https://www.thelancet.com/pdfs/journals/lancet/PIIS0140673602076031.pdf

Spinal-cord injury

Sperm DNA integrity is essential for the accurate transmission of genetic information. It has a highly compact and complex structure and is capable of decondensation-features that must be present in order for a spermatozoon to be considered fertile. Any form of sperm chromatin abnormalities or DNA damage may result in male infertility. In support of this conclusion, it was reported that in-vivo fecundity decreases progressively when > 30% of the spermatozoa are identified as having DNA damage. Several methods are used to assess sperm chromatin/DNA, which is considered an independent measure of sperm quality that may yield better diagnostic and prognostic approaches than standard sperm parameters (concentration, motility and morphology). The clinical significance of this assessment lies in its association not only with natural conception rates, but also with assisted reproduction success rates. Also, it has a serious impact on the offspring and is highly prognostic in the assessment of fertility in cancer patients. Therefore, screening for sperm DNA damage may provide useful information in cases of male idiopathic infertility and in those men pursuing assisted reproduction. Treatment should include methods for prevention of sperm DNA damage.

/pdf/role-of-sperm-chromatin-abnormalities-and-dna-damage-in-male-5a2riixlg7.pdf

Role of sperm chromatin abnormalities and DNA damage in male infertility

https://www.fertstert.org/article/S0015-0282(02)03105-9/pdf

Best practice policies for male infertility

https://www.fertstert.org/article/S0015-0282(99)00462-8/pdf

Sperm chromatin damage impairs human fertility

Infertility is a common problem, affecting perhaps one couple in six, the majority of whom now seek medical care. Although diagnostic problems make it difficult to establish the extent of the male partner's contribution with certainty, a number of studies suggest that male problems represent the commonest single defined cause of infertility. The World Health Organization has proposed a scheme for the diagnostic classification of male infertility, based upon a standardized approach to clinical assessment and to the assessment of semen quality. Some of these classifications are now controversial, and many are descriptive, rather than aetiological. Increasingly, the importance of occupation, environmental and particularly genetic factors in the causation of male infertility is being recognized.

Epidemiology and aetiology of male infertility

The quality of sperm chromatin is an important factor in fertilization and is especially critical where one spermatozoon is artificially selected for fertilizing an egg (as in intracytoplasmic sperm injection). In this study, flow cytometry after staining of human spermatozoa with Acridine Orange was used to study chromatin structure. A method is described for estimating the percentage of cells in a human sperm sample that have completed epididymal maturation in regard to chromatin condensation. Of the 121 samples of the semen that were examined, nine contained a higher percentage of hypocondensed spermatozoa and six samples contained elevated amounts of hypercondensed spermatozoa. In addition to aberrancies in chromatin condensation other defects showed up as satellite populations of spermatozoa with higher than normal ratios of red/green fluorescence after Acridine Orange staining. Such defects were found in 15 semen samples. The use of swim-up and Percoll gradient centrifugation methods was shown to improve the percentage of spermatozoa with normal chromatin structure in some samples with poor initial quality.

/pdf/evaluation-of-chromatin-condensation-in-human-spermatozoa-a-4zshsz7o6w.pdf

Evaluation of chromatin condensation in human spermatozoa: a flow cytometric assay using acridine orange staining.

Summary: 16 patients, 4 months to five years following unilateral torsion of the testis were evaluated as to semen quality and hormonal status.



In patients operated within 12 hours of the onset of pain 44% had normal semen quality while in those operated following more than 12 hours only 20% had normal semen analysis.



FSH, LH and testosterone levels were normal in 14 of the 16 patients. One patient had a low testosterone level and slightly elevated FSH, another patient had slightly elevated levels of both FSH and LH.



Zusammenfassung: Spermaqualitat und Hormonstatus bei Patienten nach Hodentorsion



16 Patienten wurden 4 Monate bis 5 Jahre nach einseitiger Hodentorsion in Hinsicht auf Spermaqualitat und Hormonstatus untersucht.



Bei Patienten, die innerhalb von 12 Stunden nach Einsetzen der Schmerzen operiert wurden, hatten 44% normale Samenqualitat, wahrend diejenigen, die mehr als 12 Stunden danach operiert wurden, nur in 20% normale Samenanalysen aufwiesen.



Die FSH-, LH- und Testosteron-Spiegel waren normal bei 14 der 16 Patienten. Ein Patient hatte einen niedrigen Testosteron-Spiegel und ein gering erhohtes FSH, ein weiterer Patient hatte gering erhohte Spiegel bei FSH und LH.

Semen quality and hormonal status of patients following testicular torsion.

BACKGROUND: Current recommendations regarding posthumous sperm retrieval (PSR) are based on a small number of cases. Our purpose was to determine the time interval from death to a successful procedure. METHODS: Seventeen consecutive PSR procedures in 14 deceased and 3 neurologically brain-dead patients at two male infertility centres [Sheba Medical Center (SMC), Tel-Hashomer, Israel and University of California San Francisco (UCSF), San Francisco, CA, USA] were analysed. Main outcome measures were retrieval of vital sperm, pregnancies and births. RESULTS: PSR methods included resection of testis and epididymis (n = 8), en-block excision of testis, epididymis and proximal vas deferens with vasal irrigation (n = 6), electroejaculation (EEJ) (n = 2) and epididymectomy (n = 1). PSR was performed 7.5-36 h after death. Sperm was retrieved in all cases and was motile in 14 cases. In two cases, testicular and epididymal tissues were cryopreserved without sperm evaluation, and in one case, no motility was detected. IVF and ICSI were performed in two cases in which sperm had been retrieved 30 h after death, and both resulted in pregnancies and live births. CONCLUSIONS: Viable sperm is obtainable with PSR well after the currently recommended 24-h time interval. PSR should be considered up to 36 h after death, following appropriate evaluation. No correlation was found between cause of death and chance for successful sperm retrieval.

Posthumous sperm retrieval: analysis of time interval to harvest sperm

Study design: Male infertility caused by anejaculation is common among patients with spinal cord injury (SCIP). The fertility options for SCIP have improved impressively over the past 10 years. We present the Israeli experience in the treatment of infertility in a large series of SCIP. The issues which are addressed include the treatment of ejaculatory dysfunction, seminal quality and fertility management in SCIP. Setting: Sexual rehabilitation clinic, Neuro-Rehabilitation department, Sheba Medical Center, Israel. Methods: Between June 1992 and May 1998, a total of 84 consecutive SCIP were treated in our clinic with electro-ejaculation (EEJ), representing a sample of the SCIP population, composed mostly of young men traumatically injured. The patients have sustained different levels and completeness of spinal injury. Among the patients 33 were interested in achieving pregnancy (39.3%), while the rest were interested in determining fertility potential for family. With EEJ, a low-current stimulation of the ejaculatory organs via a rectal probe is done. The collected semen is used for fertility determination or for fertilization. Results: Eighty-four patients were treated by EEJ. Mean age was 31.3 and mean age at injury was 21.7. There were 29 cervical, 50 thoracic and five lumbar lesions. Sixty-three had complete injury (ASIA A) and 21 incomplete (ASIA B -15, ASIC C -5, ASIA D -1). Fifty-nine had upper motor neuron lesions, and 25 had lower motor neuron. A total of 355 stimulations were performed. Ejaculate was obtained in all patients in 350 stimulations (98.6%), and sperm was present in 74 patients (88.1%) in 296 of the stimulations (83.4%). Fairly good numbers of spermatozoa were obtained, whereas sperm motility and morphology of spermatozoa were low in most cases. A significant difference in sperm count, motility and morphology was noted between antegrade and retrograde samples. No significant improvement in sperm quality after four repeated consecutive stimulations was noted in 38 SCIP. Side effects were minor and encountered in 16 patients (19.1%). Out of 33 couples who wished to achieve pregnancy, 26 reached the stage of insemination. Four pregnancies were achieved after 33 cycles of In-Uterine-Insemination (pregnancy rate 28.6% per couple), and 15 after 68 cycles of In-Vitro-Fertilization (micromanipulation) (pregnancy rate of 68.75% per couple). In all, of 101 conception attempts 23 were successful, resulting in pregnancies in 18 couples, and accounting for an overall pregnancy rate of 70% per couple. Conclusion: The high percentage of pregnancies imply that, despite the typically poor sperm motility noted in EEJ, rectal probe EEJ combined with assisted reproductive techniques, and performed by a team approach, is an efficient and safe technique for treating infertility among SCIP. Spinal Cord (2001) 39, 168–175.

/pdf/treatment-of-male-infertility-due-to-spinal-cord-injury-4en95z3irn.pdf

Treatment of male infertility due to spinal cord injury using rectal probe electroejaculation: the Israeli experience.

Human sperm were found to contain acetylcarnitine, carnitine, and only traces of propionylcarnitine and four-carbon acylcarnitines. Carnitine and actylcarnitine were present in higher concentrations in sperm than in the corresponding seminal fluid samples, and the degree of acylation of carnitine was greater in sperm than in seminal plasma. The ratio of acetylcarnitine/carnitine was 1.77 ± 0.69 in extracts of sperm from samples with a low degree of motility (0–10% motile), whereas it was 4.70 ± 1.58 in samples which were 40–80% motile. The possible significance of this difference with regard to the degree of acylation of coenzyme A is discussed.

Carnitine and acetylcarnitine in motile and immotile human spermatozoa

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