SPERM APOPTOSIS IN NONPREGNANT LUTEALPHASE SERA AFTER IN VITRO FERTILIZATION AS ASSESSED BY COMPARATIVE GENOMIC HYBRIDIZATION

Toxicity in serum has been reported in cases of recurrent spontaneous abortions and endometriosis. The null hypothesis was that serum toxicity was not involved in failed pregnancies after in vitro fertilization procedures. The objective was to expose donor sperm to pregnant versus nonpregnant patient sera and analyze for sperm DNA damaging effects using a novel comparative genomic hybridization method. Luteal phase sera (N = 21 cases) were drawn one week after embryo transfer. Colloid-washed donor sperm were incubated (48 h, 37 degrees C, 5% CO2 in air) in 0% or 50% sera. Single-stranded DNA (ssDNA) of control sperm were stained in Hoechst 33342 and hybridized to Sybr Gold-stained ssDNA of sera-treated sperm. Image analyses were performed and fluorescent intensities analyzed. Nonpregnant patient sera (57% of cases) were associated with DNA fragmentation (64.4 +/- 8.8 pixels; mean +/- S.E.M.) when compared with pregnant patient sera (106.3 +/- 8.4 pixels). There were no differences in the sera of biochemical (108.2 +/- 15.3) versus clinical pregnancy cases (105.3 +/- 11.4). The results suggest that nonpregnant patient sera contained factor(s) that cause DNA fragmentation leading to pregnancy losses.

CORRELATION OF SPERM PARAMETERS WITH APOPTOSIS ASSESSED BY DUAL FLUORESCENCE DNA INTEGRITY ASSAY

Failed fertilization after intracytoplasmic sperm injection or miscarriages occurs in cases involving apoptotic and necrotic sperm. Identifying normal sperm is important for successful assisted reproductive technologies (ART) procedures. The study was conducted to correlate sperm parameters with intact sperm with normal DNA assessed by the dual stain assay in 118 separate individuals. The results showed differences in percent DNA intact sperm in individuals with normal W.H.O. sperm features (62 +/- 1.1; mean +/- S.E.M.) compared with oligoasthenoteratozoospermia patients (38 +/- 5.3). Individuals whose sperm had fertilizing capacity had higher percentages of intact DNA (60 +/- 1.3 versus 47 +/- 2.4). The percentages of intact DNA sperm were significantly correlated to total motility in semen (R = 0.7), post-wash motility (R = 0.6), rapid progression (R = 0.6), intact acrosome (R = 0.5), and strict morphology (R = 0.5). There were no correlations with the remaining parameters. The dual stain assay identified sperm with normal physiology and fertilizing capacity. The dual stain assay measures DNA integrity and is a promising method to select normal sperm for ART.

Retention of membrane charge attributes by cryopreserved-thawed sperm and zeta selection

PURPOSE

Mature sperm can be selected based on their negative zeta electrokinetic potential. The zeta selection of cryopreserved sperm is unknown. The objective was to study the effect of zeta processing on the morphology and kinematic parameters of cryopreserved-thawed sperm.

METHODS

Colloid-washed sperm (N = 9 cases) were cryopreserved for 24 h, thawed and diluted in serum-free medium in positive-charged tubes. After centrifugation, the tubes were decanted, serum-supplemented medium was added and the resuspended sperm were analyzed. Untreated sperm and fresh sperm served as the controls.

RESULTS

There were improvements in strict normal morphology in fresh (11.8 +/- 0.3 versus control 8.8 +/- 0.3 %, mean +/- SEM) and thawed (8.7 +/- 0.2 versus control 5.4 +/- 0.2%) sperm after zeta processing. Percent sperm necrosis was reduced after zeta processing (66.0 +/- 0.6 versus unprocessed 74.6 +/- 0.3%). Progression decreased by 50% but not total motility after zeta processing of thawed sperm.

CONCLUSIONS

The results suggested that the cryopreservation process did not impact the sperm membrane net zeta potential and higher percentages of sperm with normal strict morphology, acrosome integrity and reduced necrosis were recovered. The zeta method was simple and improved the selection of quality sperm after cryopreservation but more studies would be needed before routine clinical application.

Influence of nanoparticles on morphological differentiation of mouse embryonic stem cells

OBJECTIVE

To assess mouse embryonic stem (ES) cell viability, growth, and differentiated morphology after exposure to different concentrations of nanoparticles.

DESIGN

Cell culture for 6 days.

SETTING

University research laboratory.

ANIMALS

Cryopreserved mouse ES-D3 (American Type Culture Collection, Manassas, VA) cells.

INTERVENTION(S)

ES cells were exposed to either 0 (control), 0.4, or 12.2 million/mL mixed-size fluorescent nanoparticles in culture (37 degrees C, 5% CO(2) in air) for 6 days.

MAIN OUTCOME MEASURE(S)

Cell viability and morphometric analysis were performed.

RESULT(S)

ES cells exposed to both concentrations of nanoparticles exhibited smaller cell surface area. The effect was not concentration dependent. In contrast, ES cell nucleus size was unaffected. The nanoparticles distributed into the cytoplasm, pseudopods, and the perinuclear region. ES cell viabilities were reduced 40% and 30% in the low versus high relative concentration, respectively. ES cells in low-concentration nanoparticles became mostly columnar and embryoid body shaped. However, in high-concentration nanoparticles, they differentiated toward fibroblast-like and less squamous types.

CONCLUSION(S)

The observed reduced ES cell surface area suggested disruption of cytoskeletal development but not nuclear organization by nanoparticles. The ring-like formation of nanoparticles around the nucleus and the resulting cell morphologies suggested nanoparticles may influence differentiation.

In vitro tagging of embryos with nanoparticles

PURPOSE

To develop an in vitro method for tagging embryos and to compare the development of the embryos after nanoparticles injection versus externally-applied nanoparticles derived from either polystyrene or polyacrylonitrile.

METHODS

Each mouse 1-cell embryo (the selected test-model) was either: (a) injected by intracytoplasmic injection or (b) co-incubated with different nanoparticles at 37 degrees C, 5% CO2 in air. The embryos were assessed after 2 and 6 days of culture.

RESULTS

Embryo development was similar for externally-applied polystyrene nanoparticles and control (97.6 +/- 2.7 versus 100.0 +/- 0%) but different for polyacrylonitrile nanoparticles (90.0 +/- 2.8 %) on day 2. However, the results were similar on Day 6. Injected embryos were linked to lower percent development on Day 2. Few injected embryos reached blastocyst stage on Day 6 after a brief UV-fluorescence exposure.

CONCLUSIONS

Tagging embryos by external polystyrene-based nanoparticles was the better method when compared with injected nanoparticles. Larger nanoparticles in microsphere range were easier to qualitate. Inhibited hatching limited their use beyond the blastocyst stage.

Human papilloma virus DNA exposure and embryo survival is stage-specific

PURPOSE

Human papillomavirus (HPV) has been shown to disrupt late-stage implanting embryos. The objectives were (a) to assess the development of early embryos exposed to HPV DNA and (b) to analyze the blastocyst hatching process after HPV exposure.

METHODS

The study involved exposing two-cell and 4-8-cell mouse embryos to DNA fragments from either HPV type 16, type 18 or DQA1 (control). The embryos were incubated for 120 h and assessed.

RESULTS

HPV 16 and 18 inhibited two-cell embryo development. In contrast, delaying the exposure of HPV DNA until the 4-8-cell stage resulted in further embryonic development. There was 25.9% less blastocyst formed with HPV 16 exposure. Additionally, there were 25.9-31.8% more degenerated embryos with HPV 16 exposure.

CONCLUSIONS

The study demonstrated embryo stage-specific effects of HPV on early development. The results suggested HPV exposure was linked to two-cell embryo demise and delaying the exposure of HPV until later embryo stages permitted embryo development. HPV 16 was shown to decrease blastocyst formation while HPV 18 inhibited the blastocyst hatching process.

A simple zeta method for sperm selection based on membrane charge

OBJECTIVE

The objectives were: [1] to develop a simple zeta potential method for sperm isolation; and [2] to analyze the sperm maturity, morphology, kinematic, and DNA parameters.

DESIGN

The phenomenon of sticky sperm adhering to slide surfaces was adapted for collecting charged sperm.

SETTING

Clinical and academic research environment.

PATIENT(S)

Discarded colloid-washed sperm from routine laboratory testing (n = 8).

INTERVENTION(S)

Sperm were centrifuged in serum-free medium and collected for analyses.

MAIN OUTCOME MEASURE(S)

Kinematic parameters, DNA integrity, and maturity.

RESULT(S)

The percentages of mature (73.0% +/- 0.5% vs. control 63.5% +/- 0.5% SEM) and DNA intact sperm (85.0% +/- 0.3% vs. 69.5% +/- 0.5%) increased in the male factor subgroup. Strict normal morphology (19.3% +/- 0.1% vs. 10.0% +/- 0.1%), hyperactivation (7.0% +/- 0.1% vs. 3.6% +/- 0.1%), and progressive motility (29.1% +/- 0.1% vs. 19.9% +/- 0.1%) increased by twofold.

CONCLUSION(S)

The zeta method improved sperm parameters associated with increased fertilization and pregnancy after assisted reproduction procedures. Manipulation from the attaching-detaching process stimulated sperm metabolism without causing premature acrosome reactions. Total motility was unchanged suggesting a lack of association between total motility and zeta potential.

A FOLLOW-UP EXPANDED STUDY OF THE CORRELATION OF SPERM VELOCITY IN SEMINAL PLASMA AND OFFSPRING GENDER

A preliminary study reported finding higher sperm velocity in seminal plasma in males of partners that conceived female offsprings. The null hypothesis was that sperm velocity was not related to the offspring gender. The objectives were: (a) to expand the previous study, and (b) to correlate offspring gender results with motility parameters determined through the computer-aided sperm analyzer (CASA) system. In combined fresh and frozen cycles (N = 187), sperm from cases with all female offsprings displayed higher curvilinear (48 +/- 1.0 mu/sec versus male 46 +/- 1.0, P < 0.05) and average path velocities (36 +/- 0.7 mu/sec versus male 34 +/- 0.7, P < 0.01). A criteria of less than 30 mu/sec or over 41 mu/sec average path velocity predicted 73 or 72% of the male or female offspring cases, respectively. A curvilinear velocity of less than 49 mu/sec or over 55 mu/sec predicted 58 or 59 % of the male or female offspring cases, respectively. Semen viscosity reflected in sperm velocity was linked to predominantly male or female sperm populations. Paracrine signals from the gender-skewed sperm precursor populations controlling viscosity merit further exploration.

Luteal phase serum cell-free DNA as a marker of failed pregnancy after assisted reproductive technology

PURPOSE

DNA-damaging factors have been reported in patients that failed to achieve pregnancy after assisted reproductive technologies (ART). The hypothesis was that increased circulating cell-free DNA released by damaged cells could predict unfavorable conditions leading to failed ART treatment. The objective was to compare the relative concentrations of cell-free DNA in the luteal phase sera of nonpregnant versus pregnant patients.

METHODS

Frozen-thawed sera (30 IVF cases) were obtained 1 week after embryo transfer. There were 16 pregnant and 14 nonpregnant cases and controls consisting of male sera (n = 8 cases). Modified isocratic capillary electrophoresis was performed and the images analyzed for cell-free DNA.

RESULTS

Circulating cell-free DNA were identified in the sera of all patients. The serum concentrations of high (12 kb) and low (1 kb) molecular weight cell-free DNA were similar for both nonpregnant and pregnant patients. Male control sera had higher cell-free DNA concentrations compared with females. Evaluation of sera from a control case showed no fluctuations in cell-free DNA concentrations throughout specific days of the menstrual cycle.

CONCLUSIONS

The results do not support the use of the luteal phase cell-free DNA concentration as a marker for failed pregnancies. The equal concentrations of high and low molecular weight cell-free DNA and ladder band-like gel patterns suggested cell apoptosis as the source of DNA.

Mouse embryonic stem cells for quality control testing in assisted reproductive technology programs

OBJECTIVE

To compare the mouse embryonic stem (ES) cell assay with the sperm motility test or 1-cell mouse embryo bioassay for embryotoxic materials.

STUDY DESIGN

Cryo-preserved-thawed mouse ES-D3 cells, 1-cell mouse embryos and donor sperm were incubated for 1-4 days in culture medium exposed to a control and 4 different test materials. ES cell viability (eosin method), apoptosis (Sybr-Gold fluorescence), development of blastocysts and sperm motility parameters were measured.

RESULTS

The initial viabilities of ES cell were determined to be 37.0 +/- 4.2% (n = 225) and 54.8 +/- 7.4% (n = 218) by the eosin and Sybr Gold methods, respectively. Reduced viability of ES cells in latex glove-treated medium (25.6 +/- 0.3% and 25.7 +/- 0.3% versus control, 32.8 +/- 0.2% and 33.5 +/- 1.0% by eosin or Sybr Gold, respectively, p < 0.05) was consistent with standard bioassays. However, toxicity in the syringe was detected only by the ES cell assay. The ES cell assay sensitivities were 33% and 67% (eosin and Sybr Gold methods, respectively), and specificities were 100% for both methods.

CONCLUSION

Mouse ES cell assay based on Sybr-Gold asssessment was as effective as standard bioassays for detecting embryotoxicity. The results suggested that the mouse ES assay could be used for testing contact materials and DNA-modifying agents. More studies are needed to refine and enhance the sensitivity of the ES cell assay for routine use in assisted reproductive technology clinics.

Modified isocratic capillary electrophoresis detection of cell-free DNA in semen

PURPOSE

The objectives were: i) to analyze semen for the presence of cell-free DNA and ii) to determine the association between sperm parameters and cell-free DNA.

METHODS

Cell-free DNA in semen (N = 25 cases) were detected using the modified capillary gel electrophoresis (CE) procedure. SYBR-Gold was used to stain high (12 Kb) and low (1 Kb) molecular weight DNA fragments and the images analyzed.

RESULTS

The quantity of low-molecular weight cell-free DNA was positively correlated to rapid progression, curvilinear velocity (>40 microm/s), normal strict morphology and capacitation index. High-molecular weight cell-free DNA intensity index was negatively correlated to post-wash hyperactivation. Sperm concentration was not related to cell-free DNA quantity. The sperm freezing process did not increase cell-free DNA but reduced the more labile low-molecular weight cell-free DNA.

CONCLUSIONS

Cell-free DNA present in semen was correlated to important sperm parameters linked to normal sperm function. The data suggested the possible use of cell-free DNA as a marker of semen quality. This study reports on the novel finding of cell-free DNA released along with sperm during each ejaculation.

Development of mammalian embryos exposed to mixed-size nanoparticles

Inhaled or ingested ultrafine nanoparticles and their effects on early pregnancy remain polemic. The objectives of the study were: (a) to determine the embryotoxic effects of nanoparticles at the 2-cell stage and (b) to localize the internalized nanoparticles in the blastocyst. Thawed mouse 2-cell embryos (no. = 128) were exposed to either mixed-size polystyrene-based nanoparticles (11 million/ml) or control G1.3 medium and assessed after 72 hours. Additionally, blastocysts (no. = 146) were exposed to nanoparticles and analyzed. The results showed that the nanoparticles did not inhibit 2-cell embryo development to the blastocyst stage (89.4 vs 96.8%; treated vs control). There were no differences in hatching (34.8 vs 43.5%), implantation (13.6 vs 24.2%) and degeneration (10.6 vs 3.2%). Delayed exposure to nanoparticles showed similar percent hatching (40.7 vs 47.3%) and implantation (17.6 vs 20.0%). Although nanoparticles were internalized, embryo development was not inhibited suggesting a lack of embryotoxicity. During hatching, the larger nanoparticles adhered to the extruding blastocyst, preferentially on trophoblasts, but interference was insignificant. Exposure to polystyrene-based nanoparticles at the concentration tested are not associated with embryonic loss.

Sperm velocity in seminal plasma and the association with gender of offspring

The gender of the offspring is determined by the fertilizing sperm. Previous gender studies were based on washed sperm, but not on sperm in seminal plasma. The objective was to correlate motility parameters assessed during semen analyses with the offspring gender. For comparison, fixed sperm head DNA quantitated by Hoechst 33342 fluorescence microscopy was also analyzed. Forty-six patients undergoing assisted reproduction procedures resulted in livebirth deliveries with either male or female-predominant offsprings. Sperm head fluorescence was weakly correlated to the gender in 61% of the cases. Sperm of patients with male offsprings had slower curvilinear (44.2 +/- 1.8 mean +/- SEM, versus, 49.9 +/- 2.7 micro /sec) and slower average path velocities (32.4 +/- 1.2 versus 36.3 +/- 1.7 micro /sec). Using cut-off values for the curvilinear (< 49 micro /sec) and average path (< 36 micro /sec) velocities of sperm swimming in seminal plasma, the two parameters predicted 75 and 68% of the male offspring births, respectively. The data suggest that sperm movement in seminal plasma is a marker for factors that skew the ratio of the X- to Y-sperm populations.

Dual fluorescence analysis of DNA apoptosis in sperm

OBJECTIVE

The objective was to compare fluorochrome Hoechst 33342 (Ho342) with combined Ho342/propidium iodide (PI) stains for assessment of sperm quality.

STUDY DESIGN

Washed donor sperm cells were incubated in either 0, 0.15, or 15 micromol/L camptothecin (CAM) or 0.37 or 3.7 mmol/L genistein (GEN) for 4 hours at 37 degrees C. The sperm cells were analyzed for cycle-independent apoptosis and necrosis by single- compared with dual-stained fluorescence microscopy to contrast the relative effectiveness of these two approaches.

RESULTS

The single-stain procedure did not detect viability differences (overall 76.1% +/- 2.2% live). In contrast, the dual-stain procedure identified a dose-dependent decrease in viability and increased necrozoospermia for CAM and GEN treatments. Apoptosis was 2-fold higher with topoisomerase inhibitor treatment.

CONCLUSION

The two topoisomerase inhibitors were associated with increased apoptosis and dose-dependent necrosis. The data suggested that the dual-stain combination Ho342/PI was more sensitive than the single Ho342 stain analysis and permitted quantifying the apoptosis and necrosis events in sperm.

Prevalence of negative-pressure pulmonary edema at an orthopaedic hospital

Negative-pressure pulmonary edema (NPPE) occurs when a large, negative intrathoracic pressure is generated against an obstructed upper airway, causing fluid to shift into the lung interstitium. Young, healthy, athletic male patients appear to be at increased risk for this disorder, but the prevalence in orthopaedic surgery patients has been unknown. We retrospectively reviewed the charts of 14 patients (11 male, 3 female) with NPPE at our institution over a 15-year period. The patients had 11 different surgical procedures; 16,653 similar procedures were done during this time. The overall prevalence of NPPE (< 0.1%) was not significantly different between male and female patients. Patients with NPPE were significantly younger than those without NPPE. If NPPE is recognized promptly and treated appropriately with intravenous diuretic and oxygen therapy, most patients respond well. Physicians should be vigilant to the potential for NPPE in young, otherwise healthy patients after general anesthesia.

Cyclooxygenase (COX)-2 and granulosa cell apoptosis in vitro

PURPOSE

C-myc was studied in cyclooxygenase (COX)-2 associated granulosa cell apoptosis,

METHODS

Granulosa cells (N = 5 cases) were incubated for 24 h in either 1 or 50 microM COX-2 inhibitor, 1 or 50 microM COX-1/COX-2 inhibitor, negative or positive controls Single primer polymerase chain reaction of c-myc exon 1 were performed. Bisbenzimide-stained control single-stranded (ssDNA) were hybridized to SYBR Gold-stained ssDNA and fluorescent images analyzed.

RESULTS

C-myc was disrupted by the high-dose COX-2 inhibitor. Cell viability decreased with COX-1 and COX-2 inhibition. However, cell viability was similar for the positive control and at low-dose COX-2 inhibition.

CONCLUSIONS

Inhibition of both COX-1 and COX-2 initiated apoptosis without disrupting c-myc suggesting a protective effect on c-myc. The low dosage of the COX-2 inhibitor did not disrupt c-myc and cell viability. C-myc sensitization was not part of apoptosis.

A simple DNA disc chip in a microarray design based on modified comparative genomic hybridization for sperm DNA analysis

OBJECTIVE

A DNA disc chip assay, based on comparative genomic hybridization, was designed to measure changes in sperm DNA intensities. The objective was to analyze the DNA integrity of hyperactive sperm cells after mild heat treatment.

DESIGN

The assay based on a multiple cell comet assay was used to analyze changes in genomic DNA. Washed sperm DNA were tested on the assay and images stored in a microarray design.

SETTING

Clinical and academic research environment.

PATIENT(S)

Frozen-thawed washed sperm from different donors (n = 7).

INTERVENTION(S)

Discarded sperm leftover from trial washes carried out at 37 degrees and 40 degrees C were frozen and processed for the DNA disc chip assay.

MAIN OUTCOME MEASURE(S)

Fluorescent intensities of DNA disc chips and sperm variables.

RESULT(S)

Heat treatment resulted in more than eightfold increase in sperm hyperactive motility with little degradation in DNA integrity. Sperm with low hyperactivation was associated with alterations in DNA after heat treatment.

CONCLUSION(S)

The DNA disc chip assay was simple, inexpensive, and permitted assisted reproduction technologies laboratories to use comparative genomic hybridization for cytogenotoxicity testing. However, the assay required manual processing, a fluorescent microscope, and computer. The data showed an association between sperm hyperactivation and DNA integrity suggesting that the hyperactivation marker may be used for selecting quality sperm for intracytoplasmic sperm injection. More studies are needed to examine temperature effects on ejaculated human sperm.

Comparative genomic hybridization analysis of sperm DNA apoptosis after exposure to heat shock

PURPOSE

A DNA disc chip assay based on comparative genomic hybridization (CGH) was developed to measure sperm DNA integrity. The objective was to correlate DNA integrity of heat-treated sperm with the sperm capacitation index (CI) determined from the sperm penetration assay.

METHODS

Basic semen and kinematic parameters were measured (N = 6). Sperm were washed in two-layer colloid suspensions and split portions incubated at either 3 degrees C (control) or 40 degrees C for 4 h. Single-stranded DNA of heated sperm were stained in SYBR Gold and hybridized to bisbenzimide (Hoechst 33342) stained control DNA in a membrane disc. Fluorescent intensities of the discs were measured and correlation analyses with sperm parameters performed.

RESULTS

Sperm CI was positively correlated (R = 0.737) with sperm DNA integrity. Two populations of sperm could be discerned: low capacitating sperm that initiated apoptosis and high capacitating sperm unaffected by heat shock treatment. The remaining parameters were not related to sperm DNA stability.

CONCLUSIONS

Fragile DNA were found in a population of sperm associated with poor capacitation characteristics and apoptosis was observed after heat treatment. The results suggested that sperm dysfunction might be due to apoptotic sperm DNA resulting from an elevated temperature in the surroundings. The data suggested that the second population of high capacitating sperm induced chaperones such as heat shock proteins hsp 70 to protect against apoptosis.

Oocyte comet assay of luteal phase sera from nonpregnant patients after assisted reproductive procedures

PURPOSE

Serum factors in patients with recurrent spontaneous abortions (RSA) inhibit mouse embryo development in vitro. Serum factors affecting DNA integrity remain to be tested. The null hypothesis was that patient sera do not affect DNA integrity. The objectives were (a) to use the oocyte comet assay to assess DNA damage after exposure to patient sera and (b) to determine the effect of sera from gravidity 0 parity 0 patients to induce DNA apoptosis.

METHODS

Luteal phase sera were drawn 1 week after embryo transfer following assisted reproductive procedures. Frozen-thawed hamster zona intact oocytes at metaphase II were incubated in groups of eight in either control medium or medium supplemented with 50% patient serum for 1.5 h at 37 degrees C in room air. The oocytes were fixed, stained in acridine orange, embedded in agarose, lysed, and alkaline electrophoresis performed. The intensities of the digitized fluorescent images were analyzed.

RESULTS

The sera of nonpregnant patients (64%) caused significant fragmentation of hamster oocyte DNA when compared with pregnant patient sera. This difference was also observed when adjusted for patient age. Sera of patients that had never been pregnant also resulted in oocyte DNA fragmentation.

CONCLUSIONS

The results suggested that sera from patients that did not conceive contained factors that did not support cell growth by causing DNA fragmentation and apoptosis. The level of the apoptotic factors varied from cycle to cycle. However, more studies are needed to determine if the sera factors actually reach the uterine environment to cause the undesirable effects.

Pulmonary dysfunction in patients with femoral shaft fracture treated with intramedullary nailing

BACKGROUND

This study was undertaken to determine whether alveolar dead space increases during intramedullary nailing of femoral shaft fractures and whether alveolar dead space predicts postoperative pulmonary dysfunction in patients undergoing intramedullary nailing of a femoral shaft fracture.

METHODS

All patients with a femoral shaft fracture were prospectively enrolled in the study unless there was evidence of acute myocardial infarction, shock, or heart failure. Arterial blood gases were measured at three consecutive time-periods after induction of general anesthesia: before intramedullary nailing and ten and thirty minutes after intramedullary nailing. The end-tidal carbon-dioxide level, minute ventilation, positive end-expiratory pressure, and percent of inspired and expired inhalation agent were recorded simultaneously with the blood-gas measurement. Postoperatively, all subjects were monitored for evidence of pulmonary dysfunction, defined as the need for mechanical ventilation or supplemental oxygen (at a fraction of inspired oxygen of >40%) in the presence of clinical signs of a respiratory rate of >20 breaths/min or the use of accessory muscles of respiration.

RESULTS

Seventy-four patients with a total of eighty femoral shaft fractures completed the study. Fifty fractures (62.5%) underwent nailing after reaming, and thirty fractures (37.5%) underwent nailing with minimal or no reaming. The mean alveolar dead-space measurements before canal opening and at ten and thirty minutes after canal opening were 14.5%, 15.8%, and 15.2% in the total series of seventy-four patients (general linear model, p = 0.2) and 20.5%, 22.7%, and 24.2% in the twenty patients with postoperative pulmonary dysfunction (general linear model, p = 0.05). Of the twenty-one patients with an alveolar dead-space measurement of >20% thirty minutes after nailing, sixteen had postoperative pulmonary dysfunction. According to univariate and multivariate analysis, the alveolar dead-space measurement was strongly associated with postoperative pulmonary dysfunction.

CONCLUSIONS

According to our data, intramedullary nailing of femoral shaft fractures did not significantly increase alveolar dead space, and the amount of alveolar dead space can predict which patients will have pulmonary dysfunction postoperatively.

Biceps tendinitis and subluxation

Since the 17th century, the long head of the biceps tendon as a source of shoulder pain and its functional significance has been a source of debate. Although the term tendinitis is commonly used, overuse tendon injuries infrequently demonstrate inflammatory cells; instead, degenerative changes resulting from the failure of self-repair usually are found. Bicipital tendinitis or bicipital tenosynovitis is most often secondary to impingement beneath the coracoacromical arch. Primary bicipital tendinitis and tendinitis secondary to instability are possible, however. Through a careful history, physical examination, and appropriate imaging studies, the clinician can establish the diagnosis of disorders of the biceps tendon Arthroscopic evaluation greatly improves the diagnosis and treatment of biceps tendon and related shoulder pathology. Although the exact functional role of the biceps tendon remains incompletely defined, a growing body of evidence supports its role as a stabilizer of the glenohumeral joint. This stabilizing function should be incorporated into the treatment of biceps tendon disorders. Routine tenodesis has been replaced by a more individualized approach, taking into consideration physiologic age, activity level, expectations, and exact shoulder pathology present. New repair techniques are under development, and preservation of the biceps-labral complex is now preferred when possible.

Human sperm deoxyribonucleic acid fragmentation by specific types of papillomavirus

OBJECTIVE

Human papillomaviruses are present in up to 64.3% of patients' sperm. The objectives were (1) to determine human papillomavirus deoxyribonucleic acid effects on sperm deoxyribonucleic acid integrity and (2) to assess human papillomavirus differential effects on the sperm cell.

STUDY DESIGN

Two-layer colloid washed sperm were exposed to E6-E7 deoxyribonucleic acid fragments generated from human papillomavirus types 16, 18, 31, 33, 6/11, or control (DQA1) for 24 hours. The motility parameters were measured and analyzed. Pilot studies were performed to develop a fixed sperm comet assay to assess deoxyribonucleic acid fragmentation.

RESULTS

Significant sperm deoxyribonucleic acid fragmentation occurred after exposure to deoxyribonucleic acid of human papillomavirus types 16 and 31. Human papillomavirus deoxyribonucleic acid fragment size was not a factor. Human papillomavirus types 18, 33, and 6/11 did not compromise sperm deoxyribonucleic acid integrity. Washed sperm motility was higher in the presence of human papillomavirus deoxyribonucleic acid except for type 6/11. Amplitude of head displacement was lower for human papillomavirus types 16 and 6/11. Sperm linearity was increased for all human papillomavirus types except type 18.

CONCLUSION

Human papillomavirus type 16 and 31 deoxyribonucleic acid caused deoxyribonucleic acid breakages characteristic of apoptotic but not necrotic sperm. The data suggest that these human papillomavirus types may adversely affect subsequent embryonic development after fertilization. Sperm deoxyribonucleic acid appears to resist human papillomavirus types 18, 33, and 6/11 or repairing mechanisms occurred. Although enhanced motility was found in human papillomavirus-exposed sperm, important velocity parameters were decreased, suggesting impaired sperm function.

A comparison of heat-induced hyperactivation in patients' sperm after colloid or pentoxifylline wash methods

OBJECTIVE

Our purpose was to compare kinematic parameters of human sperm after processing through two different wash methods and 40 degrees C heat treatment.

STUDY DESIGN

Sperm specimens (N = 169 cases) were washed by either colloid or pentoxifylline wash methods, and the motility parameters were measured at either 37 degrees C or 40 degrees C at baseline (0 hours) and after 4 hours. Five randomly selected washed specimens with matching 37 degrees C (control) or 40 degrees C heat treatments were assessed for changes in a sentinel gene.

RESULTS

The percentage of sperm hyperactive motility was >5 times higher after the 40 degrees C heat treatment, in comparison with the 37 degrees C treatment, for both the colloid- and the pentoxifylline-washed sperm. The percentages of total motility and progression were equally enhanced in heated sperm for the two wash methods. No changes were detected in the sentinel gene with the heat treatment.

CONCLUSION

Sperm cells mildly heated at 40 degrees C responded with greater motility, progression, and hyperactivation. The data suggest that mild heat is a stimulus for sperm function because greater sperm hyperactivation is associated with increased sperm fertilizing capacity. The absence of change in the sentinel gene in heated sperm suggests that a temperature of 40 degrees C is too low to initiate alterations in the highly condensed sperm chromatin. More studies are needed before mild heating of ejaculated sperm becomes acceptable for use in assisted reproductive technologies.

Comet assay of cumulus cell DNA status and the relationship to oocyte fertilization via intracytoplasmic sperm injection

This paper postulates that in the ovary, the close association between the cumulus cells and the oocytes permits the fertilizing ability of the oocytes to be determined indirectly through cumulus cell DNA status. The objective was to use a modified comet assay to analyse cumulus cell DNA and relate the data to oocyte fertilization after intracytoplasmic sperm injection (ICSI) procedures. Oocytes were retrieved (n = 15 cases) and free-floating cumulus cells were pooled and smeared on clear glass slides to dry. Meanwhile, the denuded oocytes were injected with spermatozoa and fertilization was assessed, followed by embryo transfer. The fixed cumulus cells were stained in acridine orange, coated with a mini-gel agarose layer, lysed in alkaline buffer and electrophoresis performed. Analyses of fluorescent cell images (n = 449) showed that the tail moment was positively correlated to the percentage of fertilization after ICSI (r = 0.567, P < 0.05). In contrast, there was no correlation between tail moment and number of oocytes retrieved, total ampoules used, endometrial thickness and age of patient. The results suggested that the competence of the oocytes was associated with the cumulus cell DNA status. A unique feature here was the comet assay for archived material with obvious advantages.

Updating quality control assays in the assisted reproductive technologies laboratory with a cryopreserved hamster oocyte DNA cytogenotoxic assay

PURPOSE

Despite advances in assisted reproduction, there is no progress in quality control bioassays. The objectives were to develop a comet assay to measure DNA fragmentation in thawed cryopreserved oocytes and compare this assay with one-cell mouse embryo bioassay.

METHODS

Thawed hamster oocytes from a commercial source were incubated in culture media with either 0-, 50-, or 100-microM hydrogen peroxide, or, in media exposed to different contact materials and unknown proficiency analytes. Incubation time was 1.5 h at 37 degrees C. The oocytes were dried, fixed, stained with acridine orange, embedded in a mini-agarose layer and electrophoresis was carried out. Fluorescent images were analyzed. The results were compared with standard one-cell mouse assay data.

RESULTS

The 100-microM hydrogen peroxide treatment caused greatest DNA fragmentation in the hamster oocytes at Hours 1 and 2. A dose response was observed. Intraassay coefficient of variation was 5.7%. Only one of the five materials tested passed both assays. The data for the unknown proficiency analytes were similar for both assays.

CONCLUSIONS

The oocyte comet assay demonstrated DNA fragmentation in the presence of toxic substances. The detection of toxicity in two materials that passed the mouse bioassay suggested increased sensitivity in the new assay. The oocyte comet assay and the mouse bioassay results matched in the proficiency test. However, more studies are still needed to determine optimal sensitivity.

A simple comet assay for archived sperm correlates DNA fragmentation to reduced hyperactivation and penetration of zona-free hamster oocytes

OBJECTIVE

To correlate sperm variables with sperm DNA fragmentation, as assessed by using a modified alkaline comet assay for sperm smears.

DESIGN

The comet assay was adapted for fixed sperm smears (59 cases), and the level of DNA fragmentation was determined.

SETTING

Clinical and academic research environment.

PATIENT(S)

59 patients undergoing fertility treatment.

INTERVENTION(S)

Sperm samples leftover from IVF procedures were fixed and processed for the comet assay.

MAIN OUTCOME MEASURE(S)

Sperm head DNA density and sperm variables.

RESULT(S)

A correlation was observed between increased sperm head DNA fragmentation and decreased penetration of zona-free hamster oocytes. Heat-induced hyperactive motility decreased as DNA fragmentation increased. The DNA fragmentation did not correlate with percentages of intact acrosome, normality, maturity, and strict normal morphology.

CONCLUSION(S)

The advantages of the comet assay for archived cells include simplicity, low intraassay coefficient of variation, and low performance cost; in addition, DNA analysis can be carried out at leisure. Low DNA damage was associated with higher hyperactivation and oocyte penetration, suggesting that failed fertilization was linked to compromised DNA integrity in the sperm. Exploration of compounds to repair damaged DNA is warranted.

Periarticular heterotopic ossification after multiple knee ligament reconstructions. A report of three cases

Heterotopic ossification is a frequently encountered clinical and radiographic entity. There are no previous reports in the English literature of heterotopic ossification after arthroscopically assisted ligament reconstructions for knee dislocations. Further, a link between the PCL reconstruction and posterior capsular ossification has not been heretofore recognized. Our three cases should raise the clinical awareness of such an entity.

Type 5 phosphodiesterase regulation of human sperm motility

OBJECTIVE

Inhibition of phosphodiesterases results in the buildup of intracellular cyclic nucleotides, which have been shown to affect sperm motility and acrosome reaction. The objective of this study was to determine whether the cyclic guanosine monophosphate-specific type 5 phosphodiesterase inhibitor sildenafil has an effect on sperm motility and acrosome parameters.

STUDY DESIGN

Sperm cells were washed by two-layer colloid wash and resuspended in modified human tubal fluid with 5% serum albumin. They were incubated in the presence of different concentrations (0-40 nmol/L) of the type 5 phosphodiesterase inhibitor sildenafil. Aliquots of sperm were removed at hours 0, 4, 24, and 48, and motility parameters were measured on the Hamilton-Thorn HTM-C (Hamilton-Thorn Research, Danvers, Mass) motility analyzer. Sperm acrosomes were analyzed with the Spermac (Stain Enterprises, South Africa; distributed by Sage Biopharma, Bedminster, NJ) acrosome stain.

RESULTS

Sperm progressive motility and hyperactivation were stimulated to greater than the control at hour 4, followed by a decrease. There was a dose-dependent effect of the type 5 phosphodiesterase inhibitor on sperm motility parameters but not on percentage of cells with acrosome reaction. The type 5 phosphodiesterase inhibitor stimulated sperm acrosome reaction by almost 50% above the control.

CONCLUSION

These results suggest that inhibition of type 5 phosphodiesterase activity in human sperm resulted in enhanced progressive motility and hyperactivation. In addition, inhibition of type 5 phosphodiesterase also caused an increase in acrosome reaction. This suggests a role for type 5 phosphodiesterase in preventing premature acrosome reaction, which is associated with failed fertilization.

Mycoplasma-mediated uptake of the exogenous human BRCA1 gene by hatching blastocysts

PURPOSE

Biological vectors for cell transfection are mainly viral in origin, with inherent shortcomings. Mycoplasmas are ubiquitous organisms that traverse cells easily. The objective was to determine if Ureaplasma urealyticum (T-mycoplasma) would vector exogenous BRCA1 DNA into blastocysts.

METHODS

Hatching mouse blastocysts (N = 70) were incubated in the presence of either viable or dead Ureaplasma urealyticum at 37 degrees C for 1 hr. The blastocysts were exposed to human BRCA1 DNA lacking homology in the mouse genome for 2 hr, followed by DNase-1 treatment and wash. Polymerase chain reaction and agarose gel electrophoresis analysis of amplified products were performed.

RESULTS

The BRCA1 gene was detected in the blastocysts only when viable Ureaplasma was present. PCR analyses of control Ureaplasma and untreated blastocysts were negative.

CONCLUSION

Viable Ureaplasma organisms were shown to mediate the uptake of DNA fragments into blastocysts, resulting in transgenic mouse blastocysts with a normal human BRCA1 exon 11 gene.

Sperm artificially exposed to antisperm antibodies show altered deoxyribonucleic acid

PURPOSE

Our purpose was to assess sperm deoxyribonucleic acid (DNA) integrity after exposure to antisperm antibodies.

METHODS

Donor semen were divided and exposed to sera containing IgG, IgA, and IgM antisperm antibodies. Untreated portions served as the control. After incubation (1 hr, 23 degrees C), the sperm were centrifuge-washed, resuspended, and incubated (23 degrees C) for 2, 5, 7, or 9 days. Acridine orange staining and kinematic parameters were measured. The sentinel (17q21 from D17S855) and beta-globin genes were amplified and analyzed using denaturing gradient gel electrophoresis.

RESULTS

Sperm preexposed to antisperm antibodies had deleted sentinel gene on days 7 and 9. The beta-globin gene was intact. There were no differences in acridine orange staining.

CONCLUSIONS

Sperm artificially exposed to antisperm antibodies resulted in a subtle deletion of genetic material. The DNA alteration process was slow and was undetectable at the gross level. More studies are needed to confirm the findings and determine whether DNA repair mechanisms can reverse the damage.

Tenacity of exogenous human papillomavirus DNA in sperm washing

PURPOSE

Sperm cells have been shown to take up exogenous DNA readily. The hypothesis was that sperm washing would remove exogenous viral DNA infecting sperm cells. The objective was to compare three types of sperm washing procedures for their capacity to remove exogenous human papillomavirus (HPV) DNA from infected sperm.

METHODS

Prewashed sperm were equally divided and sperm in one portion were exposed to L1 HPV DNA fragments for 30 min at 37 degrees C. Untreated washed sperm served as the control. After transfection, the sperm were washed by either centrifuge, two-layer Isolate colloid wash, or test-yolk buffer procedures. Sperm parameters were measured on a Hamilton Thorn HTM-C analyzer. Sperm DNA were extracted and polymerase chain reaction (PCR) was carried out targeting the L1 consensus gene of HPV and the designated sentinel gene, 17q21 spanning the D17S855 gene. Amplified products were analyzed in 2% agarose gel electrophoresis.

RESULTS

PCR analyses detected the consensus L1 HPV gene in sperm after they were processed through either of the three procedures. Controls were negative for the L1 gene. Extracted DNA were verified by PCR amplification of 17q21 spanning the D17S855 gene. Transfected sperm had higher percentages of total motility and progression compared with the control. Centrifuged, washed, transfected sperm exhibited a greater curvilinear velocity and hyperactivation.

CONCLUSIONS

The data showed that washing would not remove exogenous HPV DNA from sperm cells. The viral DNA was tenaciously bound to the sperm, suggesting an internalization into the sperm. The viral DNA also increased the motility of the sperm by affecting the velocity and progression of the sperm, which suggested either an increase in metabolism, an enhancement of the calcium-regulated motility mechanism, or an artifact of PCR reagents. More studies are needed to elucidate the mechanism of DNA stimulated sperm motility.

Spermac stain analysis of human sperm acrosomes

OBJECTIVE

To study the association between low percentages of intact sperm acrosomes and fertilization failures in conventional IVF procedures.

DESIGN

A retrospective study.

SETTING

Clinical and academic research environment.

PATIENT(S)

Patients undergoing treatment of infertility.

INTERVENTION(S)

Sperm cells were fixed and stained using the Spermac stain.

MAIN OUTCOME MEASURE(S)

Percentages of intact acrosomes and fertilization.

RESULT(S)

There was a significant association between specimens with <40% intact acrosomes and failed conventional IVF procedures. Among the 29 cases with <40% intact acrosomes, 9 cases (31%) resulted in zero penetration of the oocytes. The mean (+/-SEM) percentage of fertilization was lower in the abnormal acrosome group (43.3% +/- 6.5%) than in the normal acrosome group (64.1% +/- 5.6%). The status of the sperm acrosome was not correlated with the results of fertilization in intracytoplasmic sperm injection procedures.

CONCLUSION(S)

Sperm with low percentages of intact acrosomes were associated with failed fertilization. The Spermac stain was useful for assessing acrosomes and identifying possible male factor infertility problems. The results suggested that a minimum percentage of sperm with intact acrosomes are needed for fertilization to occur in vitro.

An alternative medicine study of herbal effects on the penetration of zona-free hamster oocytes and the integrity of sperm deoxyribonucleic acid

OBJECTIVE

To analyze the effects of certain herbs on sperm DNA and on the fertilization process.

DESIGN

Prospective comparative study.

SETTING

Clinical and academic research environment.

PATIENT(S)

Donor sperm specimens.

INTERVENTION(S)

Zona-free hamster oocytes were incubated for 1 hour in saw palmetto (Serenoa repens), echinacea purpura, ginkgo biloba, St. John's wort (Hypericum perforatum), or control medium before sperm-oocyte interaction. The DNA of herb-treated sperm was analyzed with denaturing gradient gel electrophoresis.

MAIN OUTCOME MEASURE(S)

Oocyte penetration and integrity of the sperm BRCAI exon 11 gene.

RESULT(S)

Pretreatment of oocytes with 0.6 mg/mL of St. John's wort resulted in zero penetration. A lower concentration (0.06 mg/mL) had no effect. High concentrations of echinacea and ginkgo also resulted in reduced oocyte penetration. Exposure of sperm to echinacea purpura and St. John's wort resulted in DNA denaturation. In contrast, saw palmetto and ginkgo had no effect. Sperm exposed to 0.6 mg/mL of St. John's wort showed mutation of the BRCA1 exon 11 gene.

CONCLUSION(S)

High concentrations of St. John's wort, echinacea, and ginkgo had adverse effects on oocytes. Saw palmetto had no effect. The data suggested that St. John's wort, ginkgo, and echinacea at high concentrations damage reproductive cells. St. John's wort was mutagenic to sperm cells.

Inhibition of human sperm motility by specific herbs used in alternative medicine

PURPOSE

Our purpose was to analyze sperm motility parameters in the presence of herbs.

METHODS

Washed sperm were incubated in either saw-palmetto (Serenoa repens, Permixon Sabal serrulatum), echinacea purpura, ginkgo biloba, St. John's wort (Hypericum perforatum), or control medium. Parameters were measured on a Hamilton-Thorn analyzer after 1, 4, 24, and 48 hr at 37 degrees C.

RESULTS

Sperm motility was inhibited at the high concentration (0.6 mg/mL) of St. John's wort. Curvilinear velocities and beat cross frequencies also decreased, but not hyperactivation. High-concentration saw-palmetto, echinacea, or gikgo inhibited motility at 24 and 48 hr.

CONCLUSIONS

A potent inhibition of sperm motility was seen in St. John's wort unrelated to changes in pH. Furthermore, sperm viability was compromised in St. John's wort, suggesting a spermicidal effect. Metabolic changes were observed in saw-palmetto-treated sperm. High-concentration echinacea purpura interfered with sperm enzymes. Ginkgo did not have an antioxidant effect on sperm motility.

Aggregation of human sperm at higher temperature is due to hyperactivation

Chemotaxis of sperm cells to chemicals and hormones, such as progesterone, helps us to understand the concept of sperm transport. Here, the hypothesis was that heat increased sperm hyperactive motility, which caused the sperm to aggregate at the higher temperature. The objectives were (1) to determine the concentration of sperm at both halves of an artificial female reproductive tract made from a hermetically sealed cryopreservation straw filled with culture medium and placed with each end at different temperatures, and (2) to analyze the motility or kinematic parameters and hyperactivation of sperm found at the different temperatures. Cryopreserved-thawed human donor sperm (N = 6) were pooled and processed through 2-layer colloid solution. Analyses of the motile sperm were carried out and the washed sperm were homogeneously mixed and pipetted into several 0.5-mL French cryopreservation straws and heat-sealed. The control substance, consisting of acid-treated sperm, was also placed in several straws. The plastic straws of sperm were placed half at 23 degrees C and half was at either 37 or 40 degrees C. After 4 h, sperm at different sections of the straws were analyzed using the Hamilton Thorn motility analyzer (HTM-C). After 4 h of incubation, the concentration of sperm was doubled at the 40 degrees C heated half of the straw when compared with the other half of the straw at 23 degrees C. There were no differences in sperm concentration in the straw kept half at 37 degrees C and half at 23 degrees C. There were significantly higher percent motility, mean average path velocity, straight line velocity, lateral head displacement, and percent hyperactivation in sperm at the 40 degrees C temperature. The aggregation of sperm at the higher temperature of 40 degrees C may be due to enhanced motility, increased sperm velocities, and a 10-fold increase in hyperactivation at that temperature. The 37 degrees C temperature was not sufficient to attract sperm. Sperm cells migrating into the higher temperature site of ovulation begin nonprogressive hyperactivation movement, which is the physiological "brake" to detain the sperm at the site of ovulation.

Assessment of archived paraffin-embedded cervical condyloma tissues for mycoplasma-conserved DNA using sensitive PCR-ELISA

Clinically, it is important to detect mycoplasmas because these organisms have been implicated in gastric and ovarian cancer, pneumonia, postabortal fever, pelvic inflammatory disease, pyelonephritis, endometritis, urethritis, perinatal mortality, arthritis, spontaneous abortion, infertility and interference with sperm development and they act as cofactors catalyzing the HIV disease state. Recently, the combined polymerase chain reaction and enzyme-linked immunosorbent assay method targeting the consensus DNA of over 15 species of mycoplasmas was shown to be superior for the detection of mycoplasmas. The objective was to determine if there was an association between mycoplasmas and cervical neoplasia. Cervical tissues, histopathologically categorized by cervical intraepithelial neoplasia (CIN) grade, flat or exophytic, and acanthosis or koilocytotic, were used. The results showed that mycoplasmas DNA were present in 21.4% of the condyloma tissues and in 33.3% of condyloma tissues with CIN. In contrast, mycoplasmas DNA were not detected when there were no CIN. The presence or absence of human papillomavirus (HPV) did not make a difference. Mycoplasmas DNA were present in 40.0 and 12.5% of the exophytic and flat condylomas, respectively. A higher percentage of cervical tissues graded with slight koilocytosis had (P = 0.05) mycoplasmas DNA compared with tissues graded with moderate koilocytosis. The detection of mycoplasmas DNA in archived cervical condyloma tissues with CIN corroborated previous reports of an association between mycoplasmas and CIN. However, the association between mycoplasmas and the presence of HPV could not be made in this study.

A convenient mixed immunobeads screen for antisperm antibodies during routine semen analysis

OBJECTIVE

To determine if leftover unused IgG, IgA, and IgM immunobeads could be combined as a convenient screen for antisperm antibodies in unwashed sperm. For comparisons, the mixed antiglobulin reaction (SpermMar) and immunobead test were performed.

DESIGN

Prospective comparative study.

SETTING

Clinical and academic research environment.

SUBJECT(S)

Donor human sperm negative for antisperm antibodies.

INTERVENTION(S)

Sperm specimens (n = 9) were equally divided and sera with antisperm antibodies added to one portion (positive control).

MAIN OUTCOME MEASURE(S)

Assessment of antisperm antibodies in sperm.

RESULT(S)

The mixed immunobeads screen qualitative results were the same for both the SpermMar and immunobead tests. The mixed immunobeads screen (positive when > or =10% motile sperm was bound) had a sensitivity and specificity of 100%. The percentages of bound sperm for the mixed immunobeads screen correlated with the SpermMar but not the immunobead test. The mixed immunobeads screen intraassay and interassay coefficients of variation were 28.9% and 45.6%, respectively.

CONCLUSION(S)

Matching results between the mixed immunobeads screen and the SpermMar or immunobead test suggested that the screen could be used to detect antisperm antibodies in unwashed sperm. There was no advantage to washing the sperm, although the screen was flexible and applicable for both unwashed and washed sperm.

Ofloxacin: the next generation of antibiotic in sperm and embryo cultures for assisted reproductive technologies

OBJECTIVE

To analyze the effect of different concentrations of ofloxacin on sperm kinematic parameters and to determine the embryotoxicity of ofloxacin at physiologic and at 100x concentrations.

DESIGN

Prospective comparative study.

SETTING

Clinical and academic research environment.

PATIENT(S)

Pooled cryopreserved donor sperm (n = 7).

INTERVENTION(S)

Human sperm were processed through two-layer discontinuous Percoll gradients, and the resultant pellet was resuspended in either HEPES-buffered human tubal fluid medium containing different concentrations of ofloxacin or the control medium. After measuring the kinematic parameters, the percentages of apoptosis and viability were obtained. Next, the sperm DNA was extracted and polymerase chain reaction of beta-globin gene was performed followed by denaturing gradient gel electrophoresis. Mouse embryos recovered at the one-cell pronuclear or zygote stages were cultured in the presence or absence of ofloxacin up to the hatched blastocyst stage and differences in development were recorded.

MAIN OUTCOME MEASURE(S)

Sperm kinematic parameters, sperm beta-globin gene, and number of embryos reaching the hatched blastocyst stage.

RESULT(S)

The number of embryos exposed to control and physiologic ofloxacin concentrations showed comparable excellent growth. However, the 100x concentration significantly arrested development. Rates of sperm viability and apoptosis measured 48 hours after exposure to the above concentrations were not different from controls. No differences were noted in the sperm kinematic parameters of sperm exposed to ofloxacin concentrations (1x, 10x, and 100x) or control medium after 0, 4, and 48 hours of incubation. Denaturing gradient gel electrophoresis of beta-globin genes from DNA exposed to varying ofloxacin concentrations failed to show any point mutations.

CONCLUSION(S)

Ofloxacin was embryotoxic at pharmacologic concentrations (100x). At physiologic or higher concentrations, ofloxacin appears to be safe and does not affect sperm kinematic parameters when compared with controls. This may indicate that sperm motility parameters alone cannot be relied on to evaluate the effects of drugs on fertility and that in vitro embryologic studies are essential. Ofloxacin at any concentration did not alter the rates of sperm apoptosis or viability. Ofloxacin does not appear to be mutagenic as evidenced by the beta-globin gene analysis.

Enhanced fertility after heat-induced hyperactivation

OBJECTIVE

To determine sperm hyperactivation, kinematic parameters, and fertilizing capacity after pretreating sperm at 40 degrees C for 4 hours.

DESIGN

Prospective study involving pooled donor sperm that were colloid washed and incubated at either 23 degrees C (control) or 40 degrees C (heat-treated) for 4 hours as pretreatment. After incubation, analyses were performed with a computer-assisted sperm analyzer, whereas separate portions of sperm were evaluated with the sperm penetration assay at 37 degrees C.

SETTING

Clinical and academic research environment.

PATIENT(S)

Cryopreserved-thawed sperm from different donors (n = 5).

MAIN OUTCOME MEASURE(S)

Sperm kinematic and fertilizing parameters.

RESULT(S)

Heat pretreatment of sperm resulted in over 22 times higher hyperactive motility at hour 4 compared with the control. The other kinematic parameters were also different. The heat-pretreated sperm group had a significantly higher percent penetration of zona-free oocytes with more swollen sperm heads per oocyte and enhanced sperm binding.

CONCLUSION(S)

The results showed that hyperactivation was induced by pretreatment of sperm with 40 degrees C heat, suggesting the involvement of heat factors in hyperactivation. The fertilizing capacity of sperm may be improved by the mild heat pretreatment when marked by the presence of heat-induced hyperactivation.

Heat-induced hyperactivation

PURPOSE

The objectives of this study were (1) to determine the sperm hyperactivation and related kinematic parameters at 40 degrees C after using four sperm wash procedures and (2) to correlate the heat-induced hyperactivation data with cases of clinical pregnancies from either artificial insemination or standard in vitro fertilization (IVF).

METHODS

Semen samples (n = 51) were collected by ejaculation, and semen analyses were carried out to determine the pretreatment data. Sperm kinematic measurements were performed using the Hamilton Thorn HTM-C computer-aided sperm analyzer. Hyperactivation was determined using the sort module on the HTM-C. Membrane integrity was assessed using the hypoosmotic sperm swelling procedure. Sperm morphology and acrosomal status were also determined using the Spermac stain. Each semen specimen was divided and processed through either the swim-up wash, the 1-h test-yolk buffer (TYB) wash, the 1 mg/ml pentoxifylline stimulant procedure, or the two-layer 90:47% gradient colloidal solution procedure. The washed sperm were incubated at 25 or at 40 degrees C for 4 hr. After incubation, kinematic parameters were assessed for the posttreatment data. Semen specimens were obtained on different occasions for artificial insemination or standard IVF. Data from intracytoplasmic sperm injection cases were not included to avoid confounding factors. Live births and/or pregnancies with fetal heart-beat examined by ultrasound were considered clinical pregnancies.

RESULTS

Heat-induced hyperactive motility was significantly higher in sperm of the male partner of pregnant (n = 7) patients compared with nonpregnant (n = 44) patients (mean +/- SE, 10.0 +/- 3.3 versus 5.5 +/- 0.8%) after TYB processing followed by 4 hr of incubation at 40 degrees C. This was also observed after colloid (Percoll) processing (11.6 +/- 4.6 versus 5.8 +/- 0.8%). There were no differences in hyperactivation after 4 hr at 23 degrees C between pregnant and nonpregnant cases. Parameters such as count, volume, motility, viability, and acrosomal status were not different for the groups. However, the percentage of sperm with normal morphology (WHO classification) was twice as high in the pregnant group versus the nonpregnant group.

CONCLUSIONS

Heat-induced hyperactivation was associated with fertile sperm and was predictive of pregnancy obtained after artificial insemination or IVF. The association was evident only after TYB or Percoll sperm processing. The study could not confirm the finding of significant decreases in motility after heat treatment of sperm derived from infertile males. The mechanism for heat-induced hyperactivation did not involve membrane integrity or the sperm acrosome, although an involvement of heat shock proteins was postulated. Interestingly, there were no pregnancies when sperm did not exhibit heat-induced hyperactivation.

Silane-coated silica particle colloid processing of human sperm

PURPOSE

The purpose of this study was to determine differences in the quality of human sperm processed through different lots of silane-coated silica particle colloid solutions. The objectives were to compare (a) sperm kinematic parameters, (b) the sperm acrosome status, (c) the membrane integrity of the head and tail regions, (d) the DNA normality, and (e) the heat-inducible hyperactivation motility after processing sperm through either a Silane-coated silica particle colloid solution, a Percoll solution, or a simple centrifuge sperm wash (control).

METHODS

Sperm cells were derived from pooled cryopreserved-thawed specimens of several donors (n = 10). The pooled sperm were divided and processed through either the centrifuge wash, the 90:47% two-layer Percoll, or one of three lots of silane-coated silica particle colloidal solutions from three vendors. Aliquots of sperm cells were analyzed using the Hamilton-Thorn HTM-C motility analyzer for differences in kinematics and hyperactivation. Sperm were also analyzed for membrane integrity at both head and tail regions, normal morphology, acrosome status, and viability. Sperm undergoing apoptosis were determined using the acridine orange stain. Processed sperm were also incubated at 40 degrees C for 4 hr and the quality of the sperm was assessed using the heat-induced hyperactivation and motility parameter.

RESULTS

The data showed that after sperm processing, the number of sperm recovered was higher for the three lots of colloids (silane-coated silica particle colloid solutions) compared with Percoll processing. Total sperm motility was higher in the colloidal washes compared with the control. There were no differences in motility between Percoll- and colloid-processed sperm. In contrast, the percentages of sperm exhibiting progressive motility or hyperactivation varied among the different lots of colloid solutions. The Percoll wash solution yielded the highest percentage of sperm with intact tail membranes, whereas some lots of colloid solutions disrupted sperm head membranes. The percentages of sperm undergoing apoptosis varied for the different lots of colloid solutions. There was a marked increase in hyperactivation associated with one colloid solution after heat induction.

CONCLUSIONS

The results demonstrated variability in the different lots of silane-coated silica particle colloid solutions for processing sperm. Each lot of colloid solution excelled at improving different sperm parameters. The silane-coated silica particle colloid solutions were shown to be effective in recovering motile sperm compared with Percoll but the types of motility and sperm quality varied for the different lots of colloid solutions. Due to the variability in lots of silane-coated silica colloid solutions, reported studies based on only one lot or one source of colloid solution may be difficult to interpret. Furthermore, it may be advantageous to select the best lot of silane-coated silica particle colloid solution to produce the highest number of sperm exhibiting the ideal parameters for use in assisted reproduction technologies.

Antibiotics: effect on cryopreserved-thawed human sperm motility in vitro

OBJECTIVE

To analyze the motility and fertilizing capacity of sperm treated with different antibiotics.

DESIGN

Prospective comparative study.

SETTING

Clinical and academic research environment.

PATIENT(S)

Pooled cryopreserved donor sperm (n = 14).

INTERVENTION(S)

Sperm were washed with Percoll and resuspended in HEPES-buffered human tubal fluid medium containing either amoxicillin, ofloxacin, ciprofloxacin hydrochloride, nitrofurantoin monohydrate, doxycycline hyclate, cefuroxime axetil, or control medium.

MAIN OUTCOME MEASURE(S)

Sperm kinematic and fertilizing parameters.

RESULT(S)

Sperm hyperactivation was decreased in physiologic concentrations of ciprofloxacin hydrochloride and doxycycline hyclate over the course of 48 hours. At pharmacologic concentrations, ciprofloxacin hydrochloride, cefuroxime axetil, and nitrofurantoin monohydrate adversely affected motility with decreased rapid progression. Cessation of motility occurred in cefuroxime axetil and nitrofurantoin monohydrate. Sperm hyperactivation was also absent. Cefuroxime axetil decreased the percentage of intact acrosomes. In contrast, physiologic doses of ciprofloxacin hydrochloride or ofloxacin enhanced sperm fertilizing capacity.

CONCLUSION(S)

Ciprofloxacin affected hyperactivation by altering membrane properties, whereas doxycycline inhibited the capacitation process. Cessation of motility in cefuroxime axetil was linked to disrupted sperm head membranes. Sperm motility and fertilizing capacity were decreased in nitrofurantoin because of decreased metabolism. The positive effect of ofloxacin on fertilizing capacity did not involve changes in acrosome.

Analysis of the flow cytometer stain Hoechst 33342 on human spermatozoa

Several procedures exist for processing sperm cells for sex preselection. Flow cytometric separation using the fluorochrome stain Hoechst 33342, chemically known as bisbenzimide, is the most promising. The objective of this study was to determine the effect of bisbenzimide on spermatozoa assessed by means of the sperm survival test and to analyse the beta-globin gene in sperm DNA after exposure to increasing concentrations of bisbenzimide. Donor (n = 16) sperm specimens were pooled and washed in a discontinuous Percoll gradient 95:47%, divided and incubated in tubes containing bisbenzimide at concentrations 0 (control), 0.9, 9, 90, 900 and 9000 microM at 25 degrees C and scanned on a computer-aided sperm motility analyser at 0, 1, 4 and 24 h. Spermatozoa were also incubated in a known mutagen, ethidium bromide, as positive control. After 24 h of incubation, the treated sperm cells were processed through DNA extraction and polymerase chain reaction (PCR) performed with primers targeting the beta-globin gene. The amplified DNA products were analysed for evidence of mutation in 5% polyacrylamide gel electrophoresis and 20:80 denaturing gradient gel electrophoresis (DGGE) and further confirmed in 30:40 DGGE. The results showed complete cessation of motility in sperm incubated in the presence of 900 microM or higher concentrations of bisbenzimide. The beat cross frequency sperm parameter was significantly different at the 90 microM or higher concentration of bisbenzimide compared with the control. At concentrations < 900 microM bisbenzimide, there were no differences in the remaining sperm kinematic parameters (percentage rapid progressive, percentage total progressive, sperm velocities, linearity, straightness, amplitude of lateral head displacement and percentage hyperactive motility). PCR and DGGE analyses of spermatozoa treated with bisbenzimide showed no evidence of mutation in the representative region of the beta-globin gene at concentrations < 900 microM. The data suggest an inhibitory effect of bisbenzimide on human sperm motility at 900 microM or higher concentrations of bisbenzimide. The decrease in sperm motility and rapid progression were not due to changes in pH. Point mutation in the representative region of the beta-globin gene in human spermatozoa was detected only at high concentrations (> or = 900 microM) of bisbenzimide. The data suggest that incubating sperm in low concentrations of bisbenzimide (< 90 microM) for up to 24 h does not significantly affect all the sperm kinematic parameters including the beat cross frequency parameter when compared with the control.

Sperm kinetics and morphology before and after fractionation on discontinuous Percoll gradient for sex preselection: computerized analyses

The multiple-layer discontinuous Percoll density gradient centrifugation procedure is being used for gender selection and several reports suggested separation efficiencies of over 77%. The mechanism involved in the separation of X- and Y-bearing sperm using this method seems to be the difference in sperm head dimensions or motility but supporting data are inconsistent. The specific aims of the study were to evaluate the head dimensions of sperm at the upper and lower fractions after the 8-layer Percoll gradient procedure for sex preselection and to ascertain the kinematic parameters and tail lengths of sperm derived from the 2 separate Percoll fractions. Sperm cells were obtained from thawed donor specimens (N = 20) and were layered on top of the 8-layer discontinuous Percoll gradient, which ranged from 34 to 85% in increments of 7%. After centrifugation, the resuspended sperm cells derived from the upper and lower fractions of the Percoll gradient were analyzed on the Hamilton Thorn HTM-C analyzer for differences in sperm motility patterns and sperm head dimensions. Aliquots of sperm from the 2 fractions were fixed and stained using the Spermac stain, and the lengths of each sperm tail (N = 600) were measured on the HTM-C analyzer. Sperm derived from the bottom Percoll (X) fraction had a threefold higher (p < .05) percent motility when compared with sperm from the top (Y) fraction. Sperm derived from the bottom (X) fraction maintained the higher percentage motility after 24 h of incubation. The percent total progression, rapid progression, and hyperactivation were also significantly higher (p < .05) in sperm from the bottom (X) fraction. Similarly, the curvilinear (Vcl), average path (Vap) and straight line (Vsl) velocities were significantly faster in sperm (p < .05) from the bottom (X) fraction. In contrast, the percent linearity and straightness were significantly (p < .05) higher for the top (Y) fraction. Sperm from the bottom (X) fraction have shorter (p < .07) tail length (1.6% difference) when compared with sperm from the top (Y) fraction. Although the dimensions of the sperm head from the bottom (X) fraction were numerically greater than top fraction sperm, they were not significant (p > .05). The results suggest that bottom (X) fraction sperm derived from the 8-layer discontinuous Percoll gradient for sex preselection have higher motility, progression, and hyperactivation when compared with top (Y) fraction sperm. The bottom (X) fraction sperm have greater longevity in motility and have shorter tails, supporting earlier hypotheses of sex differences in sperm parameters. However, the present data do not support observations of differences in sperm head dimensions in sperm processed for sex preselection, and an inference of a larger sperm due to more chromosome material originating from the X chromosome cannot be made.

Correlation between intact sperm acrosome assessed using the Spermac stain and sperm fertilizing capacity

Accurate determination of sperm acrosomal status is important in fertility studies. The objective was to correlate the percentage of intact acrosome assessed using the new Spermac stain with the capacity of sperm to fertilize oocytes. Sperm specimens were processed either by centrifuge wash, 48:95 Percoll gradient or test yolk buffer (TYB) wash, and tested using the zona-free hamster oocyte assay. The results indicated a correlation between the percentage of sperm with intact acrosome reaction and the percentage of sperm penetrating the oocytes in the TYB-washed group. The data suggest the usefulness of the Spermac stain for assessing the acrosomal status and in predicting the fertilizing capacity of the sperm.

On the etiologic role of ureaplasma urealyticum (T-mycoplasma) infection in infertility

Two hundred consecutive infertility patients and sixty-seven controls subjects were studied for the incidence of infection with Ureaplasma urealyticum (T-mycoplasma). On the basis of a complete infertility investigation, the infertility patients were subdivided into those with explained infertility and those with unexplained infertility. Of the patients with unexplained infertility, 55% had a positive culture for T-mycoplasma as compared with a 32% incidence of positive cultures in the control population. The differences were statistically significant. The 6-month pregnancy rate following successful antibiotic treatment in patients with unexplained infertility was 42%. The 6-month pregnancy rate in a comparable group of patients with unexplained infertility, seen during a 3-year period prior to mycoplasma culture and treatment, was 32%. The difference in pregnancy rates between the two groups was not statistically significant. No correlation was found between a poor postcoital test and the presence of T-mycoplasma infection nor between T-mycoplasma infection and poor cervical mucus. The role of T-mycoplasma infection in infertility was neither proven nor disproven by this study.

Modulation of pituitary responses to synthetic LH-RH by gonadal steroids in women with secondary amenorrhoea

LH-RH stimulation tests were performed on two successive days in 25 women with secondary amenorrhoea of probable hypothalamic origin by intravenous injection of 150 mug of synthetic LH-RH. The patients were selected by exclusion of definite pituitary or ovarian disease and in the absence of clinical or laboratory evidence of androgen excess. Five women received successive LH-RH stimulation tests only without administration of steroid hormone. Twenty women were treated with gonadal steroids in addition to the double LH-RH stimulation test by intramuscular injection of the steroid 4 h after the first LH-RH injection. Of these 20, 9 received oestradiol (Oe2), 5 received progesterone (P) and 6 received Oe2 + P. Gonadotrophin responses to LH-RH in successive tests without steroid were not significantly different. Oe2 or P alone each produced suppression of LH and FSH responses to LH-RH in the second test as compared to the first. Combined Oe2 + P produced augmentation or suppression of the second gonadotrophin responses depending on the dose of Oe2 administered. The results demonstrate a direct effect of oestrogen or progesterone alone and in combination on the pituitary responsiveness to LH-RH. The effect of the combined steroids can be modified by variation in the oestrogen: progesterone ratio.

Gonadotropin levels and secretory patterns in patients with typical and atypical polycystic ovarian disease

Gonadotropin levels and secretory patterns were studied in 28 oligomenorrheic patients with various types of polycystic ovary disease (PCO). On the basis of ovarian morphology and histology, the patients PCOuld be separated into two distinct categories arbitarily designated "typical" (type I) and "atypical" (type II) PCO. Although no differences were noted in symptomatology or 17-ketosteroid, testosterone, or follicle-stimulating hormone levels, the 12 type I patients demonstrated widely fluctuating, but markedly elevated, luteinizing hormone (LH) levels, while the 16 type II patients demonstrated lower and less fluctuating LH levels which were comparable to those found during the normal follicular phase. It is likely that type I PCO is a distinct entity similar to that described by Stein and Leventhal, while type II co represents a heterogenous spectrum of disorders, many of which remain obscure.