Clinical assessment of the male fertility

Raman spectroscopy: A promising analytical tool used in human reproductive medicine

Over the past few years, there has been growing interest in developing new methods of embryo quality assessment to improve the outcomes of assisted reproductive technologies in the medical field. Raman microscopy as an increasingly promising analytical tool has been widely used in life sciences, biomedicine and "omics" to study molecular, biochemical components, living cells and tissues due to the label-free and non-destructive nature of the imaging technique. This paper reviews the analytical capability of Raman microscopy and applications of Raman spectroscopy technology mainly in reproductive medicine. The purpose of this review is to introduce the Raman spectroscopy technology, application and underlying principles of the method, to provide an intact picture of its uses in biomedical science and reproductive medicine, to offer ideas for its future application, verification and validation. The focus is on the application of Raman spectroscopy in the reproductive medicine field, including the application in gametes, embryos and spent embryo culture media.

The association between hepatitis B virus and semen quality: a systematic review and meta-analysis

BACKGROUND

Some studies have suggested that hepatitis B virus (HBV) infection had a negative association with semen quality, but the conclusions have been inconsistent. The purpose of our study was to systematically assess the association between HBV infection and semen parameters.

METHODS

We searched electronic databases for studies published from January 1980 to August 2023. Eleven studies were included in the analysis. Primary outcomes were semen volume, sperm concentration, sperm morphology, sperm motility and sperm progressive motility. We also conducted a subgroup analysis between China and other countries.

RESULT

Compared with the semen quality of HBV-negative men, HBV infection had a negative association with semen volume (MD: -0.20 mL, 95%CI: -0.32 to - 0.09, P = 0.0004), sperm concentration (MD: -4.46 × 106/mL, 95%CI: -7.09 to - 1.84, P = 0.0009), sperm morphology (MD: -2.49%, 95%CI: -4.35 to - 0.64, P = 0.008), sperm motility (MD: -6.85%, 95%CI: -11.53 to - 2.18, P = 0.004), and sperm progressive motility (MD: -6.63%, 95%CI: -10.24 to - 3.02, P = 0.0003). However, HBV infection had no significant association with total sperm count (MD: -31.50 × 106, 95%CI: -74.11 to 11.10, P = 0.15). The association between HBV and semen quality were inconsistent between the subgroups.

CONCLUSION

HBV infection had a negative association with sperm concentration, motility, morphology, and semen volume. However, The association between HBV and total sperm count remain unclear. This metaanalysis suggests that we should pay attention to the adverse effect of HBV on sperm quality, and several studies have reported the relevant mechanisms. But due to the significant heterogeneity among studies on some semen parameters, further large and well-designed researches are needed before introducing clinical management recommendations.

Normospermic Patients Infected With Ureaplasma parvum: Role of Dysregulated miR-122-5p, miR-34c-5, and miR-141-3p

Background

Ureaplasma parvum (UP) is a causative agent of non-gonococcal urethritis, involved in the pathogenesis of prostatitis and epididymitis, and it could impair human fertility. Although UP infection is a frequent cause of male infertility the study evidence assessing their prevalence and the association in patients with infertility is still scarce. The molecular processes leading to defects in spermatozoa quality are not completely investigated. MicroRNAs (miRNAs) have been extensively reported as gene regulatory molecules on post-transcriptional levels involved in various biological processes such as gametogenesis, embryogenesis, and the quality of sperm, oocyte, and embryos.

Methods

Therefore, the study design was to demonstrate that miRNAs in body fluids like sperm could be utilized as non-invasive diagnostic biomarkers for pathological and physiological conditions such as infertility. A post-hoc bioinformatics analysis was carried out to predict the pathways modulated by the miRNAs dysregulated in the differently motile spermatozoa.

Results

Here it is shown that normospermic patients infected by UP had spermatozoa with increased quantity of superoxide anions, reduced expression of miR-122-5p, miR-34c-5, and increased miR-141-3p compared with non-infected normospermic patients. This corresponded to a reduction of sperm motility in normospermic infected patients compared with normospermic non-infected ones. A target gene prediction presumed that an essential role of these miRNAs resided in the regulation of lipid kinase activity, accounting for the changes in the constitution of spermatozoa membrane lipids caused by UP.

Conclusions

Altogether, the data underline the influence of UP on epigenetic mechanisms regulating spermatozoa motility.

Expression of sperm microRNAs related to bull fertility: A systematic review

In this study we proposed to address the following question: "Are there differentially expressed sperm microRNAs related to fertility in bulls?". A systematic review of scientific literature until November 2022 was performed, in accordance with PRISMA guidelines. The main outcome was differentially expressed sperm microRNA from bulls with low versus high fertility profiles identified by using different methods such as field fertility evaluation and sperm laboratory analysis. Were identified 786 documents, of which 13 were selected for qualitative analysis. A total of 182 unique differentially expressed miRNAs were identified, among these, 49 miRNAs were found in common between at least two studies. It is believed that from these 49 miRNAs, it is possible that miRNAs such as miR-10a, -10b, -103, -15b, -122, -125b, -126-5p, -151-5p, -193a-5p, -196a, -27a-5p and -99b could be potential universal biomarkers to assess the reproductive potential of males.

Differential Proteomic Analysis of Human Sperm: A Systematic Review to Identify Candidate Targets to Monitor Sperm Quality

PURPOSE

The advent of proteomics provides new opportunities to investigate the molecular mechanisms underlying male infertility. The selection of relevant targets based on a single analysis is not always feasible, due to the growing number of proteomic studies with conflicting results. Thus, this study aimed to systematically review investigations comparing the sperm proteome of normozoospermic and infertile men to define a panel of proteins with the potential to be used to evaluate sperm quality.

MATERIALS AND METHODS

A literature search was conducted on PubMed, Web of Science, and Scopus databases following the PRISMA guidelines. To identify proteins systematically reported, first the studies were divided by condition into four groups (asthenozoospermia, low motility, unexplained infertility, and infertility related to risk factors) and then, all studies were analysed simultaneously (poor sperm quality). To gain molecular insights regarding identified proteins, additional searches were performed within the Human Protein Atlas, Mouse Genome Informatics, UniProt, and PubMed databases.

RESULTS

Thirty-two studies were included and divided into 4 sub-analysis groups. A total of 2752 proteins were collected, of which 38, 1, 3 and 2 were indicated as potential markers for asthenozoospermia, low motility, unexplained infertility and infertility related to risk factors, respectively, and 58 for poor sperm quality. Among the identified proteins, ACR, ACRBP, ACRV1, ACTL9, AKAP4, ATG3, CCT2, CFAP276, CFAP52, FAM209A, GGH, HPRT1, LYZL4, PRDX6, PRSS37, REEP6, ROPN1B, SPACA3, SOD1, SPEM1, SPESP1, SPINK2, TEKT5, and ZPBP were highlighted due to their roles in male reproductive tissues, association with infertility phenotypes or participation in specific biological functions in spermatozoa.

CONCLUSIONS

Sperm proteomics allows the identification of protein markers with the potential to overcome limitations in male infertility diagnosis and to understand changes in sperm function at the molecular level. This study provides a reliable list of systematically reported proteins that could be potential targets for further basic and clinical studies.

Development of a biomolecular approach to identify sperm functions and fertility using sperm RNAs

Infertility affects a significant percentage of couples worldwide, and male factors contribute significantly to this problem. Traditional assessments of male fertility rely primarily on parameters such as sperm motility, morphology, viability, and concentration. However, these metrics often do not provide a comprehensive understanding of sperm function, which is critical not only for fertilization but also for successful embryo development. Herein, we used porcine spermatozoa as a model to investigate the potential of sperm RNA markers in assessing various aspects of sperm function from motility to fertility. Using artificial insemination, we evaluated male fertility based on the litter size of sows inseminated with sperm from 20 boars. In addition, we measured parameters such as weaning rate, death births, live births, and mummy births. Sperm functional parameters, including motility and kinematics, were assessed before and after in vitro capacitation. Finally, correlations between various sperm functional parameters and sperm RNA markers were explored. Our results revealed interesting relationships between sperm functional parameters. While motility and kinematics were correlated, they were not correlated with sperm capacitation status. Surprisingly, no significant correlations were found between these parameters and male fertility. However, specific parameters of sperm capacitation status after in vitro capacitation were correlated with weaning rate and live births, highlighting their importance in predicting successful fertilization. Further analysis of sperm RNA markers identified genes related to male fertility, including IZUMO1, known for its role in sperm-egg fusion. These genes showed correlations with motility, capacitation, and fertilization parameters, shedding light on their potential roles in sperm function. In conclusion, our study demonstrates that sperm RNA markers hold promise for the diagnosis and prognosis of various aspects of sperm function, providing valuable insights into male infertility. These markers may serve as diagnostic tools to improve our understanding of male fertility problems, ultimately benefiting couples struggling with infertility.

The Dutch Pregnancy Drug Register: Suitable to Study Paternal Drug Exposures?

Paternal medication use around the time of conception is common, but information about its effects on pregnancy outcome and the health of the child is generally limited. The aim of this study is to examine the feasibility of studying paternal exposure in the Dutch Pregnancy Drug Register by using immunosuppressants as a proof of concept. In 113 of 15,959 pregnancies, long-term paternal immunosuppressant use was reported 3 months before conception. In total, 134 immunosuppressants were used. Pregnancy outcome was known for 54 cases and was in accordance with previous findings. Two spontaneous abortions, two premature births, six small for gestational age babies, and two major congenital malformations were reported. Time to pregnancy (TTP) was known for 9548 pregnancies, including 89 with paternal immunosuppressant use. TTP analysis did not show a difference in pregnancies with paternal immunosuppressant use compared to the control group. Moreover, the number of fertility treatments in the paternal immunosuppressant group was similar to the control group. In our opinion, it is feasible to use the Dutch Pregnancy Drug Register to study the effects of paternal exposure on pregnancy outcome. However, to study the potential effects on fertility, more information is needed, particularly since the beginning of pregnancy attempts.

Understanding the Male Perspective: Evaluating Quality of Life and Psychological Distress in Serbian Men Undergoing Infertility Treatment

The experience of an infertility diagnosis and treatment imposes a profound burden on affected individuals, encompassing not only physical and medical aspects but also a plethora of psychological, social, and emotional factors. By employing a multimodal assessment featuring validated self-report questionnaires, physical measurements, and clinical records, the present study aimed to explore the quality of life and psycho-emotional distress of men undergoing infertility treatment in Serbia, thereby addressing the dearth of research on the underrepresented male perspective in this domain. Findings revealed diverse semen abnormalities among participants (n = 96, average age 37.69 ± 5.72), with significant associations between longer treatment durations and reduced sperm motility. The observed rates of men surpassing predetermined DASS-42 questionnaire thresholds for depression, anxiety, and stress in the analyzed cohort were 13.54%, 11.46%, and 22.92%, respectively. Summary scores in conceptual areas comprised in the SF-36 questionnaire ranged from 49.00 ± 6.25 for the mental health dimension to 90.16 ± 17.75 obtained in the physical functioning subscale. Patients with a longer treatment duration demonstrated lower scores in the role emotional domain, indicative of a less favorable emotional state. Expectedly, inverse correlations were found between the SF-36 mental health score and DASS-42 subscales. By addressing the existing knowledge gap and highlighting the unique needs of infertile men, the finding of this study may contribute to a more inclusive and holistic approach to infertility research and management.

Boar fertility is controlled through systematic changes of mitochondrial protein expression during sperm capacitation

Vigorous activation of mitochondria in spermatozoa during capacitation induces the biological and morphological changes of spermatozoa to acquire fertilizing ability. To in-depth understand the dynamic roles of mitochondrial and male fertility, this study was to identify how the mitochondrial proteins are changed during sperm capacitation and regulate male fertility using boar spermatozoa. The mitochondrial proteins were differentially changed during sperm capacitation according to fertility status, i.e., superior litter size (SL) and normal litter size (NL). Following sperm capacitation, ubiquitin-cytochrome c reductase core protein (UQCRC1) and ATP synthase F1 (ATP5F1) increased in NL, while cytochrome c oxidase subunit 5B (COX5B), and cytochrome c1 (CYC1) proteins decreased. In contrast, only and ubiquinone oxidoreductase core subunit 8 (NDUFS8) protein was increased in SL following capacitation. The protein expression difference value of CYC1, COX5B, and NDUFS8 following sperm capacitation was lower in NL than SL boars. Based on these complicated changes during sperm capacitation, the accuracy for predicting male fertility of NDUFS8 was increased to 87 %. Overall, considering the systematic orchestration of mitochondrial protein expression according to sperm capacitation status, it will be possible to better understand male fertility.

Sperm selection by the oviduct: perspectives for male fertility and assisted reproductive technologies†

The contribution of sperm to embryogenesis is gaining attention with up to 50% of infertility cases being attributed to a paternal factor. The traditional methods used in assisted reproductive technologies for selecting and assessing sperm quality are mainly based on motility and viability parameters. However, other sperm characteristics, including deoxyribonucleic acid integrity, have major consequences for successful live birth. In natural reproduction, sperm navigate the male and female reproductive tract to reach and fertilize the egg. During transport, sperm encounter many obstacles that dramatically reduce the number arriving at the fertilization site. In humans, the number of sperm is reduced from tens of millions in the ejaculate to hundreds in the Fallopian tube (oviduct). Whether this sperm population has higher fertilization potential is not fully understood, but several studies in animals indicate that many defective sperm do not advance to the site of fertilization. Moreover, the oviduct plays a key role in fertility by modulating sperm transport, viability, and maturation, providing sperm that are ready to fertilize at the appropriate time. Here we present evidence of sperm selection by the oviduct with emphasis on the mechanisms of selection and the sperm characteristics selected. Considering the sperm parameters that are essential for healthy embryonic development, we discuss the use of novel in vitro sperm selection methods that mimic physiological conditions. We propose that insight gained from understanding how the oviduct selects sperm can be translated to assisted reproductive technologies to yield high fertilization, embryonic development, and pregnancy rates.

Vitamin D supplementation for improving sperm parameters in infertile men: A systematic review and meta-analysis of randomized clinical trials

Objective

Vitamin D has been hypothesized to have a potential role in altering sperm motility and metabolism. However, experimental studies have demonstrated inconsistent results between vitamin D and sperm parameters. This study aims to investigate the role of vitamin D supplementation to improve sperm parameters in infertile men.

Methods

This is a systematic review and meta-analysis study. We comprehensively conducted a search on ClinicalTrials.gov, IRCT.ir, Europe PMC, and PubMed and collected published studies on vitamin D supplementation and sperm parameters for infertile men. The risk of bias was assessed by using Risk of Bias version 2 (RoB v2) and the statistical analysis was performed by using Review Manager 5.4 software.

Results

Five trials with a total of 648 infertile men were included. Our meta-analysis showed that supplementation with vitamin D may significantly improve total sperm motility [mean difference 4.96 (95% CI 0.38, 9.54), p = 0.03, I2 = 69%], progressive sperm motility [mean difference 4.14 (95% CI 0.25, 8.02), p = 0.04, I2 = 89%], and normal sperm morphology [mean difference 0.44 (95% CI 0.30, 0.57), p < 0.00001, I2 = 0%] better than placebo in infertile men. However, total sperm count (p = 0.15), sperm concentration (p = 0.82), and semen volume (p = 0.83) did not differ significantly between two groups.

Conclusions

Vitamin D supplementation may improve sperm motility, progressive sperm motility, and morphology in infertile men. Vitamin D supplementation may be considered in managing male fertility issue.

Aqueous extract of bay leaf (Laurus nobilis) ameliorates testicular toxicity induced by aluminum chloride in rats

Background and Aim

Human exposure to aluminum is inevitable, and one of the most adverse health effects of aluminum is a decrease in male fertility rates. Therefore, this study investigated the ameliorative effects of an aqueous extract from Laurus nobilis-bay leaf (BL) on aluminum chloride (AlCl₃)-induced testicular toxicity in rats.

Materials and Methods

Twenty-four Wistar rats were divided into four groups (n = 6, each group): The control (group 1) received normal saline; Group 2 animals were intraperitoneally administered with 30 mg/kg body weight (BW) AlCl₃; and Groups 3 and 4 were co-administered AlCl₃ with 125 or 250 mg/kg BW of BL extract, respectively, for 21 days. Testes, epididymis, and blood samples were collected. Testicular plasma enzyme activity was measured using a spectrophotometric assay, while concentrations of inflammatory biomarkers were determined using enzyme-linked immunosorbent assay kits.

Results

There was a significant increase (p < 0.05) in testicular enzyme activity in the group treated with AlCl₃. However, there was no significant (p > 0.05) difference in testicular enzyme activity in groups co-administered AlCl₃ and BL extract as compared with that in control. There was a significant (p < 0.05) increase in testicular nitrite concentration in the AlCl₃-treated group, whereas the administration of BL extract significantly (p < 0.05) decreased nitrite concentration in Groups 3 and 4. Furthermore, the administration of BL extracts increased sperm count and improved the morphology of the testes in AlCl₃-treated rats. Flavonoids, phenolic compounds, alkaloids, tannin, glycosides, saponin, anthraquinones, and steroids were identified in BL extract, with alkaloids and glycosides being the most abundant.

Conclusion

Aqueous extract from BL ameliorated the toxic effect of AlCl₃ and exhibited anti-inflammatory properties by inhibiting nitrite production while improving sperm count and morphology in AlCl₃-treated rats. The bioactivity of the extract may be attributed to the presence of a wide range of phytochemicals. Therefore, BL aqueous extract could be a promising source of novel compounds with male fertility-promoting and anti-inflammatory properties.

Sperm Adhesion Molecule 1 (SPAM1) Distribution in Selected Human Sperm by Hyaluronic Acid Test

The failures of binding to the oocyte zona pellucida are commonly attributed to defects in the sperm recognition, adhesion, and fusion molecules. SPAM1 (sperm adhesion molecule 1) is a hyaluronidase implicated in the dispersion of the cumulus-oocyte matrix. Therefore, the aim of this study was to characterize the SPAM1 distribution in the different physiological conditions of human sperm. Specifically, we evaluated the location of the SPAM1 protein in human sperm before capacitation, at one and four hours of capacitation and after hyaluronic acid (HA) selection test by fluorescence microscopy. Sperm bound to HA were considered mature and those that crossed it immature. Our results detected three SPAM1 fluorescent patterns: label throughout the head (P1), equatorial segment with acrosomal faith label (P2), and postacrosomal label (P3). The data obtained after recovering the mature sperm by the HA selection significantly (p < 0.05) highlighted the P1 in both capacitation times, being 79.74 and 81.48% after one hour and four hours, respectively. Thus, the HA test identified that human sperm require the presence of SPAM1 throughout the sperm head (P1) to properly contact the cumulus-oocyte matrix. Overall, our results provide novel insights into the physiological basis of sperm capacitation and could contribute to the improvement of selection techniques.

Mito-TEMPO protects against Bisphenol-A-induced testicular toxicity: An in vivo study

Bisphenol-A (BPA) is a common environmental toxin which alters testicular function in both animals and humans. BPA exerts its cytotoxic potential by altering mitochondrial oxidative stress and functioning. Therefore, protecting mitochondria from oxidative stress may prevent BPA-induced testicular damage. In the present study, modulation of BPA toxicity by mitochondria-targeted antioxidant, mito-TEMPO was studied in male wistar rats. Rats were administered mito-TEMPO (0.1 mg/kg b.w, i.p.) twice a week, followed by BPA (10 mg/kg b.w., orally) once a week for 4 weeks. After 4 weeks, sperm parameters were evaluated in the testis along with histopathological analysis. The mitochondrial oxidative stress, mitochondrial membrane potential (MMP) and enzymatic activity of mitochondrial complex II and IV were estimated in the testicular tissue. Pre-treatment of mito-TEMPO protected animals from toxic effect of BPA as indicated by the normalisation of sperm parameters and preserved histoarchitecture of testis. BPA treatment to animals significantly increased mitochondrial reactive oxygen species (ROS) and lipid peroxidation (LPO). A significant decrease in the activity of mitochondrial complex II was also observed after BPA exposure whereas, mitochondrial complex II activity was increased. In addition, an increase in MMP was also observed in BPA group. Mito-TEMPO successfully normalised mitochondrial ROS and LPO formation. Similar normalisation effect was also noted in the activity of mitochondrial complex II, complex IV and MMP. Results suggested that mito-TEMPO pre-treatment significantly protected BPA-induced oxidative stress and thereby mito-TEMPO effectively prevented testicular damage.

Therapeutic efficacy of N-acetylcysteine and zinc sulphate against di-(2-ethylhexyl) phthalate-induced testicular oxido-nitrergic stress in male Wistar rat

The therapeutic efficacy of N-acetylcysteine (NAC) and zinc sulphate on di-(2-ethylhexyl) phthalate (DEHP)-induced testicular oxido-nitrergic stress in rats was investigated in 36 male Wistar rats (170 ± 10 g) randomly assigned into one of six groups (n = 6). Group 1 (control) received 2.5 ml/kg of distilled water for 42 days, while group 2 (vehicle) received 2.5 ml/kg of corn oil for 42 days. Groups 3,4,5, and 6 were administered DEHP (750 mg/kg/day) for 21 days, after which groups 4, 5, and 6 received zinc sulphate (0.5 mg/kg/day), NAC (100 mg/kg/day), and zinc sulphate (0.5 mg/kg/day) + NAC (100 mg/kg/day) for an additional 21 days respectively. After the experimental period, the animals were euthanized by light thiopental sodium, and their testes were carefully dissected out for histological and biochemical assays. The result shows a significant alteration in testicular levels of malondialdehyde, nitric oxide, antioxidant enzymes, total antioxidant capacity, sulphydryl levels, dehydrogenases and testicular architecture following the administration of DEHP. These effects were reversed by coadministration of NAC and zinc sulphate in the study. We therefore concluded that the combined effects of NAC and ZnSO4 effectively improved testicular antioxidant status and reduced testicular nitregic stress, thus improving testicular architecture and functions.

Label-Free Microfluidic Impedance Cytometry for Acrosome Integrity Assessment of Boar Spermatozoa

Microfluidics and lab-on-chip technologies have been used in a wide range of biomedical applications. They are known as versatile, rapid, and low-cost alternatives for expensive equipment and time-intensive processing. The veterinary industry and human fertility clinics could greatly benefit from label-free and standardized methods for semen analysis. We developed a tool to determine the acrosome integrity of spermatozoa using microfluidic impedance cytometry. Spermatozoa from boars were treated with the calcium ionophore A23187 to induce acrosome reaction. The magnitude, phase and opacity of individual treated and non-treated (control) spermatozoa were analyzed and compared to conventional staining for acrosome integrity. The results show that the opacity at 19 MHz over 0.5 MHz is associated with acrosome integrity with a cut-off threshold at 0.86 (sensitivity 98%, specificity 97%). In short, we have demonstrated that acrosome integrity can be determined using opacity, illustrating that microfluidic impedance cytometers have the potential to become a versatile and efficient alternative in semen analysis and for fertility treatments in the veterinary industry and human fertility clinics.

A systematic review identifying fertility biomarkers in semen: a clinical approach through Omics to diagnose male infertility

OBJECTIVE

To identify the most robust molecular biomarkers in sperm and seminal plasma for the diagnosis of male infertility, and to evaluate their clinical use.

DESIGN

Systematic review.

SETTING

Not applicable.

PATIENT(S)

Accessible studies reporting well-defined (in)fertile populations and semen molecular biomarkers were included in this review.

INTERVENTION(S)

A systematic search of the literature published in MEDLINE-PubMed and EMBASE databases was performed, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

MAIN OUTCOME MEASURE(S)

The primary outcome was the content, expression, or activity of molecular biomarkers in human semen samples. Only studies reporting a receiver-operating characteristic (ROC) analysis values were included.

RESULT(S)

Eighty-nine studies were included. Direct evaluation of sperm DNA damage has high potential as a diagnostic biomarker of fertility and assisted reproductive technology outcomes (area under the curve [AUCs] median = 0.67). Regarding strand break-associated chromatin modifications, γH2AX levels show good predictive value for the diagnosis of male infertility (AUCs median = 0.93). Some noncoding ribonucleic acid (RNA) exhibit excellent predictive values; miR-34c-5p in semen is the most well-characterized and robust transcriptomic biomarker (AUCs median = 0.78). While many proteins in semen show fair diagnostic value for sperm quality and fertilizing capacity, the levels of some, such as TEX101, in seminal plasma have an excellent diagnostic potential (AUCs median = 0.69). Although individual metabolites and metabolomic profiles in seminal plasma present good predictive value, the latter seem to be better than the former when inferring sperm quality and fertilizing capacity.

CONCLUSION(S)

The current review supports that some Omics (e.g., DNA structure and integrity, genomics and epigenomics, transcriptomics, metabolomics, and proteomics) could be considered relevant molecular biomarkers that may help identify infertility etiologies and fertilization prognosis with cost-effective, simple, and accurate diagnosis.

Establishment of a male fertility prediction model with sperm RNA markers in pigs as a translational animal model

BACKGROUND

Male infertility is an important issue that causes low production in the animal industry. To solve the male fertility crisis in the animal industry, the prediction of sperm quality is the most important step. Sperm RNA is the potential marker for male fertility prediction. We hypothesized that the expression of functional genes related to fertilization will be the best target for male fertility prediction markers. To investigate optimum male fertility prediction marker, we compared target genes expression level and a wide range of field data acquired from artificial insemination of boar semen.

RESULTS

Among the genes related to acrosomal vesicle exocytosis and sperm-oocyte fusion, equatorin (EQTN), zona pellucida sperm-binding protein 4 (ZP4), and sperm acrosome membrane-associated protein 3 exhibited high accuracy (70%, 90%, and 70%, respectively) as markers to evaluate male fertility. Combinations of EQTN-ZP4, ZP4-protein unc-13 homolog B, and ZP4-regulating synaptic membrane exocytosis protein 1 (RIMS1) showed the highest prediction value, and all these markers are involved in the acrosome reaction.

CONCLUSION

The EQTN-ZP4 model was efficient in clustering the high-fertility group and may be useful for selection of animal that has superior fertility in the livestock industry. Compared to the EQTN-ZP4 model, the ZP4-RIMS1 model was more efficient in clustering the low-fertility group and may be useful in the diagnosis of male infertility in humans and other animals. The appointed translational animal model and established biomarker combination can be widely used in various scientific fields such as biomedical science.

Heat shock protein family D member 1 in boar spermatozoa is strongly related to the litter size of inseminated sows

Background

Sperm quality evaluation is the logical first step in increasing field fertility. Spermatozoa contain cytoplasmic organelles and biomolecules known as sperm-intrinsic factors, which play key roles in sperm maturation, sperm-oocyte fusion, and embryo development. In particular, sperm membrane proteins [e.g., arginine vasopressin receptor 2, beta-actin, prohibitin, and heat shock protein family D member 1 (HSPD1)] and RNA could be used as functional indicators of male fertility. We sought to clarify the effects of differential mRNA expression of selected genes on several fertilisation parameters, including sperm motility, motion kinematics, capacitation, and litter size, in a porcine model.

Results

Our results demonstrated that HSPD1 expression was significantly correlated with male fertility, as measured by the litter size of inseminated sows. The expression of HSPD1 mRNA was linked to sperm motility and other motion kinematic characteristics. Furthermore, HSPD1 had a 66.7% overall accuracy in detecting male fertility, and the high-litter size group which was selected with the HSPD1 marker had a 1.34 greater litter size than the low-litter size group.

Conclusions

Our findings indicate that HSPD1 might be a helpful biomarker for superior boar selection for artificial insemination, which could boost field fertility.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40104-022-00689-0.

Toxicological outcome of phthalate exposure on male fertility: Ameliorative impacts of the co-administration of N-acetylcysteine and zinc sulfate in rats

Background

Reports have shown that humans are consistently exposed to environmental toxicants such as phthalate (PHT) during their daily activities. This results in reproductive dysfunction and infertility-related issues as already noted in human and experimental animals. We therefore designed this study to investigate fertility outcome in phthalate-exposed male rats treated with N-acetylcysteine (NAC) and zinc sulfate (ZnSO4) with the view of providing a therapeutic alternative to reproductive toxicity caused by phthalate. The research was done in two phases. In phase 1, thirty-five male Wistar rats were randomly assigned to one of five (n = 7) groups given the following treatments for 21 days: group A was given distilled water as a control, while groups B, C, D, and E were given phthalate (750 mg/kg/day). Animals in groups C to E were also given ZnSO4 (0.5 mg/kg/day), N-acetylcysteine (100 mg/kg/day), and ZnSO4 (0.5 mg/kg/day) + N-acetylcysteine (100 mg/kg/day) in addition to phthalate. In phase 2, animals from groups in phase 1 were mated with females for fecundity testing.

Results

The result shows alteration in testicular and epididymis weight and testis/epididymis ratio, semen parameters, sperm capacitation and acrosome reaction, sperm DNA, serum Zn and Mg, testicular mitochondria apoptosis mechanisms (TNF-α and BCL-2), and testicular Ca2+-ATPase as well as fecundity outcome in the phthalate-treated group. However, ZnSO4 and NAC successfully ameliorated the deleterious effects of phthalate on semen parameters, sperm capacitation and acrosome reaction, serum electrolyte and mitochondria apoptosis mechanisms, and testicular electrogenic Ca2+-ATPase in phthalate-induced male rats with a better outcome in the combined therapy. Pregnancy outcome and litter sizes were also higher in the combined therapy when also compared with the phthalate-treated groups.

Conclusion

According to the result, ZnSO4 and NAC increased fertility outcome in phthalate-treated male rats through enhancement of testicular BCL-2, serum electrolyte, testicular Ca2+ATPase pumps, and cytoprotection.

The Concentration of ProAKAP4 and Other Indicators of Cryopotential of Spermatozoa Cryopreserved in Extender with Holothuroidea Extract Addition

Simple Summary

Scientists are constantly making efforts to determine the fertilization capacity of sperm after ejaculation. The present research proves that the application of Holothuroidea extract to the semen extender improves its cryostability, and has a positive effect on the biological quality of sperm after the freezing process. Moreover, it has been proven that the proAKAP4 biomarker can be successfully used to evaluate the effectiveness of the use of various extenders for semen cryopreservation.

Abstract

The aim of this study was to determine the concentration of proAKAP4 and other indicators of cryopotential of spermatozoa cryopreserved in extender with Holothuroidea extract addition. Nine Holstein Friesian bulls, 3.5 years old, of known health status, were used for the study. The animals were kept and fed equally. Semen was collected once a week using an artificial vagina. The commercially available Holothuroidea extract was used as a supplement to the commercial extender (0, 2, 4 and 6 µL/mL) before the freezing/thawing process. The viability, motility, motion parameters, and acrosome integrity of the sperm were analyzed with (test) or without (control) extract samples. Furthermore, the concentration of the proAKAP4 biomarker in frozen sperm was assessed. It was shown that the addition of 4 and 6 µL of the extract may have a positive effect on the quality parameters of the sperm after thawing. The results indicate that extender supplementation with the above extract modulates (increases) the concentration of proAKAP4 in sperm at all tested levels. Additionally, this indicator has become helpful in identifying sperm of poor biological quality. Moreover, it has been proven that the proAKAP4 biomarker can be successfully used to evaluate the effectiveness of the use of various extenders for semen cryopreservation.

Unexplained Total Fertilization Failure after Intracytoplasmic Sperm Injection Cycles: A Case-Control Study on Predictive Factors and Retreatment Prognosis

BACKGROUND

The aim of our study was to detect the rate of unexplained total fertilization failure (TFF) after intracytoplasmic sperm injection (ICSI) and identify its risk factors and retreatment prognosis.

MATERIALS AND METHODS

In this retrospective case-control study, we searched the computerized database of the Royan Institute (Tehran, Iran) from March 2015 to March 2019 and retrieved all cases diagnosed with TFF after ICSI. TFF cases that did not have any recognized risk factors were classified as unexplained (subgroup A). Cases with recognized risk factors were classified as subgroup B. The control group was randomly selected from infertile couples who underwent ICSI cycles with fertilization of at least one oocyte during the same time interval. Characteristics and treatment outcomes of the cases with unexplained TFF (subgroup A) were compared to the control group, and to the other TFF cases (subgroup B).

RESULTS

Out of 18,750 couples who underwent ICSI cycles, 296 (1.58%) experienced TFF for the first time. Of these, 49 (16.5%) couples were diagnosed as unexplained TFF (subgroup A) and 247 (83.5%) were placed in subgroup B, TFF with expected risk factors. Multivariable logistic regression analysis showed that the total number of mature oocytes (P<0.001), duration of infertility (P=0.043), and women's body mass index (BMI, P<0.001) were significant predictive factors for unexplained TFF. In the ICSI cycle after TFF, clinical pregnancy and live birth rates in subgroup A were higher than subgroup B. Although differences between these groups were not statistically significant (P=0.14 and P=0.07, respectively), this finding could be clinically important.

CONCLUSION

Unexplained TFF following ICSI is a rare event significantly related to a lower number of mature oocytes, longer duration of infertility and higher female BMI. It has a good prognosis in retreatment cycles in comparison with expected TFF cases. Clinicians should take this into consideration for patient counseling and management.

New Approaches to Define The Functional Competency of Human Sperm Subpopulations and Its Relationship to Semen Quality

BACKGROUND

This study aimed at comparing a comprehensive set of functional and structural sperm characteristics between sperm motility fractions and correlating results to the standard semen parameters. By grouping related variables, our objective was to establish the predictive power of semen parameters and whether they accurately reflect the functionality of sperm motility fractions or merely a small set of parameters within individual fractions.<br />Materials and Methods: In this non-invasive experimental study, donor semen samples (n=55) were separated via<br />double density gradient centrifugation, isolating a high (HM) and low motile (LM) sperm fraction. Fractions were evaluated for percentage vitality, chromatin integrity, mature spermatozoa, motility and kinematic parameters, hyperactivation, positive reactive oxygen species, intact mitochondrial membrane potential (MMP) and acrosome reaction.<br />Results: HM fractions had significantly (P<0.001) enhanced percentages of induced acrosome reaction (HM, 55.6 ±<br />14.3%, LM, 25.0 ± 16.5%), motility and kinematic parameters, hyperactivation, vitality (HM, 70.4 ± 9.7%, LM, 47.9<br />± 10.3%), mitochondrial membrane intactness (HM, 67.2 ± 10.4%, LM, 44.7 ± 15.0%) and mature spermatozoa (HM,<br />83.4 ± 10.0%, LM, 64.6 ± 8.2%) with intact chromatin (HM, 80.5 ± 8.1%, LM, 71.3 ± 8.0%). Various sperm morphology abnormalities correlated with LM fractions' grouped motility parameters (range, 0.46 to 0.51; range -0.4 to<br />-0.75), whereas combined semen traits of total motility, progressive motility, viscosity and mucus penetration (MPT) correlated with HM fractions' grouped motility parameters (range, 0.44 to 0.84).

CONCLUSION

Collectively, total and progressive motility, viscosity and MPT may represent a reliable grouping of semen parameters for predicting the quality of HM sperm fractions. Separating the same donor semen samples into two significantly diverse motility sperm fractions could be a potential model in mimicking the qualities of fertile and sub-fertile males' sperm populations and used for future research on the improvement of sperm subpopulations from males with different fertility statuses.

Endocrine disorders and fertility and pregnancy: An update

It is estimated that more and more couples suffer from fertility and pregnancy maintenance disorders. It is associated with impaired androgen secretion, which is influenced by many factors, ranging from genetic to environmental. It is also important to remember that fertility disorders can also result from abnormal anatomy of the reproductive male and female organ (congenital uterine anomalies - septate, unicornuate, bicornuate uterus; acquired defects of the uterus structure - fibroids, polyps, hypertrophy), disturbed hormonal cycle and obstruction of the fallopian tubes resulting from the presence of adhesions due to inflammation, endometriosis, and surgery, abnormal rhythm of menstrual bleeding, the abnormal concentration of hormones. There are many relationships between the endocrine organs, leading to a chain reaction when one of them fails to function properly. Conditions in which the immune system is involved, including infections and autoimmune diseases, also affect fertility. The form of treatment depends on infertility duration and the patient's age. It includes ovulation stimulation with clomiphene citrate or gonadotropins, metformin use, and weight loss interventions. Since so many different factors affect fertility, it is important to correctly diagnose what is causing the problem and to modify the treatment regimen if necessary. This review describes disturbances in the hormone secretion of individual endocrine organs in the context of fertility and the maintenance of pregnancy.

Short-term storage of semen samples in acidic extender increases the proportion of females in pigs

Background

Sex preselection is a desired goal of the animal industry to improve production efficiency, depending on industry demand. In the porcine industry, there is a general preference for pork from female and surgically castrated male pigs. Therefore, the birth of more females than males in a litter leads to economic benefits and improved animal welfare in the pig production industry. Our previous study suggested that the porcine semen extender (BTS) adjusted to pH 6.2 maximises the differences in viability between X-chromosome-bearing (X) spermatozoa and Y-chromosome-bearing (Y) spermatozoa without affecting sperm’s functional parameters. In this study we aimed to evaluate whether the pH 6.2 extender is applicable at the farm level for increasing the number of female piglets without a decline in spermatozoa fertility. Artificial insemination (AI) was carried out with spermatozoa stored at pH 6.2 and pH 7.2 (original BTS) at day 1 and day 2 of storage. Next, the functional parameters of the spermatozoa, litter size, farrowing rate, and female-to-male ratio of offspring were determined.

Results

Although sperm motility decreased significantly after 2 d of storage, the viability of spermatozoa was preserved at pH 6.2 for 3 d. There was no significant difference in the farrowing rate and average litter size between the group inseminated with the spermatozoa stored in (pH 7.2) and that inseminated with spermatozoa stored in acidic BTS. The percentage of female piglets was approximately 1.5-fold higher in sows inseminated on day 1 in the pH 6.2 than in the pH 7.2 group. Furthermore, although there was no significant difference in the female-to-male ratio, the percentage of female piglets born was slightly higher in the pH 6.2 group than in the pH 7.2 group on day 2.

Conclusions

The method optimised in our study is simple, economical, and may enhance the number of female births without any decline in spermatozoa fertility.

Progesterone, Myo-Inositol, Dopamine and Prolactin Present in Follicular Fluid Have Differential Effects on Sperm Motility Subpopulations

Considering the challenges surrounding causative factors in male infertility, rather than relying on standard semen analysis, the assessment of sperm subpopulations and functional characteristics essential for fertilization is paramount. Furthermore, the diagnostic value of sperm interactions with biological components in the female reproductive tract may improve our understanding of subfertility and provide applications in assisted reproductive techniques. We investigated the response of two sperm motility subpopulations (mimicking the functionality of potentially fertile and sub-fertile semen samples) to biological substances present in the female reproductive tract. Donor semen was separated via double density gradient centrifugation, isolated into high (HM) and low motile (LM) sperm subpopulations and incubated in human tubal fluid (HTF), capacitating HTF, HD-C medium, progesterone, myo-inositol, dopamine and prolactin. Treated subpopulations were evaluated for vitality, motility percentages and kinematic parameters, hyperactivation, positive reactive oxygen species (ROS), intact mitochondrial membrane potential (MMP) and acrosome reaction (AR). While all media had a significantly positive effect on the LM subpopulation, dopamine appeared to significantly improve both subpopulations' functional characteristics. HD-C, progesterone and myo-inositol resulted in increased motility, kinematic and hyperactivation parameters, whereas prolactin and myo-inositol improved the LM subpopulations' MMP intactness and reduced ROS. Furthermore, progesterone, myo-inositol and dopamine improved the HM subpopulations' motility parameters and AR. Our results suggest that treatment of sub-fertile semen samples with biological substances present in follicular fluid might assist the development of new strategies for IVF treatment.

Impact of Heavy Metals on Human Male Fertility-An Overview

Heavy metals are endocrine disruptors which interfere with processes mediated by endogenous hormones of the organism, negatively affecting endocrine functions. Some studies have correlated heavy metal exposure with male infertility. However, the number of studies conducted on humans are limited. Therefore, the aim of this study is to summarize the current knowledge on how heavy metals influence human male fertility. Hence, three distinct databases were consulted—PubMed, Scopus and Web of Science—using single keywords and combinations of them. The total number of identified articles was 636. Nevertheless, by using the inclusion and exclusion criteria, 144 articles were finally included in this work. Results display that the development of adequate instruments for heavy metal assessment may play an important function in human male fertility diagnosis and treatment. Furthermore, clinical trials could be useful to confirm the role of heavy metals in human male fertility diagnosis. Overall, further research is required to fully understand the molecular and cellular basis of the influence of environmental and occupational exposure to heavy metals on human male infertility and reproductive outcomes.

Influence of in vitro capacitation time on structural and functional human sperm parameters

A cascade of dramatic physiological events is linked to the sperm acrosome reaction and binding to the oocyte's zona pellucida during human sperm capacitation. However, structural and functional sperm changes during capacitation currently remain poorly defined. Here, we performed a multibiomarker approach based on the utilization of sperm concentration, motility, viability, morphology, acrosome reaction, tyrosine phosphorylation, DNA fragmentation, and lectin-binding sites to analyze the impact caused by swim-up selection times (uncapacitated, 1 h capacitated, and 4 h capacitated) on sperm function and structure in normozoospermic samples. We found that a 4 h swim-up capacitation increased sperm quality, because a large number of cells with normal morphology and lower DNA fragmentation rates were recovered. Furthermore, the long-term capacitation induced a higher percentage of cells with tyrosine phosphorylation of the principal piece as well as a redistribution of lectin-binding sites. Overall, the multivariate biomarkers analyzed showed a less variable distribution on spermatozoa recovered after 4 h capacitation than that with the shorter capacitation time. These findings stress the importance of capacitation time as a relevant factor in sperm quality with potential biological reproductive implications both for basic research and in assisted reproduction techniques.

Optimal timing for repeat semen analysis during male infertility evaluation

Objective

To assess whether the 4-week time period between semen analyses during the workup of male infertility is optimal and whether two samples are needed.

Design

Retrospective study.

Setting

Tertiary hospital.

Patient(s)

Men whose semen samples were obtained within 90 days of each other, without known fertility intervention, treatment, and/or azoospermia.

Intervention(s)

Semen analysis.

Main Outcome Measure(s)

Correlation between semen parameters and agreement among consecutive semen analyses.

Result(s)

A total of 2,150 semen samples from 1,075 men were included in the analysis. The optimal correlation for volume occurred at weeks 2, 8, and 12 (r = 0.803, r = 0.802, and r = 0.821, respectively). For concentration, the correlation was maximized at weeks 1, 4, and 5 (r = 0.950, r = 0.841, and r = 0.795, respectively). Total sperm count correlated at weeks 1, 2, and 4 (r = 0.929, r = 0.727, and r = 0.808, respectively). Motility was maximally correlated at weeks 1, 10, and 13 (r = 0.711, r = 0.760, and r = 0.708, respectively). Morphology was optimally correlated at weeks 1, 2, and 9 (r = 0.935, r = 0.815, and r = 0.839, respectively). Semen volume was correlated in 55% of men, sperm concentration in 64% of men, sperm motility in 52% of men and sperm morphology 64% of men.

Conclusion(s)

Our data suggest that four weeks may not be the optimal time for repeat semen analysis and that one sample is insufficient to assess any abnormalities in the result of semen analysis. The optimal time between repeat semen analyses should be individualized depending on the results of the initial analysis and additional factors, suggesting the need for future large-scale studies to investigate this trend.

Peroxiredoxin 4 directly affects the male fertility outcome in porcine

Peroxiredoxins (Prdxs) are known to play a critical role in regulating male fertility as antioxidant enzymes. Although several studies have suggested a close association between Prdxs and male fertility, few studies have explored the efficacy of Prdxs to predict male fertility. Therefore, the current study was designed to discover the most efficient biomarkers among the Prdxs with six isoforms. Our study showed a significant positive correlation between the litter size and the levels of PRDX 4 among all isoforms in spermatozoa. Subsequently, a regression analysis using a combination of markers was conducted to increase efficacy for fertility prediction. Nevertheless, PRDX4 had the highest efficacy compared to other combination models to predict litter size. The prediction accuracy of male fertility was further evaluated through receiver operating characteristic curve analysis, which showed that PRDX 4 could predict the litter size with high overall accuracy of 95%. Moreover, litter size was increased by 1.55 piglets after predicting high litter size using PRDX 4. This is the first study to comprehensively elucidate the role of all isoforms of PRDXs on male fertility to the best of our knowledge. PRDX 4 was tested and evaluated up to a practical level. Data here reported suggesting PRDX 4 marker allowed the highest accuracy for male fertility prediction and diagnosis, leading to a measurable improvement in the male fertility outcome.

Standardized Laboratory Procedures, Quality Control and Quality Assurance Are Key Requirements for Accurate Semen Analysis in the Evaluation of Infertile Male

Semen analysis is a basic test for evaluating male fertility potential, as it plays an essential role in driving the future management and treatment of infertility in couples. Manual semen analysis includes the evaluation of both macroscopic and microscopic parameters, whereas automated semen analysis is conducted through a computer-aided sperm analysis system and can include additional parameters that are not evaluated by manual analysis. Both quality control (QC) and quality assurance (QA) are important to ensure reproducible results for semen analysis, and represent fundamental checks and balances of all stages (pre-analytical, analytical, and post-analytical) of semen analysis. To ensure accuracy and precision, the laboratory technicians' performance should be evaluated biannually. This narrative review aims to describe standardized laboratory procedures for an accurate assessment of semen parameters that incorporate both QC and QA practices.

Characterization of Human Spermatic Subpopulations by ConA-Binding Sites and Tyrosine Phosphorylation during in vitro Capacitation and Acrosome Reaction

Spermatozoa capacitation is a time-dependent physiological process essential for acquiring the fertilizing capacity. In this context, reorganization of spermatozoa surface sugars and tyrosine phosphorylation are some of the most important biochemical changes involved in capacitation. However, the relationship between these 2 biomarkers remains poorly defined. By cytofluorescence we simultaneously characterized the head concanavalin A (ConA)-binding sites and the flagellar tyrosine phosphorylation before capacitation, during different capacitation times (1 and 4 h), and after acrosome reaction induction in human spermatozoa. The results showed a strong connection between ConA-label patterns and tyrosine phosphorylation according to the spermatozoa capacitation time and acrosomal status. Specifically, the spermatozoa subpopulation with phosphotyrosine presented proper sugar location (label in acrosomal and postacrosomal region) just after 1 h of capacitation, while cells without phosphotyrosine needed 4 h to do it. Moreover, after induction of spermatozoa acrosome reaction, phosphorylation was significantly correlated (p < 0.05) with the relocation of ConA-binding residues to the equatorial region, regardless of capacitation time. Overall, these observations provide novel insights regarding spermatozoa subpopulations based on essential physiological events like capacitation and acrosome reaction, which could have potential implications in the improvement of spermatozoa selection techniques.

Sperm nullisomy is not associated with routine semen parameters but it negatively impacts on ICSI outcomes

Sperm aneuploidy is a result of mis-segregation during meiosis and correlates with male infertility. Among the types of aneuploidy, nullisomy has been reported to be more prevalent in human spermatozoa than disomy; however, nullisomy is not always assessed by FISH, and its relation with basic semen parameters is almost unknown. To establish an association between nullisomy and semen parameters and pathologies, we evaluated the potential clinical value of semen analysis and assessed the diagnosis of sperm nullisomy. A prospective study including a total of 130 patients and 25 donors aged 30-50 years with a normal karyotype was carried out. Sperm FISH analyses were performed, and basic semen parameters and ART outcome data were collected. There were no associations between sperm nullisomy of chromosomes 13, 15, 18, 21, 22, X and Y and basic semen parameters. The odds of nullisomy of chromosomes 13, 15, 16, 17, 18, 21, 22, X and Y were not related to semen pathologies. However, sperm nullisomy had a negative impact on ART outcomes, with significant decreases in fertilisation, blastocyst, pregnancy and implantation rates after ICSI. Sperm nullisomy diagnoses are not detected in semen analyses and are a possible cause of idiopathic male infertility and unexplained recurrent pregnancy loss.

[Localization of Arylsulfatase A during in vitro incubation of human spermatozoa in capacitation media]

OBJECTIVE

To determine the localization and distribution of the ArylsulfataseA receptor (ARSA) in human spermatozoa before and after their incubation in capacitation medium for 1 and 4hours.

MATERIAL AND METHODS

Semen samples were obtained from five normozoospermic donors. Capacitation was by swim-up technique using capacitation medium for 1 and 4hours. Localization of the ARSA receptor was assessed by indirect immunofluorescence using confocal microscopy. A minimum of 200cells were observed in each physiological condition.

RESULTS

Before incubation, no representative pattern was observed among the cells positive for this biomarker (8.61%). This percentage increased significantly after incubation in the capacitation medium for 1 and 4hours (61.86% and 63.38% respectively). A majority pattern was observed among the capacitated cells, with intense labelling in the acrosomal region (27.11% and 28.20% after 1 and 4hours respectively). It should be noted that the pattern corresponding to fluorescence at the level of the periacrosomal region was not observed in the spermatozoa prior to incubation. Only after incubation in capacitation medium for 1 and 4hours, 9.13% and 12.78% of cells with such distribution were detected.

CONCLUSIONS

In vitro capacitation, regardless of time, favours the immunolocalization of ARSA in the cephalic region of the spermatozoa. The most representative subpopulation after this process was the one in which ARSA was intensely and homogeneously distributed in the acrosome region, involved in primary gamete recognition.

Assisted reproductive treatments with hyperbaric oxygen therapy in male infertility

OBJECTIVE

This study aimed to analyze the results of hyperbaric oxygen therapy (HBOT) in addition to assisted reproductive technologies in male infertility cases.

MATERIAL AND METHODS

Medical records of male infertility patients who had HBOT sessions for any reason between January 1, 2015-December 31, 2019, were analyzed retrospectively.

RESULTS

A total of 15 male patients were included. Patients were classified as group 1 [DNA fragmentation (n=5)], group 2 [globozoospermia (n=5)], and group 3 [azoospermia (n=5)]. Round spermatid injection (ROSI), intrauterine insemination (IUI), or intracytoplasmic sperm injection (ICSI) procedures were performed in 10 of the 15 patients. A total of 31 embryos were obtained out of which 19 (61%) were transferred. While a total of 15 embryos were obtained in the globozoospermic group, which was the highest number, 10 were obtained from the azoospermic patients, and 6 from the DNA fragmentation patients (p=0.515). A total of 3 (30%) healthy pregnancies were obtained, overall. The mean sperm count of the patients (n=9) before HBOT was 8.4±11.1 mil/mL, while it was found to be 15.7±15.0 mil/mL after HBOT (azoospermic patients were not included). The TESE results were analyzed for azoospermic patients; positive changes were observed in 4 patients (80%). On the other hand, there was an improvement in 50% of group 1 according to sperm DNA fragmentation after HBOT (p=0.500).

CONCLUSION

While a total of 15 embryos were obtained in the globozoospermic group, which was the highest number, 10 were obtained from the azoospermic patients.. Further studies should be conducted on HBOT and male infertility.

Quantification of human sperm concentration using machine learning-based spectrophotometry

Spectrophotometry is an indirect non-invasive and quantitative method for specifying materials with unknown contents based on absorption behavior. This paper presents the first application of artificial neural network in spectrophotometry for quantification of human sperm concentration. A well-trained full spectrum neural network (FSNN) model is developed by examining the absorption response of sperm samples from 41 human subjects to different light spectra (wavelength from 390 to 1100 nm). It is shown that this FSNN accurately estimates sperm concentration based on the full absorption spectrum with over 93% prediction accuracy, and provides 100% agreement with clinical assessments in differentiating the samples of healthy donor from patient samples. We suggest the machine learning-based spectrophotometry approach with the trained FSNN model as a rapid, low-cost, and powerful technique to quantify sperm concentration. The performance of this technique is superior to available spectrophotometry methods currently used for semen analysis and will provide novel research and clinical opportunities for tackling male infertility.

Identification of the PRM1 gene mutations in oligoasthenoteratozoospermic men

Mutations or altered expression of PRM1 gene have been associated with male infertility. This study aimed to analyse pathogenic variations of PRM1 gene in Iranian Arab infertile men with oligoasthenoteratozoospermia that was carried out for the first time in this population. Genomic DNA was used to perform PCR sequencing in PRM1 untranslated regions, exons and intron. Also, bioinformatics analysis was recruited to discover the possible effect of detected variations. Two pathogenic variations were seen in two men with oligoasthenoteratozoospermia, which were not found in the control group. The cDNA.384G>C variation is novel and was located in the 3' untranslated region, and cDNA.42G>A variation is reported for the first time related to male infertility and was found in 5' untranslated regions. Bioinformatics analysis showed that the minimum free energy was increased from -19.9kcal/mol to -13.1kcal/mol due to the cDNA.384G>C variation at hsa-miR-4326's seed site. More analysis revealed cDNA.42G>A located in transcription factors binding site, E1 and MYOD, which was detected as a promoter-associated region, and generally have regulatory features for acetylation and methylation. In conclusion, two pathogenic variations were recognised in regulatory areas of PRM1 gene, which might interfere with some critical factors related to PRM1 gene expression, hence cause male infertility.

Analysis of age-associated alternation of SCSA sperm DNA fragmentation index and semen characteristics of 1790 subfertile males in China

BACKGROUND

It has been identified that incidence of infertility was about 20% among couples worldwide, about 50% caused by male elements. However, conventional semen laboratory detections could not handle clinical needs, which led to more comprehensive parameters for male fertility evaluation. We aimed to investigate the clinical relationship of age-linked changes and the sperm chromatin structure assay (SCSA) sperm DNA fragmentation index (DFI), and routine semen characteristics among subfertile Chinese males.

METHODS

1790 clinical semen specimens were enrolled from February 2018 to October 2019. Clinical and laboratory data including routine semen analyses, sperm DFI, and sperm morphology were collected and showed age-related alterations in semen parameters.

RESULTS

Our results, displayed an increase in sperm DFI with age, were demonstrated in three age-groups, particularly within the ≥35-year cohort. There were positive and inverse correlations of sperm DFI with abnormal semen characteristics and with normal morphological parameters, respectively. Furthermore, age, sperm morphology, concentration, and progressive motility, immotile sperm percentage, semen volume, sperm survival, and high acridine orange DNA stainability (indicating immature forms) were found to be independent risk factors affecting sperm DNA integrity. Likewise, men aged ≥35 years had a higher sperm DFI than did normozoospermic men in the overall cohort. Routine semen characteristics, sperm DFI, and morphology tended to alter with age.

CONCLUSIONS

The SCSA sperm DFI showed the greatest clinical application in the assessment of male fertility in this study, which should help infertility clinics decide on reproductive options for the treatment of older infertile couples.

Bisphenols Threaten Male Reproductive Health via Testicular Cells

Male reproductive function and health are largely dependent on the testes, which are strictly regulated by their major cell components, i. e., Sertoli, Leydig, and germ cells. Sertoli cells perform a crucial phagocytic function in addition to supporting the development of germ cells. Leydig cells produce hormones essential for male reproductive function, and germ cell quality is a key parameter for male fertility assessment. However, these cells have been identified as primary targets of endocrine disruptors, including bisphenols. Bisphenols are a category of man-made organic chemicals used to manufacture plastics, epoxy resins, and personal care products such as lipsticks, face makeup, and nail lacquers. Despite long-term uncertainty regarding their safety, bisphenols are still being used worldwide, especially bisphenol A. While considerable attention has been paid to the effects of bisphenols on health, current bisphenol-related reproductive health cases indicate that greater attention should be given to these chemicals. Bisphenols, especially bisphenol A, F, and S, have been reported to elicit various effects on testicular cells, including apoptosis, DNA damage, disruption of intercommunication among cells, mitochondrial damage, disruption of tight junctions, and arrest of proliferation, which threaten male reproductive health. In addition, bisphenols are xenoestrogens, which alter organs and cells functions via agonistic or antagonistic interplay with hormone receptors. In this review, we provide in utero, in vivo, and in vitro evidence that currently available brands of bisphenols impair male reproductive health through their action on testicular cells.

Male Infertility is a Women's Health Issue-Research and Clinical Evaluation of Male Infertility Is Needed

Infertility is a devastating experience for both partners as they try to conceive. Historically, when a couple could not conceive, the woman has carried the stigma of infertility; however, men and women are just as likely to contribute to the couple’s infertility. With the development of assisted reproductive technology (ART), the treatment burden for male and unexplained infertility has fallen mainly on women. Equalizing this burden requires reviving research on male infertility to both improve treatment options and enable natural conception. Despite many scientific efforts, infertility in men due to sperm dysfunction is mainly diagnosed by a semen analysis. The semen analysis is limited as it only examines general sperm properties such as concentration, motility, and morphology. A diagnosis of male infertility rarely includes an assessment of internal sperm components such as DNA, which is well documented to have an impact on infertility, or other components such as RNA and centrioles, which are beginning to be adopted. Assessment of these components is not typically included in current diagnostic testing because available treatments are limited. Recent research has expanded our understanding of sperm biology and suggests that these components may also contribute to the failure to achieve pregnancy. Understanding the sperm’s internal components, and how they contribute to male infertility, would provide avenues for new therapies that are based on treating men directly for male infertility, which may enable less invasive treatments and even natural conception.

Relationship between sperm morphology and sperm DNA dispersion

Background

The pathogenesis of teratozoospermia (<4% morphologically normal sperm cells) and the relationship between sperm morphological abnormalities and abnormal sperm nuclear DNA fragmentation, which are considered indicators of male fertility, have not been elucidated. Our research was designed to determine the prevalence of different sperm DNA fragmentation (SDF) levels in men with teratozoospermia and to establish a discriminating threshold value for SDF in assessing sperm morphology.

Methods

Basic semen characteristics and detailed sperm morphological analysis (head, neck, midpiece, and tail defects and excess residual cytoplasm) (WHO, 2010), and the nuclear sperm DNA dispersion test were performed on semen samples obtained from 523 men with teratozoospermia (n=296) and those without teratozoospermia (n=227).

Results

Subjects with abnormal sperm morphology had not only lower results for standard sperm characteristics, including detailed sperm morphological abnormalities, but also a higher proportion of sperm cells with SDF vs. men with normal sperm morphology. Moreover, significantly fewer subjects with low SDF levels (≤15%), more subjects with high SDF levels (>30%) and a higher odds ratio (OR) for having high SDF levels were found in the group of men with teratozoospermia vs. men without teratozoospermia. However, the receiving operating characteristic (ROC) curve analysis indicated that a SDF >18% was a significant negative predictive value to distinguish between men with normal sperm morphology or men with abnormal sperm morphology. The optimal area under the ROC curve (AUC) was 0.746. In the group of men with teratozoospermia, a higher incidence of men with >18% SDF and a higher OR for having >18% SDF were observed. SDF negatively correlated with sperm number, morphologically normal sperm cells, sperm motility and sperm vitality but positively correlated with the teratozoospermia index (TZI) and detailed sperm morphological abnormalities.

Conclusions

The obtained findings demonstrated that: (I) detailed sperm structural defects coexist with abnormal nuclear sperm DNA dispersion, (II) men with teratozoospermia may have a higher risk for sperm DNA damage, (III) the calculated optimal SDF value of 18% measured by the DNA sperm dispersion test is the best criterion to predict normal and abnormal sperm morphology.

Cyclooxygenase 1 (COX1) as an indicator of sperm quality in humans

Sperm quality is important for in vitro fertilisation and embryo transfer and intracytoplasmic sperm injection in the treatment of human infertility. The purpose of this study was to screen for biomarkers that could evaluate sperm quality. We analysed semen samples in 172 fertile males; multivariate logistic regression analysis showed that the levels of COX1 (17.5 ng/ml) in seminal plasma may represent a useful biomarker for sperm quality (area under the curve: 0.745; sensitivity: 0.808; specificity: 0.722). Analysis indicated that the values of parameters related to sperm quality changed significantly (p < .05) between COX1 level ≥ 17.5 ng/ml group and COX1 level < 17.5 ng/ml group. Further analysis of two consecutive semen samples (1-hr interval) from 48 subjects revealed that the first semen samples (COX1 levels ≥ 17.5 ng/ml) had a higher sperm concentration and a larger proportion of spermatozoa showing progressive motility, a lower rate of sperm DNA fragmentation and a lower proportion of spermatozoa undergoing the acrosome reaction spontaneously (p < .05); identical results were observed for the second semen samples. These data indicated that COX1 could be used as an indicator for sperm status and may be helpful for identifying better quality spermatozoa for artificial insemination.

Male fertility in Mus musculus requires the activity of TRYX5 in sperm migration into the oviduct

Nowadays, abnormal loss of serine proteases appears very frequently in male patients with unexplained sterility. In fact, many testis-specific serine proteases, the largest family among the four protease families implicated in murine spermatogenesis, are indispensable for reproduction. In the present study, we demonstrate that the previously uncharacterized testis-specific serine protease TRYX5 (1700074P13Rik) is required for male fertility in mice. Tryx5^-/- male mice are sterile, yet they have normal spermatogenesis and normal sperm parameters. In vivo fertilization experiments showed that the fertilization rate of Tryx5^-/- sperm was almost zero. Sperm counting and analysis of paraffin sections of oviducts revealed that Tryx5^-/- sperm were unable to migrate into the oviduct, which is likely the cause of the observed infertility of the Tryx5^-/- male mice. Importantly, we also found that there was almost no mature ADAM3 present in Tryx5^-/- sperm and almost no ADAM3 precursor in Tryx5^-/- elongated spermatids of S13-16 stage, even though testes of Tryx5^-/- and wild type mice had the same amount of the total precursor ADAM3. Collectively, our results demonstrate that Tryx5 is essential for male fertility in mice and suggest that TRYX5 functions in the stability or localization of ADAM3 precursor in elongated spermatids S13-16 stage, thereby regulating the ability of sperm to migrate from the uterus into the ampulla of the oviduct, the site of fertilization.

Optimized combination of multiple biomarkers to improve diagnostic accuracy in male fertility

Artificial insemination is the general method of breeding for genetic improvement in offspring. However, almost half of the insemination cases fail to achieve full-term pregnancy, due to male infertility or subfertility. To maximize the success of insemination, accurate semen quality testing is required prior to insemination. Even though basic semen analyses have been used to provide preliminary information, it cannot fully identify the superior or inferior fertility bulls. Therefore, more powerful and easy to use methods for the prediction of male fertility are required, such as proteomic or microarray chips. During past decades, omics approaches have been developed and suggested the numerous fertility-related potential biomarkers. Our previous study identified the fertility related protein markers, enolase1 (ENO1), ATP synthase, H⁺ transporting, mitochondrial F1 complex, beta subunit (ATP5B), voltage-dependent anion channel 2 (VDAC2), phospholipid hydroperoxide glutathione peroxide (GPx4), and ubiquinol-cytochrome-c reductase complex core protein 2 (UQCRC2) in bovine spermatozoa. In the present study, we perform a marker combination assay using the western blot data of ENO1, ATP5B, VDAC2, GPx4, and UQCRC2 from 20 individual bull semen samples. And then, we identified the predictive ability of these markers for normal (non-return rate (NRR) ≥ 70%) and normal fertility (NRR<70%) in bulls. ENO1, a single protein marker, achieved an area under the curve (AUC) of 0.86 and 90% discriminatory power between normal and below-normal fertility bulls, with 90% sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Although no meaningful changes existed in overall accuracy (70-85%) to discriminate the normal and below-normal fertility between ENO1 single marker and combined marker panels, multiple marker combination methods using ENO1, VDAC2, GPx4, and UQCRC2 provided absolute sensitivity and NPV, with higher specificity (70%) and PPV (77%). ENO1 can be used as a fertility marker candidate, but there were limitations for providing absolute information about normal and below-normal fertility. Although the combined use of fertility-related markers cannot provide absolute accuracy, it can help in indicating below-normal fertility in bulls. These results may contribute to the maintenance cost in the animal industry, via selection of bulls with inferior fertility.

Porcine seminal protein-I and II mRNA expression in boar spermatozoa is significantly correlated with fertility

In recent years, genomic and proteomic biomarkers have been identified for the diagnosis of male fertility to overcome the limitations of conventional semen analysis. Owing to the limited genes available so far, the single gene approach is commonly adopted for analyzing the phenotype of interest. However, the single-gene approach is less effective than multiple-gene strategies for diagnosing a desirable phenotype. Herein, we investigate the ability of two fertility-related genomic markers (porcine seminal protein (PSP)-I and PSP-II) in spermatozoa to predict boar litter size in addition to conventional semen parameters. First, we examined different semen parameters (motility, motion kinematics, and capacitation status) and gene expression in high- and low-litter size boar spermatozoa. Then, we evaluated the correlation of these parameters with the fertility of 21 Yorkshire boars. Finally, we investigated the efficacy of single/combined markers to predict male fertility using a comprehensive statistical model. Our result showed that there were no significant differences in sperm motility, motion kinematics, or capacitation status, however, the mRNA expression of PSP-I and PSP-II in spermatozoa was significantly different in high- and low-litter size boars. In the individual screening test, the expression of both genes was negatively correlated with boar fertility (r = 0-0.578 and -0.456, respectively), whereas only hyperactivation (HYP) showed a positive correlation (r = 0.444) among the tested semen parameters. As single markers, PSP-I and PSP-II have a better diagnostic power to predict boar fertility, regardless of HYP, in quality assessment analyses. In addition, when these markers were combined, the positive predictive value, negative predictive value, and overall test effectiveness for fertility detection were improved. Surprisingly, when PSP-I and PSP-II were considered together, the deviation of the predicted average litter size between high- and low-litter size boars was 1.77. Based on the findings, we suggest that the use of genomic markers in spermatozoa rather than commonly analyzed semen parameters may be more accurate for evaluating male fertility. Moreover, using a combination of markers could increase the overall accuracy of (in)fertility predictions, and thus, could be considered for field application.

Combined Raman and polarization sensitive holographic imaging for a multimodal label-free assessment of human sperm function

Raman microspectroscopy (RM) and polarization sensitive digital holographic imaging (PSDHI) are valuable analytical tools in biological and medical research, allowing the detection of both biochemical and morphological variations of the sample without labels or long sample preparation. Here, using this multi-modal approach we analyze in vitro human sperm capacitation and the acrosome reaction induced by heparin. The multimodal microscopy provides morphofunctional information that can assess the sperms ability to respond to capacitation stimuli (sperm function). More precisely, the birefringence analysis in sperm cells can be used as an indicator of its structural normality. Indeed, digital holography applied for polarization imaging allows for revelation of the polarization state of the sample, showing a total birefringence of the sperm head in non-reacted spermatozoa, and a birefringence localized in the post-acrosomal region in reacted spermatozoa. Additionally, RM allows the detection and spectroscopic characterization of protein/lipid delocalization in the plasma and acrosomal membranes that can be used as valuable Raman biomarkers of sperm function. Interestingly, these spectral variations can be correlated with different time phases of the cell capacitation response. Although further experimentation is required, the proposed multimodal approach could represent a potential label-free diagnostic tool for use in reproductive medicine and the diagnosis of infertility.

The effect of suboptimal semen parameters on male partner's ability to conceive. Is he really subfertile because the test says so?

Context:

In many developing countries, subfertility treatment is not covered by government-funded institutions. It is observed that healthcare providers incriminate male factor for subfertility even when only a slight deviation from presumed normal criteria is observed.

Aim:

This study aims to provide scientific evidence that pregnancies are possible at semen parameters that are below the generally accepted lower limits of normal.

Setting and Design:

This was a retrospective cohort study conducted from January 2014 to December 2018.

Materials and Methods:

During the study period, couples who conceived without any treatment of male partner were included. The World Health Organization (WHO) reference values for semen analysis were utilized to assess the reports. The primary outcome measure was conception despite abnormal semen parameters.

Statistical Analysis Used:

Data were analyzed using the SPSS software program, version 15.0 (IBM, Armonk, USA).

Results:

Of the 332 couples included, 233 (70.1%) couples conceived despite suboptimal semen parameters, The most common criterion not satisfied was rapid linear motility –200 (85.8%), 87 (37.3%) men were oligozoospermic, 94 (40.3%) were asthenozoospermic, and 21 (9%) were teratozoospermic. The abnormalities were more common in men having primary subfertility (71.7% vs. 28.3%, P = 0.002). The abnormalities were most common in the age group 40–44 years (n = 91, 39.1%) and those who were overweight (n = 110, 47%).

Conclusions:

A consensus for defining poor semen criteria is the need of the hour so that these males can be counseled satisfactorily. WHO criteria are a standard commonly employed, but they do not necessarily predict the fertility potential.

IQ motif containing D (IQCD), a new acrosomal protein involved in the acrosome reaction and fertilisation

The acrosome is single, large, dense-core secretory granule overlying the nucleus of most mammalian spermatozoa. Its exocytosis, the acrosome reaction, is a crucial event during fertilisation. In this study we identified a new acrosome-associated gene, namely IQ motif containing D (IQCD), expressed nearly in multiple tissues with highest expression levels in the testis. In mouse testis, Iqcd transcript accumulated from Postnatal Day (PND) 1 to adulthood. However, expression of IQCD protein at the testicular development stage started primarily from PND 18 and increased in an age-dependent manner until plateauing in adulthood. IQCD was primarily accumulated in the acrosome area of round and elongating spermatids within seminiferous tubules of the testes during the late stage of spermiogenesis; this immunolocalisation pattern is similar in mice and humans. IQCD levels in spermatozoa were significantly lower in IVF patients with total fertilisation failure or a low fertilisation rate than in healthy men. Anti-IQCD antibody significantly inhibited the acrosome reaction and slightly reduced protein tyrosine phosphorylation levels in human spermatozoa, but specifically blocked murine IVF. IQCD interacted with mammalian homolog of C. elegans uncoordinated gene 13 (Munc13) in spermatozoa and may participate in acrosome exocytosis. In conclusion, this study identified a new acrosomal protein, namely IQCD, which is involved in fertilisation and the acrosome reaction.

Aminoguanidine Protects Boar Spermatozoa against the Deleterious Effects of Oxidative Stress

Aminoguanidine is a selective inhibitor of the inducible nitric oxide synthase (iNOS) and a scavenger of reactive oxygen species (ROS). Numerous studies have shown the antioxidant properties of aminoguanidine in several cell lines, but the in vitro effects of this compound on spermatozoa under oxidative stress are unknown. In this study, we tested the hypothesis that aminoguanidine may protect against the detrimental effects of oxidative stress in boar spermatozoa. For this purpose, sperm samples were incubated with a ROS generating system (Fe²⁺/ascorbate) with or without aminoguanidine supplementation (10, 1, and 0.1 mM). Our results show that aminoguanidine has powerful antioxidant capacity and protects boar spermatozoa against the deleterious effects of oxidative stress. After 2 h and 3.5 h of sperm incubation, the samples treated with aminoguanidine showed a significant increase in sperm velocity, plasma membrane and acrosome integrity together with a reduced lipid peroxidation in comparison with control samples (p < 0.001). Interestingly, except for the levels of malondialdehyde, the samples treated with 1 mM aminoguanidine did not differ or showed better performance than control samples without Fe²⁺/ascorbate. The results from this study provide new insights into the application of aminoguanidine as an in vitro therapeutic agent against the detrimental effects of oxidative stress in semen samples.

Seminal profile of 23,504 patients over the years: 7 years of experience

Objective

To evaluate the behavior of seminal parameters over the years - 2010 to May 2017.

Methods

A retrospective study, carried out from January 2010 to May 2017, covering men who underwent sperm examination. Seminal parameters (volume, sperm concentration, motility, morphology, age and duration of infertility in years) of 23,504 men were evaluated. The groups were compared to each other to check whether there were changes to the seminal parameters in that period.

Results

There was no change over the years considering the time of infertility, in an average of 3.78 years. The mean age of the patients was 36.53 years, with a trend of increase in 0.2 years. In relation to the volume of semen samples, the mean value was 3.29mL, with a decrease trend in 0.05mL. As for sperm concentration, the average was 34.37 million/mL, with a decrease trend of 1.0 million/mL. Progressive sperm motility showed an average of 47.27% and there was a decrease trend of 0.67%. Finally, sperm morphology presented an average of 2.79% of normal spermatozoa, with a decrease trend of 0.33%.

Conclusion

It can be noted that over the years, the sperm quality of men looking for assisted reproduction clinics has tended to decrease in macroscopic and microscopic parameters (volume, sperm concentration, motility and morphology).