الفهرس 
Review of LiteratureOnly 14 pages are availabe for public view
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Abstract
Male factor infertility is the exclusive cause of infertility in approximately 20% of infertile couples, and is present in nearly half of all infertile couples. Nevertheless, approximately 15% of patients with male factor infertility have a normal semen analysis and a definitive diagnosis of male infertility frequently cannot be made as a result of routine semen examination.
Role of sperm nuclear DNA integrity in male factor infertility is a matter of interest. A dramatic increase in genetically damaged human sperm is looked as alarm. These sperms are not only causing infertility in men, but also childhood cancers in their coming offspring of these who can reproduce and might lead to infertility in their male progeny.
Many etiologic factors have been associated with sperm DNA fragmentation and/or impaired chromatin integrity. These causes included irradiation, chemotherapy, and pathophysiologic conditions for example leukocytospermia, varicoceles and cancer as well as viral infection such as HCV chronic infection.
In Egypt HCV chronic infection has the highest prevalence rate in the world. It was verified that patients with HCV infection manifested inferior semen parameters than control subjects, suggesting a possible negative influence of the virus on spermatogenesis. However, the effect of chronic hepatitis C virus infection on sperm quality is not well explained. So, in addition to conventional semen analysis, we aimed by this study, to investigate the nature of DNA damage of human sperm in infertile patients having HCV infection, and to detect its percentage.
To achieve our aim, we selected 40 nonsmoker males complaining of primary infertility as a patients group, patients complaining of varicocele, azospermia abnormal hormonal profile and genital tract infection were excluded.
Patient group was divided into two groups: group (I) including 20 HCV positive infertile patients, and group (II) including 20 HCV negative infertile cases as evidenced by results of HCV antibody (for all patients) and confirmed by HCV RNA PCR results for seropositive patients. In addition, 20 age matched, healthy, fertile male subjects were included as a control group. For each studied subject, complete history taking and through clinical examination including general and genital examination were done. Additionally, the conventional semen parameters and functional flow cytometric sperm parameters, using PI staining, Anexin V/PI assay, JC1 staining and TUNEL assay, were evaluated.
The result of the current study showed that:
1. HCV positive infertile patients (group I) revealed a significant deterioration in their assessed conventional semen parameters than their matched fertile controls, in the form of decreased sperm concentration and sperm motility, and increased percentage of abnormal forms. Moreover, HCV positive patients had significantly higher percentage of abnormal sperm forms than HCV negative cases (p=0.005)
2. In HCV positive infertile patients, there were significant negative correlation between viral replication and percentage of sperm motility and a significant positive correlation regarding abnormal forms percentage, but insignificant correlation concerning sperm count.
3. HCV positive infertile patients exhibited a significantly higher percentage of spermatozoa with low MMP compared to HCV negative cases and control subjects respectively. Additionally, HCV negative infertile males had a significant high percentage of spermatozoa with low MMP than control subjects.
4. Most of HCV positive infertile patient’s semen samples (15 cases 75%) showed apoptotic changes 7 cases (35%) showed early apoptotic changes (AN+/PI-) 8 cases (40%) showed late apoptotic changes (AN+/PI+) and only 5 cases (25%) revealed viable sperms (AN-/PI-). However, most of control samples (18 cases, 90%) exhibited viable sperms (AN-/PI-). Even though no HCV negative semen sample showed necrotic sperms (AN+/PI+), 60% (12 cases) of them revealed early apoptotic changes (AN+/PI). Compared to HCV negative groups (controls and infertile patients), HCV positive infertile cases exhibited a significant decrease in percentage of viable spermatozoa. In addition, HCV negative infertile patients reported a significant decrease in this percentage of viable spermatozoa compared to control group.
5. Spermatozoa with decondensed chromatin (positive PI staining) was recorded in most of HCV positive cases (15 cases,75%) versus 8 cases (40%) in HCV negative infertile group and 3 subjects (15%) in controls. Compared to HCV negative subjects (controls and group II), HCV positive infertile cases reported a significant increase in percentage of spermatozoa with decondensed chromatin.
6. Among HCV positive infertile patients, 15 cases (75%) showed sperms with fragmented DNA (TUNEL assay positivity), while in controls only 3 subjects (15%) revealed fragmented DNA versus 14 cases (70%) in group II. Compared to controls, infertile patients (group I and II) had significant increase in percentage of spermatozoa with fragmented DNA. However, the difference between both infertile groups, HCV positive and HCV negative cases, regarding the percentage of spermatozoa with fragmented DNA could not reach level of significance.
7. Regarding the relationship between the viral replication and biofunctional cytometric semen parameters in HCV positive patient group, there were significant associations between viral load with all studied cytometric semen parameters; percentage of spermatozoa with decondensed chromatin (positive PI staining), low MMP (JCI positive), DNA fragmentation (positive TUNEL assay) and apoptotic changes (Anexin V/PI assay).
8. Concerning the relation between the studied conventional and cytometric sperm parameters in HCV positive cases all biofunctional cytometric semen parameters revealed significant association with sperm morphology percentage and insignificant association regarding sperm count. Meanwhile the sperm motility percentage was significantly associated with Anexin V/PI assay and MMP (JC1 staining) only.
Based on findings of this study, we can conclude that infertile patients with hepatitis C show poor semen quality in particular, these patients exhibit altered conventional and biofunctional sperm parameters. Their cytometric biofunctional alterations included a low mitochondrial membrane potential, increased the percentage of apoptotic changes, an altered compaction of sperm chromatin and lastly percentage