Clinical relevance of oxidative stress in male factor infertility: an update

Free radical theory of aging: implications in male infertility

This review examines the effect of mitochondrial generation of reactive oxygen species (ROS) and aging on human spermatozoa and seminal antioxidants. We discuss the effect of continuous ROS production on biomarkers of aging, such as germ cell telomeres and telomerase, lipofuscin, and amyloid. These markers may be responsible for telomere shortening and subsequent decrease in sperm count, decline in testosterone concentration, and decline in motility with aging. Excessive ROS can also damage mitochondrial deoxyribonucleic acid and sperm nuclear DNA, contributing to paternally transmitted diseases. ROS generation has a central role in the pathophysiology of age-related decrease in male fertility.

Non-genomic regulation of mammalian sperm hyperactivation

Although it has been suggested that the acrosome reaction is induced through non-genomic regulation in a ligand-dependent manner, it is not known whether hyperactivation is similarly regulated. Progesterone and melatonin have been identified as ligands that regulate hyperactivation, the former through non-genomic regulation with phospholipase C and the latter most likely through a reactive oxygen species-mitogen activated protein kinase cascade. Both may be involved in spontaneous regulation of hyperactivation via tyrosine phosphorylation. The concentration of many hormones changes according to environmental conditions and biological rhythms, which will modulate ligand-dependent regulation of hyperactivation.

Role of antioxidants in the treatment of male infertility

Male infertility continues to be a clinical challenge of increasing significance. While male factors such as decreased semen quality are responsible for 25% of all infertility issues, the etiology of suboptimal semen quality is poorly understood. Many physiological, environmental, and genetic factors have been implicated, including oxidative stress. Oxidative stress is induced by reactive oxygen species (ROS), or free radicals, and although ROS are required for critical aspects of sperm function, excessive levels of ROS can negatively impact sperm quality. The origin of ROS generation, and the etiologies of increased ROS in men with suboptimal sperm quality have only recently been elucidated, offering multiple targets for potential therapy. Here, we present a critical review of the literature describing the role of oxidative stress on decreased sperm function, as well as the role of antioxidants in the treatment of male factor infertility.

Seminal reactive oxygen species-antioxidant relationship in fertile males with and without varicocele

The aim of this study was to assess seminal reactive oxygen species (ROS)-antioxidants relationship in fertile and infertile men with and without varicocele. One hundred and seventy six males were studied; fertile healthy volunteers (n = 45), fertile men with varicocele (n = 45), infertile oligoasthenozoospermia (OA, n = 44) without varicocele and infertile OA with varicocele (n = 42). In their seminal plasma, two ROS parameters (malondialdehyde, hydrogen peroxide) and five antioxidants (superoxide dismutase, catalase, glutathione peroxidase, vitaminE, vitaminC) were estimated. Compared with fertile healthy men, in all other studied groups, estimated seminal ROS were significantly higher and estimated antioxidants were significantly lower. Infertile men with varicocele showed the same relationship as infertile men without varicocele. Sperm concentration, total sperm motility as well as sperm normal forms were negatively correlated with seminal malondialdehyde and were positively correlated with vitaminC. It is concluded that varicocele has an oxidative stress (OS) in fertile normozoospermic bearing conditions. This may allow understanding that, within men with varicocele, there is a threshold value of OS over which male fertility may be impaired.

Oxidative stress and epididymal sperm transport, motility and morphological defects

OBJECTIVES

Radical oxidative species (ROS) have an important effect on sperm quality and quantity. Oxidative stress (OS) occurs when production of potentially destructive reactive oxygen species (ROS) exceeds the body's own natural antioxidant defenses, resulting in cellular damage. OS is a common pathology seen in approximately half of all infertile men. Increased ROS generation and reduced antioxidant capacity is negatively correlated with sperm concentration and motility in infertile men. For the first time, we used a more stable and reliable sensitive carbonyl protein (CP) detection method to determine ROS in seminal plasma than measuring ROS directly to clarify the effect of OS on spermatozoa in terms of protein dysfunction. This is the first report to measure CP in seminal plasma as an indicator of OS. Furthermore, for the first time we correlated the results of CP measurement with light microscopy in combination with ultrastructural analysis by electron microscopy.

MATERIAL AND METHODS

20 patients with idiopathic oligoasthenoteratozoospermia (iOAT) and 10 fertile controls were enrolled in this study. CP values were measured by enzyme-linked immuno sorbent assay (ELISA) to detect the level of OS. Transmission electron microscope (TEM) was used to detect axonemal anomalies.

RESULTS

Compared to fertile controls, statistically highly significant higher degrees of abnormal sperm parameters (P<0.001) could be found in iOAT patients. CP values were highly significantly elevated in iOAT patients than in normal controls (P<0.001). A statistically highly significant difference in different axonemal anomalies were found between iOAT patients and normal controls (P<0.001). CP values have been found to be positively correlated with different axonemal anomalies (absence of axoneme (r(2)=0.841), missing of central singlet tubules (r(2)=0.702) and missing of outer doublet tubules (r(2)=0.869). A statistically negative correlation were found between different axonemal anomalies (absent axoneme (r(2)=-0.780), missing of central singlet tubules (r(2)=-0.611), and missing of outer doublet tubules (r(2)=-0.738) and forward progressive sperm motility.

CONCLUSION

High levels of CP can be measured in iOAT patients, indicating that OS could underlie the aetipopathogenesis of the syndrome. OS negatively affects flagellar axonemal structure with subsequent impairment of forward progressive sperm motility. This can put an attention for antioxidants as a therapy for iOAT syndrome and further research to find how to decrease ROS production.

Human sperm quality and lipid content after migration into normal ovulatory human cervical mucus containing low numbers of leukocytes

The aim of this study was to investigate whether a relationship exists between the presence of low numbers of leukocytes in normal ovulatory cervical mucus and sperm quality and lipid content after migration. The percentages of live, motile and morphologically normal spermatozoa, movement parameters assessed by computer-aided sperm analysis (CASA), and ionophore-induced acrosome reaction measured by flow cytometry were determined before and after migration. High-performance liquid chromatography with ultraviolet detection was used to measure the sperm lipid content, including the various diacyl subspecies. The number of leukocytes found in solubilized mucus samples was counted using a haemocytometric method. Overall, the presence of leukocytes in the cervical mucus samples did not significantly influence sperm motility and morphology, sperm kinematic parameters, or the sperm content in sphingomyelin or cholesterol. In contrast, after migration, the decrease in various sperm diacyls and the level of induced acrosome reaction was significantly less pronounced in mucus samples containing>or=10(4) leukocytes than in mucus samples with no or rare leukocytes whereas the level of induced acrosome reaction was higher. The present data suggest that the low level of leukocytes found in normal ovulatory cervical mucus could influence the process of sperm lipid remodelling/capacitation.

Role of oxidative stress in pathogenesis of varicocele and infertility

This review summarizes the published literature about the role of oxidative stress in the pathophysiology of varicocele and the beneficial effects of varicocele repair on oxidative stress. Literature survey was performed using the Medline, EMBASE, BIOSIS, and Cochrane databases between 1993 and 2008 that were relevant to oxidative stress and varicocele. Varicocele treatment can reduce reactive oxygen species levels and improve sperm parameters and pregnancy rates, although it is still controversial with Assisted Reproductive Techniques outcomes. We conclude that spermatozoal dysfunction in varicocele patients could be multifactorial, and oxidative stress-induced injury appears to be one of the main causes.

Removal of spermatozoa with externalized phosphatidylserine from sperm preparation in human assisted medical procreation: effects on viability, motility and mitochondrial membrane potential

BACKGROUND

Externalization of phosphatidylserine (EPS) occurs in apoptotic-like spermatozoa and could be used to remove them from sperm preparations to enhance sperm quality for assisted medical procreation. We first characterized EPS in sperms from infertile patients in terms of frequency of EPS spermatozoa as well as localization of phosphatidylserine (PS) on spermatozoa. Subsequently, we determined the impact of depleting EPS spermatozoa on sperm quality.

METHODS

EPS were visualized by fluorescently-labeled annexin V binding assay. Double staining with annexin V and Hoechst differentiates apoptotic from necrotic spermatozoa. We used magnetic-activated cell sorting using annexin V-conjugated microbeads (MACS-ANMB) technique to remove EPS spermatozoa from sperm prepared by density gradient centrifugation (DGC). The impact of this technique on sperm quality was evaluated by measuring progressive motility, viability, and the integrity of the mitochondrial membrane potential (MMP) by Rhodamine 123.

RESULTS

Mean percentages of EPS spermatozoa were 14% in DGC sperm. Four subpopulations of spermatozoa were identified: 70% alive, 3% early apoptotic, 16% necrotic and 11% late apoptotic or necrotic. PS were localized on head and/or midpiece or on the whole spermatozoa. MACS efficiently eliminates EPS spermatozoa. MACS combined with DGC allows a mean reduction of 70% in EPS and of 60% in MMP-disrupted spermatozoa with a mean increase of 50% in sperm survival at 24 h.

CONCLUSION

Human ejaculates contain EPS spermatozoa which can mostly be eliminated by DGC plus MACS resulting in improved sperm long term viability, motility and MMP integrity. EPS may be used as an indicator of sperm quality and removal of EPS spermatozoa may enhance fertility potential in assisted medical procreation.

Human sperm chemotaxis depends on critical levels of reactive oxygen species

OBJECTIVE

To verify whether chemotaxis is in part an oxidative process mediated by reactive oxygen species (ROS).

DESIGN

In this prospective study, after removal of seminal plasma, the sperm suspension received no treatment (control), ROS formation by stimulation with phorbol 12-myristate 13-acetate (PMA), antioxidant treatment (with catalase), or PMA stimulus in the presence of catalase. At time zero and after 3 hours of incubation, the percentage of capacitated and oriented spermatozoa and the ROS levels were determined.

SETTING

Andrology laboratory in a medical research institution.

PATIENT(S)

Normal semen was obtained from eight men.

INTERVENTION(S)

The semen samples were evaluated to determine the effect of ROS production by stimulation with PMA and/or antioxidant treatment (with catalase) on the percentage of capacitated and oriented spermatozoa.

MAIN OUTCOME MEASURE(S)

The sperm capacitation, chemotaxis and reactive oxygen species were assessed before and after PMA and/or antioxidant treatment.

RESULT(S)

Prolonged exposure to high quantities of ROS decrease the sperm chemotactic response, probably because of oxidative damage of the cell. However, this effect may be reduced by the addition of antioxidants like catalase.

CONCLUSION(S)

Similar to capacitation, chemotaxis seems to depend on the production of ROS, but in the latter process there may be a critical level of ROS necessary for chemotaxis to occur.

Physiologic and pathologic levels of reactive oxygen species in neat semen of infertile men

OBJECTIVE

To define physiologic levels of reactive oxygen species in infertile men and establish a cutoff value of reactive oxygen species level in neat semen with a high sensitivity and specificity to differentiate infertile men from fertile donors (controls).

DESIGN

Reactive oxygen species levels were measured in the neat semen samples (n = 51) from fertile donors and infertile patients (n = 54).

SETTING

Reproductive research laboratory at a tertiary care hospital.

PATIENT(S)

Infertile patients from male infertility clinic.

INTERVENTION(S)

Reactive oxygen species measurement in neat semen sample using luminol-based chemiluminescence method, receiver operating characteristic curves.

MAIN OUTCOME MEASURE(S)

Seminal reactive oxygen species levels, cutoff value, sensitivity and specificity, positive and negative predictive values.

RESULT(S)

The best cutoff value to distinguish between healthy fertile donors and infertile men was 0.0185 x 10(6) counted photons per minute/20 x 10(6) sperm. At this threshold, the specificity was 82% and the sensitivity was 78%. This value can be defined as basal reactive oxygen species level in infertile men.

CONCLUSION(S)

Reactive oxygen species levels in neat semen samples as measured by luminol-based chemiluminescence are a highly specific and sensitive test in the diagnosis of infertility. This test also may help clinicians treat patients with seminal oxidative stress.

Heme oxygenase enzyme activity in human seminal plasma of fertile and infertile males

This work aimed to assess heme oxygenase (HO) enzyme activity relationship with different human semen parameters. One hundred and twenty men were divided according to their sperm count and clinical examination into: obstructive azoospermia (n = 20), nonobstructive azoospermia (NOA) (n = 25), oligozoospermia (n = 35) and normozoospermia (n = 40). Semen analysis, western blot for HO-1 and HO-2, and estimation of seminal plasma HO enzyme activity chemically in the form of bilirubin concentration were carried out. Seminal plasma HO enzyme activity was very low in OA specimens, low in NOA, moderate in oligozoospermia while higher in normozoospermia (mean +/- SD; 6.26 +/- 2.2, 81.4 +/- 35.5, 283.8 +/- 90.1, 657.4 +/- 227.6 pmol ml(-1) min(-1)) with significant differences. Western blot analysis demonstrated HO-2 expression in all studied groups whereas HO-1 was highly expressed in fertile normozoospermic group compared with other groups. There was positive correlation between seminal plasma HO enzyme activity and sperm concentration, sperm motility percentage, motile spermatozoa ml(-1) and sperm normal morphology per cent. It is concluded that HO enzyme activity in the human seminal plasma is related to spermatogenesis and sperm-motility processes.

Effect of human oviductal in vitro secretion on human sperm DNA integrity

PURPOSE

In the female genital tract spermatozoa interact with the oviductal secretion. The aim of the study was to evaluate the effect of conditioned media (CM) from cultures of human oviductal tissue, on sperm DNA integrity. The effect of H(2)O(2) on sperm DNA integrity, before and after incubation under capacitating conditions, was also investigated.

METHODS

Motile sperm obtained from normozoospermic semen samples were incubated (4 h or 22 h) in the presence or absence of CM and further exposed to H(2)O(2). DNA damage was detected by the comet assay.

RESULTS

The CM significantly reduced the DNA damage associated with sperm incubation, and also decreased the effect of H(2)O(2) after 4 h incubation, compared to controls. The H(2)O(2) caused a dose-dependent deleterious effect on sperm DNA integrity both before and following 22 h of capacitation.

CONCLUSION

The oviductal tissue CM increased the stabilization of the sperm DNA structure under culture conditions.