DNA flow cytometry in sperm cells from unilaterally orchiectomized patients with testicular cancer before further treatment

Fatherhood and Sperm DNA Damage in Testicular Cancer Patients

Testicular cancer (TC) is one of the most treatable of all malignancies and the management of the quality of life of these patients is increasingly important, especially with regard to their sexuality and fertility. Survivors must overcome anxiety and fears about reduced fertility and possible pregnancy-related risks as well as health effects in offspring. There is thus a growing awareness of the need for reproductive counseling of cancer survivors. Studies found a high level of sperm DNA damage in TC patients in comparison with healthy, fertile controls, but no significant difference between these patients and infertile patients. Sperm DNA alterations due to cancer treatment persist from 2 to 5 years after the end of the treatment and may be influenced by both the type of therapy and the stage of the disease. Population studies reported a slightly reduced overall fertility of TC survivors and a more frequent use of ART than the general population, with a success rate of around 50%. Paternity after a diagnosis of cancer is an important issue and reproductive potential is becoming a major quality of life factor. Sperm chromatin instability associated with genome instability is the most important reproductive side effect related to the malignancy or its treatment. Studies investigating the magnitude of this damage could have a considerable translational importance in the management of cancer patients, as they could identify the time needed for the germ cell line to repair nuclear damage and thus produce gametes with a reduced risk for the offspring.

DNA flow cytometry of human spermatozoa: consistent stoichiometric staining of sperm DNA using a novel decondensation protocol

Rapid flow cytometric measurement of the frequency of aneuploid human sperms is in increasing demand but development of an exploitable method is hindered by difficulties of stoichiometric staining of sperm DNA. An aggressive decondensation protocol is needed after which cell integrity still remains intact. We used flow cytometry to examine the effect of lithium diiodosalicylate (LIS, chaotropic agent) on fluorescence intensity of propidium iodide-treated human spermatozoa from 10 normozoospermic men. When flow cytometric identification of diploid spermatozoa was achieved, validation was performed after sorting by three-color FISH. In contrast with the extremely variable histograms of nondecondensed sperms, consistent identification of haploid and diploid spermatozoa was possible if samples were decondensed with LIS prior to flow cytometry. A 76-fold enrichment of diploid sperms was observed in the sorted fractions by FISH. A significant correlation was found between the proportion of sorted cells and of diploid sperms by FISH. Application of LIS during the preparation of sperm for flow cytometry appears to ensure the stoichiometric staining of sperm DNA, making quantification of aneuploid sperm percentage possible. To our knowledge this is the first report in terms of separating spermatozoa with confirmedly abnormal chromosomal content. High correlation between the proportion of cells identified as having double DNA content by flow cytometry and diploid sperm by FISH allows rapid calculation of diploidy rate.

An evaluation of chromatin condensation and DNA integrity in the spermatozoa of men with cancer before and after therapy

Cancer has been known for a long time to have a depressive effect on sperm number and quality. Cytotoxic agents and radiotherapy have also been shown to impair spermatogenesis. The aim of this study was to assess DNA integrity and chromatin condensation in the spermatozoa of men with cancer before and after treatment. Chromatin condensation was evaluated using flowcytometric assessment with propidium iodide, DNA integrity was determined using the comet assay. Thirty-three men with cancer (testicular cancer, lymphoma and leukaemia) and 14 men with proven fertility took part in the study. The study found that in men with cancer, the percentage of spermatozoa with highly condensed DNA was less than that of controls. DNA integrity when assessed using the comet assay was also reduced by cancer. Percentage head DNA intact and percentage of condensed chromatin in the spermatozoa of men with cancer after treatment were less than those in fertile men. This study, although small, does demonstrate a detrimental effect on chromatin condensation and DNA integrity of cancer and its treatment. These findings are important because of the potential effects impaired chromatin and DNA integrity could have on fertilization, blastocyst and embryo development.

Flow cytometry of human semen: a preliminary study of a non-invasive method for the detection of spermatogenetic defects

BACKGROUND

The pathway of spermatogenesis involves the conversion of diploid stem cells (spermatogonia) to tetraploid primary spermatocytes, followed by meiosis and two cell divisions, first forming diploid secondary spermatocytes and then haploid round spermatids. Differentiation of round spermatids results in spermatozoa containing condensed chromatin. It has long been known that semen from patients with non-obstructive azoospermia or oligospermia contains small numbers of immature germinal cells. In this article, a flow cytometric procedure is described for assessing defects in spermatogenesis by identifying the ploidy of those immature cells.

METHODS

Cells in semen samples from 44 infertile patients and 14 controls were stained with propidium iodide, which displays red fluorescence when intercalated between bases in double-stranded DNA. The resulting cell suspension was examined by quantitative flow cytometry, with excitation by laser light (488 nm) and red fluorescence recorded on a logarithmic scale to allow easy differentiation between intensities of tetraploid, diploid and haploid round spermatids, and spermatozoa containing condensed chromatin.

RESULTS

The flow cytometric method differentiated between cases of 'Sertoli cell-only' syndrome (complete absence of tetraploid and haploid cells) and cases where spermatogenesis was blocked in meiosis or in spermiogenesis. Flow cytometric histograms from semen samples from normozoospermic, oligozoospermic and azoospermic patients fell into patterns that correlated well with the results obtained from testis histology findings.

CONCLUSIONS

The method described may serve as a simple, non-invasive and reliable assay to help clinicians counsel patients with severe male infertility before referring them for testicular surgery to locate spermatozoa for ICSI.

DNA flow cytometry of human semen

The aim of this study was the evaluation of DNA flow cytometry for the analysis of male infertility. 171 ejaculates from 155 patients with fertility problems were analysed by flow cytometry and by conventional microscopical procedures. Using flow cytometry, it was possible to determine the relative proportions of the various cell populations: mature haploid and abnormal diploid mature spermatozoa, cellular fragments, immature germ cells (haploid round spermatids, diploid cells, S phase and 4C cells), and of leukocytes as indicators of infection. A linear association was observed between sperm concentration in semen as quantified by light microscopy and by flow cytometry, even with fewer than 20x10(6) spermatozoa/ml. Eight classes of histograms, each with differing fractions of spermatozoa and other particles, were obtained and correlated with the results of the spermiograms. During the 10 year follow-up, the two patient groups with a low sperm concentration or a high concentration of cellular debris exhibited significantly impaired fertility. The two patient groups with >/=5% diploid spermatozoa and with malcondensed sperm chromatin were also subfertile. No ovulatory disorders were revealed in the 155 female partners. DNA flow cytometry thus provides an additional dimension to semen analysis not easily gained by other methods and has the advantage of being rapidly performed and interpreted. We therefore recommend application of this technique in the diagnosis of male infertility.

Pre-treatment DNA ploidy of sperm cells as a predictive parameter of post-treatment spermatogenesis in patients with testicular cancer

OBJECTIVE

To evaluate DNA flow cytometry (DNA FCM) as a means of predicting post-treatment spermatogenesis in patients with testicular cancer.

SUBJECTS AND METHODS

After unilateral orchidectomy and before further treatment (pre-treatment), light microscopic sperm cell analysis and FCM were performed in 96 patients in whom post-treatment sperm cell counts were available > or = 2 years after therapy. Twenty-nine patients had not received any cytotoxic treatment after orchidectomy, whereas 64 had received either abdominal radiotherapy [37] or 3-4 cycles of cisplatin-based chemotherapy [27]. Three patients had both chemotherapy and radiotherapy. A control group consisted of 26 healthy age-matched men.

RESULTS

In the pre-treatment situation 43% of the patients had low sperm counts (< 10 x 10(6)/ml). A median of 38 months after treatment the median sperm cell density had increased significantly, independent of treatment, but was still less than that of the control group. All control specimens, but only 66% of the patients' ejaculates, contained cells of which more than 90% were classified as being condensed DNA haploid sperm cells. The median percentages of cells classified as non-condensed DNA haploid, as DNA diploid or as being above DNA diploid cells were increased in the patients' samples as compared with those of the controls, both before and after treatment.

CONCLUSION

Spermatogenesis is quantitatively and qualitatively impaired in patients with newly diagnosed testicular cancer. Long-term recovery is relatively independent of routine treatment but is related to the pre-treatment sperm cell density. For the whole series of patients DNA FCM parameters did not yield independent parameters which predicted recovery of spermatogenesis. In patients in whom no sperm cells were found by light microscopy of the seminal fluid the demonstration of > or = 30% condensed DNA haploid cells was correlated with post-treatment recovery of spermatogenesis.