 10(6), range 0.6-48 x 10(6)) prepared by the standard swim-up technique. The occurrence of immunization to spermatozoa was looked for by the Gelatin Agglutination Test (GAT) and Tray Agglutination Test (TAT). Both tests gave negative results for all the controls (10 pregnant and 10 puerperal women). Antisperm antibodies were measured in the serum before, 30 d and 4-7 months after Intraperitoneal Insemination (IPI). The last check was done for only 14 patients, since six became pregnant as a consequence of the first treatment. Of the 14 patients studied after 4-7 months, seven had two, and two had three IPI. In the group of inseminated patients, 18 women with no basal sperm antibody did not show evidence of antibody formation after the treatment and it was not increased after insemination in the two patients who already had low antibody titre (1/32). In conclusion, despite the large number of spermatozoa inseminated and even after several IPI attempts, there was no evidence of de novo production of or increase in already present anti-sperm antibodies according to the methods used for the detection of ASA in this study.

Fertility and semen quality of workers exposed to high temperatures in the ceramics industry

The objective of this study was to test the hypothesis that chronic occupational exposure to high temperatures may be detrimental to male reproduction. The study was based on 92 healthy ceramics oven operators with a long exposure to high temperatures, and 87 controls, recruited from the shipment department of the same industry. Interviews with all subjects provided data on sociodemographic characteristics, health status, and fertility problems. Semen analysis was carried out on 46 of the workers exposed to high temperatures, and 14 of the controls, and included evaluation of the sperm concentration, morphology, and motility, including computer-assisted sperm motion analysis (velocity, linearity, ALH, BCF). The results of the questionnaire showed that exposed individuals had a higher incidence of childlessness and of self-reported difficulty in conceiving than controls. The semen analysis showed no significant differences except in sperm velocity. Although differences in semen parameters, taken singly, were not statistically significant, the overall evaluation of the sperm parameters indicated a higher prevalence of pathologic sperm profiles among the exposed compared to the controls.

In vitro sperm capacitation to treat antisperm antibodies bound to the sperm surface

Our objective was to study antisperm antibody bound to the acrosome region during in vitro capacitation and to determine whether acrosome-antibody free sperm can be obtained from previously acrosome-antibody-coated sperm. The spermatozoa from a selected series of 14 patients were tested for sperm antibodies bound to the sperm surface using d-IBT and focusing on the acrosome positivity. The tests were carried out before the incubation and after 3, 6, 9, and 12 h of incubation in Tyrode's solution with 0.5% human serum albumin as the capacitation medium. Tests to evaluate acrosome region, sperm motion parameters, and zonae binding ability were carried out. In this way we were able to evaluate sperm function during capacitation protocol. The patients were 14 subjects selected according to good seminal characteristics, good post-rise sperm parameters, and high percentage of ASA bound to the sperm surface. In all cases the results showed that antisperm antibodies bound to the acrosome region were shed prior to the acrosome reaction. During sperm capacitation in human a modification, migration, or shedding of plasma membrane molecules takes place. The presence of antibodies in such an important area of the sperm head could certainly interfere in the fertilization process. Our data indicate that in vitro capacitation could provide an in vitro therapy capable of eluting antibodies from the acrosome region.

Glutathione therapy for male infertility

Eleven infertile men were treated with glutathione (600 mg/day IM) for 2 months. The patients were suffering from dyspermia associated with various andrological pathologies. Standard semen and computer analyses of sperm motility were carried out before treatment and after 30 and 60 days of therapy. Glutathione exerted significant effect on sperm motility patterns. Glutathione appears to have a therapeutic effect on some andrological pathologies causing male infertility.

[Metabolism and action of L-carnitine: its possible role in sperm tail function]

The authors report a review on the L-carnitine effects on the male genital tract. L-carnitine represents a cofactor in the transport of long chain fatty acids inside mitochondria and their subsequent oxidation. Therefore, its main role is that of intramitochondrial vehicle of acyl groups. In particular, the effects of L-carnitine on the male genital function seem connected mainly with the high concentration of L-carnitine in the epididymis; the uptake of the L-carnitine from the blood is an active, in part androgen-dependent, mechanism. Moreover, epididymal spermatozoa are able to concentrate L-carnitine (while they become progressively more impermeable to such a substance) during their passage from the caput to the cauda epididymis. The main function of the L-carnitine in the epididymis is to give to the spermatozoa an energetic substrate. In fact, this function should be of great importance since the epididymal spermatozoa employ fatty acid oxidation for their energy metabolism; on the contrary, the ejaculated sperm employ glycolytic process. As a consequence of the above-mentioned effects of L-carnitine the dosage of this substance in the evaluation of the integrity of the processes of maturation of the spermatozoa was proposed. Finally, there is growing interest in the use of L-carnitine as a therapeutic tool in some forms of male infertility.

Serotoninergic dysfunction in bipolar disorder

The recent discovery of peripheral markers of central neurotransmitter systems has broadened the scope of biological research in psychiatry. Human platelets resemble presynaptic serotoninergic neurons and permit us to investigate the involvement of the serotonin system in the pathophysiology of mood disorders. In particular, platelets show an active uptake of serotonin and the related 3H-imipramine (3H-IMI), similar to cerebral binding sites. We evaluated 3H-IMI binding in a group of 30 bipolar patients as compared with healthy controls. In 20 patients, platelet 14C-5HT uptake was also measured. The results showed no difference in IMI binding parameters between bipolar patients and healthy controls. However, the patients showed a lower Vmax of 14C-5HT uptake than the controls. These findings suggest that bipolarity influences one of the main components of the 5HT transporter complex in platelets.

A comparison of the direct immunobead test and other tests for sperm antibodies detection

The authors report the results of a correlation study between the direct Immunobead Test (d-IBT) and other techniques for antisperm antibodies detection. The Gelatin Agglutination Test (GAT) and Tray Agglutination Test (TAT) were used to detect antibodies in blood serum and seminal plasma ("indirect methods"). The Direct IgG Mixed Antiglobulin Reaction Test (d-MAR test) was used to detect sperm antibodies bound to the sperm surface ("direct method"). A good concordance between the methods, measured by phi and K tests, was found and satisfactory mathematical models were established by regression analyses.

Antisperm antibodies in young boys

The authors report the results of antisperm antibody tests carried out on a group of 159 pre-pubertal boys suffering from various testicular pathologies. The data show that 21% of the patients' sera showed antibody activity against antigens on the sperm of healthy fertile donors. None of the control sera was ASA positive. Some differences were observed in pathology and age distribution of positivity.

Statistical analysis in andrology

The authors began a statistical study on a file group of 9384 records of semen analyses and anamnestic data (P-1). From this file, they selected a group of 5191 patients having undergone analysis at least one time (P-2) and a file of 850 patients having undergone analysis at least three times (P-3). Finally a new group, derived from P-3, of 203 patients followed by their medical team was created (P-4). Two control groups-composed of 20 sperm-bank donors (DON) and 740 prevasectomy subjects (VAS)-were also created. Frequency distributions and cluster analyses were carried out. The multivariate statistical analysis allows a distinction to be made between fertile and infertile subjects regarding a patient's clinical condition. The most discriminating parameters appear to be sperm concentration and, above all, forward motility and sperm morphology.

Therapy of immunologic infertility

Infertility afflicts 10-15% of the couples and the incidence is progressively increasing. There are many possible causes for infertility, but immunological factors are among the most recently proposed causes. Once have ascertained that couple's infertility problem is due to sperm antibodies, the next obvious step is to attempt some form of therapy. In this paper we review the various classic and up-to-date methods of management of immunologic infertility.

[The management of head trauma in a general surgery department. a contribution to an epidemiological analysis]

Personal experience in the management of head injury in a General Surgery Department is reported and a series of 352 patients analysed with a view to identifying variations in the epidemiological profile of this pathology over the last decade and in order to establish indications for admission and the transfer of the patient to specialist departments.

The use of the Salt Stored Zona Assay in the study of the sperm function: methodological approach

The authors mention many tests to study sperm function. On their opinion, the best model to evaluate spermo-oocyte interaction is the in vitro fertilization but it cannot be considered a test for ethical and practical problems. To overcome these problems they propose the Salt Stored Zona Assay to evaluate the spermatozoa.