Male infertility and adult polycystic kidney disease are associated with necrospermia

Identification of an SMC1B Mutation Associated With Necrozoospermia and Failure of Testi-ICSI : SMC1B Mutation Associated With Necrozoospermia

Investigating potential etiologies is important before selecting a therapeutic approach for male infertility. However, the genetic causes of idiopathic necrozoospermia are poorly understood. In this study, a heterozygous missense variant in SMC1B (NM_148674.5: c1856G > T; p.C619F) causing severe necrozoospermia in the infertile proband was identified by Whole-exome sequencing (WES). This phenotype was distinct from the phenotypes of other vertebrates harboring this mutation. Interestingly, Papanicolaou staining, light microscopy and electron microscopy results indicated severe abnormalities in the morphology of the sperm head and an irregular sperm ultrastructure in the patient with the identified variant. Additionally, the sharply decreased protein expression of SMC1B in spermatozoa and testicular tissues ultimately resulted in an abnormal chromatin structure and high sperm DNA fragmentation (SDF) in the male patient. Regrettably, poor outcomes of Intracytoplasmic sperm injection with testicular sperm (Testi-ICSI) treatment were observed for the patient harboring the identified SMC1B mutation. In Conclusion, a missense SMC1B mutation that may mediate impaired sperm vitality was the first time reported, providing new insights into a novel genetic etiology of necrozoospermia in humans.

Overview of ADPKD in Pregnancy

Autosomal dominant polycystic kidney disease (ADPKD) is a systemic disorder that often affects patients in their third to fifth decades of life and is characterized by kidney cysts, chronic kidney disease (CKD), hypertension, and hepatic cysts. The development of clinical symptoms often coincides with childbearing years. Consequently, there are several considerations regarding pregnant patients with ADPKD. In this review, we detail the effects and management of ADPKD in the peripartum period and discuss family planning options, including assisted reproductive techniques (ART) and preimplantation genetic testing.

Secondary infertility due to necrospermia in men with autosomal-dominant polycystic kidney disease: a report of two cases

Autosomal-dominant polycystic kidney disease (ADPKD) is the most common inherited kidney disease characterized by the formation of numerous cysts in organs other than the kidneys. Although female patients with ADPKD do not have direct fertility problems, infertility in male patients may arise following the formation of cystic lesions in the lower seminal tract, which impair the function of spermatozoa. Generally, the treatment strategy for necrospermia depends on the severity of sperm viability, and intracytoplasmic sperm injection may be offered to patients with necrospermia. We report two cases of secondary infertility in men with ADPKD. These men experienced an inability to reproduce naturally after the previous birth of a child, suggesting a progressive deterioration of semen quality. Semen analysis showed necrospermia in both patients, and transrectal ultrasound revealed marked dilatation of the seminal vesicles bilaterally. The main cause of secondary infertility in male patients with ADPKD is sperm death resulting from progressive dilatation of seminal vesicles. Further research is needed on the appropriate follow-up schedule for men with ADPKD who desire to reproduce naturally.

Novel insights into necrozoospermia from a single-center study: reference ranges, possible etiology, and impact on male fertility

ABSTRACT

Necrozoospermia is a poorly documented condition with a low incidence, and its definition and clinical significance are unclear. Herein, we provide a reference range for necrozoospermia and discuss its possible etiology and impact on male fertility and assisted reproductive outcomes. We extracted relevant information from 650 Chinese male partners of infertile couples and statistically analyzed sperm vitality. Necrozoospermia was present in 3.4% (22/650) of our study population, and the lower cut-off value for sperm vitality was 75.3%. We compared two methods for assessing sperm vitality (eosin-nigrosin head staining and hypo-osmotic swelling test [HOST]), for which the percentage in the eosin-nigrosin group (mean ± standard deviation [s.d.]: 77.5% ± 10.5%) was significantly higher than that in the HOST group (mean ± s.d.: 58.1% ± 6.7% [5-10 min after incubation] and 55.6% ± 8.2% [25-30 min after incubation]; both P < 0.001). The incidence of necrozoospermia increased with age (odds ratio [OR] = 1.116, 95% confidence interval [CI]: 1.048-1.189, P = 0.001), while the percentage of normal sperm morphology and DNA fragmentation index (DFI) were significantly associated with necrozoospermia, with ORs of 0.691 (95% CI: 0.511-0.935, P = 0.017) and 1.281 (95% CI: 1.180-1.390, P < 0.001), respectively. In the following 6 months, we recruited 166 patients in the nonnecrozoospermia group and 87 patients in the necrozoospermia group to compare intracytoplasmic sperm injection (ICSI) and pregnancy outcomes between the two groups. The necrozoospermia group had a significantly lower normal fertilization rate (74.7% vs 78.2%, P = 0.041; OR = 0.822; 95% CI: 0.682-0.992) than that in the nonnecrozoospermia group. This study presents substantial information on necrozoospermia to establish comprehensive and applicable reference values for sperm vitality for spontaneous conception and artificially assisted reproductive management.

Sperm Vitality and Necrozoospermia: Diagnosis, Management, and Results of a Global Survey of Clinical Practice

Sperm vitality testing is a basic semen examination that has been described in the World Health Organization (WHO) Laboratory Manual for the Examination and Processing of Human Semen from its primary edition, 40 years ago. Several methods can be used to test sperm vitality, such as the eosin-nigrosin (E-N) stain or the hypoosmotic swelling (HOS) test. In the 6th (2021) edition of the WHO Laboratory Manual, sperm vitality assessment is mainly recommended if the total motility is less than 40%. Hence, a motile spermatozoon is considered alive, however, in certain conditions an immotile spermatozoon can also be alive. Therefore, the differentiation between asthenozoospermia (pathological decrease in sperm motility) and necrozoospermia (pathological decrease in sperm vitality) is important in directing further investigation and management of infertile patients. The causes leading to necrozoospermia are diverse and can either be local or general, testicular or extra-testicular. The andrological management of necrozoospermia depends on its etiology. However, there is no standardized treatment available presently and practice varies among clinicians. In this study, we report the results of a global survey to understand current practices regarding the physician order of sperm vitality tests as well as the management practices for necrozoospermia. Laboratory and clinical scenarios are presented to guide the reader in the management of necrozoospermia with the overall objective of establishing a benchmark ranging from the diagnosis of necrozoospermia by sperm vitality testing to its clinical management.

Genetic testing, ultrasonography and preimplantation genetic testing of men with autosomal dominant polycystic kidney disease in Hunan, China

The present study identified novel mutations in polycystic kidney disease (PKD) genes in China, determined the prevalence of cysts in the genital tract and accessory gonad in autosomal dominant PKD (ADPKD) patients, correlated these genes with ADPKD and male infertility and investigated whether male infertility associated with ADPKD affected the clinical outcomes in a preimplantation genetic testing (PGT) cycle cohort. This study was a cross-sectional study. Twenty-four unrelated men with ADPKD recruited from the Reproductive and Genetic Hospital of CITIC-Xiangya in China were investigated between January 2019 and December 2020. A total of 24 variations were identified in 22 patients, including 23, 1 and 0 variations in PKD1, PKD2 and GANAB, respectively. Genital tract and accessory gonadal cysts were significant dependent variables for male infertility. A diagnosis was made in 87.04% (94/108) and 51.85% (56/108) of the embryos for ADPKD and PGT-A respectively. Clinical pregnancy reached 72.73% per embryo transfer and 84.21% per patient. We identified a group of novel mutations in PKD genes, which enriches the PKD mutation spectrum. Although genital tract and accessory gonadal cysts greatly influence the fertility of men with ADPKD, they have minimal clinical consequences on pregnancy by intracytoplasmic sperm injection (ICSI) and PGT.

[Necrozoospermia: From etiologic diagnosis to therapeutic management]

This review describes necrospermia, its diagnosis, causes and management. Sperm vitality is commonly assessed in the laboratory of reproductive biology, with the eosin test or with the hypo-osmotic swelling test. Necrospermia is defined by a percentage of living spermatozoa inferior to 58%, and can be related to male infertility. Several pathological mechanisms may be involved and can be classified either in testicular causes (hyperthyroidism, local hyperthermia, varicocele), or post-testicular causes (epididymal necrospermia, dysregulation of seminal plasma, adult polycystic kidney disease, vasectomy reversal, anti-sperm antibodies) or both (infection, toxic, age, spinal cord injury). The first treatment is to correct the underlying cause, if possible. Repetitive ejaculation has demonstrated to be effective as well. Many drugs would also improve the sperm vitality (antioxidants, non-and-steroidal anti-inflammatory drugs) but there is currently no guideline to recommend their use. With necrospermia, fertilization rates are lower but in vitro fertilization (IVF) with Intracytoplasmic sperm injection (ICSI) improves the chances of conception.

The relationship between sperm viability and DNA fragmentation rates

BACKGROUND

In humans, sperm DNA fragmentation rates have been correlated with sperm viability rates. Reduced sperm viability is associated with high sperm DNA fragmentation, while conversely high sperm viability is associated with low rates of sperm DNA fragmentation. Both elevated DNA fragmentation rates and poor viability are correlated with impaired male fertility, with a DNA fragmentation rate of >30% indicating subfertility. We postulated that in some men, the sperm viability assay could predict the sperm DNA fragmentation rates. This in turn could reduce the need for sperm DNA fragmentation assay testing, simplifying the infertility investigation and saving money for infertile couples.

METHODS

All men having semen analyses with both viability and DNA fragmentation testing were identified via a prospectively collected database. Viability was measured by eosin-nigrosin assay. DNA fragmentation was measured using the sperm chromosome structure assay. The relationship between DNA fragmentation and viability was assessed using Pearson's correlation coefficient.

RESULTS

From 2008-2013, 3049 semen analyses had both viability and DNA fragmentation testing. A strong inverse relationship was seen between sperm viability and DNA fragmentation rates, with r=-0.83. If viability was ≤50% (n=301) then DNA fragmentation was ≥ 30% for 95% of the samples. If viability was ≥75% (n=1736), then the DNA fragmentation was ≤30% for 95% of the patients. Sperm viability correlates strongly with DNA fragmentation rates.

CONCLUSIONS

In men with high levels of sperm viability≥75%, or low levels of sperm viability≤ 30%, DFI testing may be not be routinely necessary. Given that DNA fragmentation testing is substantially more expensive than vitality testing, this may represent a valuable cost-saving measure for couples undergoing a fertility evaluation.

ICSI outcome is significantly better with testicular spermatozoa in patients with necrozoospermia: a retrospective study

OBJECTIVE

To determine whether intracytoplasmic sperm injection (ICSI) outcome with testicular sperm is superior to that of ejaculated sperm in men with incomplete necrozoospermia, defined as sperm viability ≥5 to ≤45%.

STUDY DESIGN

Retrospective study at a Reproductive Medicine Center of a tertiary referral hospital. A total of 231 couples with male infertility due to incomplete necrozoospermia underwent 342 ICSI cycles with freshly ejaculated sperm (ICSI-ejaculated) and 182 cycles with testicular sperm (ICSI-TESE).

RESULTS

Overall 1624 MII oocytes were injected in the ICSI-ejaculated group with a fertilisation rate of 60.8%, while in ICSI- TESE cycles the fertilisation rate was 59.6% in 874 MII oocytes. The cleavage rate was higher in ICSI-ejaculated cycles than in ICSI-TESE cycles (96.3% versus 92.9%; p = 0.004). However, the pregnancy and implantation rates per cycle were significantly higher in the ICSI-TESE group (67/182, 36.8% versus 68/342, 19.9% (p = 0.0001); and 23.7% versus 12.7% (p = 0.0001), respectively). The miscarriage rate was similar (ICSI-ejaculated 26.5% versus ICSI-TESE 17.9%, p = 0.301). Live birth rate per cycle in the ICSI-ejaculated group was significantly lower than in the ICSI-TESE (13.7% versus 28.6%, p = 0.0001).

CONCLUSIONS

In cases of persistent necrozoospermia, testicular sperm should be favoured over ejaculated sperm. These data call for more research to understand the pathophysiology of refractory necrozoospermia.

DNA fragmentation status in patients with necrozoospermia

The aim of this study was to determine if a relationship exists between the levels of sperm DNA fragmentation and necrospermia in infertile men. Semen samples obtained from 70 men consulting for infertility evaluation were analyzed according to World Health Organization (WHO) guidelines. Patients were subdivided into three groups according to the percentage of necrotic spermatozoa: normozoospermia (<30%; n = 20), moderate necrozoospermia (50-80%; n = 30), and severe necrozoospermia (>80%; n = 20). DNA fragmentation was detected by the terminal desoxynucleotidyl transferase-mediated deoxyuridine triphosphate biotin nick-end labeling (TUNEL) assay. The sperm DNA fragmentation index (DFI) was 9.28 ± 2.98% in patients with a normal level of necrotic spermatozoa, 20.25 ± 3.21% in patients with moderate necrozoospermia, and 35.31 ± 5.25% in patients with severe necrozoospermia. There was a statistically significant increase of DNA fragmentation in the necrozoospermic group (P < 0.01). A strong correlation was found between the degree of necrozoospermia and sperm DNA fragmentation. We concluded that patients with necrozoospermia showed a high level of DNA fragmentation compared to normozoospermic men. Severe necrozoospermia (>80%) is a predictive factor for increased sperm DNA damage.

Male infertility and adult polycystic kidney disease--revisited: case report and current literature review

Adult polycystic kidney disease (APKD) is one of the most common inherited disorders affecting one in 800-1000 live births. Extra-renal manifestation of APKD is not uncommon. Cysts involving the male and female reproductive system have been reported. However, fertility is affected only in male subjects. Among cysts involving the reproductive system, seminal vesicle cysts have been reported to be the most common. The effect of seminal vesicle cysts on male fertility has been controversial. Current literature reports that majority of men remain fertile. However, uraemia and its implications on fertility and abnormal semen parameters in men with seminal vesicle cysts must be taken into consideration. We herein present two patients with APKD with contrasting semen parameters and also review the current literature.

Male infertility associated with adult dominant polycystic kidney disease: a case series

INTRODUCTION

Although described earlier, the association of male infertility with adult dominant polycystic kidney disease (ADPKD) is quite rare and unfamiliar to some of the multidisciplinary team members caring for affected men.

MATERIALS AND METHODS

Infertile men diagnosed to have ADPKD were evaluated by clinical characteristics including testis volume, as well as serum hormone levels, semen analysis, and transrectal ultrasonography (TRUS) because of low volume ejaculate.

RESULTS

Semen analysis revealed low-normal volume, normal pH, and azoospermia/virtual azoospermia. Serum hormones were within the normal range. Transrectal ultrasonography demonstrated cystic dilatation of the seminal vesicles in all three men.

CONCLUSION

Patients should be referred for andrological evaluation of a presentation similar to obstructive azoospermia. Their potential to achieve paternity by surgical sperm retrieval combined with assisted reproductive technology is another example of cooperation between andrologists and gynecologists.

Prevalence of cysts in seminal tract and abnormal semen parameters in patients with autosomal dominant polycystic kidney disease

BACKGROUND AND OBJECTIVES

Autosomal dominant polycystic kidney disease is a systemic disorder with a wide range of extrarenal involvement. The scope of this study was to analyze the prevalence of seminal cysts and to correlate these findings with the sperm parameters in patients with autosomal dominant polycystic kidney disease.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

A prospective study enrolled 30 adult men with autosomal dominant polycystic kidney disease. Of these 30 patients, 22 agreed to provide a semen sample for analysis, and 28 of 30 agreed to undergo an ultrasound rectal examination. Data obtained from the semen tests and from the ultrasound study were compared.

RESULTS

Cysts in the seminal tract were present in 10 (43.47%) of 28 individuals. Twenty of 22 patients showed abnormal semen parameters, with asthenozoospermia as the most common finding. No correlation between ultrasound findings and sperm abnormalities was observed.

CONCLUSIONS

The presence of cysts in the seminal tract is remarkably high (43.47%); however, this finding does not correlate with sperm abnormalities, which are also a frequent finding, especially asthenozoospermia. This semen abnormality is probably related to the abnormal function of polycystins. More attention should be paid to reproductive aspects in the initial evaluation of patients with autosomal dominant polycystic kidney disease before their ability to conceive is further impaired by uremia.

Necrospermia, antisperm antibodies, and vasectomy

OBJECTIVE

To present a case of necrospermia and antisperm antibodies after vasectomy reversal and in which motile sperm, subsequently used in intracytoplasmic sperm injection (ICSI) treatment, was found after testicular sperm retrieval.

DESIGN

Case report and literature review.

SETTING

Reproductive medicine unit based in a women's hospital in the United Kingdom.

PATIENT(S)

A 36-year-old man with secondary infertility who presented with necrospermia and antisperm antibodies after vasectomy reversal.

INTERVENTION(S)

Testicular sperm retrieval and IVF with ICSI.

MAIN OUTCOME MEASURE(S)

Presence of motile sperm in testicular sperm extraction biopsies.

RESULT(S)

Motile sperm found after testicular sperm retrieval successfully fertilized oocytes in an ICSI cycle.

CONCLUSION(S)

It appears difficult to dissociate the presence of antisperm antibodies from the necrospermia in our patient. Testicular sperm retrieval appeared to partially overcome the effect of the antisperm antibodies by retrieving sperm before they reach seminal plasma, where they would be exposed to the antibodies.

Male fertility and sexual function after spinal cord injury

Spinal cord injury has an enormous impact upon the sexual relationship of a man and his partner. Erection may be partial or absent, orgasm altered or impossible, and fertility severely impaired. New understanding of the physiology of sexual function and improved treatment can enable most cord-injured men to achieve erections suitable for sexual satisfaction. Modern methods of sperm collection and fertility treatment mean that many can also be fathers. The best results are obtained by a team approach involving rehabilitation and reproductive medicine clinicians, nurses, spinal cord injury specialists and counselors with the cord-injured man and his partner. Erections can be achieved by drugs, such as sildenafil, that block phosphodiesterase 5, prolonging the action of nitric oxide with resultant smooth muscle relaxation. Intracavernosal prostaglandin E1 and mechanical systems, such as vacuum pumps and constriction rings, are also effective. Sexual gratification can be promoted in the context of an understanding relationship in which the cord-injured person can gain pleasure from pleasing his partner and also from his partner's exploration of erotogenic areas not affected by the spinal cord injury. An emphasis on the broader view of sexuality in relationships allows for a continuance and strengthening of bonds between the couple. Vibration ejaculation or electroejaculation can be used to collect semen. For a limited period in the acute phase, usually for about 6-12 days after injury, normal semen can be obtained by electroejaculation from some cord-injured men. With chronic spinal cord injury the semen is of variable quality. Some patients have necrospermia, which may be improved by regular ejaculation. Others have poor quality semen or spermatogenic disorders and, in this situation, in vitro fertilization techniques must be used to achieve parenthood. Trials of assisted ejaculation help individualize cost-effective management of the infertility.

Comparison between siblings and twins supports a role for modifier genes in ADPKD

BACKGROUND

Autosomal-dominant polycystic kidney disease (ADPKD) is characterized by intrafamilial variability in renal disease progression, which could result from a combination of environmental and genetic factors. Although a role for modifier genes has been evidenced in mouse models, direct evidence in ADPKD patients is lacking. The analysis of variability in affected siblings and monozygotic (MZ) twins would help evaluate the relative contribution of environment and genetic factors on renal disease progression in ADPKD.

METHODS

The difference in the age at end-stage renal disease (ESRD) and the intraclass correlation coefficient (ICC) were quantified in a large series of ADPKD siblings from western Europe and compared with the values obtained in a series of MZ ADPKD twins from the same geographic area.

RESULTS

Fifty-six sibships (including 129 patients) and nine pairs of MZ twins were included. The difference in the age at ESRD was significantly higher in siblings (6.9 +/- 6.0 years, range 2 months to 23 years) than in MZ twins (2.1 +/- 1.9 years, range 1 month to 6 years; P = 0.02). Furthermore, the intraclass correlation coefficient was significantly lower in siblings than in MZ twins (0.49 vs. 0.92, respectively; P = 0.003). The intrafamilial difference in the age at ESRD was not influenced by gender.

CONCLUSION

These data substantiate the existence of a large intrafamilial variability in renal disease progression in ADPKD siblings. The fact that the variability in siblings is in a significant excess of that found in MZ twins strongly suggests that modifier genes account for a significant part of this variability.

Clinical management of men producing ejaculates characterized by high levels of dead sperm and altered seminal plasma factors consistent with epididymal necrospermia

Sperm quality and viability can be improved in healthy men with epididymal necrospermia by requesting a second ejaculate 60 minutes after the first specimen is obtained.