Human sperm hyperactivation and acrosome reaction and their relationships to human in vitro fertilization**Presented in part at the 47th Annual Meeting of The American Fertility Society, Orlando, Florida, October 21 to 24, 1991

Progesterone and estradiol regulate sperm hyperactivation and in vitro fertilization success in mice

Progesterone (P) and 17β-estradiol (Eβ) form the well-known hormone pair that regulates sperm capacitation. Here, we examined the regulatory effects of P and Eβ on sperm hyperactivation in mice and evaluated the in vitro fertilization (IVF) success. Although P enhanced hyperactivation, Eβ dose-dependently suppressed the P-enhanced hyperactivation. Moreover, P increased IVF success, whereas Eβ suppressed the P-induced increase in IVF success in a dose-dependent manner. Thus, P and Eβ competitively regulate hyperactivation and IVF success in mice. Since P and Eβ concentrations generally change during the estrous cycle, sperm are speculated to capacitate in response to the oviductal environment and fertilize the oocyte.

Ovarian odorant-like biomolecules in promoting chemotaxis behavior of spermatozoa olfactory receptors during migration, maturation, and fertilization

Background

Studies have shown that olfactory receptor genes are the largest in the human genome, which are significantly expressed in olfactory and non-olfactory tissues such as the reproductive systems where they perform many important biological functions.

Main body

There is growing evidence that bioactive metabolites from the ovary, follicular fluid, and other parts of the female reproductive tract signal the sperm through a series of signal transduction cascades that regulate sperm migration, maturation, and fertilization processes. Several studies have highlighted the role of G-protein-coupled receptors in these cellular processes. Thus, we aimed to summarize the existing evidence describing the physiological role of most prominent exogenous and endogenous biomolecules found in the female reproductive organ in enhancing the chemotaxis behavior of spermatozoa during migration, maturation, and fertilization and also to elucidate the pathological implications of its dysfunctions and the clinical significance in human fertility.

Short conclusion

In the future, drugs and molecules can be designed to activate these receptors on sperm to facilitate fertility among infertile couples and use as contraceptives.

Human sperm acrosomal status, acrosomal responsiveness, and acrosin are predictive of the outcomes of in vitro fertilization: A prospective cohort study

The sperm acrosome reaction (AR) is a physiological secretory course of membrane fusion and hydrolytic enzymes, as well as matrix protein release, enabling spermatozoa to penetrate the egg surroundings. An instable acrosomal status before a specific stimulus, insufficient acrosomal responsiveness, or inadequate enzymatic activity of acrosomal content can be detrimental to male fertility. This prospective cohort study was designed to determine whether three human sperm acrosome evaluation parameters-including spontaneous AR rate, AR after calcium ionophore A23187 challenge (ARIC) rate, and modified Kennedy acrosin activity-can predict fertilization outcomes in vitro and are correlated with male characteristics. A total of 485 eligible couples undergoing in vitro fertilization (IVF) therapy were included in two phases of this study. In a 'construction phase', three acrosome evaluation parameters were determined simultaneously in 132 cases, whereas in a 'validation phase', the spontaneous AR rate was determined in 353 cases. The results of the 'construction phase' revealed that the spontaneous AR rate was the only significant predictor of fertilization outcome (unadjusted odds ratio [OR] = 0.68, 95% confidence interval [CI]: 0.53-0.88, P =  0.003; adjusted OR = 0.64, 95% CI: 0.43-0.95, P =  0.03), and the cut-off value for total fertilization failure (TFF) prediction, determined by ROC curve analysis, was 9.91%; higher acrosin activity was shown to predict a higher fertilization rate only when patients were divided into groups (≥25 μIU/10⁶ spermatozoa, 14-25 μIU/10⁶ spermatozoa, <14 μIU/10⁶ spermatozoa). The spontaneous AR rate was negatively correlated with sperm motility, forward progression motility, and normal morphology; modified Kennedy acrosin activity was positively correlated with normal morphology; and the ARIC rate was not correlated with any of the male characteristics. A similar result was obtained for the spontaneous AR rate in the 'validation phase', and the cut-off value in predicting TFF was calibrated for 9.52%. Clinically, patients can voluntarily choose spontaneous AR rate alone or in combination with modified Kennedy acrosin activity to predict TFF, and early rescue intracytoplasmic sperm injection (ICSI), half ICSI, or full ICSI should be considered in advance for men with spontaneous AR rates ≥9.52% or spontaneous AR rates ≥9.52% and AE activities <25 μIU/10⁶ spermatozoa.

Quantification of CatSper1 expression in human spermatozoa and relation to functional parameters

STUDY QUESTION

Is CatSper1 expression in human spermatozoa related to semen parameter values and sperm functions?

SUMMARY ANSWER

CatSper1 expression is positively related to progressive and hyperactivated (HA) motility, [Ca(2+)]i responsiveness to progesterone but not the acrosome reaction (AR).

WHAT IS KNOWN ALREADY

The role of cationic channel of sperm (CatSper) in sperm functions is clear in animal models but less defined in human sperm cells. Current knowledge is mostly based on low specificity CatSper inhibitors showing agonistic and toxic effects on human spermatozoa and is thus of little help in clarifying the role of the CatSper channel in human sperm functions.

STUDY DESIGN, SIZE, DURATION

CatSper1 protein expression was evaluated in 115 men undergoing semen analysis for couple infertility. CatSper1 expression was related to routine semen parameters, motility kinematic parameters and basal and progesterone-stimulated [Ca(2+)]i and the AR.

PARTICIPANTS/MATERIALS, SETTING, METHODS

CatSper1 expression was evaluated (n = 85 normozoospermic, n = 30 asthenozoospermic patients) by immunofluorescence coupled to flow cytometry leading to quantitative measurement of the percentage of ejaculated sperm cells expressing the protein. Semen analysis was evaluated according to World Health Organization guidelines. Kinematic parameters were evaluated by a computer-aided sperm analysis system. [Ca(2+)]i was measured by a spectrofluorimetric method in fura-2-loaded spermatozoa. The AR was evaluated in live sperm cells by fluorescent-labeled lectin.

MAIN RESULTS AND THE ROLE OF CHANCE

CatSper1 protein expression in spermatozoa was reduced in asthenozoospermic men (mean ± SD: 53.0 ± 15.5%, n = 30 versus 67.9 ± 17.1% in normozoospermic, n = 85, P < 0.01) and was significantly correlated with progressive (r = 0.36, P < 0.001), total (r = 0.35, P < 0.001) and HA (r = 0.41, P < 0.005) motility. In addition to a higher percentage of spermatozoa not expressing CatSper1, asthenozoospermic men showed a large number of spermatozoa with immunofluorescent signal localized outside the principal piece compared with those in normozoospermia. A significant positive correlation was found between CatSper1 protein expression and the increase of [Ca(2+)]i in response to progesterone (r = 0.36, P < 0.05, n = 40) but not with basal [Ca(2+)]i. No correlation was found with the AR, either basal or in response to progesterone.

LIMITATIONS, REASONS FOR CAUTION

The study is partly descriptive. Furthermore, we cannot rule out the possibility that some round cells remain after a single round of 40% density gradient centrifugation or that this step may have removed some defective or slow swimming sperm, and therefore this preparation may not be representative of the entire sperm sample. Although our data suggest that CatSper1 may be a useful marker for infertility, and a possible contraceptive target, any clinical application is limited without further research.

WIDER IMPLICATIONS OF THE FINDINGS

Our results demonstrate an association of CatSper1 expression with human sperm progressive and HA motility and provide preliminary evidence that lack of expression or mislocalization of CatSper1 in spermatozoa may be involved in the pathogenesis of asthenozoospermia. However, mechanistic studies are needed to confirm that the correlations between CatSper1 expression and sperm functions are causative.

STUDY FUNDING/COMPETING INTERESTS

Supported by grants from Ministry of University and Scientific Research (PRIN project to E.B. and FIRB project to S.M.) and by Regione Toscana (to G.F.). L.T. was recipient of a grant from Accademia dei Lincei (Rome, Italy). The authors have no conflicts of interest to declare.

The clinical significance of calcium-signalling pathways mediating human sperm hyperactivation

STUDY QUESTION

What is the prevalence of defects in the Ca²⁺-signalling pathways mediating hyperactivation (calcium influx and store mobilization) among donors and sub-fertile patients and are they functionally significant, i.e. related to fertilization success at IVF?

SUMMARY ANSWER

This study identifies, for the first time, the prevalence of Ca²⁺ store defects in sperm from research donors, IVF and ICSI patients. It highlights the biological role and importance of Ca²⁺ signalling (Ca²⁺ store mobilization) for fertilization at IVF.

WHAT IS KNOWN ALREADY

Sperm motility and hyperactivation (HA) are important for fertility, mice with sperm incapable of HA are sterile. Recently, there has been significant progress in our knowledge of the factors controlling these events, in particular the generation and regulation of calcium signals. Both pH-regulated membrane Ca²⁺ channels (CatSper) and Ca²⁺ stores (potentially activating store-operated Ca²⁺ channels) have been implicated in controlling HA.

STUDY DESIGN, SIZE, AND DURATION

This was a prospective study examining a panel of 68 donors and 181 sub-fertile patients attending the Assisted Conception Unit, Ninewells Hospital Dundee for IVF and ICSI. Twenty-five of the donors gave a second sample (∼4 weeks later) to confirm consistency/reliability of the recorded responses. Ca²⁺ signalling was manipulated using three agonists, NH₄Cl (activates CatSper via pH), progesterone (direct activation of CatSper channels, potentially enhancing mobilization of stored Ca²⁺ by CICR) and 4-aminopyridine (4-AP) (effect on pH equivalent to NH₄Cl and mobilizes stored Ca²⁺). The broad-spectrum phosphodiesterase inhibitor 3-isobutyl-1-methyxanthine (IBMX), a potent activator of HA was also used for comparison. For patient samples, an aliquot surplus to requirements for IVF/ICSI treatment was examined, allowing direct comparison of Ca²⁺ signalling and motility data with functional competence of the sperm.

MATERIALS, SETTING, METHODS

The donors and sub-fertile patients were screened for HA (using CASA) and changes in intracellular Ca²⁺ were assessed by loading with Fura-2 and measuring fluorescence using a plate reader (FluoStar).

MAIN RESULTS AND THE ROLE OF CHANCE

The relative efficacy of the stimuli in inducing HA was 4-AP >> IBMX > progesterone. NH₄Cl increased [Ca²⁺]_i similarly to 4-AP and progesterone but did not induce a significant increase in HA. Failure of samples to generate HA (no significant increase in response to stimulation with 4-AP) was seen in just 2% of research donors but occurred in 10% of IVF patients (P = 0.025). All donor samples generated a significant [Ca²⁺]_i increase when stimulated with 4-AP but 3.3% of IVF and 28.6% of ICSI patients failed to respond. Amplitudes of HA and [Ca²⁺]_i responses to 4-AP were correlated with fertilization rate at IVF (P= 0.029; P = 0.031, respectively). Progesterone reliably induced [Ca²⁺]_i responses (97% of donors, 100% of IVF patients) but was significantly less effective than 4-AP in inducing HA. Twenty seven per cent of ICSI patients failed to generate a [Ca²⁺]_i response to progesterone (P= 0.035). Progesterone-induced [Ca²⁺]_i responses were correlated with fertilization rate at IVF (P= 0.037) but induction of HA was not. In donor samples examined on more than one occasion consistent responses for 4-AP-induced [Ca²⁺]_i (R² = 0.97) and HA (R² = 0.579) were obtained. In summary, the data indicate that defects in Ca²⁺ signalling leading to poor HA do occur and that ability to undergo Ca²⁺ -induced HA affects IVF fertilizing capacity. The data also confirm that release of stored Ca²⁺ is the crucial component of Ca²⁺ signals leading to HA and that Ca²⁺ store defects may therefore underlie HA failure.

LIMITATIONS, REASONS FOR CAUTION

This is an in vitro study of sperm function. While the repeatability of the [Ca²⁺]_i and HA responses in samples from the same donor were confirmed, data for patients were from 1 assessment and thus the robustness of the failed responses in patients’ needs to be established. The focus of this study was on using 4AP, which mobilizes stored Ca²⁺ and is a potent inducer of HA. The n values for other agonists, especially calcium assessments, are smaller.

WIDER IMPLICATIONS OF THE FINDINGS

Previous studies have shown a significant relationship between basal levels of HA, calcium responses to progesterone and IVF fertilization rates. Here, we have systematically investigated the ability/failure of human sperm to generate Ca²⁺ signals and HA in response to targeted pharmacological challenge and, related defects in these responses to IVF success. [Ca²⁺]_i signalling is fundamental for sperm motility and data from this study will lead to assessment of the nature of these defects using techniques such as single-cell imaging and patch clamping.

STUDY FUNDING/COMPETING INTEREST(S)

Resources from a Wellcome Trust Project Grant (#086470, Publicover and Barratt PI) primarily funded the study. The authors have no competing interests.

Ram Sperm Motility Parameters under The Influence of Epidermal Growth Factor

Epidermal growth factor (EGF) is one of the important cytokines that play a role in fertility. It is known that EGF affects both male and female reproduction, but its effect on sperm parameters is not fully understood. Up to the present, the effect of EGF on ram sperm motility parameters has not been published. We analyzed motility parameters of ejaculates after 24, 48, and 72 hours from the EGF addition. EGF was added to chilled ram sperm at concentrations of 0, 100, 200, and 400 ng·ml⁻¹. Analyses were realized using computer, assisted semen analyzer (CASA)—Hamilton Thorn motility analyzer (version 7). The effect of EGF was already visible after 30 min of incubation. Significant effect on ram sperm total motility and progressive movement was observed at higher EGF concentrations after 48 h of incubation. Our results show that EGF affects sperm motility parameters depending on concentration and time of exposure.

[Sperm hyperactivated motility: influence of the capacitation medium]

OBJECTIVE

Hyperactivation-associated motility is an important marker of capacitation and a prerequisite to fertilization. Computer-Assisted Sperm Analysis (CASA) is a reproducible method that can be used to predict fertilization success, in addition to the migration and survival test. However, published data are contradictory and preparation methods are heterogeneous. Changing one element in the sperm preparation (capacitation medium) may alter its kinetic parameter values.

MATERIAL AND METHOD

This prospective study with two paired series was performed on sperm considered as normal. The sperm preparation was identical up to the second centrifugation, and there after the centrifugate was divided into two groups and suspended either in the capacitating medium Upgraded B2 INRA Medium(R), or in Ferticult Flushing Medium. Measurements were carried out with a Hamilton Thorne Research Analyzer (IVOS v10.9i).

RESULTS

The analysis of the 87 sperm samples included in the study showed differences between the averages of Straight Line Velocity (SLV, p=0.02), Curvilinear Velocity (CLV, p<0.0001), Amplitude of Lateral Head Displacement (ALH, p<0.0001), and algorithmic calculation of the examined hyperactivation (Hyper 5, p<0.0001).

CONCLUSION

The diagnostic validity of hyperactivation motility cannot be dissociated from the preparation conditions. A standardised preparation is a prerequisite for scientific evaluation and validation of this technique. Although higher motility characteristics seem to be desirable in a therapeutic environment, results will have to be validated by clinical tests.

The postwash total progressively motile sperm cell count is a reliable predictor of total fertilization failure during in vitro fertilization treatment

OBJECTIVE

To predict the chance of total fertilization failure (TFF) before the day of ovum pickup with known semen and female variables.

DESIGN

A statistical model was constructed to predict TFF by retrospective analysis (2,366 couples) and subsequently tested on a new IVF population (917 couples).

SETTING

Academic tertiary referral center.

PATIENT(S)

Three thousand three hundred eighty-three couples who underwent an IVF-ET treatment.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

The ability to predict the probability of TFF in IVF.

RESULT(S)

Two variables-postwash total progressively motile sperm cell count (postwash TPMC) and number of follicles-were found to be significant. Taking a probability of 25% as an acceptable risk of TFF, we calculated that a postwash TPMC of <1.1 x 10(6) cells results in a risk of TFF of >25%. Low responders (<4 follicles) needed a postwash TPMC of >2.2 x 10(6) cells to reduce the risk of TFF to <25%. High responders (>15 follicles) needed only 0.35 x 10(6) postwash progressively motile spermatozoa.

CONCLUSION(S)

When postwash TPMC and number of follicles are known and an unacceptable TFF outcome is expected, one can propose an ICSI procedure a few days before the day of ovum pickup.

A new objective method for scoring human sperm hyperactivation based on head axis angle deviation

The aims of the present study were, first to develop a new method for evaluating sperm hyperactivation (HA) based on sperm head axis angle deviation, and second to apply this method in scoring selected sperm populations during capacitation. This was made possible by improving our original superimposed image analysis system (SIAS). The new option on the system enables us to determine the real angular deviation of the entire head in successive superimposed frames. The entire procedure for each spermatozoon requires 10-20 sec, according to the frame/rate utilized. A clear cut-off between the values of hyperactivated, transitional and non-hyperactivated spermatozoa was found at 11 and 21 frames/sec. However, at 6 frames/sec, a partial overlap between the three classes was found. We defined sperm activity as follows. At 11 frames/sec, hyperactivated: angle sum > or = 405 degrees; transitional: 200 degrees < or = angle sum < 405 degrees. At 21 frames/sec, hyperactivated: angle sum > or = 760 degrees; transitional: 350 degrees < or = angle sum < 760 degrees. The results, in agreement with previous research, show the peaks of activity at 3 h, dropping to a minimum at 6 h. This phenomenon was significantly more evident in fertile compared with subfertile semen samples.

Objective evaluation of hyperactivated motility in rat spermatozoa using computer-assisted sperm analysis

The aim of this study was to use computer-assisted sperm analysis (CASA) to examine changes in motion parameters of rat spermatozoa incubated under culture conditions that support IVF. Rat cauda epididymal spermatozoa were evaluated in six replicate experiments, at 0 and 4h of incubation. CASA was conducted at 60 Hz on digital 1s tracks ( approximately 100 spermatozoa/rat). Mean values of CASA parameters that describe the vigour of spermatozoa [curvilinear velocity (VCL), amplitude of lateral head displacement (ALH) and beat cross frequency (BCF)] increased, while those indicating progressiveness [straight line velocity (VSL), linearity (LIN) and straightness (STR)] decreased between 0 and 4 h. Visual inspection of sperm tracks after 4 h of incubation revealed classical hyperactivation patterns. Bivariate models were evaluated to objectively define the subpopulation of hyperactivated (HA) spermatozoa. Of all models considered, ALH and LIN, VCL and LIN, BCF and LIN, VCL and BCF, and VCL and ALH showed significant changes in the percentage of HA spermatozoa after the 4 h incubation period. The efficacy of detecting HA spermatozoa was evaluated using sperm tracks that were visually classified as HA or progressive. VCL and LIN provided the most accurate prediction of HA spermatozoa. It was concluded that analysis of CASA data using bivariate models could be used to detect and monitor hyperactivation in rat spermatozoa.

Effect of cooling rates on post-thaw sperm motility, membrane integrity, capacitation status and fertility of dairy bull semen used for artificial insemination in Sweden

We studied the effects of 2 different cooling rates during equilibration of semen from room temperature to 4 degrees C, at 4.2 degrees C/min (control split sample) or at 0.1 degree C/min (treatment split sample) on in vitro sperm viability post thawing and fertility after AI. Forty batches of split-frozen semen from 14 dairy bulls (Swedish Red and White breed) aged 14 to 16 m.o. or 66 to 79 m.o. were evaluated post-thawing for sperm motility (visual and computer-assisted sperm analysis [CASA], membrane integrity (fluorescent microscopy and flow cytometry post-loading with the combined fluorophores Calcein AM/EthD-1 and SYBR-14/PI); acrosomal status (with Pisum sativum agglutinin [PSA] staining); and capacitation status (CTC-assay). Fertility values (56-d nonreturn rate) of the slow cooling batches (treatment) were 0.4% units higher than for faster cooled (control) batches, but the difference was not statistically significant. Fertility values for the older bulls were 1.6% units higher than for the group of younger sires. No statistically significant correlations were found between semen viability parameters assessed in vitro and 56-d nonreturn rate. Visually assessed sperm motility, membrane integrity, capacitation and acrosomal status post-thawing did not differ significantly between cooling procedures, however the percentage of motile spermatozoa and the kinetic characteristics of spermatozoa--average path velocity (VAP), straight path velocity (VSL) and curvilinear velocity (VCL)--assessed by CASA differed significantly between cooling procedures. The results indicate that most of the in vitro sperm viability parameters post-thawing and the fertility results for bulls after AI did not differ significantly between the 2 semen cooling procedures tested.

Relationship between human sperm lipid peroxidation, comprehensive quality parameters and IVF outcome

The membranes of human spermatozoa contain an extremely high concentration of polyunsaturated fatty acids and are therefore susceptible to lipid peroxidation damage. The aim of this study was to retrospectively determine the association between the lipid peroxidation levels of washed spermatozoa, as indicated by thiobarbituric-acid-reactive substance concentration, and: (a) semen quality evaluated by basic routine, biochemical, cytological and quantitative ultramorphological analyses; (b) IVF fertilization rate. Semen samples from 45 male partners of couples who had been referred for IVF treatment due to a female infertility factor were evaluated for quality as well as for thiobarbituric-acid-reactive substance concentrations. The latter were found to have a negative correlation with total sperm count, semen volume, zinc/fructose ratio, and the integrity of sperm acrosome and axonema. It was suggested that lipid peroxidation has a deleterious effect on the ultramorphological status of the sperm cells and, thereby, on the male fertilization potential. The content of the seminal fluid, about 30% of which is produced by the prostate, may protect spermatozoa from this destructive process. A negative correlation was also found between thiobarbituric-acid-reactive substance concentrations and IVF fertilization rate. When the patients were subdivided into fertilizing (fertilization rate > 0%) and nonfertilizing (fertilization rate = 0%) subgroups (n = 33 and n = 12, respectively), the former exhibited significantly lower thiobarbituric-acid-reactive substance concentrations than the latter. A new IVF fertilization index based on the lipid peroxidation level was established. This index had a predictive power of 93% (94% sensitivity and 92% specificity). The clinical value of this index should be further verified.

A lineal equation for the classification of progressive and hyperactive spermatozoa

Capacitation of spermatozoa, a complex sequence of events that render them able to fertilize the egg, is generally associated with a switch from lineal, progressive movement to a vigorous, non-progressive pattern characterized by starlike tracks, a process known as hyperactivation. Development of a method for the analysis of progressive and hyperactive tracks is thus important for the assessment of capacitation in biochemical, physiological and clinical studies. In this study, we have applied a two-step heuristic model to deduce a lineal equation that discriminates hyperactive from progressive spermatozoa. The kinetic parameters (curvilinear velocity (VCL), linearity (LIN), amplitude of lateral head displacement (ALH), straightness (STR), wobble (WOB), mean 'dance' (DAN) and velocity of the average path (VAP)) of ram spermatozoa were evaluated with a computerized motility analyzer, and classified one by one as progressive or hyperactive by the appearance of their tracks. In a first step, a discriminating plane was defined by minimizing the number of misclassified spermatozoa ('conflicting points'); then, the plane was adjusted by an iterative process to minimize the distance from conflicting points to it. The resulting plane showed a discriminating capacity of over 95% for both classes, higher than that achieved by setting a threshold value for the parameters taken separately or in group. When included in a standard semen analysis, application of the equation allowed a rapid assessment of the percentage of hyperactive spermatozoa. The method described, developed in ram spermatozoa, can be applied to different species for a variety of purposes.

Effect of increased scrotal temperature on sperm production in normal men

OBJECTIVE

To determine whether application of polyester-lined athletic supports to bring the testes closer to the abdomen increases scrotal temperature and decreases sperm production.

DESIGN

Prospective clinical study.

SETTING

University academic medical center.

PATIENT(S)

Twenty-one healthy male volunteers.

INTERVENTION(S)

The study consisted of a pretreatment period of 6 weeks, a treatment phase of 52 weeks, and a recovery phase until return to normal sperm production. During the treatment phase, the men wore polyester-lined athletic supports (single layer, double layer, or double layer impregnated with aluminum) throughout the day.

MAIN OUTCOME MEASURE(S)

Semen parameters and sperm function tests.

RESULT(S)

In all three groups of subjects, scrotal temperature was consistently increased by 0.8 to 1 degree C while the subjects were wearing the athletic supports. Mean sperm concentration; sperm motility, morphology, and viability; sperm hyperactivation; and ability of spermatozoa to penetrate zone-free hamster oocytes were not affected by the increase in scrotal temperature.

CONCLUSION(S)

The increase in scrotal temperature induced by polyester-lined athletic supports was insufficient to cause significant suppression of spermatogenesis or alteration of sperm function.

Oligozoospermia induced by exogenous testosterone is associated with normal functioning residual spermatozoa

OBJECTIVE

To determine the functional capacity of residual spermatozoa in semen samples from normal men with T enanthate-induced oligozoospermia.

DESIGN

Prospective clinical study.

SETTING

Academic research center.

PATIENT(S)

Twelve healthy men were studied while participating in a multicenter T enanthate contraceptive efficacy study. Data were analyzed from only eight subjects, whose sperm concentrations were between 1.3 and 10 x 10(6)/mL at the suppression phase.

INTERVENTION(S)

Testosterone enanthate (200 mg) was administered IM weekly during the suppression and treatment (efficacy) phases (total 15 months).

MAIN OUTCOME MEASURE(S)

Sperm function tests (stimulated acrosome reaction, sperm hyperactivation [HA], and zona-free hamster oocyte penetration tests) were performed during the pretreatment, suppression (usually after 6 to 10 weeks of treatment, when sperm concentration was anticipated to decrease to < 10 x 10(6)/mL), and recovery phases. Studies were not done during the contraceptive efficacy phase because only one of the subjects was not azoospermic.

RESULT(S)

Mean sperm concentration was reduced but sperm motility, motility characteristics, and morphology were not affected by T enanthate treatment. The residual spermatozoa in the ejaculate could acrosome react, exhibited normal HA, and maintained the capacity to penetrate and fuse with the oocyte.

CONCLUSION(S)

Suppression of spermatogenesis to moderate oligozoospermia (< 10 x 10(6)/mL) with exogenous T enanthate administration was not associated with impaired sperm function of the residual spermatozoa. The study did not exclude the possibility that disorders of sperm function might occur when spermatogenesis is suppressed further to very severe oligozoospermia (< 1 x 10(6)/mL), commonly observed in hormonal male contraceptive clinical trials.

Assessment of hyperactivation, acrosome reaction and motility characteristics of spermatozoa from semen of men of proven fertility and unexplained infertility

Semen from men of proven fertility was compared with that of men with unexplained infertility to determine differences in spermatozoal functions such as hyperactivation and acrosome reaction and spermatozoal motility characteristics. The hyperactivated spermatozoa in both groups could be visualised on the monitor of the Computer Assisted Semen Analyser and they exhibited 'circling', 'thrashing', 'starspin' and 'helical' motility patterns and the mean hyperactivation rates were not significantly different. However, 20% of the men with unexplained infertility did not exhibit hyperactivation compared to only 4% in the fertile group. Furthermore, the semen from infertile men when evaluated for hyperactivation could be categorised into two groups with those having lower hyperactivation (< 10% or < 6% after 4 and 6 h of incubation respectively), forming the first group, and those having a higher hyperactivation rate constituting the second group. In the fertile men such distinct groups were not visible and the percentage hyperactivation ranged from 1 to 16%. No significant differences were observed in the rate of acrosome reaction of fertile and unexplained infertile men. The non-hyperactivated spermatozoa from unexplained infertile men showed a significant increase in path velocity (VAP), curvilinear velocity (VCL) and amplitude of lateral head displacement (ALH) and a decrease in linearity (LIN) and straightness (STR) compared to spermatozoa from fertile men. Furthermore, the hyperactivated spermatozoa from infertile men also showed an increase in progressive velocity (VSL) (only after 2 h of incubation) and LIN and decrease in ALH and beat cross frequency (BCF) compared to spermatozoa from fertile men. The results are discussed in the light of the importance of the above spermatozoal functions and spermatozoal parameters in fertilization.

Prognostic value of objective semen parameters in an in vitro fertilization program

PURPOSE

The basic semen parameters seem to have a limited predictive value in male fertility. Could other objective sperm analyses be helpful in the choice of the most adapted assisted procreation technique?

METHODS

This study concerns 78 infertile couples with insemination failures. For each semen, 21 objective parameters are analyzed in fresh semen and after sperm selection procedure. The 78 couples are then included in an IVF protocol and classified into two groups: fertile (at least one cleaved embryo is obtained) and infertile.

RESULTS

Using multiple variant discriminant factorial analysis, we have found nine nonconventional parameters which induce us to define two classes of semen. These two classes fit with the classification into fertile and infertile groups in 74.4% of the cases.

CONCLUSIONS

So these parameters allow us to predict the chance of obtaining embryos during an IVF trial and to choose for each couple the most appropriate technique: IVF or ICSI.

The effect of 12-myristate 13-acetate phorbol ester on human sperm hyperactivation

OBJECTIVE

To determine whether 12-myristate 13-acetate phorbol ester (PMA) can increase hyperactivated motility of human sperm.

DESIGN

A controlled pharmacological study using computer-assisted semen analysis.

SETTING

Andrology laboratory in a medical research institution.

PATIENT(S)

Normal semen was obtained from 48 men.

INTERVENTION(S)

Washed sperm were exposed to different concentrations of PMA alone or with P and pentoxifylline (PTX) for up to 2 hours and sperm motility measured by a computer-assisted semen analyzer.

MAIN OUTCOME MEASURE(S)

The percentage of sperm with hyperactivated motility was determined from the motility parameters: curvilinear velocity, linearity, and maximum amplitude of lateral head displacement.

RESULT(S)

Phorbol ester PMA increased hyperactivated motility in a dose- and time-dependent manner. At 1 hour, the average increases in hyperactivated motility were as follows: 2 microM, 4.8% +/- 1.5%; 6 microM, 9.6% +/- 1.5%; and 20 microM, 11.3% +/- 2.2%. The PMA effect was not altered when P or PTX were added although each separately had a positive effect on hyperactivation.

CONCLUSION(S)

Phorbol ester PMA stimulates human sperm hyperactivated motility, indicating the involvement of protein kinase C in the signal transduction pathway.

Comparative flow cytometric analysis of the human sperm acrosome reaction using CD46 antibody and lectins

PURPOSE

Our purpose was to determine the most suitable marker for the human sperm acrosome reaction, based on detection of CD46 antibody binding compared with lectin binding.

METHODS

Flow cytometric analysis of CD46 antibody versus lectins (PNA, PSA, and Con A) was used to quantify the acrosome reaction of human sperm.

RESULTS

Neither PSA nor Con A was able to detect significant changes in the spontaneous and ionophore-induced acrosome reactions compared to CD46 antibody. However, PNA was found to exhibit a binding pattern similar to that observed with CD46 and could be used to quantify measurable changes in acrosomal response to ionophore, albeit of a lower magnitude than the responses detected by CD46.

CONCLUSIONS

We conclude that PNA binds to the inner acrosomal membrane of acrosome-reacted sperm and is suitable for use as a marker of the acrosome reaction by flow cytometry. Data are presented which clarify the assessment of the acrosome reaction when CD46 and lectins are used.

A double-blind randomized placebo cross-over controlled trial using the antioxidant vitamin E to treat reactive oxygen species associated male infertility

OBJECTIVE

To determine the effectiveness of the in vivo administration of vitamin E as treatment for reactive oxygen species-associated male infertility.

SETTING

University-based center for reproductive medicine.

DESIGN

Double-blind randomized placebo cross-over controlled trial.

PATIENTS, PARTICIPANTS

Thirty healthy men with high levels of reactive oxygen species generation in semen and a normal female partner.

INTERVENTIONS

Patients were allocated to two groups according to the blinded randomization. Each patient received either 600 mg/d of vitamin E (Ephynal, 300 mg tablets; F. Hoffman-La Roche Ltd., Basle, Switzerland) (order A) or identical placebo tablets (order B) for 3 months. Then after a 1-month wash-out period the patients were crossed-over to the other treatment.

MAIN OUTCOME MEASURES

Improvement in the in vitro function of the spermatozoa measured by conventional semen analysis, computerized motility assessment, determination of reactive oxygen species generation, binding to the zona pellucida of the unfertilized human oocyte in a competitive zona binding assay, development of hyperactivated motility (both spontaneous and in the presence of 20% of the natural agonist, human follicular fluid) and pregnancy.

RESULTS

Rise in the blood serum vitamin E levels after treatment accompanied by improvement in one of the sperm function tests: the zona binding assay. The zona binding ratio for order A improved from 0.2 (range 0 to 0.5) before treatment to 0.5 (range 0.1 to 1.0) after treatment, the corresponding values for order B were 0.2 (range 0 to 1.0) before treatment and 0.3 (range 0.1 to 0.7) after treatment.

CONCLUSION

Oral administration of vitamin E significantly improves the in vitro function of human spermatozoa as assessed by the zona binding test.

Evaluation of the CellTrak computer-assisted sperm analysis system in comparison to the Cellsoft system to measure human sperm hyperactivation

OBJECTIVE

To measure and compare sperm hyperactivation (HA) and associated motility parameters using the CellTrak (Motion Analysis Corporation, Santa Rosa, CA) and Cellsoft (Cryo Resources, New York, NY) Computer-Assisted Sperm Analysis (CASA) Systems. The accuracy of the CellTrak system also was assessed by repeated measurements of the same sample.

SETTING

A university-affiliated tertiary care center.

PATIENTS

Normal healthy volunteers.

MAIN OUTCOME MEASURES

We assessed sperm motion parameters and HA.

RESULTS

The measurements of percent spermatozoa with star and/or transitional pattern of HA showed high within-sample variations, especially in samples showing low levels of percent spermatozoa with HA. This was due to the comparatively low numbers of hyperactivated spermatozoa that were present and counted in a sample. Excellent agreement between the two systems was observed for all parameters except for measurements of curvilinear velocity, percent spermatozoa with star-spin hyperactivity, and percent spermatozoa with transitional hyperactivity. The difference might be due to CellTrak's higher level of accuracy in determining velocity.

CONCLUSIONS

The CellTrak system effectively measures human sperm HA provided adequate numbers of motile spermatozoa are analyzed. Although it suffers from the same limitations common to all CASA systems, it is more accurate than the Cellsoft system.

Use of postseparation sperm parameters to determine the method of choice for sperm preparation for assisted reproductive technology

OBJECTIVE

To evaluate strict sperm morphology after preparation of semen specimens using three different sperm separation techniques, since strict morphology correlates well with IVF.

DESIGN

Semen from 30 men were analyzed before and after sperm separation using mini-Percoll gradient, direct swim-up, and SpermPrep filtration column (ZBL, Inc., Lexington, KY) methods.

SETTING

Assisted Reproductive Technology laboratory at Sinai Hospital of Baltimore.

MAIN OUTCOME MEASURES

Primary end points measured were percent morphologically normal sperm and percent improvement in sperm morphology, using Kruger strict criteria. Secondary factors determined were percent motility, improvement in motility, hypoosmotic swelling, improvement in hypoosmotic swelling, and 24- and 48-hour sperm survival under simulated IVF conditions.

RESULTS

Mini-Percoll produced specimens with significantly greater normal sperm morphology, morphology improvement, motility, hypoosmotic swelling, and survival than obtained with the other two separation methods. For 25 of 30 specimens, mini-Percoll yielded the greatest number of morphologically normal, motile sperm that survived for 24 hours. In four instances, mini-Percoll was associated with an increased percentage of acrosomal abnormalities despite an overall improvement in morphology. Hypoosmotic swelling scores were lower in two subjects after mini-Percoll sperm separation and in three subjects for each of the other methods.

CONCLUSIONS

Data suggest that mini-Percoll is superior to swim-up or SpermPrep for producing specimens with enhanced morphology, motility, and in vitro survival. However, no single separation technique is always superior, and methodology may induce damage to the acrosome or sperm membranes. Sperm specimens should be evaluated individually to determine the best separation method before actual ART cycles. The technique that yields the most morphologically normal, motile sperm that survive in culture should be used for ART procedures.

The effect of pentoxifylline on in-vitro fertilization in the presence of anti-sperm antibodies

In cases of severe immunological male-factor infertility, impairment of spermatozoal motility and of acrosome reaction resulting in reduced fertilization capacity have been described by several authors. The present study investigated the use of pentoxifylline in enhancing in-vitro fertilization (IVF) in the presence of anti-sperm antibodies. Thirty-seven IVF cycles were conducted in 28 different couples suffering from immunological male-factor infertility with at least 50% antibody-coated spermatozoa. Sibling oocytes were inseminated at random with spermatozoa incubated with or without 3.6 mM pentoxifylline after selection by a Percoll gradient. No difference in motility of the final sperm preparations was observed prior to insemination. Fertilization rate, cleavage rate and embryo quality were similar in both treatment and control groups. Nine out of ten pregnancies were achieved after the replacement of embryos both from the treatment and control group. Although pentoxifylline is known to enhance motility in-vitro and to promote induced acrosomal loss, its indiscriminate use failed to improve IVF performance in patients with anti-sperm antibodies. Further research may be necessary in order to elucidate whether a given subpopulation of these patients may benefit from a selective application of pentoxifylline.

Human sperm movement assessed with the Hamilton-Thorn motility analyzer and in vitro fertilization

The relationship between sperm movement characteristics obtained by computerized analysis and the in vitro fertilization rates of human oocytes was studied. In 144 consecutive in vitro fertilization treatments a sample of prepared semen was analysed by a Hamilton-Thorn Motility Analyzer. In addition a visual estimation of sperm count and motility was made. Significant correlations with the fertilization rate were found for all visual parameters. Of the computerized measurements, the mean velocities of motile spermatozoa and the concentration of motile cells were significantly correlated. The average path velocity correlated best (r = 0.42, P < 0.001). There was no relationship between the percentage of motile sperm showing hyperactivated movement and the fertilization rate. A forward stepwise logistic regression analysis selected the following variables of predictive value for fertilization: average path velocity, male factor infertility as indication for in vitro fertilization, motility and concentration, as measured by the Hamilton-Thorn analyzer. A logistic regression model to predict the cases with low (< 0.2) or high fertilization rates, included the average path velocity as a significant variable and classified the samples with 90% overall accuracy.

IN CONCLUSION

movement characteristics of spermatozoa in culture medium, especially the average path velocity are of prognostic value in prediction of human oocyte fertilization rates.