Effect of volumetric mixtures of peritoneal and follicular fluid from the same woman on sperm motility and acrosomal reactivity in vitro

Comparison of fallopian tube sperm perfusion and intrauterine tuboperitoneal insemination: a prospective randomized study

OBJECTIVE

To evaluate the results of two different methods of insemination: fallopian tube sperm perfusion (FSP) with 4 mL of inseminate and intrauterine tuboperitoneal insemination (IUTPI) with 10 mL of inseminate.

DESIGN

Prospective randomized clinical study.

SETTING

Private infertility center.

PATIENT(S)

Two hundred seventy-six couples, undergoing 403 cycles, with unexplained infertility, mild or moderate male infertility, or mild or moderate endometriosis.

INTERVENTION(S)

Patients were assigned randomly to either FSP (group A, n = 138) or IUTPI (group B, n = 138) treatment. Both groups followed the same mild ovarian stimulation protocol.

MAIN OUTCOME MEASURE(S)

Ninety-five overall pregnancies: 35 in group A (FSP) and 60 in group B (IUTPI).

RESULT(S)

The pregnancy rate per cycle (presence of gestational sac with heart beats) was 17.6% in group A (n = 199) and 29.4% in group B (n = 204). These differences were statistically significant (P < .007). The odds ratio of getting pregnant, per patient, in group B was 2.26 (95% confidence interval 1.36-3.77) compared with group A.

CONCLUSION(S)

The results of this study indicate that IUTPI may prove to be a useful technique in the treatment of unexplained infertility, mild or moderate male infertility, and mild or moderate endometriosis. Three attempts of IUTPI may be beneficial before moving on to more invasive and expensive methods of assisted reproduction techniques.

Modulation of human sperm function by peritoneal fluid

OBJECTIVE

To examine the effect of peritoneal fluid on various parameters of sperm function in vitro.

DESIGN

Prospective study.

SETTING

Basic research laboratory.

PATIENT(S)

Semen samples were obtained from normozoospermic volunteers (n = 43). Peritoneal fluids were aspirated laparoscopically from women with unexplained infertility (n = 14). Follicular fluid and oocytes were collected from patients undergoing IVF-ET.

INTERVENTION(S)

Sperm incubated under capacitating conditions were exposed to peritoneal fluid, and functional variables were evaluated in vitro.

MAIN OUTCOME MEASURE(S)

Sperm viability and motility, follicular fluid and calcium ionophore-induced acrosome reactions, protein tyrosine phosphorylation, expression of D-mannose binding sites, and ability of sperm to interact with zona pellucida.

RESULT(S)

Exposure of sperm to peritoneal fluid for up to 6 hours did not affect sperm viability or motility. Unlike follicular fluid, peritoneal fluid did not induce the acrosome reaction. Moreover, incubation of sperm with > or =20% v/v peritoneal fluid for 1 hour prevented the follicular fluid and the ionophore-induced acrosome reaction. Although treatment with peritoneal fluid allowed protein tyrosine phosphorylation during capacitation, it resulted in a significant decrease in the expression of D-mannose binding sites and sperm-zona pellucida binding.

CONCLUSION(S)

Peritoneal fluid maintains sperm survival and decreases sperm ability to respond to inducers of the acrosome reaction and bind to the zona pellucida in vitro, indicating that this fluid might modulate sperm function in vivo.

Intraperitoneal insemination in mammals: a review

This review focuses on factors associated with the development of intraperitoneal insemination in mammals. Findings to date indicate that fertility improves as the sperm cell concentration rises, but that the optimal sperm number differs in each species. Sperm washing before intraperitoneal insemination favours fertility. Peritoneal fluid shows a variable effect on spermatozoa, depending on the hormonal status of the female. The optimal time for insemination appears to be just prior to ovulation. The technique may be performed either through the abdominal or the vaginal wall. Verification of sperm deposition in the proximity of the ovaries improves fertility rates. Although associated with some risk of infection and an immune reaction against spermatozoa, the intraperitoneal technique rarely gives rise to severe anaphylactic shock, peritonitis, adhesion formation and the production of anti-sperm antibodies and these complications may be prevented by adequate sperm pretreatment and antibiotic therapy. The success of intraperitoneal insemination in humans, with results comparable with those of intrauterine insemination in the treatment of infertility, suggest the potential use of this technique in domestic mammals, especially in those in which intrauterine insemination poses practical difficulties. Some of the methods applied in human intraperitoneal insemination, such as confirming the position of the needle in the peritoneal cavity, and sperm pre-treatments might also improve results in domestic species. Conversely, the use of the animal model should help to develop some aspects of this technique in humans.

Preincubation in peritoneal fluid decreases the follicular fluid-induced acrosomal reactivity of human spermatozoa

The aim of this study was to determine the effects of preincubation in peritoneal fluid on the follicular fluid-induced acrosomal reactivity of human spermatozoa in vitro. Thirty women participating in our IVF-ET program were given a GnRH-analogue, highly purified FSH and hCG in order to induce superovulation. Peritoneal and follicular fluids were aspirated during pick-up laparoscopy, centrifuged, filtered and frozen until use. An aliquot of swim-up suspension from normospermic semen specimens (n = 30) was incubated with peritoneal fluid or HAM-F10 for 30-180 min, and follicular fluid (in volumetric proportion approximately 50/50 with peritoneal fluid) was subsequently added. The percentage of acrosomally-reacted spermatozoa was assessed using the FITC-conjugated Pisum sativum lectin before and after incubation in peritoneal fluid or control medium, as well as after follicular fluid addition. Peritoneal fluid was not able to stimulate acrosomal reactivity; further, preincubation in peritoneal fluid decreased, but not abolished, the follicular fluid-induced acrosomal reactivity. A longer pre-incubation in peritoneal fluid was associated with a lower percentage of reacted spermatozoa in response to the addition of follicular fluid. In conclusion, our data suggest that peritoneal fluid acts maintaining spermatozoa in an unreacted status in the upper female genital tract. After mixing with follicular fluid, a phenomenon that is likely to occur at ovulation, peritoneal fluid reduces, but does not abolish, the stimulating effect of follicular fluid on acrosomal reactivity.

Effect of peritoneal fluid, follicular fluid, and their volumetric mixture on acrosomal reactivity in vitro

OBJECTIVE

To determine the effects of peritoneal and follicular fluids (PFs, FFs) on sperm acrosomal reaction (AR).

DESIGN

Prospective, randomized study.

SETTING

Three hospital-based infertility units.

PATIENTS

Twenty-three women participating in GIFT programs; 23 men participating in AIH programs.

INTERVENTIONS

Hormonal stimulation after buserelin desensitation; laparoscopy 36 hrs after hCG injection.

MAIN OUTCOME MEASURE

Percentage of acrosomally-reacted sperm.

RESULTS

Compared with Earle's medium (control), moderate but significant increases of ARs were observed as function 1) of the relative content of FF in the incubation medium and 2) as function of time (these increases were constantly lower than those registered for the respective positive control, i.e. 2x frozen/thawed sperm). In contrast, when PF alone was present in the incubation medium, no such effects on AR were registered.

CONCLUSIONS

FF and mixtures of PF and FF--but not PF alone--seem to induce some rapid and time-dependent processes which finally lead to an AR. Therefore, and independently on the infertility cause (tubal, male-dependent, unexplained infertility), PF seems able to exert effects on sperm motility (Revelli et al., Fertil. Steril 57, 654-60 [1992]) while maintaining an unreacted sperm status.

Human serum and follicular fluid stimulate hyperactivation of human spermatozoa after preincubation

OBJECTIVE

To test the effects of steroid-containing media such as follicular fluid (FF) and serum and of steroid-free but human protein-rich medium on hyperactivation (HA) of human spermatozoa with and without a preincubation period.

DESIGN

Analysis of HA using a computer-aided sperm analysis system.

SETTING

Academic hospital and andrologic laboratory.

PATIENTS

Twenty-six sperm samples were obtained from 26 different IVF patients.

INTERVENTIONS

None.

RESULTS

After a preincubation period of 3 hours, FF and serum enhanced the HA after 1 hour. A human plasma protein-rich solution did not. Without preincubation, no stimulation of HA was observed.

CONCLUSION

Steroids may be involved in HA, and a preincubation period may be required for an appropriate FF-induced HA.

Immunoglobulins from human follicular fluid induce the acrosome reaction in human sperm

The ability of human follicular fluid (hFF), retrieved from women undergoing IVF to induce the acrosome reaction (AR) in human sperm has been documented by several laboratories. However, the nature of the active factors in the hFF and the physiological meaning of the AR induction are highly controversial. We performed a three step purification scheme for hFF and all the fractions were screened for the AR-inducing activity. AR activity was associated with a protein fraction of M(r) > 180 kD that on further analysis under PAGE was found to be composed by subunits of apparent M(r) 50,000 and 29,000. The N-terminal sequences of these bands showed a 100% homology with the heavy and light chains of human IgG. A polyclonal antibody raised against the purified protein and anti-human IgG were both able to suppress the acrosome reaction-inducing activity of crude hFF. However, neither normal human serum nor a purified preparation of human IgG were able to mimic the AR-inducing activity of hFF. We concluded that the AR-inducing activity of hFF is, at least in part, due to the presence of antisperm antibodies.

Influence of peritoneal fluid from spontaneous and stimulated cycles on sperm motility in vitro

Peritoneal fluids (PFs) from spontaneous (n = 14) and gonadotrophin-stimulated cycles (n = 20) were obtained during diagnostic laparoscopy and gamete intrafallopian transfer (GIFT) procedures, respectively. The effects of these fluids on the linear component of sperm motility and on the percentage of motile spermatozoa were studied in vitro by objective motility assessments and compared to a control medium (B2-Ménézo). Overall, the two types of PFs were found to have rather similar effects on the motility parameters studied. However, the fluids from hormonally-stimulated cycles sustained motility better (i.e., sperm velocity and percentage of motile sperm) and in a rather constant manner as a function of time (narrower range distributions of the motility measurements). Furthermore, it was observed that under identical experimental conditions motility measurements depended not only on the type of PF used but also on the sperm sample. These results suggest that assisted reproduction procedures in which PF is the medium where the gametes eventually meet and interact, such as direct peritoneal insemination (DIPI) or peritoneal oocyte and sperm transfer (POST), could have different success rates if performed in spontaneous rather than in stimulated cycles. At the same time, our results may help to explain why different pregnancy rates were reported in different studies using DIP or POST.