Pancreatic Dornase for Liquefaction of Viscid Human Semen**Presented at the 25th Annual Meeting of the American Fertility Society, Miami Beach, Fla., April 26, 1969.††Address reprint requests to 1612 Court Place, Denver, Colo. 80202

Seminal hyperviscosity is associated with poor outcome of in vitro fertilization and embryo transfer: a prospective study

OBJECTIVE

To investigate the effect of increased seminal viscosity on fertilization, implantation, and pregnancy outcome in patients undergoing in vitro fertilization/ intracytoplasmic sperm injection (ICSI).

DESIGN

Prospective study.

SETTING

University-affiliated infertility center.

PATIENT(S)

One hundred fifty-eight infertile couples (168 cycles) with increased seminal viscosity and 129 infertile couples (138 cycles) with normal seminal viscosity as controls.

INTERVENTION(S)

In vitro fertilization using conventional insemination or ICSI.

MAIN OUTCOME MEASURE(S)

Fertilization, embryo quality, implantation, and pregnancy rates (PR) were evaluated.

RESULT(S)

Patient age and the cause of infertility were similar between the two groups. Sperm count (36.9 +/- 34.0 vs. 28.1 +/- 25.6) and motility (41.5 +/- 19.2 vs. 37.0 +/- 20.5) was higher in the control group compared to the study group. Fertilization rate after IVF (50.4% vs. 64.6%), clinical PR (28% vs. 39.9%), and the implantation rates (10.5% vs. 16.5%) were significantly lower in patients with hyperviscosity compared to the control group.

CONCLUSION(S)

The lower implantation rate and clinical PR in couples with seminal hyperviscosity may be attributed to biophysical alterations or chemical changes of the ejaculate that could impact sperm DNA despite the presence of apparently normal motile sperm for the IVF/ICSI procedure.

Visco-elasticity of seminal fluid in relation to the epididymal and accessory sex gland function and its impact on sperm motility

Seminal viscopathy was shown to be associated with male infertility. However, our knowledge about the regulatory mechanism of this process is still limited. In semen samples from 411 men attending for fertility assessment, traditional semen parameters including visco-elasticity were assessed according to the World Health Organization guidelines. Sperm motility was evaluated by use of computer aided sperm analysis (CASA). Seminal activity of neutral alpha-glucosidase (NAG) and concentrations of prostate-specific antigen (PSA), zinc, and fructose were measured. The activity of NAG, and the concentrations of PSA and zinc were significantly lower in hyper-visco-elastic semen samples (medians: 5 vs. 8 mU/mL; 741 vs. 924 mg/L; 1 vs. 2 mM/L), than in those with normal visco-elasticity (p = 0.004, 0.005 and 0.011, respectively). When comparing the total amounts, only for seminal fructose there was a difference between samples with high visco-elasticity as compared with those of normal visco-elasticity (median: 74 vs. 53 microM/ejaculate, p = 0.007) This seminal marker was the only significant independent parameter in predicting seminal visco-elasticity in a multiple logistic regression analysis (odds ratio for the highest quartile = 4.67). Hyper-visco-elasticity was associated with a lower percentage of motile spermatozoa (43 vs. 50%, p = 0.045). Similar trend was found for the CASA motility characteristics curvilinear velocity (VCL), average path length (VAP), amplitude of lateral head displacement (ALH) (p = 0.008, 0.038 and 0.020, respectively). Our study demonstrated the interplay between the regulatory effect of post-testicular organs on semen visco-elasticity. Hyper-visco-elasticity was associated with asthenozoospermia and lower levels of VCL, VAP and ALH.

Viscosity of human seminal fluid: role of lysozyme

The aim of this research was to evaluate the role of lysozyme in the phenomenon of seminal hyper-viscosity. The enzyme was determined in 142 samples of seminal plasma either leucospermic or not, with or without active macrophages classified according to their consistency (normal or high). The kinetic method with Micrococcus lysodeikticus as substrate was employed. No difference was found in enzymatic concentration expressed in nmol/L of enzymatic protein (mean +/- 2 SEM) on comparing normal and high seminal consistency groups, while differences proved highly significant in batches either leucospermic or not (n = 44, 197.2 +/- 51.3 vs. n = 98, 108.3 +/- 12.8; p < .0005). On subdividing the normal and high-consistency groups according to the count of polymorphonuclear leucocytes and the macrophagic responses, differences were also significant (p < .005 in both cases). Lysozyme concentration increases in presence of leucospermic reaction. In vitro lysozyme addition showed no significant effect on samples with high consistency. The results indicate that lysozyme plays no direct role in the phenomenon of seminal hyperviscosity, although its deficiency in cases of chronic infections may prove a factor aggravating the clinical picture.

Dithiothreitol effects on human sperm quality

Human semen normally coagulates immediately after ejaculation and then undergoes liquefaction during the next 15 to 60 minutes. Incomplete seminal liquefaction can result in impaired sperm motility and make clinical evaluation and manipulation difficult. Dithiothreitol, a mucolytic agent that reduces the mucoprotein disulfide bonds in sputum, has been found to induce liquefaction of incompletely liquefied semen in vitro. We studied the effects of dithiothreitol on sperm motility, viability, acrosomal integrity and morphology. A semen sample was provided by 45 healthy, young men at the University of Arizona. Of the specimens 10 (22%) demonstrated incomplete liquefaction. Sperm motility and motion characteristics of untreated (control) semen and semen treated with dithiothreitol were objectively evaluated using computer assisted semen analysis. Sperm cell membrane integrity and mitochondrial integrity were measured by fluorescence microscopy using the deoxyribonucleic acid specific fluorochrome propidium iodide and the mitochondria specific fluorochrome rhodamine-123, respectively. Acrosomal integrity was determined using the fluorescent stain chlortetracycline. Sperm morphology was evaluated using bright field microscopy. For completely liquefied semen (35 cases) dithiothreitol reduced sperm motility (59.1 +/- 1.2% untreated versus 53.2 +/- 1.2% treated, p < 0.01) and motion characteristics. However, dithiothreitol had no statistically significant effect on motility on sperm in the group with incompletely liquefied semen (10 cases). Sperm cell membrane, mitochondrial and acrosomal integrity was unaffected by dithiothreitol regardless of liquefaction status. Dithiothreitol caused a significant increase in abnormally large sperm head morphology in the group with completely liquefied semen. The minimal effects of dithiothreitol on sperm motility traits and viability support its use as a possible aid in the evaluation and manipulation of incompletely liquefied semen.

Biochemical parameters of slowly liquefying human ejaculates

Abnormality in liquefaction of human semen is associated with poor scoring in postcoital tests and may lead to subfertility. A relative study on the seminal plasma characteristics of slowly and normally liquefying human ejaculates has been made. A multitude of seminal vesicular and prostatic components in the seminal plasma of eight slow-liquefying ejaculates from 4 men were compared with ten normally liquefying ejaculates from different healthy volunteers. For 60% liquefaction, the time taken by these two types of ejaculates was 46 and 7 min, respectively. The levels of the components that are mainly secreted by the seminal vesicles were similar in both the groups. But all the prostatic components demonstrated significantly (p less than 0.001) decreased levels in the slow-liquefying group from those in the group being compared. It was concluded that relative decrease in the prostatic activity with respect to that of the seminal vesicles appears to be the cause of slow-liquefaction.

Use of Sputolysin form liquefaction of viscid human semen

A comparative study evaluating the effect of different mucolytic agents on viscid semen and on sperm motility at successive time intervals was carried out. Sputolysin (dithiothreitol, Calbiochem Behring, 1978) was found to be most efficient in liquefying viscid semen and also in preserving sperm motility. The mean liquefaction times for Sputolysin, Alevaire (a mucolytic detergent), and alpha-amylase were found to be 10 minutes, 39 minutes, and 20 minutes, respectively. The rate of decline in sperm motility over an interval of 24 hours was found to be least with Sputolysin, followed in order by phosphate-buffered saline, alpha-amylase, control, and Alevaire. The adverse effect of Alevaire on sperm motility over successive time intervals was quite marked. A serial dilution study with Sputolysin showed that, at higher dilution (1:80), liquefaction time was prolonged (24 minutes), but it was still shorter than with Alevaire (39 minutes) and nearly the same as with alpha-amylase (20 minutes).