Use of clomiphene citrate in the treatment of men with high sperm chromatin stability

POSTOPERATIVE CHANGES OF SPERM CHROMATIN HETEROGENEITY, USING ACRIDINE ORANGE STAINING, IN VARICOCELE PATIENTS

The aim of this study was to evaluate postoperative changes in sperm chromatin heterogeneity in varicocele patients. In 15 infertile patients with varicocele, sperm parameters including concentration, motility, and morphology were evaluated before and after surgical correction of varicocele. Sperm motion analysis using computer-assisted semen analyzer (CASA) was also performed. To analyze the sperm nuclear proteins, the acridine orange staining method was used. On semen analysis, sperm concentration and motility significantly increased after surgery (p = 0.002, p = 0.003, respectively), although sperm morphology was unaltered postoperatively. CASA parameters, including velocity, linearity, amplitude of lateral head displacement and beat cross frequency were unaltered postoperatively. On the other hand, acridine orange staining significantly increased postoperatively (p = 0.002). Varicocele influences the sperm chromatin condition, as well as sperm concentration and motility.

Sperm chromatin stability and its relationship with fertilization rate after intracytoplasmic sperm injection (ICSI) in an assisted reproduction program

OBJECTIVE

Evaluate sperm chromatin stability and its relationship with the rate of fertilization after procedures of intracytoplasmic sperm injection (ICSI) in a program of assisted reproduction.

DESIGN

Prospective study.

SETTING

Institute of Gynecology and Reproduction.

PATIENTS

Thirty-three women with their respective partners (12 couples in the study group and 21 couples in the control group) participating in a program of assisted reproduction. The study group was defined as men with >30% of non-decondensed spermatozoa (high sperm chromatin stability).

INTERVENTIONS

A part of each seminal sample was used to evaluate sperm chromatin stability under SDS and EDTA treatment and the second aliquot was used for the ICSI procedure. Fertilization was evaluated 16-18 h post sperm injection at a pronuclear stage. The fertilized oocytes were further cultured for 24-48 h before transfer to the patient.

MAIN OUTCOME MEASURES

Fertilization rate.

RESULTS

Thirty-five oocytes (35.7%) in the group of study and 109 oocytes (78.9%) in the control group showed two pronuclei (P < 0.001). The coefficient of determination between the SDS + EDTA (Grade 2) and rate of fertilization was r (2) = 0.85 (P < 0.001) and the coefficient of regression was 1.72 +/- 0.19 (beta +/- ES) (P < 0.001).

CONCLUSIONS

High sperm chromatin stability is a factor which reduces the rate of fertilization after ICSI procedure.

Clinical significance of the Acridine Orange test performed as a routine examination: comparison with the CASA estimates and strict criteria

The aim of the present study is to clarify the clinical significance of the Acridine Orange (AO) test (a sperm function test) as a routine examination by investigating the relationships between chromatin decondensation assessed by the AO test and routine semen analysis. Totally 543 semen samples were obtained from 286 infertile men. The AO test was performed, and spermatozoa displaying green fluorescence were considered as mature. The threshold of green AO fluorescence as 50% was adopted and the values <50% were considered as positive in the test. Computer-aided sperm analysis (CASA) and strict criteria were used for routine semen analysis. Twenty-two (4.05%) of 543 semen samples were positive in the AO test. In 20 semen samples obtained from men with severe male infertility treated by intracytoplasmic sperm injections (ICSI), the positive rate was 30.0%, which was significantly higher than that (2.63%) treated by conventional in vitro fertilization (IVF) (p=0.01). As for the basic sperm parameters, there were significant correlations between the AO test and sperm motility (p<0.001), and between the AO test and normal sperm morphology (p=0.02). However, there was no relationship between the AO test and sperm concentration (p=0.585). Sperm motion parameters assessed by CASA, including amplitude of lateral head displacement (ALH), curvilinear velocity (VCL) and rapid sperm movement (Rapid), were significantly correlated with the AO test. The information obtained using the AO test was indicated to be useful in planning treatment strategy for infertile couples.

Effect of human sperm chromatin anomalies on fertilization outcome post-ICSI

The aim of this study was to evaluate the effect of sperm chromatin anomalies on fertilization outcome post-intracytoplasmic sperm injection (ICSI). Therefore, along with semen parameters, Chromomycin A3 (CMA3) staining for protamine deficiency, aniline blue staining for excessive histones, SDS for sperm chromatin stability and SDS + EDTA for the ability of sperm to undergo decondensation were carried out on 55 semen samples from patients referred to the Isfahan Fertility and Infertility Center for ICSI. The results showed that among the aforementioned tests and semen parameters only CMA3 showed a significant correlation with fertilization outcome post-ICSI. Patients were also grouped according to CMA3 level of <30% or >30% or fertilization rate of <50% or >50%. The results show that the mean percentage fertilization and mean percentage of CMA3 positivity is different in both groups, respectively. The area under receiver operator characteristics curve shows that CMA3 is a highly sensitive and specific test for prediction of fertilization outcome post-ICSI. In conclusion, that sperm protamine deficiency has profound effect on fertilization failure in ICSI.

The effect of selective estrogen receptor modulators on parameters of the hypothalamic-pituitary-gonadal axis

The SERMs currently in clinical practice or in late stages of clinical development have been studied primarily for their effects on the breast, cardiovascular, bone, and reproductive systems. The effect of SERMs on the hypothalamic-pituitary-gonadal (HPG) axis has not been the primary focus of the studies conducted thus far. However the effect of SERMs on the HPG axis and the associated regulation of endocrine parameters may play an important role in their overall clinical profile. In this review the effects of selected SERMs on the HPG axis in premenopausal women, postmenopausal women, and men are summarized.

True corrected seminal fructose level: a better marker of the function of seminal vesicles in infertile men

This study was designed to determine if the value obtained after multiplying motile sperm concentration by seminal fructose concentration, named "true corrected fructose", correlates with sperm motility in asthenozoospermic men. Forty-two male partners in infertile couples were studied. Men were treated with 100 mg daily of clomiphene citrate for 5 days. Blood and semen samples were collected before treatment and 24 h after the end of treatment. Serum testosterone, seminal fructose and sperm motility were measured in each subject. Corrected fructose (log. sperm concentration multiplied by seminal fructose), and true corrected fructose (log. motile sperm concentration multiplied by seminal fructose) values were calculated. Prevalence of asthenozoospermia was 42.85% (18 of 42). Prevalence of hypofunction of the seminal vesicles was 9.5% using seminal fructose as a marker; 40.5% using seminal corrected fructose as a marker and 47.6% using true corrected fructose as a marker of seminal vesicle function. Regression analysis showed a better coefficient of determination between true corrected fructose and motile sperm concentration (R2=0.20, p < 0.001) than with corrected fructose (R(2)=0.05, p < 0.1) or fructose concentration (R(2)=0.006, p < 0.5). Asthenozoospermia was observed in 22.7% of subjects with normal function of the seminal vesicles, and in 65% of men with low values of true corrected fructose (z=6.02, p < 0.0001). Multivariate analysis showed that sperm motility grade 3 improved after treatment with clomiphene if true corrected fructose increased (p < 0.002). In those men whose seminal vesicle function improved after clomiphene treatment, a reduction in the prevalence of asthenozoospermia from 50 to 28.6% (z=3.10, p < 0.002) was observed whereas in those whose seminal vesicles did not respond to clomiphene the prevalence of asthenozoospermia was not reduced (z=1.05; p: NS). In conclusion, true corrected fructose measurement relates with sperm motility in cases of asthenozoospermia. Asthenozoospermia improves with clomiphene treatment if seminal vesicle function improves after treatment.

Relation between different human sperm nuclear maturity tests and in vitro fertilization

PURPOSE

To consider the relationship between different sperm nuclear maturity tests and in vitro fertilization (IVF) rate, in order to select the most sensitive, specific, and independent factor(s) for prediction of in vitro fertilization.

METHODS

Infertile couples (101) were randomly selected from IVF candidates referred to Isfahan Fertility and Infertility center. Semen samples were collected on the day of oocyte recovery. Following routine semen analysis, major portion of the semen was prepared for routine IVF insemination and the remaining was used for following sperm nuclear maturity tests: chromomycin A3 (CMA3), aniline blue, sodium dodecyl sulphate (SDS) test, and acridine orange test with or without heat shock (87 degrees C, 5 min). Sperms (200) were evaluated for each test. The results were recorded and analyzed for their correlation to fertilization rate, using correlation coefficient, logistic regression analysis, student t-test, and receiver operating characteristics (ROC) curve.

RESULTS

Among these tests, aniline blue and CMA3, and semen parameters, sperm morphology, and sperm motility showed a significant correlation with fertilization rate. Using logistic regression analysis, sperm morphology and CMA3 were the only independent factors related to in vitro fertilization. ROC curves showed that among above tests, CMA3 is the most specific and sensitive for sperm nuclear maturity.

CONCLUSION

Among CMA3, aniline blue, SDS test, and acridine orange, CMA3 was the most sensitive and specific test that can be used along with routine semen analysis for more precise prediction of fertilization rate.

Sperm chromatin

Available data on dry and hydrated nuclear volume of mammalian spermatozoa indicate that available volume is clearly insufficient to contain sperm chromatin packed in nucleosome-like structures. Therefore, sperm DNA-protein complexes must be packed differently than somatic DNA-protein complexes. Packing of DNA in fixed, dehydrated mammalian sperm approaches the physical limits of molecular compaction, making mammalian sperm chromatin the most condensed eukaryotic DNA known. The fundamental packaging unit of sperm chromatin is a toroid approximately 900-A outer diameter. 200-A thickness, and 150-A diameter hole. Each toroid contains 60 kilobases of DNA and is linked to other toroids by uncoiled DNA stretches. The factors that contribute to mammalian chromatin structuration are still under study. The role of protamines in sperm chromatin condensation and nuclear shaping has been overstressed to the exclusion of other possible factors. Chromatin organization in sperm nuclei is maintained during sperm condensation by tight interactions with the nuclear matrix at fixed sites, inducing the formation of individual toroid-shaped DNA loop stuctures. Observations that abnormal manchettes affect sperm head shape and chromatin organization inducing sterility speak about manchette importance during chromatin organization. The presence in sperm chromatin of regions packaged in specific ways with several types of protamines or even with histones, indicates that nuclear shaping and chromatin organization must be under DNA control. The structural properties that distinguish sperm DNA from somatic DNA may play the most important role in chromatin organization.