The effect of screening and treatment of Ureaplasma urealyticum infection on semen parameters in asymptomatic leukocytospermia: a case-control study

Ureaplasma urealyticum upregulates seminal fluid leukocytes and lowers human semen quality: a systematic review and meta-analysis

BACKGROUND

Ureaplasma urealyticum belongs to the class Mollicutes and causes non-gonococcal urethritis, an inflammation of the urethra that is linked with impaired semen quality. However, some reports are contradictory, and the reported effect of U. urealyticum on specific sperm variables is not consistent. Thus, this study synthesized findings from published primary data and provides a robust and reliable inference on the impact and associated mechanisms of U. urealyticum on sperm quality.

METHODS

A systematic search was conducted until 31st May, 2024, on Cochrane, Google Scholar, and Pubmed. The Population, Exposure, Comparator/Comparison, Outcomes, and Study Design (PECOS) model was adopted. The populations were male in their reproductive ages who were infected with Ureaplasma urealyticum and confirmed positive versus the control who were age-matched non-infected or treated, while the outcomes included conventional semen parameters, seminal fluid leucocyte count, and sperm interleukin-6 (IL-6) concentrations, and the studies were either cross-sectional or longitudinal.

RESULTS

When compared with the control, quantitative analysis demonstrated that U. urealyticum significantly reduced ejaculate volume (SMD 0.33 [95% CI: 0.15, 0.52] p = 0.0004), sperm concentration (SMD 0.47 [95% CI: 0.31, 0.64] p < 0.00001), total sperm motility (SMD 0.73 [95% CI: 0.43, 1.02] p < 0.00001), total motile sperm count (SMD 0.21 [95% CI: 0.17, 0.26] p < 0.00001), normal sperm morphology (SMD 0.88 [95% CI: 0.42, 1.35] p = 0.0002), but increased seminal fluid leukocyte count (SMD -0.82 [95% CI: -1.61, -0.02] p = 0.04). In addition, qualitative analysis revealed that U. urealyticum-positive subjects had significantly higher levels of IL-1β, IL-6, IL-8, TNF-α, peroxidase, leukocytes, neutrophils, CD4 + T cells, and CD8 + T cells in the seminal fluid when compared with the control. Furthermore, higher sperm DNA fragmentation and apoptotic sperm cells were observed in U. urealyticum-positive subjects when compared to the control.

CONCLUSIONS

These findings revealed that U. urealyticum lowers semen quality via the upregulation of seminal fluid leukocytes, elastase, pro-inflammatory cytokines, and DNA fragmentation. However, further studies are required to elucidate the mechanisms underlying the association between U. urealyticum and semen quality decline and to develop effective therapies for this condition.

Associations of Ureaplasma urealyticum infection with male infertility and intrauterine insemination outcomes

ABSTRACT

Ureaplasma urealyticum (UU) is one of the most commonly occurring pathogens associated with genital tract infections in infertile males, but the impact of seminal UU infection in semen on intrauterine insemination (IUI) outcomes is poorly understood. We collected data from 245 infertile couples who underwent IUI at The First Affiliated Hospital of USTC (Hefei, China) between January 2021 and January 2023. The subjects were classified into two groups according to their UU infection status: the UU-positive group and the UU-negative group. We compared semen parameters, pregnancy outcomes, and neonatal birth outcomes to investigate the impact of UU infection on IUI outcomes. There were no significantly statistical differences in various semen parameters, including semen volume, sperm concentration, total and progressive motility, sperm morphology, leukocyte count, the presence of anti-sperm antibody, and sperm DNA fragmentation index (DFI), between the UU-positive and UU-negative groups of male infertile patients (all P > 0.05). However, the high DNA stainability (HDS) status of sperm differed between the UU-positive and UU-negative groups, suggesting that seminal UU infection may affect sperm nuclear maturation ( P = 0.04). Additionally, there were no significant differences in pregnancy or neonatal birth outcomes between the two groups (all P > 0.05). These results suggest that IUI remains a viable and cost-effective option for infertile couples with UU infection who are facing infertility issues.

Impact of Ureaplasma urealyticum infection on semen parameters and in vitro fertilization outcomes in infertile men

Introduction

Ureaplasma urealyticum (UU) is a common pathogen associated with genital tract infections in infertile males. However, its impact on semen quality, embryo development, and in vitro fertilization (IVF) outcomes remains underexplored. This study aims to evaluate the effect of male UU infection on semen parameters, embryo development, pregnancy outcomes, and neonatal health in infertile couples.

Methods

A retrospective analysis was conducted on 1,215 infertile couples at the First Hospital of USTC. Participants were divided into two groups based on the male partner's UU infection status: UU-positive (n=249) and UU-negative (n=966). Semen parameters (sperm concentration, motility, morphology, anti-sperm antibodies, DNA stainability) were assessed. Embryo development was evaluated through fertilization rates and blastocyst formation rates. Pregnancy outcomes (clinical pregnancy, live birth rates, miscarriage rate) and neonatal health (gestational age, birth weight, Apgar scores, preterm delivery) were also compared.

Results

Semen parameters, including sperm concentration, motility, and morphology, were similar between the UU-positive and UU-negative groups. However, the UU-positive group had significantly higher levels of anti-sperm antibodies (ASA) (p=0.020) and higher DNA stainability (HDS) (p=0.014). Despite these differences, embryo quality, as measured by fertilization rates and blastocyst formation rates, was not significantly different between the two groups. Pregnancy outcomes, including clinical pregnancy and live birth rates, were also comparable. While the UU-positive group had a slightly higher miscarriage rate, this difference was not statistically significant. Neonatal outcomes, including gestational age, birth weight, Apgar scores, and preterm delivery rate, did not differ significantly between the two groups.

Discussion

The study suggests that while male UU infection may adversely affect certain semen parameters, its impact on IVF outcomes-such as embryo quality, pregnancy rates, and neonatal health-appears to be minimal. These findings support the continued use of IVF as a viable and safe option for infertile couples with male UU infection, as it does not significantly influence reproductive or neonatal outcomes.

Effects of Ureaplasma urealyticum infection on semen quality and sperm morphology

INTRODUCTION

Ureaplasma urealyticum (U. urealyticum) infection is primarily associated with damage to male fertility through its effects on male sperm parameters. However, its effects on sperm semiological variables remain unclear. Therefore, this study aimed to investigate whether U. urealyticum infection was associated with semen quality and sperm morphology.

METHODS

From 2019 to 2021, this cross-sectional study analyzed infective pathogens and semen variables in 1064 males (22-30 years old) recruited from our reproductive center and the general public. Routine semen parameters and normal sperm morphology rate were analyzed using methods outlined by the World Health Organization. The associations between semen quality, sperm morphology, and U. urealyticum infection were studied using general linear models.

RESULTS

The participants were categorized into three groups: (i) U. urealyticum infection (n=328), (ii) non-U. urealyticum infection (including males with urogenital tract infection symptoms but no U. urealyticum detected in their semen samples, n=377), and (iii) normal volunteers (males without symptoms of urogenital tract infection and no pathogens detected in semen samples, n=359). U. urealyticum in semen samples was observed to be associated with lower sperm concentrations (p<0.001) and a lower ratio of anterograde motile spermatozoa (p<0.001). Semen cultures positive for U. urealyticum were associated with lower normal sperm morphology (p<0.001) compared to semen cultures negative for U. urealyticum.

CONCLUSION

This study shows the importance of proper investigations for U. urealyticum during routine clinical examinations and diagnoses of males with infertility.

Effects of alpha-lipoic acid on sperm quality in patients with varicocele-related male infertility: study protocol for a randomized controlled clinical trial

BACKGROUND

Varicocele is a high incidence and is considered to be the most common and correctable cause of male infertility. Oxidative stress (OS) plays a central role in the pathogenesis of varicocele-related male infertility. In addition to varicocelectomy, antioxidant supplementation seems to be an effective scheme for the treatment of varicocele-related male infertility, but it is still controversial. The purpose of this study is to determine the effects of alpha-lipoic acid (ALA) supplementation on sperm quality in patients with varicocele-related male infertility.

METHODS

In this randomized controlled clinical trial, we will randomize 80 patients with varicocele-related male infertility from Guilin People's Hospital. The non-surgical observation group (n = 20) will receive ALA, the non-surgical control group (n = 20) will receive vitamin E, the surgical observation group (n = 20) will receive ALA after the operation, and the surgical control group (n = 20) will receive vitamin E after the operation. The course of treatment will be 3 months. The results will compare the changes in semen parameters, sex hormones, testicular volume, sperm DNA fragment index (DFI), seminal plasma malondialdehyde (MDA), and total antioxidant capacity (TAC) between the groups at baseline and after 3 months of antioxidant supplementation.

DISCUSSION

Whether it is necessary to use antioxidants in varicocele-related male infertility, how potent antioxidants should be used, postoperative application or non-surgical independent application still needs to be explored. This study attempts to compare the effects of two antioxidants (ALA and vitamin E) on sperm quality in patients with varicocele-related male infertility (surgical or non-surgical) and attempted to answer the above questions.

TRIAL REGISTRATION

Chinese Clinical Trial Registry (ChiCTR) ChiCTR2100054958. Registered on 29 December 2021.

Male Infertility Coexists with Decreased Sperm Genomic Integrity and Oxidative Stress in Semen Irrespective of Leukocytospermia

Our research was designed to verify the relationship between male infertility, basic semen characteristics (with respect to detailed sperm morphology), sperm DNA fragmentation (SDF), oxidation-reduction potential in semen (ORP), and leukocytospermia. The obtained results showed that infertile groups (with or without leukocytospermia) had significantly lower basic semen characteristics and higher SDF, raw ORP, and static ORP (sORP) than fertile controls. The thresholds of 13% SDF (AUC = 0.733) and 1.40 sORP (AUC = 0.857) were predictive values for discriminating infertile from fertile men. In infertile groups, a higher prevalence and risk for >13% SDF and >1.40 sORP were revealed. Unexpectedly, leukocytospermic subjects had lower sORP, prevalence, and risk for >1.40 sORP than leukocytospermic-negative men. These groups did not differ in SDF and raw ORP. Both SDF and sORP negatively correlated with basic semen parameters but positively correlated with sperm head and midpiece defects. sORP positively correlated with sperm tail defects, immature sperm cells with excess residual cytoplasm, and SDF. In turn, raw ORP negatively correlated with sperm count but positively correlated with SDF and sORP. These findings indicate that (1) there is a relationship between male infertility, SDF, and OS in semen; (2) in infertile men, there is a clinically significant risk of SDF and OS irrespective of leukocytospermia; and (3) the assessment of SDF and oxidative stress should be independent of leukocytospermia.

Risk Prediction of Ureaplasma urealyticum Affecting Sperm Quality Based on Mathematical Model and Cross-Sectional Study

Objective. To explore the risk of Ureaplasma urealyticum (UU) affecting sperm quality. Methods. Prospective cross-sectional study was conducted. In total, 340 semen samples were collected. According to whether they were infected with UU, the samples were divided into the UU-positive group (observation group) and UU-negative group (control group). The patients with UU-positive were followed up to obtain treatment and collected the semen again after treatment. The semen characteristics and sperm parameters were detected and compared, and the relationship of UU and the sperm quality was analyzed by mathematical models. Results. There were 104 UU-positive semen samples in all, with an overall infection rate of 30.6%, which was highest in 31 to 40-year-old men, and over 40-year-old men were the lowest. The pH, PR, VCL, VSL, and STR in the observation group were significantly lower than those in the control group (all $P<0.001$ ), while SV, NP, and WOB were significantly higher (all $P<0.001$ ). After treatment, the pH, VSL, LIN, WOB, and STR in the observation group were significantly higher than before (all $P<0.001$ ), while SV and VCL were significantly lower (all $P<0.001$ ). UU infection was closely correlated with pH, PR, NP, VCL, VSL, WOB, and STR. During the treatment, pH, PR, VSL, WOB, and STR increased, but NP and VCL decreased. 7 major factors that would affect SQ were extracted, of which VAP, LIN, and UU were the first three main factors. The risk of SQ declining after UU infection increased nearly twice with the change of PR and VCL and increased 0.08 times with STR. Conclusion. UU may approximately double the risk of altering the sperm’s curvilinear movement rate and straightness to affect the sperm quality.

Semen microbiota in normal and leukocytospermic males

Large numbers of microbes can be present in seminal fluid, and there are differences in the semen microbiota between normal and abnormal semen samples. To evaluate the semen microbiota in patients with leukocytospermia, 87 seminal fluid samples, including 33 samples with a normal seminal leukocyte count and 54 samples with leukocytospermia, were obtained for a cross-sectional analysis. Twenty samples with a normal seminal leukocyte count had normal sperm parameters (Control group), and 13 samples with a normal seminal leukocyte count were from asthenozoospermia patients (Ast group). However, 32 samples with leukocytospermia were from asthenozoospermia patients (LA group), and only 22 samples with leukocytospermia had normal sperm parameters (Leu group). The 16S ribosomal RNA (rRNA) gene sequencing method was used to sequence the microbiota in the seminal fluid, and multiple bioinformatics methods were utilized to analyze the data. Finally, the results showed that the worse sperm parameters were observed in the leukocytospermia-related groups. Semen microbiota analysis found that there was increased alpha diversity in the leukocytospermia-related groups. Firmicutes, Proteobacteria, Actinobacteria, and Bacteroidetes were the primary phyla in the seminal fluid. Two microbiota profiles, namely, Lactobacillus-enriched and Streptococcus-enriched groups, were identified in this study. The majority of the samples in the groups with a normal seminal leukocyte count could be categorized as Lactobacillus-enriched, whereas the majority of the leukocytospermia samples could be categorized as Streptococcus-enriched. Our study indicated that males with leukocytospermia have worse sperm parameters and a different semen microbiota composition compared to males with a normal seminal leukocyte count.

Biochemical and morphofunctional study of sperm of men infected with antibiotic-resistant strains of Ureaplasma urealyticum

Background: The role of UU in the pathogenesis of male infertility is currently not fully understood. Despite the widespread occurrence of antibiotic-resistant UU strains, there are virtually no data on their effect on the morphofunctional characteristics of the sperm and the biochemical parameters of the ejaculate. Aims: Comprehensive evaluation of the sperm fertility in men infected with antibiotic-resistant UU strains. Methods: The semen of men of active reproductive age (n=4752, age from 18 to 46 years, with the average age of 27.84.4 years) was studied. In the semen samples, UU was detected by the microbiological method (seeding on selective culture media with the subsequent identification and determination of the antibiotic sensitivity of the obtained isolates). The semen from men with mixed infections was excluded from the study. As a control, we used samples of ejaculates from healthy fertile men (n=67, age from 19 to 43 years, with the average age of 25.85.1 years). In the study of the ejaculate, the methods recommended by the WHO expert group were used. In addition to the standard spermogram, MAR tests (IgA, IgG and IgM) were performed, the degree of fragmentation of the sperm DNA was evaluated, the interaction of the sperm with hyaluronic acid was evaluated, as well, the activity of acrosine and neutral alpha-glucosidase was measured, the levels of zinc, citric acid, fructose and the level of glycodelin were determined. The study had been carried out between 2018 and 2021. Results: The most common resistance was to erythromycin (88.2%), less often to azithromycin (47.0%), tetracycline (41.7%). The resistance to doxycycline (7.7%), josamycin (5.9%), and medicamycin (5.8%) was relatively rare. In men infected with antibiotic-resistant UU strains, the most frequently observed anomalies of a standard spermogram were those of the motor characteristics of spermatozoa asthenozoo-spermia and those of the spermatozoa's morphology teratozoospermia. In the presence of polyresistant UU strains, a high degree of the sperm DNA fragmentation was more common (10.03% of cases) in respect to the cases of UU strains not resistant to antibiotics (5.92% of cases) or resistant to only one antibiotic (6.16% of cases). Abnormalities of the spermatozoa's interaction with hyaluronic acid were observed more often (more than 12% of cases) for antibiotic-resistant UU strains than for non-antibiotic-resistant UU strains (less than 4% of cases). In men infected with antibiotic-resistant UU strains, a decrease in the enzymatic activity of acrosin was often observed (29.71% of cases), most frequently among the cases with polyresistant strains (40.46% of cases). Conclusions: Antibiotic-resistant UU strains have a negative effect on the sperm fertility, of which the most pronounced negative effects are caused by polyresistant strains. We recommend measuring the acrosin activity when performing a spermogram for patients infected with UU. In the presence of polyresistant UU strains, it is advisable to assess the degree of the sperm DNA fragmentation. We recommend carrying out an antibioticogram before prescribing a treatment for ureaplasmosis.

Sexually transmitted infections and semen quality from subfertile men with and without leukocytospermia

BACKGROUND

The role of sexually transmitted infections (STIs) in semen parameters and male infertility is still a controversial area. Previous studies have found bacterial infection in a minority of infertile leukocytospermic males. This study aims to investigate the prevalence of STIs in semen from subfertile men with leukocytospermia (LCS) and without leukocytospermia (non-LCS) and their associations with sperm quality.

METHODS

Semen samples were collected from 195 men who asked for a fertility evaluation. Infection with the above 6 pathogens was assessed in each sample. Sperm quality was compared in subfertile men with and without LCS.

RESULTS

The LCS group had significantly decreased semen volume, sperm concentration, progressive motility, total motility and normal morphology. The infection rates of Ureaplasma urealyticum (Uuu), Ureaplasma parvum (Uup), Mycoplasma hominis (MH), Mycoplasma genitalium (MG), Chlamydia trachomatis (CT), herpes simplex virus-2 (HSV-2) and Neisseria gonorrhoeae (NG) were 8.7 %, 21.0 %, 8.2 %, 2.1 %, 3.6 %, 1.0 and 0 %, respectively. The STI detection rates of patients with LCS were higher than those of the non-LCS group (52.3 % vs. 39.3 %), although there was no statistically significant difference between the two groups (P = 0.07). All semen parameters were not significantly different between LCS with STIs and without STIs, except the semen volume in the MG-infected patients with LCS was significantly lower than that in the noninfected group.

CONCLUSIONS

LCS was associated with a reduction in semen quality, but was not associated with STIs.

Identification of Bacterial Profiles and Their Interactions with Selected Quality, Oxidative, and Immunological Parameters of Turkey Semen

Simple Summary

Overbreeding—and its associated increase in the chest areas of turkeys—has led to the loss of their natural ability to reproduce. Therefore, commercial production of turkey meat relies on artificial insemination. However, along with the physiology of the genital tract of turkeys, there is high potential for bacterial contamination of ejaculates. These bacteria may affect crucial semen quality parameters required for successful fertilization. As such, it is important to pay close attention to the bacteria present in turkey ejaculates and possible solutions to eliminate their adverse effects on avian spermatozoa.

Abstract

This study focused on the identification of naturally occurring bacteria in the reproductive fluid and impact on the quality of ejaculates obtained from the turkey breed British United Turkeys (BUT) Big 6 (n = 60). We determined possible relationships between the bacterial load and advanced sperm quality parameters that are important for effective artificial insemination and high fertility, as well as the concentration of selected antimicrobial proteins and pro-inflammatory markers of turkey semen. Sperm motility was assessed with computer-assisted sperm analysis (CASA), while the membrane and acrosome integrity were examined with smearing and staining methods. Reactive oxygen species (ROS) generation was quantified via luminometry, sperm DNA fragmentation was evaluated using the TUNEL assay, and the JC-1 assay was applied to evaluate the mitochondrial membrane potential. Cell lysates were prepared to investigate the extent of lipid and protein oxidation. Furthermore, levels of interleukins 1 and 6 (IL-1, IL-6), C-reactive protein, cathelicidin, and β-defensin were quantified in the seminal plasma using the ELISA method. The most dominant species identified by the matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry was Escherichia coli, Proteus mirabilis, Staphylococcus lentus, and Citrobacter braakii. The bacterial load had a negative effect on the sperm motility (p < 0.001), as well as membrane (p < 0.05) and acrosome integrity (p < 0.01). A strong positive relationship between the bacterial load and DNA fragmentation (p < 0.001) was detected as well. Positive associations were recorded between the increasing presence of bacteria, ROS overgeneration (p < 0.001), and a subsequent oxidative damage to the proteins (p < 0.001) and lipids (p < 0.01). It was revealed that the antimicrobial peptides β-defensin (p < 0.001) and cathelicidin (p < 0.001) had a positive relationship with the motility. In contrast, pro-inflammatory markers, such as IL-1 (p < 0.001) and IL-6 (p < 0.001), had a negative impact on the motion behavior of turkey spermatozoa. Our results suggest that the semen quality may be notably affected by the bacterial quantity as well as quality. It seems that bacteriospermia is associated with inflammatory processes, oxidative stress, sperm structural deterioration, and a subsequent risk for a failed artificial insemination in turkey breeding.

Hyperammonemia syndrome associated with Ureaplasma spp. Infections in immunocompromised patients and transplant recipients: A systematic review and meta-analysis

BACKGROUND

Hyperammonemia syndrome (HS) is reported to occur in patients with Ureaplasma spp. infections. We performed a systematic review and meta-analysis of studies reporting HS in patients with Ureaplasma spp. infection.

METHODS

We searched several databases (CINAHL, OVID, ProQuest, and Scopus) from inception to January 2021. We described case reports and series, and performed a meta-analysis for all cohort studies. The pooled risk ratio (RR) for the association between HS and Ureaplasma spp. infections was derived using a random-effects model.

RESULTS

The systematic review yielded 18 studies. HS was reported in 53 patients with Ureaplasma spp. infections. The most common clinical manifestations were neurologic. Meta-analysis showed a higher incidence of HS (41.67%) and peak ammonia concentration among Ureaplasma spp.-infected lung transplant recipients compared with Ureaplasma spp.-negative recipients (2.84%). The risk of HS was significantly increased in Ureaplasma spp.-infected recipients compared with Ureaplasma spp.-negative recipients (RR: 14.64; CI: 2.85-75.24). Mortality from Ureaplasma-associated HS was 27.27% compared with 5.24% in those with HS from other causes.

CONCLUSIONS

The risk of developing HS is higher among Ureaplasma-infected patients compared with uninfected patients. Lung transplant recipients appear to be disproportionally affected, and HS should be suspected in those who present with neurologic symptoms.