Light Microscopy as an Aid in Predicting Ureaplasma Infection in Human Semen**Supported in part by grants from The Upjohn Company, Hoffman-LaRoche, Inc., and the Skwerer Mycoplasma Research Fund

Coiled sperm from infertile patients: characteristics, associated factors and biological implication

BACKGROUND

There is no systematic study on coiled sperm in semen, although they are commonly observed. This work characterizes coiled sperm in infertile men to understand the clinical implications and investigate the possible cause by osmotic swelling.

METHODS

Coiled sperm in semen from 439 infertile patients were quantified and their ultrastructure examined by electron microscopy. Hypo-osmotic swelling (HOS) and demembranation tests were performed to elucidate the nature of the coiling.

RESULTS

Semen from patients contained overall 3% of sperm with head-in-coil (HIC) and 8% other coiled forms, with 12% of patients having 20% or more such sperm. The percentage of coiled sperm (but not HIC) was correlated with age (R = 0.26, P = 0.003) and the epididymal secretory marker neutral alpha-glucosidase (R = 0.16, P < 0.001), and associated with heavy smoking and varicocele. Electron microscopy revealed coiling of tail filaments within the plasma membrane, resembling HOS. Some seminal coiled sperm and most sperm freshly coiled upon HOS could be opened by demembranation, while those that could not be opened were probably fixed in position by oxidation, which occurred more frequently in patients than semen donors.

CONCLUSIONS

Sperm coiling in semen is common and independent of sperm quantity or hormonal status. Whereas HIC may have a genetic background, other coiled forms may be associated with a hostile endogenous milieu in the epididymis that causes swelling.

Mycoplasma hominis attaches to and locates intracellularly in human spermatozoa

BACKGROUND

The study of sperm-mycoplasma interaction has been focused on the effects of infection on sperm quality, but few studies have reported the direct interaction of this bacterium with spermatozoa.

METHODS

Selected populations of viable, motile and infection-free human spermatozoa from three healthy men were incubated with 15-480 multiplicity of infection (MOI) units of DiIC18-labelled Mycoplasma hominis. Cells were analyzed by means of confocal microscopy and by the eosin-Y dye exclusion test between 10 min and 24 h post-infection.

RESULTS

As early as 10 min post-infection, clusters of M. hominis were seen attached to the sperm head, midpiece or tail. Mycoplasma showed an approximately 2.5-4.5-fold higher interaction with sperm head or tail than with midpiece. Sequential sectioning of infected spermatozoa revealed the intracellular location of M. hominis within cytosolic spaces of head and midpiece regions. A minor proportion of infected spermatozoa showed bent or coiled tails, and/or midpiece thickening. Sperm viability was not altered by M. hominis infection.

CONCLUSIONS

These results provide specific and conclusive evidence of M. hominis attachment and invasiveness towards human sperm cells, which seems not to affect their viability, suggesting that a short-term M. hominis interaction with spermatozoa results in non-apparent or subtle damage, but might have implications for long-term male or couple's fertility.

Spermoculture: improvement of the bacteriological quality of samples by direct verbal counseling before semen collection

OBJECTIVE

To compare the bacteriologic quality of samples after direct verbal or written counseling for semen collection.

DESIGN

Prospective randomized comparative study.

SETTING

Laboratories of biology of reproduction and microbiology in university hospitals.

PATIENTS

Male partners of infertile couples on their first attempt to collect semen were assigned randomly into two groups.

INTERVENTION

In one group (n = 52) the patients were given direct verbal instruction by one of the investigators on how to avoid bacterial contamination during semen collection. In the other group (n = 52) the patients were asked to follow the usual written instructions.

MAIN OUTCOME MEASURE

Bacterial count, number of species, classification of the samples in positive, negative, and noninformative cultures.

RESULTS

Direct verbal teaching significantly reduced the bacterial count (2.06 +/- 1.6 versus 3.29 +/- 1.6 log cfu/mL; mean +/- SD) and number of species (1.44 +/- 2.02 versus 3.25 +/- 2.25), increased the percentage of sterile cultures (59.6% versus 23.1%), and decreased the percentage of noninformative cultures (29.9% versus 50%).

CONCLUSION

Direct verbal counseling on how to avoid bacterial contamination during semen collection significantly improves the bacteriologic quality of the samples.

Sperm motility, morphology, hyperactivation, and ionophore-induced acrosome reactions after overnight incubation with mycoplasmas

OBJECTIVE

To evaluate the effect on the function on human sperm of overnight incubation with mycoplasma species.

DESIGN

Prospective controlled in vitro study.

SETTING

Community-based sperm bank and andrology laboratory.

INTERVENTIONS

Percoll-separated sperm were incubated overnight with a low densities of Myco-plasma hominis and Ureaplasma urealyticum serotypes.

MAIN OUTCOME MEASURES

Motility, midpiece and tail morphology, hyperactivation after overnight capacitation, and acrosome status after incubation with calcium ionophore.

RESULTS

Overnight incubation with mycoplasma species resulted in small but highly statistically significant differences in motility, morphology, hyperactivation after overnight capacitation, and proportion acrosome reacted after incubation with calcium ionophore compared with controls.

CONCLUSIONS

Incubation with mycoplasma species impairs sperm physiology. Identification and treatment of mycoplasma may augment a physiology-based infertility evaluation.

Virulence characteristics of male genital tract Escherichia coli isolated from semen of suspected infertile men

The role of Escherichia coli isolates from the semen in the etiology of male infertility, was investigated in this study. Several possible virulence factors of E. coli, such as possession of O antigens or certain K antigens (K1, K5), the type of fimbriae, resistance to antimicrobial drugs and adherence studies to various mammalian sperm cells were examined. It was found that out of 181 E. coli isolates 76.4% belonged to four different urinary serotypes: O1, O2, O4 and O6 (5.7%, 7.5%, 17.0% and 46.2%, respectively). The predominant fimbrial phenotype (81.2%) was T1F+/P-, while 15.8% showed also the possession of P fimbriae (T1F+/P+). No isolate was found with the T1F-/P+ phenotype. The possession of antigens K1, K5 was found to be low (12% only). A relatively high level of adherence to different mammalian sperm cells was found among E. coli isolates. 43% of the E. coli isolates were resistant to doxycycline (the drug of choice) and additionally, most of these were resistant also to ampicillin. We suggest that there is a close subpopulation of E. coli which possess certain virulence properties and have the potential to adhere to sperm cells and to colonize on other target tissues in the male genital tract. Such virulent may cause asymptomatic male infertility and may be termed male genital tract (MGT)-E. coli.

[Microbial flora in semen of infertile African men at Garankuwa hospital]

This study was undertaken to determine the frequency of bacteria and Mycoplasmas in semen of infertile African men and to compare abnormal semen parameters with the presence of these organisms. Routine semen analysis were performed on 100 patients, and semen and first-voided urine samples were cultured. Mycoplasma hominis was cultured in 28% of seminal fluid and Ureaplasma urealyticum in 42%. These organisms were both present in 22% of cultures. Bacteriological cultures were positive in 6 urine and 21 seminal specimens. The frequency of tail abnormalities in the Mycoplasma positive group was greater as compared to normal values. From these it would appear that culture for Ureaplasma should probably be performed routinely at the Andrology Clinic.

Screening to reduce transmission of sexually transmitted diseases in semen used for artificial insemination

The practice of artificial insemination by donor semen is increasing in the United States. Many sexually transmitted organisms are found in semen, but screening procedures for the detection of these agents in donor semen have not been standardized. Sexually transmitted organisms have been transmitted during artificial insemination by donor, and such transmission can cause local, disseminated, or fatal disease in the recipient woman and may harm the fetus or newborn. Therefore, screening of both the donor and the donated semen is necessary to avoid infectious complications. Because semen samples cannot be evaluated completely on the day of donation, the use of fresh semen for artificial insemination should be discouraged. Until accurate, rapid diagnostic tests are available, only frozen semen that has been appropriately screened should be used.

Mycoplasmic localization patterns on spermatozoa from infertile men

Two mycoplasmas have been observed with increasing frequency in patients with genitourinary disorders: Mycoplasma hominis and Ureaplasma urealyticum. Mycoplasma cells of both these species have been demonstrated to be capable of attaching to human spermatozoa of infertile patients. The mechanisms for the association of infertility and mycoplasma infection have not been established. The main objective of this article was to explain the significance of some morphologic features of spermatozoa of patients with unexplained infertility using light and electron microscopy. These studies and quantitative analysis of ureaplasmas in the semen indicate that at least two patterns can be seen. Frequently, sphere-shaped particles adhering mainly to the midpiece of spermatozoa were detected. In a second, more complex pattern ureaplasmas were seen inside a swollen zone on the midpiece, which suggests that the infection does not occur in the urethra, but at another unknown site. Furthermore, the sphere-shaped particles cannot be associated with ureaplasmas because their titers in the semen of infertile patients were much lower than those expected.

Microscopical evidence of mycoplasma-like organisms in mycoplasma positive bovine semen

Contamination with mycoplasma-like organisms was observed microscopically in a bull with impaired sperm quality and positive isolation of Mycoplasma bovigenitalium and ureaplasma. The bull's spermiogram was characterized by decreased initial motility and post-freeze survival rate, primary defects in nucleoplasm, changes in tail conformation and regressive changes of the plasmalemma and acrosome. Vesiculo-lamellar bodies in the periacrosomal region were an accompanying feature. The cytologic picture described is compatible with descriptions reported earlier and related to mycoplasma infection.

Microbial flora in semen of asymptomatic infertile men

A microbiological examination has been carried out in 116 patients with unexplained infertility and with asymptomatic bacteriospermia. Organisms more frequently isolated were Staphylococcus epidermidis (81.9%), non hemolytic streptococci (23.3%), diphtheroids (25%) and alpha-hemolytic streptococci (18.1%). None of the 103 patients were positive for C. trachomatis. Mycoplasmas were isolated in 56 (48.3%) of the 116 examined samples, U. urealyticum was present in 49 (42.2%), M. hominis in 3 (2.6%) and both species in 4 (3.5%) samples of examined fluids. Forty-one of the 56 mycoplasmas-positive patients have been treated with doxycycline therapy. The treatment improved motility and caused decrease of coiled tails in 12 cases. Conception occurred in 5 (26.3%) of the 19 treated patients whose cultures were negative for mycoplasmas. These 5 pregnancies occurred in the patients that had high titers (greater than 10(5) c.c.u./ml) of ureaplasmas and in which the antibiotic therapy was successful. No pregnancy was seen in the other 22 patients where treatment failed to eradicate mycoplasmas.

The effect of Ureaplasma urealyticum on semen characteristics

Semen samples from 280 men were cultured for Ureaplasma. The presence of Ureaplasma in the male genital tract did not affect ejaculate volume, motility, viability, or morphology. Sperm concentration was significantly lower in the presence than in the absence of Ureaplasma. The longevity of sperm as evaluated by sperm motility and viability at different intervals of time was also not influenced by the presence of Ureaplasma. Biochemical parameters, namely zinc, magnesium, acid phosphatase, and fructose were not affected by the presence of Ureaplasma. No relationship of Ureaplasma with sperm antibodies, aerobic infection, or anaerobic infection was observed.

Relationship between genital tract infections, sperm antibodies in seminal fluid, and infertility

To explore possible relationships between genital tract infections, sperm antibodies, and infertility, seminal fluid from 100 men was analyzed. Sperm antibodies, measured by an enzyme-linked immunosorbent assay, were detected in 14 of 29 men (48%) with culture-positive asymptomatic infections, 8 of 17 men (47%) with a history of prostatitis or urethritis, 11 of 33 men (33%) with either a varicocele or an abnormal semen analysis, and only 1 of 21 men (5%) with no infection and a normal semen analysis. The incidence of sperm antibodies in the men with infections or urethritis or prostatitis was significantly higher than in the control subjects (P less than 0.005). The sperm antibody isotype in men with infections was mainly IgA, although IgG or IgM were also sometimes present. Of the men with asymptomatic infections, urethritis or prostatitis, significantly (P less than 0.025) more men without sperm antibodies (12 of 24, 50%) were fertile than were those with sperm antibodies (3 of 22, 13%). Men with genital tract infections have a high incidence of antibodies, reactive with spermatozoa, which is associated with reduced fertility.

Secondary amenorrhoea associated with Chlamydia trachomatis infection

Chlamydia trachomatis was isolated from the ovaries of a 39-year-old married woman who presented with secondary amenorrhoea. Treatment with doxycycline was given and menstruation resumed spontaneously.

Ureaplasma urealyticum and infertility: the effect of different antibiotic regimens on the semen quality

Objectives criteria of semen quality were evaluated in 243 men treated for Ureaplasma urealyticum genital tract infection with 1 of 4 different antibiotic regimens. Significant improvement was observed in motility, quantity, quality, and percentages of oval and small forms. Doxycycline, whether used for 2 or 4 weeks, at a dosage of 100 mg, twice daily resulted in the same cure rate (79 and 81 per cent, respectively). Tetracycline regimens of 500 mg. 3 times daily for 2 or 4 weeks had significantly inferior cure rates (17 and 55 per cent, respectively). These findings suggest that antibiotic therapy could be valuable in improving semen quality when Ureaplasma is isolated, and that followup culture for the organism should decide the endpoint in therapy, since resistant strains for doxycycline and tetracycline are emerging.

Pyosemia and carriage of chlamydia and ureaplasma in infertile men

Chlamydia trachomatis and Ureaplasma urealyticum have been implicated as causative organisms in infections involving the male and female urogenital tracts. Seminal fluid, anterior urethral swabs and first-voided urine specimens from men undergoing infertility evaluation, with and without pyosemia, or anterior urethritis were cultured for Chlamydia trachomatis and Ureaplasma urealyticum. The method used to isolate Chlamydia trachomatis involved cytochalasin-B treated McCoy cells, and NYC and A7 solid media were used for the isolation of Ureaplasma urealyticum. Isolation of Chlamydia trachomatis from seminal fluid has not been possible even in the face of pyosemia and the presence of Chlamydia trachomatis in urine and urethral swab material. The reasons for the inability to culture Chlamydia trachomatis will be explored.

Asymptomatic bacteriospermia in fertile and infertile men

Bacterial flora of the seminal fluid were examined in 430 asymptomatic men. Fertile men had significantly fewer positive cultures than any other group selected from the infertile population. Significantly more bacterial isolates were obtained from patients with a history of genital tract infection than from infertile men without a history of genital tract infection. Asymptomatic bacteriospermia was significantly more common among patients with a history of gonorrhea infection than in any other studied groups. Ureaplasma was isolated with the highest frequency from patients with nonspecific urethritis and/or with gonorrhea. It is proposed that follow-up seminal fluid cultures should be used to determine the end-point in treating male genital tract infections.

Examination of human semen infected with Ureaplasma urealyticum by fluorescence microscopy

Semen specimens from men complaining of involuntary infertility were cultured for Ureaplasma urealyticum and large-colony mycoplasmas. Samples positive for ureaplasmas (but negative for large-colony mycoplasmas) were washed and stained with a DNA-binding fluorochrome (Hoechst No. 33258) and examined by fluorescence microscopy. DNA-containing particles of a size consistent with ureaplasmas were found adherent to the heads and tails of spermatozoa as well as to exfoliated urethral epithelial cells when present. The number of spermatozoa with adherent particles varied widely in different clinical samples, ranging from less than 1% to 20%. In a preliminary study of the possible use of this technique as an aid in diagnosing genital ureaplasma infection, we were able to correctly identify 13 of 15 positive samples prior to culture.

Asymptomatic bacteriospermia in infertile men

The aerobic and anaerobic flora of the semen was examined in 109 men visiting our infertility clinic. Not one specimen was sterile and 107 specimens contained two or more different bacterial species. Anaerobic organisms were found in 63.3% of specimens. We were able to isolate various organisms that have been shown to be spermicidal in vitro (viridans and hemolytic streptococci, Proteus vulgaris and Escherichia coli) from a large number of samples. If the presence of microorganisms in the semen is associated with infertility, it is likely that only certain organisms are involved or that the numbers of organisms must be high for an effect to be seen. The presence of organisms in the semen may also be related to gynecologic infections.

Ureaplasma urealyticum and human infertility: the effect of antibiotic therapy on semen quality

Semen characteristics were evaluated in 64 men visiting our infertility clinic before and after the eradication of genital infection with Ureaplasma urealyticum. Semen quality was also analyzed in 9 men who were unsuccessfully treated for genital Ureaplasma infection, 11 men who had negative cultures and received no treatment, and 11 men who had negative cultures but received empirical antibiotic therapy. A significant improvement in spermatozoal motility (both the speed of forward progession and the percentage of motile cells) was found in the group that was successfully treated for Ureaplasma infection. Improvements were not demonstrated in any of the other patient groups. A correlation was found between improved motility and a decrease in certain abnormal features of seminal cytology that appear to be associated with Ureaplasma genital infection.