Insemination of husband's semen with and without the addition of caffeine

Phosphodiesterase Inhibitors (PDE Inhibitors) and Male Reproduction

The nonspecific PDE inhibitors, particularly the methylxanthines: caffeine, pentoxifylline (PTX), and theophylline, are known to stimulate sperm motility in vitro and have been used to treat sperm prior to insemination. The in vivo effects are less dramatic. A beneficial effect of caffeine, which is a constituent of some medications, remains controversial. Very high doses of caffeine do have negative effects on fertility endpoints in men and experimental species. The specific PDE5 inhibitors, particularly sildenafil and tadalafil, are prescribed for erectile dysfunction, as well as pulmonary hypertension, lower urinary tract symptoms, and premature ejaculation. PDE5 is expressed throughout the contractile tissues of the male reproductive tract, generally increasing contractility. Some PDE5 inhibitors tend to increase circulating testosterone levels somewhat. For short-term exposure consistent with use prior to intercourse, there appears to be minimal effects on semen quality. Several large, randomized controlled trials (RCTs) in healthy men have not found adverse effects of long-term use of these drugs on semen quality. RCTs in infertile men have demonstrated a modest increase in semen quality. Animal studies at human equivalent doses (HED) have produced similar results in young males, but a study in aging male rats found progressive decreases in epididymal sperm quality accompanied by consistent degeneration of the seminal tubules suggesting that studies in older men might be warranted. A concerning study in mice found lower fertilization rates in males treated with HED of sildenafil and mated the next day to untreated females than for control males. Fertility studies in humans are needed.

Male infertility: lifestyle factors and holistic, complementary, and alternative therapies

While we may be comfortable with an allopathic approach to male infertility, we are also responsible for knowledge about lifestyle modifications and holistic, complementary, and alternative therapies that are used by many of our patients. This paper provides an evidence-based review separating fact from fiction for several of these therapies. There is sufficient literature to support weight reduction by diet and exercise, smoking cessation, and alcohol moderation. Supplements that have demonstrated positive effects on male fertility on small randomized controlled trial (RCT) include aescin, coenzyme Q 10 , glutathione, Korean red ginseng, L-carnitine, nigella sativa, omega-3, selenium, a combination of zinc and folate, and the Menevit antioxidant. There is no support for the use of Vitamin C, Vitamin E, or saffron. The data for Chinese herbal medications, acupuncture, mind-body practice, scrotal cooling, and faith-based healing are sparse or inconclusive.

How to Increase the Motility of Spermatozoa from the Epididymis of Bulls and Alloplastic Spermatoceles in Minipigs

The motility of spermatozoa from the head and tail of the epididymis in bulls was studied. Qualitatively and quantitatively, the motility of spermatozoa from the cauda was distinctly better than that from the caput. It was possible to achieve a highly significant increase in the motility of epididymal spermatozoa from the caput as well as the cauda area using caffeine or a caffeine-kallikrein mixture. Above all, motility stimulants improved the local motility of the epididymal spermatozoa as compared to twitching and progressive motility. The motility of caudal spermatozoa was increased by 100%, corresponding to local movement of 59% of the total number of sperm cells. It was possible to demonstrate an increase in the almost totally absent motility of the caput spermatozoa to 27% local motility. Application of kallikrein without addition of kininogens led to no significant change in spermatozoa motility. By the addition of caffeine, it was possible to increase the motility of minipig epididymal spermatozoa taken by puncture from alloplastic spermatoceles significantly. In 23 aspirates, a prompt increase in the percentage of locally motile "spermatocele spermatozoa" from 12% to 23.5% was observed.

Growth hormone or insulin-like growth factor-I extends longevity of equine spermatozoa in vitro

Growth hormone (GH) and insulin-like growth factor-I (IGF-I) are both present in blood plasma and IGF-I has been measured in epididymal fluid and seminal plasma. This study was designed to investigate the direct effects of GH or IGF-I on the motility of mature equine spermatozoa in vitro. We compared the effects of one concentration (100 ng/ml) of recombinant bovine GH (rbGH) and recombinant human IGF-I (rhIGF-I) on motility and motion characteristics of equine spermatozoa over a 24 h period. Motility was maintained longer in spermatozoa treated with either rbGH or rhIGF-I during a 24 h period at room temperature (P < 0.05). Spermatozoa motion characteristics at time 0, 1, 2, 4, 6, 12 and 24 h for both rbGH and rhlGF-I were not significantly different from the respective controls. This study has shown that GH and IGF-I are effective in promoting the in vitro longevity of spermatozoa.

Electroejaculated baboon (Papio anubis) sperm requires a higher dosage of pentoxifylline to enhance motility

PURPOSE

Sperm collected by electroejaculation often show poor motility. The objective was to determine whether the addition of the phosphodiesterase inhibitor, pentoxifylline, would stimulate electroejaculated baboon sperm motility.

METHODS

Electroejaculation was performed on several occasions on a male baboon and sperm collected after familiarization. Pentoxifylline was tested at the standard concentration (1 mg/ml) and at twice the concentration. Sperm parameters were evaluated using a sperm motility analyzer, as well as acrosome and DNA integrity techniques.

RESULTS

Sperm exposed to 2 mg/ml pentoxifylline had higher total motility when compared with the control and 1 mg/ml treatment. Rapid progression and velocities were higher after pentoxifylline. The acridine orange DNA normality test showed that over 90% of collected sperm had intact unfragmented DNA. About half the sperm population had normal morphology and intact acrosomes. A low percentage had cytoplasmic droplets.

CONCLUSIONS

Sperm collected by rectal probe electroejaculation required a higher concentration (2 mg/ml) of pentoxifylline for enhanced total motility, rapid progression, and higher velocity. This suggested differences in membrane properties or phosphodisterase activity in electrojeaculated sperm. The electroejaculation procedure did not denature sperm DNA at the acridine orange assay level nor were the acrosomes disrupted. The present study also documented unique information on baboon kinematic parameters.

Effects of pentoxifylline on sperm motility and hyperactivation in normozoospermic and normokinetic semen

OBJECTIVE

To determine the effects of in vitro incubation with pentoxifylline on sperm motion characteristics of spermatozoa from normozoospermic, normokinetic specimens.

DESIGN

Prospective, controlled experiment.

SETTING

Andrology laboratory, university-based fertility center.

PARTICIPANTS

Healthy, untreated male partners of couples attending the fertility center.

INTERVENTION

Each specimen was washed, pelleted by centrifugation, then resuspended in human tubal fluid medium (HTF). Two portions were incubated at 37 degrees C, one with pentoxifylline (final concentration = 1 mg/mL = 3.6 mM) and the other without pentoxifylline (control). After 1 hour, the pentoxifylline-treated portion was divided: one half was washed to remove pentoxifylline, then further incubated in HTF; the other half remained incubated in HTF with pentoxifylline.

MAIN OUTCOME MEASURES

Motility, hyperactivation, amplitude of lateral head displacement (ALH), curvilinear velocity (VCL), straight line velocity (VSL), linearity (LIN), beat-cross frequency.

RESULTS

Incubation with pentoxifylline did not increase motility, VSL, LIN, or beat-cross frequency but did significantly increase HA, VCL, and ALH at 1, 2, and 4 hours, compared with control. Incubation in control medium without pentoxifylline did not significantly increase any of the parameters measured. After 24 hours of incubation with or without pentoxifylline, all parameters measured were significantly decreased, with the exception of LIN.

CONCLUSIONS

Pentoxifylline does not increase percentage motility of washed spermatozoa in capacitation medium. Enhancement of sperm HA by pentoxifylline in capacitation medium occurs with normozoospermic, normokinetic semen specimens. This effect persists for up to 4 hours when pentoxifylline is removed from the medium after 1 hour of incubation.

The effect of caffeine on the ability of spermatozoa to fertilize mature human oocytes

Although caffeine has been reported to enhance spermatozoon motility as well as fertilizing ability, its use in clinical practice has remained sparse. We report here the results carried out to assess the effect of exposing normal human spermatozoa to different concentrations of caffeine on their motility, their ability to fertilize oocytes, and the subsequent development of resulting embryos. Mature human oocytes were inseminated with spermatozoa washed and capacitated in 1.25, 2.5, and 5 mM caffeine. The fertilization rates were compared with control oocytes inseminated with untreated spermatozoa. While caffeine was observed to improve significantly various motility parameters in a dose-dependent manner, it did not lead to an improvement in the fertilization rates. At the highest concentration, 5 mM, it adversely affected the fertilization rate: 38%, compared with 78% in controls. Embryonic development was also observed to be retarded at the lower concentrations, while it was virtually inhibited in the 5 mM concentration group. Our results suggest that while a definite improvement in motility may occur when spermatozoa are exposed to caffeine, this improvement did not translate into enhanced fertilizing ability and subsequent embryonic development. We are therefore of the opinion that the use of caffeine as a spermatozoon motility enhancer requires further studies prior to wider clinical use in assisted pregnancy programs.

Comparison of motility stimulants for cryopreserved human semen

Caffeine, pentoxifylline, 2-deoxyadenosine, cyclic adenosine monophosphate (cAMP), relaxin, adenosine, kallikrein, and calcium were compared for their ability to stimulate motility of cryopreserved sperm. Caffeine, pentoxifylline, and 2-deoxyadenosine significantly increased the percentage of motile sperm at 15, 30, 45, and 60 minutes after administration. Sperm velocity was significantly increased by caffeine at 0, 15, 30, and 45 minutes, and by pentoxifylline at 0, 45, and 60 minutes. Consistent stimulation was not observed for other chemicals. Caffeine, pentoxifylline, and 2-deoxyadenosine were then examined for their ability to provide motility stimulation after removal with washing. With the exception of caffeine, percent motility and velocity for stimulated and untreated sperm were similar after washing. A significant reduction in motility was observed at 48 hours after washing for caffeine. The percentage of hamster oocytes penetrated at 24 hours after washing was significantly reduced for caffeine, 2-deoxyadenosine, and pentoxifylline combined with 2-deoxyadenosine. Pentoxifylline-treated sperm showed no reduction in fertilizing capacity. These results indicate that, of the chemicals examined, pentoxifylline is superior for motility stimulation of cryopreserved sperm.

A simple nephelometric method for measuring the progressive motility and collecting motile spermatozoa

A simple method for collection and measurement of the progressive motility of spermatozoa was developed. The procedure consists of the spectrophotometric measurement of the increase in optical absorbance produced by the upward migration of spermatozoa in a high density medium of Ficoll 400. The suspension containing migrated spermatozoa may be used as a purified population of uniformly motile and undamaged spermatozoa.

The effect of relaxin on the motility of sperm in freshly thawed human semen

In an attempt to improve the motility of thawed spermatozoa after 1 week of its being frozen, we treated ten normal semen samples with 16.7 nmol relaxin and 6 mmol caffeine. Motility and grade of forward progression were examined after thawing. Caffeine significantly improved motility of spermatozoa. Relaxin, when added to semen at the time of thawing, improved motility and grade of forward progression significantly. This effect was not seen if relaxin was added before freezing. These results suggest that the biologic activity of relaxin is adversely affected by freezing and thawing in seminal plasma. These observations may have clinical importance for the improvement of motility of frozen spermatozoan samples at the time of artificial insemination and for the possible improvement of pregnancy rates.

Involvement of calcium in the caffeine stimulation of human sperm motility

The shape of the concentration-response curve and the amplitude of maximal motility increase for the stimulatory effect of caffeine on human sperm motility were similar to those of EGTA, a calcium chelator, and lanthanum chloride, a calcium entry blocker. On the other hand, the maximal motility stimulation induced by dibutyryl cyclic AMP was similar to that induced by trifluoperazine, a calmodulin antagonist. The antagonism of A23187 on the motility-stimulating effect of EGTA and caffeine was competitive in nature, while that on cyclic AMP was non-competitive. We proposed that there could be two mechanisms for caffeine to stimulate sperm motility: at higher concentrations, caffeine modified calcium translocation; at lower concentrations, caffeine increased cyclic AMP level. The importance of calcium in the regulation of human sperm motility was reconfirmed in this study.

Calcium antagonists stimulate sperm motility in ejaculated human semen

Three calcium antagonists, diltiazem, flunarizine and verapamil stimulated human sperm motility in vitro. Among them, diltiazem induced the largest amplitude of motility increase. The concentration-response curve of diltiazem was similar in shape to those of calcium chelators. EGTA, a calcium chelator, potentiated the stimulatory effect of diltiazem while A23187, a calcium ionophore, antagonized it. These observations supported our previous hypothesis that an increased concentration of calcium ion was detrimental to human sperm motility. Whether calcium antagonists could be used in the treatment of subfertile patients awaits further investigation.

Effect of caffeine on human sperm penetration into zona-free hamster ova

The effect of caffeine on spermatozoal ability to penetrate zona-free hamster ova was examined on fresh and frozen-thawed semen samples. The mean motility of 10 fresh semen samples incubated with caffeine significantly increased from 29% to 35%. Sperm penetration into zona-free hamster ova did not differ between the control group and the specimens to which caffeine was added. The same effect of caffeine on sperm motility and hamster ova penetration was noted in the frozen-thawed sperm samples. Motility was enhanced by 21%, but hamster ova penetration did not significantly change. The increase in sperm motility caused by caffeine does not change the fertilizing ability of fresh and frozen-thawed human sperm.

Glutathione and caffeine antagonize the sperm-immobilizing effect of a vaginal contraceptive

The concentration-dependent inhibition of Neosampoon, a vaginal contraceptive, on ejaculated human sperm motility was studied with a transmembrane migration method. Caffeine (5mM), glutathione (5mM) and glutathione (15mM) all reactivated the motility of Neosampoon-immobilized sperm. Caffeine (5mM) was more potent than glutathione in antagonizing Neosampoon; there was no difference between the potency of 5mM- and 15mM-glutathione. Human sperm motility could be a model for studying the interaction of membrane-active drugs, including the protective effect of glutathione against membrane-disrupting agents.

The influence of in vitro caffeine treatment on human sperm morphology and fertilizing capacity

After publication in the literature that in vitro caffeine treatment causes damage of the normal shape of the sperm head and thereby decreases fertilizing capacity, we carried out a clinical and electron microscopic study to determine the influence of caffeine on the fertilizing capacity and sperm cell morphology. Sixty women (with infertile husbands) underwent artificial insemination by donor with frozen/thawed semen over a period of 12 months, using randomized addition of caffeine in alternate months. Fourteen women became pregnant during the 6 months they received caffeine-treated semen, whereas only 7 pregnancies occurred during the 6 months the women received semen without caffeine. Scanning electron microscopic examinations of fresh proven donor semen showed no morphologic changes caused by the in vitro caffeine treatment. However, quantitative morphologic analysis of the frozen/thawed semen was unsatisfactory because of the freezing technique and the masking effect of the protective medium. It is concluded that in vitro caffeine treatment of fertile donor semen does not damage the spermatozoa; furthermore, it seems to improve the fertilizing capacity.

Pregnancy following use of the cervical cup for home artificial insemination utilizing homologous semen

Sixty-one couples with infertility from 1 to 11 years were instructed in the use of the cervical cup for artificial insemination using homologous semen in the privacy of their own homes. There have been 36 reported pregnancies in 32 of these couples. Among women with primary infertility, the pregnancy rate was 43%; it was 67% for those with secondary infertility and 53% overall. Sperm counts and percent motility, as well as postcoital test results, however, failed to be indicative of eventual ability to conceive. Regardless, among couples with documented infertility, this method provided over half of the couples with at least one pregnancy. Additionally, the technique is simple, inexpensive, without significant risk or discomfort, and can be carried out by a couple at their convenience and in privacy.

Microcinematographic analysis of the motility of human spermatozoa incubated with caffeine

The effects of incubation with caffeine at final concentration of 0.5 and 5.0 mM for 30 min at ambient temperature were examined in three normal semen samples and three from asthenozoospermic men. A 50 frames/s microcinematographic analysis of the sperm motility was performed and two characteristic parameters of the trajectories, the progression velocity (Vp) and the amplitude of lateral head displacement (Ah), were measured. At the lower concentration (0.5 mM) no significant effects on the overall mean values (i.e. for all spermatozoa analyzed over the 6 samples) of Vp Ah were found. However, at 5.0 mM a significant reduction in the overall mean Vp was noted. The individual responses were variable between the 6 samples, but only in two of the asthenozoospermic samples and one normal ejaculate were the slow-swimming (less than 20 micrometer/s) spermatozoa accelerated by caffeine treatment. In other samples a reduction in the velocity of faster-swimming spermatozoa was observed. It would seem preferable to reserve caffeine treatment only for severe cases of asthenozoospermia where the distribution of sperm velocities of skewed towards low values.

Effects of purification or split ejaculation of semen and stimulation of spermatozoa by caffeine on their motility and fertilizing ability with the use of zona-free hamster ova

Purification of semen with Sephadex G-50 medium powder or bovine serum albumin (BSA) (20% in medium) columns increases the percentage of motility. Spermatozoa that passed a BSA column or a Sephadex column have significantly higher velocity than unmanipulated spermatozoa. Caffeine (7 mM) stimulation did not show any effect on motility. Neither purification procedures nor stimulation with caffeine improved the in vitro fertilization capacity of capacitated spermatozoa, as determined by interaction with zona-free hamster ova. No difference in in vitro fertilizing capacity could be demonstrated between the first and the last fractions of split ejaculates. After grouping the fractions according to sperm counts, fractions with higher total (motile) sperm counts, and fractions with higher sperm counts had significantly higher fertilization percentages than the fractions with lower (motile) sperm counts.

Migration of hamster sperm within capillaries: effect of agents elevating cyclic AMP

Semiautomated capillary scanning was used to quantitate the migratory rate of hamster caudal epididymal (HCE) sperm populations from undiluted exudates into various defined media. The populations migrated through calcium-containing Tyrode's solution four times more rapidly than they did through buffered-glucose fortified saline or isotonic sucrose. This difference was partially eliminated by the addition to the saline or sucrose of the motility inducers, calcium ion or cyclic adenosine monophosphate (cAMP), and completely eliminated by the additional presence of the motility amplifiers, caffeine or spermine. The addition of the motility amplifiers, caffeine or spermine, alone to either calcium-saline or Tyrode's solution greatly stimulated the microscopically judged vigor of motility. However, this increase in flagellar activity was not coupled to increased forward velocity. Instead, as in the case of capacitated HCE sperm, the activation of motility resulted in significantly reduced forward velocities. Thus, it appears that under certain conditions caffeine, spermine, or capacitation can elevate sperm cAMP concentrations above those optimal for maximal forward progression.

Split ejaculate insemination with and without the addition of kallikrein

48 couples with primary sterility and a therapy-resistant male factor (oligoasthenozoospermia, asthenozoospermia) were subjected to a split ejaculate insemination therapy with and without addition of kallikrein. In all men, in vitro stimulation of sperm motility by kallikrein was possible. 468 inseminations were performed in 341 ovulatory cycles according to the BBT and the cervical score. To the sperm-rich fraction of the split ejaculate physiological saline or physiological saline containing pancreatic kallikrein in a final concentration of 5 units/ml was added and inseminated alternatively over another cycle for a period of one year. The conception optimum was around the 7th insemination cycle. 11 conceptions were obtained after split insemination with kallikrein and 6 conceptions after split insemination without kallikrein. Conception rate was 35%, abortion rate 18%. The sex ratio showed 8 healthy girls to 4 healthy boys. Within the oligoasthenozoospermic group a conception rate of 28% was obtained, whereas the conception rate of the asthenozoospermic group was 43%. In the latter, more than the double number of conceptions were achieved with kallikrein addition. Kallikrein addition showed a beneficial effect particularly in ejaculates with less than 30% progressively motile spermatozoa. The investigation shows the usefulness of split ejaculate inseminations. Furthermore, addition of kallikrein to the ejaculate for the purpose of insemination may be beneficial particularly in patients with therapy-resistant asthenozoospermia.

Vitality and morphology of human spermatozoa. Studies on the resistance to storage and centrifugation and on the removal of dead spermatozoa

The effect of storage of human spermatozoa at room temperature and in the refrigerator was studied. Loss of vitality was found to be linear and the same within the temperature range studied. Vitality was reduced by 0,9% per hour on average. The rate of this loss did not show much variation. The morphology of both all spermatozoa and the living sperm population studied separately was only slightly impaired by storage. The effect of centrifugation and resuspension of spermatozoa was studied separately. Vitality was found to be reduced by gravitation forces of 800 g for 20 minutes whereas no effect on morphology was noted by this treatment. Gravitation forces of 600 g and below did not significantly affect the spermatozoa. Two methods of separation of spermatozoa with better motility and morphology from the rest of the semen sample were studied, (1) filtration through a layer of glass beads, (2) "sperm rise" after centrifugation at low gravitation force. The clinical value of these procedures is probably limited to selected cases.

Spontaneous cure of male infertility

Four of sixteen couples whose infertility was thought to be due to a male factor achieved a pregnancy without treatment. Pregnancy without therapy, despite compromised sperm counts or motilities, has been documented by a number of other authors. Despite this information many studies concerning the treatment of male infertility neglect to include control groups, and pregnancies which occur are credited solely to the therapy. Such claims of therapeutic success should be viewed with caution.