Influence of peritoneal fluid from spontaneous and stimulated cycles on sperm motility in vitro

Comparison of fallopian tube sperm perfusion and intrauterine tuboperitoneal insemination: a prospective randomized study

OBJECTIVE

To evaluate the results of two different methods of insemination: fallopian tube sperm perfusion (FSP) with 4 mL of inseminate and intrauterine tuboperitoneal insemination (IUTPI) with 10 mL of inseminate.

DESIGN

Prospective randomized clinical study.

SETTING

Private infertility center.

PATIENT(S)

Two hundred seventy-six couples, undergoing 403 cycles, with unexplained infertility, mild or moderate male infertility, or mild or moderate endometriosis.

INTERVENTION(S)

Patients were assigned randomly to either FSP (group A, n = 138) or IUTPI (group B, n = 138) treatment. Both groups followed the same mild ovarian stimulation protocol.

MAIN OUTCOME MEASURE(S)

Ninety-five overall pregnancies: 35 in group A (FSP) and 60 in group B (IUTPI).

RESULT(S)

The pregnancy rate per cycle (presence of gestational sac with heart beats) was 17.6% in group A (n = 199) and 29.4% in group B (n = 204). These differences were statistically significant (P < .007). The odds ratio of getting pregnant, per patient, in group B was 2.26 (95% confidence interval 1.36-3.77) compared with group A.

CONCLUSION(S)

The results of this study indicate that IUTPI may prove to be a useful technique in the treatment of unexplained infertility, mild or moderate male infertility, and mild or moderate endometriosis. Three attempts of IUTPI may be beneficial before moving on to more invasive and expensive methods of assisted reproduction techniques.

Modulation of human sperm function by peritoneal fluid

OBJECTIVE

To examine the effect of peritoneal fluid on various parameters of sperm function in vitro.

DESIGN

Prospective study.

SETTING

Basic research laboratory.

PATIENT(S)

Semen samples were obtained from normozoospermic volunteers (n = 43). Peritoneal fluids were aspirated laparoscopically from women with unexplained infertility (n = 14). Follicular fluid and oocytes were collected from patients undergoing IVF-ET.

INTERVENTION(S)

Sperm incubated under capacitating conditions were exposed to peritoneal fluid, and functional variables were evaluated in vitro.

MAIN OUTCOME MEASURE(S)

Sperm viability and motility, follicular fluid and calcium ionophore-induced acrosome reactions, protein tyrosine phosphorylation, expression of D-mannose binding sites, and ability of sperm to interact with zona pellucida.

RESULT(S)

Exposure of sperm to peritoneal fluid for up to 6 hours did not affect sperm viability or motility. Unlike follicular fluid, peritoneal fluid did not induce the acrosome reaction. Moreover, incubation of sperm with > or =20% v/v peritoneal fluid for 1 hour prevented the follicular fluid and the ionophore-induced acrosome reaction. Although treatment with peritoneal fluid allowed protein tyrosine phosphorylation during capacitation, it resulted in a significant decrease in the expression of D-mannose binding sites and sperm-zona pellucida binding.

CONCLUSION(S)

Peritoneal fluid maintains sperm survival and decreases sperm ability to respond to inducers of the acrosome reaction and bind to the zona pellucida in vitro, indicating that this fluid might modulate sperm function in vivo.

Intraperitoneal insemination in mammals: a review

This review focuses on factors associated with the development of intraperitoneal insemination in mammals. Findings to date indicate that fertility improves as the sperm cell concentration rises, but that the optimal sperm number differs in each species. Sperm washing before intraperitoneal insemination favours fertility. Peritoneal fluid shows a variable effect on spermatozoa, depending on the hormonal status of the female. The optimal time for insemination appears to be just prior to ovulation. The technique may be performed either through the abdominal or the vaginal wall. Verification of sperm deposition in the proximity of the ovaries improves fertility rates. Although associated with some risk of infection and an immune reaction against spermatozoa, the intraperitoneal technique rarely gives rise to severe anaphylactic shock, peritonitis, adhesion formation and the production of anti-sperm antibodies and these complications may be prevented by adequate sperm pretreatment and antibiotic therapy. The success of intraperitoneal insemination in humans, with results comparable with those of intrauterine insemination in the treatment of infertility, suggest the potential use of this technique in domestic mammals, especially in those in which intrauterine insemination poses practical difficulties. Some of the methods applied in human intraperitoneal insemination, such as confirming the position of the needle in the peritoneal cavity, and sperm pre-treatments might also improve results in domestic species. Conversely, the use of the animal model should help to develop some aspects of this technique in humans.