Anti-Seminal Plasma Antibodies Associated With Infertility: I. Serum Antibodies Against Normozoospermic Seminal Plasma in Patients With Unexplained Infertility

PROBLEM: To determine whether patients whose infertility remains unexplained (by routine physical and laboratory investigations including sperm antibody testing) exhibit significantly elevated humoral anti-seminal plasma immune responses in comparison to fertile individuals. METHOD: Sera from 72 infertile couples were examined by ELISA for the presence of antibodies against normozoospermic seminal plasma (NSP). A group of 36 fertile individuals was used to determine the level of physiological reactivity. Kibrick's and Friberg's sperm-agglutination tests were employed to distinguish patients routinely diagnosed as immunologically infertile. RESULTS: Anti-NSP reactivity was elevated in 18% of male and 26% of female patients. In the female patients, the prevalence rate for elevated anti-NSP reactivity was significantly higher among partners of positive men. In only 4% the positive anti-NSP results coincided with sperm-agglutinating antibodies. CONCLUSION: NSP constituents other than sperm-coating antigens might interfere with infertility related autoimmune imbalance. The identification of the corresponding NSP antigens might help to resolve more cases of unexplained infertility.     

男性不育患者Y染色体微缺失的多重PCR筛查

【目的】建立一套Y染色体微缺失的多重PCR筛查方法 ,对因无精症或少精症欲行单精子卵细胞浆注射 (ICSI)治疗的男性不育患者进行Y染色体微缺失的常规筛查。【方法】建立两套稳定和可靠的五重PCR筛查方法 ,对在本中心进行ICSI治疗的 2 6例无精症患者和 6 1例少精症患者进行Y染色体微缺失的检测。【结果】在 2 6例无精症患者中发现 1例有Y染色体AZFc/DAZ的缺失 ,在 6 1例少精症患者中发现 4例Y染色体AZFc/DAZ的缺失。【结论】本研究Y染色体微缺失的多重PCR筛查方法是易行和可靠的。     

Heterogeneity in the presence of CD4-like molecules on human spermatozoa

Summary. The object of the present study was to study if there are differences in the presence of CD4-like molecules on human ejaculated spermatozoa in fertile donors and infertile patients (with globozoospermia). Indirect and absorption enzyme-linked immunosorbent assay and indirect immunofluorescence were applied. The enzyme-linked immunosorbent assay data showed that monoclonal anti-human CD4-antibody recognizes an epitope common to the human spermatozoa with normal morphology and round-headed spermatozoa. Localization of the antigenic determinants, identified by anti-human CD4-monoclonal antibody, in the acrosomal region, including equatorial segment, postnuclear cap and tail was determined in normozoospermic samples. A positive reaction was found on the sperm head both in the acrosomal and postacrosomal region of some round-headed spermatozoa in the samples with globozoospermia. The tails of the normozoospermic spermatozoa and of some round-headed spermatozoa were weakly immunopositive. The results of the experiments carried out are evidence of heterogeneity in the presence of CD4-like antigen determinants on human spermatozoa. These data increase the information about the CD4-antigen characteristic of the spermatozoa from fertile donors and infertile patients.     

Contribution of the male factor to unexplained infertility: a review

The more exhaustive the evaluation of couples with unexplained infertility, the more likely is the opportunity for detecting the aetiological factor responsible for infertility. Transport of spermatozoa through the upper genital tract and their ability to fertilize the oocyte are two obscure areas for the conventional evaluation of infertility. Although research in the former area is limited, there is indirect evidence that impaired sperm transport could be one of the causes of infertility in some couples with otherwise unexplained infertility. On the other hand, the availability of sperm function tests and the correlation of their results with in-vitro fertilization rates have allowed the detection of a previously hidden male factor in couples with unexplained infertility. It has been demonstrated that couples suffering unexplained infertility have significantly lower in-vitro fertilization rates in comparison with patients with tubal problems. These results can be explained because several case control studies in patients with unexplained infertility have reported defects in capacitation and sperm motion characteristics, binding of the spermatozoa to the zona pellucida, acrosome reaction, acrosin activity of the spermatozoa, and the ability of the spermatozoa to penetrate zona-free hamster cocytes. These observations suggest that methods for assessing the fertilizing capacity of the spermatozoa have to be incorporated in the evaluation of couples with unexplained infertility in order to amplify the scope of the workup and to better decide the appropiate treatment for these couples.     

Comparative trial between an ultra-short and long protocol of luteinizing hormone-releasing hormone agonist for ovarian stimulation in in-vitro fertilization

A total of 312 patients with tubal infertility participatedin a prospective randomized study comparing two regimens ofovarian stimulation with a luteinizing hormone-releasing hormoneagonist (buserelin) and human menopausal gonadotrophin (HMG).Half of the patients were given an ultra-short treatment protocolwhen the agonist was administered on days 2, 3 and 4 of thestimulated cycles; the other half were given a long protocolwhen the agonist was administered from the mid-luteal phaseof the cycle preceding the treatment cycle. The mean numberof HMG ampoules used per patient was significantly higher inthe long protocol. No significant differences were found betweenthe two groups in the incidence of cancelled cycles, failedoocyte recovery, mean number of oocytes recovered per patient,complete failure of fertilization and the fertilization andembryo cleavage rate. More patients undergoing the long protocolhad supernumerary embryos cryopreserved and successful deliveries.     

Factors affecting sperm yield during swim-up

Purpose The migration of sperm (expressed as the percentage of the total motile cells in the ejaculate aliquot) from seminal plasma into overlying medium (swim-up) was increased with time, temperature, and increasing the surface area of contact between the two phases by increasing the angle of tube inclination.Results The proportion of sperm migrating into the medium was relatively constant with varying sperm count. Stimulation of the progressive motility of spermatozoa in vitro using a motility enhancing drug (2-deoxyadenosine) increased sperm migration initially but no more than the maximum reached by controls after extended incubation.Conclusion Sperm yield from normozoospermic men and men with borderline asthenoteratozoospermia represented approximately 40 and 15% of the total motile cells in the ejaculate aliquots, respectively. In general, in both groups spermatozoa in the swim-up fraction exhibited superior motility, vitality, and morphology compared to the original ejaculates. Tail abnormalities were reduced more than head abnormalities and subjects with borderline sperm qualities exhibited less dramatic improvements in quality than the normozoospermic individuals.     

Relationship between sperm cell ubiquinone and seminal parameters in subjects with and without varicocele

Summary. In a previous paper it was demonstrated that Coenzyme Q10, a lipidic molecule with important antioxidant properties, is present at remarkable levels in human seminal fluid, and shows a direct correlation with seminal parameters (sperm count and motility). In patients with varicocele, on the contrary, correlation with sperm motility was lacking and a higher proportion of Coenzyme Q10 was found in seminal plasma. In the present study, the levels of Coenzyme Q10 in the cell pellet of spermatozoa, obtained after centrifugation of semen, were evaluated. In nonvaricocele subjects it was observed that a higher concentration of Coenzyme Q 10 (expressed as ng of the molecule per million of cells) was present in the spermatozoa of oligospermic and asthenospermic patients (sperm count <20*10⁶ spermatozoa ml⁻¹, sperm motility <40%). This relationship was not observed in varicocele subjects, who also showed slightly lower intracellular absolute values of the coenzyme.
Since Coenzyme Q10 is an antioxidant molecule involved in the defence of the cell from free radical damage, higher intracellular concentrations may represent a mechanism of protection of the spermatozoa. In varicocele patients, this mechanism could be deficient, leading to higher sensitivity to oxidative damage.     

An unexpected guest in follicular fluid

Parasitic infection as the only or concomitant cause of infertilityin Caucasian women is rare. A parasitic infection may also presentitself quite unexpectedly as a coincidental finding as shownwith this case report Moving microfilariae of Mansonella perstanswere found in the aspirated follic-ular fluid of a patient whounderwent in-vitro fertilization (TVF) with embryo transferbecause of tubal pathology due to Chlamydia trachomatis. Thepatient also appeared to have a Schistosoma infection. To ourknowledge, the presence of parasites in follicular fluid hasnever been reported before. We expect that infertility physiciansmay be confronted with parasitic infections more often, notonly in patients originating from tropical countries but alsoin Western women as a result of a tendency to travel more frequentlyto exotic and (sub)tropical countries.     

Pregnancies from Fallopian replacement of immature eggs with delayed intrauterine insemination

Gamete intrafallopian transfer requires that a woman shouldnot only have patent tubes but should also have had mature eggscollected for replacement. Eggs must be collected as close toovulation as possible, to give them a good chance of fertilizingupon replacing them directly into the tubes with the spermatozoa.Preliminary results from the three patients who received Fallopianreplacement of immature eggs followed by delayed intrauterineinsemination indicate that maturation of eggs can occur in vivoin the Fallopian tubes. Intrauterine insemination at a latertime when the eggs were judged to be mature has given rise totwo pregnancies from the three patients with whom this procedurewas adopted     

免疫珠试验检测抗精子抗体技术在体外受精-胚胎移植中的应用

对17对不明原因不育夫妇作了免疫珠试验以测定抗精子抗体,发现1例女性血清IgA抗精子抗体阳性;IgA免疫珠在活动精子头部的结合率达46％。该例先前作了IVF—ET治疗失败;回收的三个卵母细胞在自身血清制备的培养基中无一受精。故认为免疫珠试验测精子抗体技术可作为IVF—ET治疗前的一项常规检查,以排除不孕的免疫因素。