Antibodies to chlamydia trachomatis in semen and relationship with parameters of male fertility

[Infections and male infertility]

BACKGROUND

The role of urogenital infections in male infertility has long been the subject of debate.

METHODS

A bibliographic search limited to English-language literature on human subjects published before 5/2023 resulted in the selection of 189 articles.

RESULTS

Male infertility is often of multifactorial aetiology, and to optimise the prognosis it is important to manage all the factors that can be corrected, including infectious causes, which represent one of the most frequent aetiologies. The infectious agents involved in urogenital infections are most often bacterial or viral, and more rarely parasitic. They can infect the seminal tract, male accessory glands and/or testicles, and usually result in inflammation and increased oxidative stress. These infections reduce male fertility, in particular by altering spermogram parameters and increasing sperm DNA fragmentation. For these reasons, the search for a urogenital infection should be systematic, involving a careful history and clinical examination, ultrasound and systematic bacteriological tests guided by clinical findings. Aetiological treatment may be proposed depending on the picture and the germ involved.

CONCLUSION

This review should help the urologist to establish an accurate diagnosis of the form and extent of the infection, and enable him to define an appropriate therapeutic strategy, tailored to the patient, in order to obtain the best chances of improving male fertility.

Are sexually transmitted infections associated with male infertility? A systematic review and in-depth evaluation of the evidence and mechanisms of action of 11 pathogens

Purpose

To systematically review the evidence on the association between sexually transmitted infections (STIs) and male infertility. We sought to answer two questions: Are STIs significantly associated with detrimental changes in semen parameters?; and, is the prevalence of STIs significantly higher in infertile than fertile men?

Materials and methods

PubMed, Scopus and Google Scholar databases were searched (inceptionMarch 2023) following the PRISMA guidelines. Identified original studies in English on the association between STIs and male infertility were included. Data was tabulated/described by pathogen, mechanisms of action, number of studies and their level of evidence.

Results

Seventy out of 903 originally retrieved articles were included in this review. For the detrimental changes in semen parameters (first question), the evidence seems equivocal based on the nearly equal number of studies and similar levels of evidence. The only exception was for Ureaplasma, where the number of studies and levels of evidence supported an association with male infertility. Pertaining to a significantly higher prevalence of STI among infertile compared to fertile men (second question), evidence was insufficient to support/deny a significant association. The two exceptions were Ureaplasma and Mycoplasma, where the number of studies and evidence levels were in favour of an association with male infertility.

Conclusions

Generally, the relationship between STIs and male infertility remains to be uncovered. Our appraisal of the overall state of this relationship shows that the evidence base leaves much to be desired. The exceptions are Ureaplasma and Mycoplasma, where the evidence convincingly suggests their associations with infertility in men.

Epidemiology of Chlamydia trachomatis in the Middle East and north Africa: a systematic review, meta-analysis, and meta-regression

BACKGROUND

The epidemiology of Chlamydia trachomatis in the Middle East and north Africa is poorly understood. We aimed to provide a comprehensive epidemiological assessment of C trachomatis infection in the Middle East and north Africa.

METHODS

We did a systematic review of C trachomatis infection as well as a meta-analysis and meta-regression of C trachomatis prevalence. We searched PubMed and Embase, as well as regional and national databases up to March 13, 2019, using broad search terms with no language or year restrictions. Any document or report including biological measures for C trachomatis prevalence or incidence was eligible for inclusion. We extracted all measures of current (genital or rectal), recent, and ever infection with C trachomatis. We estimated pooled average prevalence in different populations using random-effects meta-analysis. Factors associated with prevalence and sources of between-study heterogeneity were determined using meta-regression.

FINDINGS

We identified a total of 1531 citations, of which 255 reports contributed to 552 C trachomatis prevalence measures from 20 countries. No incidence measures were identified. Pooled prevalence of current genital infection was 3·0% (95% CI 2·3-3·8) in general populations, 2·8% (1·0-5·2) in intermediate-risk populations, 13·2% (7·2-20·7) in female sex workers, 11·3% (9·0-13·7) in infertility clinic attendees, 12·4% (7·9-17·7) in women with miscarriage, 12·4% (9·4-15·7) in symptomatic women, and 17·4% (12·5-22·8) in symptomatic men. Pooled prevalence of current rectal infection was 7·7% (4·2-12·0) in men who have sex with men. Substantial between-study heterogeneity was found. Multivariable meta-regression explained 29·0% of variation. Population type was most strongly associated with prevalence. Additional associations were found with assay type, sample size, country, and sex, but not with sampling methodology or response rate (about 90% of studies used convenience sampling and >75% had unclear response rate). There was no evidence for temporal variation in prevalence between 1982 and 2018.

INTERPRETATION

C trachomatis prevalence in the Middle East and north Africa is similar to other regions, but higher than expected given its sexually conservative norms. High prevalence in infertility clinic attendees and in women with miscarriage suggests a potential role for C trachomatis in poor reproductive health outcomes in this region.

FUNDING

National Priorities Research Program from the Qatar National Research Fund (a member of Qatar Foundation).

Latheef S, Sharun K, Khurana SK, K. A, Tiwari R, Bhatt P, K. V, Chaicumpa W. Role of Antisperm Antibodies in Infertility, Pregnancy, and Potential forContraceptive and Antifertility Vaccine Designs: Research Progress and Pioneering Vision

Sperm of humans, non-human primates, and other mammalian subjects is considered to be antigenic. The effect of changes in autoimmunity on reproductive cells such as spermatozoa and oocytes play a critical but indistinct role in fertility. Antisperm antibodies (ASAs) are invariably present in both females and males. However, the degree of ASA occurrence may vary according to individual and gender. Although the extent of infertility due to ASAs alone is yet to be determined, it has been found in almost 9-12% of patients who are infertile due to different causes. Postcoital presence of spermatozoa in the reproductive tract of women is not a contributory factor in ASA generation. However, ASA generation may be induced by trauma to the vaginal mucosa, or by anal or oral sex resulting in the deposition of sperm inside the digestive tract. It is strongly believed that, in humans and other species, at least some antibodies may bind to sperm antigens, causing infertility. This form of infertility is termed as immunological infertility, which may be accompanied by impairment of fertility, even in individuals with normozoospermia. Researchers target ASAs for two major reasons: (i) to elucidate the association between ASAs and infertility, the reason ASAs causes infertility, and the mechanism underlying ASA-mediated infertility; and (ii) to assess the potential of ASAs as a contraceptive in humans in case ASAs influences infertility. Therefore, this review explores the potential application of ASAs in the development of anti-spermatozoa vaccines for contraceptive purposes. The usefulness of ASAs for diagnosing obstructive azoospermia, salpingitis, and oligoasthenoteratozoospermia has been reviewed extensively. Important patents pertaining to potential candidates for spermatozoa-derived vaccines that may be utilized as contraceptives are discussed in depth. Antifertility vaccines, as well as treatments for ASA-related infertility, are also highlighted. This review will address many unresolved issues regarding mechanisms involving ASAs in the diagnosis, as well as prognoses, of male infertility. More documented scientific reports are cited to support the mechanisms underlying the potential role of ASA in infertility. The usefulness of sperm antigens or ASAs (recombinant) in human and wild or captive animal contraceptive vaccines has been revealed through research but is yet to be validated via clinical testing.

Amelioration of sperm immobilisation factor-induced infertility by bacterial antigenic determinants cross-reacting with spermatozoa

A strain of Staphylococcus aureus, capable of invitro immobilisation of human and mouse spermatozoa, was already present in our laboratory. Therefore, in the present study, the factor responsible (sperm immobilisation factor, SIF) was isolated and purified. It was found to compromise not only motility, but also viability, morphology and Mg2+-ATPase activity of mouse spermatozoa. Also, SIF (250μgmL−1), when administered intravaginally in female BALB/c mice before mating, showed 100% contraceptive effect. Moreover, fluorescein isothiocyanate-labelled SIF was also found to bind mouse spermatozoa and various motile as well as non-motile bacteria, indicating the presence of common SIF-binding receptors on spermatozoa and bacteria. Further, to demonstrate molecular mimicry, the amelioration of SIF-induced impairment of sperm function by a SIF-binding bacterial receptor was compelling. For this, the SIF-binding receptor from Escherichia coli (E-SBR) was purified and evaluated for its ameliorative effect on SIF-induced sperm impairment invitro and invivo. Interestingly, upon the addition of mouse spermatozoa to SIF pre-incubated with E-SBR, an ameliorative effect against SIF-induced impairment of sperm function could be observed through analysis of normal sperm parameters (motility, viability, morphology, Mg2+-dependent ATPase levels). E-SBR also blocked binding of labelled SIF to spermatozoa and bacteria and alleviated SIF-induced infertility in female BALB/c mice. This provided evidence for molecular similarities between bacteria and spermatozoa, owing to which anti-bacterial antibodies cross-reacting with spermatozoa might be produced and infertility might follow.

Semen Quality of Men With Asymptomatic Chlamydial Infection

We have shown previously that the in vitro exposure of spermatozoa to elementary bodies (EBs) of Chlamydia trachomatis can lead to sperm death over a number of hours of incubation. As such, we have hypothesized that the ejaculates of men with a chlamydial infection could contain increased numbers of nonmotile (dead) spermatozoa if they are exposed to EBs prior to ejaculation. To test this hypothesis, the ejaculates of 642 men undergoing diagnostic semen analysis as part of ongoing infertility investigations with their partner were examined. All men were without symptoms of genitourinary infections and semen analysis was performed according to World Health Organisation (WHO) 1999 methods after a 3-5 day abstinence period. In addition to semen analysis, nested plasmid polymerase chain reaction (PCR) was undertaken on the ejaculate to detect the presence of C trachomatis DNA. A total of 31 semen specimens (4.9%) were found to be positive, and in 28 of these, the diagnosis was confirmed using the ligase chain reaction (LCR). Men whose ejaculates were PCR positive for chlamydial DNA had a significantly (P <.05) higher mean concentration of leukocytes (1.71 +/- 2.20 x 10(6) per mL) and a higher mean ejaculate volume (3.45 +/- 1.52 mL) than in those whose ejaculates were PCR negative (leukocyte concentration: 0.67 +/- 2.59 x 10(6) per mL; volume 2.93 +/- 1.38 mL). Leukocytospermia was twice as common in men that were PCR positive for chlamydial DNA (P <.05) but it was not always associated with the presence of chlamydial DNA in semen. However, there was no difference in the mean percent motility between the 2 groups and the proportion of asthenozoospermia also did not differ. Because these results do not confirm the hypothesis proposed from our in vitro experiments, further work needs to be undertaken to understand whether human spermatozoa are actually exposed to elementary bodies of C trachomatis in an infected individual prior to ejaculation.

Management of Chlamydia trachomatis genital tract infection: screening and treatment challenges

Chlamydia trachomatis is a prevalent sexually transmitted infection that can lead to serious reproductive morbidity. Management and control of C. trachomatis is a challenge, largely due to its asymptomatic nature and our incomplete understanding of its natural history. Although chlamydia screening programs have been implemented worldwide, several countries have observed increasing rates of reported chlamydia cases. We reviewed the literature relating to the long-term complications of C. trachomatis, as well as screening strategies, treatment, and prevention strategies for reducing chlamydia in the population. Articles from 1950-2010 were identified through a Medline search using the keyword "Chlamydia trachomatis" combined with "screening", "pelvic inflammatory disease", "endometritis", "salpingitis", "infertility", "ectopic pregnancy", "urethritis", "epididymitis", "proctitis", "prostatitis", "reinfection", "cost-effectiveness", "treatment", "vaccines", or "prevention". Progression of C. trachomatis varies, and recurrent infections are common. Currently, there is limited evidence on the effectiveness of chlamydia screening. Higher quality studies are needed to determine the efficacy of more frequent screening, on a broader range of sequelae, including infertility and ectopic pregnancy, in addition to pelvic inflammatory disease. Studies should focus on delineating the natural history of recurrent infections, paying particular attention to treatment failures. Furthermore, alternatives to screening, such as vaccines, should continue to be explored.

Chlamydia trachomatis infection is related to poor semen quality in young prostatitis patients

BACKGROUND

The impact of chronic prostatitis resulting from Chlamydia trachomatis infection on male fertility is controversial.

OBJECTIVE

To investigate the correlation between C. trachomatis infection and semen quality in young male patients affected by chronic prostatitis resulting from C. trachomatis infection and to evaluate the correlation between anti-C. trachomatis immunoglobulin (Ig) A against heat shock protein 60 (HSP60), heat shock protein 70 (HSP70), and semen parameters.

DESIGN, SETTING, AND PARTICIPANTS

All patients with clinical and instrumental diagnosis of chronic prostatitis underwent microbiological cultures for common bacteria, DNA extraction, mucosal and serum antibody evaluation for C. trachomatis, and semen parameter analysis. Western blot analysis of mucosal anti-C. trachomatis IgA was performed.

INTERVENTIONS

Subjects were split into two groups: Group A consisted of patients with chronic prostatitis resulting from common bacteria (uropathogens), and group B consisted of patients with chronic prostatitis resulting from C. trachomatis infection.

MEASUREMENTS

The relationship between C. trachomatis infection and semen parameters as well as the correlation among IgA levels, IgA characterisation, and semen analysis were determined.

RESULTS AND LIMITATIONS

We enrolled 1161 patients (mean age: 36.5 yr). Of these, 707 patients were placed in group A, and 454 were placed in group B. Significant statistical differences were reported between groups in terms of sperm concentration (p<0.001), percentage of motile sperm (p<0.001), and normal morphologic forms (p<0.001). Strong correlations between mucosal anti-C. trachomatis IgA and sperm concentration (p<0.001) and normal morphologic forms (p<0.001) were reported. Correlations among positivity to HSP60, HSP70, and sperm concentration (p<0.003) and normal morphologic forms (p<0.001) were also reported.

CONCLUSIONS

This study demonstrated the role of chronic prostatitis resulting from C. trachomatis in male fertility decrease, highlighting probable immunomediated damage to germinal cells because of C. trachomatis infections.

Reproductive tract complications associated with Chlamydia trachomatis infection in US Air Force males within 4 years of testing

BACKGROUND

Chlamydia trachomatis (CT) is a common sexually transmitted infection for which young, sexually active persons are at highest risk. Health consequences such as orchitis/epididymitis, prostatitis, infertility, and urethral stricture have been described among CT-infected males, although not all of these are indisputably linked to CT. Current literature lacks population-based studies needed to examine these associations on a larger scale, to evaluate the true risk of developing complications after a CT infection. The US Air Force contains a large population of young, sexually active males, making it suitable for conducting such a study.

METHODS

We conducted a retrospective cohort study between 2001 and 2005 comparing the incidence of orchitis/epididymitis, prostatitis, infertility, and urethral stricture among male Air Force members with and without prior CT infections. Cumulative incidence rates were calculated and Cox proportional hazard models were generated to evaluate the risk of developing complications and to adjust for potential confounders.

RESULTS

Among 17,764 men enrolled in the study, 913 (5.14%) experienced a reproductive tract outcome. Among CT-positive men, cumulative incidences of orchitis/epididymitis, prostatitis, infertility, and urethral stricture were 4.28%, 1.41%, 1.27%, and 0.13%, respectively. Orchitis/epididymitis [Hazard ratio (HR) = 1.38 (1.13-1.70)] and "any" outcome [HR = 1.37 (1.16-1.61)] were positively associated with CT; infertility was marginally associated [HR = 1.36 (0.93-2.00)].

CONCLUSIONS

Overall, the burden of reproductive health outcomes among Air Force males is small. Significant associations were observed between CT and both orchitis/epididymitis and any outcome; a larger cohort or longer follow-up may have detected a significant association between CT and infertility.

Male serum Chlamydia trachomatis IgA and IgG, but not heat shock protein 60 IgG, correlates with negatively affected semen characteristics and lower pregnancy rates in the infertile couple

BACKGROUND

The objective of this study was to evaluate whether serum Chlamydia trachomatis immunoglobulin-A (IgA), IgM and C. trachomatis heat shock protein 60 (CHSP60) IgG are of additional value to C. trachomatis IgG regarding the impact on fecundity in infertile couples, and to relate C. trachomatis serum antibodies to semen characteristics, diagnoses and pregnancy outcome.

METHODS

A total of 226 infertile couples, previously tested for C. trachomatis IgG, were tested for C. trachomatis IgA, IgM and CHSP60 IgG, and semen samples from all men were analysed.

RESULTS

Chlamydia trachomatis serum IgA in men (but not in women) correlated with reduced chances of achieving pregnancy [p = 0.021, relative risk (RR) =0.65, 95% confidence interval (CI) 0.42-1.005] and in combination with C. trachomatis IgG the chance was further reduced (p =0.001, RR = 0.35, 95% CI 0.15-0.84). Chlamydia trachomatis serum IgA was also significantly correlated with reduced motility of the spermatozoa (-8.7%, p = 0.023), increased number of dead spermatozoa (+10.5%, p = 0.014) and higher prevalence of leucocytes in semen (+122%, p = 0.005), and in combination with C. trachomatis IgG positivity, there was also a decrease in sperm concentration (-35%, p = 0.033), the number of progressive spermatozoa (-14.8%, p = 0.029) and a rise in the teratozoospermia index (+4.4%, p = 0.010). CHSP60 IgG correlated with reduced motility (-5.6%, p = 0.033), and in the women to tubal factor infertility (p = 0.033), but no correlations of C. trachomatis serum IgM or CHSP60 IgG with pregnancy rates were found.

CONCLUSIONS

Chlamydia trachomatis serum IgA in the male partner of the infertile couple has an additive value to IgG in predicting pregnancy chances, and serum IgA and IgG are associated with subtle negative changes in semen characteristics.

Chlamydia trachomatis in subfertile couples undergoing an in vitro fertilization program: a prospective study

OBJECTIVES

The objectives were to estimate the prevalence of Chlamydia trachomatis infection in subfertile couples and to study the relationship between markers of C. trachomatis infection and male infertility as well as pregnancy rates after in vitro fertilization (IVF).

STUDY DESIGN

All consecutive couples consulting for infertility and IVF in Pellegrin Hospital were screened for C. trachomatis by direct (PCR test) and serological methods.

RESULTS

Two hundred and seventy-seven couples were included in the study (mean age in years: 35 for men, 32 for women; mean duration of infertility: 4 years). The most frequent indication for IVF was tubal factor in 33%, endometriosis in 6%, dysovarian function in 12%, male infertility in 36% and others in 13%. C. trachomatis PCR was positive in 1.2% of men, 95% confidence interval (CI95%): (0.2%; 3.3%) and in 2.7% of women, CI95%: (1.1%; 5.5%). When combining all chlamydial markers, 17.3% of men, CI95%: (12.7%; 22.8%) and 20.4% of women, CI95%: (15.6%; 25.9%) had at least one positive marker. The presence of positive markers was not associated with altered semen characteristics. Couples with positive markers had a pregnancy rate of 23.1% (12 out of 52) compared with 20.2% (24 out of 119) among those with negative markers.

CONCLUSION

In this population, the presence of past or current C. trachomatis infection was associated with neither semen characteristics nor outcome of IVF in subfertile couples.

Incidence of genital Chlamydia trachomatis infection in the male partners attending an infertility clinic

Chlamydia trachomatis is an important pathogen in the aetiology of pelvic inflammatory disease, resulting in female infertility. If all female infertility patients are screened for silent genital chlamydia infection, should the male partners of these patients also be screened to decrease the risk of re-infection? To determine the incidence of current and present male infection with C. trachomatis, we carried out a prospective clinical study. We studied 100 consecutive new male partners of patients seen in the infertility clinic. The infertility was of at least 12 months duration. We used polymerase chain reaction detection of C. trachomatis in urine specimens and microimmunofluorescence serology was performed to detect both past and current infection. The female partners were also screened for chlamydia infection by cervical swabs and serology. In five male patients (5%) C. trachomatis DNA was detected in the urine specimen by polymerase chain reaction. Microimmunofluorescence serology was positive in five patients (5%). One of the subjects had positive serology and urine polymerase chain reaction testing. The proportion of male partners with current or previous C. trachomatis infection was therefore 9% (95% CI 3.39 - 14.60). Seven female patients had positive serology results (7%), one of whom also had a positive cervical swab result indicating current infection with the pathogen. In four cases, both the male and female partner had positive serology results. The cost of screening for C. trachomatis is cheaper than treating the complications of undiagnosed genital Chlamydia infection, which is implicated in tubal disease leading to infertility. The results suggest that routine screening of male partners in an infertility setting may be justified.

[Sperm biochemical markers of genital tract inflammation: usefulness of elastase determination]

Genital tract inflammation was for a long time suspected of inducing sterility in the male. The role of leukocytes in sperm changes is still debated. The identification of inflammation is based on the presence of activated leukocytes and the elastase measurement. Residual inflammation is evaluated by the reactive oxygen species activity. The true damage caused by inflammation on spermatozoa is reflected in negative changes observed during sperm apoptosis. Increased sperm DNA fragmentation is frequently observed while classical sperm characteristics are not modified automatically. The diagnosis of genital tract inflammation, follow-up after treatment and prognosis in terms of fertility require the use of different and complementary parameters.

Assessment of Chlamydia trachomatis infection in asymptomatic male partners of infertile couples

Three specimens from 111 asymptomatic male partners of infertile couples attending the Department of Urology in Amiens, France, were examined by the PCR COBAS AMPLICOR test (Roche Molecular Diagnostics) for the presence of Chlamydia trachomatis. The specimens analysed were: first void urine (FVU), urine obtained after prostatic massage (UPM) and semen specimens. Serum from each patient was also obtained and analysed for the presence of IgG and IgA chlamydial antibodies by in-house microimmunofluorescence (MIF) and pELISA. C. trachomatis was detected by PCR in 5.4% of FVU samples, 2.7% of semen specimens and in 0.9% of UPM samples. Two treatments for processing the samples (storage at -70 degrees C and heating to 95 degrees C) were routinely used before initial testing to reduce the effects of inhibitors of PCR. Despite these precautions, the PCR method revealed the presence of inhibitors in 7.3% of semen specimens and 3.6% of FVU samples. C. trachomatis was detected by PCR COBAS AMPLICOR in seven of 111 patients (6.3%) and by serology in five of 111 patients (4.5%). The detection of C. trachomatis in FVU, UPM and semen specimens can serve as a marker for the presence of this organism in the genital tract, and can be used as a reliable way of detecting asymptomatic carriers of infection.

Update on the impact of Chlamydia trachomatis infection on male fertility

With approximately 90 million cases annually, infection with Chlamydia trachomatis is the most prevalent sexually transmitted bacterial disease in the world. Considering that these infections are often asymptomatic and cause major complications like acute pelvic inflammatory disease, ectopic pregnancy, infertility or infant pneumonia, the estimated costs for diagnosis and treatment in the USA amounts to 2.2 million US dollars for each 500 cases. Therefore, there is a high need for correct, quick and cost-effective diagnosis and treatment of this urogenital tract infection. New innovative therapies provide good results with regard to efficacy and patients' compliance. The success rates of treatments are at least 95%. However, the occurrence of antibiotic resistance should not be ignored and new treatment schemes must be developed. The state-of-the-art of diagnosis and treatment of chlamydial infections as well as the pathophysiology is discussed in this review. In conclusion, infections with C. trachomatis is an important public health problem, especially in third world and developing countries, and more socio-economic studies linking secondary prevention of chlamydial infections, infertility and adverse pregnancy outcome are needed to understand more of its aetiology. In addition, diagnosis and treatment should be improved. Data in men revealed that past infections but not present infections are more related to male infertility. There is still controversial results. In future studies, function of the seminal vesicles and evaluation of the antioxidant capacity should be taken into account when role of C. trachomatis infection on male fertility is assessed.

Semen polymorphonuclear neutrophil leukocyte elastase as a diagnostic and prognostic marker of genital tract inflammation--a review

Elastase is a protease released by polymorphonuclear neutrophils (PMN) during the inflammatory process. Since 1987, seminal elastase-inhibitor complex (Ela/alpha1-PI) has been proposed as a marker of male silent genital tract inflammation. Measured by immunoassay in seminal plasma, Ela/alpha1-PI at a cut-off level of > or = 230 microg/l, is useful in the detection of genital tract inflammation. The prevalence of increased seminal Ela/alpha1-PI in infertile men is significantly higher than that observed in fertile men. The Ela/alpha1-PI level is positively correlated with other seminal fluid markers of male genital tract inflammation: reduced semen volume, citric acid, fructose, and increased albumin, complement component C3, caeruloplasmin, immunoglobulins IgG and IgA, and cytokines interleukins-8 and -6. A higher seminal Ela/alpha1-PI level is significantly associated with tubal damage in female partners. After antibiotic therapy, a decrease of Ela/alpha1-PI level is observed. The presence of tubal damage in the partner may negatively affect the response to antibiotic treatment. A higher seminal Ela/alpha1-PI is associated with lower percentage of sperm with single-stranded deoxyribonucleic acid (DNA) and better fertilization rate in in vitro fertilization. Besides infertility, the determination of Ela/alpha1-PI is useful to confirm the presence of prostate and other male accessory gland bacterial inflammation. Screening for PMN Ela/alpha1-PI is easy to perform and reproducible and is a reliable quantitative test for diagnosis and prognosis of silent genital tract inflammation of couples. Moreover, sequential determinations allow the follow-up of inflammation during and after therapy.

Age-related disease pattern in infertile men: increasing incidence of infections in older patients

In a cross-sectional retrospective study, the age-dependency of semen parameters of men with specific andrological diseases was investigated in 3,698 men (mean age 33 years; range 19-63 years) attending a tertiary referral clinic for couple infertility. In all, 1,853 patients suffered from idiopathic infertility (mean age 33.2 years; range 19-60 years), 388 from infections of the accessory glands (34.2; 20-61), 363 had a history of maldescended testes (32.0; 20-51) and 833 a varicocele (33.6; 20-63). In 172 patients, a varicocele and an infection (34.3; 24-54) and in 94 a varicocele and a history of maldecended testes (32.5; 21-53) were found. Semen analysis was performed according to WHO criteria. An age-related decrease in testicular volume was not observed in any group. Total sperm count decreased significantly with advancing age only in patients with an infection of the accessory glands. We found no evidence for age-dependent progressive deterioration of semen variables in the other groups. It may be concluded that the causes for the spermatogenetic defects in men with idiopathic infertility, a history of maldescended testes or varicocele are acquired before adolescence and do not progress during adulthood. In contrast, infections of the accessory glands may lead to decreased sperm counts by functional impairment or partial occlusion of the seminal ducts. Thus, if in the general population declining sperm counts are observed, genital tract infections may be suspected as a contributing factor.

Chlamydia trachomatis infection in male partners of infertile couples: incidence and sperm function

Chlamydia trachomatis infection is one of the most common sexually transmitted diseases. Its effect on male fertility, however, is still controversial. In this study, 284 male partners of infertile couples consulting the Center of Studies in Reproductive Biology (CEBRE) were analyzed. The incidence of C. trachomatis infection among male partners of infertile couples was 38.6%. There were no significant differences between infected and noninfected infertile men in any of the sperm parameters assessed (sperm concentration, motility and morphology). The results of the three bioassays developed to evaluate sperm physiology, namely spermatozoa-zona pellucida binding, acrosome reaction stimulated with human follicular fluid and zona-free hamster oocyte penetration, showed no differences between infected and noninfected men. Electron microscopy studies suggest that spermatozoa are active agents in the dissemination of the chlamydial infection; they could be acting as 'vehicles' for the pathogens. These, and other results, suggest that the possible effect of C. trachomatis on male fertility is not due to alterations in sperm 'quality' or function, but rather to the transmission of the disease to female partners, causing inflammatory processes and promoting the generation of antisperm antibodies.

[Genital infection and infertility]

BACKGROUND

Genital infection is the most important cause of infertility worldwide, affecting not only Fallopian tubes but all anatomic urogenital sites, both male and female.

METHODS

We present a randomized,prospective and normalized study about sexually transmitted diseases(STD). We include 487 patients, 376 of whom were infertile and the remaining 111 were not and act as control group.

RESULTS

47.3% of infertile patients showed at least one infection: 10.7% had Chlamydia trachomatis infection, whereas only 0.3% had gonococal infection. We found none syphilis. 12.9% of the patients showed yeast belonging to genus Candida, 5% bacterial vaginosis, 3.8% Escherichia coli and 0.3% Klebsiella pneumoniae. The percentage of isolation of Ureaplasma urealyticum and Mycoplasma hominis were 23.5% and 4.8%, respectively. We detected antibodies against Hepatitis B (any serological marker) in 7.8% of the cases. Chlamydial infection and the presence of U. urealyticum were related with infertility (X 12=6,070, p<0.005 and X12=8,782, p<0.005,respectively).

CONCLUSIONS

We think these results conclude that is necessary to perform routine tests to screen for C. trachomatis, N. gonorrhoeae, and for infections caused by micoplasma as well, among infertile patients. These patients must be considered of being at risk of acquiring STD, since the percentage of these diseases is higher than the percentage we found among the control group. It is important to insist on prevention and early diagnosis and treatment as a main goal to decrease the number of tubal occlusion and infertile couples.

IgA antibodies to Chlamydia trachomatis and seminal parameters in asymptomatic infertile males

Prevalence of IgA antibodies to Chlamydia trachomatis in semen samples from infertile men was estimated and its clinical meaning is discussed. The ejaculate of 102 infertile men without any symptom of genital infection was studied, and seminal alterations were classified according to WHO criteria. Antichlamydial IgA antibodies were detected using a solid-phase, enzyme-linked immunoassay (ImmunoComb II Chlamydia trachomatis monovalent IgA) and related to sperm count, motility and membrane integrity, seminal leucocyte count, and past history of sexually transmitted disease (STD). Prevalence of IgA antibodies to C. trachomatis was 23%. There was no relationship between IgA antibodies and the sperm variables or leucocyte count in semen. However, a strong association between antichlamydial IgA antibodies and the antecedent of STD was found (p < .005; OR = 6). IgA antibodies to C. trachomatis did not cause alterations in sperm function and they were not associated with inflammatory response. However, these antibodies in semen of asymptomatic infertile men would indicate a risk of C. trachomatis infection for the couples of those patients.

Semen granulocyte elastase: its relevance for the diagnosis and prognosis of silent genital tract inflammation

Elastase-inhibitor complex was assessed by immunoassay in the seminal plasma of 312 men attending the outpatient infertility clinic. Using receiver operating characteristic (ROC) curve analysis, elastase at the cut-off value of > or =290 ng/ml was shown to be efficient (sensitivity 79.5%, specificity 74.4%) in the detection of genital tract inflammation as defined by leukocytospermia (>1x10(6) leukocytes/ml). The prevalence of increased elastase in 292 infertile men was significantly higher (34%) as compared with that (5%) observed in 20 fertile men (P: = 0.02). Moreover, high elastase concentration (> or =290 ng/ml) was observed in 66 of the 264 men (25%) without leukocytospermia. A significant positive correlation was found between elastase concentration and patient age (r = 0.202, P: < 0.0001) and the number of leukocytes (r = 0.330, P: < 0.0001). A negative correlation was found between elastase concentration and semen volume (r = -0.146, P: = 0.01) and the percentage of spermatozoa with single-stranded DNA (r = -0.194, P: = 0.024), but there was no correlation between elastase and sperm reactive oxygen species production. A higher seminal elastase concentration was significantly associated with tubal damage in female partners (P: < 0.001). After norfloxacine antibiotic therapy, decrease in elastase concentration was observed in 15 (25%) of the 60 treated patients. Tubal damage in the partner negatively affected the response to antibiotic therapy. In conclusion, granulocyte elastase is a reliable screening test for silent genital tract inflammation of the couple. The elastase-inhibitor complex may have a protective effect in reducing sperm DNA denaturation.

Screening for Chlamydia trachomatis and Ureaplasma urealyticum infection in semen from asymptomatic male partners of infertile couples prior to in vitro fertilization

In a prospective study, the prevalence of infection with Chlamydia trachomatis and Ureaplasma urealyticum was evaluated in the semen of 92 asymptomatic male partners of infertile couples using polymerase chain reaction and culture, respectively. The results were compared with the detection of serologically specific antibodies. U. urealyticum and C. trachomatis were detected in 12 (13%) and 10 (10.8%) of the tested ejaculates, respectively. One mixed infection was detected. No correlation was found between detection of the pathogens in ejaculates and the presence of specific antibodies in serum. This study therefore confirms the limited diagnostic value of serological analysis to ascertain infection with C. trachomatis or U. urealyticum. The high frequency of detection of these pathogens among asymptomatic male partners of infertile couples emphasizes their potential role in the impairment of male fertility, and the need for sensitive and specific detection methods to prevent infection of the early embryo when using new reproductive techniques such as zona pellucida hatching or intracytoplasmic microinjection.

Antisperm antibodies: etiology, pathogenesis, diagnosis, and treatment

OBJECTIVE

To critically review the English-language literature and describe the current diagnosis, prevalence, etiology, and treatment of antisperm antibodies (ASA).

DESIGN

A comprehensive literature search of the English-language literature published between 1966 and December 1997 was performed on MEDLINE. Articles were also located via bibliographies of published works.

RESULT(S)

Data were excerpted from articles identified by MEDLINE search. The diagnosis, prevalence, etiology, and treatment of ASA are described.

CONCLUSION(S)

There is sufficient evidence that ASA impair fertility in couples with unexplained infertility. A number of different methodologies are available, which may be used in their detection. However, in many cases, test interpretation is subjective. Although there is not enough evidence to support systemic treatment for ASA, application of a variety of assisted reproductive technologies improves outcome.

Methods for the detection of male genital tract inflammation

Male genital tract inflammation is reflected by increased numbers of white blood cells (WBC) in semen. An ejaculate containing more than 10(6) WBC ml-1 semen is termed leukocytospermic. Among male infertility patients, the frequency of leukocytospermia is between 10% and 20%. By conventional light microscopy or sperm staining techniques, it is not possible to reliably differentiate WBC from immature germ cells in semen. In contrast, the cytochemical peroxidase method reliably identifies granulocytes, the most prevalent WBC type in semen. The method is cheap, fast and easy to perform. The gold standard for the detection of all WBC populations in semen is immunocytology using monoclonal antibodies. However, it is expensive and time-consuming, thus remaining a research tool at present. The measurement of granulocyte elastase in semen provides information on the number of granulocytes and their inflammatory activation. However, commercial granulocyte elastase enzyme immunoassays are expensive and due to logistical reasons often delay the results for more than 1 week. Leukocyte esterase dipstick tests lack both sensitivity and specificity for the detection of inflammatory changes in semen. For clinical purposes, the peroxidase method is ideally suited to detect inflammatory changes in semen.

Antisperm antibodies and microorganisms in genital secretions--a clinically significant relationship?

In asymptomatic infertility patients, no significant relationship was found between the presence of antisperm antibodies (ASA) in serum and in semen samples (IgG and/or IgA ASA), differentiated with the mixed antiglobulin reaction (MAR), and the microbial colonization of ejaculates covering a broad spectrum of microorganisms. Likewise, there was no significant association of ASA with microbial findings in patients' female partners, who also presented without symptoms of genital tract infection and were screened at the same time. Furthermore, ASA in semen (IgG and IgA) were not significantly related to several potential markers of subclinical male sexual gland infection or inflammation (leukocytes, PMN elastase, albumin, C3c) evaluated in aliquots of the same ejaculates used for immunological testing.